TY 2015 Form 990

- TIN:

Form990

Department of the TreasuryInternal 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)

Do not enter social security numbers on this form as it may be made public.

Information about Form 990 and its instructions is at www.IRS.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

A For the 2015 calendar year, or tax year beginning 10-01-2015 , and ending 09-30-2016

BCheck if applicable: Address change Name change Initial return Final return/terminated Amended return Application pending

CName of organization
MISSION HEALTH SYSTEM INC

Doing business as

Number and street (or P.O. box if mail is not delivered to street address)
400 RIDGEFIELD CT NO 100

Room/suite

City or town, state or province, country, and ZIP or foreign postal code
ASHEVILLE, NC28806

D Employer identification number

58-1450888

E Telephone number

G Gross receipts $ 213,240,062

F Name and address of principal officer:
CHARLES F AYSCUE
400 RIDGEFIELD CT NO 100
ASHEVILLE,NC28806

Tax-exempt status: 501(c)(3) 501(c) ( ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

WWW.MISSION-HEALTH.ORG

H(a)

Is this a group return for
subordinates? Yes No

H(b)

Are all subordinates
included?

Yes No

If "No," attach a list. (see instructions)

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1981

M State of legal domicile: NC

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: OPERATION OF AN INTEGRATED HEALTH CARE SYSTEM
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	21
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	18
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	20
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	190,258
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,239,845	453,068
9	Program service revenue (Part VIII, line 2g) .........	21,299,146	30,179,349
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	34,404,553	19,077,627
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	96,822	92,456
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	58,040,366	49,802,500
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,783,847	2,894,156
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)	89,143,624	154,965,185
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	-56,567,455	-116,565,120
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	35,360,016	41,294,221
19	Revenue less expenses. Subtract line 18 from line 12.......	22,680,350	8,508,279
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	2,276,787,941	2,448,670,982
21	Total liabilities (Part X, line 26).............	866,063,779	949,847,787
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,410,724,162	1,498,823,195

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

	Signature of officer	Date

	Type or print name and title

Paid Preparer Use Only

Print/Type preparer's name

Preparer's signature

Date

Check if
self-employed

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) ..........YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y Form 990 (2015)

Form 990 (2015)

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

Briefly describe the organization’s mission: MISSION HEALTH SYSTEM'S MISSION IS TO OPERATE AN INTEGRATED HEALTH DELIVERY SYSTEM FOR THE BENEFIT OF THE RESIDENTS OF WESTERN NORTH CAROLINA

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ..................... Yes No

If "Yes," describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ........................... Yes No

If "Yes," describe these changes on Schedule O.

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 $ 32,735,958 including grants of $ 2,894,156 ) (Revenue $ 17,689,496 )
	THE ORGANIZATION PROVIDES ADMINISTRATIVE, LEGAL AND FINANCIAL SERVICES FOR THE MEMBERS OF MISSION HEALTH SYSTEM IN AREAS SUCH AS CASH, DEBT, INVESTMENT AND BENEFIT MANAGEMENT AND FISCAL, STRATEGIC AND FACILITIES PLANNING.THE MISSION DEPARTMENT OF PHILANTHROPY GUIDES AND SUPPORTS ALL OF MISSION'S MEMBERS' INDIVIDUAL FOUNDATIONS. THOSE FOUNDATIONS PROVIDE PHILANTHROPIC SUPPORT TO ENABLE OUR MEMBERS TO SERVE THEIR LOCAL COMMUNITIES AND REGION.

4b	(Code: ) (Expenses $ 8,506,243 including grants of $ ) (Revenue $ 12,472,616 )
	MISSION IMAGING SERVICES, A SINGLE MEMBER LLC PROVIDES MEDICAL IMAGING SERVICES.

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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses41,242,201

Form 990 (2015)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A Click to see attachment

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

Yes

Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment

...

Yes

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 I Click to see attachment

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

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 II Click to see attachment

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

Yes

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 III Click to see attachment

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

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 I Click to see attachment

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

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 II Click to see attachment

...

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

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

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 IV Click to see attachment

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

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 V Click to see attachment

......

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.

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

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 VII Click to see attachment

.......

11b

Yes

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 VIII Click to see attachment

.......

11c

Yes

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 IX Click to see attachment

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

11d

Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X Click to see attachment

11e

Yes

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 X Click 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

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

Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E

14a

Did the organization maintain an office, employees, or agents outside of the United States? .....

14a

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......... Click to see attachment

14b

Yes

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..... Click to see attachment

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... Click to see attachment

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) ....

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

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

20a

Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment

20a

Yes

If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment

20b

Yes

Form 990 (2015)

Page 4

Part IV

Checklist of Required Schedules (continued)

Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..... Click to see attachment

Yes

Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment

Yes

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

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 list of attachments

24a

Yes

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

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

Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...

24d

25a

Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I............ Click to see attachment

25a

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 ................... Click to see attachment

25b

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 "Yes," complete Schedule L, Part II ................ Click to see attachment

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......... Click to see attachment

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 current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L,
Part IV ........................ Click to see attachment

28a

A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV..................... Click to see attachment

28b

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... Click to see attachment

28c

Yes

Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............

Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........

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

Yes

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

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

Yes

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

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

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 VI Click to see attachment

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

Yes

Form 990 (2015)

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

Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..

837

Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

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

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)

Did the organization have unrelated business gross income of $1,000 or more during the year?...

Yes

If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...

Yes

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)? ..

Yes

If "Yes," enter the name of the foreign country: MediumBullet

CJ
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............

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? ...

If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................

Organizations that may receive deductible contributions under section 170(c).

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? ....................

If "Yes," did the organization notify the donor of the value of the goods or services provided? .....

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................

If "Yes," indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................

Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................

Did the sponsoring organization make any taxable distributions under section 4966?...

Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

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

If "Yes," enter the amount of tax-exempt interest received or accrued during the year.

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

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

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

Enter the amount of reserves on hand ............

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..

14b

Form 990 (2015)

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

Enter the number of voting members of the governing body at the end of the tax year

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.

Enter the number of voting members included in line 1a, above, who are independent

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? .................

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? .

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

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? ....................

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .......................

Yes

Each committee with authority to act on behalf of the governing body? ............

Yes

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.......

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

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

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

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................

12b

Yes

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

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

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?

The organization’s CEO, Executive Director, or top management official ...........

15a

Yes

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

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

List the States with which a copy of this Form 990 is required to be filed MediumBullet

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.

Own website Another's website Upon request Other (explain in Schedule O)

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.

State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBullet

MISSION FINANCE DEPT400 RIDGEFIELD COURT SUITE 100 ASHEVILLE,NC28806 (828) 257-7004

Form 990 (2015)

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.

List all of the organization’s current key employees, if any. See instructions for definition of "key employee."

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.

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.

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
(A) Name and Title
(1) WYATT S STEVENS...................................................................... CHAIRMAN	6.00 ................. 7.00	X	X	0	0	0
(2) JOHN R BALL...................................................................... VICE CHAIR	1.00 ................. 2.00	X	X	0	0	0
(3) ROBERT C ROBERTS...................................................................... IMMEDIATE PAST CHAIR	4.00 ................. 2.00	X		0	0	0
(4) SUZANNE S DEFERIE...................................................................... SECRETARY	1.00 ................. 1.00	X	X	0	0	0
(5) BRIDGET A ECKERD...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0	0
(6) W LEON ELLISTON MD...................................................................... DIRECTOR	3.00 ................. 2.00	X		0	0	0
(7) CHRIS FLANDERS MD...................................................................... DIRECTOR	1.00 .................	X		0	15,405	0
(8) JOHN GARRETT MD...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0	0
(9) WILLIAM S HICKMAN...................................................................... TREASURER	5.00 ................. 5.00	X	X	0	0	0
(10) ALAN MORSE JOHNSON MD...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0	0
(11) LYNN KIEFFER...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0	0
(12) THOMAS MAHER...................................................................... DIRECTOR	1.00 ................. 2.00	X		0	0	0
(13) ROBERT MOORE...................................................................... DIRECTOR	2.00 ................. 2.00	X		0	0	0
(14) PEGGY O'KANE...................................................................... DIRECTOR	1.00 .................	X		0	0	0
(15) TOM ORECK...................................................................... DIRECTOR	1.00 .................	X		0	0	0
(16) ANNE PONDER...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0	0
(17) KENNETH RACHT...................................................................... DIRECTOR	1.00 ................. 2.00	X		0	0	0

Form 990 (2015)

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
(A) Name and Title
(18) JEFFREY RANKIN........................................................................ DIRECTOR	1.00 .......................4.00	X					0	0	0
(19) ROBBY RUSSELL........................................................................ DIRECTOR	2.00 .......................2.00	X					0	0	0
(20) LAVOY SPOONER JR........................................................................ DIRECTOR	1.00 .......................1.00	X					0	0	0
(21) RONALD A PAULUS MD........................................................................ SYSTEM PRESIDENT & CEO	35.00 .......................35.00	X	X				0	1,140,695	374,436
(22) CHARLES F AYSCUE........................................................................ CHIEF FINANCIAL OFFICER	28.00 .......................32.00		X				0	846,429	24,223
(23) ANN YOUNG........................................................................ GENERAL COUNSEL	29.00 .......................31.00		X				0	656,661	38,666
(24) MARC MALLOY........................................................................ SENIOR VP	58.00 .......................2.00			X			0	566,367	84,969
(25) PAUL MCDOWELL........................................................................ DEPUTY CHIEF FINANCIAL OFFICER	6.00 .......................54.00			X			0	462,080	97,292
(26) JONATHAN BROWN........................................................................ CHIEF INFORMATION OFFICER	30.00 .......................30.00			X			0	290,402	48,644
(27) SULAIMAN SULAIMAN THRU 1 1 16........................................................................ CHIEF INFORMATION OFFICER	30.00 .......................30.00			X			0	428,366	85,377
(28) DEBRA FOSS........................................................................ SR VP HUMAN RESOURCES	30.00 .......................30.00			X			0	572,400	33,784
(29) ROWENA BUFFETT TIMMS........................................................................ SR VP MARKETING	30.00 .......................30.00			X			0	355,244	61,850
(30) DR JILL HOGGARD GREEN........................................................................ PRES&CEO MISSION HOSPITAL	5.00 .......................55.00			X			0	783,528	146,300
(31) KATHY GUYETTE........................................................................ CHIEF NURSING OFFICER	10.00 .......................50.00			X			0	543,135	79,029
(32) MARC WESTLE DO........................................................................ SVP INNOVATION ADMIN	30.00 .......................30.00			X			0	614,566	94,747
(33) RHONDA MILLER........................................................................ VICE PRESIDENT	30.00 .......................30.00				X		0	349,971	59,482
(34) OSCAR WEINMEISTER........................................................................ VICE PRESIDENT	60.00 .......................				X		0	269,392	57,616
(35) JASON VANDIVER........................................................................ VICE PRESIDENT	30.00 .......................30.00				X		0	277,292	49,452
(36) JON YEATMAN........................................................................ VICE PRESIDENT	30.00 .......................30.00				X		0	292,504	45,737
(37) ROBERT BEDNAREK........................................................................ VICE PRESIDENT	30.00 .......................30.00				X		0	322,366	33,182
(38) WILLIAM MAPLES MD........................................................................ FORMERCHIEF QUALITY OFFICER	0.00 .......................0.00					X	0	260,564	7,997

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	9,047,367	1,422,783

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

Yes

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

Yes

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

Yes

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 ........

