2011-05-03T13:53:48-05:00 2010-09-30 DIXON HUGHES GOODMAN LLP 500 Ridgefield Court Asheville NC 28806 990 2009-10-01 560562293 TRANSYLVANIA COMMUNITY HOSPITAL INC TRAN 8288849111 PO BOX 1116 BREVARD NC 28712 LINDA COYE 8288849111 2011-05-02 1 Amy Bibby 8282542254 2009 2016-02-24 21:20:13Z TRANSYLVANIA REGIONAL HOSPITAL ROBERT J BEDNAREK PO BOX 1116 BREVARD NC 28712 62004251 0 X www.trhospital.org X 1933 NC PROVISION OF MEDICAL SERVICES 14 10 692 190 0 0 1836619 1799116 56352222 59259640 152055 323450 137826 573732 58478722 61955938 484583 215601 0 26676705 26538804 0 0 31645118 36575013 58806406 63329418 -327684 -1373480 72411026 69569796 26089069 26355886 46321957 43213910 TRANSYLVANIA REGIONAL HOSPITAL PROMOTES WELLNESS AND PROVIDES ACCESS TO QUALITY HEALTH SERVICES FOR THE PEOPLE IN OUR REGION. 0 0 53435637 215601 59259640 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. 2010 WAS ANOTHER TOUGH YEAR FOR OUR COMMUNITY AS WE EXPERIENCED 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 2010.IN 2010, TRH PROVIDED MORE THAN $6 MILLION IN CONTRIBUTIONS TO THE COMMUNITY. THESE BENEFITS CAME IN MANY FORMS INCLUDING $1.8 MILLION IN CHARITY CARE FOR 2,435 PEOPLE. THE HOSPITAL ALSO PROVIDED ANOTHER $2.5 MILLION IN CARE FOR 4,606 PEOPLE THROUGH NON-COLLECTIBLE SERVICES. AN ADDITIONAL $1.3 MILLION WAS PROVIDED FOR GOVERNMENT SPONSORED HEALTHCARE INCLUDING INDIGENT CARE PROGRAMS. FINALLY, $450,000 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. NEARLY 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 WHO BENEFITED FROM IN-KIND DONATIONS WERE: MARCH OF DIMES, UNITED WAY, CHAMBER OF COMMERCE, RELAY FOR LIFE, THE TRANSYLVANIA COUNTY SCHOOL SYSTEM, BREVARD COLLEGE, THE FREE CLINIC, TRANSYLVANIA PARTNERSHIP FOR HEALTH AND OTHERS. - A NEW PHYSICIAN-BASED MEDICAL PRACTICE--BREVARD INTERNAL MEDICINE & PULMONOLOGY--AS ADDED TO THE HOSPITAL IN 2010 TO SUPPORT THE PRIMARY CARE NEEDS OF PATIENTS IN THE LOCAL COMMUNITY. - THE EXISTING SYLVAN VALLEY OB/GYN MEDICAL PRACTICE BECAME PART OF TRANSYLVANIA HEALTH SYSTEM IN 2010. AN ADDITIONAL FULL-TIME OB/GYN PHYSICIAN WAS ADDED TO INCREASE LOCAL ACCESS TO MEET THE HEALTHCARE NEEDS OF WOMEN IN THE COMMUNITY FOR BOTH ROUTINE AND SPECIALIZED CARE. - TRH RECRUITED SEVERAL PHYSICIANS TO THE COMMUNITY IN 2010 TO EXPAND ACCESS TO HEALTHCARE FOR OUR RESIDENTS, INCLUDING A NEW INTERNAL MEDICINE PHYSICIAN, A FAMILY PRACTICE PHYSICIAN, A NEW HOSPITALIST AND A NEW OBSTETRICIAN/GYNECOLOGIST. - TRH CONTINUED 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. THE PROGRAM HELPED NAVIGATE MORE THAN 500 LOCAL RESIDENTS TO MORE APPROPRIATE MEDICAL CARE IN 2010 WHILE AVOIDING MORE THAN $300,000 IN EMERGENCY ROOM COSTS FOR THESE PATIENTS. - THE HOSPITAL IMPLEMENTED A PEDIATRIC HOSPITALIST PROGRAM IN 2010 TO IMPROVE LOCAL CARE FOR NEWBORNS AND HOSPITALIZED CHILDREN AT TRANSYLVANIA REGIONAL HOSPITAL. - USING HOSPITAL FUNDS ALONG WITH A FEDERAL RURAL HEALTH GRANT, TRH CONTINUED A THREE-YEAR EFFORT TO IMPLEMENT THE LOCAL USE OF ELECTRONIC MEDICAL RECORDS IN AREA PHYSICIAN OFFICES. THIS LOCAL NETWORK WILL ALLOW THE HOSPITAL AND ITS PHYSICIANS TO RAPIDLY AND SECURELY SHARE PATIENT INFORMATION AND PUBLIC HEALTH DATA WITH AREA PHYSICIAN PRACTICES AND OTHER MEMBERS OF THE WNC DATA LINK NETWORK. THE EXCHANGE OF PATIENT DATA THROUGH THE NETWORK WILL REDUCE MEDICAL COSTS AND IMPROVE PATIENT CARE. 53435637 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 1 0 0 1 75 0 692 1 0 0 0 0 0 0 0 0 0 14 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X X LINDA COYE 8288849111 PO BOX 1116 BREVARD NC 28712 ROBERT MAXWELL 1.00 X X 0 0 0 R BRYAN PADRICK 1.00 X X 0 0 0 WILLIAM R MINNICH JR 1.00 X X 0 0 0 JOHN HOLBROOK 1.00 X X 0 0 0 RICHARD MILLAR 1.00 X 0 0 0 DANA J CHRISTIANSON MD 1.00 X 0 0 0 THELMA ERICKSON 1.00 X 0 0 0 ELIZABETH K JORDAN 1.00 X 0 0 0 RICHARD C LARSON 1.00 X 0 0 0 ALVIN W LEFAIVRE 1.00 X 0 0 0 BOB SKIFF 1.00 X 0 0 0 ORA WELLS MD 1.00 X 1980 0 0 G RUFFIN BENTON III MD 1.00 X 0 277110 31203 ROBERT J BEDNAREK 40.00 X X 236950 0 59978 THERESA M PARKER 40.00 X 111411 0 20154 ELIZABETH A PELLETIER 40.00 X 156714 0 17956 LAUREL D JOHNSON 40.00 X 156587 0 16455 JUDITH H MCKAY 40.00 X 150152 0 27367 MARK E CREASMAN 40.00 X 132993 0 20344 KIMBERLY PHILLIPS 40.00 X 128684 0 24161 1075471 277110 217618 11 0 1 0 WELLS FARGO TPA PO BOX 535100 ATLANTA GA 303535100 BENEFITS ADMINISTRATION 3778046 AMERISOURCE BERGEN DRUG CORP PO BOX 5804 NEW YORK NY 100875804 MEDICAL PRODUCTS 1988121 REHAB SERVICES OF BREVARD LLC 376A GOVERNMENT STREET MOBILE AL 36693 PHYSICAL THERAPY SERVICES 1275698 TRANSYLVANIA EMERGENCY PHYSICIANS PLLC 3107 STIRLING ROAD SUITE 300 FT LAUDERDALE FL 33312 E/R PHYSICIAN SERVICES 1175993 CARDINAL HEALTH PO BOX 905867 CHARLOTTE NC 282905867 MEDICAL PRODUCTS 1128072 60 60689 1484145 220523 33759 1799116 NET PATIENT SERVICE RE 621400 57880478 57880478 OTHER PATIENT SERVICES 621610 1225335 1225335 LIFELINE RENTALS 900099 113008 113008 PHARMACY AND MED SUPP 446110 40819 40819 59259640 371763 371763 48313 -48313 -48313 -48313 CAFETERIA/VENDING 722210 230802 230802 MANAGEMENT SERVICES 900099 190280 190280 MISCELLANEOUS REVENUES 900099 152650 152650 573732 61955938 59259640 0 897182 215601 215601 743186 743186 20232169 14340517 5891652 745870 509939 235931 3294696 2252531 1042165 1522883 1041171 481712 502823 329156 173667 417281 417281 87685 87685 10180164 10138010 42154 147334 120039 27295 12841868 12109236 732632 1712660 1712660 204850 194022 10828 35074 34368 706 540702 540702 3791329 3791329 373023 373023 BAD DEBTS 5622720 5622720 MISCELLANEOUS EXPENSES 117500 110613 6887 63329418 53435637 9893781 0 765320 1916169 1098715 413454 7960572 8330374 20404 1561572 1867063 448118 567073 62293183 26803707 37993736 35489476 14766511 15396937 3190230 3315311 69381 84654 4556871 2168881 72411026 69569796 5207815 5516793 16331632 15706632 4508654 2968754 40968 2163707 26089069 26355886 X 43109727 39856535 3212230 3357375 46321957 43213910 72411026 69569796 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8974 8974 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: 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 TOTALLED APPROXIMATELY $ 8,974. 764012 764012 23649583 7621262 16028321 2882015 872799 2009216 34803176 18309646 16493530 194397 194397 35489476 3315311 C 3315311 INTEREST IN BREVARD MRI, LLC 72910 C INVESTMENT IN BLUE RIDGE DME 11744 C 84654 BOND ISSUE COSTS, NET OF AMORTIZATION 257781 RECEIVABLE FROM AFFILIATED ORGANIZATIONS 893394 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 1017706 2168881 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 2163707 2163707 61955938 63329418 -1373480 1443760 -3178328 -1734568 -3108048 59764682 1443760 139840 1583600 58181082 3774856 3774856 61955938 