Community Benefit Insight - Tax-exempt hospital

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ANC Transylvania Community Hospital Inc

Transylvania Community Hospital

260 Hospital Drive
Brevard, NC 28712

Bed count	25	Medicare provider number	341319	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 560562293

Display data for year:

Community Benefit Spending- 2018
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

4.81%

Spending by Community Benefit Category- 2018
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2018

Additional data

Community Benefit Expenditures: 2018

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 735,985 3.79 %
Medicaid as % of operating expenses	$ 197,499 1.02 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2018

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 1,732,450 8.92 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2018

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2018

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of 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 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 (Expenses $ 15005295 including grants of $ 178178) (Revenue $ 26019158)
SEE SCHEDULE O

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

TRANSYLVANIA COMMUNITY HOSPITAL, INC.:
"PART V, SECTION B, LINE 4: CHNA TAX YEAR THE ORGANIZATIONS LAST CHNA WAS CONDUCTED IN TAX YEAR 2015. IN ACCORDANCE WITH IRC SECTION 501(R)(3)(D)(4), ""A HOSPITAL ORGANIZATION IS NOT REQUIRED TO MEET THE REQUIREMENTS OF SECTION 501(R)(3) WITH RESPECT TO A HOSPITAL FACILITY IN A TAXABLE YEAR IF, BEFORE THE END OF THAT TAXABLE YEAR, THE HOSPITAL ORGANIZATION TRANSFERS ALL OWNERSHIP OF THE HOSPITAL FACILITY TO ANOTHER ORGANIZATION OR OTHERWISE CEASES ITS OPERATION OF THE HOSPITAL FACILITY OR THE FACILITY CEASES TO BE LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED AS A HOSPITAL BY A STATE."" DUE TO THE SALE OF THE HOSPITAL FACILITY DURING THE CURRENT 2018 TAX YEAR, THE ORGANIZATION DID NOT CONDUCT A NEW CHNA. TRANSYLVANIA COMMUNITY HOSPITAL, INC.: PART V, SECTION B, LINE 5: in the collaborative assessment process for Our community, the Transylvania county department of public health is a Key partner. They provided coordination for the local process that we help support and partner to implement. Transylvania regional hospital collaborated with the Transylvania department of public health and other Key community stakeholders to develop a written description of the Activities that hospital facilities, public health agencies, and other Local organizations plan to undertake collectively to address specific Health needs in our community. Community participation: representatives from boys & girls club, Transylvania county ems, Transylvania county board of health, Transylvania public health, Transylvania County planning & economic development, blue ridge community health services, Brevard College, Transylvania county parks & recreation, Transylvania regional Hospital, western Carolina community action, C.A.R.E. coalition, NAACP Health committee, Transylvania county fire marshal, city of Brevard, Transylvania county commissioners, Brevard rotary club, Brevard city council, Transylvania county schools, Transylvania county manager, blue ridge community health services, Brevard/Transylvania chamber of commerce, the haven of Transylvania County, train, vision Transylvania, united Way of Transylvania county, Val smith -Transylvania regional hospital leadership team and Pisgah forest rotary club. Surveys included: 12 community/business leaders, 1 physician, 6 public Health representatives, 2 other health providers and 9 social service Providers."

TRANSYLVANIA COMMUNITY HOSPITAL, INC.:
PART V, SECTION B, LINE 6A: REGIONAL PARTNERSHIP: Transylvania regional 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.

TRANSYLVANIA COMMUNITY HOSPITAL, INC.:
PART V, SECTION B, LINE 6B: Transylvania county department of public Health and the Macon county public health department.

TRANSYLVANIA COMMUNITY HOSPITAL, INC.:
PART V, SECTION B, LINE 7D: HTTPS://MISSIONHEALTH.ORG/OUR-COMMITMENT-TO-YOU/COMMUNITY-INVESTMENT/OUR-C OMMUNITYS-HEALTH-NEEDS/

