2012-08-15T11:50:47-05:00 2011-09-30 PERSHING YOAKLEY & ASSOCIATES PC ONE CHEROKEE MILLS 2220 SUTHERLAND KNOXVILLE TN 379192363 990 2010-10-01 560714394 HARRIS REGIONAL HOSPITAL INC HARR 8285867000 68 HOSPITAL ROAD SYLVA NC 28779 ROSE COYNE 8285867000 2012-08-15 1 DEBORAH O ERNSBERGER 8656730844 2010 2016-02-24 21:20:13Z ROSE COYNE 68 HOSPITAL ROAD SYLVA NC 28779 95860841 0 X WWW.WESTCARE.ORG X 1960 NC TO PROVIDE HIGH QUALITY, COST EFFECTIVE HEALTHCARE TARGETED TO THE NEEDS OF THE PEOPLE WE SERVE. 13 12 1278 109 343763 -146734 1882562 281071 89188598 93234104 294651 674494 2149927 1180443 93515738 95370112 31899 496052 0 0 48904576 53420334 0 0 0 47004319 47510036 95940794 101426422 -2425056 -6056310 74422414 67370962 44341324 46742920 30081090 20628042 X HARRIS REGIONAL HOSPITAL, INC. IS A MEMBER OF THE WESTCARE HEALTH SYSTEM ("WESTCARE"). THE MISSION OF WESTCARE IS TO PROVIDE HIGH QUALITY, COST EFFECTIVE HEALTHCARE TARGETED TO THE NEEDS OF THE PEOPLE WE SERVE. WESTCARE'S VISION IS EXCELLENCE IN CARE, SERVICE, AND VALUE - ONE PATIENT AT A TIME. WESTCARE'S CORE VALUES ARE COMPASSION, ACCOUNTABILITY, RESPECT, AND EXCELLENCE WHICH TOGETHER COMPRISE "WE C.A.R.E." 0 0 86629251 496052 93234104 HARRIS REGIONAL HOSPITAL ("THE HOSPITAL") IS DEDICATED TO THE PROMOTION OF HEALTH AND WELLNESS FOR THE RESIDENTS OF WESTERN NORTH CAROLINA AND SURROUNDING COMMUNITIES. HARRIS REGIONAL HOSPITAL IS AN 86-BED ACUTE CARE FACILITY LOCATED IN SYLVA, NORTH CAROLINA. HARRIS REGIONAL HAS BEEN A VITAL PART OF THE COMMUNITY AND REGION THROUGHOUT ITS HISTORY. A FULLY ACCREDITED, NOT-FOR-PROFIT COMMUNITY HOSPITAL, HARRIS REGIONAL HAS EXPERIENCED STRONG GROWTH IN RECENT YEARS, WITH MAJOR EXPANSIONS IN 1997, 1986, 1989, 1994, AND 1995. THE HOSPITAL'S MEDICAL STAFF HAS THE DIVERSITY AND PROFESSIONAL TALENTS OF MANY HOSPITALS TWICE ITS SIZE. TOGETHER WITH THE QUALIFIED STAFF, THEY SUCCESSFULLY PROVIDE PATIENTS THE FINEST IN MEDICAL CARE. THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF JACKSON, MACON, SWAIN AND GRAHAM COUNTIES OF WESTERN NORTH CAROLINA. MORE THAN 50 PERCENT OF THE HOSPITAL'S PATIENTS COME FROM OUTSIDE OF JACKSON COUNTY.HARRIS REGIONAL HOSPITAL IS A SHORT-TERM, ACUTE CARE FACILITY. THE HOSPITAL OFFERS MANY SERVICES TO HELP DIAGNOSE AND TREAT ALMOST ANY NEED. SERVICES INCLUDE: OUTPATIENT SURGERY, LABORATORY SERVICES, IMAGING SERVICES, PULMONARY REHABILITATION SERVICES, BIRTHING CENTER, TRANSITIONAL CARE UNIT, INTENSIVE CARE UNIT, PHARMACY, EMERGENCY DEPARTMENT, DIETARY SERVICES, OCCUPATIONAL HEALTH, SOCIAL SERVICES, SPORTS MEDICINE, AND PASTORAL SERVICE. 86629251 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 53 0 1 1278 1 1 1 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X LENA COCHRAN 8285867157 68 HOSPITAL ROAD SYLVA NC 28779 X MR FRED ALEXANDER 1.00 X 0 0 0 MR DANIEL ALLISON 1.00 X 0 0 0 MR JIM MANRING 1.00 X 0 0 0 MS MARTHA ANDERSON MD 1.00 X 0 0 0 MR JERRY MCKINNEY 1.00 X 0 0 0 MR JOHN BURTON 1.00 X 0 0 0 MR DENNIS SANDERS 1.00 X 0 0 0 MR DANIEL ALLISON 1.00 X 0 0 0 MS STEPHANIE TREADWAY 1.00 X 0 0 0 MR LOWELL CRISP 1.00 X 0 0 0 MS ELIZABETH JOHNS 1.00 X 0 0 0 MR WAVERLY GREEN MD 40.00 X 356673 0 21192 MS HEATHER BAKER 1.00 X 0 0 0 MR GENE COUCH PHD 1.00 X 0 0 0 MR TIM LEWIS 1.00 X 0 0 0 MR MARTIN A SENICKI MD 40.00 X 612492 0 17580 MR LAWRENCE F SUPIK MD 40.00 X 498670 0 36461 MR WILLIAM J HANDLEY MD 40.00 X 423907 0 18412 MR TODD D DAVIS MD 40.00 X 299998 0 18492 MR JEROME MARCHUK MD 40.00 X 303814 0 15935 MR MARK LEONARD FACHE 50.00 X 157732 0 0 2653286 0 128072 54 1 1 0 ARAMARK CTS 12483 COLLECTION CENTER DRIVE CHICAGO IL 60693 TECHNOLOGY SERVICES 847277 PALMETTO GBA 17 TECHNOLOGY CIRCLE COLUMBIA SC 29203 CONSULTING SERVICES 610942 ALLIANCE HEALTHCARE SERVICES 100 BAYVIEW CIRLCE SUITE 400 NEWPORT BEACH CA 92660 DIAGNOSTIC IMAGING SRVCS 414836 MCNEARY INC 6525 MORRISON BLVD SUITE 200 CHARLOTTE NC 28211 RISK MANAGEMENT 414452 TANGIBLE SOLUTIONS 1320 MATTHEWS TOWNSHIP PKWY SUITE MATTHEWS NC 28105 SOFTWARE CONSULTING SRVCS 396688 71 207403 27500 46168 281071 NET PATIENT REVENUE 621990 92486526 92143619 342907 COUNTY EMS 621910 411054 411054 LIFELINE 621990 225338 225338 GAIN-INV. IN AFFILIATE 523000 111186 111186 93234104 674430 674430 64 64 618972 490729 128243 128243 128243 MEALS & VENDING 722210 407612 407612 GIFT SHOP REVENUE 453220 326138 326138 MISCELLANEOUS INCOME 900099 228395 856 227539 90055 90055 1052200 95370112 92780011 343763 1965267 496052 496052 318668 267904 50764 43526688 36592887 6933801 1270235 1067887 202348 5436190 4570205 865985 2868553 2411593 456960 1425283 1198235 227048 1499360 1260512 238848 74052 62256 11796 5607797 4714475 893322 87101 73226 13875 3779175 3177152 602023 1274490 1071464 203026 1574813 1323945 250868 1167124 981201 185923 4343807 3651839 691968 773085 649933 123152 BAD DEBTS 8041659 8041659 MEDICAL SUPPLIES 7310349 6145810 1164539 REPAIRS & MAINTENANCE 4445581 3737400 708181 LEASES 1918070 1612521 305549 COLLECTIONS 380858 320187 60671 3807432 3200908 606524 101426422 86629251 14797171 0 6458 5842 2229578 2783521 10713855 10756672 1492239 1347460 429954 591954 94676864 62889897 32425159 31786967 10376214 13926528 10577385 1108715 1206831 1021969 4964741 4041334 74422414 67370962 9801707 8862178 222335 67510 14240551 13363736 614955 626648 19461776 23822848 44341324 46742920 X 29668113 20191015 412977 437027 30081090 20628042 74422414 67370962 X -6056310 -3396738 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2327987 2327987 43011144 29672617 13338527 491703 491703 34001562 26408254 7593308 14844468 6809026 8035442 31786967 OTHER ASSETS 9821 DEFERRED FINANCING COSTS, NET 269430 OTHER RECEIVABLES 1232602 DUE FROM RELATED PARTIES 2529481 4041334 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS, NET 109538 ACCRUED PENSION COST 9882711 INTEREST RATE SWAP 444630 OBLIGATIONS UNDER CAPITAL LEASE AGREEMENTS 11246029 ESTIMATED PHYSICIAN GUARANTEE LIABILITY 589107 DUE TO RELATED PARTY UNDER INTEGRATION AGREEMENT 887717 DUE TO RELATED PARTIES 663116 23822848 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: WESTCARE, HARRIS, AND SWAIN ARE EXEMPT FROM INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS RELATED TO THESE ORGANIZATIONS. PROCOR, INC. IS A TAXABLE ENTITY AND ACCOUNTS FOR INCOME TAXES IN ACCORDANCE WITH FASB ASC 740, INCOME TAXES. IN 2010, PROCOR, INC. ADOPTED THE UNCERTAIN TAX POSITIONS PROVISIONS OF FASB ASC 740. THE ADOPTION OF THESE PROVISIONS HAD NO MATERIAL IMPACT ON THE ORGANIZATIONS' CONSOLIDATED FINANCIAL STATEMENTS. PROCOR, INC. HAS NO UNCERTAIN TAX POSITIONS AT SEPTEMBER 30, 2011 AND 2010. 1 1 1 X 1 X 1 1 1 0 1 1 2448032 2448032 0.02620 9942554 9942554 0.10650 12390586 12390586 0.13270 1222400 1222400 0.01310 53280 53280 0.00060 1275680 1275680 0.01370 13666266 13666266 0.14640 1 9664147 24944520 24220527 723993 X 1 1 2 WESTERN REGIONAL RADIATION THERAPY CENTER HEALTH SERVICES 0.33330 0.00000 0.00000 1 1 HARRIS REGIONAL HOSPITAL

68 HOSPITAL ROAD WAYNESVILLE NC 28779

X X X HARRIS REGIONAL HOSPITAL 1 1 MOUNTAIN TRACE NURSING CENTER

417 FOX TRACE ROAD SYLVA NC 28779

NURSING HOME FACILITY PART I, LINE 7: COST IS DERIVED FROM THE ACTUAL EXPENSE DATA ACCUMULATED WITHIN THE HOSPITAL GENERAL LEDGER WHICH ADDRESSES ALL PATIENT SEGMENTS (INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, AND SELF-PAY). THE HOSPITAL ALLOCATES THOSE EXPENSES TO ALL PATIENT SEGMENTS AT THE PROCEDURE LEVEL BASED ON A COST-TO-CHARGE RATIO. PART I, L7 COL(F): BAD DEBT EXPENSE INCLUDED IN FORM 990, PART IX, LINE 25, COLUMN (A) IS $8,041,659. THE HOSPITAL EXCLUDED THE FULL AMOUNT, $8,041,659, FOR PURPOSES OF CALCULATING THE PERCENTAGE IN COLUMN (F), ON PART I, LINE 7. PART III, LINE 4: A COST-TO-CHARGE RATIO WAS ALSO USED TO DETERMINE BAD DEBT COST. THE TOTAL OPERATING EXPENSE WAS DIVIDED BY PATIENT REVENUES TO CALCULATE AN OVERALL RATIO THAT WAS THEN APPLIED TO THE BAD DEBT EXPENSE TO ARRIVE AT COST.UNINSURED DISCOUNTS AND BAD DEBTS INCLUDE THE COST OF SERVICES TO UNINSURED OR UNDERINSURED PATIENTS AND TO PATIENTS WHO OTHERWISE DO NOT PAY FOR THEIR HEALTHCARE SERVICES. DURING FISCAL YEAR 2010, THE ORGANIZATION BEGAN APPLYING A 40% DISCOUNT AT TIME OF BILLING FOR SERVICES PROVIDED TO UNINSURED PATIENTS. GROSS CHARGES SO DISCOUNTED ARE EXCLUDED FROM PATIENT REVENUE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE REPORTED USING THE HOSPITAL'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP-DOWN ALLOCATION METHODOLOGY. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE BY CMS SUCH AS: TRANSPORTATION OF A PATIENT, COMFORT ITEMS TO INCLUDE A TELEVISION OR A TELEPHONE. ADDITIONAL NON-ALLOWABLE COSTS INCLUDE THE RECRUITMENT OF PHYSICIANS, PHYSICIAN GUARANTEES AND A PORTION OF THE BAD DEBT ASSOCIATED WITH THE CARE OF THE PATIENT. PART III, LINE 9B: IT IS THE POLICY OF THE HOSPITAL TO PURSUE COLLECTION OF PATIENT BALANCES FROM PATIENTS WHO HAVE THE ABILITY TO PAY FOR THESE SERVICES. THE HOSPITAL'S COLLECTION PRACTICES APPLY TO ALL PATIENTS, CHARITY CARE AND NON-CHARITY CARE, CONSISTENTLY AND FAIRLY REGARDLESS OF INSURANCE STATUS. AFTER THE PATIENT VISIT HAS BEEN CONCLUDED, A SUMMARY OF THE CHARGES WILL BE MAILED TO THE PATIENT FOR REVIEW. IF INSURANCE INFORMATION WAS PROVIDED UPON REGISTRATION, A CLAIM WILL BE SUBMITTED TO THE INSURANCE CARRIER ON THE PATIENT'S BEHALF. AFTER INSURANCE PROCESSING, THE PATIENT WILL RECEIVE A STATEMENT EXPLAINING THE INSURANCE RESPONSE AND OUTLINING THE PATIENTS REMAINING BALANCE. SELF-PAY PATIENTS ARE ELIGIBLE TO RECEIVE A 20% PROMPT DISCOUNT IF THE ACCOUNT IS PAID IN FULL PRIOR TO OR ON THE DATE OF SERVICES. A 15% DISCOUNT WILL BE ISSUED IF PAYMENT IS MADE WITHIN 25 DAYS OF SERVICE. ADDITIONALLY, PATIENTS LACKING ADEQUATE RESOURCES TO PAY FOR MEDICAL CARE MAY QUALIFY FOR THE HOSPITAL'S CARE ASSISTANCE PROGRAM WHICH PROVIDES EXTENDED PAYMENT PLANS AND/OR PROMPT PAY DISCOUNTS UP TO 20% FOR PAYMENT IN FULL WITHIN 5 DAYS OF THE DISCHARGE AND ASSISTS PATIENTS IN APPLYING FOR STATE PROGRAMS TO MEET THEIR MEDICAL NEEDS. IF PAYMENT FOR SERVICES IS NOT RECEIVED IN FULL WITHIN 25 DAYS, THE ACCOUNT IS FORWARDED TO PROCOR BILLING SERVICES. THIS SERVICE ALLOWS FOR PATIENTS TO MAKE FINANCIAL ARRANGEMENTS THAT ARE BOTH ACCEPTABLE TO THE PATIENT AND TO THE HOSPITAL. FINANCIAL COUNSELORS DILIGENTLY WORK WITH PATIENTS AND EVALUATE NEW INFORMATION LEARNED DURING THE COLLECTION PROCESS TO DETERMINE IF COLLECTION ACTIVITIES SHOULD BE CEASED OR IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. THE HOSPITAL, ALONG WITH ASSISTANCE FROM PROCOR, STRIVES TO MEET EACH PATIENT'S FINANCIAL RESPONSIBILITIES. IF THIS IS NOT SUCCESSFUL, PAST DUE AMOUNTS WILL BE FORWARDED TO AN OUTSIDE COLLECTION AGENCY, WITH SUBSTANTIAL EXPERIENCE IN COLLECTION OF PATIENT ACCOUNTS, ONLY AFTER ALL ESTABLISHED STEPS HAVE BEEN UNDERTAKEN WITHOUT SUCCESS. PART VI, LINE 2: THE HOSPITAL COMPLETES AN ANNUAL SURVEY, WHICH INCLUDES CHARITY CARE AND COMMUNITY BENEFIT INFORMATION. THE HOSPITAL SUBMITS THIS SURVEY WITH ITS FINANCIAL ASSISTANCE POLICY TO THE NORTH CAROLINA HOSPITAL ASSOCIATION ("NCHA"). THE HOSPITAL'S CHARITY CARE AND COMMUNITY BENEFIT DATA ALONG WITH ITS FINANCIAL ASSISTANCE POLICY IS AVAILABLE FOR VIEWING ON THE NCHA PUBLIC WEBSITE. THE HOSPITAL'S FINANCIAL DATA IS REPORTED USING GUIDELINES DEVELOPED BY NCHA AND ITS MEMBERS.OUTSIDE OF THE INFORMATION SUBMITTED TO THE NCHA, THE HOSPITAL DOES NOT FORMALLY ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. HOWEVER, ANY NEW PHYSICIAN POSITIONS CREATED ARE APPROVED BY THE BOARD OF TRUSTEES AND EVALUATED FOR THE OVERALL BENEFIT PROVIDED TO THE COMMUNITY. PART VI, LINE 3: TO COMMUNICATE THE HOSPITAL'S FINANCIAL POLICY TO THE PATIENT, THE HOSPITAL'S WEBSITE HAS A "PATIENTS AND VISITORS" MENU WHERE PATIENTS CAN GO TO VIEW INFORMATION ABOUT PAYMENT POLICIES, INSURANCE INFORMATION, AND THE HOSPITAL FINANCIAL ASSISTANCE (CARE ASSISTANCE) PROGRAM. THE WEBSITE GIVES THREE PHONE NUMBERS THAT PATIENTS CAN USE TO CONTACT A FINANCIAL COUNSELOR TO DISCUSS THEIR INDIVIDUAL FINANCIAL ALTERNATIVES. THE HOSPITAL'S CHARITY CARE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IS POSTED IN THE ADMISSIONS AREAS, EMERGENCY AREAS, AND OTHER AREAS OF THE HOSPITAL'S FACILITIES IN WHICH ELIGIBLE PATIENTS MAY BE PRESENT. ALL STAFF WITH PATIENT CONTACT ARE KNOWLEDGEABLE ABOUT THE CHARITY CARE POLICY (ADMITTING AND BILLING CLERKS, NURSING AND MEDICAL STAFFS, SOCIAL WORKERS, CHAPLAINS, PATIENT ADVOCATES, ETC.). PART VI, LINE 4: THE HOSPITAL IS LOCATED IN SYLVA, JACKSON COUNTY, WHICH IS IN RURAL WESTERN NORTH CAROLINA. JACKSON COUNTY IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA WITH NEARLY 21% OF ITS POPULATION AS UNINSURED. THE POPULATION OF JACKSON COUNTY IS JUST OVER 40,000 AND ACCORDING TO THE U.S. CENSUS BUREAU, SYLVA HAS A POPULATION OF 2,588. JACKSON COUNTY HAS A MEDIAN HOUSEHOLD INCOME OF $37,190 WITH 20.4% OF THE POPULATION LIVING BELOW THE POVERTY LEVEL. PART VI, LINE 6: THE HOSPITAL IS DEDICATED TO SERVING THE COMMUNITY BY IMPROVING THE QUALITY OF LIFE OF THE COMMUNITY THROUGH BETTER HEALTH. THE HOSPITAL IS COMMITTED TO PROVIDING QUALITY HEALTH CARE SERVICES IN A CARING ENVIRONMENT THAT FULFILLS THE NEEDS OF OUR PATIENTS, PHYSICIANS, EMPLOYERS, EMPLOYEES, AND COMMUNITY. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO THE ABILITY TO PAY. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND, OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION AND RESEARCH PROGRAMS. THE HOSPITAL'S BOARD OF DIRECTORS CONSISTS OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PURPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3). PART VI, LINE 7: HARRIS REGIONAL HOSPITAL IS OWNED BY THE WESTCARE HEALTH SYSTEM, A GROWING, WELL-RESPECTED, NON-PROFIT HEALTH CARE PROVIDER THAT DELIVERS A FULL SPECTRUM OF HEALTH CARE FOR OVER 80,000 PEOPLE LIVING IN FOUR COUNTIES. WESTCARE HEALTH SYSTEM ("WESTCARE") WAS FORMED IN FEBRUARY 1997 WITH THE ESTABLISHMENT OF A COMBINATION BUSINESS AGREEMENT BETWEEN HARRIS REGIONAL HOSPITAL AND SWAIN COUNTY HOSPITAL TO DEVELOP A FULL SPECTRUM OF HEALTH SERVICES FOR WESTERN NORTH CAROLINA. WESTCARE ALSO OWNS THREE MEDICAL PARKS, WESTCARE MEDICAL PARK OF FRANKLIN LOCATED IN MACON COUNTY, WESTCARE MEDICAL PARK OF BRYSON CITY LOCATED IN SWAIN COUNTY, AND WESTCARE MEDICAL PARK OF SYLVA LOCATED IN JACKSON COUNTY. WESTCARE ALSO OPERATES MOUNTAIN REGIONAL CANCER CENTERS, TWO STATE OF THE ART RADIATION THERAPY FACILITIES PROVIDING ALL ASPECTS OF COMPREHENSIVE RADIATION THERAPY SERVICES. WESTCARE EMPLOYS ALMOST 1200 FULL AND PART TIME EMPLOYEES AND HAS A MEDICAL STAFF OF OVER 90 PHYSICIANS REPRESENTING 22 SPECIALTIES. WESTCARE IS GOVERNED BY A BOARD OF TRUSTEES, WHICH IS DRAWN FROM COMMUNITY LEADERS IN EACH OF THE FOUR PRIMARY COUNTIES IT SERVES. WESTCARE IS MANAGED AND OPERATED BY THE PEOPLE OF WESTERN NORTH CAROLINA, FOR THE PEOPLE OF WESTERN NORTH CAROLINA.IN JANUARY 2010, WESTCARE ENTERED INTO A JOINT OPERATING AGREEMENT WITH HAYWOOD REGIONAL MEDICAL CENTER IN WAYNESVILLE, NORTH CAROLINA, TO FORM MEDWEST HEALTH SYSTEM ("MEDWEST"). MEDWEST CONSISTS OF 323 LICENSED BEDS SYSTEM-WIDE. MEDWEST IS ALSO AFFILIATED WITH CAROLINAS HEALTHCARE SYSTEM, ONE OF THE SOUTHEAST'S LEADING HEALTHCARE SYSTEMS. PATIENTS BENEFIT FROM THE HOSPITAL'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 AMERICAN RED CROSS 2025 E STREET NW WASHINGTON DC 200065009 530196605 501(C)(3) 440638 GENERAL DONATION 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL. X X X 1 0 0 0 0 0 0 0 0 MR WAVERLY GREEN MD 356673 0 0 0 0 0 4900 0 16292 0 377865 0 0 0 MR MARTIN A SENICKI MD 612492 0 0 0 0 0 0 0 17580 0 630072 0 0 0 MR LAWRENCE F SUPIK MD 498670 0 0 0 0 0 18881 0 17580 0 535131 0 0 0 MR WILLIAM J HANDLEY MD 423907 0 0 0 0 0 4510 0 13902 0 442319 0 0 0 MR TODD D DAVIS MD 299998 0 0 0 0 0 2619 0 15873 0 318490 0 0 0 MR JEROME MARCHUK MD 303814 0 0 0 0 0 0 0 15935 0 319749 0 0 0 MR MARK LEONARD FACHE 10616 0 0 0 147116 0 0 0 0 0 157732 0 0 0 PART I, LINE 4A MARK LEONARD RECEIVED $128,273 IN SEVERANCE PAYMENTS. THIS AMOUNT WAS INCLUDED IN PART II, COLUMN (B)(III) COMPENSATION. FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURN IS PREPARED BY AN UNRELATED, INDEPENDENT ACCOUNTING FIRM AND SUBMITTED TO SENIOR MANAGEMENT WITHIN THE ORGANIZATION FOR INTERNAL REVIEW. COPIES ARE THEN PROVIDED TO EACH BOARD MEMBER FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES THAT EACH BOARD OF TRUSTEES MEMBER AND PRINCIPAL OFFICER REVIEWS THE CONFLICT OF INTEREST POLICY AND PROVIDES DISCLOSURE OF ANY ACTIVITIES WHICH COULD CONSTITUTE A CONFLICT OF INTEREST OR POTENTIAL CONFLICT OF INTEREST. ADDITIONALLY, BOARD OF TRUSTEES MEMBERS ARE ASKED TO RECUSE THEMSELVES ON ANY MATTERS OF INTEREST BEFORE THE BOARD IN WHICH A CONFLICT OF INTEREST MAY EXIST. ANY SUCH RECUSAL IS DOCUMENTED WITHIN THE MINUTES OF THE BOARD OR COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES REVIEWS AND APPROVES THE COMPENSATION OF EXECUTIVES AND OTHER OFFICERS. STATE AND NATIONAL COMPARABILITY DATA IS USED TO ASSIST IN DETERMINING APPROPRIATE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII: WAVERLY GREEN, M.D., BOARD OF TRUSTEES MEMBER, RECEIVED COMPENSATION FOR MEDICAL SERVICES PROVIDED TO THE ORGANIZATION, NOT FOR SERVICES AS A BOARD OF TRUSTEE MEMBER. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 320,827. CHANGE IN ACCRUED PENSION COST -1,275,161. REQUIRED SETTLEMENT - INTEGRATION AGREEMENT -2,259,051. CHANGE IN TEMPORARY NET ASSETS 24,050. CONTRIBUTION FROM RELATED PARTY -207,403. TOTAL TO FORM 990, PART XI, LINE 5: -3,396,738. WESTCARE INC 68 HOSPITAL ROAD SYLVA NC 28779 561967734 HOSPITAL NC 501(C)(3) LINE 3 MEDWEST HEALTH SYSTEM INC 0 SWAIN COUNTY HOSPITAL INC 68 HOSPITAL ROAD SYLVA NC 28779 560629325 HOSPITAL NC 501(C)(3) LINE 3 WESTCARE INC 0 MEDWEST HEALTH SYSTEM INC 68 HOSPITAL ROAD SYLVA NC 28779 271472706 HEALTHCARE MANAGEMENT NC 501(C)(3) LINE 11C, III-FI N/A 0 HAYWOOD REGIONAL MEDICAL CENTER 262 LEROY GEORGE DRIVE CLYDE NC 28721 566000535 HOSPITAL AUTHORITY NC GOVERNMENTAL GOVERNMENTAL MEDWEST HEALTH SYSTEM INC 0 WESTERN REGIONAL RADIATION THERAPY CENTER 68 HOSPITAL ROAD SYLVA NC 28779 561849395 HEALTH SERVICES NC N/A RELATED 194224 873225 0 1 0.33330 WESTCARE HEALTH CORPORATION 68 HOSPITAL ROAD SYLVA NC 38779 562039181 HEALTHCARE MANAGEMENT NC N/A C PROCOR INC 68 HOSPITAL ROAD SYLVA NC 28779 562039184 HEALTHCARE MANAGEMENT NC N/A C 0 0 1 1 0 0 0 0 1 0 0 1 0 1 1 1 0 0