62872729 0 62872729 456689 456689 63329418 Part XI, Line 8 - Other Adjustments: INCOME FROM AFFILIATED ORGANIZATION: 14758. TRANSFER TO AFFILIATES: -3318167. NET CHANGE IN VALUE OF INTEREST OF TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION: 125081. Part XII, Line 2d - Other Adjustments: NET CHANGE IN VALUE OF INTEREST IN TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION: 125082. INCOME FROM AFFILIATED ORGANIZATIONS: 14758. Part XII, Line 4b - Other Adjustments: EXPENSES INCURRED FOR TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION: 456689. TRANSFER TO AFFILIATES: 3318167. Part XIII, Line 4b - Other Adjustments: EXPENSES INCURRED FOR TRANSLYVANIA REGIONAL HOSPITAL FOUNDATION: 456689. 1 1 1 X 1 X 1 1 0 1 1 2107608 0 2107608 0.03650 6380977 4265144 2115833 0.03670 8488585 4265144 4223441 0.07320 132877 0 132877 0.00230 319732 0 319732 0.00550 452609 452609 0.00780 8941194 4265144 4676050 0.08100 7619 7619 0.00010 7619 7619 0.00010 0 2530307 265682 32691144 32186712 504432 X 1 1 BREVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL LLC MRI SERVICES 0.50000 0.50000 TRANSYLVANIA REGIONAL HOSPITAL

260 HOSPITAL DRIVE BREVARD NC 28712

X X X X 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 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 COLLECTIONS PROCEDURES, WHICH USUALLY TAKE 59 DAYS FROM DISCHARGE DATE FOR SELF-PAY PATIENTS AND LONGER FOR INSURED PATIENTS. WHEN THE ACCOUNT IS CONSIDERED UNCOLLECTABLE, IT IS THEN SENT TO AN OUTSIDE COLLECTION 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 UP 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 2010, CHARITY ADJUSTMENTS DID NOT MEET BUDGET EXPECTATIONS. A VARIANCE OF 10.5% IS CALCULATED BETWEEN ACTUAL CHARITY ADJUSTMENTS AND VARIABLE BUDGET. IF WE MAKE AN ASSUMPTION THAT THE CHARITY ADJUSTMENT BUDGET IS THE EXPECTED ELIGIBLE CHARITY PATIENT POOL, THEN THE VARIANCE PERCENTAGE 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, 12.4% OF THE POPULATION IN 2008 WAS BELOW THE POVERTY LEVEL. Part III, Line 9b: THE HOSPITAL DOES HAVE 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. THE HOSPITAL MAKES REASONABLE EFFORTS TO COLLECT DEBT THROUGH MULTIPLE NOTIFICATION OF COLLECTION ATTEMPTS, COMMUNICATED OPPORTUNITIES FOR DISCOUNTS, ASSISTANCE AND PAYMENT PLAN ARRANGEMENTS, AND PERSONAL FACE-TO-FACE CONSULTATIONS. 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 DISCUSS THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. 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 $ 3,767INDIGENT CARE 14,667HEALTH RESOURCE NAVIGATOR 69,190HEALTH EDUCATION 44,900FALLS RISK ASSESSMENT 353TOTAL $ 132,877 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 HAS PLACED SIGNAGE FOR PATIENT FINANCIAL ASSISTANCE POLICIES IN PATIENT AREAS IN THE HOSPITAL, IN THE PATIENT ACCOUNTING OFFICE, AND 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, A HEALTH RESOURCE NAVIGATOR IS UTILIZED IN THE EMERGENCY DEPARTMENT TO HELP FIND FINANCIAL ASSISTANCE RESOURCES FOR SELF-PAY PATIENTS. 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, NC WITH A RESIDENT POPULATION OF APPROXIMATELY 30,000, INCLUDING GLOUCESTER TOWNSHIP IN THE UPPER END OF THE COUNTY, WHICH IS FEDERALLY DESIGNATED AS A MEDICALLY UNDERSERVED AREA. NEARLY 12.5 PERCENT 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 APPROXIMATELY 15,000 ADDITIONAL RESIDENTS IN SOUTHERN JACKSON COUNTY, NC, 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 5: 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. NC 1 TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION 223 W JORDAN STREET BREVARD NC 28712 561458024 501(C)(3) 215601 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 COMMUNITY HOSPITAL FOUNDATION, INC.'S OPERATIONS. X X 0 0 X X X X X 0 0 0 0 0 0 0 0 0 G RUFFIN BENTON III MD 0 226544 0 39749 0 10817 0 21500 0 9703 0 308313 0 0 ROBERT J BEDNAREK 217039 0 14975 0 4936 0 50332 0 9646 0 296928 0 0 0 ELIZABETH A PELLETIER 156714 0 0 0 0 0 5557 0 12399 0 174670 0 0 0 LAUREL D JOHNSON 156587 0 0 0 0 0 14885 0 1570 0 173042 0 0 0 JUDITH H MCKAY 150152 0 0 0 0 0 17801 0 9566 0 177519 0 0 0 MARK E CREASMAN 132993 0 0 0 0 0 10811 0 9533 0 153337 0 0 0 KIMBERLY PHILLIPS 128684 0 0 0 0 0 14595 0 9566 0 152845 0 0 0 Part I, Line 1a TRAVEL FOR COMPANIONS IS PROVIDED DUE TO AN ANNUAL STIPEND FOR PHYSICIANS TO ATTEND CME. HEALTH AND SOCIAL CLUB DUES ARE A PART OF CERTAIN OFFICERS' COMPENSATION AGREEMENTS, AND AMOUNTS ARE TAXED TO THE INDIVIDUAL ON HIS OR HER RESPECTIVE W-2. Part I, Line 4a FORMER COO ANTHONY MINA RECEIVED COMPENSATION FROM A SEVERANCE AGREEMENT IN FY 2010. SEE PART II, COLUMN (B)(III). NORTH CAROLINA MEDICAL CARE COMMISSION 521309402 65820HB51 2009-03-09 13240000 QUALIFIED HOSPITAL REVENUE BONDS 0 0 242449 242449 361772 2006 1 0 1 1 0 0 0 0 1 0 0 1 0 0 0 1 ANTHONY G MINA COMPENSATION AGREEMENT X 40000 20404 1 1 1 20404 LOOKING GLASS EYE CENTER PARTIALLY OWNED BY BOARD MEMBER DANA CHRISTIANSON 309037 PASS THROUGH REIMBURSEMENT FOR MEDICAL SERVICES 0 Form 990, Part VI, Section A, line 6 THE HOSPITAL IS A NONSTOCK, NONPROPRIETARY, TAX-EXEMPT MEMBER CORPORATION UNDER SECTION 501(C)(3) AND 509(A)(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. 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. 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 IS MADE, AND WERE LAST REVIEWED IN 2007. NO CHANGES TO THE COMPENSATION PACKAGES HAVE BEEN MADE SINCE THAT TIME. 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 IN THE LOCAL NEWSPAPER ANNUALLY. TRANSYLVANIA HEALTH SYSTEM INC PO BOX 1116 BREVARD NC 28712 561456987 HEALTHCARE NC 501(c)(3) Line 3 N/A TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC PO BOX 2440 BREVARD NC 28712 561458024 SUPPORTING ORGANIZATION NC 501(c)(3) Line 11a, I N/A TRANSYLVANIA PHYSICIAN SERVICES INC PO BOX 1116 BREVARD NC 28712 561920816 HEALTHCARE NC 501(c)(3) Line 3 N/A BREVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL LLC PO BOX 1116 BREVARD NC 28712 203281110 MEDICAL NC RELATED 14758 644434 0 1 TRANSYLVANIA HEALTHCARE II LIMITED PARTNERSHIP 2 MEDICAL PARK DR BREVARD NC 28712 200333230 RENTAL NC N/A HEALTHCARE III LIMITED PARTNERSHIP PO BOX 1116 BREVARD NC 28712 561599596 RENTAL NC N/A HEALTHCARE LIMITED LIABILITY COMPANY VII PO BOX 1116 BREVARD NC 28712 200343455 RENTAL NC N/A TRANSYLVANIA SERVICES INC PO BOX 1116 BREVARD NC 28712 561448199 REAL ESTATE NC N/A C 1 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC C 1484145 TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC O 422138 TRANSYLVANIA PHYSICIAN SERVICES INC B 3318167 TRANSYLVANIA PHYSICIAN SERVICES INC N 3077618 TRANSYLVANIA PHYSICIAN SERVICES INC K 783594 TRANSYLVANIA SERVICES INC Q 702688 TRANSYLVANIA SERVICES INC A 26047 TRANSYLVANIA SERVICES INC K 45840