TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) JOSEPH L CARSON JR CHAIRMAN	1.0	X	X	0	0
(2) DIANE HAMRICK VICE CHAIRMAN	1.0	X	X	0	0
(3) E THOMAS HARDIN SECRETARY	1.0	X	X	0	0
(4) MATT BRIGHT TREASURER	1.0	X	X	0	0
(5) PAUL DECK TRUSTEE	1.0	X		0	0
(6) DAVID EAKER TRUSTEE	1.0	X		0	0
(7) J LARRY HARRILL TRUSTEE	1.0	X		0	0
(8) LEE HARRILL TRUSTEE	1.0	X		0	0
(9) THOMAS J JASKI MD TRUSTEE	1.0	X		0	0
(10) MYRA JOHNSON TRUSTEE THROUGH 02/2012	1.0	X		0	0
(11) MICHAEL S WHEELER MD TRUSTEE	1.0	X		625,458	0
(12) TERRY HINES TRUSTEE	1.0	X		0	0
(13) BETH MILLER TRUSTEE	1.0	X		0	0
(14) LUTHER PERSON MD TRUSTEE	1.0	X		0	0
(15) BOBBY ENGLAND MD TRUSTEE	1.0	X		0	0
(16) DAVID BIXLER CEO THROUGH 04/2012	40.0		X	0	0
(17) CINDY BUCK CEO BEGINNING 09/12, SEE SCH O	40.0		X	39,975	86

(A) Name and business address	(B) Description of services	(C) Compensation
HOSPITAL MEDICINE ASSOCIATES	HOSPITALISTS	1,438,434
QUORUM HEALTH RESOURCESQHR	MANAGEMENT SERVICES	1,083,701
MICHAEL S WHEELER MD	LAB MEDICAL DIRECTOR	652,458
SODEXO	MANAGEMENT SERVICES	369,312
ALLIED BARTON SECURITY SVCS	SECURITY SERVICES	224,700
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 16

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	0
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	897,998	857,937	40,061	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	38,941,940	37,049,605	1,892,335
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	6,518,111	4,829,298	1,688,813
10	Payroll taxes ...........	2,738,030	2,028,871	709,159
11	Fees for services (non-employees):
a	Management ......	400,338		400,338
b	Legal .........	214,346		214,346
c	Accounting ...........	35,540		35,540
d	Lobbying ...........	0
e	Professional fundraising. See Part IV, line 17..	0
f	Investment management fees ......	166,308		166,308
g	Other ..........	8,638,469	7,680,980	957,489
12	Advertising and promotion ....	396,855	392,973	3,882
13	Office expenses .......	2,705,013	2,333,190	371,823
14	Information technology ......	606,831	527,086	79,745
15	Royalties ..	0
16	Occupancy ...........	2,733,254	2,720,870	12,384
17	Travel ............	302,357	285,762	16,595
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......	0
19	Conferences, conventions, and meetings ....	24,945	24,945
20	Interest ...........	316,904	265,398	51,506
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization .....	5,867,350	4,913,731	953,619
23	Insurance ..............	690,709	578,448	112,261
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	BAD DEBT	20,466,731	20,466,731
b	MEDICAL SUPPLIES & DRUGS	12,278,532	12,278,532
c	REPAIRS & MAINTENANCE	2,546,933	1,694,294	852,639
d	RECRUITING	225,179	220,632	4,547
e
f	All other expenses	212,787	88,950	123,837
25	Total functional expenses. Add lines 1 through 24f	107,925,460	99,238,233	8,687,227	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	3,900	1	4,260
2	Savings and temporary cash investments .......	2,049,175	2	3,792,065
3	Pledges and grants receivable, net .........	0	3	0
4	Accounts receivable, net .........	13,363,299	4	11,220,632
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........	0	6	0
7	Notes and loans receivable, net .............	0	7	0
8	Inventories for sale or use ..............	1,788,160	8	1,746,370
9	Prepaid expenses and deferred charges ............	1,053,533	9	881,819
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	129,477,057
b	Less: accumulated depreciation. .....	10b	81,199,756	47,206,726	10c	48,277,301
11	Investments—publicly traded securities ..........	32,432,260	11	31,299,317
12	Investments—other securities. See Part IV, line 11 ......	0	12	0
13	Investments—program-related. See Part IV, line 11 ..	0	13	0
14	Intangible assets .........	599,042	14	599,042
15	Other assets. See Part IV, line 11 ...........	1,134,881	15	3,148,941
16	Total assets. Add lines 1 through 15 (must equal line 34)...	99,630,976	16	100,969,747
	17	Accounts payable and accrued expenses .	9,305,153	17	9,419,397
18	Grants payable ..........	0	18	0
19	Deferred revenue ..........	2,990	19	0
20	Tax-exempt bond liabilities ..........	15,030,386	20	19,234,551
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	806,566	23	622,650
24	Unsecured notes and loans payable to unrelated third parties ....	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	2,399,600	25	5,142,167
26	Total liabilities. Add lines 17 through 25.....	27,544,695	26	34,418,765
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	72,086,281	27	66,550,982
28	Temporarily restricted net assets .....	0	28	0
29	Permanently restricted net assets .....	0	29	0
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	72,086,281	33	66,550,982
34	Total liabilities and net assets/fund balances .....	99,630,976	34	100,969,747

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

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. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

RUTHERFORD HOSPITAL INC

Employer identification number

56-0619367

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.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

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).

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 ..................................................

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

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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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).

Gross receipts from related activities, etc. (See instructions.) ..................

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.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. 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 ...................... right arrow

33 1/3% support test—2010. 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 ..................... right arrow

17a

10%-facts-and-circumstances test—2011. 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 .................................................. right arrow

10%-facts-and-circumstances test—2010. 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 .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. 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 .......... right arrow

33 1/3% support tests—2010. 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 .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

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) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

RUTHERFORD HOSPITAL INC

Employer identification number

56-0619367

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization RUTHERFORD HOSPITAL INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization RUTHERFORD HOSPITAL INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
RUTHERFORD HOSPITAL INC

Employer identification number

56-0619367

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

RUTHERFORD HOSPITAL INC

Employer identification number

56-0619367

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

8,379

Total. Add lines 1c through 1i ...............................

8,379

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
OTHER LOBBYING ACTIVITIES	SCHEDULE C, PART II-B, LINE 1I	THE ORGANIZATION PAYS DUES TO THE NORTH CAROLINA HOSPITAL ASSOCIATION, OF WHICH $8,074 IS ATTRIBUTABLE TO LOBBYING ACTIVITIES AND TO AHA OF WHICH $305 IS ATTRIBUTABLE TO LOBBYING ACTIVITIES.

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

RUTHERFORD HOSPITAL INC

Employer identification number

56-0619367

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.

