2012-08-14T10:19:25-05:00 2011-09-30 Grant Thornton LLP 201 S College Street Suite 2500 Charlotte NC 28244 990 2010-10-01 263627231 Mission Medical Associates Inc MISS 8282138222 PO Box 5325 Asheville NC 28813 Cheryl Williams 8282138222 2012-08-10 1 7046323500 2010 2016-02-24 21:20:13Z Cheryl Williams PO Box 5325 Asheville NC 28813 65784115 0 X www.missionmd.org X 2008 NC Provide Physician Services in areas that are insufficiently served. 3 2 513 3 0 0 28304 83582 37457774 65683995 26366 16458 0 0 37512444 65784035 0 0 0 0 42346116 67713740 0 0 0 10790284 23201609 53136400 90915349 -15623956 -25131314 8638722 17369004 24262678 58124274 -15623956 -40755270 X Mission Medical Associates mission is to provide physician services in predominantly rural areas that are insufficiently served, thereby improving the health care of the general public. In many cases this involves recruiting and placing primary care physicians, as well as pediatric and adult specialty services close to where people live and work. 0 0 86615940 65683995 Physician services in the following specialties:Family Medicine, Pediatrics, Cardiology, Children's Dental, Neurology, Orthopedic Trauma, Trauma Surgery, Weight management, and Hospitalists.Mission Medical Associates provided $1,314,033 in charity care during the year.A list of the accomplishments of Mission Medical Associates (MMA), as well as individual physicians employed by Mission Medical Associates serving the local community, in addition to improving access and quality of healthcare are listed below:*MMA recruited a second pediatric orthopedist to assist with the much needed orthopedic care for Western North Carolina. This physician joins the only pediatric orthopedic surgeon in the region. Before the arrival of these physicians, patients and their families had to travel long distances to obtain care.*An MMA Physician of Haywood Family Medicine, an MMA practice, was voted the "Best Doctor in Haywood County" in the 2011 Readers' Choice Awards for the local newspaper.*A Developmental-behavioral pediatric specialist employed by MMA participated with the International Hospital for Children in the annual pediatric spina bifida evaluation clinics in Belize, Central America.*A pediatric cardiologist with Asheville Cardiology Associates, an MMA physician group, received his board certification in lipidology. He is one of a select number of cardiologists to achieve this certification.*An outpatient neurologist employed by MMA presented a poster at the 2011 Stroke Conference in New Orleans.*A PhD psychologist, employed with MMA, in the Olson Huff Center for Child Development at Mission Children's Hospital participated in a health clinic in Nicaragua.*Asheville Cardiology Associates, a physician practice of MMA, began using Cryoballoon technology for atrial fibrillation ablation in June 2011. This was the second North Carolina medical center to employ this new technology. *A cardiologist with Asheville Cardiology Associates has been asked to teach a portion of the Medtronic and Federal Drug Administration's course which will be required prior to physicians accessing equipment related to Cryoballoon technology.*Several MMA physicians from Asheville Hospitalist Group donated their time to the Medical Ministry of the Asheville-Buncombe County Christian Ministry which serves residents of Buncombe County who are uninsured or underinsured. 86615940 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 58 0 1 513 1 0 0 0 0 0 0 0 0 0 0 X 3 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Mission Medical Associates 8282138222 866 Hendersonville Road Asheville NC 28803 Ernest E Ferguson 1.00 X X 0 0 0 George M BilbreyJrMD 1.00 X 0 0 0 William E Lee 1.00 X X 0 0 0 Marc Westle DO 60.00 X 450815 0 84348 Cheryl Williams 60.00 X 124265 0 17379 Donald Martin 50.00 X 222554 0 24621 Todd Hansen MD 40.00 X 515213 0 41083 Oscar Jenkins MD 40.00 X 520589 0 38756 William Wharton MD 40.00 X 526586 0 40026 James Usedom MD 40.00 X 533143 0 38256 Amos Haddock MD 40.00 X 535658 0 33668 3428823 0 318137 117 0 1 0 Vista Staffing Solutions File 50834 Los Angeles CA 900740834 Contract labor 497033 Robinson Bradshaw & Hinson 101 North Tryon Street Suite 1900 Charlotte NC 282460103 Legal 285611 Integrated Healthcare Solutions 1061 521 Corporate Ctr Dr Suite 130 Fort Mills SC 297077156 Software Support 274821 Mediscribes Inc 4509 Lisa Ln New Albany IN 471509373 Transcription 220525 Practice Concepts PO Box 25472 Greenville SC 296160472 Consulting 129805 5 83582 83582 Net Patient Revenue 621110 48507423 48507423 PhysContSvcsRelatedOrg 900099 14088398 14088398 Other Patient Revenue 900099 3088174 3088174 65683995 16538 16538 80 -80 -80 -80 65784035 65683995 0 16458 893835 53630 840205 111351 111351 57906777 56255781 1650996 1822387 1735794 86593 4053978 3783511 270467 2925412 2765657 159755 220342 220342 12000 12000 5589194 5226240 362954 209975 160574 49401 579495 433624 145871 591518 591438 80 2353650 2158069 195581 576240 504575 71665 285152 216342 68810 903976 899883 4093 Bad Debt 7626497 7626497 Medical Supplies 2770222 2770222 Medical Equipment Lease 758330 740305 18025 Other 725018 693798 31220 90915349 86615940 4299409 0 6548 3800 245423 571642 6560927 11184782 624708 222092 182908 246805 517078 5312355 1260365 403589 4051990 550000 550000 722 84712 8638722 17369004 24262678 58041390 0 82884 24262678 58124274 X -15623956 -40755270 -15623956 -40755270 8638722 17369004 -25131314 0 X 0 1 1 X 0 X 28304 83582 111886 37457774 65683995 103141769 37486078 65767577 103253655 0 0 0 103253655 26366 16538 42904 26366 16538 42904 37512444 65784115 103296559 0.99960 0.99930 0.00040 0.00070 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1192697 57116 1135581 1964928 505671 1459257 2154730 697578 1457152 4051990 Other Deferred Compensation 82884 82884 Description of Uncertain Tax Positions Under FIN 48: Part X: Mission applies the provisions of FASB ASC Topic 740 for Income Taxes in accounting for uncertainty in income taxes. ASC 740 provides guidance on when tax positions are recognized in an entity's financial statements and how the values of these positions are determined. There is currently no impact on Mission's combined financial statements as a result of application of ASC 740. Mission Medical Associates is included in the combined financial statements described above. X X X X X 0 1 0 0 0 0 0 0 0 Marc Westle DO 319532 0 109075 0 22208 0 62862 0 21486 0 535163 0 0 0 Donald Martin 185174 0 35527 0 1853 0 863 0 23758 0 247175 0 0 0 Todd Hansen MD 411239 0 102949 0 1025 0 15865 0 25218 0 556296 0 0 0 Oscar Jenkins MD 391017 0 102949 0 26623 0 14700 0 24056 0 559345 0 0 0 William Wharton MD 422797 0 102949 0 840 0 15866 0 24160 0 566612 0 0 0 James Usedom MD 428701 0 102949 0 1493 0 16500 0 21756 0 571399 0 0 0 Amos Haddock MD 394723 0 102949 0 37986 0 16500 0 17168 0 569326 0 0 0 Part I, Line 4b Dr. Marc Westle, $46,362 Form 990, Part VI, Section A, line 6 Mission Health System, Inc is the sole member of Mission Medical Associates, Inc. Form 990, Part VI, Section A, line 7a The following action of the corporation requires the prior approval of the Member: (i) appointment and removal of Board members; (j) appointment and removal of President/Chief Executive Officer; and (k) approval of employment agreement and compensation of President/Chief Executive Officer. Form 990, Part VI, Section A, line 7b The following actions of the corporation require the prior approval of the Member: (a) amendment or repeal of the bylaws or articles of the corporation; (b) sale of assets of the corporation valued in excess of $1 million ; (c) merger or dissolution of the corporation; (d) selection of auditors; (e) adoption of strategic plans, and capital and operating budgets; (f) transactions in excess of $5 Million; (g) filing for bankruptcy; (h) incurring debt (external to the Member and its subsidiaries/affiliates) (i) appointment and removal of Board members; (j) appointment and removal of President/Chief Executive Officer; and (k) approval of compensation of President/Chief Executive Officer. Form 990, Part VI, Section B, line 11 A draft of the Form 990 is prepared by the Director of Tax Services at Mission Health System. The Form 990 is reviewed by the organization's CEO, CFO, General Counsel and Compliance Officer of Mission Health System as well as Management at Mission Medical Associates . In addition, an outside accounting firm is engaged to review and sign the 990 and prepare the return for final filing with the IRS. Before filing, highlights of Form 990 are reviewed by Board Committees which may include the Executive Committee; Audit and Compliance Committee; Finance and Property Committee and Human Resources and Compensation Committee of Mission Health System. After committee review, a draft of the 990 is provided to the Board of Directors at Mission Health System and Mission Medical Associates for review. Highlights of Form 990 are specifically reviewed with the board and they have the opportunity to ask questions and suggest improvements or provide corrections. If there are changes as a result of board review, a corrected Form 990 will be provided for final approval before filing. After final approval, the Form 990 will be filed with the IRS. Form 990, Part VI, Section B, line 12c Audit and Compliance Committee Reviews: The Independent Directors on the Audit and Compliance Committee of Mission Health System, the parent organization, review Conflicts of Interest and Disabling Situations, consider any issues involving conflicts and make determinations as to whether a particular relationship or arrangement would disable an individual from serving as a fiduciary for the Board or would reasonably be expected to exert an influence on the individual's judgment and preclude the individual from being an Independent Director. The Audit and Compliance Committee may retain counsel from outside audit, legal, governance or other experts. Any determination of percent of revenue or income received by an individual or entity may be based on certifications from outside auditors of disclosures made directly by the individual to the audit firm. The determinations of the Audit and Compliance Committee may be reviewed by the board. The organization's conflict of interest policy applies to members of senior leadership, medical staff, clinical service line leaders, elected medical staff leaders, departmental directors, staff members working in the purchasing department, and all other staff members with purchasing authority, as well as immediate family members of such interested persons and entities in which interested persons have a material financial interest. The organization's policy is for all interested persons to disclose any and all conflicts of interest in accordance with the IRS guidelines for tax-exempt entities as well as any other applicable state or federal law. Upon initial assumption of duties, interested persons are provided with a copy of the conflict of interest policy and sign a conflict of interest disclosure statement. Thereafter, the statements will be completed annually. Periodically all staff members are asked to complete a conflict of interest disclosure statement. Internal and external auditors, General Counsel or outside counsel will periodically conduct a review of the disclosure process to determine whether the organization is in compliance with the policy. Procedures used if a conflict of interest is identified: The Interested Persons shall not participate in any discussion or vote regarding the transaction and shall not be present in the meeting room for any part of the discussion or vote relating to the transaction issue. The Board of Directors will discuss the transaction but will not formally approve such transaction unless the disinterested members of the Board have decided by majority vote that the transaction is in the best interests of and for the benefit of the organization, and is fair and reasonable thereto in all respects. If a violation of the policy is identified, the interested persons are subject to appropriate sanctions, including removal from their positions. All situations such as this will be brought to the integrity steering committee for final resolution. Form 990, Part VI, Section B, line 15 The Organization's Parent, Mission Health System's Human Resources and Compensation Committee has the following process for reviewing compensation: * Recommends to the Board any revisions to the overall philosophy and policy to guide the determination of compensation and benefit packages for executives which includes the CEO, the CFO, and President as well as all other executives, which would include all key employees; and * Makes executive compensation decisions on behalf of the Board, within the parameters of the overall philosophy and policy approved by the Board, with support from outside executive compensation consultants to ensure compensation levels are at fair market value; and * Reports to the Board on its actions. The Committee also: * Conduct a periodic review of Mission Health System and Hospital executive compensation philosophy and policies and practices and recommends any revisions to the Board. * Determines which positions are eligible for the executive compensation plan. * Establishes and approves the salary parameters for the CEO, others eligible under the executive compensation plan, and employees who are Disqualified Persons. * Establishes and approves the terms of all incentives, benefits or programs included in the executive compensation plan. * Reviews and approves all employment contracts for the CEO and all others eligible under the executive compensation plan, uses discretion in recommending amendments or termination of these arrangements to the Board. * Reviews the performance and determines the compensation of the CEO and others defined as eligible under the executive compensation plan based on the achievement of shared and personal goals. * Reviews any special situations where, at the discretion of the full Board, the CEO, or independent consultants, the advice or approval of the Committee is requested. * Has sole responsibility in retaining qualified compensation and benefits consultants and other professional advisors as the need may arise, and to terminate their contracts. * Confers with members of management, such as the General Counsel and the Vice President of Human Resources, assists the Committee in performing its duties, so long as their role remains technical in nature. * Meets at least bi-monthly and conducts discussions in executive sessions as needed. * Keeps and distributes minutes of all its meetings to its members. Items of a sensitive nature are referenced in the minutes with detailed, supporting documentation retained on file. * Reports to the full Board at the next Board meeting following the Committee meeting, or as requested. * Discloses any potential conflicts of interest situations to the Committee Chairman that may affect their independent directors' status as soon as they arise. * Maintains complete documentation of all matters discussed by the Committee. * Maintains complete confidentiality on all matters reviewed and discussed. * Exercises any fiduciary, administrative, or other functions assigned to the Committee which are related to executive compensation or benefits plans. * Obtains education and training to exercise all responsibilities effectively and keeps abreast of significant developments in executive compensation practices and regulations. * Ensures that all aspects of executive compensation adhere to all relevant regulatory requirements. * Reviews the Committee charter annually and revises it as appropriate and conduct an annual evaluation of the Committee's performance. Form 990, Part VI, Section C, line 18 Form 1023 and Form 990 are available upon request. The organization does not file a 990T currently. Form 990, Part VI, Section C, line 19 The conflict of interest policy and financial statements are available upon request. Articles of Incorporation are available through the North Carolina Secretary of State website. Mission Health System Inc 509 Biltmore Avenue Asheville NC 28803 581450888 Parent Company Support Services, Mission Hospital & Affiliates NC 501(c)(3) Line 11a, I 0 Mission Hospital Inc 509 Biltmore Avenue Asheville NC 28803 560532141 Acute Care Hospital NC 501(c)(3) Line 3 Mission Health System Inc 0 Mission Healthcare Foundation Inc 980 Hendersonville Road Asheville NC 28803 561881331 Foundation NC 501(c)(3) Line 7 Mission Health System Inc 0 The McDowell Hospital Inc 430 Rankin Drive Marion NC 28752 560623938 Community Hospital NC 501(c)(3) Line 3 Mission Health System Inc 0 Blue Ridge Regional Hospital Post Office Box 9 Spruce Pine NC 28777 561025032 Community Hospital NC 501(c)(3) Line 3 Mission Health System Inc 0 Imaging Realty LLP 534 Biltmore Avenue Asheville NC 28801 561907203 Medical Building NC N/A MSJHS and CCP Joint Development Company LLC 428 Biltmore Avenue Asheville NC 28801 562250464 Long Term Acute Care Hospital NC N/A Horizon Health Corp 213 Ridgefield Court Asheville NC 28806 561341621 Holding Company NC N/A C Horizon Management Services Inc 213 Ridgefield Court Asheville NC 28806 561341624 Patient Billing and Collection Services, Medical Property NC N/A C Dogwood Insurance Company The Grand Pavilion Commercial Centr Cayman Islands CJ Captive Insurance Company CJ N/A C 0 0 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0