2013-05-08T11:57:46-05:00 2012-06-30 990 2011-07-01 510603966 TAKOMA REGIONAL HOSPITAL INC TAKO 4236362350 401 TAKOMA AVENUE GREENEVILLE TN 377434647 TOM VANDENHOVEN 4236362350 2013-05-08 2011 2016-02-25 16:41:14Z DANIEL WOLCOTT 401 TAKOMA AVENUE GREENEVILLE TN 377434647 54398376 0 X WWW.TAKOMA.ORG X 2006 TN THE PROVISION OF MEDICAL CARE TO THE COMMUNITY THROUGH THE OPERATION OF A 100 BED HOSPITAL. 17 14 561 58 12472 11372 0 8162 49020069 54346467 18765 21562 0 0 49038834 54376191 0 49939 0 0 26750518 29536870 0 0 0 24644375 22756301 51394893 52343110 -2356059 2033081 27954262 29425826 10076626 9442888 17877636 19982938 X TAKOMA REGIONAL HOSPITAL EXISTS TO EXTEND THE HEALING MINISTRY OF CHRIST BY CARING FOR THOSE WHO ARE ILL AND BY NURTURING THE HEALTH OF THE PEOPLE IN OUR COMMUNITIES. AS A MEMBER OF THE ADVENTIST HEALTH SYSTEM AND WELLMONT HEALTH SYSTEM, TAKOMA REGIONAL HOSPITAL (TRH) STRIVES TO CREATE EXCELLENT EXPERIENCES FOR EACH PERSON WHO CHOOSES TO ACCESS OUR SERVICES. TRH WILL BE A LEADER IN PATIENT SAFETY AND HEALTHCARE QUALITY. TRH WILL BE THE BEST PLACE TO WORK, PRACTICE MEDICINE, AND RECEIVE CARE. 0 0 47912212 54333995 TAKOMA REGIONAL HOSPITAL, INC. OPERATES A 100 BED ACUTE CARE HOSPITAL IN GREENEVILLE, TN. IN THE CURRENT YEAR, THERE WERE 2,365 ADMISSIONS, 10,631 PATIENT DAYS, AND 69,452 OUTPATIENT VISITS. 47912212 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 67 0 1 561 1 1 1 0 0 0 0 0 0 0 0 0 X 17 14 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 TN X TOM VANDENHOVEN 4236362350 401 TAKOMA AVE GREENEVILLE TN 37743 RICHARD REINER 1.00 X 0 0 0 MARGARET D DENARVAEZ 1.00 X 0 0 0 AL GILES 1.00 X 0 0 0 JOHN HOWARD 1.00 X 0 0 0 DANIEL WOLCOTT 50.00 X X 248174 0 76460 KARSTEN RANDOLPH 1.00 X 0 0 0 JIMM BUNCH 1.00 X 0 0 0 GREGORY UHL MD 50.00 X 378030 0 32192 ELIZABETH WARD 1.00 X 0 0 0 ALICE POPE 1.00 X 0 0 0 PATRICIA L SMITH EDD RN 1.00 X 0 0 0 MARK WILLIAMS 1.00 X 0 0 0 DON SMITH 1.00 X 0 0 0 CLAES SVENDSEN MD 50.00 X 187933 0 25626 JR MCKINNEY MD 50.00 X 146381 0 4544 JOEY BALLARD 1.00 X 0 0 0 JAMES KILGORE PHD 1.00 X 0 0 0 ED WRIGHT 1.00 X 0 0 0 SHARON FOLK 1.00 X 0 0 0 DANIEL LEWIS MD 50.00 X 205017 0 27305 TOM VANDENHOVEN 50.00 X 138654 0 22970 FRED MYERS MD 50.00 X 156353 0 22325 STEPHEN PURVIS DO 40.00 X 500224 0 19720 JOSEPH KRETSCHMAR MD 40.00 X 410193 0 28902 ROBERT W LOCKLEAR MD 46.00 X 354076 0 29349 GORDON L MARSA MD 40.00 X 315998 0 28632 DORIS PURVIS MD 40.00 X 300094 0 19105 3341127 0 337130 25 0 1 1 MEDICAL DOCTOR ASSOCIATES PO BOX 277185 ATLANTA GA 30384 HOSPITALISTS SERVICES 549859 WELLMONT MEDICAL ASSOCIATES 1989 EAST STONE DRIVE KINGSPORT TN 37660 ORTHOPEDIC SERVICES 308453 ETSU PHYSICIANS AND ASSOC PO BOX 889 MOUNTAIN HOME TN 37684 PODIATRY SERVICES 288734 ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 LAB SERVICES 235295 USTELERADIOLOGY LLC 3520 PIEDMONT RD NE 250 ATLANTA GA 30305 RADIOLOGY SERVICES 127861 6 6827 1335 8162 NET PATIENT REVENUE 900099 54198372 54198372 CAFETERIA REVENUE 900099 46003 46003 GIFT SHOP REVENUE 900099 43385 43385 MEDICAL OFFICE BUILDIN 531120 12472 12472 46235 46235 54346467 23307 23307 20440 22185 -1745 -1745 -1745 54376191 54333995 12472 21562 49939 49939 1671964 1671964 20017580 20017580 731816 731816 5608349 5608349 1507161 1507161 64596 64596 6111661 4522055 1589606 192347 192347 1892414 1605055 287359 1957307 1610390 346917 1990106 1990106 138184 138184 12250 12250 2359146 2359146 7693 3975 3718 MEDICAL SUPPLIES 3879201 3879201 STATE TAX INDIGENT ASSE 2730816 2730816 REPAIRS & MAINTENANCE 1284373 1284373 PURCHASED SERVICES 62722 62722 73485 73485 52343110 47912212 4430898 0 3282 3065 3752181 4732954 5880402 6178327 68864 32597 1030751 1058701 180240 84733 43475840 27323479 16912949 16152361 125593 1183088 27954262 29425826 3288182 3429327 0 6788444 6013561 10076626 9442888 X 17769148 19861987 108488 120951 17877636 19982938 27954262 29425826 X 2033081 72221 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10291 10291 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: REPRESENTS THE AMOUNT OF TOTAL DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION, HOSPITAL ALLIANCE OF TENNESSEE, AND TENNESSEE HOSPITAL ASSOCIATION THAT IS COMPRISED OF LOBBYING EXPENDITURES. 2604550 2604550 16527322 7608282 8919040 22868743 18821930 4046813 1475225 893267 581958 16152361 CREDIT BALANCES IN A/R 520554 LEASES PAYABLE 52431 DUE TO AFFILIATED 2247459 OTHER NON-CURRENT LIABILITIES 2294057 PAYABLE TO THIRD PARTIES 899060 6013561 PART X - AS NOTED IN OUR RESPONSE TO FORM 990 PART VI, SECTION C, LINE 19, THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION ARE NOT CONSOLIDATED WITHIN THE FINANCIAL STATEMENTS OF EITHER OF ITS MEMBERS. ADDITIONALLY, THE FILING ORGANIZATION DID NOT RECEIVE A SEPARATE AUDITED FINANCIAL STATEMENT FOR THE 6/30/2012 TAX YEAR. ACCORDINGLY, THERE IS NO APPLICABLE FIN 48 FOOTNOTE FOR THIS FILING ORGANIZATION. 1 1 X 1 X 1 X 1 1 1 0 1 0 2529441 2529441 0.04830 9163479 9123803 39676 0.00080 11692920 9123803 2569117 0.04910 5002 5002 0.00010 5002 5002 0.00010 11697922 9123803 2574119 0.04920 14917 14917 0.00030 14917 14917 0.00030 1 3159651 456452 12238244 11224238 1014006 X 1 1 1 1 TAKOMA REGIONAL HOSPITAL

401 TAKOMA AVENUE GREENEVILLE TN 37743

X X X TAKOMA REGIONAL HOSPITAL 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X 1 0 1 X 0 0 3 TAKOMA MEDICAL ASSOCIATES

438 E VANN ROAD GREENEVILLE TN 37743

PHYSICIAN SERVICES TAKOMA OUT PATIENT REHABILITATION

108W SUMMERS STREET GREENEVILLE TN 37743

REHABILITATION SERVICES GREENEVILLE URGENT CARE & OCCUPATIONAL

1021 COLLIDGE STREET GREENEVILLE TN 37743

OUTPATIENT CLINIC PART I, LINE 7: THE AMOUNTS OF COSTS REPORTED IN THE TABLE IN LINE 7 OF PART I OF SCHEDULE H WERE DETERMINED BY UTILIZING A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, CONTAINED IN THE SCHEDULE H INSTRUCTIONS. PART II: TAKOMA REGIONAL HOSPITAL, INC. (THE HOSPITAL) IS INVOLVED WITH AND SUPPORTIVE OF VARIOUS OTHER COMMUNITY AGENCIES IN ITS SERVICE AREA THAT WORK COLLABORATIVELY TO HELP THOSE IN NEED AND TO IMPROVE THE HEALTH AND SAFETY OF THE RESIDENTS OF THE COMMUNITY. THE HOSPITAL PARTICIPATES WITH A NUMBER OF OTHER COMMUNITY ORGANIZATIONS. AS AN EXAMPLE, THE HOSPITAL IS AN ACTIVE PARTICIPANT IN THE GREENE COUNTY (TN) PARTNERSHIP. THE GREENE COUNTY PARTNERSHIP IS A LOCAL COMMUNITY ORGANIZATION WHOSE MISSION IS TO PROMOTE, PRESERVE, AND ENHANCE THE QUALITY OF LIFE AND ECONOMIC WELL BEING OF ALL GREENE COUNTY RESIDENTS BY PROVIDING COLLECTIVE LEADERSHIP AND SERVING AS A FACILITATOR, CATALYST AND UNIFYING FORCE TO ACHIEVE COMMON COMMUNITY GOALS. PART III, LINE 4: BAD DEBT EXPENSE:THE AMOUNT OF BAD DEBT EXPENSE, REPORTED ON LINE 2 OF SECTION A OF PART III IS RECORDED IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS ADJUSTMENTS TO REVENUE, NOT BAD DEBT EXPENSE. METHODOLOGY FOR DETERMINING THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE THAT MAY REPRESENT PATIENTS WHO COULD HAVE QUALIFIED UNDER THE FILING ORGANIZATION'S CHARITY CARE POLICY:SELF-PAY PATIENTS ARE REQUIRED TO COMPLETE A PATIENT FINANCIAL ASSISTANCE APPLICATION SHORT FORM (PFAA). IF THE PFAA IS NOT COMPLETED AFTER REASONABLE ATTEMPTS TO OBTAIN IT ARE EXHAUSTED, PATIENT INFORMATION IS PROCESSED THROUGH A SCORER PRODUCT. THE SCORER PRODUCT UTILIZES PUBLICLY AVAILABLE DATA, SUCH AS CREDIT REPORTS, TO ASSESS AN INDIVIDUAL PATIENT'S FINANCIAL VIABILITY. PATIENTS WHO EARN A CERTAIN SCORE ON THE SCORER PRODUCT ARE CONSIDERED TO QUALIFY AS NON-STATE CHARITY PATIENTS. GENERALLY, $200 OF SUCH A PATIENT'S BILL IS WRITTEN OFF AS BAD DEBT EXPENSE, WHILE THE REMAINING PORTION OF THE PATIENT'S BILL IS CONSIDERED TO BE NON-STATE CHARITY. THE AMOUNT WRITTEN OFF AS BAD DEBT EXPENSE FOR THOSE PATIENTS WHO POTENTIALLY QUALIFY AS NON-STATE CHARITY USING THE SCORER PRODUCT IS THE AMOUNT SHOWN ON LINE 3 OF SECTION A OF PART III. RATIONALE FOR INCLUDING CERTAIN BAD DEBTS IN COMMUNITY BENEFIT:THE FILING ORGANIZATION IS DEDICATED TO THE VIEW THAT MEDICALLY NECESSARY HEALTH CARE FOR EMERGENCY AND NON-ELECTIVE PATIENTS SHOULD BE ACCESSIBLE TO ALL, REGARDLESS OF AGE, GENDER, GEOGRAPHIC LOCATION, CULTURAL BACKGROUND, PHYSICIAN MOBILITY, OR ABILITY TO PAY. THE FILING ORGANIZATION TREATS EMERGENCY AND NON-ELECTIVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY OR THE AVAILABILITY OF THIRD-PARTY COVERAGE. BY PROVIDING HEALTH CARE TO ALL WHO REQUIRE EMERGENCY OR NON-ELECTIVE CARE IN A NON-DISCRIMINATORY MANNER, THE FILING ORGANIZATION IS PROVIDING HEALTH CARE TO THE BROAD COMMUNITY IT SERVES. AS A 501(C)(3) HOSPITAL ORGANIZATION, THE FILING ORGANIZATION MAINTAINS A 24/7 EMERGENCY ROOM PROVIDING CARE TO ALL WHOM PRESENT. WHEN A PATIENT'S ARRIVAL AND/OR ADMISSION TO THE FACILITY BEGINS WITHIN THE EMERGENCY DEPARTMENT, TRIAGE AND MEDICAL SCREENING ARE ALWAYS COMPLETED PRIOR TO REGISTRATION STAFF PROCEEDING WITH THE DETERMINATION OF A PATIENT'S SOURCE OF PAYMENT. IF THE PATIENT REQUIRES ADMISSION AND CONTINUED NON-ELECTIVE CARE, THE FILING ORGANIZATION PROVIDES THE NECESSARY CARE REGARDLESS OF THE PATIENT'S ABILITY TO PAY. THE FILING ORGANIZATION'S OPERATION OF A 24/7 EMERGENCY DEPARTMENT THAT ACCEPTS ALL INDIVIDUALS IN NEED OF CARE PROMOTES THE HEALTH OF THE COMMUNITY THROUGH THE PROVISION OF CARE TO ALL WHOM PRESENT. CURRENT INTERNAL REVENUE SERVICE GUIDANCE THAT TAX-EXEMPT HOSPITALS MAINTAIN SUCH EMERGENCY ROOMS WAS ESTABLISHED TO ENSURE THAT EMERGENCY CARE WOULD BE PROVIDED TO ALL WITHOUT DISCRIMINATION. THE TREATMENT OF ALL AT THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT IS A COMMUNITY BENEFIT. UNDER THE FILING ORGANIZATION'S CHARITY CARE POLICY, EVERY EFFORT IS MADE TO OBTAIN A PATIENT'S NECESSARY FINANCIAL INFORMATION TO DETERMINE ELIGIBILITY FOR CHARITY CARE. HOWEVER, NOT ALL PATIENTS WILL COOPERATE WITH SUCH EFFORTS AND A CHARITY CARE ELIGIBILITY DETERMINATION CAN NOT BE MADE. IN THIS CASE, A PATIENT'S PORTION OF A BILL THAT REMAINS UNPAID FOR A CERTAIN STIPULATED TIME PERIOD IS WHOLLY OR PARTIALLY CLASSIFIED AS BAD DEBT. BAD DEBTS ASSOCIATED WITH PATIENTS WHO HAVE RECEIVED CARE THROUGH THE FILING ORGANIZATION'S EMERGENCY DEPARTMENT SHOULD BE CONSIDERED TO BE COMMUNITY BENEFIT AS CHARITABLE HOSPITALS EXIST TO PROVIDE SUCH CARE IN PURSUIT OF THEIR PURPOSE OF MEETING THE NEED FOR EMERGENCY MEDICAL CARE SERVICES AVAILABLE TO ALL IN THE COMMUNITY. THE FILING ORGANIZATION DID NOT HAVE AUDITED FINANCIAL STATEMENTS; THEREFORE, THERE IS NOT A FOOTNOTE TO DESCRIBE BAD DEBT EXPENSE. PART III, LINE 8: COSTING METHODOLOGY:MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. PART III, LINE 9B: AT THE TIME OF PATIENT REGISTRATION, NON-ELECTIVE SELF-PAY PATIENTS ARE INFORMED OF THE MINIMUM DISCOUNT AVAILABLE UNDER THE FILING ORGANIZATION'S SELF-PAY DISCOUNT POLICY. SUCH PATIENTS ARE ALSO INFORMED OF THE FILING ORGANIZATION'S CHARITY CARE POLICY AND TOLD THAT THEY WILL BE REQUIRED TO SUBMIT NECESSARY FINANCIAL DATA IN ORDER TO POTENTIALLY RECEIVE ANY ADDITIONAL DISCOUNTS. UNDER THE FILING ORGANIZATION'S FINANCIAL ASSISTANCE POLICY PERCENTAGE DISCOUNTS ARE APPLIED TO A PATIENT'S ACCOUNT BASED UPON AMOUNTS GENERALLY BILLED TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE.UNDER THE FILING ORGANIZATION'S POLICIES, PAYMENT PLANS FOR PARTIAL CHARITY ACCOUNTS WILL BE INDIVIDUALLY DEVELOPED WITH THE PATIENT. PARTIAL CHARITY ACCOUNTS RESULT WHEN A FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION ALLOWS FOR A PERCENTAGE REDUCTION BUT LEAVES THE PATIENT WITH A SELF-PAY BALANCE. IF THE PATIENT COMPLIES WITH THE AGREED-UPON PAYMENT PLAN, THE FILING ORGANIZATION DOES NOT PURSUE ANY COLLECTION ACTION WITH RESPECT TO THE PATIENT. HOWEVER, IF A PATIENT DOES NOT MAKE ANY PAYMENTS FOR THREE CONSECUTIVE MONTHS, THE ACCOUNT MAY BE REFERRED