2012-08-03T09:15:18-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 111 FRANKLIN RD SE SUITE 501 ROANOKE VA 240112114 990 2010-10-01 546075662 TWIN COUNTY REGIONAL HEALTHCARE INC TWIN 2762368181 200 HOSPITAL DRIVE GALAX VA 24333 STEPHANIE BRYANT 2762368181 2012-07-26 1 MICHAEL P NORTON 5409896144 2012-07-26 2010 2016-02-24 21:20:13Z STEPHANIE BRYANT 200 HOSPITAL DRIVE GALAX VA 24333 50976582 0 X WWW.TCRH.ORG X 1973 VA TO PROMOTE, PRESERVE, AND RESTORE THE HEALTH OF OUR COMMUNITY. 14 13 653 0 0 0 56214 50 48426007 50376703 161300 141988 519704 457841 49163225 50976582 0 0 0 0 27558751 27806478 0 0 0 23406532 25708725 50965283 53515203 -1802058 -2538621 23464311 22869235 14441743 16712435 9022568 6156800 TO PROVIDE HEALTH SERVICES FOR RESIDENTS IN THE SURROUNDING AREAS OF RURAL SOUTHWEST VIRGINIA. 0 0 29968514 50834544 PATIENT SERVICES PROVIDED BY A 141 BED HOSPITAL INCLUDING RURAL HEALTH CLINICS, OPERATING ROOM, PHARMACY SERVICES, HOME HEALTH SERVICES, CORONARY CARE, OCCUPATIONAL THERAPY, REPIRATORY THERAPY,PHYSICAL THERAPY AND HEALTH PROMOTION. 29968514 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 55 0 1 653 1 0 0 0 0 0 0 0 0 0 0 X 14 13 0 0 0 0 0 0 0 1 1 0 1 1 0 1 1 0 1 1 1 0 0 X STEPHANIE BRYANT CFO 5402368181 200 HOSPITAL DRIVE GALAX VA 24333 JOHN W BOLEN JR 1.00 X 0 0 0 CARLOS J BLATTNER MD 1.00 X 0 0 0 REBECCA W CARDWELL 1.00 X 0 0 0 WILLIAM L DAVIS 1.00 X 0 0 0 BLAKE M EDWARDS 1.00 X 0 0 0 JOSEPH KILLON 1.00 X 0 0 0 OLIVER MCBRIDE 1.00 X 0 0 0 EDWARD A HANKS II 1.00 X 0 0 0 BARRY MAYBERRY 1.00 X 0 0 0 ROBERT E PRYOR 1.00 X 0 0 0 WILLIAM R ROBERTS 1.00 X 0 0 0 LARRY G SOUTH 1.00 X 0 0 0 TAYLOR C VAUGHAN 1.00 X 0 0 0 DOUGLAS S VAUGHT 1.00 X 0 0 0 C M MITCHELL 1.00 X 0 0 0 JON APPLEBAUM 40.00 X X 210030 0 20718 SANDRA MORETZ 40.00 X 137560 0 12684 NELSON MONTGOMERY 40.00 X 144985 0 20995 DIANNE DILL 40.00 X 155362 0 13369 MICHAEL SHANKS 40.00 X 180585 0 21674 MITCH MIZE 40.00 X 165362 0 24389 JAMES HELMS 40.00 X 162469 0 20889 STEPHANIE WILLIAMS 40.00 X 92319 0 21084 1156353 0 134718 7 0 1 0 HOSPITAL REVENUE CYCLE MGMT 4140 CLEMMONS ROAD SUITE 202 CLEMMONS NC 27012 PATIENT ACCOUNTING SERVICES 730970 CARDINAL HEALTH PHARMACY MGMT 21377 NETWORK PLACE CHICAGO IL 60673 PHARMACY 685012 CROTHALL 995 CHESTERBROOK BLVD SUITE 300 WAYNE PA 19087 BIOMEDICAL SERVICES 450132 EPMG OF VIRGINIA PC 2000 GREEN ROAD ANN ARBOR MI 48105 EMERGENCY DEPARTMENT SERVICES 387848 JOHNSTON MEMORIAL HOSPITAL 351 COURT STREET NE ABINGDON VA 24210 BLOOD BANK 205358 5 50 50 ANCILLARY REVENUE-NET 624100 37693454 37693454 ROOM AND BOARD 624100 12683249 12683249 50376703 141988 141988 150650 150650 150650 150650 CAFETERIA AND VENDING 900099 201680 201680 GIFT SHOP SALES 900099 50307 50307 MISCELLANEOUS 900099 39319 39319 15885 15885 307191 50976582 50834544 0 141988 1156355 647559 508796 21185451 11863853 9321598 620790 347642 273148 3274064 1833476 1440588 1569818 879098 690720 202906 113627 89279 49726 27847 21879 76922 43076 33846 2458711 1376878 1081833 34417 19274 15143 140952 78933 62019 1511648 846523 665125 352679 197500 155179 328901 184185 144716 1619578 906964 712614 303989 170234 133755 SUPPLIES 6665452 3732653 2932799 BAD DEBT EXPENSE 6560704 3673994 2886710 OTHER EXPENSES 1447322 810500 636822 CONTRACT LABOR 1425404 798226 627178 REPAIRS & MAINTENANCE 1324510 741726 582784 1204904 674746 530158 53515203 29968514 23546689 0 3590527 1796150 1052630 52630 5536113 4625553 1149963 1343994 361013 447088 48054494 38515989 10605968 9538505 1168097 5065315 23464311 22869235 6084582 7577403 7976257 8985032 380904 150000 14441743 16712435 X 9022568 6156800 9022568 6156800 23464311 22869235 X -2538621 -327147 X 0 1 1 X 0 X 274349 274349 20034846 14325457 5709389 112123 104268 7855 26854329 23338950 3515379 778847 747314 31533 9538505 OTHER ASSETS AT NET 5065315 5065315 EST MC/MCAID SETTLEMENT 150000 150000 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: TCRH, FOUNDATION, TCFCC, AND TCRHS ARE EXEMPT FROM INCOME TAXES UNDER 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 FOUNDATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2011. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2008, REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE AUTHORITIES. 1 1 1 X 0 1 0 1 0 1569881 1569881 0.02930 6283144 3588071 2695073 0.05040 7853025 3588071 4264954 0.07970 18 1174 71252 71252 0.00130 5 49168 49168 0.00090 23 1174 120420 120420 0.00220 23 1174 7973445 3588071 4385374 0.08190 5 75 2568 2568 0.00000 5 75 2568 2568 1 5960705 2068365 22199354 23567071 -1367717 X 1 1 1 1 TWIN COUNTY REGIONAL HOSPITAL

200 HOSPITAL DRIVE GALAX VA 24222

X X TWIN COUNTY REGIONAL HOSPITAL 1 0 1 1 100.000000000000 0 0 1 1 X 0 0 0 0 1 PART I, LINE 3C: FPG WAS USED TO DETERMINE ELIGIBILITY FOR FREE CARE. DISCOUNTED CARE IS OFFERED IN THE FORM OF A PREPAY PROGRAM, WHERE INDIVIDUALS CAN RECEIVE DISCOUNTED PRICES FOR TESTS/PROCEDURES BY PAYING UP FRONT FOR THESE PROCEDURES. THIS IS A 30% DISCOUNT OF PRICING. THE HOSPITAL ALSO OFFERS A 20% DISCOUNT FOR PAYING THEIR ACCOUNT IN FULL WITHIN 45 DAYS OF BEING BILLED IF THEY CANNOT PAY PRIOR TO RECEIVING SERVICES. PART I, LINE 6A: AN ANNUAL COMMUNITY BENEFIT REPORT IS PREPARED BY TWIN COUNTY REGIONAL HEALTHCARE FOR INCLUSION IN THE VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION. PART II: TWIN COUNTY REGIONAL HEALTHCARE HAS REPRESENTATION OF THE VIRGINIA ASTHMA COALITION, ROANOKE ASTHMA COALITION AND THE TWIN COUNTY COALITION. THE VIRGINIA ASTHMA COALITION AND THE ROANOKE ASTHMA COALITION TARGET VIRGINIA AND SOUTHWEST VIRGINIA, RESPECTIVELY, IN A PROJECT TO IMPROVE ASTHMA EDUCATION FOR THE AREA. OUR CARDIOPULMONARY DEPARTMENT MANAGER HAS WORKED WITH THE ROANOKE BRANCH TO HELP ESTABLISH THE PROJECT IN OUR COUNTIES. THE TWIN COUNTY COALITION WAS ORGANIZED TO PROVIDE OPPORTUNITIES FOR PREVENTION, RECOVERY AND SUPPORT FOR VARIOUS HEALTH ISSUES, DRUG PREVENTION, COMMUNITY EDUCATION AND MANY EARLY CHILDHOOD PROGRAMS. PART III, LINE 4: THE AMOUNTS IN LINE 2-3 WERE DERIVED BASED ON THE COST TO CHARGE RATIO. BAD DEBT SHOULD BE INCLUDED IN COMMUNITY BENEFIT BECAUSE WE ARE PROVIDING A SERVICE TO OUR COMMUNITY POPULATION THAT IS EITHER UNABLE OR UNWILLING TO PAY. PART III, LINE 8: MEDICARE MAKES UP OVER 50% OF OUR BUSINESS. ANY SHORTFALL THAT RESULT FROM THE PAYMENTS RECEIVED BEING LESS THAN THE COST OF PROVIDING THE SERVICE SHOULD BE CONSIDERED AS A COMMUNITY BENEFIT. FOR SMALL, RURAL HOSPITALS, THIS CAN HAVE A HUGE FINANCIAL IMPACT. PART III, LINE 9B: TWIN COUNTY REGIONAL HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. THE EXPENSES INCURRED IN PROVIDING THESE SERVICES ARE INCLUDED IN THE HOSPITAL'S OPERATING EXPENSES. TWIN COUNTY REGIONAL HOSPITAL PART V, SECTION B, LINE 21: GROSS CHARGES FOR PROCEDURES ARE USED TO BILL PATIENT. IF THEY MEET ELIGIBILITY FOR CHARITY CARE, THE AMOUNT IS WRITTEN OFF IN FULL PART VI, LINE 2: TWIN COUNTY REGIONAL HEALTHCARE HAS FOUR COMMUNITY ADVISORY BOARDS; GALAX CITY ADVISORY BOARD, GRAYSON COUNTY ADVISORY BOARD, CARROLL COUNTY ADVISORY BOARD AND THE HISPANIC ADVISORY BOARD. EACH OF THESE GROUPS MEETS QUARTERLY TO DISCUSS THE NEEDS OF THE AREAS CITIZENS. GROUPS ARE MADE UP OF TCRH BOARD MEMBERS THAT LIVE IN THE RESPECTIVE AREA, SOCIAL SERVICES, LOCAL POLICE DEPARTMENTS, LOCAL PHYSICIANS AND OTHER COMMUNITY LEADERS THAT HAVE BEEN IDENTIFIED. THE GROUPS MAKE SUGGESTIONS OF NEEDED SERVICES, EXPRESS CONCERNS REGARDING HEALTHCARE NEEDS AND POLL THE CITIZENS FOR THEIR OPINIONS. PART VI, LINE 3: TWIN COUNTY REGIONAL HEALTHCARE HAS AN ELIGIBILITY WORKER IN PARTNERSHIP WITH THE LOCAL DEPARTMENT OF SOCIAL SERVICES, CASHIERS AND COLLECTION REPRESENTATIVES AVAILABLE TO HELP PATIENTS DETERMINE THEIR ELIGIBILITY FOR MEDICAID, CHARITY CARE OR OTHER PROGRAMS FOR WHICH THEY MEET THE QUALIFICATIONS. CASHIERS AND COLLECTION REPRESENTATIVES ARE ALSO TRAINED TO HELP ESTABLISH PAYMENT PLANS FOR PATIENTS WHO DO NOT QUALIFY FOR OTHER ASSISTANCE. TCRH ALSO OFFERS A PRE-PAY PROGRAM WHICH DISCOUNTS SOME OF THE MOST POPULAR SERVICES OFFERED. BROCHURES ARE AVAILABLE AT LOCAL PHYSICIAN OFFICES AND ENTRY POINTS AT TCRH. PART VI, LINE 4: GRAYSON AND CARROLL COUNTIES AND THE CITY OF GALAX ARE THE MAIN AREAS WHICH TWIN COUNTY REGIONAL HOSPITAL SERVICES. THESE COUNTIES ARE LOCATED IN SOUTHWEST VIRGINIA. WITH POPULATIONS OF 15,793 FOR GRAYSON COUNTY, 29,034 FOR CARROLL COUNTY AND 6,880 FOR GALAX CITY, IT IS A RURAL AREA WITH SEVERAL LOCAL PHYSICIAN OFFICES MEETING THE RURAL HEALTH STATUS. OVER 20% OF GRAYSON COUNTYS POPULATION IS OVER 65 YEARS OF AGE, 64% OF THE POPULATION IS A HIGH SCHOOL GRADUATE AND MOST CITIZENS HAVE A DAILY COMMUTE TO WORK FOR 30 MINUTES. CARROLL COUNTY HAS 18% OF ITS POPULATION OVER AGE 65, 64 % OF THE POPULATION IS A HIGH SCHOOL GRADUATE AND THE AVERAGE COMMUTE IS 26 MINUTES. GALAX CITY HAS A 20% POPULATION OF OVER AGE 65, 60% OF RESIDENTS HAVE A HIGH SCHOOL DEGREE AND HAVE A 15 MINUTE COMMUTE TO WORK. THE UNEMPLOYMENT RATE OF THE TWO COUNTIES IS OVER 10% AND MOST JOBS IN THE ARE MANUFACTURING AND LOCAL GOVERNMENT. IN THESE COUNTIES, 14.8-19% OF THE POPULATION IS BELOW THE POVERTY LEVEL. PART VI, LINE 5: TWIN COUNTY REGIONAL HEALTHCARE HAS REPRESENTATION OF THE VIRGINIA ASTHMA COALITION, ROANOKE ASTHMA COALITION AND THE TWIN COUNTY COALITION. THE VIRGINIA ASTHMA COALITION AND THE ROANOKE ASTHMA COALITION TARGET VIRGINIA AND SOUTHWEST VIRGINIA, RESPECTIVELY, IN A PROJECT TO IMPROVE ASTHMA EDUCATION FOR THE AREA. OUR CARDIOPULMONARY DEPARTMENT MANAGER HAS WORKED WITH THE ROANOKE BRANCH TO HELP ESTABLISH THE PROJECT IN OUR COUNTIES. THE TWIN COUNTY COALITION WAS ORGANIZED TO PROVIDE OPPORTUNITIES FOR PREVENTION, RECOVERY AND SUPPORT FOR VARIOUS HEALTH ISSUES, DRUG PREVENTION, COMMUNITY EDUCATION AND MANY EARLY CHILDHOOD PROGRAMS. X X 0 0 0 0 0 0 0 0 0 JON APPLEBAUM 210030 0 0 0 0 0 0 0 20718 0 230748 0 0 0 SANDRA MORETZ 137560 0 0 0 0 0 0 0 12684 0 150244 0 0 0 NELSON MONTGOMERY 144985 0 0 0 0 0 0 0 20995 0 165980 0 0 0 DIANNE DILL 155362 0 0 0 0 0 0 0 13369 0 168731 0 0 0 MICHAEL SHANKS 180585 0 0 0 0 0 0 0 21674 0 202259 0 0 0 MITCH MIZE 165362 0 0 0 0 0 0 0 24389 0 189751 0 0 0 JAMES HELMS 162469 0 0 0 0 0 0 0 20889 0 183358 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE CFO REVIEWS AND SIGNS THE RETURN. FORM 990, PART VI, SECTION B, LINE 15A WE HAVE A COMPENSATION COMMITTEE THAT IS PART OF OUR BOARD OF DIRECTORS. THEY ARE RESPONSIBLE FOR DETERMINING THE COMPENSATION OF THE CEO. FORM 990, PART VI, SECTION C, LINE 18 COPIES ARE PROVIDED UPON REQUEST FORM 990, PART VI, SECTION C, LINE 19 COPIES ARE PROVIDED UPON REQUEST CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PRIOR PERIOD ADJUSTMENTS: -327,147. TWIN COUNTY FAMILY CARE CENTER 200 HOSPITAL DRIVE GALAX VA 24333 621455713 PHYSICAN OFFICE VA 501(C)(3) LINE 3 TWIN COUNTY REGIONAL HEALTHCARE INC 0 TWIN COUNTY REGIONAL HEALTH SERVICES 200 HOSPITAL DRIVE GALAX VA 24333 541397631 WELLNESS CENTER VA 501(C)(3) LINE 3 TWIN COUNTY REGIONAL HEALTHCARE INC 0 TWIN COUNTY REGIONAL FOUNDATION 200 HOSPITAL DRIVE GALAX VA 24333 541593923 FOUNDATION VA 501(C)(3) LINE 11A, I TWIN COUNTY REGIONAL HEALTHCARE INC 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 TWIN COUNTY FAMILY CARE CENTERS I 138540 ACTUAL AMOUNT