			Held at the End of the Year
a	Total number of conservation easements .......................	2a	1
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c	1
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d	0

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

$ 0

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,528,211		1,528,211
b	Buildings ................	66,369,807	36,138,081	30,231,726
c	Leasehold improvements ............	681,069	0	681,069
d	Equipment ................	58,244,680	43,846,309	14,398,371
e	Other .................	2,653,290	1,215,366	1,437,924
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				48,277,301

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes		0
EST AMT DUE TO 3RD PTY PYR		2,912,472
EST INSURANCE LIABILITY		1,144,074
INTEREST RATE SWAP AGREEMENT		1,085,621






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		5,142,167
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	104,289,593
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	107,925,460
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	-3,635,867
4	Net unrealized gains (losses) on investments ..........................	4	3,646,938
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8	-340,397
9	Total adjustments (net). Add lines 4 through 8 .........................	9	3,306,541
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	-329,326

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	87,044,468
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	3,646,938
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d	-20,973,436
e	Add lines 2a through 2d .....................			2e	-17,326,498
3	Subtract line 2e from line 1.....................			3	104,370,966
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b	-81,373
c	Add lines 4a and 4b.......................			4c	-81,373
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	104,289,593

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	87,373,794
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d	81,373
e	Add lines 2a through 2d......................			2e	81,373
3	Subtract line 2e from line 1.....................			3	87,292,421
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	166,308
b	Other (Describe in Part XIV.) ............	4b	20,466,731
c	Add lines 4a and 4b.......................			4c	20,633,039
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	107,925,460

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
CONSERVATION EASEMENT FINANCIAL REPORTING	SCHEDULE D, PART II, LINE 9	THERE IS NO REVENUE ASSOCIATED WITH THE CONSERVATION EASEMENT REPORTED IN SCHEDULE D, PART II. THE ONLY EXPENSES RELATED TO THE EASEMENT RELATES TO NORMAL COSTS OF HOLDING THE BUILDING SUCH AS UTILITIES. THE BUILDING IS SHOWN IN THE BALANCE SHEET AS PART OF FIXED ASSETS AT COST, BUT IS FULLY DEPRECIATED. THERE WAS NO NOTE REGARDING THE CONSERVATION EASEMENT IN THE AUDITED FINANCIAL STATEMENTS.
OTHER CHANGES IN NET ASSETS	SCHEDULE D, PART XI, LINE 8	$ (340,397) CHANGE IN FV OF INTEREST RATE SWAP
OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12	SCHEDULE D, PART XII, LINE 2D	$ (20,466,731) BAD DEBT EXPENSE (340,397) CHANGE IN FV OF INTEREST RATE SWAP (166,308) INVESTMENT FEES --------------- $ (20,973,436)
OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1	SCHEDULE D, PART XII, LINE 4B	$ (68,836) COST OF GOODS SOLD (12,537) RENTAL EXPENSE ------------ $ (81,373)
OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25	SCHEDULE D, PART XIII, LINE 2D	$ 68,836 COST OF GOODS SOLD 12,537 RENTAL EXPENSE ----------- $ 81,373
OTHER EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1	SCHEDULE D, PART XIII, LINE 4B	$ 20,466,731 BAD DEBT EXPENSE

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

RUTHERFORD HOSPITAL INC

Employer identification number

56-0619367

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 120 %

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

Yes

200% 250% 300% 350% 400% Other

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..	1,660,240		1,660,240	1.900 %
b Medicaid (from Worksheet 3, column a) .....	18,117,495	16,495,301	1,622,194	1.850 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....	19,777,735	16,495,301	3,282,434	3.750 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	1,003,450	289,486	713,963	0.820 %
f Health professions education (from Worksheet 5) ..
g Subsidized health services (from Worksheet 6) ..	11,546,750	10,665,497	881,253	1.010 %
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....
jTotal Other Benefits ...	12,550,200	10,954,983	1,595,216	1.830 %
kTotal. Add lines 7d and 7j. ..	32,327,935	27,450,284	4,877,650	5.580 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense........

6,901,383

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

1,428,586

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

36,750,991

Enter Medicare allowable costs of care relating to payments on line 5.....

39,041,270

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-2,290,279

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

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Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	RUTHERFORD HOSPITAL INC 288 SOUTH RIDGECREST AVENUE RUTHERFORDTON,NC28139	X	X

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

RUTHERFORD HOSPITAL INC

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 120.% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 250.% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

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Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?12
Name and address		Type of Facility (describe)
1	CAROLINA HOME CARE 2270 HWY 74-A SUITE 345 FOREST CITY,NC28043	HOME HEALTH
2	RUTHERFORD ORTHOPEDICS 139 DR HENRY NORRIS DRIVE RUTHERFORDTON,NC28139	ORTHOPEDIC PRACTICE
3	RUTHERFORD SURGICAL ASSOCIATES 330 NC 108 HIGHWAY RUTHERFORDTON,NC28139	SURGICAL PRACTICE
4	RUTHERFORD EAST MEDICAL SERVICES 605 NC 120 HIGHWAY MOORESBORO,NC28114	FAMILY GENERAL MEDICINE
5	INSIGHTS PSYCHIATRIC RESOURCES 393 S OAK STREET SUITE 100 SPINDALE,NC28160	PSYCHIATRIC SERVICES
6	CHASE FAMILY CARE 1269 US HWY 74 BYPASS 341 FOREST CITY,NC28043	GENERAL MEDICAL & SURGICAL
7	BOILING SPRINGS FAMILY CARE 305 W COLLEGE AVE SUITE A SHELBY,NC28152	FAMILY GENERAL MEDICINE
8	THE CLINIC AT WALMART 197 PLAZA DRIVE FOREST CITY,NC28043	FAMILY GENERAL MEDICINE
9	FOREST FAMILY CARE CENTER 212 ALLENDALE DRIVE FOREST CITY,NC28043	FAMILY GENERAL MEDICINE
10	RUTHERFORD ANESTHESIOLOGY 288 SOUTH RIDGECREST AVENUE RUTHERFORDTON,NC28139	ANESTHESIA SERVICES
11	RUTHERFORD CHILDREN'S CARE 288 SOUTH RIDGECREST AVENUE RUTHERFORDTON,NC28139	PEDIATRIC SERVICES
12	OCCUPATIONAL MEDICINE 288 SOUTH RIDGECREST AVENUE RUTHERFORDTON,NC28139	PEDIATRIC SERVICES

