2013-08-14T17:06:51-05:00 2012-09-30 621517792 PERSHING YOAKLEY & ASSOCIATES PC ONE CHEROKEE MILLS 2220 SUTHERLAND KNOXVILLE TN 379192363 990 2011-10-01 560714394 HARRIS REGIONAL HOSPITAL INC HARR 8285867000 68 HOSPITAL ROAD SYLVA NC 28779 MICHAEL MCKNIGHT 8285867000 2013-08-14 1 DEBORAH O ERNSBERGER P00364912 8656730844 2011 2016-02-24 21:20:13Z MICHAEL MCKNIGHT 68 HOSPITAL ROAD SYLVA NC 28779 101559414 0 X WWW.WESTCARE.ORG X 1960 NC TO PROVIDE HIGH QUALITY, COST EFFECTIVE HEALTHCARE TARGETED TO THE NEEDS OF THE PEOPLE WE SERVE. 14 13 1376 84 84305 -91450 281071 486091 93234104 99127809 674494 553903 1180443 799785 95370112 100967588 496052 421704 0 0 53420334 44241376 0 0 0 47510036 64017206 101426422 108680286 -6056310 -7712698 67370962 62732089 46742920 54751034 20628042 7981055 X HARRIS REGIONAL HOSPITAL, INC. IS A MEMBER OF THE WESTCARE HEALTH SYSTEM ("WESTCARE"). THE MISSION OF WESTCARE IS TO PROVIDE HIGH QUALITY, COST EFFECTIVE HEALTHCARE TARGETED TO THE NEEDS OF THE PEOPLE WE SERVE. WESTCARE'S VISION IS EXCELLENCE IN CARE, SERVICE, AND VALUE - ONE PATIENT AT A TIME. WESTCARE'S CORE VALUES ARE COMPASSION, ACCOUNTABILITY, RESPECT, AND EXCELLENCE WHICH TOGETHER COMPRISE "WE C.A.R.E." 0 0 91892815 421704 99127809 HARRIS REGIONAL HOSPITAL ("THE HOSPITAL") IS DEDICATED TO THE PROMOTION OF HEALTH AND WELLNESS FOR THE RESIDENTS OF WESTERN NORTH CAROLINA AND SURROUNDING COMMUNITIES. HARRIS REGIONAL HOSPITAL IS AN 86-BED ACUTE CARE FACILITY LOCATED IN SYLVA, NORTH CAROLINA. HARRIS REGIONAL HAS BEEN A VITAL PART OF THE COMMUNITY AND REGION THROUGHOUT ITS HISTORY. A FULLY ACCREDITED, NOT-FOR-PROFIT COMMUNITY HOSPITAL, HARRIS REGIONAL HAS EXPERIENCED STRONG GROWTH IN RECENT YEARS, WITH MAJOR EXPANSIONS IN 1997, 1986, 1989, 1994, AND 1995. THE HOSPITAL'S MEDICAL STAFF HAS THE DIVERSITY AND PROFESSIONAL TALENTS OF MANY HOSPITALS TWICE ITS SIZE. TOGETHER WITH THE QUALIFIED STAFF, THEY SUCCESSFULLY PROVIDE PATIENTS THE FINEST IN MEDICAL CARE. HARRIS REGIONAL HOSPITAL OFFERS MANY SERVICES TO HELP DIAGNOSE AND TREAT ALMOST ANY NEED. SERVICES INCLUDE: OUTPATIENT SURGERY, LABORATORY SERVICES, IMAGING SERVICES, PULMONARY REHABILITATION SERVICES, BIRTHING CENTER, TRANSITIONAL CARE UNIT, INTENSIVE CARE UNIT, PHARMACY, EMERGENCY DEPARTMENT, DIETARY SERVICES, OCCUPATIONAL HEALTH, SOCIAL SERVICES, SPORTS MEDICINE, AND PASTORAL SERVICE. 