Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
CENTRA HEALTH INC |
540715569 | 3 | Yes | 3,415,105 | 0 | |
|
Total 1
|
3,415,105 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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.).. | ||||||
| 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 | ||||
| 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 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a | CCRC, INC. IS A CONTINUING CARE RETIREMENT COMMUNITY INCORPORATED ON DECEMBER 8, 1998 TO BUILD AND ESTABLISH A SENIOR LIVING COMMUNITY, THE SUMMIT, DEDICATED TO PROVIDING AN ENVIRONMENT FOR EACH RESIDENT TO BE ENGAGED IN LIFE. THE SUMMIT CONSISTS OF 85 INDEPENDENT LIVING APARTMENTS, 16 GARDEN HOMES AND A COMMUNITY ROOM ON A CAMPUS THAT INCLUDES AN 8 1/2-ACRE LAKE, WALKING TRAILS AND OTHER LANDSCAPE FEATURES. ALSO INCLUDED ON CAMPUS ARE THE SUMMIT ASSISTED LIVING AND THE SUMMIT HEALTH AND REHABILITATION, BOTH WHOLLY OWNED AND OPERATED BY CENTRA HEALTH, INC. AS SUCH, THE SUMMIT PROVIDES THE FACILITIES, SERVICES, AMENITIES AND PROGRAMS TO SUPPORT AN ENGAGING LIFESTYLE FOR RESIDENTS. THE SUMMIT HOSTS SEVERAL GROUPS THAT BENEFIT BOTH RESIDENTS AND MEMBERS FROM THE LARGER COMMUNITY, INCLUDING THE INTERFAITH VISION SUPPORT GROUP, THE JAMERSON YMCA AND THE CENTRAL VIRGINIA PARKINSON'S SUPPORT GROUP. THE SUMMIT HOSTS SEVERAL ANNUAL WYNDHURST COMMUNITY EVENTS INCLUDING WYNDHURST WEDNESDAY FOOD TRUCK EVENTS AND AN ANNUAL FOURTH OF JULY FIREWORKS CELEBRATION. THE SUMMIT HOSTS EDUCATIONAL EVENTS IN COOPERATION WITH AREA NONPROFIT AGENCIES SUCH AS AARP, POPLAR FOREST REDEVOLOPMENT GROUP, THE CENTRA FOUNDATION, CENTRAL AND WESTERN VIRGINIA ALZHEIMERS ASSOCAITION, JAMERSON FAMILY YMCA AND THE WYNDHURST ASSOCIATION. SEVERAL OF THE SUMMIT ACTIVITY PROGRAMS ARE OPEN TO BOTH RESIDENT AND NONRESIDENTS, INCLUDING WELLNESS PROGRAMING, USE OF OUR FITNESS CENTER, EDUCATIONAL AND CULTURAL EVENTS. THE SUMMIT IS HOST TO THE AREA BIRD WATCHING ASSOCIATION AND IS A DESIGNATED WILDLIFE HABITAT BY THE NATIONAL WILDLIFE FOUNDATION. THE SUMMIT HOSTS A WEEKLY WORSHIP SERVICE FOR RESIDENTS, INVITING AREA CLERGY TO PROVIDE LEADERSHIP. STAFF PROVIDE VOLUNTEER SUPPORT FOR EACH OF THE ABOVE ORGANIZATIONS AND OTHERS INCLUDING THE WYNDHURST ASSOCIATION, VANHA, LEADINGAGE, THE LYNCHBURG REGIONAL BUSINESS ALLIANCE, AND OTHERS. ADDITIONALLY, THE SUMMIT PROVIDES IN-KIND SERVICES TO EVENTS SPONSORED BY THE WYNDHURST ASSOCIATION. |
| Form 990, Part VI, Section A, Line 6 | THE ORGANIZATION IS A NOT-FOR-PROFIT, STOCK COMPANY. AS OF THE END OF 2019, THERE WERE 363 SHARES OF COMMON STOCK AND ZERO SHARES OF PREFERRED STOCK OUTSTANDING. CENTRA HEALTH, INC. OWN 91% OF THE COMMON STOCK. THE REMAINDER IS OWNED BY THE RETIREMENT CENTER OF THE CHRISTIAN CHURCH IN VIRGINIA, INC. |
| Form 990, Part VI, Section A, Line 7a | CENTRA HEALTH, INC., AS THE MAJORITY OWNER OF THE CCRC, INC. STOCK, HAS THE RIGHT TO APPOINT THE MAJORITY OF THE CCRC, INC. BOARD. |
| Form 990, Part VI, Section A, Line 7b | CENTRA HEALTH INC., AS THE MAJORITY OWNER OF THE CCRC, INC. STOCK, HAS THE RIGHT TO REVIEW AND APPROVE DECISIONS MADE BY THE GOVERNING BODY OF CCRC, INC. |
| Form 990, Part VI, Section B, Line 11b | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. COPIES OF THE FORM 990 HAVE BEEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS, AND ANY QUESTIONS RAISED BY THE BOARD OF DIRECTORS HAVE BEEN ADDRESSED. |
| Form 990, Part VI, Section B, Line 12c | ALL CENTRA HEALTH, INC./CCRC, INC. OFFICERS AND DIRECTORS MUST COMPLETE A POSSIBLE CONFLICT OF INTEREST QUESTIONNAIRE ON AN ANNUAL BASIS, CERTIFYING THAT NEITHER THEY NOR ANY OF THEIR IMMEDIATE FAMILY MEMBERS HAVE ENGAGED IN ANY ACTIVITIES THAT COULD LEAD TO A POTENTIAL CONFLICT OF INTEREST. ADDITIONALLY, ALL OFFICERS AND DIRECTORS MUST AGREE TO PROMPTLY REPORT ANY POTENTIAL CONFLICTS OF INTEREST THAT ARISE DURING THE YEAR TO THE PRESIDENT OR CHAIRMAN OF THE BOARD OF DIRECTORS. |
| Form 990, Part VI, Section B, Line 15a and 15b | FORM 990, PART VI, LINES 15A AND 15B WERE ANSWERED AS NO, HOWEVER, UNDER A MANAGEMENT AGREEMENT WITH CENTRA HEALTH, INC., A RELATED PARTY AND 91% SHAREHOLDER OF CCRC, INC., THE ORGANIZATIONS EXECUTIVE DIRECTORS COMPENSATION IS ESTABLISHED IN ACCORDANCE WITH CENTRA HEALTHS EXECUTIVE COMPENSATION PRACTICES WHICH INCLUDE THE USE OF A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT(S), AND COMPENSATION STUDY OR SURVEY. |
| Form 990, Part VI, Section C, Line 18 | PHOTOCOPIES OF THE ORGANIZATION'S RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. ADDITIONALLY, FILINGS OF THE FORM 990 CAN ALSO BE FOUND ONLINE AT WWW.GUIDESTAR.ORG. |
| Form 990, Part VI, Section C, Line 19 | PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CATERING SERVICES TOTAL FEES:796412 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:RESIDENT SERVICES TOTAL FEES:13575 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER MARKETING TOTAL FEES:105603 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:HEALTHCARE BENEFITS TOTAL FEES:46750 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:FACILITIES MAINTENANCE SERVICE TOTAL FEES:16217 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:SUMMIT BENEVOLENT FUND TOTAL FEES:12000 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PLANNING TOTAL FEES:6700 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MISCELLANEOUS TOTAL FEES:149 |
| Software ID: | |
| Software Version: |