TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(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) COURTNEY MAUZY........................................................................ CHAIRMAN	8.00 .......................	X	X	0	0	0
(2) JOHN BOYD........................................................................ BOARD MEMBER	2.00 .......................	X		0	0	0
(3) RICHARD MONTAGUE........................................................................ SECRETARY/TREASURER	2.00 .......................	X	X	0	0	0
(4) MARIAH MCKINNEY........................................................................ BOARD MEMBER	2.00 .......................	X		0	0	0
(5) JANICE BRUMIT........................................................................ BOARD MEMBER	1.00 .......................4.00	X		0	0	0
(6) KATHRYN ROYEN........................................................................ BOARD MEMBER	2.00 .......................	X		0	0	0
(7) MARTHA TYNER........................................................................ BOARD MEMBER	2.00 .......................	X		0	0	0
(8) SAM NASH........................................................................ BOARD MEMBER	2.00 .......................	X		0	0	0
(9) BYRON PHILLIPS........................................................................ BOARD MEMBER	2.00 .......................	X		0	0	0
(10) CHAD SMOKER........................................................................ BOARD MEMBER	2.00 .......................	X		87,632	0	0
(11) JERRY BLACK........................................................................ BOARD MEMBER	2.00 .......................	X		0	0	0
(12) OSCAR WEINMEISTER........................................................................ CEO	50.00 .......................1.00	X	X	249,250	0	44,498
(13) JON YEATMAN........................................................................ BOARD MEMBER	2.00 .......................48.00	X		0	174,605	1,198
(14) JENNIFER LARSON MD........................................................................ CHIEF OF STAFF - INTERNIST	50.00 .......................	X		100,487	0	18,040
(15) JOHN MAHER........................................................................ BOARD MEMBER	2.00 .......................58.00	X		0	321,703	77,140
(16) JONATHAN SMITH........................................................................ VP FIN & OPS: THROUGH APRIL 2013	50.00 .......................1.00		X	132,506	0	23,799
(17) SONYA RENNICK........................................................................ VP FIN & BUSINESS SERVICES: BEGINNING JUNE 2013	50.00 .......................		X	0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
HEALTHCARE SERVICES GROUP INC3220 TILLMAN DR 300BENSALEMPA19020	NUTRITION SERVICES	460,570
HORIZON CSA LLC265 PIT RDMOORESVILLENC28115	EQUIPMENT SERVICES	248,646
SPRUCE PINE EMERGENCY SERVICES1501 NW 49TH ST STE 140FORT LAUDERDALEFL33309	MEDICAL SERVICES	232,000
INFOLAB INC17400 US 61CLARKSDALEMS38614	SOFTWARE SERVICES	171,069
COMPREHENSIVE PAIN CONSULTANTS OF THE CA11523 PALM BRUSH TRAIL 354BRADENTONFL34202	PHYSICIAN SERVICES	126,000
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 5

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
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	328,841	218,311	110,530
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	19,491,616	16,600,412	2,891,204
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	306,285	260,343	45,942
9	Other employee benefits .......	3,043,412	2,586,900	456,512
10	Payroll taxes ...........	1,340,303	1,139,258	201,045
11	Fees for services (non-employees):
a	Management ......	446,976	379,930	67,046
b	Legal .........	47,353		47,353
c	Accounting ...........	65,571		65,571
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	66,536	66,536
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	1,901,554	1,602,580	298,974
12	Advertising and promotion ....	136,728	116,219	20,509
13	Office expenses .......	2,992,348	2,543,507	448,841
14	Information technology ......	122,028	103,724	18,304
15	Royalties ..
16	Occupancy ...........	746,635	746,635
17	Travel ............	119,373	101,466	17,907
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....
20	Interest ...........	16,697	16,697
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	2,193,775	1,864,709	329,066
23	Insurance ..............	726,635	617,640	108,995
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	2,521,088	2,521,088
b	REPAIRS AND MAINTENANCE	1,351,603	1,201,356	150,247
c	UNRELATED BUSINESS INCO	91,605	91,605
d
e	All other expenses	1,920,056	1,632,048	288,008
25	Total functional expenses. Add lines 1 through 24e	39,977,018	34,410,964	5,566,054	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 Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	8,083,473	1	2,600,737
2	Savings and temporary cash investments .........		2
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	4,988,136	4	6,106,492
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		37,500	5	25,000
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	745,518	8	866,833
9	Prepaid expenses and deferred charges ..........	214,878	9	158,969
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	54,508,674
b	Less: accumulated depreciation .....	10b	24,427,260	30,106,872	10c	30,081,414
11	Investments—publicly traded securities ..........	4,217,754	11	6,416,083
12	Investments—other securities. See Part IV, line 11 .....	7,305,553	12	8,530,717
13	Investments—program-related. See Part IV, line 11 .....	999,520	13	981,160
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	164,262	15	280,154
16	Total assets. Add lines 1 through 15 (must equal line 34)......	56,863,466	16	56,047,559
	17	Accounts payable and accrued expenses .........	2,587,749	17	3,225,655
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	935,000	20	735,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	2,310,038	23	1,100,857
24	Unsecured notes and loans payable to unrelated third parties ....	60,000	24	40,000
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....................	12,438,198	25	12,768,473
26	Total liabilities. Add lines 17 through 25.........	18,330,985	26	17,869,985
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	38,532,481	27	38,177,574
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets ...........		29
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........	38,532,481	33	38,177,574
34	Total liabilities and net assets/fund balances ........	56,863,466	34	56,047,559

- 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

2012

Open to Public
Inspection

Name of the organization

BLUE RIDGE REGIONAL HOSPITAL INC

Employer identification number

56-1025032

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in 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. See section 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 - Non-functionally integrated

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


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2012

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. 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—2011. If the organization did not check a 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—2012. 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—2011. 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) 2012

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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.)..

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 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. 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—2011. 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) 2012

Page 4

Part IV

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012

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

2012

Name of the organization

BLUE RIDGE REGIONAL HOSPITAL INC

Employer identification number

56-1025032

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization BLUE RIDGE REGIONAL HOSPITAL INC

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization BLUE RIDGE REGIONAL HOSPITAL INC

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 4

Name of organization
BLUE RIDGE REGIONAL HOSPITAL INC

Employer identification number

56-1025032

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) (2012)

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

2012

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, Part V, line 35c (Proxy Tax), then
Round Bullet

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

Name of the organization

BLUE RIDGE REGIONAL HOSPITAL INC

Employer identification number

56-1025032

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

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 SchCMd Bullet

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 SchCMd Bullet

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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable 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) 2012

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

434

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

434

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, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
EXPLANATION OF LOBBYING ACTIVITIES:	PART II-B, LINE 1:	BLUE RIDGE REGIONAL HOSPITAL IS A MEMBER OF THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA) EACH YEAR, THIS ORGANIZATION ENGAGES IN LOBBYING ACTIVITIES ON BEHALF OF THE MEMBERSHIP BODIES. FOR THE CURRENT YEAR, APPROXIMATELY 23.65% OF NCHA DUES HAVE BEEN ALLOCATED TO LOBBYING EXPENDITURES.

Schedule C (Form 990 or 990EZ) 2012

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

2012

Open to Public Inspection

Name of the organization

BLUE RIDGE REGIONAL HOSPITAL INC

Employer identification number

56-1025032

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.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
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

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

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

Yes No

In Part XIII, 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 XIII, 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

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

Using the organization’s acquisition, 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 XIII.

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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........