TRANSYLVANIA COMMUNITY HOSPITAL, INC.:
"PART V, SECTION B, LINE 11: the organization's leaders are involved with C.A.R.E. coalition, working with community partners on initiatives to Reduce the misuse/abuse of prescription drugs, nicotine, opioids and Others, as well as harm reduction tools like naloxone and awareness about the impacts of adverse childhood experiences. The organization's emergency department provided more than 20 medication Lockboxes to help patients manage controlled substances and reduced Dispensation of opioids by more than 100,000 pills over the past two Years. Established multi-sector ""high utilizer"" group to support patients with Frequent usage of emergency department services; utilization for patients Supported by this group decreased from 7.2 patients to 6.7 patients over the past 2 years. Increased referrals to the fresh start program, supporting patients with Mental illness, by 40% since 2013, and provided more than 130 annual hours of meeting time to the local chapter of national alliance for mental illness. The organization's leadership was represented at more than 90% of county Multi-sector crisis provider meetings. The organization's diabetes management connected with local partner, mountainwise, to implement NC diabetes prevention programming and train Two staff members; the organization received CDC diabetes prevention Recognition approval to begin programming. Nearly 400 middle and high school students received sports medicine Treatment from the system's athletic trainers. There are no significant needs identified which are not being addressed."

TRANSYLVANIA COMMUNITY HOSPITAL, INC.:
PART V, SECTION B, LINE 15E: the organization's staff work in Collaboration with the patient and appropriate community health and human services agencies and other organizations that assist people in need of health care services to determine available funding sources. PART V, SECTION B, LINE 10A HTTPS://MISSIONHEALTH.ORG/OUR-COMMITMENT-TO-YOU/COMMUNITY-INVESTMENT/OUR-C OMMUNITYS-HEALTH-NEEDS/ PART V, SECTION B, LINE 16A HTTPS://MISSIONHEALTH.ORG/OUR-COMMITMENT-TO-YOU/COMMUNITY-INVESTMENT/OUR-C OMMUNITYS-HEALTH-NEEDS/ PART V, SECTION B, LINE 16B HTTPS://MISSIONHEALTH.ORG/OUR-COMMITMENT-TO-YOU/COMMUNITY-INVESTMENT/OUR-C OMMUNITYS-HEALTH-NEEDS/ PART V, SECTION B, LINE 16C HTTPS://MISSIONHEALTH.ORG/OUR-COMMITMENT-TO-YOU/COMMUNITY-INVESTMENT/OUR-C OMMUNITYS-HEALTH-NEEDS/

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 7:
THE ORGANIZATION USED THE NCHA ANDI REPORTS WHICH ARE BASED ON THE IRS GUIDELINES. 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 AND INDIRECT COSTS.

PART II, COMMUNITY BUILDING ACTIVITIES:
The organization participates in workforce development in the community and state to help advocate the health needs of our area. Through Participation, the hospital guarantees a focused discussion on the health care issues that directly impact Transylvania county.

PART III, LINE 2:
The organization uses a cost to charge ratio to estimate bad debt.

PART III, LINE 3:
The organization uses historical percentage to estimate bad debt Attributable to patients eligible under the financial assistance policy.

PART III, LINE 8:
Per the instructions, the Medicare cost report is the basis for Calculating the costs using costs related to the revenue reported.

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. the health system'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:
"Transylvania county was home to approximately 33,090 residents in 2010, With a median age of 49, which is several years older than the state average of 37.9. Its population growth is expected to slow through 2020, but the percent of senior adults in the county is expected to continue to rise. Transylvania county has higher a proportion of whites (92.4%) than the region or state and lower proportions of all racial and ethnic minority groups. Only 0.8% of households have limited skill in speaking English. About 19% of households had children under age 18, and 69% of these were headed by a married couple. (us census bureau). WNC healthy impact is a partnership and coordinated process between Hospitals and health departments in western North Carolina to improve Community health. As part of a larger, and continuous, community health Improvement process, these partners are collaborating to conduct community health (needs) assessments across western North Carolina Www.wnchealthyimpact.com. Transylvania regional hospital is also involved in this regional/local vision and collaboration. Participating counties include: buncombe, Cherokee, clay, graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, swain, Transylvania and Yancey. The data reviewed as part of our community's health needs assessment came from the WNC healthy impact regional core set of data. WNC healthy Impact's core regional dataset includes secondary (existing) and primary (newly collected) data compiled to reflect a comprehensive look at health. The following data set elements and collection are supported by WNC Healthy impact data consulting team, a survey vendor, and partner data Needs and input: - a comprehensive set of publically available secondary data metrics with our target population compared to the other WNC regions as ""peer"" - set of maps accessed from community commons and NC center for health Statistics - telephone survey of a random sample of adults in the county - email survey of community leaders and other key informants See Transylvania county http://transylvaniahealth.org/wp-content/uploads/2019/04/2018-Transylvania -County-CHA-1.pdf for more details on the regional data. Cha team members invited the members of several organizations to share Their thoughts about health concerns in Transylvania county. The CHA team also advertised for a public meeting in the local paper and used this open public session to discuss health issues, identified opportunities, and Challenges the community might face. Feedback from these groups was used to inform data collection and analysis. In addition, reports from the local preschool task force and the C.A.R.E. coalition were used as data sources in this process."

