Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 10-01-2013 , 2013, and ending 09-30-2014
BCheck if applicable:
CName of organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Doing Business As
TRANSYLVANIA REGIONAL HOSPITAL
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 1116
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
BREVARD, NC28712
D Employer identification number

56-0562293
E Telephone number

G Gross receipts $ 66,127,996
F Name and address of principal officer:
 
PO BOX 1116
BREVARD,NC28712
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.trhospital.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1933
M State of legal domicile: NC
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: PROVISION OF MEDICAL SERVICES
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 16
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 11
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 682
6 Total number of volunteers (estimate if necessary) ............. 6 175
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 12,982
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 11,732
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,911,604 698,038
9 Program service revenue (Part VIII, line 2g) ......... 72,078,595 64,065,380
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 2,414,322 968,708
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 790,529 338,408
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 77,195,050 66,070,534
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 65,647 36,165
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) 30,757,643 31,991,413
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 40,175,191 29,832,931
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 70,998,481 61,860,509
19 Revenue less expenses. Subtract line 18 from line 12....... 6,196,569 4,210,025
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 75,885,413 78,766,658
21 Total liabilities (Part X, line 26)............. 23,145,585 25,323,692
22 Net assets or fund balances. Subtract line 21 from line 20..... 52,739,828 53,442,966
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: TRANSYLVANIA REGIONAL HOSPITAL PROMOTES WELLNESS AND PROVIDES ACCESS TO QUALITY HEALTH SERVICES FOR THE PEOPLE IN OUR REGION.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 47,487,386 including grants of $ 36,165 ) (Revenue $ 64,052,398 )
GIVING BACK TO THE COMMUNITYAS A NOT-FOR-PROFIT HOSPITAL, TRANSYLVANIA REGIONAL HOSPITAL IS COMMITTED TO GIVING BACK TO THE COMMUNITY TO HELP THOSE WHO ARE UNINSURED OR UNDERINSURED AS WELL AS PROVIDING HEALTH EDUCATION AND BENEFITS FOR THE WELL BEING OF THE ENTIRE COMMUNITY. DESPITE CHALLENGING FINANCIAL TIMES FOR THE HOSPITAL, TRH CONTINUES TO GENEROUSLY HELP THOSE IN NEED.- TRH OFFERS FREE OR LOW-COST EDUCATIONAL PROGRAMS FOR THE COMMUNITY EACH MONTH. PROGRAMS FEATURE TIMELY HEALTH TOPICS, AND ARE PRESENTED BY PHYSICIANS, NURSES, NURSE EDUCATORS, DIETITIANS AND OTHER CLINICAL PROFESSIONALS. MORE THAN 1,000 MEMBERS OF THE COMMUNITY TOOK ADVANTAGE OF THESE EDUCATIONAL OPPORTUNITIES - HELD AT THE HOSPITAL.- TRH OFFERS HEALTHCARE SERVICES THAT ARE NEEDED BY THIS COMMUNITY, REGARDLESS OF WHETHER OR NOT A MARGIN IS ACHIEVED BY PROVIDING CARE. EXAMPLES INCLUDE: EMERGENCY SERVICES AND BIRTHING CENTER.- TRH PRIORITIZES DONATIONS OF STAFF TIME, MEETING SPACE, SUPPLIES, EQUIPMENT AND ADVERTISING FOR COMMUNITY GROUPS. SOME GROUPS THAT BENEFITED FROM IN-KIND DONATIONS WERE: MARCH OF DIMES, UNITED WAY, CHAMBER OF COMMERCE, S.A.F.E., AMERICAN RED CROSS, RELAY FOR LIFE, PROJECT LAZARUS COMMUNITY-BASED OVERDOSE PREVENTION, THE TRANSYLVANIA COUNTY SCHOOL SYSTEM, TRANSYLVANIA PARTNERSHIP FOR HEALTH, TRANSYLVANIA COUNTY ECONOMIC DEVELOPMENT, WNC HEALTHY IMPACT AND OTHERS.- TRH WAS AN ACTIVE PARTICIPANT IN THE 16-COUNTY REGIONAL HEALTH NEEDS ASSESSMENT PROJECT: WNC HEALTHY IMPACT. THIS INNOVATIVE EFFORT HELPED TRH TEAM WITH HEALTH DEPARTMENTS AND HOSPITALS ACROSS WESTERN NORTH CAROLINA TO IDENTIFY CRITICAL COMMUNITY HEALTH NEEDS AND PUT RESOURCES WHERE THEY ARE MOST NEEDED TO IMPROVE THE HEALTH AND LIVES OF RESIDENTS IN THIS COMMUNITY AND ACROSS THE REGION. TRH WORKED CLOSELY WITH THE TRANSYLVANIA COUNTY DEPARTMENT OF PUBLIC HEALTH TO DEVELOP A COMMUNITY HEALTH NEEDS ASSESSMENT FOR TRANSYLVANIA COUNTY.- TRH CONTINUED A CARE MANAGEMENT PROGRAM FOR COPD PATIENTS IN OUR COMMUNITY SUPPORTED BY GRANT FUNDING.- TRH-ALONG WITH THE TRANSYLVANIA COUNTY HEALTH DEPARTMENT, THE FREE CLINIC AND OTHERS-WORKED COLLABORATIVELY TO BRING A BLUE RIDGE COMMUNITY HEALTH SERVICES CLINIC TO OUR LOCAL COMMUNITY. THE NEW BREVARD HEALTH CENTER OPENED IN FALL 2012 ON THE TRH CAMPUS TO INCREASE ACCESS TO AFFORDABLE, COMPREHENSIVE HEALTH SERVICES IN TRANSYLVANIA COUNTY. THE NEW FEDERAL HEALTH CENTER OFFERS A FULL SPECTRUM OF HEALTH SERVICES TO RESIDENTS, INCLUDING PRIMARY CARE FOR ADULTS AND CHILDREN, DENTAL SERVICES, MEDICATION ASSISTANCE AND BEHAVIORAL HEALTH.- TRH IMPLEMENTED A PALLIATIVE CARE PROGRAM WITH SUPPORT FROM THE TRH FOUNDATION TO MEET THE INCREASING NEEDS FOR THIS SERVICE IN OUR COMMUNITY. THIS LOCAL SERVICE PROVIDES COMPASSIONATE, EXPERT MEDICAL CARE TO RELIEVE AND PREVENT THE SUFFERING OF PATIENTS IN OUR COMMUNITY WHO ARE UNDERGOING TREATMENT FOR CURABLE ILLNESSES AND THOSE LIVING WITH CHRONIC DISEASES, AS WELL AS PATIENTS WHO ARE NEARING THE END OF LIFE.
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 expensesMediumBullet47,487,386
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions).... Click to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I...................
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II....................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
88
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
682
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
16
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
11
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
NC
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletMISSION FINANCE DEPARTMENT400 RIDGEFIELD CT STE 100ASHEVILLENC28806 (828) 257-7063
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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) 		(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) JOHN F HOLBROOK........................................................................
CHAIRMAN
 1.00
.......................   		X   X       0 0 0
(2) KENNETH G RACHT........................................................................
VICE CHAIR
 8.00
.......................2.00 		X   X       0 0 0
(3) WILLIAM A TOWLER........................................................................
TREASURER
 1.00
.......................   		X   X       0 0 0
(4) THELMA ERICKSON........................................................................
SECRETARY
 1.00
.......................   		X   X       0 0 0
(5) ROBERT J BEDNAREK........................................................................
CEO through May 2014
 40.00
.......................6.00 		X   X       509,321 0 30,070
(6) JOE COHEN MD........................................................................
CHIEF OF MEDICAL STAFF
 50.00
.......................0.00 		X           0 0 0
(7) CHARLES AYSCUE........................................................................
BOARD MEMBER
 1.00
.......................59.00 		X           0 715,831 19,608
(8) ERNESTO E DE LA TORRE........................................................................
BOARD MEMBER
 1.00
.......................39.00 		X           0 184,614 20,700
(9) DICK LARSON........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(10) ORA J WELLS MD........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(11) ROSWELL S BOWERS........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(12) ROBERT MAXWELL........................................................................
BOARD MEMBER
 1.00
.......................   		X           0 0 0
(13) RICHARD BOCK MD........................................................................
BOARD MEMBER
 1.00
.......................8.00 		X           0 0 0
(14) MARK LEMEL MD........................................................................
VICE CHIEF OF MEDICAL STAF
 10.00
.......................40.00 		X           0 531,754 14,488
(15) PARKER PLATT........................................................................
BOARD MEMBER
 1.00
.......................0.00 		X           0 0 0
(16) ANN YOUNG........................................................................
BOARD MEMBER
 1.00
.......................59.00 		X           0 430,428 26,679
(17) CRAIG JAMES........................................................................
INTERIM CEO STARTING MAY 2014
 1.00
.......................43.00 		X   X       0 205,845 8,589
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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) 		(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
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) MARC NAKAGAWA........................................................................
CFO
 40.00
.......................1.00 		    X       154,213 0 26,745
(19) REBECCA W CARTER........................................................................
COO
 40.00
.......................1.00 		    X       186,491 0 20,746
(20) CATHY LANDIS........................................................................
PRESIDENT / CNO
 50.00
.......................1.00 		    X       0 0 0
(21) ELIZABETH PELLETIER........................................................................
LEAD CRNA
 40.00
.......................   		        X   169,939 0 26,615
(22) MARK CREASMAN........................................................................
PHARMACIST
 40.00
.......................0.00 		        X   165,162 0 20,768
(23) JUDITH MCKAY........................................................................
CRNA
 40.00
.......................0.00 		        X   162,535 0 17,761
(24) KIMBERLY PHILLIPS........................................................................
PHARMACIST
 40.00
.......................0.00 		        X   142,989 0 18,917
(25) LAUREL JOHNSON........................................................................
CRNA
 40.00
.......................0.00 		        X   167,420 0 20,071










1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,658,070 2,068,472 271,757
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet17
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
MORRISON MANAGEMENT SPECIALISTSPO BOX 102289ATLANTAGA303682289 FOOD SERVICES 1,545,900
REHAB SERVICES OF BREVARD LLC376A GOVERNMENT STMOBILEAL36693 PHYSICAL THERAPY SERVICES 1,467,863
TRANSYL EMERG PHYS PLLC3107 STIRLING RD 300FT LAUDERDALEFL33312 E/R PHYSICIAN SERVICES 1,429,576
COMPREHENSIVE HOSPITALIST SERVICES OF NC300 SOUTH PARK ROAD STE 400HOLLYWOODFL33021 HOSPITALIST PHY. SERV. 1,161,320
AESCULAPIUS ENTERPRISES LLC377 Gallimore RoadBREVARDNC28712 BUSINESS CONSULTING 338,381
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet22
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 17,290
d Related organizations...1d 556,658
e Government grants (contributions)1e 65,516
f All other contributions, gifts, grants, and
similar amounts not included above1f 		58,574
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 698,038
Program Service RevenueAmt Business Code
2a Net Patient Service Re 621400 57,328,517 57,328,517    
b Other Revenue 621610 4,463,350 4,450,368 12,982  
c Pharmacy and Medical S 446110 2,273,513 2,273,513    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 64,065,380
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 69,584     69,584
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 9,735  
b Less: rental expenses 0  
c Rental income or (loss) 9,735  
d Net rental income or (loss).......MediumBullet 9,735     9,735
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 901,299  
b Less: cost or other basis and sales expenses 0 2,175
c Gain or (loss) 901,299 -2,175
d Net gain or (loss)..........MediumBullet 899,124     899,124
8a Gross income from fundraising events (not including
$ 17,290
of contributions reported on line 1c). See Part IV, line 18 ..
a 26,558
b Less: direct expenses ...b 19,544
c Net income or (loss) from fundraising events..MediumBullet 7,014   7,014
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...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a 49,275
b Less: cost of goods sold ..b 35,743
c Net income or (loss) from sales of inventory..MediumBullet 13,532     13,532
Miscellaneous Revenue Business Code
11a PARTNERSHIP INCOME IN 900099 235,195     235,195
b MISCELLANEOUS REVENUE 900099 72,932     72,932
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 308,127
12 Total revenue. See Instructions......MediumBullet 66,070,534 64,052,398 12,982 1,307,116
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
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 36,165 36,165
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 .... 833,354 666,683 166,671  
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 26,303,585 18,961,439 7,342,146  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 676,419 471,572 204,847  
9 Other employee benefits ....... 2,676,211 1,865,749 810,462  
10 Payroll taxes ........... 1,501,844 1,047,026 454,818  
11 Fees for services (non-employees):        
a Management ...... 3,102,632 2,416,250 686,382  
b Legal ......... 96,688   96,688  
c Accounting ........... 25,853   25,853  
d Lobbying ........... 4,560   4,560  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 4,427   4,427  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 3,646,281 3,413,958 232,323  
12 Advertising and promotion .... 71,060 3,016 68,044  
13 Office expenses ....... 2,367,932 1,573,537 794,395  
14 Information technology ......        
15 Royalties ..        
16 Occupancy ........... 2,038,087 1,732,374 305,713  
17 Travel ............ 100,885 52,343 48,542  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ........... 94,276 80,135 14,141  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 3,301,829 2,806,555 495,274  
23 Insurance .............. 436,557   436,557  
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 7,075,952 6,014,559 1,061,393  
b Purchased Services 2,550,737 2,168,126 382,611  
c Maintenance 1,175,996 999,597 176,399  
d Equipment 319,625 271,681 47,944  
e All other expenses 3,419,554 2,906,621 512,933  
25 Total functional expenses. Add lines 1 through 24e 61,860,509 47,487,386 14,373,123 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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 2,158,418 1 5,493,828
2 Savings and temporary cash investments ......... 790,043 2 824,735
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 8,564,761 4 8,284,141
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
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 ............. 712,968 7 1,739,013
8 Inventories for sale or use .............. 1,557,930 8 1,503,309
9 Prepaid expenses and deferred charges .......... 236,696 9 99,425
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 42,394,132
b Less: accumulated depreciation ..... 10b 10,200,035 31,866,901 10c 32,194,097
11 Investments—publicly traded securities .......... 8,879,260 11 6,184,048
12 Investments—other securities. See Part IV, line 11 .....   12 3,616,345
13 Investments—program-related. See Part IV, line 11 ..... 16,331,828 13 16,232,001
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 4,786,608 15 2,595,716
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 75,885,413 16 78,766,658
Liabilities 17 Accounts payable and accrued expenses ......... 5,982,842 17 4,484,428
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities ............. 13,643,264 20 12,860,000
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 ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24 1,456,783
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.................... 3,519,479 25 6,522,481
26 Total liabilities. Add lines 17 through 25......... 23,145,585 26 25,323,692
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 36,783,888 27 37,762,018
28 Temporarily restricted net assets ........... 14,413,596 28 14,058,404
29 Permanently restricted net assets ........... 1,542,344 29 1,622,544
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet 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 ........... 52,739,828 33 53,442,966
34 Total liabilities and net assets/fund balances ........ 75,885,413 34 78,766,658
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
66,070,534
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
61,860,509
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
4,210,025
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
52,739,828
5
Net unrealized gains (losses) on investments ...............
5
-23,966
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-3,482,921
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
53,442,966
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Employer identification number

56-0562293
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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).  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. 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) 2013

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Employer identification number

56-0562293
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......................... 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 its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
  		Employer identification number

56-0562293
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, RESTRICTEDRESTRICTED

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
  		Employer identification number

56-0562293
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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
  		Employer identification number

56-0562293
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 (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2013)

Additional Data


Software ID:  
Software Version:  
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.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Employer identification number

56-0562293
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
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) 2013

Schedule C (Form 990 or 990-EZ) 2013
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 Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(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? ......................................

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) 2010 (b) 2011 (c) 2012 (d) 2013 (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) 2013


Schedule C (Form 990 or 990-EZ) 2013
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)
No
Yes
(b)
Amount
1
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:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
4,560
j
Total. Add lines 1c through 1i ...............................
4,560
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
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
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
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."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
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? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
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.
Return Reference Explanation
Part II-B, Line 1: THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA), THE NORTH CAROLINA HOSPITAL ASSOCIATION (NCHA), AND THE NATIONAL RURAL HEALTH ASSOCIATION (NRHA). THE PORTION OF DUES PAID THAT IS ALLOCATED TO LOBBYING EFFORTS PERFORMED BY THESE ORGANIZATIONS ON BEHALF OF ITS MEMBERSHIP BODY IS 22.8%. FOR THE YEAR, THE LOBBYING PORTION OF MEMBERSHIP DUES IS ESTIMATED TO BE APPROXIMATELY $ 4,560.
Schedule C (Form 990 or 990EZ) 2013

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Employer identification number

56-0562293
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 ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? .......................................
9
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.
1a
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.
b
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 $  
2
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:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
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 .... 14,115,217 6,044,727      
b Contributions ........ 280,750 8,353,318      
c Net investment earnings, gains, and losses 182,293 460,965      
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		187,472 743,793      
f Administrative expenses ....          
g End of year balance ...... 14,390,788 14,115,217      
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet87.580 %
b
Permanent endowment SchDMd Bullet11.890 %
c
Temporarily restricted endowment SchDMd Bullet0.530 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   7,111,000 7,111,000
b Buildings ................   17,902,478 3,145,390 14,757,088
c Leasehold improvements ............   5,700 1,710 3,990
d Equipment ................   10,011,122 2,669,339 7,341,783
e Other .................   7,363,832 4,383,596 2,980,236
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 32,194,097
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) INTEREST IN NET ASSETS OF TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION 15,680,947 C
(2) Interest in Brevard MRI, LLC 487,247 C
(3) Interest in Blue Ridge DME 45,807 C
(4) INTEREST IN TRANSYLVANIA SERVICES, INC. 18,000 C





Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 16,232,001
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. 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.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
Due to Affiliated Organizations 6,522,481








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 6,522,481
2. Liability for uncertain tax positions 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) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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
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.
Return Reference Explanation
Part V, Line 4: TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION, INC A RELATED ORGANIZATION MAINTAINS ENDOWMENTS TO BE USED FOR THE HOSPITAL'S EXEMPT PURPOSE OF PROVIDING HEALTHCARE TO ITS COMMUNITY. ENDOWMENTS ARE MAINTAINED TO ASSIST WITH CHARITABLE HEALTHCARE FUNDING.
Part X, Line 2: THE HOSPITAL, THE FOUNDATION, AND TRANSYLVANIA PHYSICIAN SERVICES, INC. ARE INCORPORATED AS NONPROFIT ORGANIZATIONS UNDER THE LAWS OF NORTH CAROLINA AND ARE EXEMPT FROM INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. BREVARD MRI, WITH THE CONSENT OF ITS SHAREHOLDERS, HAS ELECTED TO BE TREATED AS A PARTNERSHIP FOR FEDERAL AND NORTH CAROLINA INCOME TAX PURPOSES. IN LIEU OF CORPORATE INCOME TAXES, EARNINGS AND LOSSES ARE INCLUDED IN THE INCOME TAX RETURNS OF THE SHAREHOLDERS; ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. INCOME TAXES FOR TRANSYLVANIA SERVICES, INC. ARE PROVIDED FOR THE TAX EFFECTS OF TRANSACTIONS REPORTED IN THE CONSOLIDATED FINANCIAL STATEMENTS AND CONSIST OF TAXES CURRENTLY DUE PLUS DEFERRED TAX EXPENSE OR MINUS DEFERRED TAX BENEFIT RELATED PRIMARILY TO DIFFERENCES ARISING FROM THE METHODS OF CALCULATING DEPRECIATION FOR FINANCIAL AND INCOME TAX REPORTING. AN EVALUATION OF THE PROBABILITY OF BEING ABLE TO REALIZE THE FUTURE BENEFITS OF DEFERRED TAX ASSETS IS MADE. A VALUATION ALLOWANCE IS PROVIDED FOR THE PORTION OF THE DEFERRED TAX ASSET WHEN IT IS MORE LIKELY THAN NOT THAT SOME PORTION OR ALL OF THE DEFERRED TAX ASSET WILL NOT BE REALIZED. THE ORGANIZATIONS HAVE DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS EXIST FOR OPEN TAX YEARS AS OF SEPTEMBER 30, 2014. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
right arrowInformation about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Employer identification number

56-0562293
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2013
Schedule G (Form 990 or 990-EZ) 2013
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

GOLF TOURNAMENT
(event type) 		(b) Event #2

 
(event type) 		(c) Other events

 
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 43,848     43,848
2 Less: Contributions . . 17,290     17,290
3 Gross income (line 1
minus line 2) . . . 		26,558     26,558
VerticalDirectExpenses 4 Cash prizes . . .        
5 Noncash prizes . .        
6 Rent/facility costs . .        
7 Food and beverages .        
8 Entertainment . . .        
9 Other direct expenses . 19,544     19,544
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 19,544
11 Net income summary. Subtract line 10 from line 3, column (d)........... right arrow 7,014
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
%
%
%
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Subtract line 7 from line 1, column (d) ......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2013
Schedule G (Form 990 or 990-EZ) 2013
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
%
b
An outside facility ........................
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2013
Additional Data


