2015-05-15T12:42:20-05:00 2014-06-30 990 2013-07-01 510603966 TAKOMA REGIONAL HOSPITAL INC TAKO 4236362350 401 TAKOMA AVENUE GREENEVILLE TN 377434647 DANIEL WOLCOTT CEO 4236362350 2015-05-15 2013 2016-02-25 16:41:14Z DANIEL WOLCOTT 401 TAKOMA AVENUE GREENEVILLE TN 377434647 55538999 0 X WWW.TAKOMA.ORG X 2006 TN THE PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 100 BED HOSPITAL. 15 12 618 54 0 0 456 0 49493427 55164522 -6221 -2463 1162982 376940 50650644 55538999 51405 62082 0 0 29740061 34410848 0 0 0 21837307 22899201 51628773 57372131 -978129 -1833132 27273866 29044477 8105057 11704023 19168809 17340454 X TAKOMA REGIONAL HOSPITAL EXISTS TO EXTEND THE HEALING MINISTRY OF CHRIST BY CARING FOR THOSE WHO ARE ILL AND BY NURTURING THE HEALTH OF THE PEOPLE IN OUR COMMUNITIES. AS A MEMBER OF THE ADVENTIST HEALTH SYSTEM AND WELLMONT HEALTH SYSTEM, TAKOMA REGIONAL HOSPITAL (TRH) STRIVES TO CREATE EXCELLENT EXPERIENCES FOR EACH PERSON WHO CHOOSES TO ACCESS OUR SERVICES. TRH WILL BE A LEADER IN PATIENT SAFETY AND HEALTHCARE QUALITY. TRH WILL BE THE BEST PLACE TO WORK, PRACTICE MEDICINE, AND RECEIVE CARE. 0 0 52977743 62082 55519862 TAKOMA REGIONAL HOSPITAL, INC. OPERATES A 100 BED ACUTE CARE HOSPITAL IN GREENEVILLE, TN. IN THE CURRENT YEAR, THERE WERE 2,407 ADMISSIONS, 11,481 PATIENT DAYS, AND 75,575 OUTPATIENT VISITS. 52977743 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 86 0 1 618 1 0 0 0 0 0 0 0 0 0 0 X 15 12 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 TN X STEVEN MILLER 4236362350 401 TAKOMA AVE GREENEVILLE TN 37743 BALLARD JOEY DIRECTOR 0.40 0.00 X 0 0 0 BUNCH JAMES A JIMM DIRECTOR 0.40 0.00 X 0 0 0 DENARVAEZ MARGARET DENNY CHAIRMAN/DIRECTOR 0.40 0.00 X 0 0 0 FOLK SHARON DIRECTOR 0.40 0.00 X 0 0 0 GILES AL DIRECTOR 0.40 0.00 X 0 0 0 HOWARD JOHN DIRECTOR 0.40 0.00 X 0 0 0 KILGORE PHD JAMES DIRECTOR (END 11/13) 0.20 0.00 X 0 0 0 MCKINNEY MD JR DIRECTOR 40.00 0.00 X 148311 0 4516 NORRIS TODD DIRECTOR 0.40 0.00 X 0 0 0 POPE ALICE DIRECTOR 0.40 0.00 X 0 0 0 RANDOLPH KARSTEN DIRECTOR 0.40 0.00 X 0 0 0 REINER RICHARD VICE CHAIRMAN/DIRECTOR 0.40 0.00 X 0 0 0 SMITH DON DIRECTOR 0.40 0.00 X 0 0 0 UHL MD GREGORY DIRECTOR/CHIEF OF STAFF (END 12/13) 65.00 0.00 X 382715 0 36508 WILLIAMS MARK DIRECTOR 0.40 0.00 X 0 0 0 WRIGHT ED DIRECTOR 0.40 0.00 X 0 0 0 WOLCOTT DANIEL CEO/DIRECTOR 50.00 0.00 X X 316711 0 64928 MILLER STEVEN CFO 50.00 0.00 X 107850 0 30485 LEWIS MD DANIEL CMO 50.00 0.00 X 268375 0 34519 ALBRIGHT TAMMY CNO 50.00 0.00 X 152897 0 37376 BRIDGES MD WILLIAM ROBERT PHYSICIAN 50.00 0.00 X 490556 0 35062 MARSA MD GORDON L PHYSICIAN 50.00 0.00 X 353935 0 32246 KRETSCHMAR MD JOSEPH M PHYSICIAN 50.00 0.00 X 345693 0 33361 DEOSS DO DEBORAH J PHYSICIAN 50.00 0.00 X 307391 0 34362 MORELOCK BROOKS G PHYSICIAN 50.00 0.00 X 279711 0 35626 VANDENHOVEN THOMAS P FORMER CFO 0.00 0.00 X 120811 0 14584 3274956 0 393573 31 1 1 1 ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 LAB SERVICES 226448 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 SERVICE MAINTENANCE AGREEMENT 213801 JACKSON & COKER LOCUMTENE PO BOX 277638 ATLANTA GA 30384 HOSPITALISTS SERVICES 204493 VALLEY EMERGENCY PHYSICIANS TENNESSEE P 1990 N CALIFORNIA BLVD STE 400 WALNUT CREEK CA 94596 ED PHYSICIAN SERVICES 175000 MEDICAL LAUNDRY 1905 AMERICAN WAY KINGSPORT TN 37660 LAUNDRY SERVICE 171628 12 NET PATIENT REVENUE 900099 54945978 54945978 SATISFACTION OF PROGRAM RESTRICTI 900099 59586 59586 CAFETERIA REVENUE 900099 56249 56249 GIFT SHOP REVENUE 900099 43748 43748 58961 58961 55164522 -14182 -14182 21600 0 21600 21600 21600 11719 0 11719 11719 11719 EHR REVENUE 900099 355340 355340 355340 55538999 55519862 0 19137 X 62082 62082 1585190 1585190 24524807 24524807 874475 874475 5641741 5581177 60564 1784635 1784635 44357 44357 6298674 4846853 1451821 211824 211824 1565138 1192972 372166 1929400 1592316 337084 2129236 2129236 149402 149402 6049 6049 1584786 1584786 150964 143764 7200 MEDICAL SUPPLIES 4665050 4665050 STATE TAX INDIGENT ASSE 2742563 2742563 REPAIRS & MAINTENANCE 1246978 1246978 PURCHASED SERVICES 66238 66238 108542 108542 57372131 52977743 4394388 0 3113 3146 4696076 3444994 6395 0 5603641 6363071 4797 0 1021323 1097974 167873 167821 45642293 30213185 15128939 15429108 641709 2538363 27273866 29044477 3105692 4407915 4999365 7296108 8105057 11704023 X 18911291 17101916 257518 238538 19168809 17340454 27273866 29044477 X -1833132 4777 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9456 9456 0 PART II-B, LINE 1: REPRESENTS THE AMOUNT OF TOTAL DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, HOSPITAL ALLIANCE OF TENNESSEE, AND TENNESSEE HOSPITAL ASSOCIATION THAT IS COMPRISED OF LOBBYING EXPENDITURES. 2604550 2604550 16527321 8388268 8139053 24992200 20835651 4156549 1518222 989266 528956 15429108 OTHER RECEIVABLES 21021 DUE FROM RELATED 299339 RECEIVABLE FROM THIRD PARTIES 1984110 INVESTMENT IN FOUNDATION 181393 INVESTMENT IN IPA 52500 2538363 CREDIT BALANCES IN A/R 347960 LEASES PAYABLE 389342 DUE TO AFFILIATED 2223675 PAYABLE TO THIRD PARTIES 1741903 OTHER NONCURRENT LIABILITIES 2593228 7296108 PART X AS NOTED IN OUR RESPONSE TO FORM 990 PART VI, SECTION C, LINE 19, THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION ARE NOT CONSOLIDATED WITHIN THE FINANCIAL STATEMENTS OF EITHER OF ITS MEMBERS. ADDITIONALLY, THE FILING ORGANIZATION DID NOT RECEIVE A SEPARATE AUDITED FINANCIAL STATEMENT FOR THE 6/30/2014 TAX YEAR. ACCORDINGLY, THERE IS NO APPLICABLE FIN 48 FOOTNOTE FOR THIS FILING ORGANIZATION. 1 1 X 1 X 1 X 1 1 1 0 1 0 2501705 2501705 0.04360 9499639 7774464 1725175 0.03010 12001344 7774464 4226880 0.07370 103792 103792 0.00180 103792 103792 0.00180 12105136 7774464 4330672 0.07550 1 3216358 436828 11275901 10533445 742456 X 1 1 1 1 TAKOMA REGIONAL HOSPITAL 401 TAKOMA AVENUE GREENEVILLE TN 37743 WWW.TAKOMA.ORG 86 X X X TAKOMA REGIONAL HOSPITAL 1 1 X X X X X X X X 12 1 1 1 X HTTP://WWW.TAKOMA.ORG/ABOUT-US/COMMUNITY- X X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 1 0 1 X 0 0 TAKOMA REGIONAL HOSPITAL PART V, SECTION B, LINE 3: IN CONJUNCTION WITH CONDUCTING THEIR INITIAL COMMUNITY HEALTH NEEDS ASSESSMENT, TAKOMA REGIONAL HOSPITAL, INC. (TRH OR THE HOSPITAL) CREATED A COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE (CHNAC) TO PROVIDE INPUT AND GUIDE THE HEALTH NEEDS ASSESSMENT PROCESS. ORGANIZATIONS AND INDIVIDUALS SERVING ON THE CHNAC INCLUDED REPRESENTATIVES FROM COUNTY AND CITY GOVERNMENT, THE GREENE COUNTY PUBLIC HEALTH DEPARTMENT, A GREENE COUNTY PUBLIC SCHOOL HEALTH COORDINATOR AND A NURSE EDUCATOR. THE SPECIFIC ORGANIZATIONS AND INDIVIDUALS PARTICIPATING IN THE CHNAC AND REPRESENTING THE MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE INCLUDED REPRESENTATIVES FROM FRONTIER HEALTH, A PROVIDER OF BEHAVIORAL HEALTH SERVICES, THE GREENE COUNTY FOOD BANK, RURAL RESOURCES, AN ORGANIZATION SERVING AS A RESOURCE AND EDUCATOR WITH RESPECT TO SUSTAINABLE AGRICULTURAL PRACTICES, AND WESLEY HEIGHTS, A LOWER-INCOME NEIGHBORHOOD LOCATED WITHIN THE HOSPITAL'S COMMUNITY. THE LISTING BELOW REFLECTS ALL OF THE ORGANIZATIONS/COMMUNITY AREAS REPRESENTED ON THE HOSPITAL'S CHNAC: TRH REPRESENTATIVES; GREENE COUNTY MAYOR'S OFFICE; RURAL RESOURCES; GREENE COUNTY HEALTH DEPARTMENT; CITY OF GREENEVILLE MAYOR'S OFFICE; TUSCULUM COLLEGE OF NURSING; GREENE COUNTY PARTNERSHIP; LAUGHLIN MEMORIAL HOSPITAL REPRESENTATIVES; FRONTIER HEALTH; WESLEY HEIGHTS; GREENE COUNTY FOOD BANK; AND GREENE COUNTY PUBLIC SCHOOLS.PRIMARY AND SECONDARY DATA WERE COLLECTED FOR THE PURPOSE OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS. IN ADDITION TO THE INPUT RECEIVED FROM INDIVIDUALS/ORGANIZATIONS SERVING ON THE CHNAC, PRIMARY DATA WAS COLLECTED. PRIMARY DATA CONSISTED OF GROUP INTERVIEWS AND A COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY THAT GATHERED 263 RESPONDENTS. THE INTERVIEWS INCLUDED A CROSS SECTION OF INDIVIDUALS WHO WERE ASSOCIATED WITH ORGANIZATIONS THAT SERVED THE MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY AND CHRONICALLY DISEASED POPULATIONS. A SURVEY MONKEY QUESTIONNAIRE WAS ALSO DEVELOPED AND DISTRIBUTED TO INDIVIDUALS AND POSTED ON THE HOSPITAL'S FACEBOOK SITE. THE SURVEY WAS MADE AVAILABLE TO ALL ZIP CODES WITHIN THE HOSPITAL'S PRIMARY MARKET AREA. OVER 10% OF THE SURVEYS INCLUDED POPULATIONS OF MINORITIES AND MEDICALLY UNDERSERVED. TAKOMA REGIONAL HOSPITAL PART V, SECTION B, LINE 4: THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED BY TAKOMA REGIONAL HOSPITAL, INC. (THE HOSPITAL) WAS BASED UPON THE HOSPITAL'S INVOLVEMENT AND ENRICHMENT OF THOSE WHO LIVE WITHIN GREENE COUNTY, TENNESSEE. THE PRIMARY SERVICE AREA IS SHARED BY LAUGHLIN MEMORIAL HOSPITAL AND THUS THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN COOPERATION WITH BOTH LOCAL HOSPITALS. TAKOMA REGIONAL HOSPITAL PART V, SECTION B, LINE 5D: TAKOMA REGIONAL HOSPITAL, INC. (THE HOSPITAL) HAS ADOPTED A POLICY THAT ADDRESSES THE PUBLIC POSTING REQUIREMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. UNDER THIS POLICY, THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT MUST BE POSTED ON THE HOSPITAL'S WEBSITE BY THE END OF THE YEAR IN WHICH IT IS CONDUCTED. THE HOSPITAL WILL MAKE A COPY OF ITS COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE UPON REQUEST. THE HOSPITAL WILL ALSO MAKE A PAPER COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AVAILABLE FOR PUBLIC INSPECTION AT THE HOSPITAL FACILITY. TAKOMA REGIONAL HOSPITAL PART V, SECTION B, LINE 7: THROUGH THE COLLECTION OF PRIMARY DATA (FOCUS GROUPS, INTERVIEWS AND A HEALTH QUESTIONNAIRE/SURVEY) ALONG WITH THE REVIEW OF SECONDARY DATA (HEALTH AND DEMOGRAPHIC DATA), TAKOMA REGIONAL HOSPITAL, INC. (THE HOSPITAL) IDENTIFIED A TOTAL OF 10 RECOGNIZED HEALTH PRIORITIES IN GREENE COUNTY, TENNESSEE. UPON REVIEW OF THE 10 RECOGNIZED HEALTH PRIORITIES, THE COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE AND THE HOSPITAL HEALTH NEEDS ASSESSMENT COMMITTEE (THE COMMITTEES) DETERMINED THROUGH EXTENSIVE DIALOGUE AND REVIEW OF DATA THAT THE TOP THREE HEALTH ISSUES WERE TOBACCO USE, DIABETES AND OBESITY. WITH RESPECT TO EACH OF THE TEN RECOGNIZED HEALTH PRIORITIES, A DECISION TREE WAS UTILIZED TO DETERMINE IF THE PRIORITY WOULD BECOME A TOP THREE COMMUNITY HEALTH NEEDS PROJECT. THE DECISION TREE WALKED BOTH THE COMMITTEES THROUGH A PROCESS THAT DETERMINED IF THERE WERE PROGRAMS ALREADY AVAILABLE TO HELP MEET THE IDENTIFIED HEALTH NEEDS IN THE COMMUNITY OR WHETHER IT WAS FEASIBLE TO USE THE HOSPITAL'S RESOURCES TO MEET THE IDENTIFIED HEALTH NEEDS OR BOTH. THE DECISION TREE ALSO TOOK THE COMMITTEES THROUGH THE PROCESS OF DETERMINING WHETHER THEY SHOULD TRY TO MEET THE HEALTH NEED BY THEMSELVES, PARTNER WITH AN EXISTING ORGANIZATION TO MEET THE HEALTH NEED OR JUST SUPPORT OTHERS IN MEETING THE NEED. AS IT RELATES TO DETERMINING THE TOP THREE HEALTH PRIORITIES, THE COMMITTEES' RATIONALE WAS AS FOLLOWS: THE NUMBER ONE HEALTH ISSUE WAS THE UNINSURED/UNEMPLOYED AND THOSE BELOW THE POVERTY LEVEL. AFTER MUCH DISCUSSION THE COMMITTEES DECIDED THAT THIS WAS A LARGE GROUP THAT HAD PROGRAMS AVAILABLE TO HELP MEET THEIR NEEDS AND THAT THE RESOURCES OF THE HOSPITAL COULD BE USED IN OTHER AREAS TO HELP MEET THE DIRECT NEEDS OF THE COMMUNITY. THE SECOND HEALTH ISSUE WAS OBESITY AND BOTH THE COMMITTEES FELT THAT SINCE OBESITY IS SO INTEGRATED IN MANY OTHER DISEASES AND IS A MAJOR ISSUE IN GREENE COUNTY, IT SHOULD BE ONE OF THE PROJECTS SELECTED FROM THE LIST OF TEN HEALTH ISSUES FOR THE COMMUNITY HEALTH PLAN. THE THIRD HEALTH ISSUE WAS DIABETES AND THERE WAS VIGOROUS DISCUSSION THAT DIABETES SHOULD BE ONE OF THE PLANNED PROJECTS IN THE COMMUNITY HEALTH PLAN. THE FOURTH HEALTH ISSUE WAS POOR NUTRITION. THE COMMITTEES FELT THAT THIS HEALTH ISSUE WOULD BE ADDRESSED IN THE OBESITY AND DIABETES HEALTH PLAN. THE FIFTH HEALTH ISSUE WAS MENTAL HEALTH. THE FEELING OF THE COMMITTEES WAS THAT MENTAL HEALTH ISSUES WERE SIGNIFICANT IN GREENE COUNTY BUT THAT THERE WERE PROGRAMS AVAILABLE TO ADDRESS THE EXISTING MENTAL HEALTH PROBLEMS. THE HOSPITAL AND LAUGHLIN MEMORIAL HOSPITAL AGREED THAT THE TRAINING OF PHYSICIANS ON MENTAL HEALTH ISSUES WOULD BE A WORTHWHILE PURSUIT. THE SIXTH HEALTH ISSUE WAS SMOKING AND RESPIRATORY DISEASE. THE DISCUSSION FROM THE COMMITTEES CENTERED ON GREENE COUNTY'S HIGH TOBACCO USE OF 30%. AFTER A THOUGHTFUL DISCUSSION, THE USE OF TOBACCO WAS DETERMINED TO BE THE NUMBER ONE ISSUE FOR THE COMMUNITY HEALTH PLAN. THERE IS CURRENTLY VERY LITTLE BEING DONE TO OFFSET THE DEVASTATING IMPACT THAT TOBACCO IS HAVING ON OUR COMMUNITY. CANCER WAS OUR SEVENTH HEALTH ISSUE. LAUGHLIN MEMORIAL HOSPITAL HAS AN EXCELLENT CANCER PROGRAM AND IT WAS FELT THAT THE SCOPE OF CANCER WAS TOO LARGE FOR OUR COMMUNITY HEALTH PLAN AT THIS TIME. THE EIGHTH HEALTH ISSUE WAS CARDIOVASCULAR DISEASE. WHILE THE COMMITTEES FELT THAT HEART DISEASE SHOULD HAVE BEEN AT THE TOP OF THE LIST, MANY MEMBERS EXPRESSED THEIR CONCERN AT HOW MANY OF THE HEALTH ISSUES WERE INTER-RELATED. THE NINTH HEALTH ISSUE WAS THE LACK OF DENTAL CARE AND THE COMMITTEES FELT THAT THERE WERE CURRENTLY AMPLE HEALTH CLINICS AVAILABLE ALONG WITH THE COUNTY HEALTH DEPARTMENT'S PROGRAMS. THE TENTH HEALTH ISSUE WAS LACK OF PHYSICAL ACTIVITY AND THE COMMITTEES FELT THAT THIS ISSUE WOULD BE ADDRESSED WITH THE TOP THREE HEALTH ISSUES THAT WERE CHOSEN. THEREFORE, THE COMMITTEES DECIDED THAT WHILE THE TOP THREE HEALTH PRIORITIES WOULD BE TOBACCO, OBESITY AND DIABETES, THESE WOULD ALL FALL UNDER THE UMBRELLA OF CARDIOVASCULAR DISEASE AND THAT BY PROVIDING SUPPORT FOR THE TOP THREE HEALTH ISSUES, ULTIMATELY HEART DISEASE WOULD BE POSITIVELY IMPACTED. TAKOMA REGIONAL HOSPITAL PART V, SECTION B, LINE 14G: TAKOMA REGIONAL HOSPITAL HAS DEVELOPED A PATIENT-FRIENDLY SUMMARY VERSION OF ITS FINANCIAL ASSISTANCE POLICY (FAP). THE FILING ORGANIZATION'S FAP PROVIDES THAT ITS HOSPITAL FACILITY WILL MAKE PAPER COPIES OF ITS FAP AND PATIENT-FRIENDLY SUMMARY VERSION AND ITS FINANCIAL ASSISTANCE APPLICATION FORMS AVAILABLE IN PUBLIC LOCATIONS IN THE HOSPITAL AND AVAILABLE BY MAIL. IN ADDITION, THE FAP OF THE HOSPITAL FACILITY STATES THAT SIGNAGE REGARDING THE AVAILABILITY OF THE HOSPITAL FACILITY'S FAP WILL BE VISIBLE AT POINTS OF ADMISSION AND REGISTRATION, INCLUDING THE EMERGENCY DEPARTMENT. TAKOMA REGIONAL HOSPITAL PART V, SECTION B, LINE 20D: IN DETERMINING THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE POLICY-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL USES THE FOLLOWING METHODOLOGY:THE HOSPITAL IDENTIFIES ALL COMMERCIAL PAYORS THAT HAD ANY ACTIVITY WITH THE HOSPITAL DURING THE TAXABLE YEAR. FOR THOSE IDENTIFIED COMMERCIAL PAYORS, AN AVERAGE OF THE NEGOTIATED COMMERCIAL INSURANCE RATES IS DETERMINED. THE AVERAGE OF ALL OF THE NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE IDENTIFIED COMMERCIAL PAYORS DETERMINES THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. 3 TAKOMA MEDICAL ASSOCIATES 438 E VANN ROAD GREENEVILLE TN 37743 PHYSICIAN SERVICES GREENEVILLE URGENT CARE & OCCUPATIONAL 1021 COOLIDGE STREET GREENEVILLE TN 37743 OUTPATIENT CLINIC TAKOMA OUT PATIENT REHABILITATION 108W SUMMERS STREET GREENEVILLE TN 37743 REHABILITATION SERVICES PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. PART III, LINE 2: THE AMOUNT OF BAD DEBT EXPENSE, REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE. PART III, LINE 3: METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S CHARITY CARE POLICY:SELF-PAY PATIENTS ARE REQUIRED TO COMPLETE A PATIENT FINANCIAL ASSISTANCE APPLICATION SHORT FORM (PFAA). IF THE PFAA IS NOT COMPLETED AFTER REASONABLE ATTEMPTS TO OBTAIN IT ARE EXHAUSTED, PATIENT INFORMATION IS PROCESSED THROUGH A SCORER PRODUCT. THE SCORER PRODUCT UTILIZES PUBLICLY AVAILABLE DATA, SUCH AS CREDIT REPORTS, TO ASSESS AN INDIVIDUAL PATIENT'S FINANCIAL VIABILITY. PATIENTS WHO EARN A CERTAIN SCORE ON THE SCORER PRODUCT ARE CONSIDERED TO QUALIFY AS NON-STATE CHARITY PATIENTS. GENERALLY, $200 OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED TO BE NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORER PRODUCT IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S CHARITY CARE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR CHARITY CARE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A CHARITY CARE ELIGIBILITY DETERMINATION CAN NOT BE MADE. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. PART III, LINE 4: THE FILING ORGANIZATION DID NOT HAVE AUDITED FINANCIAL STATEMENTS; THEREFORE, THERE IS NOT A FOOTNOTE TO DESCRIBE BAD DEBT EXPENSE. PART III, LINE 8: COSTING METHODOLOGY:MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. PART III, LINE 9B: AT THE TIME OF PATIENT REGISTRATION, NON-ELECTIVE SELF-PAY PATIENTS ARE INFORMED OF THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND TOLD THAT THEY WILL BE REQUIRED TO SUBMIT NECESSARY FINANCIAL DATA IN ORDER TO POTENTIALLY RECEIVE ANY DISCOUNTS. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, PERCENTAGE DISCOUNTS ARE APPLIED TO A PATIENT'S ACCOUNT BASED UPON AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE.UNDER THE FILING ORGANIZATION'S POLICIES, PAYMENT PLANS FOR PARTIAL CHARITY ACCOUNTS WILL BE INDIVIDUALLY DEVELOPED WITH THE PATIENT. PARTIAL CHARITY ACCOUNTS RESULT WHEN A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION ALLOWS FOR A PERCENTAGE REDUCTION BUT LEAVES THE PATIENT WITH A SELF-PAY BALANCE. IF THE PATIENT COMPLIES WITH THE AGREED-UPON PAYMENT PLAN, THE FILING ORGANIZATION DOES NOT PURSUE ANY COLLECTION ACTION WITH RESPECT TO THE PATIENT. THE FILING ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR A 100% REDUCTION IN CHARGES UNDER ITS FINANCIAL ASSISTANCE POLICY. SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICESTO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ 742,456- DIFFERENCE IN COSTING METHODOLOGY: ( 353,163)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (2,475,204) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS: $(2,085,911)AS INDICATED ABOVE, THE PRIMARY DIFFERENCES BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) REPORTED ON SCHEDULE H, PART III, SECTION B, LINE 7 AND THE FILING ORGANIZATION'S TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS IS DUE TO A DIFFERENCE IN THE COSTING METHODOLOGY AND DIFFERENCES IN THE POPULATION OF MEDICARE PATIENTS WITHIN THE CALCULATION. THE COST METHODOLOGY UTILIZED IN CALCULATING THE TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS IS BASED UPON THE COST-TO-CHARGE RATIO OUTLINED IN WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE SAME COST-TO-CHARGE RATIO IS USED TO DETERMINE THE COSTS ASSOCIATED WITH SERVICES PROVIDED TO CHARITY CARE PATIENTS AND MEDICAID PATIENTS AS REPORTED IN SCHEDULE H, PART I, LINE 7. IN ADDITION, THE MEDICARE COST REPORT EXCLUDES SERVICES PROVIDED TO MEDICARE PATIENTS FOR PHYSICIAN SERVICES, SERVICES PROVIDED TO PATIENTS ENROLLED IN MEDICARE HMOS, AND CERTAIN SERVICES PROVIDED BY OUTPATIENT DEPARTMENTS OF THE FILING ORGANIZATION THAT ARE REIMBURSED ON A FEE SCHEDULE. PART VI, LINE 2: AS REPORTED IN SCHEDULE H, PART V, SECTION B, LINES 1-8, TAKOMA REGIONAL HOSPITAL, INC. (THE HOSPITAL) CONDUCTED ITS INITIAL COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) DURING ITS 2012/2013 FISCAL YEAR. ITS INITIAL CHNA WAS ADOPTED BY ITS GOVERNING BOARD BY JUNE 30, 2013, THE END OF THE HOSPITAL'S TAXABLE YEAR IN WHICH IT CONDUCTED THE CHNA. THE HOSPITAL'S INITIAL CHNA COMPLIED WITH THE GUIDANCE SET FORTH BY THE IRS IN PROPOSED REGULATION SECTION 1.501(R)-(1)-(3). IN ADDITION TO THE CHNA DISCUSSED ABOVE, A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY. SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. PART VI, LINE 3: TAKOMA REGIONAL HOSPITAL HAS A PROCESS IN PLACE WHEREBY PATIENTS ARE INFORMED ABOUT THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. SIGNAGE IS POSTED IN THE EMERGENCY ROOM INDICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR THOSE SELF-PAY PATIENTS MEETING ELIGIBILITY REQUIREMENTS. AFTER EMTALA MEDICAL SCREENING AND STABILIZATION REQUIREMENTS ARE MET, REGISTRATION PERSONNEL WILL SECURE FINANCIAL INFORMATION ON AS MANY SELF-PAY PATIENTS AS POSSIBLE AT THE TIME OF SERVICE. FOR THOSE WHO APPEAR TO QUALIFY FOR MEDICAID OR UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, THE FINANCIAL COUNSELORS WILL CONTINUE TO WORK WITH THOSE PATIENTS UNTIL FINAL ACCOUNT RESOLUTION IS ACHIEVED. ALL OTHER SELF-PAY PATIENTS ARE COVERED UNDER THIS PROCESS. AT ANY TIME DURING THE PROCESS THAT DATA IS PROVIDED SHOWING THAT A PATIENT QUALIFIES FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY THE DISCOUNTS EXTENDED UNDER THAT POLICY WILL BE APPLIED.AS PART OF THE BILLING PROCESS, THE HOSPITAL INCLUDES THE APPLICATION FOR FINANCIAL ASSISTANCE ALONG WITH THE INITIAL PATIENT BILL. THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATION IS ALSO AVAILABLE TO PATIENTS ON THE HOSPITAL'S WEB-SITE IN BOTH AN ENGLISH AND SPANISH VERSION. ADDITIONALLY, THE HOSPITAL'S FINANCIAL COUNSELORS ARE AVAILABLE TO WORK WITH EVERY PATIENT DURING THE FIRST 120 DAYS OF THE BILLING PROCESS TO ASSIST THE PATIENT WITH COMPLETING FINANCIAL ASSISTANCE APPLICATIONS AND INVESTIGATING OTHER POTENTIAL SOURCES OF THIRD-PARTY ASSISTANCE. THE DETERMINATION OF A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE IS MADE ON A CASE-BY-CASE BASIS. VARIOUS FACTORS ARE CONSIDERED IN THAT DETERMINATION. EACH INDIVIDUAL PATIENT WHO IS IDENTIFIED AS POTENTIALLY BEING ELIGIBLE TO RECEIVE FINANCIAL ASSISTANCE IS SEEN BY A FINANCIAL COUNSELOR AT THE HOSPITAL. THE FINANCIAL COUNSELOR WILL WORK WITH THE PATIENT TO MAKE SURE THAT OTHER SOURCES OF ASSISTANCE (PUBLIC OR OTHERWISE) HAVE BEEN SOUGHT TO THE FULLEST EXTENT POSSIBLE. WHEN OTHER FORMS OF ASSISTANCE ARE NOT AVAILABLE OR HAVE BEEN EXHAUSTED, THE HOSPITAL WILL GATHER CERTAIN FINANCIAL INFORMATION FROM THE PATIENT TO DETERMINE THE PATIENT'S ABILITY TO PAY BASED UPON LEVEL OF INCOME. PART VI, LINE 4: TAKOMA REGIONAL HOSPITAL (THE HOSPITAL) IS A 100-BED ACUTE CARE FACILITY THAT HAS PROVIDED QUALITY HEALTH CARE SERVICES TO THE RESIDENTS OF NORTHEASTERN TENNESSEE FOR OVER 81 YEARS. IN 1974, TAKOMA ADVENTIST HOSPITAL BECAME A MEMBER OF THE SOUTHERN ADVENTIST HEALTH AND HOSPITAL SYSTEM. MAY OF 2007 BROUGHT ADDITIONAL CHANGE TO TAKOMA WHEN WELLMONT HEALTH SYSTEM BOUGHT A 60% SHARE OF THE HOSPITAL AND TAKOMA ADVENTIST HOSPITAL BECAME TAKOMA REGIONAL HOSPITAL. THE HOSPITAL IS LOCATED IN THE FOOTHILLS OF THE GREAT SMOKEY MOUNTAINS IN HISTORIC GREENEVILLE, TENNESSEE. THE HOSPITAL'S PRIMARY MARKET HAS A POPULATION OF APPROXIMATELY 74,000, WITH AN ESTIMATED 13,000 OVER THE AGE OF 65.THE HOSPITAL IS A CRUCIAL COMMUNITY AND REGIONAL ASSET. TAKOMA REGIONAL HOSPITAL IS ONE OF TWO HOSPITALS IN GREENEVILLE, TN. THE NEAREST PROVIDER DOES NOT OFFER MANY OF THE SERVICES OFFERED AT THE HOSPITAL, SUCH AS GERIATRIC PSYCHIATRIC INPATIENT SERVICES, OUTPATIENT BEHAVIORAL SERVICES, AND A CENTER FOR INPATIENT REHABILITATION. THE HOSPITAL IS ALSO ONE OF THE LARGEST EMPLOYERS IN THE CITY OF GREENEVILLE, TN.THE CITY OF GREENEVILLE, TN COVERS 15.1 SQUARE MILES. THE WEIGHTED AVERAGE HOUSEHOLD INCOME, BASED ON POPULATION, IN THE PRIMARY MARKET IS APPROXIMATELY $34,600. ABOUT 15% OF GREENE COUNTY'S RESIDENTS HAVE INCOMES BELOW THE FEDERAL POVERTY LEVEL. HIGH SCHOOL GRADUATES ACCOUNT FOR APPROXIMATELY 51% OF GREENE COUNTY, WITH AN ESTIMATED 2% HAVING A BACHELOR'S DEGREE OR HIGHER. GREENE COUNTY'S CURRENT UNEMPLOYMENT RATE IS ABOUT 7%. APPROXIMATELY 50% OF THE HOSPITAL'S PATIENTS DURING FISCAL YEAR ENDING JUNE 30, 2014 WERE MEDICARE PATIENTS, ABOUT 17% WERE MEDICAID PATIENTS, ABOUT 7% WERE SELF-PAY PATIENTS, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. APPROXIMATELY 67.5% OF THE HOSPITAL'S IN-PATIENTS ARE ADMITTED THROUGH THE EMERGENCY DEPARTMENT. PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO TAKOMA REGIONAL HOSPITAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST" AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, HOSPITAL PROVIDED $40,534 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $1,611,204 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. PART VI, LINE 6: AS EXPLAINED IN OUR RESPONSE TO FORM 990, PART VI, SECTION A, LINE 6, TAKOMA REGIONAL HOSPITAL (TRH OR THE HOSPITAL) HAS TWO MEMBERS. THE MEMBERS ARE ADVENTIST HEALTH SYSTEM/SUNBELT, INC. AND WELLMONT HEALTH SYSTEM. TRH IS ABLE TO DRAW UPON THE EXPERTISE AND LEADERSHIP OF BOTH ITS HEALTH SYSTEM MEMBERS IN ITS EFFORT TO CREATE EXCELLENT PATIENT EXPERIENCES AND OFFER A BROAD SPECTRUM OF HEALTH SERVICES NEEDED IN ITS COMMUNITY.PRIOR TO FEBRUARY 15, 2013, TRH WAS PRIMARILY MANAGED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 44 HOSPITALS IN 10 STATES THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 16 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. EFFECTIVE FEBRUARY 15, 2013, CERTAIN MANAGEMENT RESPONSIBILITIES WERE TRANSFERRED TO WELLMONT HEALTH SYSTEM (WELLMONT) IN CONNECTION WITH THE DAY-TO-DAY OPERATIONS OF THE HOSPITAL. WHILE THE EXECUTIVE LEADERSHIP TEAM OF THE HOSPITAL REMAINED ON THE PAYROLL OF AHSSHC, THE CEO OF THE HOSPITAL REPORTS TO THE PRESIDENT OF WELLMONT. IN ADDITION, VARIOUS CONSULTING SERVICES NOT GENERALLY PROVIDED ON SITE AT THE HOSPITAL, SUCH AS CASE MANAGEMENT, COMPLIANCE, INVESTMENT AND LEGAL SERVICES, ARE NOW PROVIDED BY WELLMONT. WELLMONT IS A NOT-FOR-PROFIT INTEGRATED HEALTH SYSTEM SERVING THE TRI-CITIES REGION OF NORTHEAST TENNESSEE AND SOUTHWEST VIRGINIA. WELLMONT IS GUIDED BY ITS MISSION TO DELIVER SUPERIOR HEALTH CARE WITH COMPASSION AND A VISION TO DELIVER THE BEST HEALTH CARE ANYWHERE. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS MANAGEMENT BY AHSSHC AND WELLMONT. THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO ITS AFFILIATION WITH ITS TWO MEMBERS, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. TAKOMA REGIONAL HOSPITAL PAYS A MANAGEMENT FEE TO AHSSHC AND WELLMONT FOR THE SERVICES PROVIDED. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY TAKOMA REGIONAL HOSPITAL MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL WITH NO SUCH AFFILIATION. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN MANAGEMENT FEE EXPENSE. PART VI, LINE 7: THE COMMUNITY BENEFIT REPORT PREPARED BY TAKOMA REGIONAL HOSPITAL, INC. IS NOT FILED WITH ANY STATE AGENCIES. 