91892815 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 54 0 1 1376 1 1 1 0 0 0 0 0 0 0 0 0 X 14 13 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X JOY FREEMAN 8285867653 68 HOSPITAL ROAD SYLVA NC 28779 X LAWRENCE F SUPIK MD 1.00 X 466948 36923 0 FRED ALEXANDER 1.00 X 0 0 0 DANIEL M ALLISON 1.00 X 0 0 0 JAMES A MANRING 1.00 X 0 0 0 MARTHA F ANDERSON MD 1.00 X 0 0 0 LOWELL B CRISP 1.00 X 0 0 0 ELIZABETH B JOHNS 1.00 X 0 0 0 HEATHER C BAKER 1.00 X 0 0 0 TIMOTHY C LEWIS 1.00 X 0 0 0 JOHN BUENTING MD 1.00 X 0 0 0 CLIFFORD FAULL 1.00 X 0 0 0 STEPHANIE A TREADWAY 1.00 X 0 0 0 MARK TYSON 1.00 X 0 0 0 ANN MARIE WRIGHT 1.00 X 0 0 0 MICHAEL POORE 40.00 X 444193 444193 0 STEPHEN HEATHERLY 40.00 X 94945 192288 0 WYLEY GENE WINTERS 40.00 X 264073 264073 0 ROSE COYNE 40.00 X 0 0 0 MICHAEL MCKNIGHT 40.00 X 0 0 0 DALE CHERNICH 40.00 X 164970 164970 0 GREG COPEN 40.00 X 40899 40899 0 DWAYNE HOOKS 40.00 X 235732 235732 0 TYSON SMITH MD 40.00 X 205584 205584 0 TODD D DAVIS MD 40.00 X 442299 35330 0 MARTIN A SENICKI MD 40.00 X 486065 37023 0 WILLIAM M RALSTON MD 40.00 X 413516 34750 0 JEROME M MARCHUK MD 40.00 X 437350 36706 0 RYAN M SLECHTA MD 40.00 X 369916 30869 0 4066490 1759340 0 29 0 1 0 CAROLINAS HEALTHCARE SYSTEM PO BOX 32861 CHARLOTTE NC 28232 MANAGEMENT SERVICES 1698825 ADP INC 201 REGENCY EXECUTIVE PARK DRIVE CHARLOTTE NC 28217 PAYROLL SERVICES 531340 ALLIANCE HEALTHCARE SERVICES 100 BAYVIEW CIRCLE SUITE 400 NEWPORT BEACH CA 92660 DIAGNOSTIC IMAGING SERVICES 401290 OSBORNE COMPANY INC 515 SOUTH KENNEDY AVENUE PO BOX EDEN NC 27289 GENERAL CONTRACTOR 391318 PLUS LINEN & UNIFORM SERVICES PO BOX 1188 CANTON NC 28716 LAUNDRY SERVICES 310519 51 180878 127500 177713 486091 NET PATIENT REVENUE 621990 98481085 98396780 84305 COUNTY EMS 621910 461327 461327 LIFELINE 621990 221087 221087 GAIN-INV. IN AFFILIATE 523000 -35690 -35690 99127809 549192 549192 66 66 543797 591826 -48029 -48029 -48029 4645 0 4645 4645 4645 MEALS & VENDING 722210 377375 377375 MISCELLANEOUS INCOME 900099 268997 268997 N.A. RELEASED FROM RES 900099 230752 230752 -29310 -29310 847814 100967588 99079194 84305 1317998 415204 415204 6500 6500 1417520 1172147 245373 33866855 28004502 5862353 1350460 1116695 233765 5221883 4317975 903908 2384658 1971874 412784 1287413 1064562 222851 680529 562729 117800 530 438 92 15908849 13155027 2753822 73937 61139 12798 4029921 3332342 697579 1225712 1013541 212171 1406610 1163126 243484 1321569 1092805 228764 4133024 3417598 715426 764695 632326 132369 BAD DEBTS 11277243 11277243 MEDICAL SUPPLIES 8988649 7432714 1555935 REPAIRS & MAINTENANCE 4729741 3911023 818718 LEASES 1979952 1637222 342730 6208832 5134083 1074749 108680286 91892815 16787471 0 5842 6504 2783521 2852407 10756672 9684648 1347460 1456458 591954 1004087 98028022 66903120 31786967 31124902 13926528 11791759 1108715 824592 1021969 478674 4041334 3508058 67370962 62732089 8862178 12726768 67510 6127 13363736 12217180 626648 804626 23822848 28996333 