2014-08-13T11:11:50-05:00 2013-09-30 366055558 Grant Thornton LLP 201 S College Street Suite 2500 Charlotte NC 28244 990 2012-10-01 263627231 Mission Medical Associates Inc MISS 8282138222 PO Box 5325 Asheville NC 28813 Cheryl Williams 8282138222 2014-08-13 1 P00488037 7046323500 2012 2015-11-30 17:44:51Z Paul McDowell PO Box 5325 Asheville NC 28813 73935287 0 X www.missionmd.org X 2008 NC Provide Physician Services in areas that are insufficiently served. 3 3 686 3 0 0 522059 270331 62639163 72810467 3763 3609 0 0 63164985 73084407 0 50 0 0 73515640 88904466 0 0 0 15835050 17569952 89350690 106474468 -26185705 -33390061 14854442 28467608 81795417 128798644 -66940975 -100331036 X Provide Physician Services in areas that are insufficiently served.Continued on Schedule O.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. 0 0 101831320 50 72810467 The Organization provided physician services in specialty practices including Family Medicine, Pediatrics, Cardiology, Children's Dental, Neurology, Orthopedic Trauma, Trauma Surgery, Weight Management, and Hospitalists. 33 new physicians were recruited to the area and the Organization served over 93,000 patients at 31 practice locations. Benefits to the community included almost $1.4 million in charity care.Other accomplishments of the Organizations individual physicians which include volunteering in the local community and recognition for excellence and quality of healthcare service are highlighted below, continuing on Schedule O.Four cardiologists ranked in the top ten percent of the Professional Research Consultants (PRC) National Excellence in Healthcare and presented with Service Excellence Awards from Mission. The Cardiology Research department was recognized by Thrombolysis In Myocardial Infarction Study Group as Center of Excellence for clinical research trials. The Weight Management Clinic established a collaborative care model with providers of the Cherokee Indian Hospital Authority including the ability to conduct Tele Health visits. A Developmental-Behavioral pediatric specialist again participated with the International Hospital for Children in the annual pediatric Spina Bifida evaluation clinics in Belize, Central America. The Pediatric Endocrinology practice and the Childrens Dental practice as well as several pediatric providers were recognized as 5 star recipients for outstanding patient satisfaction. Several physicians donated their time to the Medical Ministry of the Asheville-Buncombe County Christian Ministry serving uninsured and underinsured residents of Buncombe County. An outpatient neurologist remotely presented a poster at the 2013 International Stroke Conference in Honolulu. 101831320 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 79 0 1 686 1 0 0 0 0 0 0 0 0 0 0 X 3 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Mission Medical Associates 8282138222 400 Ridgefield Court Suite 100 Asheville NC 28806 Ernest E Ferguson 1.00 X X 0 0 0 George M BilbreyJrMD 1.00 3.00 X 0 0 0 William E Lee 1.00 2.00 X X 0 0 0 Cheryl Williams 60.00 X 145026 0 25350 Dr Jill Hoggard Green 6.00 54.00 X 0 656918 103138 Paul McDowell 6.00 54.00 X 0 0 0 Charles M LeCroy MD 40.00 X 634092 0 58787 Harold Frisch MD 40.00 X 582432 0 36001 William Shillinglaw MD 40.00 X 491927 0 41406 James Usedom MD 40.00 X 458628 0 41487 Jan Pattanayak MD 40.00 X 455607 0 35902 Marc Westle DO 0.00 60.00 X 123416 301555 74955 2891128 958473 417026 388 1 1 0 Navigant Consulting 4511 Paysphere Circle Chicago IL 606740045 Management Services 506244 Blue Ridge Bone & Joint 129 McDowell Street Asheville NC 28801 Medical Services 496846 Locumtenenscom PO Box 405547 Atlanta GA 303845547 Physician Services 282172 Honnie Patricia Spencer 284 Knoxview Ln Mooresville NC 281179630 Medical Services 249470 Mediscribes Inc 4509 Lisa Ln New Albany IN 471509373 Transcription 239287 12 270331 270331 Net Patient Revenue 621110 44673354 44673354 PhysContSvcsRelatedOrgs 900099 24886607 24886607 Other