TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) TIM BLENCO...................................................................... CHAIR	2.00 ................. 0.00	X	X		0	0
(2) STEVE JONES...................................................................... VICE CHAIR	2.00 ................. 0.00	X	X		0	0
(3) LEE LATTIMORE...................................................................... SECRETARY/TREASURER	2.00 ................. 0.00	X	X		0	0
(4) BOBBIE YOUNG...................................................................... IMMEDIATE PAST CHAIR	1.00 ................. 1.00	X	X		0	0
(5) HAROLD WALKER...................................................................... TRUSTEE	1.00 ................. 0.00	X			0	0
(6) SHERRON CRAWFORD...................................................................... TRUSTEE	1.00 ................. 0.00	X			0	0
(7) JEFFREY RANKIN...................................................................... TRUSTEE	1.00 ................. 4.00	X			0	0
(8) RAY MCKESSON...................................................................... TRUSTEE	1.00 ................. 0.00	X			0	0
(9) KATHY GUYETTE...................................................................... TRUSTEE	1.00 ................. 59.00	X			652,394	103,779
(10) LARRY HILL JR...................................................................... TRUSTEE	1.00 ................. 59.00	X			295,431	52,002
(11) JONATHAN BAILEY...................................................................... TRUSTEE	1.00 ................. 59.00	X			345,802	73,475
(12) MARGARET SULLIVAN MD...................................................................... TRUSTEE, CHIEF OF STAFF	40.00 ................. 0.00	X			335,372	37,894
(13) REX HENDERSON MD...................................................................... TRUSTEE, PAST CHIEF OF STAFF	10.00 ................. 0.00	X			0	0
(14) CAROL WOLFENBARGER...................................................................... PRESIDENT & CNO	49.00 ................. 1.00	X	X		272,672	27,692
(15) CLINT STEWART...................................................................... REGIONAL DIRECTOR -FINANCE	24.00 ................. 26.00		X		165,103	28,214
(16) DANIEL MCLAUGHLIN...................................................................... PHYSICIAN	40.00 ................. 0.00			X	392,950	25,299
(17) EDWARD ST BERNARD...................................................................... PHYSICIAN	40.00 ................. 0.00			X	506,021	34,965

- 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

ANC MCDOWELL HOSPITAL INC

Employer identification number

56-0623938

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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

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

(i) Name of supported organization	(ii) EIN	(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)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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.

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 12a or 12b 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) 2019

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.

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) 2019

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 (explain in Part VI). 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) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

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.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

ANC MCDOWELL HOSPITAL INC

Employer identification number

56-0623938

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization ANC MCDOWELL HOSPITAL INC

Part I Contributors	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
		$	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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization ANC MCDOWELL HOSPITAL INC		Employer identification number 56-0623938

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization ANC MCDOWELL HOSPITAL INC			Employer identification number 56-0623938
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) (2019)

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

ANC MCDOWELL HOSPITAL INC

Employer identification number

56-0623938

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2019

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 ....	51,070	46,664	46,859	44,788	44,862
b	Contributions ...			0	0	0
c	Net investment earnings, gains, and losses	2,846	4,406	-195	2,071	-74
d	Grants or scholarships ...		0		0
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	53,916	51,070	46,664	46,859	44,788

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

Board designated or quasi-endowment SchDMd Bullet

100.000 %

Permanent endowment SchDMd Bullet

Term 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)

Yes

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

Yes

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 .....	545,873		545,873
b	Buildings ....	35,670,068	3,382,235	32,287,833
c	Leasehold improvements	7,121,940	1,166,855	5,955,085
d	Equipment ....	13,908,156	7,844,529	6,063,627
e	Other .....	16,792,586	782,160	16,010,426
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				60,862,844

Schedule D (Form 990) 2019

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.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	25,215,971
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) 2019

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 V, LINE 4:

BOARD DESIGNATED ENDOWMENT FUNDS ARE HELD FOR THE BENEFIT OF THE HOSPITAL AND USED FOR EXEMPT PURPOSE.

PART X, LINE 2:

MISSION APPLIES THE PROVISIONS OF FASB ASC TOPIC 740, INCOME TAXES, IN ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. ASC TOPIC 740 PROVIDES GUIDANCE ON WHEN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND HOW THE VALUES OF THESE POSITIONS ARE DETERMINED. THERE IS CURRENTLY NO IMPACT ON THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS AS A RESULT OF THE APPLICATION OF ASC TOPIC 740. THE MCDOWELL HOSPITAL, INC. IS INCLUDED IN THE COMBINED FINANCIAL STATEMENTS DESCRIBED ABOVE.

Schedule D (Form 990) 2019

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

ANC MCDOWELL HOSPITAL INC

Employer identification number

56-0623938

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

Yes

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	3,217,026		3,217,026	4.540 %
b	Medicaid (from Worksheet 3, column a) . . . . .	9,926,898	8,137,204	1,789,694	2.530 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	13,143,924	8,137,204	5,006,720	7.070 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .	14,265		14,265	0.020 %
g	Subsidized health services (from Worksheet 6) . . . .	19,483,885	16,697,892	2,785,993	3.940 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	116,195		116,195	0.160 %
j	Total. Other Benefits . .	19,614,345	16,697,892	2,916,453	4.120 %
k	Total. Add lines 7d and 7j .	32,758,269	24,835,096	7,923,173	11.190 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

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

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other	1,857	1,857	0 %
10	Total	1,857	1,857	0 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

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

5,184,105

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. ......

58,296

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).....

17,059,336

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

15,285,663

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

1,773,673

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

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

Schedule H (Form 990) 2019

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?1Name, 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)
1	THE MCDOWELL HOSPITAL 430 RANKIN DRIVE MARION,NC28752 MISSIONHEALTH.ORG/MEMBER-HOSPITALS/MCD H0097	X	X	X

Schedule H (Form 990) 2019

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)

	THE MCDOWELL HOSPITAL INC
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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

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

Yes

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

Yes

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

Hospital facility’s website (list url): SEE EXPLANATION FOR 7D

Other website (list url):

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 16

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

Yes

If "Yes" (list url): SEE PART V

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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	THE MCDOWELL HOSPITAL INC
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 200.000000000000%
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)

Was widely publicized 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):

SEE PART V

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

SEE PART V

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

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	THE MCDOWELL HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

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

	THE MCDOWELL HOSPITAL INC
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2019