Part V

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

		(a)Current year	(b)Prior year	b (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 current year end balance (line 1g, column (a)) 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 XIII 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 .................	2,498,577		2,498,577
b	Buildings ................	37,440,208	13,257,561	24,182,647
c	Leasehold improvements ............	380,047	191,411	188,636
d	Equipment ................	13,657,655	10,978,288	2,679,367
e	Other .................	532,187		532,187
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				30,081,414

Schedule D (Form 990) 2012

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
(3)Other (A) ALTERNATIVE INVESTMENTS	3,925,850	F
(B) COLLECTIVE TRUST FUND VEHICLES	4,565,172	F
(C) REAL ESTATE FUNDS	39,695	F






Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	8,530,717

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
NOTE PAYABLE TO RELATED PARTIES		12,768,473








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		12,768,473
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
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 XIII.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements ...........		1
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 XIII.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
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
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	PART X, LINE 2:	INCOME TAXES - THE HOSPITAL AND THE FOUNDATION HAVE BEEN RECOGNIZED AS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501 (A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) AND, THEREFORE, RELATED INCOME IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. THE HOSPITAL INCURS UNRELATED BUSINESS INCOME TAX ON THE INVESTMENT IN BLUE RIDGE HOME CARE UNDER THE INTERNAL REVENUE CODE. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2008 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE AUTHORITIES. BOTH THE HOSPITAL AND THE FOUNDATION HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013. THE HOSPITAL AND FOUNDATION APPLY THE PROVISIONS OF FASB ASC 740, INCOME TAXES, IN ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. ASC 740 PROVIDES GUIDANCE ON WHEN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND HOW THE VALUES OF THESE POSITIONS ARE DETERMINED. THERE IS CURRENTLY NO IMPACT ON THE CONSOLIDATED FINANCIAL STATEMENTS AS A RESULT OF THE APPLICATION OF ASC 740.

Schedule D (Form 990) 2012

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

2012

Open to Public Inspection

Name of the organization

BLUE RIDGE REGIONAL HOSPITAL INC

Employer identification number

56-1025032

Part I

Financial Assistance 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) as a factor in determining 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 %

Did the organization use FPG as a factor in determining 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 used factors other than FPG in determining 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, as a factor in determining 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? ......

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

Financial Assistance and Means-Tested Government Programs		(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) ..	828,028		828,028	2.070 %
b	Medicaid (from Worksheet 3, column a) ....	5,080,159	3,597,123	1,483,036	3.710 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	5,908,187	3,597,123	2,311,064	5.780 %
Other Benefits		548,545		548,545	1.370 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	548,545		548,545	1.370 %
f	Health professions education (from Worksheet 5) ..	283,120		283,120	0.710 %
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	12,129		12,129	0.030 %
j	Total. Other Benefits ..	843,794		843,794	2.110 %
k	Total. Add lines 7d and 7j .	6,751,981	3,597,123	3,154,858	7.890 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

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.

		(c) Total community building expense	(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	275,019	275,019	0.690 %
8	Workforce development
9	Other
10	Total	275,019	275,019	0.690 %

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. Explain in Part VI the methodology used by the organization to estimate this amount. ......

2,676,308

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

908,607

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

13,135,997

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

12,379,632

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

756,365

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(owned 10% or more by officers, directors, trustees, key employees, and physicians—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) 2012

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, and primary website address
1	BLUE RIDGE REGIONAL HOSPITAL 125 HOSPITAL DRIVE SPRUCE PINE,NC28777	X	X	X

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	BLUE RIDGE REGIONAL HOSPITAL INC
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Yes

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	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)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	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 website
b	The policy was attached to 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 on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	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?.......	15	Yes
16	Check all of the following 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)
17	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?..........	17		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)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals 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? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

Page

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	BLUE RIDGE MEDICAL CENTER YANCEY CAMPUS 800 MEDICAL CAMPUS DRIVE BURNSVILLE,NC28714	RURAL HEALTH CLINIC
2	BLUE RIDGE MEDICAL CENTER MAYLAND CAMPUS 7968 HIGHWAY 19E SPRUCE PINE,NC28777	RURAL HEALTH CLINIC
3	BLUE RIDGE MEDICAL CENTER GENERAL SURGER 125 HOSPITAL DRIVE SPRUCE PINE,NC28777	GENERAL SURGERY
4	BLUE RIDGE MEDICAL CENTER SPRUCE PINE CA 496 ALTAPASS ROAD SPRUCE PINE,NC28777	RURAL HEALTH CLINIC
5	BLUE RIDGE MEDICAL CENTER PAIN CLINIC 125 HOSPITAL DRIVE SPRUCE PINE,NC28777	CLINIC
6	TOE RIVER CHILDRENS DENTAL CLINIC 89 N MITCHELL AVE BAKERSVILLE,NC28705	PHYSICIANS PRIVATE OFFICES
7	BRIE FOLKNER MD 88 HOSPITAL DRIVE SPRUCE PINE,NC28777	PHYSICIANS PRIVATE OFFICES
8	BLUE RIDGE REGIONAL HOSPITAL - RADIOLOGY 800 MEDICAL CAMPUS DRIVE BURNSVILLE,NC28714	RURAL HEALTH CLINIC
9	BLUE RIDGE FITNESS AND REHABILITATION CE 155 LOVE FOX ROAD BAKERSVILLE,NC28705	FITNESS CENTER
10	BLUE RIDGE MEDICAL CENTER ORTHOPAEDICS 11728 SOUTH 226 HWY SPRUCE PINE,NC28777	ORTHOPEDICS
11	DOROTHY DEGUZMAN MD 86 N MITCHELL AVE BURNSVILLE,NC28714	DELIVERY ROOM & LABOR
12	BLUE RIDGE REGIONAL HOSPITAL - LAB 800 MEDICAL CAMPUS DRIVE BURNSVILLE,NC28714	RURAL HEALTH CLINIC

Schedule H (Form 990) 2012

Page

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; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
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.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
		PART I, LINE 7: BLUE RIDGE REGIONAL HOSPITAL USED THE NCHA ANDI REPORTS WHICH ARE BASED ON THE IRS GUIDELINES TO DERIVE A COST-TO-CHARGE RATIO USED IN THE CALCULATION OF COMMUNITY BENEFIT EXPENSE AT COST.
	PART II:	SERVING THE COMMUNITY FOR OVER 55 YEARS, BLUE RIDGE REGIONAL HOSPITAL PLAYS A VITAL ROLE IN THE DEVELOPMENT AND SUPPORT OF THE REGION IT SERVES. BLUE RIDGE REGIONAL HOSPITAL PROVIDES FACILITY SPACE FOR MEETINGS AND RESOURCES THROUGH THE AMERICAN CANCER SOCIETY INCLUDING A PATIENT RESOURCE ROOM AND BI-MONTHLY LOOK GOOD, FEEL GOOD CLASSES. BLUE RIDGE REGIONAL HOSPITAL PROVIDES PRIVILEGES AND SPACES FOR VISITING SPECIALTY PHYSICIANS ON A REGULAR BASIS. THIS ARRANGEMENT ALLOWS COMMUNITY RESIDENTS TO RECEIVE NEEDED SPECIALTY CARE WITHOUT HAVING TO TRAVEL 50 OR MORE MILES ONE WAY. THIS SPACE IS PROVIDED AT MINIMAL COST TO THE VISITING PHYSICIANS TO PROVIDE COMFORT AND CONVENIENCE TO PATIENTS IN THE COMMUNITY. EMPLOYEES AT BLUE RIDGE REGIONAL HOSPITAL PARTICIPATE AND ARE MEMBERS OF MULTIPLE AGENCIES THAT SERVE THE COMMUNITY AS WELL AS MANY NON-PROFIT ORGANIZATIONS.ECONOMIC DEVELOPMENT - A MEMBER OF THE EXECUTIVE TEAM WHO SERVES AS CHAIRMAN OF THE LOCAL ECONOMIC DEVELOPMENT COMMISSION AND FOUNDING CHAIRMAN OF THE LOCAL PARTNERSHIP FOR CHILDREN, WORKS DILIGENTLY TO FIND OPPORTUNITIES TO BRING MORE BUSINESS & JOBS TO THE PEOPLE OF OUR COMMUNITY, THUS PROVIDING A GREATER LIFE POTENTIAL FOR THOSE IN NEED.WORKFORCE DEVELOPMENT - AS AN UNDERSERVED COMMUNITY WITH EVIDENT MEDICAL SHORTAGE IN ALL AREAS OF GENERAL AND SPECALITY HEALTH CARE, BLUE RIDGE STRIVES TO RECRUIT, OBTAIN AND RETAIN PHYSICIANS AND OTHER HEALTH CARE PROVIDERS TO PROVIDE SERVICES FOR MEMBERS OF THE SURROUNDING COMMUNITIES.
	PART III, LINE 3	APPROXIMATELY 68% OF BLUE RIDGE'S BAD DEBT WRITE OFFS ARE SELF-PAY PATIENTS. ABOUT 50% OF THOSE ARE UNEMPLOYED. THESE PERCENTAGES MULTIPLIED BY THE BAD DEBT COST OF $2.6 MILLION EQUALS THE ESTIMATED AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY.
		PART III, LINE 4: BLUE RIDGE REGIONAL HOSPITAL DOES NOT DISCLOSE THE COST OF BAD DEBT IN THE FOOTNOTES OF THE FINANCIALS; HOWEVER IT REPORTS THE COST OF BAD DEBT AS PART OF A REPORT TO THE NORTH CAROLINA HOSPITAL ASSOCIATION'S DATA INITIATIVE. THE FINANCIAL STATEMENTS NET BAD DEBT AGAINST PATIENT REVENUES TO ARRIVE AT "NET PATIENT REVENUE LESS PROVISION FOR BAD DEBTS".
		PART III, LINE 8: PER THE INSTRUCTIONS, THE MEDICARE COST REPORT IS THE BASIS FOR CALCULATING THE COSTS USING COSTS RELATED TO THE REVENUE REPORTED.
		PART III, LINE 9B: PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AND OTHER CHARITY CARE ARE NOTIFIED USING THE PROCESS DESCRIBED IN THE EDUCATION OF PATIENTS' ELIGIBILITY IN PART VI, ON LINE 3.
BLUE RIDGE REGIONAL HOSPITAL, INC.		PART V, SECTION B, LINE 3: AS PART OF WNC HEALTHY IMPACT, A REGIONAL DATA WORKGROUP OF PUBLIC HEALTH AND HOSPITAL REPRESENTATIVES AND REGIONAL PARTNERS, WITH SUPPORT FROM THE CONSULTING TEAM, MADE RECOMMENDATIONS TO THE STEERING COMMITTEE ON THE DATA APPROACH AND CONTENT USED TO HELP INFORM REGIONAL DATA COLLECTION. THE CORE REGIONAL DATASET WAS INFORMED BY STAKEHOLDER DATA NEEDS, GUIDELINES, AND REQUIREMENTS. FROM DATA COLLECTED AS PART OF THIS CORE DATASET, THE CONSULTING TEAM COMPILED SECONDARY (EXISTING) DATA AND NEW SURVEY FINDINGS FOR EACH COUNTY IN THE 16-COUNTY REGION. THIS ASSESSMENT INCLUDES DATA INTEGRATED FROM THE SECONDARY DATA EFFORTS AS WELL AS THE COMMUNITY HEALTH SURVEY FOR OUR COUNTY.IN THE RANDOM-SAMPLE SURVEY THAT WAS ADMINISTERED IN OUR COUNTY AS PART OF THIS COMMUNITY HEALTH ASSESSMENT, 200 COMMUNITY MEMBERS COMPLETED A QUESTIONNAIRE REGARDING THEIR HEALTH STATUS, HEALTH BEHAVIORS, INTERACTIONS WITH CLINICAL CARE SERVICES, SUPPORT FOR CERTAIN HEALTH-RELATED POLICIES, AND FACTORS THAT IMPACT THEIR QUALITY OF LIFE. IN ADDITION, IN OUR COUNTY, COMMUNITY MEMBERS AND PARTNERS ACTED AS THE CHA TEAM AND WERE INVOLVED IN LOCAL DATA INTERPRETATION AND PRIORITY SETTING.
BLUE RIDGE REGIONAL HOSPITAL, INC.		PART V, SECTION B, LINE 4: REGIONAL PARTNERSHIP:BLUE RIDGE'S COLLABORATIVE COMMUNITY HEALTH IMPROVEMENT EFFORT IS ALSO SUPPORTED BY A COMPREHENSIVE PARTNERSHIP WITH OTHER REGIONAL HOSPITALS AND LOCAL HEALTH DEPARTMENTS. THIS INITIATIVE, KNOWN AS WNC HEALTHY IMPACT, REPRESENTS 16 COUNTIES ACROSS THE WESTERN NORTH CAROLINA REGION WORKING COLLABORATIVELY TO IMPROVE COMMUNITY HEALTH. INFORMATION ABOUT THIS INNOVATIVE REGIONAL COLLABORATION, COUNTY-WIDE COMMUNITY HEALTH ASSESSMENTS, AND OVERALL REGIONAL FINDINGS, ARE MADE WIDELY AVAILABLE TO THE PUBLIC AT WWW.WNCHEALTHYIMPACT.COM.
BLUE RIDGE REGIONAL HOSPITAL, INC.		PART V, SECTION B, LINE 5C: THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE VIEWED AT WWW.WNCHEALTHYIMPACT.COM BY NAVIGATING TO "LOCAL STORIES" AND THEN TO "MITCHELL". THIS INFORMATION CAN ALSO BE FOUND WITHIN THE MISSION HEALTH SYSTEM WEBSITE: HTTP://WWW.MISSION-HEALTH.ORG/ABOUT-US/VISION-VALUES/COMMUNITY-BENEFIT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.
BLUE RIDGE REGIONAL HOSPITAL, INC.		PART V, SECTION B, LINE 12H: IN ADDITION TO THE OTHER ITEMS LISTED, BLUE RIDGE'S POLICY CONTAINS A CATASTROPHIC PROVISION DISCOUNT WHEREIN PATIENTS WHO QUALIFY UNDER OUR FINANCIAL ASSISTANCE POLICY WILL NOT OWE MORE THAN 15% OF THEIR ANNUAL INCOME.
BLUE RIDGE REGIONAL HOSPITAL, INC.		PART V, SECTION B, LINE 14G: SEE PART VI, LINE 3: THE BLUE RIDGE HOSPITAL PROVIDES INFORMATION TO PATIENTS REGARDING THE FINANCIAL ASSISTANCE POLICY BY DIRECTING PATIENTS TO A PATIENT BILLING REPRESENTATIVE OR BY DIRECTING PATIENTS TO THE MISSION HEALTH SYSTEM WEBSITE (WHICH APPLY TO ALL MISSION HEALTH LOCATIONS); MESSAGES ON BILLING STATEMENTS AND IN BROCHURES PROVIDED IN THE HOSPITAL FACILITY'S EMERGENCY ROOMS; WAITING ROOMS; AND ADMISSIONS OFFICES, WAS WELL AS ON ADMISSION TO THE HOSPITAL FACILITY. FINANCIAL ASSISTANCE APPLICATION CAN BE A COMPLICATED AND CONFUSING PROCESS TO PATIENTS AND THEIR FAMILY AND THE PROCESS IS BETTER UNDERSTOOD WHEN THE PATIENT HAS AN OPPORTUNITY TO ASK QUESTIONS AND HAVE THE APPLICATION EXPLAINED IN PERSON. PATIENTS MAY ALSO CONTACT MISSION'S CUSTOMER SERVICE CENTER AT (800) 848-8732 WITH ANY QUESTIONS.
BLUE RIDGE REGIONAL HOSPITAL, INC.		PART V, SECTION B, LINE 18E: BLUE RIDGE REGIONAL HOSPITAL PERFORMS THESE ACTIONS BEFORE INITIATING ANY COLLECTION ACTIONS.
BLUE RIDGE REGIONAL HOSPITAL, INC.		PART V, SECTION B, LINE 20D: IT IS THE INTENT OF THIS POLICY THAT ALL UNINSURED PATIENTS QUALIFYING UNDER THE POLICY WILL RECEIVE A DISCOUNT EQUIVALENT TO THE DISCOUNT RECEIVED BY MEDICARE AND COMMERCIALLY INSURED PATIENTS. THIS MINIMUM DISCOUNT LEVEL FOR UNINSURED PATIENTS IS CALCULATED AT LEAST ANNUALLY BY DIVIDING THE SUM OF ALL MEDICARE AND COMMERCIAL INSURANCE PAYMENTS FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE FROM CLAIMS THAT HAVE BEEN PAID IN FULL, BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS.
		PART VI, LINE 2: BLUE RIDGE REGIONAL HOSPITAL PARTICIPATES IN A COMMUNITY HEALTH ASSESSMENT (CHA) EVERY THREE YEARS, WITH THE MOST RECENT ASSESSMENT COMPLETED IN DECEMBER 2012.PROCESS AND PRODUCT:THE BLUE RIDGE REGIONAL HOSPITAL ASSESSMENT WAS CONDUCTED IN PARTNERSHIP WITH THE TOE RIVER HEALTH DISTRICT, MITCHELL COMMUNITY HEALTH PARTNERSHIP, HEALTHY YANCEY, AND OTHER NON-PROFIT COMMUNITY ORGANIZATIONS. THIS WRITTEN REPORT DESCRIBES: THE COMMUNITY SERVED BY THE HOSPITAL COMMUNITY DEMOGRAPHICS EXISTING HEALTH RESOURCES IN THE COMMUNITY AVAILABLE TO RESPOND TO NEEDS HOW DATA WAS COLLECTED IN THE ASSESSMENT PROCESS THE PRIORITY HEALTH NEEDS OF THE COMMUNITY HEALTH NEEDS AND ISSUES OF UNINSURED, LOW-INCOME, AND MINORITY GROUPS THE PROCESS FOR IDENTIFYING AND PRIORITIZING COMMUNITY NEEDS AND SERVICES TO MEET THE NEEDS THE PROCESS FOR CONSULTING WITH PERSONS REPRESENTING THE COMMUNITY'S INTERESTS INFORMATION GAPS THAT LIMIT THE HOSPITAL FACILITY'S ABILITY TO ASSESS THE COMMUNITY'S HEALTH NEEDSSHARING OF RESULTS:DETAILED FINDINGS FOR OUR ASSESSMENT(S) WERE POSTED ON BLUE RIDGE REGIONAL HOSPITAL WEBSITE HTTP://WWW.BLUERIDGEHOSPITAL.ORG/ABOUT-US IN SEPTEMBER 2013. THE CHNA WAS PRESENTED TO THE BLUE RIDGE REGIONAL HOSPITAL ON SEPTEMBER 23, 2013 FOR APPROVAL AND DISCUSSION. DOCUMENTATION OF THIS BOARD APPROVAL IS AVAILABLE IN THE BLUE RIDGE REGIONAL HOSPITAL BOARD MINUTES FROM SEPTEMBER 23, 2013.
		PART VI, LINE 3: BLUE RIDGE REGIONAL HOSPITAL PROVIDES INFORMATION TO OUR PATIENTS REGARDING HOW THEY WILL BE BILLED FOR PATIENT CARE AND ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S CHARITY CARE POLICY IN THE FOLLOWING WAYS: DURING THE REGISTRATION PROCESS WE VERIFY INSURANCE INFORMATION ON EACH PATIENT. IF THERE IS NO INSURANCE, THE PATIENTS ARE ASKED A SERIES OF QUESTIONS TO DETERMINE POTENTIAL MEDICAID ELIGIBILITY. IF THE PATIENT IS DETERMINED TO HAVE POTENTIAL ELIGIBILITY THE PATIENT'S ACCOUNT INFORMATION IS FORWARDED TO OUR ONSITE DSS WORKER FOR FURTHER INQUIRIES AND POSSIBLY AN APPOINTMENT IS SCHEDULED TO COMPLETE A MEDICAID APPLICATION. IF THE PATIENT DOES NOT MEET ELIGIBILITY REQUIREMENTS, OTHER OPTIONS SUCH AS PAYMENT ARRANGEMENTS AND/OR FINANCIAL ASSISTANCE IS DISCUSSED. AT THIS TIME, THE PATIENT MAY BE GIVEN A FINANCIAL ASSISTANCE APPLICATION (CHARITY CARE) TO COMPLETE AND RETURN TO THE BUSINESS OFFICE FOR PROCESSING. AFTER THE NOTIFICATIONS AND PROCESSES REFERENCED ABOVE HAVE BEEN COMPLETED, STANDARD DEBT COLLECTION POLICIES ARE IN EFFECT FOR THE PORTION OF THE BILL FOR WHICH THE PATIENT IS RESPONSIBLE.IN ADDITION TO GOING THROUGH THIS PROCESS VERBALLY WITH OUR PATIENTS OUR INTERNET WEB SITE INCLUDES THE FOLLOWING INFORMATION:ABOUT YOUR BILL WE ARE HERE TO HELP. IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT THE STATEMENTS YOU RECEIVE, PLEASE CALL US AS SOON AS POSSIBLE AT 828-765-4201.INSURANCE: THE FIRST STEP IS TO CHECK WITH YOUR INSURANCE COMPANY BEFORE ANY INPATIENT OR OUTPATIENT PROCEDURES TO BE SURE THAT YOU HAVE MET THEIR REQUIREMENTS, SUCH AS A REFERRAL FROM A PRIMARY CARE PHYSICIAN. ALSO BE SURE TO ASK YOUR INSURANCE PROVIDER ABOUT ANY DEDUCTIBLES OR CO-PAYS THAT MAY BE YOUR RESPONSIBILITY. BLUE RIDGE REGIONAL HOSPITAL WILL FILE A CLAIM WITH YOUR INSURANCE COMPANY, BUT DEDUCTIBLES AND CO-PAYS MUST BE PAID AT THE TIME OF SERVICE.UNINSURED:IF YOU DO NOT HAVE INSURANCE THEN YOU MUST PAY 'UP FRONT' AT THE TIME OF THE VISIT. HOWEVER, PLEASE DO NOT LET THIS STOP YOU FROM SEEKING THE MEDICAL CARE YOU NEED. IF YOU CAN'T PAY YOUR BILL DUE TO LACK OF INSURANCE OR LIMITED INCOME, A PATIENT REPRESENTATIVE IS AVAILABLE TO HELP YOU APPLY FOR FINANCIAL ASSISTANCE.FINANCIAL ASSISTANCE:OUR PROCESS FOR DETERMINING FINANCIAL ASSISTANCE IS KEPT STRICTLY CONFIDENTIAL AND ELIGIBILITY IS DETERMINED ON AN INDIVIDUAL BASIS. THE STEPS FOR REQUESTING FINANCIAL ASSISTANCE INCLUDE:CALL A PATIENT REPRESENTATIVE AT 828-765-4201;PARTICIPATE IN A BRIEF PHONE INTERVIEW TO DETERMINE ELIGIBILITY;FINANCIAL ASSISTANCE APPLICATION IS MAILED TO YOU OR WE CAN SCHEDULE AN APPOINTMENT TO DISCUSS THE APPLICATION PROCESS. YOU WILL NEED TO PROVIDE SPECIFIC FINANCIAL INFORMATION. DECISION ABOUT ASSISTANCE IS MADE ONCE ALL PAPERWORK IS COMPLETE BLUE RIDGE REGIONAL HOSPITAL DETERMINES ELIGIBILITY FOR ASSISTANCE BY FOLLOWING THE HOUSEHOLD INCOME GUIDELINES ESTABLISHED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. AFTER WE REVIEW YOUR ASSISTANCE APPLICATION, WE MAY DETERMINE THAT YOU QUALIFY FOR A DISCOUNT, MEDICAID BENEFITS, OR OTHER STATE ASSISTANCE AVAILABLE TO NORTH CAROLINA RESIDENTS.MEDICAID:IF YOU HAVE MEDICAID, BE SURE TO BRING YOUR CARD WITH YOU EACH TIME YOU VISIT THE HOSPITAL FOR ANY MEDICAL SERVICES. MEDICAID MAY REQUIRE YOU TO BE REFERRED BY YOUR PRIMARY CARE DOCTOR AND THEY MAY NOT COVER CERTAIN SERVICES. THE BEST WAY TO BE SURE IS TO CALL YOUR CASE WORKER AT THE DEPARTMENT OF SOCIAL SERVICES.MEDICARE PATIENTS:PLEASE BE AWARE THAT WE ARE REQUIRED BY LAW TO ASK CERTAIN QUESTIONS ABOUT YOUR RETIREMENT AND INSURANCE COVERAGE EVERY TIME YOU RECEIVE SERVICES AT BLUE RIDGE REGIONAL HOSPITAL. WE SEND A CLAIM TO YOUR SUPPLEMENTAL INSURANCE COMPANY BEFORE SUBMITTING A BILL TO MEDICARE. YOU ARE RESPONSIBLE FOR ANY PART OF YOUR BILL THAT'S NOT COVERED BY SUPPLEMENTAL INSURANCE AND MEDICARE.CONTACT INFORMATION:IF YOU HAVE ANY QUESTIONS, YOU CAN SEND THEM THROUGH OUR ONLINE FORM, OR FEEL FREE TO CALL 828-765-4201.IF YOU NEED HELP OUTSIDE OF NORMAL BUSINESS HOURS, PLEASE LEAVE A MESSAGE IN THE BUSINESS OFFICE AND A PATIENT REPRESENTATIVE WILL RETURN YOUR CALL.
		PART VI, LINE 4: BLUE RIDGE REGIONAL HOSPITAL SERVES THE RURAL MOUNTAINOUS AREA OF MITCHELL, YANCEY, LOWER AVERY AND UPPER MCDOWELL COUNTIES IN WESTERN NORTH CAROLINA. THE POPULATION WE SERVE IS A LARGELY INDIGENT POPULATION AND EVER-INCREASING ELDERLY POPULATION. IN 2013, BLUE RIDGE REGIONAL HOSPITAL PROVIDED $5.1 MILLION IN UNCOMPENSATED CARE TO THE COMMUNITY IT SERVES. IN 2013 MORE THAN 62% OF THE PATIENT POPULATION WAS MEDICAID, MEDICARE OR SELF-PAY PATIENTS.
		PART VI, LINE 5: SEE PROGRAM SERVICE ACCOMPLISHMENTS ON PAGE 2 OF THE 990.
		PART VI, LINE 6: BLUE RIDGE REGIONAL HOSPITAL IS PART OF AN AFFILIATED HEALTH CARE SYSTEM WITH THE RESPECTIVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES DESCRIBED BELOW IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.MISSION HEALTH SYSTEM, INC. IS THE PARENT ORGANIZATION FOR THE CHARITABLE ORGANIZATIONS OF MISSION HOSPITAL, INC.; MISSION HEALTHCARE FOUNDATION, INC.; MISSION MEDICAL ASSOCIATES, INC; BLUE RIDGE REGIONAL HOSPITAL, INC.; AND THE MCDOWELL HOSPITAL, INC.MISSION HOSPITAL, INC. IS A REGIONAL INTEGRATED HEALTH SYSTEM PROVIDING SUPERIOR CARE AND SERVICE TO PATIENTS AND THEIR FAMILIES THROUGH A FULL CONTINUUM OF INTEGRATED SERVICES, EDUCATION, AND RESEARCH. IT SERVES AS A TRAUMA CENTER TO PEOPLE OF WESTERN NORTH CAROLINA AND THE SURROUNDING COUNTIES. MISSION MEDICAL ASSOCIATES MISSION IS TO PROVIDE PHYSICIAN SERVICES IN PREDOMINANTLY RURAL AREAS THAT ARE INSUFFICIENTLY SERVED, THEREBY IMPROVING THE HEALTH CARE OF THE GENERAL PUBLIC. IN MANY CASES THIS INVOLVES RECRUITING AND PLACING PRIMARY CARE PHYSICIANS, AS WELL AS PEDIATRIC AND ADULT SPECIALTY SERVICES CLOSE TO WHERE PEOPLE LIVE AND WORK.BLUE RIDGE REGIONAL HOSPITAL SERVES AS A COMMUNITY HOSPITAL IN MITCHELL, YANCEY AND SURROUNDING COUNTIES.ANGEL MEDICAL CENTER, INC. SERVES AS A COMMUNITY HOSPITAL IN MACON AND SURROUNDING COUNTIES.TRANSYLVANIA COMMUNITY HOSPITAL, INC.SERVES AS A COMMUNITY HOSPITAL IN TRANSYLVANIA AND SURROUNDING COUNTIES.THE MCDOWELL HOSPITAL SERVES AS A COMMUNITY HOSPITAL IN MCDOWELL AND THE SURROUNDING COUNTIES.MISSION HEALTHCARE FOUNDATION, INC. SUPPORTS THE MISSION AND PROGRAMS OF MISSION HOSPITAL, INC. AND MISSION HEALTH SYSTEM, INC. AND OF OTHER ORGANIZATIONS THAT ARE TAX EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND WORKS TO BENEFIT THE COMMUNITY AND REGION SERVED BY THE ENTITIES LISTED ABOVE.
REPORTS FILED WITH STATES	PART VI, LINE 7	NC

