2012-05-04T07:44:04-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-10-01 560562293 TRANSYLVANIA COMMUNITY HOSPITAL INC TRAN 8288849111 260 HOSPITAL DRIVE BREVARD NC 28712 ROBERT J BEDNAREK 8288849111 2012-05-02 1 AMY BIBBY 8282542254 2010 2016-02-24 21:20:13Z X TRANSYLVANIA REGIONAL HOSPITAL ROBERT J BEDNAREK 260 HOSPITAL DRIVE BREVARD NC 28712 63250519 0 X WWW.TRHOSPITAL.ORG X 1933 NC PROVISION OF MEDICAL SERVICES 15 12 700 171 0 0 1799116 1136909 59259640 60779930 323450 631182 573732 688096 61955938 63236117 215601 461381 0 0 26538804 27021236 0 0 0 36575013 38755610 63329418 66238227 -1373480 -3002110 69569796 62254697 26355886 22938584 43213910 39316113 X TRANSYLVANIA REGIONAL HOSPITAL PROMOTES WELLNESS AND PROVIDES ACCESS TO QUALITY HEALTH SERVICES FOR THE PEOPLE IN OUR REGION. 0 0 55852233 461381 60793394 GIVING BACK TO THE COMMUNITYAS A NOT-FOR-PROFIT HOSPITAL, TRANSYLVANIA REGIONAL HOSPITAL IS COMMITTED TO GIVING BACK TO THE COMMUNITY TO HELP THOSE WHO ARE UNINSURED OR UNDERINSURED AS WELL AS PROVIDING HEALTH EDUCATION AND BENEFITS FOR THE WELL BEING OF THE ENTIRE COMMUNITY. 2011 WAS ANOTHER TOUGH YEAR FOR OUR COMMUNITY AS WE CONTINUED TO EXPERIENCE THE LINGERING EFFECTS OF THE WORST ECONOMIC RECESSION SINCE THE GREAT DEPRESSION. THIS LEFT MANY IN OUR COMMUNITY WITHOUT HEALTH INSURANCE AND STRUGGLING TO MAKE ENDS MEET. DESPITE CHALLENGING FINANCIAL TIMES FOR THE HOSPITAL, TRH CONTINUED TO GENEROUSLY HELP THOSE IN NEED IN 2011.IN 2011, TRH PROVIDED $6.4 MILLION IN CONTRIBUTIONS TO THE COMMUNITY. THESE BENEFITS CAME IN MANY FORMS INCLUDING $1.8 MILLION IN CHARITY CARE FOR 2,550 PEOPLE. THE HOSPITAL ALSO PROVIDED ANOTHER $3 MILLION IN CARE FOR 4,751 PEOPLE THROUGH NON-COLLECTIBLE SERVICES. AN ADDITIONAL $1.2 MILLION WAS PROVIDED FOR GOVERNMENT SPONSORED HEALTHCARE INCLUDING INDIGENT CARE PROGRAMS. FINALLY, $400,000 WAS PROVIDED FOR COMMUNITY BENEFIT PROGRAMS. HERE ARE JUST A FEW OF THE SERVICES SUPPORTED: - TRH OFFERS FREE OR LOW-COST EDUCATIONAL PROGRAMS FOR THE COMMUNITY EACH MONTH. PROGRAMS FEATURE TIMELY HEALTH TOPICS, AND ARE PRESENTED BY PHYSICIANS, NURSES, NURSE EDUCATORS, DIETITIANS AND OTHER CLINICAL PROFESSIONALS. MORE THAN 1,000 MEMBERS OF THE COMMUNITY TOOK ADVANTAGE OF THESE EDUCATIONAL OPPORTUNITIES HELD AT THE HOSPITAL IN BREVARD. - TRH OFFERS HEALTHCARE SERVICES THAT ARE NEEDED BY THIS COMMUNITY, REGARDLESS OF WHETHER OR NOT A MARGIN IS ACHIEVED BY PROVIDING CARE. EXAMPLES INCLUDE EMERGENCY SERVICES AND BIRTHING CENTER. - TRH PRIORITIZES DONATIONS OF STAFF TIME, MEETING SPACE, SUPPLIES, EQUIPMENT AND ADVERTISING FOR COMMUNITY GROUPS. SOME GROUPS THAT BENEFITED FROM IN-KIND DONATIONS WERE: MARCH OF DIMES, UNITED WAY, CHAMBER OF COMMERCE, S.A.F.E, AMERICAN RED CROSS, RELAY FOR LIFE, PROJECT LAZARUS COMMUNITY-BASED OVERDOSE PREVENTION, THE TRANSYLVANIA COUNTY SCHOOL SYSTEM, THE FREE CLINIC, TRANSYLVANIA PARTNERSHIP FOR HEALTH, TRANSYLVANIA COUNTY ECONOMIC DEVELOPMENT AND OTHERS. - TRH RECRUITED SEVERAL PHYSICIANS TO THE COMMUNITY IN 2011 TO EXPAND ACCESS TO HEALTHCARE FOR OUR RESIDENTS, INCLUDING A NEW FAMILY PRACTICE PHYSICIAN, A NEW KIDNEY SPECIALIST, TWO EAR, NOSE AND THROAT SPECIALISTS, AND A GENERAL SURGEON. IN ADDITION, TRH RECRUITED A UROLOGY PHYSICIANS ASSISTANT TO EXPAND CARE FOR THE COMMUNITY. - TRH CONTINUED IN 2011 ITS INNOVATIVE HEALTH RESOURCES NAVIGATION PROGRAM THAT USES TARGETED CASE MANAGEMENT FOR LOW INCOME/UNINSURED PATIENTS WHO FREQUENTLY USE EMERGENCY SERVICES, LEADING TO DIVERSION TO MORE APPROPRIATE PRIMARY CARE. BECAUSE 90 PERCENT OF THE PRIMARY CARE PHYSICIANS IN OUR AREA ARE EMPLOYED BY OUR HEALTH SYSTEM, PLACEMENT OF PATIENTS INTO A PRIMARY CARE "MEDICAL HOME" IS POSSIBLE, RESULTING IN BETTER OVERALL HEALTH FOR THESE PATIENTS AND FEWER INAPPROPRIATE EMERGENCY ROOM VISITS. LIMITED RESOURCES ARE BEING USED MUCH MORE PRUDENTLY, WITH BETTER OVERALL OUTCOMES FOR PATIENTS. - TRH INITIATED A CARE MANAGEMENT PROGRAM IN 2011 FOR COPD PATIENTS IN OUR COMMUNITY SUPPORTED BY GRANT FUNDING. - TRH LAUNCHED THE SUCCESSFUL "LIGHTEN UP 4 LIFE" WEIGHT LOSS PROGRAM IN 2011 IN OUR COMMUNITY. MORE THAN 400 PEOPLE IN THIS COMMUNITY LOST MORE THAN 1,700 POUNDS TOTAL. TRANSYLVANIA REGIONAL HOSPITAL IS COMMITTED TO MAKING TRANSYLVANIA COUNTY A HEALTHIER COMMUNITY. - TRH TEAMED UP WITH THE TRANSYLVANIA COUNTY HEALTH DEPARTMENT, BLUE RIDGE COMMUNITY HEALTH SERVICES AND N.C. FARM BUREAU TO OFFER FREE COMPREHENSIVE HEALTH AND DENTAL SCREENINGS AS WELL AS FREE MEDICAL COUNSELING TO NEARLY 150 LOCAL RESIDENTS THROUGH THE HEALTHY LIVING FOR A LIFETIME INITIATIVE, HELD DURING TRANSYLVANIA COUNTY'S 150TH ANNIVERSARY CELEBRATION IN SEPTEMBER 2011. THE INITIATIVE PROVIDES RURAL NORTH CAROLINIANS WITH FREE HEALTH SCREENINGS, EDUCATIONAL MATERIALS, AND A PATH TOWARDS A HEALTHIER LIFESTYLE. - TRH PARTICIPATED IN THE N.C. STROKE INITIATIVE IN 2011 TO ENSURE THE BEST PRACTICES IN STROKE CARE ARE EMPLOYED IN PATIENT CARE AT THE HOSPITAL AND TO BUILD PUBLIC AWARENESS OF THE RISKS OF STROKE. 55852233 1 1 0 1 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 76 0 1 700 1 0 0 0 0 0 1 1 0 0 0 0 X 15 12 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X X ROBERT J BEDNAREK 8288849111 260 HOSPITAL DRIVE BREVARD NC 28712 ROBERT O MAXWELL 2.00 X X 0 0 0 R BRYAN PADRICK 2.00 X X 0 0 0 RICHARD C LARSON 2.00 X X 0 0 0 JOHN F HOLBROOK 2.00 X X 0 0 0 WILLIAM R MINNICH JR 2.00 X X 0 0 0 CHARLES AYSCUE 2.00 X 0 0 0 JOHN FAV CECIL 2.00 X 0 0 0 THELMA B ERICKSON 2.00 X 0 0 0 ELIZABETH K JORDAN 2.00 X 0 0 0 JOHN MAHER 2.00 X 0 0 0 KENNETH G RACHT 2.00 X 0 0 0 ROBERT C SKIFF 2.00 X 0 0 0 WILLIAM A TOWLER 2.00 X 0 0 0 ORA J WELLS MD 2.00 X 33293 0 0 DANA J CHRISTIANSON MD 2.00 X 0 0 0 G RUFFIN BENTON III MD 2.00 X 0 237677 16614 ROBERT J BEDNAREK 40.00 X X 244375 0 56397 THERESA M PARKER 40.00 X 113288 0 18186 LINDA L COYE 40.00 X 308 0 0 ELIZABETH A PELLETIER 40.00 X 160882 0 25635 LAUREL D JOHNSON 40.00 X 153932 0 15752 JUDITH H MCKAY 40.00 X 142790 0 28919 MARK E CREASMAN 40.00 X 129733 0 21994 REBECCA W CARTER 40.00 X 132601 0 26505 1111202 237677 210002 10 0 1 0 WELLS FARGO TPA PO BOX 535100 ATLANTA GA 303535100 BENEFITS ADMINISTRATION 3124228 AMERISOURCE BERGEN DRUG CORP PO BOX 5804 NEW YORK NY 100875804 MEDICAL PRODUCTS 3062669 CARDINAL HEALTH PO BOX 905867 CHARLOTTE NC 282905867 MEDICAL PRODUCTS 1116072 TRANSYL EMERG PHYS PLLC 3107 STIRLING RD 300 FT LAUDERDALE FL 33312 E/R PHYSICIAN SERVICES 1097796 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 303682289 FOOD SERVICES 1093506 53 64723 610472 232420 229294 1136909 NET PATIENT SERVICE RE 621400 57925629 57925629 PHARMACY AND MED SUPP 446110 1447780 1447780 OTHER PATIENT SERVICES 621610 1300996 1300996 LIFELINE RENTALS 900099 105525 105525 60779930 645584 645584 20464 20464 20464 20464 14402 -14402 -14402 -14402 MANAGEMENT SERVICES 900099 364410 364410 CAFETERIA/VENDING 722210 257387 257387 MISCELLANEOUS REVENUES 900099 45835 45835 667632 63236117 60779930 0 1319278 461381 461381 378457 38817 339640 25577 25577 21278152 14862510 6415642 726503 499887 226616 3010120 2071182 938938 1602427 1102587 499840 210696 87910 122786 426066 426066 93466 93466 9045 9045 11407872 10821840 586032 109291 96171 13120 12182529 11897161 285368 1709700 1709700 181292 161854 19438 13903 12823 1080 470139 470139 3677192 3677192 488081 488081 BAD DEBTS 7294251 7294251 MISCELLANEOUS EXPENSES 482087 73170 408917 66238227 55852233 10385994 0 1916169 1514578 413454 8330374 6570537 20404 7500 1867063 2153050 567073 367900 63391735 29776062 35489476 33615673 15396937 10925657 0 3399965 3889102 2168881 3210700 69569796 62254697 5516793 4776942 15706632 14409167 2968754 2163707 3752475 26355886 22938584 X 39856535 35770768 3357375 3545345 43213910 39316113 69569796 62254697 X -3002110 -895687 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9045 9045 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA), THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA), AND THE NATIONAL RURAL HEALTH ASSOCIATION (NRHA). A PORTION OF THE DUES PAID IS ALLOCATED TO LOBBYING EFFORTS PERFORMED BY THESE ORGANIZATIONS ON BEHALF OF ITS MEMBERSHIP BODY. FOR THE YEAR, THE LOBBYING PORTION OF MEMBERSHIP DUES IS ESTIMATED TO BE APPROXIMATELY $ 9,045. 1 221222 764012 985234 23649583 8402149 15247434 2884880 1040707 1844173 35041709 20333206 14708503 830329 830329 33615673 INTEREST IN NET ASSETS OF TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION 3540341 C INTEREST IN BREVARD MRI, LLC 348761 C 3889102 BOND ISSUE COSTS, NET OF AMORTIZATION 345228 RECEIVABLE FROM AFFILIATED ORGANIZATIONS 582109 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 1002493 OTHER RECEIVABLES 1280870 3210700 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 3752475 3752475 63236117 66238227 -3002110 -481728 -670 -413289 -895687 -3897797 61479719 -481728 1244508 762780 60716939 2519178 2519178 63236117 65376846 0 65376846 861381 861381 66238227 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION, A RELATED ORGANIZATION, HOLDS ENDOWMENT FUNDS FOR THE BENEFIT OF THE ORGANIZATION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ASSOCIATION, 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. BREVARD MRI, WITH THE CONSENT OF ITS SHAREHOLDERS, HAS ELECTED TO BE TREATED AS A PARTNERSHIP FOR FEDERAL AND NORTH CAROLINA INCOME TAX PURPOSES. IN LIEU OF CORPORATE INCOME TAXES, EARNINGS AND LOSSES AFTER THAT DATE ARE INCLUDED IN THE INCOME TAX RETURNS OF THE SHAREHOLDERS; ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. INCOME TAXES FOR TSI ARE PROVIDED FOR THE TAX EFFECTS OF TRANSACTIONS REPORTED IN THE CONSOLIDATED FINANCIAL STATEMENTS AND CONSIST OF TAXES CURRENTLY DUE PLUS DEFERRED TAX EXPENSE OR MINUS DEFERRED TAX BENEFIT RELATED PRIMARILY TO DIFFERENCES ARISING FROM THE METHODS OF CALCULATING DEPRECIATION FOR FINANCIAL AND INCOME TAX REPORTING. AN EVALUATION OF THE PROBABILITY OF BEING ABLE TO REALIZE THE FUTURE BENEFITS OF DEFERRED TAX ASSETS IS MADE. A VALUATION ALLOWANCE IS PROVIDED FOR THE PORTION OF THE DEFERRED TAX ASSET WHEN IT IS MORE LIKELY THAN NOT THAT SOME PORTION OR ALL OF THE DEFERRED TAX ASSET WILL NOT BE REALIZED. THE ORGANIZATIONS HAVE DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS EXIST FOR OPEN TAX YEARS AS OF SEPTEMBER 30, 2011. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2008 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: INCOME FROM AFFILIATED ORGANIZATION 1,019,478. TRANSFERS TO AFFILIATES -2,119,178. NET CHANGE IN VALUE OF INTEREST OF FOUNDATION 225,030. EXPENSES INCURRED FOR FOUNDATION 461,381. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET CHANGE IN VALUE OF INTEREST IN FOUNDATION 225,030. INCOME FROM AFFILIATED ORGANIZATIONS 1,019,478. PART XII, LINE 4B - OTHER ADJUSTMENTS: TRANSFERS TO AFFILIATES 2,119,178. NONOPERATING EXPENSE RECLASSIFICATION 400,000. PART XIII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES INCURRED FOR FOUNDATION 461,381. NONOPERATING EXPENSE RECLASSIFICATION 400,000. 1 1 1 X 1 X 0 1 0 1 1 1852196 0 1852196 0.03130 5363531 4060076 1303455 0.02210 7215727 4060076 3155651 0.05340 88850 88850 0.00150 301423 301423 0.00510 390273 390273 0.00660 7606000 4060076 3545924 0.06000 12678 12678 0.00020 12678 12678 0.00020 1 3044545 4120 30765732 30455123 310609 X 1 1 1 BREVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL LLC MRI SERVICES 0.50000 0.50000 1 1 TRANSYLVANIA REGIONAL HOSPITAL