Section B. Independent Contractors

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





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 0

Form 990 (2015)

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

(D)
Revenue
excluded from
tax under sections
512-514

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	453,048
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	20

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		453,068

			Business Code
2a	SERVICES TO AFFILIATES	900099	15,096,238	15,096,238
b	MISSION IMAGING SERVICES	621400	12,472,616	12,472,616
c	OTHER PROGRAM REVENUE	900099	2,009,104	2,009,104
d	PARTNERSHIP REVENUE	900099	601,391	584,154	17,237
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			30,179,349

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			10,679,328		34,207	10,645,121
4 Income from investment of tax-exempt bond proceeds			20			20
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		151,265
b	Less: rental expenses		182,100
c	Rental income or (loss)		-30,835
d	Net rental income or (loss)......			-30,835			-30,835
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	2,487,438	168,983,243
b	Less: cost or other basis and sales expenses	8,102,603	154,969,799
c	Gain or (loss)	-5,615,165	14,013,444
d	Net gain or (loss).....			8,398,279		138,814	8,259,465
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a		306,351
b	Less: cost of goods sold ..b		183,060
c	Net income or (loss) from sales of inventory..			123,291	123,291
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See Instructions......			49,802,500	30,285,403	190,258	18,873,771

Form 990 (2015)

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 domestic organizations and domestic governments. See Part IV, line 21	2,844,656	2,844,656
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	49,500	49,500
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 ....
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	115,923,462	3,265,450	112,658,012
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,951,394	57,190	2,894,204
9	Other employee benefits .......	28,361,432	343,461	28,017,971
10	Payroll taxes ...........	7,728,897	230,885	7,498,012
11	Fees for services (non-employees):
a	Management ......	2,200,606		2,200,606
b	Legal .........	1,818,589		1,818,589
c	Accounting ...........	789,738		789,738
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	2,483,250		2,483,250
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	37,985,653	2,689,515	35,296,138
12	Advertising and promotion ....	4,350,606		4,350,606
13	Office expenses .......	856,462		856,462
14	Information technology ......	28,745,128	23,165,348	5,579,780
15	Royalties ..
16	Occupancy ...........	3,311,470	916,993	2,394,477
17	Travel ............	969,426	5,537	963,889
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	28,991,983	23,193,586	5,798,397
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	9,466,939	7,627,637	1,839,302
23	Insurance ...	3,496,663	2,797,330	699,333
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	OTHER EXPENSE	3,074,803	1,713,246	1,361,557
b	EQUIPMENT LEASES	2,779,718	2,405,183	374,535
c	ALLOCATION TO MEMBERS	-247,886,154	-30,063,316	-217,822,838
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	41,294,221	41,242,201	52,020	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Form 990 (2015)

Page 11

Part X

Balance Sheet

Check if Schedule O contains a response or note to any line in this Part IX ..............

				(A) Beginning of year		(B) End of year

1	Cash–non-interest-bearing ........			45,189,468	1	49,337,031
2	Savings and temporary cash investments .........			22,504,720	2	40,028,848
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			208,348,186	4	296,004,839
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				4,124	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 ....			16,845,587	7	29,583,068
8	Inventories for sale or use ........				8
9	Prepaid expenses and deferred charges ......			16,109	9	105,363
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	17,240,582
b	Less: accumulated depreciation	10b	10,374,969	7,270,659	10c	6,865,613
11	Investments—publicly traded securities .			644,479,716	11	638,300,525
12	Investments—other securities. See Part IV, line 11 .....			226,574,655	12	238,297,753
13	Investments—program-related. See Part IV, line 11 ..			1,085,704,983	13	1,147,124,084
14	Intangible assets ...............			7,775,716	14	7,775,716
15	Other assets. See Part IV, line 11 ...........			12,074,018	15	-4,751,858
16	Total assets. Add lines 1 through 15 (must equal line 34)...			2,276,787,941	16	2,448,670,982

17	Accounts payable and accrued expenses .....	288,715,591	17	352,864,100
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	317,002,156	20	328,649,878
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 ..	16,236,977	23	9,121,653
24	Unsecured notes and loans payable to unrelated third parties ..		24	15,000,000
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	244,109,055	25	244,212,156
26	Total liabilities. Add lines 17 through 25..	866,063,779	26	949,847,787

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	1,410,724,162	27	1,498,823,195
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	1,410,724,162	33	1,498,823,195
34	Total liabilities and net assets/fund balances ........	2,276,787,941	34	2,448,670,982

Form 990 (2015)

Page 12

Part XI

Reconcilliation of Net Assets

Check if Schedule O contains a response or note to any line in this Part XI ..............

Total revenue (must equal Part VIII, column (A), line 12) ............

49,802,500

Total expenses (must equal Part IX, column (A), line 25) ............

41,294,221

Revenue less expenses. Subtract line 2 from line 1 ..............

8,508,279

Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..

1,410,724,162

Net unrealized gains (losses) on investments ...............

25,370,821

Donated services and use of facilities .................

Investment expenses .....................

Prior period adjustments .....................

Other changes in net assets or fund balances (explain in Schedule O) ........

54,219,933

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))

1,498,823,195

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response or note to any line in this Part XII .............

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?

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:

Separate basis Consolidated basis Both consolidated and separate basis

Were the organization’s financial statements audited by an independent accountant?

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:

Separate basis Consolidated basis Both consolidated and separate basis

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?

Yes

If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.

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?

Yes

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.

Yes

Form 990 (2015)

Additional Data

Software ID:
Software Version:

Form 990, Special Condition Description:

Special Condition Description

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

MISSION HEALTH SYSTEM INC

Employer identification number

58-1450888

Part I

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

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

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

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

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............. 2

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 (see instructions))	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN		Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(A) MISSION HOSPITAL INC	560532141	3	Yes		0	0
(B) MISSION HEALTH SYSTEM FOUNDATION INC	561881331	7	Yes		2,461,943	0
Total 2					2,461,943	0

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.)..
11	Total support. Add lines 7 through 10.

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

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Yes

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Yes

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

MISSION HEALTH SYSTEM INC

Employer identification number

58-1450888

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on 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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization MISSION HEALTH SYSTEM INC

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization MISSION HEALTH SYSTEM INC		Employer identification number 58-1450888

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization MISSION HEALTH SYSTEM INC			Employer identification number 58-1450888
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

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

Name of the organization

MISSION HEALTH SYSTEM INC

Employer identification number

58-1450888

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

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

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

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

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

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(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) 2015

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

484,448

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

484,448

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	DUES PAID TO ASSOCIATION FOR HEALTHCARE PHILANTHROPY INCLUDES 2% TO BE USED FOR LOBBYING. DUES PAID TO AMERICAN HOSPITAL ASSOCIATION INCLUDES 22.12% TO BE USED FOR LOBBYING. PAYMENTS MADE TO CONSULTANTS TO ADVOCATE ON HEALTH CARE RELATED ISSUES

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

MISSION HEALTH SYSTEM INC

Employer identification number

58-1450888

Part I

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

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

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

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

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

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

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on 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 ...	3,609,183		3,609,183
b	Buildings	4,799,392	2,796,393	2,002,999
c	Leasehold improvements	3,181,552	2,416,745	764,807
d	Equipment ...	5,311,943	4,862,669	449,274
e	Other ...	338,512	299,162	39,350
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				6,865,613

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on 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	238,297,753	F
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	238,297,753

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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)INVESTMENT IN PREMIER PURCHASING	210,906	C
(2)INVESTMENT IN IMAGING REALTY	742,015	C
(3)INVESTMENT IN MSJHS/CCP JOINT VENTURE	2,146,206	C
(4)INVESTMENT IN TAX EXEMPT SUBSIDIARIES	1,133,508,965	C
(5)INVESTMENT IN DOGWOOD INSURANCE COMPANY	120,000	C
(6)INVESTMENT IN PREMIER IPO STOCK	2,616,070	F
(7)INVESTMENT IN SPRUCE PINE HC	129,300	C
(8)INVESTMENT IN WNCHCI LLC	6,590,509	C
(9)INVESTMENT IN PLPCC	1,060,113	C
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	1,147,124,084

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
LONG TERM ACCRUED EXPENSE	14,193,452
SWAP CONTRACT PAYABLE	158,704
2012 TAXABLE BOND LIABILITY	179,850,000
2015 TAXABLE BOND LIABILITY	50,010,000
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	244,212,156
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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on 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 (losses) 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' on 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 X, LINE 2:	MISSION APPLIES THE PROVISIONS OF FASB ASC TOPIC 740 FOR INCOME TAXES IN ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. ASC 740 PROVIDES GUIDANCE ON WHEN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND HOW THE VALUES OF THESE POSITIONS ARE DETERMINED. THERE IS CURRENTLY NO IMPACT ON MISSION'S COMBINED FINANCIAL STATEMENTS AS A RESULT OF APPLICATION OF ASC 740.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions. Right pointing arrow large image

Information about Schedule F (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization
MISSION HEALTH SYSTEM INC

Employer identification number

58-1450888

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.

For grantmakers.Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in region	(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in region
	CAYMAN ISLANDS			INVESTMENTS	66,319,472
	BERMUDA			INVESTMENTS	24,802,348
	IRELAND			INVESTMENTS	10,163,011
	NETHERLANDS			INVESTMENTS;LISTTOTAL 1613354	1,067,467
	GUERNSEY			INVESTMENTS	1,079,168
	CANADA			INVESTMENT	7,800,625
	BRITISH VIRGIN ISLANDS			INVESTMENTS	6,459,911










3a	Sub-total .....	0	0		117,692,002
b	Total from continuation sheets to Part I ...	0	0		0
c	Totals (add lines 3a and 3b)	0	0		117,692,002

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2015

Schedule F (Form 990) 2015

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(a)(c) Region	(b)(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2015

Schedule F (Form 990) 2015Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2015

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2015

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

ReturnReference	Explanation

Schedule F (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

MISSION HEALTH SYSTEM INC

Employer identification number

58-1450888

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

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

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

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

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

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

Yes

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

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	603,793	603,793	1.460 %
b	Medicaid (from Worksheet 3, column a) . . . . .
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	603,793	603,793	1.460 %
Other Benefits
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) . . . .	282,714	282,714	0.680 %
j	Total. Other Benefits . .	282,714	282,714	0.680 %
k	Total. Add lines 7d and 7j .	886,507	886,507	2.140 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

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

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

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

1,213,400

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. ......

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

Section B. Medicare

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

5,592,021

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

7,213,645

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

-1,621,624

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
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Schedule H (Form 990) 2015

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 (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)			Other (Describe)
1	ASHEVILLE SPECIALTY HOSPITAL 428 BILTMORE AVENUE 4TH FLOOR ASHEVILLE,NC28801 HTTP://WWW.ASHLTCH.COM/ H0279	X	LONG TERM ACUTE CARE HOSPITAL

Schedule H (Form 990) 2015

Page 4

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)

	ASHEVILLE SPECIALTY HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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 12......................

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

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

Yes

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

Hospital facility’s website (list url): SEE OTHER FOR WEBSITE

Other website (list url): HTTP://CDN3.MISSION-HEALTH.ORG

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE SUPPLEMENTAL INFORMATION

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	ASHEVILLE SPECIALTY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 150.000000000000% and FPG family income limit for eligibility for discounted care of 300.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	ASHEVILLE SPECIALTY HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized 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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

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

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

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

Other (describe in Section C)

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? ...............................

If "Yes," explain in Section C.

