2011-08-12T08:31:31-05:00 2010-09-30 990 2009-10-01 560623938 The McDowell Hospital MCDO 8286595196 430 Rankin Drive Marion NC 287520730 Sonya Greck 8286595196 2011-08-12 2009 2016-02-24 21:20:13Z Sonya Greck 430 Rankin Drive Marion NC 287520730 35594097 0 X www.McDhospital.org X 1927 NC Provide acute care inpatient, outpatient and emergency medical care. 15 11 479 102 0 0 381501 211329 33720741 35134150 -50243 192708 57170 55910 34109169 35594097 0 0 18248203 20117893 0 0 17831545 19119088 36079748 39236981 -1970579 -3642884 20851787 19709562 12863669 15371312 7988118 4338250 See Page 1, Part I, Line 1 0 0 33562753 35134150 The McDowell Hospital has been serving McDowell County for 100 years and we stand by our mission to serve the healthcare needs of our community, giving comprehensive, cost-effective quality care without regard to race, color, creed or ability to pay. Our staff continually promotes a spirit of teamwork, integrity, empowerment, and mutual respect in order to achieve the highest quality healthcare and service possible for our patients. Although The McDowell Hospital continues to evolve with the changing healthcare landscape in America, our leading principles remain constant. We were founded by selfless community leaders and dedicated physicians. Today our physicians, nurses and staff strive to honor that guiding spirit. As we look forward, we will continue to fulfill the healthcare needs of our community, promoting education, prevention, and wellness while growing to meet the healthcare demands or our community.The McDowell Hospital's Mountain View Cafe earned "the RED APPLE Distinction" as part of North Carolina Prevention Partners' efforts to promote healthy food environments in hospitals.The McDowell Hospital Diabetes Center has received full American Diabetes Association Accreditation which assures that we follow highly-respected National Standards for Diabetes Self-Management Education. 33562753 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 30 0 479 1 0 0 0 0 0 0 0 0 0 15 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X The Organization 8286595196 430 Rankin Drive Marion NC 287520730 Norman C Guthrie 2.00 X X 0 0 0 Robert L Ayers 2.00 X X 0 0 0 Bobbie Young 2.00 X X 0 0 0 George S Butler 1.00 X 0 0 0 John D Karas 1.00 X 0 0 0 William Evans 1.00 X 0 0 0 R Marshall Dark III 1.00 X 0 0 0 Mark Burton MD 1.00 X 3600 0 0 Harold Walker 1.00 X 0 0 0 George Green MD 1.00 X 256314 0 5114 Keith Holtsclaw 1.00 X 0 228255 15566 Edward Hannon 50.00 X X 232870 0 38252 Ernest Ferguson 1.00 X 0 0 0 Mark Wysokinski MD 1.00 X 0 0 0 John Maher 1.00 X 0 224988 0 Clint Stewart 50.00 X 37370 0 7105 Tommy Ginn MD 40.00 X 298777 0 17655 Andrea Moore MD 40.00 X 255192 0 17091 William Horan MD 40.00 X 281327 0 10721 Robert A Morrow 40.00 X 205380 0 10452 John Rowland MD 40.00 X 175545 0 17635 1709005 453243 132486 14 0 1 0 Comprehensive Hosp Service of NC PO Box 203251 Houston TX 77216 Hospitalist 229163 CompHealth Medical Staffing PO Box 972651 Dallas TX 75397 Physician Services 227254 Cross Country PO Box 404674 Atlanta GA 30384 Contract Nurses 120636 AMN Healthcare Inc 2735 Collection Ctr Drive Chicago IL 60693 Contract Nurses 107894 4 16340 5984 189005 211329 Net Patient Service Re 900099 34038464 34038464 Other Operating Revenu 900099 769650 769650 Cafeteria Sales 722210 195150 195150 MRI Partnership 621990 130886 130886 35134150 47406 47406 55910 55910 55910 55910 143802 1500 143802 1500 145302 145302 35594097 35134150 0 248618 614723 165975 448748 15653732 12992598 2661134 99604 82671 16933 2880516 2390828 489688 869318 721534 147784 7384 7384 77013 77013 1068 1068 3141175 2669999 471176 61872 52591 9281 280686 238583 42103 1331217 1064974 266243 61808 46974 14834 153357 119618 33739 1272202 1017762 254440 497545 422913 74632 Bad Debt 7032167 7032167 Medical Supplies 4050187 3442659 607528 Repairs & Maintenance 487273 487273 Other Expenses 335934 285434 50500 Equipment Leases 328200 328200 39236981 33562753 5674228 0 3001 882661 430158 4213896 4431906 238580 127727 85850 540272 649886 200527 266662 31129828 19439608 11771403 11690220 1852428 1096483 453391 408981 598654 442102 99975 76586 20851787 19709562 3102319 2665792 414867 867475 3620000 3200000 275748 204328 5450735 8433717 12863669 15371312 X 7901289 4248266 86829 89984 7988118 4338250 20851787 19709562 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 449525 449525 15956575 7497266 8459309 11659138 9533654 2125484 3064590 2408688 655902 11690220 Swap Payable 433717 Note Payable to Mission Health System 8000000 8433717 35594097 39236981 -3642884 -6984 -6984 -3649868 35594097 0 35594097 0 35594097 39236981 0 39236981 0 39236981 Income Taxes: The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Hospital has determined that it does not have any material unrecognized tax benefits or obligations as of September 30, 2010. 1 1 1 X 1 1 1 1 0 1 1 439168 439168 0.01360 5162696 3192693 1970003 0.06120 5601864 3192693 2409171 0.07480 4261 4261 0.00010 5254285 2886355 2367930 0.07350 3543 3543 0.00010 5262089 2886355 2375734 0.07370 10863953 6079048 4784905 0.14850 0 3201079 8221020 7776489 444531 X 1 1 McDowell MRI Medical Imaging Services 0.51000 0.00000 0.49000 The McDowell Hospital

430 Rankin Drive Marion NC 28752

X X X Part I, Line 7: McDowell used worksheets 1 through 8 provided by the IRS, using the cost to charge ratio method. For physician clinics, as described in subsidized health services, actual costs were used plus indirect costs calculated using the Medicare cost report because the cost to charge ratio did not accurately capture costs for those areas. The financials include all patient segments, including inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, and self-pay. A cost to charge ratio was generated using the IRS Worksheet 2 and used for all community benefits reported except for subsidized services which used direct expenses plus overhead to more accurately report the costs involved. See note on subsidized health services. Part I, Line 7g: Subsidized health services include physician clinics, primarily women's, children's and family practice services. $4,615,652 in cost, less $2,886,355 in net patient revenue calculates to $1,721,942 in community benefits from subsidized physician clinics. Part I, Line 7f: Part I, Column 7f.The Hospital included $7,032,167.00 of bad debt in program expenses on Form 990, Part IX, line 25 but subtracted it for the purposes of calculating the amount on line 7f. Part III, Line 4: McDowell Hospital does not disclose the cost of bad debt in the footnotes of the financials; however it reports the cost of bad debt as part of a report to the North Carolina Hospital Association's data initiative. Part III, Line 8: Per the instructions, the Medicare cost report is the basis for calculating the costs using costs related to the revenue reported, and no shortfall results when using Medicare allowable costs. Using the full costing method, there would be a shortfall and the calculated community benefit would be $3,125,110. Part III, Line 9b: Patients who qualify for financial assistance and other charity care are notified using the process described in the education of patients' eligibility in Part VI, on line 3. Part VI, Line 2: The Rutherford/Polk/McDowell County Health Department coordinates a Community Health Assessment (CHA) every three years, with the most recent assessment completed in Fall 2008. McDowell Hospital has provided in-kind staff support. Primary data in these assessments has been obtained through individual household surveys, opinion surveys conducted with leaders in education, United Way, local government programs, McDowell Hospital and non-profit health agencies, and listening sessions with specific ethnic focus groups. Secondary data is obtained from the State Center for Health Statistics (SCHS) which has links to the online County Health Data Book, NC-CATCH (North Carolina Comprehensive Assessment for Tracking Community Health), and other sources of secondary data. Data is collected using the guidelines from Division of Public Health, DHHS Community Health Assessment Guidebook, MATCH (Mobilizing Action Toward Community Health) County Ranking Report, Behavioral Risk Factory Surveillance Survey, and the Census Bureau. A broad-based community CHA Steering Committee then uses this data in defining the county health needs priorities. The McDowell County Health Assessment is the basis for the hospital's health initiatives with local and regional non-profit agencies. The CHA data is also used in McDowell Hospital's outreach program development with community and regional collaborators. Part VI, Line 3: McDowell Hospital provides information to our patients regarding how they will be billed for patient care and about their eligibility for assistance under federal, state, or local government programs or under the organization's charity care policy in the following ways:During the registration process we verify insurance information on each patient. If there is no insurance, the patients are asked a series of questions to determine potential Medicaid eligibility. If the patient is determined to have potential eligibility the patient's account information is forwarded to our onsite DSS worker for further inquiries and possibly an appointment is scheduled to complete a Medicaid application.If the patient does not meet eligibility requirements, other options such as payment arrangements and/or financial assistance is discussed. At this time, the patient may be given a financial assistance application (Charity Care) to complete