2011-01-11T07:45:34-06:00 2008-12-31 DIXON HUGHES PLLC 500 RIDGEFIELD COURT ASHVILLE NC 28806 990 2008-01-01 540555201 SOUTHSIDE COMMUNITY HOSPITAL INC SOUT 4343152432 800 OAK STREET FARMVILLE VA 23901 WILLIAM L BASS JR 4343152432 2011-01-10 1 Amy Bibby 8282542254 2008 2016-02-24 21:20:13Z X WILLIAM L BASS JR 800 OAK STREET FARMVILLE VA 23901 50612905 0 X WWW.SCH-FARMVILLE.ORG X 1926 VA TO PROVIDE HEALTHCARE SERVICES FOR EIGHT COUNTIES IN CENTRAL VIRGINIA. 20 14 607 108 0 0 666053 25603 43217867 50317523 407040 138847 289784 77340 44580744 50559313 49762 0 20686560 25566286 0 0 26384907 28882945 47071467 54498993 -2490723 -3939680 53224890 51261092 16489691 18582418 36735199 32678674 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 48590623 49762 50317523 Southside Community Hospital (Southside Community) is committed to offering affordable healthcare to residents of Southside Virginia. Southside Community is also dedicated to improving the quality of life in the communities we serve by providing high quality healthcare. 2008 Community Benefit Highlights - Traditional Charity Care includes health care services to patients who do not have the ability to pay. During fiscal year 2008, $3,474,428 of charges at an estimated cost of $1,396,408 was provided to patients of Southside Community. Eligibility for charity care is based on poverty income levels set by the state of Virginia. - Unpaid cost of Medicaid reflects the cost not reimbursed by Medicaid for care rendered to Medicaid patients, which totaled $1,667,587. - Community Education includes community/patient health education programs, health screenings, counseling, and support groups, which totaled $103,000. - 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, which totaled $49,762. - Approximately 5,000 people attended Southside Community's health education and health screening events.Community Education & Health Screenings Southside Community employees continually offer professional health education programs, classes, lectures, health fairs and health screenings throughout Southside Virginia. Southside Community has a Speaker Bureau available which consists of healthcare professionals, who are available to speak to the public on updated healthcare issues and topics. Southside Community 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 - Advanced Directives Day - Blood Pressure Checks Annual Heart of Virginia Festival - Blood Pressure Checks at local Wal-Mart 2nd Wednesday of every month - Blood Pressure Checks in several supermarkets in hospital service area - Breast Cancer Awareness Tea Party - Car Seat Safety Day - Coat and Blanket Drive - Community Diabetes Classes - Community Heart Health Day - Crossroads Health Fair for Employees - Diabetes Awareness Day at PECES - Family-Focused Classes - EMS Health Fair (2 Days) - Free Physicals to Longwood University Athletes - Health Fair at Blackstone Church - Hearing Screenings - Lunenburg Health Fair - 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 - Women's Health FairSupport Groups at Southside Community - Alcoholics Anonymous - Brain Injury Support Group - Celiac Support Group - Diabetic Support Group - Fibromyalgia/CFIDS Support Group - Multiple Sclerosis Support Group 48590623 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 62 0 1 607 1 0 0 0 