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
THE MCDOWELL HOSPITAL, INC.	PART V, SECTION B, LINE 5: THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED IN PARTNERSHIP WITH THE RUTHERFORD POLK MCDOWELL (RPM) HEALTH DISTRICT AND MCDOWELL HEALTH COALITION. THIS WRITTEN REPORT DESCRIBES: THE COMMUNITY SERVED BY THE HOSPITAL-COMMUNITY DEMOGRAPHICS-EXISTING HEALTH RESOURCES IN THE COMMUNITY AVAILABLE TO RESPOND TO NEEDS-HOW DATA WAS COLLECTED IN THE ASSESSMENT PROCESS-THE PRIORITY HEALTH NEEDS OF THE COMMUNITY-HEALTH NEEDS AND ISSUES OF UNINSURED, LOW-INCOME, AND MINORITY GROUPS-THE PROCESS FOR IDENTIFYING AND PRIORITIZING COMMUNITY NEEDS AND SERVICES TO MEET THE NEEDS-THE PROCESS FOR CONSULTING WITH PERSONS REPRESENTING THE COMMUNITY'S INTERESTS-INFORMATION GAPS THAT LIMIT THE HOSPITAL FACILITY'S ABILITY TO ASSESS THE COMMUNITY'S HEALTH NEEDS
THE MCDOWELL HOSPITAL, INC.	PART V, SECTION B, LINE 6A: THE ORGANIZATION'S COLLABORATIVE COMMUNITY HEALTH IMPROVEMENT EFFORT IS ALSO SUPPORTED BY A LARGER PARTNERSHIP WITH OTHER HOSPITAL FACILITIES AND HEALTH DEPARTMENT PARTNERS ACROSS A SIXTEEN COUNTY REGION IN WESTERN NORTH CAROLINA TO IMPROVE COMMUNITY HEALTH: WNC HEALTHY IMPACT. MORE INFORMATION ABOUT THIS INNOVATIVE REGIONAL COLLABORATION, COUNTY-WIDE COMMUNITY HEALTH ASSESSMENTS, AND OVERALL REGIONAL FINDINGS, ARE MADE WIDELY AVAILABLE TO THE PUBLIC AT WWW.WNCHEALTHYIMPACT.COM.
THE MCDOWELL HOSPITAL, INC.	PART V, SECTION B, LINE 6B: MCDOWELL COUNTY HEALTH DEPARTMENT
THE MCDOWELL HOSPITAL, INC.	PART V, SECTION B, LINE 7D: HTTPS://MISSIONHEALTH.ORG/OUR-COMMITMENT-TO-YOU/COMMUNITY-INVESTMENT/OUR-COMMUNITYS-HEALTH-NEEDS/
THE MCDOWELL HOSPITAL, INC.	PART V, SECTION B, LINE 11: IMPLEMENTED CAMPUS-WIDE EDUCATIONAL CAMPAIGN ABOUT TOBACCO-FREE CAMPUS POLICY, INCLUDING PERSONAL INSTRUCTION OF VISITORS, TABLE TENT NOTICES, ETC.PROVIDED SMOKING CESSATION EXHIBIT AT LOCAL COMMUNITY EVENTS, WITH HEALTHY VS. SMOKER'S LUNG GRAPHICS, INFORMATION CARDS WITH CESSATION RESOURCES, AND PROS AND CONS OF TOBACCO USE; PARTICIPATED IN MORE THAN 21 HEALTH FAIRS AND FESTIVALS.PARTNERED WITH LOCAL SCHOOLS TO STUDY THE SUSTAINABILITY OF SCHOOL-BASED HEALTH CLINIC TO EXPAND ACCESS TO HEALTHCARE FOR TEENAGERS AND HEALTH INFORMATION FOR HIGH SCHOOL STUDENTS.EXPANDED TELEMEDICINE STRATEGY FOR LOCAL SCHOOL SYSTEM, WITH ADDITIONAL ATHLETIC TRAINER ACCESS AT THE MIDDLE SCHOOL LEVEL.IMPLEMENTED CHRONIC PAIN CARE PROCESS MODEL (CPM) AT 100% OF MHM CLINICS.COMPLETED CONSTRUCTION OF GREENWAY CONNECTING THE HOSPITAL TO THE LOCAL YMCA.PARTNERED WITH CORPENING YMCA TO OFFER TAKING CONTROL OF TYPE 2 DIABETES PROGRAM, WITH SIGNIFICANT PROGRAMMATIC GROWTH SINCE 2017.SUPPORTED COMMUNITY EFFORTS TO ADDRESS ACCESS TO HEALTHY FOODS, INCLUDING FINAL PLANS TO OPEN A FOOD HUB THAT WILL OFFER FOOD, EDUCATION, AND RESOURCES TO THOSE WITH FOOD DISPARITIES; THE HOSPITAL DONATED SEVERAL KITCHEN ITEMS FOR UP-FIT OF THE FOOD HUB, INCLUDING STOVES AND STAINLESS STEEL TABLES.THERE ARE NO SIGNIFICANT NEEDS IDENTIFIED WHICH ARE NOT BEING ADDRESSED.SEE IMPLEMENTATION PLAN AT: HTTPS://MISSIONHEALTH.ORG/OUR-COMMITMENT-TO-YOU/COMMUNITY-INVESTMENT/OUR-COMMUNITYS-HEALTH-NEEDS/
THE MCDOWELL HOSPITAL, INC.	PART V, SECTION B, LINE 15E: THE ORGANIZATION'S STAFF WORK IN COLLABORATION WITH THE PATIENT AND APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED OF HEALTH CARE SERVICES TO DETERMINE AVAILABLE FUNDING SOURCES.
PART V, SECTION B, LINE 10A	HTTPS://MISSIONHEALTH.ORG/OUR-COMMITMENT-TO-YOU/COMMUNITY-INVESTMENT/OUR-COMMUNITYS-HEALTH-NEEDS/
PART V, SECTION B, LINE 16A	HTTPS://MISSIONHEALTH.ORG/WP-CONTENT/UPLOADS/2018/05/FINASSDISCOUNT_POLICY_04.PDF
PART V, SECTION B, LINE 16B	HTTPS://MISSIONHEALTH.ORG/WP-CONTENT/UPLOADS/2018/05/PATIENT_FINANCIAL_ASSISTANCE_PAGE.PDF
PART V, SECTION B, LINE 16C	HTTPS://MISSIONHEALTH.ORG/WP-CONTENT/UPLOADS/2018/03/FINASSISTPLAIN_LANGUAGE_SUMMARY_4.PDF