Schedule H (Form 990) 2011

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Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
PERCENT OF TOTAL EXPENSE	SCHEDULE H, PART I, QUESTION 7, COLUMN F	TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 ($107,925,460) WAS REDUCED BY BAD DEBT EXPENSE ($20,466,731).
COST TO CHARGE RATIO	SCHEDULE H, PART I, LINE 7	THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATIONS ON IRS WORKSHEETS 1 AND 3. FOR IRS WORKSHEET 6 CALCULATING SUBSIDIZED SERVICES, THE ORGANIZATION USED A COST ACCOUNTING SYSTEM USING DIRECTLY ALLOCABLE DEDUCTIONS FOR THE CALCULATION OF ONE GROUP OF SUBSIDIZED SERVICES AND USED THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 FOR THE CALCULATION OF ANOTHER GROUP OF SUBSIDIZED SERVICES.
BAD DEBT EXPENSE	SCHEDULE H, PART III, SECTION A, QUESTION 4	THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE: IN EVALUATIONG THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE PROVISION FOR UNCOLLECTABLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTABLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. tHE DIFFERENCE BETWEEN THE STANDARD RATES ( OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNT FOR SELF-PAY PATIENTS INCREASED FROM 81% OF SELF PAY ACCOUNTS RECEIVABLE AT 9-30-11 TO 87% OF SELF PAY ACCOUNTS RECEIVABLE AT 9-30-12.
COMMUNITY BENEFIT	SCHEDULE H, PART III, SECTION B, QUESTION 8	SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
COLLECTION POLICY	SCHEDULE H, PART III, SECTION C, QUESTION 9B	RUTHERFORD HOSPITAL, INC., WILL RECOGNIZE PATIENTS WHO DO NOT QUALIFY UNDER THE CREDIT AND COLLECTION POLICY GUIDELINES AND PROVIDE ASSISTANCE IN OBTAINING THIRD PARTY COVERAGE OR IN QUALIFYING FOR THE MEDICAL ASSISTANCE PROGRAM AS OUTLINED IN ESTABLISHED HOSPITAL PROCEDURES. ALL PATIENTS WILL BE GIVEN THE OPPORTUNITY TO APPLY FOR THE MEDICAL ASSISTANCE PROGRAM IF THEY ARE UNABLE TO PAY FOR DESIRED MEDICAL TREATMENT. SELF-PAY ACCOUNTS WHICH REMAIN UNPAID, OR HAVE NO PAYMENT CONTRACT ESTABLISHED, WILL BE TRANSFERRED TO A BAD DEBT STATUS 60 DAYS AFTER THE ACCOUNT IS BILLED BY THE HOSPITAL'S BILLING SYSTEM. INSURANCE ACCOUNTS WILL BE TRANSFERRED TO A BAD DEBT STATUS WHEN IT IS DETERMINED BY THE FINANCIAL COUNSELOR THAT THE ACCOUNT WILL REQUIRE MORE INTENSE COLLECTION EFFORTS THAN THOSE PROVIDED BY THE HOSPITAL BUSINESS OFFICE. FOR PATIENTS COVERED BY MEDICARE, THIS TRANSFER TO A BAD DEBT STATUS WILL NOT OCCUR BEFORE 120 DAYS AFTER FINAL BILLING BY THE HOSPITAL PATIENT ACCOUNTING SYSTEM.
INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE	SCHEDULE H, PART V, SECTION B, LINE 19D	OUR MEDICAL ASSISTANCE POLICY ALLOWS UP TO 120% OF FEDERAL POVERTY GUIDELINE FOR 100% REDUCTION OF BALANCE/CHARGES. THE SLIDING SCALE ALLOWS UP TO 250% OF THE FEDERAL POVERTY GUIDELINE IN ALLOWING A 30% REDUCTION OF THE BALANCE/CHARGES. ALL SELF PAY ACCOUNTS RECEIVE A 20% DISCOUNT OF CHARGES AT THE TIME OF FINAL BILLING. ALSO, IF SELF PAY BALANCE IS PAID PROMPTLY (15 DAYS FROM FINAL BILLING), PATIENT IS ENTITLED TO AND ADDITIONAL 30% DISCOUNT OF CHARGES.
NEEDS ASSESSMENT	SCHEDULE H, PART VI, QUESTION 2	THE ORGANIZATION USES A NEEDS ASSESSMENT CONDUCTED BY THE UNITED WAY OF RUTHERFORD COUNTY (UWRC) IN 2008 TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. TO CONDUCT THIS ASSESSMENT, THE UWRC AND THE RUTHERFORD HEALTH DEPARTMENT, IN COLLABORATION WITH THE COMMUNITY HEALTH COUNCIL (OF WHICH RUTHERFORD HOSPITAL, INC. WAS A FOUNDING MEMBER AND CONTINUES AS ITS PRIMARY SPONSOR), WORKED TOGETHER AND COMPILED LEADERS IN VARIOUS FIELDS FROM THE COMMUNITY AS MEMBERS OF A STEERING COMMITTEE. THE COMMITTEE REVIEWED SEVERAL NEEDS ASSESSMENTS CONDUCTED BY OTHER COMMUNITIES IN NORTH CAROLINA AND OTHER STATES AND USED "COMPASS", A NEEDS ASSESSMENT GUIDE CREATED BY THE UNITED WAY OF AMERICA, WHICH PROVIDED A BASIC FRAMEWORK FOR THE ASSESSMENT. THE COMMITTEE SURVEYED THE GENERAL PUBLIC, SURVEYED SERVICE PROVIDERS (INCLUDING RUTHERFORD HOSPITAL), AND CONDUCTED FOCUS GROUPS. NEEDS IDENTIFIED IN THIS ASSESSMENT WERE UNEMPLOYMENT/LACK OF JOBS, FOLLOWED BY SUBSTANCE ABUSE, AND ACCESS TO AFFORDABLE MEDICAL CARE. TEEN PREGNANCY, CRIME, AND OBESITY WERE ALSO IDENTIFIED AS ISSUES IN SOME CATEGORIES.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	SCHEDULE H, PART VI, QUESTION 3	PATIENTS WITH ESTIMATED BALANCES AFTER INSURANCE ARE CONTACTED PRIOR TO VISIT. THIS ALLOWS THE ESTIMATE TO BE PROVIDED TO PATIENT, AND TO DISCUSS INSURANCE BENEFITS AND ESTIMATED BALANCES AFTER INSURANCE. THIS DOES INCLUDE ALL SELF PAY PATIENTS AS WELL. A FINANCIAL COUNSELOR MAKES THIS CALL AND EXPLAINS ALL PAYMENT OPTIONS AND OPPORTUNITIES TO APPLY FOR MEDICAL ASSISTANCE. PATIENT REPRESENTATIVES ALSO FOLLOW UP WITH ALL SELF PAY PATIENTS TO PURSUE QUALIFICATION OF PATIENT INTO SOME TYPE OF ASSISTANCE (NCMEDICAID, DISABILITY, CRIME VICTIMS, VOCATIONAL REHAB OR OTHER POSSIBLE PAYMENT SOURCE). IF NO RESOURCES ARE IDENTIFIED FROM PATIENT REPRESENTATIVES, THE REPRESENTATIVE FACILITATES GETTING A MEDICAL ASSISTANCE APPLICATION TO THE PATIENT FOR POSSIBLE QUALIFICATION. REGISTRATION EMPLOYEES HAVE MEDICAL ASSISTANCE FORMS AND ARE TO PROVIDE THESE TO PATIENTS AT TIME OF REGISTRATION. PMAB (EXTENDED BUSINESS OFFICE) STAFF ALSO HAVE MEDICAL ASSISTANCE APPLICATIONS AND ARE TO PROVIDE THESE AS NECESSARY TO PATIENTS AFTER PHONE CONTACT. THE MEDICAL ASSISTANCE POLICY IS ON THE RRHS WEBSITE FOR PUBLIC VIEWING, ALONG WITH THE APPLICATION THAT CAN BE PRINTED FOR COMPLETION FROM THE INDIVIDUAL REQUESTING ASSISTANCE.
COMMUNITY INFORMATION	SCHEDULE H, PART VI, QUESTION 4	RUTHERFORD COUNTY, NORTH CAROLINA IS LOCATED AT THE BASE OF THE BLUE RIDGE MOUNTAINS AND IS CENTERED BETWEEN ASHEVILLE AND CHARLOTTE. IT IS DESIGNATED AS RURAL BY HRSA RURAL HEALTH POLICY. THE COUNTY IS COMPRISED OF EIGHT MUNICIPALITIES: BOSTIC, CHIMNEY ROCK, ELLENBORO, FOREST CITY, RUTHERFORDTON, RUTH, SPINDALE AND LAKE LURE. RUTHERFORD COUNTY IS 563 SQ. MILES, THE COUNTY SEAT IS RUTHERFORDTON. ONE MUNICIPALITY, FOREST CITY, IS CONSIDERED A MICROPOLITAN STATISTICAL AREA; HOWEVER, IT DOES NOT HAVE A METROPOLITAN STATISTICAL AREA DESIGNATION (AS DESIGNATED BY OMB BULLETIN FOR FY04 B04-03). ACCORDING TO THE MOST RECENT US CENSUS BUREAU DATA FROM 2010, THE TOTAL POPULATION OF RUTHERFORD COUNTY IS 67,810. OF THIS AMOUNT, 49% ARE MALE AND 51% ARE FEMALE. THE RACIAL/ETHNIC BACKGROUND OF THE POPULATION INCLUDES 87.3% WHITE, 10.3% BLACK OR AFRICAN AMERICAN, 3.7% HISPANIC OR LATINO WITH THE REMAINING AS OTHER. OF THE TOTAL POPULATION, 20.4% HAVE NOT GRADUATED FROM HIGH SCHOOL OR OBTAINED A HIGH SCHOOL EQUIVALENCY. PERSONS BELOW POVERTY LEVEL FOR 2006-2010 WERE 20.7%, WITH MEDIAN HOUSEHOLD INCOME AT $35,364. RUTHERFORD COUNTY WORKFORCE TOTALS 22,790 (2006 REPORT). IT BREAKS DOWN AS FOLLOWS: MANUFACTURING, 18.2 %; CONSTRUCTION, 5.5%; TRANSPORTATION AND UTILITIES, 21.4%; EDUCATION AND HEALTH SERVICES, 24%; PROFESSIONAL AND BUSINESS SERVICES, 9.3%; LEISURE AND HOSPITALITY, 8.4%; INFORMATION, 4%; FINANCIAL ACTIVITIES, 2%; PUBLIC ADMINISTRATION, 5.3% AND ALL OTHER, 2.08%. FOR EMPLOYMENT OPPORTUNITIES CALL THE N.C. EMPLOYMENT SECURITY COMMISSION AT (828) 246-9841 OR CONTACT THE CHAMBER AND ASK FOR A LISTING OF TEMPORARY AGENCIES.