Patient Revenue 900099 3250506 3250506 72810467 4149 4149 850340 850340 0 540 -540 -540 -540 73084407 72810467 0 3609 50 50 172721 172721 138688 138688 76710340 74129889 2580451 2364997 2293610 71387 5583177 5235523 347654 3934543 3742456 192087 150 150 152043 152043 48 48 7822256 7408418 413838 9792 9792 672613 581967 90646 385417 385417 3163352 2997408 165944 703827 641157 62670 780907 642563 138344 1166724 1163665 3059 Departmental Supplies 1603450 1597546 5904 Other 628339 520825 107514 Medical Equipment Lease 481034 481034 106474468 101831320 4643148 0 1207735 1376761 500000 250000 7578485 19916483 98393 141771 180123 72241 567825 569246 8003185 2585734 4040961 5417451 550000 550000 130920 173655 14854442 28467608 81671945 128629579 123472 169065 81795417 128798644 X -66940975 -100331036 -66940975 -100331036 14854442 28467608 -33390061 0 X 0 1 X 1 0 X 28304 83582 522059 270331 904276 37457774 65683995 62639164 72810467 238591400 37486078 65767577 63161223 73080798 239495676 0 0 0 239495676 26366 16538 411176 854489 1308569 26366 16538 411176 854489 1308569 37512444 65784115 63572399 73935287 240804245 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3498646 531081 2967565 3287442 1218227 2069215 1217097 836426 380671 5417451 Other Deferred Compensation 169065 169065 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Mission applies the provisions of FASB ASC Topic 740 for Income Taxes in accounting for uncertainty in income taxes. ASC 740 provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There is currently no impact on Mission's combined financial statements as a result of application of ASC 740. Mission Medical Associates is included in the combined financial statements described above. X X X X X 0 1 0 0 0 0 0 0 0 Cheryl Williams 100550 0 20569 0 23907 0 8339 0 17011 0 170376 0 0 0 Dr Jill Hoggard Green 0 444915 0 207563 0 4440 0 84808 0 18330 0 760056 0 0 Charles M LeCroy MD 509294 0 118291 0 6507 0 14040 0 44747 0 692879 0 0 0 Harold Frisch MD 457302 0 123038 0 2092 0 10000 0 26001 0 618433 0 0 0 William Shillinglaw MD 457498 0 25466 0 8963 0 17000 0 24406 0 533333 0 0 0 James Usedom MD 333673 0 78123 0 46832 0 17000 0 24487 0 500115 0 0 0 Jan Pattanayak MD 331581 0 78123 0 45903 0 10000 0 25902 0 491509 0 0 0 Marc Westle DO 122823 196517 0 103750 593 1288 17293 34264 8999 14399 149708 350218 0 0 Part I, Line 4b Dr. Marc Westle, $34,557 Dr. Jill Hoggard Green $81,346 Form 990, Part VI, Section A, line 6 Mission Health System, Inc is the sole member of Mission Medical Associates, Inc. Form 990, Part VI, Section A, line 7a The following action of the corporation requires the prior approval of the Member: (i) appointment and removal of Board members; (j) appointment and removal of President/Chief Executive Officer; and (k) approval of employment agreement and compensation of President/Chief Executive Officer. Form 990, Part VI, Section A, line 7b The following actions of the corporation require the prior approval of the Member: (a) amendment or repeal of the bylaws or articles of the corporation; (b) sale of assets of the corporation valued in excess of $1 million ; (c) merger or dissolution of the corporation; (d) selection of auditors; (e) adoption of strategic plans, and capital and operating budgets; (f) transactions in excess of $5 Million; (g) filing for bankruptcy; (h) incurring debt (external to the Member and its subsidiaries/affiliates) (i) appointment and removal of Board members; (j) appointment and removal of President/Chief Executive Officer; and (k) approval of compensation of President/Chief Executive Officer. Form 990, Part VI, Section B, line 11 A draft of the Form 990 is prepared by the Director of Tax Services at Mission Health System. The Form 990 is reviewed by the organization's CEO, CFO, General Counsel and Compliance Officer of Mission Health System as well as Management at Mission Medical Associates . In addition, an outside accounting firm is engaged to review and