2015-08-17T14:44:40-05:00 2014-09-30 111986323 MARCUM LLP CITY PLACE II 185 ASYLUM STREET HARTFORD CT 06103 990 2013-10-01 050445136 SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM SOUT 4017828000 100 KENYON AVENUE WAKEFIELD RI 02879 THOMAS J BREEN CHIEF FINANCIAL OFFICER 4017828000 2015-08-17 1 DOUGLAS FARRINGTON P00370668 8607600600 2013 2016-03-07 17:11:31Z THOMAS J BREEN 100 KENYON AVENUE WAKEFIELD RI 02879 146089912 0 X SCHOSPITAL.COM X 1920 RI TO OPERATE A NOT FOR PROFIT HOSPITAL. 18 15 1351 313 680210 -53095 29135 29100 124001594 140898179 674549 461639 4425479 4700994 129130757 146089912 0 0 0 0 62637289 73174630 0 0 0 62300520 66580456 124937809 139755086 4192948 6334826 115062718 121197595 96534404 96559258 18528314 24638337 X SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM IS DEDICATED TO ENRICHING THE QUALITY OF LIFE OF SOUTHERN RHODE ISLAND COMMUNITY MEMBERS AND VISITORS THROUGH THE DELIVERY OF QUALITY HEALTHCARE SERVICES, THE DEVELOPMENT OF COOPERATIVE RELATIONSHIPS WITH OTHER HEALTHCARE PROVIDERS AND THE PROMOTION OF WELLNESS THROUGH HEALTH EDUCATION AND AWARENESS. 0 0 110216027 144218324 SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM (THE HOSPITAL) IS AN INDEPENDENT, NON-PROFIT, ACUTE-CARE HOSPITAL, SERVING THE COMMUNITIES OF SOUTHERN RHODE ISLAND OFFERING THE LATEST ADVANCES IN TECHNOLOGY AND A COMPREHENSIVE RANGE OF MEDICAL AND SURGICAL SERVICES DELIVERED BY EXPERT PHYSICIANS AND HIGHLY TRAINED STAFF. THE SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM IS COMMITTED TO ITS COMMUNITY AND GUIDED BY THE VALUES OF CARING, RESPECT, INTEGRITY, COLLABORATION AND EXCELLENCE. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2014, THE HOSPITAL REPORTED 5,157 DISCHARGES AND 17,056 INPATIENT DAYS. THE DISCHARGES INCLUDED 695 DELIVERIES AND 1,925 INPATIENT SURGERIES. THE HOSPITAL PROVIDED 191,699 OUTPATIENT VISITS; INCLUDING 23,984 OUTPATIENT EMERGENCY ROOM VISITS AND 11,831 URGENT CARE VISITS. THE PROVIDERS IN THE HOSPITAL MEDICAL GROUP PROVIDED 89,540 VISITS. 110216027 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 104 0 1 1351 1 1 1 0 0 0 0 0 0 0 0 0 X 18 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 RI X X MARCIA POLHEMUS 4017828000 100 KENYON AVENUE WAKEFIELD RI 02879 TED ALMON TRUSTEE 1.00 1.00 X 0 0 0 IRWIN M BIRNBAUM ESQ TRUSTEE 1.00 1.00 X 0 0 0 KATHLEEN CASSIN MD TRUSTEE / PHYSICIAN 40.00 1.00 X 139996 0 8014 STEPHANIE CHAFEE RN MBA TRUSTEE 1.00 1.00 X 0 0 0 EDWARD M CIMILLUCA TRUSTEE 1.00 1.00 X 0 0 0 DUNCAN COCROFT TRUSTEE 1.00 1.00 X 0 0 0 RICHARD DEL SESTO MD TRUSTEE 1.00 1.00 X 0 0 0 JAMES FARRELL TRUSTEE 1.00 1.00 X 0 0 0 JASON MARSHALL TRUSTEE 1.00 2.00 X 0 0 0 ROBERT PANOFF TRUSTEE 1.00 2.00 X 0 0 0 LISA RAMEAKA VP OF THE MEDICAL STAFF / PHYSICIAN 40.00 1.00 X 304728 0 26657 HENRY D SHARPE III TRUSTEE 1.00 1.00 X 0 0 0 MEG SISCO TRUSTEE 1.00 2.00 X 0 0 0 THE HONORABLE ERNEST C TORRES TRUSTEE 1.00 1.00 X 0 0 0 DONNA VANDERBECK TRUSTEE 1.00 1.00 X 0 0 0 WILLIAM SABINA MD FACEP PRESIDENT OF THE MEDICAL STAFF 10.00 1.00 X 54767 0 0 AARON WEISBORD VP OF THE MEDICAL STAFF / PHYSICIAN 40.00 1.00 X 250294 0 17632 EVE KEENAN CHAIRPERSON 1.00 2.00 X X 0 0 0 BEVERLY SWAN VICE CHAIRPERSON 1.00 1.00 X X 0 0 0 DENNIS LYNCH SECRETARY 1.00 1.00 X X 0 0 0 JOSEPH MATTHEWS TREASURER 1.00 1.00 X X 0 0 0 LOUIS R GIANCOLA PRESIDENT AND CEO 40.00 2.00 X 342592 0 23911 THOMAS J BREEN CHIEF FINANCIAL OFFICER 40.00 2.00 X 359903 0 26502 ANNE SCHMIDT VP OF PATIENT CARE SERVICES 40.00 X 158702 0 5139 FREDERICK A BROWNE VP OF MEDICAL AFFAIRS 40.00 X 345088 0 15128 MATTHEW JONES PHYSICIAN 40.00 X 313101 0 38546 JAMES L SMYTHE PHYSICIAN 40.00 X 308959 0 26468 JEFFREY F JOSEPH PHYSICIAN 40.00 X 302867 0 26665 STEVEN H SCHNEIDER PHYSICIAN 40.00 X 302358 0 26675 DAVID BADER PHYSICIAN 40.00 X 289425 0 17873 BARBARA SEAGRAVE FORMER VP OF PATIENT CARE SERVICES 40.00 X 201574 0 21080 3674354 0 280290 54 1 1 0 SOUTH COUNTY ORTHOPEDICS & PHYSICAL THER 1 HIGH ST WAKEFIELD RI 02879 ORTHOPEDICS AND PHYSICAL THERAPY 368876 SOUTH COUNTY PULMONARY MEDICINE INC 360 KINGSTOWN ROAD NARRAGANSETT RI 02882 PULMONARY SERVICES- PULMONARY EVALUATION 160220 ANNE M HEBERT MD PO BOX 628 WEST KINGSTON RI 02892 PULMONARY SERVICES AND SLEEP STUDIES 159200 CHACE RUTTENBERG & FREEDMAN LLP ONE PARK ROW PROVIDENCE RI 02903 LEGAL SERVICES 131862 MICHAEL GAZDIK 19 N DRIVE WESTPORT MA 02790 IT CONSULTANT 100800 5 29100 29100 PATIENT SERVICE REVENUE 622110 140898179 140367110 531069 140898179 461639 461639 828717 0 828717 828717 828717 MEANINGFUL USE REVENUE 900099 1485387 1485387 CAFETERIA 722212 402991 402991 JV RADIATION 621512 355994 355994 1627905 1478764 149141 3872277 146089912 143687255 680210 1693347 2322999 1013235 1309764 56737104 45143778 11593326 2137362 1694759 442603 8040475 6319471 1721004 3936690 3080037 856653 580053 580053 168665 168665 41893 41893 51235 51235 8857552 4635452 4222100 799161 1408 797753 4084474 3138510 945964 1567140 1204190 362950 3696138 2840112 856026 48499 21331 27168 386933 157992 228941 2635276 2635276 6930786 5325616 1605170 1771584 1624400 147184 MEDICAL SUPPLIES & DRUG 25195094 25195094 PROVISION FOR BAD DEBTS 4377216 4377216 STATE LICENSE FEE 3628580 3628580 MAINTENANCE & REPAIR 1158956 497637 661319 601221 317209 284012 139755086 110216027 29539059 0 4896 6560 8641269 13732577 11122364 9690100 2140919 2467974 2019969 2910785 146271236 93097603 53703865 53173633 33440629 35559384 3562101 2889093 426706 767489 115062718 121197595 15563585 18269551 47217637 45409846 119582 87567 33633600 32792294 96534404 96559258 X 18483314 24593337 45000 45000 18528314 24638337 115062718 121197595 X 6334826 1438554 -1663357 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 0 0 1 0 1 41893 41893 0 PART II-B, LINE 1: THE ORGANIZATION PAID OUTSIDE VENDORS FOR THE PERFORMANCE OF LOBBYING ACTIVITIES. 