FOR FURTHER COLLECTION ACTIVITY. THE FILING ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR A 100% REDUCTION IN CHARGES UNDER ITS CHARITY CARE POLICY. SUPPLEMENTAL SCHEDULE TO SCHEDULE H, PART III, SECTION B RECONCILIATION OF SCHEDULE H REPORTED MEDICARE SURPLUS/(SHORTFALL) TO UNREIMBURSED MEDICARE COSTS ASSOCIATED WITH THE PROVISION OF SERVICESTO ALL MEDICARE BENEFICIARIES:THE MEDICARE REVENUE AND ALLOWABLE COSTS OF CARE REPORTED IN SECTION B OF PART III OF SCHEDULE H ARE BASED UPON THE AMOUNTS REPORTED IN THE FILING ORGANIZATION'S MEDICARE COST REPORT IN ACCORDANCE WITH THE IRS INSTRUCTIONS FOR SCHEDULE H. ON AN ANNUAL BASIS, THE FILING ORGANIZATION ALSO DETERMINES ITS TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS. THE PRIMARY RECONCILING ITEMS BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF PART III OF SCHEDULE H AND THE FILING ORGANIZATION'S UNREIMBURSED COSTS OF SERVICES PROVIDED TO MEDICARE PATIENTS ARE AS FOLLOWS:- MEDICARE SURPLUS/(SHORTFALL) SHOWN ON LINE 7 OF SECTION B OF SCHEDULE H: $ 1,014,006- DIFFERENCE IN COSTING METHODOLOGY: ( 256,426)- UNREIMBURSED COSTS INCURRED FOR SERVICES PROVIDED TO MEDICARE PATIENTS THAT ARE NOT INCLUDED IN THE ORGANIZATION'S MEDICARE COST REPORT: (2,198,451) -------------TOTAL UNREIMBURSED COSTS OF SERVING ALL MEDICARE PATIENTS: $(1,440,871)AS INDICATED ABOVE, THE PRIMARY DIFFERENCES BETWEEN THE MEDICARE SURPLUS/(SHORTFALL) REPORTED ON SCHEDULE H, PART III, SECTION B, LINE 7 AND THE FILING ORGANIZATION'S TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS IS DUE TO A DIFFERENCE IN THE COSTING METHODOLOGY AND DIFFERENCES IN THE POPULATION OF MEDICARE PATIENTS WITHIN THE CALCULATION. THE COST METHODOLOGY UTILIZED IN CALCULATING THE TOTAL UNREIMBURSED COSTS ASSOCIATED WITH PROVIDING SERVICES TO ALL MEDICARE PATIENTS IS BASED UPON THE COST-TO-CHARGE RATIO OUTLINED IN WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE SAME COST-TO-CHARGE RATIO IS USED TO DETERMINE THE COSTS ASSOCIATED WITH SERVICES PROVIDED TO CHARITY CARE PATIENTS AND MEDICAID PATIENTS AS REPORTED IN SCHEDULE H, PART I, LINE 7. IN ADDITION, THE MEDICARE COST REPORT EXCLUDES SERVICES PROVIDED TO MEDICARE PATIENTS FOR PHYSICIAN SERVICES, SERVICES PROVIDED TO PATIENTS ENROLLED IN MEDICARE HMOS, AND CERTAIN SERVICES PROVIDED BY OUTPATIENT DEPARTMENTS OF THE FILING ORGANIZATION THAT ARE REIMBURSED ON A FEE SCHEDULE. TAKOMA REGIONAL HOSPITAL PART V, SECTION B, LINE 13G: TAKOMA REGIONAL HOSPITAL HAS DEVELOPED A PATIENT-FRIENDLY SUMMARY VERSION OF ITS FINANCIAL ASSISTANCE POLICY (FAP). THE FILING ORGANIZATION'S FAP PROVIDES THAT ITS HOSPITAL FACILITY WILL POST THE PATIENT-FRIENDLY SUMMARY VERSION OF ITS FAP ON THE HOSPITAL'S WEBSITE. IN ADDITION, THE FAP OF THE HOSPITAL FACILITY STATES THAT SIGNAGE REGARDING THE AVAILABILITY OF THE HOSPITAL FACILITY'S FAP WILL BE VISIBLE AT POINTS OF ADMISSION AND REGISTRATION, INCLUDING THE EMERGENCY DEPARTMENT. TAKOMA REGIONAL HOSPITAL PART V, SECTION B, LINE 19D: IN DETERMINING THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO FINANCIAL ASSISTANCE POLICY-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL USES THE FOLLOWING METHODOLOGY:THE HOSPITAL IDENTIFIES ALL COMMERCIAL PAYORS WHOSE VOLUME OF ACTIVITY WITH THE HOSPITAL EQUALS OR EXCEEDS $100,000 FOR THE TAXABLE YEAR. FOR THOSE IDENTIFIED COMMERCIAL PAYORS, AN AVERAGE OF THE NEGOTIATED COMMERCIAL INSURANCE RATES IS DETERMINED. THE AVERAGE OF ALL OF THE NEGOTIATED COMMERCIAL INSURANCE RATES FOR THOSE IDENTIFIED COMMERCIAL PAYORS DETERMINES THE MAXIMUM AMOUNT THAT CAN BE CHARGED TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART VI, LINE 2: THE FILING ORGANIZATION MUST SATISFY THE COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) PROVISIONS OF 501(R)(3) FOR ITS TAXABLE YEAR BEGINNING JULY 1, 2012. THE FILING ORGANIZATION IS CURRENTLY CONDUCTING THE NECESSARY STEPS AND ACTIONS TO COMPLETE ITS FIRST REQUIRED CHNA FOR ITS 2012 TAXABLE YEAR. THE CHNA WILL COMPLY WITH ALL OF THE REQUIREMENTS SET FORTH IN IRC SECTION 501(R)(3)(A) AND (B). FURTHER, THE FILING ORGANIZATION INTENDS TO RELY ON THE GUIDANCE SET FORTH IN IRS NOTICE 2011-52 UNTIL FURTHER GUIDANCE IS ISSUED BY THE IRS CONCERNING THE CHNA REQUIREMENTS. A VARIETY OF PRACTICES AND PROCESSES ARE IN PLACE TO ENSURE THAT THE FILING ORGANIZATION IS RESPONSIVE TO THE HEALTH NEEDS OF ITS COMMUNITY. SUCH PRACTICES AND PROCESSES INVOLVE THE FOLLOWING:1. A HOSPITAL OPERATING/COMMUNITY BOARD COMPOSED OF INDIVIDUALS BROADLY REPRESENTATIVE OF THE COMMUNITY, COMMUNITY LEADERS, AND THOSE WITH SPECIALIZED MEDICAL TRAINING AND EXPERTISE;2. POST-DISCHARGE PATIENT FOLLOW-UP RELATED TO THE ON-GOING CARE AND TREATMENT OF PATIENTS WHO SUFFER FROM CHRONIC DISEASES; 3. SPONSORSHIP AND PARTICIPATION IN COMMUNITY HEALTH AND WELLNESS ACTIVITIES THAT REACH A BROAD SPECTRUM OF THE FILING ORGANIZATION'S COMMUNITY; AND 4. COLLABORATION WITH OTHER LOCAL COMMUNITY GROUPS TO ADDRESS THE HEALTH CARE NEEDS OF THE FILING ORGANIZATION'S COMMUNITY. PART VI, LINE 3: TAKOMA REGIONAL HOSPITAL HAS A PROCESS IN PLACE WHEREBY PATIENTS ARE INFORMED ABOUT THE HOSPITAL'S CHARITY CARE POLICY AND OTHER FORMS OF FINANCIAL ASSISTANCE, SUCH AS SELF-PAY DISCOUNTS. SIGNAGE IS POSTED IN THE EMERGENCY ROOM INDICATING THAT FINANCIAL ASSISTANCE IS AVAILABLE FOR THOSE SELF-PAY PATIENTS MEETING ELIGIBILITY REQUIREMENTS. AFTER EMTALA MEDICAL SCREENING AND STABILIZATION REQUIREMENTS ARE MET, REGISTRATION PERSONNEL WILL SECURE FINANCIAL INFORMATION ON AS MANY SELF-PAY PATIENTS AS POSSIBLE AT THE TIME OF SERVICE. FOR THOSE WHO APPEAR TO QUALIFY FOR MEDICAID OR UNDER THE HOSPITAL'S CHARITY CARE POLICY, THE FINANCIAL COUNSELORS WILL CONTINUE TO WORK WITH THOSE PATIENTS UNTIL FINAL ACCOUNT RESOLUTION IS ACHIEVED. ALL OTHER SELF-PAY PATIENTS ARE COVERED UNDER THIS PROCESS. AT ANY TIME DURING THE PROCESS THAT DATA IS PROVIDED SHOWING THAT A PATIENT QUALIFIES FOR ASSISTANCE UNDER THE CHARITY CARE POLICY THE DISCOUNTS EXTENDED UNDER THAT POLICY WILL BE APPLIED.AS PART OF THE BILLING PROCESS, THE HOSPITAL INCLUDES THE APPLICATION FOR CHARITY CARE ASSISTANCE ALONG WITH THE INITIAL PATIENT BILL. THE HOSPITAL'S CHARITY CARE APPLICATION IS ALSO AVAILABLE TO PATIENTS ON THE HOSPITAL'S WEB-SITE IN BOTH AN ENGLISH AND SPANISH VERSION. ADDITIONALLY, THE HOSPITAL'S FINANCIAL COUNSELORS ARE AVAILABLE TO WORK WITH EVERY PATIENT DURING THE FIRST 120 DAYS OF THE BILLING PROCESS TO ASSIST THE PATIENT WITH COMPLETING CHARITY CARE APPLICATIONS AND INVESTIGATING OTHER POTENTIAL SOURCES OF THIRD-PARTY ASSISTANCE. THE DETERMINATION OF A PATIENT'S ELIGIBILITY FOR CHARITY CARE IS MADE ON A CASE-BY-CASE BASIS. VARIOUS FACTORS ARE CONSIDERED IN THAT DETERMINATION. EACH INDIVIDUAL PATIENT WHO IS IDENTIFIED AS POTENTIALLY BEING ELIGIBLE TO RECEIVE CHARITY CARE IS SEEN BY A FINANCIAL COUNSELOR AT THE HOSPITAL. THE FINANCIAL COUNSELOR WILL WORK WITH THE PATIENT TO MAKE SURE THAT OTHER SOURCES OF ASSISTANCE (PUBLIC OR OTHERWISE) HAVE BEEN SOUGHT TO THE FULLEST EXTENT POSSIBLE. WHEN OTHER FORMS OF ASSISTANCE ARE NOT AVAILABLE OR HAVE BEEN EXHAUSTED, THE HOSPITAL WILL GATHER CERTAIN FINANCIAL INFORMATION FROM THE PATIENT TO DETERMINE THE PATIENT'S ABILITY TO PAY BASED UPON LEVEL OF INCOME. PART VI, LINE 4: TAKOMA REGIONAL HOSPITAL (THE HOSPITAL) IS A 100-BED ACUTE CARE FACILITY THAT HAS PROVIDED QUALITY HEALTH CARE SERVICES TO THE RESIDENTS OF NORTHEASTERN TENNESSEE FOR OVER 81 YEARS. IN 1974, TAKOMA ADVENTIST HOSPITAL BECAME A MEMBER OF THE SOUTHERN ADVENTIST HEALTH AND HOSPITAL SYSTEM. MAY OF 2007 BROUGHT ADDITIONAL CHANGE TO TAKOMA WHEN WELLMONT HEALTH SYSTEM BOUGHT A 60% SHARE OF THE HOSPITAL AND TAKOMA ADVENTIST HOSPITAL BECAME TAKOMA REGIONAL HOSPITAL. THE HOSPITAL IS LOCATED IN THE FOOTHILLS OF THE GREAT SMOKEY MOUNTAINS IN HISTORIC GREENEVILLE, TENNESSEE. THE HOSPITAL'S PRIMARY MARKET HAS A POPULATION OF APPROXIMATELY 74,000, WITH AN ESTIMATED 13,000 OVER THE AGE OF 65.THE HOSPITAL IS A CRUCIAL COMMUNITY AND REGIONAL ASSET. TAKOMA REGIONAL HOSPITAL IS ONE OF TWO HOSPITALS IN GREENEVILLE, TN. THE NEAREST PROVIDER DOES NOT OFFER MANY OF THE SERVICES OFFERED AT THE HOSPITAL, SUCH AS GERIATRIC PSYCHIATRIC INPATIENT SERVICES, OUTPATIENT BEHAVIORAL SERVICES, AND A CENTER FOR INPATIENT REHABILITATION. THE HOSPITAL IS ALSO ONE OF THE LARGEST EMPLOYERS IN THE CITY OF GREENEVILLE, TN.THE CITY OF GREENEVILLE, TN COVERS 15.1 SQUARE MILES. THE WEIGHTED AVERAGE HOUSEHOLD INCOME, BASED ON POPULATION, IN THE PRIMARY MARKET IS APPROXIMATELY $34,600. ABOUT 15% OF GREENE COUNTY'S RESIDENTS HAVE INCOMES BELOW THE FEDERAL POVERTY LEVEL. HIGH SCHOOL GRADUATES ACCOUNT FOR APPROXIMATELY 51% OF GREENE COUNTY, WITH AN ESTIMATED 2% HAVING A BACHELOR'S DEGREE OR HIGHER. GREENE COUNTY'S CURRENT UNEMPLOYMENT RATE IS ABOUT 7%. APPROXIMATELY 48% OF THE HOSPITAL'S PATIENTS DURING FISCAL YEAR 2012 WERE MEDICARE PATIENTS, ABOUT 18% WERE MEDICAID PATIENTS, ABOUT 8% WERE SELF-PAY PATIENTS, AND THE REMAINING PERCENTAGE WERE PATIENTS COVERED UNDER COMMERCIAL INSURANCE. APPROXIMATELY 67% OF THE HOSPITAL'S IN-PATIENTS ARE ADMITTED THROUGH THE EMERGENCY DEPARTMENT. PART VI, LINE 5: THE PROVISION OF COMMUNITY BENEFIT IS CENTRAL TO TAKOMA REGIONAL HOSPITAL'S MISSION OF SERVICE AND COMPASSION. RESTORING AND PROMOTING THE HEALTH AND QUALITY OF LIFE OF THOSE IN THE COMMUNITIES SERVED BY THE HOSPITAL IS A FUNCTION OF "EXTENDING THE HEALING MINISTRY OF CHRIST" AND EMBODIES THE HOSPITAL'S COMMITMENT TO ITS VALUES AND PRINCIPLES. THE HOSPITAL COMMITS SUBSTANTIAL RESOURCES TO PROVIDE A BROAD RANGE OF SERVICES TO BOTH THE UNDERPRIVILEGED AS WELL AS THE BROADER COMMUNITY. IN ADDITION TO THE COMMUNITY BENEFIT INFORMATION PROVIDED IN PARTS I, II AND III OF THIS SCHEDULE H, THE HOSPITAL CAPTURES THE BENEFITS PROVIDED TO ITS COMMUNITY THROUGH FAITH-BASED CARE. EXAMPLES OF SUCH BENEFITS INCLUDE THE COST ASSOCIATED WITH CHAPLAINCY CARE PROGRAMS AND MISSION PEER REVIEWS AND MISSION CONFERENCES. DURING THE CURRENT YEAR, HOSPITAL PROVIDED $84,483 OF BENEFIT WITH RESPECT TO THE FAITH-BASED AND SPIRITUAL NEEDS OF THE COMMUNITY IN CONJUNCTION WITH ITS OPERATION OF A COMMUNITY HOSPITAL. THE HOSPITAL ALSO PROVIDES BENEFITS TO ITS COMMUNITY'S INFRASTRUCTURE BY INVESTING IN CAPITAL IMPROVEMENTS TO ENSURE THAT FACILITIES AND TECHNOLOGY PROVIDE THE BEST POSSIBLE CARE TO THE COMMUNITY. DURING THE CURRENT YEAR, THE HOSPITAL EXPENDED $1,417,359 IN NEW CAPITAL IMPROVEMENTS. AS A FAITH-BASED MISSION-DRIVEN COMMUNITY HOSPITAL, THE HOSPITAL IS CONTINUALLY INVOLVED IN MONITORING ITS COMMUNITY, IDENTIFYING UNMET HEALTH CARE NEEDS AND DEVELOPING SOLUTIONS AND PROGRAMS TO ADDRESS THOSE NEEDS. IN ACCORDANCE WITH ITS CONSERVATIVE APPROACH TO FISCAL RESPONSIBILITY, SURPLUS FUNDS OF THE HOSPITAL ARE CONTINUALLY BEING INVESTED IN RESOURCES THAT IMPROVE THE AVAILABILITY AND QUALITY OF DELIVERY OF HEALTH CARE SERVICES AND PROGRAMS TO ITS COMMUNITY. PART VI, LINE 6: AS EXPLAINED IN OUR RESPONSE TO FORM 990, PART VI, SECTION A, LINE 6, TAKOMA REGIONAL HOSPITAL (TRH OR THE HOSPITAL) HAS TWO MEMBERS. THE MEMBERS ARE ADVENTIST HEALTH SYSTEM/SUNBELT, INC. AND WELLMONT HEALTH SYSTEM. TRH IS ABLE TO DRAW UPON THE EXPERTISE AND LEADERSHIP OF BOTH ITS HEALTH SYSTEM MEMBERS IN ITS EFFORT TO CREATE EXCELLENT PATIENT EXPERIENCES AND OFFER A BROAD SPECTRUM OF HEALTH SERVICES NEEDED IN ITS COMMUNITY.DURING ITS 2011 TAX YEAR, TRH WAS MANAGED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC AND ITS SUBSIDIARY ORGANIZATIONS OPERATE 42 HOSPITALS IN 10 STATES THROUGHOUT THE U.S., PRIMARILY IN THE SOUTHEASTERN PORTION OF THE U.S. AHSSHC AND ITS SUBSIDIARIES ALSO OPERATE 16 NURSING HOME FACILITIES AND OTHER ANCILLARY HEALTH CARE PROVIDER FACILITIES, SUCH AS AMBULATORY SURGERY CENTERS AND DIAGNOSTIC IMAGING CENTERS. AHSSHC PROVIDES EXECUTIVE LEADERSHIP AND OTHER PROFESSIONAL SUPPORT SERVICES TO TAKOMA REGIONAL HOSPITAL. PROFESSIONAL SUPPORT SERVICES INCLUDE AMONG OTHERS CORPORATE COMPLIANCE, LEGAL, HUMAN RESOURCES, REIMBURSEMENT, RISK MANAGEMENT, AND TAX AS WELL AS TREASURY FUNCTIONS. THE PROVISION OF THESE EXECUTIVE AND SUPPORT SERVICES ON A CENTRALIZED BASIS BY AHSSHC PROVIDES AN APPROPRIATE BALANCE BETWEEN PROVIDING TAKOMA REGIONAL HOSPITAL WITH MISSION-DRIVEN CONSISTENT LEADERSHIP AND SUPPORT WHILE ALLOWING THE HOSPITAL ORGANIZATION TO FOCUS ITS RESOURCES ON MEETING THE SPECIFIC HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE READER OF THIS FORM 990 SHOULD KEEP IN MIND THAT THIS REPORTING ENTITY MAY DIFFER IN CERTAIN AREAS FROM THAT OF A STAND-ALONE HOSPITAL ORGANIZATION DUE TO ITS MANAGEMENT BY AHSSHC. THE FILING ORGANIZATION BENEFITS FROM REDUCED COSTS DUE TO ITS AFFILIATION WITH AHSSHC, SUCH AS LARGE GROUP PURCHASING DISCOUNTS, AND THE AVAILABILITY OF INTERNAL RESOURCES SUCH AS INTERNAL LEGAL COUNSEL. TAKOMA REGIONAL HOSPITAL PAYS A MANAGEMENT FEE TO AHSSHC FOR THE INTERNAL SERVICES PROVIDED BY AHSSHC. AS A RESULT, MANAGEMENT FEE EXPENSE REPORTED BY TAKOMA REGIONAL HOSPITAL MAY APPEAR GREATER IN RELATION TO MANAGEMENT FEE EXPENSE THAT MAY BE REPORTED BY A SINGLE STAND-ALONE HOSPITAL WITH NO SUCH AFFILIATION. THE SINGLE STAND-ALONE HOSPITAL WOULD LIKELY REPORT COSTS ASSOCIATED WITH MANAGEMENT AND OTHER PROFESSIONAL SERVICES ON VARIOUS EXPENSE LINE ITEMS IN ITS STATEMENT OF REVENUE AND EXPENSE AS OPPOSED TO REPORTING SUCH COSTS IN ONE OVERALL MANAGEMENT FEE EXPENSE. 1 BOYS AND GIRLS CLUB OF GREENEVILLEGREENE COUNTY 740 W CHURCH STREET GREENEVILLE TN 37744 621706248 501(C)(3) 7750 GENERAL SUPPORT UNITED FUND FOR GREENE COUNTY INC 115 ACADEMY STREET GREENEVILLE TN 37743 626015767 501(C)(3) 5750 GENERAL SUPPORT GREENE COUNTY PARTNERSHIP INC 115 ACADEMY STREET GREENEVILLE TN 37743 621552105 501(C)(4) 8275 GENERAL SUPPORT 2 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS ARE GENERALLY MADE TO AFFILIATED ORGANIZATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER 501(C)(3) OR TO OTHER 501(C)(3) ORGANIZATIONS THAT ARE A PART OF THE GROUP EXEMPTION RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS, OR TO LOCAL 501(C)(3) COMMUNITY ORGANIZATIONS. ACCORDINGLY, THE FILING ORGANIZATION HAS NOT ESTABLISHED SPECIFIC PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES AS THE FILING ORGANIZATION DOES NOT HAVE A GRANT MAKING PROGRAM THAT WOULD NECESSITATE SUCH PROCEDURES. X X X X 1 1 0 0 0 0 0 1 0 0 0 DANIEL WOLCOTT 229733 0 0 0 18441 0 24237 0 52223 0 324634 0 4135 0 GREGORY UHL MD 367389 0 36 0 10605 0 13343 0 18849 0 410222 0 0 0 CLAES SVENDSEN MD 165872 0 18304 0 3757 0 9878 0 15748 0 213559 0 0 0 JR MCKINNEY MD 146279 0 36 0 66 0 4397 0 147 0 150925 0 0 0 DANIEL LEWIS MD 200587 0 36 0 4394 0 10966 0 16339 0 232322 0 0 0 TOM VANDENHOVEN 134801 0 0 0 3853 0 6769 0 16201 0 161624 0 0 0 FRED MYERS MD 152520 0 36 0 3797 0 7916 0 14409 0 178678 0 0 0 STEPHEN PURVIS DO 498340 0 36 0 1848 0 13343 0 6377 0 519944 0 0 0 JOSEPH KRETSCHMAR MD 402272 0 36 0 7885 0 13343 0 15559 0 439095 0 0 0 ROBERT W LOCKLEAR MD 166284 0 184175 0 3617 0 13343 0 16006 0 383425 0 0 0 GORDON L MARSA MD 270917 0 35036 0 10045 0 13343 0 15289 0 344630 0 0 0 DORIS PURVIS MD 276685 0 11823 0 11586 0 13343 0 5762 0 319199 0 0 0 PART I, LINE 1A AS DISCUSSED IN OUR RESPONSE TO SECTION B, PART VI, QUESTION 15A & B, THE FILING ORGANIZATION IS 40% OWNED BY ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI). AHSSI IS PART OF THE SYSTEM OF HEALTHCARE ORGANIZATIONS KNOWN AS ADVENTIST HEALTH SYSTEM (AHS). THE FILING ORGANIZATION IS MANAGED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC), THE PARENT ORGANIZATION OF AHSSI. IN CONJUNCTION WITH THE MANAGEMENT AGREEMENT WITH AHSSHC, MEMBERS OF THE FILING ORGANIZATION'S EXECUTIVE MANAGEMENT TEAM THAT HOLD THE POSITION OF VICE-PRESIDENT OR ABOVE ARE COMPENSATED BY AND ON THE PAYROLL OF AHSSHC. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE FILING ORGANIZATION REIMBURSES AHSSHC FOR THE SALARY AND BENEFIT COST OF THOSE EXECUTIVES ON THE PAYROLL OF AHSSHC THAT PROVIDE SERVICES AND ARE ON THE MANAGEMENT TEAM OF THE FILING ORGANIZATION. TRAVEL FOR COMPANIONS: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT PROVIDES A BENEFIT TO ALLOW FOR A TRAVELING AHSSHC EXECUTIVE TO HAVE HIS OR HER SPOUSE ACCOMPANY THE EXECUTIVE ON TWO BUSINESS TRIPS EACH YEAR. TYPICALLY, REIMBURSEMENT IS ONLY PROVIDED TO VICE PRESIDENTS AND ABOVE AND IS LIMITED TO ONE BUSINESS TRIP PER YEAR AND THE ANNUAL AHS PRESIDENT'S COUNCIL BUSINESS MEETING. THE AHSSHC CORPORATE EXECUTIVE SPOUSAL TRAVEL POLICY WAS ORIGINALLY APPROVED AND REVIEWED BY THE AHSSHC BOARD STRATEGY & COMPENSATION COMMITTEE, AN INDEPENDENT BODY OF THE AHSSHC BOARD OF DIRECTORS. ALL SPOUSAL TRAVEL COSTS REIMBURSED TO THE EXECUTIVE ARE CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: AHS HAS A SYSTEM-WIDE POLICY ADDRESSING GROSS-UP PAYMENTS PROVIDED IN CONNECTION WITH EMPLOYER-PROVIDED BENEFITS/OTHER TAXABLE ITEMS. UNDER THE POLICY, CERTAIN TAXABLE BUSINESS-RELATED REIMBURSEMENTS (I.E. TAXABLE BUSINESS-RELATED MOVING EXPENSES, TAXABLE ITEMS PROVIDED IN CONNECTION WITH EMPLOYMENT) PROVIDED TO ANY EMPLOYEE MAY BE GROSSED-UP AT A 25% RATE UPON APPROVAL OF THE FILING ORGANIZATION'S CEO AND CFO. ADDITIONALLY, EMPLOYEES AT THE DIRECTOR LEVEL AND ABOVE ARE ELIGIBLE FOR GROSS-UP PAYMENTS ON GIFTS RECEIVED FOR BOARD OF DIRECTOR SERVICES. DISCRETIONARY SPENDING ACCOUNT: A NOMINAL DISCRETIONARY SPENDING AMOUNT WAS PROVIDED IN THE CURRENT YEAR TO ALL ELIGIBLE EXECUTIVES WHO ATTEND THE ANNUAL AHS PRESIDENT'S COUNCIL BUSINESS MEETING ($500 PER EXECUTIVE). ELIGIBLE EXECUTIVES INCLUDE ALL AHSSHC VICE PRESIDENTS AND ABOVE AND ALL AHSSHC SUBSIDIARY ORGANIZATION CEOS AND REGIONAL CFOS. THE PAYMENT PROVIDED TO EACH EXECUTIVE WAS CONSIDERED TAXABLE COMPENSATION TO THE EXECUTIVE. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: AHSSHC HAS A CORPORATE EXECUTIVE POLICY THAT ADDRESSES BUSINESS DEVELOPMENT EXPENDITURES. UNDER THIS POLICY, CERTAIN AHS ELIGIBLE EXECUTIVES MAY BE REIMBURSED FOR MEMBER DUES AND USAGE CHARGES FOR A COUNTRY CLUB OR OTHER SOCIAL CLUB UPON AUTHORIZATION. CLUB MEMBERSHIPS MUST BE RECOMMENDED BY THE CEO OF THE AHS HOSPITAL ORGANIZATION AND APPROVED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS OF THE ORGANIZATION. IN ADDITION, THE PROPOSED MEMBERSHIP MUST BE APPROVED ANNUALLY BY THE AHSSHC BOARD STRATEGY & COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ELIGIBLE EXECUTIVES ARE LIMITED TO CERTAIN SENIOR LEVEL EXECUTIVES (HOSPITAL ORGANIZATION CEOS, THE CEO OF THE NURSING HOME DIVISION OF AHS, SENIOR VICE PRESIDENTS AT THREE LARGE HOSPITAL ORGANIZATIONS, REGIONAL CEOS AND CFOS AND THE PRESIDENT AND SENIOR VICE PRESIDENTS OF AHSSHC). IN THE CURRENT YEAR, FOR THIS FILING ORGANIZATION, ONE EXECUTIVE WAS ELIGIBLE TO RECEIVE REIMBURSEMENT FOR CLUB FEES. EACH AHS EXECUTIVE WHO IS APPROVED FOR A CLUB MEMBERSHIP MUST SUBMIT AN ANNUAL REPORT TO THE AHSSHC BOARD STRATEGY & COMPENSATION COMMITTEE THAT DESCRIBES HOW THE MEMBERSHIP BENEFITED THEIR ORGANIZATION DURING THE PRECEDING YEAR. PART I, LINE 6 THE FILING ORGANIZATION'S PHYSICIAN COMPENSATION FORMULA IS DESIGNED TO RESULT IN TOTAL COMPENSATION THAT WOULD BE REASONABLE FOR EACH PHYSICIAN. THE FILING ORGANIZATION UTILIZES NATIONAL SURVEY PRODUCTIVITY, COST, AND COMPENSATION DATA IN FORMULATING ALL ASPECTS OF THE COMPENSATION PLAN. PHYSICIAN COMPENSATION ARRANGEMENTS INCLUDE A CEILING OR REASONABLE MAXIMUM ON THE AMOUNT A PHYSICIAN MAY EARN. THE FILING ORGANIZATION'S EMPLOYED PHYSICIANS ENTER INTO A WRITTEN AGREEMENT THAT REQUIRES THE PHYSICIANS TO PROVIDE MEDICAL CARE TO INDIVIDUALS WHO ARE REFERRED BY THE FILING ORGANIZATION. PURSUANT TO THE AGREEMENT, AN INDIVIDUAL MAY NOT BE REJECTED AS A PATIENT BY A PHYSICIAN DUE TO RACE, SEX, AGE, COLOR, CREED, NATIONAL ORIGIN OR INABILITY TO PAY. THE FILING ORGANIZATION'S COMPENSATION ARRANGEMENT DOES NOT USE A METHOD OF COMPENSATION THAT IS BASED UPON A PERCENTAGE OF THE ORGANIZATION'S NET INCOME. RATHER, UNDER THE COMPENSATION ARRANGEMENT, PHYSICIAN BASE SALARY IS SET BASED ON FAIR MARKET VALUE BENCHMARKS, AND ANY ADDITIONAL COMPENSATION IS BASED ON A PERCENTAGE OF THE PRACTICE/LOCATION NET REVENUE. SUPPLEMENTAL INFORMATION PART III PART I, QUESTION 3: AS NOTED IN OUR RESPONSE TO QUESTION 15 OF PART VI OF FORM 990, THE INDIVIDUAL WHO SERVES AS THE CEO OF THE FILING ORGANIZATION IS COMPENSATED BY ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC) FOR THAT INDIVIDUAL'S ROLE IN SERVING AS THE CEO. COMPENSATION AND BENEFITS PROVIDED TO THIS INDIVIDUAL ARE DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC USES ALL OF THE FOLLOWING TO ESTABLISH COMPENSATION OF THE CEO: - COMPENSATION COMMITTEE; - INDEPENDENT COMPENSATION CONSULTANT; - COMPENSATION SURVEY OR STUDY; AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SUPPLEMENTAL INFORMATION PART III FORM 990, PART VII, SECTION A, LINE 5: AS DISCUSSED IN OUR RESPONSE TO SCHEDULE J, PART I, LINE 1A; 40% OF THE MEMBERSHIP INTEREST IN THE FILING ORGANIZATION IS HELD BY ADVENTIST HEALTH SYSTEM/SUNBELT, INC.(AHSSI). AHSSI IS A WHOLLY-OWNED SUBSIDIARY OF ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). BOTH AHSSI AND AHSSHC ARE ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). THE FOLLOWING INDIVIDUAL OFFICERS OF THE FILING ORGANIZATION ARE ON THE PAYROLL OF AND COMPENSATED BY AHSSHC FOR SERVICES PROVIDED TO THE FILING ORGANIZATION: - DANIEL WOLCOTT - TOM VANDENHOVEN THE TYPE AND AMOUNT OF COMPENSATION PAID TO EACH OF THE INDIVIDUALS LISTED ABOVE BY AHSSHC FOR SERVICES RENDERED TO THE FILING ORGANIZATION IS DETAILED IN PART II OF THIS SCHEDULE J. AHSSHC PROVIDES ELIGIBLE EXECUTIVES AN OPPORTUNITY TO PARTICIPATE IN THE AHS EXECUTIVE FLEX BENEFIT PROGRAM (THE PLAN). THE PURPOSE OF THE PLAN IS TO OFFER ELIGIBLE EXECUTIVES AN OPPORTUNITY TO ELECT FROM AMONG A VARIETY OF SUPPLEMENTAL BENEFITS, INCLUDING DEFERRED COMPENSATION BENEFITS TAXABLE UNDER INTERNAL REVENUE CODE (IRC) SECTION 457(F), TO INDIVIDUALLY TAILOR A BENEFITS PROGRAM APPROPRIATE TO EACH EXECUTIVE'S NEEDS. THE PLAN PROVIDES ELIGIBLE PARTICIPANTS A PRE-DETERMINED BENEFITS ALLOWANCE CREDIT THAT IS EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE PAY FROM WHICH IS DEDUCTED THE COST OF MANDATORY AND ELECTIVE EMPLOYEE BENEFITS. THE PRE-DETERMINED BENEFITS ALLOWANCE CREDIT PERCENTAGE IS APPROVED BY THE AHS BOARD STRATEGY & COMPENSATION COMMITTEE, AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF AHSSHC. ANY FUNDS THAT REMAIN AFTER THE COST OF MANDATORY AND ELECTIVE BENEFITS ARE SUBTRACTED FROM THE ANNUAL PRE-DETERMINED BENEFITS ALLOWANCE ARE CONTRIBUTED, AT THE EMPLOYEE'S OPTION, TO EITHER AN IRC 457(F) DEFERRED COMPENSATION ACCOUNT OR TO AN IRC 457(B) ELIGIBLE DEFERRED COMPENSATION PLAN. UPON ATTAINMENT OF AGE 65, ALL PREVIOUS 457(F) DEFERRED AMOUNTS ARE PAID IMMEDIATELY TO THE PARTICIPANT AND ANY FUTURE EMPLOYER CONTRIBUTIONS ARE MADE QUARTERLY FROM THE PLAN DIRECTLY TO THE PARTICIPANT. THE PLAN DOCUMENTS DEFINE AN EMPLOYEE WHO IS ELIGIBLE TO PARTICIPATE IN THE PLAN TO GENERALLY INCLUDE THE CHIEF EXECUTIVE OFFICERS OF AHS ENTITIES AND VICE PRESIDENTS OF ALL AHS ENTITIES WHOSE BASE SALARY IS AT LEAST $204,000. THE PLAN PROVIDES FOR A CLASS YEAR VESTING SCHEDULE (2 YEARS FOR EACH CLASS YEAR) WITH RESPECT TO AMOUNTS ACCUMULATED IN THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT. DISTRIBUTIONS COULD ALSO BE MADE FROM THE EXECUTIVE'S 457(F) DEFERRED COMPENSATION ACCOUNT UPON ATTAINMENT OF AGE 65 OR UPON AN INVOLUNTARY SEPARATION. THE ACCOUNT IS FORFEITED BY THE EXECUTIVE UPON A VOLUNTARY SEPARATION. DURING 