TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) TONY KECK MSHA SVP...................................................................... DIRECTOR	0.50 ................. 54.50	X				451,023	47,064
(2) ERIC SACKNOFF MD MSMG PHYSICIAN...................................................................... DIRECTOR	0.00 ................. 40.00	X				442,373	32,446
(3) SEAN MCMURRAY JMH CEO...................................................................... DIRECTOR	5.00 ................. 40.00	X				385,990	51,190
(4) JOHN JETER JMHSCCH CFO SECRETARY	9.00 ................. 36.00	X	X			217,684	26,523
(5) ANTHONY CLARYMDMSMG PHYSICIAN...................................................................... DIRECTOR	0.50 .................	X				175,684	24,982
(6) ALLEN ABEL...................................................................... DIRECTOR	1.25 .................	X				0	0
(7) JIM BEAR JR...................................................................... VICE-CHAIR	0.75 .................	X	X			0	0
(8) ANDY BLEVINS...................................................................... DIRECTOR	0.50 .................	X				0	0
(9) RUTH COX...................................................................... DIRECTOR	0.75 .................	X				0	0
(10) JOANNE GROSECLOSE...................................................................... CHAIR	0.75 .................	X	X			0	0
(11) JIM MCDOWELL MD...................................................................... DIRECTOR	0.50 .................	X				0	0
(12) ROBERT SHULTS...................................................................... TREASURER	1.00 .................	X	X			0	0
(13) AMANDA CURRIN...................................................................... DIRECTOR	0.50 .................	X				0	0
(14) GARY PEACOCK...................................................................... DIRECTOR	0.50 ................. 11.00	X				0	0
(15) JAMES TYLER...................................................................... SCCH CEO	45.00 .................		X			246,044	16,458
(16) CATHY MAINE...................................................................... ASSOC. ADMIN	45.00 .................			X		173,767	10,777
(17) BELDON FLEMING...................................................................... PHARMACY MAN	40.00 .................				X	143,998	31,596

(A) Name and business address	(B) Description of services	(C) Compensation
VEP MSHA ED INC 1990 N CALIFORNIA BLVD STE 400 WALNUT CREEK,CA94596	EMERGENCY SERV.	728,333
VIRGINIA HIGHLANDS ANESTHESIA PO BOX 1476 ABINGDON,VA24212	ANESTHESIA SVCS	600,791
HANCOCK DANIEL JOHNSON & NAGLE PO BOX 72050 RICHMOND,VA232552050	ATTORNEY SVCS	366,131
CROTHALL LAUNDRY SERVICES EAST TN 13028 COLLECTIONS CENTER DRIVE CHICAGO,IL60693	LINEN SERVICES	197,588
UMS UROLOGY SERVICES OF SMYTH COUNTY 700 WEST PARK DRIVE SUITE 410 WESTBOROUGH,MA01581	LITHOTRIPSY SVC	121,959
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 5

- TIN:

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

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

SMYTH COUNTY COMMUNITY HOSPITAL

Employer identification number

54-0794913

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

SMYTH COUNTY COMMUNITY HOSPITAL

Employer identification number

54-0794913

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... 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 its Form 990PF, Part I, line 2, 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization SMYTH COUNTY COMMUNITY HOSPITAL

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization SMYTH COUNTY COMMUNITY HOSPITAL		Employer identification number 54-0794913

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization SMYTH COUNTY COMMUNITY HOSPITAL			Employer identification number 54-0794913
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose 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

(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

(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

(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) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

SMYTH COUNTY COMMUNITY HOSPITAL

Employer identification number

54-0794913

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

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 SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ..............................................................................................................	Yes No

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable 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) 2015

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

1,492

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

1,492

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

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

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART IV	SCCH HAD LOBBYING EXPENSES OF 1,492 WHICH REPRESENTS THE PORTION OF DUES PAID TO VIRGINIA HOSPITAL AND HEALTHCARE ASSOCIATION ATTRIBUTABLE TO DIRECT LOBBYING.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

SMYTH COUNTY COMMUNITY HOSPITAL

Employer identification number

54-0794913

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

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? ...........

Yes No

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? ............................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, 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" on Form 990, Part IV, line 8.

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 XIII, the text of the footnote to its financial statements that describes these items.

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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII 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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on 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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. 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 ...	2,123,969		2,123,969
b	Buildings	57,302,945	9,407,223	47,895,722
c	Leasehold improvements	72,169	67,909	4,260
d	Equipment ...	59,545,343	45,678,996	13,866,347
e	Other ...	783,432	640,884	142,548
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				64,032,846

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. 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)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
RESERVE FOR PROF. LIABILITIES	379,740
OTHER LONG-TERM LIABILITIES	19,024
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	398,764
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	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 XIII.) ...........	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 XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 XIII.) ............	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 XIII.) ............	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 XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

SCHEDULE D, PAGE 3, PART X

"THE ALLIANCE IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3)OF THE INTERNAL REVENUE CODE. AS SUCH, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE ALLIANCE AND ITS TAX-EXEMPT SUBSIDIARIES. THE ALLIANCE'S TAXABLE SUBSIDIARIES ARE DISCUSSED IN NOTE L. THE ALLIANCE HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS AT JUNE 30, 2016 AND 2015. AT JUNE 30, 2016, TAX RETURNS FOR 2013 THROUGH 2015 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE."

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

SMYTH COUNTY COMMUNITY HOSPITAL

Employer identification number

54-0794913

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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, as a factor in determining eligibility for free or discounted care.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	447,823		447,823	0.920 %
b	Medicaid (from Worksheet 3, column a) . . . . .	4,844,777	2,681,003	2,163,774	4.440 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	5,292,600	2,681,003	2,611,597	5.350 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	293,607		293,607	0.600 %
f	Health professions education (from Worksheet 5) . . .	573,441	4,717	568,724	1.170 %
g	Subsidized health services (from Worksheet 6) . . . .	5,927,204	3,956,679	1,970,525	4.040 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	10,554		10,554	0.020 %
j	Total. Other Benefits . .	6,804,806	3,961,396	2,843,410	5.830 %
k	Total. Add lines 7d and 7j .	12,097,406	6,642,399	5,455,007	11.180 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

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
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

5,294,035

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

3,326,075

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

13,216,018

Enter Medicare allowable costs of care relating to payments on line 5.....

13,837,312

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-621,294

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—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) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	SMYTH COUNTY COMMUNITY HOSPITAL PO BOX 880 MARION,VA24354 WWW.MOUNTAINSTATESHEALTH.COM H 1902	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	SMYTH COUNTY COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.MOUNTAINSTATESHEALTH.COM

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 16

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SMYTH COUNTY COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000% and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWWMOUNTAINSTATESHEALTHCOM

The FAP application form was widely available on a website (list url):

WWWMOUNTAINSTATESHEALTHCOM

A plain language summary of the FAP was widely available on a website (list url):
WWWMOUNTAINSTATESHEALTHCOM