PART VI, LINE 3:
The organization places signage for its patient financial assistance Policies in patient areas in the hospital, in the patient accounting Office, and the patient registration area. At the point of registration And pre-registration, patients are notified of the patient financial Assistance policy. In the patient accounting office, the available Financial assistance programs are verbally communicated by financial Counselors to patients who might be eligible. Billing statements are Printed with invitations to seek patient financial assistance through the patient accounting office. The patient financial assistance policy also resides on the health system's website: Https://missionhealth.org/patients-visitors/financial-assistance/

PART VI, LINE 5:
As a not-for-profit hospital, the organization is committed to giving back to the community to help those who are uninsured or underinsured as well as providing health education and benefits for the wellbeing of the Entire community. Fiscal year 2017 was a challenging year for our Community as we experienced the lingering effects of a depressed economy. This has left many in our community without health insurance and Struggling to make ends meet. Despite challenging financial times for the Hospital, the organization continued to generously help those in need.

PART VI, LINE 7, List of States Receiving Community Benefit Report:
NC

PART VI, LINE 4:
The primary service area for the organization is Transylvania county, North Carolina, with a resident population of 33,956 including Gloucester township in the upper end of the county, which is federally designated as a medically underserved area. Nearly 16.6% of Transylvania county's total resident population have a household income below the federal poverty level. Transylvania regional hospital is the only local hospital serving this primary service area. Transylvania regional hospital's secondary coverage area includes Additional residents in southern Jackson county, North Carolina, including the medically underserved area of cashiers township, as well as western Henderson county, NC which has a federally designated medically Underserved population of low income, migrant farm workers. Besides Transylvania regional hospital, three additional community Hospitals provide some coverage to these residents in the secondary Coverage area; however, Transylvania regional hospital is in many cases The closest, most readily accessible provider of care for many of these Residents.

PART VI, LINE 6:
ANC HEALTHCARE, INC. (FKA MISSION HEALTH SYSTEM) IS THE PARENT ORGANIZATION FOR THE CHARITABLE ORGANIZATIONS OF MISSION HOSPITAL, INC.; MISSION HEALTH SYSTEM FOUNDATION, INC.; ANC MISSION MEDICAL ASSOCIATES, INC; ANC BLUE RIDGE HOSPITAL, INC.; ANC MCDOWELL HOSPITAL, INC.; ANC ANGEL MEDICAL CENTER,INC.; ANC TRANSYLVANIA COMMUNITY HOSPITAL, INC.; ANC HIGHLANDS-CASHIERS HOSPITAL, INC. AND MOUNTAIN CARE, INC. (FKA 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. ANC 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. ANC BLUE RIDGE HOSPITAL SERVES AS A COMMUNITY HOSPITAL IN MITCHELL, YANCEY AND SURROUNDING COUNTIES. ANC 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 ANC HEALTHCARE, INC. (MISSION HEALTH SYSTEM, INC.) AND 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. ANC ANGEL MEDICAL CENTER, INC. SERVES AS A COMMUNITY HOSPITAL IN MACON AND SURROUNDING COUNTIES. ANC TRANSYLVANIA COMMUNITY HOSPITAL, INC. SERVES AS A COMMUNITY HOSPITAL IN TRANSYLVANIA AND SURROUNDING COUNTIES. ANC HIGHLANDS-CASHIERS HOSPITAL, INC. SERVES AS A COMMUNITY HOSPITAL FOR JACKSON AND MACON AND SURROUNDING COUNTIES. MOUNTAINCARE, 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.

Operating expenses	$ 19,422,586
Total amount spent on community benefits as % of operating expenses	$ 933,484 4.81 %