returnoforganization exemptfromincometax ombno...

Form 990Department of the Treasury

Internal Revenue Service

Return of Organization Exempt From Income TaxOMB No 1545-0047

Under section 501 (c), 527 , or 4947(a)(1) of the Internal Revenue Code (except black lung 2®1 tlbenefit trust or private foundation) Open to Public

00, The organization may have to use a copy of this return to satisfy state reporting requirements Inspection

A For the 2011 calendar year , or tax year beginning OCT 1 , 2 011 and ending S EP 30, 2012

B Check if C Name of organization D Employer identification numberapplicable

-]Addrechangess Mission Hospital, IncNamehange Doln Business As

Initialreturn

Da1edinNumber and street ( or P.O. box if mail is not delivered to street address)

400 Ridgefield CourtAmeeFX-I returnnded

E:Iii n °a-ho

City or town , state or country , and ZIP + 4

Asheville , NC 28806pending

F Name and address of principal officer Charles F.

same as C aboveAyscue

I Tax-exem pt status L-XJ 501 ( c)(3) 501 ( c) ( A (insert no .) 4947(a)(

J Website www.mission-health.org

K Form of orcianization : Corporation Trust Association Other 00

mmarv

1:5t0

1--UCD

0LL9

56-05321 41

Room/suite E Telephone number100 (828)257 -7004

G Gross receipts $ 915,839,322.H(a) Is this a group return

for affiliates? Li Yes ©No

H(b) Are all affiliates included? El Yes E::]No

1) or 527 If "No," attach a list (see instructions)

H(c) Group exemption number 00.

L Year of formation: 19 5 51 M State of legal domicile NC

1 Briefly describe the organization's mission or most significant activities To improve the health of thepeople of Western North Carolina and the surrounding region.

2 Check this box 00- L-J if the organization discontinued its operations or disposed of more than 25% of its net assets

a 3 Number of voting members of the governing body (Part VI, line 1 a) 203

O 4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 16

5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) 5 7253

6 Total number of volunteers (estimate if necessary) 6 779

7 a Total unrelated business revenue from Part VIII, column (C), line 12 7a 807 , 507

b Net unrelated business taxable income from Form 990-T, line 34 7b 549, 508.

Prior Year Current Year

8 Contributions and grants (Part VIII, line 1 h) 9,443 , 904. • 8,191, 059 .

9 Program service revenue (Part VIII, line 2g) 862,508 , 231. 905,167,732.w 10 Investment Income (Part VIII, column (A), lines 3, 4, and 7d) -157, 728. 28, 946.

11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11 e) 777, 588. 970,824 .

12 Total revenue - add lines 8 through 11 must equ al Part VIII, column (A) , line 12 ) 872,571 , 995. 914,358,561.13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) 2,338,450. 3,106,255.14 Benefits paid to or for members (Part IX, column (A), line 4) 0 . 0 .

Go 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 369,822, 637. 393,706,467.co) 16a Professional fundraising fees (Part IX, column (A), line 11e) 0 . 0

X b Total fundraising expenses (Part IX, column (D), line 25) 00, 0

W 17 Other expenses (Part IX, column (A), lines 11 a-11 d, 11 f-24e) 430,135,568. 428,472,176.18 Total expenses Add lines 13-17 (must equal Part IX, column (A), line 25) 802,296 ,655. 825,284,898.19 Revenue less expenses Subtract line 18 from li ne 12 70,275,340. 89,073,663.

ow Beginning of Current Year End of Year

N^ 20 Total assets (Part X, line 16) 8 4 8 ,19 2, 4 8 4. 9 6 4, 2 2 0, 8 8 8.aco 21 Total liabilities (Part X , line 26) 82,524,600. 109,429,491.

22 Net assets or fund balances Subtract line 21 from line 20 765,667,884. 1 854,791,397.

Under penalties of perjury,

true, correct, and complo6

Sign

Here

Paid

Preparer

Use Only

132001 01-23-12 LHA For Paperwork Reduction Act Notice , see the

Form 990 2011 Mission Hosp ital, Inc 56-0532141 Part [[I Statement of Program Service Accomplishments

Check if Schedule 0 contains a response to any question in this Part III 0

1 Briefly describe the organization's mission:

See Schedule 0

2 Did the organization undertake any significant program services during the year which were not listed on

the prior Form 990 or 990-EZ? E]Yes 0 No

If "Yes," describe these new services on Schedule 0.

3 Did the organization cease conducting , or make significant changes in how it conducts , any program services? LlYes 0 No

If "Yes," describe these changes on Schedule 0.

4 Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses.

Section 501 (c)(3) and 501 (c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to

others, the total expenses, and revenue, if any, for each program service reported.

4a (Code ) (Expenses $ 676,967,433 . including grants of $ 3,059,255 . ) (Revenue $ 900,177,190. )In 2012, Thomson Reuters released its fourth annual study identifyingthe top U.S. health systems based on balanced system-wide clinicalperformance. The Thomson Reuters 15 Top Health Systems study culleddata from more than 300 organizations and singled out 15 health systemsthat achieved superior clinical outcomes based on a composite score ofeight measures of quality, patient perception of care and efficiency.

See Schedule 0 for additional program service accomplishments.

4b (Code ) (Expenses $ including grants of $ (Revenue $

4c (Code ) (Expenses $ including grants of $ ) (Revenue $

4d Other program services (Describe in Schedule 0.)

(Expenses $ including grants of $ ) (Revenue $

4e Total program service expenses► 676,967,433.

Form 990 (2011)

08530901 351485 56-0532141 2011.05070 Mission Hospital, Inc

O2-092 See Schedule 0 for Continuation(s)2

56-05322

3Form 99O 2011 Mission Hospital, Inc 56-0532141 PagePart EV Checklist of Required Schedules

Yes No

1 Is the organization described in section 501 (c)(3) or 4947(a)(1) (other than a private foundation)?

If "Yes," complete Schedule A 1 X

2 Is the organization required to complete Schedule B, Schedule of Contributors? 2 X

3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for

public office? If "Yes," complete Schedule C, Part 1 3 X

4 Section 501 (c)(3) organizations . Did the organization engage in lobbying activities, or have a section 501(h) election in effect

during the tax year? If "Yes," complete Schedule C, Part Il 4 X

5 Is the organization a section 501 (c)(4), 501 (c)(5), or 501 (c)(6) organization that receives membership dues, assessments, or

similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part 111 5 X

6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to

provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part 1 6 X

7 Did the organization receive or hold a conservation easement, including easements to preserve open space,

the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part// 7 X

8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete

Schedule D, Part 111 8 X

9 Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide

credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV 9 X

10 Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent

endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V 10 X

11 If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X

as applicable.

a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete Schedule D,

Part Vl 11 a X

b Did the organization report an amount for investments - other securities in Part X, line 12 that is 5% or more of its total

assets reported in Part X, line 16? If "Yes," complete Schedule D, Part Vll 11b X

c Did the organization report an amount for investments - program related in Part X, line 13 that is 5% or more of its total

assets reported in Part X, line 16? If "Yes," complete Schedule D, Part Vlll 11c X

d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in

Part X, line 16? If "Yes," complete Schedule D, Part IX 11d X

e Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X 11e X

f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses

the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X 11f X

12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete

Schedule D, Parts X1, X11, and X111 12a X

b Was the organization included in consolidated, independent audited financial statements for the tax year?

If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI, X11, and Xlll is optional 12b X

13 Is the organization a school described in section 170(b)(1)(A)(u)? If "Yes," complete Schedule E 13 X

14a Did the organization maintain an office, employees, or agents outside of the United States? 14a X

b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business,

investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000

or more? If "Yes," complete Schedule F, Parts 1 and IV 14b X

15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization

or entity located outside the United States? If "Yes," complete Schedule F, Parts ll and IV 15 X

16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals

located outside the United States? If "Yes," complete Schedule F, Parts 111 and IV 16 X

17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,

column (A), lines 6 and 11 e? If "Yes," complete Schedule G, Part 1 17 X

18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines

1 c and 8a? If "Yes," complete Schedule G, Part ll 18 X

19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes,"

complete Schedule G, Part 111 19 X

20a Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H 20a X

b If "Yes" to line 20a. did the organization attach a copy of its audited financial statements to this return? 20b X

Form 990 (2011)

13200301-23-12

308530901 351485 56-0532141 2011.05070 Mission Hospital, Inc 56-05322

4Form 990 2011 Mission Hosp ital, Inc 56-0532141 PagePart IV Checklist of Required Schedules (continued)

Yes No

21 Did the organization report more than $5,000 of grants and other assistance to any government or organization in the

United States on Part IX, column (A), line 1 ? If "Yes," complete Schedule I, Parts I and 11 21 X

22 Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX,

column (A), line 2? If "Yes," complete Schedule 1, Parts 1 and 1/l 22 X

23 Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current

and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete

Schedule J 23 X

24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the

last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b through 24d and complete

Schedule K. If "No", go to line 25 24a X

b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? 24b

c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease

any tax-exempt bonds" 24c

d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? 24d

25a Section 501 (c)(3) and 501 (c)(4) organizations . Did the organization engage in an excess benefit transaction with a

disqualified person during the year? If "Yes," complete Schedule L, Part I 25a X

b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and

that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? If "Yes," complete

Schedule L, Part I 25b X

26 Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified

person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part /l 26 X

27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial

contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member

of any of these persons? If "Yes," complete Schedule L, Part 111 27 X

28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV

instructions for applicable filing thresholds, conditions, and exceptions):

a A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV 28a X

b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV 28b X

c An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer,

director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV 28c X

29 Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M 29 X

30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation

contributions? If "Yes," complete Schedule M 30 X

31 Did the organization liquidate, terminate, or dissolve and cease operations?

If "Yes," complete Schedule N, Part 1 31 X

32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete

Schedule N, Part ll 32 X

33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations

sections 301.7701-2 and 301.7701-3? If "Yes, " complete Schedule R. Part 1 33 X

34 Was the organization related to any tax-exempt or taxable entity?

If "Yes," complete Schedule R, Parts II, Ill, IV, and V, line 1 34 X

35a Did the organization have a controlled entity within the meaning of section 512(b)(13)" 35a X

b Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of

section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 35b X

36 Section 501 (c)(3) organizations . Did the organization make any transfers to an exempt non-charitable related organization?

If "Yes," complete Schedule R, Part V, line 2 36 X

37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization

and that is treated as a partnership for federal income tax purposes) If "Yes," complete Schedule R, Part VI 37 X

38 Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11 and 19?

Note. All Form 990 filers are required to complete Schedule 0 38 X

Form 990 (2011)

13200401-23-12


Form 990 2011 Mission Hosp ital, Inc 56-0532141 Pa e5Part V Statements Regarding Other IRS Filings and Tax Compliance

Check if Schedule 0 contains a response to any question in this Part V

la Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable la 422

b Enter the number of Forms W-2G included in line 1 a Enter -0- if not applicable lb 0

c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming

(gambling) winnings to prize winners?

2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,

filed for the calendar year ending with or within the year covered by this return 2a 7253

b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note . If the sum of lines 1 a and 2a is greater than 250, you may be required to a-file (see instructions)

3a Did the organization have unrelated business gross income of $1,000 or more during the year?

b If "Yes," has it filed a Form 990-T for this year? If "No," provide an explanation in Schedule 0

4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a

financial account in a foreign country (such as a bank account, securities account, or other financial account)?

b If "Yes," enter the name of the foreign country: No, -

See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.

5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?

b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

c If "Yes," to line 5a or 5b, did the organization file Form 8886-T?

6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit

any contributions that were not tax deductible?

b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts

were not tax deductible'?

7 Organizations that may receive deductible contributions under section 170(c).

a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor'

b If "Yes," did the organization notify the donor of the value of the goods or services provided?

c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required

to file Form 8282?

d If "Yes," indicate the number of Forms 8282 filed during the year 7d

e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?

g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?

h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?

8 Sponsoring organizations maintaining donor advised funds and section 509(a )( 3) supporting organizations . Did the supporting

organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?

9 Sponsoring organizations maintaining donor advised funds.

a Did the organization make any taxable distributions under section 4966?

b Did the organization make a distribution to a donor, donor advisor, or related person?

10 Section 501(c)(7) organizations . Enter:

a Initiation fees and capital contributions included on Part VIII, line 12 10a

b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities 10b

11 Section 501(c)(12) organizations . Enter:

a Gross income from members or shareholders 11a

b Gross income from other sources (Do not net amounts due or paid to other sources against

amounts due or received from them.) 11b

12a Section 4947(a)(1) non -exempt charitable trusts . Is the organization filing Form 990 in lieu of Form 1041?

b If "Yes," enter the amount of tax-exempt interest received or accrued during the year 12b

13 Section 501 (c)(29) qualified nonprofit health insurance issuers.

a Is the organization licensed to issue qualified health plans in more than one state?

Note. See the instructions for additional information the organization must report on Schedule 0.

b Enter the amount of reserves the organization is required to maintain by the states in which the

organization is licensed to issue qualified health plans 13b

c Enter the amount of reserves on hand 13c

14a Did the organization receive any payments for indoor tanning services during the tax year?

b If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule 0

13200501-23-12


Yes No

1c X

2b X

3a X

3b X

4a X

5a X

5b X

5c

6a X

6b

7a X

7b

7c X

7e

7f X

7

7h

8

12a

14a I I X

Form 990 (2011)

56-05322

Form 990 (2011) Mission Hospital, Inc 56-0532141 Page6Tart VI Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and fora "No" response

to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule 0. See instructions.

Check if Schedule 0 contains a response to any question in this Part VI 0

Section A. Governin g Body and ManagementYes No

la Enter the number of voting members of the governing body at the end of the tax year 1 a 20

If there are material differences in voting rights among members of the governing body, or if the governing

body delegated broad authority to an executive committee or similar committee, explain in Schedule 0

b Enter the number of voting members included in line 1 a, above, who are independent 1 b 16

2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other

officer, director, trustee, or key employee? 2 X

3 Did the organization delegate control over management duties customarily performed by or under the direct supervision

of officers, directors, or trustees, or key employees to a management company or other person? 3 X

4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? 4 X

5 Did the organization become aware during the year of a significant diversion of the organization's assets? 5 X

6 Did the organization have members or stockholders? 6 X

7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or

more members of the governing body? 7a X

b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or

persons other than the governing body? 7b X

8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following

a The governing body? 8a X

b Each committee with authority to act on behalf of the governing body? 8b X

9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the

organization's mailin g address? If "Yes " provide the names and addresses in Schedule 0 9 X

Section B. Policies his Section B requests information about policies not required by the Internal Revenue Code )

Yes No

10a Did the organization have local chapters, branches, or affiliates? 10a X

b If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates,

and branches to ensure their operations are consistent with the organization's exempt purposes? 10b

11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? 11a X

b Describe in Schedule 0 the process, if any, used by the organization to review this Form 990.

12a Did the organization have a written conflict of interest policy? If "No," go to line 13 12a X

b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts 12b X

c Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe

in Schedule 0 how this was done 12c X

13 Did the organization have a written whistleblower policy? 13 X

14 Did the organization have a written document retention and destruction policy? 14 X

15 Did the process for determining compensation of the following persons include a review and approval by independent

persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

a The organization's CEO, Executive Director, or top management official 15a X

b Other officers or key employees of the organization 15b X

If "Yes" to line 15a or 15b, describe the process in Schedule 0 (see instructions).

16a Did the organization invest in, contribute assets to, or participate in a point venture or similar arrangement with a

taxable entity during the year? 16a X

b If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation

in point venture arrangements under applicable federal tax law, and take steps to safeguard the organization's

exempt status with respect to such arrangements? 16b X

Section C . Disclosure17 List the states with which a copy of this Form 990 is required to be filed ► None

18 Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only) available

for public inspection Indicate how you made these available . Check all that apply.

0 Own website Another's website 0 Upon request

19 Describe in Schedule 0 whether (and if so , how), the organization made its governing documents , conflict of interest policy , and financial

statements available to the public during the tax year.

20 State the name , physical address, and telephone number of the person who possesses the books and records of the organization: ►Mission Finance Dept - 828-257-7004400 Ridgefield Court, Suite 100, Asheville, NC 28806

01-23-12 Form 990 (2011)


Form 990 2011 Mission Hospital, Inc 56-0532141

Part, VU Compensation of Officers , Directors, Trustees, Key Employees, Highest Compensated

Employees, and Independent ContractorsCheck if Schedule 0 contains a response to any question in this Part VII 1XI

Section A. Officers . Directors , Trustees . Key Employees, and Highest Compensated Employees

1a Complete this table for all persons required to be listed Report compensation for the calendar year ending with or within the organization's tax year

• List all of the organization' s current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation.Enter •0• in columns (D), (E), and (F) if no compensation was paid.

• List all of the organization' s current key employees, if any. See instructions for definition of "key employee."

• List the organization' s five current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable

compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations.

• List all of the organization' s former officers, key employees, and highest compensated employees who received more than $100,000 of

reportable compensation from the organization and any related organizations.

• List all of the organization' s former directors or trustees that received, in the capacity as a former director or trustee of the organization,

more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees;and former such persons.

O Check this box if neither the organization nor any related or anizatlon compensated any current officer, director, or trustee.

(A) (B) (C) (D) (E) (F)

Name and Title Average Position Reportable Reportable Estimated

hours per(do not check more than onebox, unless person is both an compensation compensation amount of

week officer and a director/trustee ) from from related other

(describe the organizations compensation

hours for i & organization (W-2/1099•MISC) from the

related3 01 (W 2/1099 MISC) organization

organizations 9 o and related

in Schedule a organizations0) b Pn

Y x aEi

(1) Janice W. Brumit

Chairman 9.20 X X 0. 0. 0

(2) Robert C . Roberts

Vice Chairman & Treasurer 2.30 X X 0. 0. 0.

(3) Darryl J. Hart

Secretary 3.20 X X 0. 0. 0.

(4) George D . Renfro

Director 12.00 X 0 • 0 • 0

(5) R. Ray Bailey

Director 2.80 X 0. 0. 0

(6) John R. Ball

Director 2.80 X 0. 0• 0

(7) George Bilbrey , Jr., M.D.

-

Director 7.50 X 0 . 0 • 0

( B) Richard W. Bock, M.D.

Director 5.10 X 0 • 0 • 0

(9) John F.A.V. Cecil

Director 2. 70 X 0• 0• 0

(10) W. Leon Elliston, M.D.

-

Director 4 .2 0 X 0. 0. 0.

( 11) Brian R . England, M.D.

Director 2. 10 X 0• 0• 0

( 12) John W. Garrett, M.D.

Director 4.20 X 0. 0. 0.(13) William S. Hickman

Director 7.40 X 0. 0. 0.

(14) William E. Lee

Director 2.70 X 0. 0. 0

(15) Robert M. Moore, Jr.

Director 3.00 X 0. 0. 0.

(16) Charles D. Owen, III

Director 4.20 X 0. 0• 0

(17) Anna S. Shivers

Director 2.70 X 0. 0. 0 .-

132007 01 - 23-12 Form 990 (2011)7


Form 990 2011 Mission Hosp ital, Inc 56-0532141 V.'lrt V111 ce..ti,rn A mm- n;-t- T.,,.f- Levu RmnI, vuec an'1 Winhact (mmnonsated Emnlnvees (cnnttnued)

(A) (B) (C) (D) (E) (F)

Name and title Average Position Reportable Reportable Estimated

hours per(do not ch eck more than onebox, unless person is both an compensation compensation amount of

week officer and a director/trustee) from from related other(describe i the organizations compensationhours for b organization (W2/1099•MISC) from therelated (W2/1099•MISC) organization

organizations g and relatedin Schedule 9 1-3 organizations

0) oC

E E

= d

`

(18) Wyatt S. Stevens

Director 5.50 X 0. 0. 0 .

(19) Pamela M. Turner

Director 3.00 X 0. 0. 0 .

( 20) Ronald Paulus, M.D.

System President & CEO 70.00 X X 1, 371, 164. 0. 232, 641.

(21) Charles F. Ayscue

Chief Financial Officer 65.00 X 577, 872. 0. 112,792.

(22) Dr. Jill Hoggard Green,

Hospital President & COO 65.00 X 146, 785. 0. 23,890.(23) Ann Y. Young

General Counsel 60.00 X 373, 306. 0. 54,191.(24) Brian Aston

Chief Operating Officer 60.00 X 390, 345. 0. 13,076.( 25) Dale Fell, M.D.

Chief Medical Officer 60.00 X 483,613. 0. 92,199.(26) Donald A. Jennings

Chief Information Officer 60.00 X 436, 081. 0 . 33,118.

1b Sub-total ► 3, 779, 946. 0 . 561,907.

c Total from continuation sheets to Part VII, Section A ► 2,486,450. 0 . 344,146.

d Total (add lines lbandlc) ► 6,266,396. 0. 906,053.

2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable

compensation from the organization ► 227

Yes No

3 Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on

line 1 a? If "Yes, " complete Schedule J for such individual 3 X

4 For any individual listed on line 1 a, is the sum of reportable compensation and other compensation from the organization

and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual 4 X

5 Did any person listed on line 1 a receive or accrue compensation from any unrelated organization or individual for services

rendered to the organization? If "Yes " complete Schedule J for such person 5 X

Section B. Independent Contractors

1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from

thn nr, ,n-tinn Rennrt rmmnaneatinn fnr tha calonrinr va r anrlinn with or within tha nrnnnl7atinn'e tax vP.ar_

(A) (B) (C)Name and business address Description of services Compensation

MAHEC501 Biltmore Avenue, Asheville, NC 28801 Residenc y Program 8,000,987.Asheville Anesthesia, 76 Peachtree Road,Suite 300, Asheville, NC 28803 Medical Services 3,899,020.Freeman White Architectural8845 Red Oak Boulevard, Charlotte, NC 28217 Services 2,333,771.Asheville Heart, PA257 McDowell Street, Asheville, NC 28803 edical Services 2,129,013.Asheville Pulmonary & Critical Care Associa30 Choctaw Street, Asheville, NC 28801 edical Services 1,590,457.2 Total number of independent contractors (including but not limited to those listed above) who received more than

$ 100 ,000 of com pensation from the or anization ► 10 3

See Part VII, Section A Continuation sheets

132008 01-23-12


Form 990 (2011)

56-05322

Form 990 2011 Mission Hosp ital, Inc 56-0532141

Part V4f Section A. Officers. Directors . Trustees . Kev Emnlovees. and Hiahest Compensated Emolovees (continued)

(A)

Name and title

(B)

Average

hours

(C)

Position

(check all that apply)

(D)

Reportable

compensation

(E)

Reportable

compensation

(F)

Estimated

amount of

per

week

v n .Y

o

_a2

o

from

theorganization

(W-2/1099-MISC)

from related

organizations(W-2/1099-MISC)

other

compensation

from the

organization

and related

organizations

(27) Kathy Guyette

Chief Nursing Officer 60.00 X 334, 767. 0 . 55,299.(28) Maria Roloff

VP Human Resources 60.00 X 255, 250. 0. 55,626.(29) Dr. William Maples

Chief Quality Officer 60.00 X 425, 535. 0. 47,489.(30) Rhonda Miller

VP Revenue Cycle 60.00 X 326, 923. 0 . 38,283.(31) James F. Reel, M.D.

Chief Medical Information Officer 60.00 X 301, 502. 0 . 23, 580 .(32) John J. Maher

VP System Integration 60.00 X 251, 302. 0 . 68,054.(33) Karen Lemieux

VP Heart Services 60.00 X 245, 895. 0 . 49,989.(34) Joseph F. Damore

Former CEO and Director 0.00 X 345, 276. 0 . 5,826.

Total to Part VII Section A , line 1 c 2 F 4861450. 344,146.

132201 05-01-11


Form 990 2011 Mission Hospital , Inc 56-0532141 Page9

Part VIII Statement of Revenue

(A) (B) (C) (D)Revenue

Total revenue Related or Unrelated excluded fromexempt function business tax under

revenue revenue sections 512,513, or 514

y y>= C

1 a Federated campaigns la

o b Membership dues lb

yQ c Fundraising events 1c

6 d Related organizations 1 d 8, 191 , 0 5 9.

vi E_ e Government grants (contributions) 1eOy f All other contributions , gifts, grants, and

M.C similar amounts not included above if

C'p 9 Noncash contnbutions included in lines la-1f $

VIn h Total. Add lines 1 a-1 f ► 8 , 191,059.

Business Code

0 2a Patient Revenue 900099 885039181. 884231674. 807,507.b Affiliate Income 900099 12855163. 12855163.

Oar- c Dietary Services 722210 4,183,035. 4183035.MW d Joint Ventures 621990 3,090,353. 3,090,353.

o e

a f All other program service revenue

Total . Add lines 2a-2f ► 905167732. :3 Investment income (including dividends , interest, and

other similar amounts) ► 7,528. 7,528.

4 Income from investment of tax-exempt bond proceeds ►5 Royalties ►

( i ) Real a Personal

6 a Gross rents 489,870. 5,180..b Less- rental expenses 2 88,866 . 5,180.

c Rental income or (loss ) 2 01,004. 0. 1d Net rental income or (loss ) ► 201,004* 201,004.

7 a Gross amount from sales of ( i ) Securities a Other

assets other than inventory 102,027

b Less . cost or other basis

and sales expenses 80,609.c Gain or (loss) 21,418 .

d Net gain or (loss ) ► 21,418. 21,418.

d 8 a Gross income from fundraising events (not

including $ of

ai contributions reported on line 1c). See

Part IV, line 18 a

= b Less: direct expenses b

c Net income or (loss ) from fundraising events ►9 a Gross income from gaming activities. See

Part IV, line 19 a

b Less - direct expenses b

c Net income or (loss ) from gaming activities ►10 a Gross sales of inventory , less returns

and allowances a 1875926.

b Less : cost of goods sold b 1106106.

c Net income or loss from sales of invento ► 769 , 820. 769,820.Miscellaneous Revenue Business Code

11 a

b

c

d All other revenue

e Total . Add lines 11a-11d ►12 Total revenue See instructions ► 914358561. 1900177190. 1 807,507. 1 5182805*

13200901-23-12 Form 990 (2011)


Mission Hospital, IncStatement of Functional

56-0532141

Section 501(c)(3) and 501 (c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to

complete columns (B), (C), and (D).

Check if Schedule 0 contains a res onse to any question in this Part IX E]

Do not include amounts reported on lines Bb,76, 86, 96, and f06 of Part V///.

(A)Total expenses

(B)Program service

expenses

(C)Management andgeneral eenses

(D)Fundraisingexpenses

1 Grants and other assistance to governments and

organizations in the United States See Part IV , line 21 3 ,059,255. 3,059,255.

2 Grants and other assistance to individuals in

the United States . See Part IV , line 22 47,000. 47,000.

3 Grants and other assistance to governments,

organizations , and individuals outside the

United States . See Part IV , lines 15 and 16

4 Benefits paid to or for members

5 Compensation of current officers, directors,

trustees , and key employees 4,678,714. 4,678,714.

6 Compensation not included above , to disqualified

persons ( as defined under section 4958(f)(1)) and

persons described in section 4958 (c)(3)(B)

7 Other salaries and wages 313,565, 391. 38, 309, 697. 75,255,694.

8 Pension plan accruals and contributions (include

section 401 ( k) and section 403(b) employer contributions ) 10 , 366, 516 7,878,552. 2 , 487 , 964

9 Other employee benefits 41, 498, 788. 31, 539, 079. 9, 959, 709.

10 Payroll taxes 23, 597, 058. 17, 933, 764. 5,663,294.

11 Fees for services (non-employees).

a Management 3, 052, 965. 2, 533, 961. 519,004.

b Legal 1 , 739, 490. 1, 739, 490.

c Accounting 221,902. 221,902.

d Lobbying 113, 500. 113,500.

e Professional fundraising services See Part IV, line 17

f Investment management fees

g Other 84,747,147. 70,340,132. 14,407,015.

12 Advertising and promotion 5,197,099. 4,313,592. 883,507.

13 Office expenses 2, 710, 639. 2, 249, 830. 460,809.

14 Information technology 13,509,981. 11,213,284. 2,296,697.

15 Royalties

16 Occupancy 36, 110, 341. 29, 971, 583. 6,138,758.

17 Travel 1, 401, 782. 1, 163, 479. 238, 303.

18 Payments of travel or entertainment expenses

for any federal , state, or local public officials

19 Conferences , conventions , and meetings

20 Interest

21 Payments to affiliates

22 Depreciation , depletion, and amortization 60,418,883. 50,147,673. 10,271,210.

23 Insurance 15, 937, 119. 13, 227, 809. 2,709,310.24 Other expenses Itemize expenses not covered

above ( List miscellaneous expenses in line 24e If line24e amount exceeds 10% of line 25, column (A)amount , list line 24e expenses on Schedule 0 )

a Medical Supplies 172,432,881. 167,259,895. 5,172,986.b Equipment Leases 11,714,565. 9,723,081. 1,991,484.c medical Equip Repairs & 9,099,407. 7,552,508. 1,546,899.d UBI Taxes 213,151. 213,151.e All other expenses 9, 851, 324. 8, 176, 608. 1, 674, 716.

25 Total functional ex p enses . Addlines1throu g h 24e 825,284,898 . 676,967,433. 148,317,465. 0.26 Joint costs . Complete this line only it the organization

reported in column ( B) joint costs from a combined

educational campaign and fundraising solicitation

Check here 0' if followin g SOP 98-2 (ASC 958-720)

132010 01-23-12 Form 990 (2011)11


Form 990 2011 Mission Hosp ital, Inc 56-0532141 Pa ellPart X Balance Sheet

(A) (B)Beginning of year End of year

1 Cash - non-interest-bearing 1

2 Savings and temporary cash investments 1,162,086. 2 1,162,088.3 Pledges and grants receivable, net 3

4 Accounts receivable, net 185,557,162. 4 288,372,80 8.5 Receivables from current and former officers, directors, trustees, key

,

employees, and highest compensated employees. Complete Part II

of Schedule L 5

6 Receivables from other disqualified persons (as defined under section

4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing

employers and sponsoring organizations of section 501 (c)(9) voluntary

employees' beneficiary organizations (see instructions) 6

y 7 Notes and loans receivable, net 7

, 8 Inventories for sale or use 14,016,791. 8 14,252,680.9 Prepaid expenses and deferred charges 6,330,771. 9 7,885,787.10a Land, buildings, and equipment: cost or other

basis. Complete Part VI of Schedule D 10a 1233291726.b Less: accumulated depreciation 10b 600,436,059. 622,916,007. 1 0c 632,855,667.

11 Investments - publicly traded securities 11

12 Investments - other securities. See Part IV, line 11 12

13 Investments - program-related. See Part IV, line 11 18,209,667. 13 19,691,858.14 Intangible assets 14

15 Other assets. See Part IV, line 11 15

16 Total assets. Add lines 1 throw h 15 must equal line 34 848,192,484. 16 964,220,888.17 Accounts payable and accrued expenses 66,911,812. 17 69,745,393.18 Grants payable 18

19 Deferred revenue 15, 464, 768. 19 36, 298, 827.20 Tax-exempt bond liabilities 20

0 21 Escrow or custodial account liability. Complete Part IV of Schedule D 2122 Payables to current and former officers, directors, trustees, key employees,

,o highest compensated employees, and disqualified persons. Complete Part II

of Schedule L 22

23 Secured mortgages and notes payable to unrelated third parties 23

24 Unsecured notes and loans payable to unrelated third parties 24

25 Other liabilities (including federal income tax, payables to related third

parties, and other liabilities not included on lines 17.24). Complete Part X of

ScheduleD 148,020. 25 3,385,271.26 Total liabilities . Add lines 17 throu gh 25 82,524,600. 26 109,429,491.

Organizations that follow SFAS 117, check here L and complete

lines 27 through 29, and lines 33 and 34.

E_ 27 Unrestricted net assets 765,667,884. 27 854,791,397.m 28 Temporarily restricted net assets 28

29 Permanently restricted net assets 29

LL Organizations that do not follow SFAS 117, check here ► 0 and

o complete lines 30 through 34.

30 Capital stock or trust principal, or current funds 30

31 Paid-in or capital surplus, or land, building, or equipment fund 31

32 Retained earnings, endowment, accumulated income, or other funds 32

Z 33 Total net assets or fund balances 765,667,884. 33 854,791,397.34 Total liabilities and net assets/fund balances 848,192,484. 34 964,220,888.

Form 990 (2011)

132011 01-23-12


Form 990 2011 Mission Hospital, Inc 56-0532141 Pa e12Part Xl Reconciliation of Net Assets

Check if Schedule 0 contains a response to any question in this Part XI

1 Total revenue (must equal Part VIII, column (A), line 12) 1 914,358,561.2 Total expenses (must equal Part IX, column (A), line 25) 2 825,284,898.3 Revenue less expenses. Subtract line 2 from line 1 3 89,073,663.4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) 4 765,667,884.

5 Other changes in net assets or fund balances (explain in Schedule 0) 5 49,850.6 Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must eq ual Part X, line 33, column (B)) 6 85417911397.Part X[ Financial Statements and Reporting

Check if Schedule 0 contains a response to any question in this Part XII EJYes No

1 Accounting method used to prepare the Form 990 : = Cash 0 Accrual = Other

If the organization changed its method of accounting from a prior year or checked " Other ,' explain in Schedule 0.

2a Were the organization 's financial statements compiled or reviewed by an independent accountant? 2a X

b Were the organization 's financial statements audited by an independent accountant? 2b X

c If "Yes " to line 2a or 2b , does the organization have a committee that assumes responsibility for oversight of the audit,

review , or compilation of its financial statements and selection of an independent accountant? 2c X

If the organization changed either its oversight process or selection process during the tax year , explain in Schedule 0.

d If "Yes ' to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a

separate basis, consolidated basis , or both:

= Separate basis 0 Consolidated basis = Both consolidated and separate basis

3a As a result of a federal award , was the organization required to undergo an audit or audits as set forth in the Single Audit

Act and OMB Circular A• 133? 3a X

b If "Yes ," did the organization undergo the required audit or audits? If the organization did not undergo the required audit

or audits . explain why in Schedule 0 and describe any steps taken to undergo such audits. 3b F

Form 990 (2011)

13201201-23-12

1308530901 351485 56 -0532141 2011.05070 Mission Hospital, Inc 56-05322

SCHEDULE A Public Charity Status and Public Support(Form 990 or 990-EZ)

Complete if the organization is a section 501 (c)(3) organization or a section

Department of the Treasury 4947(a)(1) nonexempt charitable trust.

Internal Revenue Service ► Attach to Form 990 or Form 990-EZ. ► See separate instructions.

OMB No 1545-0047

2011Open to publicInspection

Name of the organization Employer identification number

Mission Hosp ital, Inc 56-0532141

Part Reason for Public Charity Status (All organizations must complete this part.) See Instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box)

1 E] A church, convention of churches, or association of churches described in section 170 (b)(1)(A)(i).

2 El A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

3 A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

4 A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name,

city, and state:

5 71 An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170 (b)(1)(A)(iv) . (Complete Part II.)

6 D A federal, state , or local government or governmental unit described in section 170 (b)(1)(A)(v).

7 EJ An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170 (b)(1)(A)(vi ). (Complete Part II.)

8 E] A community trust described in section 170(b)(1)(A)(vi ). (Complete Part II.)

9 = An organization that normally receives * ( 1) more than 33 1/3% of its support from contributions , membership fees, and gross receipts from

activities related to its exempt functions • subject to certain exceptions , and (2 ) no more than 33 1/3% of its support from gross investment

income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975.

See section 509(a )(2). (Complete Part III.)

10 An organization organized and operated exclusively to test for public safety . See section 509(a)(4).

11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or

more publicly supported organizations described in section 509 (a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that

describes the type of supporting organization and complete lines 11 a through 11 h.

a = Type I b = Type II c 0 Type III • Functionally integrated d = Type Ill Other

e By checking this box , I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than

foundation managers and other than one or more publicly supported organizations described in section 509 (a)(1) or section 509(a)(2).

f If the organization received a written determination from the IRS that it is a Type I , Type II, or Type III

supporting organization, check this box

Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (II) and (iii) below,

the governing body of the supported organization?

(ii) A family member of a person described in (I) above''

(iii) A 35% controlled entity of a person described in (I) or (II) above?

Provide the following information about the supported organization(s).

Yes No

11 i

11 ii

(i) Name of supportedorganization

(II) EIN(iii) Type oforganization

(described on lines 1-9above or IRC section

iv) Is the organization

in col (1) listed in yourgoverning document?

(v) Did you notify theorganization in col(i) of your support?

(vi) Is thecol

(I)or Inzedlln

the(I) gaU S

(vii) Amount of

support

(see instructions )) Yes No Yes No Yes No

Total

LHA For Paperwork Reduction Act Notice, see the Instructions for Schedule A (Form 990 or 990 -EZ) 2011

Form 990 or 990-EZ.

13202101-24-12


Schedule A (Form 990 or 990-E 2011 Page 2

Part It Support Schedule for Organizations Described in Sections 170(b)( 1)(A)(iv) and 170(b)(1)(A)(vi)(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization

fails to qualify under the tests listed below, please complete Part III.)

Section A. Public SupportCalendar year (or fiscal year beginning in ) ► (a) 2007 (b) 2008 (c) 2009 2010 (e) 2011 Total

1 Gifts, grants, contributions, and

membership fees received. (Do not

include any 'unusual grants.")

2 Tax revenues levied for the organ-

ization's benefit and either paid to

or expended on its behalf

3 The value of services or facilities

furnished by a governmental unit to

the organization without charge

4 Total. Add lines 1 through 3

5 The portion of total contributions

by each person (other than a

governmental unit or publicly

supported organization) included

on line 1 that exceeds 2% of the

amount shown on line 11,

column (f)

6 Public support. Subtract line 5 from line 4

Section B. Total Support

Calendar year ( or fiscal year beginning In) ►7 Amounts from line 4

8 Gross income from interest,

dividends, payments received on

securities loans, rents, royalties

and income from similar sources

9 Net income from unrelated business

activities, whether or not the

business is regularly carried on

10 Other income. Do not include gain

or loss from the sale of capital

11

12

(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 Total

assets (Explain in Part IV.)

Total support . Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) 12

13 First five years . If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501 (c)(3)

Section C.14 Public support percentage for 2011 (line 6, column (f) divided by line 11, column (f)) 14 %

15 Public support percentage from 2010 Schedule A, Part II, line 14 15 %

16a 33 1 /3% support test - 2011 . If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and

stop here . The organization qualifies as a publicly supported organization ►0b 331 /3% support test - 2010. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box

and stop here . The organization qualifies as a publicly supported organization ►017a 10% -facts -and-circumstances test - 2011 . If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more,

and if the organization meets the "facts-and-circumstances" test, check this box and stop here . Explain in Part IV how the organization

meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ►0b 10% -facts -and-circumstances test - 2010 . If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or

more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here . Explain in Part IV how the

organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ►018 Private foundation . If the oroamzation did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions ►

Schedule A (Form 990 or 990-EZ) 2011

13202201-24-12


Schedule A (Form 990 or 990-EZ) 2011 Page 3Part Il Support Schedule for Organizations Described in Section 509(a)(2)

(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to

qualify under the tests listed below, please complete Part II.)

Section A. Public SupportCalendar year ( or fiscal year beginning in ) ► (a) 2007 (b) 2008 (c) 2009 (cQ 2010 (e) 2011 Total

1 Gifts, grants, contributions, and

membership fees received. (Do not

include any "unusual grants ")

2 Gross receipts from admissions,merchandise sold or services per-formed, or facilities furnished inany activity that is related to theorganization's tax-exempt purpose

3 Gross receipts from activities thatare not an unrelated trade or bus-

iness under section 513

4 Tax revenues levied for the organ-

ization's benefit and either paid to

or expended on its behalf

5 The value of services or facilities

furnished by a governmental unit to

the organization without charge

6 Total . Add lines 1 through 5

7a Amounts included on lines 1, 2, and

3 received from disqualified persons

b Amounts included on lines 2 and 3 received

from other than disqualified persons that

exceed the greater of $5,000 or 1 % of the

amount on line 13 for the year

c Add lines 7a and 7b

8 Public support (Subuzict line 7c from line 6 )

Section B. Total SupportCalendar year (or fiscal year beginning in) ►9 Amounts from line 6

10a Gross income from interest,dividends, payments received onsecurities loans, rents, royaltiesand income from similar sources

b Unrelated business taxable income

(less section 511 taxes) from businesses

acquired after June 30, 1975

c Add lines 1 Oa and 1 Ob11 Net income from unrelated business

activities not included in line 10b,whether or not the business isregularly carried on

12 Other income. Do not include gainor loss from the sale of capitalassets (Explain in Part IV.)

13 Total support (Add lines 9, 10c, 11, and 12)

(a ) 2007 b 2008 c 2009 2010 a 2011 Total

14 First five years . If the Form 990 is for the organization ' s first , second, third, fourth, or fifth tax year as a section 501 (c)(3) organization,

check this box and stop here ► []Section C . Computation of Public SuDDOrt Percentage15 Public support percentage for 2011 (line 8, column (f) divided by line 13, column (f)) 15 %

16 Public support percentage from 2010 Schedule A, Part III, line 15 16 %

Section D. Computation of Investment Income Percentage

17 Investment income percentage for 2011 (line 10c, column (f) divided by line 13, column (f)) 17

18 Investment income percentage from 2010 Schedule A, Part III, line 17 18

19a 33 1 /3% support tests - 2011 . If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not

more than 33 1/3%, check this box and stop here . The organization qualifies as a publicly supported organization

b 33 1 /3% support tests - 2010 . If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and

line 18 is not more than 33 1/3%, check this box and stop here . The organization qualifies as a publicly supported organization ►020 Private foundation . If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ► LI132023 01-24- 12 Schedule A (Form 990 or 990-EZ) 2011

16

%


SCHEDULE C(Form 990 or 990-EZ)

Department of the TreasuryInternal Revenue Service

Political Campaign and Lobbying ActivitiesFor Organizations Exempt From Income Tax Under section 501 (c) and section 527

01 Complete if the organization is described below. 01 Attach to Form 990 or Form 990-EZ.

101, See seDarate instructions.

OMB No 1545-0047

2011Open to Public

Inspection

If the organization answered "Yes" to Form 990, Part IV , line 3, or Form 990-EZ , Part V, line 46 (Political Campaign Activities), then

• Section 501 (c)(3) organizations: Complete Parts I•A and B. Do not complete Part I•C.

• Section 501(c) (other than section 501 (c)(3)) organizations: Complete Parts I•A and C below. Do not complete Part I•B.

• Section 527 organizations: Complete Part I•A only.

If the organization answered "Yes" to Form 990, Part IV, line 4, or Form 990-EZ , Part VI, line 47 (Lobbying Activities), then

• Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A Do not complete Part II-B.

• Section 501 (c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A

If the organization answered "Yes" to Form 990, Part IV , line 5 (Proxy Tax), or Form 990-EZ, Part V, line 35c (Proxy Tax), then

• Section 501 (c )(4) , (5 ) , or (6 ) organizations: Complete Part Ill.

Name of organization Employer identification number

Mission Hospital, Inc 1 56-0532141

?Part [A Complete if the organization is exempt under section 501 (c) or is a section 527 organization.

1 Provide a description of the organization's direct and indirect political campaign activities in Part IV.

2 Political expenditures $

3 Volunteer hours

Part l-B Complete if the organization is exempt under section 501 (c)(3).1 Enter the amount of any excise tax incurred by the organization under section 4955 $

2 Enter the amount of any excise tax incurred by organization managers under section 4955

3 If the organization incurred a section 4955 tax, did it file Form 4720 for this year? Yes No

4a Was a correction made? Yes No

b If "Yes describe in Part IV.

Part i-G Complete if the organization is exempt under section 501 (c), except section 501 (c)(3).

1 Enter the amount directly expended by the filing organization for section 527 exempt function activities $

2 Enter the amount of the filing organization's funds contributed to other organizations for section 527

exempt function activities $

3 Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120•POL,

line 17b $

4 Did the filing organization file Form 1120-POL for this year? Yes No

5 Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing organization

made payments. For each organization listed, enter the amount paid from the filing organization's funds. Also enter the amount of political

contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a

political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name (b) Address (c) EIN (d) Amount paid fromfiling organization's

funds. If none, enter -0•.

(e) Amount of politicalcontributions received and

promptly and directlydelivered to a separatepolitical organization

If none, enter -0-.

For Paperwork Reduction Act Notice , see the Instructions for Form 990 or 990 -EZ. Schedule C (Form 990 or 990- EZ) 2011

LHA

13204101-27-12


ScheduleC (Form 990or990•E 2011 Mission Hospital, Inc 56-0532141 Pa e2Part fl-A Complete if the organization is exempt under section 501 (c)(3) and filed Form 5768

(election under section 501(h)).

A Check 00, LJ if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN,

expenses , and share of excess lobbying expenditures).

01 if the filina oraanization checked box A and " limited cor

(a) Filing I (b) Affiliated groupLimits on Lobbying Expenditures

organization's totals(The term expenditures means amounts paid or incurred .) totals

1 a Total lobbying expenditures to influence public opinion (grass roots lobbying)

b Total lobbying expenditures to influence a legislative body (direct lobbying)

c Total lobbying expenditures (add lines 1 a and 1 b)

d Other exempt purpose expenditures

g Grassroots nontaxable amount (enter 25% of line 10

h Subtract line 1g from line la. If zero or less, enter -0-

i Subtract line if from line 1c. If zero or less, enter •0•

If there is an amount other than zero on either line 1 h or line 11, did the organization file Form 4720

reporting section 4911 tax for this year? El Yes El No

4-Year Averaging Period Under Section 501(h)

(Some organizations that made a section 501(h) election do not have to complete all of the five

columns below. See the instructions for lines 2a through 2f on page 4.)

Lobbying Expenditures During 4-Year Averaging Period

Calendar year(or fiscal year beginning in)

(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total

2a Lobby in g nontaxable amount

b Lobbying ceiling amount

(150% of line 2a, column(e))

c Total lobbyin g expenditures

d Grassroots nontaxable amount

e Grassroots ceiling amount

(150% of line 2d, column (e))

f Grassroots lobby in g expenditures

Schedule C (Form 990 or 990-EZ) 2011

13204201-27-12


e Total exempt purpose expenditures (add lines 1c and 1d)

Schedule C (Form 990or990•E 2011 Mission Hospital, Inc 56-0532141 Pa e3

Part 11-8 Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768

(election under section 501(h)).

For each "Yes" response to lines la through 1/ below, provide in Part IV a detailed description (a) (b)

of the lobbying activity. Yes No Amount

1 During the year, did the filing organization attempt to influence foreign, national, state or

local legislation, including any attempt to influence public opinion on a legislative matter

or referendum, through the use of:

a Volunteers? X

b Paid staff or management (include compensation in expenses reported on lines 1 c through 11)? X

c Media advertisements? X

d Mailings to members, legislators, or the public? X

e Publications, or published or broadcast statements? X

f Grants to other organizations for lobbying purposes? X

g Direct contact with legislators, their staffs, government officials, or a legislative body? X 91,145.

h Rallies , demonstrations, seminars, conventions, speeches, lectures, or any similar means? X

i Other activities? X 231 , 750.

j Total. Add lines 1 c through 11 322,895.

2a Did the activities in line 1 cause the organization to be not described in section 501 (c)(3)? X

b If "Yes," enter the amount of any tax incurred under section 4912

c If "Yes," enter the amount of any tax incurred by organization managers under section 4912

d If the filing organization incurred a section 4912 tax , did it file Form 4720 for this year?

