2011-05-16T13:58:31-05:00 2010-06-30 Pershing Yoakley & Associates PC One Cherokee Mills 2220 Sutherland Knoxville TN 379192363 990 2009-07-01 540794913 Smyth County Community Hospital SMYT 2767821234 PO Box 880 Marion VA 24354 John Jeter 2767821234 2011-05-16 1 8656730844 2009 2016-02-24 21:20:13Z Linda P White PO Box 880 Marion VA 24354 51215812 0 X www.scchosp.org X 1965 VA Smyth County Community Hospital is a nonstock corporation that owns and operates an acute care facility, a home health agency, and Francis Marion Manor, a long term care facility. The facilities are located in Smyth County, Virginia. They provide inpatient, outpatient, emergency services, and long-term medical care to the general public. Services include, but are not limited to, radiology, electrocardiology, laboratory, physical therapy, speech pathology, home health, blood bank, long term care, and nursery. 13 7 0 60 92940 32727 199120 221609 45299437 47128516 1362161 3182738 653261 625738 47513979 51158601 6826 7973 0 31979324 31314322 0 70749 22013365 22977592 53999515 54299887 -6485536 -3141286 94152978 89714998 10189961 8110078 83963017 81604920 Smyth County Community Hospital is committed to bringing loving care to healthcare. We exist to identify and respond to the healthcare needs of individuals and communities in our region and to assist them in attaining their highest possible level of health. 0 0 49653933 47367741 Smyth County Community Hospital ("SCCH") has a 40-plus year history of providing healthcare services within the community of Marion, Virginia. SCCH is a 170-bed, acute care, community-based hospital. Additionally, SCCH has a 109-bed nursing care facility that offers both skilled nursing care and nursing care, Francis Marion Manor. SCCH has a variety of outreach programs including Homecare.As a not-for-profit hospital, all of SCCH's net income is invested in improving healthcare in the community. With a strong commitment to quality patient care and a heritage of services, SCCH continues to meet the healthcare needs of Smyth and the adjoining counties.Patient Care Services:As a community facility, SCCH is directly responsible for, and responsive to, our families, friends and communities. How will it improve patient care? Should we make an investment now, or wait for an imminent break-through? Where can we benefit the most people? These concerns direct our dollars in introducing new procedures, more in-depth services and innovation. Currently, SCCH services include:24-Hour Emergency DepartmentAudiologyBone DensitometryCardiac RehabilitationComputerized TomographyHomecareFamily Birthing Center (Prepared Childbirth, Rooming In, Sibling Visitation)Intensive Care Unit (ICU)Intermediate Care (Francis Marion Manor)Laboratory ServicesLifeline Emergency Response SystemLithotripsyMagnetic Resonance Imaging (MRI)MammographyMedical and Surgical ServicesOccupational TherapyPastoral CarePediatricsPharmacyPhysical TherapyPre-Admission CenterPulmonary RehabilitationRadiology ServicesRespiratory TherapySame Day SurgerySkilled Nursing FacilitySleepZone Diagnostic CenterSpeech TherapyTransrectal UltrasoundUltrasonographyHomecare Services:SCCH understands the value of home healthcare and the relief patients feel to be back in familiar surroundings while continuing to receive expert care. Under the physician's supervision, patients continue to receive quality medical treatment from skilled nurses, therapists and home health aides who follow the patient's individual plan of treatment. Homecare services allow patients the convenience of:- Treatment in the comfort and security of home- Continuity of family relationships- Individual plan of treatment- Continuing relationship with familiar physician- Freedom to participate in the plan of treatment at home- Caring, personal service by experienced, qualified home health professionals working toward the success of the patient's plan of treatment- Agency accepts assignment of benefits and assists in billing issuesFor eligible patients, charges are 100 percent reimbursable by Medicare when prescribed by the physician under home health guidelines.SCCH Homecare meets the physician's requirements that his or her plan of treatment is carried out by qualified home health professionals. Trained home