0 0 0 0 0 0 20 14 1 0 0 0 1 1 1 1 1 0 1 0 1 1 1 1 1 1 1 0 VA X X WILLIAM L BASS JR 4343152432 800 OAK STREET FARMVILLE VA 23901 STEPHEN C KEITH EDD 2.00 X 0 0 0 SARAH PUCKETT MD 2.00 X 0 0 0 LEROY O PFEIFFER JR 2.00 X 0 0 0 BARBARA FEINMAN 40.00 X 56678 0 7043 WILLIAM BASS JR 50.00 X X 187759 0 40778 LEWIS C ADDISON 2.00 X 0 386573 152164 SARAH BROWNING 2.00 X 0 0 0 GLENN E CULLEY 2.00 X 0 0 0 GEORGE W DAWSON 2.00 X 0 883153 154143 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 KRISTEN L HUBER MD 50.00 X 275737 0 16377 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 LARRY ROACH 2.00 X 0 0 0 BERNICE SMITH 2.00 X 0 0 0 CHARLES TAYLOR MD 2.00 X 0 0 0 FRANCIS WOOD JR 2.00 X 0 0 0 GWEN EDDLEMAN EDD 50.00 X X 325907 0 65790 KWABENA DONKOR MD 2.00 X 14888 0 0 THOMAS E BASCO MD 50.00 X 169892 0 7290 JOSEPH E BROWNING MD 50.00 X 175644 0 7524 DAVID E JOHNSEN MD 50.00 X 214461 0 5707 JOHN A KONA MD 50.00 X 423424 0 12195 EVGENIY A SHCHELCHKOV 50.00 X 195863 0 21196 2040253 1269726 490207 8 0 1 0 CL LEWIS INC PO BOX 10728 LYNCHBURG VA 24506 BUILDING CONTRACTORS 1674403 Crothal 13028 collections center dr chicaGO IL 60693 HOUSEKEEPING & MAINTENANCE SVC. 1115828 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 303682289 DIETARY SERVICES 886316 ALLIANCE IMAGING PO BOX 96485 CHICAGO IL 60693 MRI SERVICES 736640 ENDURACARE PO BOX 52524 PHOENIX AZ 850722524 PHYSICAL THERAPISTS 705291 16 10944 14659 25603 NET PATIENT SERVICE RE 621400 50227474 50227474 ANCILLIARY SERVICES 900099 90049 90049 50317523 108847 108847 116362 14570 53592 62770 14570 77340 77340 30000 30000 30000 30000 50559313 50317523 0 216187 49762 49762 2129965 1475751 654214 19464394 16596917 2867477 2483371 2078373 404998 1488556 1245797 242759 687463 687463 115073 115073 35196 35196 25686 25686 5804378 5723586 80792 569188 198324 370864 9076066 8821604 254462 25935 25935 729261 729261 159816 143935 15881 83666 78546 5120 526564 526564 2622018 2622018 818510 818510 BAD DEBTS 6549757 6549757 MAINTENANCE CONTRACTS 747407 573336 174071 COLLECTIONS EXPENSES 296050 296050 10911 10911 54498993 48590623 5908370 0 40339 488483 4960558 2921096 5108639 6009214 1040192 1182886 753684 539100 47019580 24584266 19226727 22435314 3645439 2067432 18449312 15617567 53224890 51261092 3949834 4689119 11634955 11091602 310816 297254 594086 2504443 16489691 18582418 X 36648176 32614525 22874 0 64149 64149 36735199 32678674 53224890 51261092 X 0 1 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 87610 1297 -25822 63085 1.00000 0 0 163194 163194 26414967 12034087 14380880 18075324 11666746 6408578 2366095 883433 1482662 22435314 OTHER RECEIVABLES 17334 DUE FROM RELATED PARTY 15600233 15617567 DUE TO A RELATED PARTY 2355836 ESTIMATED THIRD PARTY SETTLEMENTS 148607 2504443 50559313 54498993 -3939680 -604548 487703 -116845 -4056525 50496060 -604548 541295 -63253 50559313 0 50559313 54552585 53592 53592 54498993 0 54498993 Part V, Line 4: Description of Intended Use of Endowment Funds: THESE FUNDS WERE DONOR RESTRICTED FOR LPN NURSING SCHOLARSHIPS. Part XI, Line 8 - Other Adjustments: CONTRIBUTED CAPITAL FROM AFFILIATE: 487703. Part XII, Line 2d - Other Adjustments: RENTAL EXPENSES: 53592. CONTRIBUTED CAPITAL FROM AFFILATE: 487703. Part XIII, Line 2d - Other Adjustments: RENTAL EXPENSES: 53592. SOUTHSIDE COMMUNITY HOSPITAL INC

