Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2010 HEALTH CAMPUS DRIVE
 
Room/suite
City or town, state or country, and ZIP + 4
HARRISONBURG, VA22801
D Employer identification number

54-0506331
E Telephone number

G Gross receipts $ 388,744,871
F Name and address of principal officer:
J MICHAEL BURRIS
2010 HEALTH CAMPUS DRIVE
HARRISONBURG,VA22801
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.RMHONLINE.COM
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1908
M State of legal domicile: VA
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: NOT-FOR-PROFIT COMMUNITY HOSPITAL ORGANIZATION.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 11
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 6
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 2,728
6 Total number of volunteers (estimate if necessary) .... 6 418
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 2,096,638 8,836,589
9 Program service revenue (Part VIII, line 2g) ......... 308,876,991 357,665,123
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -673,912 3,469,884
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 7,902,021 4,497,165
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 318,201,738 374,468,761
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 69,735 1,295,879
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 154,281,338 162,513,874
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet437,201    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 182,405,058 189,775,805
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 336,756,131 353,585,558
19 Revenue less expenses. Subtract line 18 from line 12....... -18,554,393 20,883,203
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 571,441,385 420,450,379
21 Total liabilities (Part X, line 26)............. 374,877,003 370,823,705
22 Net assets or fund balances. Subtract line 21 from line 20..... 196,564,382 49,626,674
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: OUR MISSION IS TO IMPROVE HEALTH AND PROMOTE WELLBEING AND TO BE AN INNOVATIVE, COMMUNITY-ORIENTED HEALTH CARE PROVIDER COMMITTED TO OFFERING ACCESSIBLE, PERSONALIZED, AND HIGH-QUALITY SERVICES IN A COST-EFFECTIVE MANNER.WE WILL WORK IN PARTNERSHIP WITH THE LOCAL MEDICAL COMMUNITY AND OTHER LOCAL AND REGIONAL HEALTH CARE RESOURCES TO ENSURE THAT NECESSARY HEALTH SERVICES ARE AVAILABLE TO ALL, REGARDLESS OF THEIR FINANCIAL STATUS. WITH OUT PARTNERS, WE WILL SEEK TO ENHANCE THE HEALTH STATUS OF THE COMMUNITY WE SERVE BY OFFERING AN APPROPRIATE RANGE OF SERVICES, INCLUDING SELECTED AREAS OF EXCELLENCE. WORKING WITH OUR LOCAL PHYSICIAN PARTNERS, WE WILL ACTIVELY PARTICIPATE IN THE FORMATION OF A LOCALLY CONTROLLED, INTEGRATED DELIVERY SYSTEM. IN OUR EFFORTS, WE WILL BE GUIDED BY THE SHARED VALUES, BELIEFS AND NEEDS OF OUR LOCAL COMMUNITY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 328,389,075 including grants of $ 1,295,879 ) (Revenue $ 357,665,123 )
HOSPITAL SERVICES:THE HOSPITAL PROVIDES HIGH-QUALITY HEALTH CARE TO THE COMMUNITY BY OFFERING THE LATEST TECHNOLOGY AND THE BEST TECHNICAL EXPERTISE. THE HOSPITAL SERVES A SEVEN-COUNTY AREA WITH A POPULATION OF CLOSE TO 200,000 ADMITTING MORE THAN 16,300 INPATIENTS AND DELIVERING CLOSE TO 1,700 BABIES PER YEAR. THE HOSPITAL IS LICENSED AS A 238-BED HOSPITAL AND PROVIDES AN APPROPRIATE ARRAY OF REGIONAL COMMUNITY HOSPITAL SERVICES INCLUDING ONCOLOGY, CARDIOLOGY INCLUDING CARDIAC SURGERY, BEHAVIORAL HEALTH, OBSTETRICS AND WOMEN'S SERVICES, OUTPATIENT AND INPATIENT SURGERY, SLEEP MEDICINE, EMERGENCY CARE, SENIOR SERVICES, HOME AND HOSPICE CARE, PHYSICIAN PRACTICES AND A VARIETY OF OTHER OUTPATIENT SERVICES AS WELL AS EDUCATION AND OUTREACH. THE HOSPITAL IS HOME TO SCHOOLS OF RADIOLOGICAL TECHNOLOGY AND MEDICAL TECHNOLOGY. ALONG WITH TRADITIONAL HEALTH SERVICES, THE HOSPITAL MAKES ITS RESOURCES AVAILABLE TO SUPPORT MANY COMMUNITY HEALTH INITIATIVES AND PROGRAMS.IN 2011, THE HOSPITAL RECORDED 16,363 ADMISSIONS (INCLUDING NEWBORNS), 357,412 OUTPATIENT VISITS, 72,699 EMERGENCY DEPARTMENT VISITS, 191,985 REGISTERED OUTPATIENTS (LAB AND X-RAY), 7,440 CHEMOTHERAPY THERAPY VISITS, 6,963 RADIATION THERAPY TREATMENTS AND 18,576 SURGERY PATIENTS.
4b (Code:   ) (Expenses $ 738,960 including grants of $   ) (Revenue $   )
FREE CLINIC:PROVIDES VOLUNTEER OUTPATIENT HEALTHCARE SERVICES TO THE UNINSURED IN A MANNER THAT PROMOTES DIGNITY, WHOLENESS, AND COORDINATION OF SERVICES WITH PRIORITY GIVEN TO WORKING PEOPLE WHOSE INCOME IS UNDER 175% OF FEDERAL POVERTY LEVEL. IN 2011, THE FREE CLINIC RECORDED APPROXIMATELY 20,000 PATIENT VISITS.
4c (Code:   ) (Expenses $ 229,692 including grants of $   ) (Revenue $   )
HEALTHY FAMILIES OF BLUE RIDGE AND HAND-IN-HAND RESOURCES FOR MOTHERS:HEALTHY FAMILIES OF BLUE RIDGE IS A HOME VISITATION PROGRAM TARGETING HIGH-RISK FIRST TIME FAMILIES WHO VOLUNTARILY AGREE TO PARTICIPATE IN ONGOING HOME VISITS UNTIL THE CHILD IS FIVE YEARS OLD. HAND-IN-HAND IS A MENTORING PROGRAM FOR PREGNANT AND PARENTING TEENS AGE 19 AND YOUNGER. THE PROGRAM FOCUSES ON HELPING TEENS KEEP MEDICAL APPOINTMENTS, REMAIN IN SCHOOL, DEVELOP PLANS FOR BABY'S CARE, DELAY REPEAT PREGNANCIES UNTIL ADULTHOOD AND SOLVE THE DAILY CHALLENGES OF BEING A NEW PARENT.
(Code:   ) (Expenses $ 1,079,472 including grants of $   ) (Revenue $   )
COMMUNITY HEALTH EDUCATION AND AWARENESS PROGRAM:INCLUDES STRONG FAMILIES/GREAT YOUTH, PEAS, AND SAFE KIDS. AS A PARTNER IN THE STRONG FAMILIES/GREAT YOUTH COALITION, RMH WORKS WITH THE COALITION TO REDUCE RISK FACTORS AND INCREASE PROTECTIVE FACTORS IN YOUTH UNDER THE AGE OF 18 IN THE HARRISONBURG-ROCKINGHAM COMMUNITY. AREAS OF FOCUS INCLUDE REDUCING SUBSTANCE ABUSE, UNINTENTIONAL INJURY, TEEN PREGNANCY, AND VIOLENCE, INCREASING SCHOOL ATTENDANCE, AND INCREASING ACCESS TO MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT IN YOUTH. THROUGH THE PARENTING EDUCATION AND SUPPORT (PEAS) PROGRAM, RMH OFFERED A SERIES OF CLASSES TO ADULTS INCLUDING THE INCREDIBLE YEARS, ALL ABOUT BABY, AND STAYING CONNECTED WITH YOUR TEEN IN BOTH ENGLISH AND SPANISH.EXPENSES $ 124,362. INCLUDING GRANTS OF $ 0. REVENUE $ 0.HEALTHQUEST:A FREE QUARTERLY HEALTH AND WELLNESS PUBLICATION THAT THE HOSPITAL PRODUCES TO HIGHLIGHT THE PRINCIPLES OF HEALTHY LIFESTYLE CHOICES, PREVENTATIVE CARE AND EARLY DETECTION AND SCREENING. IT ALSO FEATURES MEMBERS OF THE HOSPITAL MEDICAL AND CLINICAL STAFF, AND SERVES TO MARKET OUR PROGRAMS AND SERVICES. THE MAGAZINE IS MAILED PRIMARILY TO PEOPLE IN OUR LARGER SERVICE AREA AND IN 2011 THERE WERE MORE THAN 36,000 DISTRIBUTIONS.EXPENSES $ 223,154. INCLUDING GRANTS OF $ 0. REVENUE $ 0.CHILD CARE CONNECTION:A RESOURCE AND REFERRAL CENTER FOR CHILDCARE PROVIDERS AND PARENTS. THIS PROGRAM ENHANCES THE QUALITY OF CHILDCARE BY PROVIDING EDUCATION AND EDUCATIONAL MATERIALS, ALONG WITH TOYS AND GAMES RELATED TO SAFE, NURTURING CHILDCARE. IT ALSO SUPPORTS INCREASING THE QUANTITY AND QUALITY OF PROVIDERS IN THE AREA BY OFFERING CONSULTATION AND EDUCATION ON STARTING A CHILDCARE BUSINESS. CHILDCARE CONNECTION HAS CREATED A COORDINATED SYSTEM OF CHILDCARE WITH A CUSTOMIZABLE DATABASE OF CHILDCARE PROVIDERS THAT CAN BE ACCESSED BY PARENTS.EXPENSES $ 114,846. INCLUDING GRANTS OF $ 0. REVENUE $ 0.HEALTHSOURCE:PHYSICIAN REFERRAL, HEALTH INFORMATION AND CLASS REGISTRATION ARE PROVIDED FREE TO THE PUBLIC, ALONG WITH ASSISTANCE FOR COMMUNITY AND CORPORATE HEALTHCARE EVENTS.EXPENSES $ 33,825. INCLUDING GRANTS OF $ 0. REVENUE $ 0.HEALTH SCREENINGS:NUMEROUS FREE HEALTH SCREENINGS, SUCH AS SKIN CANCER, PROSTATE CANCER, CHOLESTEROL AND BLOOD GLUCOSE ARE OFFERED TO RESIDENTS AT LOCAL HEALTH FAIRS AND COMMUNITY EVENTS WITH WIDE-SPREAD PARTICIPATION.EXPENSES $ 16,129. INCLUDING GRANTS OF $ 0. REVENUE $ 0.FOUNDATION:GRANTS THROUGH THE RMH FOUNDATION SUPPORT INITIATIVES THAT WILL HAVE A POSITIVE IMPACT ON THE OVERALL HEALTH OF OUR COMMUNITY. EXPENSES $ 62,944. INCLUDING GRANTS OF $ 0. REVENUE $ 0.HEALTH SCIENCE LIBRARY:THE VIRGINIA FUNKHOUSER HEALTH SCIENCE LIBRARY IS A BIOMEDICAL REFERENCE SERVICE FOR HOSPITAL STAFF AND THE SURROUNDING COMMUNITY.EXPENSES $ 64,254. INCLUDING GRANTS OF $ 0. REVENUE $ 0.LIFE LINE:LIFELINE IS AN EMERGENCY RESPONSE SYSTEM THAT ENABLES THOSE WITH SAFETY ISSUES TO REMAIN INDEPENDENT AND IN THEIR OWN HOMES FOR AS LONG AS POSSIBLE.EXPENSES $ 13,735. INCLUDING GRANTS OF $ 0. REVENUE $ 0.MISCELLANEOUS PROGRAM SERVICES:IN ADDITION TO THE PROGRAM SERVICES HIGHLIGHTED ABOVE, THE HOSPITAL SUPPORTS VARIOUS OTHER PROGRAMS FOR THE BENEFIT OF THE COMMUNITY INCLUDING BUT NOT LIMITED TO GRIEF SUPPORT, FAMILY FAIR, WOMEN'S HEALTH EDUCATION, AND SENIOR ADVANTAGE.EXPENSES $ 426,223. INCLUDING GRANTS OF $ 0. REVENUE $ 0.TOTAL OTHER PROGRAM SERVICES, FORM 990, PAGE 2, LINE 4D
4d Other program services (Describe in Schedule O.)
(Expenses $ 1,079,472 including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 330,437,199
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see attachment
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
Yes
 