2011, DANIEL WOLCOTT PARTICIPATED IN THE AHS EXECUTIVE FLEX BENEFIT PROGRAM. EMPLOYER CONTRIBUTIONS TO THE PLAN WERE $11,487 DURING 2011. MR. WOLCOTT RECEIVED A DISTRIBUTION OF $5,500 FROM THE PLAN IN 2011. DANIEL LEWIS MD EMPLOYMENT RELATED X 125000 32597 0 0 1 32597 LORI VANDENHOVEN FAMILY OF BOARD MEMBER 38488 EMPLOYEE COMPENSATION 0 FORM 990, PART IV, LINE 20B: TAKOMA REGIONAL HOSPITAL, INC. (TRH OR THE HOSPITAL) DID NOT UNDERGO AN INDEPENDENT FINANCIAL STATEMENT AUDIT FOR ITS TAX YEAR BEGINNING JULY 1, 2011 AND ENDING JUNE 30, 2012. TRH IS A NOT-FOR-PROFIT MEMBERSHIP ORGANIZATION WITH TWO MEMBERS. THE MEMBERS OF THE FILING ORGANIZATION ARE ADVENTIST HEALTH SYSTEM /SUNBELT, INC. (AHSSI) AND WELLMONT HEALTH SYSTEM (WHS) (COLLECTIVELY, THE MEMBERS). BOTH AHSSI AND WHS ARE NOT-FOR-PROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). EACH OF THE TWO MEMBERS HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY THREE OF THE SIX MEMBERS OF THE BOARD OF DIRECTORS OF TRH. BASED UPON THIS DIVISION OF CONTROL OVER THE POWER TO APPOINT THE GOVERNING BODY OF THE HOSPITAL, BOTH OF THE MEMBERS ACCOUNT FOR THEIR INTEREST IN TRH USING THE EQUITY METHOD AND DO NOT CONSOLIDATE TRH INTO THEIR OWN FINANCIAL STATEMENTS OR FINANCIAL STATEMENT AUDITS. IRC SECTION 6033(B)(15)(B) STATES THAT A FORM 990 FILING ORGANIZATION THAT IS SUBJECT TO THE REQUIREMENTS OF IRC SECTION 501(R) MUST ATTACH A COPY OF ITS AUDITED FINANCIAL STATEMENTS (OR, IN THE CASE OF ANY ORGANIZATION THE FINANCIAL STATEMENTS OF WHICH ARE INCLUDED IN A CONSOLIDATED FINANCIAL STATEMENT WITH OTHER ORGANIZATIONS, SUCH CONSOLIDATED FINANCIAL STATEMENT). TO DATE, THE HOSPITAL IS NOT AWARE OF ANY GUIDANCE THAT HAS BEEN ISSUED BY THE IRS THAT ADDRESSES A SITUATION IN WHICH A HOSPITAL ORGANIZATION SUBJECT TO THE REQUIREMENTS OF SECTION 501(R) DOES NOT RECEIVE A SEPARATE AUDITED FINANCIAL STATEMENT AND IS NOT INCLUDED IN A CONSOLIDATED FINANCIAL STATEMENT WITH OTHER ORGANIZATIONS. THERE IS NO STATED REQUIREMENT IN IRC SECTIONS 501(R) OR 6033(B)(15) THAT REQUIRES A FINANCIAL STATEMENT AUDIT FOR A HOSPITAL ORGANIZATION SUBJECT TO THE PROVISIONS OF SECTION 501(R). THE 2011 FORM 990 INSTRUCTIONS STATE THAT IF THE FILING ORGANIZATION OPERATED ONE OR MORE HOSPITAL FACILITIES AT ANY TIME DURING THE TAX YEAR, THEN IT MUST ATTACH A COPY OF ITS MOST RECENT AUDITED FINANCIAL STATEMENT. AS NOTED IN OUR SCHEDULE O DISCLOSURE WITH RESPECT TO FORM 990, PART VI, SECTION B, LINE 15, ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI) HOLDS A 40% MEMBER INTEREST IN THE FILING ORGANIZATION. THE TOP TIER PARENT OF AHSSI IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION, D/B/A ADVENTIST HEALTH SYSTEM (AHSSHC). BOTH AHSSI AND AHSSHC ARE ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). AHSSHC PROVIDES EXECUTIVE AND OTHER MANAGEMENT SERVICES TO THE FILING ORGANIZATION. THE CONSOLIDATED 2011 FINANCIAL STATEMENT AUDIT FOR AHSSHC AND ITS CONTROLLED ENTITIES HAS BEEN ATTACHED TO THIS FORM 990. AS NOTED ABOVE, THE FILING ORGANIZATION IS ACCOUNTED FOR ON THE EQUITY METHOD IN THE ATTACHED AUDITED CONSOLIDATED FINANCIAL STATEMENTS FOR AHSSHC AND ITS CONTROLLED ENTITIES. FORM 990, PART VI, SECTION A, LINE 2 JOHN HOWARD AND ALICE POPE - BUSINESS RELATIONSHIP ELIZABETH WARD AND JOHN HOWARD - BUSINESS RELATIONSHIP JOHN HOWARD AND MARGARET DENARVAEZ - BUSINESS RELATIONSHIP MARK WILLIAMS AND SHARON FOLK - BUSINESS RELATIONSHIP MARK WILLIAMS AND JAMES KILGORE, MD - BUSINESS RELATIONSHIP MARK WILLIAMS AND TOM VANDENHOVEN - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 TAKOMA REGIONAL HOSPITAL, INC. (THE FILING ORGANIZATION) HAS TWO MEMBERS. THE MEMBERS OF THE FILING ORGANIZATION ARE ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI) AND WELLMONT HEALTH SYSTEM (WHS). BOTH AHSSI AND WHS ARE NOT-FOR-PROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THERE ARE NO OTHER CLASSES OF MEMBERSHIP IN THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY AHSSI AND WHS, THE TWO MEMBERS OF THE FILING ORGANIZATION. EACH OF THE TWO MEMBERS HAS THE RIGHT TO ELECT, APPOINT OR REMOVE ANY THREE OF THE SIX MEMBERS OF THE BOARD OF DIRECTORS OF THE FILING ORGANIZATION. IN ADDITION, THE MEMBERS OF THE FILING ORGANIZATION APPOINT THE MEMBERS OF THE FILING ORGANIZATION'S HOSPITAL COMMUNITY BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE FILING ORGANIZATION'S CURRENT YEAR FORM 990 WAS REVIEWED BY THE BOARD OF DIRECTORS PRIOR TO ITS FILING WITH THE IRS. THE REVIEW CONDUCTED BY THE BOARD OF DIRECTORS DID NOT INCLUDE THE REVIEW OF ANY SUPPORTING WORKPAPERS THAT WERE USED IN PREPARATION OF THE CURRENT YEAR FORM 990, BUT DID INCLUDE A REVIEW OF THE ENTIRE FORM 990 AND ALL SUPPORTING SCHEDULES. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY OF THE FILING ORGANIZATION APPLIES TO MEMBERS OF ITS BOARD OF DIRECTORS, HOSPITAL COMMUNITY BOARD, AND ITS PRINCIPAL OFFICERS (TO BE KNOWN AS INTERESTED PERSONS). IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTERESTS, ANY INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST WITH THE FILING ORGANIZATION AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS CONCERNING THE FINANCIAL INTEREST/ARRANGEMENT TO THE BOARD OF DIRECTORS/HOSPITAL COMMUNITY BOARD OF THE FILING ORGANIZATION OR TO ANY MEMBERS OF A COMMITTEE WITH BOARD DELEGATED POWERS THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. SUBSEQUENT TO ANY DISCLOSURE OF ANY FINANCIAL INTEREST/ARRANGEMENT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE RELEVANT BOARD MEMBER OR PRINCIPAL OFFICER, THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS/HOSPITAL COMMUNITY BOARD OR COMMITTEE WITH BOARD DELEGATED POWERS SHALL DISCUSS, ANALYZE, AND VOTE UPON THE POTENTIAL FINANCIAL INTEREST/ARRANGEMENT TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. ACCORDING TO THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OF DIRECTORS/HOSPITAL COMMUNITY BOARD (OR COMMITTEE WITH BOARD DELEGATED POWERS), BUT AFTER SUCH PRESENTATION, SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN A CONFLICT OF INTEREST. EACH INTERESTED PERSON, AS DEFINED UNDER THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTERESTS POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE FILING ORGANIZATION IS A CHARITABLE ORGANIZATION THAT MUST PRIMARILY ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES. THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY ALSO REQUIRES THAT PERIODIC REVIEWS SHALL BE CONDUCTED TO ENSURE THAT THE FILING ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 ADVENTIST HEALTH SYSTEM/SUNBELT, INC. (AHSSI) HOLDS A 40% MEMBER INTEREST IN THE FILING ORGANIZATION. THE TOP-TIER PARENT OF AHSSI IS ADVENTIST HEALTH SYSTEM SUNBELT HEALTHCARE CORPORATION (AHSSHC). AHSSHC IS THE PARENT ORGANIZATION OF A HEALTHCARE SYSTEM, KNOWN AS ADVENTIST HEALTH SYSTEM, THAT OPERATES HOSPITALS, NURSING HOME FACILITIES, AND OTHER HEALTHCARE PROVIDER ORGANIZATIONS. AHSSHC IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3) PURSUANT TO A GROUP RULING ISSUED TO THE GENERAL CONFERENCE OF SEVENTH-DAY ADVENTISTS. THE INDIVIDUALS WHO SERVE AS THE CEO, CFO OR VICE PRESIDENT OF THE FILING ORGANIZATION ARE COMPENSATED BY AHSSHC FOR SERVICES PROVIDED TO THE FILING ORGANIZATION. COMPENSATION AND BENEFITS PROVIDED TO THESE INDIVIDUALS IS DETERMINED PURSUANT TO POLICIES, PROCEDURES, AND PROCESSES OF AHSSHC THAT ARE DESIGNED TO ENSURE COMPLIANCE WITH THE INTERMEDIATE SANCTIONS LAWS AS SET FORTH IN IRC SECTION 4958. AHSSHC HAS TAKEN STEPS TO ENSURE THAT PROCESSES ARE IN PLACE TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS STANDARD AS SET FORTH IN TREASURY REGULATION 53.4958-6 WITH RESPECT TO ITS ACTIVE EXECUTIVE-LEVEL POSITIONS. THE AHSSHC BOARD STRATEGY AND COMPENSATION COMMITTEE (THE COMMITTEE) SERVES AS THE GOVERNING BODY FOR ALL EXECUTIVE COMPENSATION MATTERS. THE COMMITTEE IS COMPOSED OF CERTAIN MEMBERS OF THE BOARD OF TRUSTEES (THE BOARD) OF AHSSHC. VOTING MEMBERS OF THE COMMITTEE INCLUDE ONLY INDIVIDUALS WHO SERVE ON THE BOARD AS INDEPENDENT REPRESENTATIVES OF THE COMMUNITY, WHO HOLD NO EMPLOYMENT POSITIONS WITH AHSSHC AND WHO DO NOT HAVE RELATIONSHIPS WITH ANY OF THE INDIVIDUALS WHOSE COMPENSATION IS UNDER THEIR REVIEW THAT IMPACTS THEIR BEST INDEPENDENT JUDGMENT AS FIDUCIARIES OF AHSSHC. THE COMMITTEE'S ROLE IS TO REVIEW AND APPROVE ALL COMPONENTS OF THE EXECUTIVE COMPENSATION PLAN OF AHSSHC. AS AN INDEPENDENT GOVERNING BODY WITH RESPECT TO EXECUTIVE COMPENSATION, IT SHOULD BE NOTED THAT THE COMMITTEE WILL OFTEN CONFER IN EXECUTIVE SESSIONS ON MATTERS OF COMPENSATION POLICY AND POLICY CHANGES. IN SUCH EXECUTIVE SESSIONS, NO MEMBERS OF MANAGEMENT OF AHSSHC ARE PRESENT. THE COMMITTEE IS ADVISED BY AN INDEPENDENT THIRD PARTY COMPENSATION ADVISOR. THIS ADVISOR PREPARES ALL THE BENCHMARK STUDIES FOR THE COMMITTEE. COMPENSATION LEVELS ARE BENCHMARKED WITH A NATIONAL PEER GROUP OF OTHER NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS OF SIMILAR SIZE AND COMPLEXITY TO AHS AND EACH OF ITS AFFILIATED ENTITIES. THE FOLLOWING PRINCIPLES GUIDE THE ESTABLISHMENT OF INDIVIDUAL EXECUTIVE COMPENSATION: - THE SALARY OF THE PRESIDENT/CEO OF AHS WILL NOT EXCEED THE 40TH PERCENTILE OF COMPARABLE SALARIES PAID BY SIMILARLY SITUATED ORGANIZATIONS; AND - OTHER EXECUTIVE SALARIES SHALL BE ESTABLISHED USING MARKET MEDIANS. THE COMPENSATION PHILOSOPHY, POLICIES, AND PRACTICES OF AHSSHC ARE CONSISTENT WITH THE ORGANIZATION'S FAITH-BASED MISSION AND CONFORM TO APPLICABLE LAWS, REGULATIONS, AND BUSINESS PRACTICES. AS A FAITH-BASED ORGANIZATION SPONSORED BY THE SEVENTH-DAY ADVENTIST CHURCH (THE CHURCH), AHSSHC'S PHILOSOPHY AND PRINCIPLES WITH RESPECT TO ITS EXECUTIVE COMPENSATION PRACTICES REFLECT THE CONSERVATIVE APPROACH OF THE CHURCH'S MISSION OF SERVICE AND WERE DEVELOPED IN COUNSEL WITH THE CHURCH'S LEADERSHIP. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION ARE NOT GENERALLY MADE AVAILABLE TO THE PUBLIC AS A WHOLE. AS NOTED PREVIOUSLY IN OUR RESPONSES TO QUESTION 6 OF SECTION A OF PART VI OF THIS FORM 990, THE FILING ORGANIZATION HAS TWO MEMBERS. AS NEITHER MEMBER IS CONSIDERED TO CONTROL THE FILING ORGANIZATION; THE FINANCIAL STATEMENTS OF THE FILING ORGANIZATION ARE NOT CONSOLIDATED WITHIN THE FINANCIAL STATEMENTS OF EITHER MEMBER. EACH MEMBER ACCOUNTS FOR ITS PROPORTIONATE OWNERSHIP SHARE OF THE EQUITY OF THE FILING ORGANIZATION IN ITS FINANCIAL STATEMENTS. THE FILING ORGANIZATION DOES NOT GENERALLY MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: DONATED PROPERTY -682. NET INCREASE IN TEMPORARILY RESTRICTED FUNDS 98,365. TRANSFER FROM FOUNDATION 20,018. TEMPORARILY RESTRICTED FUNDS TRANSFERRED FOR OPERATIONS -45,480. TOTAL TO FORM 990, PART XI, LINE 5: 72,221. PART VI, SECTION A, LINE 1A THE GOVERNMENT AND MANAGEMENT OF THE AFFAIRS OF TAKOMA REGIONAL HOSPITAL (TRH) IS VESTED IN ITS BOARD OF DIRECTORS. THE BOARD OF DIRECTORS HAS SUPERVISION, CONTROL AND DIRECTION OF THE MANAGEMENT, AFFAIRS AND PROPERTY OF THE CORPORATION; SHALL DETERMINE ITS POLICIES AND PERIODICALLY REVIEW THEM, AND SHALL ACTIVELY PURSUE ITS POLICIES AND OBJECTIVES AND SUPERVISE THE DISBURSEMENT OF ITS FUNDS. THE BOARD OF DIRECTORS IS COMPOSED OF SIX INDIVIDUALS WHO VOTE ON ALL MATTERS THAT COME BEFORE THIS GOVERNING BODY. THE BYLAWS OF TRH ALSO PROVIDE FOR A HOSPITAL COMMUNITY BOARD THAT MAY INCLUDE UP TO FIFTEEN VOTING MEMBERS. THE HOSPITAL COMMUNITY BOARD IS APPOINTED BY THE MEMBERS OF TRH, NAMELY ADVENTIST HEALTH SYSTEM/SUNBELT, INC. AND WELLMONT HEALTH SYSTEM. THE HOSPITAL COMMUNITY BOARD IS RESPONSIBLE TO OVERSEE THE OPERATION OF THE HOSPITAL AND POSSESSES ALL POWER RELATED TO THE MEDICAL STAFF OF THE HOSPITAL, INCLUDING THE POWER TO APPROVE ALL BYLAWS, RULES AND REGULATIONS WITH RESPECT TO THE MEDICAL STAFF.