SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Mission Hospital Inc
 
Employer identification number

56-0532141
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
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) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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, as a factor in determining 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 "medically indigent"? . . . . . . . . . . . . .

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    20,949,959   20,949,959 2.130 %
b Medicaid (from Worksheet 3, column a) . . . . .     126,463,082 137,138,949 -10,675,867 0 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     147,413,041 137,138,949 10,274,092 2.130 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     13,199,650 888,002 12,311,648 1.250 %
f Health professions education (from Worksheet 5) . . .     9,865,643 8,375,667 1,489,976 0.150 %
g Subsidized health services (from Worksheet 6) . . . .     98,846,421 51,712,112 47,134,309 4.800 %
h Research (from Worksheet 7) .     1,708,782 208,875 1,499,907 0.150 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     5,364,869 100,000 5,264,869 0.540 %
j Total. Other Benefits . .     128,985,365 61,284,656 67,700,709 6.890 %
k Total. Add lines 7d and 7j .     276,398,406 198,423,605 77,974,801 9.020 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
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 building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development     557,528   557,528 0.060 %
9 Other            
10 Total     557,528   557,528 0.060 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
24,616,518
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
199,574
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
263,182,263
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
272,364,861
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-9,182,598
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
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 qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
11 AshevilleImagingCenterLLP
  		Outpatient Imaging Services 69.000 % 0.890 % 30.110 %
22 Asheville MRI
  		Magnetic Resonance Imaging 50.000 % 1.280 % 48.720 %
33 WNC Stone Center LLP
  		Lithotripter Rental 33.000 % 0 % 67.000 %
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Mission Hospital
509 and 428 Biltmore Avenue
Asheville,NC28801
www.mission-health.org
H0036 		X X   X     X      
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Mission Hospital Inc
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................. 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): See supplemental information
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Mission Hospital Inc
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 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 all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 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 the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Mission Hospital Inc
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Page 1
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Mission Hospital, Inc. Part V, Section B, Line 5: In a random-sample survey that was administered in our county as part of this community health needs assessment, 300 community members completed a questionnaire regarding their health status, health behaviors, interactions with clinical care areas, support for certain health-related policies, and factors that impact their quality of life. In addtion, in our county, community members and partners were involved in the "Tell Us What You Think!" community listening project.Two outside consulting groups were hired to engage community residents in the community listening project. The collaborative team hired seven Community Partners to serve as community liaisons, using their expertise about their local communities to help shape and faciliate the primary data collection process.To collect data that would be both in-depth, and engage a large number of community residents, three primary data collection methods were used: Six 90-minute community listening sessions with 45 participants total, 297 brief community resident surveys collected by community partners and four telephone interviews with service providers.As part of WNC Healthy Impact, a regional data workgroup of public health and hospital representatives and regional partners, with support of a consulting team, made recommendations to the steering committee on the data approach and content used to help inform regional data collection. From data collected as part of this core dataset, the consulting team compiled secondary data for each county in the region. This data was then compared to the data collected in the 2011 Madison County CHA and 2010 Buncombe County CHA to identify similarities and differences.As part of the collaborative health assessment process in our communities, Mission representatives were involved in the prioritization process in both counties and will be involved in the subsequent Community Health Improvement Plans. In North Carolina, community-level prioritization is a required part of the community health (needs) assessment process.
Mission Hospital, Inc. Part V, Section B, Line 6a: Regional PartnershipMission Hospital's collaborative community health improvement effort is also supported by a comprehensive partnership with other regional hospitals and local health departments. This initiative, known as WNC Healthy Impact, represents 16 counties across the Western North Carolina region working collaboratively to improve community health. Information about this innovative regional collaboration, county-wide community health assessments, and overall regional findings, are made widely available to the public at www.WNCHealthyImpact.com.
Mission Hospital, Inc. Part V, Section B, Line 6b: Buncombe County Department of HealthMadison County Health Department
Mission Hospital, Inc. Part V, Section B, Line 7d: https://www.mission-health.org/community-health-needs-assessment.phphttp://www.buncombecounty.org/governing/depts/health/health_reports.aspxSince the CHNA url's truncate on the 990 Schedule H form, the links above display the full url for the CHNA report on the hospital's website and the other website.
Mission Hospital, Inc. Part V, Section B, Line 11: The Organization is addressing the need for Access to Care by providing significant health care at no cost or reduced cost through financial assistance as well as providing subidized services and health screenings and other low or no cost community health improvement services (Page 1, Schedule H). In addition to services provided directly,the Organization partners with various local charities to provide Access to Care through grants specific to the identified community needs (Schedule I).For the need identified as Healthy Living/Chronic Condition Management/Tobacco Prevention and Health, the Organization provides funds directly to local agencies for these needs (Schedule I). The Organization offers screenings and education services for chronic conditions. The Organization and the Counties have implemented smoke-free and tobacco-free policies for their buildings and campuses. The full list of partners and programs is provided in the implementation plan for needs which are addressed by programs other than those provided/funded by the Organization.In the area of Early Childhood Development, The Organization provides funds directly to local agencies for these needs (Schedule I). The Organization's Children's Hospital is the primary provider of care for children in WNC that have special healthcare or developmental needs. The subsidized services and community health improvement programs section of Schedule H includes many children's service areas. A full list of partner agencies and their roles is included in the implementation strategy.Finally, Mission provides funds directly to local agencies for Preconception Health (Schedule I), as well as offering preconception health care providers and preconception health trainings for consumers.The Organization is currently addressing all identified needs either directly or in partnership with other organizations.Highlights of 2012-2015 Implementation Strategy:Supported WNC Pediatric Care Collaborative to facilitate implementation of evidence-based obesity pediatric care for children and adolescents in fifteen primary care practices reaching over 40,000 children and adolescentsPartnered with the YMCA of Asheville & Buncombe County to present Healthy Kids Day--engaging more than 4,000 kids and their families.Supported Asheville Buncombe Institute on Parity Achievement in building a health awareness and screening program for 50 African-American churches.Funded MANNA Foodbank's Packs for Kids to provide nutritious food to more than 1,000 Buncombe and Madison County students each week.Supported Council on Aging of Buncombe County's coordinated care and in-home visits to more than 100 seniors annually to coordinate access to community resources.Trained more than 600 health and dental providers in effective tobacco interventionSupported Madison County Health Department's tobacco cessation counseling. Of the 25 program participants, 52% decreased tobacco usage and 44% stopped tobacco utilization.Provided Nicotine Cessation Counseling to an average of 125 inpatients monthlyFunded Tobacco Free Madison education to more than 2,000 students annually in Madison CountyProvided outreach education and counseling to vulnerable populations through sessions at AHOPE, Veteran's Restoration Quarters, Dr. Wesley Grant Senior Center, Black Mountain Children's Center and othersProvided training for Folic Acid Community Ambassadors to serve as community health educators. More than 600 men & women of childbearing age have been reached through this program.More than 140 providers have received specialized preconception health training on subjects ranging from Healthy Weight to Early Prenatal Care.Funded implementation of Centering Pregnancy model for routine prenatal care at MAHECSupported Homeward Bound's Women At Risk program's work with 40 high risk women of child-bearing age at risk of incarcerationSupported Verner Center for Early Learning's Rainbow in My Tummy curriculum for 15 child care centers. Partnered with Buncombe County Health Department to provide school nurses in Buncombe County Schools and helped more than 200 students manage their chronic illnesses.Funded location of the Mountain Child Advocacy Center in the Reuter Outpatient Center to provide wrap-around services for child victims in a child-friendly environment.Supported CARING for Children's multiple specialty outpatient program providing psychotherapy and psychiatric services for 600 children and their families annually in Buncombe and Madison counties regardless of their ability to pay.Funded Pisgah Legal Service's HEALS program to provide free civil legal aid to improve the health outcomes of more than 250 vulnerable, low-income children and their families annually.Worked with community partners and financially supported the development of a comprehensive psychiatric urgent care center (crisis and ongoing care), C3@356, serving western North Carolina. Supported Homeless Outreach Team to engage and provide healthcare services to 150 homeless patients.Supported the development of a Federally Qualified Health Center (FQHC) serving vulnerable populations in Asheville. The Dale Fell Center is placed in a strategic, central location focusing on the homeless population--accessible to those who most frequently need it and offers a primary medical home to members of our community regardless of their ability to pay. Collaborated with a behavioral health provider) and MAHEC ACTT+ program to provide primary care to patients with severe mental illness in their community setting--engaging 56 patients in the first six months. Provided support to Asheville-Buncombe Community Christian Ministry's Free Clinic to provide patient visits and access to care to some of the most vulnerable in our community.
Mission Hospital, Inc. Part V, Section B, Line 16i: 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; 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.
Mission Hospital, Inc. Part V, Section B, Line 20e: All policies and procedures applying to financial assistance and financial clearance are applied consistently and include reasonable efforts to ensure that financial assistance is offered before any collection agency assignment.
Mission Hospital, Inc. Part V, Section B, Line 22d: It is the intent of this policy that all uninsured patients qualifying under the policy will receive a discount equivalent to the discount received by Medicare and commercially insured patients. This minimum discount level for uninsured patients is calculated at least annually by dividing the sum of all Medicare and commercial insurance payments allowed for emergency and other medically necessary care from claims that have been paid in full, by the sum of the associated gross charges for those claims.
Schedule H Part VI, Question 10a url http://www.mission-health.org/mydocuments/download.php?f=mission_hospital_i
Part V, Section B, Line 16 Financial Assistance Policy Website Availability
Mission Hospital, Inc. Part V, Section B, line 16c website: http://www.mission-health.org/financial-assistance.php
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?21
Name and address Type of Facility (describe)
1 Radiation Therapy Infusion & Testing
21 Hospital Drive
Asheville,NC28801 		Radiation Therapy;Positronic Emissions Testing; Outpatient Infusion
2 Asheville Surgery Center
5 Medical Park Drive
Asheville,NC28803 		Ambulatory Surgical Services
3 CardiopulmonaryHealth&DiagnostSleepCtr
5 Vanderbilt Park Drive
Asheville,NC28803 		PulmonaryRehab/SleepStudies/CardiovascularDiagnostics
4 Cardiovascular DiagHeart Failure Clinic
5 Vanderbilt Park Drive
Asheville,NC28803 		Cardiovascular&PulmonaryRehab/Diagnostics
5 Mission Radiology at Hope
100 Ridgefield Court
Asheville,NC28806 		Radiology, Outpatient Infusion
6 Mission Radiology & Interventional SPine
7 Vanderbilt Park Dr
Asheville,NC28803 		Radiological Services
7 Children's Services
11 Vanderbilt Drive
Asheville,NC28803 		Outpatient Children's Services
8 WoundCareOutpatientClinicalPharmOther
1 Hospital Drive
Asheville,NC28803 		Clinics,Wound Care, Pharmacy
9 Mission Breast Center
534 Biltmore Avenue
Asheville,NC28801 		Radiological Services
10 Mission Radiology at Victoria Urological
100 Victoria Road
Asheville,NC28803 		Radiology
11 Genetics Center
9 Vanderbilt Park Drive
Asheville,NC28803 		Genetics Testing
12 Mission Intervention and Vascular Center
222 Asheland Avenue
Asheville,NC28801 		Radiological Services
13 Outpatient Services
490 Hospital Drive
Clyde,NC28721 		Laboratory & Radiology
14 Mission My Care Plus
1388 Sand Hill Road
Asheville,NC28806 		Radiology, Outpatient Svcs
15 Low Vision Center
240 Sardis Road
Asheville,NC28806 		Low Vision
16 Mission Breast Center at Biltmore Park
2 Town Square BlvdSte 100
Asheville,NC28803 		Radiological Services
17 WNC Breastfeeding Center
2 Medical Park Drive
Asheville,NC28801 		Education
18 Mission Radiology at Reuters
One University Heights
Asheville,NC28804 		Radiology Services
19 Breast Center Spine Center
2695 Hendersonville Road Suite 150
Arden,NC28704 		Radiological Services
20 Mission My Care Plus at Biltmore Park
310 Long Shoals Road
Asheville,NC28704 		Outpatient Clinic
21 Cardiovascular Diagnostics
691 Blythe St Court
Hendersonville,NC28739 		Cardiovascular Diagnostics
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
Part I, Line 7: Mission used worksheets 1 through 8 provided by the IRS, using the cost to charge 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 Offsetting Revenue includes $2,436,591 in revenue from prior years that was finalized in the current year. Medicaid surplus from current year programs would have been $8,855,028 without the prior period revenue.
Part I, Line 7g: Subsidized health services include physician clinics primarily serving pediatric specialty patients. Other services include trauma, psychiatric and senior services. $87,660,167 in cost, less $43,897,673 in net patient and other revenue calculates to $43,762,494 in community benefits from subsidized health services provided.
Part II, Community Building Activities: Workforce development: Recruitment of Physicians and other health professionals to medical shortage areas.
Part III, Line 2: Bad debt expense is completed at the estimated cost to provide the services which were uncollectible.Charitable discounts and other discounts decrease net patient revenue as reported on page 9 of the core form of the 990. Reocveries of previous bad debt written off are netted against bad debt expense before reducing to the cost basis.
Part III, Line 3: 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, 2015 but for which information was not available until after the fiscal year end.
Part III, Line 4: Per the Footnotes to the Consolidated Financial Statements: "Costs of services associated with uncollectible accounts are estimated at $37,257,000 and $31,066,000 for September 30, 2015 and 2014, respectively."Above numbers are for entire Health system, which includes the above amount for Mission Hospital.The above estimates were developed using the methodology adopted by the North Carolina Hospital Association in 2006 for such costs, including information from Mission's cost reporting systems used to support its related filings with the Medicare and Medicaid programs.
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 $54.6 million dollars. Per the Form 990 instructions, the Medicare cost report is the basis for calculating the costs using costs related to the revenue reported, including DSH and IME.
Part III, Line 9b: Patients who qualify 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.
Part VI, Line 2: Mission Hospital participates in a Community Health Needs Assessment CHNA) every three years, with the most recent assessment completed in December 2012. Process and Product:The Mission Hospital community health needs assessment (CHNA) was conducted in partnership with the Buncombe County Department of Health, the Madison County Health Department, and Western North Carolina Healthy Impact Project. This written report describes:The community served by the hospital.Community demographics;Existing health resources in the community available to respond to needs.The data collection process for the assessment.Health needs and issues of uninsured, low-income, and minority groups.The process for identifying and prioritizing community needs, and the available services to address those needs.The process for consulting with persons representing the communitys interests.Information gaps that limit the hospital facilitys ability to assess the communitys health needs.Regional Partnership:Mission Hospital's collaborative community health improvement effort is also supported by a comprehensive partnership with other regional hospitals and local health departments. This initiative, known as WNC Healthy Impact, represents 16 counties across the Western North Carolina region working collaboratively to improve community health. Information about this innovative regional collaboration, county-wide community health assessments, and overall regional findings, are made widely available to the public at www.WNCHealthyImpact.com. Prioritization Process:Community Health Needs Assessment (CHNA) is the foundation for improving and promoting the health of our communities. Mission Hospital partnered closely with both the Buncombe County Department of Health and the Madison County Health Department to conduct a comprehensive CHNA. In addition, Mission, and both counties were key partners in the WNC Healthy Impact efforts. The role of the CHNA is to identify factors that affect the health of the residents of both Madison and Buncombe counties, Mission Hospitals defined services areas, and determined the availability of resources within the county to adequately address those factors. The process involves the collection and analysis of a large range of secondary data as well as primary data. The evaluation and prioritization of identified health needs involved teams of representatives from a broad range of health and human service agencies, local non-profit organizations as well as community partners and residentsAs a part of the Affordable Care Act, non-profit hospitals are also required to conduct a community health needs assessment at least every three years. In order to achieve the requirements for health department and hospital needs, both Madison County and Buncombe County, along with other hospitals and health departments in our 16 county regions, a new CHNA was completed in 2012. For this reason,the 2012 CHNA has involved the examination of the 2011 priority areas for Madison County and the 2010 priority areas for Buncombe County and the engagement of a smaller number of community leaders rather than re-creating the extensive process that took place in 2011 and 2010 respectively.As part of WNC Healthy Impact, a regional data workgroup of public health and hospital representatives and regional partners, with support of a consulting team, made recommendations to the steering committee on the data approach and content used to help inform regional data collection. From data collected as part of this core dataset, the consulting team compiled secondary data for each county in the region. This data was then compared to the data collected in the 2011 Madison County CHA and 2010 Buncombe County CHA to identify similarities and differences.As part of the collaborative health assessment process in our communities, Mission representatives were involved in the prioritization process in both counties and will be involved in the subsequent Community Health Improvement Plans. In North Carolina, community-level prioritization is a required part of the community health (needs) assessment process.
Part VI, Line 3: We provide information to our patients regarding how to apply for financial assistance/charity care in the following ways: A plain language description of the financial assistance policy is posted on the hospital facility's website, attached to billing invoices, posted in the emergency rooms or waiting rooms and in the admissions offices. It is also provided in writing to patients on admission to the hospital facility, and upon request. The organization's internet website and brochures contain information about financial assistance that offer help in obtaining financial assistance, options for insurance processing and payment for services. In addition, assistance is offered to help in determining if a patient qualifies for stage agency programs and Medicaid benefits as well as assistance with the application process. The website and brochures explain that the hospital offers discounts based on certain criteria, and notes the range of discounts and how household income guidelines are used to determine discount eligibility.The patient is directed to call the customer service center or visit the hospital's business office and lists the hours the office and center are open.There are also messages on patient bills giving information on financial assistance and how to contact the hospital if they have questions or want to apply.