health nurses carefully document patients' medical charts and provide the physician with prompt and accurate information about the patient's condition.Other home health benefits which support the physician in quality patient care include:- Thorough pre-discharge assessment between the physician, home health nurse and hospital discharge planner to evaluate the patient's needs before leaving the hospital- Assured continuity of the physician's plan of treatment- Consistent, timely communication about the patient's condition- Licensed nurses who meet regulatory standards- Dedicated teamwork with the physician and respect for the patient/physician relationship- Clear communication with the patient and his or her family about reimbursement and covered home care servicesSCCH Homecare provides prompt access to care for qualified patients. It assists hospital discharge planners and other decision makers in delivering alternatives for patients and their families or caregivers, as well as their physician - an alternative that brings flexibility, sensitivity, convenience, and dependability.Other benefits of home health care for the hospital professional staff include: - Pre-discharge home care assessment and planning by our home care coordinator- Immediate, responsive assistance with transition from hospital to home- An expanded network of services to serve the patient- Continuous assessment of the plan of care with the physician- Coordination of communication among patients and their families/caregivers, the physician and the referral source- Coordination and evaluation of reimbursement with a mix of payers, including Medicare, Medicaid and private/commercial insurance companiesSkilled Nursing:SCCH registered and licensed nurses are highly trained and experienced in providing nursing services in the patient's home. They understand the special needs of homebound patients and maintain continuous education in clinical and psychosocial skills development.The policies, procedures and quality assurance programs SCCH nurses follow meet the standards required by federal/state regulations; SCCH routinely surveys patients and physicians to assess the satisfaction level of our nursing services in order to improve nursing quality.Our nursing services include, but are not limited to:- Coordination and implementation of physician's plan of treatment- Routine patient evaluation and communication with physician regarding patient's responses to care and changes in the patient's condition- Interaction with patient's family/caregiver, co-workers and other disciplines to provide observation and feedback regarding patient's condition- Review of medication regiment and patient trainingInfusion Therapy:Our infusion therapy nurses are skilled, registered nurses who understand the special requirements of infusion therapy.The policies, procedures and quality assurance programs they follow meet standards published by the Intravenous Nurses Society and regularity organizations.Our infusion therapy nursing services include, but are not limited to:- Initial and ongoing assessment of patient and family capabilities and needs- Patient and family education- Peripheral intravenous site rotation- Central venous catheter care- Blood Drawing- Follow-up reports to physicians and pharmacy service providers- Psychosocial support for patients and families/caregiversHome Health Aide:Our home health aides assist the professional nursing staff by performing routine duties in caring for in-home patients. They are qualified to provide an extension to therapeutic services, personal care, ambulation, exercise, and household services essential to health care at home. Home health aide services can only be offered to individuals qualifying for skilled nursing or therapist services.Home health aide services include, but are not limited to:- Maintaining accurate clinical records regarding all patient observations, care and treatment- Assisting patient with ambulation and/or transfer, using proper body mechanics to protect patient and personal safety- Assisting patient in meeting personal hygiene needs- Preparing meals and assisting with eating if necessary- Providing simple household procedures essential to health care at homePhysical Therapy:Physical therapists provided