Part Ili-A Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section

501 (c)(6).Yes No

1 Were substantially all (90% or more) dues received nondeductible by members? 1

2 Did the organization make only in-house lobbying expenditures of $2,000 or less? 2

3 Did the organization agree to carry over lobby in g and political expenditures from the prior year? 3

Part III-B Complete if the organization is exempt under section 501 (c)(4), section 501(c)(5), or section

501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered " No" OR (b) Part III -A, line 3, is

answered "Yes."

1 Dues, assessments and similar amounts from members 1

2 Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political

expenses for which the section 527 (f) tax was paid).

a Current year 2a

b Carryover from last year 2b

c Total 2c

3 Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues 3

4 If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess

does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political

expenditure next year? 4

5 Taxable amount of lobbying and political expenditures (see instructions) 5

Complete this part to provide the descriptions required for Part I-A, line 1; Part 1•B, line 4 ; Part I•C, line 5; Part II -A; and Part II- B, line 1 Also, complete

this part for any additional information.

Part II-B, Line 1, Lobbying Activities:

Mission Hospital employs consultants for health care issues - Other

than direct contact with legislators, staffs, government officials or a

legislative body, other activities include tracking of proposed and

filed legislation, attendance at administrative and legislative

committee meetings, advising senior leadership on strategy,Schedule C (Form 990 or 990-EZ) 2011

132043 01-27-12


ScheduleC (Form 990or990•E 2011 Mission Hospital , Inc 56-0532141 Pa e4

Part tV Supplemental Information (continued)

oraanization of briefing sessions and loqistics and scheduling of

senior leadership visits.

Breakdown of above costs:

Direct contact with legislators paid to independent contractors $

56,750

Estimate of portion of AHA dues expended for specific lobbying $

34, 395

Other activities paid to independent contractors(described above) $

56,750

Advocacy on National Issues

$175,000

Schedule C (Form 990 or 990-EZ) 2011

132044 01-27-12


SCHEDULE D Supplemental Financial Statements V'"'°'"° "'-VV"'(Form 990) ► Complete if the organization answered "Yes," to Form 990 , 2011

Part IV , line 6, 7 , 8, 9, 10 , 11 a, l l b, 11 c, l l d , Ile, 11If , 12a, or 12b. Open to Pub.116Department the TreasuryInternal Reven ue Serv

iceice 10, Attach to Form 990. 10' See separate instructions . Instpection


Mission Hosp ital, Inc 56-0532141Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts . Complete if the

organization answered "Yes" to Form 990, Part IV, line 6.(a) Donor advised funds (b) Funds and other accounts

1 Total number at end of year

2 Aggregate contributions to (during year)

3 Aggregate grants from (during year)

4 Aggregate value at end of year

5 Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds

are the organization's property, subject to the organization's exclusive legal control? Yes No

6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only

for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring

impermissible private benefit? 0 Yes No

Part It Conservation Easements . Complete if the organization answered "Yes' to Form 990, Part IV, line 7.

1 Purpose (s) of conservation easements held by the organization (check all that apply)

Preservation of land for public use (e . g., recreation or education ) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last

day of the tax year.

[ 1 Held at the End of the Tax Year

a Total number of conservation easements 2a

b Total acreage restricted by conservation easements 2b

c Number of conservation easements on a certified historic structure included in (a) 2c

d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure

listed in the National Register 2d

3 Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax

year ►4 Number of states where property subject to conservation easement is located ►

5 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of

violations, and enforcement of the conservation easements it holds? 0 Yes E] No

6 Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year ►

7 Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year ► $

8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(I)

and section 170(h)(4)(B)(II)? 0 Yes No

9 In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and

include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for

conservation easements.

Pert It[ Organizations Maintaining Collections of Art, Historical Treasures , or Other Similar Assets.

Complete if the organization answered "Yes" to Form 990, Part IV, line 8

is If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art,

historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIV,

the text of the footnote to its financial statements that describes these items.

b If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical

treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts

relating to these items.

(i) Revenues Included in Form 990, Part VIII, line 1 ► $

(ii) Assets included in Form 990, Part X ► $

2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide

the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

a Revenues Included in Form 990, Part VIII, line 1 ► $

b Assets Included in Form 990, Part X ► $

LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule D (Form 990) 201113205101-23-12


ScheduleD (Form 990 2011 Mission Hospital, Inc 56-0532141 Pa e2

part 111 Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

3 Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its collection items

(check all that apply):

a EDPublic exhibition d 0 Loan or exchange programs

b Scholarly research e 0 Other

c Preservation for future generations

4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIV.

5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets

to be sold to raise funds rather than to be maintained as part of the orci anization's collection? 0 Yes No

Part IV Escrow and Custodial Arrangements . Complete if the organization answered "Yes" to Form 990, Part IV, line 9, or

reported an amount on Form 990 , Part X, line 21.

la Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included

on Form 990, Part X?

b If "Yes," explain the arrangement in Part XIV and complete the following table:

c Beginning balance

d Additions during the year

e Distributions during the year

f Ending balance

2a Did the organization include an amount on Form 990, Part X, line 21?

b If "Yes." explain the arrangement in Part XIV.

= Yes = No

Part V Endowment Funds . Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

la Beginning of year balance

b Contributions

c Net investment earnings, gains, and losses

d Grants or scholarships

e other expenditures for facilities

and programs

f Administrative expenses

g End of year balance

(a ) Current year (b) Prior year (c) Two years back d Three ears back a Four years back

4 , 664 , 953. 4 , 711 , 681. 4 , 547 , 329. 3 1 839 , 833.

61 , 836. 103 544. 131 834. 552 663.

900 879. 65 , 168. 183 727. 307 349.

229 450. 215 440. 151 209. 152 516.

5 , 398 , 218. 4 , 664 , 953. 4 1 711 , 681. 4 , 547 , 329.

2 Provide the estimated percentage of the current year end balance (line 1 g, column (a)) held as,

a Board designated or quasi•endowment ► 15 • 4 3 %

b Permanent endowment ► 63.93 %c Temporarily restricted endowment ► 20.64 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

3a Are there endowment funds not in the possession of the organization that are held and administered for the organization

by: Yes No

(i) unrelated organizations 3a i X

(ii) related organizations 3a ii X

b If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? 3b X

4 Describe in Part XIV the intended uses of the organization's endowment funds.

Part V1 Land_ Buildinas . and Eauioment . See Form 990. Part X. line 10.

Description of property (a) Cost or other

basis (investment)

(b) Cost or other

basis (other)

(c) Accumulated

depreciation

(d) Book value

la Land 31 ,336,747. : 31,336,747.

b Buildings 712, 344, 203. 40, 982, 296 .

c Leasehold improvements 8, 516 , 4 5 4.

.

2, 3 8 0, 916 .

d Equipment 324, 317, 365. 80, 723, 734 .

e other 156,776,957. 77,431,974.Total . Add lines 1 a throu g h 1 e. (Column (d) must equal Form 990, Part X column (B), line 10(c)) ► 632,855,667.

Schedule D (Form 990) 2011

13205201-23-12


ScheduleD (Form 990 2011 Mission Hospital, Inc 56-0532141 Pa e3

Part VII Investments - Other Securities . See Form 990, Part X, line 12.

(a) Description of security or category

(including name of security)(b) Book value

(c) Method of valuation:

Cost or end-of-year market value

(1) Financial derivatives

(2) Closely- held equity interests

(3) Other

(A)

(B)

(C)

( D)

(G )

(H )

Total. ( Col ( b ) must a ual Form 990 , Part X col 8 line 12 ►

Part Vi11I Investments - Program Related . See Form 990, Part X, line 13

(a) Description of investment type (b) Book value(c) Method of valuation:

Cost or end-of-year market value

1

(2 )

(3 )

(4 )

(5 )

(6 )

(7 )

(8 )

(9)

( 10 )

Total. ( Col ( b ) must e q ual Form 990 , Part X , col ( B ) line 13 ►


Schedule D (Form 990 ) 2011 Mission Hospital, Inc 56-0532141 Page4

Part X1 I Reconciliation of Change in Net Assets from Form 990 to Audited Financial Statements

1 Total revenue (Form 990, Part VIII, column (A), line 12) 12 Total expenses (Form 990, Part IX, column (A), line 25) 2

3 Excess or (deficit) for the year. Subtract line 2 from line 1 3

4 Net unrealized gains (losses) on investments 4

5 Donated services and use of facilities 5

6 Investment expenses 6

7 Prior period adjustments 7

8 Other (Describe in Part XIV.)

9 Total adjustments (net). Add lines 4 through 8T-9n10 Excess or deficit for the year per audited financial statements. Combine lines 3 and 9

Part Al Reconciliation of Revenue per Audited Financial Statements With Revenue per Return

1 Total revenue, gains, and other support per audited financial statements 1

2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:

a Net unrealized gains on investments 2a

b Donated services and use of facilities 2b

c Recoveries of prior year grants 2c

d Other (Describe in Part XIV.) 2d

e Add lines 2a through 2d 2e

3 Subtract line 2e from line 1 3

4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:

a Investment expenses not included on Form 990, Part VIII, line 7b 4a

b Other (Describe in Part XIV.) 4b

c Add lines 4a and 4b 4c

5 Total revenue. Add lines 3 and 4c. his must equal Form 990, Part 1 line 12 ) 5

Part X1111 Reconciliation of Expenses per Audited Financial Statements With Expenses per Return

1 Total expenses and losses per audited financial statements 1

2 Amounts included on line 1 but not on Form 990, Part IX, line 25:

a Donated services and use of facilities 2a

b Prior year adjustments 2b

c Other losses 2c

d Other (Describe in Part XIV.) 2d

e Add lines 2a through 2d 2e

3 Subtract line 2e from line 1 3

4 Amounts included on Form 990, Part IX, line 25, but not on line 1:

a Investment expenses not included on Form 990, Part VIII, line 7b 4a

b Other (Describe in Part XIV) 4b

c Add lines 4a and 4b 4c

5 Total expenses Add lines 3 and 4c. his must equal Form 990, Part 1 line 18. ) 5

Part XIV Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1 a and 4; Part IV, lines 1 b and 2b; Part V, line 4; Part

X, line 2; Part XI, line 8, Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Part V, line 4: Endowment Funds are held at the Mission Healthcare

Foundation, Inc and used for various donor restrictions in accordance with

Mission Hospital's tax exempt purpose.

Part X, Line 2: Mission applies the provisions of FASB ASC Topic 740

for Income Taxes in accountinq 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.Schedule D (Form 990) 2011

13205401-23-12


ScheduleD (Form 990 2011 Mission Hosp ital , Inc 56-0532141 Pa e5Par AR Supplemental Information (continued)

There is currently no impact on mission's combined financial statements as

a result of the aoolication of ASC 740.

13205501-23-12


Schedule D (Form 990) 2011

56-05322

SCHEDULE H OMB No 1545-0047

(Form 990) Hospitals10, 2 1Complete if the organization answered "Yes" to Form 990, Part IV , question 20.

Department of the Treasury ► Attach to Form 990. ► See separate instructions . Open to PublicInternal Revenue Service Inspection


Mission Hosp ital, Inc 56-0532141Part I Financial Assistance and Certain Other Community Benefits at Cost

Yes No

1 a Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a la X

b If "Yes ," was it a written policy? 1 b X2 If the organization had multiple hospital facilities , indicate which of the following best describes application of the financial assistance policy to its vanous hospital

facilities during the tax year

Applied uniformly to all hospital facilities EJ Applied uniformly to most hospital facilities

Generally tailored to individual hospital facilities

3 Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization ' s patients during the tax year

a Did the organization use Federal Poverty Guidelines ( FPG) to determine eligibility for providing free care ? If "Yes,"

Indicate which of the following was the FPG family income limit for eligibility for free care: 3a X

0 100% 0 150% 0 200% [_1 Other %

b Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: 3b X

= 200% = 250% 300% El 350% E] 400% Other %

c If the organization did not use FPG to determine eligibility , describe in Part VI the income based criteria for determining

eligibility for free or discounted care . Include in the description whether the organization used an asset test or other

threshold , regardless of income , to determine eligibility for free or discounted care.

4 Did the organization ' s financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the

'medicall indi ent'?

4 X

y g

X5a Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? 5a

b If "Yes ," did the organization ' s financial assistance expenses exceed the budgeted amount? 5b X

c If 'Yes " to line 5b , as a result of budget considerations , was the organization unable to provide free or discounted

care to a patient who was eligible for free or discounted care? 5c X

6a Did the organization prepare a community benefit report during the tax year? 6a X

b If "Yes ," did the organization make it available to the public? 6b X

Comp lete the followin g table usin g the worksheets provided in the Schedule H instructions Do not submit these worksheets with the Schedule H

7 Cinanniel Acmetanrn and (.nrtain (lthar (:nmmiinity Ranafit at rnct

Financial Assistance and

Means-Tested Government Programs

(a) Number ofactivities or

programs (optional)

(b) Personsserved

(optional )

(C) Totalcommunity

benefit expense

(d) Directoffsettingrevenue

(e) Netcommunity

benefit expense

(f) Percent oftotal expense

a Financial Assistance at cost (from

Worksheet 1) 2 0427511. 0427511. 2.48%

b Medicaid (from Worksheet 3,

column a) 113055208 120470509 - 7415301. .00%

c Costs of other means -tested

government programs (from

Worksheet 3, column b)

d Total Financial Assistance and

Means-Tested Government Programs 133482719 120470509 13012210. 2.48'o

Other Benefits

e Community health

improvement services and

community benefit operations

(from Worksheet 4) 8706474. 930,504. 7775970. .94%f Health professions education

(from Worksheet 5) 9443580. 6929301. 2514279. .30%g Subsidized health services

(from Worksheet 6) 31926040. 5995242. 25930798. 3.14%h Research (from Worksheet 7) 2223071. 570,758. 1652313. .20%i Cash and in -kind contributions

for community benefit (from

worksheet s) 3631549. 3631549. .44%j Total . Other Benefits 5 5930714. 14425805. 141504909. 5.02%k Total . Add lines 7dand7 189413433 134896314 54517119. 7.50%

132091 01-23-12 LHA For Paperwork Reduction Act Notice , see the Instructions for Form 990.


Schedule H (Form 990) 2011

56-05322

ScheduleH (Form 990 2011 Mission Hosp ital , Inc 56-0532141 Pa e2

Part I1 Community Building Activities complete this table if the organization conducted any community building activities during the

tax year. and describe in Part VI how its community budding activities promoted the health of the communities it serves.

(a) Number ofactivities or programs

(optional)

(b) Persons

served (optional)(C) Totalcommunity

building expense

(d) Directoffsetting revenue

(e) Netcommunity

building expense

(f) Percent of

total expense

1 Ph ysical im p rovements and housin g

2 Economic development

3 Community support

4 Environmental improvements

5 Leadership development and

trainin g for communit y members

6 Coalition buildin g

7 Community health improvement

advocacy

8 Workforce development 811, 611. 811, 611. .10%9 Other

10 Total 811,611. 1 1 811 611. .10%

I.Part RI I Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

1 Did the organization report bad debt expense in accordance with Healthcare Financial Management Association

Statement No. 15? 1

2 Enter the amount of the organization's bad debt expense 2 6 9 , 6 4 4 , 4 5 6 .

3 Enter the estimated amount of the organization's bad debt expense attributable to

patients eligible under the organization's financial assistance policy 3

4 Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt

expense. In addition, describe the costing methodology used in determining the amounts reported on lines

2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

5 Enter total revenue received from Medicare (including DSH and IME) 5 53, 0 0 7 , 19 0 .

6 Enter Medicare allowable costs of care relating to payments on line 5 6 R 71,033 , 475.

7 Subtract line 6 from line 5. This is the surplus (or shortfall) 7 j- 1 8 , 0 2 6 , 2 85 .

8 Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.

Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.

Check the box that describes the method used:

Cost accounting system MI Cost to charge ratio El Other

Section C . Collection Practices

9a Did the organization have a written debt collection policy during the tax year? 9a

b If "Yes," did the organization's collection policy that applied to the largest number of its patients during the tax year contain provisions on the

collection practices to be followed for patients who are known to q uali fy for financial assistance' Describe in Part VI 9b

Yes I No

X

X

XPart IV I Manaaement Companies and Joint Ventures (see instructions)

(a) Name of entity (b) Description of primaryactivity of entity

(c) Organization'sprofit % or stockownership %

(d) Officers, direct-ors, trustees, orkey employees'profit % or stockownership %

(e) Physicians'profit % or

stockownership %

1 Asheville Imaging ut atient ImagingCenter, LLP Services 69.00% .84% 29.16%

a netic Resonance

2 Asheville MRI Imag ing 50.00% 2.82% 47.18%-

132092 01-23-12



56-05322

ScheduleH (Form 990 2011 Mission Hospital , Inc 56-0532141 Pa e3

Part 1l Facility Information

Section A. Hospital Facilities

(list in order of size, from largest to smallest)

ow many hospital facilities did the organization operate

during the tax year? 1

Name and address

d^'

o

'a

C

U

=i

rn

f0

-5E

N

N

0

YO-

o

y

LU

0^

o

o

L

U

f-

U)

Nt

ro

ftl

Y

U

T„

ro

CoN

No^

o

N'iw

OEw

her (describe)

1 Mission Hosp ital509 and 428 Biltmore AvenueAsheville, NC 28801 X X X X

132093 01-23-12



56-05322

ScheduleH (Form 990 2011 Mission Hosp ital, Inc 56-0532141 Pa e4

Part Y Facility Information (continued)Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility : Mission Hospital, Inc.

Line Number of Hospital Facility (from Schedule H, Part V, Section A):

Community Health Needs Assea tax year 2011

1 During the tax year or any prior tax year , did the hospital facility conduct a community health needs assessment (Needs

Assessment)? If "No," skip to line 8

If "Yes," indicate what the Needs Assessment describes (check all that apply):

a 0 A definition of the community served by the hospital facility

b Demographics of the community

c Existing health care facilities and resources within the community that are available to respond to the health needs

of the community

d How data was obtained

e The health needs of the community

f Primary and chronic disease needs and other health issues of uninsured persons , low-income persons , and minority

groups

g The process for identifying and prioritizing community health needs and services to meet the community health needs

h The process for consulting with persons representing the community's interests

i Information gaps that limit the hospital facility's ability to assess the community ' s health needs

j Other (describe in Part VI)

2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20

3 In conducting its most recent Needs Assessment , did the hospital facility take into account input from persons who represent

the community served by the hospital facility? If "Yes," describe in Part VI how the hospital facility took into account input

from persons who represent the community , and identify the persons the hospital facility consulted

4 Was the hospital facility ' s Needs Assessment conducted with one or more other hospital facilities ? If "Yes," list the other

hospital facilities in Part VI

5 Did the hospital facility make its Needs Assessment widely available to the public?

If "Yes," indicate how the Needs Assessment was made widely available (check all that apply):

a Hospital facility' s website

b Available upon request from the hospital facility

c Other (describe in Part VI)

6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment , indicate how (check all

that apply)-

a Adoption of an implementation strategy to address the health needs of the hospital facility 's community

b Execution of the implementation strategy

c Participation in the development of a community -wide community benefit plan

d Participation in the execution of a community -wide community benefit plan

e Inclusion of a community benefit section in operational plans

f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment

g Prioritization of health needs in its community

h Prioritization of services that the hospital facility will undertake to meet health needs in its community

i Other (describe in Part VI)

7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment ? If "No," explain

in Part VI which needs it has not addressed and the reasons why it has not addressed such needs

Financial Assistance

Did the hospital facility have in place during the tax year a written financial assistance policy that.

8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?

9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate the FPG family income limit for eligibility for free care: 150 %

If "No," explain in Part VI the criteria the hospital facility used.

132094 01-23-12

No



Mission Hospital, Inc 56-0532141 Pa e5Pali Y Facilitv Information (continued) Mission Hospital, Inc.

Yes No

10 Used FPG to determine eligibility for providing discounted care? 10 X

If "Yes," indicate the FPG family income limit for eligibility for discounted care: 300 %

If "No," explain in Part VI the criteria the hospital facility used.

11 Explained the basis for calculating amounts charged to patients? 11 X

If "Yes," indicate the factors used in determining such amounts (check all that apply):

a Income level

b Asset level

c Medical indigency

d Insurance status

e Uninsured discount

f 0 Medicaid/Medicare

g State regulation

h MI Other (describe in Part VI)

12 Explained the method for applying for financial assistance? 12 X

13 Included measures to publicize the policy within the community served by the hospital facility? 13 X

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

a The policy was posted on the hospital facility ' s website

b The policy was attached to billing invoices

c The policy was posted in the hospital facility ' s emergency rooms or waiting rooms

d The policy was posted in the hospital facility ' s admissions offices

e 0 The policy was provided, in writing , to patients on admission to the hospital facility

f The policy was available on request

q Other (describe in Part VI)

Billin g and Collections

14 Did the hospital facility have in place during the tax year a separate billing and collections policy , or a written financial

assistance policy (FAP) that explained actions the hospital facility may take upon non -payment? 14 X

15 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax

year before making reasonable efforts to determine patient's eligibility under the facility's FAP:

a Reporting to credit agency

b Lawsuits

c Liens on residences

d Body attachments

e Other similar actions (describe in Part VI)

16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making

reasonable efforts to determine the patient's eligibility under the facility' s FAP? 16 X

If "Yes," check all actions in which the hospital facility or a third party engaged:

a Reporting to credit agency

b Lawsuits

c Liens on residences

d Body attachments

e Other similar actions (describe in Part VI)

17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that

apply),

a 0 Notified patients of the financial assistance policy on admission

b 0 Notified patients of the financial assistance policy prior to discharge

c Notified patients of the financial assistance policy in communications with the patients regarding the patients' bills

d Documented its determination of whether patients were eligible for financial assistance under the hospital facility's

financial assistance policy

132095 01-23-12 Schedule H (Form 990) 2011


ScheduleH (Form 990 2011 Mission Hospital, Inc 56-0532141 Pa e6

Part Facility Information (continued) Mission Hospital, Inc.

18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the

hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their

eligibility under the hospital facility's financial assistance policy?

If "No," indicate why:

a The hospital facility did not provide care for any emergency medical conditions

b The hospital facility's policy was not in writing

c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

d Other (describe in Part VI)

Individuals El

19 Indicate how the hospital facility determined , during the tax year , the maximum amounts that can be charged to FAP•eligible

individuals for emergency or other medically necessary care

a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts

that can be charged

b The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating

the maximum amounts that can be charged

c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

d EXI Other (describe in Part VI)

20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility's financial

assistance policy , and to whom the hospital facility provided emergency or other medically necessary services , more than

No

the amounts generally billed to individuals who had insurance covering such care? 20

If 'Yes," explain in Part A.

21 Did the hospital facility charge any of its FAP•eligible patients an amount equal to the gross charge for any service provided

to that patient? 21 X

If "Yes," explain in Part VI.

132096 01-23-12 Schedule H (Form 990) 2011


ScheduleH Form990 2011 Mission Hospital, Inc 56-0532141 Pa e7

Part V Facility Information (continued)Section C . Other Health Care Facilities That Are Not Licensed , Registered , or Similarly Recognized as a Hospital Facility


How many non-hospital health care facilities did the organization operate during the tax year? 32

Name and address Type of Facility (describe)

1 Outpatient Infusion21 Hosp ital DriveAsheville, NC 28801 Infusion Services

2 Asheville Surgery Center5 Medical Park DriveAsheville, NC 28803 Ambulatory Surgical Services

3 Asheville Imagin g Center, LLC

534 Biltmore AvenueAsheville, NC 28801 Outpatient Imaging Services

3 Heartpath, Sleep Lab, Cardiovascular5 Vanderbilt Park DriveAsheville, NC 28803 Pulmonary Rehab, Sleep Studies

4 Children's Services11 Vanderbilt DriveAsheville, NC 28803 Outpatient Children's Services

4 Asheville MRI, LLC222 Asheland AvenueAsheville, NC 28801 MRI Facility

5 Positronic Emissions Testing21 Hosp ital DriveAsheville, NC 28801 Imaging Radiology

5 Wound Care7 Yorkshire StreetAsheville, NC 28803 Wound Therapy

6 Mission Rehabilitation Services534 Biltmore AvenueAsheville, NC 28801 Rehabilitation Services

7 Outpatient Clinical Pharmacy Services Medication assistance;

501 Biltmore Avenue anticoagulation;Asheville, NC 28801 pharmacotherapy programs

132097 01-23-12



56-05322

Schedule l- ( Form 990 2011 Mission Hospital , Inc 56-0532141 Pa e7

Part Facility Information (continued)Section C . Other Health Care Facilities That Are Not Licensed , Registered , or Similarly Recognized as a Hospital Facility


How many non-hospital health care facilities did the organization operate during the tax year?