Part VI, Line 4: For Buncombe County and the surrounding counties representing the primary and secondary service areas, the percentage of uninsured adults is estimated at 20%, children living in poverty at 22%, with unemployment estimated at 6.1%. (NC County Health Rankings 2015)The persons living in these counties with only a high school education or less ranges from 78-83%. The 2010 populations for these counties are as follows:(Southern Rural Development Data Center 2010) 0-24 years 26.5-29.5 % 25-64 years 50.9-54.9 % 65+ years 16.0-22.4 %
Part VI, Line 5: See Program Service Accomplishments listed in Schedule O 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.;The McDowell Hospital, Inc.; Angel Medical Center, Inc.; Transylvania Community Hospital, Inc.; Highlands-Cashiers Hospital, Inc. and Community CarePartners, Inc.The System's mission is to operate an integrated health care system for the benefit of the residents of Western North Carolina.Mission Hospital, Inc. is a regional integrated health facility providing 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, thereby improving the health care of the general public. In many cases this involves recruiting and placing primary care physicians, as well as pediatric and adult specialty services close to where people live and work.Blue Ridge Regional Hospital serves as a community hospital in Mitchell, Yancey and surrounding counties.The McDowell Hospital serves as a community hospital in McDowell and the surrounding counties.Mission Health System 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.Angel Medical Center, Inc. serves as a community hospital in Macon and surrounding counties.Transylvania Community Hospital, Inc.serves as a community hospital in Transylvania and surrounding counties.Highlands-Cashiers Hospital, Inc. serves as a community hospital for Jackson and Macon and surrounding counties.Community CarePartners, Inc. operates an inpatient facility for acute rehabilitation located in Asheville, North Carolina, and provides a wide variety of post-acute care services to residents of western North Carolina, including rehabilitation, home health, adult care, and hospice and palliative care.MSJHS and CCP Joint Development Company dba Asheville Specialty Hospital operates an inpatient facility for long-term acute care.
Part VI, Line 7, Reports Filed With States NC
Part VI Line 2 Explanation: Mission Hospital participates in a Community Health Needs Assessment (CHNA) every three years, with the most recent assessment completed in December 2012.Process and Product: The Mission Hospital community health needs assessment (CHNA) was conducted in partnership with the Buncombe County Department of Health, the Madison County Health Department, and Western North Carolina Healthy Impact Project. This written report describes the community served by the hospital; community demographics; existing health resources in the community available to respond to needs; the data collection process for the assessment; health needs and issues of uninsured, low-income, and minority groups; the process for identifying and prioritizing community needs and the available services to address those needs; the process for consulting with persons representing the community's interests; and information gaps that limit the hospital facility's ability to assess the community health needs.Regional Partnership: Mission Hospital's collaborative community health improvement effort is also supported by a comprehensive partnership with other regional hospitals and local health departments. This initiative, known as WNC Healthy Impact, represents 16 counties across the Western North Carolina region working collaboratively to improve community health. Information about this innovative regional collaboration, county-wide community health assessments, and overall regional findings, are widely available to the public at www.WNCHealthyImpact.comPrioritization Process: Community Health Needs Assessment (CHNA) is the foundation for improving and promoting the health of our communities. Mission Hospital partnered closely with both the Buncombe County Department of Health and the Madison County Health Department to conduct a comprehensive CHNA. In addition, Mission and both counties were key partners in the WNC Healthy Impact efforts.The role of the CHNA is to identify factors that affect the health of the residents of both Madison and Buncombe counties, Mission Hospital's defined service areas, and determined the availability of resources within the county to adequately address those factors. The process involves the collection and analysis of a large range of secondary data as well as primary data. The evaluation and prioritization of identified health needs involved teams of representatives from a broad range of health and human agencies, local non-profit organizations as well as community partners and residents.As a part of the Affordable Care Act, non-profit hospitals are also required to conduct a community health needs assessment at least every three years. In order to achieve the requirements for health department and hospital needs, both Madison County and Buncombe County, along with other hospitals and health departments across our 16 county regions, a new CHNA was completed in 2012. For this reason, the 2012 CHNA has involved the examination of the 2011 priority areas for Madison County and the 2010 priority areas for Buncombe County and the engagement of a smaller number of community leaders rather than recreating the extensive process that took place in 2011 and 2010 respectively. As part of WNC Healthy Impact, a regional data workgroup of public health and hospital representatives and regional partners, with support of a consulting team, made recommendations to the steering committee on the data approach and content used to help inform regional data collection.From data collected as part of this core dataset, the consulting team compiled secondary data for each county in the region. This data was then compared to the data collected in the 2011 Madison County CHA and 2010 Buncombe County CHA to identify similarities and differences.As part of the collaborative health assessment process in our communities, Mission representatives were involved in the prioritization process in both counties and will be involved in the subsequent Community Health Improvement Plans. In North Carolina, community-level prioritization is a required part of the community health (needs) assessment process.
Schedule H (Form 990) 2014
Additional Data


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