Software ID:  
Software Version:  
SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Employer identification number

56-0562293
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
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.
3
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.
a
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:
3a
Yes
 
%
b
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: .........
3b
Yes
 
%
c
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.
4
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"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
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? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (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) .. 		    2,019,569   2,019,569 3.260 %
b Medicaid (from Worksheet 3,
column a) .... 		    7,675,105 7,069,629 605,476 0.980 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    9,694,674 7,069,629 2,625,045 4.240 %
Other Benefits
     56,200   56,200 0.090 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		           
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    37,585   37,585 0.060 %
j Total. Other Benefits ..     93,785   93,785 0.150 %
k Total. Add lines 7d and 7j .     9,788,459 7,069,629 2,718,830 4.390 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development     260,050   260,050 0.420 %
9 Other            
10 Total     260,050   260,050 0.420 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
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
2,757,980
3
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. ......
3
 
4
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
5
Enter total revenue received from Medicare (including DSH and IME).....
5
21,827,114
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
21,330,345
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
496,769
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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.......................

9b

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 %
11 BREVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL LLC
  		MRI SERVICES 50.000 % 1.430 % 50.000 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 TRANSYLVANIA REGIONAL HOSPITAL
260 HOSPITAL DRIVE
BREVARD,NC28712
www.trhospital.org
H0111 		X X     X   X      
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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)
TRANSYLVANIA COMMUNITY HOSPITAL INC
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 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.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests 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 .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 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 ........ 7 Yes  
8a 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)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c 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) 2013
Schedule H (Form 990) 2013
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: 400.000000000000%
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
b
c
d
e
f
g
h
i
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
b
c
d
e
f
g
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 individual’s eligibility under the facility’s FAP:
a
b
c
d
e
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 individual’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
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
TRANSYLVANIA COMMUNITY HOSPITAL, INC. Part V, Section B, Line 3: AFTER GATHERING ALL PUBLICALLY AVAILABLE SECONDARY HEALTH DATA FOR OUR PRIMARY SERVICE AREA, THE TRANSYLVANIA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT EMPLOYED A STRATIFIED RANDOM SAMPLE OF 200 RESIDENTS OF TRANSYLVANIA COUNTY, N.C. TO SUPPLEMENT THE SECONDARY CORE DATASET, MEET ADDITIONAL STAKEHOLDER DATA NEEDS, AND HEAR FROM COMMUNITY MEMBERS ABOUT THEIR CONCERNS AND PRIORITIES, A COMMUNITY SURVEY, 2012 WNC HEALTHY IMPACT SURVEY, WAS DEVELOPED AND IMPLEMENTED IN 16 COUNTIES ACROSS WESTERN NORTH CAROLINA. THE SURVEY INSTRUMENT WAS DEVELOPED BY WNC HEALTHY IMPACT'S DATA WORKGROUP, CONSULTING TEAM, AND LOCAL PARTNERS WITH ASSISTANCE FROM PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC). MANY OF THE QUESTIONS ARE DERIVED FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), AS WELL AS OTHER PUBLIC HEALTH SURVEYS; OTHER QUESTIONS WERE DEVELOPED SPECIFICALLY FOR WNC HEALTHY IMPACT TO ADDRESS PARTICULAR ISSUES OF INTEREST TO COMMUNITIES IN WESTERN NORTH CAROLINA. EACH COUNTY WAS GIVEN THE OPPORTUNITY TO INCLUDE THREE ADDITIONAL QUESTIONS OF PARTICULAR INTEREST TO THEIR COUNTY, WHICH WERE ASKED OF THEIR COUNTY'S RESIDENTS. TO ENSURE THE BEST REPRESENTATION OF THE POPULATION SURVEYED, A TELEPHONE INTERVIEW METHODOLOGY (ONE THAT INCORPORATES BOTH LANDLINE AND CELL PHONE INTERVIEWS) WAS EMPLOYED. THE SAMPLE DESIGN USED FOR THIS REGIONAL EFFORT CONSISTED OF A STRATIFIED RANDOM SAMPLE OF 3,300 INDIVIDUALS AGE 18 AND OLDER IN WESTERN NORTH CAROLINA. OUR COUNTY'S SAMPLE SIZE WAS 200.THE INTERVIEWS WERE CONDUCTED IN EITHER ENGLISH OR SPANISH, AS PREFERRED BY RESPONDENTS. FOR THE TRANSYLVANIA COUNTY FINDINGS, THE MAXIMUM ERROR RATE IS 6.9%. IN ADDITION, SEVERAL COMMUNITY-WIDE LISTENING SESSIONS WERE CONDUCTED TO HEAR THE COMMUNITY'S CONCERNS AND TO RANK THE COMMUNITY HEALTH PRIORITIES BASED ON THE SURVEY RESULTS.
TRANSYLVANIA COMMUNITY HOSPITAL, INC. Part V, Section B, Line 4: Regional Partnership:Transylvania Regional Hospital'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 Carolinaregion 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.
TRANSYLVANIA COMMUNITY HOSPITAL, INC. Part V, Section B, Line 14g: -BROCHURES AVAILABLE AT PRACTICES AND HOSPITALS-FINANCIAL COUNSELORS REVIEW WITH PATIENTS
TRANSYLVANIA COMMUNITY HOSPITAL, INC. Part V, Section B, Line 20d: THE HOSPITAL USES THE AVERAGE OF COMMERICAL INSURANCE RATES INCLUDING MEDICARE.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. 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?9
Name and address Type of Facility (describe)
1 TRH OUTPATIENT REHABILITATION
92 CHESTNUT STREET
BREVARD,NC28712 		OUTPATIENT REHAB
2 TRH HOME CARE SERVICES
1234 ASHEVILLE HWY
BREVARD,NC28712 		HOME CARE
3 BREVARD MRI
301 HOSPITAL DRIVE
BREVARD,NC28712 		IMAGING CENTER
4 TOXAWAY HEALTH CENTER
16825 ROSMAN HWY
LAKE TOXAWAY,NC28747 		PROVIDER-BASED CLINICS
5 BREVARD FAMILY PRACTICE
187 MEDICAL PARK DR
BREVARD,NC28712 		PROVIDER-BASED CLINICS
6 MEDICAL ASSOCIATES OF TRH
377 GALLIMORE ROAD
BREVARD,NC28712 		PROVIDER-BASED CLINICS
7 BREVARD INTERNAL MEDICINE & PULMONOLOGY
159 MEDICAL PARK DR SUITE B
BREVARD,NC28712 		PROVIDER-BASED CLINICS
8 KOALA
23 MEDICAL PARK CIRCLE
BREVARD,NC28712 		OUTPATIENT
9 BREVARD CANCER & INFUSION CENTER
89 HOSPITAL DR
BREVARD,NC28712 		OUTPATIENT
10
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
TRANSYLVANIA COMMUNITY HOSPITAL, INC. Part V, Section B, Line 3: AFTER GATHERING ALL PUBLICALLY AVAILABLE SECONDARY HEALTH DATA FOR OUR PRIMARY SERVICE AREA, THE TRANSYLVANIA COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT EMPLOYED A STRATIFIED RANDOM SAMPLE OF 200 RESIDENTS OF TRANSYLVANIA COUNTY, N.C. TO SUPPLEMENT THE SECONDARY CORE DATASET, MEET ADDITIONAL STAKEHOLDER DATA NEEDS, AND HEAR FROM COMMUNITY MEMBERS ABOUT THEIR CONCERNS AND PRIORITIES, A COMMUNITY SURVEY, 2012 WNC HEALTHY IMPACT SURVEY, WAS DEVELOPED AND IMPLEMENTED IN 16 COUNTIES ACROSS WESTERN NORTH CAROLINA. THE SURVEY INSTRUMENT WAS DEVELOPED BY WNC HEALTHY IMPACT'S DATA WORKGROUP, CONSULTING TEAM, AND LOCAL PARTNERS WITH ASSISTANCE FROM PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC). MANY OF THE QUESTIONS ARE DERIVED FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), AS WELL AS OTHER PUBLIC HEALTH SURVEYS; OTHER QUESTIONS WERE DEVELOPED SPECIFICALLY FOR WNC HEALTHY IMPACT TO ADDRESS PARTICULAR ISSUES OF INTEREST TO COMMUNITIES IN WESTERN NORTH CAROLINA. EACH COUNTY WAS GIVEN THE OPPORTUNITY TO INCLUDE THREE ADDITIONAL QUESTIONS OF PARTICULAR INTEREST TO THEIR COUNTY, WHICH WERE ASKED OF THEIR COUNTY'S RESIDENTS. TO ENSURE THE BEST REPRESENTATION OF THE POPULATION SURVEYED, A TELEPHONE INTERVIEW METHODOLOGY (ONE THAT INCORPORATES BOTH LANDLINE AND CELL PHONE INTERVIEWS) WAS EMPLOYED. THE SAMPLE DESIGN USED FOR THIS REGIONAL EFFORT CONSISTED OF A STRATIFIED RANDOM SAMPLE OF 3,300 INDIVIDUALS AGE 18 AND OLDER IN WESTERN NORTH CAROLINA. OUR COUNTY'S SAMPLE SIZE WAS 200.THE INTERVIEWS WERE CONDUCTED IN EITHER ENGLISH OR SPANISH, AS PREFERRED BY RESPONDENTS. FOR THE TRANSYLVANIA COUNTY FINDINGS, THE MAXIMUM ERROR RATE IS 6.9%. IN ADDITION, SEVERAL COMMUNITY-WIDE LISTENING SESSIONS WERE CONDUCTED TO HEAR THE COMMUNITY'S CONCERNS AND TO RANK THE COMMUNITY HEALTH PRIORITIES BASED ON THE SURVEY RESULTS.
TRANSYLVANIA COMMUNITY HOSPITAL, INC. Part V, Section B, Line 4: Regional Partnership:Transylvania Regional Hospital'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 Carolinaregion 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.
TRANSYLVANIA COMMUNITY HOSPITAL, INC. Part V, Section B, Line 14g: -BROCHURES AVAILABLE AT PRACTICES AND HOSPITALS-FINANCIAL COUNSELORS REVIEW WITH PATIENTS
TRANSYLVANIA COMMUNITY HOSPITAL, INC. Part V, Section B, Line 20d: THE HOSPITAL USES THE AVERAGE OF COMMERICAL INSURANCE RATES INCLUDING MEDICARE.
Schedule H (Form 990) 2013
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Employer identification number
56-0562293
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC
223 W JORDAN STREET
BREVARD,NC28712 		56-1458024 501(C)(3) 36,165       OPERATIONAL ASSISTANCE






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2013

Schedule I (Form 990) 2013
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
Schedule I (Form 990) 2013


Additional Data


Software ID:  
Software Version:  


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, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Employer identification number

56-0562293
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)ROBERT J BEDNAREKCEO through May 2014 (i)
(ii)		 236,283
0 		74,500
0 		198,538
0 		9,708
0 		20,362
0 		539,391
0 		90,160
0
(2)CHARLES AYSCUEBOARD MEMBER (i)
(ii)		 0
442,283 		0
141,971 		0
131,577 		0
15,300 		0
4,308 		0
735,439 		0
92,070
(3)ERNESTO E DE LA TORREBOARD MEMBER (i)
(ii)		 0
169,546 		0
14,917 		0
151 		0
5,100 		0
15,600 		0
205,314 		0
0
(4)MARK LEMEL MDVICE CHIEF OF MEDICAL STAF (i)
(ii)		 0
374,662 		0
119,835 		0
37,257 		0
10,530 		0
3,958 		0
546,242 		0
0
(5)ANN YOUNGBOARD MEMBER (i)
(ii)		 0
321,735 		0
18,950 		0
89,743 		0
17,500 		0
9,179 		0
457,107 		0
45,358
(6)CRAIG JAMESINTERIM CEO STARTING MAY 2014 (i)
(ii)		 0
188,887 		0
16,958 		0
0 		0
6,176 		0
2,413 		0
214,434 		0
0
(7)MARC NAKAGAWACFO (i)
(ii)		 124,316
0 		25,331
0 		4,566
0 		2,625
0 		24,120
0 		180,958
0 		0
0
(8)REBECCA W CARTERCOO (i)
(ii)		 159,011
0 		18,815
0 		8,665
0 		8,177
0 		12,569
0 		207,237
0 		0
0
(9)ELIZABETH PELLETIERLEAD CRNA (i)
(ii)		 166,216
0 		3,369
0 		354
0 		6,388
0 		20,227
0 		196,554
0 		0
0
(10)MARK CREASMANPHARMACIST (i)
(ii)		 149,531
0 		6,092
0 		9,539
0 		6,391
0 		14,377
0 		185,930
0 		0
0
(11)JUDITH MCKAYCRNA (i)
(ii)		 161,119
0 		0
0 		1,416
0 		8,164
0 		9,597
0 		180,296
0 		0
0
(12)KIMBERLY PHILLIPSPHARMACIST (i)
(ii)		 141,542
0 		82
0 		1,365
0 		7,094
0 		11,823
0 		161,906
0 		0
0
(13)LAUREL JOHNSONCRNA (i)
(ii)		 166,088
0 		320
0 		1,012
0 		8,500
0 		11,571
0 		187,491
0 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
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.
Return Reference Explanation
Part I, Line 3 Compensation for officers and executives are set by Mission Health System. See Schedule O for additional detail.
Part I, Line 4b Directors, Officers, Key employees and Top Five Employees who participated in a Supplemental Non-Qualified retirement plan with contribution amounts. These amounts are disclosed in the deferred compensation section of Schedule J. Marc Nakagawa $5,074 Directors, Officers, Key employees and Top Five Employees who received payments from a supplemental non-qualified retirement plan. These payments are included in Other Reportable Compensation on Schedule J, page 2. Charles Ayscue $92,070 Robert Bednarek $166,305
Schedule J (Form 990) 2013

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Employer identification number
56-0562293
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer 		(i) Pool
financing
Yes No Yes No Yes No
A NORTH CAROLINA MEDICAL CARE COMMISSION
  		52-1309402   08-24-2011 14,655,000 CURRENT REFUNDING   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 1,795,000      
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 14,655,000      
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . .        
8 Credit enhancement from proceeds . . . . . . . . . . .        
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . .        
11 Other spent proceeds . . . . . . . . . . . . . . 14,655,000      
12 Other unspent proceeds . . . . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . . 2006
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . . X              
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2013
Schedule K (Form 990) 2013
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .   X            
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   X            
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet        
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet        
6 Total of lines 4 and 5 . . . . . . . . . . . . .        
7 Does the bond issue meet the private security or payment test? . . . . .   X            
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? . . . . . . . 		  X            
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T? . . . . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .   X            
b Exception to rebate? . . . . . . . . X              
c No rebate due? . . . . . . . . X              
If you checked "No rebate due" in line 2c, provide in
Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . . X              
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was the hedge terminated? . . . . . .                
Schedule K (Form 990) 2013
Schedule K (Form 990) 2013
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   X            
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X              
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
Date Rebate Computation Performed Issuer Name: NORTH CAROLINA MEDICAL CARE COMMISSION Date the Rebate Computation was Performed: 09/09/2011
SCHEDULE K, PART II, LINE 11, OTHER SPENT PROCEEDS: THE AMOUNT PRESENT ON PART II, LINE 11 REPRESENTS AMOUNTS USED TO CURRENTLY REFUND PRIOR ISSUES DATED NOVEMBER 20, 1997 AND MARCH 9, 2009. SERIES 1997 REFUNDING: $ 2,255,000 SERIES 2009 REFUNDING: 12,400,000 TOTAL TO LINE 11: $ 14,655,000
Schedule K (Form 990) 2013

Additional Data


Software ID:  
Software Version:  

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.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Employer identification number

56-0562293
Return Reference Explanation
Form 990, Part VI, Section A, line 1 THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE BOARD CHAIRMAN, THE VICE CHAIRMAN, THE SECRETARY, THE TREASURER, THE PRESIDENT, THE CHIEF OF THE MEDICAL STAFF, THE CHAIR OF GOVERNANCE, AND THE CHAIR OF QUALITY. THE BOARD CHAIRMAN SHALL SERVE AS THE CHAIRMAN OF THE EXECUTIVE COMMITTEE. THE TERM OF OFFICE OF THE ELECTED MEMBER OF THE EXECUTIVE COMMITTEE SHALL BE ONE YEAR OR UNTIL A SUCCESSOR SHALL HAVE BEEN DULY ELECTED BY THE BOARD OF TRUSTEES. ANY VACANCY IN THE POSITION OF THE ELECTED MEMBER OF THE EXECUTIVE COMMITTEE SHALL BE FILLED AS SOON AS POSSIBLE AFTER THE OCCURRENCE OF THE VACANCY. THE EXECUTIVE COMMITTEE SHALL HAVE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE PERIODS BETWEEN MEETINGS OF THE BOARD OF TRUSTEES SUBJECT TO ANY PRIOR LIMITATION IMPOSED BY THE BOARD OF TRUSTEES AND WITH THE UNDERSTANDING THAT ALL MATTERS OF MAJOR IMPORTANCE SHALL, EXCEPT IN EMERGENCY, BE REFERRED TO THE BOARD OF TRUSTEES. IN ORDER TO TRANSACT THE BUSINESS OF THE HOSPITAL, THE EXECUTIVE COMMITTEE SHALL HOLD A MEETING AT WHICH AT LEAST FIVE MEMBERS OF THE COMMITTEE ARE SIMULTANEOUSLY PRESENT IN PERSON OR BY TELEPHONE AND ALL MEMBERS HAVE BEEN GIVEN NOTICE OF THE MEETING. THIS NOTICE SHALL STATE THE BUSINESS FOR WHICH THE MEETING HAS BEEN CALLED, AND NO BUSINESS OTHER THAN THAT STATED IN THE NOTICE SHALL BE TRANSACTED AT SUCH MEETING. MINUTES OF THE EXECUTIVE COMMITTEE MEETINGS WILL BE SUBMITTED TO THE BOARD, AND ITS ACTIONS SHALL BE SUBJECT TO APPROVAL AT THE NEXT REGULAR BOARD MEETING.
Form 990, Part VI, Section A, line 3 IN OCTOBER 2012, TRANSYLVANIA REGIONAL HOSPITAL WAS AFFILIATED WITH MISSION HEALTH SYSTEM AND WAS NO LONGER BEING ONLY MANAGED BY THE MISSION HEALTH SYSTEM. THE CEO, REGIONAL DIRECTOR OF FINANCE, AND DIRECTOR OF IT ARE MISSION HEALTH SYSTEM EMPLOYEES THAT TRH CONTRACTS FOR THEIR EXPERTISE.
Form 990, Part VI, Section A, line 6 THE HOSPITAL IS A MEMBERSHIP CORPORATION, OF WHICH THE SOLE MEMBER (THE "MEMBER") IS MISSION HEALTH SYSTEM, INC.
Form 990, Part VI, Section A, line 7a THE BOARD OF TRUSTEES WILL CONSIST OF NOT LESS THAN 11 AND NOT MORE THAN 16 VOTING MEMBERS. UP TO TWO TRUSTEES MAY BE APPOINTED BY MISSION AT ANY TIME (THE "MISSION TRUSTEES") AND IN ALL EVENTS, AT LEAST A MAJORITY OF THE TRUSTEES MUST BE COMMUNITY TRUSTEES. TRUSTEES OTHER THAN MISSION TRUSTEES ARE REFERRED TO HEREIN AS "COMMUNITY TRUSTEES." THERE WILL BE NOT LESS THAN NINE (9) AND NO MORE THAN THIRTEEN (13) COMMUNITY TRUSTEES. THE HOSPITAL SHALL EACH YEAR, NO LATER THAN THE MONTH OF AUGUST, SUBMIT FOR RATIFICATION TO THE MEMBER THE NAMES OF PERSONS TO FILL VACANCIES AMONG THE COMMUNITY TRUSTESS CAUSED BY THE EXPIRATION OF THE TERMS OF OFFICE OR OTHERWISE. THE RATIFICATION OF THE COMMUNITY TRUSTEES BY THE MEMBER SHALL TAKE PLACE BEFORE THE END OF SEPTEMBER.
Form 990, Part VI, Section A, line 7b FOR SO LONG AS IT IS THE MEMBER, MISSION HEALTH SYSTEM, NC. AND ITS SUCCESSORS AND ASSIGNS ("MISSION" OR "MEMBER"), SHALL HAVE THE AUTHORITY TO APPROVE THE FOLLOWING REGARDING THE HOSPITAL WITHOUT ANY SEPARATE OR FURTHER ACTION B THE BOARD OF TRUSTEES OF THE HOSPITAL: (A) ON AND AFTER OCTOBER 26, 2012, ANY AMENDMENT TO THE ARTICLES OF INCORPORATION OR BYLAWS; PROVIDED HOWEVER, THE TERMS OF SECTION III.3 OF THESE BYLAWS MAY NOT BE AMENDED AT ANY TIME WITHOUT THE JOINT APPROVAL OF MISSION AND TRANSYLVANIA COMMUNITY HOSPITAL ("HOSPITAL") (B) THE MISSION, VISION AND VALUES STATEMENTS AND ANY AMENDMENTS THERETO. (C) THE SALE, LEASE OR OTHER TRANSFER OF A MATERIAL PORTION, SUBSTANTIALLY ALL OR ALL OF THE ASSETS OF THE HOSPITAL. (D) THE PLEDGE OF, OR GRANTING OF ANY LIEN OR ENCUMBRANCE ON, A MATERIAL PORTION, SUBSTANTIALLY ALL OR ALL OF THE ASSETS OF THE HOSPITAL TO SECURE THE OBLIGATIONS OF THE HOSPITAL OR ANY OF ITS SUBSIDIARIES. (E) THE PURCHASE, LEASE, PLEDGE OR SALE OF REAL OR PERSONAL PROPERTY OUTSIDE THE ORDINARY COURSE OF BUSINESS. (F) THE DISSOLUTION OR ANY MERGER, SALE, CONSOLIDATION OR OTHER BUSINESS COMBINATION. (G) THE FORMATION AND GOVERNING DOCUMENTS OF, AND INVESTMENT BY THE HOSPITAL IN, ANY NEW CORPORATION, PARTNERSHIP OR EQUITY OR CONTRACTUAL JOINT VENTURE IN WHICH THE HOSPITAL PROPOSES TO HAVE AN INTEREST THROUGH MEMBERSHIP, VOTING STOCK OR OTHER EQUITY PARTICIPATION. (H) THE REMOVAL OF THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE HOSPITAL. (I) ANY DEBT ISSUANCE OR INCURRENCE, REFINANCING AND RETIREMENT OF DEBT, INCLUDING WITHOUT LIMITATION INDEBTEDNESS FOR BORROWED MONEY AND CAPITAL LEASES, INCLUDING ANY PROPOSALS AND RECOMMENDATIONS AS TO SAME BY THE BOARD OF TRUSTESS. (J) THE CAPITAL AND OPERATING BUDGETS (BASED ON RECOMMENDATIONS FROM THE BOARD OF TRUSTESS) AND ANY EXPENDITURES THAT WOULD CAUSE ANY LINE ITEM EXPENSE IN ANY APPROVED BUDGET TO EXCEED THE LIMITS ESTABLISHED FROM TIME TO TIME BY MISSION BASED ON RECOMMENDATIONS FROM THE BOARD OF TRUSTEES. (K) STRATEGIC AND FINANCIAL PLANS, INCLUDING ANY PROPOSALS AND RECOMMENDATIONS FOR REVISIONS TO SAME BY THE BOARD OF TRUSTEES. (L) THE SELECTION OF EXTERNAL AUDITORS AND LEGAL COUNSEL; PROVIDED HOWEVER, THE COMMUNITY DIRECTORS (AS DEFINED IN THE BYLAWS OF THE MEMBER) SHALL HAVE THE EXCLUSIVE RIGHT TO SELECT LEGAL COUNSEL TO ENFORCE THE HOSPITAL'S RIGHTS UNDER THE AFFILIATION AGREEMENT.
Form 990, Part VI, Section B, line 11 The organization provides data to the senior treasury analyst of tax services for Mission Health System, Inc. The 990 is prepared and reviewed by management prior to the review by the organizations finance committee. An independent accounting firm reviews Schedule R. After review by the board, and revisions for any clarifications or corrections, the full copy of the 990 is provided to the board prior to filing the 990.
Form 990, Part VI, Section B, line 12c THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS REVIEWED AND UPDATED ANNUALLY. EDUCATION ABOUT THE POLICY AND THE RESPONSIBILITIES OF A BOARD MEMBER OCCURS ANNUALLY AND FOR NEW BOARD MEMBERS DURING ORIENTATION. IF A CONFLICT OF INTEREST IS IDENTIFIED, THE MEMBER IS RECUSED FROM DISCUSSION AND A VOTE ON THE CONFLICTING MATTER, AND MAY BE EXCUSED. THE POLICY IS ADHERED TO DURING MEETINGS IN EXECUTIVE SESSION FOR CEO EVALUATION AND COMPENSATION DISCUSSION, AUDIT PLANNING, AND OTHER TIMES AS REQUIRED.
Form 990, Part VI, Section B, line 15 The setting and review of compensation of the Hospitals officers and key employees is conducted by its sole member, Mission Health System, Inc. with assistance from a national consulting firm who specializes in healthcare compensation setting practices. Base compensation is primarily determined by using the prevailing market rate for that position. Additional compensation incentives are determined using the same process and reviewed annually.
Form 990, Part VI, Section C, line 18 PHOTOCOPIES OF RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG.
Form 990, Part VI, Section C, line 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. AN ANNUAL REPORT OF THE ORGANIZATION'S FINANCIAL STATEMENTS IS AVAILABLE ON THE ORGANIZATION'S WEBSITE AND IS PUBLISHED ANNUALLY IN THE LOCAL NEWSPAPER.
Form 990, Part XI, line 9: NET CHANGE IN INTEREST OF FOUNDATION -80651. TRANSFER TO TRANSYLVANIA PHYSICIAN SERVICES, INC. -2841270. TRANSFER TO TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION, INC. -561000.
FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Employer identification number

56-0562293
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on 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" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC

PO BOX 2440

BREVARD,NC28712
56-1458024 		SUPPORTING ORGANIZATION NC 501(c)(3) Line 11a, I TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Yes
 
(2) TRANSYLVANIA PHYSICIAN SERVICES INC

260 HOSPITAL DRIVE

BREVARD,NC28712
56-1920816 		PHYSICIAN SERVICES NC 501(c)(3) Line 3 TRANSYLVANIA COMMUNITY HOSPITAL INC
 
Yes
 
(3) MISSION HEALTH SYSTEM INC

400 RIDGEFIELD COURT SUITE 100

ASHEVILLE,NC28806
58-1450888 		PARENT COMPANY SUPPORT NC 501(c)(3) Line 11a, I N/A
 
No
(4) MISSION MEDICAL ASSOCIATES INC

400 RIDGEFIELD COURT

ASHEVILLE,NC28806
26-3627231 		EMPLOYED PHYSICIAN GROUP NC 501(c)(3) Line 9 MISSION HEALTH SYSTEM INC
 
 
No
(5) THE MCDOWELL HOSPITAL INC

430 RANKIN AVENUE

MARION,NC28742
56-0623938 		COMMUNITY HOSPITAL NC 501(c)(3) Line 3 MISSION HEALTH SYSTEM INC
 
 
No
(6) MISSION HEALTHCARE FOUNDATION INC

400 RIDGEFIELD COURT SUITE 100

ASHEVILLE,NC28806
56-1881331 		FOUNDATION NC 501(c)(3) Line 7 MISSION HEALTH SYSTEM INC
 
 
No
(7) BLUE RIDGE REGIONAL HOSPITAL INC

PO BOX 9

SPRUCE PINE,NC28777
56-1025032 		COMMUNITY HOSPITAL NC 501(c)(3) Line 3 MISSION HEALTH SYSTEM INC
 
 
No
(8) BLUE RIDGE REGIONAL HOSPITAL FOUNDATION

PO BOX 247

SPRUCE PINE,NC28777
58-2172660 		HOSPITAL FOUNDATION NC 501(c)(3) Line 11a, I BLUE RIDGE REGIONAL HOSPITAL
 
 
No
(9) ANGEL MEDICAL CENTER INC

PO BOX 1209

FRANKLIN,NC28744
56-6000064 		COMMUNITY HOSPITAL NC 501(c)(3) Line 3 MISSION HEALTH SYSTEM INC
 
 
No
(10) MCDOWELL HEALTHCARE FOUNDATION INC

430 RANKIN AVENUE

MARION,NC28752
46-3395393 		FOUNDATION NC 501(c)(3) Line 11a, I THE MCDOWELL HOSPITAL INC
 
 
No
(11) MISSION HOSPITAL INC

428 BILTMORE AVENUE

ASHEVILLE,NC28801
56-0532141 		ACUTE CARE HOSPITAL NC 501(c)(3) Line 3 MISSION HEALTH SYSTEM INC
 
 
No
(12) ANGEL MEDICAL CENTER AUXILIARY INC

PO BOX 1209

FRANKLIN,NC28744
56-2133719 		SUPPORTING ORGANIZATION NC 501(c)(3) Line 11a, I ANGEL MEDICAL CENTER
 
 
No
(13) HIGHLANDS-CASHIERS HOSPITAL INC

PO BOX 190

HIGHLANDS,NC28741
56-0509400 		COMMUNITY HOSPITAL NC 501(c)(3) Line 3 MISSION HEALTH SYSTEM INC
 
 
No
(14) HIGHLANDS-CASHIERS PHYSICIAN SERVICES INC

PO BOX 742

HIGHLANDS,NC28741
45-2422428 		PHYSICIAN SERVICES NC 501(c)(3) Line 11a, I HIGHLANDS-CASHIERS HOSPITAL INC
 
 
No
(15) COMMUNITY CAREPARTNERS INC

PO BOX 5779

ASHEVILLE,NC28813
56-2005198 		LONG TERM REHABILITATION NC 501(c)(3) Line 9 MISSION HEALTH SYSTEM INC
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(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 V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) ASHEVILLE IMAGING LLP

534 BILTMORE AVENUE
ASHEVILLE,NC28801
56-1907201 		IMAGING SERVICES NC N/A
                  
(2) ASHEVILLE MRI

PO BOX 2959
ASHEVILLE,NC28802
56-1665863 		IMAGING SERVICES NC N/A
                  
(3) BLUE RIDGE DME LLC

125 HOSPITAL DRIVE
SPRUCE PINE,NC28777
26-3570174 		HOME MEDICAL EQUIPMENT AND SUPPLIES SALES NC N/A
                  
(4) BLUE RIDGE-TKC LLC

5935 CARNEGIE BOULEVARD
CHARLOTTE,NC28209
47-1382912 		REAL ESTATE RENTAL NC N/A
                  
(5) BREVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL LLC

260 HOSPITAL DRIVE
BREVARD,NC28712
20-3281110 		HEALTHCARE NC TRANSYLVANIA COMMUNITY HOSPITAL INC
  		RELATED 358,686 1,172,861   No   Yes   50.000 %
(6) HEALTHCARE III LIMITED PARTNERSHIP

260 HOSPITAL DRIVE
BREVARD,NC28712
56-1599596 		RENTAL NC N/A
                  
(7) HEALTHCARE LIMITED LIABILITY COMPANY VII

260 HOSPITAL DRIVE
BREVARD,NC28712
20-0343455 		RENTAL NC N/A
                  
(8) IMAGING REALTY LLP

534 BILTMORE AVENUE
ASHEVILLE,NC28801
56-1907203 		MEDICAL BUILDING NC N/A
                  
(9) MCDOWELL MRI LLC

414 RANKIN AVENUE
MARION,NC28752
75-3046378 		MEDICAL IMAGING NC N/A
                  
(10) MSJHS AND CCP JOINT DEVELOPMENT COMPANY LLC

428 BILTMORE AVENUE
ASHEVILLE,NC28801
56-2250464 		LONG TERM ACUTE CARE HOSPITAL NC N/A
                  
(11) SPRUCE PINE HEALTHCARE LLC

5935 CARNEGIE BOULEVARD
CHARLOTTE,NC28209
47-1390107 		REAL ESTATE NC N/A
                  
(12) TRANSYLVANIA HEALTHCARE II LIMITED PARTNERSHIP

2 MEDICAL PARK DR
BREVARD,NC28712
20-0333230 		RENTAL NC N/A
                  
(13) WESTERN NC HEALTHCARE INNOVATORS III LLC

5935 CARNEGIE BOULEVARD
CHARLOTTE,NC28209
46-4053310 		REAL ESTATE RENTAL NC N/A
                  
(14) WESTERN NC HEALTHCARE INNOVATORS LLC

5935 CARNEGIE BOULEVARD
CHARLOTTE,NC28209
80-0787882 		REAL ESTATE RENTAL NC N/A
                  
(15) WESTERN REGIONAL RADIATION THERAPY CENTER

68 HOSPITAL DRIVE
SYLVA,NC28779
56-1849395 		RADIATION THERAPY NC N/A
                  
(16) WNC STONE CENTER

509 BILTMORE AVENUE
ASHEVILLE,NC28801
27-2152974 		LITHOTRIPTER RENTAL NC N/A
                  
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) TRANSYLVANIA SERVICES INC

260 HOSPITAL DRIVE
BREVARD,NC28712
56-1448199 		REAL ESTATE NC TRANSYLVANIA COMMUNITY HOSPITAL INC
  		C 865,636 6,953,131 100.000 % Yes  
(2) MISSION VENTURES INC

400 RIDGEFIELD CT SUITE 100
ASHEVILLE,NC28806
56-1341621 		HOLDING COMPANY NC N/A
 C         No
(3) HORIZON MANAGEMENT SERVICES INC MERGED WITH MISSION VENTURES INC SEP 2014

400 RIDGEFIELD CT SUITE
ASHEVILLE,NC28806
56-1341624 		PATIENT BILLING AND COLLECTION SERVICES, MEDICAL PROPERTY NC N/A
 C         No
(4) DOGWOOD INSURANCE COMPANY LTD

PO BOX 30600 THE GRAND PAVILION COM
  CAYMAN ISLANDS  
CJ
CAPTIVE INSURANCE ENTITY CJ N/A
 C         No
(5) MISSION HEALTH PARTNERS

509 BILTMORE AVE
ASHEVILLE,NC28801
46-5566095 		CLINICALLY INTEGRATED NETWORK NC N/A
 C         No




Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on 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
No
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 . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) BREVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL

 K 941,949 CASH
(2) TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC

 B 36,165 CASH
(3) TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC

 C 556,658 CASH
(4) TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC

 R 561,000 CASH
(5) TRANSYLVANIA PHYSICIAN SERVICES INC

 R 2,841,270 CASH
(6) breVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL

 S 256,000 CASH
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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 V?UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


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