by our home health agency use the latest techniques and equipment to assist patients in achieving the most complete recovery possible in the shortest period of time. Patients who require these services often become frustrated in their attempts at recovering skills that were once easy for them. Our professionals' assistance can help overcome this downside of rehabilitative therapy by providing expert aid with an encouraging attitude that helps the patient achieve more in less time.Our physical therapy services include, but are not limited to:- Assisting the physician with initial and on-going patient evaluation- Directing and aiding patients in various exercises and activities- Gait training- Instructing patient and caregiver in use of durable medical equipment and prosthetic and orthotic devices- The application of various devices, simulators and traction- Coordinating physical therapy with our agency's nursing servicesOccupational Therapy:Our occupational therapist is highly trained and experienced in rehabilitating patients. The goal of therapy is to improve and restore function lost or impaired by illness or injury and promote a return to independence through training and re-education in skills and activities associated with daily living.Our occupational therapy services include, but are not limited to:- Evaluation of the patient's level of function- Guiding the patient in therapeutic, creative and self-care activities 49653933 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 102 0 1 0 1 1 0 0 0 0 0 0 0 0 13 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X John Jeter 2767821194 565 Radio Hill Road Marion VA 24354 X AC Squires MD 40.00 X 0 157797 15638 Jim Patterson MD 8.00 X 0 90457 0 Allen J Abel 1.00 X 0 0 0 David F Jim Bear 1.00 X 0 0 0 Ruth Rhea Cox 1.00 X 0 0 0 Marvin Eichorn 1.00 X 0 649704 213607 Bob Feathers 1.00 X 0 0 0 Ann Fleming 1.00 X 0 427191 59477 Joanne Groseclose 1.00 X 0 0 0 Mark Groseclose 1.00 X 0 0 0 Jim McDowell MD 1.00 X 0 0 0 Cindy Salyer 1.00 X 0 251254 40467 Bob Shults 1.00 X 0 0 0 Linda P White 55.00 X 0 250573 31321 Timothy C Anderson Jr 50.00 X 0 125957 15671 Michael H Widener 20.00 X 0 131660 2817 John L Jeter 50.00 X 0 23046 9940 Mark F Montgomery 50.00 X 0 98597 14918 Jean M Marine MD 40.00 X 0 450558 15369 Robert B Evans MD 40.00 X 0 464316 15633 Eric J Sacknoff MD 40.00 X 0 417969 23353 Ramzi K Humsi MD 40.00 X 0 391717 24197 Arthur T Steed 40.00 X 0 298975 21222 0 4229771 503630 0 0 1 0 Morrison Management PO Box 102289 Atlanta GA 30368 Food Service Management 2002681 Cardinal Health 1330 Enclave Parkway Houston TX 77077 Pharmacy Management 570725 Smyth County Radiology Inc 1048 Terrace Drive Marion VA 24354 Radiology Services 397076 Skanska USA Building Inc 30 Burton Hills Blvd Nashville TN 37215 Construction Services 375226 Johnston Memorial Hospital 351 Court Street Abingdon VA 24210 Blood Preparation 321574 16 197269 24340 221609 Patient Services 621990 47035809 47035809 P/S Inc Related to pro 561000 92707 87711 4996 47128516 3065270 3065270 132847 132847 132847 132847 152810 21869 57211 152810 -35342 117468 117468 3087 3087 3087 OTHER REVENUE 621500 214697 126753 87944 cafeteria sales 722210 197408 197408 Management fee revenue 900099 38024 38024 39675 39675 489804 51158601 47367741 92940 3476311 7973 7973 881845 881845 24851603 24830224 21379 737450 711566 25884 3251475 3147960 80525 22990 1591949 1535042 56907 33261 33261 164972 164972 58397 58397 78501 78501 5262850 4445693 807957 9200 79932 62491 17441 845428 754065 61884 29479 974286 891921 82365 1382228 1271637 110591 167827 134652 24095 9080 11952 10476 1476 779442 779442 3090498 2265991 824507 460360 28272 432088 Medical Supplies & Drug 5897129 5974903 -77774 Repairs & Maintenance 1084506 1066976 17530 Bad Debt 284701 284701 Retention & Recruitment 189499 185345 4154 Taxes - Other 15710 15710 2116113 2044045 72068 54299887 49653933 4575205 70749 878948 11075080 551393 8363942 6932193 1142422 1036234 213302 415438 64106387 45127178 18145246 18979209 15403301 23591544 202000 202000 38728737 38006987 94152978 89714998 7629641 6413210 2560320 1696868 10189961 8110078 X 83935903 81561102 27114 43818 83963017 81604920 94152978 89714998 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2456 0 1 