Schedule H (Form 990) 2012

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

2012

Open to Public Inspection

Name of the organization

BLUE RIDGE REGIONAL HOSPITAL INC

Employer identification number

56-1025032

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 of the expenses described above? If "No," complete Part III to explain....

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? .......

Indicate which, if any, of the following the filing organization used 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? .........

Yes

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

Cat. No. 50053T

Schedule J (Form 990) 2012

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 (E) amounts for that individual.

(A) Name and Title		(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 and Title		(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)OSCAR WEINMEISTERCEO	(i) (ii)	193,227 0	50,000 0	6,023 0	21,696 0	22,802 0	293,748 0	0 0
(2)JON YEATMANBOARD MEMBER	(i) (ii)	0 139,721	0 34,219	0 665	0 220	0 978	0 175,803	0 0
(3)JOHN MAHERBOARD MEMBER	(i) (ii)	0 260,635	0 58,433	0 2,635	0 56,048	0 21,092	0 398,843	0 0
(4)JONATHAN SMITHVP FIN & OPS: THROUGH APRIL 2013	(i) (ii)	119,956 0	0 0	12,550 0	15,301 0	8,498 0	156,305 0	0 0
(5)MARVIN VICESTAFF PHYSICIAN	(i) (ii)	462,626 0	0 0	16,178 0	0 0	24,522 0	503,326 0	0 0
(6)DAVID ROBINSONSTAFF PHYSICIAN	(i) (ii)	332,282 0	35,029 0	5,996 0	0 0	17,716 0	391,023 0	0 0
(7)SHEHLA KAHNSTAFF PHYSICIAN	(i) (ii)	275,124 0	63,646 0	508 0	10,534 0	22,807 0	372,619 0	0 0
(8)KEVIN HOLLIFIELDCRNA	(i) (ii)	186,990 0	35 0	31,944 0	6,601 0	22,648 0	248,218 0	0 0
(9)RICHARD RHEINBOLTSTAFF PHYSICIAN	(i) (ii)	156,807 0	33,329 0	7,090 0	3,867 0	11,399 0	212,492 0	0 0

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

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

Identifier	Return Reference	Explanation
	PART I, LINE 4B	OSCAR WEINMEISTER - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: $18,927.
	PART I, LINE 7	PART I, LINE 4B: THE FOLLOWING RECEIVED SUPPLEMENTAL NON-QUALIFIED PLAN PAYMENTS FROM THE FILING ORGANIZATION: JONATHAN SMITH: $3,559 THE FOLLOWING RECEIVED SUPPLEMENTAL NON-QUALIFIED PLAN PAYMENTS FROM A RELATED ORGANIZATION: JON YEATMAN: $16,686 JOHN MAHER: $11,512

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

BLUE RIDGE REGIONAL HOSPITAL INC

Employer identification number

56-1025032

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) OSCAR WEINMEISTER	EMPLOYEE	RECRUITMENT LOAN		X	37,500	25,000		No	Yes		Yes





Total ...... $						25,000

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) MELISSA SMITH	FAMILY RELATIONSHIP	51,632	COMPENSATION		No

Part V

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

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2012

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

2012

Open to Public
Inspection

Name of the organization

BLUE RIDGE REGIONAL HOSPITAL INC

Employer identification number

56-1025032

Identifier	Return Reference	Explanation
	FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER OF THE CORPORATION IS MISSION HEALTH SYSTEM, INC.
	FORM 990, PART VI, SECTION A, LINE 7A	THE DIRECTORS OF THE CORPORATION SHALL BE APPOINTED AT THE ANNUAL MEETING OF THE MEMBER (MISSION HEALTH SYSTEM) OF THE CORPORATION. THE TWO EX-OFFICO DIRECTORS SHALL BE EX-OFFICIO BOARD MEMBERS WHO SERVE IN THE POSITIONS OF CHIEF EXECUTIVE OFFICER OF THE CORPORATION AND CHIEF OF STAFF OF THE HOSPITAL. THE BOARD OF DIRECTORS OF THE CORPORATION SHALL ELECT THE SEVEN INDIVIDUALS TO SERVE AS COMMUNITY DIRECTORS AS SOON AS REASONABLY POSSIBLE SUBSEQUENT TO THE APPOINTMENT OF THE SOLE MEMBER'S DIRECTORS. THE COMMUNITY DIRECTORS ELECTED MUST BE APPROVED BY THE MEMBER OF THE CORPORATION; HOWEVER, SAID APPROVAL SHALL NOT BE ARBITRARILY AND CAPRICIOUSLY WITHHELD.
	FORM 990, PART VI, SECTION A, LINE 7B	THE SOLE MEMBER HAS THE FOLLOWING RIGHTS WITH RESPECT TO THE CORPORATION (A) APPROVAL OF THE GOVERNING INSTRUMENTS OF THE CORPORATION, (B) APPROVAL OF THE MISSION, VISION, AND VALUES STATEMENT, (C) ELECTION AND REMOVAL OF THE BOARD OF DIRECTORS, (D) APPROVAL OF THE PLEDGE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, THE PURCHASE OR SALE OF PROPERTY, AND LONG-TERM BORROWING, (E) APPROVAL OF DISSOLUTION, MERGER, SALE, OR CONSOLIDATION, (F) APPROVAL OF THE FORMATION AND GOVERNANCE OF NEW CORPORATIONS, PARTNERSHIPS, OR JOINT VENTURES (ABOVE FINANCIAL AND OTHER LIMITS), (G) APPROVAL OF THE CAPITAL AND OPERATING BUDGET, (H) APPROVAL OF THE CONSOLIDATION, MATERIAL EXPANSION, OR ELIMINATION OF ANY CLINICAL SERVICE, (I) APPROVAL OF THE ELECTION OF THE PRESIDENT/CEO, (J) THE OPTION TO REMOVE THE PRESIDENT/CEO.
	FORM 990, PART VI, SECTION B, LINE 11	THE RETURN WAS PREPARED BY STAFF FROM BLUE RIDGE REGIONAL HOSPITAL AND MISSION HEALTH SYSTEM WITH THE ASSISTANCE FROM MANAGEMENT. THE FINAL REVIEW WAS COMPLETED BY AN INDEPENDENT ACCOUNTANT. THE RETURN WAS PRESENTED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. PRIOR TO FILING WITH THE IRS, THE COMPLETED RETURN WAS GIVEN TO THE FULL BOARD OF DIRECTORS.
	FORM 990, PART VI, SECTION B, LINE 12C	THE INDEPENDENT DIRECTORS WILL REVIEW CONFLICTS OF INTEREST AND DISABLING SITUATIONS, CONSIDER ANY ISSUES INVOLVING CONFLICTS AND MAKE DETERMINATIONS AS TO WHETHER A PARTICULAR RELATIONSHIP OR ARRANGEMENT WOULD DISABLE AN INDIVIDUAL FROM SERVING AS A FIDUCIARY FOR THE BOARD OR WOULD REASONABLY BE EXPECTED TO EXERT AN INFLUENCE ON THE INDIVIDUAL'S JUDGMENT AND THEREFORE PRECLUDE THE INDIVIDUAL FROM BEING AN INDEPENDENT DIRECTOR. THE BOARD MAY RETAIN COUNSEL FROM OUTSIDE AUDIT, LEGAL, GOVERNANCE OR OTHER EXPERTS. ANY DETERMINATION OF PERCENT OF REVENUE OR INCOME RECEIVED BY AN INDIVIDUAL OR ENTITY MAY BE BASED ON CERTIFICATIONS FROM OUTSIDE AUDITORS OF DISCLOSURES MADE DIRECTLY BY THE INDIVIDUAL TO THE AUDIT FIRM. PROCEDURES UPON DETERMINATION OF A CONFLICT OF INTEREST: THE INTERESTED PERSON SHALL NOT PARTICIPATE IN ANY DISCUSSION OR VOTE REGARDING THE BUSINESS RELATIONSHIP ISSUE, AND SHALL NOT BE PRESENT IN THE MEETING ROOM FOR ANY PART OF THE DISCUSSION OR VOTE RELATING TO THE BUSINESS RELATIONSHIP ISSUE. THE BOARD OF DIRECTORS WILL DISCUSS THE BUSINESS RELATIONSHIP BUT WILL NOT FORMALLY APPROVE SUCH BUSINESS RELATIONSHIP UNLESS THE DISINTERESTED MEMBERS OF THE BOARD HAVE DECIDED BY MAJORITY VOTE THAT THE BUSINESS RELATIONSHIP IS IN THE BEST INTERESTS OF AND FOR THE BENEFIT OF BLUE RIDGE AND IS FAIR AND REASONABLE THERETO IN ALL RESPECTS.
	FORM 990, PART VI, SECTION B, LINE 15	ANNUALLY, THE FINANCE COMMITTEE OF THE BOARD REVIEWS AND COMPARES COMPENSATION DATA FOR THE TOP EXECUTIVE AND OTHER KEY POSITIONS USING DATA FROM FOUR DIFFERENT COMPARABLE SOURCES, INCLUDING THE FORM 990 FROM OTHER ORGANIZATIONS, TWO NATIONAL SALARY SURVEYS, AND ONE STATE SALARY SURVEY. THE CEO'S COMPENSATION PACKAGE IS APPROVED BY THE FINANCE COMMITTEE. THE CEO AND FINANCE COMMITTEE WORK TOGETHER TO SET COMPENSATION FOR OTHER KEY POSITIONS. THE BOARD REVIEWS AND APPROVES THE COMPENSATION FOR THE CEO, CFO, VP OF NURSING, VP OF PHYSICIAN PRACTICES, AND THE VP OF OUTREACH.
	FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, DETAILS FROM THE ORGANIZATION'S FINANCIAL STATEMENTS ARE WIDELY DISTRIBUTED IN THE HOSPITAL'S COMMUNITY BENEFIT REPORT TO THE COMMUNITY, AS WELL AS BEING ATTACHED TO THIS RETURN.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

