CCRC INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CCRC INC (EIN 54-1929580)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-15
IRS object ID
201143199349305839
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-15T14:13:06-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1
CityASHEVILLECity
StateNCState
ZIP Code28806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN541929580EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CCRC INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCCRCNameControl
Phone4342004708Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11920 ATHERHOLT ROADAddressLine1
CityLYNCHBURGCity
StateVAState
ZIP Code24501ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLEWIS C ADDISONName
TitleTREASURERTitle
Phone4342004708Phone
Date Signed2011-11-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAMY BIBBYName
Phone8282542254Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLEWIS C ADDISONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11920 ATHERHOLT ROADAddressLine1
CityLYNCHBURGCity
StateVAState
ZIP Code24501ZIPCode
FieldValueIRS element (for citing)
Gross Receipts3874787GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SUMMITLYNCHBURG.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1998YearFormation
State Legal DomicileVAStateLegalDomicile
Activity Or Mission DescriptionCONTINUING CARE RETIREMENT CENTERActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members3NbrIndependentVotingMembers
Total Nbr Employees28TotalNbrEmployees
Total Nbr Volunteers60TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year3590747ProgramServiceRevenuePriorYear
Program Service Revenue CY3640211ProgramServiceRevenueCY
Investment Income Prior Year-326675InvestmentIncomePriorYear
Investment Income Current Year234576InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year3264072TotalRevenuePriorYear
Total Revenue Current Year3874787TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year556929SalariesEtcPriorYear
Salaries Etc Current Year611045SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3148775OtherExpensePriorYear
Other Expenses Current Year3220391OtherExpensesCurrentYear
Total Expenses Prior Year3705704TotalExpensesPriorYear
Total Expenses Current Year3831436TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-441632RevenuesLessExpensesPriorYear
Revenues Less Expenses CY43351RevenuesLessExpensesCY
Total Assets BOY19679999TotalAssetsBOY
Total Assets EOY19092842TotalAssetsEOY
Total Liabilities BOY21696231TotalLiabilitiesBOY
Total Liabilities EOY20730433TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-2016232NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-1637591NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE SUMMIT IS A SENIOR LIVING COMMUNITY PROVIDING AN ENVIRONMENT FOR EACH RESIDENT TO BE ENGAGED IN LIFE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense3247697Expense
Revenue3640211Revenue
DescriptionCCRC, 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, THE CENTRAL VIRGINIA PARKINSON'S SUPPORT GROUP, AN ESSENTIAL TREMORS SUPPORT GROUP, THE VANHA BOARD OF DIRECTORS AND THE AAHSA SENATE. THE SUMMIT HOSTS A QUARTERLY EVENT COORDINATED BY THE LYNCHBURG REGIONAL CHAMBER OF COMMERCE, CALLED "BUSINESS AT BREAKFAST" THAT IS OPEN TO AREA BUSINESS PROFESSIONALS. THE SUMMIT HOSTS EDUCATIONAL EVENTS IN COOPERATION WITH AREA NONPROFIT AGENCIES, INCLUDING A 6-PART SERIES ON ALZHEIMER'S RESEARCH AND UNDERSTANDING IN PARTNERSHIP WITH THE CENTRAL VIRGINIA ALZHEIMER'S ASSOCIATION; SEVERAL PROGRAMS RELATED TO FINANCIAL MANAGEMENT AND INVESTMENTS IN COOPERATION WITH CENTRA FOUNDATION, INC. AND SUNTRUST BANK; AND, PROGRAMS RELATED TO ELDER LAW IN COOPERATION WITH AREA ATTORNEYS.STAFF PROVIDE VOLUNTEER SUPPORT FOR EACH OF THE ABOVE ORGANIZATIONS AND OTHERS INCLUDING THE WYNDHURST ASSOCIATION, PASTORAL COUNSELING SERVICES OF CENTRAL VIRGINIA, THE EXCHANGE CLUB, THE YOUTH PHILANTHROPY COMMITTEE OF THE GREATER LYNCHBURG COMMUNITY TRUST AND OTHERS. ADDITIONALLY, THE SUMMIT PROVIDES IN-KIND SERVICES TO EVENTS SPONSORED BY THE WYNDHURST ASSOCIATION AND OTHERS.Description
Total Program Service Expense3247697TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109611NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees28NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members3NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LEWIS C ADDISONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4342004708TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11920 ATHERHOLT ROADAddressLine1
CityLYNCHBURGCity
StateVAState
ZIP Code24501ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
DAVID D ADAMS
BOARD MEMBER2.00XX022041749022
LEWIS C ADDISON
BOARD MEMBER2.00X056647976508
DAVID COBB
BOARD MEMBER2.00X000
GEORGE W DAWSON
BOARD MEMBER2.00X01131633145311
THOMAS JIVIDEN
BOARD MEMBER2.00XX070336480304
WILLIAM MOORE
BOARD MEMBER2.00X000
LEE PARKER
BOARD MEMBER2.00X000
DARRELL POWERS
BOARD MEMBER2.00X0613270
KENNETH BURGER
EXECUTIVE DIRECTOR50.00X77487016915
FieldValueIRS element (for citing)
Total Reportable Comp From Org77487TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2683220TotalReportableCompFrmRltdOrgs
Total Other Compensation368060TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MERIWETHER GODSEY INCBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14944 OLD BOONSBORO ROADAddressLine1
CityLYNCHBURGCity
StateVAState
ZIP Code24503ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesFOOD SERVICESDescriptionOfServices
Compensation534825Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICE REDescription
Business Code623000BusinessCode
Total Revenue Column3640211TotalRevenueColumn
Related Or Exempt Function Income3640211RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue3640211TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column227426TotalRevenueColumn
Exclusion$227,426ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other7150Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other7150Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column7150TotalRevenueColumn
Exclusion$7,150ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column3874787TotalRevenueColumn
Related Or Exempt Function Income3640211RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$234,576ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total94402Total
Management And General94402ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total389913Total
Program Services276685ProgramServices
Management And General113228ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total126730Total
Program Services91112ProgramServices
Management And General35618ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total710Total
Management And General710ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total139195Total
Management And General139195ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total668622Total
Program Services628829ProgramServices
Management And General39793ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total62174Total
Management And General62174ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total222318Total
Program Services211028ProgramServices
Management And General11290ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total969622Total
Program Services961028ProgramServices
Management And General8594ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total1284Total
Program Services1284ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total7242Total
Management And General7242ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1093782Total
Program Services1077731ProgramServices
Management And General16051ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total55442Total
Management And General55442ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3831436Total
Program Services3247697ProgramServices
Management And General583739ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY336137BOY
EOY123449EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY10719BOY
EOY7839EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY131362BOY
EOY123431EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis20319221LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec8380473LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY12788042BOY
EOY11938748EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY4373835BOY
EOY4930598EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2039904BOY
EOY1968777EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY19679999BOY
EOY19092842EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY597963BOY
EOY467786EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY9832403BOY
EOY9440921EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY10760000BOY
EOY10575000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY505865BOY
EOY246726EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY21696231BOY
EOY20730433EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY4400000BOY
EOY4400000EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY-6416232BOY
EOY-6037591EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-2016232BOY
EOY-1637591EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19679999BOY
EOY19092842EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses43351ReconcilationRevenueExpenses
Reconcilation Other Changes335290ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1CENTRA HEALTH INCBusinessNameLine1
FieldValueIRS element (for citing)
EIN540715569EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$3,247,697Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts3247697SumOfAmounts