1 GREENEVILLE CITY SCHOOLS FOUNDATION PO BOX 1420 GREENEVILLE TN 37744 621672018 501(C)(3) 6750 GENERAL SUPPORT BOYS AND GIRLS CLUB OF GREENEVILLE GREENE COUNTY PO BOX 1977 GREENEVILLE TN 37744 621706248 501(C)(3) 6080 GENERAL SUPPORT 2 0 PART I, LINE 2: GRANTS ARE GENERALLY MADE TO AFFILIATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER 501(C)(3) OR TO LOCAL 501(C)(3) COMMUNITY ORGANIZATIONS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. X X X X X 1 1 0 0 0 0 0 0 0 0 0 MCKINNEY MD JR DIRECTOR 143806 0 4388 0 117 0 4372 0 144 0 152827 0 0 0 UHL MD GREGORY DIRECTOR/CHIEF OF STAFF (END 12/13) 375003 0 0 0 7712 0 13850 0 22658 0 419223 0 0 0 WOLCOTT DANIEL CEO/DIRECTOR 239929 0 55905 0 20877 0 26084 0 38844 0 381639 0 11487 0 LEWIS MD DANIEL CMO 214177 0 26549 0 27649 0 13621 0 20898 0 302894 0 0 0 ALBRIGHT TAMMY CNO 124857 0 22639 0 5401 0 7598 0 29778 0 190273 0 0 0 BRIDGES MD WILLIAM ROBERT PHYSICIAN 310003 0 137844 0 42709 0 13850 0 21212 0 525618 0 0 0 MARSA MD GORDON L PHYSICIAN 277992 0 68294 0 7649 0 13850 0 18396 0 386181 0 0 0 KRETSCHMAR MD JOSEPH M PHYSICIAN 298622 0 40922 0 6149 0 13850 0 19511 0 379054 0 0 0 DEOSS DO DEBORAH J PHYSICIAN 206080 0 23281 0 78030 0 13850 0 20512 0 341753 0 0 0 MORELOCK BROOKS G PHYSICIAN 199781 0 21354 0 58576 0 13850 0 21776 0 315337 0 0 0 VANDENHOVEN THOMAS P FORMER CFO 65965 0 26787 0 28059 0 5636 0 8948 0 135395 0 0 0 PART I, LINE 1A THE FILING ORGANIZATION IS 40% OWNED BY ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI). AHSSI IS PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS) WHOSE PARENT IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). IN CONJUNCTION WITH THE MANAGEMENT AGREEMENT WITH AHSSHC AND WELLMONT HEALTH SYSTEM, MEMBERS OF THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF AHSSHC. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE FILING ORGANIZATION REIMBURSES AHSSHC FOR THE SALARY AND BENEFIT COST OF THOSE EXECUTIVES ON THE PAYROLL OF AHSSHC THAT PROVIDE SERVICES AND ARE ON THE MANAGEMENT TEAM OF THE FILING ORGANIZATION. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING AHSSHC EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON TWO BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO VICE PRESIDENTS AND ABOVE AND IS LIMITED TO ONE BUSINESS TRIP PER YEAR AND THE ANNUAL AHS PRESIDENT'S COUNCIL BUSINESS MEETING. THE AHSSHC CORPORATE EXECUTIVE SPOUSAL TRAVEL POLICY WAS ORIGINALLY APPROVED AND REVIEWED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. ALL SPOUSAL TRAVEL COSTS REIMBURSED TO THE EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: AHS HAS A SYSTEM-WIDE POLICY ADDRESSING GROSS-UP PAYMENTS PROVIDED IN CONNECTION WITH EMPLOYER-PROVIDED BENEFITS/OTHER TAXABLE ITEMS. UNDER THE POLICY, CERTAIN TAXABLE BUSINESS-RELATED REIMBURSEMENTS (I.E. TAXABLE BUSINESS-RELATED MOVING EXPENSES, TAXABLE ITEMS PROVIDED IN CONNECTION WITH EMPLOYMENT) PROVIDED TO ANY EMPLOYEE MAY BE GROSSED-UP AT A 25% RATE UPON APPROVAL OF THE FILING ORGANIZATION'S CEO AND CFO. ADDITIONALLY, EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE ARE ELIGIBLE FOR GROSS-UP PAYMENTS ON GIFTS RECEIVED FOR BOARD OF DIRECTOR SERVICES. DISCRETIONARY SPENDING ACCOUNT: A NOMINAL DISCRETIONARY SPENDING AMOUNT WAS PROVIDED IN THE CURRENT YEAR TO ALL ELIGIBLE EXECUTIVES WHO ATTEND THE ANNUAL AHS PRESIDENT'S COUNCIL BUSINESS MEETING ($500 PER EXECUTIVE). OTHER DISCRETIONARY SPENDING ACCOUNTS MAY BE PROVIDED IN CONNECTION WITH OTHER AHS SPONSORED CONFERENCES BUT TYPICALLY DO NOT EXCEED $200 PER PARTICIPANT. ELIGIBLE EXECUTIVES INCLUDE ALL AHSSHC VICE PRESIDENTS AND ABOVE AND ALL AHSSHC SUBSIDIARY ORGANIZATION CEOS AND REGIONAL CFOS. THE PAYMENT PROVIDED TO EACH EXECUTIVE WAS CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES ASSISTANCE TO EXECUTIVES WHO HAVE BEEN RELOCATED BY THE COMPANY DURING THE YEAR. RELOCATION ASSISTANCE PROVIDED TO EXECUTIVES MAY INCLUDE RELOCATION ALLOWANCES TO ASSIST WITH DUPLICATE HOUSING EXPENSES. RELOCATION ASSISTANCE IS ADMINISTERED PER AHSSHC POLICY BY AN EXTERNAL RELOCATION COMPANY. ANY TAXABLE REIMBURSEMENTS MADE TO EXECUTIVES IN CONNECTION WITH RELOCATION ASSISTANCE ARE TREATED AS WAGES TO THE EXECUTIVE AND ARE SUBJECT TO ALL PAYROLL WITHHOLDING AND REPORTING REQUIREMENTS. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES BUSINESS DEVELOPMENT EXPENDITURES. UNDER THIS POLICY, CERTAIN AHS ELIGIBLE EXECUTIVES MAY BE REIMBURSED FOR MEMBER DUES AND USAGE CHARGES FOR A COUNTRY CLUB OR OTHER SOCIAL CLUB UPON AUTHORIZATION. CLUB MEMBERSHIPS MUST BE RECOMMENDED BY THE CEO OF THE AHS HOSPITAL ORGANIZATION AND APPROVED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS OF THE ORGANIZATION. IN ADDITION, THE PROPOSED MEMBERSHIP MUST BE APPROVED ANNUALLY BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ELIGIBLE EXECUTIVES ARE LIMITED TO CERTAIN SENIOR LEVEL EXECUTIVES (HOSPITAL ORGANIZATION CEOS, THE CEO OF THE NURSING HOME DIVISION OF AHS, SENIOR VICE PRESIDENTS AT THREE LARGE HOSPITAL ORGANIZATIONS, REGIONAL CEOS AND CFOS AND THE PRESIDENT AND SENIOR VICE PRESIDENTS OF AHSSHC). IN THE CURRENT YEAR, FOR THIS FILING ORGANIZATION, ONE EXECUTIVE WAS ELIGIBLE TO RECEIVE REIMBURSEMENT FOR CLUB FEES. EACH AHS EXECUTIVE WHO IS APPROVED FOR A CLUB MEMBERSHIP MUST SUBMIT AN ANNUAL REPORT TO THE AHSSHC BOARD COMPENSATION COMMITTEE THAT DESCRIBES HOW THE MEMBERSHIP BENEFITED THEIR ORGANIZATION DURING THE PRECEDING YEAR. PART I, LINE 3 THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) FOR THAT INDIVIDUAL'S ROLE IN SERVING AS THE CEO. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF DIRECTORS (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO AHS AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF AHS WILL NOT EXCEED THE 40TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. FORM 990, PART VII, SECTION A, LINE 4B: AS DISCUSSED IN OUR RESPONSE TO SCHEDULE J, PART I, LINE 1A; 40% OF THE MEMBERSHIP INTEREST IN THE FILING ORGANIZATION IS HELD BY ADVENTIST HEALTH SYSTEM/SUNBELT, INC.(AHSSI). AHSSI IS A WHOLLY-OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). BOTH AHSSI AND AHSSHC ARE ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE FOLLOWING INDIVIDUAL OFFICERS OF THE FILING ORGANIZATION ARE ON THE PAYROLL OF AND COMPENSATED BY AHSSHC FOR SERVICES PROVIDED TO THE FILING ORGANIZATION: - DANIEL WOLCOTT - TOM VANDENHOVEN (FORMER CFO) - STEVEN MILLER THE TYPE AND AMOUNT OF COMPENSATION PAID TO EACH OF THE INDIVIDUALS LISTED ABOVE BY AHSSHC FOR SERVICES RENDERED TO THE FILING ORGANIZATION IS DETAILED IN PART II OF THIS SCHEDULE J. AHSSHC PROVIDES ELIGIBLE EXECUTIVES AN OPPORTUNITY TO PARTICIPATE IN THE AHS EXECUTIVE FLEX BENEFIT PROGRAM (THE PLAN). THE PURPOSE OF THE PLAN IS TO OFFER ELIGIBLE EXECUTIVES AN OPPORTUNITY TO ELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING DEFERRED COMPENSATION BENEFITS TAXABLE UNDER INTERNAL REVENUE CODE (IRC) SECTION 457(F), TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. THE PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH IS DEDUCTED THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS. THE PRE-DETERMINED BENEFITS ALLOWANCE CREDIT PERCENTAGE IS APPROVED BY THE AHSSHC BOARD COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED FROM THE ANNUAL PRE-DETERMINED BENEFITS ALLOWANCE ARE CONTRIBUTED, AT THE EMPLOYEE'S OPTION, TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN DOCUMENTS DEFINE AN EMPLOYEE WHO IS ELIGIBLE TO PARTICIPATE IN THE PLAN TO GENERALLY INCLUDE THE CHIEF EXECUTIVE OFFICERS OF AHS ENTITIES AND VICE PRESIDENTS OF ALL AHS ENTITIES WHOSE BASE SALARY IS AT LEAST $218,000. THE PLAN PROVIDES FOR A CLASS YEAR VESTING SCHEDULE (2 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT. DISTRIBUTIONS COULD ALSO BE MADE FROM THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT UPON ATTAINMENT OF AGE 65 OR UPON AN INVOLUNTARY SEPARATION. THE ACCOUNT IS FORFEITED BY THE EXECUTIVE UPON A VOLUNTARY SEPARATION. DURING 2013, DANIEL WOLCOTT PARTICIPATED IN THE AHS EXECUTIVE FLEX BENEFIT PROGRAM. EMPLOYER CONTRIBUTIONS TO THE PLAN WERE $12,234 DURING 2013. MR. WOLCOTT RECEIVED A DISTRIBUTION OF $11,493 FROM THE PLAN IN 2013. ELIZABETH A WILLIAMS FAMILY OF BOARD MEMBER 13922 EMPLOYEE COMPENSATION 0 FORM 990, PART IV, LINE 20B: TAKOMA REGIONAL HOSPITAL, INC. (TRH OR THE HOSPITAL) DID NOT UNDERGO AN INDEPENDENT FINANCIAL STATEMENT AUDIT FOR ITS TAX YEAR BEGINNING JULY 1, 2013 AND ENDING JUNE 30, 2014. TRH IS A NOT-FOR-PROFIT MEMBERSHIP ORGANIZATION WITH TWO MEMBERS. THE MEMBERS OF THE FILING ORGANIZATION ARE ADVENTIST HEALTH SYSTEM /SUNBELT, INC. (AHSSI) AND WELLMONT HEALTH SYSTEM (WHS) (COLLECTIVELY, THE MEMBERS). BOTH AHSSI AND WHS ARE NOT-FOR-PROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). EACH OF THE TWO MEMBERS HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY THREE OF THE SIX MEMBERS OF THE BOARD OF DIRECTORS OF TRH. BASED UPON THIS DIVISION OF CONTROL OVER THE POWER TO APPOINT THE GOVERNING BODY OF THE HOSPITAL, BOTH OF THE MEMBERS ACCOUNT FOR THEIR INTEREST IN TRH USING THE EQUITY METHOD AND DO NOT CONSOLIDATE TRH INTO THEIR OWN FINANCIAL STATEMENTS OR FINANCIAL STATEMENT AUDITS. IRC SECTION 6033(B)(15)(B) STATES THAT A FORM 990 FILING ORGANIZATION THAT IS SUBJECT TO THE REQUIREMENTS OF IRC SECTION 501(R) MUST ATTACH A COPY OF ITS AUDITED FINANCIAL STATEMENTS (OR, IN THE CASE OF ANY ORGANIZATION THE FINANCIAL STATEMENTS OF WHICH ARE INCLUDED IN A CONSOLIDATED FINANCIAL STATEMENT WITH OTHER ORGANIZATIONS, SUCH CONSOLIDATED FINANCIAL STATEMENT). TO DATE, THE HOSPITAL IS NOT AWARE OF ANY GUIDANCE THAT HAS BEEN ISSUED BY THE IRS THAT ADDRESSES A SITUATION IN WHICH A HOSPITAL ORGANIZATION SUBJECT TO THE REQUIREMENTS OF SECTION 501(R) DOES NOT RECEIVE A SEPARATE AUDITED FINANCIAL STATEMENT AND IS NOT INCLUDED IN A CONSOLIDATED FINANCIAL STATEMENT WITH OTHER ORGANIZATIONS. THERE IS NO STATED REQUIREMENT IN IRC SECTIONS 501(R) OR 6033(B)(15) THAT REQUIRES A FINANCIAL STATEMENT AUDIT FOR A HOSPITAL ORGANIZATION SUBJECT TO THE PROVISIONS OF SECTION 501(R). THE 2013 FORM 990 INSTRUCTIONS STATE THAT IF THE FILING ORGANIZATION OPERATED ONE OR MORE HOSPITAL FACILITIES AT ANY TIME DURING THE TAX YEAR, THEN IT MUST ATTACH A COPY OF ITS MOST RECENT AUDITED FINANCIAL STATEMENT. AS NOTED IN OUR SCHEDULE O DISCLOSURE WITH RESPECT TO FORM 990, PART VI, SECTION B, LINE 15, ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI) HOLDS A 40% MEMBER INTEREST IN THE FILING ORGANIZATION. THE TOP TIER PARENT OF AHSSI IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, D/B/A ADVENTIST HEALTH SYSTEM (AHSSHC). BOTH AHSSI AND AHSSHC ARE ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC PROVIDES EXECUTIVE AND CERTAIN OTHER MANAGEMENT SERVICES TO THE FILING ORGANIZATION. THE CONSOLIDATED 2013 FINANCIAL STATEMENT AUDIT FOR AHSSHC AND ITS CONTROLLED ENTITIES HAS BEEN ATTACHED TO THIS FORM 990. AS NOTED ABOVE, THE FILING ORGANIZATION IS ACCOUNTED FOR ON THE EQUITY METHOD IN THE ATTACHED AUDITED CONSOLIDATED FINANCIAL STATEMENTS FOR AHSSHC AND ITS CONTROLLED ENTITIES. FORM 990, PART VI, SECTION A, LINE 2 MARK WILLIAMS AND TOM VANDENHOVEN - BUSINESS RELATIONSHIP TODD NORRIS AND MARGARET DENARVAEZ - BUSINESS RELATIONSHIP TODD NORRIS AND JOHN HOWARD - BUSINESS RELATIONSHIP TODD NORRIS AND ALICE POPE - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 TAKOMA REGIONAL HOSPITAL, INC. (THE FILING ORGANIZATION) HAS TWO MEMBERS. THE MEMBERS OF THE FILING ORGANIZATION ARE ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI) AND WELLMONT HEALTH SYSTEM (WHS). BOTH AHSSI AND WHS ARE NOT-FOR-PROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY AHSSI AND WHS, THE TWO MEMBERS OF THE FILING ORGANIZATION. EACH OF THE TWO MEMBERS HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY THREE OF THE SIX MEMBERS OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION. IN ADDITION, THE MEMBERS OF THE FILING ORGANIZATION APPOINT THE MEMBERS OF THE FILING ORGANIZATION'S HOSPITAL COMMUNITY BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD OF DIRECTORS PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD OF DIRECTORS DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS, HOSPITAL COMMUNITY BOARD, AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTERESTS, ANY INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS/HOSPITAL COMMUNITY BOARD OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS/HOSPITAL COMMUNITY BOARD OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS/HOSPITAL COMMUNITY BOARD (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTERESTS POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI) HOLDS A 40% MEMBER INTEREST IN THE FILING ORGANIZATION. THE TOP-TIER PARENT OF AHSSI IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM, KNOWN AS ADVENTIST HEALTH SYSTEM, THAT OPERATES HOSPITALS, NURSING HOME FACILITIES, AND OTHER HEALTHCARE PROVIDER ORGANIZATIONS. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3) PURSUANT TO A GROUP RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. PURSUANT TO AN EXECUTIVE MANAGEMENT AGREEMENT, THE FILING ORGANIZATION'S CEO, OTHER OFFICERS AND KEY EMPLOYEES ARE ON THE PAYROLL OF AHSSHC. PLEASE SEE THE DISCUSSION CONCERNING THE PROCESS FOLLOWED BY AHSSHC IN DETERMINING EXECUTIVE COMPENSATION IN OUR RESPONSE TO SCHEDULE J, LINE 3. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION ARE NOT GENERALLY MADE AVAILABLE TO THE PUBLIC AS A WHOLE. AS NOTED PREVIOUSLY IN OUR RESPONSES TO QUESTION 6 OF SECTION A OF PART VI OF THIS FORM 990, THE FILING ORGANIZATION HAS TWO MEMBERS. AS NEITHER MEMBER IS CONSIDERED TO CONTROL THE FILING ORGANIZATION; THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION ARE NOT CONSOLIDATED WITHIN THE FINANCIAL STATEMENTS OF EITHER MEMBER. EACH MEMBER ACCOUNTS FOR ITS PROPORTIONATE OWNERSHIP SHARE OF THE EQUITY OF THE FILING ORGANIZATION IN ITS FINANCIAL STATEMENTS. THE FILING ORGANIZATION DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G RECRUITING : PROGRAM SERVICE EXPENSES 111,708. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 111,708. MISC PURCHASED SERVICE : PROGRAM SERVICE EXPENSES 73,284. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,284. PAYMENTS TO HEALTHCARE PROFESSIONAL : PROGRAM SERVICE EXPENSES 1,568,476. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,568,476. PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 2,199,046. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,199,046. PURCHASED MEDICAL SERVICES : PROGRAM SERVICE EXPENSES 860,385. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 860,385. ENVIRONMENTAL SERVICES : PROGRAM SERVICE EXPENSES 33,954. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,954. AHS/WHS MGMT FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 328,591. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 328,591. BILLING & COLLECTION SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,123,230. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,123,230. FORM 990, PART XI, LINE 9: OTHER DECREASE IN FUND BALANCE -28,833. CHANGE IN INTEREST IN FOUNDATION 21,074. GIFTS 72,119. TRANSFER TO UNRESTRICTED FOR CREATION HEALTH GRANT -59,586. ROUNDING 3. PART VI, SECTION A, LINE 1A THE GOVERNMENT AND MANAGEMENT OF THE AFFAIRS OF TAKOMA REGIONAL HOSPITAL (TRH) IS VESTED IN ITS BOARD OF DIRECTORS. THE BOARD OF DIRECTORS HAS SUPERVISION, CONTROL AND DIRECTION OF THE MANAGEMENT, AFFAIRS AND PROPERTY OF THE CORPORATION; SHALL DETERMINE ITS POLICIES AND PERIODICALLY REVIEW THEM, AND SHALL ACTIVELY PURSUE ITS POLICIES AND OBJECTIVES AND SUPERVISE THE DISBURSEMENT OF ITS FUNDS. THE BOARD OF DIRECTORS IS COMPOSED OF SIX INDIVIDUALS WHO VOTE ON ALL MATTERS THAT COME BEFORE THIS GOVERNING BODY. THE BYLAWS OF TRH ALSO PROVIDE FOR A HOSPITAL COMMUNITY BOARD THAT MAY INCLUDE UP TO FIFTEEN VOTING MEMBERS. THE HOSPITAL COMMUNITY BOARD IS APPOINTED BY THE MEMBERS OF TRH, NAMELY ADVENTIST HEALTH SYSTEM/SUNBELT, INC. AND WELLMONT HEALTH SYSTEM. THE HOSPITAL COMMUNITY BOARD IS RESPONSIBLE TO OVERSEE THE OPERATION OF THE HOSPITAL AND POSSESSES ALL POWER RELATED TO THE MEDICAL STAFF OF THE HOSPITAL, INCLUDING THE POWER TO APPROVE ALL BYLAWS, RULES AND REGULATIONS WITH RESPECT TO THE MEDICAL STAFF.