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

2012

Open to Public Inspection

Name of the organization

BLUE RIDGE REGIONAL HOSPITAL INC

Employer identification number

56-1025032

Part I

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

(a) Name, address, and EIN (if applicable) 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" to 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 entity?
(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) BLUE RIDGE REGIONAL HOSPITAL FOUNDATION PO BOX 247 SPRUCE PINE,NC28777 58-2172660	SUPPORTING ORGANIZATION/FUNDRAISING	NC	501(C)(3)	LINE 11A, I	BLUE RIDGE REGIONAL HOSPITAL INC	Yes
(2) MISSION HEALTH SYSTEM INC 400 RIDGEFIELD COURT SUITE 100 ASHEVILLE,NC28806 58-1450888	SUPPORTING ORGANIZATION	NC	501(C)(3)	LINE 11A, I	N/A		No
(3) MISSION HOSPITAL INC 400 RIDGEFIELD COURT SUITE 100 ASHEVILLE,NC28806 56-0532141	HEALTHCARE	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC		No
(4) MISSION HEALTHCARE FOUNDATION INC 400 RIDGEFIELD COURT SUITE 100 ASHEVILLE,NC28806 56-1881331	FUNDRAISING	NC	501(C)(3)	LINE 7	MISSION HEALTH SYSTEM INC		No
(5) MISSION MEDICAL ASSOCIATES 12 ARDMORE STREET ASHEVILLE,NC28803 26-3627231	HEALTHCARE	NC	501(C)(3)	LINE 9	MISSION HEALTH SYSTEM INC		No
(6) THE MCDOWELL HOSPITAL INC 430 RANKIN AVENUE MARION,NC28752 56-0623938	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC		No
(7) BLUE RIDGE REGIONAL HOSPITAL PO BOX 9 SPRUCE PINE,NC28777 56-1025032	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC		No
(8) MCDOWELL HEALTHCARE FOUNDATION INC 430 RANKIN AVENUE MARION,NC28752 46-3395393	FOUNDATION	NC	501(C)(3)	LINE 7	THE MCDOWELL HOSPITAL		No
(9) TRANSYLVANIA COMMUNITY HOSPITAL INC 260 HOSPITAL DRIVE BREVARD,NC28712 56-0562293	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC		No
(10) TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC PO BOX 2440 BREVARD,NC28712 56-1450824	FOUNDATION	NC	501(C)(3)	LINE 7	TRANSYLVANIA COMMUNITY HOSPITAL		No
(11) ANGEL MEDICAL CENTER INC PO BOX 1209 FRANKLIN,NC28744 56-6000064	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC		No
(12) TRANSYLVANIA PHYSICIAN SERVICES INC 260 HOSPITAL DRIVE BREVARD,NC28712 56-1920816	HEALTHCARE	NC	501(C)(3)	LINE 3	TRANSYLVANIA COMMUNITY HOSPITAL		No
(13) TRANSYLVANIA HEALTH SYSTEM INC 260 HOSPITAL DRIVE BREVARD,NC28712 56-1456987	MERGED WITH TRANSYLVANIA COMMUNITY HOSPITAL JUNE 2013	NC	501(C)(3)	LINE 11B, II	DISSOLVED		No
(14) ANGEL MEDICAL CENTER AUXILIARY PO BOX 1209 FRANKLIN,NC28744 56-2133719	SUPPORTING ORGANIZATION	NC	501(C)(3)	LINE 11A, I	ANGEL MEDICAL CENTER INC		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(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?		(k) Percentage ownership
(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
(1) BLUE RIDGE DME LLC 125 HOSPITAL DRIVE SPRUCE PINE,NC28777 26-3570174	HOME MEDICAL EQUIPMENT AND SUPPLIES SALES	NC	BLUE RIDGE REGIONAL HOSPITAL INC	UNRELATED	625,332	1,045,076		No	377,346	Yes		96.000 %
(2) IMAGING REALTY LLP 534 BILTMORE AVENUE ASHEVILLE,NC28801 56-1907203	REAL ESTATE HOLDING	NC	N/A
(3) MSJHS AND CCP JOINT DEVELOPMENT COMPANY 428 BILTMORE AVENUE ASHEVILLE,NC28801 56-2250464	HEALTHCARE	NC	N/A
(4) MCDOWELL MRI 414 RANKIN AVENUE MARION,NC28752 75-3046378	MEDICAL IMAGING	NC	N/A
(5) ASHEVILLE IMAGING LLP 534 BILTMORE AVENUE ASHEVILLE,NC28801 56-1907201	OUTPATIENT IMAGING	NC	N/A
(6) BREVARD MRI AT TRANSYLVANIA REGIONAL HOSPITAL LLC 260 HOSPITAL DRIVE BREVARD,NC28712 20-3281110	MEDICAL	NC	N/A
(7) TRANSYLVANIA HEALTHECARE II LIMITED PARTNERSHIP 2 MEDICAL PARK DRIVE BREVARD,NC28712 20-0333230	RENTAL	NC	N/A
(8) HEALTHCARE III LIMITED PARTNERSHIP 260 HOSPITAL DRIVE BREVARD,NC28712 56-1599696	RENTAL	NC	N/A
(9) HEALTHCARE LIMITED LIABILITY COMPANY VII 260 HOSPITAL DRIVE BREVARD,NC28712 20-0343455	RENTAL	NC	N/A
(10) WESTERN NC HEALTHCARE INNOVATORS LLC 5935 CARNEGIE BLVD CHARLOTTE,NC28209 80-0787882	REAL ESTATE RENTAL	NC	N/A
(11) WESTERN REGIONAL RADIATION THERAPY CENTER 68 HOSPITAL DRIVE SYLVA,NC28799 56-1849395	RADIATION THERAPY	NC	N/A
(12) ASHEVILLE MRI PO BOX 2959 ASHEVILLE,NC28802 56-1665863	IMAGING SERVICES	NC	N/A
(13) WNC STONE CENTER 509 BILTMORE AVENUE ASHEVILLE,NC28801 27-2152974	LITHOTRIPSY RENTAL	NC	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) HORIZON HEALTH CORP 213 RIDGEFIELD COURT ASHEVILLE,NC28806 56-1341621	HOLDING COMPANY	NC	N/A	C				No
(2) HORIZON MANAGEMENT SERVICES 213 RIDGEFIELD COURT ASHEVILLE,NC28806 56-1341624	COLLECTIONS, BILLING, MEDICAL PROPERTY	NC	N/A	C				No
(3) DOGWOOD INSURANCE COMPANY LTD THE GRANT PAVILION COMMERCIAL CENTR CJ	CAPTIVE INSURANCE ENTITY	CJ	N/A	C				No
(4) TRANSYLVANIA SERVICES INC 260 HOSPITAL DRIVE BREVARD,NC28712 56-1448199	REAL ESTATE	NC	N/A	C				No