sign the 990 and prepare the return for final filing with the IRS. Before filing, highlights of Form 990 are reviewed by Board Committees which may include the Executive Committee; Audit and Compliance Committee; Finance and Property Committee and Human Resources and Compensation Committee of Mission Health System. After committee review, a draft of the 990 is provided to the Board of Directors at Mission Health System and Mission Medical Associates for review. Highlights of Form 990 are specifically reviewed with the board and they have the opportunity to ask questions and suggest improvements or provide corrections. If there are changes as a result of board review, a corrected Form 990 will be provided for final approval before filing. After final approval, the Form 990 will be filed with the IRS. Form 990, Part VI, Section B, line 12c The Organizations Conflict of Interest Policy is reviewed and updated annually. Education about the policy and the responsibilities of a board member occurs annually and for new board members during orientation. If a conflict of interest is identified, the interested person does not participate in any decision relating to the transaction issue. A conflict of interest is a particular relationship or arrangement that would reasonably be expected to exert an influence on the individual's judgment and preclude the individual from being an Independent Director or being independent with respect to the transaction under consideration. In addition to board members, the organization's conflict of interest policy applies to members of senior leadership, medical staff, clinical service line leaders, elected medical staff leaders, departmental directors, staff members working in the purchasing department, and all other staff members with purchasing authority, as well as immediate family members of such interested persons and entities in which interested persons have a material financial interest. The organization's policy is for all interested persons to disclose any and all conflicts of interest in accordance with the IRS guidelines for tax-exempt entities as well as any other applicable state or federal law. Upon initial assumption of duties, interested persons are provided with a copy of the conflict of interest policy and submit a conflict of interest disclosure statement. Thereafter, the statements will be completed annually. Periodically all staff members are asked to complete a conflict of interest disclosure statement. Internal and external auditors, General Counsel or outside counsel will periodically conduct a review of the disclosure process to determine whether the organization is in compliance with the policy. Form 990, Part VI, Section B, line 15 The Organization draws wage comparison data from outside executive compensation consultants to ensure compensation levels are at fair market value The Human Resources and Compensation Committee (Committee) reviews this data and recommends to the Board any revisions to the overall philosophy and policy to guide the determination of compensation and benefit packages for executives which includes the CEO, the CFO, and President as well as all other executives, which would include all key employees. The Committee keeps and distributes minutes of all its meetings to its members. Items of a sensitive nature are referenced in the minutes with detailed, supporting documentation retained on file. The Committee also discloses any potential conflicts of interest situations to the Committee Chairman that may affect their independent directors' status as soon as they arise, and maintains complete documentation of all matters discussed by the Committee. The Committee obtains education and training to exercise all responsibilities effectively and keeps abreast of significant developments in executive compensation practices and regulations, and ensures that all aspects of Mission Health System and Hospital executive compensation adhere to all relevant regulatory requirements, and reviews the Committee charter annually revising as appropriate and conducts an annual evaluation of the Committee's performance. Form 990, Part VI, Section C, line 19 The conflict of interest policy and financial statements are available upon request. Articles of Incorporation are available through the North Carolina Secretary of State website. Mission Health System Inc 509 Biltmore Avenue Asheville NC 28803 581450888 Parent Company Support Services, Mission Hospital & Affiliates NC 501(c)(3) Line 11a, I 0 Mission Hospital Inc 509 Biltmore Avenue Asheville NC 28803 560532141 Acute Care Hospital NC 501(c)(3) Line 3 Mission Health System Inc 0 Mission Healthcare Foundation Inc 980 Hendersonville Road Asheville NC 28803 561881331 Foundation NC 501(c)(3) Line 7 Mission Health System Inc 0 The McDowell Hospital Inc 430 Rankin Drive Marion NC 28752 560623938 Community Hospital NC 501(c)(3) Line 3 Mission Health System Inc 0 Blue Ridge Regional Hospital Post Office Box 9 Spruce Pine NC 28777 561025032 Community Hospital NC 501(c)(3) Line 3 Mission Health System Inc 0 Blue Ridge Regional Hospital Foundation PO Box 247 Spruce Pine NC 28777 582172660 Foundation NC 501(c)(3) Line 11a, I Blue Ridge Regional Hospital Inc 0 Transylvania Health System Inc 260 Hospital Drive Brevard NC 28712 561456987 Dissolved NC 501(c)(3) Line 11b, II Dissolved June 2013 0 Transylvania Regional Hospital Foundation PO Box 2440 Brevard NC 28712 561458024 Foundation NC 501(c)(3) Line 11a, I Transylvania Community Hospital 0 Transylvania Physician Services Inc 260 Hospital Drive Brevard NC 28712 561920816 Healthcare NC 501(c)(3) Line 3 Transylvania Community Hospital 0 Transylvania Community Hospital (DBA Transylvania Regional HOspital) 260 Hospital Drive Brevard NC 28712 560562293 Healthcare NC 501(c)(3) Line 3 Mission Health System Inc 0 McDowell Healthcare Foundation Inc 430 Rankin Drive Marion NC 28752 463395393 Supporting Organization NC 501(c)(3) Line 7 The McDowell Hospital Inc 0 Angel Medical Center Auxiliary PO Box 1209 Franklin NC 28744 562133719 Supporting Organization NC 501(c)(3) Line 11a, I Angel Medical Center Inc 0 Angel Medical Center PO Box 1209 Franklin NC 28712 566000064 Community Hospital NC 501(c)(3) Line 3 Mission Health System Inc 0 Imaging Realty LLP 534 Biltmore Avenue Asheville NC 28801 561907203 Medical Building NC N/A MSJHS and CCP Joint Development Company LLC 428 Biltmore Avenue Asheville NC 28801 562250464 Long Term Acute Care Hospital NC N/A Asheville Imaging 534 Biltmore Avenue Asheville NC 28801 561907201 Medical Imaging NC N/A Blue Ridge DME LLC 125 Hospital Drive Spruce Pine NC 28777 263570174 Home Medical Supplies NC N/A McDowell MRI LLC Medical Imaging Marion NC 28752 753046378 Medical Imaging NC N/A Brevard MRI at Transylvania 260 Hospital Drive Brevard NC 28712 203281110 Healthcare NC N/A Transylania Healthcare II LP 2 Medical Park Drive Brevard NC 28712 200333230 Rental NC N/A Healthcare III LP 260 Hospital Drive Brevard NC 28712 561599596 Rental NC N/A Healthcare Limited Liability Company VII 260 Hospital Drive Brevard NC 28712 200343455 Rental NC N/A Western NC Healthcare InnovatorsLLC 5935 Carnegie Blvd Charlotte NC 28209 800787882 Real Estate Rental NC N/A Western Regional Radiation Therapy Center 68 Hospital Drive Sylva NC 28779 561849395 NC N/A Asheville MRI PO Box 2959 Asheville NC 28802 561665863 NC N/A WNC Stone Center 509 Biltmore Avenue Asheville NC 28801 272152974 NC N/A Horizon Health Corp 213 Ridgefield Court Asheville NC 28806 561341621 Holding Company NC N/A C 0 Horizon Management Services Inc 213 Ridgefield Court Asheville NC 28806 561341624 Patient Billing and Collection Services, Medical Property NC N/A C 0 Dogwood Insurance Company The Grand Pavilion Commercial Centr Cayman Islands CJ Captive Insurance Company CJ N/A C 0 Transylvania Services Inc 260 Hospital Drive Brevard NC 28712 561448199 Real Estate NC N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0