PROMOTION OF COMMUNITY HEALTH	SCHEDULE H, PART VI, QUESTION 5	COMMUNITY BENEFIT IS COLLABORATION WITH A COMMUNITY TO BENEFIT ITS RESIDENTS - PARTICULARLY THOSE BELOW THE POVERTY LEVEL, MINORITIES AND UNDERSERVED GROUPS - BY IMPROVING THEIR HEALTHCARE STATUS AND QUALITY OF LIFE. AS A NOT-FOR-PROFIT HOSPITAL, RHI EMBRACES ITS ROLE AS THE HEALTHCARE PROVIDER OF CHOICE FOR THE COMMUNITY. RUTHERFORD HOSPITAL HOSTED A SERIES OF SEVEN RUTHERFORD REGIONAL CONNECTS EVENTS IN 2012. RUTHERFORD REGIONAL CONNECTS EVENTS WERE HELD IN THE FOLLOWING LOCATIONS: FOREST CITY - DUNBAR ELEMENTARY, LAKE LURE TOWN HALL, R-S CENTRAL HIGH SCHOOL, ELLENBORO ELEMENTARY, CLIFFSIDE ELEMENTARY AND SUNSHINE ELEMENTARY. EVENTS WERE SCHEDULED FOR EITHER A MORNING OR EVENING. EACH EVENT INCLUDED FREE CHOLESTEROL, GLUCOSE, BLOOD PRESSURE AND BODY MASS INDEX (BMI) SCREENINGS. EXHIBITS PROVIDED INFORMATION ON THE CHANGES AT RUTHERFORD REGIONAL HOSPITAL, AND PARTICIPANTS HAD THE OPPORTUNITY TO VISIT WITH DEPARTMENT REPRESENTATIVES AND RRHS PRESIDENT AND CEO DAVE BIXLER TO ASK QUESTIONS. DURING THE RUTHERFORD REGIONAL CONNECTS EVENTS, SCREENINGS WERE GIVEN FREE OF CHARGE. THOSE WHO VISITED BOOTHS AT THE EVENTS LEARNED ABOUT THE MANY PROGRAMS OFFERED THROUGH THE ORGANIZATION. SIXTY INDUSTRIES ENROLLED IN THE WELLNESSWORKS PROGRAM, RUTHERFORD HOSPITAL'S EMPLOYER HEALTH PROGRAM, IN 2012. DESIGNED TO HELP PROVIDE ONGOING COMMUNICATION AND EASY ACCESS TO HEALTHCARE SERVICES TO EMPLOYERS AND THEIR EMPLOYEES, THE FOUR BASIC COMPONENTS THAT MAKE UP THE WELLNESSWORKS PROGRAM ARE OCCUPATIONAL HEALTH SERVICES, WORKER'S COMPENSATION SERVICES, PREVENTATIVE HEALTH/WELLNESS SERVICES AND GROUP HEALTH SERVICES. THERE IS NO COST ASSOCIATED WITH ENROLLING IN THE PROGRAM. IN JULY 2011, THE RUTHERFORD REGIONAL CANCER OUTREACH PROGRAM LAUNCHED A NEW CANCER SUPPORT GROUP FOR ANYONE WHO HAS EVER HEARD THE WORDS "YOU HAVE CANCER." SURVIVIN' MEETS ON THE THIRD MONDAY OF EACH MONTH AT THE CANCER RESOURCE CENTER. EACH MONTH THE GROUP EXPLORES WAYS TO LIVE LIFE TO THE FULLEST AFTER A CANCER DIAGNOSIS. INFORMATION REGARDING NUTRITION, EXERCISE AND EMOTIONAL WELL-BEING IS ALSO PRESENTED. FRIENDS AND FAMILY MAY ATTEND AS WELL. THE RUTHERFORD REGIONAL AUXILIARY RAISED MONEY DURING SEVERAL FUNDRAISING EFFORTS, THE GIFT SHOP, BABY PHOTO PROGRAM, VENDING MACHINES AND EVENTS SUCH AS THE $5 JEWELRY, BOOK AND UNIFORM SALES. THE AUXILIARY'S SERVICE AREAS INCLUDE FRONT DESK, GIFT SHOP, INTENSIVE CARE WAITING, MESSENGER, OUTPATIENT SERVICES AND SURGERY WAITING. VOLUNTEERS ALSO SERVE IN THE PET THERAPY PROGRAM, AS CLERICAL ASSISTANTS IN MEDICAL RECORDS, AS CARETAKERS OF ST. LUKE'S CHAPEL, AS CLOWNS WITH THE TOY CHEST, AT THE CANCER RESOURCE CENTER MAKING TRAY FAVORS FOR PATIENT FOOD TRAYS, WITH THE EDUCATION DEPARTMENT FOR COMMUNITY SCREENINGS, AND AS TEEN VOLUNTEERS. IN JUNE, 39 TEEN VOLUNTEERS ATTENDED ORIENTATION, AND FOR THE NEXT EIGHT WEEKS THEY VOLUNTEERED IN 17 DIFFERENT DEPARTMENTS AT THE HOSPITAL, ALLOWING MANY ADULT VOLUNTEERS TO TAKE TIME OFF. THE TOY CHEST COMMITTEE MADE A TOTAL OF 1,054 ITEMS, WHICH INCLUDED STUFFED ANIMALS, "PATIENT PALS" FOR PEDIATRIC PATIENTS, PILLOWS FOR MASTECTOMY PATIENTS AND BABY CAPS FOR INFANTS AS A REMINDER TO PARENTS OF THE DANGERS OF CHILD ABUSE. DONATIONS WERE MADE TO LIFELINE DURING THE YEAR IN MEMORY AUXILIARY MEMBERS WHO PASSED AWAY. A TOTAL OF 194 ADULT VOLUNTEERS VOLUNTEERED 21,364 HOURS AND A TOTAL OF 78 TEEN VOLUNTEERS VOLUNTEERED 2,366 HOURS WITH A COMBINED TOTAL OF 23,730 SERVICE HOURS FOR THE YEAR. THE ACCUMULATED HOURS OF SERVICE TO RUTHERFORD HOSPITAL, SINCE THE FOUNDING OF THE AUXILIARY 47 YEARS AGO, IS 846,067 HOURS AND THE ACCUMULATED DONATION IS $2,992,030.56. THE SCHOOL OF CLINICAL PASTORAL EDUCATION OF RUTHERFORD REGIONAL MEDICAL CENTER IS ACCREDITED TO OFFER CPE LEVELS I & II BY THE ASSOCIATION FOR CLINICAL PASTORAL EDUCATION, INC. CLINICAL PASTORAL EDUCATION WILL ENABLE YOU TO INTEGRATE FAITH, EXPERIENCE AND KNOWLEDGE FOR MORE EFFECTIVE MINISTRY. CPE IS PROFESSIONAL TRAINING FOR MINISTRY DESIGNED FOR SEMINARIANS, CLERGY AND LAITY OF DIVERSE CULTURES, ETHNIC GROUPS AND FAITH TRADITIONS. THE METHOD IS LEARNING BY DOING AND REFLECTING UNDER THE DIRECTION OF A CERTIFIED ACPE SUPERVISOR; INSTRUCTED BY AN INTERDISCIPLINARY ADJUNCT FACULTY IN A SUPPORTIVE COLLEGIAL GROUP.
AFFILIATED HEALTH CARE SYSTEM	SCHEDULE H, PART VI, QUESTION 6	RUTHERFORD HOSPITAL IS AFFILIATED WITH RUTHERFORD HOSPITAL FOUNDATION, WHOSE PRIMARY PURPOSE IS TO PROVIDE SUPPORT FOR THE HOSPITAL. THE FOUNDATION PROVIDES SCHOLARSHIPS TO INDIVIDUALS AND GRANTS TO ORGANIZATIONS IN THE COMMUNITY, WHICH IS THE SAME COMMUNITY THAT RUTHERFORD HOSPITAL SERVES. THE MISSION OF RUTHERFORD HOSPITAL FOUNDATION IS TO "SECURE CURRENT AND FUTURE GIFTS OF SUPPORT FOR RUTHERFORD REGIONAL MEDICAL SYSTEM, ENSURING THAT ALL MEMBERS OF OUR COMMUNITY CONTINUE TO HAVE ACCESS TO A BROAD RANGE OF COMPASSIONATE, HIGH QUALITY HEALTH SERVICES." THE RUTHERFORD HOSPITAL FOUNDATION SEEKS TO GIVE ALL SEGMENTS OF THE COMMUNITY THE OPPORTUNITY TO INVEST IN THE FUTURE OF THE HOSPITAL, TO ENSURE GOOD STEWARDSHIP OF AVAILABLE RESOURCES, AND TO BE RECOGNIZED AS A SIGNIFICANT CONTRIBUTOR TO ECONOMIC GROWTH AND DEVELOPMENT OF RUTHERFORD REGIONAL HEALTH SYSTEM. RUTHERFORD HOSPITAL CONTINUES TO HAVE AN AFFILIATION WITH DUKE ONCOLOGY NETWORK. THIS AGREEMENT PROVIDES EDUCATION FOR PHYSICIANS AND NURSING STAFF, PHYSICIAN CONSULTATION AND A REVIEW AND EVALUATION OF THE CARE PROVIDED OUR CANCER PATIENTS. IN 2011, AN EXPERT IN THE FIELD OF BREAST CANCER HELPED TO CONDUCT A STUDY ABOUT OUR CARE AND PRESENTED INFORMATION RELATED TO THE STUDY AS AN EDUCATION SESSION. IT IS A GREAT OPPORTUNITY FOR RUTHERFORD REGIONAL MEDICAL CENTER TO BE ALIGNED WITH DUKE, WHICH HAS BEEN CONSISTENTLY IN THE TOP-RANKED CENTERS FOR CANCER CARE IN THE UNITED STATES.