Schedule R (Form 990) 2012

Page 3

Part V

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

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

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 or (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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

Yes

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

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

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

Yes

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-s)	(c) Amount involved	(d) Method of determining amount involved
(1) BLUE RIDGE DME LLC	S	575,111	FMV
(2) BLUE RIDGE REGIONAL HOSPITAL FOUNDATION INC	C	226,757	FMV

Schedule R (Form 990) 2012

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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) 2012

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: PROVISION OF INPATIENT AND OUTPATIENT HOSPITAL SERVICES
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	9
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	489
6	Total number of volunteers (estimate if necessary) .............	6	48
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	377,346
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	349,448

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	608,617	226,757
9	Program service revenue (Part VIII, line 2g) .........	36,606,613	37,722,109
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	44,831	1,023,437
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	76,616	84,848
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	37,336,677	39,057,151
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	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)	21,660,255	24,510,457
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–24e)....	13,412,199	15,466,561
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	35,072,454	39,977,018
19	Revenue less expenses. Subtract line 18 from line 12.......	2,264,223	-919,867
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	56,863,466	56,047,559
21	Total liabilities (Part X, line 26).............	18,330,985	17,869,985
22	Net assets or fund balances. Subtract line 21 from line 20.....	38,532,481	38,177,574

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 34,410,964 including grants of $ ) (Revenue $ 37,165,878 )
	BLUE RIDGE REGIONAL HOSPITAL BELIEVES THAT PATIENT AND FAMILY-CENTERED CARE IS THE BEST APPROACH TO MEETING OUR PATIENTS' HEALTHCARE NEEDS. PATIENT AND FAMILY-CENTERED CARE MEANS PATIENTS, THEIR FAMILIES, DOCTORS, NURSES AND OTHER HEALTHCARE PROFESSIONALS FORM A PARTNERSHIP THAT BENEFITS EVERYONE.A FAMILY MEMBER IS RECOGNIZED AS ANYONE WHO PATIENTS REGARD AS SIGNIFICANT IN THEIR LIVES. FAMILIES ARE NOT CONSIDERED VISITORS, BUT ESSENTIAL PARTICIPANTS IN CARE AND DECISIONS THAT AFFECT THE TOTAL HEALING OF THE PATIENT. THE COMPONENTS OF FAMILY-CENTERED CARE ARE RESPECT AND DIGNITY; INFORMATION SHARING; AND PARTICIPATION AND COLLABORATION.THE GOAL IN CARING FOR PATIENTS AT BLUE RIDGE REGIONAL HOSPITAL IS THE SAME FOR PHYSICIANS, MEDICAL STAFF AND FAMILIES TO PROVIDE THE BEST CARE AND OUTCOME FOR THE PATIENT. IT TAKES A COMBINATION OF MODERN MEDICINE, COMPASSIONATE CARE, ADVANCED TECHNOLOGY, DEDICATED STAFF, AS WELL AS CARE PROVIDED BY FAMILIES TO REACH THE BEST POSSIBLE OUTCOME. THE STAFF AT BLUE RIDGE REGIONAL HOSPITAL IS DEDICATED TO CREATING THIS TYPE OF EXPERIENCE FOR EVERY PATIENT AND FAMILY MEMBER WHO ENTERS OUR DOORS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses34,410,964

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)		(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) MARVIN VICE........................................................................ STAFF PHYSICIAN	40.00 .......................	X	478,804	0	24,522
(19) DAVID ROBINSON........................................................................ STAFF PHYSICIAN	40.00 .......................	X	373,307	0	17,716
(20) SHEHLA KAHN........................................................................ STAFF PHYSICIAN	40.00 .......................	X	339,278	0	33,341
(21) KEVIN HOLLIFIELD........................................................................ CRNA	40.00 .......................	X	218,969	0	29,249
(22) RICHARD RHEINBOLT........................................................................ STAFF PHYSICIAN	40.00 .......................	X	197,226	0	15,266

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	2,177,459	496,308	284,769

				(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		226,757
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.......			226,757
			Business Code
2a	NET PATIENT REVENUE		900099	36,179,383	36,179,383
b	OTHER PROGRAM SERVICE REVENUE		900099	761,893	761,893
c	PARTNERSHIP REVENUE		900099	556,231	178,885	377,346
d	CAFETERIA REVENUE		722210	224,602			224,602
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			37,722,109
3	Investment income (including dividends, interest, and other similar amounts).......			195,568			195,568
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	102,515
b	Less: rental expenses	17,667
c	Rental income or (loss)	84,848
d	Net rental income or (loss).......			84,848			84,848
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	827,869
b	Less: cost or other basis and sales expenses	0
c	Gain or (loss)	827,869
d	Net gain or (loss)..........			827,869			827,869
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..
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...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See Instructions......			39,057,151	37,120,161	377,346	1,332,887


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			8,083,473	1	2,600,737
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			4,988,136	4	6,106,492
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				37,500	5	25,000
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			745,518	8	866,833
9	Prepaid expenses and deferred charges ..........			214,878	9	158,969
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	54,508,674
b	Less: accumulated depreciation .....	10b	24,427,260	30,106,872	10c	30,081,414
11	Investments—publicly traded securities ..........			4,217,754	11	6,416,083
12	Investments—other securities. See Part IV, line 11 .....			7,305,553	12	8,530,717
13	Investments—program-related. See Part IV, line 11 .....			999,520	13	981,160
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			164,262	15	280,154
16	Total assets. Add lines 1 through 15 (must equal line 34)......			56,863,466	16	56,047,559
17	Accounts payable and accrued expenses .........			2,587,749	17	3,225,655
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			935,000	20	735,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			2,310,038	23	1,100,857
24	Unsecured notes and loans payable to unrelated third parties ....			60,000	24	40,000
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....................			12,438,198	25	12,768,473
26	Total liabilities. Add lines 17 through 25.........			18,330,985	26	17,869,985
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			38,532,481	27	38,177,574
28	Temporarily restricted net assets ...........				28
29	Permanently restricted net assets ...........				29
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........			38,532,481	33	38,177,574
34	Total liabilities and net assets/fund balances ........			56,863,466	34	56,047,559