RHI LEGACY FOUNDATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: RHI LEGACY FOUNDATION INC (EIN 56-0619367)
Tax period: 2011-10-01 to 2012-09-30
Filed: 2013-08-15
IRS object ID: 201332279349303768
Schema version: 2011v1.5
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-08-15T15:49:58-05:00	Timestamp
Tax Period End Date	2012-09-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BKD LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	910 E ST LOUIS 200/PO BOX 1190	AddressLine1
City	SPRINGFIELD	City
State	MO	State
ZIP Code	658062523	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	560619367	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	RUTHERFORD HOSPITAL INC	BusinessNameLine1

Field	Value	IRS element (for citing)
In Care Of Name	% CINDY BUCK	InCareOfName
Name Control	RUTH	NameControl
Phone	8282865000	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	288 SOUTH RIDGECREST AVENUE	AddressLine1
City	RUTHERFORDTON	City
State	NC	State
ZIP Code	28139	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	CINDY BUCK	Name
Title	CEO	Title
Phone	8282865000	Phone
Date Signed	2013-08-13	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Brian D Todd	Name
Phone	4178658701	Phone

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	RUTHERFORD REGIONAL HEALTH SYSTEM	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	CINDY BUCK	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	288 SOUTH RIDGECREST AVENUE	AddressLine1
City	RUTHERFORDTON	City
State	NC	State
ZIP Code	28139	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	153400167	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.RUTHERFORDHOSP.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1906	YearFormation
State Legal Domicile	NC	StateLegalDomicile
Activity Or Mission Description	RUTHERFORD HOSPITAL IS A GENERAL ACUTE CARE HOSPITAL THAT PROVIDES TRADITIONAL PATIENT CARE TO RESIDENTS OF ITS SERVICE AREA, REGARDLESS OF ABILITY TO PAY.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	15	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	14	NbrIndependentVotingMembers
Total Nbr Employees	993	TotalNbrEmployees
Total Nbr Volunteers	190	TotalNbrVolunteers
Total Gross UBI	143927	TotalGrossUBI
Net Unrelated Business Txbl Income	-68687	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	84050	ContributionsGrantsPriorYear
Contributions Grants Current Year	235920	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	94250107	ProgramServiceRevenuePriorYear
Program Service Revenue CY	102899727	ProgramServiceRevenueCY
Investment Income Prior Year	479486	InvestmentIncomePriorYear
Investment Income Current Year	992349	InvestmentIncomeCurrentYear
Other Revenue Prior Year	168617	OtherRevenuePriorYear
Other Revenue Current Year	161597	OtherRevenueCurrentYear
Total Revenue Prior Year	94982260	TotalRevenuePriorYear
Total Revenue Current Year	104289593	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	1225	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	48739454	SalariesEtcPriorYear
Salaries Etc Current Year	49096079	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	51357598	OtherExpensePriorYear
Other Expenses Current Year	58829381	OtherExpensesCurrentYear
Total Expenses Prior Year	100098277	TotalExpensesPriorYear
Total Expenses Current Year	107925460	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-5116017	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-3635867	RevenuesLessExpensesCY
Total Assets BOY	99630976	TotalAssetsBOY
Total Assets EOY	100969747	TotalAssetsEOY
Total Liabilities BOY	27544695	TotalLiabilitiesBOY
Total Liabilities EOY	34418765	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	72086281	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	66550982	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	RUTHERFORD HOSPITAL'S MISSION IS TO COMPASSIONATELY IMPROVE THE HEALTH AND WELL-BEING OF OUR PATIENTS.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	46582898	Expense
Revenue	44789464	Revenue
Description	THE HOSPITAL PROVIDES OUTPATIENT SERVICES. WITH IMPROVED TECHNOLOGY, MANY LESS INVASIVE SURGICAL PROCEDURES ARE NOW BEING PERFORMED ON AN OUTPATIENT BASIS. THE HOSPITAL'S OUTPATIENT SURGERIES INCLUDE GENERAL, ONCOLOGY, ORTHOPEDIC, PLASTIC, PODIATRIC, UROLOGY, GASTROENTEROLOGY, GYNECOLOGY, OPHTHALMOLOGY, EAR, NOSE, AND THROAT SURGERY. DURING FY 2012, THERE WERE 48,933 OUTPATIENT VISITS AND 37,822 EMERGENCY DEPARTMENT VISITS.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	30039098	Expense
Revenue	36124476	Revenue
Description	THE HOSPITAL PROVIDES INPATIENT SERVICES INCLUDING SURGICAL PROCEDURES, AN INTENSIVE CARE UNIT, AND THE BIRTH PLACE. GENERAL SURGEONS PROVIDE A FULL RANGE OF CONSULTING, DIAGNOSTIC, AND TREATMENT SERVICES. THE ICU IS SPECIFICALLY DESIGNED TO PROVIDE ONGOING, INTENSIVE NURSING ATTENTION FOR THOSE WHO ARE SERIOUSLY ILL OR INJURED OR WHO SUFFER FROM COMPLEX HEALTH CONDITIONS. THE BIRTH PLACE OFFERS COMFORT, PRIVACY, PEACE OF MIND, AND FLEXIBILITY TO ITS PATIENTS, AS WELL AS EDUCATIONAL CLASSES FOR EXPECTANT FAMILIES. INPATIENT FLOORS UTILIZE HOURLY ROUNDING TO ENSURE THE PATIENT PROGRESS AND NEEDS ARE CONTINUALLY MONITORED. DURING FY 2012, 5,293 PATIENTS RECEIVED INPATIENT SERVICES.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	21181677	Expense
Revenue	19051964	Revenue
Description	RUTHERFORD REGIONAL HAS TEN PHYSICIAN PRACTICES TO SERVE THE COMMUNITY'S SURGICAL, FAMILY PRACTICE, AND PSYCHIATRIC NEEDS. THE HOSPITAL HAS BEEN HONORED FOUR TIMES AS A THOMPSON COMPANY 100 TOP PERFORMANCE IMPROVEMENT LEADER FACILITY. EDUCATION DEPARTMENT MAKES HEALTH FAIRS, EDUCATION, AND SUPPORT AVAILABLE TO OUR COMMUNITY. SOME OF THE ACTIVITIES OFFERED INCLUDE CLASSES FOR EXPECTANT MOTHERS AND THEIR FAMILIES, SAFE SITTER COURSES, SUPPORT GROUPS FOR THOSE EXPERIENCING PARTICULAR ILLNESSES, FREEDOM FROM SMOKING CLASSES, THE LIFELINE PROGRAM, DIABETES EDUCATION, AND CPR/FIRST AID TRAINING.	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	1434560	TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev	2789896	TotalOfOtherProgramServiceRev
Total Program Service Expense	99238233	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	true	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	true	TaxExemptBonds
Invest Tax Exempt Bonds	false	InvestTaxExemptBonds
Escrow Account	false	EscrowAccount
On Behalf Of Issuer	false	OnBehalfOfIssuer
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	true	RelatedOrgControlledEntity
Transaction Related Entity	true	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	127	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	993	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	true	UnrelatedBusinessIncome
Form990-T Filed	true	Form990-TFiled
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	15	NbrVotingGoverningBodyMembers
Number Independent Voting Members	14	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	true	DelegationOfManagementDuties
Changes To Organizing Docs	true	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	CINDY BUCK	NamePerson
Telephone Number	8282865202	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	288 SOUTH RIDGECREST AVENUE	AddressLine1
City	RUTHERFORDTON	City
State	NC	State
ZIP Code	28139	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
JOSEPH L CARSON JR
CHAIRMAN	1.0	X	X	0	0	0
DIANE HAMRICK
VICE CHAIRMAN	1.0	X	X	0	0	0
E THOMAS HARDIN
SECRETARY	1.0	X	X	0	0	0
MATT BRIGHT
TREASURER	1.0	X	X	0	0	0
PAUL DECK
TRUSTEE	1.0	X		0	0	0
DAVID EAKER
TRUSTEE	1.0	X		0	0	0
J LARRY HARRILL
TRUSTEE	1.0	X		0	0	0
LEE HARRILL
TRUSTEE	1.0	X		0	0	0
THOMAS J JASKI MD
TRUSTEE	1.0	X		0	0	0
MYRA JOHNSON
TRUSTEE THROUGH 02/2012	1.0	X		0	0	0
MICHAEL S WHEELER MD
TRUSTEE	1.0	X		625458	0	0
TERRY HINES
TRUSTEE	1.0	X		0	0	0
BETH MILLER
TRUSTEE	1.0	X		0	0	0
LUTHER PERSON MD
TRUSTEE	1.0	X		0	0	0
BOBBY ENGLAND MD
TRUSTEE	1.0	X		0	0	0
DAVID BIXLER
CEO THROUGH 04/2012	40.0		X	0	0	0
CINDY BUCK
CEO BEGINNING 09/12, SEE SCH O	40.0		X	39975	0	86
DEAN R BACKSTROM
MEDICAL DIRECTOR	40.0			229915	0	2564	X
CHARLES BOND
PHYSICIAN	40.0			733547	0	3515		X
MICHAEL ROBERTS
PHYSICIAN	40.0			791343	0	3515		X
GREGG ALLEN DRABEK
PHYSICIAN	40.0			544993	0	3621		X
DOUGLAS B FREELS
PHYSICIAN	40.0			529257	0	4278		X
WILLIAM C HADEN
PHYSICIAN	40.0			432510	0	2564		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	3926998	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	20143	TotalOtherCompensation
Number Individuals GT100 K	40	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Description Of ServicesDescriptionOfServices	CompensationCompensation
HOSPITAL MEDICINE ASSOCIATES
HOSPITALISTS	1438434
QUORUM HEALTH RESOURCESQHR
MANAGEMENT SERVICES	1083701
MICHAEL S WHEELER MD
LAB MEDICAL DIRECTOR	652458
SODEXO
MANAGEMENT SERVICES	369312
ALLIED BARTON SECURITY SVCS
SECURITY SERVICES	224700

