Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
BLUE RIDGE REGIONAL HOSPITAL INC
Employer identification number
56-1025032
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
BLUE RIDGE REGIONAL HOSPITAL INC
Employer identification number
56-1025032
Identifier
Return Reference
Explanation
BLUE RIDGE REGIONAL HOSPITAL TO WORK WITH ASHEVILLE RADIOLOGY ASSOCIATES BLUE RIDGE REGIONAL HOSPITAL IS PLEASED TO ANNOUNCE A NEW PARTNERSHIP WITH ASHEVILLE RADIOLOGY ASSOCIATES. RADIOLOGISTS FROM ASHEVILLE RADIOLOGY ASSOCIATES WILL BEGIN PROVIDING IMAGING READINGS FOR BLUE RIDGE REGIONAL HOSPITAL PATIENTS ON MARCH 21, 2011. "THIS PARTNERSHIP IS A BENEFIT FOR THE PATIENTS AS WELL AS BOTH ORGANIZATIONS" SAYS ROBIN NICHOLS, DIRECTOR OF IMAGING SERVICES AT BLUE RIDGE REGIONAL HOSPITAL. "OUR USE OF THE NEW PICTURE ARCHIVING SYSTEM (PACS) AND OUR PARTNERSHIP WITH ASHEVILLE RADIOLOGY ASSOCIATES MEANS OUR PATIENTS NOW HAVE ACCESS TO ADVANCED IMAGING SERVICES AS WELL AS SPECIALIZED IMAGING READINGS WITHOUT HAVING TO LEAVE OUR AREA." THE NEW PARTNERSHIP ALLOWS BLUE RIDGE REGIONAL HOSPITAL PATIENTS TO RECEIVE A NEW LEVEL OF IMAGING SERVICES AND READINGS. USING SOPHISTICATED AND SECURE TECHNOLOGY, THE IMAGING DEPARTMENT AT BLUE RIDGE REGIONAL HOSPITAL IS NOW ABLE TO SHARE AND CONSULT WITH LEADING IMAGING EXPERTS IN ASHEVILLE. FOR EXAMPLE, A MAMMOGRAM STUDY CAN BE SENT TO A MAMMOGRAPHY SPECIALIST IN ASHEVILLE DIGITALLY THROUGH THE USE OF THE PICTURE ARCHIVING SYSTEM ON A SECURE NETWORK. "FOR OUR PATIENTS, THIS COLLABORATION MEANS HAVING TWO EXPERIENCED TEAMS WORKING CLOSELY TOGETHER EVERY DAY TO PROVIDE ADVANCED IMAGING AND DIAGNOSTIC SERVICES", SAYS NICHOLS "WE ARE PLEASED TO OFFER EVERYTHING FROM HEART CARE AND NEUROLOGY TO BREAST IMAGING AND BONE HEALTH TO OUR COMMUNITY." CAR SEAT CERTIFICATION BLUE RIDGE REGIONAL HOSPITAL IS PLEASED TO ANNOUNCE THAT HEATHER GREENE, WELLNESS COORDINATOR IN THE DISEASE MANAGEMENT DEPARTMENT, ACHIEVED ANOTHER STEP IN CHILD PASSENGER SAFETY. GREENE BECAME A CERTIFIED CHILD PASSENGER SAFETY TECHNICIAN IN MAY 2005 AND A CERTIFIED CHILD PASSENGER SAFETY TECHNICIAN INSTRUCTOR IN APRIL 2009. THIS CERTIFICATION MEANS THAT GREENE CAN CHECK THE SAFETY OF CAR SEATS, PROPERLY INSTALL CAR SEATS AND TRAIN OTHERS TO PROPERLY INSTALL CAR SEATS. TO RECEIVE HER CERTIFICATION, GREENE COMPLETED AN EXTENSIVE COURSE DEVELOPED BY THE NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, MONITORED BY THE CHILD PASSENGER SAFETY BOARD AND CERTIFIED THROUGH THE SAFE KIDS WORLDWIDE. IN ADDITION TO THE NATIONAL CERTIFICATION, HEATHER RECENTLY EARNED HER SENIOR CHECKER CERTIFICATION THROUGH THE SAFE KIDS BUCKLE UP PROGRAM. ACHIEVING SENIOR CHECKER STATUS MEANS THAT GREENE IS CERTIFIED TO NOT ONLY CHECK THE INSTALLATION AND SAFETY OF CAR SEATS, BUT THE SKILLS AND ABILITIES OF OTHER CHILD PASSENGER SAFETY TECHNICIANS. HEATHER IS THE ONLY NATIONALLY CERTIFIED CHILD PASSENGER SAFETY TECHNICIAN INSTRUCTOR/SENIOR CHECKER IN MITCHELL, AVERY, YANCEY, AND MCDOWELL COUNTIES. "IT IS AN HONOR TO BE A SENIOR CHECKER AS WELL AS A NATIONALLY CERTIFIED CHILD PASSENGER SAFETY TECHNICIAN INSTRUCTOR" SAYS HEATHER, "I CAN HELP PARENTS AND CAREGIVERS PROPERLY SECURE THEIR CHILDREN IN THE CORRECT RESTRAINTS AS WELL AS HELP OTHER CHILD PASSENGER SAFETY TECHNICIANS IN OUR AREA." WORKING AT BLUE RIDGE REGIONAL HOSPITAL, GREENE IS ABLE TO PROVIDE CAR SEAT SAFETY SERVICES TO THE COMMUNITY. "WORKING HERE AT THE HOSPITAL, I CHECK SEATS FOR NEWBORNS AND THEIR FAMILIES BEFORE THEY LEAVE THE HOSPITAL", SAYS GREENE "I CAN ALSO CHECK ALL OTHER SEATS AND RESTRAINTS. ALL PARENTS HAVE TO DO IS COME TO THE HOSPITAL."