1837 0 4293 0 3374666 3374666 14929479 9872877 5056602 130505 92296 38209 42902629 35162005 7740624 2769108 2769108 18979209 Due from SWCHS, NET 11493668 Other Assets 172397 Due from MSHA, NET 26301663 Due from Affiliates 39259 38006987 Other long-term liabilities 671188 Long-term compensation payable 522704 lEASE PAYABLE 35615 Due to third-party 467361 1696868 Part X: Description of Uncertain Tax Positions Under FIN 48: THE HOSPITAL PREVIOUSLY ADOPTED THE PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) NO. 740, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. This provision PROVIDES GUIDANCE FOR HOW UNCERTAIN TAX POSITIONS SHOULD BE RECOGNIZED, MEASURED, PRESENTED AND DISCLOSED IN THE CONSOLIDATED FINANCIAL STATEMENTS. FASB 740 REQUIRES THE EVALUATION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN THE COURSE OF PREPARING TAX RETURNS TO DETERMINE WHETHER THE TAX POSITIONS ARE "MORE LIKELY THAN NOT" OF BEING SUSTAINED BY THE APPLICABLE TAX AUTHORITY, INCLUDING RESOLUTION OF ANY APPEALS OR LITIGATION, BASED ON THE TECHNICAL MERITS OF THE POSITION, INCLUDING ADMINISTRATIVE PRACTICES AND PRECEDENTS. THE TAX BENEFIT TO BE RECOGNIZED IS MEASURED AS THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN FIFTY PERCENT LIKELY OF BEING REALIZED UPON ULTIMATE SETTLEMENT WHICH COULD RESULT IN THE HOSPITAL RECORDING A TAX LIABILITY THAT WOULD REDUCE NET ASSETS. TAX POSITIONS NOT DEEMED TO MEET A "MORE LIKELY THAN NOT" THRESHOLD WOULD BE RECORDED AS TAX EXPENSE IN THE CURRENT YEAR. THE HOSPITAL HAS NOT IDENTIFIED ANY SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2010. 1 1 X 1 X 1 X 1 1 1 0 1 0 1102461 1102461 0.02030 8974230 4622167 4352063 0.08010 10076691 4622167 5454524 0.10040 260759 260759 0.00480 6973 6973 0.00010 267732 267732 0.00490 10344423 4622167 5722256 0.10530 1000 1000 0.00000 1000 1000 1 1770886 1062531 10911109 12065113 -1154004 X 1 1 Smyth County Community Hospital

565 Radio Hill Road Marion VA 24354

X X X Francis Marion Manor

100 Francis Marion Lane Marion VA 24354

Nursing Home Part I, Line 6a: mountain states health alliance (MSHA) prepared an annual written report that describes the organization's programs and services that promote the health of the communities it serves. SCCH, as a member of MSHA, is included in MSHA's report. Part I, Line 7: A cost to charge ratio was derived from the Schedule H applicable worksheets, including worksheet 2, Ratio of Patient Care Cost to Charges. Part I, Line 7f: Bad Debt expense of $284,701 is included in Statement of Functional Expenses on Form 990, part IX, line 25, but has been subtracted for purposes of calculating percentages on part 1, line 7, column f. Part III, Line 4: Worksheet A was used for Part III, lines 2 and 3 in determining bad debt at cost. SCCH follows the Healthcare Financial Management Associations Principles and Practices Board issued Statement 15: Valuation and Financial Statement Presentation of Charity Care and Bad Debts by Institutional Healthcare Providers (the Statement). The Statement provides guidance on collectability criteria and emphasizes revenue recognition only when collections are reasonably assured. Part III, Line 8: Medicare allowable costs were reported using SCCHs filed Medicare Cost Report (C/R). The C/R uses a cost to charge ratio based on a step down method. In caring for the patient, there are several services that are considered non-allowable such as: transportation of a patient, comfort items to include a television, magazines, or a telephone. Additional non-allowable costs include the recruitment of physicians, physician guarantees and a portion of the Bad Debt (30%) associated with the care of the patient. Medicare losses, including some non-allowable costs, should be counted as a community benefit as this is the cost of care for serving the aging population. As a not-for-profit organization, we exist to identify and respond to the health care needs of the community and the individual while maintaining a high level of health care services without losses. Since losses do occur through the CMS system of reimbursement, these losses are a cost of doing business for our community and should be considered a community benefit. As a participating provider in the Medicare program, SCCH is