800 OAK STREET FARMVILLE VA 23901

X X X SARTORI MEDICAL CENTER

312 KINGS STREET KEYSVILLE VA 23947

FAMILY PRACTICE CENTRA SOUTHSIDE PROF SVC FARMVILLE

1705 EAST THIRD STREET FARMVILLE VA 23974

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 0 SOUTHSIDE VIRGINIA COMMUNITY COLLEGE 109 CAMPUS DRIVE ALBERTA VA 23821 541268239 N/A 40762 0 CASH PARTIAL FUNDING FOR RN PROGRAM LONGWOOD UNIVERSITY 201 HIGH STREET FARMVILLE VA 23901 546001788 N/A 9000 0 CASH SPONSORSHIP OF HALL OF FAME DINNER/HANDICAP ENTRANCE 2 0 X X X X 0 1 0 0 0 0 0 0 0 WILLIAM BASS JR 154233 32845 681 18847 21931 228537 LEWIS C ADDISON 316259 67786 2528 132595 19569 538737 GEORGE W DAWSON 540616 51458 291079 138571 15572 1037296 KRISTEN L HUBER MD 259521 16216 11500 4877 292114 GWEN EDDLEMAN EDD 266743 55600 3564 62275 3515 391697 THOMAS E BASCO MD 169572 320 7290 177182 JOSEPH E BROWNING MD 175324 320 7524 183168 DAVID E JOHNSEN MD 213840 621 5707 220168 JOHN A KONA MD 420256 3168 12195 435619 EVGENIY A SHCHELCHKOV MD 195485 378 9231 11965 217059 Part I, Line 4a GEORGE DAWSON, ACCRUED $251,903 FOR 2008, INCLUDED IN TAXABLE WAGES. AMANDA HAYTASINGH FAMILY MEMBER OF GWEN EDDLEMAN, OFFICER 26338 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 BOARD OF DIRECTORS FOR THE BEDFORD MEMORIAL HOSPITAL, A 50% JOINT VENTURE 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 6 CENTRA HEALTH, INC. IS THE SOLE MEMBER CORPORATION OF SOUTHSIDE COMMUNITY HOSPITAL. 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. Form 990, Part VI, Section A, line 7b CENTRA HEALTH, INC. IS THE SOLE MEMBER CORPORATION OF SOUTHSIDE COMMUNITY HOSPITAL (SCH) AND HAS THE POWER TO APPROVE DECISIONS MADE BY SCH'S GOVERNING BODY. Form 990, Part VI, Section A, line 10 THE ORGANIZATION WILL PROVIDE ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS WITH A COPY OF THE FORM 990 PRIOR TO ITS FILING. ADDITIONALLY, SOUTHSIDE COMMUNITY HOSPITAL WILL REVIEW THE FORM 990 WITH ITS FINANCE COMMITTEE, WHO WILL THEN PRESENT IT TO THE BOARD OF DIRECTORS FOR 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 (SOUTHSIDE HOSPITAL'S SOLE MEMBER) 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 (ONE OF WHICH IS A PHYSICIAN). FOUR OF THESE FIVE MEMBERS MEET THE IRS DEFINITION OF INDEPENDENCE FOR PURPOSES OF THE FORM 990. 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 OF SOUTHSIDE HOSPITAL. 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 SOUTHSIDE HOSPITAL, BASED ON THE RECOMMENDATIONS MADE BY THE CEO. METHODS USED TO DETERMINE SALARY RANGES AND ADJUSTMENTS INCLUDE, BUT ARE NOT LIMITED TO, INDEPENDENT COMPENSATION CONSULTANTS, AS WELL AS THIRD PARTY COMPENSATION SURVEYS AND 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. THE MOST RECENT FILING OF THE FORM 990 IS ALSO 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. AMENDMENTS HAVE BEEN MADE TO SCHEDULE J PART II OF THE FORM 990. THE AMENDMENTS INCLUDE THE RECLASSIFICATION OF COMPENSATION FROM "BASE COMPENSATION" TO "OTHER COMPENSATION" AND VICE VERSA IN ORDER TO MORE PROPERLY ALIGN THE PRESENTATION OF COMPENSATION ON THE FORM 990 WITH THE GUIDANCE SET FORTH IN THE 2009 IRS FORM 990 INSTRUCTIONS. THE TOTAL COMPENSATION AMOUNTS REPORTED ON THE FORM 990 AND RELATED SCHEDULE J HAVE NOT CHANGED FROM THE PREVIOUSLY FILED VERSION. CENTRA SOUTHSIDE PROFESSIONAL SERVICES LLC 800 OAK STREET FARMVILLE VA 23901 260771274 PHYSICIAN OFFICES VA 4825375 1050000 SOUTHSIDE COMMUNITY HOSPITAL INC CENTRA HEALTH INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 540715569 HEALTHCARE VA 501(C)(3) HOSPITAL N/A CENTRA HEALTH FOUNDATION INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541604094 SUPPORTING ORGANIZATION VA 501(C)(3) 509(A)(3) CENTRA HEALTH INC LYNCHBURG FAMILY PRACTICE RESIDENCY PROGRAM INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541457983 HEALTHCARE VA 501(C)(3) 509(A)(3) CENTRA HEALTH INC CCRC INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541929580 CONTINUING CARE RESIDENCY VA 501(C)(3) 509(A)(3) CENTRA HEALTH INC THE VIRGINIA BAPTIST HOSPITAL AUXILIARY INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 546060503 SUPPORTING ORGANIZATION VA 501(C)(3) 509(A)(3) CENTRA HEALTH INC AUXILIARY TO LYNCHBURG GENERAL HOSPITAL INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 546047293 SUPPORTING ORGANIZATION VA 501(C)(3) 509(A)(3) CENTRA HEALTH INC VBH ASSOCIATES 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541292948 OPERATION OF MEDICAL BUILDING VA N/A GENERAL BUSINESS CONCERNS INC 1920 ATHERHOLT ROAD LYNCHBURG VA 24501 541299682 REAL ESTATE - PHYSICIAN OFFICES VA N/A C 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0