FORM 990, PART VI, SECTION A, LINE 6
THE SOLE MEMBER OF THE CORPORATION IS MISSION-ST. JOSEPH HEALTH SYSTEM, INC.
FORM 990, PART VI, SECTION A, LINE 7A
THE DIRECTORS OF THE CORPORATION SHALL BE APPOINTED AT THE ANNUAL MEETING OF THE MEMBER OF THE CORPORATION (SEE ABOVE). THE TWO EX-OFFICIO DIRECTORS SHALL BE EX-OFFICIO BOARD MEMBERS WHO SERVE IN THE POSITIONS OF CHIEF EXECUTIVE OFFICER OF THE CORPORATION AND CHIEF OF STAFF OF THE HOSPITAL. THE BOARD OF DIRECTORS OF THE CORPORATION SHALL ELECT THE SEVEN INDIVIDUALS TO SERVE AS COMMUNITY DIRECTORS AS SOON AS REASONABLY PRACTICABLE SUBSEQUENT TO THE APPOINTMENT OF THE SOLE MEMBER'S DIRECTORS. THE COMMUNITY DIRECTORS ELECTED MUST BE APPROVED BY THE MEMBER OF THE CORPORATION; HOWEVER, SAID APPROVAL SHALL NOT BE ARBITRARILY AND CAPRICIOUSLY WITHHELD.
FORM 990, PART VI, SECTION A, LINE 7B
THE SOLE MEMBER HAS THE FOLLOWING RIGHTS WITH RESPECT TO THE CORPORATION: (A) APPROVAL OF THE GOVERNING INSTRUMENTS OF THE CORPORATION, (B) APPROVAL OF THE MISSION, VISION, AND VALUES STATEMENT, (C) ELECTION AND REMOVAL OF THE BOARD OF DIRECTORS, (D) APPROVAL OF THE PLEDGE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, THE PURCHASE OR SALE OF PROPERTY, AND LONG-TERM BORROWING, (E) APPROVAL OF DISSOLUTION, MERGER, SALE, OR CONSOLIDATION, (F) APPROVAL OF THE FORMATION AND GOVERNANCE OF NEW CORPORATIONS, PARTNERSHIPS, OR JOINT VENTURES (ABOVE FINANCIAL AND OTHER LIMITS), (G) APPROVAL OF THE CAPITAL AND OPERATING BUDGET, (H) APPROVAL OF THE CONSOLIDATION, MATERIAL EXPANSION, OR ELIMINATION OF ANY CLINICAL SERVICE, (I) APPROVAL OF THE ELECTION OF THE PRESIDENT/CEO, (J) THE OPTION TO REMOVE THE PRESIDENT/CEO UPON THE HAPPENING OF ANY OF THE EVENTS LISTED IN THE BYLAWS AT SECTION 3.4(J).
FORM 990, PART VI, SECTION B, LINE 11
THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH THE OVERSIGHT AND ASSISTANCE OF MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND PRESENTED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. PRIOR TO FILING WITH THE IRS, THE FINANCE COMMITTEE PRESENTED THE RETURN TO THE FULL VOTING BOARD AT A SCHEDULED MEETING, AND A PERIOD OF TIME WAS ALLOWED FOR QUESTIONS AND DISCUSSION.
FORM 990, PART VI, SECTION B, LINE 12C
IN ALL BOARD MEETINGS, THE CHAIRMAN OF THE BOARD REVIEWS THE POLICY BEFORE VOTES, INQUIRING IF ANY MEMBER HAS A POTENTIAL CONFLICT. POTENTIALLY INTERESTED PARTIES ARE EXCUSED FROM DISCUSSIONS AND VOTES.
FORM 990, PART VI, SECTION B, LINE 15
ANNUALLY THE FINANCE COMMITTEE OF THE BOARD REVIEWS AND COMPARES COMPENSATION DATA FOR THE TOP EXECUTIVE AND OTHER KEY POSITIONS WITH DATA FROM FOUR DIFFERENT COMPARABLE SOURCES, INCLUDING THE FORMS 990 OF OTHER ORGANIZATIONS, TWO NATIONAL SALARY SURVEYS, AND ONE STATE SALARY SURVEY. COMPENSATION PACKAGES ARE THEN APPROVED BY THE FINANCE COMMITTEE. IN ADDITION TO THE CEO, THE BOARD REVIEWS THE COMPENSATION FOR THE CFO, VP OF NURSING, VP OF PHYSICIAN PRACTICES, AND THE VP OF OUTREACH.
FORM 990, PART VI, SECTION C, LINE 18
PHOTOCOPIES OF THE ORGANIZATION'S FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT GUIDESTAR.ORG, A NON-PROFIT ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 19
PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, DETAILS FROM THE ORGANIZATION'S FINANCIAL STATEMENTS ARE WIDELY DISTRIBUTED IN THE HOSPITAL'S REPORT TO THE COMMUNITY.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED LOSSES ON INVESTMENTS: -260,572. NET OF CONSOLIDATED ORGANIZATION -103,231. TOTAL TO FORM 990, PART XI, LINE 5: -363,803.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.