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis352816OtherCostOrOtherBasis
Book Value352816BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis16139018OtherCostOrOtherBasis
Depreciation6753245Depreciation
Book Value9385773BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3174055OtherCostOrOtherBasis
Depreciation1219946Depreciation
Book Value1954109BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis653332OtherCostOrOtherBasis
Depreciation407282Depreciation
Book Value246050BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings11938748TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
UNAMORTIZED BOND FINANCING COSTS478727
BOND FUNDS LIMITED TO USE1309423
LAKE MAINTENANCE FUND180627
FieldValueIRS element (for citing)
Total Book Value Other Assets1968777TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATE, CENTRA HEALTH, INC.$66,099
LAKE MAINTENANCE LIABILITY$180,627
FieldValueIRS element (for citing)
Total Of Amounts246726TotalOfAmounts
Total Revenue3874787TotalRevenue
Total Expenses3831436TotalExpenses
Excess Or Deficit For Year43351ExcessOrDeficitForYear
Net Unrealized GL On Investments335290NetUnrealizedGLOnInvestments
Total Adjustments335290TotalAdjustments
Excess Or Deficit Per FS378641ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt4210077TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments335290NetUnrealizedGainsInvestments
Revenue Not Rptd F990335290RevenueNotRptdF990
Revenue Subtotal3874787RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9903874787TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt3831436TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal3831436ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9903831436TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE 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, 2010.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DAVID D ADAMS
0203468000169490281320208900269439015956
LEWIS C ADDISON
03283940002380850568470196610642987029362
GEORGE W DAWSON
059586500053576801299560153550127694400
THOMAS JIVIDEN
03762680003270960583990219050783668027955

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 4BGEORGE DAWSON, PRESIDENT/CEO OF CENTRA HEALTH, INC. (A RELATED ORGANIZATION): ACCRUED FOR 2010 $501,567 IN A NONQUALIFIED RETIREMENT PLAN, INCLUDED IN HIS W-2 WAGES.
PART IIIPART 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.SUPPLEMENTAL INFORMATION

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2BOARD MEMBERS DAVID ADAMS, LEWIS ADDISON, GEORGE DAWSON, AND TOM JIVIDEN ALL SERVE TOGETHER ON THE BOARD OF DIRECTORS FOR BEDFORD MEMORIAL HOSPITAL, A 50% JOINT VENTURE OF CENTRA HEALTH, INC. BOARD MEMBERS LEWIS ADDISON AND GEORGE DAWSON ARE BOTH OFFICERS OF PIEDMONT COMMUNITY HEALTH PLAN, A 50% JOINT VENTURE OF CENTRA HEALTH, INC. LEWIS ADDISON AND GEORGE DAWSON ARE ON CENTRAL VIRGINIA IMAGING'S BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION IS A NOT-FOR-PROFIT, STOCK COMPANY. AS OF THE END OF 2010, 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 7ACENTRA 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 7BCENTRA 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 11THE 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.
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 CENTRAS BOARD OF DIRECTORS.FORM 990, PART VI, SECTION B, LINE 12C
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 B, LINE 15
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 18
PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.FORM 990, PART VI, SECTION C, LINE 19
AVERAGE HOURS WORKED:DAVID ADAMS, LEWIS ADDISON, GEORGE DAWSON, AND THOMAS JIVIDEN EACH DEVOTE AN AVERAGE OF 50 HOURS PER WEEK TO CENTRA HEALTH, INC., A RELATED ORGANIZATION.FORM 990, PART VII, LINE 1:
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 335,290.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
CENTRA HEALTH INC
1920 ATHERHOLT ROADLYNCHBURGVA24501540715569HEALTHCAREVA501(C)(3)HOSPITALN/A0
CENTRA HEALTH FOUNDATION
1920 ATHERHOLT ROADLYNCHBURGVA24501541604094SUPPORTING ORGANIZATIONVA501(C)(3)509(A)(3)N/A0
LYNCHBURG FAMILY PRACTICE RESIDENCY PROGRAM INC
1920 ATHERHOLT ROADLYNCHBURGVA24501541457983HEALTHCAREVA501(C)(3)509(A)(3)N/A0
SOUTHSIDE COMMUNITY HOSPITAL INC
1920 ATHERHOLT ROADLYNCHBURGVA24501540555201HEALTHCAREVA501(C)(3)HOSPITALN/A0

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1GENERAL BUSINESS CONCERNS INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11920 ATHERHOLT ROADAddressLine1
CityLYNCHBURGCity
StateVAState
ZIP Code24501ZIPCode
FieldValueIRS element (for citing)
EIN541299682EIN
Primary ActivityREAL ESTATE - PHYSICIANS OFFICESPrimaryActivity
Legal Domicile StateVALegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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