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? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
ASHEVILLE SPECIALTY HOSPITAL	PART V, SECTION B, LINE 5: COMMUNITY INPUT & ENGAGEMENTINCLUDING INPUT FROM THE COMMUNITY IS AN IMPORTANT ELEMENT OF THE COMMUNITY HEALTH ASSESSMENT PROCESS. THE FOLLOWING PRIMARY DATA (COLLECTED DIRECTLY FROM COMMUNITY MEMBERS VIA SURVEYS OR FOCUS GROUPS) WAS REVIEWED. YOU WILL NOTE ICONS FOR EACH DATA TYPE. THE SAME ICONS APPEAR THROUGHOUT THIS DOCUMENT AS EACH DATA TYPE IS REFERENCED.RESULTS FROM PRIMARY SURVEY OF 300 BUNCOMBE COUNTY RESIDENTS DONE BY PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC) AS PART OF THE WNC HEALTHY IMPACT PARTNERSHIP. THE SAME SURVEY WAS DONE OF 200 RESIDENTS OF PARTNERING COUNTIES FOR COMPARISON.ELECTRONIC SURVEY OF 43 LOCAL COMMUNITY LEADERS ACROSS BUNCOMBE COUNTY WHO HAVE LEADERSHIP ROLES IN COMMUNITY HEALTH, BUSINESSES, SOCIAL SERVICE, MENTAL HEALTH AND HEALTHCARE ORGANIZATIONS. THIS SURVEY WAS ALSO DONE BY PRC AND SO WAS DONE IN MANY OTHER WESTERN NC COUNTIES.LOCALLY COMPILED ELECTRONIC SURVEYS COLLECTED FROM 60 COMMUNITY HEALTH PARTNERS CURRENTLY WORKING WITHIN AGENCIES IN BUNCOMBE COUNTY TO UNDERSTAND WHAT THEY SEE AS THEIR CLIENTS GREATEST HEALTH CONCERNS AND CHALLENGES.SURVEY DATA FROM 400 OLDER ADULTS COMPLETED THROUGH THE AREA COUNCIL ON AGING, AGING PLANNING CONSORTIUM TO GATHER INFORMATION ON HEALTHY LIFESTYLES.WOMEN AND CHILDREN S SAFETY COALITION S INTIMATE PARTNER VIOLENCE VICTIM FOCUS GROUP RESULTS THAT GATHERED INPUT FROM WOMEN EXPERIENCING INTIMATE PARTNER VIOLENCE TO HELP IMPROVE THE SYSTEM.SURVEY DATA FROM RESIDENTS OF A LOCAL PUBLIC HOUSING COMMUNITY ASKING ABOUT THEIR BIGGEST HEALTH CONCERNS AND CHALLENGES.RESPONSES FROM PREGNANT AND PARENTING WOMEN IN OUR COMMUNITY WHO WERE ASKED, WHAT ARE THE MAIN ISSUES IMPACTING YOUR HEALTH AND PREGNANCY? AS PART OF THE COMMUNITY CENTERED HEALTH HOME PROJECT THROUGH MAHEC. IN ADDITION, RESULTS FROM THE PHOTOVOICE PROJECT CONDUCTED BY POSITIVE PARENTING PROGRAM AND BUNCOMBE PARTNERSHIP FOR CHILDREN THAT CAPTURED THE VOICE OF PREGNANT AND PARENTING WOMEN THROUGH THEIR PHOTOS AND STORIES TO BETTER UNDERSTAND THE CHALLENGES AND NEEDS FACING THESE WOMEN.IN ADDITION TO THE WNC HEALTHY IMPACT'S CORE DATA SET, BUNCOMBE COUNTY CHIP DATA TEAM REVIEWED MANY ADDITIONAL SECONDARY (ALREADY EXISTING) DATA SOURCES INCLUDING:SMOKY MOUNTAIN LOCAL MANAGEMENT ENTITIES 2015 PROVIDER CAPACITY, COMMUNITY NEEDS ASSESSMENT AND GAP ANALYSIS FOR 2013-2014,THE HOMELESSNESS COUNT,DEPARTMENT OF SOCIAL SERVICES REGIONAL DATA REPORT,MAHEC'S COMMUNITY CENTERED HEALTH HOME EPIDEMIOLOGY REPORT,NC CENTER FOR HEALTH STATISTICS DATA ON ADVERSE CHILDHOOD EXPERIENCES IN NC.THE CHIP DATA TEAM (MADE UP OF REPRESENTATIVES FROM BCHHS, MISSION HOSPITAL, MAHEC AND NC CENTER FOR HEALTH & WELLNESS) REVIEWED AND PRIORITIZED KEY DATA CONCERNS IDENTIFIED THAT WERE ALSO COMMUNITY CONCERNS VOICED IN THE SURVEYS AND FOCUS GROUPS. RESULTS OF THE DATA REVIEW WERE SHARED WITH THE CHIP ADVISORY, WHICH PROVIDES LEADERSHIP FOR OUR CHIP. THE ADVISORY BOARD'S 30+ COMMUNITY LEADERS PRIORITIZED THE HEALTH CONCERNS AND RECOMMENDED THE TOP FOUR HEALTH PRIORITIES. PARTNERS AND STAKEHOLDERS WILL COME TOGETHER AROUND THE PRIORITIES TO GATHER INPUT ON WHAT IS CURRENTLY HAPPENING, GAPS AND ADDITIONAL OPPORTUNITIES TO BETTER ADDRESS THE ISSUES.
ASHEVILLE SPECIALTY HOSPITAL	PART V, SECTION B, LINE 6A: MISSION HOSPITAL, INC. AND COMMUNITY CAREPARTNERS, INC.
ASHEVILLE SPECIALTY HOSPITAL	PART V, SECTION B, LINE 6B: BUNCOMBE COUNTY HEALTH AND HUMAN SERVICESMOUNTAIN AREA HEALTH EDUCATION CENTER (MAHEC)
ASHEVILLE SPECIALTY HOSPITAL	PART V, SECTION B, LINE 7D: HTTP://WWW.MISSION-HEALTH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.PHP
ASHEVILLE SPECIALTY HOSPITAL	PART V, SECTION B, LINE 11: FOR THE TAX YEAR OF THIS FILING, THE ORGANIZATION WAS STILL IN PROCESS OF FINALIZING THE IMPLEMENTATION STRATEGY AND THERE 2013 WAS THE LAST COMPLETED IMPLEMENTATION STRATEGY AS REFERENCED ON LINE 9. HOWEVER IN ORDER TO PROVIDE CONSISTENT AND RELEVANT DATA, OUR NARRATIVES IN THIS FILING ARE UPDATED TO REFLECT OUR IMPLEMENTATION STRATEGY THAT ADDRESSES THE HEALTH NEEDS IDENTIFIED IN THE 2015 CHNA, AND THAT WAS TIMELY ADOPTED EARLY IN THE FOLLOWING FISCAL YEAR.COLLABORATIVE ACTION PLANNINGTHE ORGANIZATION WILL PARTICIPATE IN A COLLABORATIVE ACTION PLANNING PROCESS WITH OUR COMMUNITY PARTNERS WHICH RESULTS IN THE CREATION OF A COMMUNITY-WIDE PLAN AT THE COUNTY LEVEL. WE WILL THEN DEVELOP A FACILITY SPECIFIC IMPLEMENTATION STRATEGY THAT SPEAKS TO OUR SPECIFIC CONTRIBUTIONS TO THE IDENTIFIED PRIORITY HEALTH ISSUE. WE AIM TO LEVERAGE EXISTING ASSETS, AVOID DUPLICATION, AND IMPLEMENT EVIDENCE-BASED AND INNOVATIVE EFFORTS, WHILE WORKING TOWARDS A VISION OF COLLECTIVE IMPACT.THE ORGANIZATION ADDRESSES ACCESS TO CARE AS AN ACUTE LONG-TERM CARE HOSPITAL, AND OTHER ORGANIZATIONS IN THE MISSION HEALTH CARE SYSTEM AS WELL AS COMMUNITY ORGANIZATIONS ADDRESS OTHER PRIORITIES IDENTIFIED IN THE CHNA.ASHEVILLE SPECIALTY HOSPITAL (ASH) IS A LONG-TERM ACUTE CARE FACILITY THAT PROVIDES ACCESS TO HEALTH CARE FOR ALL THOSE WHO NEED LONG-TERM ACUTE CARE. NEEDS OTHER THAN THIS ARE ADDRESSED BY OTHER ORGANIZATIONS IN THE COMMUNITY, AS WELL AS THROUGH ASH'S RELATIONSHIP WITH MISSION HEALTH AND CAREPARTNERS AS AN INDEPENDENT AFFILIATE.MOVING THE NEEDLE ON POPULATION LEVEL HEALTH PRIORITIES REQUIRES AN ARRAY OF INITIATIVES ACROSS THE COMMUNITY AND IS THE COLLECTIVE ACCOUNTABILITY OF THE PROGRAMS, AGENCIES, AND SERVICE SYSTEMS STRIVING TO ADDRESS THESE PRIORITY HEALTH ISSUES. AS PART OF A COLLABORATIVE RESPONSE TO ADDRESSING HEALTH NEEDS IN OUR COMMUNITY, OUR HOSPITAL FACILITY IS AN IMPORTANT CONTRIBUTOR TO MEANINGFUL PROGRESS ON THESE HEALTH PRIORITIES.
ASHEVILLE SPECIALTY HOSPITAL	PART V, SECTION B, LINE 16I: EVERY PATIENT RECEIVES THE POLICY AS PART OF THE PATIENT CONSENT TO TREATMENT AND FINANCIAL AUTHORIZATION FORM.
ASHEVILLE SPECIALTY HOSPITAL	PART V, SECTION B, LINE 21D: THE HOSPITAL FACILITY IS LICENSED AS A LONG-TERM ACUTE CARE FACILITY AND IS UNABLE TO PROVIDE EMERGENCY CARE DUE TO THE NATURE OF THE SERVICES PROVIDED. THE FACILITY HAS A POLICY FOR EMERGENCY SERVICES AND SURGICAL CARE THAT STATES THAT THOUGH A FORMAL EMERGENCY DEPARTMENT IS NOT AVAILABLE AT ASHEVILLE SPECIALTY HOSPITAL, BASIC EMERGENCY CARE WILL BE AVAILABLE TO TREAT PATIENTS AS NECESSARY. FINANCIAL ASSISTANCE IS ADDRESSED THROUGH THE CONSENT FOR TREATMENT DOCUMENT.
SCHEDULE H, PART V, QUESTION 10, MOST RECENTLY ADOPTED IMPLEMENTATION POSTIN	THE FACILITY FOR ASHEVILLE SPECIALTY HOSPITAL IS LOCATED ON THE 4TH FLOOR OF THE ST. JOSEPH'S CAMPUS OF MISSION HOSPITAL. THE ORGANIZATION'S IMPLEMENTATION STRATEGY IS ENCOMPASSED IN THE OVERALL ACCESS TO CARE ADDRESSED IN MISSION HOSPITAL'S IMPLEMENTATION STRATEGY. THE ORGANIZATION ADOPTED A SEPARATE IMPLEMENTATION STRATEGY IN EARLY 2016.HTTP://WWW.MISSION-HEALTH.ORG/MYDOCUMENTS/DOWNLOAD.PHP?F=MISSION_HOSPITAL_IMPLEMENTATION_STRATEGY_2013_20152.PDF

Schedule H (Form 990) 2015

Page 8

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?5
Name and address		Type of Facility (describe)
1	1 - MISSION IMAGING SERVICES 534 BILTMORE AVENUE ASHEVILLE,NC28801	OUTPATIENT IMAGING SERVICES
2	2 - MISSION IMAGING SERVICES 2695 HENDERSONVILLE ROAD ARDEN,NC28704	OUTPATIENT IMAGING SERVICES
3	3 - MISSION IMAGING SERVICES 2 TOWN SQUARE ASHEVILLE,NC28803	OUTPATIENT IMAGING SERVICES
4	4 - MISSION IMAGING SERVICES 490 HOSPITAL DRIVE CLYDE,NC28721	OUTPATIENT IMAGING SERVICES
5	5 - MISSION IMAGING SERVICES 149 W PARKER ROAD MORGANTON,NC28655	OUTPATIENT IMAGING SERVICES
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Schedule H (Form 990) 2015

Page 9

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
PART I, LINE 3C:	THE ORGANIZATION IS COMMITTED TO PROVIDING CHARITY CARE FOR THE HOSPITAL COMPONENT OF SERVICES PROVIDED TO PERSONS WHO HAVE HEALTHCARE NEEDS AND ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM, OR OTHERWISE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE BASED ON THEIR INDIVIDUAL FINANCIAL SITUATIONS. CONSISTENT WITH ITS MISSION TO DELIVER COMPASSIONATE, HIGH QUALITY, AFFORDABLE HEALTHCARE SERVICES AND TO ADVOCATE FOR THOSE WHO ARE POOR AND DISENFRANCHISED, THE HOSPITAL STRIVES TO ENSURE THAT THE FINANCIAL CAPACITY OF PEOPLE WHO NEED HEALTH CARE SERVICES DOES NOT PREVENT THEM FROM SEEKING OR RECEIVING CARE. ELIGIBILITY FOR CHARITY WILL BE CONSIDERED FOR THOSE INDIVIDUALS WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND WHO ARE UNABLE TO PAY FOR THEIR CARE, BASED UPON A DETERMINATION OF FINANCIAL NEED IN ACCORDANCE WITH THE HOSPITALS CHARITY CARE POLICY AND ALSO BASED UPON THE MEANS OF THE HOSPITAL TO PROVIDE CHARITY CARE. THE GRANTING OF CHARITY SHALL BE BASED ON AN INDIVIDUALIZED DETERMINATION OF FINANCIAL NEED, AND SHALL NOT TAKE INTO ACCOUNT AGE, GENDER, RACE, SOCIAL OR IMMIGRANT STATUS, SEXUAL ORIENTATION OR RELIGIOUS AFFILIATION. THE HOSPITAL SHALL ALSO DETERMINE WHETHER OR NOT PATIENTS ARE ELIGIBLE TO RECEIVE CHARITY FOR DEDUCTIBLES, CO-INSURANCE, OR CO-PAYMENT RESPONSIBILITIES. IF YOU BELIEVE THAT YOU MAY QUALIFY FOR CHARITY CARE, PLEASE ADVISE AN INTAKE PLANNER/ADMITTING OFFICE AND REQUEST A COPY OF THE HOSPITALS CHARITY CARE POLICY.
PART III, LINE 2:	THE COST TO CHARGES RATIO IS APPLIED TO BAD DEBT EXPENSE BASED ON CHARGES AND CONVERTED TO THE COST OF PROVIDING CARE
PART III, LINE 4:	PER THE FOOTNOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS: "COSTS OF SERVICES ASSOCIATED WITH UNCOLLECTIBLE ACCOUNTS ARE ESTIMATED AT $40,248,000 AND $37,257,000 FOR SEPTEMBER 30, 2016 AND 2015, RESPECTIVELY."ABOVE NUMBERS ARE FOR ENTIRE HEALTH SYSTEM, WHICH INCLUDES THE ABOVE AMOUNT FOR ASHEVILLE SPECIALTY HOSPITAL.THE ABOVE ESTIMATES WERE DEVELOPED USING THE METHODOLOGY ADOPTED BY THE NORTH CAROLINA HOSPITAL ASSOCIATION IN 2006 FOR SUCH COSTS, INCLUDING INFORMATION FROM MISSION'S COST REPORTING SYSTEMS USED TO SUPPORT ITS RELATED FILINGS WITH THE MEDICARE AND MEDICAID PROGRAMS.
PART III, LINE 8:	THE SHORTFALL REPORTED IS BASED ON USING THE MEDICARE ALLOWABLE COSTS. PER THE FORM 990 INSTRUCTIONS, THE MEDICARE COST REPORT IS THE BASIS FOR CALCULATING THE COSTS USING COSTS RELATED TO THE REVENUE REPORTED. MISSION HEALTH SYSTEM IS REPORTING 2/3 OF THE TOTAL SHORTFALL AS ITS PRO RATA OWNERSHIP IN ASHEVILLE SPECIALTY HOSPITAL
PART VI, LINE 2:	THE ORGANIZATION'S FACILITY ASHEVILLE SPECIALTY HOSPITAL IS PART OF MISSION HEALTH SYSTEM (MISSION HEALTH). THE SYSTEM'S APPROACH TO ASSESSING COMMUNITY HEALTH IS DESCRIBED BELOW.WESTERN NORTH CAROLINA IS HOME TO A UNIQUE COLLABORATION BETWEEN HOSPITALS AND HEALTH DEPARTMENTS WORKING TOGETHER TO IDENTIFY HEALTH NEEDS AND IMPROVE HEALTH. TOGETHER, MISSION HEALTH AND OTHER HOSPITALS AND HEALTH DEPARTMENTS IN THE REGION CONDUCT COMMUNITY HEALTH ASSESSMENTS EVERY THREE (3) YEARS TO DETERMINE THE GREATEST HEALTH NEEDS IN THE COMMUNITIES WE SERVE.MISSION HEALTH'S HOSPITAL FACILITIES SERVE 18 COUNTIES IN WESTERN NORTH CAROLINA, WITH SEVEN (7) OF THOSE COUNTIES INCLUDED IN OUR PRIMARY SERVICE AREAS. REPRESENTATIVES FROM EACH HOSPITAL PARTNER WITH LOCAL HEALTH DEPARTMENTS IN THEIR PRIMARY SERVICE COUNTIES AND WITH WNC HEALTHY IMPACT TO ASSESS AND PRIORITIZE COMMUNITY HEALTH NEEDS, AND PLAN TO ADDRESS THEM.HOW WE PLAN TO ADDRESS COMMUNITY HEALTH NEEDSIN THE COMMUNITY HEALTH ASSESSMENT PROCESS, HOSPITALS AND HEALTH DEPARTMENTS PRODUCE PARALLEL REPORTS DETAILING HOW THE COMMUNITY HEALTH NEEDS WERE IDENTIFIED AND PRIORITIZED, AND EACH ENTITY'S STRATEGY FOR ADDRESSING THE IDENTIFIED NEEDS. THESE REPORTS ARE MADE PUBLICLY AVAILABLE BY EACH ENTITY (MISSION HEALTH FACILITY REPORTS ARE LINKED BELOW).REPORTS PRODUCED BY EACH HOSPITAL:COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) EXECUTIVE SUMMARYHOSPITAL IMPLEMENTATION STRATEGYREPORTS PRODUCED BY EACH COUNTY HEALTH DEPARTMENT:COMMUNITY HEALTH ASSESSMENT (CHA)COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP)HEALTH PRIORITIES AND REPORTSCOMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES ARE FACILITY-SPECIFIC AND UNIQUE TO THE COMMUNITIES SERVED BY EACH HOSPITAL. IMPLEMENTATION STRATEGIES ARE BASED ON COLLABORATIVE PLANNING, AND OUTLINE THE WAYS EACH HOSPITAL WILL SUPPORT SPECIFIC EFFORTS TO ADDRESS THE IDENTIFIED HEALTH NEEDS AS PART OF A COMMUNITY-WIDE PLAN.ASHEVILLE SPECIALTY HOSPITAL'S ABILITY TO ADDRESS ACCESS TO CARE AS A LONG-TERM ACUTE FACILITY THAT PROVIDES ACCESS TO HEALTHCARE FOR ALL THOSE WHO NEED LONG-TERM ACUTE CARE IS AN IMPORTANT RESOURCE IN ADDRESSING THE COMMUNITY'S NEEDS. NEEDS OTHER THAN THIS ARE ADDRESSED BY ORGANIZATIONS IN THE COMMUNITY AS WELL AS THROUGH ITS RELATIONSHIPS WITH MISSION HOSPITAL, INC. AND COMMUNITY CAREPARTNERS.
PART VI, LINE 4:	INITIALLY REFERRED TO AS THE "STATE OF BUNCOMBE" DUE TO ITS VASTNESS, BUNCOMBE COUNTY WAS ESTABLISHED IN 1791 BY THE NORTH CAROLINA HOUSE OF COMMONS. IT IS LOCATED IN THE SOUTHWESTERN PORTION OF NORTH CAROLINA. ALREADY AN ESTABLISHED CROSSROADS FOR THE REGION AT THE TURN OF THE TWENTIETH CENTURY, BUNCOMBE COUNTY HAS UNDERGONE TREMENDOUS DEVELOPMENT AND TRANSFORMATION SINCE ITS INCEPTION. BUNCOMBE COUNTY HAS A TOTAL LAND AND WATER AREA OF 660 SQUARE MILES. BUNCOMBE COUNTY IS MADE UP OF A VARIETY OF TIGHTLY KNIT UNINCORPORATED COMMUNITIES AS WELL AS SIX DISTINCT MUNICIPALITIES: CITY OF ASHEVILLE, TOWN OF BILTMORE FOREST, TOWN OF BLACK MOUNTAIN, TOWN OF MONTREAT, TOWN OF WEAVERVILLE AND TOWN OF WOODFIN. THE COUNTY IS LOCATED IN THE BLUE RIDGE MOUNTAINS AT THE CONFLUENCE OF THE SWANNANOA AND THE FRENCH BROAD RIVERS. THE FRENCH BROAD RIVER IS THE 3RD OLDEST RIVER IN THE WORLD AND ONE OF THE FEW RIVERS TO FLOW FROM SOUTH TO NORTH. THE RIVER ENTERS THE COUNTY AT ITS BORDER WITH HENDERSON COUNTY TO THE SOUTH AND FLOWS NORTH INTO MADISON COUNTY. THE SOURCE OF THE SWANNANOA RIVER, WHICH JOINS THE FRENCH BROAD RIVER IN ASHEVILLE, IS IN NORTHEAST BUNCOMBE COUNTY NEAR MOUNT MITCHELL. THE AMOUNT OF BUNCOMBE COUNTY LAND CATEGORIZED AS "RURAL" DECREASED BY 17% BETWEEN 2000 AND 2010. INTERSTATE 40 RUNS EAST/WEST AND FUTURE I-26 RUNS NORTH/SOUTH THROUGH BUNCOMBEASHEVILLE IS THE COUNTY SEAT OF BUNCOMBE COUNTY. IT IS THE LARGEST CITY IN WESTERN NORTH CAROLINA, AND THE 11TH LARGEST CITY IN NORTH CAROLINA. ORIGINALLY, ASHEVILLE WAS NAMED MORRISTOWN AND KNOWN IN THOMAS WOLFE'S NOVEL LOOK HOMEWARD ANGEL AS ALTAMONT. THOMAS WOLFE WAS BORN AND RAISED IN ASHEVILLE. THE CITY'S POPULATION WAS 83,393 ACCORDING TO THE 2010 UNITED STATES CENSUS. IT IS THE PRINCIPAL CITY IN THE FOUR-COUNTY ASHEVILLE METROPOLITAN AREA, WITH A POPULATION OF 424,858 IN 2010. ASHEVILLE IS HOME TO THE UNITED STATES NATIONAL CLIMATIC DATA CENTER (NCDC), THE WORLD'S LARGEST ACTIVE ARCHIVE OF WEATHER DATA. ASHEVILLE IS ALSO HOME TO THE BILTMORE HOUSE, THE LARGEST PRIVATE RESIDENCE IN NORTH AMERICA. MOST RECENTLY, READERS OF CONDE NAST TRAVELER VOTED ASHEVILLE #3 AMONG "THE BEST SMALL CITIES IN AMERICA." THE LEADING MAJOR INDUSTRY EMPLOYMENT TYPES INCLUDE HEALTH SERVICES, RETAIL, LEISURE AND HOSPITALITY, GOVERNMENT AND MANUFACTURING.BUNCOMBE COUNTY HAS A TOTAL POPULATION OF 238,318 (2010 CENSUS) WITH A MEDIAN AGE OF 40.6 WHICH IS 4.1 YEARS"YOUNGER" THAN THE WESTERN NORTH CAROLINA (WNC) REGION BUT 3.2 YEARS "OLDER" THAN THE NC AVERAGE. BUNCOMBEHAS SIGNIFICANTLY LOWER PROPORTIONS OF AFRICAN AMERICANS, AMERICAN INDIANS, ASIANS AND HISPANICS THAN NC AS AWHOLE BUT SLIGHTLY HIGHER PROPORTIONS OF AFRICAN AMERICANS AND HISPANICS THAN WNC REGION.A DOUBLE-DIGIT RATE OF GROWTH IN BUNCOMBE COUNTY IS EXPECTED TO CONTINUE FOR THE NEXT TWO DECADES, AT NEARLY TWICE THE RATE OF GROWTH OF WNC AND SURPASSING THE PACE OF GROWTH FOR NC AS A WHOLE. THE PROPORTION OF THE POPULATION IN EACH MAJOR AGE GROUP 65 AND OLDER IN BUNCOMBE COUNTY WILL INCREASE BETWEEN 2010 AND 2030. THE POPULATION IN THE COUNTY AGE 65-74 IS EXPECTED TO GROW BY 44% BETWEEN 2010 AND 2013. THE POPULATION AGES 75-84 WILL GROW BY 63% AND THE POPULATION OVER THE AGE OF 85 WILL GROW BY 21% OVER THE SAME PERIOD. BY 2030, PROJECTIONS ESTIMATE THERE WILL BE MORE THAN 70,500 PERSONS AGE 65+ IN BUNCOMBE COUNTY. THE PORTION OF BUNCOMBE COUNTY'S POPULATION CATEGORIZED AS "RURAL" DECREASED BY 17% FROM 2000 (29.2%) TO 2010 (24.1%). (NC OFFICE OF BUDGET AND MANAGEMENT; US CENSUS BUREAU)IN THE 5-YEAR PERIOD FROM 2009-2013, AN ESTIMATED 1,916 BUNCOMBE COUNTY GRANDPARENTS LIVING WITH THEIR MINOR-AGED GRANDCHILDREN ALSO WERE FINANCIALLY RESPONSIBLE FOR THEM. OVER THE SAME PERIOD, THERE WERE AN ESTIMATED 100,838 HOUSEHOLDS IN BUNCOMBE COUNTY, 23,662 OF THEM WITH CHILDREN UNDER 18 YEARS OF AGE. AMONG THE HOUSEHOLDS WITH MINOR-AGE CHILDREN, A MARRIED COUPLE HEADED 66%. A FEMALE SINGLE PARENT HEADED AN ADDITIONAL 26%, AND 8% WERE HEADED BY A MALE SINGLE PARENT. (US CENSUS BUREAU)BY 2009-2013 ESTIMATES, BUNCOMBE COUNTY WAS HOME TO HIGHER PROPORTIONS OF VETERANS UNDER THE AGE OF 54 AND LOWER PROPORTIONS OF VETERANS AGE 55 AND OLDER THAN THE WNC REGION OVERALL. OF THE ESTIMATED 100,838 HOUSEHOLDS IN BUNCOMBE COUNTY IN THE 2009-2013 PERIOD, 1,936 (2%) WERE CATEGORIZED AS HAVING LIMITED SKILL IN SPEAKING ENGLISH. (US CENSUS BUREAU, 2015)
PART VI, LINE 6:	MISSION HEALTH SYSTEM, INC. IS THE PARENT ORGANIZATION FOR THE CHARITABLE ORGANIZATIONS OF MISSION HOSPITAL, INC.; MISSION HEALTHCARE FOUNDATION, INC.; MISSION MEDICAL ASSOCIATES, INC; BLUE RIDGE REGIONAL HOSPITAL, INC.;THE MCDOWELL HOSPITAL, INC.;ANGEL MEDICAL CENTER, INC.; TRANSYLVANIA COMMUNITY HOSPITAL, INC.;HIGHLANDS-CASHIERS HOSPITAL, INC. AND COMMUNITY CAREPARTNERS, INC.THE SYSTEM'S MISSION IS TO SUPPORT THE ACTIVITIES OF MISSION HOSPITAL INC AND MISSION HEALTHCARE FOUNDATION, INC. MISSION HOSPITAL, INC. IS A REGIONAL INTEGRATED HEALTH FACILITY PROVIDING SUPERIOR CARE AND SERVICE TO PATIENTS AND THEIR FAMILIES THROUGH A FULL CONTINUUM OF INTEGRATED SERVICES, EDUCATION, AND RESEARCH. IT SERVES AS A TRAUMA CENTER TO PEOPLE OF WESTERN NORTH CAROLINA AND THE SURROUNDING COUNTIES. MISSION MEDICAL ASSOCIATES' MISSION IS TO PROVIDE PHYSICIAN SERVICES IN PREDOMINANTLY RURAL AREAS THAT ARE INSUFFICIENTLY SERVED, THEREBY IMPROVING THE HEALTH CARE OF THE GENERAL PUBLIC. IN MANY CASES THIS INVOLVES RECRUITING AND PLACING PRIMARY CARE PHYSICIANS, AS WELL AS PEDIATRIC AND ADULT SPECIALTY SERVICES CLOSE TO WHERE PEOPLE LIVE AND WORK.BLUE RIDGE REGIONAL HOSPITAL SERVES AS A COMMUNITY HOSPITAL IN MITCHELL, YANCEY AND SURROUNDING COUNTIES.THE MCDOWELL HOSPITAL SERVES AS A COMMUNITY HOSPITAL IN MCDOWELL AND THE SURROUNDING COUNTIES.MISSION HEALTHCARE FOUNDATION, INC. SUPPORTS THE MISSION AND PROGRAMS OF MISSION HOSPITAL, INC. AND MISSION HEALTH SYSTEM, INC. AND OF OTHER ORGANIZATIONS THAT ARE TAX EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND WORKS TO BENEFIT THE COMMUNITY AND REGION SERVED BY THE ENTITIES LISTED ABOVE.ANGEL MEDICAL CENTER, INC. SERVES AS A COMMUNITY HOSPITAL IN MACON AND SURROUNDING COUNTIES.TRANSYLVANIA COMMUNITY HOSPITAL, INC.SERVES AS A COMMUNITY HOSPITAL IN TRANSYLVANIA AND SURROUNDING COUNTIES.HIGHLANDS-CASHIERS HOSPITAL, INC. SERVES AS A COMMUNITY HOSPITAL FOR JACKSON AND MACON AND SURROUNDING COUNTIES.COMMUNITY CAREPARTNERS, INC. OPERATES AN INPATIENT FACILITY FOR ACUTE REHABILITATION LOCATED IN ASHEVILLE, NORTH CAROLINA, AND PROVIDES A WIDE VARIETY OF POST-ACUTE CARE SERVICES TO RESIDENTS OF WESTERN NORTH CAROLINA, INCLUDING REHABILITATION, HOME HEALTH, ADULT CARE, AND HOSPICE AND PALLIATIVE CARE.MSJHS AND CCP JOINT DEVELOPMENT COMPANY DBA ASHEVILLE SPECIALTY HOSPITAL OPERATES AN INPATIENT FACILITY FOR LONG-TERM ACUTE CARE.
PART VI QUESTION 3 - PATIENT EDUCATION OF ABILITY FOR ASSISTANCE	EVERY PATIENT IS PROVIDED A COPY OF THE POLICY AS PART OF THE CONSENT TO TREATMENT AND FINANCIAL AUTHORIZATION FORM.PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE IS DESCRIBED IN PART V, QUESTIONS 13 - 16.
PART VI QUESTION 5 - PROMOTION OF COMMUNITY HEALTH	ASHEVILLE SPECIALTY HOSPITAL IS A LICENSED LONG TERM ACUTE CARE HOSPITAL SITUATED WITHIN MISSION HOSPITAL. ASHEVILLE SPECIALTY HOSPITAL AND MISSION HOSPITAL ARE BOTH PART OF THE MISSION HEALTH SYSTEM GROUP OF AFFILIATED ENTITIES. PROMOTION OF COMMUNITY HEALTH IS HANDLED BY MISSION HOSPITAL.