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
292
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
2,728
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletCJ
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
11
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
6
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
VA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
CORPORATE OFFICERS
2010 HEALTH CAMPUS DRIVE
HARRISONBURG,VA228018679
(540) 689-1245
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) ANN E C HOMAN
CHAIR (AS OF 5/2011)/DIRECTOR
 2.00 X   X       0 0 0
(2) HOWARD P KERN
DIRECTOR/VICE CHAIR (AS OF 5/2011)
 2.00 X   X       0 1,612,156 910,858
(3) JAMES R MESSNER
DIRECTOR/SECRETARY
 2.00 X   X       0 0 0
(4) BARBARA B STOLTZFUS
DIRECTOR/CHAIR (THRU 4/2011)
 2.00 X   X       0 0 0
(5) W CARLTON BANKS
DIRECTOR
 2.00 X           0 0 0
(6) A JERRY BENSON
DIRECTOR (THRU 4/2011)
 2.00 X           0 0 0
(7) DAVID L BERND
DIRECTOR (AS OF 5/2011)
 2.00 X           0 3,838,264 743,146
(8) LAWRENCE D BOWERS JR
DIRECTOR (THRU 4/2011)
 2.00 X           0 0 0
(9) MENSEL D DEAN JR
VICE CHAIR (THRU 4/2011)/DIRECTOR
 2.00 X   X       0 0 0
(10) DOUGLAS G DRIVER
DIRECTOR (THRU 4/2011)
 2.00 X           0 0 0
(11) JOSEPH K FUNKHOUSER II
DIRECTOR
 2.00 X           0 0 0
(12) C WAYNE GATES MD
DIRECTOR (THRU 4/2011)
 2.00 X           0 0 0
(13) ALDEN L HOSTETTER
DIRECTOR
 2.00 X           0 0 0
(14) ELMER E KENNEL
DIRECTOR
 2.00 X           0 0 0
(15) KENNETH M KRAKAUR
DIRECTOR (AS OF 5/2011)
 2.00 X           0 1,003,009 184,819
(16) ALLON H LEFEVER
DIRECTOR
 2.00 X           0 0 0
(17) W NEAL MENEFEE
DIRECTOR (THRU 4/2011)
 2.00 X           0 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) GEORGE W PACE
DIRECTOR (THRU 4/2011)
 2.00 X           0 0 0
(19) STEWART G POLLOCK MD
DIRECTOR (THRU 4/2011)
 2.00 X           0 0 0
(20) MICHAEL R KING
TREASURER/SR. VP, FINANCE/CFO
 40.00     X       336,324 0 80,969
(21) JAMES D KRAUSS
ASST. TREAS (THRU 4/2011)/PRESIDENT
 40.00     X       633,239 0 121,323
(22) DALE A CARROLL
SR. VP, CLINICAL EFFECT./CMO
 40.00       X     438,843 0 138,738
(23) DONNA HAHN
VP, ACUTE CARE/CNE
 40.00       X     216,425 0 69,831
(24) KATHERINE HARRISON
VP, BUSINESS DEVELOPMENT
 40.00       X     185,200 0 77,903
(25) RICHARD L HAUSHALTER
SR. VP, OPERATIONS/COO
 40.00       X     390,301 0 123,361
(26) JOHN MCGOWAN
RMH MEDICAL GROUP CEO
 40.00       X     319,133 0 39,504
(27) P RICHARD PIERCE
VP, AMBULATORY CARE
 40.00       X     248,120 0 178,018
(28) MICHAEL ROZMUS
VP, INFORMATION SERVICES/CIO
 40.00       X     231,994 0 94,193
(29) MERV WEBB
VP, FOUNDATION
 40.00       X     201,746 0 137,694
(30) MARK ZIMMERMAN
VP, HUMAN RESOURCES
 40.00       X     245,048 0 108,431
(31) WILLIAM LENNEN MD
DIERCTOR - PULMONARY SERVICES
 40.00         X   768,602 0 30,476
(32) STEVEN MARRA MD
CARDIOTHORACIC SURGEON
 40.00         X   694,743 0 42,088
(33) OLUMIDE DANISA MD
ORTHOPAEDIC SURGEON
 40.00         X   531,692 0 28,177
(34) THOMAS WEBER MD
FAMILY PRACTITIONER
 40.00         X   512,310 0 35,792
(35) HEIDI GORSUCH-RAFFERTY MD
BREAST SURGEON
 40.00         X   493,248 0 41,859
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,446,968 6,453,429 3,187,180
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet156
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
AMERISOURCE BERGEN - RICHMOND
PO BOX 5188
NEW YORK,NY100875188 		PHARMACEUTICAL SVCS 20,462,479
HARRISONBURG MEDICAL ASSOCIATES
1871 EVELYN BYRD AVE
HARRISONBURG,VA22801 		MEDICAL SERVICES 13,439,422
HARRISONBURG PHYSICIANS ANETHESIOLOGY
1840 EAST MARKET ST
HARRISONBURG,VA22801 		MEDICAL SERVICES 8,873,556
SHENANDOAH SHARED HOSPITAL SERVICES
304 NEFF AVE
HARRISONBURG,VA22801 		MEDICAL SERVICES 8,288,836
CARDINAL HEALTH MEDICAL PRODUCTS & SERVI
PO BOX 905867
CHARLOTTE,NC282905867 		MEDICAL SERVICES 5,065,227
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet184
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b 780
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e 889,701
f All other contributions, gifts, grants, and
similar amounts not included above1f 		7,946,108
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 8,836,589
Program Service Revenue Business Code
2a NET PATIENT SRVC REV 621,300 354,869,169 354,869,169    
b OTHER PROGRAM SERVICES 621,300 2,795,954 2,795,954    
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 357,665,123
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 2,890,680     2,890,680
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross rents 109,079  
b Less: rental expenses 32,643  
c Rental income or (loss) 76,436  
d Net rental income or (loss).......MediumBullet 76,436     76,436
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 13,394,707 1,175,810
b Less: cost or other basis and sales expenses 13,830,258 161,055
c Gain or (loss) -435,551 1,014,755
d Net gain or (loss)..........MediumBullet 579,204     579,204
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a 399,762
b Less: cost of goods sold ..b 252,154
c Net income or (loss) from sales of inventory..MediumBullet 147,608     147,608
Miscellaneous Revenue Business Code
11a OTHER 900,099 2,187,529     2,187,529
b EQUITY ALLOCATIONS 900,099 2,060,917     2,060,917
c DIETARY SALES 722,210 24,675     24,675
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 4,273,121
12 Total revenue. See Instructions....MediumBullet 374,468,761 357,665,123 0 7,967,049
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 1,217,084 1,217,084
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 78,795 78,795
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 4,616,338   4,616,338  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 127,891,644 119,093,978 8,574,130 223,536
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 8,158,255 7,597,049 545,777 15,429
9 Other employee benefits ....... 13,284,379 12,370,547 890,902 22,930
10 Payroll taxes ........... 8,563,258 7,974,191 574,385 14,682
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 683,558 568,512 115,046  
c Accounting ........... 215,854   215,854  
d Lobbying ...........        
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ...... 26,474   26,474  
g Other .......... 53,022,257 50,781,895 2,240,362  
12 Advertising and promotion .... 1,849,266 1,436,965 356,932 55,369
13 Office expenses ....... 5,583,531 3,724,028 1,769,014 90,489
14 Information technology ...... 4,334,442 3,709,579 621,239 3,624
15 Royalties ..        
16 Occupancy ........... 5,458,298 5,456,897   1,401
17 Travel ............ 410,955 410,698 257  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 800,012 677,116 114,847 8,049
20 Interest ........... 11,606,909 11,606,909    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 17,707,868 17,547,576 160,292  
23 Insurance .............. 4,706,928 4,431,794 275,134  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUPPLIES 53,575,684 53,575,684    
b BAD DEBT PROVISION 26,273,144 26,273,144    
c PURCHASED & CONTRACTED 2,146,559 653,051 1,493,315 193
d DUES, BOOKS & SUBSCRIPT 632,826 631,854   972
e
f All other expenses 741,240 619,853 120,860 527
25 Total functional expenses. Add lines 1 through 24f 353,585,558 330,437,199 22,711,158 437,201
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 61,370,294 1 70,359,781
2 Savings and temporary cash investments ....... 23,360,811 2  
3 Pledges and grants receivable, net ......... 3,293,228 3 2,126,632
4 Accounts receivable, net ......... 40,457,298 4 41,951,342
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 3,500,102 5 99,231
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 4,136,934 7 5,699,308
8 Inventories for sale or use .............. 5,181,378 8 5,381,819
9 Prepaid expenses and deferred charges ............ 2,964,890 9 2,845,419
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 141,978,332
b Less: accumulated depreciation. ..... 10b 7,596,335 366,608,189 10c 134,381,997
11 Investments—publicly traded securities .......... 36,492,911 11 102,534,027
12 Investments—other securities. See Part IV, line 11 ...... 15,048,046 12 34,711,284
13 Investments—program-related. See Part IV, line 11 .. 0 13  
14 Intangible assets .........   14 1,326,477
15 Other assets. See Part IV, line 11 ........... 9,027,304 15 19,033,062
16 Total assets. Add lines 1 through 15 (must equal line 34)... 571,441,385 16 420,450,379
Liabilities 17 Accounts payable and accrued expenses . 37,442,881 17 25,085,416
18 Grants payable ..........   18  
19 Deferred revenue .......... 231,376 19 198,697
20 Tax-exempt bond liabilities .......... 300,160,065 20 181,613,508
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 37,042,681 25 163,926,084
26 Total liabilities. Add lines 17 through 25..... 374,877,003 26 370,823,705
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 166,691,561 27 15,932,801
28 Temporarily restricted net assets ..... 15,126,649 28 18,960,064
29 Permanently restricted net assets ..... 14,746,172 29 14,733,809
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 196,564,382 33 49,626,674
34 Total liabilities and net assets/fund balances ..... 571,441,385 34 420,450,379
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
374,468,761
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
353,585,558
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
20,883,203
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
196,564,382
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-167,820,911
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
49,626,674
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number

54-0506331
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number

54-0506331
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
ROCKINGHAM MEMORIAL HOSPITAL
  		Employer identification number

54-0506331
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
ROCKINGHAM MEMORIAL HOSPITAL
  		Employer identification number

54-0506331
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
ROCKINGHAM MEMORIAL HOSPITAL
  		Employer identification number