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

RUTHERFORD HOSPITAL INC

Employer identification number

56-0619367

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Yes

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) MICHAEL S WHEELER MD	(i) (ii)	625,458 0	0 0	0 0	0 0	0 0	625,458 0	0 0
(2) DEAN R BACKSTROM	(i) (ii)	218,078 0	11,837 0	0 0	0 0	2,564 0	232,479 0	0 0
(3) CHARLES BOND	(i) (ii)	690,264 0	26,783 0	16,500 0	0 0	3,515 0	737,062 0	0 0
(4) MICHAEL ROBERTS	(i) (ii)	747,111 0	27,732 0	16,500 0	0 0	3,515 0	794,858 0	0 0
(5) GREGG ALLEN DRABEK	(i) (ii)	544,993 0	0 0	0 0	0 0	3,621 0	548,614 0	0 0
(6) DOUGLAS B FREELS	(i) (ii)	495,891 0	0 0	33,366 0	0 0	4,278 0	533,535 0	0 0
(7) WILLIAM C HADEN	(i) (ii)	420,421 0	12,089 0	0 0	0 0	2,564 0	435,074 0	0 0

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
HOUSING ALLOWANCES	SCHEDULE J, PART I, LINE 1A	DOUGLAS B FREELS RECEIVED A HOUSING ALLOWANCE DURING THE YEAR INCLUDING $4,800 FOR HOUSING RENTAL AND $8,562 FOR CLOSING COSTS ON A NEW HOME. THESE WERE INCLUDED AS PART OF TAXABLE COMPENSATION.
CEO COMPENSATION DETERMINATION	SCHEDULE J, PART I, LINE 3	THE ORGANIZATION'S CEO WAS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY FOR HIS SERVICES PERFORMED FOR THE ORGANIZATION. THE MANAGEMENT COMPANY CONTRACT TERMINATED IN JUNE 2012 AND SERVICES HAVE CEASED, INCLUDING THE SERVICES OF THE CEO, WHICH WERE RELINQUISHED IN APRIL 2012. AT THIS TIME, CINDY BUCK, WHO WAS THE VP/CFO, BECAME INTERIM CEO UNTIL SHE WAS APPOINTED AS CEO IN SEPTEMBER 2012. UNDER THE REBUTTABLE PRESUMPTION POLICY DESCRIBED IN THE NARRATIVE FOR FORM 990, PART VI, SECTION B, QUESTION 15A LOCATED ON SCHEDULE O, A COMPENSATION SURVEY AND BOARD APPROVAL ARE USED. CINDY WILL BE SUBJECT TO THIS REVIEW IN FY2012.

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
RUTHERFORD HOSPITAL INC

Employer identification number
56-0619367

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		12-16-2010	22,160,000	SEE PART V		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . .	0
2 Amount of bonds legally defeased . . . . . . . . . .	0
3 Total proceeds of issue . . . . . . . . . . . . .	22,160,000
4 Gross proceeds in reserve funds . . . . . . . .	0
5 Capitalized interest from proceeds . . . . . . . . . .	0
6 Proceeds in refunding escrows . . . . . . . . . . .	8,140,000
7 Issuance costs from proceeds . . . . . . . . . . .	252,250
8 Credit enhancement from proceeds . . . . . . . . . .	0
9 Working capital expenditures from proceeds . . . . . . .	0
10 Capital expenditures from proceeds . . . . . . . . . .	11,591,309
11 Other spent proceeds . . . . . . . . . . .	2,462
12 Other unspent proceeds . . . . . . . . . . .	2,173,979
13 Year of substantial completion . . . . . . . . . . .
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . .	X
15 Were the bonds issued as part of an advance refunding issue? . . . .		X
16 Has the final allocation of proceeds been made? . . . . . .		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . .	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2011

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .		X
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .		X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0%		%		%		%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	%		%		%		%
6 Total of lines 4 and 5 . . .. . . . . . . . .	%		%		%		%
7 Does the bond issue meet the private security or payment test? . . .	X
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2?	X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X
2 Is the bond issue a variable rate issue?	X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider . . . . . . . .	0
c Term of hedge . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was a hedge terminated? . . . . .
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .		X
b Name of provider . . . . . .	0
c Term of GIC . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .		X
6 Did the bond issue qualify for an exception to rebate? .		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X

Schedule K (Form 990) 2011

Page 3

Part V

Procedures To Undertake Corrective Action

Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . . YesNo

Part VI

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation
PURPOSE	SCHEDULE K, PART I, LINE A, COLUMN F	A PORTION OF THE BONDS WERE USED TO ADVANCE REFUND THE OUTSTANDING PORTIONS OF PREVIOUSLY ISSUED REVENUE BONDS. THE REMAINING PROCEEDS WERE USED TO FINANCE THE UPGRADE AND EXPANSION OF AN INTENSIVE CARE UNIT, THE REPLACEMENT OF THE WOMEN'S CENTER ON THE HOSPITAL'S PREMISES AND THE PURCHASE OF MOBILE MAGNETIC RESONANCE IMAGING EQUIPMENT.

Schedule K (Form 990) 2011

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.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