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	16	NumberOfContractorsGT100K
Related Organizations	235920	RelatedOrganizations
Total Contributions	235920	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT SERVICE REVENUE	621110	85618226	85618226
LABORATORY CLIENT REVENUE	621500	13592226	13472594	119632
PATHOLOGY CLIENT REVENUE	621110	2157722	2152597	5125
CAFETERIA & VENDING REVENUE	722410	506998	506052	946
OTHER REVENUE	900099	1024555	1006331	18224

Field	Value	IRS element (for citing)
Total Program Service Revenue	102899727	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	874649	TotalRevenueColumn
Exclusion	$874,649	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	100284	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	12537	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	87747	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	87747	TotalRevenueColumn
Exclusion	$87,747	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	49146401	Securities
Other	500	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	49028842	Securities
Other	359	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	117559	Securities
Other	141	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	117700	TotalRevenueColumn
Exclusion	$117,700	ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	142686	GrossSalesOfInventory
Cost Of Goods Sold	68836	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	73850	TotalRevenueColumn
Exclusion	$73,850	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	0	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	104289593	TotalRevenueColumn
Related Or Exempt Function Income	102755800	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	143927	UnrelatedBusinessRevenue
Exclusion	$1,153,946	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	0	Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	0	Total

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	897998	Total
Program Services	857937	ProgramServices
Management And General	40061	ManagementAndGeneral
Fundraising	0	Fundraising

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	38941940	Total
Program Services	37049605	ProgramServices
Management And General	1892335	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	0	Total

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	6518111	Total
Program Services	4829298	ProgramServices
Management And General	1688813	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	2738030	Total
Program Services	2028871	ProgramServices
Management And General	709159	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	400338	Total
Management And General	400338	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	214346	Total
Management And General	214346	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	35540	Total
Management And General	35540	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	166308	Total
Management And General	166308	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	8638469	Total
Program Services	7680980	ProgramServices
Management And General	957489	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	396855	Total
Program Services	392973	ProgramServices
Management And General	3882	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	2705013	Total
Program Services	2333190	ProgramServices
Management And General	371823	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	606831	Total
Program Services	527086	ProgramServices
Management And General	79745	ManagementAndGeneral

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	2733254	Total
Program Services	2720870	ProgramServices
Management And General	12384	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	302357	Total
Program Services	285762	ProgramServices
Management And General	16595	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	24945	Total
Program Services	24945	ProgramServices

Interest Interest

Field	Value	IRS element (for citing)
Total	316904	Total
Program Services	265398	ProgramServices
Management And General	51506	ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	5867350	Total
Program Services	4913731	ProgramServices
Management And General	953619	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	690709	Total
Program Services	578448	ProgramServices
Management And General	112261	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
BAD DEBT	20466731	20466731
MEDICAL SUPPLIES & DRUGS	12278532	12278532
REPAIRS & MAINTENANCE	2546933	1694294	852639
RECRUITING	225179	220632	4547

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	212787	Total
Program Services	88950	ProgramServices
Management And General	123837	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	107925460	Total
Program Services	99238233	ProgramServices
Management And General	8687227	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	3900	BOY
EOY	4260	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	2049175	BOY
EOY	3792065	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	13363299	BOY
EOY	11220632	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	1788160	BOY
EOY	1746370	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	1053533	BOY
EOY	881819	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	129477057	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	81199756	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	47206726	BOY
EOY	48277301	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	32432260	BOY
EOY	31299317	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	599042	BOY
EOY	599042	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	1134881	BOY
EOY	3148941	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	99630976	BOY
EOY	100969747	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	9305153	BOY
EOY	9419397	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	2990	BOY
EOY	0	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	15030386	BOY
EOY	19234551	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	806566	BOY
EOY	622650	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	2399600	BOY
EOY	5142167	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	27544695	BOY
EOY	34418765	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	72086281	BOY
EOY	66550982	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	72086281	BOY
EOY	66550982	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	99630976	BOY
EOY	100969747	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	-3635867	ReconcilationRevenueExpenses
Reconcilation Other Changes	-1899432	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Org Belongs To Affiliated Group	X	OrgBelongsToAffiliatedGroup
Limited Control Provisions Apply	X	LimitedControlProvisionsApply
Total Grassroots Lobbying		TotalGrassrootsLobbying
Total Direct Lobbying		TotalDirectLobbying
Total Lobbying Expenditures		TotalLobbyingExpenditures
Other Exempt Purpose Expenditures		OtherExemptPurposeExpenditures
Total Exempt Purpose Expenditures		TotalExemptPurposeExpenditures
Lobbying Nontaxable		LobbyingNontaxableAmount
Grassroots Nontaxable		GrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non Tx		TotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying Nontx		TotLobbyExpendMnsLobbyingNontx
Form4720 Filed	false	Form4720Filed
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$8,379	OtherActivitiesAmount
Total Lobbying Expenditures IIB	8379	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	OTHER LOBBYING ACTIVITIES	Identifier
Return Reference	SCHEDULE C, PART II-B, LINE 1I	ReturnReference
Explanation	THE ORGANIZATION PAYS DUES TO THE NORTH CAROLINA HOSPITAL ASSOCIATION, OF WHICH $8,074 IS ATTRIBUTABLE TO LOBBYING ACTIVITIES AND TO AHA OF WHICH $305 IS ATTRIBUTABLE TO LOBBYING ACTIVITIES.	Explanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Historic Structure	X	HistoricStructure
Total Number Of Easements	1	TotalNumberOfEasements
Nmbr Hist Struct Easements	1	NmbrHistStructEasements
Nmbr Hist Struct Easements After	0	NmbrHistStructEasementsAfter
Nmbr States In Which Easements Held	1	NmbrStatesInWhichEasementsHeld
Written Policy Monitoring	false	WrittenPolicyMonitoring
Expenses Incurred For Enforcement	0	ExpensesIncurredForEnforcement
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts
Agent Trustee Etc	false	AgentTrusteeEtc
Included On FS	false	IncludedOnFS
Current Year Minus3 Years		CurrentYearMinus3Years