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?9
Name and address		Type of Facility (describe)
1	1 - MCDOWELL SURGICAL 472 RANKIN DRIVE MARION,NC28752	OUTPATIENT SURGERY
2	2 - MCDOWELL URGENT CARE 472 RANKIN DRIVE MARION,NC28752	RURAL HEALTH CLINIC
3	3 - MCDOWELLOBGYNMCDOWELLINTERNALMEDICINE 1633 SUGAR HILL ROAD MARION,NC28752	OB/GYN
4	4 - MCDOWELL REHABILIATION SERVICES 1633 SUGAR HILL ROAD MARION,NC28752	REHABILITATION
5	5 - MCDOWELL PEDIATRICS 387 US 70 WEST MARION,NC28752	RURAL HEALTH CLINIC
6	6 - FAMILY MEDICINE NEBO 339 NEBO SCHOOL ROAD NEBO,NC28761	RURAL HEALTH CLINIC
7	7 - COMMUNITY MEDICINE OLD FORT 32 E MAIN STREET OLD FORT,NC28762	RURAL HEALTH CLINIC
8	8 - FAMILY MEDICINE GLENWOOD 5623 US HIGHWAY 221 S MARION,NC28752	RURAL HEALTH CLINIC
9	9 - MCDOWELL PAIN MANAGEMENT CENTER 100 SPAULDING ROAD MARION,NC28752	PAIN MANAGEMENT SERVICES
10