8 Sports Medicine ProgramOne University HeightsAsheville, NC 28804 Sports Medicine, PT

8 Occumed & Staff Health50 Doctors Drive Company & Staff HealthAsheville, NC 28801 Services

10 Low Vision Center, Staff Health240 Sardis RoadAsheville, NC 28806 Low Vision, Staff Health

11 Mission Fitness Center534 Biltmore AvenueAsheville, NC 28801 Physical Therapy

13 Outpatient Laboratory490 Hospital DriveClyde, NC 28721 Laboratory & Radiology

14 Breastfeeding Center2 Medical Park DriveAsheville, NC 28803 Education

15 Genetics Center11 Vanderbilt DriveAsheville, NC 28803 Genetics Testing

16 Health Education Center Diabetes; Asthma:HTN

501 Biltmore Avenue Program;Cholesterol, OPAsheville, NC 28801 Nutritional Therapy

17 MCC Procedure & Radiology Suites11 Vanderbilt DriveAsheville, NC 28803 Radiological Suites

18 High Risk OB490 Hospital DriveClyde, NC 28721 OB Consultations

132097 01-23-12



56-05322


Fart w Facility Information (continued)Section C . Other Health Care Facilities That Are Not Licensed, Registered , or Similarly Recognized as a Hospital Facility




23 Mission Rehabilitation Services200 Racquet Club RoadAsheville, NC 28803 Rehabilitation Services

24 Mission Rehabilitation ServicesOne University HeightsAsheville, NC 28806 Rehabilitation Services

25 Mission Rehabilitation services151 Weaverville PlazaWeaverville, NC 28787 Rehabilitation Services

26 Mission Rehabilitation services1388 Sand Hill RoadAsheville, NC 28806 Rehabilitation Services

27 Pediatric Hematology/oncology21 Hosp ital DriveAsheville, NC 28801 Pediatric Cancer Services

28 Radiation Therapy21 Hosp ital DriveAsheville, NC 28801 Radiation Therapy

29 Mission Radiology100 Victoria RoadAsheville, NC 28801 Radiological Services

30 Mission My Care Plus1388 Sand Hill RoadAsheville, NC 28806 Radiological Services

32 Mission Radiology7 Vanderbilt Park Dr.Asheville, NC 28803 Radiological Services

33 qports Medicine Program534 Biltmore AvenueAsheville, NC 28801 Sports Medicine, PT

132097 01-23-12



56-05322

ScheduleH (Form 990 2011 Mission Hospital , Inc 56-0532141 Pa e7part V 1 Facility Information (continued)Section C . Other Health Care Facilities That Are Not Licensed , Registered , or Similarly Recognized as a Hospital Facility




34 Wound Healin g & Hyperbaric Program7 Yorkshire StreetAsheville, NC 28803 Wound Therapy

35 Wound Healin g Center490 Hospital DriveClyde, NC 28721 Wound Therapy

132097 01-23-12



56-05322

ScheduleH (Form 990 2011 Mission Hos pital , Inc 56-0532141 Pa e6Pan VI Supplemental InformationComplete this part to provide the following information.

1 Required descriptions . Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B,

lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11 h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.

2 Needs assessment . Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs

assessments reported in Part V, Section B.

3 Patient education of eligibility for assistance . Describe how the organization informs and educates patients and persons who may be billed

for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's financial

assistance policy.

4 Community information . Describe the community the organization serves, taking into account the geographic area and demographic

constituents it serves.

5 Promotion of community health . Provide any other information important to describing how the organization's hospital facilities or other health

care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus

funds, etc.).

6 Affiliated health care system . If the organization is part of an affiliated health care system, describe the respective roles of the organization

and its affiliates in promoting the health of the communities served.

7 State filing of community benefit report . If applicable, identify all states with which the organization, or a related organization, files a

community benefit report.

Part I, Line 7: Mission used worksheets 1 throuqh 8 provided by the

IRS, using the cost to charae ratio method. For physician clinics, as

described in subsidized health services, actual costs were used plus

indirect costs calculated using the Medicare cost report because the cost

to charge ratio did not accurately capture costs for those areas. The

financials include all patient segments, including inpatient, outpatient,

emergency room, private insurance, Medicaid, Medicare, uninsured, and

self-pay. A cost to charge ratio was generated using the IRS Worksheet 2

and used for all community benefits reported except for subsidized

services which used direct expenses plus overhead to more accurately

report the costs involved. See note on subsidized health services.

Medicaid Direct Offsettinq Revenue includes $17,603,085 in revenue from

for years. Medicaid surplus from current year programs would have been

$7,415,301 without the prior period revenue.

Part I, Line 7g: Subsidized health services include physician clinics

rimarily serving pediatric specialty patients. Other services include

trauma, psychiatric and senior services. $31,926,040 in cost, less

$5,995,242 in net patient revenue calculates to $25,930,798 in community132098 01-23-12 Schedule H (Form 990) 2011



Part 'V1 Supplemental Information

benefits from subsidized health services provided.

Part II: Workplace development: Recruitment of Physicians

and other health professionals to medical shortage areas.

Part III, Line 4: Per the Footnotes to the Consolidated Financial

Statements: "Costs of services associated with uncollectible accounts are

estimated at $32,014,000 and $31,692,000 for September 30, 2012 and 2011,

respectively."

Above numbers are for entire Health system, which includes the $25,653,000

for mission Hospital.

Estimates for the estimated bad debt expense attributable to patients

eligible under the organization's financial assistance policy is based on

estimated charity care provided for the fiscal year ended September 30

2012 but for which information was not available until after the fiscal

ear end.

The above estimates were developed using the methodology adopted by the

North Carolina Hospital Association in 2006 for such costs, includin

information from Mission's cost reporting systems used to support its

related filinqs with the Medicare and Medicaid programs.

Charitable discounts and other discounts decrease net patient revenue as

reported on page 9 of the core form of the 990. Recoveries of previous

bad debt written off are netted against bad debt expense before reduci

to the cost basis.Schedule H (Form 990) 2011

132271 05-01-11


ScheduleH (Form 990 2011 Mission Hospital , Inc 56-0532141 Pa esPart V! Supplemental Information

Part III, Line 8: The shortfall reported is based on using the

Medicare allowable costs. However , if full costing were used , there would

be a shortfall of approximately $35 million dollars. Per the Form 990

instructions, the Medicare cost report is the basis for calculating the

costs using costs related to the revenue reoorted, including DSH and IME.

Part III, Line 9b: Patients who aualifv for financial assistance and

other charity care are notified using the process described in the

education of patients' eligibility in Part VI, on line 3.

Mission ' s stated policy with respect to financial assistance: "Mission

Hospital will make every effort to thoroughly screen all patients that are

uninsured or underinsured in an effort to identify a source of financial

sponsorship. Only after a final determination is made that the patient is

not eligible for any source of funding to cover the medical expenses will

the account be eligible for consideration of financial assistance."

After the notifications and processes referenced above have been

completed, standard debt collection policies are in effect for the portion

of the bill for which the patient is responsible.

Mission Hospital, Inc.:

Part V, Section B, Line llh: Mission has a catastrophic provision for

balances over $10,000. The patient will not owe more than 25% of their

annual income.

132271 05-01-11



56-05322

ScheduleH ( Form990 2011 Mission Hosp ital, Inc 56-0532141 Pa e8Part Vi Supplemental Information


Part V, Section B, Line 13g: See Part VI, line 3: Mission provides

information to patients on the financial assistance policy by directing

patients to a patient billing representative on the Mission Hospital

website; messages on billing statements and in brochures provided in the

hospital facility's emergency rooms; waiting rooms; and admissions

offices, was well as on admission to the hospital facility. Financial

assistance application can be a complicated and confusing process to

patients and their family and the process is better understood when the

patient has an opportunity to ask questions and have the application

explained in person. As of October 2012, the policy was posted on the

Hospital website and the policy is now provided to the patient when

services are provided.


Part V. Section B. Line 17e: Mission performs these actions before

initiating any collection actions.


Part V, Section B, Line 19d: Patients with income levels of 251% to 300%

of the FPG receive a minimum of 25% discount. This compares to managed

care discounts with an averaqe of 20 to 25%.

Patients with income levels of less than or equal to 150% of the FPG

throuah 250% of the FPG receive greater discounts: 50% - 100%.


132271 05-01-11


ScheduleH (Form 990 2011 Mission Hospital, Inc 56-0532141 Pa e8

Part ./l Supplemental Information


Part V, Section B, Line 20: Less than 5% of patients eligible under the

Hospital's FAP were charged more than the amounts generally billed to

individuals who had insurance covering such care. These patients received

a 25% discount. The rest of the patients eligible under the FAP were give

a 50% or Greater discount from the gross charges.

For the upcoming tax years, processes and policies have been put into

place to prevent FAP patients from being charged more than amounts

nerallv billed to individuals who had insurance covering such care.

Part VI, Line 2: The Buncombe County Health Department coordinates a

Community Health Assessment (CHA) every three years, with the most recent

assessment completed in December 2012. Mission Hospital has provided

funding for this process as well as in-kind staff support. Primary data in

these assessments has been obtained through individual household surveys

inion surveys conducted with leaders in education, United Way, local

government programs, mission Hospital and non-profit health agencies, and

listening sessions with specific ethnic focus groups. Secondary data is

obtained from MATCH (Mobilizing Action Toward Community Health) County

Ranking Report, Behavioral Risk Factory Surveillance Survey, and the

Census Bureau . A broad based community CHA Steering Committee then uses

this data in defining the county health needs priorities. The Buncombe

County Health Assessment and the Madison County Health Assessment

riorities are the basis for the hospital's Community Benefit Grants

awarded annually to local and regional non-profit agencies. The CHA dataSchedule H (Form 990) 2011

132271 05-01-11


ScheduleH (Form 990 2011 Mission Hospital, Inc 56-0532141 Pa e8Part VI Supplemental Information

is also used in Mission Hospital's outreach program development with

community and regional collaborators.

Part VI, Line 3: We provide information to our patients regarding how

to apply for financial assistance /charity care in the following ways:

Our internet website and our brochures contain the following information

about financial assistance:

We understand your concerns about the cost of your healthcare, and we're

here to help you find financial assistance if you need it.

If you choose to submit your own insurance claim to your insurance company

instead of assianina benefits to mission, or do not have insurance to

cover your services, you must pay "up front" for services at the time of

your visit. However, if you are unable to pay your bill due to

insufficient insurance coverage, no insurance coverage , or limited income,

we have staff available to assist you in applying for financial assistance

through the following sources:

State Agency Programs: We'll help you determine if you qualify for a

variety of state agency programs.

Medicaid: We can help you determine whether you qualify for Medicaid

benefits, and help you apply for Medicaid if you are unable to go to your

local DSS (Department of Social Services) office.

Hospital Discounts: You may qualify for discounts on your balance owed.Schedule H (Form 990) 2011

132271 05-01-11


ScheduleH (Form 990 2011 Mission Hos pital , Inc 56-0532141 Pa e8

Part 1/1 Supplemental Information

Hospital discounts are determined usinq criteria such as household income

asset and other fund sources available, considered in relation to total

amount owed.

Based upon these criteria, you may be eligible to receive a 25%, 50%, 75%

or a 100% discount. Mission Hospital's financial assistance policy

utilizes household income quidelines published by the Health and Human

Services department to determine discount eligibility. Our staff can

assist you in making application for a discount.

There are also a variety of state agency assistance programs available to

North Carolina residents. Our staff can help you determine if you qualify

for help from these programs. For further information contact us at (828)

213-1590 or (800) 848-8732, extension 31590.

To make a payment or apply for financial assistance, visit our Business

Office or call our Customer Service Center:

(828) 213-1500 or (800) 848-8732

M - F, 8:00 a.m. - 4:30 p.m.

There are also messages on patient bills giving additional information

regarding amounts due such as how to contact the hospital if they have

questions.

Part VI, Line 4: For Buncombe County and the surroundinq counties

representing the primary and secondary service areas, the percentage of

uninsured adults ranqes from 19-24%, children living in poverty from

20-25%, and unemployment ranges from 7.3-12.2%. The persons living inSchedule H (Form 990) 2011

132271 05-01-11


ScheduleH (Form 990 2011 Mission Hospital, Inc 56-0532141 Pages

Part VI Supplemental Information

these counties with only a hiqh school education or less ranges from

42-68 %. (NC County Health Rankinqs 2011

The 2009 populations for these counties are as follows:

(Southern Rural Development Data Center 2010)

0-24 years 27.1-30.4 %

25-64 years 50.1-52.5 %

65+vear 15.9-22.4 %

Part VI, Line 5: See Program Service Accomplishments listed in

Schedule 0 for Form 990, Part II, line 4.

Part VI, Line 6: Mission Health System, Inc. is the parent

organization for the charitable organizations of Mission Hospital, Inc.;

Mission Healthcare Foundation, Inc.; Mission Medical Associates, Inc; Blue

Ridge Regional Hospital, Inc.; and The McDowell Hospital, Inc.

The System's mission is to support the activities of mission Hospital Inc

and Mission Healthcare Foundation, Inc.

Mission Hospital, Inc. is a regional integrated health system providin

superior care and service to patients and their families through a full

continuum of integrated services, education, and research. It serves as a

trauma center to people of Western North Carolina and the surrounding

counties.

Mission Medical Associates mission is to provide physician services in

predominantly rural areas that are insufficiently served, therebySchedule H (Form 990) 2011

132271 05-01-11


ScheduleH (Form 990 2011 Mission Hospital , Inc 56-0532141 Pa e8Part '111 Supplemental Information

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.

Blue Ridge Regional Hospital serves as a community hospital in Mitchell,

Yancev and surrounding counties.

The McDowell Hospital serves as a community hospital in McDowell and the

surrounding counties.

Mission Healthcare Foundation, Inc. supports the mission and programs of

Mission Hospital, Inc. and Mission Health System, Inc. and of other

organizations that are tax exempt under the provisions of Section

501(c)(3) of the Internal Revenue Code and works to benefit the community

and region served by the entities listed above.

Part VI. Line 7, List of States Receiving Community Benefit

NC

t:

132271 05-01-11



56-05322

SCHEDULEI(Form 990) Grants and Other Assistance to Organizations,

Governments, and Individuals in the United States

Department of the Treasury I Complete if the organization answered "Yes" to Form 990, Part IV, line 21 or 22.Internal Revenue Service ► Attach to Form 990.

OMB No 1545-0047

2011Open to Public

Inspection


Mission Hospital, Inc 56-0532141

Part; General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees ' eligibility for the grants or assistance, and the selection

criteria used to award the grants or assistance? Yes No

2 Describe in Part IV the organization's procedures for monitorin g the use of g rant funds in the United States.

f( Grants and Other Assistance to Governments and Organizations in the United States . Complete if the organization answered 'Yes' to Form 990, Part IV, line 21, for any

recipient that received more than $5,000 Check this box if no one recipient received more than $5,000. Part II can be duplicated if additional space is needed ► 01 (a) Name and address of organization (b) EIN (c) IRC section (d) Amount of (e) Amount of (f) Method of (g) Description of (h) Purpose of grant

or government if applicable cash grant non cashvaluation (book,FMV, appraisal,

non-cash assistance or assistanceassistance other)

Asheville Buncombe Community Assistance to local

Christian Ministry - 155 nonprofit

Livingston St - Asheville, NC Assistance for local

28801 56-1987021 5 01(c)(3) 370 000. 0. nonprofit

Asheville Chamber of Commerce

151 Haywood Road Assistance to local

Asheville , NC 28801 56-0125440 01(c)(6) 75 , 000. 0. nonprofit

All Souls Counseling Ctr

9 Swan Street Mental Health & Substance

Asheville , NC 28803 56-2200862 01(c)(3) 95 , 000. 0. Counseling

Council on Aging

1617 Hendersonville Road ealth Care Support for

Asheville , NC 28803 23-7410586 01(c)(3) 32 , 500. 0. Aging

Community Care of WNC

53 S French Broad Suite 300 Access to Health Care -

Asheville , NC 28801 56-2097503 01(c)(3) 109 218. 0. edicaid

ssistance to local

Literacy Council of Buncombe onprofit

County - 31 College St Suite B-221 ssistance to local

- Asheville , NC 28801 58-1696409 O1(c)(3) 5 , 800. 1 0. 1 1 onprofit

2 Enter total number of section 501 (c)(3) and government organizations listed in the line 1 table _ ► 27.

3 Enter total number of other organizations listed in the line 1 table ► 4

LHA For Paperwork Reduction Act Notice , see the Instructions for Form 990. Schedule I (Form 990) (2011)

132101 01-27-12 49

Schedule) (Form 990 Mission Hospital, Inc 56-0532141 Pane lPart 11 Continuation of Grants and Other Assistance to Governments and Organizations in the United States (Schedule I (Form 990), Part II.)

(a) Name and address of (b) EIN (c) IRC section (d) Amount of (e) Amount of (f) Method of (g) Description of (h) Purpose of grantorganization or government if applicable cash grant non-cash valuation non-cash assistance or assistance

assistance (book, FMV,appraisal, other)

MAHEC

121 Hendersonville Road

Asheville , NC 28803 56-1071426 5 01(c)(3) 13 , 500. 0. Access to Health Care

Memory Care

100 Far Horizons Lane Support for Healthcare

Asheville , NC 28803 56-2178294 01(c)(3) 110 000. 0, or Aging

Buncombe County Health Department

35 Woodfin St

Asheville , NC 28801 56-6000279 Buncombe County 200 000. 0. Access to Health Care

Pisgah Legal Services

89 Montford Avenue Legal Services for Low

Asheville , NC 28802 56-1191115 01(c)(3) 100 000. 0. I ncome Families

United Way

50 South French Broad Avenue Assistance to Local

Asheville , NC 28801 56-0576157 01(c)(3) 105 000. 0. nonprofits

YWCA

185 South French Broad Avenue Assistance to Local

Asheville , NC 28801 56-0547476 01(c)(3) 37 , 500. 0. nonprofits

The Lewis Rathbun Center emporary lodging for

121 Sherwood Road families of out of town

Asheville , NC 28803 56-1706625 01(c)(3) 220 000. 0, patients.

Manna Food Bank

627 Swannanoa River Road Assistance to local

Asheville , NC 28805 58-1514800 01(c)(3) 25 , 000. 0. nonprofits

American Red Cross

100 Edgewood Road Assistance to local

Asheville , NC 28801 53-0196605 0l(c)(3) 9 , 000. 0. onprofits

Schedule I (Form 990)

132241 05-01-11 50

Schedulel (Form 990 Mission Hospital, Inc 56-0532141 Page 1

I Part # I Continuation of Grants and Other Assistance to Governments and Organizations in the United States (Schedule I (Form 990), Part II.)



Buncombe County Medical Society

PO Box 15126

Asheville , NC 28813 58-1480867 01(c)(3) 150 000. 0. ccess to Health Care

YMCA

53 Ashland Avenue, Suite 105 Assistance to Local


Western Carolina University

230 HFR Admin Building ssistance to Local

Cullowhee , NC 28723 24-5150850 overnmental 50 , 000. 0, governmental agency

Three Streams Family Health Center

1710 Old Haywood Road

Asheville , NC 28806 56-2252990 01(c)(3) 100 000. 0, cce.ss to Health Care

Cancer Care of WNC

PO BOx 695

Asheville , NC 28802 56-1693667 14 , 600. 0, ccess to Health Care

Homeward Bound of Asheville

35 Grove St ssistance to Local


The McDowell Hospital

430 Rankin Drive

Marion , NC 28752 56-0623938 01(c)(3) 0. 447 , 430. ost Equipment Access to Health Care

Mission Healthcare Foundation, Inc

980 Hendersonville Road Assistance to Local

Asheville , NC 28803 56-1881331 5 01(c)(3) 0. 421 , 582. ost Equipment nonprofit

Mountain Area Child & Family

2586 Riceville Road utrition Support for

Asheville , NC 28805 56-2040462 01(c)(3) 22 , 000. 0, hildren


132241 05-01-11 51

Schedule) (Form 990 Mission Hospital , Inc 56-0532141 Pa e1Part f1 Continuation of Grants and Other Assistance to Governments and Organizations in the United States (Schedule I (Form 990), Part II.)



Child Abuse Prevention Services

Inc. - 50 S FrenchBroadAve Ste 152 Assistance to Local

- Asheville , NC 28801 58-1828408 01(c)(3) 37 , 000. 0. nonprofit

Girls on the Run of WNC, Inc.

50 S FrenchBroadAve Ste 249

Asheville , NC 28801 35-2177794 01(c)(3) 6 , 000. 0. Prevent Childhood Obesity

Western Carolinians For Criminal

Justice - PO Box 7472 - Asheville, Assistance to Local

NC 28802 58-1491257 01(c)(3) 45 , 000. 0. nonprofit

WNC Community Health Services

PO Box 338

Asheville , NC 28802 56-1852922 5 01(c)(3) 37 , 500. 0, ccess to Health Care

WNC Aids Project

PO Box 2411 Assistance to Local



132241 05-01-ti 52

Schedule) (Form 990 2011 Mission Hospital , Inc 56-0532141 Page 2

Pa t#I# Grants and Other Assistance to Individuals in the United States . Complete if the organization answered "Yes" to Form 990, Part IV, line 22.Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance (b) Number ofrecipients

(c) Amount ofcash grant

(d) Amount of non-cash assistance

(e) Method of valuation(book, FMV, appraisal, other)

(f) Description of non-cash assistance

Scholarship program for health careers for members

of minority groups - $2 , 400 scholarships 19 45 , 600. 0.

Part IV I Supplemental Information . Complete this part to provide the information required in Part I, line 2, and any other additional information.

Schedule I, Part I, Line 2: The Hospital donates funds to various local and

national non-profits in furtherance of its charitable mission.

For grants to organizations, mission makes grants to governmental and

501(c)(3) entities. These entities have demonstrated their mission through

their qualification as exempt organizations. A special committee reviews

grant requests received through the application process and allocates

donations each near.

132102 01-27-12 53 Schedule I (Form 990) (2011)

Schedule) (Form990 2011 Mission Hospital , Inc 56-0532141 Pa e2Part 1V Supplemental Information

To qualify for a Kesha Young Health Careers Scholarship, the following

requirements must be met and provided along with an application for the

scholarship.

Be a member of a minority group. Minority is defined according to the

guidelines of the federal and state governments as African-American,

Hispanic, Asian/Pacific Islander, and Native American.

Be a resident of Western North Carolina.

Maintain a minimum cumulative Grade Point Averaqe of 2.75 on a 4.0 scale.

Pursue a field of study for which Mission Hospital has an employment need.

Students must be interested in pursuina a career in the followinq areas:

Occupational Therapist, Pharmacist, Paramedic, Reqistered Nurse ( ADN or

AND-BSN programs),Physical Therapist, Physical Therapist Assistant,

SpeechThera ist,Surgical Tech.

Schedule I (Form 990) 2011

132291 05-01-11


SCHEDULE J Compensation Information OMB No 1545-0047

(Form 990) For certain Officers, Directors, Trustees, Key Employees, and Highest2011Compensated Employees

► Complete if the organization answered "Yes" to Form 990,

Department of the Treasury Part IV, line 23. Open to Public

Internal Revenue Service ► Attach to Form 990. ► See separate instructions. Inspection



Part i Questions Regarding CompensationYes No

la Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form 990,

Part VII , Section A , line 1a . Complete Part III to provide any relevant information regarding these items.