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1528211	OtherCostOrOtherBasis
Book Value	1528211	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	66369807	OtherCostOrOtherBasis
Depreciation	36138081	Depreciation
Book Value	30231726	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	681069	OtherCostOrOtherBasis
Depreciation	0	Depreciation
Book Value	681069	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	58244680	OtherCostOrOtherBasis
Depreciation	43846309	Depreciation
Book Value	14398371	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2653290	OtherCostOrOtherBasis
Depreciation	1215366	Depreciation
Book Value	1437924	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	48277301	TotalOfBookValueLandBuildings
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
EST AMT DUE TO 3RD PTY PYR	$2,912,472
EST INSURANCE LIABILITY	$1,144,074
INTEREST RATE SWAP AGREEMENT	$1,085,621

Field	Value	IRS element (for citing)
Total Of Amounts	5142167	TotalOfAmounts
Total Revenue	104289593	TotalRevenue
Total Expenses	107925460	TotalExpenses
Excess Or Deficit For Year	-3635867	ExcessOrDeficitForYear
Net Unrealized GL On Investments	3646938	NetUnrealizedGLOnInvestments
Other	-$340,397	OtherAmount
Total Adjustments	3306541	TotalAdjustments
Excess Or Deficit Per FS	-329326	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	87044468	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	3646938	NetUnrealizedGainsInvestments
Other Revenues	-20973436	OtherRevenues
Revenue Not Rptd F990	-17326498	RevenueNotRptdF990
Revenue Subtotal	104370966	RevenueSubtotal
Other Revenues Not Included	-81373	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	-81373	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	104289593	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	87373794	TotExpensesEtcAuditedFinclStmt
Other Expenses Included	81373	OtherExpensesIncluded
Expenses Not Rptd F990	81373	ExpensesNotRptdF990
Expenses Subtotal	87292421	ExpensesSubtotal
Investment Expenses Not Included2	166308	InvestmentExpensesNotIncluded2
Other Expenses Not Included	20466731	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	20633039	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	107925460	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
CONSERVATION EASEMENT FINANCIAL REPORTING	SCHEDULE D, PART II, LINE 9	THERE IS NO REVENUE ASSOCIATED WITH THE CONSERVATION EASEMENT REPORTED IN SCHEDULE D, PART II. THE ONLY EXPENSES RELATED TO THE EASEMENT RELATES TO NORMAL COSTS OF HOLDING THE BUILDING SUCH AS UTILITIES. THE BUILDING IS SHOWN IN THE BALANCE SHEET AS PART OF FIXED ASSETS AT COST, BUT IS FULLY DEPRECIATED. THERE WAS NO NOTE REGARDING THE CONSERVATION EASEMENT IN THE AUDITED FINANCIAL STATEMENTS.
OTHER CHANGES IN NET ASSETS	SCHEDULE D, PART XI, LINE 8	$ (340,397) CHANGE IN FV OF INTEREST RATE SWAP
OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12	SCHEDULE D, PART XII, LINE 2D	$ (20,466,731) BAD DEBT EXPENSE (340,397) CHANGE IN FV OF INTEREST RATE SWAP (166,308) INVESTMENT FEES --------------- $ (20,973,436)
OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1	SCHEDULE D, PART XII, LINE 4B	$ (68,836) COST OF GOODS SOLD (12,537) RENTAL EXPENSE ------------ $ (81,373)
OTHER EXPENSE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25	SCHEDULE D, PART XIII, LINE 2D	$ 68,836 COST OF GOODS SOLD 12,537 RENTAL EXPENSE ----------- $ 81,373
OTHER EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1	SCHEDULE D, PART XIII, LINE 4B	$ 20,466,731 BAD DEBT EXPENSE

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	true	FPGReferenceFreeCare

Other Percentage OtherPercentage

Field	Value	IRS element (for citing)
Other	X	Other
Free Other Percentage	120.	FreeOtherPercentage

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent250	X	Pcent250
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	true	ExpensesExceededBudget
Unable To Provide Care	false	UnableToProvideCare
Annual Community Benefit Report	true	AnnualCommunityBenefitReport
Report Publically Available	true	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1660240	TotalCommunityBenefitExpense
Net Community Benefit Expense	1660240	NetCommunityBenefitExpense
Percent Of Total Expense	0.01900	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	18117495	TotalCommunityBenefitExpense
Direct Offsetting Revenue	16495301	DirectOffsettingRevenue
Net Community Benefit Expense	1622194	NetCommunityBenefitExpense
Percent Of Total Expense	0.01850	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	19777735	TotalCommunityBenefitExpense
Direct Offsetting Revenue	16495301	DirectOffsettingRevenue
Net Community Benefit Expense	3282434	NetCommunityBenefitExpense
Percent Of Total Expense	0.03750	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1003450	TotalCommunityBenefitExpense
Direct Offsetting Revenue	289486	DirectOffsettingRevenue
Net Community Benefit Expense	713963	NetCommunityBenefitExpense
Percent Of Total Expense	0.00820	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	11546750	TotalCommunityBenefitExpense
Direct Offsetting Revenue	10665497	DirectOffsettingRevenue
Net Community Benefit Expense	881253	NetCommunityBenefitExpense
Percent Of Total Expense	0.01010	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	12550200	TotalCommunityBenefitExpense
Direct Offsetting Revenue	10954983	DirectOffsettingRevenue
Net Community Benefit Expense	1595216	NetCommunityBenefitExpense
Percent Of Total Expense	0.01830	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	32327935	TotalCommunityBenefitExpense
Direct Offsetting Revenue	27450284	DirectOffsettingRevenue
Net Community Benefit Expense	4877650	NetCommunityBenefitExpense
Percent Of Total Expense	0.05580	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$6,901,383	BadDebtExpenseAmount
Amount Attributable To	1428586	AmountAttributableTo
Amount Reimbursed By Medicare	36750991	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	39041270	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-2290279	MedicareSurplusOrShortfall
Costing Methodology Used		CostingMethodologyUsed
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	RUTHERFORD HOSPITAL INC	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	288 SOUTH RIDGECREST AVENUE	AddressLine1
City	RUTHERFORDTON	City
State	NC	State
ZIP Code	28139	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	RUTHERFORD HOSPITAL INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	120.	FPGFreePercent
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	250.	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
State Regulation	X	StateRegulation
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	true	IncludesPublicityMeasures
Posted On Website	X	PostedOnWebsite
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Available On Request	X	AvailableOnRequest
Actions On Nonpayment	true	ActionsOnNonpayment
Collection Activities	false	CollectionActivities
Notify Upon Admission	X	NotifyUponAdmission
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	12	NumberOfOtherFacilities