and return to the Business Office for processing.In addition to going through this process verbally with our patients our internet web site includes the following information:About Your BillWe are here to help. If you have any questions or concerns about the statements you receive, please call us as soon as possible at 659-5000.InsuranceThe first step is to check with your insurance company before any inpatient or outpatient procedures to be sure that you have met their requirements, such as a referral from a primary care physician. Also be sure to ask your insurance provider about any deductibles or co-pays that may be your responsibility. McDowell Hospital will file a claim with your insurance company, but deductibles and co-pays must be paid at the time of service.UninsuredIf you do not have insurance then you must pay 'up front' at the time of the visit. However, please do not let this stop you from seeking the medical care you need. If you can't pay your bill due to lack of insurance or limited income, a Patient Representative is available to help you apply for financial assistance.Financial AssistanceOur process for determining financial assistance is kept strictly confidential and eligibility is determined on an individual basis. The steps for requesting financial assistance include:Call a Patient Representative at 659-5000Participate in a brief phone interview to determine eligibilityFinancial assistance application is mailed to you or we can schedule an appointment to discuss the application processYou will need to provide specific financial information.Decision about assistance is made once all paperwork is completeMcDowell Hospital determines eligibility for assistance by following the household income guidelines established by the U.S. Department of Health and Human Services. After we review your assistance application, we may determine that you qualify for a discount, Medicaid benefits, or other state assistance available to North Carolina residents.MedicaidIf you have Medicaid, be sure to bring your card with you each time you visit the hospital for any medical services. Medicaid may require you to be referred by your primary care doctor and they may not cover certain services. The best way to be sure is to call your case worker at the Department of Social Services.Medicare PatientsPlease be aware that we are required by law to ask certain questions about your retirement and insurance coverage every time you receive services at McDowell Hospital. We send a claim to your supplemental insurance company before submitting a bill to Medicare. You are responsible for any part of your bill that's not covered by supplemental insurance and Medicare.Contact InformationIf you have any questions, you can send them through our online form, or feel free to call 828-659-5000.If you need help outside of normal business hours, please leave a message in the business office and a patient representative will return your call. Part VI, Line 4: McDowell Hospital is the only hospital in McDowell County, providing services to a community of over 45,000 members. Our Mission is to serve the healthcare needs of our community, giving comprehensive, cost-effective quality care without regard to race, color, creed or ability to pay. We provide quality care to the community of McDowell County, including the City of Marion, as well as the surrounding communities of Old Fort, Glenwood, Little Switzerland, Nebo, Pleasant Gardens, and North Cove. The ethnic breakdown for the population served includes Caucasian, Hispanic, African American, Asian/Other. Over the years, our community has seen great economic downturn; statistics supplied by our Chamber of Commerce indicate 13 plant closings since 2000, resulting in McDowell County being classified as a low-wealth district with an unemployment rate of 11.5% and an uninsured population of 21% -roughly 9,000 people. With so many families losing jobs and health insurance in the community, the demand for charitable healthcare at TMH continues to rise. The Health Department does not provide primary care for adults. The uninsured and underserved residents of McDowell County have no recourse but to show up at our Emergency Room and Health Plus Clinic for healthcare, knowing they will not be turned away. Part VI, Line 5: none to report currently Part VI, Line 6: See Program Service Accomplishments on page 2 of 990 continuing on Schedule O. Part VI, Line 7: The McDowell is part of an affiliated health care system with the respective roles of the organization and its affiliates described bellow in promiting the health of the communities served.Mission Health System, Inc. is the parent organization for the charitable organizations of Mission Hospital, Inc.; Mission Healthcare Foundation, Inc.; Mission Medical