46742920 54751034 X 20191015 7377923 437027 603132 20628042 7981055 67370962 62732089 X -7712698 -4934289 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2327987 2327987 43246050 29672617 13573433 907408 907408 35793254 26408254 9385000 15753323 10822249 4931074 31124902 OTHER ASSETS 9074 DEFERRED FINANCING COSTS, NET 245121 OTHER RECEIVABLES 1386154 DUE FROM RELATED PARTIES 1407675 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS, NET 460034 3508058 ACCRUED PENSION COST 9848002 INTEREST RATE SWAP 88475 OBLIGATIONS UNDER CAPITAL LEASE AGREEMENTS 10773040 ESTIMATED PHYSICIAN GUARANTEE LIABILITY 338649 DUE TO RELATED PARTY UNDER INTEGRATION AGREEMENT 6383198 DUE TO RELATED PARTIES 1564969 28996333 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: WESTCARE, HARRIS, AND SWAIN ARE EXEMPT FROM INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS RELATED TO THESE ORGANIZATIONS. PROCOR, INC. IS A TAXABLE ENTITY AND ACCOUNTS FOR INCOME TAXES IN ACCORDANCE WITH FASB ASC 740, INCOME TAXES. THE ORGANIZATIONS HAVE NO UNCERTAIN TAX POSITIONS AT SEPTEMBER 30, 2012. 1 1 1 X 1 X 1 1 1 0 1 1 1059907 1059907 0.01090 4740877 4740877 0.04870 5800784 5800784 0.05960 1337003 1337003 0.01370 17450 17450 0.00020 1354453 1354453 0.01390 7155237 7155237 0.07350 1 6094031 0 25209333 25841667 -632334 X 1 1 1 WESTERN REGIONAL RADIATION THERAPY CENTER HEALTH SERVICES 0.33330 0.00000 0.00000 1 1 HARRIS REGIONAL HOSPITAL

68 HOSPITAL ROAD WAYNESVILLE NC 28779

X X X HARRIS REGIONAL HOSPITAL 1 1 1 150.000000000000 1 300.000000000000 1 X X X 1 1 X X X X X 1 0 1 X 0 0 PART I, LINE 7: COST IS DERIVED FROM THE ACTUAL EXPENSE DATA ACCUMULATED WITHIN THE HOSPITAL GENERAL LEDGER WHICH ADDRESSES ALL PATIENT SEGMENTS (INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, AND SELF-PAY). THE HOSPITAL ALLOCATES THOSE EXPENSES TO ALL PATIENT SEGMENTS AT THE PROCEDURE LEVEL BASED ON A COST-TO-CHARGE RATIO. PART I, L7 COL(F): BAD DEBT EXPENSE INCLUDED IN FORM 990, PART IX, LINE 24, COLUMN (A) IS $11,277,243. THE HOSPITAL EXCLUDED THE FULL AMOUNT, $11,277,243, FOR PURPOSES OF CALCULATING THE PERCENTAGE IN COLUMN (F), ON PART I, LINE 7. PART III, LINE 4: A COST-TO-CHARGE RATIO WAS ALSO USED TO DETERMINE BAD DEBT COST. THE TOTAL OPERATING EXPENSE WAS DIVIDED BY PATIENT REVENUES TO CALCULATE AN OVERALL RATIO THAT WAS THEN APPLIED TO THE BAD DEBT EXPENSE TO ARRIVE AT COST.PER THE WESTCARE, INC. AND AFFILIATES AUDITED CONSOLIDATED FINANCIAL STATEMENTS AS OF AND FOR THE YEAR ENDED SEPTEMBER 30, 2012: FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE, THE ORGANIZATIONS RECOGNIZE REVENUE ON THE BASIS OF ITS STANDARD RATES, DISCOUNTED ACCORDING TO