Other Facilities OtherFacilities (12 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
CAROLINA HOME CARE
2270 HWY 74-A SUITE 345	FOREST CITY	NC	28043	HOME HEALTH
RUTHERFORD ORTHOPEDICS
139 DR HENRY NORRIS DRIVE	RUTHERFORDTON	NC	28139	ORTHOPEDIC PRACTICE
RUTHERFORD SURGICAL ASSOCIATES
330 NC 108 HIGHWAY	RUTHERFORDTON	NC	28139	SURGICAL PRACTICE
RUTHERFORD EAST MEDICAL SERVICES
605 NC 120 HIGHWAY	MOORESBORO	NC	28114	FAMILY GENERAL MEDICINE
INSIGHTS PSYCHIATRIC RESOURCES
393 S OAK STREET SUITE 100	SPINDALE	NC	28160	PSYCHIATRIC SERVICES
CHASE FAMILY CARE
1269 US HWY 74 BYPASS 341	FOREST CITY	NC	28043	GENERAL MEDICAL & SURGICAL
BOILING SPRINGS FAMILY CARE
305 W COLLEGE AVE SUITE A	SHELBY	NC	28152	FAMILY GENERAL MEDICINE
THE CLINIC AT WALMART
197 PLAZA DRIVE	FOREST CITY	NC	28043	FAMILY GENERAL MEDICINE
FOREST FAMILY CARE CENTER
212 ALLENDALE DRIVE	FOREST CITY	NC	28043	FAMILY GENERAL MEDICINE
RUTHERFORD ANESTHESIOLOGY
288 SOUTH RIDGECREST AVENUE	RUTHERFORDTON	NC	28139	ANESTHESIA SERVICES
RUTHERFORD CHILDREN'S CARE
288 SOUTH RIDGECREST AVENUE	RUTHERFORDTON	NC	28139	PEDIATRIC SERVICES
OCCUPATIONAL MEDICINE
288 SOUTH RIDGECREST AVENUE	RUTHERFORDTON	NC	28139	PEDIATRIC SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
PERCENT OF TOTAL EXPENSE	SCHEDULE H, PART I, QUESTION 7, COLUMN F	TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 ($107,925,460) WAS REDUCED BY BAD DEBT EXPENSE ($20,466,731).
COST TO CHARGE RATIO	SCHEDULE H, PART I, LINE 7	THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATIONS ON IRS WORKSHEETS 1 AND 3. FOR IRS WORKSHEET 6 CALCULATING SUBSIDIZED SERVICES, THE ORGANIZATION USED A COST ACCOUNTING SYSTEM USING DIRECTLY ALLOCABLE DEDUCTIONS FOR THE CALCULATION OF ONE GROUP OF SUBSIDIZED SERVICES AND USED THE COST TO CHARGE RATIO COMPUTED ON IRS WORKSHEET 2 FOR THE CALCULATION OF ANOTHER GROUP OF SUBSIDIZED SERVICES.
BAD DEBT EXPENSE	SCHEDULE H, PART III, SECTION A, QUESTION 4	THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE: IN EVALUATIONG THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND THE PROVISION FOR UNCOLLECTABLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTABLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. tHE DIFFERENCE BETWEEN THE STANDARD RATES ( OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNT FOR SELF-PAY PATIENTS INCREASED FROM 81% OF SELF PAY ACCOUNTS RECEIVABLE AT 9-30-11 TO 87% OF SELF PAY ACCOUNTS RECEIVABLE AT 9-30-12.
COMMUNITY BENEFIT	SCHEDULE H, PART III, SECTION B, QUESTION 8	SERVING PATIENTS WITH GOVERNMENT HEALTH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
COLLECTION POLICY	SCHEDULE H, PART III, SECTION C, QUESTION 9B	RUTHERFORD HOSPITAL, INC., WILL RECOGNIZE PATIENTS WHO DO NOT QUALIFY UNDER THE CREDIT AND COLLECTION POLICY GUIDELINES AND PROVIDE ASSISTANCE IN OBTAINING THIRD PARTY COVERAGE OR IN QUALIFYING FOR THE MEDICAL ASSISTANCE PROGRAM AS OUTLINED IN ESTABLISHED HOSPITAL PROCEDURES. ALL PATIENTS WILL BE GIVEN THE OPPORTUNITY TO APPLY FOR THE MEDICAL ASSISTANCE PROGRAM IF THEY ARE UNABLE TO PAY FOR DESIRED MEDICAL TREATMENT. SELF-PAY ACCOUNTS WHICH REMAIN UNPAID, OR HAVE NO PAYMENT CONTRACT ESTABLISHED, WILL BE TRANSFERRED TO A BAD DEBT STATUS 60 DAYS AFTER THE ACCOUNT IS BILLED BY THE HOSPITAL'S BILLING SYSTEM. INSURANCE ACCOUNTS WILL BE TRANSFERRED TO A BAD DEBT STATUS WHEN IT IS DETERMINED BY THE FINANCIAL COUNSELOR THAT THE ACCOUNT WILL REQUIRE MORE INTENSE COLLECTION EFFORTS THAN THOSE PROVIDED BY THE HOSPITAL BUSINESS OFFICE. FOR PATIENTS COVERED BY MEDICARE, THIS TRANSFER TO A BAD DEBT STATUS WILL NOT OCCUR BEFORE 120 DAYS AFTER FINAL BILLING BY THE HOSPITAL PATIENT ACCOUNTING SYSTEM.
INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE	SCHEDULE H, PART V, SECTION B, LINE 19D	OUR MEDICAL ASSISTANCE POLICY ALLOWS UP TO 120% OF FEDERAL POVERTY GUIDELINE FOR 100% REDUCTION OF BALANCE/CHARGES. THE SLIDING SCALE ALLOWS UP TO 250% OF THE FEDERAL POVERTY GUIDELINE IN ALLOWING A 30% REDUCTION OF THE BALANCE/CHARGES. ALL SELF PAY ACCOUNTS RECEIVE A 20% DISCOUNT OF CHARGES AT THE TIME OF FINAL BILLING. ALSO, IF SELF PAY BALANCE IS PAID PROMPTLY (15 DAYS FROM FINAL BILLING), PATIENT IS ENTITLED TO AND ADDITIONAL 30% DISCOUNT OF CHARGES.
NEEDS ASSESSMENT	SCHEDULE H, PART VI, QUESTION 2	THE ORGANIZATION USES A NEEDS ASSESSMENT CONDUCTED BY THE UNITED WAY OF RUTHERFORD COUNTY (UWRC) IN 2008 TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. TO CONDUCT THIS ASSESSMENT, THE UWRC AND THE RUTHERFORD HEALTH DEPARTMENT, IN COLLABORATION WITH THE COMMUNITY HEALTH COUNCIL (OF WHICH RUTHERFORD HOSPITAL, INC. WAS A FOUNDING MEMBER AND CONTINUES AS ITS PRIMARY SPONSOR), WORKED TOGETHER AND COMPILED LEADERS IN VARIOUS FIELDS FROM THE COMMUNITY AS MEMBERS OF A STEERING COMMITTEE. THE COMMITTEE REVIEWED SEVERAL NEEDS ASSESSMENTS CONDUCTED BY OTHER COMMUNITIES IN NORTH CAROLINA AND OTHER STATES AND USED "COMPASS", A NEEDS ASSESSMENT GUIDE CREATED BY THE UNITED WAY OF AMERICA, WHICH PROVIDED A BASIC FRAMEWORK FOR THE ASSESSMENT. THE COMMITTEE SURVEYED THE GENERAL PUBLIC, SURVEYED SERVICE PROVIDERS (INCLUDING RUTHERFORD HOSPITAL), AND CONDUCTED FOCUS GROUPS. NEEDS IDENTIFIED IN THIS ASSESSMENT WERE UNEMPLOYMENT/LACK OF JOBS, FOLLOWED BY SUBSTANCE ABUSE, AND ACCESS TO AFFORDABLE MEDICAL CARE. TEEN PREGNANCY, CRIME, AND OBESITY WERE ALSO IDENTIFIED AS ISSUES IN SOME CATEGORIES.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	SCHEDULE H, PART VI, QUESTION 3	PATIENTS WITH ESTIMATED BALANCES AFTER INSURANCE ARE CONTACTED PRIOR TO VISIT. THIS ALLOWS THE ESTIMATE TO BE PROVIDED TO PATIENT, AND TO DISCUSS INSURANCE BENEFITS AND ESTIMATED BALANCES AFTER INSURANCE. THIS DOES INCLUDE ALL SELF PAY PATIENTS AS WELL. A FINANCIAL COUNSELOR MAKES THIS CALL AND EXPLAINS ALL PAYMENT OPTIONS AND OPPORTUNITIES TO APPLY FOR MEDICAL ASSISTANCE. PATIENT REPRESENTATIVES ALSO FOLLOW UP WITH ALL SELF PAY PATIENTS TO PURSUE QUALIFICATION OF PATIENT INTO SOME TYPE OF ASSISTANCE (NCMEDICAID, DISABILITY, CRIME VICTIMS, VOCATIONAL REHAB OR OTHER POSSIBLE PAYMENT SOURCE). IF NO RESOURCES ARE IDENTIFIED FROM PATIENT REPRESENTATIVES, THE REPRESENTATIVE FACILITATES GETTING A MEDICAL ASSISTANCE APPLICATION TO THE PATIENT FOR POSSIBLE QUALIFICATION. REGISTRATION EMPLOYEES HAVE MEDICAL ASSISTANCE FORMS AND ARE TO PROVIDE THESE TO PATIENTS AT TIME OF REGISTRATION. PMAB (EXTENDED BUSINESS OFFICE) STAFF ALSO HAVE MEDICAL ASSISTANCE APPLICATIONS AND ARE TO PROVIDE THESE AS NECESSARY TO PATIENTS AFTER PHONE CONTACT. THE MEDICAL ASSISTANCE POLICY IS ON THE RRHS WEBSITE FOR PUBLIC VIEWING, ALONG WITH THE APPLICATION THAT CAN BE PRINTED FOR COMPLETION FROM THE INDIVIDUAL REQUESTING ASSISTANCE.