Associates, Inc; Blue Ridge Regional Hospital, Inc.; and The McDowell Hospital, Inc.Mission Hospital, Inc. is a regional integrated health system providing superior care and service to patients and their families through a full continuum of integrated services, education, and research. It serves as a trauma center to people of Western North Carolina and the surrounding counties. Mission Medical Associates mission is to provide physician services in predominantly rural areas that are insufficiently served, thereby improving the health care of the general public. In many cases this involves recruiting and placing primary care physicians, as well as pediatric and adult specialty services close to where people live and work.Blue Ridge Regional Hospital serves as a community hospital in Mitchell, Yancey and surrounding counties.The McDowell Hospital serves as a community hospital in McDowell and the surrounding counties.Mission Healthcare Foundation, Inc. supports the mission and programs of Mission Hospital, Inc. and Mission Health System, Inc. and of other organizations that are tax exempt under the provisions of Section 501(c)(3) of the Internal Revenue Code and works to benefit the community and region served by the entities listed above. NC X X X X X 0 1 0 0 0 0 0 0 0 George Green MD 256314 5114 261428 Keith Holtsclaw 203025 25230 6506 9060 243821 Edward Hannon 194965 36555 1350 25413 12839 271122 John Maher 224988 224988 Tommy Ginn MD 263830 34947 1670 15985 316432 Andrea Moore MD 235360 10000 9832 17091 272283 William Horan MD 222547 58780 10721 292048 Robert A Morrow 195496 9884 10452 215832 John Rowland MD 164228 11317 1000 16635 193180 Part I, Line 4a Edward Hannon $29,210 George Green MD Recruitment Guarantee X 476656 40336 0 1 1 William Horan MD Recruitment Guarantee X 150000 26327 0 1 1 John Rowland MD Recruitment Guarantee X 30000 7291 0 1 1 Andrea Moore MD Recruitment Guarantee X 27513 9981 0 1 1 Tommy Ginn MD Recruitment Guarantee X 54725 18738 0 1 1 Robert Morrow MD Recruitment Guarantee X 45099 25054 0 1 1 127727 Form 990, Part VI, Section A, line 6 Mission Health System, Inc, a 501(c)(3) is the parent company of The McDowell Hospital. It is the sole member of The McDowell Hospital. Form 990, Part VI, Section A, line 7a Mission Health System, as sole member has sole voting control of The McDowell Hospital, Incorporated. As the sole member of the corporation, MISSION shall have the following rights at all times with respect to the corporation: Approval of any amendments to the articles of incorporation or bylaws of the corporation. Approval of the mission, vision and values statements of the corporation and any amendments thereto. Election and removal of two (2) Mission members of the Board of Directors and approval of the Community Directors selected and submitted to MISSION for approval by its Board of Directors. Approval of the election of the President/Chief Executive Officer, provided however, that said approval shall not be unreasonably withheld. Form 990, Part VI, Section A, line 7b Mission Health System, Inc has reserve powers related to Approval of the sale, lease or other transfer of substantially all the assets of MCDOWELL Approval of (i) the pledge of all or substantially all of the assets of the corporation, (ii) the purchase or sale of property outside the ordinary course of business, and (iii) long-term borrowing (for a term of more than one (1) year) by the corporation above financial and other limits reasonably recommended by MISSION for the corporations Board approval unless such borrowing is applied to pay in full all indebtedness owed by the corporation to MISSION. Election and removal of two (2) Mission members of the Board of Directors and approval of the Community Directors selected and submitted to MISSION for approval by its Board of Directors. Approval of the formation and governance of any new corporations, partnerships or joint ventures, above financial and other limits approved by MISSION for the corporations Board approval, in which the corporation has an interest through membership, voting stock or other equity participation. Approval of the capital and operating budgets of the corporation. Approval of the election of the President/Chief Executive Officer, provided however, that said approval shall not be unreasonably withheld. Form 990, Part VI, Section B, line 11 The organization provides tax data to the manager of tax services for Mission Health System, Inc. The 990 is prepared and reviewed by management prior to review by The McDowell Hospital audit committee. After review by the board, and revisions for any clarifications or corrections, the full copy of the 990 is provided to the board for review prior to filing the 990. Form 990, Part VI, Section B, line 12c The Independent Directors will review Conflicts of Interest and Disabling Situations, consider any issues involving conflicts and make determinations as to whether a particular relationship or arrangement would disable an individual from serving as a fiduciary for the Board or would reasonably be expected to exert an influence on the individuals judgment and therefore preclude the individual from being an Independent Director. The Board may retain counsel from outside audit, legal, governance or other experts. Any determination of percent of revenue or income received by an individual or entity may be based on certifications from outside auditors of disclosures made directly by the individual to the audit firm. Procedures Upon Determination of a Conflict of Interest: The Interested Person shall not participate in any discussion or vote regarding the business relationship issue, and shall not be present in the meeting room for any part of the discussion or vote relating to the business relationship issue. The Board of Directors will discuss the business relationship but will not formally approve such business relationship unless the disinterested members of the Board have decided by majority vote that the business relationship is in the best interests of and for the benefit of McDowell, and is fair and reasonable thereto in all respects. Form 990, Part VI, Section B, line 15 Each year the Board reviews the overall philosophy and policy used to guide the determination of executive compensation. Executive compensation decisions are made within the parameters of the overall philosophy and policy approved by the Board, with support from outside executive compensation consultants to ensure compensation levels are at fair market value. The board approves contracts, compensation, and business transactions with Disqualified Persons other than executives. The Board also has the following responsibilities: Conducting a periodic review of executive compensation philosophy and policies and practices. Determining which positions are eligible for the executive compensation plan. Establishing and approve=ing the salary parameters for the CEO, others eligible under the executive compensation plan, and employees who are Disqualified Persons. Establishing and approving the terms of all incentives, benefits or programs included in the executive compensation plan. Reviewing and approving all employment contracts for the CEO and all others eligible under the executive compensation plan, and recommending amendments or termination of these arrangements. Reviewing the performance and determining the compensation of the CEO and others defined as eligible under the executive compensation plan based on the achievement of shared and personal goals. Sole responsibility to retain qualified compensation and benefits consultants and other professional advisors as the need may arise, and to terminate their contracts. Conferring with members of management to assist the Board in performing its duties, so long as their role remains technical in nature. Form 990, Part VI, Section C, line 19 The McDowell Hospital makes its governing documents, conflict of interest policy and financial statements available to the public upon request. Mission Hospital Inc 509 Biltmore Avenue Asheville NC 28801 560532141 Acute Care Hospital NC 501(c)(3) Line 3 Mission Health System Inc Mission Healthcare Foundation Inc 980 Hendersonville Road Asheville NC 28803 561881331 Foundation NC 501(c)(3) Line 7 Mission Health System Inc Mission Health System Inc 509 Biltmore Avenue Asheville NC 28803 581450888 Parent Company/Support Services NC 501(c)(3) Line 11a, I Mission Medical Associates Inc 213 Ridgefield Court Asheville NC 28806 263627231 Employed Physician Group NC 501(c)(3) Line 3 Mission Health System Inc Blue Ridge Regional Hospital Post Office Box 9 Spruce Pine NC 28777 561025032 Community Hospital NC 501(c)(3) Line 3 Mission Health System Inc McDowell Community Health Services 430 Rankin Drive Marion NC 28752 561629452 Physician Clinic NC 501(c)(3) Line 3 Imaging Realty LLP 534 Biltmore Avenue Asheville NC 28801 561907203 Medical Building NC N/A MSJHS and CCP Joint Development Company LLC 428 Biltmore Avenue Asheville NC 28801 562250464 Long Term Acute Care Hospital NC N/A McDowell MRI LLC 414 Rankin Avenue Marion NC 28752 753046378 Medical Imaging NC Related 96000 421379 0 0 Horizon Health Corp 213 Ridgefield Court Asheville NC 28806 561341621 Holding Company NC N/A C Horizon Management Services 213 Ridgefield Court Asheville NC 28806 561341624 Patient Billing and Collection Services, Medical Property NC N/A C Dogwood Insurance Company Ltd The Grant Pavilion Commercial Centr CJ Captive Insurance Entity CJ N/A C 0 0 1 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 McDowell MRI I McDowell MRI K