POLICY, FOR SERVICES RENDERED. HISTORICAL EXPERIENCE HAS SHOWN A SIGNIFICANT PROPORTION OF THE ORGANIZATIONS' UNINSURED PATIENTS, IN ADDITION TO A GROWING PROPORTION OF THE ORGANIZATIONS' INSURED PATIENTS, WILL BE UNABLE OR WILLING TO PAY FOR THEIR RESPONSIBLE AMOUNTS FOR THE SERVICES PROVIDED. IN ORDER TO ESTIMATE THE NET REALIZABLE VALUE OF THE REVENUES AND ACCOUNTS RECEIVABLES ASSOCIATED WITH THIRD-PARTY PAYORS AND UNINSURED PATIENTS, MANAGEMENT REGULARLY ANALYZES COLLECTION HISTORY. BASED ON THESE HISTORICAL COLLECTION ANALYSES, THE ORGANIZATIONS RECORD A PROVISION FOR BAD DEBTS AND AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS FOR THIRD-PARTY AND UNINSURED PATIENT ACCOUNTS RECEIVABLE BALANCES FOR WHICH THE PATIENT IS RESPONSIBLE. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE REPORTED USING THE HOSPITAL'S FILED MEDICARE COST REPORT (C/R). THE C/R USES A COST TO CHARGE RATIO BASED ON A STEP-DOWN ALLOCATION METHODOLOGY. IN CARING FOR THE PATIENT, THERE ARE SEVERAL SERVICES THAT ARE CONSIDERED NON-ALLOWABLE BY CMS SUCH AS: TRANSPORTATION OF A PATIENT, COMFORT ITEMS TO INCLUDE A TELEVISION OR A TELEPHONE. ADDITIONAL NON-ALLOWABLE COSTS INCLUDE THE RECRUITMENT OF PHYSICIANS, PHYSICIAN GUARANTEES AND A PORTION OF THE BAD DEBT ASSOCIATED WITH THE CARE OF THE PATIENT. PART III, LINE 9B: IT IS THE POLICY OF THE HOSPITAL TO PURSUE COLLECTION OF PATIENT BALANCES FROM PATIENTS WHO HAVE THE ABILITY TO PAY FOR THESE SERVICES. THE HOSPITAL'S COLLECTION PRACTICES APPLY TO ALL PATIENTS, CHARITY CARE AND NON-CHARITY CARE, CONSISTENTLY AND FAIRLY REGARDLESS OF INSURANCE STATUS. AFTER THE PATIENT VISIT HAS BEEN CONCLUDED, A SUMMARY OF THE CHARGES WILL BE MAILED TO THE PATIENT FOR REVIEW. IF INSURANCE INFORMATION WAS PROVIDED UPON REGISTRATION, A CLAIM WILL BE SUBMITTED TO THE INSURANCE CARRIER ON THE PATIENT'S BEHALF. AFTER INSURANCE PROCESSING, THE PATIENT WILL RECEIVE A STATEMENT EXPLAINING THE INSURANCE RESPONSE AND OUTLINING THE PATIENTS REMAINING BALANCE. SELF-PAY PATIENTS ARE ELIGIBLE TO RECEIVE A 20% PROMPT DISCOUNT IF THE ACCOUNT IS PAID IN FULL PRIOR TO OR ON THE DATE OF SERVICES. A 15% DISCOUNT WILL BE ISSUED IF PAYMENT IS MADE WITHIN 25 DAYS OF SERVICE. ADDITIONALLY, PATIENTS LACKING ADEQUATE RESOURCES TO PAY FOR MEDICAL CARE MAY QUALIFY FOR THE HOSPITAL'S CARE ASSISTANCE PROGRAM WHICH PROVIDES EXTENDED PAYMENT PLANS AND/OR PROMPT PAY DISCOUNTS UP TO 20% FOR PAYMENT IN FULL WITHIN 5 DAYS OF THE DISCHARGE AND ASSISTS PATIENTS IN APPLYING FOR STATE PROGRAMS TO MEET THEIR MEDICAL NEEDS. IF PAYMENT FOR SERVICES IS NOT RECEIVED IN FULL WITHIN 25 DAYS, THE ACCOUNT IS FORWARDED TO PROCOR BILLING SERVICES. THIS