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) DEBORAH DAVIS...................................................................... FORMER BOARD MEMBER	0.00 ................. 40.00				X	0	868,646	57,517
(2) MELINDA HANCOCK...................................................................... BOARD MEMBER	1.00 ................. 40.00	X				0	737,241	38,940
(3) RALPH CLARK MD DEC-JUNE...................................................................... BOARD MEMBER	1.00 ................. 40.00	X				0	610,947	39,415
(4) JOHN WARD MD...................................................................... FORMER BOARD MEMBER	0.00 ................. 40.00				X	0	591,405	56,996
(5) THOMAS YACKEL MD...................................................................... BOARD MEMBER	1.00 ................. 40.00	X				0	545,756	44,420
(6) PAUL NEIMEYER...................................................................... SECRETARY	1.00 ................. 40.00		X			0	553,864	31,181
(7) MOHAMMAD MOJADIDI MD...................................................................... PHYSICIAN	40.00 ................. 0.00			X		518,887	0	55,002
(8) NIMESH PATEL MD...................................................................... PHYSICIAN	40.00 ................. 0.00			X		490,805	0	47,980
(9) RAVI EDARA MD...................................................................... PHYSICIAN	40.00 ................. 0.00			X		494,529	0	42,205
(10) SALEEM NAVIWALA MD...................................................................... PHYSICIAN	40.00 ................. 0.00			X		470,835	0	42,834
(11) DAVID H BROWN MD...................................................................... BOARD MEMBER	40.00 ................. 1.00	X				467,251	0	35,238
(12) MANHAL SALEEBY MD...................................................................... PHYSICIAN	40.00 ................. 0.00			X		447,123	0	54,872
(13) W SCOTT BURNETTE...................................................................... CEO VCU CMH	40.00 ................. 1.00		X			396,320	0	48,415
(14) KENNETH LIBBY JR...................................................................... FORMER OFFICER	40.00 ................. 0.00				X	203,129	0	19,347
(15) ANDREW T HOWELL...................................................................... FORMER KEY EMPLOYEE	40.00 ................. 0.00				X	168,416	0	26,401
(16) BRENDA PALMORE...................................................................... FORMER KEY EMPLOYEE	40.00 ................. 0.00				X	156,534	0	17,819
(17) CLINT CLARY...................................................................... BOARD MEMBER	1.00 ................. 0.00	X				0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
SUPPLEMENTAL HEALTH CARE 1640 W REDSTONE CENTER DRIVE PARK CITY,UT84098	RN SERVICES	6,218,735
MCV PHYSICIANS PB79203 BOX 980510 RICHMOND,VA23298	PHYSICIAN SERVICES	4,551,295
MEDICUS HOSPITALISTS LLC 22 ROULSTON RD WINHAM,NH03087	HOSPITALISTS	2,960,370
AVANT HEALTHCARE PROFESSION 1211 STATE ROAD 436 SUITE 227 CASSELBERRY,FL32707	MEDICAL PROFESSIONALS	1,586,696
VCU HEALTH SYSTEM DBA MCV BOX 980620 RICHMOND,VA23298	MEDICAL SERVICES	1,417,908
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 21

- 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

COMMUNITY MEMORIAL HOSPITAL

Employer identification number

54-0551711

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

COMMUNITY MEMORIAL HOSPITAL

Employer identification number

54-0551711

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 COMMUNITY MEMORIAL HOSPITAL

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 COMMUNITY MEMORIAL HOSPITAL		Employer identification number 54-0551711

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 COMMUNITY MEMORIAL HOSPITAL			Employer identification number 54-0551711
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 C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

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

Name of the organization

COMMUNITY MEMORIAL HOSPITAL

Employer identification number

54-0551711

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

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

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

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

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

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

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

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

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

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

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

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

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

Yes

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

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

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

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

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

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

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

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

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

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

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

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

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

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

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

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

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

Part IV

Supplemental Information

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

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1	LOBBYING ACTIVITIES THE ORGANIZATION WAS PART OF SEVERAL ASSOCIATIONS THAT ENGAGED IN LOBBYING ON BEHALF OF ITS MEMBERS. THE FOLLOWING IS A LIST OF THE ORGANIZATIONS AND MEMBER DUES USED FOR LOBBYING. AMERICAN HEALTHCARE ASSOCIATION $4,896 VIRGINIA HEALTHCARE ASSOCIATION $1,115 VIRGINIA ASSOCIATION FOR HOMECARE & HOSPICE $421 -------- TOTAL $6,432

Schedule C (Form 990 or 990EZ) 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

COMMUNITY MEMORIAL HOSPITAL

Employer identification number

54-0551711

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 .....	1,628,516		1,628,516
b	Buildings ....	126,596,421	43,180,048	83,416,373
c	Leasehold improvements
d	Equipment ....	57,751,781	34,478,755	23,273,026
e	Other .....	2,416,484	1,586,345	830,139
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				109,148,054

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)DUE FROM VCUHS				83,474,944
(2)AWUIL INTERIM LIFE SAFETY FUND				1,982,819
(3)CMH LOAN ISSUE COSTS				167,152
(4)DEPOSITS				41,906
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				85,666,821

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
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	30,124,143
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:	COMMUNITY MEMORIAL HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS.

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

COMMUNITY MEMORIAL HOSPITAL

Employer identification number

54-0551711

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 13300.0000000000 %

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

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

Yes

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

Yes

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

Yes

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

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

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	743,917	743,917
b	Medicaid (from Worksheet 3, column a) . . . . .	30,850,919	39,375,053	0	0 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	31,594,836	40,118,970	0	0 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	45,762		45,762	0.040 %
f	Health professions education (from Worksheet 5) . . .	77,647		77,647	0.060 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	4,750		4,750	0 %
j	Total. Other Benefits . .	128,159		128,159	0.100 %
k	Total. Add lines 7d and 7j .	31,722,995	40,118,970	128,159	0.100 %

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

5,090,648

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. ......

1,789,978

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).....

39,380,965

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

68,408,327

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

-29,027,362

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 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)					Other (describe)
1	COMMUNITY MEMORIAL HOSPITAL 1755 N MECKLENBURG AVE SOUTH HILL,VA23970 WWW.VCU-CMH.ORG H 1847	X	X	X	SKILLED NURSING/LONG TERM CARE FACILITY

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)

	COMMUNITY MEMORIAL 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): SEE PART V, SECTION C NARRATIVE

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): SEE PART V, SECTION C

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)

	COMMUNITY MEMORIAL 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 133.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

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):

SEE PART V, SECTION C

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

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

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

	COMMUNITY MEMORIAL 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)

	COMMUNITY MEMORIAL 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
COMMUNITY MEMORIAL HOSPITAL	PART V, SECTION B, LINE 3J: COMMUNITY HEALTH NEEDS ASSESSMENT ADDITIONAL FINDINGS THE NEEDS ASSESSMENT ALSO DESCRIBED INSIGHT FROM COMMUNITY STAKEHOLDERS REGARDING IMPORTANT HEALTH CONCERNS, SIGNIFCANT SERVICE GAPS, SPECIALTY SERVICE GAPS, AND IDEAS FOR ADDRESSING THESE CONCERNS AND GAPS.
COMMUNITY MEMORIAL HOSPITAL	PART V, SECTION B, LINE 5: CHNA, INPUT FROM COMMUNITYIN AN EFFORT TO GENERATE COMMUNITY INPUT, A COMMUNITY INSIGHT SURVEY WAS CONDUCTED WITH COMMUNITY RESIDENTS BETWEEN MAY AND JUNE OF 2018. INSIGHTS WERE COLLECTED VIA SURVEYS ADMINISTERED ONLINE AND IN PERSON AT THE HOSPITAL. THE PROFILE OF THE RESPONDENTS WAS 93% WHITE AND 6% BLACK OR AFRICAN AMERICAN OR MULTI-RACIAL (1%). 27% HAD HOUSEHOLD INCOME OF LESSTHAN $50,000. EFFORTS WERE MADE TO REACH MINORITY POPULATIONS BY REACHING OUT TO THE LOCAL CHURCH COMMUNITY.A COMMUNITY INSIGHT SURVEY WAS ALSO COMPLETD BY COMMUNITY PROFESSIONALS IDENTIFIED BY CMH. THIS REPRESENTATION INCLUDED A WIDE RANGE OF COMMUNITY ORGANIZATIONS INCLUDING PUBLIC HEALTH, PRIVATE FIRMS, LOCAL GOVERNMENT AND HEALTHCARE PROVIDERS.
COMMUNITY MEMORIAL HOSPITAL	PART V, SECTION B, LINE 11: CONSIDERATION OF NEEDS FROM CHNA REPORT TO ADDRESS THE SIGNIFICANT NEEDS OF OUR COMMUNITY, CMH TOOK SEVERAL ACTIONS THROUGHOUT THE YEAR. THE TOP MEDICAL CONCERNS IDENTIFIED ANDACTION PLAN TO ADDRESS THE CONCERNS WERE:CANCER - 83% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN- EXPANDING RADIATION ONCOLOGY SERVICES WITH ADDITION OF CT SIMULATION TO OFFER MORE LOCAL TREATMENT- EXPANDING RADIATION ONCOLOGY SERVICES WITH ADDITION OF CT SIMULATION TO OFFER MORE LOCAL TREATMENT- CMH MARKETING PROVIDES EDUCATIONAL MATERIALS AT COMMUNITY EVENTS AND OFFERS MULTIPLE CORE (COMMUNITY OUT-REACH EDUCATION) PROGRAMS ON CANCER RELATED TOPICS. MOST RECENT ON BREAST CANCER (10/18)- CMH PARTNERS WITH THE SUSAN G. KOMEN FOUNDATION TO OFFER FREE MAMMOGRAMS TO LOW INCOME RESIDENTS- CMH OFFERS SCREENING MAMMOGRAMS WITH PHYSICIAN ORDER AND MAKES REFERRALS UPON POSITIVE FINDINGS- WITH LOSS OF SMOKING CESSATION SERVICES IN THE AREA, EVALUATE DEVELOPING A CMH SERVICE.- SOLARI RADIATION CENTER NOW PROVIDING VAN SERVICE TO SOUTH BOSTON, CLARKSVILLE AND BOYDTON TO ASSIST PATIENTS WITH TRANSPORTATION TO RADIATION THERAPY SERVICES.- GENETIC COUNSELING SERVICES STARTED IN 2018- PALLIATIVE TELEMEDICINE STARTED IN 2018HIGH BLOOD PRESSURE - 72% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN- THE CMH COMMUNITY HEALTH & WELLNESS DEPARTMENT OFFERS BLOOD PRESSURESCREENING PROGRAMS THROUGHOUT REGION AS SCHEDULED LOCATIONS AND AT COMMUNITY/CIVIC EVENTS- CORE PROGRAMS ON HIGH BLOOD PRESSURE/STROKE HAVE BEEN PROVIDED WITHIN LAST 12 MONTHSHEART DISEASE - 68% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN- RECRUITED 2ND FULL-TIME CARDIOLOGIST TO CMH 10/18- WORKED WITH VCU HEALTH SYSTEM TO CONSOLIDATE ALL CARDIOLOGY SERVICES IN ONE LOCATION FOR EASE OF ACCESS.- OFFER CORE PROGRAMS ON CARDIAC RELATED ISSUES EACH YEAR.- EXPANDING DIAGNOSTIC CARDIAC CATHETERIZATION SERVICES AND INTRODUCED VASCULAR SERVICES TO COMMUNITY IN OCT. 18OBESITY - 66% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN- CMH FITNESS CENTER IS AVAILABLE FOR COMMUNITY USE.- CMH LISTED AS SILVER SNEAKERS FITNESS PROVIDER FOR MEDICARE RECIPIENTS.- FANS CHEF NOW OFFERING COMMUNITY CLASSES ON HEALTHY COOKINGALZHEIMER'S DISEASE - 66% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN- DEVELOPING PLANS TO ESTABLISH A MEMORY CARE ASSISTED LIVING UNIT IN THE COMMUNITY.- WORKING TO ESTABLISH A GERIATRICS SERVICE WITHIN CMHPSBEHAVIORAL HEALTH - 65% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN- CMH HAS PARTNERED WITH VCUHS TO RECRUIT AND ESTABLISH AN OUT-PATIENT PEDIATRIC AND ADULT PSYCHIATRY PRACTICE TO OPEN IN CY 2019- EXPLORING OPPORTUNITIES FOR ARTS (ADDICTION RECOVERY TREATMENT SERVICE) IN COOPERATION WITH SOUTHSIDE COMMUNITY SERVICES BOARD- ESTABLISHING ENHANCED RECOVERY AFTER SURGERY (ERAS) AND PAIN MGT. PROGRAM TO REDUCE THE USE OF OPIOIDSIN REVIEWING THE 2018 CHNA THAT ALSO WOULD NOT BE ADDRESSED BY US AS AN ORGANIZATION. THERE ARE THINGS IN THE 2018 CHNA THAT ALSO WOULD NOT BE ADDRESSED BY US AS AN ORGANIZATION; HOWEVER, CMH SUPPORTS OTHERS WORKING TO ADDRESS THAT ISSUE WHEN POSSIBLE.
PART V, SECTION B, LINE 3J	COMMUNITY HEALTH NEEDS ASSESSMENT ADDITIONAL FINDINGSTHE NEEDS ASSESSMENT ALSO DESCRIBED INSIGHT FROM COMMUNITY STAKEHOLDERS REGARDING IMPORTANT HEALTH CONCERNS, SIGNIFCANT SERVICE GAPS, SPECIALTY SERVICE GAPS, AND IDEAS FOR ADDRESSING THESE CONCERNS AND GAPS.
PART V, SECTION B, LINE 5	CHNA, INPUT FROM COMMUNITYIN AN EFFORT TO GENERATE COMMUNITY INPUT, A COMMUNITY INSIGHT SURVEY WAS CONDUCTED WITH COMMUNITY RESIDENTS BETWEEN MAY AND JUNE OF 2018. INSIGHTS WERE COLLECTED VIA SURVEYS ADMINISTERED ONLINE AND IN PERSON AT THE HOSPITAL. THE PROFILE OF THE RESPONDENTS WAS 93% WHITE AND 6% BLACK OR AFRICAN AMERICAN OR MULTI-RACIAL (1%). 27% HAD HOUSEHOLD INCOME OF LESS THAN $50,000. EFFORTS WERE MADE TO REACH MINORITY POPULATIONS BY REACHING OUT TO THE LOCAL CHURCH COMMUNITY.A COMMUNITY INSIGHT SURVEY WAS ALSO COMPLETD BY COMMUNITY PROFESSIONALS IDENTIFIED BY CMH. THIS REPRESENTATION INCLUDED A WIDE RANGE OF COMMUNITY ORGANIZATIONS INCLUDING PUBLIC HEALTH, PRIVATE FIRMS, LOCAL GOVERNMENT AND HEALTHCARE PROVIDERS.
PART V, SECTION B, LINE 7A	HOSPITAL FACILITY'S WEBSITEHTTPS://WWW.VCUHEALTH.ORG/COMMUNITY-MEMORIAL-HOSPITAL/COMMUNITY-RESOURCES/COMMUNITY-RESOURCES
PART V, SECTION B, LINE 10A	HTTPS://WWW.VCUHEALTH.ORG/COMMUNITY-MEMORIAL-HOSPITAL/COMMUNITY-RESOURCES/COMMUNITY-RESOURCES
PART V, SECTION B, LINE 11	CONSIDERATION OF NEEDS FROM CHNA REPORTTO ADDRESS THE SIGNIFICANT NEEDS OF OUR COMMUNITY, CMH TOOK SEVERAL ACTIONS THROUGHOUT THE YEAR. THE TOP MEDICAL CONCERNS IDENTIFIED AND ACTION PLAN TO ADDRESS THE CONCERNS WERE:CANCER - 83% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN-EXPANDING RADIATION ONCOLOGY SERVICES WITH ADDITION OF CT SIMULATION TO OFFER MORE LOCAL TREATMENT-EXPANDING RADIATION ONCOLOGY SERVICES WITH ADDITION OF CT SIMULATION TO OFFER MORE LOCAL TREATMENT-CMH MARKETING PROVIDES EDUCATIONAL MATERIALS AT COMMUNITY EVENTS AND OFFERS MULTIPLE CORE (COMMUNITY OUT-REACH EDUCATION) PROGRAMS ON CANCER RELATED TOPICS. MOST RECENT ON BREAST CANCER (10/18)-CMH PARTNERS WITH THE SUSAN G. KOMEN FOUNDATION TO OFFER FREE MAMMOGRAMS TO LOW INCOME RESIDENTS-CMH OFFERS SCREENING MAMMOGRAMS WITH PHYSICIAN ORDER AND MAKES REFERRALS UPON POSITIVE FINDINGS-WITH LOSS OF SMOKING CESSATION SERVICES IN THE AREA, EVALUATE DEVELOPING A CMH SERVICE.-SOLARI RADIATION CENTER NOW PROVIDING VAN SERVICE TO SOUTH BOSTON, CLARKSVILLE AND BOYDTON TO ASSIST PATIENTS WITH TRANSPORTATION TO RADIATION THERAPY SERVICES.-GENETIC COUNSELING SERVICES STARTED IN 2018-PALLIATIVE TELEMEDICINE STARTED IN 2018HIGH BLOOD PRESSURE - 72% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN-THE CMH COMMUNITY HEALTH & WELLNESS DEPARTMENT OFFERS BLOOD PRESSURE SCREENING PROGRAMS THROUGHOUT REGION AS SCHEDULED LOCATIONS AND AT COMMUNITY/CIVIC EVENTS -CORE PROGRAMS ON HIGH BLOOD PRESSURE/STROKE HAVE BEEN PROVIDED WITHIN LAST 12 MONTHSHEART DISEASE - 68% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN-RECRUITED 2ND FULL-TIME CARDIOLOGIST TO CMH 10/18-WORKED WITH VCU HEALTH SYSTEM TO CONSOLIDATE ALL CARDIOLOGY SERVICES IN ONE LOCATION FOR EASE OF ACCESS.-OFFER CORE PROGRAMS ON CARDIAC RELATED ISSUES EACH YEAR.-EXPANDING DIAGNOSTIC CARDIAC CATHETERIZATION SERVICES AND INTRODUCED VASCULAR SERVICES TO COMMUNITY IN OCT. 18OBESITY - 66% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN-CMH FITNESS CENTER IS AVAILABLE FOR COMMUNITY USE.-CMH LISTED AS SILVER SNEAKERS FITNESS PROVIDER FOR MEDICARE RECIPIENTS.-FANS CHEF NOW OFFERING COMMUNITY CLASSES ON HEALTHY COOKING ALZHEIMER'S DISEASE - 66% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN-DEVELOPING PLANS TO ESTABLISH A MEMORY CARE ASSISTED LIVING UNIT IN THE COMMUNITY.-WORKING TO ESTABLISH A GERIATRICS SERVICE WITHIN CMHPSBEHAVIORAL HEALTH - 65% OF RESPONDENTS IDENTIFIED AS A HEALTH CONCERN-CMH HAS PARTNERED WITH VCUHS TO RECRUIT AND ESTABLISH AN OUT-PATIENT PEDIATRIC AND ADULT PSYCHIATRY PRACTICE TO OPEN IN CY 2019-EXPLORING OPPORTUNITIES FOR ARTS (ADDICTION RECOVERY TREATMENT SERVICE) IN COOPERATION WITH SOUTHSIDE COMMUNITY SERVICES BOARD-ESTABLISHING ENHANCED RECOVERY AFTER SURGERY (ERAS) AND PAIN MGT.PROGRAM TO REDUCE THE USE OF OPIOIDSIN REVIEWING THE 2018 CHNA THAT ALSO WOULD NOT BE ADDRESSED BY US AS AN ORGANIZATION. THERE ARE THINGS IN THE 2018 CHNA THAT ALSO WOULD NOT BE ADDRESSED BY US AS AN ORGANIZATION; HOWEVER, CMH SUPPORTS OTHERS WORKING TO ADDRESS THAT ISSUE WHEN POSSIBLE.
PART V, SECTION C, LINE 16A	HTTPS://WWW.VCUHEALTH.ORG/MEDIA/FILE/CMH/FINANCIAL%20ASSISTANCE%20POLICY.PDFPART V, SECTION C, LINE 16BHTTPS://WWW.VCUHEALTH.ORG/MEDIA/FILE/CMH/FINANCIAL%20ASSISTANCE%20APPLICATION%20FORM.PDFPART V, SECTION C, LINE 16CHTTPS://WWW.VCUHEALTH.ORG/MEDIA/FILE/CMH/FINANCIAL%20ASSISTANCE%20POLICY_DEC2019.PDF

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?14
Name and address		Type of Facility (describe)
1	1 - CMH WOMEN'S HEALTH SERVICES LLC 1755 N MECKLENBURG AVE LACROSSE,VA23950	HEALTHCARE PRACTICE
2	2 - CMH ORTHOPEDIC SERVICES LLC 1755 N MECKLENBURG AVE LACROSSE,VA23950	HEALTHCARE PRACTICE
3	3 - CMH SURGICAL SERVICES LLC 1755 N MECKLENBURG AVE LACROSSE,VA23950	HEALTHCARE PRACTICE
4	4 - CMH PAIN MANAGEMENT SERVICES LLC 1755 N MECKLENBURG AVE LACROSSE,VA23950	HEALTHCARE PRACTICE
5	5 - CLARKSVILLE PRIMARY CARE CENTER 61 BURLINGTON DRIVE CLARKSVILLE,VA23927	HEALTHCARE PRACTICE
6	6 - CHASE CITY PRIMARY CARE CENTER LLC 200 E 5TH STREET CHASE CITY,VA23924	RHC
7	7 - CMH UROLOGICAL SERVICES LLC 1755 N MECKLENBURG AVE LACROSSE,VA23950	HEALTHCARE PRACTICE
8	8 - CMH PHYSICIAN SERVICES LLC 1755 N MECKLENBURG AVE LACROSSE,VA23950	HEALTHCARE PRACTICE
9	9 - CMH CARDIOLOGY LLC 1755 N MECKLENBURG AVE LACROSSE,VA23950	HEALTHCARE PRACTICE
10	10 - CMH EAR NOSE THROAT & ALLERGY LLC 1755 N MECKLENBURG AVE LACROSSE,VA23950	HEALTHCARE PRACTICE
11	11 - CMH PHYSICIAN SERVICES - FAMILY CARE 1755 N MECKLENBURG AVE LACROSSE,VA23930	HEALTHCARE PRACTICE
12	12 - CMH PULMOLOGY LLC 1755 N MECKLENBURG AVE LACROSSE,VA23950	HEALTHCARE PRACTICE
13	13 - CMH VASCULAR LLC 1755 N MECKLENBURG AVE SOUTH HILL,VA23970	HEALTHCARE PRACTICE
14	14 - CMH DENTAL CLINIC LLC 1755 N MECKLENBURG AVE SOUTH HILL,VA23970	HEALTHCARE PRACTICE

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 III, LINE 2:	BAD DEBT FOR PURPOSES OF LINE 2 IS PRESENTED AT ESTIMATED COST. THE COST OF THE BAD DEBT CHARGES WAS CALCULATED USING RATIO OF PATIENT CARE COST TO CHARGES. RATIONALE FOR INCLUDING A PORTION OF BAD DEBT AS COMMUNICATED BENEFIT IS AS FOLLOWS: THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS OTHERWISE ELIGIBLE UNDER THE CHARITY CARE POLICY WAS DETERMINED BY REVIEWING UNCOLLECTIBLE ACCOUNTS FOR THIRD PARTY AND UNINSURED PATIENT ACCOUNTS RECEIVABLE BALANCES FOR WHICH THE PATIENT IS RESPONSIBLE.
PART III, LINE 3:	DESCRIPTION OF BAD EXPENSEFOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES, DISCOUNTED ACCORDING TO POLICY, FOR SERVICES RENDERED. HISTORICAL EXPERIENCE HAS SHOWN A SIGNIFICANT PROPORTION OF THE HOSPITAL'S UNINSURED PATIENTS, IN ADDITION TO A GROWING PROPORTION OF THE HOSPITAL'S INSURED PATIENTS, WILL BE UNABLE OR UNWILLING TO PAY FOR THEIR RESPONSIBLE AMOUNTS FOR THE SERVICES PROVIDED. IN ORDER TO ESTIMATE THE NET REALIZABLE VALUE OF THE REVENUES AND ACCOUNTS RECEIVABLES ASSOCIATED WITH THIRD-PARTY PAYORS AND UNINSURED PATIENTS, MANAGEMENT REGULARLY ANALYZES COLLECTION HISTORY. BASED ON THESE HISTORICAL ANALYSES, THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS AND AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FOR THIRD PARTY AND UNINSURED PATIENT ACCOUNTS RECEIVABLE BALANCES FOR WHICH THE PATIENT IS RESPONSIBLE.THE "EMPLOYER" IS ON ALL PATIENT ACCOUNTS THAT WERE WRITTEN OFF TO BAD DEBT EXPENSE. THOSE ACCOUNTS THAT LISTED NO EMPLOYER WERE ASSUMED TO HAVE QUALIFIED UNDER THE CHARITY CARE POLICY BECAUSE OF THE LACK OF INCOME FROM BEING UNEMPLOYED.
PART III, LINE 8:	MEDICARE COSTING METHODOLOGYMEDICARE ALLOWABLE COST WAS CALCULATED USING A COMBINATION OF COST FROM FILED FY 2020 MEDICARE COST REPORT; COST TO CHARGE RATIOS FROM FILED FY 2020 MEDICARE COST REPORT; AND A CALCULATION OF DIRECT COSTS PLUS ALLOCATED OVERHEAD.THE SHORTFALL IS RELATED TO PROVIDING SERVICES TO OUR RURAL COMMUNITY THAT OUR BOARD OF DIRECTORS HAS DETERMINED TO BE NECESSARY FOR THE BENEFIT OF THE COMMUNITY. THESE SERVICES INCLUDE OPERATING PHYSICIAN PRACTICES BECAUSE THE SERVICES WOULD NOT BE AVAILABLE LOCALLY IF NOT PROVIDED BY THE ORGANIZATION. COMMUNITY MEMORIAL HOSPITAL COULD CEASE TO PROVIDE THE SERVICES BUT OUR COMMUNITY WOULD THEN BE REQUIRED TO TRAVEL UP TO AN HOUR TO RECEIVE THE SERVICES IN ANOTHER COMMUNITY.
PART III, LINE 9B:	APPLICATION OF COLLECTION PRACTICES TO THOSE QUALIFYING FOR FINANCIAL ASSISTANCE COMMUNITY MEMORIAL HOSPITAL'S COLLECTION POLICY STATES THAT ALL UNINSURED PATIENTS WILL BE REFERRED TO OUR FINANCIAL SPECIALIST TO BE SCREENED FOR FINANCIAL ASSISTANCE CONSISTENT WITH OUR INDIGENT AND CHARITY CARE PROGRAMS. INFORMATION IS PROVIDED UPON REGISTRATION TO ALL UNINSURED PATIENTS INFORMING THEM OF OUR FINANCIAL ASSISTANCE PROGRAMS. A NOTE IS ALSO INCLUDED ON STATEMENTS SENT TO UNINSURED PATIENTS REGARDING HOW TO REQUEST INFORMATION ABOUT FINANCIAL ASSISTANCE. THE POLICY FURTHER STATES THAT WE WILL UNDERTAKE REASONABLE EFFORTS TO ENSURE THAT FINANCIAL ASSISTANCE WAS OFFERED BEFORE ANY COLLECTION AGENCY ASSIGNMENT.
PART VI, LINE 2:	NEEDS ASSESSMENTA COMMUNITY NEEDS ASSESSMENT IS CONDUCTED ONCE EVERY THREE YEARS. WE WITH LOCAL PARTNERS AND AGENCIES TO GATHER DATA TO COMPLETE AN ECONOMIC AND WORKFLOW PROFILE OF THE SERVICE AREA. FEEDBACK FROM THE COMMUNITY SOUGHT BY UTILIZING FOCUS GROUPS, COMMUNITY FORUMS AND BY MEETINGS OTHER HEALTH CARE PROVIDERS. INFORMATION IS ALSO SOUGHT FROM THE MEMBERS OF THE BOARD OF DIRECTORS WHO REPRESENT THE COMMUNITIES WE SERVE.
PART VI, LINE 3:	PATIENT EDUCATIONCOMMUNITY MEMORIAL HOSPITAL TAKES MANY STEPS TO ENSURE THAT ITS COMMUNITY IS MADE AWARE OF THE FINANCIAL ASSISTANCE PROGRAMS AVAILABLE TO IT. OUR POLICY FOR FINANCIAL ASSISTANCE, INCLUDING THE APPLICATION, IS AVAILABLE ON OUR WEBSITE. A NOTICE THAT FINANCIAL ASSISTANCE IS AVAILABLE IS POSTED AT EACH REGISTRATION AREA. OUR PATIENT FINANCIAL BROCHURE, WHICH DESCRIBES OUR REGISTRATION REQUIREMENTS, BILLING PROCESS AND FINANCIAL ASSISTANCE PROGRAMS, IS PROVIDED TO EACH UNINSURED PATIENT AT REGISTRATION AND IS ALSO AVAILABLE IN ALL REGISTRATION AREAS AND WAITING ROOMS.THE HOSPITAL EMPLOYS A FINANCIAL SPECIALIST WHOSE RESPONSIBILITY IS TO ASSIST OUR PATIENTS WITH OUR FINANCIAL ASSISTANCE PROGRAMS AND WITH OTHER TYPES OF HEALTHCARE COVERAGE INCLUDING MEDICAID AND DISABILITY APPLICATIONS. THE BUSINESS CARD FOR THE FINANCIAL SPECIALIST IS PROVIDED TO EACH UNINSURED PATIENT AT REGISTRATION. THE FINANCIAL SPECIALIST ATTEMPTS TO VISIT EACH UNINSURED PATIENT WHO HAS BEEN ADMITTED AS AN INPATIENT TO THE HOSPITAL WHILE THEY ARE STILL A PATIENT TO DISCUSS FINANCIAL ASSISTANCE PROGRAMS. A NOTE IS INCLUDED ON EACH STATEMENT THAT IS SENT TO AN UNINSURED PATIENT NOTIFYING THEM OF THE FINANCIAL PROGRAM AND WHO THEY CAN CONTACT FOR ASSISTANCE.
PART VI, LINE 4:	COMMUNITY INFORMATIONCOMMUNITY MEMORIAL HOSPITAL IS A RURAL, NON-PROFIT HEALTH SYSTEM LOCATED IN SOUTH CENTRAL VIRGINIA. WE SERVE THE RURAL COUNTIES OF MECKLENBURG, BRUNWICK AND LUNENBURG IN VIRGINIA AS WELL AS WARREN COUNTY, NORTH CAROLINA. OUR PRIMARY MARKET AREA IS MECKLENBURG COUNTY. MECKLENBURG COUNTY HAS A POPULATION OF 30,587 THE PER CAPITA INCOME OF $25,056 IS ABOUT TWO-THIRDS OF THE STATE AVERAGE. THE ESTIMATED TOTAL POPULATION IN POVERTY PERCENTAGE IS 17.3% - ABOVE THE STATE AVERAGE OF 9.9%. COMMUNITY MEMORIAL HOSPITAL QUALIFIES AS A SOLE COMMUNITY HOSPITAL FOR MEDICARE REGULATIONS AS THE CLOSEST HOSPITAL IS 35 MILES AWAY.
PART VI, LINE 5:	PROMOTION OF COMMUNITY HEALTHCOMMUNITY MEMORIAL HOSPITAL (CMH) IS A VITAL COMPONENT OF THE SOUTHSIDE VIRGINIA AREA, PROVIDING QUALITY CARE TO OUR PATIENTS, SERVING AS A VITAL PART OF THE SAFETY NET AND ENHANCING COMMUNITY HEALTH. OUR MISSION IS TO PROVIDE EXCELLENCE IN THE DELIVERY OF HEALTHCARE. WE ARE LED BY A VOLUNTEER 14 MEMBER BOARD OF DIRECTORS WHO REPRESENT ALL OF THE AREAS WE SSVE AS WELL AS VCU HEALTH SYSTEM REPRESENTATIVES. CMH IS DESIGNATED ASVOLUNTEER 14 MEMBER BOARD OF DIRECTORS WHO REPRESENT ALL OF THE AREAS WE SERVE AS WELL AS VCU HEALTH SYSTEM REPRESENTATIVES. CMH IS DESIGNATED AS A SOLE COMMUNITY HOSPITAL BY MEDICARE WHICH MEANS THAT WE ARE LOCATED IN A RURAL AREA AND 35 MILES FROM OTHER HOSPITALS. WE ARE ALSO DESIGNATED A DISPROPORTIONATE SHARE HOSPITAL BY MEDICARE WHICH MEANS THAT WE PROVIDE CARE TO A HIGHER LEVEL OF LOW-INCOME INDIVIDUALS. OUR PRIMARY SERVICE AREA OF MECKLENBURG COUNTY RANKS BELOW THE STATE AVERAGE IN PER CAPITA INCOME AND ABOVE THE STATE AVERAGE IN ESTIMATED TOTAL POPULATION IN POVERTY PERCENT. WE OFFER A FULL SPECTRUM OF SERVICES TO THE COMMUNITY INCLUDING IN-PATIENT ACUTE CARE, POST ACUTE, AND LONG TERM CARE, OUT-PATIENT SERVICES, HOME HEALTH AND HOSPICE. LOCATED IN A HEALTH PROFESSIONAL SHORTAGE AREA, WE OPERATE PRIMARY HEALTH PRACTICES THAT BRING NEEDED PRIMARY CARE SERVICES TO THE COMMUNITY. WE HAVE ALSO MADE THE DECISION TO OPERATE PRACTICES IN THE SPECIALTY AREAS OF DENTAL, DERMATOLOGY, VASCULAR, CARDIOLOGY/PULMONARY SERVICES, EAR, NOSE & THROAT SERVICES, ORTHOPEDICS, PAIN MANAGEMENT, SURGICAL SERVICES, WOMEN'S HEALTH SERVICES, AND UROLOGY SERVICES AS THESE SPECIALTY SERVICES OTHERWISE MIGHT NOT BE AVAILABLE FOR OUR COMMUNITY WITHOUT SIGNIFICANT TRAVEL. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS BUT RECRUITING TO A RURAL AREA COMES WITH MANY CHALLENGES. OUR EMERGENCY DEPARTMENT HAD ALMOST 22,000 PATIENT VISITS LAST YEAR AND SEES PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. WE OFFER FINANCIAL ASSISTANCE TO OUR UNINSURED PATIENTS. UNINSURED PATIENTS QUALIFYING WITH INCOME BELOW THE FEDERAL POVERTY LEVEL ARE OFFERED FREE CARE. UNINSURED PATIENTS WITH FAMILY INCOME UP TO 300% OF THE FEDERAL POVERTY LEVEL ARE OFFERED SLIDING SCALE DISCOUNTS. INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAM IS POSTED ON OUR WEBSITE, POSTED IN ALL REGISTRATION WAITING AREAS, PROVIDED TO UNINSURED PATIENTS AT REGISTRATION AND INCLUDED AS A NOTE ON ALL PROMOTION OF COMMUNITY SENT TO UNINSURED PATIENTS. WE EMPLOY A FINANCIAL SPECIALIST WHOSE RESPONSIBILITY IS TO ASSIST UNINSURED PATIENTS WITH OUR FINANCIAL ASSISTANCE PROGRAMS AS WELL AS TO ASSIST THE PATIENTS WITH APPLYING AND QUALIFYING FOR OTHER COVERAGE SUCH AS DISABILITY OR MEDICAID. WITH THE HELP OF SEVERAL GRANTS, CMH HAS BEEN ABLE TO OFFER FREE MAMMOGRAMS AND BREAST EXAMS TO UNDERSERVED WOMEN IN THE AREA. AS THE GRANTS DO NOT COVER TOTAL PROGRAM EXPENSES, CMH MUST SUPPLEMENT THE COSTS TO PROVIDE THESE SERVICES TO THE COMMUNITY. LAST YEAR, OUR MEDICATION ASSISTANCE PROGRAM, THE PHARMACY CONNECTION, HELPED 97 PATIENTS OBTAIN MORE THAN 366 MEDICATIONS WITH A RETAIL VALUE OF MORE THAN $742,700. ANY SURPLUS FUNDS GO BACK INTO THE OPERATION OF THE HOSPITAL TO MAINTAIN THE FACILITY AND UPDATE EQUIPMENT AND TECHNOLOGY. CMH ALSO BELONGS TO AND SUPPORTS 8 CHAMBERS OF COMMERCE AND PARTICIPATES IN THEIR COMMUNITY EVENTS. OUR INVOLVEMENT HELPS SUPPORT COMMUNITY GROWTH AND WE SHARE MANY HEALTH RELATED EVENT NOTICES AT THESE MEETINGS. WE ALSO SUPPORT MANY OF THEIR SPECIAL EVENTS AND LOCATE WELLNESS AND SCREENING BOOTHS THERE. HOSPITALS PLAY A CRITICAL ROLE IN THEIR COMMUNITY. AS MAJOR EMPLOYERS AND PURCHASERS, HOSPITALS ARE ENGINES OF ECONOMIC GROWTH AND STABILITY. A STRONG COMMUNITY HOSPITAL HELPS TO RECRUIT BUSINESS AND INDUSTRY TO THE AREA AND HELPS ATTRACT AND RETAIN COLLEGE GRADUATES AND SKILLED CRAFTSMEN. CMH IS THE LARGEST SINGLE EMPLOYER IN THE AREA PROVIDING JOBS AT A WIDE RANGE OF SKILL LEVELS FOR MORE THAN 750 PEOPLE FROM OVER 12 VIRGINIA AND NORTH CAROLINA LOCALITIES WE CONTRIBUTE TO THE TAX BASE THROUGH WAGES, SALARIES AND BENEFITS TOTALLY NEARLY $63M OVER THE PAST YEAR. CMH AND OUR EMPLOYEES PURCHASE GOODS AND SERVICES LOCALLY, CREATING INCOME AND JOBS FOR OTHER BUSINESSES IN THE COMMUNITY. BY PARTICIPATING ON THE TOWN REVITALIZATION COMMITTEE, CMH HAS BEEN ABLE TO PROVIDE SUPPORT TO EFFORTS TO MODERNIZE THE TOWN IN ORDER TO MAKE IT MORE ATTRACTIVE TO NEW BUSINESSES. BY PROVIDING JOBS IN THE REGION, RESIDENTS HAVE A BETTER OPPORTUNITY TO RECEIVE PREVENTATIVE CARE THROUGH THEIR HEALTH INSURANCE PROGRAMS. THE COMMUNITY IS ALSO INVESTED IN CMH. VOLUNTEERS ARE A VITAL PART OF OUR HEALTH CARE TEAM, GOVERNANCE AND FUNDRAISING. ACTIVE VOLUNTEERS SERVE IN DIFFERENT CAPACITIES. THE MEN AND WOMEN OF OUR AUXILIARY VOLUNTEER THOUSANDS OF HOURS EACH YEAR AND PROVIDE A WIDE RANGE OF SERVICES TO STRENGTHEN OUR HOSPITAL AND ENHANCE THE QUALITY OF CARE FOR PATIENTS AND FAMILIES. THE COMMUNITY ALSO SUPPORTS THE OPERATION OF CMH BY SUPPORT OF THE CMH FOUNDATION. THE CMH FOUNDATION IS ALSO LED BY A VOLUNTEER BOARD OF DIRECTORS AND AIMS TO RAISE FUNDS TO ALLOW OUR HOSPITAL TO OFFER THE BEST POSSIBLE CARE AND MAINTAIN STATE-OF-THE-ART FACILITIES AND TECHNOLOGIES TO BETTER SERVE OUR COMMUNITY.
PART VI, LINE 6:	AFFILIATED HEALTH CARE SYSTEMEFFECTIVE JULY 1, 2014 CMH ENTERED INTO AN AFFILIATION AGREEMENT WITH VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY (VCUHS). IN CONNECTION WITH THE AFFILIATION TRANSACTION WE HAVE DEVELOPED A COMPREHENSIVE STRATEGIC PLAN FOR CMH THAT IDENTIFIES STRATEGIC CAPITAL PROJECTS, INCLUDING THE DEVELOPMENT AND CONSTRUCTION OF A REPLACEMENT ACUTE CARE FACILITY AND RELATED EQUIPMENT WITH SUFFICIENT INFRASTRUCTURE AND LICENSED BED CAPACITY NECESSARY TO SUPPORT CMH'S EXISTING SERVICE LINES AND CLINICAL PROGRAMS INITIATIVES BASED ON A DETAILED ANALYSIS OF FACILITY NEEDS AND CLINICAL PROGRAM EXPANSIONS NEEDED TO BEST SERVE THE COMMUNITY AND ENSURE LONG-TERM SUCCESS OF CMH. CMH IMPLEMENTED THE SAME ELECTRONIC MEDICAL RECORD SYSTEM AS VCUHS SO PATIENT CARE INFORMATION WILL BE AVAILABLE TO PHYSICIANS IN BOTH MARKETS.

Schedule H (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

COMMUNITY MEMORIAL HOSPITAL

Employer identification number

54-0551711

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? .........

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)
1DEBORAH DAVIS FORMER BOARD MEMBER	(i) (ii)	0 ------------- 750,108	0 ------------- 93,051	0 ------------- 25,487	0 ------------- 37,505	0 ------------- 20,012	0 ------------- 926,163	0 ------------- 0
2MELINDA HANCOCK BOARD MEMBER	(i) (ii)	0 ------------- 634,209	0 ------------- 99,716	0 ------------- 3,316	0 ------------- 16,800	0 ------------- 22,140	0 ------------- 776,181	0 ------------- 0
3RALPH CLARK MD DEC-JUNE BOARD MEMBER	(i) (ii)	0 ------------- 571,798	0 ------------- 18,305	0 ------------- 20,844	0 ------------- 36,587	0 ------------- 2,828	0 ------------- 650,362	0 ------------- 0
4JOHN WARD MD FORMER BOARD MEMBER	(i) (ii)	0 ------------- 546,204	0 ------------- 32,507	0 ------------- 12,694	0 ------------- 37,505	0 ------------- 19,491	0 ------------- 648,401	0 ------------- 0
5THOMAS YACKEL MD BOARD MEMBER	(i) (ii)	0 ------------- 497,719	0 ------------- 44,638	0 ------------- 3,399	0 ------------- 32,702	0 ------------- 11,718	0 ------------- 590,176	0 ------------- 0
6PAUL NEIMEYER SECRETARY	(i) (ii)	0 ------------- 469,497	0 ------------- 76,713	0 ------------- 7,654	0 ------------- 21,200	0 ------------- 9,981	0 ------------- 585,045	0 ------------- 0
7MOHAMMAD MOJADIDI MD PHYSICIAN	(i) (ii)	459,186 ------------- 0	7,819 ------------- 0	51,882 ------------- 0	32,185 ------------- 0	22,817 ------------- 0	573,889 ------------- 0	0 ------------- 0
8NIMESH PATEL MD PHYSICIAN	(i) (ii)	468,391 ------------- 0	8,350 ------------- 0	14,064 ------------- 0	32,185 ------------- 0	15,795 ------------- 0	538,785 ------------- 0	0 ------------- 0
9RAVI EDARA MD PHYSICIAN	(i) (ii)	473,501 ------------- 0	19,500 ------------- 0	1,528 ------------- 0	32,185 ------------- 0	10,020 ------------- 0	536,734 ------------- 0	0 ------------- 0
10SALEEM NAVIWALA MD PHYSICIAN	(i) (ii)	448,471 ------------- 0	8,300 ------------- 0	14,064 ------------- 0	32,185 ------------- 0	10,649 ------------- 0	513,669 ------------- 0	0 ------------- 0
11DAVID H BROWN MD BOARD MEMBER	(i) (ii)	421,453 ------------- 0	16,591 ------------- 0	29,207 ------------- 0	32,864 ------------- 0	2,374 ------------- 0	502,489 ------------- 0	0 ------------- 0
12MANHAL SALEEBY MD PHYSICIAN	(i) (ii)	421,517 ------------- 0	14,361 ------------- 0	11,245 ------------- 0	32,185 ------------- 0	22,687 ------------- 0	501,995 ------------- 0	0 ------------- 0
13W SCOTT BURNETTE CEO VCU CMH	(i) (ii)	366,376 ------------- 0	16,272 ------------- 0	13,672 ------------- 0	26,500 ------------- 0	21,915 ------------- 0	444,735 ------------- 0	0 ------------- 0
14KENNETH LIBBY JR FORMER OFFICER	(i) (ii)	188,754 ------------- 0	8,318 ------------- 0	6,057 ------------- 0	5,792 ------------- 0	13,555 ------------- 0	222,476 ------------- 0	0 ------------- 0
15ANDREW T HOWELL FORMER KEY EMPLOYEE	(i) (ii)	156,737 ------------- 0	7,119 ------------- 0	4,560 ------------- 0	4,957 ------------- 0	21,444 ------------- 0	194,817 ------------- 0	0 ------------- 0
16BRENDA PALMORE FORMER KEY EMPLOYEE	(i) (ii)	148,708 ------------- 0	6,534 ------------- 0	1,292 ------------- 0	4,559 ------------- 0	13,260 ------------- 0	174,353 ------------- 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

PART I, LINE 1A

SCHEDULE J, PART I, LINE 3 FOR FISCAL YEAR ENDING JUNE 30, 2020 THE COMPENSATION (SALARIES AND INCENTIVES) FOR THE CEO OF COMMUNITY MEMORIAL HOSPITAL IS DETERMINED BY THE CEO OF VCU HEALTH SYSTEM (VCUHS). THIS IS CONSISTENT WITH THE REQUIREMENTS ESTABLISHED IN THE BYLAWS OF VCUHS. THE CEO OF VCUHS USES A THIRD PARTY COMPENSATION CONSULTING FIRM TO CONDUCT A MARKET STUDY TO DETERMINE MARKET POSITION. THE CEO OF VCUHS MAY ALSO CONDUCT A 360 DEGREE EVALUATION OF ALL SENIOR LEVEL ADMINISTRATORS. THESE DATA ELEMENTS IN CONJUNCTION WITH A VIEW OF INDIVIDUAL PERFORMANCE AND THE ATTAINMENT OF GOALS FOR THE YEAR, ARE THE BASIS FOR COMPENSATION RECOMMENDATIONS. THE CEO OF VCUHS THEN MEETS WITH THE COMPENSATION COMMITTEE OF THE VCUHS BOARD OF DIRECTORS TO DISCUSS THE MATTER AND PRESENT RECOMMENDATIONS AND RECEIVE FINAL APPROVAL. THE COMPENSATION COMMITTEE MAY DISCUSS THESE RECOMMENDATIONS IN EXECUTIVE SESSION OF THE VCUHS BOARD OF DIRECTORS.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

COMMUNITY MEMORIAL HOSPITAL

Employer identification number

54-0551711

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

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

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

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






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

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2019

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) REBECCA TOONE	CHILD OF BRENDA PALMORE	29,608	REBECCA TOONE WAS PAID REASONABLE COMPENSATION AS AN EMPLOYEE		No

Part V

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

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

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

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

COMMUNITY MEMORIAL HOSPITAL

Employer identification number

54-0551711

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( MEDICAL EQUIPMENT )	X	5	12,567,574	COST
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2019)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation

Schedule M (Form 990) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

COMMUNITY MEMORIAL HOSPITAL

Employer identification number

54-0551711

Return Reference	Explanation
FORM 990, PART III, LINE 2	DURING FY2020, THE VCU HEALTH SYSTEM WAS SIGNIFICANTLY IMPACTED BY THE COVID PANDEMIC. EACH ENTITY WITHIN THE HEALTH SYSTEM EXPERIENCED FINANCIAL IMPACTS. IN MARCH 2020, CMS AND THE GOVERNOR OF VIRGINIA ISSUED EMERGENCY GUIDANCE TO MINIMIZE INPATIENT AND OUTPATIENT VOLUMES WITHIN HOSPITALS. THE GUIDANCE CONTINUED THROUGH THE END OF APRIL, 2020 AND AS A RESULT, EACH ENTITY WITHIN THE VCU HEALTH SYSTEM EXPERIENCED DECLINES IN REVENUE. CONCURRENTLY, CLINICAL AREAS ALSO EXPERIENCED AN INCREASE IN EXPENSES. CMH ESTIMATED REVENUE LOSSES DUE TO THE PANDEMIC FOR FY20 WERE $5.1M WITH $1.4M OF ADDITIONAL EXPENSES. A PORTION OF THE FINANCIAL IMPACT WAS OFFSET BY COVID RELIEF FUNDING, INCLUDING CARES ACT PROVIDER RELIEF FUNDS, OF $7.6M.
PART I, LINE 4A	COMMUNITY MEMORIAL HOSPITAL (CMH) IS A VITAL COMPONENT OF THE SOUTHSIDE VIRGINIA AREA, PROVIDING QUALITY CARE TO OUR PATIENTS, SERVICING AS A VITAL PART OF THE SAFETY NET AND ENHANCING COMMUNITY HEALTH. OUR MISSION IS TO PROVIDE EXCELLENCE IN THE DELIVERY OF HEALTHCARE. WE ARE LED BY A VOLUNTEER 14 MEMBER BOARD OF DIRECTORS. CMH IS DESIGNATED AS A SOLE COMMUNITY HOSPITAL BY MEDICARE WHICH MEANS THAT WE ARE LOCATED IN A RURAL AREA AND 35 MILES FROM OTHER HOSPITALS. WE ARE ALSO DESIGNATED A DISPROPORTIONATE SHARE HOSPITAL BY MEDICARE WHICH MEANS THAT WE PROVIDE CARE TO A HIGHER LEVEL OF LOW-INCOME INDIVIDUALS. OUR PRIMARY SERVICE AREA OF MECKLENBURG COUNTY RANKS BELOW THE STATE AVERAGE IN PER CAPITA INCOME AND ABOVE THE STATE AVERAGE IN ESTIMATED TOTAL POPULATION IN POVERTY PERCENTAGE. WE OFFER A FULL SPECTRUM OF SERVICES TO THE COMMUNITY INCLUDING IN-PATIENT ACUTE CARE, POST-ACUTE, AND LONG-TERM CARE, OUT-PATIENT SERVICES, HOME HEALTH AND HOSPICE. OUR EMERGENCY DEPARTMENT SEES PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. WE OFFER FINANCIAL ASSISTANCE TO OUR UNINSURED PATIENTS. UNINSURED PATIENTS QUALIFYING WITH INCOME BELOW THE FEDERAL POVERTY LEVEL ARE OFFERED FREE CARE. UNINSURED PATIENTS WITH FAMILY INCOME UP TO 300% OF THE FEDERAL POVERTY LEVEL ARE OFFERED SLIDING SCALE DISCOUNTS. INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAM IS POSTED ON OUR WEBSITE, POSTED IN ALL REGISTRATION WAITING AREAS, PROVIDED TO UNINSURED PATIENTS AT REGISTRATION AND INCLUDED AS A NOTE ON ALL STATEMENTS SENT TO UNINSURED PATIENTS. WE EMPLOY A FINANCIAL SPECIALIST WHOSE RESPONSIBILITY IS TO ASSIST UNINSURED PATIENTS WITH OUR FINANCIAL ASSISTANCE PROGRAMS AS WELL AS TO ASSIST THE PATIENTS WITH APPLYING AND QUALIFYING FOR OTHER COVERAGE SUCH AS DISABILITY OR MEDICAID. WITH THE HELP OF SEVERAL GRANTS, CMH HAS BEEN ABLE TO OFFER FREE MAMMOGRAMS AND BREAST EXAMS TO UNDERSERVED WOMEN IN THE AREA. AS THE GRANTS DO NOT COVER TOTAL PROGRAM EXPENSES, CMH MUST SUPPLEMENT THE COSTS TO PROVIDE THESE SERVICES TO THE COMMUNITY. AS A NOT FOR PROFIT ORGANIZATION, ANY SURPLUS FUNDS GO BACK INTO THE OPERATION OF THE HOSPITAL TO MAINTAIN THE FACILITY AND UPDATE EQUIPMENT AND TECHNOLOGY. CMH ALSO BELONGS TO AND SUPPORTS 8 CHAMBERS OF COMMERCE AND PARTICIPATES IN THEIR COMMUNITY EVENTS. OUR INVOLVEMENT HELPS SUPPORT COMMUNITY GROWTH AND WE SHARE MANY HEALTH RELATED EVENT NOTICES AT THESE MEETINGS. WE ALSO SUPPORT MANY OF THEIR SPECIAL EVENTS AND LOCATE WELLNESS AND SCREENING BOOTHS THERE. HOSPITALS PLAY A CRITICAL ROLE IN THEIR COMMUNITY. AS MAJOR EMPLOYERS AND PURCHASERS, HOSPITALS ARE ENGINES OF ECONOMIC GROWTH AND STABILITY. A STRONG COMMUNITY HOSPITAL HELPS TO RECRUIT BUSINESS AND INDUSTRY TO THE AREA AND HELPS ATTRACT AND RETAIN COLLEGE GRADUATES AND SKILLED CRAFTSMEN. CMH IS THE LARGEST SINGLE EMPLOYER IN THE AREA PROVIDING JOBS AT A WIDE RANGE OF SKILL LEVELS FROM OVER 12 VIRGINIA AND NORTH CAROLINA LOCALITIES.CMH AND OUR EMPLOYEES PURCHASE GOODS AND SERVICES LOCALLY, CREATING INCOME AND JOBS FOR OTHER BUSINESSES IN THE COMMUNITY. BY PARTICIPATING ON THE TOWN REVITALIZATION COMMITTEE, CMH HAS BEEN ABLE TO PROVIDE SUPPORT TO EFFORTS TO MODERNIZE THE TOWN IN ORDER TO MAKE IT MORE ATTRACTIVE TO NEW BUSINESSES. BY PROVIDING JOBS IN THE REGION, RESIDENTS HAVE A BETTER OPPORTUNITY TO RECEIVE PREVENTATIVE CARE THROUGH THEIR HEALTH INSURANCE PROGRAMS. THE COMMUNITY IS ALSO INVESTED IN COMMUNITY MEMORIAL HOSPITAL. VOLUNTEERS ARE A VITAL PART OF OUR HEALTH CARE TEAM, GOVERNANCE AND FUNDRAISING. THE MEN AND WOMEN OF OUR AUXILIARY VOLUNTEER THOUSANDS OF HOURS EACH YEAR AND PROVIDE A WIDE RANGE OF SERVICES TO STRENGTHEN OUR HOSPITAL AND ENHANCE THE QUALITY OF CARE FOR PATIENTS AND FAMILIES. THE COMMUNITY ALSO SUPPORTS THE OPERATION OF CMH BY SUPPORT OF THE CMH FOUNDATION. THE CMH FOUNDATION IS ALSO LED BY A VOLUNTEER BOARD OF DIRECTORS AND AIMS TO RAISE FUNDS TO ALLOW OUR HOSPITAL TO OFFER THE BEST POSSIBLE CARE AND MAINTAIN STATE-OF-THE-ART FACILITIES AND TECHNOLOGIES TO BETTER SERVE OUR COMMUNITY.
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF COMMUNITY MEMORIAL HOSPITAL ("HOSPITAL") SHALL BE THE VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY, A PUBLIC BODY CORPORATE AND POLITICAL SUBDIVISION OF THE COMMONWEALTH OF VIRGINIA. THE MEMBER SHALL HAVE THE RIGHTS RESERVED TO IT AS SET FORTH IN THE ARTICLES OF INCORPORATION AND THE BYLAWS OF THE HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7A	THE SOLE MEMBER OF COMMUNITY MEMORIAL HOSPITAL ("HOSPITAL") SHALL BE THE VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY, A PUBLIC BODY CORPORATE AND POLITICAL SUBDIVISION OF THE COMMONWEALTH OF VIRGINIA. THE MEMBER SHALL HAVE THE RIGHTS RESERVED TO IT AS SET FORTH IN THE ARTICLES OF INCORPORATION AND THE BYLAWS OF THE HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7B	GOVERNANCE DECISIONS RESERVED TO MEMBERS THE RESERVED POWERS OF THE SOLE MEMBER, VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY ("VCUHSA"), INCLUDE THE APPROVAL OF THE FOLLOWING MATTERS: (1) ANY AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION, BYLAWS OR OTHER GOVERNING DOCUMENTS OF THE HOSPITAL OR ITS AFFILIATES, INCLUDING ANY CHANGE TO THE NAME OF THE HOSPITAL, ITS AFFILIATES OR ANY FACILITIES OPERATED BY THE HOSPITAL OR ITS AFFILIATES;(2) APPOINTMENT OF ANY DIRECTORS, MANAGERS OR OTHER GOVERNING PERSONS OF THE HOSPITAL OR ITS AFFILIATES; (3) THE ANNUAL OPERATING AND CAPITAL BUDGETS THE HOSPITAL OR ITS AFFILIATES (TO THE EXTENT SEPARATELY APPROVED FROM THE HOSPITAL'S BUDGETS); (4) ANY TRANSACTION, OR SERIES OF TRANSACTIONS IN ANY FISCAL YEAR, INVOLVING CAPITAL EXPENDITURES OR CONTRACTUAL COMMITMENTS BY THE HOSPITAL OR ITS AFFILIATES NOT PREVIOUSLY SPECIFIED IN A BUDGET APPROVED BY THE MEMBER IN AN AMOUNT EXCEEDING $500,000; (5) ANY TRANSACTION, OR ANY SERIES OF TRANSACTIONS IN ANY FISCAL YEAR, INVOLVING THE INCURRENCE OF DEBT OR THE CREATION OF LIENS OR OTHER ENCUMBRANCES ON ASSETS BY THE HOSPITAL OR ITS AFFILIATES, INCLUDING ANY MORTGAGES, CAPITAL LEASES, SECURITY INTERESTS OR GUARANTEES, NOT PREVIOUSLY SPECIFIED IN A BUDGET APPROVED BY THE MEMBER IN AN AMOUNT EXCEEDING $500,000; (6) ANY SALE, DISTRIBUTION OR OTHER DISPOSITION OF CASH, INVESTMENTS OR OTHER ASSETS BY THE HOSPITAL OR ITS AFFILIATES TO ANY THIRD PARTIES, WITH OR WITHOUT CONSIDERATION, IN AN AMOUNT EXCEEDING $500,000; (7) ANY MERGER, CONSOLIDATION, DISSOLUTION OR SALE OR OTHER DISPOSITION OF SUBSTANTIALLY ALL OF THE ASSETS OF THE HOSPITAL OR ANY OF ITS AFFILIATES; (8) CREATION OF ANY SUBSIDIARY OR AFFILIATED ENTITY, OR PARTICIPATION IN ANY JOINT VENTURE, PARTNERSHIP, LIMITED LIABILITY COMPANY OR SIMILAR ARRANGEMENT, BY THE HOSPITAL OR ITS AFFILIATES; (9)ANY CLOSURE OR OTHER SIGNIFICANT CHANGE TO CLINICAL SERVICE LINES PROVIDED BY THE FACILITIES OPERATED BY THE HOSPITAL OR ITS AFFILIATES;(10) APPOINTMENT OR REMOVAL OF THE CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER OR CHIEF NURSING OFFICER OF THE HOSPITAL; AND (11) ANY MANAGED CARE PAYOR CONTRACTING ON BEHALF OF THE HOSPITAL.
FORM 990, PART VI, SECTION B, LINE 11B	PROCESS USED TO REVIEW 990 THE FINANCIAL INFORMATION IS PROVIDED TO THE INDEPENDENT ACCOUNTANT BY THE VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM'S FINANCE OFFICE. THE INDEPENDENT ACCOUNTANT PREPARES FORM 990 AND RETURNS THE COMPLETED 990 TO THE FINANCE OFFICE FOR REVIEW. THE FINANCE OFFICE REVIEWS THE FORM 990 TO ENSURE IT IS COMPLETE AND ACCURATE. THE FINANCE OFFICE REVIEWS THE FORM 990 WITH THE CEO AND THE VP OF FINANCE. UPON COMPLETING THE REVIEW WITH THE LEADERSHIP, THE GOVERNING BODY IS PROVIDED WITH A COPY OF FORM 990 BEFORE IT IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	PROCESS TO MONITOR TRANSACTIONS FOR COI THE ORGANIZATION REQUIRES ITS BOARD OF DIRECTORS AND OFFICERS TO SIGN A CONFLICT OF INTEREST POLICY ANNUALLY. BOARD MEMBERS ARE RESPONSIBLE FOR DISCLOSING POTENTIAL CONFLICTS AS THEY ARISE. IF A CONFLICT OF INTEREST ARISES, THE BOARD MEMBER IN CONFLICT ABSTAINS FROM VOTING ON THE MATTER.
FORM 990, PART VI, SECTION B, LINE 15	COMPENSATION DETERMINATION THE COMPENSATION (SALARIES AND INCENTIVES) FOR THE OFFICERS OF COMMUNITY MEMORIAL HOSPITAL IS DETERMINED BY THE CEO OF THE VCU HEALTH SYSTEM (VCUHS). THIS IS CONSISTENT WITH THE REQUIREMENTS ESTABLISHED IN THE BYLAWS OF VCUHS. THE CEO OF VCUHS USES A THIRD PARTY COMPENSATION CONSULTING FIRM TO CONDUCT A MARKET STUDY TO DETERMINE MARKET POSITION. THE CEO OF VCUHS MAY ALSO CONDUCT A 360 DEGREE EVALUATION OF ALL SENIOR LEVEL ADMINISTRATORS. THESE DATA ELEMENTS IN CONJUNCTION WITH A REVIEW OF INDIVIDUAL PERFORMANCE AND THE ATTAINMENT OF GOALS FOR THE YEAR, ARE THE BASIS FOR COMPENSATION RECOMMENDATIONS. THE CEO OF VCUHS THEN MEETS WITH THE COMPENSATION COMMITTEE OF THE VCUHS BOARD OF DIRECTORS TO DISCUSS THE MATTER AND PRESENT RECOMMENDATIONS AND RECEIVE FINAL APPROVAL. THE COMPENSATION COMMITTEE MAY DISCUSS THESE RECOMMENDATIONS IN EXECUTIVE SESSION OF THE VCUHS BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19	AVAILABILITY OF GOVERNING DOCUMENTS & POLICIES COMMUNITY MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	CLINICAL SERVICES: PROGRAM SERVICE EXPENSES 18,747,729. MANAGEMENT AND GENERAL EXPENSES 165,885. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,913,614. COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,135,752. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,135,752.
PART XII, LINE 2C:	THIS PROCESS HAS NOT CHANGED FROM LAST YEAR.

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

COMMUNITY MEMORIAL HOSPITAL

Employer identification number

54-0551711

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) CMH PHYSICIAN SERVICES LLC 1747 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0999466	HEALTH PRACTICE	VA	-228,982,183	1,694,073	CMH INC
(2) CMH ER PHYSICIAN SERVICES LLC 1748 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0999466	HEALTH PRACTICE	VA	0	0	CMH INC
(3) CHASE CITY PRIMARY CARE CENTER LLC 1751 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0170508	HEALTH PRACTICE	VA	0	0	CMH INC
(4) CMH ANESTHESIA SERVICES LLC 1752 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 26-2103434	HEALTH PRACTICE	VA	0	0	CMH INC
(5) CMH PAIN MANAGEMENT SERVICES LLC 1744 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 26-2103308	HEALTH PRACTICE	VA			CMH INC
(6) CMH UROLOGICAL SERVICES LLC 1745 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 26-2103187	HEALTH PRACTICE	VA			CMH INC
(7) CMH EAR NOSE THROAT & ALLERGY LLC 1746 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 27-0619525	HEALTH PRACTICE	VA			CMH INC
(8) CLARKSVILLE PRIMARY CARE CENTER LLC 1748 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0999466	HEALTH PRACTICE	VA			CMH INC
(9) CMH CARDIOLOGY & PULMONOLOGY LLC 1749 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0999466	HEALTH PRACTICE	VA			CMH INC
(10) CMH FAMILY CARE LLC 1750 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0999466	HEALTH PRACTICE	VA			CMH INC
(11) CHASE CITY PRIMARE CARE CENTER LLC 1751 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0170508	HEALTH PRACTICE	VA			CMH INC
(12) CMH SURGICAL SERVICES LLC 1753 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-3961907	HEALTH PRACTICE	VA			CMH INC
(13) CMH ORTHOPEDIC SERVICES LLC 1754 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0999466	HEALTH PRACTICE	VA			CMH INC
(14) CMH WOMEN'S HEALTH SERVICES LLC 1755 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0999466	HEALTH PRACTICE	VA			CMH INC
(15) CMH VASCULAR LLC 1756 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0999466	HEALTH PRACTICE	VA			CMH INC
(16) CMH PULMONOLOGY LLC 1756 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0999466	HEALTH PRACTICE	VA			CMH INC
(17) CMH DENTAL CLINIC LLC 1757 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-0999466	HEALTH PRACTICE	VA			CMH INC
(18) CMH RADIOLOGY 1758 N MECKLENBURG AVE PO BOX 90 SOUTH HILL,VA23970 20-3961895	HEALTH PRACTICE	VA			CMH INC

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)COMMUNITY MEMORIAL HOSPITAL FOUNDATION 1755 N MECKLENBERG AVE RICHMOND,VA23970 54-1831331	ADMIN FOR CMH	VA	501(C)(3)	LINE 12A, I	CMH	Yes
(2)VCU HEALTH SYSTEM AUTHORITY PO BOX 980510 RICHMOND,VA23298 54-1848065	ACA MED CTR	VA			N/A		No
(3)VIRGINIA PREMIER HEALTH PLAN INC 600 EAST BROAD STREET RICHMOND,VA23219 54-1760974	HEALTH PLAN	VA	501(C)(3)	LINE 10	VCUHSA	Yes
(4)CRIPPLED CHILDREN'S HOSPITAL 2924 BROOK ROAD RICHMOND,VA23220 54-0506309	HOSPITAL	VA	501(C)(3)	LINE 3	VCUHSA	Yes
(5)MCV ASSOCIATED PHYSICIANS PO BOX 980620 RICHMOND,VA23298 54-1581185	HEALTHCARE	VA	501(C)(3)	LINE 12A, I	VCUHSA	Yes
(6)UHS PROFESSIONAL EDUCATION PROGRAM PO BOX 980048 RICHMOND,VA23298 54-1790553	EDUCATION	VA	501(C)(3)	LINE 12A, I	VCUHSA	Yes
(7)UNIVERSITY HEALTH SERVICES INC PO BOX 980152 RICHMOND,VA23298 54-1790550	EDUCATION	VA	501(C)(3)	LINE 12A, I	VCUHSA	Yes
(8)VIRGINIA COMMONWEALTH UNIVERSITY PO BOX 842512 RICHMOND,VA23284 54-6001758	EDU INSTITUTE	VA			N/A		No
(9)VIRGINIA CHILDREN'S CARE NETWORK LLC PO BOX 980152 RICHMOND,VA23298 85-1396091	CLINICAL CARE	VA	501(C)(3)	LINE 12A, I	VCUHSA	Yes

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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
(1) COMMUNITY MEMORIAL HOSPITAL FOUNDATION	C	1,014,657	FMV

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 EXCELLENCE IN THE DELIVERY OF HEALTHCARE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	1,021
6	Total number of volunteers (estimate if necessary) .............	6	64
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	12,832

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	3,568,543	23,616,463
9	Program service revenue (Part VIII, line 2g) .........	121,978,273	142,579,425
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	520,995	431,403
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	105,906	411,879
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	126,173,717	167,039,170
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
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)	58,923,402	63,216,186
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 192,373
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	75,783,345	89,379,416
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	134,706,747	152,595,602
19	Revenue less expenses. Subtract line 18 from line 12.......	-8,533,030	14,443,568
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	191,584,171	244,960,734
21	Total liabilities (Part X, line 26).............	87,888,013	126,525,026
22	Net assets or fund balances. Subtract line 21 from line 20.....	103,696,158	118,435,708

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 69,691,929 including grants of $ ) (Revenue $ 312,585,750 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ 8,187,338 including grants of $ ) (Revenue $ 17,186,933 )
	THE HUNDLEY CENTER IS A 140 BED EXTENDED CARE FACILITY THAT PROVIDES INTERMEDIATE AND SKILLED NURSING CARE. OUR NURSING HOME IS PROUDLY ACCREDITED BY THE JOINT COMMISSION AND IS A MEDICARE AND MEDICAID CERTIFIED PROVIDER. TWENTY-FOUR HOUR NURSING CARE IS PROVIDED UNDER THE SUPERVISION OF PROFESSIONAL NURSES, AS WELL AS PHYSICIANS ON CALL AT ALL TIMES. FACILITY SERVICES INCLUDE NURSING CARE, PERSONAL CARE, SOCIAL WORK SERVICES, PLANNED ACTIVITY PROGRAMS, MAINTENANCE AND HOUSEKEEPING, PHYSICAL THERAPY, SPEECH THERAPY, OCCUPATIONAL THERAPY, DIETARY AND PHARMACY.

4c	(Code: ) (Expenses $ 46,108,152 including grants of $ ) (Revenue $ -186,919,203 )
	CMH PHYSICIANS LLC: LOCATED IN A HEALTH PROFESSIONAL SHORTAGE AREA, WE OPERATE THREE PRIMARY HEALTH PRACTICES THAT BRING NEEDED PRIMARY CARE SERVICES TO THE COMMUNITY. WE HAVE ALSO MADE THE DECISION TO OPERATE PRACTICES IN THE SPECIALTY AREAS OF CARDIOLOGY/PULMONARY SERVICES, EAR, NOSE & THROAT SERVICES, ORTHOPEDICS, PAIN MANAGEMENT, SURGICAL SERVICES, WOMEN'S HEALTH SERVICES, AND UROLOGY SERVICES AS THESE ARE SPECIALTY SERVICES OTHERWISE MIGHT NOT BE AVAILABLE FOR OUR COMMUNITY WITHOUT SIGNIFICANT TRAVEL. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS BUT RECRUITING TO A RURAL AREA COMES WITH MANY CHALLENGES.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses123,987,419

(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) JAY STAFFORD........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(19) KENDELE UNDERWOOD........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(20) CECIL SHELL........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(21) DAVID CHELMOW MD........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(22) WILLIAM WILKINSON........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0
(23) G NELSON BAIRD........................................................................ BOARD MEMBER/CHAIR	1.00 .......................0.00	X	X	0	0	0
(24) WILLIAM E WELLS JR........................................................................ BOARD MEMBER/VICE CHAIR	1.00 .......................0.00	X	X	0	0	0
(25) CINDY H PECHT........................................................................ BOARD MEMBER/TREASURER	1.00 .......................0.00	X	X	0	0	0
(26) JOHN C LEE JR........................................................................ BOARD MEMBER	1.00 .......................0.00	X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,813,829	3,907,859	658,582

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	16,050,179
e	Government grants (contributions)		1e	7,566,284

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

g	Noncash contributions included in lines 1a - 1f:$		1g	12,567,573

h Total. Add lines 1a-1f.......		23,616,463

		Business Code
2a	NET PATIENT SRVC REV	622110	142,579,425	142,579,425
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		142,579,425

3 Investment income (including dividends, interest, and othersimilar amounts) ......			355,104			355,104
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		21,662	6a
b	Less: rental expenses		0	6b
c	Rental income or (loss)		21,662	6c
d	Net rental income or (loss).......			21,662			21,662
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	12,800	63,499	7a
b	Less: cost or other basis and sales expenses	0	0	7b
c	Gain or (loss)	12,800	63,499	7c
d	Net gain or (loss).........			76,299			76,299
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	43,596
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			43,596			43,596
Business Code			Miscellaneous Revenue
11a	BUNDLED & QUALITY PMTS		900099	77,770	77,770
b	OTHER SERVICES & TRAIN		900099	52,144	52,144
c	EQUIPMENT TRADE IN CRE		900099	45,000			45,000
d	All other revenue ....			171,707	144,141		27,566
e	Total. Add lines 11a–11d ......			346,621
12	Total revenue. See instructions.....			167,039,170	142,853,480	0	569,227

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,000,725	845,528	155,197
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	49,116,659	41,168,156	7,826,814	121,689
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,766,496	1,538,261	225,032	3,203
9	Other employee benefits .......	8,138,769	7,138,500	970,399	29,870
10	Payroll taxes ...........	3,193,537	2,658,619	526,012	8,906
11	Fees for services (non-employees):
a	Management ......	3,093,103	2,744,930	348,173
b	Legal .........	21,550	3,130	18,420
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	21,049,366	18,747,729	2,301,637
12	Advertising and promotion ....	168,309	220	165,714	2,375
13	Office expenses .......	3,551,873	1,863,917	1,665,282	22,674
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	1,245,366	1,239,485	5,881
17	Travel ............	139,759	108,631	30,459	669
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	108,312	93,469	14,593	250
20	Interest ...........	2,488,596		2,488,596
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	8,962,659	187,919	8,774,740
23	Insurance ...	1,996,196		1,996,196
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	BAD DEBT EXPENSE	21,989,089	21,989,089
b	MEDICAL SUPPLIES	18,540,881	18,455,021	85,253	607
c	REPAIRS & MAINTENANCE	3,382,580	3,285,099	95,527	1,954
d	PURCHASED SERVICES	1,694,460	1,694,015	445
e	All other expenses	947,317	225,701	721,440	176
25	Total functional expenses. Add lines 1 through 24e	152,595,602	123,987,419	28,415,810	192,373
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 ........			780,936	1	5,115
2	Savings and temporary cash investments .........			15,148,859	2	10,683,403
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			24,199,534	4	20,683,834
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 .......
					5
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) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			1,788,828	8	2,040,702
9	Prepaid expenses and deferred charges ......			476,053	9	504,318
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	188,393,202
b	Less: accumulated depreciation	10b	79,245,148	100,684,109	10c	109,148,054
11	Investments—publicly traded securities .			14,217,282	11	14,817,463
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			1,572,492	13	1,411,024
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			32,716,078	15	85,666,821
16	Total assets. Add lines 1 through 15 (must equal line 33)...			191,584,171	16	244,960,734

17	Accounts payable and accrued expenses .....	11,359,328	17	26,373,620
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
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 .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	74,530,781	23	70,027,263
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	1,997,904	25	30,124,143
26	Total liabilities. Add lines 17 through 25..	87,888,013	26	126,525,026

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	103,696,158	27	118,435,708
28	Net assets with donor restrictions ...........		28
	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 ...........	103,696,158	32	118,435,708
33	Total liabilities and net assets/fund balances ........	191,584,171	33	244,960,734