RUTHERFORD HOSPITAL INC

Employer identification number

56-0619367

Identifier	Return Reference	Explanation
ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES	FORM 990, PART I, QUESTION 1	OUR VISION IS THAT WE WILL PROVIDE AN EXCELLENT PATIENT CARE EXPERIENCE EVERY TIME. OUR VALUES ARE TRUST, EXCELLENCE, ACCOUNTABILITY, AND MUTUAL RESPECT.
DESCRIPTION OF OTHER PROGRAM SERVICES	FORM 990, PART III, QUESTION 4D	THE HOSPITAL PROVIDES REGIONAL TREATMENT FOR BEHAVIORAL & MENTAL HEALTH SERVICES. PROGRAMS AND SERVICES INCLUDE 24-HR NURSING CARE, MEDICATION MANAGEMENT & EDUCATION, GROUP OR RECREATIONAL THERAPY, & FAMILY EDUCATION. THE BEHAVIORAL DEPARTMENT ALSO OFFERS PSYCHIATRIC INDEPENDENT MEDICAL EVALUATIONS, CONSULTATIONS, DIAGNOSIS, & TREATMENT OF VARIOUS CONDITIONS, INCLUDING DEPRESSION, ANXIETY, AUTISM, SLEEP DISORDERS, BRAIN INJURIES, HEADACHES, & DEMENTIA, AMONG OTHERS. DURING FISCAL YEAR 2012, 805 PATIENTS RECEIVED BEHAVIORAL HEALTH SERVICES. ADDITIONALLY, THE ORGANIZATION PROVIDES GRANTS TO ORGANIZATIONS IN THE COMMUNITY.
DELEGATION OF CONTROL TO A MANAGEMENT COMPANY	FORM 990, PART VI, SECTION A, QUESTION 3	THE ORGANIZATION USES A MANAGEMENT COMPANY, QUORUM, TO DELEGATE DAY TO DAY MANAGEMENT FUNCTIONS. ADDITIONALLY, THE CEO IS COMPENSATED THROUGH THE MANAGEMENT COMPANY. PAYMENTS TO QUORUM ARE REPORTED ON FORM 990, PART X, LINE 11A. THIS CONTRACT TERMINATED IN JUNE 2012 AND SERVICES HAVE CEASED.
SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS	FORM 990, PART VI, SECTION A, QUESTION 4	DUE TO THE DISCONTINUANCE OF THE SERVICES OF THE MANAGEMENT COMPANY, A REPRESENTATIVE OF QUORUM HEALTH RESOURCES IS NO LONGER REQUIRED TO ATTEND BOARD MEETINGS OR TO BE A MEMBER OF THE EXECUTIVE COMMITTEE.
PROCESS TO REVIEW THE FORM 990	FORM 990, PART VI, SECTION B, QUESTION 11B	THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE ORGANIZATION PROVIDES A COPY OF THE 990 TO EACH BOARD MEMBER VIA EMAIL, PRIOR TO FILING THE 990.
PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY	FORM 990, PART VI, SECTION B, QUESTION 12C	THE ORGANIZATION HAS AN OBLIGATION TO CONDUCT ITS BUSINESS OPERATIONS, INCLUDING THE PROVISION OF PATIENT CARE, IN AN OBJECTIVE MANNER THAT IS NOT MOTIVATED BY AN INDIVIDUALS' DESIRE FOR PERSONAL OR FINANCIAL GAIN, EITHER FOR THEMSELVES, THEIR FRIENDS, OR THEIR FAMILY MEMBERS. ESPECIALLY FOR THOSE ON THE BOARD OF TRUSTEES, EXECUTIVE COMMITTEE, KEY LEADERS OF RHI MEDICAL STAFF, EXECUTIVE AND MANAGEMENT LEADERSHIP TEAM, AND RHI STAFF DIRECTLY INVOLVED IN PROCUREMENT AND CASE MANAGEMENT SERVICES, THERE IS INCREASING REGULATORY OVERSIGHT AND ACCOMPANYING PUBLIC SCRUTINY OF SPECIFIC SITUATIONS ASSOCIATED WITH CONFLICTS OF INTEREST. THE ORGANIZATION'S COMPLIANCE OFFICER COMPLETES AN ANNUAL COMPLIANCE SURVEY TO ENSURE THAT THE CONFLICT OF INTEREST POLICY IS BEING ENFORCED EFFECTIVELY. IN ADDITION, EMPLOYEES ARE REQUIRED TO PROACTIVELY IDENTIFY SPECIFIC CONFLICTS OF INTEREST. EMPLOYEES MUST SEEK GUIDANCE AND APPROVAL FROM THEIR DEPARTMENT DIRECTOR WHEN POTENTIAL CONFLICTS OF INTEREST ARE IDENTIFIED. WHEN DEEMED NECESSARY BY THEIR DEPARTMENT DIRECTOR, EMPLOYEES MUST AVOID OR DISCONTINUE THE ACTIVITY OR INTEREST AND MAY ALSO BE REQUIRED TO TAKE CORRECTIVE ACTION IF THEIR ACTIVITY HAS HARMED RHI IN ANY WAY. VIOLATION OF THE CONFLICT OF INTEREST POLICY IS GROUNDS FOR DISCIPLINARY ACTION APPROPRIATE TO THE VIOLATION UP TO AND INCLUDING TERMINATION.
REVIEW OF CEO COMPENSATION	FORM 990, PART VI, SECTION B, QUESTION 15A	THE ORGANIZATION'S MANAGEMENT COMPANY PROVIDED COMPARATIVE DATA AND INDUSTRY AND MARKET STANDARDS FROM A COMPENSATION REVIEW PERFORMED USING NC HOSPITAL ASSOCIATION DATA FOR THE CEO COMPENSATION. THE ORGANIZATION HAS A REBUTTABLE PRESUMPTION POLICY ADMINISTERED BY THE PCQ COMMITTEE OF THE BOARD THAT COVERS THE REVIEW AND THE APPROVAL OF THE CEO USING THE IRS MODEL. THE COMMITTEE SHALL REVIEW PROPOSALS FOR THE COMPENSATION OF THE CEO ANNUALLY FOR THE FOLLOWING YEAR. THE CURRENT CEO WILL BE SUBJECT TO THE REVIEW POLICY IN FY2012.
REVIEW OF OTHER OFFICER OR KEY EMPLOYEES COMPENSATION	FORM 990, PART VI, SECTION B, QUESTION 15B	THE ORGANIZATION HAS A REBUTTABLE PRESUMPTION POLICY, UPDATED IN MARCH 2012, ADMINISTERED BY THE PCQ COMMITTEE OF THE BOARD THAT COVERS THE REVIEW AND APPROVAL OF THE CEO AND OTHER LEADERS, INCLUDING TRUSTEES, OFFICERS, KEY EMPLOYEES, AND OTHER HIGHLY COMPENSATED EMPLOYEES OR INDEPENDENT CONTRACTORS. FOR POLICY PURPOSES, THIS APPLIES TO ALL HIGHLY COMPENSATED OFFICERS AND KEY EMPLOYEES WITH COMPENSATION EXCEEDING A THRESHOLD OF $125,000 ANNUALLY IN TOTAL COMPENSATION. AFTER THE COMMITTEE'S INITIAL BENEFIT TRANSACTION REVIEW OF COMPENSATION FOR EACH OF THE OFFICERS AND KEY EMPLOYEES, FURTHER REVIEW WILL NOT BE NECESSARY EXCEPT FOR INSTANCES WHERE THERE HAS BEEN SIGNIFICANT CHANGES MADE IN THE SPAN OF AUTHORITY OR THE TOTAL VALUE OF THE EXISTING COMPENSATION ARRANGEMENT IS INCREASING BY MORE THAN THREE PERCENT.
DOCUMENT DISCLOSURE	FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
CEO COMPENSATION & CEO CHANGE	FORM 990, PART VII	THE ORGANIZATION'S CEO WAS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY FOR HIS SERVICES PERFORMED FOR THE ORGANIZATION. THE MANAGEMENT COMPANY CONTRACT TERMINATED IN JUNE 2012 AND SERVICES HAVE CEASED, INCLUDING THE SERVICES OF THE CEO, WHICH WERE RELINQUISHED IN APRIL 2012. AT THIS TIME, CINDY BUCK, WHO WAS THE VP/CFO, BECAME INTERIM CEO UNTIL SHE WAS APPOINTED AS CEO IN SEPTEMBER 2012.
TRUSTEE COMPENSATION	FORM 990, PART VII	MICHAEL S. WHEELER, MD, A TRUSTEE, IS CONTRACTED BY THE ORGANIZATION AS A MEDICAL DIRECTOR. THE COMPENSATION REPORTED IN PART VII IS RELATED TO HIS ROLE AS MEDICAL DIRECTOR AND NOT AS A TRUSTEE OF THE BOARD. NO MEMBERS OF THE BOARD RECEIVE COMPENSATION FOR THEIR SERVICES AS TRUSTEES OF THE BOARD.
RELATED HOURS	FORM 990, PART VII	THE FOLLOWING BOARD MEMBERS, OFFICERS, AND HIGHEST COMPENSATED EMPLOYEES SERVE ON THE BOARD OF RUTHERFORD HOSPITAL FOUNDATION, A RELATED ORGANIZATION, FOR AN AVERAGE OF ONE HOUR OF SERVICE PER WEEK: DIANE HAMRICK THOMAS J JASKI, M.D. DAVID BIXLER MICHAEL ROBERTS, M.D. CINDY BUCK IN ADDITION, DAVID BIXLER, CEO, SERVED AS CEO FOR RUTHERFORD HOSPITAL FOUNDATION, A RELATED ORGANIZATION, FOR AN AVERAGE OF 40 HOURS PER WEEK BETWEEN THE TWO ORGANIZATIONS THROUGH 04/06/2012. CINDY BUCK SERVED AS VP/CFO UNTIL APRIL 2012, INTERIM CEO UNTIL SEPTEMBER 2012, AND CEO BEGINNING SEPTEMBER 2012 FOR RUTHERFORD HOSPITAL FOUNDATION AND SERVES AN AVERAGE OF 40 HOURS PER WEEK BETWEEN THE TWO ORGANIZATIONS.
OTHER CHANGES IN NET ASSETS	FORM 990, PART XI, LINE 5	$ (5,185,633) PRIOR PERIOD ADJUSTMENT 3,646,938 UNREALIZED GAINS (340,397) CHANGE IN FV OF INTEREST RATE SWAP (20,340) TRANSFER TO FOUNDATION -------------- $ (1,899,432)

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

RUTHERFORD HOSPITAL INC

Employer identification number

56-0619367

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) RUTHERFORD HOSPITAL FOUNDATION INC 288 S RIDGECREST AVENUE RUTHERFORDTON,NC28139 56-1968736	SUPPORT	NC	501(C)(3)	11A I	NA	Yes

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) RUTHERFORD HOSPITAL FOUNDATION INC	C	235,920	FMV
(2) RUTHERFORD HOSPITAL FOUNDATION INC	N	57,604	2011 W-2 BOX 5
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: RUTHERFORD HOSPITAL IS A GENERAL ACUTE CARE HOSPITAL THAT PROVIDES TRADITIONAL PATIENT CARE TO RESIDENTS OF ITS SERVICE AREA, REGARDLESS OF ABILITY TO PAY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	14
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	993
6	Total number of volunteers (estimate if necessary) ....	6	190
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	143,927
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-68,687

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	84,050	235,920
9	Program service revenue (Part VIII, line 2g) .........	94,250,107	102,899,727
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	479,486	992,349
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	168,617	161,597
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	94,982,260	104,289,593
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,225	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	48,739,454	49,096,079
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	51,357,598	58,829,381
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	100,098,277	107,925,460
19	Revenue less expenses. Subtract line 18 from line 12.......	-5,116,017	-3,635,867
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	99,630,976	100,969,747
21	Total liabilities (Part X, line 26).............	27,544,695	34,418,765
22	Net assets or fund balances. Subtract line 21 from line 20.....	72,086,281	66,550,982

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 46,582,898 including grants of $ ) (Revenue $ 44,789,464 )
	THE HOSPITAL PROVIDES OUTPATIENT SERVICES. WITH IMPROVED TECHNOLOGY, MANY LESS INVASIVE SURGICAL PROCEDURES ARE NOW BEING PERFORMED ON AN OUTPATIENT BASIS. THE HOSPITAL'S OUTPATIENT SURGERIES INCLUDE GENERAL, ONCOLOGY, ORTHOPEDIC, PLASTIC, PODIATRIC, UROLOGY, GASTROENTEROLOGY, GYNECOLOGY, OPHTHALMOLOGY, EAR, NOSE, AND THROAT SURGERY. DURING FY 2012, THERE WERE 48,933 OUTPATIENT VISITS AND 37,822 EMERGENCY DEPARTMENT VISITS.