33440630 2269181 150427 35559384 29841928 1596046 2002656 33440630 25013653 1735368 3192907 100000 29841928 18755158 8167639 -1709144 200000 25013653 11068232 6539170 1147756 18755158 0.99870 0.00130 0.00000 1 0 266821 266821 54724325 27825408 26898917 1245150 477776 767374 86369874 62369763 24000111 3665066 2424656 1240410 53173633 UNITS OF POOLED ENDOWMENT INVESTMENTS 24894304 F ASSETS HELD IN SELF INSURANCE TRUST 10438242 F HELD IN TRUST UNDER BOND INDENTURE 226838 F 35559384 OTHER CURRENT LIABILITIES 21946 POSTRETIREMENT BENEFIT OBLIGATION 614025 ACCRUED PENSION COST 13447473 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 2407986 OTHER LIABILITIES 8595415 FAIR VALUE OF SWAP AGREEMENTS 7705449 32792294 X 147477231 1438554 -51235 1387319 146089912 0 146089912 139703851 0 139703851 51235 51235 139755086 PART V, LINE 4: THE HOSPITAL'S ENDOWMENT FUNDS ARE USED PRIMARILY TO SUPPORT OPERATIONS AND FUND CAPITAL EXPENDITURES. PART X, LINE 2: THE NOT-FOR-PROFIT ENTITIES (SOUTH COUNTY HEALTHCARE SYSTEM ENDOWMENT, SOUTH COUNTY HOSPITAL AND VNS HOMECARE, INC.) OPERATE AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE TAX PROVISIONS AND RELATED LIABILITIES FOR SILVER SPRING HEALTH CARE MANAGEMENT WHICH IS TAXABLE ENTITY WHICH IS CONTROLLED BY THE HOSPITAL ARE NOT SIGNIFICANT. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN FIFTY PERCENT LIKELY TO BE REALIZED UPON SETTLEMENT. CHANGES IN RECOGNITION IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. THE HOSPITAL DID NOT RECOGNIZE THE EFFECT OF ANY INCOME TAX POSITIONS IN EITHER 2014 OR 2013. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT EXPENSES -51,235. 1 1 1 X 1 X 1 1 1 0 1 1 4355144 2989825 1365319 0.01010 1660269 1360016 300253 0.00220 9425193 6840605 2584588 0.01910 15440606 11190446 4250160 0.03140 1114442 538773 575669 0.00430 579557 313731 265826 0.00200 37250 37250 0.00030 1731249 852504 878745 0.00660 17171855 12042950 5128905 0.03800 0 2560271 29477999 38651057 -9173058 X 1 1 1 SOUTH COUNTY RADIATION THERAPY LLC RADIATION ONCOLOGY 0.35000 0.00000 0.00000 1 1 SOUTH COUNTY HOSPITAL 100 KENYON AVE WAKEFIELD RI 02879 WWW.SCHOSPITAL.COM X SOUTH COUNTY HOSPITAL 1 1 X X X X X X X X 12 1 1 1 X WWW.SCHOSPITAL.COM X X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X 1 1 X X X X 1 X 1 X X X 1 X 0 0 SOUTH COUNTY HOSPITAL PART V, SECTION B, LINE 3: TO ENSURE THE CHNA REFLECTED THE NEEDS OF THE COMMUNITY SERVED BY THE