Schedule H (Form 990) 2019

Page 10

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 7:	THE ORGANIZATION USED THE NCHA ANDI REPORTS WHICH ARE BASED ON THE IRS GUIDELINES. FOR PHYSICIAN CLINICS, AS DESCRIBED IN SUBSIDIZED HEALTH SERVICES, DIRECT AND INDIRECT COSTS WERE USED. THE FINANCIALS INCLUDE ALL PATIENT SEGMENTS, INCLUDING INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, AND SELF-PAY. A COST TO CHARGE RATIO WAS GENERATED USING THE IRS WORKSHEET 2 AND USED FOR ALL COMMUNITY BENEFITS REPORTED EXCEPT FOR SUBSIDIZED SERVICES WHICH USED DIRECT AND INDIRECT COSTS.
PART III, LINE 2:	THE ORGANIZATION USES A COST TO CHARGE RATIO TO ESTIMATE BAD DEBT.
PART III, LINE 3:	THE ORGANIZATION USES THE COST TO CHARGE RATIO APPLIED TO BAD DEBTS RECLASSIFIED TO CHARITY CARE AS OF THE MOST RECENT DATE AVAILABLE AFTER YEAR END.
PART III, LINE 4:	THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR MISSION HEALTH SYSTEM. THE COST OF THE ORGANIZATION'S BAD DEBT IS INCLUDED IN TOTAL COST OF UNCOLLECTIBLE ACCOUNTS REPORTED ON THESE AUDITED FINANCIALS.
PART III, LINE 8:	PER THE INSTRUCTIONS, THE MEDICARE COST REPORT IS THE BASIS FOR CALCULATING THE COSTS USING ALLOWABLE COSTS RELATED TO THE REVENUE REPORTED.
PART III, LINE 9B:	PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AND OTHER CHARITY CARE ARENOTIFIED USING THE PROCESS DESCRIBED IN THE EDUCATION OF PATIENTS'ELIGIBILITY IN PART VI, ON LINE 3.MISSION'S STATED POLICY WITH RESPECT TO FINANCIAL ASSISTANCE: "MISSIONHOSPITAL WILL MAKE EVERY EFFORT TO THOROUGHLY SCREEN ALL PATIENTS THAT AREUNINSURED OR UNDERINSURED IN AN EFFORT TO IDENTIFY A SOURCE OF FINANCIALSPONSORSHIP. ONLY AFTER A FINAL DETERMINATION IS MADE THAT THE PATIENT ISNOT ELIGIBLE FOR ANY SOURCE OF FUNDING TO COVER THE MEDICAL EXPENSES WILLTHE ACCOUNT BE ELIGIBLE FOR CONSIDERATION OF FINANCIAL ASSISTANCE."AFTER THE NOTIFICATIONS AND PROCESSES REFERENCED ABOVE HAVE BEENCOMPLETED, STANDARD DEBT COLLECTION POLICIES ARE IN EFFECT FOR THE PORTIONOF THE BILL FOR WHICH THE PATIENT IS RESPONSIBLE.
PART VI, LINE 2:	MCDOWELL COUNTY HAS A POPULATION OF 45,231 PEOPLE AND GEOGRAPHICALLY CONSISTS OF 442 SQUARE MILES LOCATED IN THE APPALACHIAN MOUNTAINS. MCDOWELL COUNTY RESIDENTS ARE 90.6% WHITE AND 9.4% NON-WHITE, COMPARED TO A NORTH CAROLINA AVERAGE OF 68.5% WHITE AND 31.5% NONWHITE. FIVE (5%) PERCENT OF THE POPULATION IDENTIFIES AS HISPANIC OR LATINO. APPROXIMATELY 70.3% OF THE POPULATION IN THIS COUNTY LIVE IN A RURAL AREA. SOME MAY EXPERIENCE TRANSPORTATION BARRIERS. UNEMPLOYMENT IS SLIGHTLY HIGHER IN MCDOWELL THAN IN THE REST OF NORTH CAROLINA, AT 5.8% IN THE COUNTY AS COMPARED TO 5.4% IN THE REST OF THE STATE. MCDOWELL COUNTY ALSO HAS A RELATIVELY LARGE ELDERLY POPULATION. MCDOWELL IS CONSISTENTLY RANKED IN THE LOWER HALF OF COUNTIES IN NORTH CAROLINA FOR HEALTH OUTCOMES: 22% OF MCDOWELL ADULTS (VS.18% OF NC RESIDENTS AND 16.9% OF US RESIDENTS OVERALL) REPORT THEY ARE IN POOR OR FAIR HEALTH; 23% ARE CURRENT SMOKERS (VS. 22% OF NC RESIDENTS AND 19.6% OF US RESIDENTS OVERALL); 33% OF ADULTS ARE OBESE (VS. 29% OF NC RESIDENTS AND 27.6% OF US RESIDENTS OVERALL); 31% OF ADULTS IN MCDOWELL COUNTY REPORT NO LEISURE TIME PHYSICAL ACTIVITY (VS. 25% OF NC RESIDENTS AND 22.9% OF US RESIDENTS OVERALL). MANY HEALTH INDICATORS IN MCDOWELL COUNTY HAVE SHOWN LITTLE IMPROVEMENT IN THE LAST THREE YEARS SINCE THE 2012 COMMUNITY HEALTH NEEDS ASSESSMENT. NOTABLE UNFAVORABLE CHANGES IN SOCIAL DETERMINANTS OF HEALTH THAT HAVE OCCURRED OVER THE PAST THREE YEARS INCLUDE: A REDUCTION IN THE MEDIAN FAMILY INCOME, AN INCREASE IN RESIDENTS LIVING BELOW THE POVERTY LEVEL AND CHILDHOOD POVERTY ALONG WITH INCREASES IN CRIME AND DOMESTIC VIOLENCE. FROM A HEALTH OUTCOMES STANDPOINT, MCDOWELL COUNTY HAS DEMONSTRATED INCREASES IN CANCER (LUNG, PROSTATE, BREAST AND COLORECTAL) ALONG WITH RATES OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) THAT ARE MORE THAN DOUBLE STATE RATES. FURTHER, THERE ARE CONTINUED HIGH RATES OF POISONING DEATHS DUE TO MEDICATION OR DRUG OVERDOSES AND CONTINUED HIGH RATES OF ADULT OBESITY. IN THE PAST THREE YEARS, AN ALARMING HIKE IN THE RATES OF CURRENT SMOKING, SMOKING DURING PREGNANCY AND USE OF E-CIGARETTES IS OF CONCERN. THE FOLLOWING SECTION DESCRIBES HOW DATA WAS OBTAINED, COMPILED AND ANALYZED IN OUR ASSESSMENT PROCESS. WNC HEALTHY IMPACT IS A PARTNERSHIP WHICH PROVIDES A COORDINATED PROCESS BETWEEN HOSPITALS AND HEALTH DEPARTMENTS IN WESTERN NORTH CAROLINA TO IMPROVE COMMUNITY HEALTH. AS PART OF A LARGER, AND CONTINUOUS, COMMUNITY HEALTH IMPROVEMENT PROCESS, THESE PARTNERS ARE COLLABORATING TO CONDUCT COMMUNITY HEALTH (NEEDS) ASSESSMENTS ACROSS WESTERN NORTH CAROLINA WWW.WNCHEALTHYIMPACT.COM. MCDOWELL HOSPITAL IS ALSO INVOLVED IN THIS REGIONAL/LOCAL VISION AND COLLABORATION. PARTICIPATING COUNTIES INCLUDE: BUNCOMBE, CHEROKEE, CLAY, GRAHAM, HAYWOOD,HENDERSON, JACKSON, MACON, MADISON, MCDOWELL, MITCHELL, POLK, RUTHERFORD, SWAIN, TRANSYLVANIA AND YANCEY. THE DATA REVIEWED AS PART OF OUR COMMUNITY'S HEALTH NEEDS ASSESSMENT CAME FROM THE WNC HEALTHY IMPACT REGIONAL CORE SET OF DATA. WNC HEALTHY IMPACT'S CORE REGIONAL DATASET INCLUDES SECONDARY (EXISTING) AND PRIMARY (NEWLY COLLECTED) DATA COMPILED TO REFLECT A COMPREHENSIVE LOOK AT HEALTH. THE FOLLOWING DATA SET ELEMENTS AND COLLECTION ARE SUPPORTED BY WNC HEALTHY IMPACT DATA CONSULTING TEAM, A SURVEY VENDOR, AND PARTNER DATA NEEDS AND INPUT: - A COMPREHENSIVE SET OF PUBLICALLY AVAILABLE SECONDARY DATA METRICS WITH OUR TARGET POPULATION COMPARED TO THE OTHER WNC REGIONS AS "PEER" - SET OF MAPS ACCESSED FROM COMMUNITY COMMONS AND NC CENTER FOR HEALTH STATISTICS - TELEPHONE SURVEY OF A RANDOM SAMPLE OF ADULTS IN THE COUNTY - EMAIL KEY-INFORMANT SURVEY SEE MCDOWELL COUNTY LOCAL COMMUNITY HEALTH ASSESSMENTS HTTP://WWW.RPMHD.ORG/INDEX.PHP/HEALTH-PROMOTION/COMMUNITY-HEALTH-ASSESSMENT FOR MORE DETAILS ON THE REGIONAL DATA COLLECTION METHODOLOGY. DURING THE DATA COLLECTION PROCESS, THE TEAM LOCALLY REVIEWED NC DETECT DATA AND HIGHWAY SAFETY DATA AS WELL AS PRIDE SURVEY DATA FOR 8TH GRADERS IN MCDOWELL TO LEARN MORE ABOUT SPECIFIC HEALTH CONCERNS. IN 2015, A COLLABORATION BETWEEN MCDOWELL COUNTY, UNC-CHAPEL HILL GILLINGS SCHOOL OF GLOBAL PUBLIC HEALTH AND THE CAROLINA COLLABORATIVE FOR RESEARCH ON WORK & HEALTH PRODUCED THE MCDOWELL COUNTY WORKSITE WELLNESS PROJECT REPORT. THIS REPORT PROVIDES A GREAT DEAL OF INFORMATION ABOUT CURRENT PRACTICES AT WORKSITES IN MCDOWELL AS WELL AS RECOMMENDATIONS TO IMPROVE EMPLOYEE HEALTH AND WELLNESS. THE FULL REPORT CAN BE FOUND IN THE APPENDIX A OF THE MCDOWELL COUNTY COMMUNITY NEEDS ASSESSMENT LOCATED AT HTTP://WWW.RPMHD.ORG/INDEX.PHP/HEALTH-PROMOTION/COMMUNITY-HEALTH-ASSESSMENT.
PART VI, LINE 3:	THE ORGANIZATION PROVIDES INFORMATION TO OUR PATIENTS REGARDING HOW TO APPLY FOR FINANCIAL ASSISTANCE/CHARITY CARE IN THE FOLLOWING WAYS: A PLAIN LANGUAGE DESCRIPTION OF THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL FACILITY'S WEBSITE, ATTACHED TO BILLING INVOICES, POSTED IN THE EMERGENCY ROOMS OR WAITING ROOMS AND IN THE ADMISSIONS OFFICES. IT IS ALSO PROVIDED IN WRITING TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY, AND UPON REQUEST. THE ORGANIZATION'S INTERNET WEBSITE AND BROCHURES CONTAIN INFORMATION ABOUT FINANCIAL ASSISTANCE THAT OFFER HELP IN OBTAINING FINANCIAL ASSISTANCE, OPTIONS FOR INSURANCE PROCESSING AND PAYMENT FOR SERVICES. IN ADDITION, ASSISTANCE IS OFFERED TO HELP IN DETERMINING IF A PATIENT QUALIFIES FOR STAGE AGENCY PROGRAMS AND MEDICAID BENEFITS AS WELL AS ASSISTANCE WITH THE APPLICATION PROCESS. THE WEBSITE AND BROCHURES EXPLAIN THAT THE HOSPITAL OFFERS DISCOUNTS BASED ON CERTAIN CRITERIA, AND NOTES THE RANGE OF DISCOUNTS AND HOW HOUSEHOLD INCOME GUIDELINES ARE USED TO DETERMINE DISCOUNT ELIGIBILITY.THE PATIENT IS DIRECTED TO CALL THE CUSTOMER SERVICE CENTER OR VISIT THE HOSPITAL'S BUSINESS OFFICE AND LISTS THE HOURS THE OFFICE AND CENTER ARE OPEN.THERE ARE ALSO MESSAGES ON PATIENT BILLS GIVING INFORMATION ON FINANCIAL ASSISTANCE AND HOW TO CONTACT THE HOSPITAL IF THEY HAVE QUESTIONS OR WANT TO APPLY.
PART VI, LINE 4:	MCDOWELL HOSPITAL IS THE ONLY HOSPITAL IN MCDOWELL COUNTY, PROVIDING SERVICES TO A COMMUNITY OF ALMOST 45,159 RESIDENTS. THERE ARE 20.1% OVER TEH AGE OF 65 AND 18.4% LIVING IN POVERTY. THE ORGIZATION'S MISSION IS TO SERVE THE HEALTHCARE NEEDS OF OUR COMMUNITY, GIVING COMPREHENSIVE, COST-EFFECTIVE QUALITY CARE WITHOUT REGARD TO RACE, COLOR, CREED OR ABILITY TO PAY. WE PROVIDE QUALITY CARE TO THE COMMUNITY OF MCDOWELL COUNTY, INCLUDING THE CITY OF MARION, AS WELL AS THE SURROUNDING COMMUNITIES OF OLD FORT, GLENWOOD, LITTLE SWITZERLAND, NEBO, PLEASANT GARDENS, AND NORTH COVE.
PART VI, LINE 5:	SEE PROGRAM SERVICE ACCOMPLISHMENTS ON PAGE 2 OF THE 990.
PART VI, LINE 6:	THE MCDOWELL HOSPITAL IS PART OF AN AFFILIATED HEALTH CARE SYSTEM WITH THE RESPECTIVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES DESCRIBED BELOW IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.MISSION HEALTH SYSTEM, INC. IS THE PARENT ORGANIZATION FOR THE CHARITABLE ORGANIZATIONS OF MISSION HOSPITAL, INC.; MISSION HEALTHCARE FOUNDATION, INC.; MISSION MEDICAL ASSOCIATES, INC; BLUE RIDGE REGIONAL HOSPITAL, INC.; 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 OPERATE AN INTEGRATED HEALTH CARE SYSTEM FOR THE BENEFIT OF THE RESIDENTS OF WESTERN NORTH CAROLINA.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 HEALTH SYSTEM 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, LINE 7, REPORTS FILED WITH STATES	NC

Schedule H (Form 990) 2019

Additional Data

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
ANC MCDOWELL HOSPITAL INC

Employer identification number
56-0623938

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 noncash assistance	(h) Purpose of grant or assistance
(1) MCDOWELL HEALTHCARE FOUNDATION 430 RANKIN AVENUE MARION,NC28752	46-3395393	501(C)(3)	123,080				OPERATIONAL SUPPORT.

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) 2019

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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(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:	THE ORGANIZATION PROVIDES SUPPORT TO THE MCDOWELL HEALTHCARE FOUNDATION, INC. AS PART OF ITS EXEMPT PURPOSE. THE HOSPITAL HAS OVERSIGHT THROUGH REVIEW OF THE MONTHLY FINANCIALS OF THE FOUNDATION TO ENSURE THAT IT CONTINUES TO OPERATE IN ACCORDANCE WITH ITS EXEMPT PURPOSE.

Schedule I (Form 990) 2019

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

ANC MCDOWELL HOSPITAL INC

Employer identification number

56-0623938

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 on 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 on 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? .............

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 nonfixed
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) 2019

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)
1KATHY GUYETTE TRUSTEE	(i) (ii)	0 ------------- 394,637	0 ------------- 145,000	0 ------------- 112,757	0 ------------- 95,445	0 ------------- 8,334	0 ------------- 756,173	0 ------------- 105,769
2LARRY HILL JR TRUSTEE	(i) (ii)	0 ------------- 216,539	0 ------------- 58,786	0 ------------- 20,106	0 ------------- 39,338	0 ------------- 12,664	0 ------------- 347,433	0 ------------- 17,081
3JONATHAN BAILEY TRUSTEE	(i) (ii)	0 ------------- 245,891	0 ------------- 77,265	0 ------------- 22,646	0 ------------- 48,039	0 ------------- 25,436	0 ------------- 419,277	0 ------------- 21,630
4MARGARET SULLIVAN MD TRUSTEE, CHIEF OF STAFF	(i) (ii)	0 ------------- 283,831	0 ------------- 30,743	0 ------------- 20,798	0 ------------- 13,500	0 ------------- 24,394	0 ------------- 373,266	0 ------------- 0
5CAROL WOLFENBARGER PRESIDENT & CNO	(i) (ii)	0 ------------- 219,145	0 ------------- 49,049	0 ------------- 4,478	0 ------------- 2,269	0 ------------- 25,423	0 ------------- 300,364	0 ------------- 0
6CLINT STEWART REGIONAL DIRECTOR -FINANCE	(i) (ii)	0 ------------- 130,111	0 ------------- 23,535	0 ------------- 11,457	0 ------------- 4,101	0 ------------- 24,113	0 ------------- 193,317	0 ------------- 0
7DANIEL MCLAUGHLIN PHYSICIAN	(i) (ii)	0 ------------- 333,974	0 ------------- 15,404	0 ------------- 43,572	0 ------------- 0	0 ------------- 25,299	0 ------------- 418,249	0 ------------- 0
8EDWARD ST BERNARD PHYSICIAN	(i) (ii)	0 ------------- 301,054	0 ------------- 36,820	0 ------------- 168,147	0 ------------- 16,200	0 ------------- 18,765	0 ------------- 540,986	0 ------------- 0
9MARK BURTON PHYSICIAN	(i) (ii)	0 ------------- 369,973	0 ------------- 35,178	0 ------------- 23,984	0 ------------- 15,085	0 ------------- 23,650	0 ------------- 467,870	0 ------------- 0
10MARK HAYES PHYSICIAN	(i) (ii)	0 ------------- 428,458	0 ------------- 0	0 ------------- 3,652	0 ------------- 606	0 ------------- 24,808	0 ------------- 457,524	0 ------------- 0
11MARK MUELLER PHYSICIAN	(i) (ii)	0 ------------- 420,985	0 ------------- 0	0 ------------- 172,636	0 ------------- 0	0 ------------- 23,953	0 ------------- 617,574	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

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

Return Reference

Explanation

PART I, LINE 3

COMPENSATION FOR OFFICERS AND EXECUTIVES ARE SET BY MISSION HEALTH SYSTEM. SEE SCHEDULE O FOR ADDITIONAL DETAIL.

PART I, LINE 4B

PERSONS WHO PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ARE LISTED BELOW. THE CONTRIBUTIONS TO THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ARE INCLUDED ON SCHEDULE J, PART II, COLUMN C AS PART OF DEFERRED COMPENSATION KATHY GUYETTE $ 81,945 SONYA GRECK $ 85,049 JONATHAN BAILEY $ 37,500 LARRY HILL JR. $ 26,098 PERSONS WHO RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN ARE LISTED BELOW. THE PAYMENTS ARE INCLUDED ON SCHEDULE J, PART II, COLUMN B(III). KATHY GUYETTE $105,769 SONYA GRECK $111,170 JONATHAN BAILEY $ 21,630 LARRY HILL $ 17,081

Schedule J (Form 990) 2019

Additional Data

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Software Version:

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

ANC MCDOWELL HOSPITAL INC

Employer identification number

56-0623938

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 4	THE MCDOWELL HOSPITAL, INC. CHANGED ITS NAME TO ANC MCDOWELL HOSPITAL, INC. DURING CALENDAR YEAR 2019. THE FILING ORGANIZATION WILL HEREBY BE REFERRED TO AS "THE ORGANIZATION" THROUGHOUT THE RETURN UNLESS OTHERWISE INDICATED BY ITS OLD NAME, THE MCDOWELL HOSPITAL, INC.
FORM 990, PART VI, SECTION A, LINE 6	MISSION HEALTH SYSTEM, INC. (MISSION), A 501(C)(3) IS THE PARENT COMPANY OF THE ORGANIZATION. IT IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	MISSION HEALTH SYSTEM, AS SOLE MEMBER, HAS SOLE VOTING CONTROL OF THE ORGANIZATION. AS THE SOLE MEMBER OF THE ORGANIZATION, MISSION SHALL HAVE THE FOLLOWING RIGHTS AT ALL TIMES WITH RESPECT TO THE CORPORATION: APPROVAL OF ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE ORGANIZATION. APPROVAL OF THE MISSION, VISION AND VALUES STATEMENTS OF THE CORPORATION AND ANY AMENDMENTS THERETO. ELECTION AND REMOVAL OF THREE (3) MISSION MEMBERS OF THE BOARD OF DIRECTORS AND APPROVAL OF THE COMMUNITY DIRECTORS SELECTED AND SUBMITTED TO MISSION FOR APPROVAL BY ITS BOARD OF DIRECTORS. APPROVAL OF THE ELECTION OF THE PRESIDENT/CHIEF NURSING OFFICER, PROVIDED HOWEVER, THAT SAID APPROVAL SHALL NOT BE UNREASONABLY WITHHELD.
FORM 990, PART VI, SECTION A, LINE 7B	MISSION HEALTH SYSTEM, INC HAS RESERVED POWERS RELATED TO APPROVAL OF THE SALE, LEASE OR OTHER TRANSFER OF SUBSTANTIALLY ALL THE ASSETS OF THE ORGANIZATION. APPROVAL OF (I) THE PLEDGE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, (II) THE PURCHASE OR SALE OF PROPERTY OUTSIDE THE ORDINARY COURSE OF BUSINESS, AND (III) LONG-TERM BORROWING (FOR A TERM OF MORE THAN ONE (1) YEAR) BY THE CORPORATION ABOVE FINANCIAL AND OTHER LIMITS REASONABLY RECOMMENDED BY MISSION FOR THE CORPORATION'S BOARD APPROVAL UNLESS SUCH BORROWING IS APPLIED TO PAY IN FULL ALL INDEBTEDNESS OWED BY THE CORPORATION TO MISSION. ELECTION AND REMOVAL OF UP TO THREE MISSION MEMBERS OF THE BOARD OF DIRECTORS AND APPROVAL OF THE COMMUNITY DIRECTORS SELECTED AND SUBMITTED TO MISSION FOR APPROVAL BY ITS BOARD OF DIRECTORS. APPROVAL OF THE FORMATION AND GOVERNANCE OF ANY NEW CORPORATIONS, PARTNERSHIPS OR JOINT VENTURES, ABOVE FINANCIAL AND OTHER LIMITS APPROVED BY MISSION FOR THE CORPORATION'S BOARD APPROVAL, IN WHICH THE CORPORATION HAS AN INTEREST THROUGH MEMBERSHIP, VOTING STOCK OR OTHER EQUITY PARTICIPATION. APPROVAL OF THE CAPITAL AND OPERATING BUDGETS OF THE CORPORATION. APPROVAL OF THE ELECTION OF THE PRESIDENT/CHIEF EXECUTIVE OFFICER, PROVIDED HOWEVER, THAT SAID APPROVAL SHALL NOT BE UNREASONABLY WITHHELD.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 IS REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. A FINAL COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS THE WEEK AFTER FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	THE INDEPENDENT DIRECTORS REVIEW CONFLICTS OF INTEREST AND DISABLING SITUATIONS, CONSIDER ANY ISSUES INVOLVING CONFLICTS AND MAKE DETERMINATIONS AS TO WHETHER A PARTICULAR RELATIONSHIP OR ARRANGEMENT WOULD DISABLE AN INDIVIDUAL FROM SERVING AS A FIDUCIARY FOR THE BOARD OR WOULD REASONABLY BE EXPECTED TO EXERT AN INFLUENCE ON THE INDIVIDUAL'S JUDGMENT AND THEREFORE PRECLUDE THE INDIVIDUAL FROM BEING AN INDEPENDENT DIRECTOR. THE BOARD MAY RETAIN COUNSEL FROM OUTSIDE AUDIT, LEGAL, GOVERNANCE OR OTHER EXPERTS. ANY DETERMINATION OF PERCENT OF REVENUE OR INCOME RECEIVED BY AN INDIVIDUAL OR ENTITY MAY BE BASED ON CERTIFICATIONS FROM OUTSIDE AUDITORS OF DISCLOSURES MADE DIRECTLY BY THE INDIVIDUAL TO THE AUDIT FIRM. PROCEDURES UPON DETERMINATION OF A CONFLICT OF INTEREST: THE INTERESTED PERSON SHALL NOT PARTICIPATE IN ANY DISCUSSION OR VOTE REGARDING THE BUSINESS RELATIONSHIP ISSUE, AND SHALL NOT BE PRESENT IN THE MEETING ROOM FOR ANY PART OF THE DISCUSSION OR VOTE RELATING TO THE BUSINESS RELATIONSHIP ISSUE. THE BOARD OF DIRECTORS WILL DISCUSS THE BUSINESS RELATIONSHIP BUT WILL NOT FORMALLY APPROVE SUCH BUSINESS RELATIONSHIP UNLESS THE DISINTERESTED MEMBERS OF THE BOARD HAVE DECIDED BY MAJORITY VOTE THAT THE BUSINESS RELATIONSHIP IS IN THE BEST INTERESTS OF AND FOR THE BENEFIT OF THE ORGANIZATION, AND IS FAIR AND REASONABLE THERETO IN ALL RESPECTS.
FORM 990, PART VI, SECTION B, LINE 15	THE ORGANIZATION DOES NOT COMPENSATE ITS CEO, OFFICERS, OR KEY EMPLOYEES. A RELATED 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 OF THE RELATED ORGANIZATION (COMMITTEE) REVIEWS THIS DATA AND RECOMMENDS TO THE BOARD OF THE RELATED ORGANIZATION 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	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE ATTACHED TO THIS FORM 990 OR ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G	MEDICAL CONTRACT LABOR AND FEES: PROGRAM SERVICE EXPENSES 512,607. MANAGEMENT AND GENERAL EXPENSES 314,709. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 827,316. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 837,955. MANAGEMENT AND GENERAL EXPENSES 147,874. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 985,829. INTERCOMPANY CONTRACT LABOR: PROGRAM SERVICE EXPENSES 9,459,407. MANAGEMENT AND GENERAL EXPENSES 4,569,197. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,028,604. CATERING FEES: PROGRAM SERVICE EXPENSES 1,469. MANAGEMENT AND GENERAL EXPENSES 1,469. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,938. DISPENSING FEES: PROGRAM SERVICE EXPENSES 671,250. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 671,250. SYSTEM ALLOCATION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 559,486. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 559,486.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

ANC MCDOWELL HOSPITAL INC

Employer identification number

56-0623938

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) MCDOWELL HOSPITAL IMAGING SERVICES LLC 414 RANKIN DRIVE MARION,NC28752	MEDICAL IMAGING SERVICES	NC	2,406	168,827	THE MCDOWELL HOSPITAL 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)ANGEL MEDICAL CENTER AUXILIARY INC PO BOX 1209 FRANKLIN,NC28744 56-2133719	SUPPORTING ORGANIZATION	NC	501(C)(3)	LINE 12A, I	ANGEL MEDICAL CENTER INC		No
(2)ANGEL MEDICAL CENTER INC PO BOX 1209 FRANKLIN,NC28744 56-6000064	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC		No
(3)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		No
(4)BLUE RIDGE REGIONAL HOSPITAL FOUNDATION INC PO BOX 247 SPRUCE PINE,NC28777 58-2172660	FOUNDATION	NC	501(C)(3)	LINE 12A, I	BLUE RIDGE REGIONAL HOSPITAL INC		No
(5)COMMUNITY CAREPARTNERS INC PO BOX 5779 ASHEVILLE,NC28813 56-2005198	LONG TERM REHABILITATION	NC	501(C)(3)	LINE 10	MISSION HEALTH SYSTEM INC		No
(6)HIGHLANDS-CASHIERS HOSPITAL INC PO BOX 190 HIGHLANDS,NC28741 56-0509400	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC		No
(7)HIGHLANDS-CASHIERS PHYSICIAN SERVICES INC PO BOX 742 HIGHLANDS,NC28741 45-2422428	PHYSICIAN SERVICES	NC	501(C)(3)	LINE 12A, I	HIGHLANDS-CASHIERS HOSPITAL INC		No
(8)MCDOWELL HEALTHCARE FOUNDATION INC 430 RANKIN DRIVE MARION,NC28752 46-3395393	FOUNDATION	NC	501(C)(3)	LINE 7	THE MCDOWELL HOSPITAL INC	Yes
(9)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		No
(10)MISSION HEALTH SYSTEM INC 400 RIDGEFIELD COURT SUITE 100 ASHEVILLE,NC28806 58-1450888	SUPPORTING ORGANIZATION	NC	501(C)(3)	LINE 12A, I	N/A		No
(11)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		No
(12)MISSION MEDICAL ASSOCIATES INC 400 RIDGEFIELD COURT ASHEVILLE,NC28806 26-3627231	EMPLOYED PHYSICIAN GROUP	NC	501(C)(3)	LINE 10	MISSION HEALTH SYSTEM INC		No
(13)TRANSYLVANIA COMMUNITY HOSPITAL INC 260 HOSPITAL DRIVE BREVARD,NC28712 56-0562293	COMMUNITY HOSPITAL	NC	501(C)(3)	LINE 3	MISSION HEALTH SYSTEM INC		No
(14)TRANSYLVANIA PHYSICIAN SERVICES INC 260 HOSPITAL DRIVE BREVARD,NC28712 56-1920816	PHYSICIAN SERVICES	NC	501(C)(3)	LINE 3	TRANSYLVANIA COMMUNITY HOSPITAL		No
(15)TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC PO BOX 2440 BREVARD,NC28712 56-1458024	FOUNDATION	NC	501(C)(3)	LINE 12A, I	TRANSYLVANIA COMMUNITY HOSPITAL		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code 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	NONE - OPERATIONS DISCONTINUED	NC	N/A
(2) ASHEVILLE MRI PO BOX 2959 ASHEVILLE,NC28802 56-1665863	NONE - OPERATIONS DISCONTINUED	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 56-1599696	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	N/A
(8) MSJHS AND CCP JOINT DEVELOPMENT COMPANY LLC 428 BILTMORE AVENUE ASHEVILLE,NC28801 56-2250464	LONG TERM ACUTE CARE HOSPITAL	NC	N/A
(9) SPRUCE PINE HEALTHCARE LLC 5935 CARNEGIE BLVD CHARLOTTE,NC28209 47-1390107	REAL ESTATE	NC	N/A
(10) TRANSYLVANIA HEALTHECARE II LIMITED PARTNERSHIP 2 MEDICAL PARK DRIVE BREVARD,NC28712 20-0333230	REAL ESTATE	NC	N/A
(11) WESTERN NC HEALTHCARE INNOVATORS LLC 5935 CARNEGIE BLVD CHARLOTTE,NC28209 80-0787882	REAL ESTATE RENTAL	NC	N/A
(12) WNC STONE CENTER 509 BILTMORE AVENUE ASHEVILLE,NC28801 27-2152974	LITHOTRIPSY RENTAL	NC	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" 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	(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) DOGWOOD INSURANCE COMPANY LTD THE GRAND PAVILION COMMERCIAL CENTR CJ	CAPTIVE INSURANCE ENTITY	CJ	N/A	C				No
(2) TRANSYLVANIA SERVICES INC 260 HOSPITAL DRIVE BREVARD,NC28712 56-1448199	REAL ESTATE	NC	N/A	C				No
(3) MISSION HEALTH PARTNERS INC 509 BILTMORE AVENUE ASHEVILLE,NC28806 46-5566095	CLINICALLY INTEGRATED NETWORK	NC	N/A	C				No
(4) HEALTHY STATE INC 509 BILTMORE AVENUE ASHEVILLE,NC28801 81-2108613	ADMINISTRATIVE	NC	N/A	C				No
(5) AVENU HEALTH INC 509 BILTMORE AVENUE ASHEVILLE,NC28801 82-3337055	HEALTH CARE	NC	N/A	C				No

Schedule R (Form 990) 2019

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

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) ............................

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

Yes

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

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

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

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

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

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

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

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

Yes

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

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

Yes

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

Yes

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

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

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) MCDOWELL HEALTHCARE FOUNDATION	B	123,080	FMV
(2) MCDOWELL HEALTHCARE FOUNDATION	C	234,054	FMV

Schedule R (Form 990) 2019

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) 2019

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) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO IMPROVE THE HEALTH OF THE PEOPLE OF WESTERN NORTH CAROLINA AND THE SURROUNDING REGION.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	501
6	Total number of volunteers (estimate if necessary) .............	6	9
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	266,940	234,054
9	Program service revenue (Part VIII, line 2g) .........	67,718,962	70,075,900
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	13,696	-82,196
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	67,999,598	70,227,758
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	135,742	133,087
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)	25,065,661	25,385,480
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)....	34,117,698	45,263,996
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	59,319,101	70,782,563
19	Revenue less expenses. Subtract line 18 from line 12.......	8,680,497	-554,805
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	62,729,516	80,173,406
21	Total liabilities (Part X, line 26).............	26,843,827	44,842,522
22	Net assets or fund balances. Subtract line 21 from line 20.....	35,885,689	35,330,884

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 59,282,736 including grants of $ 133,087 ) (Revenue $ 70,075,900 )
	THE ORGANIZATION FORMERLY KNOWN AS THE MCDOWELL HOSPITAL, INC. IS COMMITTED TO PROMOTING HEALTH IN THE COMMUNITY THROUGH DIVERSE AND INNOVATIVE PROGRAMS, DESIGNED TO REACH A BROAD-RANGE TARGET POPULATION AND CREATE THE HIGHEST IMPACT, WITH A SPECIAL EMPHASIS ON THE UNINSURED AND UNDERINSURED. THESE PROGRAMS INCLUDE SPORTS MEDICINE THROUGH THE LOCAL SCHOOL, NATIONAL CANCER SURVIVOR DAY CELEBRATION AND A QUARTERLY MAGAZINE PUBLICATION TO YOUR HEALTH. WHILE NOT AN EXHAUSTIVE LIST, THESE PROGRAMS PROVIDE AN EXAMPLE OF THE EFFORTS TO PROMOTE HEALTHY LIVING WITHIN THE COMMUNITY.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses59,282,736

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) MARK BURTON........................................................................ PHYSICIAN	40.00 .......................0.00	X	0	429,135	38,735
(19) MARK HAYES........................................................................ PHYSICIAN	40.00 .......................0.00	X	0	432,110	25,414
(20) MARK MUELLER........................................................................ PHYSICIAN	40.00 .......................0.00	X	0	593,621	23,953

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	4,420,611	471,422

(A) Name and business address	(B) Description of services	(C) Compensation
COMPREHENSIVE PAIN CONSULTANTS PO BOX 254 SKYLAND,NC28776	MEDICAL SERVICES	188,579
MORRISON MGMT SPECIALISTS INC PO BOX 102289 ATLANTA,GA30368	FOOD & NUTRITION MANAGEMENT	145,482



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 2

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	234,054
e	Government grants (contributions)		1e

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

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		234,054

		Business Code
2a	NET PATIENT SVCS	900099	68,318,810	68,318,810
b	OTHER PROGRAMS	900099	1,757,090	1,757,090
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		70,075,900

3 Investment income (including dividends, interest, and othersimilar amounts) ......			7,939			7,939
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		23,281	6a
b	Less: rental expenses		23,281	6b
c	Rental income or (loss)		0	6c
d	Net rental income or (loss).......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	9,841		7a
b	Less: cost or other basis and sales expenses	99,976		7b
c	Gain or (loss)	-90,135		7c
d	Net gain or (loss).........			-90,135			-90,135
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			70,227,758	70,075,900	0	-82,196

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	133,087	133,087
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	266,841		266,841
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........	20,057,638	18,947,402	1,110,236
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	335,008	278,057	56,951
9	Other employee benefits .......	3,203,430	2,658,847	544,583
10	Payroll taxes ...........	1,522,563	1,263,727	258,836
11	Fees for services (non-employees):
a	Management ......	1,319,012	1,121,160	197,852
b	Legal .........	92,230		92,230
c	Accounting ...........	11,559		11,559
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	17,075,423	11,482,688	5,592,735
12	Advertising and promotion ....	89,407	75,996	13,411
13	Office expenses .......	212,881	180,949	31,932
14	Information technology ......	1,253,554	1,065,521	188,033
15	Royalties ..
16	Occupancy ...........	1,444,042	1,155,234	288,808
17	Travel ............	72,874	55,384	17,490
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	12,579	10,063	2,516
20	Interest ...........	880,537	686,819	193,718
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	12,711,341	10,169,073	2,542,268
23	Insurance ...	64,068	54,458	9,610
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	PHARMACEUTICALS	5,598,130	5,598,130
b	MEDICAL SUPPLIES	4,025,274	4,025,274
c	ALL OTHER EXPENSES	401,085	320,867	80,218
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	70,782,563	59,282,736	11,499,827	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).

1	Cash–non-interest-bearing ........			1,245,367	1	1,817,153
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			9,717,308	4	15,498,750
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			918,984	8	1,078,267
9	Prepaid expenses and deferred charges ......			15,138	9	4,259
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	74,038,623
b	Less: accumulated depreciation	10b	13,175,779	50,040,597	10c	60,862,844
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			62,679	13	77,680
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			729,443	15	834,453
16	Total assets. Add lines 1 through 15 (must equal line 33)...			62,729,516	16	80,173,406

17	Accounts payable and accrued expenses .....	6,599,145	17	3,833,478
18	Grants payable ...		18
19	Deferred revenue .........	4,238,656	19	2,507,402
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23	13,285,671
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	16,006,026	25	25,215,971
26	Total liabilities. Add lines 17 through 25..	26,843,827	26	44,842,522

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	35,885,689	32	35,330,884
33	Total liabilities and net assets/fund balances ........	62,729,516	33	80,173,406