4b	(Code: ) (Expenses $ 30,039,098 including grants of $ ) (Revenue $ 36,124,476 )
	THE HOSPITAL PROVIDES INPATIENT SERVICES INCLUDING SURGICAL PROCEDURES, AN INTENSIVE CARE UNIT, AND THE BIRTH PLACE. GENERAL SURGEONS PROVIDE A FULL RANGE OF CONSULTING, DIAGNOSTIC, AND TREATMENT SERVICES. THE ICU IS SPECIFICALLY DESIGNED TO PROVIDE ONGOING, INTENSIVE NURSING ATTENTION FOR THOSE WHO ARE SERIOUSLY ILL OR INJURED OR WHO SUFFER FROM COMPLEX HEALTH CONDITIONS. THE BIRTH PLACE OFFERS COMFORT, PRIVACY, PEACE OF MIND, AND FLEXIBILITY TO ITS PATIENTS, AS WELL AS EDUCATIONAL CLASSES FOR EXPECTANT FAMILIES. INPATIENT FLOORS UTILIZE HOURLY ROUNDING TO ENSURE THE PATIENT PROGRESS AND NEEDS ARE CONTINUALLY MONITORED. DURING FY 2012, 5,293 PATIENTS RECEIVED INPATIENT SERVICES.

4c	(Code: ) (Expenses $ 21,181,677 including grants of $ ) (Revenue $ 19,051,964 )
	RUTHERFORD REGIONAL HAS TEN PHYSICIAN PRACTICES TO SERVE THE COMMUNITY'S SURGICAL, FAMILY PRACTICE, AND PSYCHIATRIC NEEDS. THE HOSPITAL HAS BEEN HONORED FOUR TIMES AS A THOMPSON COMPANY 100 TOP PERFORMANCE IMPROVEMENT LEADER FACILITY. EDUCATION DEPARTMENT MAKES HEALTH FAIRS, EDUCATION, AND SUPPORT AVAILABLE TO OUR COMMUNITY. SOME OF THE ACTIVITIES OFFERED INCLUDE CLASSES FOR EXPECTANT MOTHERS AND THEIR FAMILIES, SAFE SITTER COURSES, SUPPORT GROUPS FOR THOSE EXPERIENCING PARTICULAR ILLNESSES, FREEDOM FROM SMOKING CLASSES, THE LIFELINE PROGRAM, DIABETES EDUCATION, AND CPR/FIRST AID TRAINING.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 1,434,560 including grants of $ ) (Revenue $ 2,789,896 )
4e	Total program service expenses$ 99,238,233

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,926,998	0	20,143

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) DEAN R BACKSTROM MEDICAL DIRECTOR	40.0	X		229,915	0	2,564
(19) CHARLES BOND PHYSICIAN	40.0		X	733,547	0	3,515
(20) MICHAEL ROBERTS PHYSICIAN	40.0		X	791,343	0	3,515
(21) GREGG ALLEN DRABEK PHYSICIAN	40.0		X	544,993	0	3,621
(22) DOUGLAS B FREELS PHYSICIAN	40.0		X	529,257	0	4,278
(23) WILLIAM C HADEN PHYSICIAN	40.0		X	432,510	0	2,564

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		235,920
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			235,920
			Business Code
2a	NET PATIENT SERVICE REVENUE		621,110	85,618,226	85,618,226
b	LABORATORY CLIENT REVENUE		621,500	13,592,226	13,472,594	119,632
c	PATHOLOGY CLIENT REVENUE		621,110	2,157,722	2,152,597	5,125
d	CAFETERIA & VENDING REVENUE		722,410	506,998	506,052	946
e	OTHER REVENUE		900,099	1,024,555	1,006,331	18,224
f	All other program service revenue .
g	Total. Add lines 2a–2f........			102,899,727
3	Investment income (including dividends, interest
	and other similar amounts).....			874,649			874,649
4	Income from investment of tax-exempt bond proceeds..			0
5	Royalties............			0
		(i) Real	(ii) Personal
6a	Gross rents	100,284
b	Less: rental expenses	12,537
c	Rental income or (loss)	87,747
d	Net rental income or (loss).......			87,747			87,747
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	49,146,401	500
b	Less: cost or other basis and sales expenses	49,028,842	359
c	Gain or (loss)	117,559	141
d	Net gain or (loss)..........			117,700			117,700
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...			0
10a	Gross sales of inventory, less returns and allowances .
	a		142,686
b	Less: cost of goods sold ..b		68,836
c	Net income or (loss) from sales of inventory..			73,850			73,850
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See Instructions....			104,289,593	102,755,800	143,927	1,153,946


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			3,900	1	4,260
2	Savings and temporary cash investments .......			2,049,175	2	3,792,065
3	Pledges and grants receivable, net .........			0	3	0
4	Accounts receivable, net .........			13,363,299	4	11,220,632
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			0	5	0
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........			0	6	0
7	Notes and loans receivable, net .............			0	7	0
8	Inventories for sale or use ..............			1,788,160	8	1,746,370
9	Prepaid expenses and deferred charges ............			1,053,533	9	881,819
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	129,477,057
b	Less: accumulated depreciation. .....	10b	81,199,756	47,206,726	10c	48,277,301
11	Investments—publicly traded securities ..........			32,432,260	11	31,299,317
12	Investments—other securities. See Part IV, line 11 ......			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets .........			599,042	14	599,042
15	Other assets. See Part IV, line 11 ...........			1,134,881	15	3,148,941
16	Total assets. Add lines 1 through 15 (must equal line 34)...			99,630,976	16	100,969,747
17	Accounts payable and accrued expenses .			9,305,153	17	9,419,397
18	Grants payable ..........			0	18	0
19	Deferred revenue ..........			2,990	19	0
20	Tax-exempt bond liabilities ..........			15,030,386	20	19,234,551
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			0	21	0
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..			806,566	23	622,650
24	Unsecured notes and loans payable to unrelated third parties ....			0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			2,399,600	25	5,142,167
26	Total liabilities. Add lines 17 through 25.....			27,544,695	26	34,418,765
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			72,086,281	27	66,550,982
28	Temporarily restricted net assets .....			0	28	0
29	Permanently restricted net assets .....			0	29	0
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			72,086,281	33	66,550,982
34	Total liabilities and net assets/fund balances .....			99,630,976	34	100,969,747