HOSPITAL, APPROXIMATLEY 25 INDIVIDUALS REPRESENTING THE HOSPITAL AND HEALTH-RELATED ORGANIZATIONS FROM THE COMMUNITY MEET TO REVIEW THE RESULTS OF THE CHNA. THE GOAL OF THE MEETING WAS TO DISCUSS AND PRIORITIZE KEY FINDINGS AND SET THE STAGE FOR COMMUNITY HEALTH IMPROVEMENT INITIATIVES AND DEVELOPMENT OF THE HOSPITAL'S IMPLEMENTATION STRATEGY. THE LIST OF THE ATTENDEES IS INCLUDED IN APPENDIX A OF THE ATTACHED SCHHS IMPLEMENTATION PLAN DATED AUGUST 26, 2013. SOUTH COUNTY HOSPITAL PART V, SECTION B, LINE 4: THE OTHER ORGANIZATIONS AND HOSPITAL FACILITIES THAT SOUTH COUNTY HOSPITAL PARTNERED WITH FOR THE COMPLETION OF THE CHNA WERE: THE HOSPITAL ASSOCIATION OF RHODE ISLAND, CARE NEW ENGLAND HEALTH SYSTEMS, CHARTERCARE, LANDMARK MEDICAL CENTER, THE WESTERLY HOSPITAL AND THE RHODE ISLAND DEPARTMENT OF HEALTH. SOUTH COUNTY HOSPITAL PART V, SECTION B, LINE 5D: THE HOSPITAL ALSO PARTICIPATED IN A STATEWIDE COMPREHENSIVE CHNA LED BY THE HOSPITAL ASSOCIATION OF RHODE ISLAND (HARI) AND ITS MEMBER HOSPITALS AND ENGAGED THE HEALTH COMMUNITIES INSTITUTE (HCI) AND CREATED A WEB SITE (WWW.RIHEALTHMATTERS.ORG). THE SITE PROVIDES ACCESS TO HEALTH STATISTICS AND INDICATORS FROM SECONDARY DATA SOURCES THAT ARE SPECIFIC TO LOCAL GEOGRAPHIES IN RI AND ALSO IS A COMMUNICATION VENUE FOR SHARING BEST PRACTICES AND RELEVANT HEALTH INFORMATION. SOUTH COUNTY HOSPITAL PART V, SECTION B, LINE 7: BY ALIGNING COMMUNITY HEALTH ACTIVITIES WITH THE LOCAL AND STATEWIDE PRIORITIES OF MENTAL HEALTH AND SUBSTANCE ABUSE, HEART DISEASE, DIABETES, AND CANCER, THE HOSPITAL WILL TAKE A COMPREHENSIVE APPROACH TO ADDRESSING THE MOST URGENT NEEDS IN THE COMMUNITY IT SERVES. AS WITH ALL PROGRAMS AND SERVICES, THE HOSPITAL WILL CONTINUE TO MONITOR COMMUNITY NEEDS AND ADJUST PROGRAMMING AND SERVICES ACCORDINGLY. SOUTH COUNTY HOSPITAL PART V, SECTION B, LINE 20D: CHARGES ARE UNIFORMLY SET FOR ALL PATIENTS REGARDLESS OF PAYOR. CHARGES FOR PATIENTS IDENTIFIED AS ELIGIBLE FOR FINANCIAL ASSISTANCE UPON DISCHARGE ARE ADJUSTED PER POLICY PRIOR TO BILLING. CHARGES FOR PATIENTS IDENIFIED AS ELIGIBLE FOR FINANCIAL ASSISTANCE AFTER INITIAL BILLING ARE ADJUSTED PER POLICY. PART I, LINE 6A: THE ORGANIZATION PREPARES AN ANNUAL REPORT DETAILING MAJOR ACCOMPLISHMENTS AND COMMUNITY BENEFITS. IN ADDITION, THE ORGANIZATION MAINTAINS A COMPREHENSIVE WEBSITE INCLUDING INFORMATION ON AVAILABLE SERVICES, RESULTS OF VARIOUS QUALITY SURVEYS, AND GENERAL HEALTH EDUCATIONAL INFORMATION FOR THE COMMUNITY. THE HOSPITAL COMPLETED A CHNA WHICH IS AVAILABLE ON THE HOSPITAL WEB SITE. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 4,377,216. PART II, COMMUNITY BUILDING ACTIVITIES: SOUTH COUNTY HOSPITAL PROVIDES VARIOUS PROGRAMS FREE OF CHARGE OR FOR A NOMINAL FEE TO PROMOTE THE HEALTH OF THE COMMUNITY IT SERVES. THESE PROGRAMS INCLUDE FREQUENT SUPPORT GROUPS, WELLNESS SCREENINGS, LECTURES, SEMINARS AND PRESENTATIONS ON VARIOUS HEALTH TOPICS. A NUMBER OF THE PROGRAMS FOCUS ON CHRONIC DISEASE MANAGEMENT. THESE PROGRAMS ARE PROVIDED TO THE COMMUNITY EITHER FREE OF CHARGE OR FOR A NOMINAL FEE. THE HOSPITAL HAS CREATED A PATIENT CENTERED MEDICAL COMMUNITY. PART III, LINE 4: THE FOOTNOTE REFERENCES TO BAD DEBT EXPENSE ARE ON THE FOLLOWING PAGES IN THE ATTACHED AUDITED FINANCIAL STATEMENTS: PAGE 15 FN #1 (X) AND PAGE 27 FN #8. PART III, LINE 8: SOUTH COUNTY HOSPITAL SERVES THE MEDICARE POPULATION IN THE COMMUNITY AS PART OF IT'S MISSION WITH THE KNOWLEDGE OF THE SIGNIFICANT DIFFERENTIAL BETWEEN PAYMENT AND COST. THIS SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT AS IS THE HOSPITAL'S CHARITY CARE AND BAD DEBT. THE HOSPITAL UTILIZED THE COST TO CHARGES RATIO AS REPORTED IN THE FY2013 MEDICARE COST REPORT FOR INPATIENT AND OUTPATIENT CHARGES. PART III, LINE 9B: PER THE HOSPITAL'S POLICY, PRIOR TO THE PATIENT'S DISCHARGE, REASONABLE EFFORTS ARE TAKEN BY STAFF TO COMPLETE THE REQUIRED DOCUMENTATION FOR THOSE PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. THESE EFFORTS CONTINUE AFTER DISCHARGE INCLUDING INFORMATION PROVIDED ON THE BILLING STATEMENT. PART III, LINE 2 SOUTH COUNTY HOSPITAL RECORDS BAD DEBT EXPENSE IN ACCORDANCE WITH U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPALS (GAAP). A COST TO CHARGE RATIO WAS USED AS A COSTING METHOD FOR THE AMOUNTS REPORTED IN LINES 2 AND 3. THE HOSPITAL PROVIDES AN AUTOMATIC 40% SELF PAY DISCOUNT. THE AMOUNT REPORTED ON THE HOSPITAL'S AUDITED STATEMENTS WAS UNDERSTATED BY THIS DISCOUNT ON GROSS CHARGES AND THE APPLICATION OF A COST TO CHARGE RATIO BASED ON GROSS CHARGES NOT NET CHARGES. PART VI, LINE 2: SOUTH COUNTY HOSPITAL IDENTIFIES IT'S COMMUNITIES HEALTH NEEDS BY PARTICIPATION IN COMMUNITY AND STATE COALITIONS, BOARDS, COMMITTEES, COMMISSIONS, PANELS AND ADVISORY GROUPS INCLUDING INPUT FROM COMMUNITY MEMBERS AND PROVIDERS. QUARTERLY (OR AS AVAILABLE) INTERNAL PATIENT SURVEYS AND PUBLICLY AVAILABLE DATA ON THE COMMUNITY INCLUDING DEMOGRAPHICS AND UTILIZATION ARE ANALYZED. THE HOSPITAL PARTICIPATES WITH OTHER HEALTH CARE PROVIDERS AND ORGANIZATIONS IN THE STATE FOR THE COMPLETION OF A CHNA. THE RHODE ISLAND DEPARTMENT OF HEALTH SERVES AS AN IMPORTANT SOURCE OF INFORMATION AND POPULATION BASED DISEASE OCCURENCE AND HEALTHCARE NEEDS FOR THE STATE AND THE HOSPITAL'S COMMUNITY. PART VI, LINE 3: SOUTH COUNTY HOSPITAL COMMUNICATES WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS BY PROVIDING FINANCIAL COUNSELING TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL ASSISTANCE POLICIES AND EXTERNAL PROGRAMS (INCLUDING