54-0506331
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number

54-0506331
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
16,176
j
Total. Add lines 1c through 1i ...............................
16,176
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE HOSPITAL IS INVOLVED IN INDIRECT LOBBYING ACTIVITIES THROUGH PAYMENT OF MEMBERSHIP DUES TO THE FOLLOWING ORGANIZATIONS: VIRGINIA HOSPITAL & HEALTHCARE ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number

54-0506331
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 29,171,837 31,098,549 29,446,900 36,688,003
b Contributions ........ 7,634,593 1,334,949 1,310,621 2,014,074
c Net investment earnings, gains, and losses ... 119,000 2,080,749 3,427,364 -6,513,327
d Grants or scholarships .....       11,000
e Other expenditures for facilities
and programs ........ 		3,231,557 5,342,410 3,086,336 2,730,850
f Administrative expenses ....        
g End of year balance ...... 33,693,873 29,171,837 31,098,549 29,446,900
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet43.730 %
c
Temporarily restricted endowment SchDMd Bullet56.270 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   11,780,878 11,780,878
b Buildings ................   38,283,997 561,843 37,722,154
c Leasehold improvements ............        
d Equipment ................   84,367,008 6,813,349 77,553,659
e Other .................   7,546,449 221,143 7,325,306
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 134,381,997
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) AIG PRIVATE EQUITY PORTFOLIO 		1,440,500 F

(B) AUSTIN CAPITAL SAFE HARBOR 		557,549 F

(C) CMS ENTREPRENEURIAL REAL ESTATE FUND IV 		145,099 F

(D) K2 HIGHLAND OVERSEAS FUND 		12,547,783 F

(E) OCM PRINCIPLE OPPORTUNITIES FUND III 		1,952,678 F

(F) SILVER CREEK LOW VOLATILITY STRATEGIES 		3,801,954 F

(G) UBS TRUMBULL PROPERTY INCOME FUND 		6,637,670 F

(H) WELLINGTON CTF MID CAP GROWTH PORTFOLIO 		7,628,051 F

Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 34,711,284
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes  
PAYABLE TO AFFILIATES 89,853,383
ANNUITIES PAYABLE 497,788
MARK-TO-MARKET LIABILITY 867,699
PENSION LIABILITY 35,353,103
DUE TO THIRD PARTIES 2,301,647
OTHER CURRENT LIABILITIES 8,808,477
OTHER NON-CURRENT LIABILITIES 26,243,987


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 163,926,084
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number

54-0506331
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ..............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICES JOINT VENTURE AGREEMENT WITH VIRGINIA SOLUTIONS SPC, LTD - INSURANCE CAPTIVE THAT UNDERWRITES HOSPITAL AND PHYSICIAN LIABILITY AND WORKERS COMPENSATION POLICIES FOR ITS MEMBER HOSPITALS. THE HOSPITAL HAS A 16.67% OWNERSHIP INTEREST IN THE CAPTIVE.  
CENTRAL AMERICA AND THE CARIBBEAN -     INVESTMENTS   16,907,286
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 16,907,286
b Total from continuation sheets to Part I ... 0 0 0
c Totals (add lines 3a and 3b) 0 0 16,907,286
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
METHOD USED TO ACCCOUNT FOR EXPENDITURES:   SCHEDULE F, PART I, LINE 3: EQUITY
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
Additional Data


Software ID:  
Software Version:  



SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number

54-0506331
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
 
No
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
 
No
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
 
No
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    10,346,151   10,346,151 3.160 %
b Medicaid (from Worksheet 3, column a) .....     20,327,493 15,390,745 4,936,748 1.510 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    30,673,644 15,390,745 15,282,899 4.670 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    596,772   596,772 0.180 %
f Health professions education
(from Worksheet 5) .. 		    1,625,179 628,964 996,215 0.300 %
g Subsidized health services
(from Worksheet 6) .. 		    96,278,243 76,901,316 19,376,927 5.920 %
h Research (from Worksheet 7)            
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     2,511,384   2,511,384 0.770 %
jTotal Other Benefits ...     101,011,578 77,530,280 23,481,298 7.170 %
kTotal. Add lines 7d and 7j. ..     131,685,222 92,921,025 38,764,197 11.840 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     5,570   5,570 0 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building     7,484   7,484 0 %
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     13,054   13,054  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
26,273,144
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
87,719,671
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
103,221,508
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-15,501,837
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 ROCKINGHAM MEMORIAL HOSPITAL
2010 HEALTH CAMPUS DR
HARRISONBURG,VA22801 		X X         X   OTHER MENTAL HEALTH AND SUBSTANCE ABUSE
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
ROCKINGHAM MEMORIAL HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9   No
If "Yes," indicate the FPG family income limit for eligibility for free care:   %
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?16
Name and address Type of Facility (describe)
1 MEDICAL OFFICE BLDG - PHYSIC PRACT
2006 HEALTH CAMPUS DRIVE
HARRISONBURG,VA22801 		PHYSICIAN OFFICES - SPECIALTY PRACTICES
2 WOMEN'S CENTER
530 NEFF AVE
HARRISONBURG,VA22801 		MAMMOGRAPHY SERVICES, BREAST SURGERY CLINIC
3 RMH SOUTH MAIN HEALTH CENTER
1661 S MAIN STREET
HARRISONBURG,VA22801 		FAMILY PRACTICE
4 RMH EAST ROCKINGHAM HEALTH CENTER
13737 SPOTSWOOD TRAIL
ELKTON,VA22827 		FAMILY PRACTICE, LEAB, REHAB SERVICES
5 HOME HEALTH AND HOSPICE
411 STONE SPRING ROAD
HARRISONBURG,VA22801 		IN-HOME AND END-OF-LIFE CARE
6 REHAB SERVICES - PAVILION
501 STONE SPRING ROAD
HARRISONBURG,VA22801 		OUTPATIENT PHYSICAN THERAPY SERVICES
7 RMH CANCER CENTER
2008 HEALTH CAMPUS DRIVE
HARRISONBURG,VA22801 		SPECIALTY PHYSICIAN OFFICES
8 RMH VALLEY BEHAVIOR MEDICINE
644 UNIVERSITY BLVD
HARRISONBURG,VA22801 		MENTAL HEALTH SERVICES
9 RMH SPRINGBROOK FAMILY MEDICINE
173 E SPRINGBROOK ROAD
BROADWAY,VA22815 		FAMILY MEDICINE
10 RMH OCCUPATIONAL HEALTH CENTER
1790-64B E MARKET STREET
HARRISONBURG,VA22801 		OCCUPATIONAL MEDICINE
11 RMH LURAY HEALTH CENTER
135 GENERAL DRIVE
LURAY,VA22835 		FAMILY PRACTICE
12 RMH NEW MARKET HEALTH CENTER
9626 S CONGRESS ST
NEW MARKET,VA22844 		FAMILY PRACTICE
13 RMH MOUNT JACKSON HEALTH CENTER
120 MEDICAL AVENUE
MT JACKSON,VA22842 		FAMILY PRACTICE
14 BRIDGEWATER REHAB
302 N SECOND STREET
BRIDGEWATER,VA22812 		OUTPATIENT PHYSICAL THERAPY
15 IMAGE RECOVERY CENTER
2989 S MAIN STREET
HARRISONBURG,VA22801 		SALON & MASSAGE SERVICES FOR CANCER PATIENTS
16 RMH CENTER FOR SLEEP MEDICINE
640 SOUTH MAIN ST
HARRISONBURG,VA22801 		SLEEP STUDIES
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    PART I, LINE 3C: AND PART V, SECTION B LINES 9&10:UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, UNINSURED INDIVIDUALS RECEIVING EMERGENCY OR OTHER MEDICALLY NECESSARY CARE ARE CHARGED NO MORE THAN AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE. IN ADDITION, AN INDIVIDUAL WHOSE INCOME IS AT OR BELOW 400% OF THE FPG MAY BE ELIGIBLE FOR ADDITIONAL FINANCIAL ASSISTANCE. WHEN AN INDIVIDUAL SUBMITS A FINANCIAL ASSISTANCE APPLICATION, THE ORGANIZATION USES A MULTI-FACETED REVIEW OF AN APPLICANT'S SITUATION TO DETERMINE BOTH ELIGIBILITY FOR FREE OR ADDITIONAL DISCOUNTED CARE, AND THE LEVEL OF DISCOUNT PROVIDED. AMONG THE FACTORS TAKEN INTO CONSIDERATION ARE WHETHER THE INDIVIDUAL HAS HEALTH INSURANCE COVERAGE, THE AMOUNT OF ASSETS AVAILABLE TO CONTRIBUTE TOWARDS THE COST OF CARE, THE AMOUNT OF INCOME AVAILABLE TO CONTRIBUTE TOWARDS THE COST OF CARE, EITHER THE INDIVIDUAL HAD THE ABILITY TO PURCHASE HEALTH INSURANCE THROUGH AN EMPLOYER AND DECLINED TO DO SO OR HAD ELIGIBILITY THROUGH A GOVERNMENT PROGRAM AND FAILED TO APPLY, FAMILY SIZE, AND WHETHER THE INDIVIDUAL HAS A HEALTH CONDITION THAT IS REASONABLY EXPECTED TO RESULT IN THEM BECOMING A RECURRING PATIENT WHO WILL CONTINUE TO ACCUMULATE HEALTH CARE EXPENSES. THE PROGRAM PROVIDES A SLIDING SCALE AMOUNT BASED ON THE ABOVE FACTORS, WHICH IS CAPPED BY A "MAXIMUM OUT OF POCKET" LIMIT THAT ALSO FOLLOWS A SLIDING SCALE. THE OUT-OF-POCKET MINIMUM COST FOR ALL FAP-ELIGIBLE INDIVIDUALS IS $25.
    PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 26273144.
  PART I, LINE 7 A COST-TO-CHARGE RATIO, CALCULATED USING WORKSHEET 2, WAS USED TO CALCULATE COSTS REPORTED IN LINES 7A AND 7B. FOR LINE 7G, A DEPARTMENT COST-TO-CHARGE RATIO WAS CALCULATED FOR EACH SUBSIDIZED HEALTH SERVICE.
  PART I, LINE 7G $14,569,536 OF THE AMOUNT REPORTED IN COLUMN (E) IS ATTRIBUTABLE TO PHYSICIAN CLINICS.
  PART II: COMMUNITY BUILDING ACTIVITIES --COMMUNITY SUPPORT: RMH LEADERS SERVE ON VARIOUS COMMUNITY BOARDS BECAUSE OF THEIR ROLES AT RMH, INCLUDING THE HARRISONBURG COMMUNITY HEALTH CENTER, THE HARRISONBURG-ROCKINGHAM FREE CLINIC, THE COLLINS CENTER, THE MARCH OF DIMES, THE CENTER FOR MARRIAGE AND FAMILY COUNSELING, AND GENERATIONS CROSSING.--COALITION BUILDING: RMH STAFF PARTICIPATE ON VARIOUS LOCAL COALITIONS (INCLUDING STRONG FAMILIES GREAT YOUTH COALITION, WOMEN'S AND GIRL'S HEALTH COALITION, HEALTHY COMMUNITY COUNCIL STEERING COMMITTEE, SMART BEGINNINGS HARRISONBURG-ROCKINGHAM, SMART BEGINNINGS STAUNTON-AUGUSTA-WAYNESBORO, AND SEASONS PLUS) AS PART OF THEIR ROLES AT RMH.
    PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REPORTED AT NET REALIZABLE VALUE. BALANCES NOT PAID WITHIN 30 DAYS ARE CONSIDERED PAST DUE. BALANCES ARE CONSIDERED DELINQUENT WHEN THEY ARE OUTSTANDING FOR 120 DAYS WITH NO ACTIVITY AT WHICH TIME THE BALANCES ARE TRANSFERRED TO A COLLECTION AGENCY AND THE BALANCE IS MOVED TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. BALANCES ARE WRITTEN OFF AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN MADE. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED ON HISTORICAL BAD DEBT EXPERIENCE AND MANAGEMENTS' EVALUATION OF THE COMPONENTS OF ACCOUNTS RECEIVABLE.
    PART III, LINE 8: INTERNAL COST ACCOUNTING CALCULATIONS WERE USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS.
    PART III, LINE 9B: PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE WILL HAVE THEIR BALANCES DISCOUNTED BY THE APPLICABLE RATE AND ANY REMAINING BALANCES WILL BE BILLED TO THEM. THE COLLECTION PRACTICES OF STATEMENTS, LETTERS, PHONE CALLS, REFERRAL TO THIRD PARTY COLLECTION AGENCIES, ETC. ARE THE SAME FOR ALL PATIENTS WITH A BALANCE DUE. IF DURING A CALL THE PATIENT ASKS FOR FINANCIAL ASSISTANCE, AN APPLICATION IS MAILED TO THEM. THE ORGANIZATION DID NOT IMPOSE COLLECTION ACTIONS FOR ANY PATIENT WITHOUT FIRST MAKING REASONABLE EFFORTS TO DETERMINE WHETHER THAT PATIENT WAS ELIGIBLE FOR FINANCIAL ASSISTANCE.
ROCKINGHAM MEMORIAL HOSPITAL   PART V, SECTION B, LINE 9: SEE EXPLANATION FOR PART I, LINE 3C
ROCKINGHAM MEMORIAL HOSPITAL   PART V, SECTION B, LINE 10: SEE EXPLANATION FOR PART I, LINE 3C
ROCKINGHAM MEMORIAL HOSPITAL   PART V, SECTION B, LINE 13G: NOTICES OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THE CONTACT INFORMATION FOR MORE INFORMATION OR TO APPLY IS POSTED ON THE HOSPITAL'S WEB SITE, POSTED IN ALL WAITING ROOMS AND REGISTRATION AREAS, AND ON ALL PATIENT BILLING STATEMENTS.
  PART VI, LINE 2 THE HEALTH OF THE RESIDENTS OF HARRISONBURG AND ROCKINGHAM COUNTY IS ASSESSED EVERY FIVE YEARS FOR ADULTS AND SENIORS AND EVERY TWO YEARS FOR YOUTH. THESE ASSESSMENTS ARE COMPLETED BY THE HEALTHY COMMUNITY COUNCIL, A PARTNERSHIP INCLUDING RMH AS WELL AS REPRESENTATIVES FROM GOVERNMENT, SCHOOLS, BUSINESS, HIGHER EDUCATION, HEALTH AND HUMAN SERVICES, FAITH COMMUNITY, LAW ENFORCEMENT, AND MEDIA.
  PART VI, LINE 3 THE HOSPITAL HAS POSTED INFORMATION ABOUT FINANCIAL ASSISTANCE AND HOW TO APPLY IN EACH REGISTRATION AND EATING AREA. BILLING STATEMENTS AND THE WEBSITE HAVE INSTRUCTIONS AND PHONE NUMBERS LISTED FOR ALL PATIENTS WHO MAY BE HAVING DIFFICULTY PAYING BILLS. SELF PAY PATIENTS ARE SCREENED IN PERSON TO DETERMINE IF THEY QUALIFY FOR FEDERAL OR STATE PROGRAMS THAT MAY OFFER INSURANCE. PATIENTS ARE ALSO SCREENED FOR AND GIVEN THE OPPORTUNITY TO APPLY FOR RMH FINANCIAL ASSISTANCE. THE HOSPITAL USES AN OUTSIDE VENDOR THAT SCREENS ALL PATIENTS WITHOUT INSURANCE FOR ELIGIBILITY FOR GOVERNMENT PROGRAMS, AND A FINANCIAL COUNSELOR WHO SCREENS THOSE THAT ARE NOT ELIGIBLE FOR GOVERNMENT PROGRAMS TO DETERMINE WHETHER THEY MEET CRITERIA FOR CHARITY CARE.
  PART VI, LINE 4 THE HARRISONBURG-ROCKINGHAM COUNTY AREA COVERS 871 SQUARE MILES OF LAND AND IS HOME TO ABOUT 111,000 PEOPLE. THE MEDIAN AGE IS 32 YEARS WITH 22 PERCENT OF THE POPULATION FALLING UNDER THE AGE OF 18 AND 12 PERCENT OVER AGE 65. RMH IS A SOLE COMMUNITY HOSPITAL IN THE HARRISONBURG - ROCKINGHAM COUNTY AREA. THE AREA IS CONSIDERED RURAL. COMMUNITIES.
  PART VI, LINE 5 THE ORGANIZATION HAS A COMMUNITY-BASED BOARD COMPRISED OF A MAJORITY OF MEMBERS WHO ARE NEITHER EMPLOYEES, CONTRACTORS, NOR FAMILY MEMBERS THEREOF.GENERALLY, MEDICAL STAFF MEMBERSHIP IS OPEN TO ALL CARE PROVIDERS WHO MAY QUALIFY. THE ORGANIZATION'S SURPLUS FUNDS ARE USED FOR IMPROVEMENTS IN PATIENT CARE, PROVISION OF SERVICES TO THE UNINSURED AND UNDERINSURED, MEDICAL EDUCATION, AND COMMUNITY PROGRAMS.
  PART VI, LINE 6 IN A MOVE TO INCREASE ITS ABILITY TO PROVIDE HIGH QUALITY, COMPREHENSIVE HEALTH CARE SERVICES TO PATIENTS, THE ORGANIZATION AFFILIATED WITH THE SENTARA HEALTHCARE SYSTEM ("SENTARA") EFFECTIVE MAY 1, 2011. SENTARA, A NOT-FOR-PROFIT HEALTH SYSTEM, OPERATES MORE THAN 100 SITES OF CARE SERVING RESIDENTS ACROSS VIRGINIA AND NORTHEASTERN NORTH CAROLINA. THE SYSTEM IS COMPRISED OF 10 ACUTE CARE HOSPITALS, INCLUDING SEVEN IN HAMPTON ROADS, ONE IN NORTHERN VIRGINIA AND TWO IN THE BLUE RIDGE REGION, ADVANCED IMAGING CENTERS, NURSING AND ASSISTED-LIVING CENTERS, OUTPATIENT CAMPUSES, TWO HOME HEALTH AND HOSPICE AGENCIES, A 3,680-PROVIDER MEDICAL STAFF, AND THREE MEDICAL GROUPS WITH 618 PROVIDERS.THE ORGANIZATION, ALONG WITH ITS SUBSIDIARIES, HAS JOINED WITH SENTARA IN ORDER TO ENHANCE ITS ABILITY TO ACHIEVE BEST PRACTICES IN HEALTHCARE DELIVERY; ACQUIRE CUTTING EDGE TECHNOLOGY AND INTEGRATED INFORMATION SYSTEMS; AND PROVIDE A HIGHER LEVEL OF MEDICAL CARE TO VIRGINIA'S BLUE RIDGE REGION COMMUNITY. COMBINED, THESE ATTRIBUTES BETTER POSITION THE ORGANIZATION TO ADDRESS HEALTH CARE REFORM AND OTHER PROFOUND CHANGES AFFECTING THE HEALTHCARE ENVIRONMENT.
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number
54-0506331
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) GENERATIONS CROSSING3765 TAYLOR SPRING LANE
HARRISONBURG,VA22801 		54-2061192 501(C)(3) 7,500       SCHOLARSHIPS FOR DAY CAER FOR ELDERLY AND DISABLED ADULTS
(2) BLUE RIDGE AREA HEALTH EDUCATION CENTERMSC 9009 JAMES MADISON UNIVERSITY
HARRISONBURG,VA22807 		54-6001756 501(C)(3) 14,725       BEHAVIORAL HEALTH PROJECT FOR NON-ENGLISH SPEAKING POPULATION IN THE COMMUNITY
(3) OUR COMMUNITY PLACE17 E JOHNSON STREET
HARRISONBURG,VA22802 		54-1835664 501(C)(3) 8,090       HEALTH INITIATIVE FOR THOSE INDIVIDUALS WHO FIND OCP THEIR HOME AND COMMUNITY
(4) INSTITUTE OF HEALTH & HUMAN SERVICESMSC 9009 JAMES MADISON UNIVERSITY
HARRISONBURG,VA22807 		54-6001756 501(C)(3) 15,000       HEALTHCARE FOR HOMELESS SUITCASE CLINIC
(5) HARRISONBURG COMMUNITY HEALTH CENTER563 A NEFF AVE
HARRISONBURG,VA22801 		02-0813294 501(C)(3) 500,000       HEALTHCARE FOR INDIGENTS
(6) HARRISONBURG ROCKINGHAM FREE CLINIC25 WEST WATER STREET
HARRISONBURG,VA22801 		54-1568909 501(C)(3) 500,000       HEALTHCARE FOR INDIGENTS
(7) EASTERN MENNONITE UNIVERSITY1200 PARK ROAD
HARRISONBURG,VA22802 		54-0575812 501(C)(3) 10,000       SPONSORSHIP










2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
7
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) EMPLOYEE RELIEF FUND 38 47,210      
(2) PATIENT MEDICAL EXPENSES 52 12,212      
(3) FITNESS CENTER SCHOLARSHIPS 136 7,873      
(4) SCHOLARSHIPS 11 11,500      







Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ROCKINGHAM MEMORIAL HOSPITAL HAS A CAREFUL SCREENING PROCESS IN REVIEWING GRANT APPLICANTS. THE APPLICATIONS ARE FIRST REVIEWED BY A SMALL COMMITTEE USING ESTABLISHED CRITERIA SUCH AS 1) WHAT COMMUNITY NEED IS BEING ADDRESSED, 2) THE ROLE OF PARTNERS IN THE INITIATIVE, 3) AN ACTION PLAN WITH SPECIFIC ACTIVITIES, 4) MEASURABLE GOALS OR OUTCOMES, 5) BUDGET, AND 6) SUSTAINABILITY FOR THE PROJECT IN THE FUTURE. IF AWARDED THE GRANT, THE APPLICANT IS REQUIRED TO SUBMIT A WRITTEN REPORT OF THE OUTCOME WITHIN 12 MONTHS. NO GRANTS ARE MADE OUTSIDE OF THE UNITED STATES.
SCHEDULE I, PART III   -THE EMPLOYEE RELIEF FUND PROVIDES ASSITANCE TO EMPLOYEES WITH FINANCIAL NEED. -PATIENT MEDICAL EXPENSES IS THE PAYMENT OF MEDICAL COSTS FOR INDIGENT PATIENTS. -FITNESS CENTER SCHOLARSHIPS ARE SCHOLARSHIPS AWARDED TO INDIVUALS WHO HAVE AN IDENTIFIED MEDICAL NEED REQUIRING ONGOING PARTICIPATION IN AN EXERCISE PROGRAM. -SCHOLARSHIPS ARE AWARDED TO NURSING STUDENTS WITH FINANCIAL NEED.
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number