COMMUNITY INFORMATION	SCHEDULE H, PART VI, QUESTION 4	RUTHERFORD COUNTY, NORTH CAROLINA IS LOCATED AT THE BASE OF THE BLUE RIDGE MOUNTAINS AND IS CENTERED BETWEEN ASHEVILLE AND CHARLOTTE. IT IS DESIGNATED AS RURAL BY HRSA RURAL HEALTH POLICY. THE COUNTY IS COMPRISED OF EIGHT MUNICIPALITIES: BOSTIC, CHIMNEY ROCK, ELLENBORO, FOREST CITY, RUTHERFORDTON, RUTH, SPINDALE AND LAKE LURE. RUTHERFORD COUNTY IS 563 SQ. MILES, THE COUNTY SEAT IS RUTHERFORDTON. ONE MUNICIPALITY, FOREST CITY, IS CONSIDERED A MICROPOLITAN STATISTICAL AREA; HOWEVER, IT DOES NOT HAVE A METROPOLITAN STATISTICAL AREA DESIGNATION (AS DESIGNATED BY OMB BULLETIN FOR FY04 B04-03). ACCORDING TO THE MOST RECENT US CENSUS BUREAU DATA FROM 2010, THE TOTAL POPULATION OF RUTHERFORD COUNTY IS 67,810. OF THIS AMOUNT, 49% ARE MALE AND 51% ARE FEMALE. THE RACIAL/ETHNIC BACKGROUND OF THE POPULATION INCLUDES 87.3% WHITE, 10.3% BLACK OR AFRICAN AMERICAN, 3.7% HISPANIC OR LATINO WITH THE REMAINING AS OTHER. OF THE TOTAL POPULATION, 20.4% HAVE NOT GRADUATED FROM HIGH SCHOOL OR OBTAINED A HIGH SCHOOL EQUIVALENCY. PERSONS BELOW POVERTY LEVEL FOR 2006-2010 WERE 20.7%, WITH MEDIAN HOUSEHOLD INCOME AT $35,364. RUTHERFORD COUNTY WORKFORCE TOTALS 22,790 (2006 REPORT). IT BREAKS DOWN AS FOLLOWS: MANUFACTURING, 18.2 %; CONSTRUCTION, 5.5%; TRANSPORTATION AND UTILITIES, 21.4%; EDUCATION AND HEALTH SERVICES, 24%; PROFESSIONAL AND BUSINESS SERVICES, 9.3%; LEISURE AND HOSPITALITY, 8.4%; INFORMATION, 4%; FINANCIAL ACTIVITIES, 2%; PUBLIC ADMINISTRATION, 5.3% AND ALL OTHER, 2.08%. FOR EMPLOYMENT OPPORTUNITIES CALL THE N.C. EMPLOYMENT SECURITY COMMISSION AT (828) 246-9841 OR CONTACT THE CHAMBER AND ASK FOR A LISTING OF TEMPORARY AGENCIES.
PROMOTION OF COMMUNITY HEALTH	SCHEDULE H, PART VI, QUESTION 5	COMMUNITY BENEFIT IS COLLABORATION WITH A COMMUNITY TO BENEFIT ITS RESIDENTS - PARTICULARLY THOSE BELOW THE POVERTY LEVEL, MINORITIES AND UNDERSERVED GROUPS - BY IMPROVING THEIR HEALTHCARE STATUS AND QUALITY OF LIFE. AS A NOT-FOR-PROFIT HOSPITAL, RHI EMBRACES ITS ROLE AS THE HEALTHCARE PROVIDER OF CHOICE FOR THE COMMUNITY. RUTHERFORD HOSPITAL HOSTED A SERIES OF SEVEN RUTHERFORD REGIONAL CONNECTS EVENTS IN 2012. RUTHERFORD REGIONAL CONNECTS EVENTS WERE HELD IN THE FOLLOWING LOCATIONS: FOREST CITY - DUNBAR ELEMENTARY, LAKE LURE TOWN HALL, R-S CENTRAL HIGH SCHOOL, ELLENBORO ELEMENTARY, CLIFFSIDE ELEMENTARY AND SUNSHINE ELEMENTARY. EVENTS WERE SCHEDULED FOR EITHER A MORNING OR EVENING. EACH EVENT INCLUDED FREE CHOLESTEROL, GLUCOSE, BLOOD PRESSURE AND BODY MASS INDEX (BMI) SCREENINGS. EXHIBITS PROVIDED INFORMATION ON THE CHANGES AT RUTHERFORD REGIONAL HOSPITAL, AND PARTICIPANTS HAD THE OPPORTUNITY TO VISIT WITH DEPARTMENT REPRESENTATIVES AND RRHS PRESIDENT AND CEO DAVE BIXLER TO ASK QUESTIONS. DURING THE RUTHERFORD REGIONAL CONNECTS EVENTS, SCREENINGS WERE GIVEN FREE OF CHARGE. THOSE WHO VISITED BOOTHS AT THE EVENTS LEARNED ABOUT THE MANY PROGRAMS OFFERED THROUGH THE ORGANIZATION. SIXTY INDUSTRIES ENROLLED IN THE WELLNESSWORKS PROGRAM, RUTHERFORD HOSPITAL'S EMPLOYER HEALTH PROGRAM, IN 2012. DESIGNED TO HELP PROVIDE ONGOING COMMUNICATION AND EASY ACCESS TO HEALTHCARE SERVICES TO EMPLOYERS AND THEIR EMPLOYEES, THE FOUR BASIC COMPONENTS THAT MAKE UP THE WELLNESSWORKS PROGRAM ARE OCCUPATIONAL HEALTH SERVICES, WORKER'S COMPENSATION SERVICES, PREVENTATIVE HEALTH/WELLNESS SERVICES AND GROUP HEALTH SERVICES. THERE IS NO COST ASSOCIATED WITH ENROLLING IN THE PROGRAM. IN JULY 2011, THE RUTHERFORD REGIONAL CANCER OUTREACH PROGRAM LAUNCHED A NEW CANCER SUPPORT GROUP FOR ANYONE WHO HAS EVER HEARD THE WORDS "YOU HAVE CANCER." SURVIVIN' MEETS ON THE THIRD MONDAY OF EACH MONTH AT THE CANCER RESOURCE CENTER. EACH MONTH THE GROUP EXPLORES WAYS TO LIVE LIFE TO THE FULLEST AFTER A CANCER DIAGNOSIS. INFORMATION REGARDING NUTRITION, EXERCISE AND EMOTIONAL WELL-BEING IS ALSO PRESENTED. FRIENDS AND FAMILY MAY ATTEND AS WELL. THE RUTHERFORD REGIONAL AUXILIARY RAISED MONEY DURING SEVERAL FUNDRAISING EFFORTS, THE GIFT SHOP, BABY PHOTO PROGRAM, VENDING MACHINES AND EVENTS SUCH AS THE $5 JEWELRY, BOOK AND UNIFORM SALES. THE AUXILIARY'S SERVICE AREAS INCLUDE FRONT DESK, GIFT SHOP, INTENSIVE CARE WAITING, MESSENGER, OUTPATIENT SERVICES AND SURGERY WAITING. VOLUNTEERS ALSO SERVE IN THE PET THERAPY PROGRAM, AS CLERICAL ASSISTANTS IN MEDICAL RECORDS, AS CARETAKERS OF ST. LUKE'S CHAPEL, AS CLOWNS WITH THE TOY CHEST, AT THE CANCER RESOURCE CENTER MAKING TRAY FAVORS FOR PATIENT FOOD TRAYS, WITH THE EDUCATION DEPARTMENT FOR COMMUNITY SCREENINGS, AND AS TEEN VOLUNTEERS. IN JUNE, 39 TEEN VOLUNTEERS ATTENDED ORIENTATION, AND FOR THE NEXT EIGHT WEEKS THEY VOLUNTEERED IN 17 DIFFERENT DEPARTMENTS AT THE HOSPITAL, ALLOWING MANY ADULT VOLUNTEERS TO TAKE TIME OFF. THE TOY CHEST COMMITTEE MADE A TOTAL OF 1,054 ITEMS, WHICH INCLUDED STUFFED ANIMALS, "PATIENT PALS" FOR PEDIATRIC PATIENTS, PILLOWS FOR MASTECTOMY PATIENTS AND BABY CAPS FOR INFANTS AS A REMINDER TO PARENTS OF THE DANGERS OF CHILD ABUSE. DONATIONS WERE MADE TO LIFELINE DURING THE YEAR IN MEMORY AUXILIARY MEMBERS WHO PASSED AWAY. A TOTAL OF 194 ADULT VOLUNTEERS VOLUNTEERED 21,364 HOURS AND A TOTAL OF 78 TEEN VOLUNTEERS VOLUNTEERED 2,366 HOURS WITH A COMBINED TOTAL OF 23,730 SERVICE HOURS FOR THE YEAR. THE ACCUMULATED HOURS OF SERVICE TO RUTHERFORD HOSPITAL, SINCE THE FOUNDING OF THE AUXILIARY 47 YEARS AGO, IS 846,067 HOURS AND THE ACCUMULATED DONATION IS $2,992,030.56. THE SCHOOL OF CLINICAL PASTORAL EDUCATION OF RUTHERFORD REGIONAL MEDICAL CENTER IS ACCREDITED TO OFFER CPE LEVELS I & II BY THE ASSOCIATION FOR CLINICAL PASTORAL EDUCATION, INC. CLINICAL PASTORAL EDUCATION WILL ENABLE YOU TO INTEGRATE FAITH, EXPERIENCE AND KNOWLEDGE FOR MORE EFFECTIVE MINISTRY. CPE IS PROFESSIONAL TRAINING FOR MINISTRY DESIGNED FOR SEMINARIANS, CLERGY AND LAITY OF DIVERSE CULTURES, ETHNIC GROUPS AND FAITH TRADITIONS. THE METHOD IS LEARNING BY DOING AND REFLECTING UNDER THE DIRECTION OF A CERTIFIED ACPE SUPERVISOR; INSTRUCTED BY AN INTERDISCIPLINARY ADJUNCT FACULTY IN A SUPPORTIVE COLLEGIAL GROUP.
AFFILIATED HEALTH CARE SYSTEM	SCHEDULE H, PART VI, QUESTION 6	RUTHERFORD HOSPITAL IS AFFILIATED WITH RUTHERFORD HOSPITAL FOUNDATION, WHOSE PRIMARY PURPOSE IS TO PROVIDE SUPPORT FOR THE HOSPITAL. THE FOUNDATION PROVIDES SCHOLARSHIPS TO INDIVIDUALS AND GRANTS TO ORGANIZATIONS IN THE COMMUNITY, WHICH IS THE SAME COMMUNITY THAT RUTHERFORD HOSPITAL SERVES. THE MISSION OF RUTHERFORD HOSPITAL FOUNDATION IS TO "SECURE CURRENT AND FUTURE GIFTS OF SUPPORT FOR RUTHERFORD REGIONAL MEDICAL SYSTEM, ENSURING THAT ALL MEMBERS OF OUR COMMUNITY CONTINUE TO HAVE ACCESS TO A BROAD RANGE OF COMPASSIONATE, HIGH QUALITY HEALTH SERVICES." THE RUTHERFORD HOSPITAL FOUNDATION SEEKS TO GIVE ALL SEGMENTS OF THE COMMUNITY THE OPPORTUNITY TO INVEST IN THE FUTURE OF THE HOSPITAL, TO ENSURE GOOD STEWARDSHIP OF AVAILABLE RESOURCES, AND TO BE RECOGNIZED AS A SIGNIFICANT CONTRIBUTOR TO ECONOMIC GROWTH AND DEVELOPMENT OF RUTHERFORD REGIONAL HEALTH SYSTEM. RUTHERFORD HOSPITAL CONTINUES TO HAVE AN AFFILIATION WITH DUKE ONCOLOGY NETWORK. THIS AGREEMENT PROVIDES EDUCATION FOR PHYSICIANS AND NURSING STAFF, PHYSICIAN CONSULTATION AND A REVIEW AND EVALUATION OF THE CARE PROVIDED OUR CANCER PATIENTS. IN 2011, AN EXPERT IN THE FIELD OF BREAST CANCER HELPED TO CONDUCT A STUDY ABOUT OUR CARE AND PRESENTED INFORMATION RELATED TO THE STUDY AS AN EDUCATION SESSION. IT IS A GREAT OPPORTUNITY FOR RUTHERFORD REGIONAL MEDICAL CENTER TO BE ALIGNED WITH DUKE, WHICH HAS BEEN CONSISTENTLY IN THE TOP-RANKED CENTERS FOR CANCER CARE IN THE UNITED STATES.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Housing Allowance Or Residence	X	HousingAllowanceOrResidence
Written Policy Re T And E Expenses	true	WrittenPolicyReTAndEExpenses
Substantiation Required	true	SubstantiationRequired
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MICHAEL S WHEELER MD
625458	0	0	0	0	0	0	0	0	0	625458	0	0	0
DEAN R BACKSTROM
218078	0	11837	0	0	0	0	0	2564	0	232479	0	0	0
CHARLES BOND
690264	0	26783	0	16500	0	0	0	3515	0	737062	0	0	0
MICHAEL ROBERTS
747111	0	27732	0	16500	0	0	0	3515	0	794858	0	0	0
GREGG ALLEN DRABEK
544993	0	0	0	0	0	0	0	3621	0	548614	0	0	0
DOUGLAS B FREELS
495891	0	0	0	33366	0	0	0	4278	0	533535	0	0	0
WILLIAM C HADEN
420421	0	12089	0	0	0	0	0	2564	0	435074	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
HOUSING ALLOWANCES	SCHEDULE J, PART I, LINE 1A	DOUGLAS B FREELS RECEIVED A HOUSING ALLOWANCE DURING THE YEAR INCLUDING $4,800 FOR HOUSING RENTAL AND $8,562 FOR CLOSING COSTS ON A NEW HOME. THESE WERE INCLUDED AS PART OF TAXABLE COMPENSATION.
CEO COMPENSATION DETERMINATION	SCHEDULE J, PART I, LINE 3	THE ORGANIZATION'S CEO WAS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY FOR HIS SERVICES PERFORMED FOR THE ORGANIZATION. THE MANAGEMENT COMPANY CONTRACT TERMINATED IN JUNE 2012 AND SERVICES HAVE CEASED, INCLUDING THE SERVICES OF THE CEO, WHICH WERE RELINQUISHED IN APRIL 2012. AT THIS TIME, CINDY BUCK, WHO WAS THE VP/CFO, BECAME INTERIM CEO UNTIL SHE WAS APPOINTED AS CEO IN SEPTEMBER 2012. UNDER THE REBUTTABLE PRESUMPTION POLICY DESCRIBED IN THE NARRATIVE FOR FORM 990, PART VI, SECTION B, QUESTION 15A LOCATED ON SCHEDULE O, A COMPENSATION SURVEY AND BOARD APPROVAL ARE USED. CINDY WILL BE SUBJECT TO THIS REVIEW IN FY2012.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	NORTH CAROLINA MEDICAL CARE COMMISSION	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	521309402	IssuerEIN
Date Issued	2010-12-16	DateIssued
Issue Price	22160000	IssuePrice
Description Of Purpose	SEE PART V	DescriptionOfPurpose
Defeased	false	Defeased
On Behalf Of Issuer	false	OnBehalfOfIssuer
Pool Financing	false	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Amount Retired	0	AmountRetired
Amount Bond Defeased	0	AmountBondDefeased
Total Proceeds	22160000	TotalProceeds
Amount In Reserve Fund	0	AmountInReserveFund
Capitalized Interest	0	CapitalizedInterest
Refunding Escrow	8140000	RefundingEscrow
Issuance Costs From Proceeds	252250	IssuanceCostsFromProceeds
Credit Enhancement	0	CreditEnhancement
Working Capital Expenditures	0	WorkingCapitalExpenditures
Capital Expenditures	11591309	CapitalExpenditures
Other Spent Proceeds	2462	OtherSpentProceeds
Amount Unspent	2173979	AmountUnspent
Current Refunding	true	CurrentRefunding
Advance Refunding	false	AdvanceRefunding
Final Allocation Made	false	FinalAllocationMade
Adequate Books And Recds Maintaind	true	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Owning Bond Financed Property	false	OwningBondFinancedProperty
Any Lease Arrangements	false	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	false	MngmentCntrctBondFinancdPrprty
Any Research Agreements	false	AnyResearchAgreements
Prcntge Prvt Business Use By Others	0	PrcntgePrvtBusinessUseByOthers
Post Issuance Compliance Procdrs	true	PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Form8038 T Filed	false	Form8038TFiled
Variable Rate Issue	true	VariableRateIssue
Hedge Identified In Books And Recds	false	HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