0 First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax indemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid , chauffeur, chef)

b If any of the boxes on line 1 a are checked, did the organization follow a written policy regarding payment or

reimbursement or provision of all of the expenses described above? If "No,' complete Part I I I to explain lb X

2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers, directors,

trustees, and the CEO/Executive Director, regarding the items checked in line 1 a? 2 X

3 Indicate which , if any, of the following the filing organization used to establish the compensation of the organization's

CEO/Executive Director . Check all that apply . Do not check any boxes for methods used by a related organization to

establish compensation of the CEO/Executive Director . Explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

4 During the year, did any person listed in Form 990, Part VII, Section A, line 1 a, with respect to the filing

organization or a related organization:

a Receive a severance payment or change-of-control payment? 4a X

b Participate in, or receive payment from, a supplemental nonqualified retirement plan? 4b X

c Participate in, or receive payment from, an equity-based compensation arrangement? 4c X

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only section 501(c)(3) and 501(c)(4) organizations must complete lines 5-9.

5 For persons listed in Form 990, Part VII, Section A, line 1 a, did the organization pay or accrue any compensation

contingent on the revenues of-

a The organization? 5a X

b Any related organization? 5b X

If 'Yes' to line 5a or 5b, describe in Part Ill.

6 For persons listed in Form 990, Part VII, Section A, line 1 a, did the organization pay or accrue any compensation

contingent on the net earnings of:

a The organization? 6a X

b Any related organization? 6b X

If "Yes" to line 6a or 6b, describe in Part III.

7 For persons listed in Form 990, Part VII, Section A, line 1 a, did the organization provide any non-fixed payments

not described in lines 5 and 6? If "Yes," describe in Part III 7 X

8 Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the

initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe in Part III 8 X

9 If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in

Reg ulations section 53 4958-6 (c) ? 9

LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 . Schedule J (Form 990) 2011

13211101-23-12


2011 Mission Hospital, Inc 56-0532141I Part H 1 Officers , Directors , Trustees, Key Employees, and Highest Compensated Employees . Use duplicate copies if additional space is needed.For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (I) and from related organizations, described in the instructions, on row ().Do not list any individuals that are not listed on Form 990, Part VII.

Note . The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1 a, applicable column (D) and (E) amounts for that individual.

(B) Breakdown of W-2 and/or 1099-MISC compensation (C) (D) (E) (F)

(A) Name(i) Base

compensation(ii) Bonus &incentive

compensation

(iii) Otherreportable

compensation

Retirement andother deferredcompensation

Nontaxablebenefits

Total of columns(B)()•(D)

Compensationreported as deferred

in prior Form 990

(i) 749,748. 290,000. 331,416. 208,197. 24,444. 1,603,805. 0.1Ronald Paulus, M.D. 0. 0. 0. 0. 0. 0. 0.

(i) 396,351. 138,400. 43,121. 107,570. 5,222. 690,664. 0.2Charles F. Ayscue 0. 0. 0. 0. 0. 0. 0.Dr. Jill Hoggard (;) 106,511. 39,898. 376. 21,256. 2,634. 170,675. 0.

3Green, 0. 0. 0. 0. 0. 0. 0.(i) 268,502. 65,489. 39,315. 45,955. 8,236. 427,497. 8,900.

4Ann Y. Young 0. 0. 0. 0. 0. 0. 0.0) 100,704. 0. 289,641. 10,809. 2,267. 403,421. 0.

5 Brian Aston 0. 0. 0. 0. 0. 0. 0.(;) 341,851. 92,794. 48,968. 76,628. 15,571. 575,812. 33,716.

6Dale Fell, M.D. 0. 0. 0. 0. 0. 0. 0.(i) 255,531. 58,180. 122,370. 16,500. 16,618. 469,199. 91,223.

Donald A. Jenning s 0. 0. 0. 0. 0. 0. 0.(;) 260,634. 69,327. 4,806. 44,225. 11,074. 390,066. 0.

8 KathGuyette ;, 0. 0. 0. 0. 0. 0. 0.(i) 230,816. 0. 24,434. 38,360. 17,266. 310,876. 13,959.

9Maria Roloff 0. 0. 0. 0. 0. 0. 0.0) 337,916. 85,493. 2,126. 44,399. 3,090. 473,024. 0.

1oDr. William maples 0. 0. 0. 0. 0. 0. 0.(;) 221,685. 84,925. 20,313. 29,904. 8,379. 365,206. 0.

11Rhonda Miller 0. 0. 0. 0. 0. 0. 0.(;) 253,044. 46,260. 2,198. 9,800. 13,780. 325,082. 0.

12James F. Keel, M.D. 0. 0. 0. 0. 0. 0. 0.(i) 248,692. 0. 2,610. 48,111. 19,943. 319,356. 0.

13 John J. Maher 0. 0. 0. 0. 0 . 0. 0.V) 207,308. 33,977. 4,610. 33,987. 16,002. 295,884. 0.-

14Karen LeMieux 0. 0. 0. 0. 0. 0. 0.0) 0. 0. 345,276. 2,538. 3,288. 351,102. 83,267.

15Jose h F. Damore 0. 0. 0. 0. 0. 0. 0.M

16 i;

Schedule J (Form 990) 2011132112 01-23-12 56

Schedule) (Form 990 2011 Mission Hospital , Inc 56-0532141 Pa e3dart fit Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1 a, 1 b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for anyadditional information.

Part I, Line la: First class travel and charter travel are approved for

unusual circumstances. First class travel can be approved if coach class

is unavailable and travel is necessary for an urgent business purpose.

Charter travel can be approved if it is a less expensive alternative to

booking multiple individual seats on commercial aircraft.

Board member travelled first class for a required business meeting when

economy class was unavailable. Management and board members used chartered

air travel for required hospital business travel because it was a less

expensive travel option on occasion.

Part I, Lines 4a-b: Joseph Damore, Former CEO received Severance Pay of

252.135 in calendar year 2011.

Brian Aston, Former COO received Severance Pav of $289,516 in calendar year

2011.

Key Employees and Highest Compensated Employees who participated in a

Supplemental Non-Qualified retirement plan with contribution amounts.Schedule J (Form 990) 2011

132113 01-23-12 57

Schedule ) (Form 990 2011 Mission Hospital , Inc 56-0532141 Page 3Part IIE Supplemental Information

Complete this part to provide the information , explanation , or descriptions required for Part I, lines 1 a , 1 b, 3, 4a , 4b, 4c, 5a, 5b , 6a, 6b, 7, and 8, and for Part II. Also complete this part for any

additional information.

These amounts are included in Retirement and other Deferred Compensation on

page 2 of Schedule J:

Ronald Paulus $203,755

Charles Ayscue $ 85,570

Jill Hoggard Green $ 21,256

Brian Aston $ 9,074

Dale Fell $ 60,128

Ann Young $ 29,455

Maria Roloff $ 24,200

Kathy Guyette $ 34,425

Rhonda Miller $ 5,265

John Maher $ 48,111

Karen LeMieux $ 25,187

William Maples $ 44,399

Key Employees and Highest Compensated who received payments from a

supplemental non-qualified retirement plan. These payments are included in

Other Reportable Compensation on Schedule J, page 2.

Maria Roloff $ 19,662Schedule J (Form 990) 2011

132113 01-23-12 58

Schedule) (Form 990 2011 Mission Hos ital , Inc 56-0532141 Page 3Pail Eft Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1 a, 1 b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for anyadditional information

Ann Young $ 10,798

Joseph Damore $ 90,148

Donald Jennings $105,433

Dale Fell $ 44,321

Schedule J (Form 990) 2011

132113 01 -23-12 59

SCHEDULE L Transactions With Interested Persons OMB No 1545-0047

(Form 990 or 990-EZ) ► Complete if the organization answered2011"Yes" on Form 990, Part IV , line 25a , 25b, 26 , 27, 28a , 28b, or 28c,

Department of the Treasuryor Form 990- EZ, Part V, line 38a or 40b. 4pep To public

Internal Revenue Service ► Attach to Form 990 or Form 990-EZ. ► See separate instructions . Inspection


Mission Hospital , Inc 56-0532141

Part I Excess Benefit Transactions (section 501 (c)(3) and section 501(c)(4) organizations only).

Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990•EZ, Part V, line 40b .

1 c Corrected?(a) Name of disqualified person (b) Description of transaction

Yes No

2 Enter the amount of tax imposed on the organization managers or disqualified persons during the year under

section 4958 ► $

3 Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ► $

Part fl Loans to and/or From Interested Persons.(:mmnleta if fha nrnnnnatinn ancwarpri "Voc" on Form 99f1 Part IV_ line 2R _ or Fnrm 990•F7. Part V. line 38a.

(a) Name of interestedperson and purpose

(b) Loan to or fromthe organization?

(c) Original principalamount

(d) Balance due (e) Indefault?

(f) Approvedby board ornornmittPP

(g) Writtenagreement?

To From Yes No Yes No Yes No

Total ►Part II[ Grants or Assistance Benefiting Interested Persons.

Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person (b) Relationship between interested person and (c) Amount and type ofthe organization assistance

LHA For Paperwork Reduction Act Notice , see the Instructions for Form 990 or 990 - EZ. Schedule L (Form 990 or 990 - EZ) 2011

132131 01-19-12


ScheduleL (Form 990or990-E 2011 Mission Hos p ital, Inc 56-0532141 Pa e2

Part IV, Business Transactions Involving Interested Persons.

(.mmnlete if thu nrnnnr afinn nnewurcrl "Vac" nn Fnrm QQn Par} IV fin,- 9Ra 9Rh nr 9RC

(a) Name of interested person (b) Relationship between interestedperson and the organization

(c) Amount oftransaction

(d) Description oftransaction

(e) Sharing oorganization'srevenues?

Yes No

Janet Garrett Wife of Board Membe 15,925. om ensatio xWilliam Lee Board Member 597,284. William Lee XWyatt Stevens Board Member 363,444. Wyatt Steve X

Part V Supplemental InformationComplete this part to provide additional information for responses to questions on Schedule L (see Instructions).

Sch L, Part IV, Business Transactions Involvina Interested Persons:

a) Name of Person: Janet Garrett

b) Relationship Between Interested Person and Organization:

Wife of Board Member

c) Amount of Transaction $ 15,925.

(d) Description of Transaction: Compensation for participation on board

committee

(e) Sharing of Organization Revenues? = No

a) Name of Person: William Lee

b) Relationship Between Interested Person and Orqanization:

Board Member

c) Amount of Transaction $ 597,284.

(d) Description of Transaction: William Lee is a greater than 5%

shareholder of Blue Ridae X-Rav which does business with the hospital.

The hospital purchases pharmaceutical supplies in arms-length

transactions at fair market value. The price for the supplies is

negotiated through a group purchasing arrangement and not directly

negotiated with the vendor. Mr. Lee is not involved in negotiating the

ricina for these aoods.Schedule L (Form 990 or 990-EZ) 2011

13213201-19-12


ScheduleL Form990or990 •E 2011 Mission Hospital, Inc 56-0532141 Pa e2

RArt 1l Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

(e) Sharing of Oraanization Revenues? = No

(a) Name of Person: Wyatt Stevens

(b) Relationship Between Interested Person and Organization:

Board Member

(c) Amount of Transaction $ 363,444.

(d) Description of Transaction: Wyatt Stevens together with another

family member owns a greater than 5% share of Roberts & Stevens which

performs legal services for the hospital. The hospital engages Roberts &

Stevens for legal services in arms-length transactons at fair market

value. Mr. Stevens is not involved in negotiating the pricing for the

services rendered, nor does he perform any of the services engaged by the

hospital.

(e) Sharinq of Organization Revenues? = No

13246105-01-11 Schedule L (Form 990 or 990-EZ) 2011


SCHEDULE 0 Supplemental Information to Form 990 or 990-EZ UM N 1040-UU4/(Form 990 or 990-EZ) Complete to provide information for responses to specific questions on 2011

Form 990 or 990-EZ or to provide any additional information. Open to PublicDepartmen t the Treasury )kts5#^ectioltInternalrnal Reven ue Service 101, Attach to Form 990 or 990 -EZ.



Form 990, Part III, Line 1, Description of organization mission:

and Part I, line 1, most significant activities

Mission Statement

To improve the health of the people of Western North Carolina and the

surrounding region.

Guiding Principles

Serve people as a not-for-profit health system governed by a voluntary

community board

Ensure sustainability through stewardship of the region's assets

Significantly enhance the quality of services we provide to patients

in a compassionate and cost-effective manner

Collaborate in order to improve access across the entire continuum of

care

Promote wellness and health to benefit the reqion

Eliminate preventable incidents of patient harm

2020 Vision

A reaional integrated health system providinq superior care and service

to patients and their families throuqh a full continuum of integrated

services, education, and research.

Form 990, Part III, Line 4a, Program Service Accomplishments:

As a result, Mission Health was ranked as one of the Top 15 Health

Systems in the nation, and one of only five such health systems in itsLHA For Paperwork Reduction Act Notice , see the Instructions for Form 990 or 990 -EZ. Schedule 0 (Form 990 or 990-EZ) (2011)13221101-23-12




size category ($750 million to $1.5 billion in revenue ). Among the key

findinas were : Lower 30-Day Mortality Rates; Better Survival Rates;

Fewer Complications;Shorter Hospital Stays;Better Patient Safety and

Core Measure Adherence

For the fourth-straight year, Thomson Reuters named mission Hospital

one of the nation's Top 100 Hospitals. The annual study evaluates

hospitals across the nation on measures of Overall Organization

Performance;Patient Care;Operational Efficiency;Financial Stability

Mission Hospital was named one of the Top 100 out of nearly 3,000 U.S.

hospitals. The award is a testament to mission Hospital's ability to

achieve high-quality patient outcomes while improving efficiency.

According to the study, annual metrics for Medicare inpatients would be

significantly improved if every hospital in the nation performed at the

level of Mission Hospital and the other Top 100 Hospitals.

Mission Children's Hospital is the only Children's Hospital in western

North Carolina.

Mission Children's Hospital has over 60 Board-certified pediatric

subspecialists in 23 different specialties and dedicated facilities and

staff for children.

Mission Children's Hospital has 129 beds with 2,700 children cared for

on the pediatric inpatient unit each year, 4,000 outpatient pediatric

surgeries and nearly 14,000 pediatric visits to the Emergency

Department.Each year approximately 700 ill and premature newborns

receive lifesaving care in the Neonatal Intensive Care Unit.Mission

Children's Hospital babies go home from our NICU 13 days earlier than

the national average.012312 Schedule 0 (Form 990 or 990-EZ) (2011)


Mission Hospital is licensed for 735 beds and bassinets.

The medical staff has more than 750 physicians representing nearly all

specialties and subspecialties. Mission Hospital is the busiest

surgical hospital in the state, with more than 40,000 surgical cases

per year. Mission Hospital is the largest hospital west of Charlotte

and houses the region's only dedicated Level II Trauma Center.Mission

Hospital is the 91st largest hospital out of more than 6,000 hospitals

in the United States. Patients are 50 percent local and 50 percent

reqional.

Mission Health ' s performance on publicly reported quality measures has

reached the top 10 percent in the nation across multiple metrics

resulting in mission Health earninq a performance-based incentive bonus

from CMS.Over the past 10 years, Mission Health has implemented changes

which have resulted in steady improvement in eliminating all

bloodstream infections. The rate for mission Health as a whole is

approaching zero. Mission Hospital is in the top third nationally and a

top performer in the state of North Carolina for readmission rates

(preventing people from having to come back to the hospital

unnecessarilv).Patients are extremely satisfied with the care at

Mission Hospital. Patient satisfaction scores have reached the top 10

percent nationally due to Mission Hospital providing compassionate care

and enhancina communication. In addition, nine departments received the

elite five-star award from Professional Research Consultants, rankin

them in the top 10 percent nationally.

Mission Hospital's innovative initiatives and implementation of best

ractices helped sianificantlv decrease the number of days patients

13223- 2 Schedule 0 (Form 990 or 990-EZ) (2011)


Schedule 0 (Form 990 or 990-EZ) (2011 ) Page 2



Paae 2



require ventilator support in the Intensive Care Unit, as well as the

total number of days they require ICU care.

Throuah implementation of evidence-based best practices, mission

Hospital has had a significant decrease in Urinary Tract Infections and

Respiratory Infections and is reaching top performance levels

nationallv.Throuah a relentless focus on quality and safety, Mission

Hospital has attained one of the highest risk-adjusted survival rates

in the nation.

Mission Hospital's Stroke Program received the Gold Plus Award from the

American Heart Association/American Stroke Association. Mission

Hospital was recognized for at least 24 months of 85 percent or higher

adherence on all applicable achievement measures and at least 75

percent or higher adherence on select stroke quality measures .Mission

Hospital's Cardiovascular Critical Care and Recovery Units received the

prestigious Beacon Award for Critical Care Excellence given

semiannually by the American Association of Critical Care Nurses. This

award recognizes units that exhibit the highest quality standards in

nurse recruitment and retention, patient outcomes, staff training,

healthy work environments, leadership and evidence-based practice and

research.Mission Hospital's Weight Management Center was named a Blue

Distinction Center for Specialty Care for Bariatric Surgery by the

BlueCross BlueShield Association.Mission Hospital's Heart Services

received the Gold Performance Achievement Award from the American

Colleae of Cardioloav Foundation for heart attack treatment. The award

is based on a hospitals consistent use of treatment guidelines that

were created using criteria from two rigorous programs: ACTION

Registry, developed by the National Cardiovascular Data Registry, and13221201-23-12 Schedule 0 (Form 990 or 990-EZ) (2011)



Mission Hospital, Inc 56-0 532141

the "Get With the Guidelines" program for heart attack, developed by

the American Heart Association.

Mission Hospital earned full accreditation from the Society of Chest

Pain Centers, making it the only accredited center in western North

Carolina and one of only 24 in the state.

Three Mission Hospital nurses were named among "North Carolina's Great

100 Nurses" in 2012 for exemplary patient care by the Great 100, a

grassroots peer recognition organization honoring the nursing

ession in North Carolina.

Mission Health created the Office of Patient Experience to ensure an

optimal environment at mission Health by assisting our patients with

needs, resolving problems and bridging language barriers.Mission Health

established a new protocol initiative, a short checklist reviewed by

healthcare professionals before every procedure.A new mission Hospital

Physician Executive Council was created to provide a vehicle for

increased physician input and to more fully integrate their wisdom into

the administration of the hospital.Mission Health collaborated with the

Mountain Area Health Education Center (MAHEC) to bring a Hospice and

Palliative Medicine Fellowship program to Mission Health.

The Mission Health Cancer Center's qoal is to provide state-of-the-art

care for patients with cancer and ensure an exceptional experience

durinq a very difficult time. The Center is structured in a partnership

model, that allows the patient to have the best possible outcome,

without harm or waste. The Center is accredited through the American

College of Surgeons as a Comprehensive Community Cancer Program with01-23-12 Schedule 0 (Form 990 or 990 -EZ) (2011)




commendation.

In 2012, Mission Health established a Center for Innovation which

exists to encourage, support and develop ideas for innovative

ovements in healthcare. Innovation is the introduction of new

ideas, services, processes and products aimed at dramatically improving

treatment, diagnosis, education, outreach, prevention or research, with

the long-term goal of improving quality, safety, outcomes and

efficiencies.

In September 2012, Mission Health opened a comprehensive care clinic,

Mission My Care Plus, in Candler, North Carolina. The practice is part

of Mission Health's vision for the future of healthcare and represents

an innovative approach to caring for individuals and families in a

patient-centered, comprehensive manner. Mission My Care Plus provides

family care, pediatrics, prenatal care, physical therapy, minor

procedures and a complete on-site pharmacy.

In 2012, Mission Health continued its legacy of providing leading-edge

heart care by performing the first transcatheter aortic valve

replacement surgery (TAVR) in western North Carolina. The life-changing

procedure is a treatment for patients with severe aortic stenosis who

were previously considered inoperable. Surgeons at Mission Hospital

perform more than 400 valve procedures annually, ranking mission

Hospital in the top five percent nationally according to the Society of

Thoracic Surgeons.

Form 990, Part VI, Section A, line 2: Mr. Charles Owen, board member and

01-2312 Schedule 0 (Form 990 or 990-E2) (2011)




Ms. Janice Brumit, board member have a business relationship, as Mr. Owen &

Ms. Brumit's spouse have a business relationship.

Form 990, Part VI, Section A, line 6: Mission Health System, Inc, a

501(c)(3) is the parent company of Mission Hospital, Inc. It is the sole

member of Mission Hospital, Inc.

Form 990, Part VI, Section A, line 7a: Mission Health System, the sole

member of mission Hospital, Inc has reserved powers relatinq to the

governing body of Mission Hospital as follows:

Appointment of members of the Board of Directors of the Hospital, including

the power to fill any vacancies on the Hospital Board of Directors.

Removal, with or without cause, and at any time, of members of the Board of

Directors of the Hospital.

intment and/or removal of the President of the Hospital.

Form 990, Part VI, Section A, line 7b : Mission Health System as sole

member of Mission Hospital has reserve powers as follows:

Approval of any plan of dissolution, consolidation or merger of the

Hospital.

Approval of the acquisition, purchase, sale or disposition of assets of the

Hospital with a value in excess of $5,000,000.

Approval of the incurrence of long-term debt.

Development and implementation of strategies for contracting with managed

care providers and other payors, including the development of a

nhvsician-hospital oraanization.

royal of strategic and financial plans of the Hospital.

Approval of capital and operating budgets of the Hospital.fo3- 2 Schedule 0 (Form 990 or 990 - EZ) (2011)




Approval of any material expansion or elimination of any clinical service

or non-clinical service at the Hospital.

Form 990, Part VI, Section B, line 11: A draft of the Form 990 is prepared

by the Manager of Tax Services at Mission Hospital. The Form 990 is

reviewed by the organization's CEO, CFO, General Counsel and Compliance

Officer. 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 Audit and Compliance Committee; Finance and Property Committee

and HR and Compensation Committee. After committee review, a draft of the

990 is provided to the Mission Hospital Board of Directors for review.

Highlights of the governance, compensation, and financial statements are

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 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 ludament and preclude the individual from

being an Independent Director. The Audit and Compliance Committee may13221201-23-iz Schedule 0 (Form 990 or 990-EZ) (2011 ))



Mission Hospital, Inc 5 6-0532141

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 formallyf2-1o32 Schedule 0 (Form 990 or 990-EZ) (2011)




rove 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 Human Resources and

Compensation Committee

* 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

lan.

* Establishes and approves the salary parameters for the CEO, others

eligible under the executive compensation plan, and employees who aref-1o232 Schedule 0 (Form 990 or 990-EZ) (2011)


Name of the organization Employer identification numberMission Hospital, Inc 56-0 532141

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.13221201-23-12 Schedule 0 (Form 990 or 990-EZ) (2011 )

7308530901 351485 56 -0532141 2011.05070 Mission Hospital, Inc 56-05322

1 Page 2



* 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 traininq to exercise all responsibilities

effectively and keeps abreast of significant developments in executive

compensation practices and regulations.

* Ensures that all aspects of Mission Health System and Hospital 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 19: Mission Hospital prepares an annual

report to the community and makes its significant accomplishments available

through this report on the Mission Hospital website. Audited Financials

are attached to the 990. The articles of incorporation are available to the

ublic through the North Carolina Secretary of State website. Conflict of

interest policy and by-laws are available upon request.

Form 990, Paqe 7 , Part VII A

Board Member Hours

Mission Health System, Inc. and Mission Hospital, Inc. share a common

board and key employees. The hours spent on the two entities cannot be

separated with accuracy as the activities are interrelated to a ve

high degree as Mission Health System provides administrative and other

support to Mission Hospital, Inc.

012312 Schedule O (Form 990 or 990 -EZ) (2011)




Form 990, Part XI, line 5, Changes in Net Assets:

Net unrealized gains on investments: 49,850.

of22-12 Schedule 0 (Form 990 or 990-EZ) (2011)75


SCHEDULER Related Organizations and Unrelated PartnershipsOMB No 1545-0047

990 2011(Form ) ► Complete if the organization answered " Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37. Open to PublicDepartment of the Treasury ► Attach to Form 990. ► See separate instructions. InInternal Revenue Service '&pecWn



Part t Identification of Disregarded Entities (Complete if the organization answered 'Yes' to Form 990, Part IV, line 33.)

(a)

Name, address, and EINof disregarded entity

(b)

Primary activity

(c)

Legal domicile (state or

foreign country)

(d)

Total Income

(e)

End-of-year assets

(f)

Direct controllingentity

Part II Identification of Related Tax-Exempt Organizations (Complete if the organization answered 'Yes' to Form 990, Part IV, line 34 because it had one or more related tax-exemptorganizations during the tax year.)

(a)Name, address, and EINof related organization

(b)

Prima activitrY Y

(c)

Leal domicile or9 (state

foreign country)

(d)

Exempt CodePsection

(e)

Public chantYstatus (if section

(f)

Direct controllin 9entity

(9)Section 512(b)(13)

controlledentity?

501 (c)(3)) Yes No

Mission Health System , Inc - 58-1450888

400 Ridgefield Court , Suite 100 Parent Company Support

Asheville , NC 28806 ervicesMissionHospital Mi North Carolina 5 01(c)(3) L ine 11a I X

Mission Medical Associates , Inc - 26-3627231

866 Hendersonville Road ission Health

Asheville , NC 28803 Employed Physician Group North Carolina 01(c)(3) L ine 9 - System , Inc X

The McDowell Hospital , Inc - 56-0623938

430 Rankin Avenue ission Health

Marion , NC 28742 C ommunity Hospital orth Carolina 5 01(c)(3) ine 3 System , Inc X

Mission Healthcare Foundation , Inc -

56-1881331 , 980 Hendersonville Road , ission Health

Asheville , NC 28803 oundatioa orth Carolina 01(c)(3) L ine 7 System , Inc X

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule R (Form 990) 2011

13216101-23-12 LHA 76

Schedule R (Form 990) Mission Hospital, Inc 56-0532141

#Par! 11 Continuation of Identification of Related Tax-Exempt Organizations

(a)

Name, address, and EINof related organization

(b)

Primary activity

(c)

Legal domicile (state or

foreign country)

(d)

Exempt Codesection

(e)

Public chantystatus (if section

(f)

Direct controllin 9entity

(g)Section 512(b)(13)

controlledorganization?

501(c)(3)) Yes NoBlue Ridge Regional Hospital , Inc -

56-1025032 , P 0 Box 9 , Spruce Pine , NC ission Health

28777 C ommunity Hospital North Carolina 01(c)(3 ) L ine 3 ystem Inc X

Blue Ridge Regional Hospital Foundation - lue Ridge

58-2172660 , PO Box 247 , Spruce Pine , NC egional

28777 Hospital Foundation North Carolina 01(c)(3) Line ila I ospital Inc. X-

132222 05-01-11 77

Schedule R (Form 990) 2011 Mission Hospital, Inc 56-0532141 Page 2

Part fit Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more relatedorganizations treated as a partnership during the tax year.)

(a)

Name, address , and EINof related organization

(b)

Primary activity

(c)Legal

domicile(state or

(d)


y

(e)

Predominant income(related unrelated,

excluded from tax under

(f)

Share of totalincome

(9)

Share ofend of ear

t

(h)

D isproport i on -ate allocat ons^

(i)

Code V-UBIamount in box20 of Schedule

U)

General omanaging

artne/1

(k)

Percentageownership

foreigncountry ) sections 512-514)

asse sYes No K-1 (Form 1065) Ye No

Asheville Imaging , LLP Outpatient

56-1907201 , 534 Biltmore Imaging

Avenue , Asheville , NC 28801 S ervices NC elated 1 , 638 , 693. 635 452. N/A X 69.00%

Imaging Realty , LLP -

56-1907203 , 534 Biltmore edical Office

Avenue , Asheville , NC 28801 Building NC N/A N/A N/A N/A / N/A / N/AMSJHS and CCP Joint

Development Company , LLC -

56-2250464 , 428 Biltmore Yong Term Acute

Avenue , Asheville , NC 28801 are Hospital NC N/A N/A N/A N/A N/A N/A / N/A

Blue Ridge DME LLC - R ome Medical-

26-3570174 , 125 Hospital quipment and

Drive , Spruce Pine , NC 28777 upplies Sales NC N/A N/A N/A N/A / N/A / N/APar f Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered 'Yes' to Form 990, Part IV, line 34 because it had one or more related

organizations treated as a corporation or trust during the tax year.)

(a)

Name, address, and EINof related organization

(b)

Primary activity

(c)

Legal domicile(state orforeigncountry)

(d)


(e)

Type of entity(C corp, S corp,

or trust)

(f)


(g)

Share ofend-of-year

assets

(h)

Percentageownership

Horizon Health Corp - 56-1341621

213 Ridgefield Court

Asheville , NC 28806 Holding Company NC N/A CORP N/A N/A N/AHorizon Management Services Inc - 56 -1341624 Patient Billing and

213 Ridgefield Court Collection Services,

Asheville , NC 28806 edical Property NC N/A CORP N/A N/A N/ADogwood Insurance Company , Ltd

The Grand Pavilion Commercial Centre , PO Box 30600 Captive Insurance ayman-

Cayman Islands , CAYMAN ISLANDS Entity Islands N/A CORP N/A N/A N/A

132162 01 -23-12 78

See Part VII for ContinuationsSchedule R (Form 990) 2011

Schedule R (Form 990) Mission Hospital, Inc 56-0532141

Part tit Continuation of Identification of Related Organizations Taxable as a Partnership

(a)

Name, address , and EINof related organization

(b)

Primary activity

(c)Legal

domicile(state or

(d)


(e)

Predominant income( related, unrelated ,

excluded from tax under

(1)


(g)

Share ofend-of-year

t

(h )

D isproport i on-ate allocations?

(1)

Code V-UBIamount in box20 of Schedule

Gj)General omanaging

artnefT

(k)

Percentageownership

foreigncountry) sections 512-514)

asse sYes No K-1 (Form 1065) a No

McDowell MRI LLC - 75-3046378

414 Rankin Avenue

Marion , NC 28752 edical Imaging NC N/A N/A N/A N/A / N/A / N/A

132223 05-01-11 79

Schedule R(Form 990)2011 Mission Hospital, Inc 56-0532141 Paoe3

Part V Transactions With Related Organizations (Complete if the organization answered 'Yes' to Form 990, Part IV, line 34, 35, 35a, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule. Yes No

1 During the tax year, did the organization engage in any of the following transactions with one or more related organizations listed in Parts II-IV'?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity _ 1a X

b Gift, grant, or capital contribution to related organization(s) 1 b X

c Gift, grant, or capital contribution from related organization(s) 1c X

d Loans or loan guarantees to or for related organization(s) 1 d X

e Loans or loan guarantees by related organization(s) le X

If Sale of assets to related organization(s) if X

g Purchase of assets from related organization(s) _ 1 X

h Exchange of assets with related organization(s) 1 h X

i Lease of facilities, equipment, or other assets to related organization(s) 1 i X

j Lease of facilities, equipment, or other assets from related organization(s)

k Performance of services or membership or fundraising solicitations for related organization(s)

I Performance of services or membership or fundraising solicitations by related organization(s)

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)

n Sharing of paid employees with related organization(s)

o Reimbursement paid to related organization(s) for expenses 10 X

p Reimbursement paid by related organization(s) for expenses _ 1 X

q Other transfer of cash or property to related organization(s) 1 X

r Other transfer of cash or property related organization s l r X

2 If the answer to any of the above is "Yes.' see the instructions for information on who must complete this line- including covered relatinnshins and transaction thresholrts

(a)Name of other organization

(b)Transactiontype (a•r)

(c)Amount involved

(d)Method of determining

amount involved

(i)Asheville Imaging , LLP R 1,456,304. ash

(2) Asheville Imaging , LLP I 43,076. MV

(3) Asheville Imaging , LLP K 112,530. MV

(4)

(5)

(6)

132163 01-23-12 8 0 Schedule R (Form 990) 2011

Schedule R (Form 990) 2011 Mission Hospital, Inc 56-0532141 Page4

Part 1lf Unrelated Organizations Taxable as a Partnership (Complete if the organization answered 'Yes' to Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue)that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a)

Name, address, and EINof entity

(b)

Primary activity

(c)

Legal domicile(state or foreign

(d)Predominant income(related, unrelated,

from tax

(e)armersl^So1(s^^

(f)

Share oftotal

(g)

Share ofend of year

(h)oispropor-

anotoanos^

(i)

Code V-UBIamount in box 20of Schedule K-1

01General omani^

(k)

Percentageownership

country) under section 512-514 ) Yes N. income assets Yes No (Form 1065) Yes No

Schedule R (Form 990) 2011

13216401-23-12 81

ScheduleR (Form 990 2011 Mission Hospital, Inc 56-0532141 Pa e5

Pad V.. Supplemental InformationComplete this part to provide additional information for responses to questions on Schedule R (see instructions).

Part IV, Identification of Related Organizations Taxable as Corp or Trust:

Name of Related Organization:

Horizon Management Services Inc

Primary Activity: Patient Billinq and Collection Services, Medical

Pronerty Rental

01-23-12 Schedule R (Form 990) 2011


KP G

MISSION HEALTH SYSTEM, INC.AND AFFILIATES

Combined Financial Statements

September 30, 2012 and 2011

(With Independent Auditors' Report Thereon)

KPMG LLPSuite 1000401 Commerce StreetNashville , TN 37219-2422

Independent Auditors' Report

The Board of DirectorsMission Health System, Inc.:

We have audited the accompanying combined balance sheets of Mission Health System, Inc. and Affiliates(Mission) as of September 30, 2012 and 2011, and the related combined statements of operations, changesin net assets, and cash flows for the years then ended. These combined financial statements are theresponsibility of Mission's management. Our responsibility is to express an opinion on these combinedfinancial statements based on our audits.

We conducted our audits in accordance with auditing standards generally accepted in the United States ofAmerica. Those standards require that we plan and perform the audit to obtain reasonable assurance aboutwhether the financial statements are free of material misstatement. An audit includes consideration ofinternal control over financial reporting as a basis for designing audit procedures that are appropriate in thecircumstances, but not for the purpose of expressing an opinion on the effectiveness of Mission's internalcontrol over financial reporting. Accordingly, we express no such opinion. An audit also includesexamining, on a test basis, evidence supporting the amounts and disclosures in the financial statements,assessing the accounting principles used and significant estimates made by management, as well asevaluating the overall financial statement presentation. We believe that our audits provide a reasonablebasis for our opinion.

In our opinion, the combined financial statements referred to above present fairly, in all material respects,the financial position of Mission Health System, Inc. and Affiliates as of September 30, 2012 and 2011,and the results of their operations, their changes in net assets, and their cash flows for the years then ended,in conformity with U.S. generally accepted accounting principles.

As discussed in note 1(w) to the combined financial statements, Mission changed its presentation of theprovision for bad debts as a result of the adoption of Accounting Standards Update 2011-07: Health CareEntities: Presentation and Disclosure of Patient Service Revenue, Provision for Bad Debts, and theAllowancefor Doubtful Accounts for Certain Health Care Entities.

K'PMG LcPJanuary 11, 2013

KPMG LLP is a Delaware limited liability partnership,the U S member firm of KPMG International Cooperative('KPMG Intemational '), a Swiss entity


Combined Balance Sheets


(In thousands)

Assets

Current assets:Cash and cash equivalentsInvestmentsCurrent portion of assets limited as to useAccounts receivable, less allowance for uncollectible

accounts of $50,037 in 2012 and $60,264 in 2011Other receivablesInventoriesPrepaid expenses and other

Total current assets

Assets limited as to useProperty and equipment, netOther assets

2012 2011

$ 119,81278,43215,560

118,518

16,895

147,86951,59316,0689,690

439,024

580,186690,48928,869

$ 1,738,568

124,40344,98915,7137,838

328,356

504,673679,29827,474

1,539,801

Liabilities and Net Assets

Current liabilities:Current portion of long-term debtLine of creditAccounts payableAccrued payroll and other expensesDue to third-party payors

Total current liabilities

Long-term debtOther long-term liabilities

Total liabilities

$ 9,16430,80035,75077,56939,801

193,084

363,84537,673

594,602

10,506850

25,58072,04017,546

126,522

375,17227,943

529,637

Net assets:UnrestrictedTemporarily restrictedPermanently restricted

Total net assets attributable to Mission Health System, Inc.

Noncontrolling interests

Total net assets

See accompanying notes to combined financial statements.

1,122,79516,1633,561

1,142,519

1,447

1,143,966

$ 1,738,568

989,60315,6173,585

1,008,805

1,359

1,010,164

1,539,801

2


Combined Statements of Operations

Years ended September 30, 2012 and 2011

(In thousands)

Unrestricted revenue, gains, and other support:Net patient service revenueProvision for bad debts

Net patient service revenue less provision for bad debts

2012

$ 1,091,512(93,974)

997,538

2011

985,787(93,826)

891,961

Other revenue

Total unrestricted revenue, gains, and other support

Expenses:Salaries and wagesEmployee benefitsSupplies and other expensesDepreciation and amortizationInterest

Total expenses

Operating income

Nonoperating gains:Investment income, netOther nonoperating gains, net

Nonoperating gains, net

Revenue, gains, and other support in excess of expenses

and losses before noncontrolling interests

Noncontrolling interests

Revenue, gains, and other support in excess of expensesand losses attributable to Mission Health System, Inc

Net unrealized gains (losses) on investmentsOtherNet assets released from restriction for capital expenditures and

contributed capital equipment

Change in unrestricted net assets


56,863

1,054,401

435,91697,258

384,27865,68215,761

998,895

55,506

18,7226,703

25,425

80,931

43,757

935,718

408,11691,552

328,42060,55114,922

903,561

32,157

17,5043,740

21,244

53,401

(932) (699)

79,999

49,624(422)

52,702

(23,729)(133)

3,991

$ 133,192

4,685

33,525

3

Balance at September 30, 2010

Revenue, gains, and other support inexcess of expenses and losses

Net unrealized losses on investmentsInvestment income, netDonor-restricted gifts, grants, and bequestsOtherDistributions to noncontrolling interestsNet assets released from restriction

for operationsNet assets released from restriction

for capital expenditures and contributedcapital equipment

Change in net assets


Revenue, gains, and other support inexcess of expenses and losses

Net unrealized gains on investmentsInvestment income, netDonor-restricted gifts, grants, and bequestsOtherDistributions to noncontrolling interestsNet assets released from restriction

for operationsNet assets released from restriction

for capital expenditures and contributedcapital equipment

Change in net assets



Combined Statements of Changes in Net Assets


(In thousands)

Temporarily PermanentlyUnrestricted restricted restricted

$ 956,078 14,857 3,481

Noncontrollinginterest Total

1,707 976,123

52,702 - - 699 53,401(23,729) - - - (23,729)- 186 - - 186- 7,523 104 - 7,627

(133) - - - (133)- - - (1,047) (1,047)

(2,264) - - (2,264)

4,685 (4,685) - - -

33,525 760 104 (348) 34,041

989,603 15,617 3,585 1,359 1,010,164

79,999 - - 932 80,93149,624 533 - - 50,157- 789 - - 789- 5,457 61 - 5,518

(422) 85 (85) - (422)- - - (844) (844)

(2,327) - - (2,327)

3,991 (3,991) - - -

133,192 546 (24) 88 133,802

$ 1,122,795 16,163 3,561 1,447 1,143,966

See accompanying notes to combined financial statements

4


Combined Statements of Cash Flows


(In thousands)

Cash flows from operating activities:Change in net assetsAdjustments to reconcile change in net assets to net cash

provided by operating activities:Net realized and unrealized (gains) losses on investmentsDepreciation and amortizationProvision for uncollectible accountsDistributions to noncontrolling interests(Gain) loss on sale of property and equipmentPermanently restricted and capital contributionsChanges in operating assets and liabilities:

Patient and other receivablesAccounts payable and accrued payroll and other expensesOther operating assets and liabilities, net

Net cash provided by operating activities

Cash flows from investing activities:Capital expendituresPurchases of investmentsPurchases of assets limited as to useSales of assets limited as to useProceeds from sale of property and equipment

Net cash used in investing activities

Cash flows from financing activities:Line of credit proceeds, netRepayment of debtDistributions to noncontrolling interestsPermanently restricted and capital contributions

Net cash provided by (used in) financing activities

Net increase (decrease) in cash and cash equivalents

Cash and cash equivalents, beginning of year

Cash and cash equivalents, end of year

Supplemental information:Cash paid for interest , net of amount capitalized

2012

133,802

(65,312)65,68293,974

844(1,246)(3,967)

(125,468)15,69929,600

2011

34,041

10,18860,55193,8261,047134

(4,789)

(114,233)6,2023,133

143,608 90,100

(77,839) (147,829)(78,432) -

(101,583) ( 148,661)92,717 175,3272,419 34

(162,718) (121,129)

30,338 32,620(13,057) (39,276)

(844) (1,047)3,967 4,789

20,404 (2,914)

1,294 (33,943)

118,518 152,461

$ 119,812 118,518

15,563 16,027



Notes to Combined Financial Statements


(1) Organization and Summary of Significant Accounting Policies

Mission Health System, Inc. (Mission) is a multidimensional healthcare organization, principally located inAsheville, North Carolina, providing inpatient, outpatient, and emergency services largely for residents ofwestern North Carolina. The significant accounting policies used by Mission in preparing and presentingits combined financial statements follow:

(a) Principles of Combination

The combined financial statements include the accounts of Mission and its controlled affiliates. Suchaffiliates of Mission include Mission Hospital, Inc. (the Hospital ), Mission Medical Associates, Inc.(MMA), Horizon Health Corporation, Imaging Realty , LLC, Asheville Specialty Hospital, BlueRidge Regional Hospital , Inc., The McDowell Hospital , Inc. (McDowell ), and Mission HealthcareFoundation, Inc.

Dogwood Insurance Company (SPC), Ltd. (Dogwood) is incorporated as an exempted SegregatedPortfolio Company with Limited Liability under the Companies Law of the Cayman Islands, andholds an Unrestricted Class `B' Insurer's license under Section 4 of Cayman Islands Insurance Law.The license enables Dogwood to transact insurance business, other than domestic business, fromwithin the Cayman Islands. Dogwood is equally owned by Mission and WakeMed, was originallyincorporated under the name Dogwood Insurance Company, Ltd. on April 9, 2010, and onNovember 18, 2010 changed its name to Dogwood Insurance Company (SPC), Ltd. Dogwood

currently consists of the "General Company" (which comprises only nominal financial amounts) andtwo segregated portfolios. The segregated portfolios are Mission Segregated Portfolio (Mission SP)and WakeMed Segregated Portfolio. The accompanying combined financial statements include thefinancial position and results of operations of Mission SP only.

Noncontrolling interests have been recorded to recognize the portion of the net assets and operatingresults of affiliates not wholly owned by Mission.

All significant intercompany accounts and transactions have been eliminated in combination.

(b) Use ofEstimates

The preparation of combined financial statements in conformity with U.S. generally acceptedaccounting principles requires management to make estimates and assumptions that affect thereported amounts of assets, liabilities, revenue, and expenses, as well as disclosure of contingentassets and liabilities. Actual results could differ from those estimates.

Significant items subject to such estimates and assumptions include the determination of theallowances for uncollectible accounts and contractual adjustments, accrued general and professionalliability costs, reserves for employee healthcare and workers' compensation claims, estimatedthird-party payor settlements, and the valuation of certain alternative investments as furtherdescribed in note 1(d).

In particular, laws and regulations governing the Medicare and Medicaid programs are extremelycomplex and subject to interpretation. As a result, there is at least a reasonable possibility that

6 (Continued)




recorded estimates associated with these programs will change by a material amount in the near

term.

(c) Cash Equivalents

Cash equivalents include certain investments in highly liquid debt instruments with original

maturities of three months or less.

(d) Investments and Investment Income

Investments in equity securities with readily determinable fair values and all investments in debt

securities are measured at fair value in the combined balance sheets. Investment income items

(including realized gains and losses on investments, earnings and losses on equity method alternative

investments, impairment losses, interest, and dividends) are included in revenue, gains, and other

support in excess of expenses and losses unless the income or loss is restricted by donor or law.

Mission reports the net change in unrealized gains and losses on investments in portfolios where

Mission retains sole investment management control as a change in unrestricted net assets unless

their use is restricted by explicit donor stipulations or law and, in accordance with relevant

accounting literature, generally excludes such net unrealized amounts from revenue, gains, and other

support in excess of expenses and losses.

Mission also has investments in certain marketable and nonmarketable alternatives (most often

referred to as hedge funds or private equity funds and generally organized as limited partnerships,

limited liability companies or corporations) and commingled funds (generally organized as collective

trust funds). Mission accounts for marketable and nonmarketable alternatives organized as limited

partnerships or limited liability companies with specific ownership accounts using the equity

method, which generally approximates net asset value. Mission accounts for commingled funds

using the fair value method or the equity method, dependent on its percentage ownership in a

specific fund. Mission accounts for marketable and nonmarketable alternatives organized as

corporations at net asset value as a practical expedient to fair value, when the investment has a

readily determinable value and transacts frequently (at least quarterly).

Mission routinely evaluates and measures its individual investments for unrealized losses that are

deemed to be "other-than-temporary," using the relevant guidance in Financial Accounting

Standards Board (FASB) Accounting Standards Codification (ASC) 320, Investments-Debt and

Equity Securities, for subsequent measurement of investments in debt and equity securities. Any

such losses are characterized in the period of determination as nonoperating losses and included in

the period's revenue, gains, and other support in excess of expenses and losses. The underlying

holdings of marketable alternatives and commingled funds are typically valued by the general

partner and trustee, respectively, using quoted market prices for publicly traded securities and

valuation estimates for derivative instruments. The underlying holdings of nonmarketable

alternatives are typically valued by general partners at cost or adjusted value based on recent

arms-length transactions, appraisals by third parties of properties held, or other methodologies. The

valuations provided by the general partners and trustees are routinely evaluated by management, and

management believes such values are reasonable.

(Continued)




Management is required to make certain estimates in the preparation of the combined financial

statements. Among those potentially significant estimates are the valuation of certain marketable and

nonmarketable alternatives. These estimates may be subjective and can require judgment regarding

significant matters such as the amount and timing of future cash flows and the selection of discount

rates that appropriately reflect market and credit risks. Mission believes that the carrying amounts of

these investments are reasonable estimates of fair value. Changes in assumptions or actual results

that differ from such estimates could have a material impact on the combined financial statements.

(e) Fair Value Accounting Standard

Mission follows the following financial accounting and reporting literature regarding fair valuemeasurements:

FASB ASC 820, Fair Value Measurements and Disclosures, which defines fair value,

establishes an enhanced framework for measuring fair value, and expands disclosures about fair

value measurements;

FASB Accounting Standards Update (ASU) 2010-06, Improving Disclosures about Fair Value

Measurements, which amended Topic 820 and also requires that Mission provide additional

enhanced disclosures related to its fair value measurements; and

the measurement provisions of FASB ASU 2009-12, Investments in Certain Entities That

Calculate Net Asset Value per Share (or Its Equivalent), as it applies to certain investments in

funds that do not have readily determinable fair values - including private equity investments,

hedge funds, real estate, and other funds. This guidance amends ASC 820 and permits, as a

practical expedient, the use of net asset value or its equivalent for the estimation of the fair value

of investments in investment companies for which the investment does not have a readily

determinable fair value. Net asset value, in many instances, may not equal fair value that would

be calculated pursuant to ASC 820.

(j9 Assets Limited as to Use

Assets limited as to use primarily include assets held by trustees under indenture agreements, funds

subject to donor restriction, and assets set aside by the Board of Directors for future operational andcapital needs. Amounts required to meet related current liabilities of Mission are classified as current

assets in the accompanying combined balance sheets.

(g) Property and Equipment

Property and equipment are stated at cost. Provisions for depreciation are computed using thestraight-line method over the estimated useful lives of the assets, which range from 3 to 40 years.Equipment under capital lease obligations is amortized using the straight-line method over theshorter of the lease term or the estimated useful life of the equipment. Leasehold improvements areamortized over the shorter of the lease term or estimated useful life. Such amortization is included indepreciation and amortization in the combined financial statements.

Gifts of long- lived assets such as land, buildings , or equipment are reported as unrestricted support,and are excluded from revenue, gains, and other support in excess of expenses and losses unless

8 (Continued)




explicit donor stipulations specify how the donated assets must be used. Gifts of long-lived assetswith explicit restrictions that specify how the assets are to be used, and gifts of cash or other assetsthat must be used to acquire long-lived assets, are reported as restricted support. Absent explicit

donor stipulations about how long those long-lived assets must be maintained, expirations of donor

restrictions are reported when the donated or acquired long-lived assets are placed into service.

Contributions restricted to the purchase of property and equipment, which restrictions are met within

the same year as received, are reported as increases in unrestricted net assets in the combined

financial statements.

(h) Costs ofBorrowing

Bond issuance costs and bond discounts are amortized over the term of the related bond issue using amethod that approximates the interest method.

Interest cost incurred on borrowed funds during the period of construction of capital assets is

capitalized, net of income earned on related trusteed assets, as a component of the cost of acquiring

those assets.

(i) Temporarily and Permanently Restricted Net Assets

Temporarily restricted net assets are assets which use by Mission is restricted by donors for a

specific time period or purpose. Permanently restricted net assets have been restricted by donors to

be maintained in perpetuity.

(f) Revenue, Gains, and Other Support in Excess ofExpenses and Losses

The combined statements of operations include revenue, gains, and other support in excess ofexpenses and losses. Changes in unrestricted net assets, which are excluded from revenue, gains, and

other support in excess of expenses and losses, include contributions of long-lived assets, specifically

defined impacts from adoption of required accounting standards, and certain investment incomeitems as previously described.

(k) Net Patient Service Revenue

Net patient service revenue is reported at the estimated net realizable amounts due from patients,

third-party payors, and others for services rendered, including estimated retroactive adjustments

arising from future audits, reviews, and investigations. Retroactive adjustments are considered in the

recognition of revenue on an estimated basis in the period the related services are rendered, and such

amounts are adjusted in future periods as adjustments become known or as years are no longer

subject to such audits, reviews, and investigations.

(l) Charity Care

Mission provides care to patients who meet certain criteria under its charity care policy without

charge or at amounts less than its established rates. Because Mission does not pursue collection of

amounts determined to qualify as charity care, they are not reported as revenue.

9 (Continued)




(m) Contributions

Unconditional promises to give cash and other assets are reported at estimated fair value at the date

the promise is received. Conditional promises to give are recognized when the conditions are

substantially met, and indications of intentions to give are reported at fair value at the date the gift is

received. The gifts are reported as either temporarily or permanently restricted support if they are

received with donor stipulations that limit the use of the donated assets. When a donor restriction

expires (that is, when a stipulated time restriction ends or purpose restriction is accomplished),

temporarily restricted net assets are reclassified as unrestricted net assets and reported in the

combined statements of operations as net assets released from restriction.

(n) Income Taxes

Mission and its affiliates, except for Horizon Health Corporation, Imaging Realty , LLC, and

Asheville Specialty Hospital , have been recognized as exempt from federal income tax under

Internal Revenue Code Section 501(a) as organizations described in Section 501 (c)(3), and therefore,

related income is generally not subject to federal or state income taxes. Horizon Health Corporation

is a for-profit corporation and subject to federal and state income taxes. Imaging Realty , LLC and

Asheville Specialty Hospital are taxable pass -through entities . Taxes on unrelated business income

and taxable income from Horizon Health Corporation are recognized as necessary in the

accompanying combined financial statements; regardless , associated tax accounting impacts are not

material.

Mission applies the provisions of FASB ASC 740, 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 the application of ASC 740.

(o) Derivative Financial Instruments

Mission includes the accrued differential payable or receivable on its derivative financial instruments

in operating income. Estimated gains or losses arising from fair value changes in derivatives are

included as nonoperating items in the determination of revenue, gains, and other support in excess of

expenses and losses. Mission has not elected hedge accounting with respect to any of its derivatives.

(p) Estimated Professional and General Liability Costs

The provision for estimated professional and general liability costs includes estimates of the ultimate

costs for both reported claims and claims incurred but not reported.

(q) Functional Expense Classification

All expenses in the accompanying combined statements of operations were incurred for or related tothe provision of healthcare services by Mission.

10 (Continued)




(r) Impairment ofLong-Lived Assets

Long-lived assets, such as property and equipment and purchased intangibles subject to amortization,

are reviewed for impairment whenever events or changes in circumstances indicate that the carrying

amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured

by a comparison of the carrying amount of an asset to estimated undiscounted future cash flows

expected to be generated by the asset. If the carrying amount of an asset exceeds its estimated future

cash flows, an impairment charge is recognized to the extent the carrying amount of the asset

exceeds its fair value. If applicable, assets to be disposed of are separately presented in the combined

balance sheet and reported at the lower of the carrying amount or fair value less costs to sell, and are

no longer depreciated. If applicable, the assets and liabilities of a disposal group classified as held for

sale are presented separately in the appropriate asset and liability sections of the combined balance

sheets.

(s) Inventories

Inventories , consisting principally of medical supplies and pharmaceuticals , are stated at the lower of

cost (first-in , first-out method) or replacement market.

(t) Guarantees

Mission follows the provisions of FASB ASC 460, Guarantees . ASC 460 requires entities to

disclose additional information about certain guarantees , or groups of similar guarantees , even if the

likelihood of the guarantor having to make any payments under the guarantee is remote . For certain

guarantees , ASC 460 also requires that a guarantor recognize a liability equal to the fair value of the

guarantee upon its issuance . ASC 460 recognition accounting has had no impact on the

accompanying combined financial statements , and Mission otherwise complies with the additional

disclosure requirements of ASC 460 when applicable.

(u) Subsequent Events

Mission has evaluated subsequent events for recognition and disclosure through January 11, 2013,

the date the combined financial statements were issued.

In October 2012, Mission became the sole member of Transylvania Health System, (Transylvania).

Transylvania is the sole member of Transylvania Community Hospital, Inc., d/b/a Transylvania

Regional Hospital, Transylvania Regional Hospital Foundation, Inc. and Transylvania Physician

Services, Inc., not-for-profit corporations, and the sole stockholder of Transylvania Services, Inc., a

for-profit corporation. Transylvania operates a critical access community hospital in Brevard, North

Carolina with 25 acute care beds and 10 sub-acute care beds.

Mission continues to evaluate opportunities to enter into affiliation agreements with community

hospitals resident within Mission's general service area. In addition to the affiliation agreement with

Transylvania finalized and described above, Mission has three separate affiliation agreements under

discussion, one facility of which, Mission currently provides management services. In general,

Mission would expect the consummation of affiliation transactions to result in the facilities

becoming a part of the Mission combined group for financial reporting purposes. While there can be

11 (Continued)




no assurance that final agreements will in fact be consummated, Mission currently expects that any

final agreements would be fiscal year 2013 transactions.

In November 2012, Mission issued taxable revenue bonds, Series 2012. Mission will use theproceeds of the Series 2012 bonds to finance the costs of various capital improvements, equipmentand other strategic initiatives for the benefit of Mission. The proceeds will also be used to pay certain

expenses incurred in connection with the authorization, issuance and sale of the Series 2012 bonds.

In December 2012, as part of its financing plans, Mission received a commitment from a local

commercial bank for a taxable loan totaling $70,150 (the "Bank Loan"). The Bank Loan has a fixed

rate and will be amortized over a 15 year period. The proceeds from the Bank Loan will be used to

supplement the Series 2012 Bonds for the purposes of various capital improvements, equipment and

other strategic initiatives for the benefit of Mission.

(v) Endowment Accounting

Mission follows FASB ASC 958 , Not-for-Profit Entities . Among its financial reporting guidance for

such entities , ASC 958 provides guidance on (a) the net asset classification of donor-restrictedendowment funds for a not-for-profit organization that is subject to an enacted version of the

Uniform Prudent Management of Institutional Funds Act of 2006 (UPMIFA ), and (b) related

enhanced disclosures about an organization ' s endowment funds (both donor-restricted and

board-designated).

Mission does not maintain any board-designated endowment funds and its endowment assets (and

related activities) are otherwise immaterial for purposes of the detail disclosures mentioned above.

(w) Accounting Standards

Recently Adopted

The FASB issued ASU 2010-23, Health Care Entities: Measuring Charity Care for Disclosure, in

August 2010. ASU 2010-23 amends ASC Subtopic 954-605, Health Care Entities: RevenueRecognition, to require that cost be used as the measurement basis for charity care disclosurepurposes. The method used to estimate such costs as well as any funds received to offset or subsidizecharity services provided should also be disclosed. Mission adopted the provisions of this standardon October 1, 2011 and retrospectively applied the provisions to all periods presented. The adoptionhad no impact on the combined financial statements.

The FASB issued ASU 2010-24, Health Care Entities: Presentation of Insurance Claims and

Related Insurance Recoveries, in August 2010. ASU 2010-24 amends ASC Subtopic 954-450,

Health Care Entities: Contingencies, to clarify that a health care entity should not net insurance

recoveries against a related liability and the claim liability should be determined without

consideration of insurance recoveries. Mission adopted the provisions of this standard prospectively

on October 1, 2011.

In July 2011, the FASB issued ASU 2011-07, Health Care Entities, Presentation and Disclosure of

Patient Service Revenue, Provision for Bad Debts, and the Allowance for Doubtful Accounts for

12 (Continued)




Certain Health Care Entities. This ASU changed Mission's presentation of the provision for bad

debts in the combined statements of operations from an operating expense to a deduction from net

patient service revenue. It also expands disclosures regarding policies for recognizing revenue,

assessing contra revenue line items, and activity in the allowance for bad debts. Mission adopted the

provisions of this standard on October 1, 2011 and retrospectively applied the provisions to all

periods presented.

The FASB issued ASU 2011-08, Testing Goodwill for Impairment, in September 2011.ASU 2011-08 permits an entity to make a qualitative assessment of whether it is more likely than not

that a reporting unit's fair value is less than its carrying amount before applying the two-step test for

impairment of goodwill. If an entity concludes that it is more likely than not that the fair value of a

reporting unit is less than its carrying amount, it would not be required to perform the two-step

impairment test for that reporting unit. Mission adopted the provisions of this standard on October 1,

2011. The adoption had no impact on the combined financial statements.

(x) Healthcare Industry Environment

In the light of the current sluggish pace of recovery of the U.S. economy from the downturn

experienced in 2008 - 2009 , Mission management continues to monitor economic conditionsclosely , both with respect to potential impacts on the healthcare provider industry and from a more

general business perspective. Management recognizes that economic conditions may continue to

impact the System in a number of ways, including (but not limited to) uncertainties associated with

U.S. financial system reform and rising self-pay patient volumes and corresponding increases in

uncompensated care.

Additionally , the general healthcare industry environment is increasingly uncertain, especially with

respect to the impacts of federal healthcare reform legislation , which was passed in the spring of

2010 and largely upheld by the U. S. Supreme Court in June 2012. Potential impacts of ongoing

healthcare industry transformation include, but are not limited to:

• Significant (and potentially unprecedented) capital investment in healthcare information

technology (HCIT);

• Continuing volatility in the state and federal government reimbursement programs;

• Lack of clarity related to the health benefit exchange framework mandated by reform legislation,

including important open questions regarding exchange reimbursement levels, changes in

combined state/federal disproportionate share payments, and impact on the healthcare "demand

curve" as the previously uninsured enter the insurance system;

• Effective management of multiple major regulatory mandates, including achievement of

meaningful use of HCIT and the transition to ICD-l0; and

• Significant potential business model changes throughout the healthcare ecosystem, including

within the healthcare commercial payor industry.

13 (Continued)




The business of healthcare in the current economic, legislative, and regulatory environment is volatile. Any

of the above factors, along with others both currently in existence and which may arise in the future, could

have a material adverse impact on the System's financial position and operating results.

(2) Certificate of Public Advantage

A Certificate of Public Advantage (COPA) was issued by the state of North Carolina in December 1995 topermit a collaborative relationship between the then-separate Memorial Mission Hospital and St. Joseph's

Hospital to achieve economies of scale through cost reduction initiatives. As part of the acquisition of St.Joseph's Hospital in October 1998, the COPA was amended. Among other provisions, the COPA requires

that Mission maintain certain operating margin and cost targets (as amended in 2005). Compliance with

COPA restrictions is the responsibility of Mission's management and is subject to monitoring by state

regulatory agencies.

In the fall of 2011, a Select Committee on Certificate of Need and Related Hospital Issues (the

"Committee") was established and held public hearings across the State regarding, among other matters,

the State's certificate of public advantage laws. Although the Committee issued no actions orrecommendations regarding the COPA, several questions were raised regarding assurance of compliance

with its non-financial provisions. Therefore, Mission volunteered to undergo a five year review of such

compliance. This assessment, which was completed and made public on September 13, 2012, found

Mission to be in full compliance in all major areas. Furthermore, as of the date of this issuance, Mission

has filed all periodic and interim reports required under the Certificate of Public Advantage, and neither

DHHS nor the Attorney General has proposed to revoke or modify the Certificate of Public Advantage

after reviewing these periodic and interim reports.

14 (Continued)




(3) Investments and Assets Limited as to Use

The composition of investments and assets limited as to use follows:

2012

Investments:Fixed income securities $ 78,432

Assets limited as to use:By indenture agreements - held by trustee:

Cash and cash equivalents 15,560Fixed income securities -

15,560

By donor restriction:Cash and cash equivalentsFixed income securitiesCommon stocksAlternative investment vehiclesCollective trust funds

By board for future needs:Cash and cash equivalentsFixed income securitiesCommon stocksAlternative investment vehiclesCollective trust funds

Under terms of deferred compensation planagreements - common stocks

Amounts classified as current assets

3502,0925,7721,0561,148

10,418

20,85163,503121,077170,508185,316

561,255

8,513

674,178

(93,992)

$ 580,186

2011

16,507388

16,895

8932,2143,7481,7721,894

10,521

16,67359,05786,698157,784168,506

488,718

5,434

521,568

(16,895)

504,673

15 (Continued)




Alternative investment vehicles include limited partnerships and offshore investment funds. These fundsmay invest in certain types of financial instruments intended to hedge against market risk, including,among others, futures and forward contracts, options, and securities sold not yet purchased. These financialinstruments, which involve varying degrees of off-balance sheet risk, may result in loss due to market riskand other factors. Alternative investment vehicles by strategy type follow:

Hedge fundsPrivate equityReal estateNatural resources

2012 2011

$ 122,18837,9026,8564,618

$ 171,564

124,24828,0545,5181,736

159,556

Mission has outstanding commitments to private equity interests to provide capital infusions upon request.The projected capital call amounts for the next five fiscal years are summarized in the table below (thereare currently no such commitments after fiscal year 2018):

Projectedcapital calls

Fiscal year:2013 $ 14,9002014 11,3002015 7,0002016 4,3002017 2,4002018 1,000

$ 40,900

Private equity interests have initial 10 to 12 year terms, with potential extensions of I to 6 years. As ofSeptember 30, 2012, the average remaining contractual life of the private equity interests is approximatelynine years.

Mission's current hedge fund investments are generally restricted from redemption for defined lock-upperiods. Some of the hedge fund investments with redemption restrictions allow early redemption forspecified fees. The terms and conditions under which Mission may redeem these investments vary, usuallyrequiring 30 to 180 days notice after the initial lock-up period.

16 (Continued)




Based upon the terms and conditions in effect at September 30, 2012, Mission's hedge fund investmentscan be redeemed or sold as follows:

Fiscal year:2013 $ 101,4012014 16,004

Total $ 117,405

The following tables reflect investments with unrealized losses at September 30, 2012 and 2011. The tablessegregate investments that have been in a sustained unrealized loss position for less than 12 months fromthose that have been in a sustained unrealized loss position for 12 or more months.

2012Sustained loss of less than Sustained loss of

12 months 12 months or longer Total unrealized losses

Unrealized Unrealized Unrealized

Description of securities Fair value losses Fair value losses Fair value losses

Equity securities $ 9,210 790 9,210 790Collective trust funds - - 32,506 2,255 32,506 2,255

Total $ - - 41,716 3,045 41,716 3,045

2011Sustained loss of less than Sustained loss of

12 months 12 months or longer Total unrealized lossesUnrealized Unrealized Unrealized

Description of securities Fair value losses Fair value losses Fair value losses

Equity securities $ 8,109 1,891 - - 8,109 1,891Collective trust funds 29,580 5,994 - - 29,580 5,994

Total $ 37,689 7,885 - - 37,689 7,885

For financial reporting purposes, the collective trust funds, in all material respects, "private mutual funds"comprise fully marketable debt and equity securities, which are carried in the accompanying combinedbalance sheets at Mission's proportionate interest in the underlying fair value of the related fundinvestments. The terms and conditions associated with Mission's participation in the noted collective trustfunds do not require that Mission make additional investments in the funds nor is Mission restricted in itsability to make withdrawals from the funds. Therefore, Mission appropriately measures its ability andintent at the fund level and, therefore, currently considers the unrealized losses noted in the tables above as"temporary" in assessing the required financial accounting under Mission's policy as described in note 1.

Unrealized losses on investments are generally due to fluctuations in market price caused by factors suchas credit quality of issuers, interest rates, demand, and market expectations. As a result of evaluation ofthese factors, Mission currently considers the unrealized losses noted in the tables above as "temporary" inassessing the required financial accounting under Mission's policy as described in note 1.

17 (Continued)




Mission recognized $601 and $8,679 in other-than-temporary losses (consistent with its policy described in

note 1) in 2012 and 2011, respectively.

Net investment income (loss) reported in unrestricted net assets comprises of the following:

2012 2011

Net investment income included in nonoperating gains:Interest and dividend income $ 3,034 3,963Realized gains on sales of investments , net 6,616 11,145Alternative investment program gains, net 9,072 2,396

18,722 17,504

Other changes in unrestricted net assets:Net unrealized gains (losses ) on investments 49,624 (23,729)

Total $ 68,346 (6,225)

(4) Property and Equipment

Property and equipment consist of the following:

2012

Land and land improvementsBuildingsEquipment and capitalized software costsInformation technology licensing contract (note 17)

$ 70,382785,092447,34811,933

1,314,755

2011

53,971707,507412,39511,933

1,185,806

Accumulated depreciation and amortization (660,575) (606,943)

654,180 578,863

Construction in progress 36,309 100,435

$ 690,489 679,298

Construction in progress at September 30, 2012 is principally related to projects for facility enhancements,

clinical equipment, and information system upgrades. These projects are expected to be completed duringfiscal year 2012 at an estimated total remaining cost to complete of approximately $41,853 to be funded

from operations. Mission capitalized interest of $1,152 and $2,911 in 2012 and 2011, respectively.

(5) Employee Benefit Plans

Mission has a defined contribution savings plan available to all employees who have met certain length ofservice requirements. Under this plan, Mission matches employee contributions up to 8% of compensation

18 (Continued)




depending on years of service and hire date. Expense associated with the plan was approximately $10,441and $9,933 in 2012 and 2011, respectively.

Mission sponsored a nonqualified deferred income plan for certain members of senior management, fundedentirely by elective contributions of the participants. Funding of this plan was discontinued in May 2002.

Participants are fully vested in the associated prior funding and, therefore, a liability equal to the

corresponding funding is recognized by Mission. Plan funding and the related liability, each totaling

$1,078 and $1,006, respectively, at September 30, 2012 and 2011, are included in assets limited as to use

and other long-term liabilities, respectively, in the accompanying combined balance sheets.

Mission sponsors and funds a nonqualified deferred income plan for certain members of senior

management. Plan participants are entitled to the benefits once they comply with established substantial

risk of forfeiture rules. Plan funding, including accrued earnings, and the related liability of $3,516 and

$2,692, respectively, at September 30, 2012 and 2011, are included in assets limited as to use and other

long-term liabilities, respectively, in the accompanying combined balance sheets. The plan also includes a

split dollar insurance agreement funded by Mission. The cash surrender value of $123 and $72 is included

in assets limited as to use at September 30, 2012 and 2011, respectively, in the accompanying combinedbalance sheets.

(6) Accrued Payroll and Other Expenses

Accrued payroll and other expenses consist of the following:

2012 2011

Accrued salaries, wages, and benefits $ 39,346 36,231Other accrued expenses 12,335 8,346Interest payable 7,683 7,485Employee health reserves 7,232 6,606Patient credit balances 6,041 5,658Workers' compensation liability reserves 4,289 4,378Current portion of capitalized software obligation - 1,438Retainage payable - 1,080Due to affiliates 643 818

$ 77,569 72,040

(7) Line of Credit

Mission maintains a $30,000 unsecured line of credit with a bank at LIBOR plus 0.50%. This line of credit

had an outstanding balance of $30,000 at September 30, 2012 and no amounts were outstanding at

September 30, 2011. The line of credit expires on December 6, 2014 and Mission retains the right to renew

at this date.

One of Mission's affiliates maintains a $3,000 unsecured line of credit with a bank at LIBOR plus 1.75%.

This line of credit had an outstanding balance of $800 and $850 at September 30, 2012 and 2011,

19 (Continued)




respectively. The line of credit expires in March 2013 and management anticipates routine renewal of the

expiring facility under substantially the same terms and conditions as noted.

(8) Long-term Debt

A summary of long-term debt follows:

2012 2011

Revenue bonds, issued in January 2007 through theCommission. Interest rates range from 4.00% to 5.00%;interest payments due semiannually on April 1 andOctober 1; principal payments due annually onOctober 1 through 2032. $ 251,805 253,775

Revenue bonds, issued in February 2010 through theCommission. Interest rates range from 3.00% to 5.00%;interest payments due semiannually on April 1 andOctober 1; principal payments due annually onOctober I through 2035. 63,405 65,000

Revenue bonds, issued in August 2011 through theCommission. Interest rates is 2.50% for the first five years;interest payments due semiannually on April 1 andOctober 1; principal payments due annually onOctober 1 through 2028. 31,405 32,270

Revenue bonds, issued in October 2003 through theCommission. Interest at variable rates (0.16% atSeptember 30, 2012); interest payments due monthly;principal payments due annually on October 1 through 2018. 10,030 11,260

Revenue bonds, issued in July 1997 through the NorthCarolina Medical Care Commission (the Commission).Interest at variable rates (0.34% at September 30, 2012);interest payments due quarterly on January 1, April 1,July 1, and October 1; principal payments due annually(beginning in July 2006) on July 1 through 2017. 935 1,135

Revenue bonds issued in December 1999 through theCommission. Interest at a variable rate convertible to afixed rate through May 2016 (0.25% at September 30,2011). Interest payments due monthly; principalpayments due annually on May 1 through 2016. - 2,740

Revenue bonds, issued in October 2001 through theCommission. Interest rates range from 4.00% to 4.13%;interest payments due semiannually on April 1 andOctober 1; principal payments due annually onOctober I through 2011. - 1,920

20 (Continued)




Net unamortized premium

2012 2011

Total revenue bonds

Various notes payable and capital lease obligations, interestranging from 2.38% to 10.79%, maturing through June2025, generally secured by property and equipment

Total long-term debt

Current portion

Long-term debt, excluding current portion

Future maturities of long-term debt follow:

$ 5,923 6,171

363,503 374,271

9,506 11,407

373,009 385,678

(9,164) (10,506)

$ 363,845 375,172

Amount

20132014201520162017Thereafter

9,1649,0679,3389,5319,538

320,448

367,086

Plus net unamortized premium 5,923

$ 373,009

All revenue bonds are generally secured by Mission net revenue (as defined) and certain trusteed fundsdescribed in note 3. Additionally, there are a number of customary restrictive covenants contained in theagreements related to Mission's revenue bond issues, including maintenance of certain debt servicecoverage and other financial ratios.

The 1997, 1999, and 2003 revenue bonds bear interest at variable rates and are supported by remarketingand standby bond purchase agreements. Interest rates are periodically adjusted based upon prevailing ratesfor the contract period related to the remarketed tranche. In the event a market for variable rate instrumentsis not sustained, the standby agreements provide for refinancing the bonds. The average annual interest rateon the 1997, 1999, and 2003 revenue bonds approximated 3.67% and 3.90% for the years endedSeptember 30, 2012 and 2011, respectively.

In August 2011, Mission issued $32,270 in Series 2011 revenue bonds through the Commission. Theproceeds of this issue were used to refund the Series 1998 revenue bonds.

21 (Continued)




On August 17, 2011, Mission entered into agreements to guarantee portions of borrowings totaling $14,485

and $14,655 obtained, respectively, by the community hospitals which Mission is in affiliation discussions

with as described in note 1(v) community hospitals. These guarantees are secured by certain property of

the hospitals. The loan balances of $13,355 and $14,422 at September 30, 2012 are equal to the guarantees.

If either of the entities default, Mission would be required to perform under the guarantee in an amount

equal to the then-outstanding amounts. Mission monitors the financial performance of the entities on amonthly basis. No accrual for Mission's obligation under this guarantee is currently required.

(9) Derivative Financial Instruments

Mission does not use derivative financial instruments for trading purposes. In each instance, the fair value

of the relevant instrument is generally estimated as the amount Mission would receive or pay for the

termination right at the reporting date, taking into account current interest rates and other factors, including

credit default risk.

In 2000, McDowell entered into a swap agreement, which is in effect until May 2016. The swap agreement

exchanges a variable rate for a fixed rate of 4.92%. The fair value of the swap as of September 30, 2012

and 2011 was a liability of $236 and $331, respectively, which is included in other long-term liabilities in

the combined balance sheets.

In September 2002, Mission entered into a forward-starting swap agreement that was executed in

conjunction with the refunding of the balance of the Series 1993 revenue bonds, which were refunded with

proceeds from the Series 2003 bonds. The swap agreement exchanged a variable rate for a fixed rate of

3.59%. The effective date of this transaction was October 2003, which mirrored the call date of the Series

1993 bonds. The fair value of the swap was a net liability of $1,022 and $1,166 at September 30, 2012 and

2011, respectively, which is included in other long-term liabilities.

(10) Other Long-Term Liabilities

A summary of other long-term liabilities follows:

Accrued general and professional liability costsFair value of derivative financial instrumentsDeferred compensation payableOther

2012 2011

$ 27,461 20,8891,258 1,4978,391 5,213563 344

$ 37,673 27,943

(11) Leases

Rental expense, including short-term cancelable rentals, was $18,989 and $17,525 during 2012 and 2011,respectively.

Mission has master agreements with financing companies (the Lessors) and the Commission for certainequipment financing. Financing under the agreements is provided concurrent with Mission's assignment of

22 (Continued)




security interest and title in eligible assets to the Lessors and the Commission. The Lessors obtain

financing from the Commission, reimburse Mission for its purchase cost of eligible assets, and then lease

the related assets back to Mission. Individual lease arrangements under the agreements are generally

structured as operating leases, and related payments are included in the future minimum lease payments

outlined below. Mission has the option to purchase the equipment from the Lessors at the end of the

respective lease terms, generally at fair value (as defined).

The following is a schedule by year of future minimum lease payments due under noncancelable operating

leases that have initial or remaining lease terms in excess of one year:

Amount

2013 $ 11,4322014 9,6362015 6,5732016 2,2002017 1,435

Thereafter 7,950

$ 39,226

In late 2010, the FASB issued for comment Proposed Accounting Standards Update - Leases (Topic 840).

After receiving and considering significant feedback, the FASB has indicated its intention to issue a related

final ASU in calendar year 2014. This new guidance is expected to require Mission to recognize virtually

all of its leases on the combined balance sheet. Assuming the ASU is in fact issued, adoption could cause

considerable changes in the presentation of Mission's debt and interest expense in its combined financial

statements (among other things). Management is reviewing the implications of the proposed ASU for

Mission, including potential implications for many complex agreements and arrangements, which might be

impacted by this major accounting change. While that work is ongoing, management is optimistic that

there will not be material issues associated with important related matters, such as overall Mission credit

ratings or future debt covenant compliance.

(12) Net Patient Service Revenue

Certain affiliates of Mission have agreements with governmental and other third-party payors that provide

for reimbursement to such affiliates at amounts different from established rates. Contractual adjustments

under third-party reimbursement programs represent the difference between billings at established rates for

services and amounts reimbursed by third-party payors. A summary of the basis of reimbursement with

major third-party payors follows:

Medicare - Inpatient and outpatient services rendered to Medicare program beneficiaries are

generally paid at prospectively determined rates. These rates vary according to patient classification

systems based on clinical, diagnostic, and other factors. Additionally, payments for certain other

reimbursable items are made at tentative rates, with final settlements determined after submission of

annual cost reports by Mission and audits by the Medicare fiscal intermediary. Mission's Medicare

cost reports have been audited by the Medicare fiscal intermediary through September 30, 2006.

23 (Continued)




Revenue from the Medicare program totaled approximately 36% and 38% of Mission's net patientservice revenue for the years ended September 30, 2012 and 2011, respectively.

Medicaid - Inpatient services rendered to Medicaid program beneficiaries are paid at prospectivelydetermined rates per discharge. Outpatient services are generally paid based upon costreimbursement methodologies . Mission is reimbursed at a tentative rate with final settlementdetermined after it submits its annual Medicaid cost reports. Mission ' s Medicaid cost reports havebeen audited by the Medicaid program through September 30, 2006 , and with periods September 30,2009 and 2010 currently settled without audit. Revenue from the Medicaid program totaledapproximately 16% and 13% of Mission's net patient service revenue for the years endedSeptember 30, 2012 and 2011, respectively.

In March 2012, the federal government approved an amendment to the North Carolina MedicaidDisproportionate Share (DSH) Program that provides a new funding model, which employsassessments of all hospitals as a percentage of their costs. Assessment payments, as well as existingstate funds, are matched by federal funds and redistributed so that declines in private hospitalpayments are mitigated. During 2012, Mission's gross Medicaid receipts from the DSH Programwere $110,750. Total assessments paid by Mission during the year were $32,388. The net of thegross receipts less the assessment is included as a reduction in net patient revenues.

Regulators continue to review North Carolina's Medicaid disproportionate share program, which hasdelayed the settlement of associated program funds relative to amounts received by Mission in fiscalyears 2008 through 2012. Conclusions from the ongoing regulatory review of the state's programhave not been finalized and the impact on the program from the finalization of the review (eitherpositive or negative) has yet to be determined. There can be no assurance that Mission will continueto qualify for future participation in this program or that the program will not be discontinued ormaterially modified.

Other - Mission has also entered into payment agreements with certain commercial insurancecarriers, health maintenance organizations , preferred provider organizations, and directly with localemployers . The basis for payment to Mission under these agreements includes prospectivelydetermined rates per discharge, discounts from established charges, and prospectively determineddaily rates.

In the spring of 2010, the Patient Protection and Affordable Care Act and the Health Care and EducationReconciliation Act (collectively, the Health Care Acts) were signed into law by President Obama. Theimpact of the Health Care Acts is complicated and difficult to predict, but Mission anticipates itsreimbursement in the future will be affected by major elements of the Health Care Acts designed to (1)increase insurance coverage, (2) change provider and payor behavior, and (3) encourage alternativepayment and delivery models. Many healthcare reform variables remain unknown and are, among otherthings, dependent on implementation by federal and state governments and reactions by providers, payors,employers, and individuals. Mission continues to monitor developments in healthcare reform andparticipates actively in contemplating and designing new programs that are encouraged and/or required bythe Health Care Acts.

24 (Continued)




The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted as partof the American Recovery and Reinvestment Act of 2009 and signed into law in February 2009. In the

context of the HITECH Act, Mission must implement a certified Electronic Health Record (EHR) in an

effort to promote the adoption and "meaningful use" of health information technology. The HITECH Act

includes significant monetary incentives and payment penalties meant to encourage the adaption of EHR

technology. Mission anticipates system-wide compliance with the Meaningful Use objectives mandated in

the HITECH legislation. Certain Mission entities have met and attested to various stages of meaningful use

in 2012 and 2011, with $8,010 and $5,203 of incentives recognized and either received or pending final

third party settlement in 2012 and 2011, respectively.

With respect to reserves for third-party payor cost report audits and anticipated settlements , Mission

routinely provides such reserves through the periods of initial audit and final settlement of the cost reports.

Mission has historically provided such reserves in recognition of the complexity of relevant reimbursement

regulations and the volatility of related settlement processes . In any event , Mission ' s estimates in this area

will differ from actual experience , and those differences may be material . During 2012 and 2011, net

patient service revenue increased approximately $25,960 and $3,744 , respectively , due to settlements

related to prior periods , changes in estimates related to prior cost reporting periods, and removal of

allowances previously estimated that are no longer necessary as a result of final settlements and years that

are no longer subject to audits, reviews, and investigations . The 2012 increase primarily represents

settlements related to a Medicare rural floor appeal of $7,419, and recognition of Medicaid DSH revenue

related to prior periods of $18,541.

The composition of net patient service revenue follows:

2012

Gross patient service revenue $ 2,305,997Less provision for contractual and other adjustments (1,214,485)Less provision for bad debts (93,974)

Net patient service revenue $ 997,538

2011

2,090,748(1,104,961)

(93,826)

891,961

Patient accounts receivable are reduced by an allowance for bad debts. In evaluating the collectibility of

accounts receivable, Mission analyzes historical collections and write-offs and identifies trends for each of

its major payor sources of revenue to estimate the appropriate allowance for bad debts and provision for

bad debts. Management regularly reviews data about these major payor sources of revenue in evaluation of

the sufficiency of the allowance for bad debts. For receivables associated with services provided to patients

who have third-party coverage, Mission analyzes contractually due amounts and provides an allowance for

uncollectible accounts, allowance for contractual adjustments, provision for bad debts, and contractual

adjustments on accounts for which the third-party payor has not yet paid or for payors who are known to be

having financial difficulties that make the realization of amounts due unlikely. For receivables associated

with self-pay patients or with balances remaining after the third-party coverage has already paid, Mission

records a significant provision for bad debts in the period of service on the basis of its historical

collections, which indicates that many patients decline to pay the portion of their bill for which they are

financially responsible. The difference between the discounted rate and the amounts collected after all

25 (Continued)




reasonable collection efforts have been exhausted is written off against the allowance for bad debts.Mission has not changed it charity core or uninsured discount policies during fiscal year 2012 or 2011.Mission's self-pay write-offs increased approximately $3,242 from $65,989 for fiscal year 2011 toapproximately $69,231 for fiscal year 2012. Increased write-offs were the result of higher utilization and

other contributing factors leading to increased gross charges. Mission maintains an allowance for

uncollectible accounts from other third-party payors which is not material.

(13) Service to the Community

Mission accepts all patients regardless of their ability to pay. Mission has established a formal policy

whereby a patient may qualify for charity care if certain criteria are met. These policies define charityservices as those services for which no or only partial payment is anticipated because of a patient's ability

to pay. In assessing a patient's ability to pay, Mission utilizes the generally recognized poverty income

levels, but also includes certain cases where incurred charges are significant when compared to thepatient's available resources. In addition to providing services to the financially disadvantaged, Missionparticipates in state and federal programs designed for the indigent and elderly whereby healthcare servicesare often times reimbursed at or below Mission's full cost of providing such services. Additionally,Mission subsidizes graduate medical education in the community. Estimated total community benefit costs

and unreimbursed costs of government healthcare programs for Mission are $112,901 and $85,804 for

September 30, 2012 and 2011, respectively (as detailed below). Additionally, costs of services associated

with uncollectible accounts are estimated at $32,014 and $31,692 for September 30, 2012 and 2011,

respectively.

Estimated costs of treating charity care patientsUnreimbursed medical education and research costsOther direct community benefit costs

Total community benefit costs

Estimated unreimbursed costs of treating Medicare patientsEstimated unreimbursed costs of treating Medicaid patients

Total community benefit costs and unreimbursedcosts of government healthcare programs

2012 2011

$ 21,6256,521

47,385

75,531

16,7876,741

44,230

67,758

35,444 14,4301,926 3,616

$ 112,901 85,804

The above estimates were developed using the methodology adopted by the North Carolina HospitalAssociation in 2006 for such costs, including information from Mission's cost reporting systems used tosupport its related filings with the Medicare and Medicaid programs.

Mission presents the above information as only one series of quantifiable measures associated with itscommunity commitment . Importantly, management believes this information presents only one facet of themultiple ways in which Mission fulfills its obligation to serve the communities within its service area.

26 (Continued)




(14) Temporarily and Permanently Restricted Net Assets

Temporarily restricted net assets are available for the following purposes:

Capital expendituresHospital programs

2012 2011

$ 7,287 6,9228,876 8,695

$ 16,163 15,617

Permanently restricted net assets consist of endowment contributions to be maintained in perpetuity, the

income from which is expendable to support healthcare services.

(15) Insurance Programs

The accompanying combined financial statements include Mission SP, which as described in note I is asegregated portfolio of Dogwood, a captive insurance affiliate of Mission that issues professional andgeneral liability insurance to Mission. Effective September 30, 2010, Mission transferred the liability forboth known and incurred but not reported claims for all policy periods prior to June I, 2010 to Dogwood.Mission is self-insured with respect to general and professional liability risks in an underlying layer of$4,000 per occurrence, with an additional $2,000 per occurrence, $4,000 aggregate buffer layer, and$16,000 aggregate retention. Incurred losses under Mission's incident reporting system and incurred butnot reported losses are accrued based on estimates that incorporate Mission's past experience, as well asother considerations such as the nature of each claim or incident, relevant trend factors, and advice fromconsulting actuaries. As of September 30, 2012 and 2011, Mission has recorded an accrual for estimatedlosses, discounted at 2%, of $27,461 and $20,889, respectively, which is included in other long-termliabilities in the accompanying combined balance sheets.

Mission has substantial excess professional liability coverage available under the provisions of excessclaims-made policies, which expire June 1, 2012. To the extent that any claims-made coverage is notrenewed or replaced with equivalent insurance, claims based on occurrences during the term of suchcoverage, but reported subsequently, would be uninsured. Management believes, based on incidentsidentified through Mission's incident reporting system, that any such claims would not have a materialeffect on Mission's operations or financial position. In any event, management anticipates that theclaims-made coverage currently in place will be renewed or replaced with equivalent insurance as the termof such coverage expires. Mission also has substantial excess general liability coverage under theprovisions of occurrence-based excess policies.

Mission is self-insured with respect to employee health coverage, up to a lifetime limit of $2,000 peremployee. In addition, Mission is self-insured with respect to workers' compensation coverage, up to alimit of $400 per individual claim. Substantial coverage with a third-party carrier is maintained for excesslosses with respect to both employee health and workers' compensation exposures.

As of September 30, 2012 and 2011, Mission has recorded accruals for employee health and workers'compensation exposures, including the cost of both reported and unreported claims, totaling $11,521 and

27 (Continued)




$10,984, respectively, which are included in accrued payroll and other expenses in the accompanying

combined balance sheets.

Mission's self-insured employee health plan allows employees to elect a consumer-driven option, whereby

Mission funds first-dollar coverage of qualifying medical expenses up to certain limits. Unused amountscredited under the first-dollar coverage may be rolled into future plan years, subject to a ceiling.

Beginning in fiscal year 2009, amounts in excess of the carry-over ceiling are credited to a health

reimbursement account and a post-retirement benefit component was added to the health plan. Excludingan employee's interest in their qualifying balance, all other unused balances are forfeited upon termination

of employment. As of September 30, 2012 and 2011, Mission has recognized a liability of $2,845 and

$2,364, respectively, which is included in accrued payroll and other expenses, for the post-retirement

obligation component (as defined) of the plan.

Mission's commitment to fund first-dollar health expenses as described above is recognized in employee

health plan expense as employees incur medical costs and file for reimbursement with the health plan.

Future commitments, based on active employees, under the first-dollar healthcare reimbursement plan atSeptember 30, 2012 are $4,400. Actual future utilization under the plan is not reasonably estimable.

(16) Concentrations of Credit Risk

Mission grants credit to patients, substantially all of whom reside in the service areas of Mission. Missiongenerally does not require collateral or other security in extending credit to patients; however, it routinely

obtains assignment of (or is otherwise entitled to receive) patients' benefits payable under their healthinsurance programs, plans, or policies (e.g., Medicare, Medicaid, and other preferred providerarrangements and commercial insurance policies). The mix of gross receivables from patients and

third-party payors follows:

2012 2011

Medicare 26% 23%Medicaid 19 19Other third-party payors 28 27Commercial 11 11Patients 16 20

100% 100%

(17) Information Technology Contract

Effective October 1, 2005, Mission entered into a contract with a major information technology vendor.The agreement, which itself incorporates and substantially modified the terms of a prior existing agreementwith the vendor, is for a term of seven years. The contract generally commits Mission to the purchase of avariety of information technology products and services from this vendor for a defined payment streamover the term of the contract. Certain software license and related implicit maintenance costs (totalingapproximately $3,892 and $2,231, respectively) were capitalized at the inception of the agreement, withrecognition of an associated liability related to Mission's acquisition of these intangible assets. During

28 (Continued)




2007, the contract was amended such that certain information technology products included in the contractwere recharacterized as software licenses. As a result, Mission capitalized additional software license and

related implicit maintenance costs of $2,557 and $1,466, respectively, at the time the contract was

amended. Capitalized software and implied maintenance costs are being amortized over the estimateduseful life of the software licenses (generally seven years) and the implicit maintenance period (whichvaries depending on first date of productive use), respectively. Other contract costs are evaluated forcapitalization or expense recognition under relevant accounting literature as associated products and/orservices are provided. Mission's payment commitments under the contract concluded in fiscal year 2012

and consisted of $1,438 for capitalized software obligation and $4,319 for other contract costs.

(18) Fair Value of Financial Instruments

(a) Fair Value ofFinancial Instruments

The carrying amounts of all applicable asset and liability financial instruments reported in the

combined balance sheets (except for certain fixed rate debt instruments) approximate their fair values

at September 30, 2012 and 2011. Fair value of a financial instrument is defined as the amount atwhich the instrument could be exchanged in a current transaction between willing parties.

The fair value of Mission's debt portfolio has been estimated using interest rates currently availableto Mission for borrowings of similar character, collateral, and duration. The aggregate fair value ofthe portfolio approximates $393,483 and $389,853 at September 30, 2012 and 2011, respectively.

(b) Fair Value Hierarchy

In accordance with ASC 820, Mission has categorized its financial instruments, based on the priority

of inputs used in related valuation techniques, into a three-level fair value hierarchy. The fair value

hierarchy gives the highest priority to quoted prices in active markets for identical assets (Level 1)and the lowest priority to unobservable inputs (Level 3). If the inputs used to measure the financial

instruments fall within different levels of the hierarchy, the categorization is based on the lowest

level input that is significant to the fair value measurement of the instrument. The three levels of the

fair value hierarchy are as follows:

Level I inputs are quoted prices (unadjusted) in active markets for identical assets or liabilitiesthat Mission has the ability to access at the measurement date;

• Level 2 inputs are inputs other than quoted prices included within Level I (including net assetvalue) that are observable for the asset or liability, either directly or indirectly; and

• Level 3 inputs are unobservable inputs for the asset or liability.

29 (Continued)




The fair value hierarchy of investments and assets limited as to use at September 30, 2012 and 2011

follows:

2012

Cash and cash equivalents

Fixed income securities:DomesticInternational

Common stocks:DomesticInternational

Alternative investment vehicles:

Hedge funds

Private equity

Real estate

Natural resources

Commodities

Collective trust funds:

Domestic

International

Level I Level 2 Level 3 Total

$ 41,228 - - 41,228

129,161 17,074 - 146,235

482 - - 482

115,601 - - 115,601

12,436 - - 12,436

- 103,559 18,567 122,126

- - 37,964 37,96481 - 6,856 6,937- - 4,618 4,61887 - - 87

- 92,984 - 92,984

- 93,480 - 93,480

$ 299,076 307,097 68,005 674,178

2011

Cash and cash equivalents

Fixed income securities:

DomesticCommon stocks:

Domestic

Alternative investment vehicles:

Hedge funds

Private equityReal estateNatural resources

Collective trust funds:

DomesticInternational

Total

Level1 Level 2 Level 3 Total

$ 36,894 - - 36,894

61,659 - - 61,659

93,059 - - 93,059

- 97,841 26,407 124,248

- - 28,054 28,054- - 5,518 5,518

- - 1,736 1,736

- 76,064 - 76,064

- 94,336 - 94,336

$ 191,612 268,241 61,715 521,568

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The roll-forward of Level 3 assets limited as to use for the years ended September 30, 2012 and 2011follows:

Fair value at September 30, 2010 $ 45,527Unrealized and realized gains, net 4,164Sales, net (2,821)Purchases 14,845

Fair value at September 30, 2011 61,715

Unrealized and realized gains, net 2,537Sales, net (12,884)Purchases 16,637

Fair value at September 30, 2012 $ 68,005

Assets limited as to use classified as Level 2 are generally categorized based on the following

principles:

Shares or units in collective trust funds (as opposed to direct interests in the funds' underlying

holdings) and hedge funds, which may be marketable. Because the net asset value reported by

each fund is used as a practical expedient to estimate the fair value of Mission's interest therein,classification as Level 2 is based on Mission's ability to redeem its interest at or near the date of

the combined balance sheet. If the interest can be redeemed in the near term, the investment isclassified in Level 2. The classification of investments in the fair value hierarchy is not

necessarily an indication of the risks, liquidity, or degree of difficulty in estimating the fair value

of each investment's underlying assets and liabilities.

• Bonds whose fair values are determined by independent vendors. The vendors compile prices

from various sources and may apply matrix pricing for similar bonds or loans where no price is

observable in an actively traded market. If available, the vendor may also use quoted prices for

recent trading activity of assets with similar characteristics to the bond being valued.

Assets limited as to use classified as Level 3 are generally categorized based on the following

principles:

Ownership interests in hedge funds and private equity are valued by and obtained from the fund

manager. Account statements are received directly from independent administrators or the

underlying hedge funds managers, who are responsible for the pricing of these funds. Before

reliance on these valuations, Mission evaluates the fair value estimation processes and control

environment, the investee fund's policies and procedures for estimating fair value of underlying

investments, the investee fund's use of independent third party valuation experts, and the

professional reputation and standing of the investee fund's auditor.

• The System had no significant transfers of assets and liabilities into or out of Level 1, Level 2 or

Level 3 during either fiscal year 2012 or 2011.

31 (Continued)




Mission's interest rate swaps are executed over the counter and are valued using the net present

value of the cash flow streams and current market rates, as no quoted market prices exist for such

instruments. Mission categorizes its interest rate swaps as Level 2 within the fair value hierarchy.

(c) Limitations

Fair value estimates are made at a specific point in time, based on relevant market information and

information about the financial instruments. These estimates are subjective in nature and involve

uncertainties and matters of significant judgment and, therefore, cannot be determined with

precision. Changes in assumptions could significantly affect the estimates.

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