SERVICE ALLOWS FOR PATIENTS TO MAKE FINANCIAL ARRANGEMENTS THAT ARE BOTH ACCEPTABLE TO THE PATIENT AND TO THE HOSPITAL. FINANCIAL COUNSELORS DILIGENTLY WORK WITH PATIENTS AND EVALUATE NEW INFORMATION LEARNED DURING THE COLLECTION PROCESS TO DETERMINE IF COLLECTION ACTIVITIES SHOULD BE CEASED OR IF THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. PAST DUE AMOUNTS ARE FORWARDED TO AN OUTSIDE COLLECTION AGENCY, WITH SUBSTANTIAL EXPERIENCE IN COLLECTION OF PATIENT ACCOUNTS, ONLY AFTER ALL ESTABLISHED STEPS HAVE BEEN UNDERTAKEN WITHOUT SUCCESS. HARRIS REGIONAL HOSPITAL PART V, SECTION B, LINE 19D: THE HOSPITAL USED MEDICARE RATES TIMES THE MARKUP PERCENTAGE FOR THAT FISCAL YEAR. PART VI, LINE 2: HARRIS REGIONAL HOSPITAL IS COMPLETING A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT TO COMPLY WITH INTERNAL REVENUE CODE SECTION 501(R) REQUIREMENTS. THE HARRIS REGIONAL HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE FINALIZED AND MADE WIDELY AVAILABLE TO THE PUBLIC BY SEPTEMBER 30, 2013. PART VI, LINE 3: TO COMMUNICATE THE HOSPITAL'S FINANCIAL POLICY TO THE PATIENT, THE HOSPITAL'S WEBSITE HAS A "PATIENTS AND VISITORS" MENU WHERE PATIENTS CAN GO TO VIEW INFORMATION ABOUT PAYMENT POLICIES, INSURANCE INFORMATION, AND THE HOSPITAL FINANCIAL ASSISTANCE (CARE ASSISTANCE) PROGRAM. THE WEBSITE GIVES THREE PHONE NUMBERS THAT PATIENTS CAN USE TO CONTACT A FINANCIAL COUNSELOR TO DISCUSS THEIR INDIVIDUAL FINANCIAL ALTERNATIVES. THE HOSPITAL'S CHARITY CARE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IS POSTED IN THE ADMISSIONS AREAS, EMERGENCY AREAS, AND OTHER AREAS OF THE HOSPITAL'S FACILITIES IN WHICH ELIGIBLE PATIENTS MAY BE PRESENT. ALL STAFF WITH PATIENT CONTACT ARE KNOWLEDGEABLE ABOUT THE CHARITY CARE POLICY (ADMITTING AND BILLING CLERKS, NURSING AND MEDICAL STAFFS, SOCIAL WORKERS, CHAPLAINS, PATIENT ADVOCATES, ETC.). PART VI, LINE 4: THE HOSPITAL IS LOCATED IN SYLVA, JACKSON COUNTY, WHICH IS IN RURAL WESTERN NORTH CAROLINA. JACKSON COUNTY IS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA WITH NEARLY 21% OF ITS POPULATION AS UNINSURED. THE POPULATION OF JACKSON COUNTY IS JUST OVER 40,000 AND HAS A MEDIAN HOUSEHOLD INCOME OF $36,826 WITH 19.5% OF THE POPULATION LIVING BELOW THE POVERTY LEVEL. PART VI, LINE 5: THE HOSPITAL IS DEDICATED TO SERVING THE COMMUNITY BY IMPROVING THE QUALITY OF LIFE OF THE COMMUNITY THROUGH BETTER HEALTH. THE HOSPITAL IS COMMITTED TO PROVIDING QUALITY HEALTH CARE SERVICES IN A CARING ENVIRONMENT THAT FULFILLS THE NEEDS OF OUR PATIENTS, PHYSICIANS, EMPLOYERS, EMPLOYEES, AND COMMUNITY. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO THE ABILITY TO PAY. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND, OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION AND RESEARCH PROGRAMS. THE HOSPITAL'S BOARD OF DIRECTORS CONSISTS OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PURPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3). PART VI, LINE 6: HARRIS REGIONAL HOSPITAL IS OWNED BY THE WESTCARE HEALTH SYSTEM, A GROWING, WELL-RESPECTED, NON-PROFIT HEALTH CARE PROVIDER THAT DELIVERS A FULL SPECTRUM OF HEALTH CARE FOR OVER 80,000 PEOPLE LIVING IN FOUR COUNTIES. WESTCARE HEALTH SYSTEM ("WESTCARE") WAS FORMED IN FEBRUARY 1997 WITH THE ESTABLISHMENT OF A COMBINATION BUSINESS AGREEMENT BETWEEN HARRIS REGIONAL HOSPITAL AND SWAIN COUNTY HOSPITAL TO DEVELOP A FULL SPECTRUM OF HEALTH SERVICES FOR WESTERN NORTH CAROLINA. WESTCARE ALSO OWNS THREE MEDICAL PARKS, WESTCARE MEDICAL PARK OF FRANKLIN LOCATED IN MACON COUNTY, WESTCARE MEDICAL PARK OF BRYSON CITY LOCATED IN SWAIN COUNTY, AND WESTCARE MEDICAL PARK OF SYLVA LOCATED IN JACKSON COUNTY. WESTCARE ALSO OPERATES MOUNTAIN REGIONAL CANCER CENTERS, TWO STATE OF THE ART RADIATION THERAPY FACILITIES PROVIDING ALL ASPECTS OF COMPREHENSIVE RADIATION THERAPY SERVICES. WESTCARE EMPLOYS ALMOST 1200 FULL AND PART TIME EMPLOYEES AND HAS A MEDICAL STAFF OF OVER 90 PHYSICIANS REPRESENTING 22 SPECIALTIES. WESTCARE IS GOVERNED BY A BOARD OF TRUSTEES, WHICH IS DRAWN FROM COMMUNITY LEADERS IN EACH OF THE FOUR PRIMARY COUNTIES IT SERVES. WESTCARE IS MANAGED AND OPERATED BY THE PEOPLE OF WESTERN NORTH CAROLINA, FOR THE PEOPLE OF WESTERN NORTH CAROLINA.IN JANUARY 2010, WESTCARE ENTERED INTO A JOINT OPERATING AGREEMENT WITH HAYWOOD REGIONAL MEDICAL CENTER IN WAYNESVILLE, NORTH CAROLINA, TO FORM MEDWEST HEALTH SYSTEM ("MEDWEST"). MEDWEST CONSISTS OF 323 LICENSED BEDS SYSTEM-WIDE. MEDWEST IS ALSO AFFILIATED WITH CAROLINAS HEALTHCARE SYSTEM, ONE OF THE SOUTHEAST'S LEADING HEALTHCARE SYSTEMS. PATIENTS BENEFIT FROM THE HOSPITAL'S AFFILIATION WITH A HEALTHCARE SYSTEM WHERE THEY CAN BE EFFICIENTLY MOVED ALONG AN INTEGRATED, COMPREHENSIVE CONTINUUM OF CARE AS THEIR HEALTH STATUS DICTATES. REPORTS FILED WITH STATES PART VI, LINE 7 NC 1 AMERICAN RED CROSS 2025 E STREET NW WASHINGTON DC 200065009 530196605 501(C)(3) 333564 GENERAL DONATION WCU FOUNDATION 315 HF ROBINSON ADMINISTRATION BLDG CULLOHOWEE NC 28723 237159170 501(C)(3) 17750 GENERAL DONATION MARCH OF DIMES 1275 MAMARONECK AVENUE WHITE PLAINS NY 10605 131846366 501(C)(3) 7500 GENERAL DONATION GOOD SAMARITAN CLUB OF JACKSON COUNTY 538 SCOTTS CREEK ROAD SYLVA NC 28779 562266536 501(C)(3) 37500 GENERAL DONATION NORTH CAROLINA HOSPITAL ASSOCIATION PO BOX 4449 CARY NC 27519 560641290 501(C)(6) 7137 GENERAL