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	SMYTH COUNTY COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual 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? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
FACILITY 1, SMYTH COUNTY COMMUNITY HOSPITAL - PART V, LINE 5	MSHA MET WITH TEN FOCUS GROUPS, EACH REPRESENTING ONE OF THE THIRTEEN HOSPITAL FACILITIES, INCLUDING SCCH. EACH GROUP CONSISTED OF PUBLIC HEALTH LEADERS, NURSES, NON-PROFIT DIRECTORS, COMMUNITY DEVELOPERS, FAITH BASED LEADERS, PUBLIC OFFICIALS AND SCHOOL REPRESENTATIVES. SPECIFIC TO SCCH, THE GROUP CONSISTED OF REPRESENTATIVES FROM THE SMYTH COUNTY SCHOOL BOARD, MOUNT ROGERS HEALTH DEPARTMENT, SMYTH COUNTY PUBLIC SCHOOLS, SMYTH COUNTY COMMUNITY HOSPITAL, AND THE TOWN OF CHILHOWIE. EACH GROUP RANGED IN ATTENDANCE FROM 5 TO 18 INDIVIDUALS. PARTICIPANTS WERE GIVEN SURVEYS TO DETERMINE A COUNTY'S PERCEIVED HEALTH STATUS RATING, AVAILABLE RESOURCES, TOP HEALTH PRIORITIES (DISEASE CONDITIONS, HEALTH BEHAVIORS, AND SOCIOECONOMIC FACTORS), AND SUGGESTIONS FOR IMPROVEMENT. OPEN DISCUSSION FOLLOWED. THE COLLECTED INFORMATION WAS THEN PAIRED WITH STATISTICAL DATA IN ORDER TO PRIORITIZE HEALTH NEEDS. THE FACILITY COMMUNITY BOARDS (SUCH AS SCCH'S BOARD) WERE PRESENTED THIS INFORMATION AND SHARED THEIR THOUGHTS AS WELL ON THE HEALTH NEEDS TO PRIORITIZE. THE SPECIFIC NEEDS FOR EACH COUNTY WERE THEN ADDRESSED IN THE RESPECTIVE FACILITY IMPLEMENTATION PLAN WHICH WAS ADOPTED SEVERAL MONTHS LATER.
FACILITY 1, SMYTH COUNTY COMMUNITY HOSPITAL - PART V, LINE 6A	EACH HOSPITAL WITHIN THE MSHA SYSTEM COMPLETED A CHNA. SCCH'S CHNA WAS CONDUCTED WITH ALL MSHA HOSPITALS TO INCLUDE: JOHNSON CITY MEDICAL CENTER (INCLUDES NISWONGER CHILDREN'S HOSPITAL AND WOODRIDGE HOSPITAL), FRANKLIN WOODS COMMUNITY HOSPITAL, INDIAN PATH MEDICAL CENTER, SYCAMORE SHOALS HOSPITAL, JOHNSON COUNTY COMMUNITY HOSPITAL, UNICOI COUNTY MEMORIAL HOSPITAL, RUSSELL COUNTY MEDICAL CENTER, JOHNSTON MEMORIAL HOSPITAL, NORTON COMMUNITY HOSPITAL AND DICKENSON COMMUNITY HOSPITAL.
FACILITY 1, SMYTH COUNTY COMMUNITY HOSPITAL - PART V, LINE 11	MSHA PUBLISHED ITS COMMUNITY HEALTH NEEDS ASSESSMENT ON JUNE 29, 2015. THE DATA INCLUDED WAS COLLECTED OVER THE COURSE OF 2014 AND 2015. DUE TO LIMITED RESOURCES, EACH FACILITY PRIORITIZED FOUR TO FIVE HEALTH PRIORITIES ON WHICH TO FOCUS AND DEVELOP IMPLEMENTATION PLANS TO IMPACT. THERE WERE SEVEN COMMON HEALTH PRIORITIES SELECTED BY THE VARIOUS 11 FACILITIES, BUT NOT ALL FACILITIES SELECTED THE SAME AREAS. THE SEVEN ARE OBESITY, SUBSTANCE/PRESCRIPTION DRUG ABUSE, DIABETES, CANCER, HEART DISEASE, SMOKING AND MENTAL HEALTH. ALL OF THESE ARE SIGNIFICANT ISSUES FOR ALL 11 FACILITIES, BUT EACH CHOSE TO PRIORITIZE ON A DIFFERENT SET SO THEY COULD TARGET THEIR EFFORTS AND BE MORE EFFECTIVE WITH LIMITED RESOURCES. FOR EXAMPLE, WHILE NEARLY ALL THE FACILITIES IDENTIFIED OBESITY (11 OF 11) AND SUBSTANCE/ PRESCRIPTION DRUG ABUSE (10 OF 11), ONLY CERTAIN FACILITIES ELECTED TO FOCUS ON SOME NUMBER OF THE OTHER FIVE COMMON HEALTH PRIORITIES. WHILE MENTAL HEALTH IS CLEARLY A SIGNIFICANT ISSUE FOR ALL 11 FACILITIES, ONLY THREE ARE FOCUSED ON IT DUE TO LIMITED RESOURCES. THE SAME IS TRUE WITH SMOKING WHERE ONLY 5 OF THE 11 FACILITIES ARE FOCUSED ON IT, BUT IT IS AN ISSUE FOR ALL FACILITIES. SIX OF THE 11 FACILITIES SELECTED CANCER; 6 OF THE 11 SELECTED HEART DISEASE; AND 9 OF THE 11 CHOSE DIABETES. ANOTHER WAY TO STATE THIS IS BY FACILITY. FOR EXAMPLE, WHILE CANCER AND MENTAL HEALTH ARE PREVALENT CHALLENGES FOR JCMC'S PRIMARY SERVICE AREA, THE HOSPITAL ELECTED NOT TO FOCUS ON THOSE DUE TO LIMITED TIME, FUNDING, PERSONNEL AND OTHER RESOURCES NEEDED TO EFFECTUATE CHANGE. UCMH FELT IT WAS UNABLE TO ADDRESS HEART DISEASE, SMOKING, AND MENTAL HEALTH ISSUES IN ITS PRIMARY SERVICE AREA. SOME FACILITIES IDENTIFIED ISSUES SUCH AS TRANSPORTATION AND EDUCATION AS BARRIERS TO GOOD HEALTH, BUT WERE ALSO UNABLE TO SET ASIDE SUFFICIENT RESOURCES TO MEANINGFULLY IMPACT THOSE CHALLENGES. AFTER THE FACILITIES SELECTED A REASONABLE NUMBER OF HEALTH PRIORITIES THEY FELT THEY COULD ADEQUATELY IMPACT, AN IMPLEMENTATION PLAN WAS CREATED FOR EACH HOSPITAL, AND EACH HOSPITAL'S BOARD APPROVED THE IMPLEMENTATION PLAN DURING THE MONTHS OF NOVEMBER AND DECEMBER 2015. MSHA ANNUALLY TRACKS PROGRESS OF IMPLEMENTATION STRATEGIES FOR EACH HOSPITAL. THE FACILITIES HAVE BEEN CONDUCTING ACTIVITIES CONSISTENT WITH THEIR RESPECTIVE IMPLEMENTATION PLANS. FOR EXAMPLE, SCCH SPONSORS THE LOCAL COMMUNITY ACTION NETWORK AND PROVIDES NUTRITIONAL AND WELLNESS INFORMATION TARGETING OBESITY. RCMC SUPPORTS THE RUSSELL COUNTY SCHOOL BACKPACK PROGRAM WHICH PROVIDES HEALTHY FOOD FOR KIDS IN NEED TO HELP ADDRESS CHILDHOOD OBESITY. JMH SUPPORTS THE LOCAL MORNING MILE PROGRAM WHICH IS A SCHOOL BASED PROGRAM IN WHICH KIDS ARRIVE AT SCHOOL EARLY AND PARTICIPATE IN A SUPERVISED WALK OR RUN FOR A MILE. FWCH PROVIDES COOKING AND PHYSICAL ACTIVITY CLASSES TO THE COMMUNITY TO ADDRESS OBESITY AND DIABETES. UCMH PARTNERS WITH THE LOCAL YMCA TO PROVIDE DIABETES EDUCATION CLASSES AND SUPPORT FOR THE COMMUNITY. IPMC HAS BEEN SUPPORTING SUGAR FREE INITIATIVES AT THE LOCAL BOYS AND GIRLS CLUB TO HELP REDUCE OBESITY IN CHILDREN. JCCH MEETS WITH LOCAL SCHOOLS TO PROVIDE EDUCATION ON THE DANGERS OF SMOKING. THESE ARE JUST A FEW EXAMPLES OF THE EFFORTS MADE BY MSHA HOSPITALS TO SUPPORT THEIR IMPLEMENTATION PLANS.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. 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?1
Name and address		Type of Facility (describe)
1	FRANCIS MARION MANOR HEALTH & REHABILITATION 100 FRANCIS MARION LANE MARION,VA24354	NURSING HOME
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE	FINANCIAL ASSISTANCE APPROVAL CAN APPLY TO AN ASSORTMENT OF PATIENTS SUCH AS THOSE WHO HAVE EXHAUSTED THEIR MEDICAID BENEFITS, THOSE WHO QUALIFIED FOR MEDICAID AFTER THE DATE OF SERVICE, DECEASED PATIENTS WITH NO ESTATE OR ASSETS, UNINSURED PATIENTS, AND UNDERINSURED PATIENTS. MSHA CHARITY QUALIFICATION IS BASED ON FEDERAL POVERTY GUIDELINES BUT ALSO USES ASSET VALUES TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY. CHARITY APPROVAL COVERS ALL DATES OF SERVICE FOR THE PATIENT WHEN THEY ARE APPROVED AND THERE IS NO LIMITATION OR CAP ON THE AMOUNT OF CHARITY THAT THEY CAN RECEIVE. MSHA ALWAYS ATTEMPTS TO FULFILL ITS OBLIGATION TO PROVIDE FINANCIAL ASSISTANCE TO THOSE PATIENTS WITHOUT THE ABILITY TO PAY. THE MAJORITY OF MSHA HOSPITALS ARE LOCATED IN TENNESSEE AND PURSUANT TO TENNESSEE LAW ALL PATIENTS WITHOUT THIRD-PARTY PAYER COVERAGE RECEIVE A DISCOUNT OF 67%, WITH THE EXCEPTION OF CRITICAL ACCESS HOSPITALS THAT RECEIVE 58%. THIS IS A CALCULATED DISCOUNT THAT IS UPDATED ON AN ANNUAL BASIS. ALTHOUGH VIRGINIA DOES NOT HAVE A LAW THAT REQUIRES HOSPITALS TO PROVIDE DISCOUNTS TO UNINSURED PATIENTS, MSHA EXTENDS THESE UNINSURED DISCOUNTS TO ITS VIRGINIA HOSPITALS AS WELL, INCLUDING SCCH.
PART I, LINE 6A - RELATED ORGANIZATION INFORMATION	MSHA'S COMMUNITY BENEFIT REPORT COMPLETED IN FY15 INCLUDED SCCH. OUR NEXT COMMUNITY BENEFIT REPORT WILL BE ISSUED DURING FY17.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION	THE COST TO CHARGE RATIO (WORKSHEET 2 "RATIO OF PATIENT CARE COST TO CHARGES") WAS USED TO CALCULATE LINE 7A FINANCIAL ASSISTANCE COST. OUR COST ACCOUNTING SYSTEM PROVIDED MEDICAID/TENNCARE LOSSES REPORTED ON LINE 7B, WITH THE EXCEPTION OF HOME HEALTH AND OUR PHYSICIAN CLINICS. WE USED COST TO CHARGE RATIOS FOR HOME HEALTH AND OUR SMALL PHYSICIAN CLINICS BECAUSE THEIR DATA ARE NOT AVAILABLE IN OUR COST ACCOUNTING SOFTWARE. THE PHYSICIAN CLINICS' MEDICAID LOSS WAS 14,776. LINE 7E COMMUNITY HEALTH IMPROVEMENT INCLUDES COSTS THAT ARE TAKEN DIRECTLY FROM DEPARTMENTAL OPERATING REPORTS, WITH NO ADDITIONAL OVERHEAD INCLUDED IN THE COST. LINE 7F HEALTH PROFESSIONS EDUCATION IS COMPRISED OF INTERNSHIPS (NURSING, THERAPY, EMT, PHARMACY, AND SOCIAL WORK STUDENTS) FROM AREA SCHOOLS AND UNIVERSITIES, ALLOWING THEIR HEALTH PROFESSION STUDENTS TO GET HANDS-ON TRAINING AT A HOSPITAL AS PART OF THEIR EDUCATION AND TRAINING. OUR ORGANIZATIONAL DEVELOPMENT DEPARTMENT KEEPS DETAILED RECORDS OF HOURS SPENT ON THESE STUDENT ACTIVITIES, THE NUMBER OF STUDENTS THAT ROTATE THROUGH OUR HOSPITAL, ETC. INFORMATION IS MAINTAINED FOR EACH HOSPITAL UNIT THAT PARTICIPATES. WE ONLY INCLUDE LABOR COSTS AND WE ONLY ASSUME A PERCENTAGE OF OUR INVOLVED TEAM MEMBERS' TIME IS DEVOTED TO THESE STUDENTS. NEW IN FY16 IS A MEDICARE-APPROVED CERTIFIED NURSE ASSISTANT PROGRAM. FOR LINE 7G SUBSIDIZED HEALTH SERVICES, WE USE OUR COST ACCOUNTING SYSTEM, EXCEPT FOR OUR RURAL PHYSICIAN CLINICS. WE ARE CAREFUL TO ENSURE NO DOUBLE COUNTING OF COST (FOR EXAMPLE, WE DO NOT INCLUDE CHARITY AND MEDICAID/TENNCARE ALREADY REPORTED ON LINES 7A AND 7B). AND, PURSUANT TO IRS INSTRUCTIONS, WE DO NOT INCLUDE BAD DEBT LOSSES. ALTHOUGH WE HAVE MANY SERVICE LINES WITHIN OUR HOSPITAL THAT LOSE MONEY, WE DO NOT REPORT SERVICES THAT HOSPITALS ARE REQUIRED BY STATE LICENSURE TO PROVIDE OR SERVICES READILY AVAILABLE IN OUR AREA. FOR THE SERVICE LINES WE DO REPORT, SUCH AS OUTPATIENT REHABILITATION, WE USED OUR COST ACCOUNTING SYSTEM SINCE THESE PARTICULAR SERVICES HAVE ESTABLISHED, STANDARD FINANCIAL REPORTS. THE HOSPITAL SUBSIDIZED TWO CLINICS OWNED AND OPERATED BY SCCH. THE CLINICS ARE LOCATED IN RURAL, MEDICALLY UNDERSERVED AREAS. WE INCLUDED THE HOSPITAL'S 246,920 SUBSIDY IN LINE 7G. LINE 7I CASH AND IN-KIND CONTRIBUTIONS INCLUDE IN-KIND DONATIONS OF MEDICATIONS AND SUPPLIES TO LOCAL NONPROFIT RESCUE SQUADS. IN-KIND DONATIONS OF MEDICATIONS ARE BASED ON OUR ACTUAL COST FOR THESE ITEMS.
PART II - COMMUNITY BUILDING ACTIVITIES	SCCH LEADERS SUPPORT AND ENCOURAGE ALL TEAM MEMBERS TO VOLUNTEER TIME, MONEY AND SKILLS TO COMMUNITY SERVICE PROJECTS AND CHARITABLE ORGANIZATIONS. SENIOR LEADERS AND BOARD MEMBERS SET A POSITIVE EXAMPLE FOR TEAM MEMBERS, SERVING VOLUNTARILY ON COMMITTEES AND BOARDS OF LOCAL SERVICE AND NONPROFIT ORGANIZATIONS. SOME ALSO SERVE AS MEMBERS AND CONSULTANTS ON PROFESSIONAL COMMITTEES AND TASK FORCES THAT AFFECT REGIONAL DEVELOPMENT IN HEALTHCARE AND EDUCATION. WE DO NOT CAPTURE COSTS ASSOCIATED WITH TEAM MEMBERS THAT SERVE ON OTHER NONPROFIT BOARDS OR PROVIDE SERVICES TO OTHER NONPROFITS. SCCH, IN COLLABORATION WITH AREA HEALTH AGENCIES AND PROVIDERS, MAY OFFER ASSISTANCE WITH COORDINATION, ADVOCACY, OR CONTRIBUTE SUPPLIES TO SUPPORT GROUPS FOR THEIR PROGRAM ACTIVITIES THAT SERVE TO ASSIST SPECIAL POPULATIONS WITHIN OUR AREA. MOST OF THESE ORGANIZATIONS WORK TO IMPROVE THE LIVES OF COMMUNITY MEMBERS THAT HAVE LIMITED, OR NO, FINANCIAL RESOURCES.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY	SELF-PAY BALANCES INCLUDE ACCOUNTS AFTER PAYMENTS AND CONTRACTUAL ADJUSTMENTS (DISCOUNTS) HAVE BEEN POSTED FROM ALL THIRD-PARTY PAYERS- GENERALLY LEAVING THE PATIENT RESPONSIBLE FOR ANY REMAINING DEDUCTIBLE AND/OR CO-PAYMENT. OTHER SELF-PAY ACCOUNTS ARE FROM PATIENTS WITH NO INSURANCE OR OTHER THIRD-PARTY COVERAGE. AFTER THE NORMAL COLLECTION PROCESS HAS INDICATED AN ACCOUNT IS UNCOLLECTIBLE, SCCH WRITES THE ACCOUNT OFF TO BAD DEBT. THE HOSPITAL'S OVERALL SELF-PAY ACCOUNTS RECEIVABLE BALANCE IS EVALUATED ON AN ONGOING BASIS TO GATHER HISTORICAL INFORMATION TO APPLY TO THE CURRENT BALANCE. IN OTHER WORDS, THE HOSPITAL EVALUATES PAST COLLECTION HISTORY ON ACCOUNTS WRITTEN OFF TO BAD DEBT AND APPLIES THE HISTORICAL UNPAID RATE TO THE CURRENT SELF-PAY ACCOUNTS RECEIVABLE BALANCE.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE	SCCH'S PATIENT FINANCIAL SERVICES MANAGEMENT ESTIMATE THAT 63% OF BAD DEBT EXPENSE IS ASSUMED ATTRIBUTABLE TO PATIENTS LIKELY ELIGIBLE FOR FINANCIAL ASSISTANCE. WE BASE THIS PERCENTAGE ON THE COMPOSITION OF BAD DEBTS ATTRIBUTABLE TO PEOPLE WITH NO FORM OF INSURANCE OR OTHER THIRD-PARTY COVERAGE, WHICH REPRESENTS THE MAJORITY OF BAD BEBT ACCOUNTS. WE ALSO ESTIMATE A MUCH SMALLER PERCENTAGE OF LIKELY CHARITY-ELIGIBLE ACCOUNTS TO PEOPLE WITH BALANCES AFTER INSURANCE/THIRD-PARTY COVERAGE HAS PAID (E.G. DEDUCTIBLES AND CO-PAYMENT BALANCES). IT IS IMPLAUSIBLE TO DETERMINE WITH EXACTITUDE THE AMOUNT OF SCCH'S BAD DEBT ASSOCIATED WITH THOSE PATIENTS WHO MAY HAVE MET THE CRITERIA SET FORTH IN OUR FINANCIAL ASSISTANCE POLICY WITHOUT HAVING A COMPLETED FINANCIAL ASSESSMENT. WE ARE UNABLE TO DETERMINE OUR PATIENTS' FINANCIAL CIRCUMSTANCES UNLESS A COMPLETED FINANCIAL ASSISTANCE FORM IS VOLUNTARILY PROVIDED TO US. WE CAN ASSERT THAT 95% OF OUR PATIENTS WHO COMPLETED OUR FINANCIAL ASSISTANCE APPLICATION WERE APPROVED FOR AT LEAST PARTIAL FINANCIAL ASSISTANCE. IN FACT 83% OF COMPLETED APPLICATIONS RECEIVED A COMPLETE WRITE-OFF OF ALL CHARGES (FREE CARE). ANOTHER 12% RECEIVED A PARTIAL DISCOUNT. DURING FY16, ONLY 5% OF COMPLETED FINANCIAL ASSISTANCE APPLICATIONS WERE DENIED. UNFORTUNATELY, 33% OF SUBMITTED APPLICATIONS ARE INCOMPLETE. WE RETURN INCOMPLETE APPLICATIONS TO PATIENTS ALONG WITH A NOTICE OF MISSING INFORMATION. THE NOTICE ALSO PROVIDES A CONTACT PHONE NUMBER PATIENTS MAY CALL. WE HAVE MANY INSTANCES OF PATIENTS WITH LARGE ACCOUNT BALANCES AND NO HEALTH INSURANCE COVERAGE THAT WE ARE SURE WOULD QUALIFY FOR CHARITY CARE. ALTHOUGH HOSPITAL TEAM MEMBERS ENCOURAGE THESE INDIVIDUALS TO COMPLETE OUR FINANCIAL ASSISTANCE APPLICATION, MANY WILL NOT DO SO. EVEN WHEN THESE INDIVIDUALS ARE TOLD WE FEEL SURE THEY DO QUALIFY FOR FULL OR PARTIAL ASSISTANCE, THEY STILL FAIL TO COMPLETE OUR FINANCIAL ASSISTANCE APPLICATION.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS	THE TEXT OF MSHA'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE APPEARS ON PAGE 13 IN OUR MOST RECENT AUDITED FINANCIAL STATEMENTS (ATTACHED).