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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," on 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

2015

Open to Public
Inspection

Name of the organization
MISSION HEALTH SYSTEM INC

Employer identification number
58-1450888

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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) MISSION HEALTH SYSTEM FOUNDATION INC 980 HENDERSONVILLE ROAD ASHEVILLE,NC28803	56-1881331	501(C)(3)	2,461,943	SUPPORT OF MISSION HEALTHCARE FOUNDATION OPERATIONS
(2) UNITED WAY 50 S FRENCH BROAD ASHEVILLE,NC28801	56-0576157	501(C)(3)	110,000	ASSISTANCE TO LOCAL NONPROFIT
(3) ASHEVILLE CHAMBER OF COMMERCE 151 HAYWOOD STREET ASHEVILLE,NC28801	56-0125440	501(C)(6)	100,000	ASSISTANCE TO LOCAL NONPROFIT
(4) MAHEC 121 HENDERSONVILLE ROAD ASHEVILLE,NC28803	56-1071426	501(C)(3)	10,000	ASSISTANCE TO LOCAL NON-PROFIT.

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

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) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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

(1) SCHOLARSHIP PROGRAM FOR HEALTH CAREERS FOR MEMBERS OF MINORITY GROUPS - $2,000 AND $2,350 SCHOLARSHIPS	23	49,500	COST
(1)
(2)
(3)
(4)
(5)
(6)
(7)

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

PART I, LINE 2:

MISSION HEALTH SYSTEM, INC PROVIDES SUPPORT TO THE MISSION HEALTHCARE FOUNDATION, INC. AS PART OF ITS EXEMPT PURPOSE. THE HEALTH SYSTEM HAS OVERSIGHT THROUGH REVIEW OF THE MONTHLY FINANCIALS OF THE FOUNDATION TO ENSURE THAT IT CONTINUES TO OPERATE IN ACCORDANCE WITH ITS EXEMPT PURPOSE. OTHER GRANTS ARE PROVIDED TO LOCAL NONPROFITS TO SUPPORT ACTIVITIES WHICH BENEFIT THE COMMUNITY IN THE AREAS OF HEALTH AND EDUCATION. THE ORGANIZATION REVIEWS THE ACTIVITIES OF NONPROFITS PERIODICALLY TO EVALUATE THE MERITS OF DONATING TO THEM. TO QUALIFY FOR A KEISHA YOUNG HEALTH CAREERS SCHOLARSHIP, THE FOLLOWING REQUIREMENTS MUST BE MET AND PROVIDED ALONG WITH AN APPLICATION FOR THE SCHOLARSHIP. BE A MEMBER OF A MINORITY GROUP. MINORITY IS DEFINED ACCORDING TO THE GUIDELINES OF THE FEDERAL AND STATE GOVERNMENTS AS AFRICAN-AMERICAN, HISPANIC, ASIAN/PACIFIC ISLANDER, AND NATIVE AMERICAN. BE A RESIDENT OF WESTERN NORTH CAROLINA. MAINTAIN A MINIMUM CUMULATIVE GRADE POINT AVERAGE OF 2.75 ON A 4.0 SCALE. PURSUE A FIELD OF STUDY FOR WHICH MISSION HOSPITAL HAS AN EMPLOYMENT NEED. STUDENTS MUST BE INTERESTED IN PURSUING A CAREER IN THE FOLLOWING AREAS: OCCUPATIONAL THERAPIST, PHARMACIST, PARAMEDIC, REGISTERED NURSE ( ADN OR AND-BSN PROGRAMS),PHYSICAL THERAPIST, PHYSICAL THERAPIST ASSISTANT, SPEECHTHERAPIST,SURGICAL TECH.

Schedule I (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

MISSION HEALTH SYSTEM INC

Employer identification number

58-1450888

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

Yes

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

Yes

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

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

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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

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

Any related organization?

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

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

The organization?

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

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

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

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1RONALD A PAULUS MDSYSTEM PRESIDENT & CEO	(i) (ii)	0 ------------- 938,238	0 ------------- 0	0 ------------- 202,457	0 ------------- 349,743	0 ------------- 24,693	0 ------------- 1,515,131	0 ------------- 82,742
2CHARLES F AYSCUECHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 583,660	0 ------------- 182,468	0 ------------- 80,301	0 ------------- 13,250	0 ------------- 10,973	0 ------------- 870,652	0 ------------- 69,084
3ANN YOUNGGENERAL COUNSEL	(i) (ii)	0 ------------- 416,564	0 ------------- 77,299	0 ------------- 162,798	0 ------------- 15,900	0 ------------- 22,766	0 ------------- 695,327	0 ------------- 94,293
4MARC MALLOYSENIOR VP	(i) (ii)	0 ------------- 367,823	0 ------------- 196,500	0 ------------- 2,044	0 ------------- 69,592	0 ------------- 15,377	0 ------------- 651,336	0 ------------- 0
5PAUL MCDOWELLDEPUTY CHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 362,834	0 ------------- 97,222	0 ------------- 2,024	0 ------------- 73,913	0 ------------- 23,379	0 ------------- 559,372	0 ------------- 0
6JONATHAN BROWNCHIEF INFORMATION OFFICER	(i) (ii)	0 ------------- 211,475	0 ------------- 76,845	0 ------------- 2,082	0 ------------- 43,726	0 ------------- 4,918	0 ------------- 339,046	0 ------------- 0
7SULAIMAN SULAIMAN THRU 1 1 16CHIEF INFORMATION OFFICER	(i) (ii)	0 ------------- 326,292	0 ------------- 99,334	0 ------------- 2,740	0 ------------- 58,717	0 ------------- 26,660	0 ------------- 513,743	0 ------------- 0
8DEBRA FOSSSR VP HUMAN RESOURCES	(i) (ii)	0 ------------- 422,625	0 ------------- 144,891	0 ------------- 4,884	0 ------------- 10,600	0 ------------- 23,184	0 ------------- 606,184	0 ------------- 0
9ROWENA BUFFETT TIMMSSR VP MARKETING	(i) (ii)	0 ------------- 252,417	0 ------------- 100,860	0 ------------- 1,967	0 ------------- 49,575	0 ------------- 12,275	0 ------------- 417,094	0 ------------- 0
10DR JILL HOGGARD GREENPRES&CEO MISSION HOSPITAL	(i) (ii)	0 ------------- 562,385	0 ------------- 213,304	0 ------------- 7,839	0 ------------- 124,184	0 ------------- 22,116	0 ------------- 929,828	0 ------------- 0
11KATHY GUYETTECHIEF NURSING OFFICER	(i) (ii)	0 ------------- 360,580	0 ------------- 142,400	0 ------------- 40,155	0 ------------- 66,890	0 ------------- 12,139	0 ------------- 622,164	0 ------------- 34,027
12MARC WESTLE DOSVP INNOVATION ADMIN	(i) (ii)	0 ------------- 362,669	0 ------------- 144,825	0 ------------- 107,072	0 ------------- 70,995	0 ------------- 23,752	0 ------------- 709,313	0 ------------- 63,318
13RHONDA MILLERVICE PRESIDENT	(i) (ii)	0 ------------- 253,425	0 ------------- 74,875	0 ------------- 21,671	0 ------------- 52,360	0 ------------- 7,122	0 ------------- 409,453	0 ------------- 20,179
14OSCAR WEINMEISTERVICE PRESIDENT	(i) (ii)	0 ------------- 208,055	0 ------------- 44,075	0 ------------- 17,262	0 ------------- 35,491	0 ------------- 22,125	0 ------------- 327,008	0 ------------- 0
15JASON VANDIVERVICE PRESIDENT	(i) (ii)	0 ------------- 213,587	0 ------------- 59,140	0 ------------- 4,565	0 ------------- 33,224	0 ------------- 16,228	0 ------------- 326,744	0 ------------- 0
16JON YEATMANVICE PRESIDENT	(i) (ii)	0 ------------- 218,846	0 ------------- 72,558	0 ------------- 1,100	0 ------------- 43,211	0 ------------- 2,526	0 ------------- 338,241	0 ------------- 0
17ROBERT BEDNAREKVICE PRESIDENT	(i) (ii)	0 ------------- 242,967	0 ------------- 0	0 ------------- 79,399	0 ------------- 9,960	0 ------------- 23,222	0 ------------- 355,548	0 ------------- 30,791
18WILLIAM MAPLES MDFORMERCHIEF QUALITY OFFICER	(i) (ii)	0 ------------- 82,750	0 ------------- 0	0 ------------- 177,814	0 ------------- 3,333	0 ------------- 4,664	0 ------------- 268,561	0 ------------- 0

Schedule J (Form 990) 2015

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, LINES 4A-B

SEVERANCE PAY - WILLIAM MAPLES $177,070 OFFICERS AS WELL AS KEY EMPLOYEES AND TOP FIVE HIGHEST COMPENSATED EMPLOYEES WHO PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN WITH CONTRIBUTION AMOUNTS. RONALD PAULUS $339,143 JILL HOGGARD GREEN $113,584 SULAIMAN SULAIMAN $ 52,522 KATHY GUYETTE $ 53,640 ROWENA BUFFETT TIMMS$ 39,917 MARC WESTLE $ 55,095 PAUL MCDOWELL $ 63,313 JONATHAN BROWN $ 33,275 MARC MALLOY $ 62,378 RHONDA MILLER $ 39,653 OSCAR WEINMEISTER $ 26,891 JASON VANDIVER $ 28,875 JON YEATMAN $ 37,257 OFFICERS AS WELL AS KEY EMPLOYEES AND TOP FIVE HIGHEST COMPENSATED EMPLOYEES WHO RECEIVED PAYMENTS FROM A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. RONALD PAULUS $82,742 CHARLES AYSCUE $69,084 KATHY GUYETTE $34,027 ANN YOUNG $94,293 MARC WESTLE $63,318 RHONDA MILLER $20,179 ROBERT BEDNAREK $30,791

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
MISSION HEALTH SYSTEM INC

Employer identification number
58-1450888

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65820PCT0	01-31-2007	266,042,836	CONSTRUCT A HOSPITAL AND PARTIALLY REFUND THE 1998 BONDS AND 2001 BONDS	X			X		X
B	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65820PDL6	02-24-2010	65,144,060	CONSTRUCT HOSPITAL BUILDINGS AND STRUCTURES, AND ACQUIRE HOSPITAL EQUIPMENT.	X			X		X
C	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65820PBT1	10-01-2003	18,530,000	REFUND THE SERIES 1993 BONDS		X		X		X
D	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65820PFJ9	03-25-2015	82,465,746	PARTIALLY REFUND 2007 TAX-EXEMPT BONDS		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		11-13-2015	47,265,000	REFUND SERIES 2011 BONDS		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65820PGS8	09-14-2016	64,798,718	PARTIALLY REFUND 2007 AND 2010 TAX-EXEMPT BONDS		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	25,540,000		8,395,000		13,875,000		150,000
2 Amount of bonds legally defeased ..............	108,520,000		48,805,000
3 Total proceeds of issue ..................	295,108,088		65,271,359		18,530,000		83,556,454
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............	3,688,534		5,022,670
6 Proceeds in refunding escrows ...............			64,311,545		18,166,200		82,936,807
7 Issuance costs from proceeds ...............	1,975,135		921,516		319,444		619,646
8 Credit enhancement from proceeds .............					44,356
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	96,499,847		59,327,172
11 Other spent proceeds .............	192,944,572
12 Other unspent proceeds .............
13 Year of substantial completion .............	2009		2011
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X	X			X
15 Were the bonds issued as part of an advance refunding issue? .....	X			X		X	X
16 Has the final allocation of proceeds been made? ..........	X		X		X			X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		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		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2015

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		X		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?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		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 ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X		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		X		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		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X	X
b Exception to rebate? ........		X		X	X			X
c No rebate due? .........	X		X		X			X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X		X		X
b Name of provider ..........	BOFAWACHOVIA		NA		NA
c Term of hedge .........	210.0000000000 %
d Was the hedge superintegrated? ......		X		X		X
e Was the hedge terminated? ........	X			X		X

Schedule K (Form 990) 2015

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		X		X		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		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		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		X		X		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: 01/01/2011 ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2012 ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 09/30/2008
FORM 990, SCHEDULE K, PAGE 1, PART I COLUMN (E) AND PART II LINE 3	2007 BOND ISSUE INTEREST EARNED $29,065,252 2010 BOND ISSUE INTEREST EARNED $127,299 2015 BOND ISSUE ORIGINAL ISSUE DISCOUNT $8,580,746; INTEREST ON 2015 PROCEEDS $1,090,708 2016 BOND ISSUE DIFFERENCE BETWEEN PART I AND PART II ISSUE PRICE: PRESENT VALUE ACCRUAL OF $23,281
FORM 990, SCHEDULE K, PART VI, PAGE 4	SERIES 2015 BONDS: THE ORGANIZATION IS COMPLETING ANNUAL ARBITRAGE COMPLIANCE REVIEWS FOR SERIES 2015 BONDS. THE LAST ANNUAL REPORT COMPLETED WITHIN THIS SCHEDULE K FISCAL YEAR ENDING PERIOD WAS COMPLETED AS OF THE MARCH 25, 2016 EVALUATION DATE, OR THE SECOND BOND YEAR DURING THE FIRST INSTALLMENT PERIOD. THE ANNUAL REPORT REFLECTED THAT AN ARBITRAGE REBATE LIABILITY WAS NOT ACCRUING AS OF THIS REPORTING PERIOD.
FORM 990, SCHEDULE K, PART VI, PAGE 4	SERIES 2015B BONDS: THE ORGANIZATION HAS COMPLETED AN ARBITRAGE COMPLIANCE REVIEW FOR THE SERIES 2015B BONDS. THE ARBITRAGE COMPLIANCE REVIEW DETERMINED THAT THE SERIES 2015B BONDS QUALIFIED FOR THE SIX-MONTH SPENDING EXCEPTION AS OF MAY 13, 2016 AND THAT AN ARBITRAGE REBATE PAYMENT WOULD NOT BE DUE TO THE IRS AS OF NOVEMBER 13, 2020, THE FIRST INSTALLMENT PERIOD. THE SERIES 2015B BONDS DID NOT RECEIVE ANY TRANSFERRED PROCEEDS AND THERE ARE NO ADDITIONAL PLEDGED FUNDS THAT WOULD REQUIRE ADDITIONAL REBATE CALCULATIONS IN THE FUTURE.
FORM 990, SCHEDULE K, PART VI, PAGE 4	SERIES 2016 BONDS: THE ORGANIZATION HAS ENGAGED A FIRM TO COMPLETE ANNUAL ARBITRAGE COMPLIANCE REVIEWS FOR THE SERIES 2016 BONDS.

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
MISSION HEALTH SYSTEM INC

Employer identification number
58-1450888

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65820PCT0	01-31-2007	266,042,836	CONSTRUCT A HOSPITAL AND PARTIALLY REFUND THE 1998 BONDS AND 2001 BONDS	X			X		X
B	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65820PDL6	02-24-2010	65,144,060	CONSTRUCT HOSPITAL BUILDINGS AND STRUCTURES, AND ACQUIRE HOSPITAL EQUIPMENT.	X			X		X
C	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65820PBT1	10-01-2003	18,530,000	REFUND THE SERIES 1993 BONDS		X		X		X
D	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65820PFJ9	03-25-2015	82,465,746	PARTIALLY REFUND 2007 TAX-EXEMPT BONDS		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402		11-13-2015	47,265,000	REFUND SERIES 2011 BONDS		X		X		X
	NORTH CAROLINA MEDICAL CARE COMMISSION	52-1309402	65820PGS8	09-14-2016	64,798,718	PARTIALLY REFUND 2007 AND 2010 TAX-EXEMPT BONDS		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	25,540,000		8,395,000		13,875,000		150,000
2 Amount of bonds legally defeased ..............	108,520,000		48,805,000
3 Total proceeds of issue ..................	295,108,088		65,271,359		18,530,000		83,556,454
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............	3,688,534		5,022,670
6 Proceeds in refunding escrows ...............			64,311,545		18,166,200		82,936,807
7 Issuance costs from proceeds ...............	1,975,135		921,516		319,444		619,646
8 Credit enhancement from proceeds .............					44,356
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	96,499,847		59,327,172
11 Other spent proceeds .............	192,944,572
12 Other unspent proceeds .............
13 Year of substantial completion .............	2009		2011
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....		X		X	X			X
15 Were the bonds issued as part of an advance refunding issue? .....	X			X		X	X
16 Has the final allocation of proceeds been made? ..........	X		X		X			X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		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		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2015

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		X		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?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X		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 ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X		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		X		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		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X	X
b Exception to rebate? ........		X		X	X			X
c No rebate due? .........	X		X		X			X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X		X		X
b Name of provider ..........	BOFAWACHOVIA		NA		NA
c Term of hedge .........	210.0000000000 %
d Was the hedge superintegrated? ......		X		X		X
e Was the hedge terminated? ........	X			X		X

Schedule K (Form 990) 2015

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		X		X		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		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		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		X		X		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: 01/01/2011 ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 10/01/2012 ISSUER NAME: NORTH CAROLINA MEDICAL CARE COMMISSION DATE THE REBATE COMPUTATION WAS PERFORMED: 09/30/2008
FORM 990, SCHEDULE K, PAGE 1, PART I COLUMN (E) AND PART II LINE 3	2007 BOND ISSUE INTEREST EARNED $29,065,252 2010 BOND ISSUE INTEREST EARNED $127,299 2015 BOND ISSUE ORIGINAL ISSUE DISCOUNT $8,580,746; INTEREST ON 2015 PROCEEDS $1,090,708 2016 BOND ISSUE DIFFERENCE BETWEEN PART I AND PART II ISSUE PRICE: PRESENT VALUE ACCRUAL OF $23,281
FORM 990, SCHEDULE K, PART VI, PAGE 4	SERIES 2015 BONDS: THE ORGANIZATION IS COMPLETING ANNUAL ARBITRAGE COMPLIANCE REVIEWS FOR SERIES 2015 BONDS. THE LAST ANNUAL REPORT COMPLETED WITHIN THIS SCHEDULE K FISCAL YEAR ENDING PERIOD WAS COMPLETED AS OF THE MARCH 25, 2016 EVALUATION DATE, OR THE SECOND BOND YEAR DURING THE FIRST INSTALLMENT PERIOD. THE ANNUAL REPORT REFLECTED THAT AN ARBITRAGE REBATE LIABILITY WAS NOT ACCRUING AS OF THIS REPORTING PERIOD.
FORM 990, SCHEDULE K, PART VI, PAGE 4	SERIES 2015B BONDS: THE ORGANIZATION HAS COMPLETED AN ARBITRAGE COMPLIANCE REVIEW FOR THE SERIES 2015B BONDS. THE ARBITRAGE COMPLIANCE REVIEW DETERMINED THAT THE SERIES 2015B BONDS QUALIFIED FOR THE SIX-MONTH SPENDING EXCEPTION AS OF MAY 13, 2016 AND THAT AN ARBITRAGE REBATE PAYMENT WOULD NOT BE DUE TO THE IRS AS OF NOVEMBER 13, 2020, THE FIRST INSTALLMENT PERIOD. THE SERIES 2015B BONDS DID NOT RECEIVE ANY TRANSFERRED PROCEEDS AND THERE ARE NO ADDITIONAL PLEDGED FUNDS THAT WOULD REQUIRE ADDITIONAL REBATE CALCULATIONS IN THE FUTURE.
FORM 990, SCHEDULE K, PART VI, PAGE 4	SERIES 2016 BONDS: THE ORGANIZATION HAS ENGAGED A FIRM TO COMPLETE ANNUAL ARBITRAGE COMPLIANCE REVIEWS FOR THE SERIES 2016 BONDS.

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

MISSION HEALTH SYSTEM INC

Employer identification number

58-1450888

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

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

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

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

Part II

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

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No










Total ............... $

Part III

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

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

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2015

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) WILLIAM LEE	FORMER BOARD MEMBER	155,841	FORMER BOARD MEMBER HAS AN OWNERSHIP INTEREST IN A BUSINESS FROM WHICH THE ORGANIZATION PURCHASES SUPPLIES. SUPPLIES ARE PURCHASED AT FAIR MARKET VALUE, AND THE PRICE FOR THE SUPPLIES IS NEGOTIATED THROUGH A GROUP PURCHASING ARRANGEMENT AND NOT DIRECTLY WITH THE VENDOR. THE BOARD MEMBER IS NOT INVOLVED IN NEGOTIATING THE PRICING FOR THESE GOODS.		No
(2) WYATT STEVENS	BOARD MEMBER	223,313	THE BOARD MEMBER AND ANOTHER FAMILY MEMBER ARE PARTNERS IN A LAW FIRM WHICH PERFORMS LEGAL SERVICES FOR THE ORGANIZATION. THE ORGANIZATION ENGAGES THE LAW FIRM FOR LEGAL SERVICES IN ARMS-LENGTH TRANSACTIONS AT FAIR MARKET VALUE. THE BOARD MEMBER IS NOT INVOLVED IN NEGOTIATING THE PRICING FOR THE SERVICES RENDERED, NOR DOES HE PERFORM ANY OF THE SERVICES ENGAGED BY THE HOSPITAL.		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ 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

2015

Open to Public
Inspection

Name of the organization

MISSION HEALTH SYSTEM INC

Employer identification number

58-1450888

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11	FORM 990 IS PREPARED BY THE TAX FINANCE STAFF AT MISSION HEALTH SYSTEM. FORM 990 IS REVIEWED BY THE ORGANIZATION'S SENIOR LEADERSHIP TEAM. AN OUTSIDE ACCOUNTING FIRM IS ENGAGED TO REVIEW AND SIGN THE 990 FOR FINAL FILING WITH THE IRS. A DRAFT OF THE 990 IS PROVIDED TO THE MISSION HEALTH SYSTEM BOARD OF DIRECTORS FOR REVIEW. HIGHLIGHTS OF THE 990 ARE PRESENTED TO THE BOARD AND THEY HAVE THE OPPORTUNITY TO ASK QUESTIONS AND SUGGEST IMPROVEMENTS OR PROVIDE CORRECTIONS. IF THERE ARE CHANGES AS A RESULT OF BOARD REVIEW, A CORRECTED FORM 990 WILL BE PROVIDED FOR FINAL APPROVAL BEFORE FILING. AFTER FINAL APPROVAL, THE FINAL FORM 990 IS PROVIDED TO THE BOARD BEFORE FILING WITH THE IRS.
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 INCLUDING CONFLICTS OF INTEREST IS PROVIDED DURING ORIENTATION FOR NEW BOARD MEMBERS. BOARD MEETINGS BEGIN WITH A COMMENT SUMMARIZING THE CONFLICT OF INTEREST POLICY AND THE DUTY TO DISCLOSE CONFLICTS. IF A CONFLICT OF INTEREST IS IDENTIFIED, THE INTERESTED PERSON DOES NOT PARTICIPATE IN ANY DECISION RELATING TO THE TRANSACTION ISSUE. A CONFLICT OF INTEREST IS A PARTICULAR RELATIONSHIP OR ARRANGEMENT THAT WOULD REASONABLY BE EXPECTED TO EXERT AN INFLUENCE ON THE INDIVIDUAL'S JUDGMENT AND PRECLUDE THE INDIVIDUAL FROM BEING AN INDEPENDENT DIRECTOR OR BEING INDEPENDENT WITH RESPECT TO THE TRANSACTION UNDER CONSIDERATION. IN ADDITION TO BOARD MEMBERS, THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO MEMBERS OF SENIOR LEADERSHIP, MEDICAL STAFF, CLINICAL SERVICE LINE LEADERS, ELECTED MEDICAL STAFF LEADERS, DEPARTMENTAL DIRECTORS, STAFF MEMBERS WORKING IN THE PURCHASING DEPARTMENT, AND ALL OTHER STAFF MEMBERS WITH PURCHASING AUTHORITY, AS WELL AS IMMEDIATE FAMILY MEMBERS OF SUCH INTERESTED PERSONS AND ENTITIES IN WHICH INTERESTED PERSONS HAVE A MATERIAL FINANCIAL INTEREST. THE ORGANIZATION'S POLICY IS FOR ALL INTERESTED PERSONS TO DISCLOSE ANY AND ALL CONFLICTS OF INTEREST IN ACCORDANCE WITH THE IRS GUIDELINES FOR TAX-EXEMPT ENTITIES AS WELL AS ANY OTHER APPLICABLE STATE OR FEDERAL LAW. UPON INITIAL ASSUMPTION OF DUTIES, INTERESTED PERSONS ARE PROVIDED WITH A COPY OF THE CONFLICT OF INTEREST POLICY AND SUBMIT A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THEREAFTER, THE STATEMENTS WILL BE COMPLETED ANNUALLY. PERIODICALLY ALL STAFF MEMBERS ARE ASKED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT. INTERNAL AND EXTERNAL AUDITORS, GENERAL COUNSEL OR OUTSIDE COUNSEL WILL PERIODICALLY CONDUCT A REVIEW OF THE DISCLOSURE PROCESS TO DETERMINE WHETHER THE ORGANIZATION IS IN COMPLIANCE WITH THE POLICY.
FORM 990, PART VI, SECTION B, LINE 15	THE ORGANIZATION DRAWS WAGE COMPARISON DATA FROM OUTSIDE EXECUTIVE COMPENSATION CONSULTANTS TO ENSURE COMPENSATION LEVELS ARE AT FAIR MARKET VALUE THE HUMAN RESOURCES AND COMPENSATION COMMITTEE (COMMITTEE) REVIEWS THIS DATA AND RECOMMENDS TO THE BOARD ANY REVISIONS TO THE OVERALL PHILOSOPHY AND POLICY TO GUIDE THE DETERMINATION OF COMPENSATION AND BENEFIT PACKAGES FOR EXECUTIVES WHICH INCLUDES THE CEO, THE CFO, AND PRESIDENT AS WELL AS ALL OTHER EXECUTIVES, WHICH WOULD INCLUDE ALL KEY EMPLOYEES. THE COMMITTEE KEEPS AND DISTRIBUTES MINUTES OF ALL ITS MEETINGS TO ITS MEMBERS. ITEMS OF A SENSITIVE NATURE ARE REFERENCED IN THE MINUTES WITH DETAILED, SUPPORTING DOCUMENTATION RETAINED ON FILE. THE COMMITTEE ALSO DISCLOSES ANY POTENTIAL CONFLICTS OF INTEREST SITUATIONS TO THE COMMITTEE CHAIRMAN THAT MAY AFFECT THEIR INDEPENDENT DIRECTORS' STATUS AS SOON AS THEY ARISE, AND MAINTAINS COMPLETE DOCUMENTATION OF ALL MATTERS DISCUSSED BY THE COMMITTEE. THE COMMITTEE OBTAINS EDUCATION AND TRAINING TO EXERCISE ALL RESPONSIBILITIES EFFECTIVELY AND KEEPS ABREAST OF SIGNIFICANT DEVELOPMENTS IN EXECUTIVE COMPENSATION PRACTICES AND REGULATIONS, AND ENSURES THAT ALL ASPECTS OF MISSION HEALTH SYSTEM AND HOSPITAL EXECUTIVE COMPENSATION ADHERE TO ALL RELEVANT REGULATORY REQUIREMENTS, AND REVIEWS THE COMMITTEE CHARTER ANNUALLY REVISING AS APPROPRIATE AND CONDUCTS AN ANNUAL EVALUATION OF THE COMMITTEE'S PERFORMANCE.
FORM 990, PART VI, SECTION C, LINE 19	MISSION HEALTH SYSTEM PREPARES AN ANNUAL REPORT TO THE COMMUNITY AND MAKES ITS FINANCIAL STATEMENTS AND SIGNIFICANT ACCOMPLISHMENTS AVAILABLE THROUGH THIS REPORT ON THE MISSION HOSPITAL WEBSITE. THE ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC THROUGH THE NORTH CAROLINA SECRETARY OF STATE WEBSITE. CONFLICT OF INTEREST POLICY AND BY-LAWS ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G	MEDICAL CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,689,515. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,689,515. NON-MEDICAL CONTRACT LABOR: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 21,220,202. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,220,202. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 5,820,519. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,820,519. COLLECTION FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 5,276,649. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,276,649. BOND SERVICE FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 186,735. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 186,735. OTHER CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,792,033. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,792,033.
FORM 990, PART XI, LINE 9:	SUBSIDIARY EARNINGS - CONSOLIDATED 62,950,482. OTHER 1,540. MISSION IMAGING AND WNC CARESOURCE EARNINGS -8,732,089.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

MISSION HEALTH SYSTEM INC

Employer identification number

58-1450888

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
(1) MISSION IMAGING SERVICES LLC 509 BILTMORE AVENUE ASHEVILLE,NC28801 46-5181350	MEDICAL IMAGING	NC	12,478,412	7,515,776	MISSION HEALTH SYSTEM INC
(2) WNC CARESOURCE LLC 509 BILTMORE AVENUE ASHEVILLE,NC28801	SUPPORT CHARITABLE ACTIVITIES OF MISSION HEALTH SYSTEM	NC	93,854	2,808,764	MISSION HEALTH SYSTEM INC