Field	Value	IRS element (for citing)
Business Name Line1	0	BusinessNameLine1

Field	Value	IRS element (for citing)
Gross Proceeds Invested In GIC	false	GrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

Field	Value	IRS element (for citing)
Business Name Line1	0	BusinessNameLine1

Field	Value	IRS element (for citing)
Gross Proceeds Invested	false	GrossProceedsInvested
Exception To Rebate	false	ExceptionToRebate

Field	Value	IRS element (for citing)
Fed Tax Requirements Compliance	X	FedTaxRequirementsCompliance

Form990 Schedule K Part VI Form990ScheduleKPartVI

Field	Value	IRS element (for citing)
Identifier	PURPOSE	Identifier
Return Reference	SCHEDULE K, PART I, LINE A, COLUMN F	ReturnReference
Explanation	A PORTION OF THE BONDS WERE USED TO ADVANCE REFUND THE OUTSTANDING PORTIONS OF PREVIOUSLY ISSUED REVENUE BONDS. THE REMAINING PROCEEDS WERE USED TO FINANCE THE UPGRADE AND EXPANSION OF AN INTENSIVE CARE UNIT, THE REPLACEMENT OF THE WOMEN'S CENTER ON THE HOSPITAL'S PREMISES AND THE PURCHASE OF MOBILE MAGNETIC RESONANCE IMAGING EQUIPMENT.	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES	FORM 990, PART I, QUESTION 1	OUR VISION IS THAT WE WILL PROVIDE AN EXCELLENT PATIENT CARE EXPERIENCE EVERY TIME. OUR VALUES ARE TRUST, EXCELLENCE, ACCOUNTABILITY, AND MUTUAL RESPECT.
DESCRIPTION OF OTHER PROGRAM SERVICES	FORM 990, PART III, QUESTION 4D	THE HOSPITAL PROVIDES REGIONAL TREATMENT FOR BEHAVIORAL & MENTAL HEALTH SERVICES. PROGRAMS AND SERVICES INCLUDE 24-HR NURSING CARE, MEDICATION MANAGEMENT & EDUCATION, GROUP OR RECREATIONAL THERAPY, & FAMILY EDUCATION. THE BEHAVIORAL DEPARTMENT ALSO OFFERS PSYCHIATRIC INDEPENDENT MEDICAL EVALUATIONS, CONSULTATIONS, DIAGNOSIS, & TREATMENT OF VARIOUS CONDITIONS, INCLUDING DEPRESSION, ANXIETY, AUTISM, SLEEP DISORDERS, BRAIN INJURIES, HEADACHES, & DEMENTIA, AMONG OTHERS. DURING FISCAL YEAR 2012, 805 PATIENTS RECEIVED BEHAVIORAL HEALTH SERVICES. ADDITIONALLY, THE ORGANIZATION PROVIDES GRANTS TO ORGANIZATIONS IN THE COMMUNITY.
DELEGATION OF CONTROL TO A MANAGEMENT COMPANY	FORM 990, PART VI, SECTION A, QUESTION 3	THE ORGANIZATION USES A MANAGEMENT COMPANY, QUORUM, TO DELEGATE DAY TO DAY MANAGEMENT FUNCTIONS. ADDITIONALLY, THE CEO IS COMPENSATED THROUGH THE MANAGEMENT COMPANY. PAYMENTS TO QUORUM ARE REPORTED ON FORM 990, PART X, LINE 11A. THIS CONTRACT TERMINATED IN JUNE 2012 AND SERVICES HAVE CEASED.
SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS	FORM 990, PART VI, SECTION A, QUESTION 4	DUE TO THE DISCONTINUANCE OF THE SERVICES OF THE MANAGEMENT COMPANY, A REPRESENTATIVE OF QUORUM HEALTH RESOURCES IS NO LONGER REQUIRED TO ATTEND BOARD MEETINGS OR TO BE A MEMBER OF THE EXECUTIVE COMMITTEE.
PROCESS TO REVIEW THE FORM 990	FORM 990, PART VI, SECTION B, QUESTION 11B	THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE ORGANIZATION PROVIDES A COPY OF THE 990 TO EACH BOARD MEMBER VIA EMAIL, PRIOR TO FILING THE 990.
PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY	FORM 990, PART VI, SECTION B, QUESTION 12C	THE ORGANIZATION HAS AN OBLIGATION TO CONDUCT ITS BUSINESS OPERATIONS, INCLUDING THE PROVISION OF PATIENT CARE, IN AN OBJECTIVE MANNER THAT IS NOT MOTIVATED BY AN INDIVIDUALS' DESIRE FOR PERSONAL OR FINANCIAL GAIN, EITHER FOR THEMSELVES, THEIR FRIENDS, OR THEIR FAMILY MEMBERS. ESPECIALLY FOR THOSE ON THE BOARD OF TRUSTEES, EXECUTIVE COMMITTEE, KEY LEADERS OF RHI MEDICAL STAFF, EXECUTIVE AND MANAGEMENT LEADERSHIP TEAM, AND RHI STAFF DIRECTLY INVOLVED IN PROCUREMENT AND CASE MANAGEMENT SERVICES, THERE IS INCREASING REGULATORY OVERSIGHT AND ACCOMPANYING PUBLIC SCRUTINY OF SPECIFIC SITUATIONS ASSOCIATED WITH CONFLICTS OF INTEREST. THE ORGANIZATION'S COMPLIANCE OFFICER COMPLETES AN ANNUAL COMPLIANCE SURVEY TO ENSURE THAT THE CONFLICT OF INTEREST POLICY IS BEING ENFORCED EFFECTIVELY. IN ADDITION, EMPLOYEES ARE REQUIRED TO PROACTIVELY IDENTIFY SPECIFIC CONFLICTS OF INTEREST. EMPLOYEES MUST SEEK GUIDANCE AND APPROVAL FROM THEIR DEPARTMENT DIRECTOR WHEN POTENTIAL CONFLICTS OF INTEREST ARE IDENTIFIED. WHEN DEEMED NECESSARY BY THEIR DEPARTMENT DIRECTOR, EMPLOYEES MUST AVOID OR DISCONTINUE THE ACTIVITY OR INTEREST AND MAY ALSO BE REQUIRED TO TAKE CORRECTIVE ACTION IF THEIR ACTIVITY HAS HARMED RHI IN ANY WAY. VIOLATION OF THE CONFLICT OF INTEREST POLICY IS GROUNDS FOR DISCIPLINARY ACTION APPROPRIATE TO THE VIOLATION UP TO AND INCLUDING TERMINATION.
REVIEW OF CEO COMPENSATION	FORM 990, PART VI, SECTION B, QUESTION 15A	THE ORGANIZATION'S MANAGEMENT COMPANY PROVIDED COMPARATIVE DATA AND INDUSTRY AND MARKET STANDARDS FROM A COMPENSATION REVIEW PERFORMED USING NC HOSPITAL ASSOCIATION DATA FOR THE CEO COMPENSATION. THE ORGANIZATION HAS A REBUTTABLE PRESUMPTION POLICY ADMINISTERED BY THE PCQ COMMITTEE OF THE BOARD THAT COVERS THE REVIEW AND THE APPROVAL OF THE CEO USING THE IRS MODEL. THE COMMITTEE SHALL REVIEW PROPOSALS FOR THE COMPENSATION OF THE CEO ANNUALLY FOR THE FOLLOWING YEAR. THE CURRENT CEO WILL BE SUBJECT TO THE REVIEW POLICY IN FY2012.
REVIEW OF OTHER OFFICER OR KEY EMPLOYEES COMPENSATION	FORM 990, PART VI, SECTION B, QUESTION 15B	THE ORGANIZATION HAS A REBUTTABLE PRESUMPTION POLICY, UPDATED IN MARCH 2012, ADMINISTERED BY THE PCQ COMMITTEE OF THE BOARD THAT COVERS THE REVIEW AND APPROVAL OF THE CEO AND OTHER LEADERS, INCLUDING TRUSTEES, OFFICERS, KEY EMPLOYEES, AND OTHER HIGHLY COMPENSATED EMPLOYEES OR INDEPENDENT CONTRACTORS. FOR POLICY PURPOSES, THIS APPLIES TO ALL HIGHLY COMPENSATED OFFICERS AND KEY EMPLOYEES WITH COMPENSATION EXCEEDING A THRESHOLD OF $125,000 ANNUALLY IN TOTAL COMPENSATION. AFTER THE COMMITTEE'S INITIAL BENEFIT TRANSACTION REVIEW OF COMPENSATION FOR EACH OF THE OFFICERS AND KEY EMPLOYEES, FURTHER REVIEW WILL NOT BE NECESSARY EXCEPT FOR INSTANCES WHERE THERE HAS BEEN SIGNIFICANT CHANGES MADE IN THE SPAN OF AUTHORITY OR THE TOTAL VALUE OF THE EXISTING COMPENSATION ARRANGEMENT IS INCREASING BY MORE THAN THREE PERCENT.
DOCUMENT DISCLOSURE	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.
CEO COMPENSATION & CEO CHANGE	FORM 990, PART VII	THE ORGANIZATION'S CEO WAS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY FOR HIS SERVICES PERFORMED FOR THE ORGANIZATION. THE MANAGEMENT COMPANY CONTRACT TERMINATED IN JUNE 2012 AND SERVICES HAVE CEASED, INCLUDING THE SERVICES OF THE CEO, WHICH WERE RELINQUISHED IN APRIL 2012. AT THIS TIME, CINDY BUCK, WHO WAS THE VP/CFO, BECAME INTERIM CEO UNTIL SHE WAS APPOINTED AS CEO IN SEPTEMBER 2012.
TRUSTEE COMPENSATION	FORM 990, PART VII	MICHAEL S. WHEELER, MD, A TRUSTEE, IS CONTRACTED BY THE ORGANIZATION AS A MEDICAL DIRECTOR. THE COMPENSATION REPORTED IN PART VII IS RELATED TO HIS ROLE AS MEDICAL DIRECTOR AND NOT AS A TRUSTEE OF THE BOARD. NO MEMBERS OF THE BOARD RECEIVE COMPENSATION FOR THEIR SERVICES AS TRUSTEES OF THE BOARD.
RELATED HOURS	FORM 990, PART VII	THE FOLLOWING BOARD MEMBERS, OFFICERS, AND HIGHEST COMPENSATED EMPLOYEES SERVE ON THE BOARD OF RUTHERFORD HOSPITAL FOUNDATION, A RELATED ORGANIZATION, FOR AN AVERAGE OF ONE HOUR OF SERVICE PER WEEK: DIANE HAMRICK THOMAS J JASKI, M.D. DAVID BIXLER MICHAEL ROBERTS, M.D. CINDY BUCK IN ADDITION, DAVID BIXLER, CEO, SERVED AS CEO FOR RUTHERFORD HOSPITAL FOUNDATION, A RELATED ORGANIZATION, FOR AN AVERAGE OF 40 HOURS PER WEEK BETWEEN THE TWO ORGANIZATIONS THROUGH 04/06/2012. CINDY BUCK SERVED AS VP/CFO UNTIL APRIL 2012, INTERIM CEO UNTIL SEPTEMBER 2012, AND CEO BEGINNING SEPTEMBER 2012 FOR RUTHERFORD HOSPITAL FOUNDATION AND SERVES AN AVERAGE OF 40 HOURS PER WEEK BETWEEN THE TWO ORGANIZATIONS.
OTHER CHANGES IN NET ASSETS	FORM 990, PART XI, LINE 5	$ (5,185,633) PRIOR PERIOD ADJUSTMENT 3,646,938 UNREALIZED GAINS (340,397) CHANGE IN FV OF INTEREST RATE SWAP (20,340) TRANSFER TO FOUNDATION -------------- $ (1,899,432)

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

Field	Value	IRS element (for citing)
Business Name Line1	RUTHERFORD HOSPITAL FOUNDATION INC	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	288 S RIDGECREST AVENUE	AddressLine1
City	RUTHERFORDTON	City
State	NC	State
ZIP Code	28139	ZIPCode

Field	Value	IRS element (for citing)
EIN	561968736	EIN
Primary Activities	SUPPORT	PrimaryActivities
Legal Domicile State	NC	LegalDomicileState
Exempt Code Section	501(C)(3)	ExemptCodeSection
Public Charity Status	11A I	PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	NA	BusinessNameLine1

Field	Value	IRS element (for citing)
Controlled Org	true	ControlledOrg

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	false	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	true	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	false	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	false	PerformOfServicesByOtherOrgs
Sharing Of Facilities	true	SharingOfFacilities
Sharing Of Paid Employees	true	SharingOfPaidEmployees
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	true	OtherTransferToOtherOrg
Other Transfer From Other Org	false	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
RUTHERFORD HOSPITAL FOUNDATION INC
C	235920	FMV
RUTHERFORD HOSPITAL FOUNDATION INC
N	57604	2011 W-2 BOX 5