required to provide the full regimen of care for our Medicare population. There are a number of care regimens that are compensated by the Medicare program at levels below our cost. Therefore it is only logical to allow SCCH to report these uncompensated services as a community benefit on this document. By making this change, non-profit providers will be encouraged to sustain important care delivery models for our aging population in spite of the fact it is sometimes economically injurious. Part III, Line 9b: SCCH follows a strong collection program that communicates financial responsibility to the patient prior to service. Collection practices apply to all patients, charity and non-charity. In routine circumstances when it is determined that a patient has not responded to requests for payment, an account can be referred to an outside collection agency for collection assistance. SCCH ensures that outside collection agencies follow hospital billing and collection guidelines. Once a delinquent patient account has been submitted to an outside collection agency it can be retracted if it is determined that the patient is eligible for financial assistance. All requests for financial assistance must be accompanied by a completed financial assessment form and supporting documentation. Part VI, Line 2: SCCH is a member of Mountain States Health Alliance (MSHA). During FY08 and FY09, MSHA conducted the largest community health needs assessment in its history in an effort to profile the health of the residents within the local region. The assessment focused on state, regional, and county specific data collection. This assessment also included primary data collected through approximately 50 one-on-one interviews. Those interviewed were individuals from around the region which included local and state government officials, health department representatives, physicians, general public, local industry, civic organizations, education officials, and community resource groups. This information was collected, and then analyzed, and a summary of the findings was listed in an effort to obtain a more detailed snapshot specific to each county located throughout the SCCH service area. This information was reviewed by SCCHs Strategic Planning Team along with Government Relations and Quality Departments. The MSHA steering committee identified childhood obesity as the health disparity targeted for improvement. During FY09, MSHA began collaborative efforts with East Tennessee State University's College of Public Health to develop the MSHA-ETSU Obesity Collaborative Committee. The focus of this committee is to pull together many partners and organizations in collaboration to reduce the level of childhood obesity throughout Northeast Tennessee and Southwest Virginia. During FY10, the committee offered 25 seed grants of $2,000 each to local community organizations such as churches, community groups, schools, and employers that want to explore obesity reduction efforts.In addition to the grants program, an annual symposium is provided free to the region and available to residents and community groups. National, regional, and local experts share information on trends regarding childhood obesity and proven community-based strategies to reduce the prevalence. Part VI, Line 3: SCCH provides communication of financial assistance on its web site and on posters placed in prominent areas such as Admitting areas, Emergency Departments and patient payment (cashier) locations. Printed educational materials including financial assistance contact information are also provided in the patient's admitting paperwork. Posters and reference materials are written in both English and Spanish. Admitting staff are trained to educate patients on SCCHs Financial Assistance Policy. SCCH also has Financial Counselors which communicate the patients financial responsibility prior to service as well as provide education on SCCHs financial assistance policy. These counselors also help uninsured patients determine sources of payment for medical bills and help patients determine eligibility for programs such as TennCare or Medicaid. In addition, SCCH contracts with the company MedAssist to work with self-paying patients who have limited financial resources. MedAssist determines a patients eligibility in medical coverage options and assists with their enrollment. SCCH bears the cost for the MedAssist program. Part VI, Line 4: SCCH is located in Marion, Smyth County, which is in rural Southwest Virginia. Smyth County is a federally designated medically underserved area and has a high rate of individuals who are uninsured. The population of Smyth County was 31,738 in 2009 and, according to the U.S. Census Bureau, Marion has a population of 5,926. The median age of residents of Smyth County is 42.0, which is older than the average age of 36.5 in the United States. Smyth County has a median household income of $36,103, which is well below $51,425, the median household income of the U.S. It is estimated that 17.6% of Smyth County's residents live in poverty compared to 13.5% statewide. Part VI, Line 5: The activities reported in Part II seek to achieve specified objectives, including: improving access to health services, enhancing public health, and relief of government burden. The activities are available to the general public, focusing on low-income consumers. Part VI, Line 6: SCCH is dedicated to operating efficiently so that waste is minimized and surpluses may be applied to maintaining adequate facilities and equipment for the care for our patients. Various checks and balances are established to ensure that expenditures for operating expenses and capital costs are reasonable and necessary. Part VI, Line 7: SCCH is a 170-bed, acute care facility operated under the direction of a 13-member Board of Directors primarily comprised of local community residents. Additionally, SCCH has a 109-bed nursing care facility that offers both skilled nursing care and nursing care. SCCH is majority owned by Mountain States Health Alliance (MSHA) based in Johnson City, Tennessee. MSHA is integrated both vertically and horizontally and is the largest regional healthcare system with 14 hospitals. MSHA provides care to people in 29 counties in Tennessee, Virginia, Kentucky, and North Carolina. SCCH serves as the county's primary health service provider. Patients benefit from SCCH's affiliation with a healthcare system where they can be efficiently moved along an integrated, comprehensive continuum of care as their health status dictates. Patients can be moved to the system's flagship facility - Johnson City Medical Center which is a tertiary care facility providing advanced treatment options. VA 1 X Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL. X X 0 1 X X X X X 0 1 0 0 0 0 0 0 0 AC Squires MD 0 156433 0 0 0 1364 0 5693 0 9945 0 173435 0 0 Marvin Eichorn 0 420689 0 171393 0 57622 0 187084 0 26523 0 863311 0 0 Ann Fleming 0 294561 0 110625 0 22005 0 39321 0 20156 0 486668 0 0 Cindy Salyer 0 180720 0 61029 0 9505 0 20722 0 19745 0 291721 0 0 Linda P White 0 180262 0 58247 0 12064 0 16050 0 15271 0 281894 0 0 Jean M Marine MD 0 368643 0 48592 0 33323 0 14110 0 1259 0 465927 0 0 Robert B Evans MD 0 398927 0 65389 0 0 0 8584 0 7049 0 479949 0 0 Eric J Sacknoff MD 0 409115 0 0 0 8854 0 13421 0 9932 0 441322 0 0 Ramzi K Humsi MD 0 310035 0 5000 0 76682 0 13060 0 11137 0 415914 0 0 Arthur T Steed 0 283676 0 5000 0 10299 0 10488 0 10734 0 320197 0 0 Part I, Line 1a Temporary housing was provided for a portion of the year ending June 30, 2010 to an executive for recruitment purposes only. Minimal amounts are remitted for rotary club dues, subject to "business use only" restrictions. Part I, Line 1b no written policy exists at this time; However, all Expenses must be approved on an individual basis by administration, with sufficient substantiation to be provided as documentation. Part I, Line 4a THE FOLLOWING EXECUTIVES LISTED IN SCHEDULE J, PART II PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY Mountain States Health Alliance: ANN FLEMING, CINDY SALYER, AND LINDA WHITE. THE 457(F) PLAN IS A NONQUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE." IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISFIES THE TWO-YEAR NON-COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR SIX OR MORE YEARS. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN.) THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIEs OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON" OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24 MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURS. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION. Linda P. White, CEO of SCCH, received a distribution of $9,283 as a participant in the 457(f) retirement plan. Form 990, Part VI, Section B, line 11 THE FORM 990, WHICH WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, WAS REVIEWED BY FINANCIAL MANAGEMENT PRIOR TO FILING. COPIES OF THE RETURN WERE MADE AVAILABLE TO THE BOARD MEMBERS. Form 990, Part VI, Section B, line 12c ANNUALLY, THE AUDIT AND COMPLIANCE DEPARTMENT PROVIDES THE POLICY AND THE CONFLICT OF INTEREST DISCLOSURE FORMS TO ALL COVERED PERSONS. EACH PERSON IS REQUIRED TO PROVIDE A COMPLETED DISCLOSURE FORM, NOTING ANY CONFLICTS OR ATTESTING THEY HAVE "NONE", AND RETURN THOSE BACK TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY DISCLOSURES ARE FORWARDED TO THE APPROPRIATE MANAGEMENT OR BOARD PERSONNEL TO EVALUATE AND UTILIZE WHEN A TRANSACTION INVOLVING A CONFLICTED PERSON ARISES. ADDITIONALLY, PERSONNEL WHO HAVE A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND FORMS ARE REQUIRED TO DISCLOSE THE CONFLICT, AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND ENGAGED IN A CONFLICTED TRANSACTION. Form 990, Part VI, Section B, line 15 The CEO and CFO are employed and compensated by Mountain States Health Alliance ("MSHA"). MSHA's COMPENSATION COMMITTEE, WHICH IS THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, OBTAINS THE SERVICES OF AN OUTSIDE, INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE THE COMMITTEE WITH RELEVANT MARKET DATA FROM COMPENSATION SURVEYS AND WITH ADVICE WHEN THE COMMITTEE MAKES RECOMMENDATIONS ON PAY AND BENEFITS FOR THE CEO. MSHA's BOARD ALSO APPROVES PAY AND BENEFITS FOR THE CFO. THE COMPENSATION COMMITTEE REVIEWS AND HAS FINAL APPROVAL OF CEO RECOMMENDATIONS FOR PAY AND BENEFITS FOR ALL OTHER EXECUTIVES. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM, AND THEY ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY ON A QUARTERLY AND ANNUAL BASIS. Form 990, Part V, Line 2a Number of Employees Reported on Form W-3 Effective January 1, 2009, all Smyth County Community Hospital team members are employed by Mountain States Health Alliance for payroll reporting purposes. All officers and highest paid employees are reported in Part VII and Schedule J as compensated by a related organization. Mountain States Health Alliance 400 N State of Franklin Road Johnson City TN 37604 620476282 Hospital TN 501(C)(3) Line 3 N/A Smyth County Comm Foundation 1 Health Way Marion VA 24354 311650055 Supporting Organization to scch VA 501(C)(3) Line 11A N/A Norton Community Hospital 100 15th street northwest Norton VA 24273 540566029 hospital VA 501(C)(3) Line 3 N/A Dickenson Community Hospital PO Box 1440 Clintwood VA 24228 770599553 Hospital VA 501(C)(3) Line 3 N/A Johnston Memorial Hospital 351 Court Street NE Abingdon VA 24210 540544705 Hospital VA 501(C)(3) Line 3 N/A Abingdon Physician Partners 351 Court Street NE Abingdon VA 24210 205485346 Medical Services VA 501(C)(3) Line 11A N/A Integrated Solutions Health Network LLC 400 N State of Franklin Road Johnson City TN 37604 621711997 Investment Company TN N/A (D) -1241 3484 0 0 EMMAUS Community Healthcare PLLC 6070 HWY 11E Piney Flats TN 37686 200577483 Medical Services TN N/A N/A 0 0 Southwest Community Health Services PO BOX 880 Marion VA 24354 541460695 Health Services VA N/A C 422802 1119453 1.00000 Blue Ridge Medical Management Corporation 1019 W Oakland Avenue Ste 5 Johnson City TN 37604 621490616 Physician Offices TN N/A C Mediserve Medical Equip of Kingsport 1021 W Oakland Avenue STE 103 Johnson City TN 37604 621212286 Durable Medical Equipment TN N/A C Mountain States Properties 1021 W Oakland Avenue STE 207 Johnson City TN 37604 621845895 Property Management TN N/A C blue ridge physician group 1019 W Oakland Avenue Ste 5 Johnson City TN 37604 621700412 Healthcare services TN N/A C Community Home Care Inc 1460 Park Avenue Norton VA 24273 541453810 Medical Equip. Sales & Rental VA N/A C Community Physicians Serv Corp 100 15th Street NW Norton VA 24273 541641446 Medical Services VA N/A C 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 Southwest Community Health Services D 1143407