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)MISSION HOSPITAL INC 400 RIDGEFIELD COURT SUITE 100 ASHEVILLE,NC28806 56-0532141	ACUTE CARE HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC	Yes
(2)MISSION HEALTH SYSTEM FOUNDATION INC 400 RIDGEFIELD COURT SUITE 100 ASHEVILLE,NC28806 56-1881331	FOUNDATION	NC	501(C)(3)	LINE 7	MISSION HEALTH SYSTEM INC	Yes
(3)MISSION MEDICAL ASSOCIATES INC 400 RIDGEFIELD COURT SUITE 100 ASHEVILLE,NC28806 26-3627231	EMPLOYED PHYSICIAN GROUP	NC	501(C)(3)	LINE 9	MISSION HEALTH SYSTEM INC	Yes
(4)THE MCDOWELL HOSPITAL INC 430 RANKIN DRIVE MARION,NC28752 56-0623938	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC	Yes
(5)BLUE RIDGE REGIONAL HOSPITAL INC POST OFFICE BOX 9 SPRUCE PINE,NC28777 56-1025032	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC	Yes
(6)BLUE RIDGE REGIONAL HOSPITAL FOUNDATION INC PO BOX 247 SPRUCE PINE,NC28777 58-2172660	FOUNDATION	NC	501(C)(3)	LINE 11A, I	BLUE RIDGE REGIONAL HOSPITAL INC		No
(7)TRANSYLVANIA COMMUNITY HOSPITAL INC 260 HOSPITAL DRIVE BREVARD,NC28712 56-0562293	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC	Yes
(8)TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC PO BOX 2440 BREVARD,NC28712 56-1458024	FOUNDATION	NC	501(C)(3)	LINE 11A, I	TRANSYLVANIA COMMUNITY HOSPITAL INC		No
(9)TRANSYLVANIA PHYSICIAN SERVICES INC 260 HOSPITAL DRIVE BREVARD,NC28712 56-1920816	PHYSICIAN SERVICES	NC	501(C)(3)	LINE 3	TRANSYLVANIA COMMUNITY HOSPITAL INC		No
(10)ANGEL MEDICAL CENTER INC PO BOX 1209 FRANKLIN,NC28744 56-6000064	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC	Yes
(11)ANGEL MEDICAL CENTER AUXILIARY INC PO BOX 1209 FRANKLIN,NC28744 56-2133719	SUPPORTING ORGANIZATION	NC	501(C)(3)	LINE 11A, I	ANGEL MEDICAL CENTER INC		No
(12)COMMUNITY CAREPARTNERS INC PO BOX 5779 ASHEVILLE,NC28813 56-2005198	LONG TERM REHABILITATION	NC	501(C)(3)	LINE 9	MISSION HEALTH SYSTEM INC	Yes
(13)MCDOWELL HEALTHCARE FOUNDATION INC 430 RANKIN DRIVE MARION,NC28752 46-3395393	FOUNDATION	NC	501(C)(3)	LINE 7	THE MCDOWELL HOSPITAL INC		No
(14)HIGHLANDS-CASHIERS HOSPITAL INC PO BOX 190 HIGHLANDS,NC28741 56-0509400	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC	Yes
(15)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

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) ASHEVILLE IMAGING LLP 534 BILTMORE AVENUE ASHEVILLE,NC28801 56-1907201	MEDICAL IMAGING	NC	N/A
(2) ASHEVILLE MRI PO BOX 2959 ASHEVILLE,NC28802 56-1665863	MEDICAL IMAGING	NC	N/A
(3) BLUE RIDGE DME LLC 125 HOSPITAL DRIVE SPRUCE PINE,NC28777 26-3570174	HOME MEDICAL EQUIPMENT & SUPPLIES SALES	NC	N/A
(4) BLUE RIDGE-TKC LLC 5935 CARNEGIE BLVD CHARLOTTE,NC28209 47-1382912	REAL ESTATE RENTAL	NC	N/A
(5) HEALTHCARE III LIMITED PARTNERSHIP 260 HOSPITAL DRIVE BREVARD,NC28712 56-1599596	RENTAL	NC	N/A
(6) HEALTHCARE LIMITED LIABILITY COMPANY VII 260 HOSPITAL DRIVE BREVARD,NC28712 20-0343455	RENTAL	NC	N/A
(7) IMAGING REALTY LLP 534 BILTMORE AVENUE ASHEVILLE,NC28801 56-1907203	MEDICAL BUILDING	NC	MISSION HEALTH SYSTEM INC	RELATED	130,130	381,529		No		Yes		69.000 %
(8) MCDOWELL MRI LLC 414 RANKIN DRIVE MARION,NC28752 75-3046378	MEDICAL IMAGING	NC	N/A
(9) MSJHS AND CCP JOINT DEVELOPMENT COMPANY LLC 428 BILTMORE AVENUE ASHEVILLE,NC28801 56-2250464	LONG TERM ACUTE CARE HOSPITAL	NC	MISSION HEALTH SYSTEM INC	RELATED	-294,415	3,786,530		No		Yes		67.000 %
(10) SPRUCE PINE HEALTHCARE LLC 5935 CARNEGIE BLVD CHARLOTTE,NC28209 47-1390107	REAL ESTATE	NC	N/A
(11) TRANSYLVANIA HEALTHCARE II LIMITED PARTNERSHIP 2 MEDICAL PARK DRIVE BREVARD,NC28712 20-0333230	RENTAL	NC	N/A
(12) WESTERN NC HEALTHCARE INNOVATORS III LLC - SOLD 2 24 16 5935 CARNEGIE BLVD CHARLOTTE,NC28209 46-4053310	REAL ESTATE RENTAL	NC	MISSION HEALTH SYSTEM INC	RELATED				No		Yes
(13) WESTERN NC HEALTHCARE INNOVATORS LLC 5935 CARNEGIE BLVD CHARLOTTE,NC28209 80-0787882	REAL ESTATE RENTAL	NC	MISSION HEALTH SYSTEM INC	RELATED		6,240,101		No		Yes		85.560 %
(14) WESTERN REGIONAL RADIATION THERAPY CENTER 68 HOSPITAL DRIVE SYLVA,NC28779 56-1849395	RADIATION THERAPY	NC	MISSION HEALTH SYSTEM INC	RELATED	-81,083	801,477		No		Yes		50.000 %
(15) WNC STONE CENTER 509 BILTMORE AVENUE ASHEVILLE,NC28801 27-2152974	LITHOTRIPTER RENTAL	NC	N/A
(16) BREVARD MRI AT TRANSYLVANIA COMMUNITY HOSPITAL LLC 260 HOSPITAL DRIVE BREVARD,NC28712 20-3281110	MEDICAL IMAGING	NC		UNRELATED				No			No

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) MISSION VENTURES INC 400 RIDGEFIELD COURT SUITE 100 ASHEVILLE,NC28806 56-1341621	DISSOLVED SEPTEMBER 7 2016	NC	MISSION HEALTH SYSTEM INC	C			100.000 %	Yes
(2) DOGWOOD INSURANCE COMPANY LTD THEGRANDPAVILIONCOMMERCIALCENTREPOB GRAND CAYMAN CJ	CAPTIVE INSURANCE ENTITY	CJ	MISSION HEALTH SYSTEM INC	C	8,475,101	64,722,458	100.000 %	Yes
(3) TRANSYLVANIA SERVICES INC 260 HOSPITAL DRIVE BREVARD,NC28712 56-1448199	REAL ESTATE	NC	N/A	C				Yes
(4) MISSION HEALTH PARTNERS INC 509 BILTMORE AVENUE ASHEVILLE,NC28801 46-5566095	CLINICALLY INTEGRATED NETWORK	NC	MISSION HEALTH SYSTEM INC	C				Yes
(5) HEALTHY STATE INC 509 BILTMORE AVENUE ASHEVILLE,NC28801 81-2108613	ADMINISTRATIVE	NC	MISSION HEALTH SYSTEM INC	C			100.000 %		No

Schedule R (Form 990) 2015

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

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

Yes

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

Yes

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

Yes

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

Yes

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ANGEL MEDICAL CENTER INC	A	114,117	INTEREST RATE FMV/CASH RECD
(2) ANGEL MEDICAL CENTER INC	C	484	CASH VALUE
(3) ANGEL MEDICAL CENTER INC	D	7,145,000	FMV
(4) ANGEL MEDICAL CENTER INC	L	4,225,546	CASH VALUE
(5) ANGEL MEDICAL CENTER INC	S	1,286,761	CASH VALUE
(6) BLUE RIDGE REGIONAL FOUNDATION INC	C	32,609	CASH VALUE
(7) BLUE RIDGE REGIONAL FOUNDATION INC	S	202,969	CASH VALUE
(8) BLUE RIDGE REGIONAL HOSPITAL INC	D	11,088,473	FMV
(9) BLUE RIDGE REGIONAL HOSPITAL INC	L	4,049,342	CASH VALUE
(10) BLUE RIDGE REGIONAL HOSPITAL INC	R	301,438	CASH VALUE
(11) COMMUNITY CARE PARTNERS INC	L	1,055,188	CASH VALUE
(12) COMMUNITY CARE PARTNERS INC	M	3,510	CASH VALUE
(13) DOGWOOD INSURANCE COMPANY	M	1,570,532	CASH VALUE
(14) DOGWOOD INSURANCE COMPANY	R	33,954,581	CASH VALUE
(15) HIGHLANDS CASHIERS HOSPITAL INC	L	1,227,716	CASH VALUE
(16) HIGHLANDS CASHIERS HOSPITAL INC	R	1,195,498	CASH VALUE
(17) HIGHLANDS CASHIERS PHYSICIAN SERVICES INC	L	159,958	CASH VALUE
(18) HIGHLANDS CASHIERS PHYSICIAN SERVICES INC	R	70,485	CASH VALUE
(19) HEALTHY STATE INC	R	180,313	CASH VALUE
(20) IMAGING REALTY LLC	J	51,270	CASH VALUE
(21) IMAGING REALTY LLC	L	1,383	CASH VALUE
(22) IMAGING REALTY LLC	S	201,240	CASH VALUE
(23) MISSION COMMUNITY ANESTHESIOLOGY	R	928,022	CASH VALUE
(24) MISSION HEALTH SYSTEM FOUNDATION INC	B	2,461,943	CASH VALUE
(25) MISSION HEALTH SYSTEM FOUNDATION INC	C	337,554	CASH VALUE
(26) MISSION HEALTH SYSTEM FOUNDATION INC	M	1,030	CASH VALUE
(27) MISSION HEALTH SYSTEM FOUNDATION INC	S	11,330	CASH VALUE
(28) MISSION HEALTH PARTNERS INC	L	21	CASH VALUE
(29) MISSION MEDICAL ASSOCIATES INC	L	8,685,143	CASH VALUE
(30) MISSION MEDICAL ASSOCIATES INC	M	458,308	CASH VALUE
(31) MISSION MEDICAL ASSOCIATES INC	R	52,530,864	CASH VALUE
(32) MISSION HOSPITAL INC	J	4,659	CASH VALUE
(33) MISSION HOSPITAL INC	L	135,902,617	CASH VALUE
(34) MISSION HOSPITAL INC	M	203,765	CASH VALUE
(35) MISSION HOSPITAL INC	S	47,526,190	CASH VALUE
(36) MSJHS AND CCP JOINT DEVELOPMENT COMPANY LLC	L	7,365	CASH VALUE
(37) THE MCDOWELL HOSPITAL INC	A	38,814	INTEREST RATE FMV/CASH RECD
(38) THE MCDOWELL HOSPITAL INC	D	2,734,377	FMV
(39) THE MCDOWELL HOSPITAL INC	L	4,156,985	CASH VALUE
(40) THE MCDOWELL HOSPITAL INC	R	2,441,112	CASH VALUE
(41) THE MCDOWELL HOSPITAL FOUNDATION INC	C	82,401	CASH VALUE
(42) TRANSYLVANIA PHYSICIAN SERVICES	L	220,234	CASH VALUE
(43) TRANSYLVANIA PHYSICIAN SERVICES	S	312,363	CASH VALUE
(44) TRANSYLVANIA COMMUNITY HOSPITAL INC	A	174,420	INTEREST RATE FMV/CASH RECD
(45) TRANSYLVANIA COMMUNITY HOSPITAL INC	D	10,823,041	FMV
(46) TRANSYLVANIA COMMUNITY HOSPITAL INC	L	5,960,315	CASH VALUE
(47) TRANSYLVANIA COMMUNITY HOSPITAL INC	S	1,134,315	CASH VALUE
(48) TRANSYLVANIA SERVICES INC	J	36,000	CASH VALUE
(49) TRANSYLVANIA SERVICES INC	S	4,460	CASH VALUE

Schedule R (Form 990) 2015

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2015

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) 2015

Additional Data

Software ID:
Software Version:

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No