DONATION 4 1 SCHOLARSHIPS 11 6500 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL. X X X 0 0 0 0 0 0 0 0 0 LAWRENCE F SUPIK MD 466948 36923 0 0 0 0 0 0 0 0 466948 36923 0 0 MICHAEL POORE 444193 444193 0 0 0 0 0 0 0 0 444193 444193 0 0 STEPHEN HEATHERLY 91449 159881 0 27916 3496 4491 0 0 0 0 94945 192288 0 0 WYLEY GENE WINTERS 264073 264073 0 0 0 0 0 0 0 0 264073 264073 0 0 DALE CHERNICH 164970 164970 0 0 0 0 0 0 0 0 164970 164970 0 0 DWAYNE HOOKS 235732 235732 0 0 0 0 0 0 0 0 235732 235732 0 0 TYSON SMITH MD 205584 205584 0 0 0 0 0 0 0 0 205584 205584 0 0 TODD D DAVIS MD 442299 35330 0 0 0 0 0 0 0 0 442299 35330 0 0 MARTIN A SENICKI MD 486065 37023 0 0 0 0 0 0 0 0 486065 37023 0 0 WILLIAM M RALSTON MD 413516 34750 0 0 0 0 0 0 0 0 413516 34750 0 0 JEROME M MARCHUK MD 437350 36706 0 0 0 0 0 0 0 0 437350 36706 0 0 RYAN M SLECHTA MD 369916 30869 0 0 0 0 0 0 0 0 369916 30869 0 0 FORM 990, PART VI, SECTION A, LINE 3 PURSUANT TO THE INTEGRATION AGREEMENT, BY AND AMONG WESTCARE, INC., HAYWOOD REGIONAL MEDICAL CENTER, THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY, INC. (D/B/A CAROLINAS HEALTHCARE SYSTEM) AND MEDWEST HEALTH SYSTEM, INC. (THE "SYSTEM"), WESTCARE, INC. HAS DELEGATED TO THE SYSTEM THE GENERAL AUTHORITY TO DIRECT AND OPERATE WESTCARE, INC. AND ITS RELATED ENTITIES, AND HAYWOOD REGIONAL MEDICAL CENTER ("HAYWOOD") HAS DELEGATED TO THE SYSTEM THE GENERAL AUTHORITY TO DIRECT AND OPERATE HAYWOOD AND ITS RELATED ENTITIES; PROVIDED, HOWEVER, THAT THE GENERAL AUTHORITY DELEGATED TO THE SYSTEM BY WESTCARE, INC. AND HAYWOOD IS LIMITED BY THE RETENTION BY WESTCARE, INC. AND HAYWOOD OF CERTAIN POWERS AND AUTHORITY OVER THEIR RESPECTIVE ACTIVITIES AND THE ACTIVITIES OF THEIR RESPECTIVE RELATED ENTITIES, AS DESCRIBED IN THE INTEGRATION AGREEMENT. FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURN IS PREPARED BY AN UNRELATED, INDEPENDENT ACCOUNTING FIRM AND SUBMITTED TO SENIOR MANAGEMENT WITHIN THE ORGANIZATION FOR INTERNAL REVIEW. COPIES ARE THEN PROVIDED TO EACH BOARD MEMBER FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES THAT EACH BOARD OF TRUSTEES MEMBER AND PRINCIPAL OFFICER REVIEWS THE CONFLICT OF INTEREST POLICY AND PROVIDES DISCLOSURE OF ANY ACTIVITIES WHICH COULD CONSTITUTE A CONFLICT OF INTEREST OR POTENTIAL CONFLICT OF INTEREST. ADDITIONALLY, BOARD OF TRUSTEES MEMBERS ARE ASKED TO RECUSE THEMSELVES ON ANY MATTERS OF INTEREST BEFORE THE BOARD IN WHICH A CONFLICT OF INTEREST MAY EXIST. ANY SUCH RECUSAL IS DOCUMENTED WITHIN THE MINUTES OF THE BOARD OR COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES REVIEWS AND APPROVES THE COMPENSATION OF EXECUTIVES AND OTHER OFFICERS. STATE AND