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ObjectId: 201432259349301613 - Submission: 2014-08-13
TIN: 26-3627231
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
Attach to Form 990.
See separate instructions.
OMB No. 1545-0047
20
12
Open to Public Inspection
Name of the organization
Mission Medical Associates Inc
Employer identification number
26-3627231
Part I
Identification of Disregarded Entities
(Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
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-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
Mission Health System Inc
509 Biltmore Avenue
Asheville
,
NC
28803
58-1450888
Parent Company Support Services, Mission Hospital & Affiliates
NC
501(c)(3)
Line 11a, I
No
(2)
Mission Hospital Inc
509 Biltmore Avenue
Asheville
,
NC
28803
56-0532141
Acute Care Hospital
NC
501(c)(3)
Line 3
Mission Health System Inc
No
(3)
Mission Healthcare Foundation Inc
980 Hendersonville Road
Asheville
,
NC
28803
56-1881331
Foundation
NC
501(c)(3)
Line 7
Mission Health System Inc
No
(4)
The McDowell Hospital Inc
430 Rankin Drive
Marion
,
NC
28752
56-0623938
Community Hospital
NC
501(c)(3)
Line 3
Mission Health System Inc
No
(5)
Blue Ridge Regional Hospital
Post Office Box 9
Spruce Pine
,
NC
28777
56-1025032
Community Hospital
NC
501(c)(3)
Line 3
Mission Health System Inc
No
(6)
Blue Ridge Regional Hospital Foundation
PO Box 247
Spruce Pine
,
NC
28777
58-2172660
Foundation
NC
501(c)(3)
Line 11a, I
Blue Ridge Regional Hospital Inc
No
(7)
Transylvania Health System Inc
260 Hospital Drive
Brevard
,
NC
28712
56-1456987
Dissolved
NC
501(c)(3)
Line 11b, II
Dissolved June 2013
No
(8)
Transylvania Regional Hospital Foundation
PO Box 2440
Brevard
,
NC
28712
56-1458024
Foundation
NC
501(c)(3)
Line 11a, I
Transylvania Community Hospital
No
(9)
Transylvania Physician Services Inc
260 Hospital Drive
Brevard
,
NC
28712
56-1920816
Healthcare
NC
501(c)(3)
Line 3
Transylvania Community Hospital
No
(10)
Transylvania Community Hospital (DBA Transylvania Regional HOspital)
260 Hospital Drive
Brevard
,
NC
28712
56-0562293
Healthcare
NC
501(c)(3)
Line 3
Mission Health System Inc
No
(11)
McDowell Healthcare Foundation Inc
430 Rankin Drive
Marion
,
NC
28752
46-3395393
Supporting Organization
NC
501(c)(3)
Line 7
The McDowell Hospital Inc
No
(12)
Angel Medical Center Auxiliary
PO Box 1209
Franklin
,
NC
28744
56-2133719
Supporting Organization
NC
501(c)(3)
Line 11a, I
Angel Medical Center Inc
No
(13)
Angel Medical Center
PO Box 1209
Franklin
,
NC
28712
56-6000064
Community Hospital
NC
501(c)(3)
Line 3
Mission Health System Inc
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Page 2
Schedule R (Form 990) 2012
Page
2
Part III
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 related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
Imaging Realty LLP
534 Biltmore Avenue
Asheville
,
NC
28801
56-1907203
Medical Building
NC
N/A
(2)
MSJHS and CCP Joint Development Company LLC
428 Biltmore Avenue
Asheville
,
NC
28801
56-2250464
Long Term Acute Care Hospital
NC
N/A
(3)
Asheville Imaging
534 Biltmore Avenue
Asheville
,
NC
28801
56-1907201
Medical Imaging
NC
N/A
(4)
Blue Ridge DME LLC
125 Hospital Drive
Spruce Pine
,
NC
28777
26-3570174
Home Medical Supplies
NC
N/A
(5)
McDowell MRI LLC
Medical Imaging
Marion
,
NC
28752
75-3046378
Medical Imaging
NC
N/A
(6)
Brevard MRI at Transylvania
260 Hospital Drive
Brevard
,
NC
28712
20-3281110
Healthcare
NC
N/A
(7)
Transylania Healthcare II LP
2 Medical Park Drive
Brevard
,
NC
28712
20-0333230
Rental
NC
N/A
(8)
Healthcare III LP
260 Hospital Drive
Brevard
,
NC
28712
56-1599596
Rental
NC
N/A
(9)
Healthcare Limited Liability Company VII
260 Hospital Drive
Brevard
,
NC
28712
20-0343455
Rental
NC
N/A
(10)
Western NC Healthcare InnovatorsLLC
5935 Carnegie Blvd
Charlotte
,
NC
28209
80-0787882
Real Estate Rental
NC
N/A
(11)
Western Regional Radiation Therapy Center
68 Hospital Drive
Sylva
,
NC
28779
56-1849395
NC
N/A
(12)
Asheville MRI
PO Box 2959
Asheville
,
NC
28802
56-1665863
NC
N/A
(13)
WNC Stone Center
509 Biltmore Avenue
Asheville
,
NC
28801
27-2152974
NC
N/A
Part IV
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 EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
Horizon Health Corp
213 Ridgefield Court
Asheville
,
NC
28806
56-1341621
Holding Company
NC
N/A
C
No
(2)
Horizon Management Services Inc
213 Ridgefield Court
Asheville
,
NC
28806
56-1341624
Patient Billing and Collection Services, Medical Property
NC
N/A
C
No
(3)
Dogwood Insurance Company
The Grand Pavilion Commercial Centr
Cayman Islands
CJ
Captive Insurance Company
CJ
N/A
C
No
(4)
Transylvania Services Inc
260 Hospital Drive
Brevard
,
NC
28712
56-1448199
Real Estate
NC
N/A
C
No
Schedule R (Form 990) 2012
Page 3
Schedule R (Form 990) 2012
Page
3
Part V
Transactions With Related Organizations
(Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, 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 orgranization 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
.
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1a
No
b
Gift, grant, or capital contribution to related organization(s)
.
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1b
No
c
Gift, grant, or capital contribution from related organization(s)
.
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1c
Yes
d
Loans or loan guarantees to or for related organization(s)
.
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1d
No
e
Loans or loan guarantees by related organization(s)
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1e
No
f
Dividends from related organization(s)
.
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1f
No
g
Sale of assets to related organization(s)
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1g
No
h
Purchase of assets from related organization(s)
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1h
No
i
Exchange of assets with related organization(s)
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1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
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1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
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1k
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
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1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
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1m
Yes
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
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1n
No
o
Sharing of paid employees with related organization(s)
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1o
No
p
Reimbursement paid to related organization(s) for expenses
.
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1p
No
q
Reimbursement paid by related organization(s) for expenses
.
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1q
No
r
Other transfer of cash or property to related organization(s)
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1r
No
s
Other transfer of cash or property from related organization(s)
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1s
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
Schedule R (Form 990) 2012
Page 4
Schedule R (Form 990) 2012
Page
4
Part VI
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 EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2012
Page 5
Schedule R (Form 990) 2012
Page
5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier
Return Reference
Explanation
Additional Data
Software ID:
Software Version: