2012-05-05T15:38:05-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-10-01 561458024 TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC TRAN 8288874777 PO BOX 2440 BREVARD NC 28712 PATRICIA R WEBB 8288874777 2012-05-02 1 AMY BIBBY 8282542254 2010 2016-02-24 21:20:13Z SHARON C JOHNSON 153 WEST JORDAN ST BREVARD NC 28712 3199369 0 X N/A X 1985 NC RECEIVE AND ADMINISTER CHARITABLE CONTRIBUTIONS 14 12 5 150 0 0 1528001 2161129 0 0 625819 1012536 -288 14365 2153532 3188030 1525435 1086431 0 0 219053 217826 0 0 0 395389 258639 2139877 1562896 13655 1625134 8159182 8932335 1875202 2059489 6283980 6872846 X THE PURPOSE OF THE FOUNDATION IS TO SOLICIT, MANAGE, AND DISBURSE CHARITABLE GIFTS TO ENABLE THE HOSPITAL TO MAINTAIN AN UP-TO-DATE FACILITY, PURCHASE NEEDED EQUIPMENT, AND SUPPORT AND EXPAND HEALTH PROGRAMS AND SERVICES FOR THE COMMUNITY IT SERVES. 0 0 1096064 1086431 PROVIDED SUPPORT TO TRANSYLVANIA COMMUNITY HOSPITAL, INC. (D/B/A TRANSYLVANIA REGIONAL HOSPITAL, "THE HOSPITAL"):- $ 36,750 FOR THE CANCER AND INFUSION CENTER- $ 400,000 FOR CAPITAL CAMPAIGN- $ 598,096 FOR OPERATIONAL SUPPORTAPPROXIMATELY $1,200,000 IN CONTRIBUTIONS WERE RECEIVED FROM: - ESTATE OF RUTH P. HAGGERTY - $ 900,000 - CHARITABLE GIFT ANNUITIES (4) - $ 297,430 - ESTATE OF MIRIAM AND EDWARD P. STUART - $ 83,441OVER $158,000 IN CONTRIBUTIONS RECEIVED FROM: - NC DEPT. OF HEALTH AND HUMAN SERVICES - LAKE TOXAWAY CHARITIES (TOXAWAY RX, FRANCIS WARD RX, KOALA, TOXAWAY HEALTH CENTER ENDOWMENT, NC STROKE CARE COLLABORATIVE) - MISCELLANEOUS FAMILY FOUNDATIONS (THC ENDOWMENT, MAMMOGRAPHY, HEALTH EDUCATION)OVER $50,000 IN GRANTS WAS DISTRIBUTED TO: - RX ASSISTANCE PROGRAMS $8,221 - HEALTH EDUCATION $ 10,342 - SCHOLARSHIPS $ 13,750 - OTHER PROGRAMS AND EVENTS $ 19,272"DESSERT WITH THE DOC" WAS PRESENTED THIS YEAR, WITH 21 PHYSICIANS AND HEALTHCARE PROFESSIONALS PARTICIPATING. OVER 900 ATTENDEES ATTENDED THE 23 EVENTS DURING THE YEAR. THE EVENT WAS SPONSORED BY THE HURLBURT FAMILY FOUNDATION. 1096064 1 1 0 0 0 0 0 1 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 1 5 1 0 0 0 0 1 1 1 1 0 0 0 0 X 14 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 0 0 X X SHARON JOHNSON 8288774777 153 WEST JORDAN STREET BREVARD NC 28712 JEFFREY P HUNT 5.00 X X 0 0 0 FREDERICK J MARKERT 2.00 X X 0 0 0 R THOMAS NIX 2.00 X X 0 0 0 ROBERT J BEDNAREK 2.00 X 0 244375 56397 RAY H DUNKELBERG MD 2.00 X 0 0 0 DANIEL P ELLIOT 2.00 X 0 0 0 RUSSELL R FRENCH 2.00 X 0 0 0 RICHARD R MILLAR 2.00 X 0 0 0 EDWIN W PARKER 2.00 X 0 0 0 VERONICA K PETERMAN 2.00 X 0 0 0 ROBERT L REARDEN JR 2.00 X 0 0 0 CAROL F WATKINS 2.00 X 0 0 0 PATRICIA R WEBB 2.00 X 0 0 0 KATHRYN DANNELLY 2.00 X 0 0 0 SHARON C JOHNSON CFRE 40.00 X 83475 0 10955 83475 244375 67352 0 0 1 0 0 51107 461380 111720 1536922 277331 2161129 1012607 1012607 71 -71 -71 -71 25633 51107 11268 14365 14365 3188030 0 0 1026901 1054118 1054118 32313 32313 83475 83475 134351 134351 400 400 86882 86882 1064 1064 154074 154074 6193 6193 9633 9633 MISCELLANEOUS EXPENSES 393 393 1562896 1096064 466832 0 28813 20058 735504 408788 247403 133373 2090 3992 466432 51476 174256 414956 6939945 7916434 31171 34734 8159182 8932335 399 2157 1874803 2057332 1875202 2059489 X 2513063 2464590 3421696 4058785 349221 349471 6283980 6872846 8159182 8932335 X 1625134 -1036268 X X 0 1 1 X 0 X X X 0 0 0 TRANSYLVANIA COMMUNITY HOSPITAL INC 560562293 3 1 1 1 1034846 1 1034846 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 3611599 198551 3810150 3079854 531745 3611599 3008487 71367 3079854 0.86250 0.09170 0.04580 0 0 171000 171000 250000 8333 241667 45432 43143 2289 414956 3188030 1562896 1625134 -901911 -134357 -1036268 588866 2316386 -901911 30267 -871644 3188030 0 3188030 1727520 164624 164624 1562896 0 1562896 PART IV, LINE 2B: THE FOUNDATION ACTS AS TRUSTEE FOR IRREVOCABLE CHARITABLE REMAINDER UNITRUSTS AND CHARITABLE REMAINDER ANNUITY TRUSTS. THE ASSETS IN THESE TRUSTS WILL REMAIN IN TRUST, PAYING DISTRIBUTIONS TO THE DONORS FOR THE REST OF THE DONORS' LIVES OR THE ASSETS OF THE TRUST ARE DEPLETED, WHICHEVER COMES FIRST. THE REMAINDER ASSETS AFTER THE DONORS' DEATH WILL BECOME THE PROPERTY OF THE FOUNDATION UPON THE DONORS' DEATHS. SUCH AMOUNTS RECEIVED ARE REPORTED AS ASSETS RESTRICTED AS TO USE. THESE TRUSTS REQUIRE SPECIFIED DISTRIBUTIONS TO THEIR DESIGNATED BENEFICIARIES OVER THE TRUSTS' TERMS. THE PRESENT VALUE OF THE EXPECTED DISTRIBUTIONS TO BE MADE IS RECORDED AS ANNUITIES PAYABLE. AT THE TIME THAT THE TRUST IS CREATED, THE DIFFERENCE IN THE VALUE OF THE INITIAL TRUST ASSETS AND THE PRESENT VALUE OF THE EXPECTED DISTRIBUTIONS IS RECORDED AS CONTRIBUTION INCOME. SUBSEQUENT CHANGES TO THE PRESENT VALUE OF THE EXPECTED DISTRIBUTIONS ARE RECORDED AS A CHANGE IN THE VALUE OF SPLIT INTEREST AGREEMENTS. EACH YEAR, THE FOUNDATION ADJUSTS THE PRESENT VALUE OF EXPECTED DISTRIBUTIONS BASED ON CHANGES IN THE ACTUARIAL ASSUMPTIONS OF THE DONORS' LIFE EXPECTANCY. THE PRESENT VALUE IS ALSO AFFECTED BY CHANGES IN THE DISCOUNT RATE USED. THE DISCOUNT RATE USED TO CALCULATE THE PRESENT VALUE OF EXPECTED DISTRIBUTIONS IS THE SAME AS THE RATE DEVELOPED BY THE INTERNAL REVENUE SERVICE TO VALUE THESE TYPES OF AGREEMENTS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE FOUNDATION'S ENDOWMENT CONSISTS OF SEVEN INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. ITS ENDOWMENT INCLUDES BOTH DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE BOARD OF TRUSTEES TO FUNCTION AS ENDOWMENTS. AS REQUIRED BY GAAP, NET ASSETS ASSOCIATED WITH ENDOWMENT FUNDS, INCLUDING FUNDS DESIGNATED BY THE BOARD OF TRUSTEES TO FUNCTION AS ENDOWMENTS, ARE CLASSIFIED AND REPORTED BASED ON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ASSOCIATION, THE HOSPITAL, THE FOUNDATION, AND TPSI ARE INCORPORATED AS NONPROFIT ORGANIZATIONS UNDER THE LAWS OF NORTH CAROLINA AND ARE EXEMPT FROM INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATIONS HAVE DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS EXIST FOR OPEN TAX YEARS AS OF SEPTEMBER 30, 2011. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2008 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT 18,999. ADJUSTMENT TO ACTUARIAL LIABILITY -153,356. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 11,268. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT 18,999. PART XIII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 11,268. ADJUSTMENT TO ACTUARIAL LIABILITY 153,356. BREVARD DESIGNER SHOWCASE 39191 15680 23511 THINK PINK RALLY WEEK 27798 27798 3211 4507 1 9751 7629 2122 928 2622 76740 51107 25633 928 5833 4507 11268 14365 1 TRANSYLVANIA COMMUNITY HOSPITAL INC PO BOX 1116 BREVARD NC 28712 560562293 501(C)(3) 36750 CANCER AND INFUSION CENTER TRANSYLVANIA COMMUNITY HOSPITAL INC PO BOX 1116 BREVARD NC 28712 560562293 501(C)(3) 400000 CAPITAL CAMPAIGN TRANSYLVANIA COMMUNITY HOSPITAL INC PO BOX 1116 BREVARD NC 28712 560562293 501(C)(3) 598096 OPERATIONAL SUPPORT 1 0 JANE WALKER FREEMAN & LINDGREN MEMORIAL NURSING SCHOLARSHIP 8 13750 RX ASSISTANCE PROGRAM 50 8221 FMV PROVISION OF PRESCRIPTION MEDICATION FOR THE MEDICALLY INDIGENT AND UNDERINSURED HEALTH EDUCATION PROGRAM 900 10342 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: TRANSYLVANIA REGIONAL HOSPITAL IS THE PRIMARY RECIPIENT OF GRANTS FROM THE FOUNDATION, AND ALL PAYMENTS ARE DIRECTLY RELATED TO PROJECTS AUTHORIZED BY THE BOARD OF THAT ORGANIZATION. GRANTS PROVIDED TO ORGANIZATIONS OTHER THAN THE HOSPITAL ARE REQUIRED TO SUBMIT A REPORT ONE YEAR FOLLOWING THE GRANT DETAILING THE USE OF THE FUNDS. SCHOLARSHIPS FOR NURSING ARE ONLY AVAILABLE FOR TUITION FURTHERING EDUCATION IN THE FIELD OF NURSING. AMOUNTS AND SUPPORT FOR INDIVIDUAL PERSCRIPTION ASSITANCE PROGRAMS GOES DIRECTLY TO THE PHARMACY TO COVER PORTIONS OF DRUG COSTS FOR ASSISTANCE RECIPIENTS. THE FOUNDATION REQUIRES SUBSTANTIATION FROM MEDICAL PROFESSIONALS FOR ALL AMOUNTS REQUESTED UNDER THE PRORGRAM. 0 0 0 0 0 0 0 0 0 ROBERT J BEDNAREK 0 237471 0 2125 0 4779 0 45354 0 11043 0 300772 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: OFFICERS OF THE ORGANIZATION ARE COMPENSATED BY TRANSYLVANIA COMMUNITY HOSPITAL, INC., A RELATED ORGANIZATION. THE HOSPITAL HAS AN INDEPENDENT BOARD OF DIRECTORS THAT OVERSEES EXECUTIVE COMPENSATION PACKAGES. THE HOSPITAL UTILIZED THE FOLLOWING MEASURES TO ESTABLISH THE COMPENSATION OF THE COMPENSATED OFFICERS LISTED ON FORM 990, PART VII, LINE 1: - COMPENSATION COMMITTEE - COMPENSATION STUDY/SURVEY - APPROVAL BY THE BOARD/COMPENSATION COMMITTEE X 2 27331 STOCK PRICE X 1 250000 APPRAISAL 0 1 1 THIRD PARTY USE: PART I, LINE 32B: THE ORGANIZATION USES FINANCIAL INSTITUTIONS TO PROCESS AND SELL CONTRIBUTIONS OF PUBLICLY-TRADED STOCK. FORM 990, PART VI, SECTION A, LINE 6 THE FOUNDATION IS A MEMBERSHIP CORPORATION, OF WHICH THE SOLE MEMBER IS TRANSYLVANIA HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION A, LINE 7A TRUSTEES TO THE BOARD ARE NOMINATED BY THE EXECUTIVE COMMITTEE OF THE BOARD, APPROVED BY THE FOUNDATION BOARD AND RATIFIED BY THE BOARD OF TRANSYLVANIA HEALTH SYSTEM, THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD'S POWER TO AMEND OR RESTATE THE FOUNDATION'S ARTICLES OF INCORPORATION, AMEND OR RESTATE THE BYLAWS, AND MERGE, CONSOLIDATE, REORGANIZE OR DISSOLVE THE FOUNDATION IS SUBJECT TO APPROVAL BY TRANSYLVANIA HEALTH SYSTEM, THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE ASSITANCE AND OVERSIGHT OF MANAGEMENT. UPON REVIEW BY MANAGMENT, THE RETURN WAS PRESENTED TO THE BOARD OF DIRECTORS BY INCLUSION ON THE AGENDA OF A SCHEDULED MEETING. A PERIOD OF DISCUSSION WAS ALLOWED FOR QUESTIONS AND COMMENTS BEFORE FILING THE RETURN WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO FILL OUT OR RENEW A COPY OF THE CONFLICT OF INTEREST POLICY ANNUALLY. MEMBERS ARE EXPECTED TO DISCLOSE ANY POTENTIAL CONFLICTS BEFORE DISCUSSIONS OR ACTIONS AFFECTING THE DECISION. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION DOES NOT COMPENSATE ANY EMPLOYEES. THE EXECUTIVE DIRECTOR IS COMPENSATED BY TRANSYLVANIA COMMUNITY HOSPITAL, INC., A RELATED ORGANIZATION, AND HER SALARY IS DETERMINED BY THE PRESIDENT/CEO OF THE HOSPITAL THROUGH REVIEWS OF MARKET DATA COMPARED TO SPECIFIC GOALS AND COMPETENCIES. THE PRESIDENT/CEO ALSO REVIEWS THE SALARY WITH A COMPENSATION COMMITTEE OF THE BOARD. THERE ARE NO OTHER KEY POSITIONS TO WHICH THIS PROCEDURE WOULD APPLY. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -901,911. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT 18,999. ADJUSTMENT TO ACTUARIAL LIABILITY -153,356. TOTAL TO FORM 990, PART XI, LINE 5: -1,036,268. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. TRANSYLVANIA HEALTH SYSTEM INC 260 HOSPITAL DRIVE BREVARD NC 28712 561456987 HEALTHCARE NC 501(C)(3) LINE 11B, II N/A 0 TRANSYLVANIA COMMUNITY HOSPITAL INC 260 HOSPITAL DRIVE BREVARD NC 28712 560562293 HEALTHCARE NC 501(C)(3) LINE 3 TRANSYLVANIA HEALTH SYSTEM INC 0 TRANSYLVANIA PHYSICIAN SERVICES INC 260 HOSPITAL DRIVE BREVARD NC 28712 561920816 HEALTHCARE NC 501(C)(3) LINE 3 TRANSYLVANIA HEALTH SYSTEM INC 0 BREVARD MRI AT TRANSYLVANIA REGIONAL HOSPITAL LLC 260 HOSPITAL DRIVE BREVARD NC 28712 203281110 MEDICAL NC N/A TRANSYLVANIA HEALTHCARE II LIMITED PARTNERSHIP 2 MEDICAL PARK DR BREVARD NC 28712 200333230 RENTAL NC N/A HEALTHCARE III LIMITED PARTNERSHIP 260 HOSPITAL DRIVE BREVARD NC 28712 561599696 RENTAL NC N/A HEALTHCARE LIMITED LIABILITY COMPANY VII 260 HOSPITAL DRIVE BREVARD NC 28712 200343455 RENTAL NC N/A TRANSYLVANIA SERVICES INC 260 HOSPITAL DRIVE BREVARD NC 28712 561448199 REAL ESTATE NC N/A C 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0