54-0506331
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) HOWARD P KERN (i)
(ii)		 0
726,289 		0
868,885 		0
16,982 		0
888,823 		0
22,035 		0
2,523,014 		0
0
(2) DAVID L BERND (i)
(ii)		 0
1,060,556 		0
1,541,673 		0
1,236,035 		0
718,589 		0
24,557 		0
4,581,410 		0
0
(3) KENNETH M KRAKAUR (i)
(ii)		 0
453,890 		0
457,834 		0
91,285 		0
159,233 		0
25,586 		0
1,187,828 		0
7,755
(4) MICHAEL R KING (i)
(ii)		 252,679
0 		29,700
0 		53,945
0 		54,859
0 		26,110
0 		417,293
0 		0
0
(5) JAMES D KRAUSS (i)
(ii)		 480,386
0 		41,400
0 		111,453
0 		94,814
0 		26,509
0 		754,562
0 		0
0
(6) DALE A CARROLL (i)
(ii)		 345,791
0 		42,462
0 		50,590
0 		110,239
0 		28,499
0 		577,581
0 		0
0
(7) DONNA HAHN (i)
(ii)		 180,899
0 		27,360
0 		8,166
0 		45,111
0 		24,720
0 		286,256
0 		0
0
(8) KATHERINE HARRISON (i)
(ii)		 153,088
0 		23,792
0 		8,320
0 		62,786
0 		15,117
0 		263,103
0 		0
0
(9) RICHARD L HAUSHALTER (i)
(ii)		 294,714
0 		34,572
0 		61,015
0 		100,569
0 		22,792
0 		513,662
0 		0
0
(10) JOHN MCGOWAN (i)
(ii)		 284,229
0 		33,320
0 		1,584
0 		14,700
0 		24,804
0 		358,637
0 		0
0
(11) P RICHARD PIERCE (i)
(ii)		 71,427
0 		30,764
0 		145,929
0 		170,141
0 		7,877
0 		426,138
0 		0
0
(12) MICHAEL ROZMUS (i)
(ii)		 196,682
0 		29,268
0 		6,044
0 		66,645
0 		27,548
0 		326,187
0 		0
0
(13) MERV WEBB (i)
(ii)		 173,943
0 		26,448
0 		1,355
0 		116,976
0 		20,718
0 		339,440
0 		0
0
(14) MARK ZIMMERMAN (i)
(ii)		 202,927
0 		31,537
0 		10,584
0 		85,682
0 		22,749
0 		353,479
0 		0
0
(15) WILLIAM LENNEN MD (i)
(ii)		 529,283
0 		150,099
0 		89,220
0 		7,350
0 		23,126
0 		799,078
0 		0
0
(16) STEVEN MARRA MD (i)
(ii)		 652,519
0 		17,100
0 		25,124
0 		14,700
0 		27,388
0 		736,831
0 		0
0
(17) OLUMIDE DANISA MD (i)
(ii)		 489,476
0 		31,856
0 		10,360
0 		14,700
0 		13,477
0 		559,869
0 		0
0
(18) THOMAS WEBER MD (i)
(ii)		 247,403
0 		249,012
0 		15,895
0 		14,700
0 		21,092
0 		548,102
0 		0
0
(19) HEIDI GORSUCH-RAFFERTY MD (i)
(ii)		 334,203
0 		138,607
0 		20,438
0 		14,700
0 		27,159
0 		535,107
0 		0
0
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINE 1A PART I, LINE 1A: MEMBERSHIP TO VALLEY WELLNESS CENTER, A RELATED 501(C)(3) ORGANIZATION WAS PROVIDED AT REDUCED RATES. THIS BENEFIT IS AVAILABLE TO ALL ORGANIZATION'S EMPLOYEES.
  PART I, LINES 4A-B RECEIVED SEVERANCE PAYMENT AND/OR SUPPLEMENTAL NQ RETIREMENT P. RICHARD PIERCE, VICE PRESIDENT THROUGH 4/2011, RECEIVED $128,436 IN COMPENSATION RELATED TO HIS SEPARATION FROM SERVICE. THIS AMOUNT HAS BEEN INCLUDED IN COLUMN (B)(III) OF SCHEDULE J, PART II. HOWARD KERN PARTICIPATES IN THE SENTARA SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. PARTICIPATION IN THE PLAN IS LIMITED TO SELECT INDIVIDUALS AS APPROVED BY SENTARA HEALTHCARE'S BOARD OF DIRECTOR'S COMPENSATION COMMITTEE. THE PLAN IS CURRENTLY CLOSED TO ADDITIONAL MEMBERS. VESTING OCCURS UPON THE COMPLETION OF A TWO YEAR NON-COMPETE PERIOD FOLLOWING TERMINATION AFTER EARLY RETIREMENT DATE OR UPON DEATH. EARLY RETIREMENT DATE IS WHEN THE EXECUTIVE OBTAINS AT LEAST AGE 55 AND HAS 10 YEARS OF SERVICE AND BENEFITS ARE FORFEITED IF PARTICIPANT LEAVES PRIOR TO AGE 55 WITH 10 YEARS OF SERVICE. DAVID BERND PARTICIPATES IN AN INDIVIDUAL SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN SPONSORED BY SENTARA. VESTING OCCURS EACH DECEMBER 31 AND THE PRESENT VALUE OF THE ADDITIONAL ACCRUAL IS DISTRIBUTED IN A TAXABLE LUMP SUM. FOR 2011, MR. BERND RECEIVED A TOTAL LUMP SUM DISTRIBUTION OF $1,192,399. THIS AMOUNT HAS BEEN REPORTED IN COLUMN(B)(III) OF SCHEDULE J, PART II. DAVID BERND AND HOWARD KERN PARTICIPATE IN THE SENTARA OPTION PLAN FOR EXECUTIVES. THIS PLAN IS UNRELATED TO "EQUITY" OF THE EMPLOYER. PARTICIPATION IS LIMITED TO SELECT INDIVIDUALS AS APPROVED BY SENTARA HEALTHCARE'S BOARD OF DIRECTOR'S COMPENSATION COMMITTEE. VESTING IS DETERMINED BY THE GOVERNING BOARD OF SENTARA HEALTHCARE AND IS SEPARATELY STATED IN EACH PARTICIPANT'S OPTION AGREEMENT. THERE WERE NO OPTIONS GRANTED AFTER 2002. DAVID BERND, HOWARD KERN AND KENNETH KRAKAUR PARTICIPATE IN THE SENTARA CAPITAL ACCUMULATION ACCOUNT PLAN. PARTICIPATION IS LIMITED TO A SELECT GROUP OF CORPORATE EXECUTIVES AS APPROVED BY SENTARA HEALTHCARE'S BOARD OF DIRECTOR'S COMPENSATION COMMITTEE. TERMS OF THE PLAN CHANGED EFFECTIVE JANUARY 1, 2009, WHEREBY VESTING OF CONTRIBUTIONS MADE ON OR AFTER THAT DATE NOW OCCURS ON THE EARLIER OF FIVE YEARS FOR EACH YEARS' CONTRIBUTIONS OR AGE 55 WITH 10 YEARS OF SERVICE. UNDER THE OLD TERMS, VESTING OF CONTRIBUTIONS MADE PRIOR TO JANUARY 1, 2009 OCCURS ON THE EARLIEST OF ASSIGNED DISTRIBUTION DATE, DEATH, INVOLUNTARY TERMINATION WITHOUT CAUSE OR COMPLETION OF TWO-YEAR NON-COMPETE AFTER VOLUNTARY TERMINATION (REGARDLESS OF ORIGINAL ASSIGNED DISTRIBUTION DATE). DURING 2011, KENNETH KRAKAUR RECEIVED VESTED DISTRIBUTIONS OF $71,345 UNDER THE PLAN. THIS AMOUNT HAS BEEN REPORTED IN COLUMN(B)(III) OF SCHEDULE J, PART II. SENTARA HEALTHCARE OWNED A SPOUSAL SURVIVOR SPLIT-DOLLAR LIFE INSURANCE POLICY FOR KENNETH KRAKAUR. THE SPLIT DOLLAR PLAN PROVIDES FOR TRANSFER OF THE POLICY TO THE PARTICIPANT UPON CERTAIN EVENTS. AT TRANSFER (OR THE PARTICIPANT'S DEATH), THE ORGANIZATION RECOVERS THE PREMIUMS THAT IT HAS PAID. DURING 2011, THE SPOUSAL SURVIVOR SPLIT-DOLLAR LIFE INSURANCE POLICY FOR KENNETH KRAKAUR WAS SURRENDERED. THE POLICY VALUE REMAINING AFTER REDUCTION FOR CORPORATE RECOVERY OF PREMIUMS AND AFTER TAX ART AMOUNTS WAS $10,147. THIS AMOUNT WAS TREATED AS ADDITIONAL TAXABLE COMPENSATION AND HAVE BEEN REPORTED IN COLUMN(B)(III) OF SCHEDULE J PART II. JAMES KRAUSS, DALE CARROLL, RICHARD HAUSHALTER AND MIKE KING PARTICIPATE IN THE ORGANIZATION'S SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. PARTICIPATION IS LIMITED TO THE CEO, CMO, COO, AND CFO POSITIONS. THE PLAN IS A DEFINED CONTRIBUTION PLAN WITH ANNUAL CONTRIBUTIONS EQUAL TO A FIXED PERCENT OF TOTAL COMPENSATION. THE FIXED PERCENT IS SET AT PLAN ENTRY AND NEVER ADJUSTED REGARDLESS OF WHETHER OR NOT ASSUMPTIONS ARE REALIZED. CONTRIBUTIONS ARE MADE AT THE END OF THE PLAN YEAR TO ACTIVE EXECUTIVES (NOT PAID IF SEPARATION OF SERVICE DURING YEAR.) DURING 2011, DISTRIBUTIONS UNDER THE PLAN WERE AS FOLLOWS: JAMES KRAUSS ($95,266); DALE CARROLL ($31,643); RICHARD HAUSHALTER (42,224); MIKE KING ($44,633). THESE AMOUNTS HAVE BEEN REPORTED IN COLUMN(B)(III) OF SCHEDULE J, PART II.
  PART I, LINE 7 DURING 2011, THE ORGANIZATION MADE NON-FIXED PAYMENTS OF COMPENSATION UNDER THE FOLLOWING INCENTIVE PROGRAM: SHORT TERM INCENTIVE PLAN - EXECUTIVES AND SENIOR LEADERS ARE ELIGIBLE FOR ANNUAL AWARDS BASED ON SYSTEM AND INDIVIDUAL PERFORMANCE.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number
54-0506331
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HARRISONBURG VA
  		54-2000436 415669BN9 12-28-2006 196,167,653 FUND CONSTRUCTION OF NEW HOSPITAL FACILITY   X   X   X
B INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF HARRISONBURG VA
  		54-2000436 NONEAVAIL 04-15-2009 30,000,000 REFUNDED ISSUE DATED 4/4/2007   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 7,117,653 10,000,000    
2 Amount of bonds legally defeased . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . 198,951,052 30,000,000    
4 Gross proceeds in reserve funds . . . . . . . . 15,036,899      
5 Capitalized interest from proceeds . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . 1,336,500      
8 Credit enhancement from proceeds . . . . . . . . . . 4,253,886      
9 Working capital expenditures from proceeds . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . 178,323,767      
11 Other spent proceeds . . . . . . . . . . . 30,000,000 30,000,000    
12 Other unspent proceeds . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . 2011 2007
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . .   X X          
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X        
16 Has the final allocation of proceeds been made? . . . . . . X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X          
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X        
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X          
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . . X   X          
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X        
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0.00000%   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000%   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0.00000%   %   %
7 Does the bond issue meet the private security or payment test? . . . X   X          
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X          
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X        
2 Is the bond issue a variable rate issue?   X X          
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X X          
b Name of provider . . . . . . . . NA
  		SUNTRUST BANK
  		 
  		 
 
c Term of hedge . . . . . . . . 7.000000000000 7.000000000000    
d Was the hedge superintegrated? . . . .   X X          
e Was a hedge terminated? . . . . .   X   X        
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . X     X        
b Name of provider . . . . . . JP MORGAN CHASE
BANK 		 
  		 
  		 
 
c Term of GIC . . . . . . . 2.500000000000      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . . X              
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X        
6 Did the bond issue qualify for an exception to rebate? .   X X          
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X X          
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
PART II, B, 1   $10M OF ORIGINAL REFUNDING ISSUE WAS NOTE SUBSTITUTED TO PARENT, SENTARA HEALTHCARE 52-1271901, IN 2011. THE NOTE IS REPORTED IN SENTARA'S 990, SCHEDULE K AS OF 12/31/2011.
PART II, COLUMN A, LINE 3   TOTAL PROCEEDS OF THE BOND ISSUE = $190,000,000 PAR VALUE, $6,167,653 BOND PREMIUM, $11,069 EARNINGS ON THE INTEREST FUND AND $2,772,330 FROM EARNINGS ON DSRF.
PART II, COLUMN A, LINE 4   GROSS PROCEEDS IN RESERVE INCLUDE $12,253,500 DEPOSITED INTO RESERVE ON CLOSING DATE PLUS $2,772,330 EARNINGS ON DSRF AND $11,069 EARNINGS ON INTEREST FUND.
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number

54-0506331
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
(1) DR WILLIAM LENNEN HIGHEST COMPENS
PHYS RECRUIT-INC GUAR 		  X 150,000 99,231   No   No Yes  
Total ...............Small Bullet $ 99,231
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) SHENANDOAH SHARED HOSPITAL SERVICES INC
  		OVERLAP OF OFFICERS/DIRECTORS 8,288,836 CLINICAL SERVICES   No
(2) PATHOLOGY ASSOCIATES OF HARRISONBURG
  		>5%-OWNED BY DIRECTOR ALDEN HOSTETTER, M.D. 185,232 PATHOLOGY SERVICES   No
(3) HARRISONBURG MEDICAL ASSOCIATES
  		>5%-OWNED BY DIRECTOR STEWART POLLACK, M.D. 13,439,422 PROFESSIONAL SERVICES   No
(4) PAR-MED LLC
  		>5%-OWNED BY DIRECTOR STEWART POLLACK, M.D. 360,660 RENT EXPENSE   No
(5) LANTZ CONSTRUCTION COMPANY
  		>5%-OWNED BY DIRECTOR DOUGLAS DRIVER. 502,268 CONSTRUCTION SERVICES   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
    DIRECTORS/TRUSTEES/OFFICERS/KEY EMPLOYEES OF THE ORGANIZATION MAY ALSO SERVE AS DIRECTORS/TRUSTEES/OFFICERS OF RELATED TAXABLE ENTITIES WITHIN THE SENTARA HEALTHCARE SYSTEM. SEE SCHEDULE R FOR A LISTING OF TRANSACTIONS THE ORGANIZATION HAD WITH THESE RELATED TAXABLE ENTITIES.
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number

54-0506331
Identifier Return Reference Explanation
  FORM 990, PART V, LINE 1A: FORM 1096 THE ORGANIZATION IS THE 501(C)(3) SOLE MEMBER OF ANOTHER 501(C)(3) ORGANIZATION FOR WHICH IT MAINTAINS AN AGENCY RELATIONSHIP AND ISSUES 1099S. THE NUMBER REPORTED IS A BEST ESTIMATE OF THE 1099S ATTRIBUTABLE TO THE ORGANIZATION. THE EXACT NUMBER CANNOT BE DETERMINED; AS SOME OF THE 1099S ISSUED BY THE ORGANIZATION ARE ATTRIBUTABLE TO MORE THAN ONE ENTITY, AND THERE IS NO REPORTING MECHANISM TO DETERMINE 1099S ATTRIBUTABLE SOLELY TO THE ORGANIZATION.
  FORM 990, PART I LINE 5 AND PART V LINE 2A THE ORGANIZATION IS THE 501(C)(3) SOLE MEMBER OF ANOTHER 501(C)(3) ORGANIZATION FOR WHICH IT ACTS AS COMMON PAY AGENT AND ISSUES ALL FORM W-2S. SINCE THE ORGANIZATION HAS NO REPORTING MECHANISM TO DETERMINE W-2S ATTRIBUTABLE SOLELY TO THE ORGANIZATION, THE NUMBER REPORTED APPROXIMATES THE NUMBER OF W-2S ISSUED BY THE ORGANIZATION ON ITS OWN BEHALF.
  FORM 990, PART VI, SECTION A, LINE 2 BUSINESS OR FAMILY RELATIONSHIP OF OFFICERS, DIRECTORS, ETC. DAVID BERND AND HOWARD KERN HAVE A BUSINESS RELATIONSHIP THROUGH COMMON OWNERSHIP OF AN ENTITY UNRELATED TO THE ORGANIZATION. THE ORGANIZATION'S OFFICERS AND DIRECTORS SERVED TOGETHER ON THE BOARDS OF OTHER TAXABLE ORGANIZATIONS WITHIN THE SENTARA HEALTHCARE SYSTEM ("THE SYSTEM"), AS WELL AS JOINT VENTURES IN WHICH THE SYSTEM HAD AN OWNERSHIP INTEREST. SEE SCHEDULE R FOR A LISTING OF SUCH ENTITIES.
  FORM 990, PART VI, SECTION A, LINE 4 SIGNIFICANT CHANGES MADE TO GOVERNING DOCUMENTS ON DECEMBER 6, 2010, THE ORGANIZATION ENTERED INTO AN AFFILIATION AGREEMENT WITH SENTARA HEALTHCARE, A 501(C)(3) ORGANIZATION ("SENTARA"), WHEREBY SENTARA REPLACED ROCKINGHAM HEALTH CARE, INC. ("RHC")AS SOLE MEMBER OF THE ORGANIZATION EFFECTIVE MAY 1, 2011. AS A RESULT OF THE AFFILIATION, THE ORGANIZING AND GOVERNING DOCUMENTS WERE CHANGED IN THE FOLLOWING MANNER: --RHC WAS REPLACED BY SENTARA AS SOLE MEMBER OF THE ORGANIZATION. --THE ORGANIZATION'S PURPOSE CLAUSE WAS EXPANDED TO INCLUDE THE PROVISION OF ANCILLARY AND RELATED MEDICAL AND OTHER HEALTHCARE SERVICES; THE PROVISION OF MANAGEMENT, ADVISORY, SERVICE ASSISTANCE AND OTHER SUPPORT TO HEALTH CARE ORGANIZATIONS HAVING THE SAME PURPOSES AS ITS OWN; AND THE ENGAGEMENT IN OTHER RELATED, EXCLUSIVELY CHARITABLE, SCIENTIFIC, EDUCATIONAL AND MEDICAL RESEARCH ACTIVITIES AS MAY BE AUTHORIZED FROM TIME TO TIME BY ITS BOARD OF DIRECTORS. --THE ELEVEN-TO EIGHTEEN-MEMBER BOARD OF DIRECTORS, WHICH WAS PREVIOUSLY SELECTED BY RHC, WAS REPLACED WITH A NINE-TO-ELEVEN MEMBER BOARD OF DIRECTORS COMPRISED OF TWO CLASSES: SIX-TO-EIGHT CLASS A DIRECTORS SELECTED BY THE ORGANIZATION'S NOMINATING COMMITTEE, AND THREE CLASS B DIRECTORS APPOINTED BY SENTARA. IN ADDITION, CLASS A DIRECTORS MUST BE SELECTED BY THE NOMINATING COMMITTEE FROM CURRENT MEMBERS OF RHC'S BOARD OF DIRECTORS; ELECTED BY A MAJORITY OF THE MEMBERS OF THE ORGANIZATION'S BOARD; AND RATIFIED BY SENTARA AS SOLE MEMBER. --SENTARA, AS SOLE MEMBER, HAS EXCLUSIVE AUTHORITY TO DIRECT AND MANAGE THE OPERATIONS AND AFFAIRS OF THE ORGANIZATION, SUBJECT TO BOARD OVERSIGHT TO THE EXTENT AND IN THE MANNER SET FORTH IN THE ORGANIZATION'S BYLAWS. THE BOARD OF DIRECTORS SHALL FUNCTION IN AN ADVISORY CAPACITY, PROVIDING RECOMMENDATIONS TO SENTARA REGARDING THE ESTABLISHMENT OF ORGANIZATION POLICIES, THE MAINTENANCE OF QUALITY PATIENT CARE, AND THE PROVISION OF INSTITUTIONAL PLANNING IN A MANNER RESPONSIVE TO LOCAL COMMUNITY NEEDS. --UPON ANY LIQUIDATION OR DISSOLUTION OF THE ORGANIZATION, ITS REMAINING ASSETS SHALL BE DISTRIBUTED TO SENTARA. --ORGANIZING OR ENABLING DOCUMENTS OR BYLAWS MAY BE AMENDED, RESTATED OR REPEALED THROUGH APPROVAL OF A MAJORITY OF THE ORGANIZATION'S BOARD, PROVIDED THAT A MAJORITY OF CLASS A DIRECTORS VOTE IN THE AFFIRMATIVE AND SUCH AMENDMENT, RESTATEMENT OR REPEAL IS APPROVED BY SENTARA.
  FORM 990, PART VI, SECTION A, LINE 6 EXPLANATION OF CLASSES OF MEMBERS OR SHAREHOLDERS THE ORGANIZATION HAD ONE CLASS OF MEMBER. EFFECTIVE MAY 1, 2011, THE SOLE MEMBER WAS SENTARA HEALTHCARE, A VIRGINIA NONSTOCK CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION'S SOLE MEMBER PRIOR TO MAY 1, 2011, WAS ROCKINGHAM HEALTH CARE, INC., A VIRGINIA NONSTOCK CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.
  FORM 990, PART VI, SECTION A, LINE 7A HOW MEMBERS OR SHAREHOLDERS ELECT GOVERNING BODY PRIOR TO THE ORGANIZATION'S AFFILIATION WITH SENTARA HEALTHCARE, BOARD MEMBERS WERE ELECTED BY ROCKINGHAM HEALTH CARE, INC., THE FORMER SOLE MEMBER OF THE ORGANIZATION. EFFECTIVE MAY 1, 2011, THE DATE OF AFFILIATION WITH SENTARA HEALTHCARE, CLASS B DIRECTORS OF THE ORGANIZATION ARE NOW APPOINTED BY SENTARA HEALTHCARE, THE 501(C)(3) SOLE MEMBER OF THE ORGANIZATION. THE SOLE MEMBER ALSO RATIFIES CLASS A DIRECTORS OF THE ORGANIZATION ONCE NOMINATED BY THE ORGANIZATION'S NOMINATING COMMITTEE AND ELECTED BY THE ORGANIZATION'S BOARD OF DIRECTORS.
  FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY APPROVAL BY MEMBERS OR SHAREHOLDERS THE ORGANIZATION MAY NOT TAKE OR ALLOW ANY OF THE FOLLOWING GOVERNANCE ACTIONS WITHOUT THE CONSENT OF ITS 501(C)(3) SOLE MEMBER, SENTARA HEALTHCARE: APPROVAL OR ADOPTION OF ANY PLAN OF MERGER OR CONSOLIDATION, ANY SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, THE PROPERTY AND ASSETS OF THE ORGANIZATION, THE VOLUNTARY DISSOLUTION OR LIQUIDATION OF THE ORGANIZATION, REVOCATION OF AN SUCH VOLUNTARY DISSOLUTION PROCEEDINGS, OR ANY DECISION TO FILE A PETITION REQUESTING OR CONSENTING TO AN ORDER FOR RELIEF UNDER THE FEDERAL BANKRUPTCY LAWS OR SIMILAR STATE LAWS FOR THE ORGANIZATION; ELECTION OF NEW BOARD MEMBERS; OR AMENDMENT, RESTATEMENT OR REPEAL OF ANY ORGANIZING OR ENABLING DOCUMENTS OR BYLAWS. THE APPROVAL OF THE SOLE MEMBER IS ALSO REQUIRED FOR CERTAIN OPERATIONAL ACTIONS, AS OUTLINED IN THE ORGANIZATION'S BYLAWS. SUCH ACTIONS INCLUDE, BUT ARE NOT LIMITED TO, APPROVAL OF STRATEGIC PLANS AND ANNUAL OPERATING AND CAPITAL BUDGETS; TRANSACTIONS WITH INTERESTED PERSONS; CREATION OR ACQUISITION OF SUBSIDIARIES OR INTERESTS IN WHICH THE ORGANIZATION WILL BE A MEMBER; ENTRANCE INTO JOINT VENTURE OR OTHER SIMILAR ARRANGEMENTS; EMPLOYMENT MATTERS CONCERNING THE ORGANIZATION'S PRESIDENT; UNBUDGETED CAPITAL EXPENDITURES OR INDEBTEDNESS OVER SPECIFIED DOLLAR AMOUNTS; AND THE COMMENCEMENT OR SETTLEMENT OF LITIGATION. SENTARA HEALTHCARE HAS EXCLUSIVE AUTHORITY TO DIRECT AND MANAGE THE OPERATIONS AND AFFAIRS OF THE HOSPITAL, SUBJECT TO BOARD OVERSIGHT TO THE EXTENT AND IN THE MANNER SET FORTH IN THE ORGANIZATION'S BYLAWS.
  FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION WAS PART OF THE SENTARA HEALTHCARE SYSTEM ("THE SYSTEM"), AND AS SUCH, USED THE SYSTEM'S IN-HOUSE TAX DEPARTMENT, HEADED BY A LICENSED CERTIFIED PUBLIC ACCOUNTANT, TO BOTH PREPARE AND REVIEW ITS FORM 990. DURING THE PREPARATION AND REVIEW PROCESS, THE TAX DEPARTMENT WORKED CLOSELY WITH THE ORGANIZATION AND OTHER SYSTEM DEPARTMENTS, SUCH AS LEGAL, COMPENSATION AND BENEFITS, COMPLIANCE, FINANCE, AND MARKETING, TO ENSURE THAT A COMPLETE AND ACCURATE RETURN WAS FILED.
  FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS WITH ANY CONFLICT OF INTEREST ARE MADE AWARE OF THE NEED TO EXCUSE THEMSELVES FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON ANY ISSUES WHERE THERE MAY BE A CONFLICT. OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE AWARE OF THEIR DUTIES AND RESPONSIBILITIES IN REGARDS TO THIS ISSUE.
  FORM 990, PART VI, SECTION B, LINE 15 PRESIDENT/CEO: AN INDEPENDENT COMPENSATION CONSULTING FIRM WAS RETAINED BY THE BOARD OF DIRECTORS (BOD) TO COMPLETE MARKET ANALYSIS AND RECOMMEND PRESIDENT/CEO COMPENSATION CHANGES. THE BOD APPROVES ALL COMPENSATION CHANGES FOR THE PRESIDENT/CEO. OFFICERS AND KEY EMPLOYEES: AN INDEPENDENT COMPENSATION CONSULTING FIRM WAS RETAINED BY THE BOARD OF DIRECTORS (BOD) TO COMPLETE MARKET ANALYSIS AND RECOMMEND OFFICER AND KEY EMPLOYEE COMPENSATION CHANGES. THE BOD APPROVES ALL COMPENSATION CHANGES FOR THE OFFICERS AND KEY EMPLOYEES. VICE CHAIRMAN: THE VICE CHAIRMAN ALSO SERVES AS THE COO/PRESIDENT OF THE SENTARA HEALTHCARE SYSTEM ("SENTARA"), WHICH AFFILIATED WITH THE ORGANIZATION EFFECTIVE MAY 1, 2011. SENTARA FOLLOWED PROCESSES AND PROCEDURES SET FORTH IN ITS GOVERNING DOCUMENTS TO ENSURE COMPLIANCE WITH ITS OBLIGATIONS AS A 501(C)(3) HEALTHCARE ORGANIZATION TO PAY DISQUALIFIED PERSONS REASONABLE COMPENSATION. SUCH PROCESSES AND PROCEDURES ARE INTENDED TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERNAL REVENUE CODE SECTION 4958 REGULATIONS. THE COMPENSATION PHILOSOPHY OF SENTARA IS TO BASE OVERALL COMPENSATION AND BENEFITS FOR EXECUTIVES ON MARKET COMPARABLES, ADJUSTED AS APPLIED TO EACH EXECUTIVE, TAKING INTO CONSIDERATION THE INDIVIDUAL SKILLS, EXPERIENCE, TENURE AND PERFORMANCE OF THE EXECUTIVE BEING COMPENSATED AND OVERALL PERFORMANCE OF THE ORGANIZATION. IN LINE WITH THIS PHILOSOPHY, SENTARA PERFORMED SUBSTANTIAL DUE DILIGENCE AS TO MARKET COMPARABLES. SENTARA'S COMPENSATION COMMITTEE, WHICH CONSISTS OF BOARD MEMBERS WITHOUT CONFLICTS OF INTERESTS, ENGAGED AN OUTSIDE CONSULTANT, WHO REPORTS TO THE COMPENSATION COMMITTEE, TO CONDUCT A STUDY ASSESSING THE COMPETITIVENESS OF TOTAL COMPENSATION (INCLUDING CASH COMPENSATION, BENEFITS AND PERQUISITES) OF ITS SENIOR EXECUTIVES PRIOR TO MAKING DECISIONS REGARDING ANNUAL BASE SALARY ADJUSTMENTS, APPROVING INCENTIVE AWARDS, OR CONSIDERING PROGRAMMATIC CHANGES. THE STUDY COMPARED THE COMPENSATION OF THE SENTARA'S SENIOR EXECUTIVES TO COMPENSATION DATA FROM MULTIPLE PUBLISHED SURVEY SOURCES BASED ON THE SENIOR EXECUTIVES FUNCTIONAL RESPONSIBILITY. IN CONDUCTING THE STUDY, THE CONSULTANT TARGETED OTHER HEALTH SYSTEMS OF SIMILAR SIZE BASED ON NET REVENUE AND COMPLEXITY. FOR HEALTH PLAN POSITIONS, HEALTH PLANS WITH SIMILAR PREMIUMS, OR MEMBERS, WERE TARGETED. THE CONSULTANT ALSO CONDUCTS A REVIEW OF SENTARA'S PERFORMANCE RELATIVE TO A GROUP OF NOT-FOR-PROFIT HEALTH SYSTEMS OF COMPARABLE SIZE AND SCOPE OF OPERATIONS EVERY TWO TO THREE YEARS. THE MOST RECENT STUDY COMPARED SENTARA'S PERFORMANCE TO 19 HEALTHCARE SYSTEMS BASED ON NET REVENUE GROWTH, OPERATING MARGIN, BOND RATING, AND QUALITATIVE PERFORMANCE MEASURES BASED ON RANKINGS FROM SDI'S NATIONAL TOP INTEGRATED HEALTH NETWORKS. OVERALL, THE CONSULTANT DETERMINED THAT SENTARA'S PAY WAS ALIGNED WITH ITS RELATIVE PERFORMANCE. THE COMPENSATION STUDY WAS PRESENTED TO SENTARA'S COMPENSATION COMMITTEE, WHICH MADE ITS COMPENSATION DECISIONS BASED ON A)ITS REVIEW AND ANALYSIS OF THE PERFORMANCE OF BOTH THE ORGANIZATION AND ITS SENIOR EXECUTIVES AND, B) A REASONABLENESS OF COMPENSATION ANALYSIS AND OPINION FROM AN EXTERNAL EXPERT IN THE COMPENSATION OF EXECUTIVES IN THE TAX-EXEMPT HEALTH CARE FIELD. THE COMMITTEE'S BASES FOR ITS DECISIONS WERE DOCUMENTED IN COMMITTEE MINUTES TAKEN DURING THE MEETING AND THEN CIRCULATED FOR REVIEW AND APPROVAL. ALL DECISIONS REGARDING COMPENSATION WERE MADE BY THE COMMITTEE, WHICH CONSISTS OF BOARD MEMBERS WITHOUT CONFLICT OF INTERESTS.
  FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST
  FORM 990, PART VII COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND INDEPENDENT CONTRACTORS. HOURS DEVOTED TO RELATED ORGANIZATIONS ANN E. C. HOMAN DEVOTED AN AVERAGE OF 3 HOURS PER WEEK TO RELATED ORGANIZATIONS. HOWARD P. KERN DEVOTED AN AVERAGE OF 50 HOURS PER WEEK TO RELATED ORGANIZATIONS. JAMES R. MESSNER DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. BARBARA B. STOLTZFUS DEVOTED AN AVERAGE OF 1 HOUR PER WEEK TO RELATED ORGANIZATIONS. W. CARLTON BANKS DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. A. JERRY BENSON DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. DAVID L. BERND DEVOTED AN AVERAGE OF 51 HOURS PER WEEK TO RELATED ORGANIZATIONS. LAWRENCE D. BOWERS, JR. DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. MENSEL D. DEAN, JR. DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. DOUGLAS G. DRIVER DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. JOSEPH K. FUNKHOUSER, II DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. C. WAYNE GATES, M.D. DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. ALDEN L. HOSTETTER DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. ELMER E. KENNEL DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. KENNETH M. KRAKAUR DEVOTED AN AVERAGE OF 48 HOURS PER WEEK TO RELATED ORGANIZATIONS. ALLON H. LEFEVER DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. W. NEAL MENEFEE DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. GEORGE W. PACE DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. STEWART G. POLLOCK, M.D. DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. MICHAEL R. KING DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. JAMES D. KRAUSS DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS. P. RICHARD PIERCE DEVOTED AN AVERAGE OF 0.2 HOUR PER WEEK TO RELATED ORGANIZATIONS.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,985,154. NET ASSET TRANSFER FROM ROCKINGHAM HEALTH CARE, INC. 88,050,937. PENSION COMPREHENSIVE LOSS -21,943,734. ASU 2010-07 FAIR MARKET VALUE ADJUSTMENTS -231,782,831. OTHER CHANGES -160,129. TOTAL TO FORM 990, PART XI, LINE 5: -167,820,911.
CHANGES IN AUDITED FINANCIAL STATEMENT OVERSIGHT PROCESS FORM 990, PART XII, LINE 2C: DURING THE YEAR, THE ORGANIZATION AFFILIATED WITH THE SENTARA HEALTHCARE SYSTEM, WHO ASSUMED RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTED THE INDEPENDENT ACCOUNTANT.
STATEMENT FILED PURSUANT TO TREASURY REGULATION SEC. 1.6038-2(J)(3):   THE TAXPAYER IS A MEMBER OF THE SENTARA HEALTHCARE ("SHC") CONTROLLED GROUP. SHC, EIN 52-1271901, OWNS BAY PRIMEX INSURANCE COMPANY, LTD., A CONTROLLED FOREIGN CORPORATION. SHC FURNISHES ALL INFORMATION REQUIRED OF THE TAXPAYER BY IRC SECTION 6038 AND THE REGULATIONS THEREUNDER WITH RESPECT TO BAY PRIMEX INSURANCE COMPANY, LTD. THEREFORE, PURSUANT TO TREASURY REGULATION SEC. 1.6038-2(J)(2), THE TAXPAYER IS EXCEPTED FROM PROVIDING SUCH INFORMATION. THE REQUIRED INFORMATION IS E-FILED WITH SHC'S FORM 990 RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
ROCKINGHAM MEMORIAL HOSPITAL
 