PART III, LINE 8 - MEDICARE EXPLANATION	MEDICARE ALLOWABLE COSTS ARE REPORTED USING SCCH'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP-DOWN ALLOCATION METHODOLOGY. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE SUCH AS TRANSPORTATION OF A PATIENT AND COMFORT ITEMS TO INCLUDE A TELEVISION AND A TELEPHONE. THE RECRUITMENT OF PHYSICIANS AND PHYSICIAN GUARANTEES ARE NON-ALLOWED COSTS BY THE MEDICARE PROGRAM EVEN THOUGH PHYSICIANS ARE RECRUITED BASED ON DOCUMENTED COMMUNITY NEED. ALSO, A PORTION OF THE BAD DEBT ASSOCIATED WITH THE CARE OF THE PATIENT IS NOT AN ALLOWED COST BY MEDICARE. MEDICARE LOSSES, INCLUDING SOME NON-ALLOWABLE COSTS SUCH AS THOSE NOTED ABOVE, SHOULD BE COUNTED AS A COMMUNITY BENEFIT AS THIS IS THE COST OF CARE FOR SERVING THE AGING POPULATION. WHILE WE AGREE THAT COSTS SUCH AS MARKETING TO ATTRACT PATIENTS AND LOBBYING ARE REASONABLE TO EXCLUDE, IT DOES NOT SEEM REASONABLE TO EXCLUDE RECRUITMENT OF PHYSICIANS AND BASIC ITEMS SUCH AS TELEVISIONS IN PATIENT ROOMS. AS A NONPROFIT ORGANIZATION, WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF THE COMMUNITY AND THE INDIVIDUAL WHILE MAINTAINING A HIGH LEVEL OF HEALTH CARE SERVICES WITHOUT LOSSES. SINCE LOSSES DO OCCUR THROUGH THE CMS SYSTEM OF REIMBURSEMENT, THESE LOSSES ARE A COST OF DOING BUSINESS FOR OUR COMMUNITY AND SHOULD BE CONSIDERED A COMMUNITY BENEFIT. AS A PARTICIPATING PROVIDER IN THE MEDICARE PROGRAM, SCCH IS REQUIRED TO PROVIDE THE FULL REGIMEN OF CARE FOR OUR MEDICARE POPULATION. THERE ARE A NUMBER OF CARE REGIMENS THAT ARE COMPENSATED BY THE MEDICARE PROGRAM AT LEVELS BELOW OUR COST. THEREFORE, IT IS ONLY LOGICAL TO ALLOW HOSPITALS TO REPORT THESE UNCOMPENSATED SERVICES AS A COMMUNITY BENEFIT. BY MAKING THIS CHANGE, NONPROFIT PROVIDERS WILL BE ENCOURAGED TO SUSTAIN IMPORTANT CARE DELIVERY MODELS FOR OUR AGING POPULATION IN SPITE OF THE FACT IT IS SOMETIMES ECONOMICALLY INJURIOUS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION SCCH HAS ESTABLISHED A STRONG COMMITMENT TO MEET THE MEDICAL NEEDS OF THE COMMUNITIES WE SERVE. ALL REQUESTS FOR FINANCIAL ASSISTANCE ARE EVALUATED USING ESTABLISHED GENERAL GUIDELINES, WHILE ALLOWING FOR UNIQUE FINANCIAL CIRCUMSTANCES. SMYTH COUNTY COMMUNITY HOSPITAL RECOGNIZES ITS OBLIGATION TO PROVIDE QUALITY HEALTH CARE TO THOSE WHO ARE UNABLE TO PAY. SCCH CHARITY GUIDELINES ARE BASED ON THE NATIONAL POVERTY GUIDELINES. HOWEVER, FINANCIAL ASSISTANCE IS NOT BASED SOLELY ON INCOME. UNIQUE FINANCIAL CIRCUMSTANCES ARE CONSIDERED, WHICH CAN CHANGE THE CATEGORY OF ELIGIBILITY. IN ADDITION, CHARITY DETERMINATION MAY BE RETROACTIVE FOR ALL DATES OF SERVICE. WHEN A PATIENT REQUESTS FINANCIAL ASSISTANCE OR WHEN AN APPLICATION HAS BEEN RECEIVED, THE PATIENT ACCOUNT IS PLACED IN A HOLD STATUS TO PREVENT FURTHER COLLECTION ACTIVITIES UNTIL FINANCIAL ASSISTANCE ELIGIBILITY IS DETERMINED.
PART VI, LINE 2 - NEEDS ASSESSMENT	MSHA INCLUDED AMERICA'S HEALTH RANKINGS (AHR) IN ITS ASSESSMENT IN ORDER TO BETTER DEFINE THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. IN 2016, VIRGINIA'S OVERALL HEALTH RANKING MOVED UP TO 19TH, WHILE TENNESSEE IS RANKED 44TH. HOWEVER, IT SHOULD BE NOTED THAT SOUTHWEST VIRGINIA (WHERE SCCH IS LOCATED) CLOSELY RESEMBLES THE HEALTH RANKINGS FOR TENNESSEE. AMERICA'S HEALTH RANKINGS ARE BASED ON A SERIES OF MEASURES INCLUDING SEVERAL HEALTH OUTCOMES AND HEALTH FACTORS. A SURVEY WAS GIVEN TO 106 INDIVIDUALS REPRESENTING THE TEN COUNTIES IN WHICH MSHA OWNS A FACILITY. THESE INDIVIDUALS INCLUDED PHYSICIANS, PUBLIC HEALTH LEADERS, NON-PROFIT DIRECTORS, SCHOOL NURSES AND OFFICIALS, AND BUSINESS LEADERS. A SURVEY WAS GIVEN TO EACH INDIVIDUAL SEEKING FEEDBACK REGARDING AVAILABLE RESOURCES IN EACH AREA, THE PERCEIVED HEALTH STATUS, HEALTH PRIORITIES (DISEASE CONDITIONS, HEALTH BEHAVIORS AND SOCIOECONOMIC FACTORS), AND SUGGESTIONS FOR IMPROVEMENT. THE MAJORITY OF RESPONSES SUGGESTED FOCUSING ON EDUCATION IN ORDER TO PROMOTE HEALTHY HABITS AND INCREASED ACCESS TO RESOURCES. OTHER RESPONSES INCLUDED: MAKE PHYSICAL EDUCATION A REQUIREMENT AS PART OF SCHOOL CURRICULUM, IMPROVE NATURAL TRAILS AND WALKWAYS, INCREASE COMMUNITY SUPPORT FOR SMOKE-FREE AREAS, PARTNER WITH LOCAL FARMER'S MARKETS, SHARE HEALTH INFORMATION BETWEEN PHARMACIES, NETWORK WITH SMALL BUSINESSES AND NONPROFITS IN ORDER TO AVOID DUPLICATING RESOURCES, AND PROVIDE EARLY SCREENINGS FOR THE UNINSURED OR UNDERINSURED. OVERALL, THE COMMUNITY MEMBERS GAVE MSHA'S CORE SERVICE AREA A HEALTH STATUS RANKING OF 4.55 OUT OF 10 (1 BEING THE LOWEST, 10 BEING THE HIGHEST). SCCH WAS GIVEN A HEALTH STATUS RANKING OF 5.0. AMONG THE 106 PARTICIPANTS, THE AREAS OF OBESITY, CANCER, HEART DISEASE, SMOKING, SUBSTANCE/PRESCRIPTION DRUG ABUSE, AND DIABETES WERE THE TOP HEALTH PRIORITIES IN OUR REGION. ACCORDING TO THE MOST RECENT AHR REPORTS, VIRGINIA AND TENNESSEE BOTH SAW AN INCREASE IN DIABETES AND OBESITY WITHIN THE PAST TEN YEARS. VIRGINIA RANKS 25TH FOR CARDIOVASCULAR DEATHS, 23RD FOR CANCER DEATHS AND 28TH FOR DIABETES. THE ROBERT WOOD JOHNSON FOUNDATION REPORTS 27% OF OUR COUNTY'S ADULTS ARE CONSIDERED OBESE AND PHYSICALLY INACTIVE. SMYTH COUNTY'S HEALTH RANKING IS 100 OUT OF 134 STATEWIDE (1 BEING THE BEST AND 134 BEING THE WORST).
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	MOUNTAIN STATES HEALTH ALLIANCE COMMUNICATES WITH AND EDUCATES OUR PATIENTS THROUGH VARIOUS AVENUES FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND HOSPITAL FINANCIAL ASSISTANCE. EDUCATION IS PROVIDED TO PATIENTS THROUGH SIGNAGE AND FINANCIAL ASSISTANCE BROCHURES AT ALL HOSPITAL AND AMBULATORY ADMISSION LOCATIONS. FINANCIAL ASSISTANCE APPLICATIONS AND PLAIN LANGUAGE SUMMARIES ARE PROVIDED TO PATIENTS SHOULD THEY REQUEST ONE DURING THEIR PRE- REGISTRATION, REGISTRATION OR FINANCIAL COUNSELING PROCESS. OUR GOVERNMENTAL PROGRAM ELIGIBILITY REPRESENTATIVES ASSIST PATIENTS IN SECURING ELIGIBILITY FOR MEDICAID, FEDERAL DISABILITY AND OTHER GOVERNMENTAL ASSISTANCE PROGRAMS. ADDITIONALLY, IF A PATIENT OR COMMUNITY RESIDENT EXPRESSES AN INTEREST IN THE ACA-HEALTHCARE EXCHANGE, OUR REPRESENTATIVES HAVE THE QUALIFICATIONS AND EXPERIENCE TO ASSIST THEM THROUGH THE ENTIRE PROCESS. FINANCIAL COUNSELORS OFFER FINANCIAL ASSISTANCE APPLICATIONS TO PATIENTS WHO DO NOT QUALIFY FOR GOVERNMENTAL ASSISTANCE PROGRAMS AND ARE UNABLE TO PAY FOR THE COST OF THEIR HEALTHCARE. FINANCIAL ASSISTANCE APPLICATIONS ARE AVAILABLE ON OUR WEBSITE TO INCLUDE THE FINANCIAL ASSISTANCE APPLICATION, POLICY AND PLAIN LANGUAGE SUMMARY IN BOTH ENGLISH AND SPANISH. ALL PATIENT STATEMENTS HAVE VERBIAGE DISCUSSING FINANCIAL ASSISTANCE ALONG WITH THE CONTACT INFORMATION. OUR LAST LETTER TO THE PATIENT DISPLAYS THE PLAIN LANGUAGE SUMMARY. IN ALL ORAL CORRESPONDENCES WITH THE PATIENT, IF IT IS IDENTIFIED THEY CANNOT MEET THE PAYMENT REQUIREMENTS ON THEIR ACCOUNT, FINANCIAL ASSISTANCE IS DISCUSSED AS AN OPTION.
PART VI, LINE 4 - COMMUNITY INFORMATION	SCCH IS LOCATED IN THE TOWN OF MARION, SMYTH COUNTY, WHICH IS IN RURAL SOUTHWEST VIRGINIA. SOUTHWEST VIRGINIA (SWVA) IS LOCATED WITHIN THE APPALACHIAN MOUNTAINS, SPECIFICALLY THE BLUE RIDGE MOUNTAIN REGION. SWVA IS CONSIDERED RURAL AND MUCH DIFFERENT THAN THE REST OF THE STATE. SWVA HAS BEEN AND REMAINS A MAJOR COAL MINING REGION AND HAS A HIGH RATE OF INDIVIDUALS WHO ARE UNINSURED. ACCORDING TO U.S. CENSUS BUREAU ESTIMATES, THE TOWN OF MARION HAS A POPULATION OF APPROXIMATELY 5,970, WHILE SMYTH COUNTY'S POPULATION IS JUST OVER 32,000. THE LATEST CENSUS BUREAU DATA ESTIMATES THE MEDIAN AGE OF RESIDENTS OF SMYTH COUNTY IS 44.3 WHICH IS OLDER THAN THE MEDIAN AGE OF 37.6 IN VIRGINIA. THE BUREAU ESTIMATES SMYTH COUNTY MEDIAN HOUSEHOLD INCOME AT 37,983 COMPARED TO 65,015 FOR THE STATE OF VIRGINIA. 27% OF SMYTH COUNTY'S CHILDREN LIVE IN POVERTY COMPARED TO 16% STATEWIDE. SMYTH COUNTY'S HEALTH OUTCOMES RANK 100 OUT OF 134 IN THE STATE.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH	SCCH IS DEDICATED TO OPERATING EFFICIENTLY SO THAT WASTE IS MINIMIZED. OPERATING SURPLUSES ARE INVESTED INTO IMPROVING TREATMENT OPTIONS FOR OUR PATIENTS THROUGH NEW TECHNOLOGIES, RECRUITING PHYSICIANS AND OTHER HEALTH PROFESSIONALS IN SHORTAGE AREAS, AND IMPROVING OUR FACILITIES AND EQUIPMENT. VARIOUS CHECKS AND BALANCES ARE ESTABLISHED TO ENSURE THAT EXPENDITURES FOR OPERATING EXPENSES AND CAPITAL COSTS ARE REASONABLE AND NECESSARY. THE MAJORITY OF SCCH'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREAS. THERE ARE FOUR DIRECTORS DEEMED NON-INDEPENDENT, PER IRS INSTRUCTIONS. ONE IS SCCH'S CFO, RESPONSIBLE FOR BOTH SCCH AND JOHNSTON MEMORIAL HOSPITAL (JMH), A RELATED ORGANIZATION. ONE MEMBER IS AN EMPLOYEE OF MSHA, A RELATED ORGANIZATION. A THIRD IS A PHYSICIAN EMPLOYED BY MSMG, A RELATED ORGANIZATION. THE FOURTH DIRECTOR IS A PHYSICIAN EMPLOYED BY MSMG, A RELATED ORGANIZATION, AND HE ALSO HAS INTEREST IN A COMPANY THAT PROVIDES SERVICES TO SCCH, WITH ALL TRANSACTIONS CONDUCTED AT ARMS LENGTH. PHYSICIANS THAT REQUEST PRIVILEGES WHO ARE QUALIFIED AND CREDENTIALED ARE EXTENDED PRIVILEGES BY SCCH.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM	SCCH IS A 44-BED, ACUTE-CARE FACILITY OPERATED UNDER THE DIRECTION OF A 12-MEMBER BOARD OF DIRECTORS PRIMARILY COMPRISED OF LOCAL COMMUNITY RESIDENTS. SCCH IS MAJORITY OWNED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA) BASED IN JOHNSON CITY, TENNESSEE, THE LARGEST REGIONAL HEALTHCARE SYSTEM WITH 13 HOSPITALS. MSHA PROVIDES CARE TO PEOPLE IN 29 COUNTIES IN TENNESSEE, VIRGINIA, KENTUCKY, AND NORTH CAROLINA. SCCH SERVES AS ITS COUNTY'S PRIMARY HEALTH SERVICE PROVIDER. PATIENTS BENEFIT FROM SCCH'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. IF NEEDED, PATIENTS CAN BE MOVED TO THE SYSTEM'S FLAGSHIP FACILITY, JOHNSON CITY MEDICAL CENTER, WHICH IS A TERTIARY CARE FACILITY PROVIDING ADVANCED TREATMENT OPTIONS. MSHA HOSPITALS WORK CLOSELY WITH ONE ANOTHER TO SHARE EXPERTISE AND RESOURCES. FOR EXAMPLE, JMH ASSISTED SCCH ESTABLISH A DIABETES CENTER. JMH'S CENTER HAS BEEN OPERATIONAL FOR MANY YEARS SO THE EXPERIENCED CLINICAL TEAM AT JMH PROVIDED VALUABLE INSIGHT THAT SAVED SCCH TIME, MONEY, AND MISTAKES. THERE ARE MANY OTHER EXAMPLES OF SHARED EXPERTISE AND SERVICES BETWEEN MSHA FACILITIES - LABORATORY, CARDIAC SERVICES, ADMINISTRATIVE, ETC. AND, AS NOTED EARLIER, TWO OF SCCH'S BOARD MEMBERS HAVE SHARED RESPONSIBILITIES BETWEEN SCCH AND JMH.
PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT	VIRGINIA

Schedule H (Form 990) 2015

Additional Data

Software ID:
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- TIN:

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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
SMYTH COUNTY COMMUNITY HOSPITAL

Employer identification number
54-0794913

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC 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) LINCOLN THEATRE
117 E MAIN STREET
MARION,VA24354

54-1477479

501C3

5,500

SPONSORSHIP

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated 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)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference

Explanation

SCHEDULE I, PAGE 1, PART I, LINE 2

SCCH CHARITABLE DONATIONS REQUIRE FINAL APPROVAL BY THE CEO. DURING PART OF THE YEAR, WE ENCOURAGED DONATION REQUESTS TO BE COMPLETED USING OUR ONLINE DONATION APPLICATION FORM, BUT WE ACCEPTED DONATION REQUESTS IN THE FORM OF LETTERS WHEN AN ADEQUATE EXPLANATION FOR THE REQUEST WAS PROVIDED IN THE LETTER. IN ORDER TO IMPROVE THE OVERALL EFFICIENCY OF CONTRIBUTION REQUEST EVALUATION, WE CHANGED OUR PROCESS SO THAT ALL REQUESTS ARE NOW REQUIRED TO BE COMPLETED USING THE ONLINE APPLICATION FORM. THE ONLINE FORM PROVIDES CONSISTENCY AMONG APPLICANTS AND GIVES US THE INFORMATION WE NEED IN ORDER TO MAKE A FULLY VETTED FUNDING DECISION. SOME OF THE INFORMATION WE REQUIRE FROM APPLICANTS INCLUDES: IF THE APPLICANT IS REQUESTING FUNDING FOR A SPECIFIC EVENT OR PROGRAM, THE DATE, LOCATION, AND TIME ARE REQUIRED DESCRIPTION OF THE EVENT/PROGRAM APPLICANTS OTHER SOURCES OF INCOME EVENT/PROGRAM BUDGET HOW THE EVENT/PROGRAM SUPPORTS SCCH'S MISSION WHO WILL BENEFIT FROM OUR CONTRIBUTION WHAT WILL THE EVENT/PROGRAM ACCOMPLISH APPLICANT ORGANIZATION'S MISSION STATEMENT YEAR THE APPLICANT ORGANIZATION WAS FOUNDED NUMBER OF PEOPLE SERVED ANNUALLY BY THE APPLICANT APPLICANT'S WEBSITE TAX STATUS OF THE APPLICANT AND FEDERAL TAXPAYER ID NUMBER WITH FEW EXCEPTIONS, DONATIONS TO NATIONAL ORGANIZATIONS ARE HANDLED AT MSHA'S CORPORATE LEVEL, WHICH PREVENTS MULTIPLE CONTRIBUTIONS BEING MADE TO THE SAME NATIONAL ORGANIZATION AND ALLOWS ADDITIONAL CONTRIBUTION DOLLARS TO BE USED FOR REGION-SPECIFIC REQUESTS. DONATIONS FROM MSHA HOSPITALS, INCLUDING SCCH, ARE ALMOST ENTIRELY DIRECTED TO LOCAL NONPROFIT ORGANIZATIONS. MSHA'S SOCIAL RESPONSIBILITY COMMITTEE, WHICH PROVIDES SYSTEM-WIDE GUIDANCE, IS COMPRISED OF COMMUNITY LEADERS INCLUDING THE DEAN OF A LOCAL UNIVERSITY, THE PRESIDENT OF A LOCAL COLLEGE, UNITED WAY OF WASHINGTON COUNTY'S PRESIDENT, COMMUNITY VOLUNTEERS, BUSINESS LEADERS, MOUNTAIN STATES FOUNDATION'S PRESIDENT, MSHA'S PRESIDENT AND CEO, AND OTHERS. COMMITTEE MEMBERS WERE SELECTED SO THAT MEMBERSHIP EXPERTISE INCLUDES PUBLIC HEALTH, HEALTH PROFESSIONS EDUCATION, KNOWLEDGE OF OTHER RESOURCES AVAILABLE TO CHARITABLE ORGANIZATIONS, AND INDIVIDUALS WITH HANDS-ON COMMUNITY VOLUNTEER EXPERIENCE. SOME OF THE ROUTINE ACTIVITIES OF THE COMMITTEE DURING QUARTERLY MEETINGS INCLUDE: QUARTERLY REVIEW OF THE SOCIAL RESPONSIBILITY SCORECARD; A MEASUREMENT OF ACTUAL ACCOMPLISHMENTS IN THE YEAR COMPARED TO TARGETS SET AT THE BEGINNING OF THE YEAR REVIEW OF CHARITABLE CONTRIBUTION GIVING FOR THE PREVIOUS QUARTER THIS YEAR, THE COMMITTEE BEGAN WORK TO DEVELOP A SOCIAL RESPONSIBILITY BUSINESS PLAN OPPORTUNITY FOR LOCAL TAX EXEMPT ORGANIZATIONS TO PRESENT TO THE COMMITTEE PROGRAMS THEY OFFER, ACHIEVEMENTS, AND FUNDING NEEDS THE COMMITTEE MAY OR MAY NOT RECOMMEND MSHA CORPORATE/HOSPITAL FUNDING OF PROGRAMS SOMETIMES, MSHA DEPARTMENTS WILL BRING PROPOSALS FOR NEW PROGRAMS TO BENEFIT A SPECIFIC POPULATION, SUCH AS CHILDREN

Schedule I (Form 990) 2015

Additional Data

Software ID:
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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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

SMYTH COUNTY COMMUNITY HOSPITAL

Employer identification number

54-0794913

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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 of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used 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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization?

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

Any related organization? .........................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on 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 ............

Were any amounts reported on 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 .............................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 (E) amounts for that individual.

(A) Name and Title		(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 in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1TONY KECK MSHA SVPDIRECTOR	(i) (ii)	------------- 361,624	------------- 84,485	------------- 4,914	------------- 34,596	------------- 14,884	------------- 498,087	-------------
2ERIC SACKNOFF MD MSMG PHYSICIANDIRECTOR	(i) (ii)	------------- 426,356	-------------	------------- 16,017	------------- 12,773	------------- 20,283	------------- 474,819	-------------
3SEAN MCMURRAY JMH CEODIRECTOR	(i) (ii)	------------- 302,663	------------- 71,472	------------- 11,855	------------- 31,719	------------- 23,005	------------- 437,180	-------------
4JOHN JETER JMHSCCH CFO SECRETARY	(i) (ii)	------------- 176,353	------------- 37,433	------------- 3,898	------------- 8,555	------------- 18,399	------------- 244,207	-------------
5ANTHONY CLARYMDMSMG PHYSICIANDIRECTOR	(i) (ii)	------------- 174,061	-------------	------------- 1,623	------------- 5,452	------------- 19,960	------------- 200,666	-------------
6JAMES TYLERSCCH CEO	(i) (ii)	------------- 187,683	------------- 51,134	------------- 7,227	-------------	------------- 18,305	------------- 262,502	-------------
7CATHY MAINEASSOC. ADMIN. & CNO	(i) (ii)	------------- 144,405	------------- 27,253	------------- 2,109	------------- 5,895	------------- 5,110	------------- 184,544	-------------
8BELDON FLEMINGPHARMACY MANAGER	(i) (ii)	------------- 142,376	------------- 1,544	------------- 78	------------- 8,910	------------- 22,906	------------- 175,594	-------------
9BRUCE BRIGGSPHARMACIST	(i) (ii)	------------- 124,769	------------- 613	------------- 15	------------- 7,851	------------- 21,624	------------- 154,802	-------------
10RAMZI K HUMSI MDMSMG PHYSICIAN	(i) (ii)	------------- 234,316	------------- 5,233	------------- 10,962	------------- 7,319	------------- 15,262	------------- 272,896	-------------
11LINDA WHITE CEO FWCHWRFORMER SCCH CEO	(i) (ii)	------------- 261,240	------------- 54,065	------------- 10,478	------------- 28,850	------------- 20,812	------------- 372,085	-------------

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

SCHEDULE J, PAGE 1, PART I, LINE 4

TONY KECK, MSHA SVP 0 34,596 0 SEAN MCMURRAY, JMH CEO 0 14,925 0 LINDA WHITE, CEO FWCH/WR 0 12,840 0

SCHEDULE J, PART III

PART I, LINE 4B SEAN MCMURRAY, TONY KECK, AND LINDA WHITE PARTICIPATED IN A 457(F) RETIREMENT PLAN PROVIDED BY MOUNTAIN STATES HEALTH ALLIANCE (MSHA). THE 457(F)PLAN IS A NONQUALIFIED TAX-DEFERRED COMPENSATION PLAN AVAILABLE TO A SELECT GROUP OF KEY EXECUTIVES FOR THE INTENT OF SUPPORTING RETENTION AND TO OFFER A COMPETITIVE TOTAL RETIREMENT PROGRAM. ACCOUNT BALANCES HAVE A "SUBSTANTIAL RISK OF FORFEITURE". IN ADDITION TO CREDITOR RISK, SUBSTANTIAL RISK OF FORFEITURE IS CREATED THROUGH DEFAULT RISK IF THE PARTICIPANT'S EMPLOYMENT WITH MSHA IS TERMINATED PRIOR TO AGE 65. HOWEVER, THE 457(F) PLAN CONTAINS A NON-COMPETE PROVISION THAT PROVIDES THE ACCOUNT BALANCE TO BE PAID IN A LUMP SUM AFTER THE EXECUTIVE SATISFIES THE TWO-YEAR NON- COMPETE PERIOD. THIS PROVISION APPLIES TO EMPLOYER CONTRIBUTIONS IF THE EXECUTIVE HAS PROVIDED ELIGIBLE SERVICE FOR SIX OR MORE YEARS. (ELIGIBLE SERVICE IS OFFICER SERVICE THAT PERMITTED THE EXECUTIVE TO PARTICIPATE IN THE PLAN.) THE EXECUTIVE WILL RECEIVE THE ENTIRE ACCOUNT BALANCE IF HE/SHE BECOMES DISABLED, DIES OR IF THE EXECUTIVE TERMINATES FOR "GOOD REASON- OR IS INVOLUNTARILY TERMINATED WITHOUT "GOOD CAUSE" WITHIN A 24-MONTH PERIOD AFTER A CHANGE-OF-CONTROL OCCURS. DISTRIBUTIONS FROM THIS PLAN ARE SUBJECT TO FEDERAL, STATE, AND LOCAL TAXES ON THE ENTIRE ACCOUNT BALANCE UPON DISTRIBUTION.

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

SMYTH COUNTY COMMUNITY HOSPITAL

Employer identification number

54-0794913

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No










Total ............... $

Part III

Grants or Assistance Benefiting 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 assistance	(d) Type of assistance	(e) Purpose of assistance

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) UMS UROLOGY SERVICES OF SMYTH CO	VENDOR	107,703	SEE PART V		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation
SCHEDULE L, PART V	ERIC SACKNOFF, M.D., BOARD MEMBER OF SCCH, HAS PARTNERSHIP INTEREST IN UMS UROLOGY SERVICES OF SMYTH COUNTY (UMS). UMS PROVIDES UROLOGY SERVICES TO SCCH. TRANSACTIONS ARE CONDUCTED AT ARMS-LENGTH.

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

SMYTH COUNTY COMMUNITY HOSPITAL

Employer identification number

54-0794913

Return Reference	Explanation
FORM 990 - ORGANIZATION'S MISSION	PART I, LINE I - ORGANIZATION'S MISSION: SMYTH COUNTY COMMUNITY HOSPITAL (SCCH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH.
FORM 990, PAGE 2, PART III, LINE 4A	(CONTINUED)FOR THE YEAR ENDING JUNE 30, 2016, SCCH RECORDED 1,560 INPATIENT HOSPITAL ADMISSIONS AND 287 NURSING HOME ADMISSIONS. THERE WERE 81,023 OUTPATIENT VISITS, 17,545 EMERGENCY VISITS AND 13,625 HOME HEALTH VISITS. SCCH IS ON THE FRONT LINES IN THE BATTLE AGAINST PRESCRIPTION DRUG ABUSE. THE HOSPITAL HAS PARTNERED WITH EAST TENNESSEE STATE UNIVERSITY'S BILL GATTON COLLEGE OF PHARMACY TO CREATE A PHARMACY TASK FORCE. THE GROUP INCLUDES SCCH MEDICAL STAFF, MSHA PHARMACISTS, AND PHARMACISTS FROM THE COMMUNITY. DRUG ABUSE IN SMYTH COUNTY IS A SIGNIFICANT PROBLEM SO GETTING TOGETHER THE PHYSICIANS WHO WRITE PRESCRIPTIONS WITH THE PHARMACISTS WHO FILL THE PRESCRIPTIONS, THE PROBLEM CAN BE ADDRESSED WITH MUTUAL DIALOGUE. THE PHARMACY TAX FORCE IS FOCUSED ON PRESCRIPTION DRUG ABUSE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THE HOSPITAL SUBSIDIZES TWO PHYSICIAN PRACTICES LOCATED IN RURAL, MEDICALLY UNDERSERVED AREAS. THESE CLINICS ALLOW RESIDENTS TO RECEIVE QUALITY CARE WITHOUT HAVING TO TRAVEL OUTSIDE OF THEIR HOME AREA. THIS IS ESPECIALLY IMPORTANT FOR ELDERLY RESIDENTS AND OTHERS THAT REQUIRE FAMILY OR FRIENDS TO PROVIDE TRANSPORTATION TO PHYSICIAN APPOINTMENTS. OUR COST DURING THE YEAR TO SUBSIDIZE THE TWO CLINICS WAS JUST UNDER 247,000. THE HOSPITAL CONTINUES THE VALUE OPTIMIZATION SYSTEM (VOS), A PRACTICE THAT USES THE "LEAN" PHILOSOPHY THAT LOOKS AT WORKDAY PROCESSES AND LOCATES WASTEFUL ACTIVITY. AFTER IDENTIFYING WASTE, WAYS ARE IDENTIFIED TO ELIMINATE THE WASTE. THE END RESULT FOR A HOSPITAL IS TO FREE UP MORE TIME TO SPEND WITH PATIENTS RATHER THAN DOING UNNECESSARY THINGS. DURING THE YEAR, SCCH CONDUCTED NINE VOS EVENTS. SEVERAL OF THE PROJECTS RESULTED IN BETTER PATIENT CARE AND IMPROVED PATIENT SATISFACTION, AS MEASURED BY PATIENT SURVEYS CONDUCTED BY AN OUTSIDE, INDEPENDENT FIRM. SOME OF THE MEASUREABLE IMPROVEMENTS INCLUDED: NURSE-PATIENT COMMUNICATION, PHYSICIAN- PATIENT COMMUNICATION, AND INFORMATION PROVIDED TO PATIENTS AT DISCHARGE. AT FRANCIS MARION MANOR (FMM), OUR NURSING HOME, VOS TEAMS WERE ABLE TO ACHIEVE A NUMBER OF SUCCESSES, SUCH AS: REDUCING THE NUMBER OF PATIENT FALLS, URINARY TRACT INFECTIONS, THE USE OF HYPNOTIC MEDICATIONS, AND EXCESSIVE WEIGHT LOSS. ANOTHER FMM IMPROVEMENT DURING THE YEAR WAS A SHARP DECLINE (70%) IN THE NUMBER OF TEAM MEMBER CALL-INS (ABSENTEEISM OR LATE FOR WORK). SCCH SERVES AS A CLINICAL TRAINING FACILITY FOR HEALTH PROFESSIONAL EDUCATION STUDENTS. WE HAVE DEDICATED STAFF TO WORK WITH REGIONAL COLLEGES AND UNIVERSITIES TO COORDINATE THE PLACEMENT OF HEALTHCARE PROFESSIONAL STUDENTS AS PART OF THEIR EDUCATIONAL CURRICULUM. IN ADDITION TO CLINICAL TRAINING, THE HEALTH CARE STUDENTS ENTERING OUR SYSTEM ARE REQUIRED TO HAVE ORIENTATION AND COMPUTER TRAINING. INCLUDED IN THE NUMBER OF PARTICIPANTS RECEIVING CLINICAL EXPERIENCE AT SCCH WERE 74 NURSING STUDENTS FROM VARIOUS COLLEGES, UNIVERSITIES AND PROGRAMS, A 23% INCREASE OVER PRIOR YEAR. IN ADDITION TO THE INCREASED NUMBER OF STUDENTS RECEIVING TRAINING IN OUR HOSPITALS, THE HOURS DEVOTED TO EACH STUDENT ALSO INCREASED. THIS NURSING CLINICAL EXPERIENCE REQUIRED EXTENSIVE SCCH NURSING STAFF INVOLVEMENT. THE CLINICAL SETTING AND HANDS-ON INSTRUCTION COST SCCH 196,538. SCCH PROVIDED A CLINICAL SETTING FOR ANOTHER 72 STUDENTS TRAINING IN HEALTH-RELATED PROGRAMS SUCH AS PHARMACY, SOCIAL WORK, OT/PT, EMT/PARAMEDIC AND OTHER ALLIED-HEALTH DISCIPLINES, A MORE THAN FOURFOLD INCREASE OVER PRIOR YEAR. NOT ONLY DID THE NUMBER OF STUDENTS INCREASE, BUT THE NUMBER OF HOURS DEVOTED TO EACH STUDENT INCREASED. THE INCREASED HOURS PER STUDENT WAS PREDOMINANTLY RELATED TO MORE STUDENTS IN PROGRAMS THAT REQUIRE MUCH LONGER HOSPITAL EXPERIENCE/TRAINING. THESE ADDITIONAL CLINICAL STUDENTS COST SCCH 315,009. SCCH'S NURSING CARE FACILITY, FRANCIS MARION MANOR, CONTINUES TO OFFER A SUCCESSFUL PROGRAM TO TRAIN CERTIFIED NURSE ASSISTANTS. THIS YEAR, OUR CERTIFIED NURSE ASSISTANT (CNA) PROGRAM WAS APPROVED BY MEDICARE AS AN ALLIED HEALTH EDUCATION PROGRAM. IN ORDER TO QUALIFY AS A MEDICARE-APPROVED PROGRAM, A PROVIDER MUST INCUR THE COSTS ASSOCIATED WITH BOTH THE CLINICAL AND THE CLASSROOM INSTRUCTION PORTIONS OF THE PROGRAM, MUST CONTROL THE PROGRAM CURRICULUM AND ADMINISTRATIVE DUTIES, MUST EMPLOY THE FACULTY, AND MUST CONTROL THE CLASSROOM INSTRUCTION AND CLINICAL TRAINING. IN ADDITION, THE PROGRAM MUST BE RECOGNIZED BY A NATIONAL APPROVING BODY OR STATE LICENSING ORGANIZATION. WE OFFER THE CNA PROGRAM FREE OF CHARGE AND PARTICIPANTS ARE UNDER NO OBLIGATION TO WORK FOR SCCH OR ANOTHER MSHA FACILITY UPON COMPLETION OF THE PROGRAM. BASED ON COMMUNITY NEED, SCCH INCURRED DIRECT EXPENSE OF 265,895 TO RECRUIT PHYSICIANS INTO OUR COMMUNITY. IN ADDITION, MSHA CORPORATE ALLOCATES A PORTION OF ITS PHYSICIAN RECRUITMENT DEPARTMENTAL EXPENSES TO ITS HOSPITALS, INCLUDING SCCH, SINCE THE CORPORATE DEPARTMENT SERVICES ALL MSHA DIVISIONS. PHYSICIANS ARE RECRUITED TO REPLACE PHYSICIANS THAT RETIRE OR LEAVE THE AREA. RECRUITMENT EXPENSE DURING FY16 INCLUDED RECRUITMENT FOR EMERGENCY MEDICINE, PRIMARY CARE, GENERAL SURGERY, AND A HOSPITALIST. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. A PORTION OF OUR RECRUITMENT IS PHYSICIAN DEBT FORGIVEN BY THE HOSPITAL OVER A PERIOD OF YEARS SO LONG AS THE PHYSICIAN REMAINS IN OUR COMMUNITY AND CONTINUES PROVIDING MEDICAL SERVICES TO OUR RESIDENTS. WITH A DONATION FROM SMYTH COUNTY HOSPITAL HEALTHTRUST, RENOVATION OF THE REGIONAL CANCER CENTER AT SCCH MADE TREATMENT EASIER AND MORE EFFICIENT FOR CANCER PATIENTS. THE RENOVATION INVESTMENT ENABLED THE HOSPITAL TO PROVIDE ESSENTIAL CANCER TREATMENT THAT PATIENTS PREVIOUSLY HAD TO LEAVE THE AREA TO RECEIVE. THE PROJECT ALLOWED DIFFERENT ELEMENTS OF CARE TO BE CONSOLIDATED SO PATIENTS ARE ABLE TO CHECK IN, SEE THEIR PROVIDER AND RECEIVE INFUSION OR CHEMOTHERAPY SERVICES WITHIN THE SAME AREA. THE RENOVATED SPACE INCLUDES A SUITE WITH EXAM ROOMS AND NURSING AREA, A WORK SPACE FOR THE CENTER'S PHYSICIAN AND NURSE PRACTITIONER, CANCER NAVIGATORS, SOCIAL WORKER AND DIETICIAN. THE NEW SPACE IS MORE CONVENIENT AND COMFORTABLE FOR OUR PATIENTS, WHO ARE OFTEN WEAK AND TIRED, TO BE SEEN IN ONE LOCATION. CHARITY AND OTHER UNREIMBURSED COSTS: WHILE REIMBURSEMENT FOR HEALTHCARE SERVICES RENDERED IS CRITICAL TO THE OPERATION AND SUSTAINABILITY OF THE ORGANIZATION, SCCH RECOGNIZES ITS OBLIGATION TO PROVIDE FREE OR DISCOUNTED CARE TO INDIVIDUALS WHO CANNOT AFFORD ESSENTIAL MEDICAL SERVICES, INCLUDING EMERGENCY CARE. A PATIENT IS DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE WHEN THEY MEET THE ESTABLISHED POLICIES OF SCCH AND GUIDELINES OUTLINED BY THE FEDERAL GOVERNMENT. IT IS NOT UNTIL AFTER VERIFICATION OF INCOME AND ASSETS THAT A DECISION REGARDING THE AMOUNT OF WRITE-OFF CAN BE MADE. IN FISCAL YEAR 2016, SCCH INCURRED A LOSS OF 448,039 ATTRIBUTABLE TO THE COSTS OF PROVIDING CARE TO PATIENTS APPROVED FOR FINANCIAL ASSISTANCE. SCCH PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS, SUCH AS MEDICAID, FOR LOW INCOME PEOPLE. SCCH INCURRED A LOSS OF 2.163,774 PROVIDING CARE TO THIS POPULATION OF PATIENTS DURING THE YEAR. SCCH PARTNERED WITH THE COMPANY ADVANCED PATIENT ADVOCACY TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. REPRESENTATIVES WERE AVAILABLE FOR OUR PATIENTS TO DETERMINE POSSIBLE GOVERNMENTAL MEDICAL ASSISTANCE ELIGIBILITY AND TO HELP WITH THE APPLICATION PROCESS AND FOLLOW-UP. 451 PATIENTS WERE APPROVED DURING FY16 FOR COVERAGE AND ONCE A PERSON IS APPROVED FOR MEDICAID THROUGH THIS PROGRAM OFFERED THROUGH SCCH, THEY RETAIN COVERAGE FOR FUTURE MEDICAL CARE. SCCH BEARS THE EXPENSE FOR THIS SERVICE, WHICH TOTALED 19,781 IN FY16. COMMUNITY DONATIONS: FOR MANY YEARS, SCCH HAS PROVIDED ASSISTANCE TO LOCAL NON-PROFIT LIFESAVING ORGANIZATIONS SUCH AS AMBULANCE SERVICES, FIRE DEPARTMENTS AND RESCUE SQUADS. SCCH DONATES FREE MEDICATIONS AND PHARMACEUTICAL SUPPLIES TO THESE ORGANIZATIONS. THE COST OF DONATED MEDICATIONS TO RESCUE ORGANIZATIONS DURING FY16 WAS MORE THAN 7,000. SCCH CONTRIBUTED TO LOCAL CHAPTERS OF NATIONAL NON-PROFIT ORGANIZATIONS WHOSE RESEARCH FOCUSES ON THOSE DISEASES AND CONDITIONS MOST PREVALENT IN THE REGION, INCLUDING AMERICAN HEART ASSOCIATION AND AMERICAN CANCER SOCIETY. WE ALSO SUPPORTED REMOTE AREA MEDICAL CLINICS THAT PROVIDE FREE DENTAL, VISION, AND MEDICAL CARE TO ISOLATED, IMPOVERISHED, OR UNDERSERVED COMMUNITIES; A LOCAL BLOOD DONATION ORGANIZATION; A LOCAL HEALTH WEEK EVENT; AND, A LITTLE LEAGUE FOR CHILDREN WITH DISABILITIES. CONSISTENT WITH PRIOR YEARS, WE WROTE OFF LAB CHARGES OF MORE THAN 24,000 RELATED TO LAB TESTS PERFORMED FOR A LOCAL FREE CLINIC. THE HOSPITAL SUPPORTED LOCAL PROGRAMS THAT ENHANCE THE QUALITY OF LIFE TO RESIDENTS, WHICH IS ALSO IMPORTANT IN THE RECRUITMENT EFFORTS OF BUSINESSES IN THE REGION TO ATTRACT AND RETAIN THE BEST TALENT. DONATIONS WERE MADE TO LINCOLN THEATRE AND MARION DOWNTOWN REVITALIZATION ASSOCIATION. SEVERAL SCCH TEAM MEMBERS SERVED AT THE REMOTE AREA MEDICAL (RAM) CLINIC HE
FORM 990, PART V	PART V, LINE 2A MSHA, SCCH'S MAJORITY OWNER, PROCESSES PAYROLL FOR SCCH. SCCH REIMBURSES MSHA FOR ALL SALARY AND BENEFITS RELATED TO OUR TEAM MEMBERS AND THE EXPENSE IS RECORDED ON SCCH'S BOOKS. SCCH OPERATES A RURAL HEALTH CLINIC. UNDER CURRENT CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) REGULATIONS GOVERNING STAFFING AT A RURAL HEALTH CLINIC, AT LEAST ONE MIDLEVEL PROVIDER (NURSE PRACTITIONER, PHYSICIAN ASSISTANT, ETC.) MUST BE A W-2 EMPLOYEE OF THE CLINIC. THEREFORE, SCCH PAYS ONE MIDLEVEL PROVIDER DIRECTLY (RATHER THAN MSHA PAYING THIS TEAM MEMBER'S SALARY WITH SCCH REIMBURSING MSHA).
FORM 990, PAGE 6, PART VI, LINE 6	MOUNTAIN STATES HEALTH ALLIANCE IS THE 80% MEMBER OF SMYTH COUNTY COMMUNITY HOSPITAL. SMYTH COUNTY COMMUNITY HOSPITAL FOUNDATION IS THE 20% MEMBER OF SMYTH COUNTY COMMUNITY HOSPITAL.
FORM 990, PAGE 6, PART VI, LINE 7A	THERE ARE TWO CLASSES OF MEMBERS, AND EACH CLASS IS ENTITLED TO ELECT A SPECIFIED NUMBER OF DIRECTORS TO THE BOARD. THE MOUNTAIN STATES HEALTH ALLIANCE (MSHA) CLASS IS ELECTED BY THE MSHA BOARD OF DIRECTORS AND THE SMYTH COUNTY COMMUNITY HOSPITAL CLASS IS ELECTED BY THE SMYTH COUNTY COMMUNITY HOSPITAL FOUNDATION BOARD OF DIRECTORS. NEITHER SIDE CAN VETO AN APPOINTMENT.
FORM 990, PAGE 6, PART VI, LINE 7B	CERTAIN DECISIONS OF THE BOARD ARE, PURSUANT TO CHARTER AND VIRGINIA STATUTE, SUBJECT TO APPROVAL OF THE MEMBERS. THESE DECISIONS INCLUDE: DISSOLUTION OF THE CORPORATION; MERGER OF THE CORPORATION; NON-ORDINARY COURSE OF BUSINESS SALE OF ASSETS; ETC. NO ORDINARY, DAY-TO-DAY DECISIONS ARE SUBJECT TO MEMBER APPROVAL.
FORM 990, PAGE 6, PART VI, LINE 11B	THE CFO REVIEWED THE FORM 990 WITH THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS AND THE RETURN WAS MADE AVAILABLE TO EACH BOARD MEMBER IN AN ELECTRONIC FORMAT PRIOR TO THE REVIEW.
FORM 990, PAGE 6, PART VI, LINE 12C	ANNUALLY, THE CORPORATE AUDIT AND COMPLIANCE DEPARTMENT OF MSHA FORWARDS THE CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM TO ALL MSHA MANAGEMENT TEAM MEMBERS AND BOARD MEMBERS INCLUDING THOSE AT SCCH. EMPLOYEES AND BOARD MEMBERS MUST NOTE ANY CONFLICTS OR ATTEST THEY HAVE "NONE", AND RETURN THE FORM TO THE AUDIT AND COMPLIANCE DEPARTMENT. ANY NOTED DISCLOSURES ARE FORWARDED TO THE APPROPRIATE MANAGEMENT OR BOARD PERSONNEL TO EVALUATE AND UTILIZE WHEN A TRANSACTION INVOLVING A CONFLICTED PERSON ARISES. ADDITIONALLY, PERSONNEL WHO HAVE A CONFLICT ARISE BETWEEN THE ANNUAL DISTRIBUTION OF THE POLICY AND FORMS ARE REQUIRED TO DISCLOSE THE CONFLICT AND WOULD BE DISCIPLINED IN ANY INSTANCE WHERE THEY HAVE NOT DISCLOSED AND ENGAGED IN A CONFLICTED TRANSACTION.
FORM 990, PAGE 6, PART VI, LINE 15A	MSHA'S HUMAN RESOURCE (H/R) DEPARTMENT EVALUATES SALARY AND BENEFITS FOR SCCH'S CEO ON AN ANNUAL OR NEAR-ANNUAL BASIS. H/R'S EVALUATION IS BASED ON MARKET DATA OBTAINED FROM INDEPENDENT THIRD-PARTY CONSULTANTS FOR POSITIONS WITH SIMILAR RESPONSIBILITIES AT SIMILARLY SITUATED ORGANIZATIONS. BASED ON THAT REVIEW, H/R MAKES A RECOMMENDATION TO MSHA'S PRESIDENT & CEO, WHO HAS FINAL APPROVAL FOR THE COMPENSATION OF SCCH'S CEO. IN ADDITION, MSHA OFFERS AN INCENTIVE PLAN TO EXECUTIVES BASED ON TARGETED ACHIEVEMENT METRICS SET IN ADVANCE OF THE PAY YEAR. ESTABLISHED METRICS INCLUDE: COMMUNICATION WITH PATIENTS, PATIENT EVIDENCE-BASED CARE SCORES AND PATIENT SAFETY, VALUE- BASED PURCHASING, ETC. THESE SAME METRICS ARE USED FOR ALL EMPLOYEES WITHIN MSHA, WITH A SMALL NUMBER OF EXCEPTIONS FOR OUR COMPANIES THAT DO NOT PROVIDE DIRECT PATIENT CARE.
FORM 990, PAGE 6, PART VI, LINE 15B	SIMILAR TO THE CEO'S COMPENSATION, THE CFO RECEIVES COMPENSATION AND BENEFITS THAT COMPLY WITH MSHA'S SALARY POLICY. HIS PAY IS SET AT A MARKET PERCENTILE SPECIFIC TO HIS POSITION.
FORM 990, PAGE 6, PART VI, LINE 19	GOVERNING DOCUMENTS AND OUR CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE UPON REQUEST TO APPROPRIATE PARTIES REQUESTING THEM. FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THOSE PARTIES WHO OWN INDEBTEDNESS OF THE COMPANY ON A QUARTERLY BASIS. FORM 990, PART VII - RELATED ORGANIZATIONS DIRECTOR COMPENSATION: HOSPITAL BOARD OF DIRECTORS MEMBERS JOHN JETER, SEAN MCMURRAY, AND ANTHONY CLARY, M.D. HAVE FORM 990 REPORTABLE COMPENSATION DERIVED FROM SERVICES THEY PROVIDE TO RELATED ORGANIZATIONS AND TO SCCH. TONY KECK HAS FORM 990 REPORTABLE COMPENSATION FOR SERVICES PROVIDED TO MSHA, A RELATED ORGANIZATION. ERIC SACKNOFF, M.D., HAS FORM 990 REPORTABLE COMPENSATION FOR SERVICES PROVIDED TO MSMG, A RELATED ORGANIZATION. NONE OF THEIR COMPENSATION IS RELATED TO THEIR BOARD SERVICE.
FORM 990, PART IX, LINE 11G	HOSPITAL SUPPORTED CLINICS 4,169,277 0 0 PHYSICIAN FEES 1,799,065 0 0 DIETARY FEES 1,497,399 0 0 LAUNDRY SERVICES 210,783 0 0 ENVIRONMENTAL SERVICES 0 134,277 0 LABORATORY SERVICES 68,421 0 0 OTHER 953,885 13,807 0 LITHOTRIPSY SERVICES 142,871 0 0 TRANSCRIPTION SERVICES 63,344 0 0 COLLECTION SERVICES 0 314,459 0 CONSULTING FEES 0 169,214 0
FORM 990, PART X	PART IV, LINE 24A AND PART X, LINE 20 - TAX EXEMPT BOND LIABILITY THE TAX EXEMPT BOND LIABILITY REFLECTS THE PORTION OF BONDS ISSUED BY MOUNTAIN STATES HEALTH ALLIANCE, SCCH'S MAJORITY OWNER, ON BEHALF OF SCCH FOR CAPITAL NEEDS. SCCH PAYS ALL COSTS RELATED TO THIS PORTION OF THE BOND ISSUE.
FORM 990, PART XI, LINE 9	CAPITAL CONTRIBUTION TO RELATED ORGANIZATION -110,118 TEMPORARILY RESTRICTED GRANTS -149 TOTAL -110,267

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

SMYTH COUNTY COMMUNITY HOSPITAL

Employer identification number

54-0794913

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) 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

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 entity?
(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	Yes	No
(1)MOUNTAIN STATES HEALTH ALLIANCE 400 N STATE OF FRANKLIN ROAD JOHNSON CITY,TN37604 62-0476282	HOSPITAL	TN	501C3	3	NA		No
(2)SMYTH COUNTY COMM FOUNDATION 1 HEALTH WAY MARION,VA24354 31-1650055	SUPPORT	VA	501C3	11A	NA		No
(3)NORTON COMMUNITY HOSPITAL 100 15TH STREET NORTHWEST NORTON,VA24273 54-0566029	HOSPITAL	VA	501C3	3	NA		No
(4)DICKENSON COMMUNITY HOSPITAL ONE HOSPITAL DRIVE CLINTWOOD,VA24238 77-0599553	HOSPITAL	VA	501C3	3	NCH		No
(5)JOHNSTON MEMORIAL HOSPITAL 16000 JOHNSTON MEMORIAL DRIVE ABINGDON,VA24211 54-0544705	HOSPITAL	VA	501C3	3	NA		No
(6)ABINGDON PHYSICIAN PARTNERS 16000 JOHNSTON MEMORIAL DRIVE ABINGDON,VA24211 20-5485346	MED. SERV.	VA	501C3	11A	JMH		No
(7)MOUNTAIN STATES FOUNDATION 2335 KNOB CREEK ROAD STE 101 JOHNSON CITY,TN37604 58-1418862	FUNDRAISER	TN	501C3	11A	MSHA		No
(8)MSHA AUXILIARY 400 N STATE OF FRANKLIN ROAD JOHNSON CITY,TN37604 58-1418345	SUPPORT	TN	501C3	11A	MSHA		No
(9)APPALACHIAN EMERGENCY PHYSICIANS 1021 W OAKLAND AVENUE STE 207 JOHNSON CITY,TN37604 80-0592504	MED. SERV	VA	501C3	11A	N/A		No
(10)NEWCO INC 211 COMMERCE ST STE 800 NASHVILLE,TN372011817 61-1771290	SUPP. ORG	TN	501C3	11B	NA		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2015

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	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) INTEGRATED SOLUTIONS HLTH NTWK LLC 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-1711997	INVESTMENT	TN	NA				No			No
(2) EMMAUS COMMUNITY HEALTHCARE PLLC 6070 HWY 11E PINEY FLATS,TN37686 20-0577483	MED. SERV.	TN	NA				No			No
(3) MEDICAL SPECIALISTS OF J C LLC 2528 WESLEY STREET SUITE 2 JOHNSON CITY,TN37604 27-2199037	MED. SERV.	TN	NA				No			No
(4) EAST TN AMBULATORY SURGERY CNTR 701 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-1787537	MED. SERV.	TN	NA				No			No

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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) BLUE RIDGE MEDICAL MANAGEMENT CORP 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY,TN37604 62-1490616	MED. SERV.	TN	NA	C CORP				No
(2) MEDISERVE MED EQUIP OF KINGSPORT 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY,TN37604 62-1212286	DME	TN	NA	C CORP				No
(3) MOUNTAIN STATES PROPERTIES 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY,TN37604 62-1845895	PROP MGMT	TN	NA	C CORP				No
(4) MOUNTAIN STATES PHYSICIANS GRP INC 1021 W OAKLAND AVENUE SUITE 207 JOHNSON CITY,TN37604 62-1700412	HEALTHCARE	TN	NA	C CORP				No
(5) COMMUNITY HOME CARE INC 1460 PARK AVENUE NORTON,VA24273 54-1453810	MED. EQUIP	TN	NA	C CORP				No
(6) WILSON PHARMACY INC PO BOX 5289 JOHNSON CITY,TN37602 62-0329587	PHARMACY	TN	NA	C CORP				No
(7) CRESTPOINT HEALTH INSURANCE CO INC 509 MED TECH PARKWAY SUITE 100 JOHNSON CITY,TN37604 62-0381170	INSURANCE	TN	NA	C CORP				No

Schedule R (Form 990) 2015

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

Yes

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2015

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: PART I, LINE I - ORGANIZATION'S MISSION: SMYTH COUNTY COMMUNITY HOSPITAL (SCCH) IS COMMITTED TO BRINGING LOVING CARE TO HEALTH CARE. WE EXIST TO IDENTIFY AND RESPOND TO THE HEALTH CARE NEEDS OF INDIVIDUALS AND COMMUNITIES IN OUR REGION AND TO ASSIST THEM IN ATTAINING THEIR HIGHEST POSSIBLE LEVEL OF HEALTH.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	1
6	Total number of volunteers (estimate if necessary) .............	6	54
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	74,922
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	21,692

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	15,712	287,543
9	Program service revenue (Part VIII, line 2g) .........	43,201,932	45,469,679
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,487,190	1,051,909
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	830,811	756,185
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	45,535,645	47,565,316
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	9,151	17,655
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	21,911,072	22,370,567
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	24,262,807	26,393,409
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	46,183,030	48,781,631
19	Revenue less expenses. Subtract line 18 from line 12.......	-647,385	-1,216,315
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	104,500,332	101,207,946
21	Total liabilities (Part X, line 26).............	22,377,677	21,294,182
22	Net assets or fund balances. Subtract line 21 from line 20.....	82,122,655	79,913,764

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 33,445,957 including grants of $ 17,655 ) (Revenue $ 38,955,151 )
	SMYTH COUNTY COMMUNITY HOSPITAL (SCCH) HAS A 55-PLUS YEAR HISTORY OF PROVIDING HEALTHCARE SERVICES WITHIN THE COMMUNITY OF MARION, VIRGINIA. SCCH IS A 44-BED COMMUNITY-BASED HOSPITAL THAT OFFERS BOTH ACUTE CARE AND INPATIENT REHABILITATION CARE. THE HOSPITAL PROVIDES COMPREHENSIVE OUTPATIENT SERVICES AND A VARIETY OF OUTREACH PROGRAMS SUCH AS HOMECARE. ADDITIONALLY, SCCH HAS A 109-BED NURSING CARE FACILITY, FRANCIS MARION MANOR HEALTH AND REHABILITATION (FMM). (CONTINUED ON SCHEDULE O) (CONTINUED)FOR THE YEAR ENDING JUNE 30, 2016, SCCH RECORDED 1,560 INPATIENT HOSPITAL ADMISSIONS AND 287 NURSING HOME ADMISSIONS. THERE WERE 81,023 OUTPATIENT VISITS, 17,545 EMERGENCY VISITS AND 13,625 HOME HEALTH VISITS. SCCH IS ON THE FRONT LINES IN THE BATTLE AGAINST PRESCRIPTION DRUG ABUSE. THE HOSPITAL HAS PARTNERED WITH EAST TENNESSEE STATE UNIVERSITY'S BILL GATTON COLLEGE OF PHARMACY TO CREATE A PHARMACY TASK FORCE. THE GROUP INCLUDES SCCH MEDICAL STAFF, MSHA PHARMACISTS, AND PHARMACISTS FROM THE COMMUNITY. DRUG ABUSE IN SMYTH COUNTY IS A SIGNIFICANT PROBLEM SO GETTING TOGETHER THE PHYSICIANS WHO WRITE PRESCRIPTIONS WITH THE PHARMACISTS WHO FILL THE PRESCRIPTIONS, THE PROBLEM CAN BE ADDRESSED WITH MUTUAL DIALOGUE. THE PHARMACY TAX FORCE IS FOCUSED ON PRESCRIPTION DRUG ABUSE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THE HOSPITAL SUBSIDIZES TWO PHYSICIAN PRACTICES LOCATED IN RURAL, MEDICALLY UNDERSERVED AREAS. THESE CLINICS ALLOW RESIDENTS TO RECEIVE QUALITY CARE WITHOUT HAVING TO TRAVEL OUTSIDE OF THEIR HOME AREA. THIS IS ESPECIALLY IMPORTANT FOR ELDERLY RESIDENTS AND OTHERS THAT REQUIRE FAMILY OR FRIENDS TO PROVIDE TRANSPORTATION TO PHYSICIAN APPOINTMENTS. OUR COST DURING THE YEAR TO SUBSIDIZE THE TWO CLINICS WAS JUST UNDER 247,000. THE HOSPITAL CONTINUES THE VALUE OPTIMIZATION SYSTEM (VOS), A PRACTICE THAT USES THE "LEAN" PHILOSOPHY THAT LOOKS AT WORKDAY PROCESSES AND LOCATES WASTEFUL ACTIVITY. AFTER IDENTIFYING WASTE, WAYS ARE IDENTIFIED TO ELIMINATE THE WASTE. THE END RESULT FOR A HOSPITAL IS TO FREE UP MORE TIME TO SPEND WITH PATIENTS RATHER THAN DOING UNNECESSARY THINGS. DURING THE YEAR, SCCH CONDUCTED NINE VOS EVENTS. SEVERAL OF THE PROJECTS RESULTED IN BETTER PATIENT CARE AND IMPROVED PATIENT SATISFACTION, AS MEASURED BY PATIENT SURVEYS CONDUCTED BY AN OUTSIDE, INDEPENDENT FIRM. SOME OF THE MEASUREABLE IMPROVEMENTS INCLUDED: NURSE-PATIENT COMMUNICATION, PHYSICIAN- PATIENT COMMUNICATION, AND INFORMATION PROVIDED TO PATIENTS AT DISCHARGE. AT FRANCIS MARION MANOR (FMM), OUR NURSING HOME, VOS TEAMS WERE ABLE TO ACHIEVE A NUMBER OF SUCCESSES, SUCH AS: REDUCING THE NUMBER OF PATIENT FALLS, URINARY TRACT INFECTIONS, THE USE OF HYPNOTIC MEDICATIONS, AND EXCESSIVE WEIGHT LOSS. ANOTHER FMM IMPROVEMENT DURING THE YEAR WAS A SHARP DECLINE (70%) IN THE NUMBER OF TEAM MEMBER CALL-INS (ABSENTEEISM OR LATE FOR WORK). SCCH SERVES AS A CLINICAL TRAINING FACILITY FOR HEALTH PROFESSIONAL EDUCATION STUDENTS. WE HAVE DEDICATED STAFF TO WORK WITH REGIONAL COLLEGES AND UNIVERSITIES TO COORDINATE THE PLACEMENT OF HEALTHCARE PROFESSIONAL STUDENTS AS PART OF THEIR EDUCATIONAL CURRICULUM. IN ADDITION TO CLINICAL TRAINING, THE HEALTH CARE STUDENTS ENTERING OUR SYSTEM ARE REQUIRED TO HAVE ORIENTATION AND COMPUTER TRAINING. INCLUDED IN THE NUMBER OF PARTICIPANTS RECEIVING CLINICAL EXPERIENCE AT SCCH WERE 74 NURSING STUDENTS FROM VARIOUS COLLEGES, UNIVERSITIES AND PROGRAMS, A 23% INCREASE OVER PRIOR YEAR. IN ADDITION TO THE INCREASED NUMBER OF STUDENTS RECEIVING TRAINING IN OUR HOSPITALS, THE HOURS DEVOTED TO EACH STUDENT ALSO INCREASED. THIS NURSING CLINICAL EXPERIENCE REQUIRED EXTENSIVE SCCH NURSING STAFF INVOLVEMENT. THE CLINICAL SETTING AND HANDS-ON INSTRUCTION COST SCCH 196,538. SCCH PROVIDED A CLINICAL SETTING FOR ANOTHER 72 STUDENTS TRAINING IN HEALTH-RELATED PROGRAMS SUCH AS PHARMACY, SOCIAL WORK, OT/PT, EMT/PARAMEDIC AND OTHER ALLIED-HEALTH DISCIPLINES, A MORE THAN FOURFOLD INCREASE OVER PRIOR YEAR. NOT ONLY DID THE NUMBER OF STUDENTS INCREASE, BUT THE NUMBER OF HOURS DEVOTED TO EACH STUDENT INCREASED. THE INCREASED HOURS PER STUDENT WAS PREDOMINANTLY RELATED TO MORE STUDENTS IN PROGRAMS THAT REQUIRE MUCH LONGER HOSPITAL EXPERIENCE/TRAINING. THESE ADDITIONAL CLINICAL STUDENTS COST SCCH 315,009. SCCH'S NURSING CARE FACILITY, FRANCIS MARION MANOR, CONTINUES TO OFFER A SUCCESSFUL PROGRAM TO TRAIN CERTIFIED NURSE ASSISTANTS. THIS YEAR, OUR CERTIFIED NURSE ASSISTANT (CNA) PROGRAM WAS APPROVED BY MEDICARE AS AN ALLIED HEALTH EDUCATION PROGRAM. IN ORDER TO QUALIFY AS A MEDICARE-APPROVED PROGRAM, A PROVIDER MUST INCUR THE COSTS ASSOCIATED WITH BOTH THE CLINICAL AND THE CLASSROOM INSTRUCTION PORTIONS OF THE PROGRAM, MUST CONTROL THE PROGRAM CURRICULUM AND ADMINISTRATIVE DUTIES, MUST EMPLOY THE FACULTY, AND MUST CONTROL THE CLASSROOM INSTRUCTION AND CLINICAL TRAINING. IN ADDITION, THE PROGRAM MUST BE RECOGNIZED BY A NATIONAL APPROVING BODY OR STATE LICENSING ORGANIZATION. WE OFFER THE CNA PROGRAM FREE OF CHARGE AND PARTICIPANTS ARE UNDER NO OBLIGATION TO WORK FOR SCCH OR ANOTHER MSHA FACILITY UPON COMPLETION OF THE PROGRAM. BASED ON COMMUNITY NEED, SCCH INCURRED DIRECT EXPENSE OF 265,895 TO RECRUIT PHYSICIANS INTO OUR COMMUNITY. IN ADDITION, MSHA CORPORATE ALLOCATES A PORTION OF ITS PHYSICIAN RECRUITMENT DEPARTMENTAL EXPENSES TO ITS HOSPITALS, INCLUDING SCCH, SINCE THE CORPORATE DEPARTMENT SERVICES ALL MSHA DIVISIONS. PHYSICIANS ARE RECRUITED TO REPLACE PHYSICIANS THAT RETIRE OR LEAVE THE AREA. RECRUITMENT EXPENSE DURING FY16 INCLUDED RECRUITMENT FOR EMERGENCY MEDICINE, PRIMARY CARE, GENERAL SURGERY, AND A HOSPITALIST. ALL PHYSICIAN RECRUITMENT ACTIVITIES ARE BASED ON DOCUMENTED COMMUNITY NEED. A PORTION OF OUR RECRUITMENT IS PHYSICIAN DEBT FORGIVEN BY THE HOSPITAL OVER A PERIOD OF YEARS SO LONG AS THE PHYSICIAN REMAINS IN OUR COMMUNITY AND CONTINUES PROVIDING MEDICAL SERVICES TO OUR RESIDENTS. WITH A DONATION FROM SMYTH COUNTY HOSPITAL HEALTHTRUST, RENOVATION OF THE REGIONAL CANCER CENTER AT SCCH MADE TREATMENT EASIER AND MORE EFFICIENT FOR CANCER PATIENTS. THE RENOVATION INVESTMENT ENABLED THE HOSPITAL TO PROVIDE ESSENTIAL CANCER TREATMENT THAT PATIENTS PREVIOUSLY HAD TO LEAVE THE AREA TO RECEIVE. THE PROJECT ALLOWED DIFFERENT ELEMENTS OF CARE TO BE CONSOLIDATED SO PATIENTS ARE ABLE TO CHECK IN, SEE THEIR PROVIDER AND RECEIVE INFUSION OR CHEMOTHERAPY SERVICES WITHIN THE SAME AREA. THE RENOVATED SPACE INCLUDES A SUITE WITH EXAM ROOMS AND NURSING AREA, A WORK SPACE FOR THE CENTER'S PHYSICIAN AND NURSE PRACTITIONER, CANCER NAVIGATORS, SOCIAL WORKER AND DIETICIAN. THE NEW SPACE IS MORE CONVENIENT AND COMFORTABLE FOR OUR PATIENTS, WHO ARE OFTEN WEAK AND TIRED, TO BE SEEN IN ONE LOCATION. CHARITY AND OTHER UNREIMBURSED COSTS: WHILE REIMBURSEMENT FOR HEALTHCARE SERVICES RENDERED IS CRITICAL TO THE OPERATION AND SUSTAINABILITY OF THE ORGANIZATION, SCCH RECOGNIZES ITS OBLIGATION TO PROVIDE FREE OR DISCOUNTED CARE TO INDIVIDUALS WHO CANNOT AFFORD ESSENTIAL MEDICAL SERVICES, INCLUDING EMERGENCY CARE. A PATIENT IS DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE WHEN THEY MEET THE ESTABLISHED POLICIES OF SCCH AND GUIDELINES OUTLINED BY THE FEDERAL GOVERNMENT. IT IS NOT UNTIL AFTER VERIFICATION OF INCOME AND ASSETS THAT A DECISION REGARDING THE AMOUNT OF WRITE-OFF CAN BE MADE. IN FISCAL YEAR 2016, SCCH INCURRED A LOSS OF 448,039 ATTRIBUTABLE TO THE COSTS OF PROVIDING CARE TO PATIENTS APPROVED FOR FINANCIAL ASSISTANCE. SCCH PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS, SUCH AS MEDICAID, FOR LOW INCOME PEOPLE. SCCH INCURRED A LOSS OF 2.163,774 PROVIDING CARE TO THIS POPULATION OF PATIENTS DURING THE YEAR. SCCH PARTNERED WITH THE COMPANY ADVANCED PATIENT ADVOCACY TO WORK WITH SELF-PAYING PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. REPRESENTATIVES WERE AVAILABLE FOR OUR PATIENTS TO DETERMINE POSSIBLE GOVERNMENTAL MEDICAL ASSISTANCE ELIGIBILITY AND TO HELP WITH THE APPLICATION PROCESS AND FOLLOW-UP. 451 PATIENTS WERE APPROVED DURING FY16 FOR COVERAGE AND ONCE A PERSON IS APPROVED FOR MEDICAID THROUGH THIS PROGRAM OFFERED THROUGH SCCH, THEY RETAIN COVERAGE FOR FUTURE MEDICAL CARE. SCCH BEARS THE EXPENSE FOR THIS SERVICE, WHICH TOTALED 19,781 IN FY16. COMMUNITY DONATIONS: FOR MANY YEARS, SCCH HAS PROVIDED ASSISTANCE TO LOCAL NON-PROFIT LIFESAVING ORGANIZATIONS SUCH AS AMBULANCE SERVICES, FIRE DEPARTMENTS AND RESCUE SQUADS. SCCH DONATES FREE MEDICATIONS AND PHARMACEUTICAL SUPPLIES TO THESE ORGANIZATIONS. THE COST OF DONATED MEDICATIONS TO RESCUE ORGANIZATIONS DURING FY16 WAS MORE THAN 7,000. SCCH CONTRIBUTED TO LOCAL CHAPTERS OF NATIONAL NON-PROFIT ORGANIZATIONS WHOSE RESEARCH FOCUSES ON THOSE DISEASES AND CONDITIONS MOST PREVALENT IN THE REGION, INCLUDING AMERICAN HEART ASSOCIATION AND AMERICAN CANCER SOCIETY. WE ALSO SUPPORTED REMOTE AREA MEDICAL CLINICS THAT PROVIDE FREE DENTAL, VISION, AND MEDICAL CARE TO ISOLATED, IMPOVERISHED, OR UNDERSERVED COMMUNITIES; A LOCAL BLOOD DONATION ORGANIZATION; A LOCAL HEALTH WEEK EVENT; AND, A LITTLE LEAGUE FOR CHILDREN WITH DISABILITIES. CONS

4b	(Code: ) (Expenses $ 6,714,138 including grants of $ ) (Revenue $ 6,733,776 )
	FRANCIS MARION MANOR HEALTH AND REHABILITATION (FMM), PROVIDES BOTH SKILLED-LEVEL AND NURSING FACILITY-LEVEL HEALTH CARE SERVICES. THERE WERE 287 ADMISSIONS AND 34,828 PATIENT DAYS DURING FY16. WE RECEIVED THE "2015 BEST OF SMYTH COUNTY AWARD" FOR BEING THE BEST NURSING HOME/ASSISTED LIVING FACILITY, AS VOTED BY READERS OF THE SMYTH COUNTY NEWS AND MESSENGER.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses40,160,095

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)			(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
(A) Name and Title
(18) BRUCE BRIGGS........................................................................ PHARMACIST	40.00 .......................	X		0	125,397	29,405
(19) ROBERT O'DONNELL........................................................................ REHAB. THER.	40.00 .......................	X		0	119,716	26,130
(20) BETTY SCHWARTZ........................................................................ PHYSICAL THE	40.00 .......................	X		0	108,078	30,141
(21) PATRICIA DEBUSK........................................................................ PHYSICAL THE	40.00 .......................	X		0	101,354	27,618
(22) RAMZI K HUMSI MD........................................................................ MSMG PHYSICI	.......................		X	0	250,511	22,385
(23) LINDA WHITE CEO FWCHWR........................................................................ FORMER SCCH	.......................		X	0	325,783	46,302

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,267,402	423,017

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	273,031
e	Government grants (contributions)		1e	7,686

f	All other contributions, gifts, grants, and similar amounts not included above		1f	6,826

g	Noncash contributions included in lines 1a-1f:$ 1,263
h Total.Add lines 1a-1f.......		287,543

			Business Code
2a	PATIENT SERVICES	622110	44,426,980	44,426,980
b	WELLNESS PROGRAMS	622110	967,777	967,777
c	LABORATORY	621511	74,922		74,922
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			45,469,679

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			977,773	431,444		546,329
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		307,161
b	Less: rental expenses		206,943
c	Rental income or (loss)		100,218
d	Net rental income or (loss)......			100,218			100,218
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	75,488	328,137
b	Less: cost or other basis and sales expenses	329,489
c	Gain or (loss)	-254,001	328,137
d	Net gain or (loss).....			74,136	-254,001		328,137
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..
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..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	CAFETERIA SALES		722514	317,227			317,227
b	VENDOR SETTLEMENT		900099	257,651			257,651
c	REVENUE FROM PARENT		900099	41,805	41,805
d	All other revenue ....			39,284			39,284
e	Total. Add lines 11a–11d ......			655,967
12	Total revenue. See Instructions......			47,565,316	45,614,005	74,922	1,588,846

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	17,655	17,655
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
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 ....	530,936	190,324	340,612
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	17,408,974	15,589,077	1,819,897
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	582,650	514,329	68,321
9	Other employee benefits .......	2,660,198	2,199,676	460,522
10	Payroll taxes ...........	1,187,809	1,129,916	57,893
11	Fees for services (non-employees):
a	Management ......	9,753		9,753
b	Legal .........	143,304		143,304
c	Accounting ...........	15,750		15,750
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	59,571		59,571
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	9,536,802	8,905,045	631,757
12	Advertising and promotion ....	126,768	3,826	122,942
13	Office expenses .......	352,114	281,192	70,922
14	Information technology ......	1,104,366	1,056,126	48,240
15	Royalties ..
16	Occupancy ...........	990,072	927,787	62,285
17	Travel ............	155,441	134,047	21,394
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	168,014		168,014
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	4,218,775	2,083,994	2,134,781
23	Insurance ...	1,292,756	342	1,292,414
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES & DRUGS	5,487,880	5,487,880
b	REPAIRS & MAINTENANCE	1,201,257	1,165,468	35,789
c	MANAGEMENT FEES	886,984	57,926	829,058
d	UBIT	7,374		7,374
e	All other expenses	636,428	415,485	220,943
25	Total functional expenses. Add lines 1 through 24e	48,781,631	40,160,095	8,621,536	0
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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			2,939,379	1	3,103,122
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			6,294,996	4	6,560,667
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....				7	137,203
8	Inventories for sale or use ........			948,864	8	859,623
9	Prepaid expenses and deferred charges ......			269,817	9	348,084
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	119,827,858
b	Less: accumulated depreciation	10b	55,795,012	67,549,835	10c	64,032,846
11	Investments—publicly traded securities .			24,807,217	11	25,042,606
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			741,011	13	729,011
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			949,213	15	394,784
16	Total assets. Add lines 1 through 15 (must equal line 34)...			104,500,332	16	101,207,946

17	Accounts payable and accrued expenses .....	4,451,185	17	4,264,014
18	Grants payable ...		18
19	Deferred revenue .........	1,142,696	19	799,176
20	Tax-exempt bond liabilities .........	15,965,896	20	15,832,228
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other 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	817,900	25	398,764
26	Total liabilities. Add lines 17 through 25..	22,377,677	26	21,294,182

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	82,113,596	27	79,904,854
28	Temporarily restricted net assets ...........	9,059	28	8,910
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	82,122,655	33	79,913,764
34	Total liabilities and net assets/fund balances ........	104,500,332	34	101,207,946