2011-05-03T13:53:48-05:00 2010-09-30 DIXON HUGHES GOODMAN LLP 500 Ridgefield Court Asheville NC 28806 990 2009-10-01 561458024 TRANSYLVANIA REGIONAL HOSPITAL FOUNDATION INC TRAN 8288874777 PO BOX 2440 BREVARD NC 28712 R THOMAS NIX 8288874777 2011-05-02 1 Amy Bibby 8282542254 2009 2016-02-24 21:20:13Z ROBERT J BEDNAREK PO BOX 2440 BREVARD NC 28712 2157005 0 X n/a X 1985 NC RECEIVE AND ADMINISTER CHARITABLE CONTRIBUTIONS 17 15 7 150 0 0 1517318 1528001 0 -411234 625819 9467 -288 1115551 2153532 1945629 1525435 0 227141 219053 0 104988 344600 395389 2517370 2139877 -1401819 13655 7911068 8159182 1900457 1875202 6010611 6283980 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 1552887 1525435 SUPPORT PROVIDED TO TRANSYLVANIA COMMUNITY HOSPITAL, INC. (D/B/A TRANSYLVANIA REGIONAL HOSPITAL, "THE HOSPITAL"):- $ 453,000 FOR THE CANCER AND INFUSION CENTER- $ 400,000 FOR CAPITAL CAMPAIGN- $ 630,000 FOR OPERATIONAL SUPPORTAPPROXIMATELY $367,700 IN GRANTS WERE RECEIVED FROM: - THE DUKE ENDOWMENT (HEALTH RESOURCE NAVIGATOR, THE FREE CLINIC OF TRANSYLVANIA COUNTY) - THE JANIRVE FOUNDATION (CANCER) - LAKE TOXAWAY CHARITIES (TOXAWAY RX, HEALTH CENTER, FRANCES WARD RX, KOALA) - NC STROKE CARE COLLABORATIVE (STROKE) - NC DEPARTMENT OF HEALTH AND HUMAN SERVICES (BIRTHING CENTER, COLLABORATION)NEARLY $ 650,000 IN GRANTS WERE RECEIVED FROM DONORS SUCH AS THE LAKE TOXAWAY ENDOWMENT, AS WELL AS VARIOUS CHARITABLE GIFT ANNUITIES.OVER $88,000 WAS DISTRIBUTED TO: - RX ASSISTANCE PROGRAMS $7,187 - FREE CLINIC OF TRANSYLVANIA COUNTY $ 20,000 - SCHOLARSHIPS $ 11,194 - OTHER PROGRAMS AND EVENTS $ 50,084"DESSERT WITH THE DOC" WAS PRESENTED THIS YEAR, WITH 18 PHYSICIANS AND HEALTHCARE PROFESSIONALS PARTICIPATING. OVER 1,100 ATTENDEES ATTENDED THE 33 EVENTS DURING THE YEAR. THE EVENT WAS SPONSORED BY THE HURLBURT FAMILY FOUNDATION. 1552887 1 1 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 7 0 0 0 0 0 0 0 0 0 0 17 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X X SHARON JOHNSON 8288774777 153 WEST JORDAN STREET BREVARD NC 28712 W ANDREW HARVILL 5.00 X X 0 0 0 JEFFREY P HUNT 2.00 X X 0 0 0 R THOMAS NIX 2.00 X X 0 0 0 ROBERT J BEDNAREK 2.00 X X 0 236950 59978 RAY H DUNKELBERG MD 2.00 X 0 97605 0 DANIEL P ELLIOTT 2.00 X 0 0 0 RUSSELL R FRENCH 2.00 X 0 0 0 CARTER W HOPKINS 2.00 X 0 0 0 KATHERYN DANNELLY 2.00 X 0 0 0 DONALD E JORDAN ESQ 2.00 X 0 0 0 RAYMOND MILLER 2.00 X 0 0 0 ALVIN W LEFAIVRE 2.00 X 0 0 0 FREDERICK J MARKERT 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 PATRICIA R WEBB 2.00 X 0 0 0 SHARON C JOHNSON CFRE 40.00 X 84265 0 25542 84265 334555 85520 0 0 1 0 0 26858 215601 140000 1145542 107003 1528001 241636 241636 384183 384183 384183 384183 3185 26858 3473 -288 -288 2153532 0 0 625531 1506748 1506748 18687 18687 109807 27452 27451 54904 109246 109246 23 23 177980 177980 16 16 188882 138798 50084 22675 22675 1146 1146 MISCELLANEOUS EXPENSES 4667 4667 2139877 1552887 482002 104988 16064 28813 567653 735504 492181 247403 2098 2090 216432 42176 175402 174256 6621938 6939945 35732 31171 7911068 8159182 639 399 1899818 1874803 1900457 1875202 X 2236286 2513063 3287519 3421696 486806 349221 6010611 6283980 7911068 8159182 X 0 1 1 X 0 X X X 0 0 0 TRANSYLVANIA COMMUNITY HOSPITAL INC 560562293 3 1 1 1 1525435 1 1525435 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 3079854 531745 3611599 3008487 71367 3079854 0.87380 0.02950 0.09670 0 0 171000 171000 45432 42176 3256 174256 SALES TAX RECEIVABLE 4273 ARTWORK HELD FOR RESALE 26898 31171 2153532 2139877 13655 127005 241087 -108378 259714 273369 2525097 127005 241087 3473 371565 2153532 0 2153532 2251728 111851 111851 2139877 0 2139877 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. Part V, Line 4: Description of Intended Use of Endowment Funds: 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. Part XI, Line 8 - Other Adjustments: CHANGE IN SPLIT INTEREST AGREEMENT: -108378. Part XII, Line 2d - Other Adjustments: FUNDRAISING EVENT EXPENSES: 3473. Part XIII, Line 2d - Other Adjustments: CHANGE IN SPLIT INTEREST AGREEMENT: 108378. FUNDRAISING EVENT EXPENSES: 3473. BREAST CANCER AWARENESS LUNCHEON 10757 7572 3185 863 2610 THINK PINK RALLY WEEK 14116 14116 1 5170 5170 30043 26858 3185 863 2610 3473 -288 1 TRANSYLVANIA COMMUNITY HOSPITAL INC PO BOX 1116 BREVARD NC 28712 560562293 501(C)(3) 453552 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) 630593 OPERATIONAL SUPPORT THE FREE CLINIC OF TRANSYLVANIA COUNTY INC PO BOX 1135 BREVARD NC 28712 431980011 501(C)(3) 20000 MEDICATION FOR THE UNINSURED AND MEDICALLY INDIGENT 2 0 JANE WALKER FREEMAN & LINDGREN MEMORIAL NURSING SCHOLARSHIP 7 11194 RX ASSISTANCE PROGRAM 7187 PROVISION OF PRESCRIPTION MEDICATION FOR THE MEDICALLY INDIGENT AND UNDERINSURED 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. X X X X X 0 0 0 0 0 0 0 0 0 ROBERT J BEDNAREK 0 217039 0 14975 0 4936 0 50332 0 9646 0 296928 0 0 Supplemental Information Part III PART I, LINE 3: OFFICERS OF THE ORGANIZATION ARE COMPENSATED BY TRANSYLVANIA REGIONAL 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 - INDEPENDENT COMPENSATION CONSUTANTS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION STUDY/SURVEY - APPROVAL BY THE BOARD/COMPENSATION COMMITTEE X 2 107003 STOCK PRICE ON GIFT DATE 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. TRANSYLVANIA HEALTH SYSTEM INC 260 HOSPITAL DRIVE BREVARD NC 28712 561456987 HEALTHCARE NC 501(c)(3) Line 11b, II N/A TRANSYLVANIA COMMUNITY HOSPITAL INC 260 HOSPITAL DRIVE BREVARD NC 28712 560562293 HEALTHCARE NC 501(c)(3) Line 3 N/A TRANSYLVANIA PHYSICIAN SERVICES INC 260 HOSPITAL DRIVE BREVARD NC 28712 561920816 HEALTHCARE NC 501(c)(3) Line 3 N/A 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