Employer identification number

54-0506331
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity







(1) RMH MEDICAL GROUP LLC
2010 HEALTH CAMPUS DRIVE
HARRISONBURG,VA22801
27-1444665 		HEALTHCARE VA 24,243,176 0 ROCKINGHAM MEMORIAL HOSPITAL
 










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) SENTARA HEALTHCARE

6015 POPLAR HALL DRIVE

NORFOLK,VA23502
52-1271901 		HEALTH CARE VA 501(C)(3) LN7_NORMALGOVTSUPPOR N/A
 
No
(2) SENTARA PRINCESS ANNE HOSPITAL

6015 POPLAR HALL DRIVE

NORFOLK,VA23502
52-1277419 		HEALTH CARE VA 501(C)(3) LN3_HOSPITALCOOPINSE SENTARA HOSPITALS
 
Yes
 
(3) SENTARA HOSPITALS

6015 POPLAR HALL DRIVE

NORFOLK,VA23502
54-1547408 		HEALTH CARE VA 501(C)(3) LN3_HOSPITALCOOPINSE SENTARA HEALTHCARE
 
Yes
 
(4) SENTARA MEDICAL GROUP

6015 POPLAR HALL DRIVE

NORFOLK,VA23502
54-1217184 		HEALTH CARE VA 501(C)(3) LN9_MORETHAN30PCTCON SENTARA HEALTHCARE
 
Yes
 
(5) SENTARA ENTERPRISES

6015 POPLAR HALL DRIVE

NORFOLK,VA23502
54-1917649 		HEALTH CARE VA 501(C)(3) LN9_MORETHAN30PCTCON SENTARA HEALTHCARE
 
Yes
 
(6) SENTARA LIFE CARE CORP

6015 POPLAR HALL DRIVE

NORFOLK,VA23502
54-1217183 		HEALTH CARE VA 501(C)(3) LN9_MORETHAN30PCTCON SENTARA HEALTHCARE
 
Yes
 
(7) MPB INC

6015 POPLAR HALL DRIVE

NORFOLK,VA23502
54-1346393 		TITLE HOLDING COMPANY VA 501(C)(2)   SENTARA ENTERPRISES
 
Yes
 
(8) OPTIMA HEALTH PLAN

6015 POPLAR HALL DRIVE

NORFOLK,VA23502
54-1283337 		HMO VA 501(C)(3) 11A - I SENTARA HEALTHCARE
 
Yes
 
(9) POTOMAC HOSPITAL CORP OF PRINCE WILLIAM

6015 POPLAR HALL DRIVE

NORFOLK,VA23502
54-0853898 		HEALTH CARE VA 501(C)(3) LN3_HOSPITALCOOPINSE SENTARA HEALTHCARE
 
Yes
 
(10) VALLEY WELLNESS CENTER

501 STONE SPRING ROAD

HARRISONBURG,VA22801
52-1309257 		PREVENTATIVE HEALTH/REHAB VA 501(C)(3) LN9_MORETHAN30PCTCON ROCKINGHAM MEMORIAL HOSPITAL
 
Yes
 
(11) MJH FOUNDATION

500 MARTHA JEFFERSON DRIVE

CHARLOTTESVILLE,VA22911
54-1401357 		INVEST/MGT SVCS FOR MARTHA JEFFERSON HOSPITAL VA 501(C)(3) 11A - I MARTHA JEFFERSON HOSPITAL
 
Yes
 
(12) MARTHA JEFFERSON HOSPITAL FOUNDATION

500 MARTHA JEFFERSON DRIVE

CHARLOTTESVILLE,VA22911
30-0041113 		FUNDRAISING VA 501(C)(3) 11A - I MARTHA JEFFERSON HOSPITAL
 
Yes
 
(13) MARTHA JEFFERSON HOSPITAL

500 MARTHA JEFFERSON DRIVE

CHARLOTTESVILLE,VA22911
54-0261840 		HEALTH CARE VA 501(C)(3) LN3_HOSPITALCOOPINSE SENTARA HEALTHCARE
 
Yes
 
(14) ROCKINGHAM HEALTH CARE INC

2010 HEALTH CAMPUS DRIVE

HARRISONBURG,VA22801
52-1309259 		SUPPORT OF HEALTHCARE ORGS VA 501(C)(3) 11B - II N/A
 
No
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) MANAGEMENT SERVICES LLC

814 GREENBRIER CIRCLE
CHESAPEAKE,VA23320
54-1365012 		HLTH MGT SV VA N/A
                  
(2) OBICI REAL ESTATE HOLDINGS LLC

6015 POPLAR HALL DRIVE
NORFOLK,VA23502
26-1749881 		RE RENTAL VA N/A
                  
(3) PRINCESS ANNE AMB SURG MGT LLC

1975 GLENN MITCHELL SUITE 300
VA BEACH,VA23456
20-4920880 		HEALTH CARE VA N/A
                  
(4) VA BEACH AMBULATORY SURGERY CENTER

1700 WILL O WISP DRIVE
VA BEACH,VA23454
54-1448218 		HEALTH CARE VA N/A
                  
(5) AMER HEALTH EVAL CTR-WMSBG LLC

739 THIMBLE SHOALS STE 105
NEWPORT NEWS,VA23606
26-3761741 		HEALTH CARE VA N/A
                  
(6) CANCER CENTERS OF VA LLC

5900 LAKE WRIGHT DRIVE
NORFOLK,VA23502
20-1338518 		HEALTH CARE VA N/A
                  
(7) HAMPTON ROADS LITHOTRIPSY LLC

225 CLEARFIELD AVE
VIRGINIA BEACH,VA23462
20-0942600 		HEALTH CARE VA N/A
                  
(8) HEALTHCARE PERFORMANCE IMPROVEMENT LLC

5041 CORPORATE WOODS DR STE 180
VIRGINIA BEACH,VA23462
20-4024074 		CONSULTING VA N/A
                  
(9) RADIOLOGY SERVICES OF HAMPTON ROADS LC

814 GREENBRIER CIRCLE STE L
CHESAPEAKE,VA23320
54-1774472 		HEALTH CARE VA N/A
                  
(10) SENTARA OBICI AMBULATORY SURGERY LLC

2750 GODWIN BLVD
SUFFOLK,VA23434
26-0144898 		HEALTH CARE VA N/A
                  
(11) ST LUKES PROPERTIES LLC

6015 POPLAR HALL DRIVE
NORFOLK,VA23502
27-2774684 		MOB RENTAL VA N/A
                  
(12) POTOMAC INOVA HEALTHCARE ALLIANCE LLC

8110 GATEHOUSE RD SUITE 400W
FALLS CHURCH,VA22042
54-1802733 		HEALTHCARE VA N/A
                  
(13) CAREPLEX WEST LLC

18000 W SARAH LANE SUITE 250
BROOKFIELD,WI53045
20-2738977 		RENTAL RE WI N/A
                  
(14) PORT WARWICK II LLC

18000 WEST SARAH LANE SUITE 250
BROOKFIELD,WI53045
20-2739075 		RENTAL RE WI N/A
                  
(15) ORTHOPAEDIC HOSPITAL MANAGEMENT LLC

3000 COLISEUM DRIVE
HAMPTON,VA23666
27-4185117 		MGT SVCS VA N/A
                  
(16) CAREPLEX ORTHOPAEDIC ASC LLC

3000 COLISEUM DRIVE
HAMPTON,VA23666
27-1867311 		HEALTH CARE VA N/A
                  
(17) PORT WARWICK III LLC

18000 WEST SARAH LANE SUITE 250
BROOKFIELD,WI53045
61-1499371 		RENTAL RE WI N/A
                  
(18) MARTHA JEFFERSON OSC LLC

595 MARTHA JEFFERSON DR
CHARLOTTESVILLE,VA22911
11-3656095 		HEALTH CARE VA N/A
                  
(19) VALIANCE HEALTH LLC

3190 PEOPLES DRIVE
HARRISONBURG,VA22801
54-1866081 		HEALTH CARE VA RMH
  		RELATED 1,368,105 2,054,532   No   Yes   33.340 %
(20) PHYSICAL THERAPY ACACLLC

501 ALBEMARLE SQUARE
CHARLOTTESVILLE,VA22901
26-0080717 		HEALTH CARE VA N/A
                  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) SENTARA HOLDINGS INC
6015 POPLAR HALL DRIVE
NORFOLK,VA23502
54-1555638 		HOLDING COMPANY VA N/A
 C      
(2) SENTARA HEALTH PLANS INC
6015 POPLAR HALL DRIVE
NORFOLK,VA23502
52-2368125 		TPA VA N/A
 C      
(3) OPTIMA HEALTH GROUP
6015 POPLAR HALL DRIVE
NORFOLK,VA23502
54-1473382 		HMO VA N/A
 C      
(4) OPTIMA HEALTH INSURANCE COMPANY
6015 POPLAR HALL DRIVE
NORFOLK,VA23502
54-1642752 		HEALTH INSURANCE VA N/A
 C      
(5) OPTIMA BEHAVIORAL HEALTH SERVICES
6015 POPLAR HALL DRIVE
NORFOLK,VA23502
62-1382666 		MENTAL HEALTH SVCS VA N/A
 C      
(6) SENTARA VENTURES INC
6015 POPLAR HALL DRIVE
NORFOLK,VA23502
54-1688615 		HOLDING COMPANY VA N/A
 C      
(7) SMG INNOVATIONS INC
6015 POPLAR HALL DRIVE
NORFOLK,VA23502
20-3730331 		HEALTH CARE VA N/A
 C      
(8) SENTARA OBICI PROFESSIONAL CENTER
6015 POPLAR HALL DRIVE
NORFOLK,VA23502
54-1445865 		RE RENTAL VA N/A
 C      
(9) SENTARA OBICI MED MGT SERVICES
6015 POPLAR HALL DRIVE
NORFOLK,VA23502
54-1020941 		HEALTH CARE VA N/A
 C      
(10) POTOMAC VENTURES CORP
6015 POPLAR HALL DRIVE
NORFOLK,VA23502
54-1441420 		PHARMACY VA N/A
 C      
(11) ROCKINGHAM HEALTH SERVICES INC
2010 HEALTH CAMPUS DRIVE
HARRISONBURG,VA22801
54-1721387 		CONTRACTING SVCS VA ROCKINGHAM MEMORIAL HOSPITAL
  		C     100.000 %
(12) MARTHA JEFFERSON MEDICAL ENTERPRISES INC
630 PETER JEFFERSON PARKWAY
CHARLOTTESVILLE,VA22911
54-1841528 		MEDICAL BILLING SVCS VA N/A
 C      
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) VALLEY WELLNESS CENTER

 J 147,306 CORP BOOKS/REC
(2) VALLEY WELLNESS CENTER

 R 1,090,368 CORP BOOKS/REC
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


Software ID:  
Software Version: