2013-08-28T10:44:24-05:00 2012-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2011-10-01 561458024 TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC TRAN 8288874777 PO BOX 2440 BREVARD NC 28712 RAY H DUNKELBERG MD 8288874777 2013-08-28 1 AMY BIBBY P00445891 8282542254 2011 2016-02-24 21:20:13Z X SHARON C JOHNSON 153 WEST JORDAN ST BREVARD NC 28712 2635471 0 X N/A X 1985 NC RECEIVE AND ADMINISTER CHARITABLE CONTRIBUTIONS 10 8 5 150 0 0 2161129 2370031 0 0 1012536 262815 14365 -255 3188030 2632591 1086431 1541242 0 0 217826 213500 0 0 0 258639 355133 1562896 2109875 1625134 522716 8932335 10393217 2059489 2228536 6872846 8164681 X THE PURPOSE OF THE FOUNDATION IS TO SOLICIT, MANAGE, AND DISBURSE CHARITABLE GIFTS TO ENABLE THE HOSPITAL TO MAINTAIN AN UP-TO-DATE FACILITY, PURCHASE NEEDED EQUIPMENT, AND SUPPORT AND EXPAND HEALTH PROGRAMS AND SERVICES FOR THE COMMUNITY IT SERVES. 0 0 1541242 1541242 THE FOUNDATION'S PROGRAM SERVICES INVOLVES SOLICITING AND COLLECTING CHARITABLE GIFTS TO SUPPORT TRANSYLVANIA REGIONAL HOSPITAL. THE FOLLOWING ARE FOUNDATION ACTIVITIES THAT GENERATE THAT SUPPORT.-PROVIDED FUNDING FOR NEW SURGICAL EQUIPMENT FOR ENT PHYSICIANS TO DO PROCEDURES AT TRANSYLVANIA REGIONAL HOSPITAL.-COMMITTED $150,000 TOWARD THE LAUNCH OF A PALLIATIVE CARE PROGRAM TO MEET THE INCREASING NEED FOR THIS SERVICE IN OUR COMMUNITY.-OBTAINED GRANT FOR $40,000 FROM NC OFFICE OF RURAL HEALTH GRANT TOWARD THE COST OF EXPANDING 87 HOSPITAL DRIVE PARKING LOT TO ACCOMODATE BLUE RIDGE HEALTH SERVICES PRESENCE ON OUR CAMPUS.-IMPLEMENTED NET COMMUNITY GROW THAT WILL ENHANCE FOUNDATION FUNDRAISING CAPABILITIES AND COMMUNICATION WITH CONSTITUENTS AND COMMUNITY.-PROVIDED $8,885 IN NURSING SCHOLARSHIPS TO TRANSYLVANIA COUNTY RESIDENTS AND TRANSYLVANIA REGIONAL HOSPITAL NURSES SEEKING DEGREES IN NURSING.-PROVIDED ANNUAL SUPPORT FOR HOSPICE AND HOME CARE SERVICES FOR THE COMMUNITY INCLUDING LIFELINE AND SUPPORT SERVICES FOR THE INDIGENT.-CONDUCTED A CAMPAIGN WITH THE RESIDENTS OF LAKE TOXAWAY/SAPPHIRE AREA TO ENDOW THE TOXAWAY HEALTH CENTER. $1.2 MILLION HAS BEEN CONTRIBUTED TO THE $3 MILLION GOAL.-PROVIDED FUNDS ($60,000) TO COVER THE COST OF THE INTERIM PHYSICIAN AT TOXAWAY HEALTH CENTER TO ENSURE MEDICAL SERVICES COVERAGE TO THAT COMMUNITY.-PROVIDED $300,000 TO ENSURE SURGEONS ARE AVAILABLE TO SERVE PEOPLE OF TRANSYLVANIA COUNTY.-PROVIDED $42,000 IN CHARITY CARE INCLUDING FREE MAMMOGRAMS AND FOLLOW-UP DIAGNOSTIC TESTS.-SPONSORED 33 FREE COMMUNITY HEALTH EDUCATION PROGRAMS SUCH AS DESSERT WITH THE DOC WHICH HAD RECORD ATTENDANCE. THESE PROGRAMS ARE CONDUCTED BY PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS IN THE COMMUNITY. 1541242 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 7 0 1 5 1 0 0 0 0 1 1 1 1 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 1 0 X X SHARON JOHNSON 8288774777 153 WEST JORDAN STREET BREVARD NC 28712 RICHARD R MILLAR 5.00 X X 0 0 0 FREDERICK J MARKERT 2.00 X X 0 0 0 PATRICIA R WEBB 2.00 X X 0 0 0 ROBERT J BEDNAREK 2.00 X 0 289424 52981 RAY H DUNKELBERG MD 2.00 X 0 0 0 DANIEL P ELLIOT 2.00 X 0 0 0 RUSSELL R FRENCH 2.00 X 0 0 0 EDWIN W PARKER 2.00 X 0 0 0 VERONICA K PETERMAN 2.00 X 0 0 0 ROBERT L REARDEN JR 2.00 X 0 0 0 CAROL F WATKINS 2.00 X 0 0 0 SHARON C JOHNSON CFRE 40.00 X 84667 0 15645 84667 289424 68626 0 0 1 0 0 26121 560910 40000 1743000 277848 2370031 199058 199058 63757 0 63757 63757 63757 2625 26121 2880 -255 -255 2632591 0 0 262560 1516287 1516287 24955 24955 84667 84667 128833 128833 120822 120822 34560 34560 170462 170462 20967 20967 2516 2516 686 686 MISCELLANEOUS EXPENSES 5120 5120 2109875 1541242 568633 0 20058 44574 408788 524860 133373 84605 3992 11049 466432 55436 414956 410996 7916434 9314232 34734 2901 8932335 10393217 2157 10954 2057332 2217582 2059489 2228536 X 2464590 3537171 4058785 3203793 349471 1423717 6872846 8164681 8932335 10393217 X 522716 769119 X X 0 1 1 X 0 X X X 0 0 0 TRANSYLVANIA COMMUNITY HOSPITAL INC 560562293 3 1 1 1 1216288 TRANSYLVANIA PHYSICIAN SERVICES INC 561920816 3 0 1 1 300000 2 1516288 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 3810150 1918581 506197 6234928 3611599 198551 3810150 3079854 531745 3611599 3008487 71367 3079854 0.75860 0.22830 0.01300 0 0 171000 150000 321000 100000 12126 87874 45432 43310 2122 410996 2632591 2109875 522716 973497 61426 -265804 769119 1291835 PART IV, LINE 2B: THE FOUNDATION ACTS AS TRUSTEE FOR IRREVOCABLE CHARITABLE REMAINDER UNITRUSTS AND CHARITABLE REMAINDER ANNUITY TRUSTS. THE ASSETS IN THESE TRUSTS WILL REMAIN IN TRUST, PAYING DISTRIBUTIONS TO THE DONORS UNDER THE TERMS OF THE AGREEMENTS, AND THE REMAINDER OF ASSETS WILL BECOME THE PROPERTY OF THE FOUNDATION ACCORDING TO THE TERMS OF THE TRUST AGREEMENTS. SUCH AMOUNTS RECEIVED ARE REPORTED AS ASSETS RESTRICTED AS TO USE. THESE TRUSTS REQUIRE SPECIFIED DISTRIBUTIONS TO THEIR DESIGNATED BENEFICIARIES OVER THE TRUSTS' TERMS. THE PRESENT VALUE OF THE EXPECTED DISTRIBUTIONS TO BE MADE IS RECORDED AS ANNUITIES PAYABLE. AT THE TIME THAT THE TRUST IS CREATED, THE DIFFERENCE IN THE VALUE OF THE INITIAL TRUST ASSETS AND THE PRESENT VALUE OF THE EXPECTED DISTRIBUTIONS IS RECORDED AS CONTRIBUTION INCOME. SUBSEQUENT CHANGES TO THE PRESENT VALUE OF THE EXPECTED DISTRIBUTIONS ARE RECORDED AS A CHANGE IN THE VALUE OF SPLIT INTEREST AGREEMENTS. EACH YEAR, THE FOUNDATION ADJUSTS THE PRESENT VALUE OF EXPECTED DISTRIBUTIONS BASED ON CHANGES IN THE ACTUARIAL ASSUMPTIONS OF THE DONORS' LIFE EXPECTANCY. THE PRESENT VALUE IS ALSO AFFECTED BY CHANGES IN THE DISCOUNT RATE USED. THE DISCOUNT RATE USED TO CALCULATE THE PRESENT VALUE OF EXPECTED DISTRIBUTIONS IS THE SAME AS THE RATE DEVELOPED BY THE INTERNAL REVENUE SERVICE TO VALUE THESE TYPES OF AGREEMENTS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE FOUNDATION'S ENDOWMENT CONSISTS OF SEVEN INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. ITS ENDOWMENT INCLUDES BOTH DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE BOARD OF TRUSTEES TO FUNCTION AS ENDOWMENTS. AS REQUIRED BY GAAP, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS, INCLUDING FUNDS DESIGNATED BY THE BOARD OF TRUSTEES TO FUNCTION AS ENDOWMENTS, ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: TRANSYLVANIA, THE HOSPITAL, THE FOUNDATION, AND TPSI ARE INCORPORATED AS NONPROFIT ORGANIZATIONS UNDER THE LAWS OF NORTH CAROLINA AND ARE EXEMPT FROM INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATIONS HAVE DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS EXIST FOR OPEN TAX YEARS AS OF SEPTEMBER 30, 2012. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2008 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. FORM 990, SCHEDULE D, PART V, LN 1B: DURING THE YEAR, THE FOUNDATION'S BOARD EVALUATED THE FOUNDATION'S ASSETS AND RECLASSIFIED ASSETS AS ENDOWMENT FUNDS. THESE FUNDS AS WELL AS CURRENT YEAR CONTRIBUTIONS ARE INCLUDED AS CONTRIBUTIONS IN THIS SECTION. THESE FUNDS ARE INVESTED ACCORDING TO THE FOUNDATION'S INVESTMENT POLICY FOR ITS ENDOWMENTS. THINK PINKS 17734 17734 BREAST CANCER AWARENESS LUNCHEON 11012 8387 2625 2880 28746 26121 2625 2880 2880 -255 1 TRANSYLVANIA COMMUNITY HOSPITAL INC 260 HOSPITAL DRIVE BREVARD NC 28712 560562293 501(C)(3) 414437 CAPITAL TRANSYLVANIA COMMUNITY HOSPITAL INC 260 HOSPITAL DRIVE BREVARD NC 28712 560562293 501(C)(3) 801850 PROGRAMS AND SERVICES TRANSYLVANIA PHYSICIAN SERVICES INC 260 HOSPITAL DRIVE BREVARD NC 28712 561920816 501(C)(3) 300000 PROGRAMS AND SERVICES 2 0 JANE WALKER FREEMAN & LINDGREN MEMORIAL NURSING SCHOLARSHIP 8 8885 RX ASSISTANCE PROGRAM FOR THE MEDICALLY INDIGENT AND UNINSURED 50 5564 FMV PRESCRIPTION MEDICATION PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: TRANSYLVANIA REGIONAL HOSPITAL IS THE PRIMARY RECIPIENT OF GRANTS FROM THE FOUNDATION, AND ALL PAYMENTS ARE DIRECTLY RELATED TO PROJECTS AUTHORIZED BY THE BOARD OF THAT ORGANIZATION. GRANTS PROVIDED TO ORGANIZATIONS OTHER THAN THE HOSPITAL ARE REQUIRED TO SUBMIT A REPORT ONE YEAR FOLLOWING THE GRANT DETAILING THE USE OF THE FUNDS. SCHOLARSHIPS FOR NURSING ARE ONLY AVAILABLE FOR TUITION FURTHERING EDUCATION IN THE FIELD OF NURSING. AMOUNTS AND SUPPORT FOR INDIVIDUAL PRESCRIPTION ASSISTANCE PROGRAMS GOES DIRECTLY TO THE PHARMACY TO COVER PORTIONS OF DRUG COSTS FOR ASSISTANCE RECIPIENTS. THE FOUNDATION REQUIRES SUBSTANTIATION FROM MEDICAL PROFESSIONALS FOR ALL AMOUNTS REQUESTED UNDER THE PROGRAM. X X X 0 1 0 0 0 0 0 0 0 ROBERT J BEDNAREK 0 267073 0 0 0 22351 0 41716 0 11265 0 342405 0 0 PART I, LINE 4B SUPPLEMENTAL NON-QUALIFIED PLAN PAYMENTS: ROBERT BEDNAREK $25,660 X 3 80383 STOCK PRICE X 1 197465 STOCK PRICE 0 1 1 THIRD PARTY USE: PART I, LINE 32B: THE ORGANIZATION USES FINANCIAL INSTITUTIONS TO PROCESS AND SELL CONTRIBUTIONS OF PUBLICLY-TRADED STOCK. FORM 990, PART VI, SECTION A, LINE 6 THE FOUNDATION IS A MEMBERSHIP CORPORATION, OF WHICH THE SOLE MEMBER IS TRANSYLVANIA HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A TRUSTEES TO THE BOARD ARE NOMINATED BY THE EXECUTIVE COMMITTEE OF THE BOARD, APPROVED BY THE FOUNDATION BOARD AND RATIFIED BY THE BOARD OF TRANSYLVANIA HEALTH SYSTEM, THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD'S POWER TO AMEND OR RESTATE THE FOUNDATION'S ARTICLES OF INCORPORATION, AMEND OR RESTATE THE BYLAWS, AND MERGE, CONSOLIDATE, REORGANIZE OR DISSOLVE THE FOUNDATION IS SUBJECT TO APPROVAL BY TRANSYLVANIA HEALTH SYSTEM, THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE ASSITANCE AND OVERSIGHT OF MANAGEMENT. UPON REVIEW BY MANAGMENT, THE RETURN WAS PRESENTED TO THE BOARD OF DIRECTORS BY INCLUSION ON THE AGENDA OF A SCHEDULED MEETING. A PERIOD OF DISCUSSION WAS ALLOWED FOR QUESTIONS AND COMMENTS BEFORE FILING THE RETURN WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO FILL OUT OR RENEW A COPY OF THE CONFLICT OF INTEREST POLICY ANNUALLY. MEMBERS ARE EXPECTED TO DISCLOSE ANY POTENTIAL CONFLICTS BEFORE DISCUSSIONS OR ACTIONS AFFECTING THE DECISION. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE DIRECTOR'S SALARY IS DETERMINED BY THE PRESIDENT/CEO OF THE HOSPITAL THROUGH REVIEWS OF MARKET DATA COMPARED TO SPECIFIC GOALS AND COMPETENCIES. THE PRESIDENT/CEO ALSO REVIEWS THE SALARY WITH A COMPENSATION COMMITTEE OF THE BOARD. THE ORGANIZATION DOES NOT HAVE ANY OTHER PAID OFFICERS OR KEY EMPLOYEES THAT THIS REVIEW AND DETERMINATION PROCESS WOULD APPLY TO. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 973,497. PRIOR PERIOD ADJUSTMENTS: 61,426. ADJUSTMENT TO ACTUARIAL LIABILITY -265,804. TOTAL TO FORM 990, PART XI, LINE 5: 769,119. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, LINE 16B: THE ORGANIZATION RECEIVED A MINORITY INTEREST IN A PUBLICLY TRADED PARTNERSHIP DURING THE YEAR. THE ORGANIZATION DOES NOT ACTIVITY SEEK CONTRIBUTIONS OF PARTNERSHIP INTEREST AND DOES NOT ACCEPT CONTRIBUTIONS THAT COULD JEOPARDIZE ITS EXEMPT STATUS. REASON FOR AMENDMENT FORM 990, HEADER, BOX A THE ORGANIZATION'S FORM 990 WAS AMENDED TO DISCLOSE DEFERRED COMPENSATION FROM A RELATED ORGANIZATION PREVIOUSLY NOT DISCLOSED. FORM 990 PART VII AND SCHEDULE J PARTS I, II, AND III HAVE BEEN UPDATED ACCORDINGLY. TRANSYLVANIA HEALTH SYSTEM INC 260 HOSPITAL DRIVE BREVARD NC 28712 561456987 HEALTHCARE NC 501(C)(3) LINE 11B, II N/A 0 TRANSYLVANIA COMMUNITY HOSPITAL INC 260 HOSPITAL DRIVE BREVARD NC 28712 560562293 HEALTHCARE NC 501(C)(3) LINE 3 TRANSYLVANIA HEALTH SYSTEM INC 0 TRANSYLVANIA PHYSICIAN SERVICES INC 260 HOSPITAL DRIVE BREVARD NC 28712 561920816 HEALTHCARE NC 501(C)(3) LINE 3 TRANSYLVANIA HEALTH SYSTEM INC 0 BREVARD MRI AT TRANSYLVANIA REGIONAL HOSPITAL LLC 260 HOSPITAL DRIVE BREVARD NC 28712 203281110 MEDICAL NC N/A TRANSYLVANIA HEALTHCARE II LIMITED PARTNERSHIP 2 MEDICAL PARK DR BREVARD NC 28712 200333230 RENTAL NC N/A HEALTHCARE III LIMITED PARTNERSHIP 260 HOSPITAL DRIVE BREVARD NC 28712 561599696 RENTAL NC N/A HEALTHCARE LIMITED LIABILITY COMPANY VII 260 HOSPITAL DRIVE BREVARD NC 28712 200343455 RENTAL NC N/A TRANSYLVANIA SERVICES INC 260 HOSPITAL DRIVE BREVARD NC 28712 561448199 REAL ESTATE NC N/A C 0 1 1 0 0 0 0 0 1 0 1 0 0 1 0 1 0 0