260 HOSPITAL DRIVE BREVARD NC 28712

X X X X NA FOR 2010 1 9 TRH OUTPATIENT REHABILITATION

92 CHESTNUT STREET BREVARD NC 28712

OUTPATIENT REHAB TRH HOME CARE SERVICES

1234 ASHEVILLE HWY BREVARD NC 28712

HOME CARE BREVARD MRI

301 HOSPITAL DRIVE BREVARD NC 28712

IMAGING CENTER TOXAWAY HEALTH CENTER

16825 ROSMAN HWY LAKE TOXAWAY NC 28747

PROVIDER-BASED CLINICS BREVARD FAMILY PRACTICE

187 MEDICAL PARK DR BREVARD NC 28712

PROVIDER-BASED CLINICS MEDICAL ASSOCIATES OF TRH

377 GALLIMORE ROAD BREVARD NC 28712

PROVIDER-BASED CLINICS BREVARD INTERNAL MEDICINE & PULMONOLOGY

159 MEDICAL PARK DR SUITE B BREVARD NC 28712

PROVIDER-BASED CLINICS KOALA

23 MEDICAL PARK CIRCLE BREVARD NC 28712

OUTPATIENT BREVARD CANCER & INFUSION CENTER

89 HOSPITAL DR BREVARD NC 28712

OUTPATIENT PART I, LINE 3C: IN ADDITION TO THE FPG-DETERMINED ELIGIBILITY FOR FREE AND DISCOUNTED CARE, A DISCOUNT IS OFFERED TO SELF-PAY PATIENTS FOR THEIR TIMELY PAYMENT WITHIN 60 DAYS FROM THEIR INITIAL STATEMENT DATE. PART I, LINE 7: THE ORGANIZATION USED WORKSHEET 2 OF THE 2010 SCHEDULE H INSTRUCTIONS TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE FINANCIAL ASSISTANCE AND UNREIMBURSED MEDICAID AT COST. PART I, L7 COL(F): FOR THE PURPOSES OF CALCULATING PERCENTAGE OF TOTAL EXPENSE FOR LINE 7, COL (F), TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25 HAS BEEN ADJUSTED FOR THE FOLLOWING: - REMOVAL OF BAD DEBT EXPENSE: (7,294,251) - REMOVAL OF NONOPERATING EXPENSE: (400,000) - REMOVAL OF FOUNDATION EXPENSES: (461,381) - ADDITION OF JOINT VENTURE EXPENSES: 1,019,478 TOTAL ADJUSTMENT: (7,136,154) PART II: THE HOSPITAL PARTICIPATES IN COALITION BUILDING IN THE COMMUNITY AND STATE TO HELP ADVOCATE THE HEALTH NEEDS OF OUR AREA. THROUGH PARTICIPATION, THE HOSPITAL GUARANTEES A FOCUSED DISCUSSION ON THE HEALTH CARE ISSUES THAT DIRECTLY IMPACT TRANSYLVANIA COUNTY. PART III, LINE 4: TRANSYLVANIA REGIONAL HOSPITAL'S NOTES TO THE FINANCIAL STATEMENTS DO NOT INCLUDE A NOTE ABOUT BAD DEBT EXPENSE. PATIENT ACCOUNTS ARE CONSIDERED UNCOLLECTABLE AFTER EXHAUSTING IN-HOUSE COLLECTION PROCEDURES, WHICH USUALLY TAKES 59 DAYS FROM DISCHARGE DATE FOR SELF-PAY PATIENTS AND LONGER FOR UNINSURED PATIENTS. WHEN AN ACCOUNT IS CONSIDERED UNCOLLECTABLE, IT IS SENT TO AN OUTSIDE AGENCY, WHICH HAS 180 DAYS TO ACTIVELY ATTEMPT COLLECTIONS. WHEN THE ACCOUNT HAS BEEN INACTIVE FOR 180 DAYS WHILE AT AN OUTSIDE COLLECTION AGENCY, THE ACCOUNT IS RETURNED TO THE HOSPITAL FROM THE COLLECTION AGENCY, AND IT IS CONSIDERED A BAD DEBT ACCOUNT AND EXPENSED. THE TOTAL BAD DEBT EXPENSE FOR THE FISCAL YEAR IS THEN REDUCED TO COST UTILIZING A COST-TO-CHARGE RATIO (CCR). THE FORMULA FOR THE CCR IS (ADJUSTED COSTS / ADJUSTED CHARGES). THE COST-TO-CHARGE RATIO IS CALCULATED FROM THE INCOME STATEMENT. TOTAL OPERATING EXPENSES LESS BAD DEBT, OTHER OPERATING INCOME, AND DIRECT COMMUNITY BENEFIT COSTS MAKE THE COST COMPONENT OF THE RATIO AND GROSS PATIENT CHARGES LESS DIRECT COMMUNITY BENEFIT REVENUES MAKE UP THE CHARGES COMPONENT OF THE RATIO.FOR BUDGET PURPOSES, THE HOSPITAL CALCULATES THE EXPECTED CHARITY ADJUSTMENTS FOR THE HOSPITAL BASED ON PRIOR YEAR ADJUSTMENTS. FOR 2011, CHARITY ADJUSTMENTS DID NOT MEET BUDGET EXPECTATIONS. A VARIANCE OF 0.3% EXISTS BETWEEN ACTUAL AND EXPECTED CHARITY ADJUSTMENTS. IF WE MAKE AN ASSUMPTION THAT THE CHARITY ADJUSTMENT BUDGET IS THE EXPECTED ELIGIBLE CHARITY PATIENT POOL, THEN THE VARIANCE % BETWEEN BUDGET AND ACTUAL IS THE AMOUNT OF CHARITY ELIGIBLE PATIENTS THAT WENT TO BAD DEBT. THIS ESTIMATE IS BASED ON HISTORICAL FINANCIAL DATA AND DOES NOT FULLY REPRESENT THE POOL OF ELIGIBLE CHARITY CARE PATIENTS THAT DO NOT PARTICIPATE IN THE CHARITY PROCESS. FOR TRANSYLVANIA COUNTY, 19.9% OF THE POPULATION IN 2009 WAS BELOW THE POVERTY LEVEL. PART III, LINE 9B: THE HOSPITAL HAS A WRITTEN DEBT COLLECTION POLICY, WHICH DOES NOT DIFFERENTIATE COLLECTION PRACTICE GUIDELINES FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. IN SOME CASES, A PATIENT WHO QUALIFIES FOR PARTIAL FINANCIAL ASSISTANCE WILL STILL HAVE OUTSTANDING DEBT WITH THE HOSPITAL. THROUGH MULTIPLE NOTIFICATIONS OF COLLECTION ATTEMPTS, COMMUNICATED OPPORTUNITIES FOR DISCOUNTS, ASSISTANCE AND PAYMENT PLAN ARRANGEMENTS, AND PERSONAL FACE-TO-FACE CONSULTATIONS, THE HOSPITAL MAKES REASONABLE EFFORTS TO COLLECT DEBT. THE HOSPITAL DOES NOT UTILIZE CREDIT ACCEPTANCE PROCEDURES TO VET OUT PATIENTS. IN GENERAL, THE HOSPITAL CONTINUOUSLY MONITORS SELF-PAY ACCOUNTS TO TARGET ACCOUNTS THAT ARE SLOW TO PAY IN ORDER TO IDENTIFY ACCOUNTS THAT ARE POTENTIAL CHARITY CARE OR FINANCIAL ASSISTANCE ELIGIBLE PATIENTS. THE HOSPITAL ALSO EMPLOYEES A HEALTH RESOURCE NAVIGATOR IN THE EMERGENCY DEPARTMENT (ED) WHO MONITORS SELF-PAY PATIENTS WHO MAY BE ELIGIBLE FOR CHARITY CARE OR FINANCIAL ASSISTANCE. THE NAVIGATOR ALSO HELPS ED PATIENTS SEEK AFFORDABLE FOLLOW-UP HEALTHCARE AND DISCUSSES THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART V, SECTION A: TRANSYLVANIA REGIONAL HOSPITAL ALSO PROVIDES HOME HEALTH CARE, SKILLED NURSING, HOSPICE, AND PROVIDER-BASED CLINICS. PART I, LINE 7E: EXPLANATION OF COMMUNITY HEALTH IMPROVEMENT SERVICES: THE ORGANIZATION PROVIDED THE FOLLOWING SERVICES THAT COMPRISE THE EXPENSE LISTED AS COMMUNITY BENEFIT IN PART I, LINE 7E:RX ASSISTANCE PROGRAM $ 9,000HEALTH EDUCATION 48,600HEALTH RESOURCE NAVIGATOR 31,250TOTAL $ 88,850 PART VI, LINE 2: TRANSYLVANIA REGIONAL HOSPITAL USES MULTIPLE TOOLS TO ASSESS THE CURRENT AND FUTURE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES INCLUDING: - CONDUCTING ENVIRONMENTAL ASSESSMENTS; - REVIEWING MARKET SHARE DATA FOR EXISTING SERVICES; AND - COMPILING A MEDICAL STAFF DEVELOPMENT PLAN EVERY TWO YEARS THAT ASSESSES PHYSICIAN NEED PER POPULATION ADJUSTED FOR DEMOGRAPHICS. TRH ALSO ACTIVELY PARTICIPATES IN THE TRANSYLVANIA COUNTY HEALTH DEPARTMENT'S REQUIRED ASSESSMENT OF HEALTH NEEDS EVERY FOUR YEARS. IN ADDITION, THE TRH BOARD OF TRUSTEES IS MADE UP OF RESIDENTS OF THE ORGANIZATION'S SERVICE AREA WHO CAN VOICE THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: TRANSYLVANIA REGIONAL HOSPITAL PLACES SIGNAGE FOR ITS PATIENT FINANCIAL ASSISTANCE POLICIES IN PATIENT AREAS IN THE HOSPITAL, IN THE PATIENT ACCOUNTING OFFICE, AND THE PATIENT REGISTRATION AREA. AT THE POINT OF REGISTRATION AND PRE-REGISTRATION, PATIENTS ARE NOTIFIED OF THE PATIENT FINANCIAL ASSISTANCE POLICY. IN THE PATIENT ACCOUNTING OFFICE, THE AVAILABLE FINANCIAL ASSISTANCE PROGRAMS ARE VERBALLY COMMUNICATED BY FINANCIAL COUNSELORS TO PATIENTS WHO MIGHT BE ELIGIBLE. BILLING STATEMENTS ARE PRINTED WITH INVITATIONS TO SEEK PATIENT FINANCIAL ASSISTANCE THROUGH THE PATIENT ACCOUNTING OFFICE. IN ADDITION TO THIS, THE EMERGENCY DEPARTMENT UTILIZES A HEALTH RESOURCE NAVIGATOR TO HELP FIND FINANCIAL ASSISTANCE RESOURCES FOR SELF-PAY PATIENTS. THE PATIENT FINANCIAL ASSISTANCE POLICY ALSO RESIDES ON THE HOSPITAL'S WEBSITE, HTTP://WWW.TRHOSPITAL.ORG/PATIENTS/FINANCIAL.PHP. PART VI, LINE 4: THE PRIMARY SERVICE AREA FOR TRANSYLVANIA REGIONAL HOSPITAL IS TRANSYLVANIA COUNTY, NORTH CAROLINA, WITH A RESIDENT POPULATION OF 30,000 INCLUDING GLOUCESTER TOWNSHIP IN THE UPPER END OF THE COUNTY, WHICH IS FEDERALLY DESIGNATED AS A MEDICALLY UNDERSERVED AREA. NEARLY 12.5% OF TRANSYLVANIA COUNTY'S TOTAL RESIDENT POPULATION HAS A HOUSEHOLD INCOME BELOW THE FEDERAL POVERTY LEVEL. TRANSYLVANIA REGIONAL HOSPITAL IS THE ONLY LOCAL HOSPITAL SERVING THIS PRIMARY SERVICE AREA.TRANSYLVANIA REGIONAL HOSPITAL'S SECONDARY COVERAGE AREA INCLUDES 15,000 ADDITIONAL RESIDENTS IN SOUTHERN JACKSON COUNTY, NORTH CAROLINA, INCLUDING THE MEDICALLY UNDERSERVED AREA OF CASHIERS TOWNSHIP, AS WELL AS WESTERN HENDERSON COUNTY, NC WHICH HAS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED POPULATION OF LOW INCOME, MIGRANT FARM WORKERS. BESIDES TRANSYLVANIA REGIONAL HOSPITAL, THREE ADDITIONAL COMMUNITY HOSPITALS PROVIDE SOME COVERAGE TO THESE 15,000 RESIDENTS IN THE SECONDARY COVERAGE AREA; HOWEVER, TRANSYLVANIA REGIONAL HOSPITAL IS IN MANY CASES THE CLOSEST, MOST READILY ACCESSIBLE PROVIDER OF CARE FOR MANY OF THESE RESIDENTS. PART VI, LINE 6: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE ORGANIZATION. IN ADDITION, THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR ALL OF ITS DEPARTMENTS. TRANSYLVANIA REGIONAL HOSPITAL APPLIES THE SURPLUS OF ITS FUNDS DIRECTLY TO PATIENT CARE. FOR EXAMPLE, CAPITAL ACQUISITIONS OF MEDICAL EQUIPMENT AND EXPANDED PATIENT FACILITIES ARE FUNDED DIRECTLY BY SUPLUS OF FUNDS, AND PATIENT CARE IS BENEFITED BY THESE ACQUISITIONS.AS A NOT-FOR-PROFIT HOSPITAL, TRANSYLVANIA REGIONAL HOSPITAL IS COMMITTED TO GIVING BACK TO THE COMMUNITY TO HELP THOSE WHO ARE UNINSURED OR UNDERINSURED AS WELL AS PROVIDING HEALTH EDUCATION AND BENEFITS FOR THE WELL BEING OF THE ENTIRE COMMUNITY. 2011 WAS ANOTHER TOUGH YEAR FOR OUR COMMUNITY AS WE EXPERIENCED THE LINGERING EFFECTS OF A DECLINING ECONOMY. THIS LEFT MANY IN OUR COMMUNITY WITHOUT HEALTH INSURANCE AND STRUGGLING TO MAKE ENDS MEET. DESPITE CHALLENGING FINANCIAL TIMES FOR THE HOSPITAL, TRH CONTINUED TO GENEROUSLY HELP THOSE IN NEED IN 2011.IN 2011, TRH PROVIDED MORE THAN $6.4 MILLION IN CONTRIBUTIONS TO THE COMMUNITY. THESE BENEFITS CAME IN MANY FORMS INCLUDING $1.8 MILLION IN CHARITY CARE FOR 2,550 PEOPLE. THE HOSPITAL ALSO PROVIDED ANOTHER $3.1 MILLION IN CARE FOR 4,751 PEOPLE THROUGH NON-COLLECTIBLE SERVICES. AN ADDITIONAL $1.2 MILLION WAS PROVIDED FOR GOVERNMENT SPONSORED HEALTHCARE INCLUDING INDIGENT CARE PROGRAMS. FINALLY, $400,000 WAS PROVIDED FOR COMMUNITY BENEFIT PROGRAMS INCLUDING WELLNESS PROGRAMS AND THE DONATION OF STAFF TIME AND RESOURCES TO OTHER LOCAL COMMUNITY NONPROFIT GROUPS THAT WORK TO IMPROVE THE HEALTH AND WELL-BEING OF RESIDENTS IN TRANSYLVANIA COUNTY, NC. PART VI, LINE 7: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC 223 W JORDAN STREET BREVARD NC 28712 561458024 501(C)(3) 461381 OPERATIONAL ASSISTANCE 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION SUBSIDIZES TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION, INC.'S OPERATIONS. X X X X X 0 0 0 0 0 0 0 0 0 G RUFFIN BENTON III MD 0 237677 0 0 0 0 0 5397 0 11217 0 254291 0 0 ROBERT J BEDNAREK 237471 0 2125 0 4779 0 45354 0 11043 0 300772 0 0 0 ELIZABETH A PELLETIER 160882 0 0 0 0 0 5500 0 20135 0 186517 0 0 0 LAUREL D JOHNSON 153932 0 0 0 0 0 7800 0 7952 0 169684 0 0 0 JUDITH H MCKAY 142790 0 0 0 0 0 10096 0 18823 0 171709 0 0 0 MARK E CREASMAN 129733 0 0 0 0 0 5488 0 16506 0 151727 0 0 0 REBECCA W CARTER 132601 0 0 0 0 0 10400 0 16105 0 159106 0 0 0 NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 NONEAVAIL 2011-08-24 14655000 CURRENT REFUNDING 0 0 0 235000 14655000 14655000 2006 1 0 1 1 0 0 0 0 1 1 0 1 0 0 0 1 ANTHONY G MINA COMPENSATION AGREEMENT X 40000 7500 1 1 1 7500 LOOKING GLASS EYE CENTER PARTIALLY OWNED BY BOARD MEMBER DANA CHRISTIANSON 294906 PASS THROUGH REIMBURSEMENT FOR MEDICAL SERVICES 0 EDWARD A COYE FAMILY RELATIONSHIP WITH OFFICER LINDA COYE 25577 INDEPENDENT CONTRACTOR AGREEMENT PROVIDING EHS IMPLEMENTATION SERVICES 0 FORM 990, PART VI, SECTION A, LINE 2 ROBERT J. BEDNAREK AND CHARLES AYSCUE HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 IN AN AGREEMENT EFFECTIVE JANUARY 1, 2011, MISSION HEALTH SYSTEM, INC., A 501(C)(3) HEALTHCARE ORGANIZATION, COMMENCED PROVIDING ADMINISTRATIVE MANAGEMENT SERVICES CONSISTENT WITH THE STANDARDS OF THE HEALTHCARE INDUSTRY FOR AN INDEPENDENT HOSPITAL MANAGEMENT COMPANY CONTRACTING AT AN ARM'S LENGTH BASIS TO PROVIDE COMPREHENSIVE HOSPITAL MANAGEMENT SERVICES. AS PART OF THE AGREEMENT, THE HOSPITAL CEO, DIRECTOR OF INFORMATION SERVICES, AND LATER THE INTERIM CFO, WOULD BECOME EMPLOYEES OF MISSION HEALTH SYSTEM, INC. AND CONTINUE TO PROVIDE SERVICE TO THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A NONSTOCK, NONPROPRIETARY, TAX-EXEMPT MEMBER CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND HAS AS ITS SOLE MEMBER TRANSYLVANIA HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A TRUSTEES ARE NOMINATED TO THE BOARD BY THE GOVERNANCE COMMITTEE OF THE BOARD, APPROVED BY THE FULL HOSPITAL BOARD, AND ARE RATIFIED BY THE BOARD OF THE MEMBER ORGANIZATION. TRUSTEES ARE SUBJECT TO REMOVAL BY THE MEMBER AT ANY TIME WITHOUT CAUSE. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS THE RESERVE POWER TO APPROVE BOARD MEMBERS AND APPROVE NEW DEBT. IN ADDITION, IT IS WITIN THE SOLE MEMBER'S POWER TO SUPERVISE AND CONTROL ALL MAJOR OPERATIONAL ASPECTS OF THE HOSPITAL. THE ADMINISTRATIVE POWERS OF THE HOSPITAL ARE VESTED IN THE BOARD OF TRUSTEES, WHICH HAVE CHARGE, CONTROL, AND MANAGEMENT OF THE PROPERTY, AFFAIRS AND FUNDS OF THE HOSPITAL, INCLUDING BUT NOT LIMITED TO: (A) THE SALE, LEASE, EXCHANGE, PLEDGE, OR MORTGAGE OF ANY PART OF THE ASSETS OF THE HOSPITAL, OR ANY CONTRACT OPTION OR OTHER AGREEMENT WITH RESPECT TO THE SALE, LEASE, EXCHANGE, PLEDGE OR MORTGAGE OF THE ASSETS OF THE HOSPITAL; PROVIDED HOWEVER, THAT ANY SUCH TRANSACTION ABOVE A LIMIT SPECIFIED BY THE SYSTEM MUST FIRST BE APPROVED BY THE SYSTEM; AND (B) THE ELECTION OF ALL EXECUTIVE OFFICERS OF THE HOSPITAL AND THE DIRECTION OF THE OFFICERS IN THE DUTIES PRESCRIBED IN THESE BYLAWS AND IN SUCH OTHER SPECIAL DUTIES AS THE BOARD OF TRUSTEES DEEMS FROM TIME TO TIME APPROPRIATE AND IN THE BEST INTERESTS OF THE HOSPITAL. (C) THE EXERCISE OF ALL OTHER POWERS EXPLICITLY DELEGATED BY THE SYSTEM. SUBJECT TO THE APPROVAL OF THE SYSTEM, THE BOARD OF TRUSTEES SHALL HAVE THE POWER TO (I) AMEND OR RESTATE THE HOSPITAL'S ARTICLES OF INCORPORATION; (II) AMEND OR RESTATE THE BYLAWS; AND (III) MERGE, CONSOLIDATE, REORGANIZE OR DISSOLVE THE HOSPITAL; PROVIDED, HOWEVER, THAT IN NO EVENT SHALL THE HOSPITAL'S ARTICLES OF INCORPORATION OR BYLAWS AS PRESENTLY IN EFFECT OR AS HEREAFTER AMENDED, CONFLICT WITH THE SYSTEM'S ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND INFORMATION PROVIDED BY MANAGEMENT. THE RETURN WAS THEN REVIEWED BY THE HOSPITAL FINANCE COMMITTEE OF THE BOARD AND A COPY DISTRIBUTED TO EVERY VOTING BOARD MEMBER. AGENDA TIME WAS RESERVED AT A SCHEDULED BOARD MEETING PRIOR TO THE FILING OF THE 990 FOR MANAGMENT RESPONSE TO MEMBERS' QUESTIONS AND COMMENTS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS REVIEWED AND UPDATED ANNUALLY. EDUCATION ABOUT THE POLICY AND THE RESPONSIBILITIES OF A BOARD MEMBER OCCURS ANNUALLY AND FOR NEW BOARD MEMBERS DURING ORIENTATION. IF A CONFLICT OF INTEREST IS IDENTIFIED, THE MEMBER IS RECUSED FROM DISCUSSION AND A VOTE ON THE CONFLICTING MATTER, AND MAY BE EXCUSED. THE POLICY IS ADHERED TO DURING MEETINGS IN EXECUTIVE SESSION FOR CEO EVALUATION AND COMPENSATION DISCUSSION, AUDIT PLANNING, AND OTHER TIMES AS REQUIRED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DRAWS WAGE COMPARISON DATA FROM TWO INDEPENDENT SOURCES, AND THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD REVIEWS THE INFORMATION AND SETS THE COMPENSATION PACKAGES FOR THE CEO AND IS INFORMED OF THE COMPENSATION PACKAGES OF THE CFO, COO, VP OF MARKETING, COO OF TPSI, DIRECTOR OF THE FOUNDATION, SYSTEM DIRECTOR OF HR AND FACILITY SERVICES. COMPENSATION PACKAGES FOR THE CEO ARE REVIEWED ANNUALLY. COMPENSATION FOR ALL OTHER POSITIONS ARE REVIEWED WHENEVER A CHANGE IN THE POSITION IS MADE. CHANGES FROM THE 2010 REVIEW WERE MADE EFFECTIVE FOR THE 2011 CALENDAR YEAR. BEGINNING MARCH 2011, THE ORGANIZATION BEGAN CONTRACTING THE SERVICES OF ITS CEO FROM MISSION HEALTH SYSTEM, A 501(C)(3) HEALTHCARE ORGANIZATION. COMPENSATION PER THIS AGREEMENT IS PAID THROUGH MISSION HEALTH SYSTEM FROM AN ESTABLISHED MANAGEMENT CONTRACT. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF 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 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. AN ANNUAL REPORT OF THE ORGANIZATION'S FINANCIAL STATEMENTS IS AVAILABLE ON THE ORGANIZATION'S WEBSITE AND IS PUBLISHED ANNUALLY IN THE LOCAL NEWSPAPER. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -481,728. PRIOR PERIOD ADJUSTMENTS: -670. INCOME FROM AFFILIATED ORGANIZATION 1,019,478. TRANSFERS TO AFFILIATES -2,119,178. NET CHANGE IN VALUE OF INTEREST OF FOUNDATION 225,030. EXPENSES INCURRED FOR FOUNDATION 461,381. TOTAL TO FORM 990, PART XI, LINE 5: -895,687. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. TRANSYLVANIA HEALTH SYSTEM INC 260 HOSPITAL DRIVE BREVARD NC 28712 561456987 HEALTHCARE NC 501(C)(3) LINE 3 N/A 0 TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC PO BOX 2440 BREVARD NC 28712 561458024 SUPPORTING ORGANIZATION NC 501(C)(3) LINE 11A, I 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 COMMUNITY HOSPITAL LLC 260 HOSPITAL DRIVE BREVARD NC 28712 203281110 HEALTHCARE NC N/A RELATED 293736 351110 0 1 0.50000 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 561599596 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 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 BREVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL A 8820 CASH BREVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL R 741282 CASH BREVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL J 367840 CASH BREVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL O 30083 CASH