TY 2019 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)
(1) BIKRAM S BAL MD...................................................................... DIRECTOR	50.0 ................. 0.0	X			994,015	0	14,395
(2) HANY MOUSTAFA MD...................................................................... MEDICAL DOCTOR	50.0 ................. 0.0			X	480,399	0	16,864
(3) EDWARD FENTON MD...................................................................... MEDICAL DOCTOR	50.0 ................. 0.0			X	408,950	0	53,140
(4) JONATHAN LOGAN MD...................................................................... MEDICAL DOCTOR	50.0 ................. 0.0			X	412,021	0	44,150
(5) ZAKI ELSARRAG MD...................................................................... MEDICAL DOCTOR	50.0 ................. 0.0			X	418,121	0	32,767
(6) JOHN KONA MD...................................................................... MEDICAL DOCTOR	50.0 ................. 0.0			X	427,398	0	22,115
(7) WILLIAM BASS JR...................................................................... VP & BMH CEO	2.0 ................. 50.0	X			0	356,171	20,786
(8) THOMAS ANGELO...................................................................... VP & SCH CEO	50.0 ................. 0.0		X		223,759	0	51,570
(9) CLAUDIA MEINHARD...................................................................... CHIEF NURSING OFFICER	50.0 ................. 0.0		X		182,044	0	28,190
(10) SHARON L HARRUP...................................................................... CHAIRMAN	2.0 ................. 0.0	X	X		0	0	0
(11) FRANCIS E WOOD JR...................................................................... VICE CHAIRMAN	2.0 ................. 0.0	X	X		0	0	0
(12) LEROY O PFEIFFER JR...................................................................... SECRETARY/TREASURER	2.0 ................. 0.0	X	X		0	0	0
(13) RHONDA B ALGEIER MD...................................................................... DIRECTOR	2.0 ................. 0.0	X			0	0	0
(14) REV CALVIN GRAY...................................................................... DIRECTOR	2.0 ................. 0.0	X			0	0	0
(15) HAROLD M HARRIS JR...................................................................... DIRECTOR	2.0 ................. 0.0	X			0	0	0
(16) WILLIAM MCGUIRE...................................................................... DIRECTOR	2.0 ................. 0.0	X			0	0	0
(17) ODESSA PRIDE...................................................................... DIRECTOR	2.0 ................. 0.0	X			0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
VIZIENT INC, 5543 LEGACY DRIVE PLANO,TX75024	CONTRACT LABOR SVS	2,699,239
CROTHALL FACILITIES MGMT, 955 CHESTERBROOK BLVD SUITE 300 WAYNE,PA19087	HOUSEKEEPING SVCS	1,532,068
MOORES ELECTRICAL, PO BOX 119 ALTAVISTA,VA24517	ELECTRICAL SERVICES	575,412
PATHOLOGY CONSULTANTS, 1914 THOMSON DR LYNCHBURG,VA24501	PATHOLOGY SERVICES	352,091
PUTNEY MECHANICAL, PO BOX A FARMVILLE,VA23901	MECHANICAL SERVICES	328,590
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 12

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

SOUTHSIDE COMMUNITY HOSPITAL INC

Employer identification number

54-0555201

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

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.

Section B. Total Support

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

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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 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.)

Section B. Total Support

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.)..

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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2019

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) 2019

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 (explain in Part VI). 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) 2019

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 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.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
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.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

SOUTHSIDE COMMUNITY HOSPITAL INC

Employer identification number

54-0555201

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization SOUTHSIDE COMMUNITY HOSPITAL INC

Part I Contributors	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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization SOUTHSIDE COMMUNITY HOSPITAL INC		Employer identification number 54-0555201

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization SOUTHSIDE COMMUNITY HOSPITAL INC			Employer identification number 54-0555201
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) (2019)

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SOUTHSIDE COMMUNITY HOSPITAL INC

Employer identification number

54-0555201

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2019

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

Term 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 .....	163,194		163,194
b	Buildings ....	47,266,850	27,283,168	19,983,682
c	Leasehold improvements	2,787,804	2,603,452	184,352
d	Equipment ....	38,343,624	33,053,343	5,290,281
e	Other .....	594,326		594,326
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				26,215,835

Schedule D (Form 990) 2019

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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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)RECEIVABLES FROM 3RD PARTY				2,009,317
(2)OTHER ASSETS				1,227,536
(3)DUE FROM RELATED PARTIES				25,600,441
(4)OTHER ACCOUNTS RECEIVABLE				-15,318
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				28,821,976

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	0
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	2,645,571
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) 2019

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

PART X, LINE 2:

SOUTHSIDE COMMUNITY HOSPITAL, INC. IS INCLUDED IN CENTRA HEALTH, INCS CONSOLIDATED AUDIT REPORT FOR YEAR ENDING DECEMBER 31, 2019. THE FOLLOWING FOOTNOTE REGARDING LIABILITY FOR UNCERTAIN TAX POSITIONS (FIN48) IS FOUND IN THIS CONSOLIDATED REPORT. CENTRA HEALTH, INC., CCRC, INC., FOUNDATION, SOUTHSIDE, AND BEDFORD ARE EXEMPT FROM INCOME TAX UNDER SECTION 501 (A) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO INCOME TAXES HAVE BEEN PROVIDED FOR THESE ENTITIES IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS EXCEPT FOR TAXES RELATED TO CERTAIN UNRELATED BUSINESS INCOME ENGAGED IN BY CENTRA. CENTRA MEDICAL GROUP, LLC, CHIC, CENTRA SPECIALTY HOSPITAL, HEALTHWORKS, CVQCN, AND OUTPATIENT REHAB ARE DISREGARDED FOR FEDERAL INCOME TAX PURPOSES AND, THEREFORE, ARE INCLUDED UNDER CENTRAS TAX RETURN. CENTRA HAS ADOPTED RELEVANT ACCOUNTING STANDARDS RELATED TO TAXES FOR ITS SUBSIDIARIES, GBC, PCHP HOLDING, INC. AND PCHP. UNDER THE ASSET-AND-LIABILITY METHOD FOR THESE STANDARDS, DEFERRED TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL STATEMENT CARRYING AMOUNTS AND THE TAX BASIS OF THE SUBSIDIARYS ASSETS AND LIABILITIES AT INCOME TAX RATES EXPECTED TO BE IN EFFECT WHEN SUCH AMOUNTS ARE REALIZED OR SETTLED. THE EFFECT ON DEFERRED TAX ASSETS AND LIABILITIES OF A CHANGE IN TAX RATES IS RECOGNIZED IN EARNINGS IN THE PERIOD THAT INCLUDES THE ENACTMENT DATE. CHIC IS WHOLLY OWNED BY CENTRA HEALTH, INC. ANY LIABILITY FOR TAXES IS PASSED THROUGH TO CENTRA HEALTH, INC. A PROVISION WILL BE MADE WHEN OPERATIONS OF THIS SUBSIDIARY INDICATES A LIABILITY FOR TAXES. CENTRA HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2019. CENTRA BELIEVES THEY ARE NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2016.

Schedule D (Form 990) 2019

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SOUTHSIDE COMMUNITY HOSPITAL INC

Employer identification number

54-0555201

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

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? . . . . . . . . .

Yes

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

Yes

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) . . .	1,986,585		1,986,585	2.460 %
b	Medicaid (from Worksheet 3, column a) . . . . .	17,114,105	15,800,361	1,313,744	1.620 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	19,100,690	15,800,361	3,300,329	4.080 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	100,919		100,919	0.120 %
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	26,450		26,450	0.030 %
j	Total. Other Benefits . .	127,369		127,369	0.150 %
k	Total. Add lines 7d and 7j .	19,228,059	15,800,361	3,427,698	4.230 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	1,299	1,299	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	4,974	4,974	0.010 %
7	Community health improvement advocacy	5,138	5,138	0.010 %
8	Workforce development
9	Other
10	Total	11,411	11,411	0.020 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

8,680,656

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. ......

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).....

30,786,613

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

34,493,392

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

-3,706,779

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 %
1NONE
2
3
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Schedule H (Form 990) 2019

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?1Name, 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	SOUTHSIDE COMMUNITY HOSPITAL 800 OAK STREET FARMVILLE,VA23901 WWW.CENTRAHEALTH.COM/SCH	X	X	X

Schedule H (Form 990) 2019

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)

	SOUTHSIDE 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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

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

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.CENTRAHEALTH.COM/SCH

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 18

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

Yes

If "Yes" (list url): WWW.CENTRAHEALTH.COM/SCH

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

10b

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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	SOUTHSIDE 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.%
and FPG family income limit for eligibility for discounted care of 400.%

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)

Was widely publicized 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):

WWW.CENTRAHEALTH.COM/SCH

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

WWW.CENTRAHEALTH.COM/SCH

A plain language summary of the FAP was widely available on a website (list url):
WWW.CENTRAHEALTH.COM/SCH

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	SOUTHSIDE 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 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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	SOUTHSIDE COMMUNITY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
SCHEDULE H, PART V, SECTION B, LINE 5:	IN 2017, THE PARTNERSHIP FOR HEALTHY COMMUNITIES WAS FORMED AND IS A PLANNING INITIATIVE LED BY CENTRA, CENTRA FOUNDATION, THE COMMUNITY ACCESS NETWORK AND THE CENTRAL VIRGINIA, PIEDMONT, AND PITTSYLVANIA/DANVILLE HEALTH DISTRICTS IN COLLABORATION WITH THE BEDFORD COMMUNITY HEALTH FOUNDATION, GREATER LYNCHBURG COMMUNITY FOUNDATION, AND UNITED WAY OF CENTRAL VIRGINIA. THE PARTNERS ARE COMMITTED TO REGIONAL ALIGNMENT OF A COLLABORATIVE AND RIGOROUS NEEDS ASSESSMENT PROCESS THAT WILL RESULT IN ACTION-ORIENTED SOLUTIONS TO IMPROVE THE HEALTH OF THE COMMUNITIES THEY SERVE. A COMMUNITY HEALTH ASSESSMENT TEAM COMPOSED OF 30 INDIVIDUALS WITH A BROAD REPRESENTATION OF COMMUNITY LEADERS AND CROSS-SECTOR STAKEHOLDERS ACTED TO OVERSEE, ADVISE AND SUPPORT THE CHNA ACTIVITIES. THE PARTICIPANTS OF THIS CHNA & IMPLEMENTATION PLAN WERE: 2018 Farmville Area Core Team - Greater Lynchburg Community Foundation Centra- Pittsylvania Central Virginia Health District Community Access Network Centra Foundation Central Virginia Health District Bedford Community Health Foundation Centra- Bedford Centra- Lynchburg Centra- Farmville Piedmont Health District Christopher Nye Consulting Pittsylvania/Danville Health District United Way of Central Virginia CommunityWorks Data Entry & Analysis Team Liberty University Centra College of Nursing CommunityWorks Virginia Commonwealth University 2018 Farmville Area Community Health Assessment Team - Centra Southside Community Hospital STEPS, Inc. Community Action Agency Greater Lynchburg Community Foundation Community Foundation United Way Community Foundation Central Virginia Health District Public Health Piedmont Health Coalition/HEAL Community Coalition Buckingham County DSS Social Services Community Access Network Health center; free clinic Cumberland County Government Farmville Police Department Public Safety Amelia County Government Longwood University Education Central VA Health Services Health center Roma Morris Department of Social Services, Prince Edward County Piedmont Health District Public Health Christopher Nye Consulting Data consultant Community Volunteers Farmville Presbyterian Church Faith-based FACES Food Pantry Hampden Sydney College Education Heart of Virginia Free Clinic Consultant- Economic Development Va Coop Extension Central Virginia Health Services Health center UW Central VA Community Foundation CommunityWorks Project Management Piedmont Senior Resources Area Agency on Aging
SCHEDULE H, PART V, SECTION B, LINE 7d:	HARD COPIES OF THE CHNA & IMPLEMENTATION PLAN WERE SENT TO ALL CHNA COMMUNITY ADVISORY BOARD MEMBERS.
SCHEDULE H, PART V, SECTION B, LINE 11:	THE FARMVILLE AREA COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN WAS CONDUCTED IN 2018 AND IDENTIFIED THREE OVERARCHING ACTION PLAN PRIORITIES AIMED AT IMPROVING THE HEALTH OF THE VARIOUS COMMUNITIES SERVED. THESE PRIORITIES INCLUDED TRANSPORTATION; ACCESS TO AFFORDABLE HEALTHCARE AND ACCESS TO AFFORDABLE HOUSING. WITH REGARD TO TRANSPORTATION, THE CENTRA FOUNDATION, FOR TWO YEARS, HAS COLLABORATED WITH PIEDMONT SENIOR RESOURCES TO PROVIDE VEHICLES TO TRANSPORT THEIR SENIOR CITIZENS. IN JUNE OF 2018, CENTRA STARTED A COMMUNITY PARAMEDIC PROGRAM IN FARMVILLE. IN THIS PROGRAM PARAMEDICS VISIT PATIENTS IN THEIR HOMES AFTER HOSPITAL ADMISSIONS TO PROVIDE CARE AND COORDINATE TRANSPORTATION TO VARIOUS MEDICAL APPOINTMENTS. CENTRA HAS IMPLEMENTED TELEMEDICINE; THE ACCESS TO AFFORDABLE HEALTHCARE PRIORITY HAS RESULTED IN CONTINUED EXPANSION OF THE CENTRA SOUTHSIDE COMMUNITY MEDICAL CENTER IN FARMVILLE. CENTRA HAS ADDED SEVERAL MORE PROVIDERS AND SPECIALISTS AND HAS EXTENDED THE HOURS OF OUR MAIN CLINIC TO 8AM-8PM, MONDAY-SATURDAY. CENTRA HAS UTILIZED THE MAMMO-VAN TO INCREASE THE NUMBER OF MAMMOGRAMS TO BE PERFORMED IN THIS AREA. CENTRA CONTINUES TO PROVIDE HEALTHFAIRS AND SCREENINGS IN MANY OF ITS COMMUNITIES, INCLUDING VERY DISCOUNTED SPORTS PHYSICLAS FOR CHILDREN, AND A CARDIAC FAIR AT THE HOSPITAL. THE AUXULIARY CONTINUES THE GUILD FUND, WHICH OFFSETS THE COSTS OF PRESCRIPTIONS FOR THOSE WHO CANNOT AFFORD THEM. WITH REGARD TO AFFORDABLE HOUSING, A COALITION WITH HOSPITAL REPRESENTATION HAS BEEN FORMED. AN APPROXIMATE $3 MILLLION DOLLAR GRANT HAS BEEN SECURED TO PARTNER WITH OTHER BUSINESSES AND SCHOOLS TO DEVELOP A LARGE COMMUNITY THAT HAS MULTIPLE TYPES OF HOUSING. CENTR AHS PARTNERED WITH HABITAT FOR HUMANITY AS WELL. RATIONALE FOR NOT INCLUDING THE REMAINING INDICATORS AS PRIORITIZED BY OUR CHNA COMMUNITY ADVISORY BOARD INCLUDED A SENSE THAT THESE CRITICAL NEEDS WERE HIGHLY COMPLEX IN NATURE AND AFFECTED A WIDE VARIETY OF INFLUENCING FACTORS - MANY WELL BEYOND THE CAPABILITY AND RESOURCES AND AVAILABLE THROUGH CENTRA AND/OR ITS COLLABORATING PARTNERS. FURTHERMORE, OTHER COMMUNITY-BASED INITIATIVES WERE ALREADY TARGETING THESE ISSUES.

Schedule H (Form 990) 2019

Page 9

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?3
Name and address		Type of Facility (describe)
1	SOUTHSIDE COMM HOSP HOMECARE SERVICES 711 OAK STREET FARMVILLE,VA23901	HOME HEALTH SERVICES
2	SOUTHSIDE HOSPICE 713 OAK STREET FARMVILLE,VA23901	HOSPICE CARE
3	SOUTHSIDE PACE 1530 SOUTH MAIN STREET FARMVILLE,VA23901	CARE FOR ELDERLY
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Schedule H (Form 990) 2019

Page 10

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 6A:	INFORMATION ON COMMUNITY BENEFIT IS REPORTED ANNUALLY THROUGH A REPORT PREPARED BY CENTRA HEALTH, INC., SOLE MEMBER CORPORATION OF SOUTHSIDE COMMUNITY HOSPITAL, INC.
PART I, LINE 7:	COST-TO-CHARGE RATIO WAS USED TO CALCULATE THE EXPENSE.
PART II:	SOUTHSIDE COMMUNITY HOSPITAL, INC. CONTINUOUSLY WORKS ON IMPROVING ITS RELATIONSHIP WITH THE COMMUNITY IT SERVES BY OFFERING MANY SERVICES, SUCH AS, COMMUNITY SUPPORT, COMMUNITY HEALTH IMPROVEMENT, WORKFORCE DEVELOPMENT, ETC. SOUTHSIDE COMMUNITY HOSPITAL, INC. ALSO HOSTS AND/OR PARTICIPATES IN VARIOUS CAREER FAIRS IN ORDER TO REACH OUT TO YOUNG ADULTS WHO MAY BE INTERESTED IN THE HEALTHCARE PROFESSION. COMMUNITY SUPPORT: SOUTHSIDE COMMUNITY HOSPITAL, INC. CONTINUOUSLY WORKS ON IMPROVING ITS RELATIONSHIP WITH THE COMMUNITY IT SERVES BY PARTICIPATING IN NUMEROUS HEALTH FAIRS, CONDUCTING HEALTH EDUCATION SEMINARS, PROVIDING SCHOOL-BASED HEALTH PROGRAMS, ETC. IT SPONSORS AND/OR PARTICIPATES IN NUMEROUS EVENTS THROUGHOUT THE YEAR. WE FEEL AN ESSENTIAL PART OF BEING A GOOD NEIGHBOR WITHIN THE COMMUNITY IS TO PROMOTE HEALTH, SAFETY, AND WELL-BEING ACTIVITIES IN ORDER TO BENEFIT THOSE AROUND THE COMMUNITY. COALITION BUILDING: SOUTHSIDE COMMUNITY HOSPITAL, INC. IS COMMITTED TO REACHING OUT TO THE COMMUNITY IN ORDER TO INFORM THE PUBLIC ABOUT THE NUMEROUS HEALTH FAIRS, HEALTH SEMINARS, AND GENERAL INFORMATIONAL SESSIONS OFFERED BY THE ORGANIZATION THROUGHOUT THE YEAR. WE PARTICIPATE IN LOCAL EVENTS IN ORDER TO REACH AS MANY COMMUNITY MEMBERS AS POSSIBLE IN ORDER TO PROMOTE HEALTH AND WELL-BEING TO AS MANY INDIVIDUALS AS POSSIBLE. COMMUNITY HEALTH IMPROVEMENT ADVOCACY: HELPING THE COMMUNITY IMPROVE THEIR HEALTH IS AN IMPORTANT MISSION OF SOUTHSIDE COMMUNITY HOSPITAL, INC. WE FEEL PASSIONATE ABOUT IMPROVING ACCESS TO CARE, PUBLIC HEALTH, ETC. WE ARE EXCITED TO PARTICIPATE IN NUMEROUS EVENTS SUCH AS THE MORTON COMMUNITY PRAYER BREAKFASTS THROUGHOUT THE YEAR IN ORDER TO STAY CONNECTED TO THE COMMUNITY WE SERVE. BY STAYING CONNECTED WE ARE ABLE TO RECOGNIZE AND ADDRESS NEEDS THROUGHOUT OUR REGION.
PART III, SECTION A, LINE 1:	ON JANUARY 1, 2012, CENTRA HEALTH, INC. AND SUBSIDIARIES ADOPTED ACCOUNTING STANDARDS UPDATE (ASU) 2011-07 WHICH CHANGED CENTRAS PRESENTATION OF PROVISION FOR DOUBTFUL ACCOUNTS TO A DEDUCTION FROM NET PATIENT SERVICE REVENUE. THIS HAS BEEN DISCLOSED IN THE FOOTNOTES OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THEREFORE, CENTRA HEALTH, INC. AND ITS SUBSIDIARIES, INCLUDING SOUTHSIDE COMMUNITY HOSPITAL, INC. AND BEDFORD MEMORIAL HOSPITAL, REPORT BAD DEBT IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15.
PART III, SECTION A, LINES 2 & 3:	SEE DESCRIPTION FOR PART III, SECTION A, LINE 4.
PART III, SECTION A, LINE 4:	THE ORGANIZATION BELIEVES THAT ITS PROCEDURES CONCERNING THE APPLICATION OF ITS FINANCIAL ASSISTANCE POLICY ARE SUFFICIENTLY THOROUGH TO EXCLUDE ALL PATIENTS WHO ARE ELIGIBLE FOR CHARITY CARE FROM BAD DEBT. THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS INCLUDE THE FOLLOWING FOOTNOTE ABOUT BAD DEBT: GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. CENTRA ALSO PROVIDES SERVICES TO UNINSURED PATIENTS AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT FROM STANDARD CHARGES. CENTRA ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. IMPLICIT PRICE CONCESSIONS RELATE PRIMARILY TO AMOUNTS DUE DIRECTLY FROM PATIENTS. ESTIMATED PRICE CONCESSIONS ARE RECORDED FOR ALL UNINSURED ACCOUNTS, REGARDLESS OF THE AGE OF THOSE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN MADE. THERE HAVE BEEN NO SIGNIFICANT CHANGES IN THE CURRENT YEAR TO THE UNDERLYING ASSUMPTIONS USED BY CENTRA TO ESTIMATE THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SIGNIFICANT CHANGES IN PAYOR MIX, ECONOMIC CONDITIONS OR TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTHCARE COVERAGE COULD AFFECT THE NEATURE, AMOUNT, TIMING, AND UNSERTAINTY OF THESE REVENUES AND CASH FLOWS. ADJUSTMENTS TO PREVIOUS REIMBURSEMENT ESTIMATES ARE REPORTED IN NET PATIENT SERVICE REVENUES IN THE PERIODS THAT SUCH ADJUSTMENTS BECOME KNOWN. FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018, THE IMPACT OF CHANGES TO PREVIOUS TRANSACTIONS PRICE ESTIMATES WAS CONSIDERED IMMATERIAL TO THE CURRENT PERIOD. (CENTRA HEALTH, INC. AND SUBSIDIARIES, FY 2019 AUDIT REPORT, PAGE 13) CONSISTENT WITH CENTRAS MISSION, SERVICES ARE PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THEREFORE, CENTRA HAS DETERMINED IT HAS PROVIDED IMPLICIT PRICE CONCESSIONS TO UNINSURED PATIENTS AND PATIENTS WITH OTHER UNINSURANCE BALANCES (FOR EXAMPLE, COPAYS AND DEDUCTIBLES). THE IMPLICIT PRICE CONCESSIONS INCLUDED IN ESTIMATING THE TRANSACTION PRICE REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED TO PATIENTS AND THE AMOUNTS CENTRA EXPECTS TO COLLECT BASED ON ITS COLLECTION HISTORY WITH THOSE PATIENTS. (CENTRA HEALTH, INC. AND SUBSIDIARIES, FY 2019 AUDIT REPORT, PAGE 15) PATIENTS WHO MEET CENTRAS CRITERIA FOR CHARITY CARE ARE PROVIDED CARE WITHOUT CHARGE OR AT AMOUNTS SUBSTANTIALLY LESS THAN ESTABLISHED RATES IN ACCORDANCE WITH CENTRAS FINANCIAL ASSISTANCE POLICY. SINCE CENTRA DOES NOT PURSUE COLLECTION OF THESE AMOUNTS, THEY ARE DETERMINED TO QUALIFY AS CHARITY CARE AND ARE NOT REPORTED AS REVENUE. WHILE CHARITY CARE IS EXCLUDED FROM NET PATIENT SERVICE REVENUE, CENTRA MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THIS INCLUDES THE AMOUNT OF CHARGES FOREGONE AND THE ESTIMATED COSTS INCURRED FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. COSTS INCURRED ARE ESTIMATED BASED ON THE RATIO OF TOTAL OPERATING EXPENSE TO GROSS CHARGES. (CENTRA HEALTH, INC. AND SUBSIDIARIES, FY 2019 AUDIT REPORT, PAGE 15)
PART III, SECTION B, LINE 8:	THE CALCULATION OF MEDICARE SHORTFALL DOES NOT REFLECT ALL OF THE ORGANIZATIONS REVENUES AND COSTS ASSOCIATED WITH ITS PARTICIPATION IN THE MEDICARE PROGRAM, PER IRS INSTRUCTIONS. MEDICARE ALLOWABLE COSTS ARE DETERMINED FROM THE MEDICARE COST REPORT USING THE COST TO CHARGE RATIO. THE TOTAL AMOUNT OF MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE SOUTHSIDE COMMUNITY HOSPITAL INCS MISSION IS TO PROMOTE HEALTH IN THE COMMUNITY AND WE DO NOT LIMIT THE CARE AVAILABLE TO ANY OF OUR PATIENTS, INCLUDING THOSE COVERED BY MEDICARE. WE ARE RELIEVING A GOVERNMENT BURDEN BY PROVIDING CARE TO MEDICARE PATIENTS EVEN THOUGH REIMBURSEMENTS WERE LESS THAN THE COST TO PROVIDE SERVICES. TOTAL MEDICARE SHORTFALL FOR 2019 WAS $3,706,779.
PART III, SECTION C, LINE 9B:	SOUTHSIDE COMMUNITY HOSPITAL RECOGNIZES THAT MEDICAL EXPENSES ARE OFTEN UNEXPECTED AND CAUSE FINANCIAL HARDSHIP. ALL ACCOUNTS WITH SELF PAY BALANCES WILL FOLLOW UNIFORM COLLECTION PROTOCOLS. THESE PROTOCOLS ARE ELECTRONICALLY ADMINISTERED THROUGH CENTRA'S HOSPITAL INFORMATION SYSTEM. WHEN AN ACCOUNT REACHES THE END OF THE SYSTEM GENERATED COLLECTION CYCLE AND MEETS SAID CRITERIA, THE ACCOUNT BALANCE WILL BE PROCESSED AS BAD DEBT AND REPORTED TO A COLLECTION AGENCY. CRITERIA FOR BAD DEBT WILL BE APPLIED CONSISTENTLY REGARDLESS OF AGE, RACE, RELIGION OR OTHER PROTECTIVE CLASS. PRIOR TO BAD DEBT PROCESSING, ACCOUNTS ARE ELECTRONICALLY SCREENED FOR PRESUMPTIVE FINANCIAL ASSISTANCE AND WRITTEN DOWN TO ZERO WHEN SCORES ARE WITHIN PRE-ESTABLISHED RANGES. SOUTHSIDE COMMUNITY HOSPITAL APPLIES UNIFORM COLLECTION PROTOCOLS TO ALL UNPAID ELIGIBLE CHARGES REGARDLESS OF RACE, SEX, AGE, DISABILITY, NATIONAL ORIGIN OR RELIGION. PATIENTS KNOWN BY CENTRA TO QUALIFY FOR FINANCIAL ASSISTANCE ARE NOT SUBJECT TO COLLECTION PROTOCOLS. IF DURING COLLECTION PROTOCOLS, OR AFTER REFERRAL TO AN OUTSIDE COLLECTION AGENCY, IT IS DISCOVERED PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY, INCLUDING ANY AND ALL EXTRAORDINARY COLLECTION EFFORT, IS IMMEDIATELY STOPPED. FINANCIAL ASSISTANCE FOR ELIGIBLE CHARGES IS AVAILABLE TO ALL CENTRA PATIENTS WHO QUALIFY BASED ON ESTABLISHED AND WIDELY PUBLISHED INCOME AND ASSET CRITERIA.
PART VI, LINE 2:	THE 2018 FARMVILLE AREA COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) INCORPORATED AN EXPANDED COMMUNITY VOICE (PRIMARY DATA) AS WELL AS THE COLLECTION OF OVER 65 SOURCES OF PUBLICLY AVAILABLE SECONDARY DATA. IN ADDITION, INFORMATION REGARDING AVAILABLE COMMUNITY RESOURCES WAS GATHERED. PRIMARY DATA INCLUDED FINDINGS FROM A COMMUNITY HEALTH SURVEY; STAKEHOLDERS FOCUS GROUP AND SURVEY; AND TARGET POPULATION FOCUS GROUPS. DETAILS ON THE SPECIFIC METHODOLOGY AND FINDINGS OF THE PRIMARY AND SECONDARY DATA COMPONENTS ARE INCLUDED IN THE FOLLOWING SECTIONS. THE DATA COLLECTED FOR THE CHNA IS REPORTED USING THE FRAMEWORK FOR COUNTY HEALTH RANKINGS AND ROADMAPS, A COLLABORATION BETWEEN THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE AND THE ROBERT WOOD JOHNSON FOUNDATION. THE WORK IS ROOTED IN A DEEP BELIEF IN HEALTH EQUITY, THE IDEA THAT EVERYONE HAS A FAIR AND JUST OPPORTUNITY TO BE AS HEALTHY AS POSSIBLE, REGARDLESS OF RACE, ETHNICITY, GENDER, INCOME, LOCATION OR ANY OTHER FACTOR. RELEASED ANNUALLY, THE RANKINGS ARE BASED ON A MODEL OF POPULATION HEALTH THAT EMPHASIZES THE MANY FACTORS, THAT IF IMPROVED, CAN HELP MAKE COMMUNITIES HEALTHIER PLACES TO LIVE, LEARN, WORK AND PLAY. THE COUNTY HEALTH RANKINGS MODEL MEASURES HEALTH OUTCOMES AND HEALTH FACTORS FOR EACH COMMUNITY. HEALTH OUTCOMES REPRESENT HOW HEALTHY A COUNTY IS BY DETERMINING: * LENGTH OF LIFE (MORTALITY) --PREMATURE DEATH * QUALITY OF LIFE (MORBIDITY) --HEALTH-RELATED QUALITY OF LIFE (OVERALL HEALTH, PHYSICAL AND MENTAL HEALTH) --BIRTH OUTCOMES HEALTH FACTORS REPRESENT WHAT INFLUENCES THE HEALTH OF A COUNTY AND INCLUDES FOUR TYPES OF FACTORS: * SOCIAL AND ECONOMIC FACTORS (ACCOUNTS FOR 40% OF WHAT INFLUENCES HEALTH) --COMMUNITY SAFETY -- EDUCATION -- EMPLOYMENT -- FAMILY AND SOCIAL SUPPORT -- INCOME * HEALTH BEHAVIORS (ACCOUNTS FOR 30% OF WHAT INFLUENCES HEALTH) --ALCOHOL AND DRUG USE --DIET AND EXERCISE --SEXUAL ACTIVITY --TOBACCO USE --OTHER BEHAVIORS * CLINICAL CARE (ACCOUNTS FOR 20% OF WHAT INFLUENCES HEALTH) --ACCESS TO CARE --QUALITY OF CARE * PHYSICAL ENVIRONMENT (ACCOUNTS FOR 10% OF WHAT INFLUENCES HEALTH) --AIR AND WATER QUALITY --HOUSING AND TRANSIT (HTTP://WWW.COUNTYHEALTHRANKINGS.ORG/) ALL OF THE DATA COLLECTED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS USED TO PRIORITIZE NEEDS FOR THE FARMVILLE SERVICE AREA AND WILL BE USED TO DEVELOPMENT A 3-YEAR IMPLEMENTATION PLAN FOR THE HOSPITAL SYSTEM, COMMUNITY PARTNERS, AND STAKEHOLDERS IN THE FARMVILLE SERVICE AREA.
PART VI, LINE 3:	SOUTHSIDE COMMUNITY HOSPITAL TAKES A MULTIDISCIPLINARY APPROACH TO INFORMING OUR PATIENTS AND COMMUNITY ABOUT FINANCIAL ASSISTANCE. INFORMATION ABOUT FINANCIAL ASSISTANCE AND CHARITY CAN BE FOUND ON CENTRA'S INTERNET PAGE PROVIDING FULL DISCLOSURE ABOUT QUALIFICATIONS AND THE APPLICATION PROCESS. INDIVIDUALS MAY OBTAIN INFORMATION AND AN APPLICATION FROM ANY REGISTRATION POINT OR CUSTOMER SERVICE UNIT, IN PERSON OR BY PHONE. SIGNS ARE POSTED IN CONSPICUOUS LOCATIONS ALERTING INDIVIDUALS THAT FINANCIAL ASSISTANCE IS AVAILABLE AND WHERE TO OBTAIN ADDITIONAL INFORMATION. BROCHURES ABOUT FINANCIAL ASSISTANCE ARE MADE AVAILABLE IN REGISTRATION AND CUSTOMER SERVICE. WHILE PATIENTS ARE HOSPITALIZED, A FINANCIAL COUNSELOR PROVIDES FINANCIAL ASSISTANCE INFORMATION, SCREENS PATIENTS FOR FEDERAL AND STATE PROGRAMS AND GIVES AN OPPORTUNITY TO ASK QUESTIONS. ADDITIONALLY, ON THE BOTTOM OF THE CURRENT STATEMENTS IS THE FOLLOWING VERBIAGE: CANT PAY YOUR BILL? FINANCIAL ASSISTANCE AND FLEXIBLE PAYMENT OPTIONS ARE AVAILABLE BY CONTACTING CENTRA CUSTOMER SERVICE AT (434) 200-3777.
PART VI, LINE 4:	SOUTHSIDE COMMUNITY HOSPITAL, INC. IS LOCATED IN FARMVILLE, VIRGINIA, WHICH IS 50 MILES EAST OF LYNCHBURG AND 50 SOUTHWEST OF RICHMOND. AS A SOLE COMMUNITY HOSPITAL, IT IS CENTRALLY LOCATED TO SERVE THE RESIDENTS OF AMELIA, BUCKINGHAM, CHARLOTTE, CUMBERLAND, LUNENBURG, NOTTOWAY, AND PRINCE EDWARD COUNTIES, WHICH MAKES UP ITS PRIMARY SERVICE AREA (PSA). THE HOSPITAL WAS ESTABLISHED TO PROVIDE HEALTHCARE TO THIS MOSTLY RURAL AREA. THE 2019 POPULATION FOR THE HOSPITALS PSA WAS APPROXIMATELY 110,181. THE 2019 AVERAGE PERCENT OF THE PSA POPULATION THAT WAS 65 YEARS OF AGE AND OLDER WAS 19.28%. THE MEDIAN HOUSEHOLD INCOME (IN 2018 DOLLARS) IN THE PSA WAS $44,529 AS COMPARED TO THE STATE MEDIAN OF $71,564.
PART VI, LINE 5:	SOUTHSIDE COMMUNITY HOSPITAL, INC. PLAYS AN IMPORTANT ROLE IN PROMOTING HEALTH IN THE COMMUNITIES IT SERVES. THE HOSPITAL HOSTS FREE WORKSHOPS AND EDUCATIONAL SEMINARS ON DIABETES, STROKE PREVENTION, AND HEART HEALTH, TO NAME A FEW. SOUTHSIDE COMMUNITY HOSPITAL, INC. ALSO PARTICIPATES IN NUMEROUS HEALTH FAIRS ANNUALLY, PROVIDING FREE SCREENINGS TO THE PUBLIC. IN ADDITION TO THE FREE SCREENINGS AT HEALTH FAIRS, THE HOSPITAL PROVIDES FREE SERVICES, INCLUDING ALL LAB TESTS AND RADIOLOGY EXAMS AT NO CHARGE TO INDIVIDUALS AT THE HEART OF VIRGINIA FREE CLINIC LOCATED IN DOWNTOWN FARMVILLE. THE HOSPITAL HOSTED TWO ADVANCE DIRECTIVE DAYS TO BRING AWARENESS TO THE NEED OF PREPAREDNESS AT END OF LIFE. BREAST-FEEDING, CHILDBIRTH, AND CAR SEAT SAFETY ARE JUST A FEW OF OTHER CLASSES MADE AVAILABLE FOR COMMUNITY MEMBERS. SOUTHSIDE COMMUNITY HOSPITAL, INC. ALSO HOSTS SEVERAL SUPPORT GROUPS INCLUDING CHRONIC PAIN SUPPORT GROUP AND DIABETES SUPPORT GROUP. WE ALSO HAVE A TEEN VOLUNTEER PROGRAM AND A COLLEGE VOLUNTEER PROGRAM FOR STUDENTS AT LONGWOOD UNIVERSITY, HAMPDEN-SYDNEY COLLEGE, AND SOUTHSIDE VIRGINIA COMMUNITY COLLEGE. DURING THE YEAR, THE HOSPITAL ALSO SUPPORTS NUMEROUS HEALTH RELATED SUPPORT GROUPS WITH EDUCATIONAL MATERIALS AND PROFESSIONAL KNOWLEDGE.
PART VI, LINE 6:	SOUTHSIDE COMMUNITY HOSPITAL, INC.S AFFILIATION WITH CENTRA HEALTH, INC. BEGAN JANUARY 2006. IT SEEMED ONLY NATURAL THAT SOUTHSIDE COMMUNITY HOSPITAL, INC. WOULD PARTNER WITH CENTRA HEALTH, INC. SINCE THE OTHER CENTRA HOSPITALS ARE LOCATED WITHIN 50 MILES WEST OF SOUTHSIDE COMMUNITY HOSPITAL, INC. CENTRA HEALTH, INC. HAS A NATIONAL REPUTATION FOR CLINICAL EXCELLENCE AND PATIENT SATISFACTION. SOUTHSIDE COMMUNITY HOSPITAL, INC. AND CENTRA OFFICIALS BELIEVE THE COMBINED ORGANIZATIONS WILL BE STRENGTHENED THROUGH AN EXCHANGE OF BEST PRACTICES AND ECONOMIES OF SCALE. SOUTHSIDE PATIENTS HAVE BETTER ACCESS TO A BROADER RANGE OF ADVANCED CLINICAL SERVICES THAT ARE AVAILABLE AT CENTRA HEALTH, INC.S LYNCHBURG HOSPITALS. THE AFFILIATION IS ONE IN A SERIES OF STEPS IN WHICH SOUTHSIDE COMMUNITY HOSPITAL, INC.S LEADERS RECOGNIZED THE NEED TO PARTNER WITH AN ORGANIZATION THAT SHARED A MISSION OF EXCELLENT CARE. SOUTHSIDE HAS BEEN ABLE TO MAKE STRUCTURAL IMPROVEMENTS, REPLACE MEDICAL EQUIPMENT WITH NEWER MEDICAL TECHNOLOGY, AND UPDATE COMPUTER SYSTEMS. SOUTHSIDE COMMUNITY HOSPITAL, INC. HAS, ALSO, SUCCESSFULLY RECRUITED BOARD-CERTIFIED SURGEONS AND SPECIALISTS, NEW EMERGENCY PHYSICIANS, AND EXTENDED THEIR HOSPITALIST PROGRAM. SOUTHSIDE COMMUNITY HOSPITAL, INC. HAS BEEN THE HEALTHCARE CENTER OF SOUTHSIDE VIRGINIA SINCE OPENING ITS DOORS NOVEMBER 9, 1927. SINCE THEN, IT HAS OPERATED ON A NON-PROFIT BASIS WITH THE GOAL OF HELPING TO HEAL THE ILL AND INJURED. THE HOSPITAL SERVES THE RESIDENTS OF THE TOWN OF FARMVILLE AND AMELIA, BUCKINGHAM, CHARLOTTE, CUMBERLAND, LUNENBURG, NOTTOWAY, AND PRINCE EDWARD COUNTIES.
PART VI, LINE 7:	STATE FILING OF COMMUNITY BENEFIT REPORT: VIRGINIA

Schedule H (Form 990) 2019

Additional Data

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
SOUTHSIDE COMMUNITY HOSPITAL INC

Employer identification number
54-0555201

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 noncash assistance	(h) Purpose of grant or assistance
(1) FARMVILLE AREA CHAMBER OF COMMERCE 118 N MAIN STREET FARMVILLE,VA23901	54-1785415	501(C)(6)	10,000				GENERAL OPERATIONAL SUPPORT

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) 2019

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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash 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, PART I, LINE 2:	THROUGHOUT THE YEAR, GRANT REQUESTS ARE SUBMITTED TO THE EXECUTIVE COMMITTEE FOR THEIR REVIEW AND APPROVAL.

Schedule I (Form 990) 2019

Additional Data

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SOUTHSIDE COMMUNITY HOSPITAL INC

Employer identification number

54-0555201

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 on 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 on 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 nonfixed
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) 2019

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)
1WILLIAM BASS JR VP & BMH CEO	(i) (ii)	0 ------------- 303,651	0 ------------- 0	0 ------------- 52,520	0 ------------- 7,586	0 ------------- 13,200	0 ------------- 376,957	0 ------------- 50,189
2BIKRAM S BAL MD DIRECTOR	(i) (ii)	938,705 ------------- 0	54,297 ------------- 0	1,013 ------------- 0	8,400 ------------- 0	5,995 ------------- 0	1,008,410 ------------- 0	0 ------------- 0
3THOMAS ANGELO VP & SCH CEO	(i) (ii)	217,303 ------------- 0	0 ------------- 0	6,456 ------------- 0	6,832 ------------- 0	44,738 ------------- 0	275,329 ------------- 0	0 ------------- 0
4CLAUDIA MEINHARD CHIEF NURSING OFFICER	(i) (ii)	181,163 ------------- 0	0 ------------- 0	881 ------------- 0	5,593 ------------- 0	22,597 ------------- 0	210,234 ------------- 0	0 ------------- 0
5HANY MOUSTAFA MD MEDICAL DOCTOR	(i) (ii)	435,033 ------------- 0	25,500 ------------- 0	19,866 ------------- 0	8,400 ------------- 0	8,464 ------------- 0	497,263 ------------- 0	0 ------------- 0
6JOHN KONA MD MEDICAL DOCTOR	(i) (ii)	421,805 ------------- 0	0 ------------- 0	5,593 ------------- 0	8,400 ------------- 0	13,715 ------------- 0	449,513 ------------- 0	0 ------------- 0
7ZAKI ELSARRAG MD MEDICAL DOCTOR	(i) (ii)	390,585 ------------- 0	25,188 ------------- 0	2,348 ------------- 0	8,400 ------------- 0	24,367 ------------- 0	450,888 ------------- 0	0 ------------- 0
8JONATHAN LOGAN MD MEDICAL DOCTOR	(i) (ii)	344,205 ------------- 0	47,452 ------------- 0	20,364 ------------- 0	8,400 ------------- 0	35,750 ------------- 0	456,171 ------------- 0	0 ------------- 0
9EDWARD FENTON MD MEDICAL DOCTOR	(i) (ii)	327,703 ------------- 0	60,389 ------------- 0	20,858 ------------- 0	8,400 ------------- 0	44,740 ------------- 0	462,090 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

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, PART I, LINE 3:	UNDER A MANAGEMENT ARRANGEMENT WITH CENTRA HEALTH, INC. (A RELATED PARTY), THE ORGANIZATIONS EXECUTIVE COMPENSATION IS ESTABLISHED IN ACCORDANCE WITH CENTRA HEALTH, INC.S EXECUTIVE COMPENSATION PRACTICES WHICH INCLUDE THE USE OF A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT(S), AND COMPENSATION STUDY OR SURVEY.
Form Sch J Part I Line 4b:	THE FOLLOWING INDIVIDUALS RECEIVED A PAYOUT FROM A NONQUALIFIED RETIREMENT PLAN DURING FY 2019. THE AMOUNT WAS INCLUDED IN THEIR W-2 WAGES. NAME TITLE AMOUNT OF PAYOUT WILLIAM BASS, JR VP & CEO BEDFORD MEMORIAL HOSPITAL $ 50,189 (A RELATED PARTY)

Schedule J (Form 990) 2019

Additional Data

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

SOUTHSIDE COMMUNITY HOSPITAL INC

Employer identification number

54-0555201

Return Reference	Explanation
Form 990, Part III, Line 4a:	2019 SOUTHSIDE COMMUNITY HOSPITAL, INC. PROGRAM SERVICE ACCOMPLISHMENTS COMMUNITY BENEFIT HIGHLIGHTS * DURING FY 2019, $8,627,348 IN CHARGES AT AN ESTIMATED COST OF $1,986,585 WAS CONTRIBUTED AS TRADITIONAL CHARITY CARE TO PATIENTS WHO DID NOT HAVE THE ABILITY TO PAY. ELIGIBILITY FOR CHARITY CARE IS BASED ON POVERTY INCOME LEVELS SET BY THE STATE. * CHARGES OF $8,680,656 AT AN ESTIMATED COST OF $1,998,860 WERE CONTRIBUTED AS BAD DEBT TO PATIENTS WHO DID NOT HAVE THE ABILITY TO PAY. * LOSS FROM MEDICARE BASED ON COST TO CHARGE RATIO TOTALED $3,706,779. * LOSS FROM MEDICAID BASED ON COST TO CHARGE RATIO TOTALED $1,313,744. * CASH DONATIONS MADE BY SOUTHSIDE COMMUNITY HOSPITAL, INC. TO THE COMMUNITY DURING 2019 TOTALED $26,450. SOUTHSIDE COMMUNITY HOSPITAL, INC. IS EAGER TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY, WHICH CONSISTS OF ITS EIGHT SURROUNDING COUNTIES OF AMELIA, BUCKINGHAM, CHARLOTTE, CUMBERLAND, LUNENBURG, NOTTOWAY, APPOMATTOX, AND PRINCE EDWARD COUNTIES. EMPLOYEES CONTINUALLY OFFER PROFESSIONAL HEALTH EDUCATION PROGRAMS, CLASSES, LECTURES, HEALTH FAIRS, HEALTH SCREENINGS, SUPPORT GROUPS, ETC., THROUGHOUT SOUTHSIDE VIRGINIA. SOUTHSIDE COMMUNITY HOSPITAL, INC. IS DEDICATED TO IMPROVING THE HEALTHCARE OF ITS COMMUNITY. SOME EXAMPLES ARE LISTED BELOW. COMMUNITY EDUCATION AND HEALTH SCREENINGS - ADVANCED DIRECTIVES DAY COLON CANCER AWARENESS DAY COMMUNITY HEALTH FAIRS BREAST CANCER EDUCATION HEALTHY HEART/STROKE EDUCATION BLOOD PRESSURE SCREENINGS FAMILY EDUCATION AND COMMUNITY CLASSES - BREASTFEEDING CLASSES CAR SEAT CLASSES CHILDBIRTH AND FAMILY EDUCATION SUPPORT GROUPS BREAST FEEDING SUPPORT GROUP SPECIAL PROJECTS/ HEALTH MINISTRY WOMENS MINISTRY HEART HEALTH VOLUNTEER SERVICES SOUTHSIDE COMMUNITY HOSPITAL, INC. IS HONORED TO HAVE MANY VOLUNTEERS FROM THROUGHOUT OUR SERVICE AREA MAKING A DIFFERENCE TO OUR PATIENTS, VISITORS, AND STAFF. IN 2019, 39 VOLUNTEERS DONATED 5,101 HOURS OF SERVICE TO OUR HOSPITAL. SOME OF OUR VOLUNTEER SERVICES ARE: WOMENS AUXILIARY OF SOUTHSIDE COMMUNITY HOSPITAL, INC.: FUNDRAISING FOR HOSPITAL - PROVIDES SCHOLARSHIPS FOR MEDICAL/NURSING STUDENTS. CSCH VOLUNTEERS: FRONT DESK, REGISTRATION, EMERGENCY DEPT., CENTRA MEDICAL GROUP, TRANSPORT, TELE-MED-SURG, OB, SAME DAY SURGERY, GIFT SHOP, ETC. CARDIO-REHAB VOLUNTEERS: ASSISTANTS IN THE GYM FOR CARDIO PATIENTS PACE (PROGRAM FOR ALL INCLUSIVE CARE FOR THE ELDERLY) VOLUNTEERS: ASSISTS WITH ACTIVITIES FOR THE ELDERLY LONGWOOD UNIVERSITY/HAMPDEN-SYDNEY COLLEGE/LOCAL HIGH SCHOOL STUDENT VOLUNTEERS IN 2019, FARMVILLE HOSPICE VOLUNTEERS DONATED 1,091 HOURS OF SERVICE TO THE HOSPICE PROGRAM. A LARGE PORTION OF THEIR TIME AND TALENT WAS COMMITTED TO THE HOSPICE HOUSE. VOLUNTEERS SUPPORT THE HOSPICE HOUSE BY GROCERY SHOPPING, MEAL AND MEDICATION DELIVERY, CLEANING, INTERACTING WITH PATIENTS AND FAMILIES. THEY ALSO OFFER SUPPORT TO FAMILIES WHO HAVE LOST A LOVED ONE THROUGH PARTICIPATING IN THE HOSPICE MEMORIAL SERVICES 6 TIMES DURING THE YEAR. OUR VOLUNTEERS USE THEIR OWN CARS AND HAVE REPORTED DRIVING 395 MILES IN 2019. STORIES OF ASSISTANCE TO THE COMMUNITY Centra Southside Community Hospital serves its community and the surrounding eight counties in many ways. Our nurses and staff are enthusiastic about participating in community events by conducting blood pressure checks, providing free health education materials to the general public, and assisting in health screenings. Nurses from our Pediatric Unit teach breast feeding classes, child car seat classes and give free car seats to participants who qualify. Centra Southside Community Hospital employees are encouraged to share their professional health knowledge to the community by speaking to local organizations. We continually donate school supplies to area school supply drives, and we have active members in many civic organizations, such as the Lions Club, the Rotary Club, Chamber of Commerce, Prince Edward United Way, VFW, and the Downtown Farmville Organization. We partnered with the Lions Club this year to build a food pantry at the local High School. We also partnered with the Lions Club to give free vision screening to schools. A team of employees and volunteers regularly volunteer at FACES, the local food pantry. Several employees participated in high school career days at local high schools, in addition to a Chamber Youth Summit. We also partnered with the YMCA for many activities, one being Health Kids Day. During 2019, the hospital held many health fairs throughout the community offering cholesterol, glucose, BMI, and blood pressure screenings. We offered low cost or free school physicals for children playing sports in school, and school bus drivers. Centra Southside Community Hospital is the primary sponsor in the free monthly community Morton Museum Prayer Breakfast event, located in downtown Farmville. The hospital provides the breakfast and sends employees from different departments each month to assist in serving the breakfast and participating in the prayer time. The hospital is eager to connect with and to help serve our community in this way. The hospital leadership continues to conduct meetings with local community leaders and community representatives to better understand the medical needs of our community. The hospital wants to ensure that members of the communities that we serve have the opportunity to voice their current medical care concerns and provide insight on how the hospital can better meet the medical needs of the community in the future. Centra Southside Community Hospital participates in the Heart of Virginia Free Clinic, by providing all lab tests and radiology exams for free. In 2019, 623 tests and exams were provided to the community at no charge. This donated service resulted in a community benefit exceeding $89,631. Many of our staff volunteer at the clinic. We also provide food for the clinical workers at the clinic as a small token of appreciation for those individuals who volunteer their professional services to benefit those individuals who cannot afford medical care. The hospital is eager to help educate our community on the importance of preventive care. The SCOPE/Meals on Wheels program provides balanced, nutritious meals to the elderly, disabled, or homebound who have no reliable means of obtaining their daily food requirements. Our caring volunteers help alleviate the sense of isolation and worry of clients and observe their physical condition. In cooperation with the community and county agencies, we identify those in need of these services, prepare all meals, and get them ready for distribution by volunteers. During 2019, approximately 12,681 meals were provided by the hospital, at a cost of approximately $39,311. Below is a list of various educational classes and support groups provided by the hospital throughout the year, at no cost to the participants. Educational classes: Advance Directive Education Breastfeeding Classes & Support Group Car Seat Classes Childbirth and Family Education Nursing Career Day Organ Donation Education Stroke Awareness Volunteers: Centra Southside Community Hospital is honored to have many volunteers from throughout our service area making a difference to our patients, visitors, and staff. Some of our volunteer services are: Womens Auxiliary of Southside Community Hospital: Fundraising for hospital - provides scholarships for medical/nursing students. CSCH Volunteers: Front desk, Registration, Emergency Dept., Centra Medical Group, Transport, Tele-Med-Surg, OB, Same Day Surgery, Gift Shop. Hospice Volunteers: Care for end-of-life patients Cardio-Rehab Volunteers: Assistants in the gym for cardio patients PACE (Program for All Inclusive Care for the Elderly) Volunteers: Assists with activities for the elderly Longwood University/Hampden-Sydney College/Local High School Student Volunteers In 2019, 39 Centra Southside Community Hospital volunteers donated 5,101 hours of service.
Form 990, Part VI, Section A, Line 2:	BOARD MEMBER WILLIAM MCGUIRE AND OFFICER LEROY PFEIFFER, JR. SERVE AS OFFICERS OF THE WOODLAND, INC.S BOARD OF DIRECTORS. THE WOODLAND. INC IS A FULL-SERVICE RETIREMENT COMMUNITY OFFERING INDEPENDENT LIVING, ASSISTED LIVING AND SKILLED NURSING CARE FACILITIES.
FORM 990, PART VI, SECTION A, LINE 6:	THROUGH AN AFFILIATION AGREEMENT, SOUTHSIDE COMMUNITY HOSPITAL, INC.S SOLE CORPORATE MEMBER IS CENTRA HEALTH, INC.
FORM 990, PART VI, SECTION A, LINES 7A & 7B:	CENTRA HEALTH, INC. IS THE SOLE MEMBER CORPORATION OF SOUTHSIDE COMMUNITY HOSPITAL, INC. AND HAS THE POWER TO ELECT/APPROVE THE BOARD OF DIRECTORS OF SOUTHSIDE COMMUNITY HOSPITAL, INC.S GOVERNING BODY AND APPROVE DECISIONS MADE BY SOUTHSIDE COMMUNITY HOSPITAL, INC.S BOARD.
FORM 990, PART VI, SECTION A, LINES 8A & 8B:	MINUTES ARE TAKEN AT EACH MEETING.
FORM 990, PART VI, SECTION B, LINE 11B:	THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. SOUTHSIDE COMMUNITY HOSPITAL, INC. WILL PROVIDE ALL VOTING MEMBERS OF THE BOARD OF DIRECTORS WITH A COPY OF THE FORM 990 PRIOR TO ITS FILING.
FORM 990, PART VI, SECTION B, LINE 12C:	ALL SOUTHSIDE COMMUNITY HOSPITAL, INC. OFFICERS, DIRECTORS, AND KEY EMPLOYEES, MUST COMPLETE A 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, DIRECTORS, AND KEY EMPLOYEES MUST AGREE TO PROMPTLY REPORT ANY POTENTIAL CONFLICTS OF INTEREST THAT ARISE DURING THE YEAR TO THE PRESIDENT OR CHAIRMAN OF SOUTHSIDE COMMUNITY HOSPITAL, INC.'S BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINES 15A & B:	FORM 990, PART VI, LINES 15A & 15B WERE ANSWERED AS NO, HOWEVER, UNDER A MANAGEMENT AGREEMENT WITH CENTRA HEALTH, INC., A RELATED PARTY, THE ORGANIZATIONS CHIEF EXECUTIVE OFFICERS 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 FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. ADDITIONALLY, FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG.
FORM 990, PART VI, SECTION C, LINE 19:	THE ORGANIZATION PROVIDES PHOTOCOPIES OF ITS FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY UPON REQUEST AT ITS ADMINISTRATIVE OFFICE.
FORM 990, PART XI, LINE 9:	CONTRIBUTED CAPITAL FROM CENTRA HEALTH $15,400 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT ($11,746) ROUNDING (1) --------- TOTAL TO FORM 990, PART XI, LINE 9 $3,653 =========
FORM 990, PART XII, LINE 2C:	COMMITTEE RESPONSIBLE FOR AUDIT PROCESS OVERSIGHT THE AUDIT PROCESS OF THE ORGANIZATION INCLUDING THE OVERSIGHT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT AUDITOR IS OVERSEEN BY THE AUDIT & COMPLIANCE COMMITTEE OF CENTRA HEALTH, INC., SOLE MEMBER AND RELATED ORGANIZATION.
FORM 990 PART IX LINE 11G	DESCRIPTION:INTERHOSPITAL CHARGES TOTAL FEES:7116823
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:3704080
FORM 990 PART IX LINE 11G	DESCRIPTION:CAPITATED MEDICAL CLAIMS TOTAL FEES:2838180
FORM 990 PART IX LINE 11G	DESCRIPTION:CONTRACT LABOR TOTAL FEES:2593604
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN REMUNERATION TOTAL FEES:1295525
FORM 990 PART IX LINE 11G	DESCRIPTION:MEDICAL PURCHASED SERVICES TOTAL FEES:902088
FORM 990 PART IX LINE 11G	DESCRIPTION:INTERPRETER SERVICES TOTAL FEES:16101
FORM 990 PART IX LINE 11G	DESCRIPTION:CLEANING SERVICES TOTAL FEES:9100
FORM 990 PART IX LINE 11G	DESCRIPTION:MISCELLANEOUS TOTAL FEES:2152

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

SOUTHSIDE COMMUNITY HOSPITAL INC

Employer identification number

54-0555201

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
(1) CENTRA MEDICAL GROUP SOUTHSIDE LLC 800 OAK STREET FARMVILLE,VA23901 26-0771274	PHYS. OFFICES	VA	0	0	SCH

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)CENTRA HEALTH INC 1920 ATHERHOLT ROAD LYNCHBURG,VA24501 54-0715569	HEALTHCARE	VA	501(C)(3)	3	NA		No
(2)CENTRA HEALTH FOUNDATION INC 1920 ATHERHOLT ROAD LYNCHBURG,VA24501 54-1604094	SUPPORTING OR	VA	501(C)(3)	12A	NA		No
(3)CCRC INC 1920 ATHERHOLT ROAD LYNCHBURG,VA24501 54-1929580	CONTINUE CARE	VA	501(C)(3)	12A	NA		No
(4)BEDFORD MEMORIAL HOSPITAL 1613 OAKWOOD STREET BEDFORD,VA24523 54-0566100	HEALTHCARE	VA	501(C)(3)	3	NA		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

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

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) GENERAL BUSINESS CONCERNS INC 1920 ATHERHOLT ROAD LYNCHBURG,VA24501 54-1299682	REAL ESTATE/PHYS	VA	NA	C Corp
(2) PCHP HOLDING INC 2316 ATHERHOLT ROAD LYNCHBURG,VA24501 54-1749492	HOLDING COMPANY	VA	NA	C Corp
(3) PIEDMONT COMMUNITY HEALTH PLAN INC 2316 ATHERHOLT ROAD LYNCHBURG,VA24501 54-1755768	HEALTH INSURANCE	VA	NA	C Corp

Schedule R (Form 990) 2019

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) ............................

Yes

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

Yes

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) ......................

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) .................

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

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

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) ............................

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) 2019

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) 2019

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) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE HEALTHCARE SERVICES FOR EIGHT COUNTIES IN CENTRAL VIRGINIA
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	652
6	Total number of volunteers (estimate if necessary) .............	6	51
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	116,251	23,070
9	Program service revenue (Part VIII, line 2g) .........	91,153,978	95,254,440
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	167,525	164,467
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,197,018	1,074,241
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	92,634,772	96,516,218
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	54,050	26,450
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	34,500,168	34,549,691
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	44,299,087	46,326,081
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	78,853,305	80,902,222
19	Revenue less expenses. Subtract line 18 from line 12.......	13,781,467	15,613,996
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	68,834,782	84,765,991
21	Total liabilities (Part X, line 26).............	7,034,862	7,110,826
22	Net assets or fund balances. Subtract line 21 from line 20.....	61,799,920	77,655,165

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 70,717,523 including grants of $ 26,450 ) (Revenue $ 95,254,440 )
	SOUTHSIDE COMMUNITY HOSPITAL, INC. IS A 501(C)(3) HOSPITAL COMMITTED TO OFFERING AFFORDABLE HEALTHCARE TO THE RESIDENTS OF SOUTHSIDE VIRGINIA. WE ARE DEDICATED TO IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES WE SERVE BY PROVIDING HIGH QUALITY HEALTHCARE. (PLEASE SEE THE CONTINUATION ON SCHEDULE O.)

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses70,717,523

(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)	(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) TIMOTHY R THARPE........................................................................ DIRECTOR	2.0 .......................0.0	X	0	0	0
(19) PATRICIA TUCKER........................................................................ DIRECTOR	2.0 .......................0.0	X	0	0	0
(20) CSCOTT DAVIS........................................................................ DIRECTOR	2.0 .......................0.0	X	0	0	0
(21) KEMPER BEASLEY III........................................................................ DIRECTOR	2.0 .......................0.0	X	0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,546,707	356,171	283,977

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	0
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	23,070

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		23,070

		Business Code
2a	NET PATIENT REVENUE	621400	94,698,502	94,698,502	0	0
b	ANCILLARY SERVICES	900099	555,938	555,938	0	0
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		95,254,440

3 Investment income (including dividends, interest, and othersimilar amounts) ......			96,434			96,434
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		302,447	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	302,447	6c
d	Net rental income or (loss).......			302,447			302,447
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		68,033	7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)		68,033	7c
d	Net gain or (loss).........			68,033			68,033
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	CAFETERIA		621400	454,531	0	0	454,531
b	MISCELLANEOUS REVENUE		900099	317,263	0	0	317,263
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			771,794
12	Total revenue. See instructions.....			96,516,218	95,254,440	0	1,238,708

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	26,450	26,450
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	485,563	0	485,563	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	26,913,222	25,111,639	1,801,583	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	7,150,906	6,566,484	584,422	0
10	Payroll taxes ...........	0
11	Fees for services (non-employees):
a	Management ......	3,576,495	0	3,576,495	0
b	Legal .........	37,129	0	37,129	0
c	Accounting ...........	33,706	0	33,706	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	13,177	0	13,177	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	18,477,653	15,519,759	2,957,894	0
12	Advertising and promotion ....	323,940	0	323,940	0
13	Office expenses .......	3,248,018	2,963,276	284,742	0
14	Information technology ......	36,303	0	36,303	0
15	Royalties ..	0
16	Occupancy ...........	1,461,224	1,461,224	0	0
17	Travel ............	508,548	462,585	45,963	0
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	10,031	6,249	3,782	0
20	Interest ...........	15,400	15,400	0	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	3,808,528	3,808,528	0	0
23	Insurance ...	485,846	485,846	0	0
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	DRUGS	8,896,913	8,896,913	0	0
b	MEDICAL SUPPLIES	5,329,923	5,329,923	0	0
c	COLLECTIONS EXPENSES	63,247	63,247	0	0
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	80,902,222	70,717,523	10,184,699	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 ........			1,904,365	1	5,506,339
2	Savings and temporary cash investments .........			113,113	2	214,488
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			18,984,348	4	18,360,219
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			3,118,573	8	2,921,553
9	Prepaid expenses and deferred charges ......			257,321	9	126,350
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	89,155,798
b	Less: accumulated depreciation	10b	62,939,963	28,374,210	10c	26,215,835
11	Investments—publicly traded securities .			2,325,202	11	2,599,231
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			13,757,650	15	28,821,976
16	Total assets. Add lines 1 through 15 (must equal line 33)...			68,834,782	16	84,765,991

17	Accounts payable and accrued expenses .....	5,166,247	17	4,199,360
18	Grants payable ...	0	18	0
19	Deferred revenue .........	200,382	19	265,895
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
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	1,668,233	25	2,645,571
26	Total liabilities. Add lines 17 through 25..	7,034,862	26	7,110,826

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	61,799,920	27	77,655,165
28	Net assets with donor restrictions ...........	0	28	0
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	61,799,920	32	77,655,165
33	Total liabilities and net assets/fund balances ........	68,834,782	33	84,765,991