NATIONAL COMPARABILITY DATA IS USED TO ASSIST IN DETERMINING APPROPRIATE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. MANAGEMENT COMPANY COMPENSATION: FORM 990, PART VII, SECTION A, MEDWEST AND THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY D/B/A CAROLINAS HEALTHCARE SYSTEM (CHS), A NORTH CAROLINA HOSPITAL AUTHORITY, ARE PARTIES IN A MANAGEMENT SERVICES AGREEMENT (MSA). THROUGH THIS AGREEMENT, MEDWEST HAS GRANTED CHS FULL POWER, AUTHORITY AND RESPONSIBILITY FOR THE MANAGEMENT OF MEDWEST, SUBJECT TO THE GENERAL OVERSIGHT OF THE MEDWEST BOARD OF DIRECTORS. THE TERMS OF THE MSA REQUIRE MEDWEST TO PAY CHS AN ANNUAL MANAGEMENT FEE BASED ON MEDWEST'S NET OPERATING REVENUES. IN ADDITION, CHS IS REQUIRED TO FURNISH MEDWEST WITH A CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER AND VARIOUS OTHER EXECUTIVE POSITIONS AND MEDWEST IS REQUIRED TO REIMBURSE CHS FOR THE SALARY AND BENEFITS OF THESE INDIVIDUALS. CHS MAY ALSO PROVIDE PROJECT-SPECIFIC CONSULTING OR PROJECT-MANAGEMENT SERVICES AS REQUESTED FOR ADDITIONAL FEES. BOARD OF TRUSTEES COMPENSATION: FORM 990, PART VII, SECTION A, LAWRENCE SUPIK, M.D., BOARD OF TRUSTEES MEMBER, RECEIVED COMPENSATION FOR MEDICAL SERVICES PROVIDED TO THE ORGANIZATION, NOT FOR SERVICES AS A BOARD OF TRUSTEES MEMBER. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 953,801. NET ASSETS RELEASED FOR CAPITAL 92,231. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 166,105. CHANGE IN ACCRUED PENSION COST -470,067. REQUIRED SETTLEMENT - INTEGRATION AGREEMENT -5,495,481. CONTRIBUTION FROM RELATED PARTY -180,878. TOTAL TO FORM 990, PART XI, LINE 5: -4,934,289. WESTCARE INC 68 HOSPITAL ROAD SYLVA NC 28779 561967734 HOSPITAL NC 501(C)(3) LINE 3 MEDWEST HEALTH SYSTEM INC 0 SWAIN COUNTY HOSPITAL INC 68 HOSPITAL ROAD SYLVA NC 28779 560629325 HOSPITAL NC 501(C)(3) LINE 3 WESTCARE INC 0 MEDWEST HEALTH SYSTEM INC 68 HOSPITAL ROAD SYLVA NC 28779 271472706 HEALTHCARE MANAGEMENT NC 501(C)(3) LINE 11C, III-FI N/A 0 HAYWOOD REGIONAL MEDICAL CENTER 262 LEROY GEORGE DRIVE CLYDE NC 28721 566000535 HOSPITAL AUTHORITY NC 501(C)(1) MEDWEST HEALTH SYSTEM INC 0 WESTERN REGIONAL RADIATION THERAPY CENTER 68 HOSPITAL ROAD SYLVA NC 28779 561849395 HEALTH SERVICES NC HARRIS REGIONAL HOSPITAL INC RELATED -51886 714021 0 1 0.33330 WESTCARE HEALTH CORPORATION 68 HOSPITAL ROAD SYLVA NC 38779 562039181 HEALTHCARE MANAGEMENT NC N/A C PROCOR INC 68 HOSPITAL ROAD SYLVA NC 28779 562039184 HEALTHCARE MANAGEMENT NC N/A C WESTERN CAROLINA PHYSICIAN NETWORK DBA MEDWEST PHYSICIAN NETWORK 262 LEROY GEORGE DRIVE CLYDE NC 28721 261870386 HEALTHCARE SERVICES NC N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0