MEDICAID, ETC) THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES. IN RESPONSE TO PATIENTS SEEKING FINANCIAL ASSISTANCE, THE SAME INFORMATION REGARDING THE FINANCIAL ASSISTANCE PROGRAMS IS PROVIDED BY ONSITE PATIENT FINANCIAL SERVICES STAFF IN BOTH INPATIENT AND OUTPATIENT DEPARTMENTS INCLUDING THE EMERGENCY DEPARTMENT. THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS PROVIDED ON THE HOSPITAL WEB SITE AND POSTED IN VARIOUS DEPARTMENTS. THE SELF PAY BILLING STATEMENTS ADVISE PATIENTS TO CONTACT THE HOSPITAL REGARDING FINANCIAL ASSISTANCE ELIGIBILITY. PART VI, LINE 4: THE CITIES AND TOWNS THAT COMPRISE THE PRIMARY SERVICE AREA OF SOUTH COUNTY HOSPITAL INCLUDE THE TOWNS OF CHARLESTOWN, EXETER, JAMESTOWN, NARRAGANSETT, NORTH KINGSTOWN, AND SOUTH KINGSTOWN. THE TOWNS THAT COMPRISE THE SECONDARY SERVICE AREA INCLUDE THE TOWNS OF BLOCK ISLAND, HOPKINTON, RICHMOND, WESTERLY, AS WELL AS, THE POPULATION FROM ADJOINING COMMUNITIES IN KENT COUNTY (EAST GREENWICH AND WEST GREENWICH).THE 2000 TOTAL POPULATION FOR THE APPLICANT'S PRIMARY AND SECONDARY SERVICE AREA FOR ALL AGES, TAKEN FROM THE 2000 CENSUS IS 147,201. THE SERVICE AREA POPULATION IS EXPECTED TO CONTINUE TO GROW TO 163,063 (10.8%) BY THE YEAR 2015. THIS PROJECTION IS BASED ON INFORMATION IN THE STATEWIDE PLANNING PROGRAM TECHNICAL PAPER, NUMBER 154, DATED AUGUST 2004. THE RI STATEWIDE PLANNING PROGRAM TECHNICAL PAPER IDENTIFIES AN IMPORTANT DEMOGRAPHIC TREND THAT WILL HAVE A POTENTIAL IMPACT ON SOUTH COUNTY HOSPITAL - THE AGING POPULATION IN ITS PRIMARY AND SECONDARY SERVICE AREA. THE NUMBER OF INDIVIDUALS IN THE PRIMARY AND SECONDARY SERVICE AREA THAT ARE 65 YEARS AND OLDER IS PROJECTED TO INCREASE FROM 18,709 RECORDED IN THE 2000 CENSUS TO 24,761 BY 2015, WHICH REPRESENTS A 32.3% INCREASE. IN 2000, THE PERCENT OF INDIVIDUALS OVER 65 YEARS OF AGE COMPARED TO THE TOTAL NUMBER OF INDIVIDUALS IN THE PRIMARY AND SECONDARY SERVICE AREA WAS 12.7% (18,709/147,201). IN 2015, THIS PERCENTAGE IS PROJECTED TO INCREASE TO 15.2% (24,761/163,063). INDIVIDUALS 65 YEARS AND OLDER TEND TO UTILIZE HEALTHCARE SERVICES AT A RATE HIGHER THAN INDIVIDUALS 64 YEARS AND YOUNGER.THE CHNA ASSESSMENT COMPLETED IN 2013 PROVIDES ADDITIONAL INFORMATON ON THE COMMUNTIY SERVED BY THE HOSPITAL AND IS AVAILABLE ON THE HOSPITAL WEB SITE AT THE FOLLOWING LINK: WWW.SCHOSPITAL.COM PART VI, LINE 5: SOUTH COUNTY HOSPITAL IS COMMITTED TO SERVING THE COMMUNITY'S HEALTH NEEDS BY CONTINUED INVESTMENT OF FUNDS INTO THE FACILITIES, EQUIPMENT, AND SERVICES PROVIDED. THE HOSPITAL IS COMMITTED TO PROVIDING FUNDS TO RECRUIT AND MAINTAIN PHYSICIANS IN THE COMMUNITY TO MEET THE POPULATIONS NEEDS.THE HOSPITAL AND ITS PHYSICIAN AND COMMUNITY PARTNERS HAVE EMBARKED ON THE CREATION OF A "PATIENT CENTERED MEDICAL COMMUNITY." THE PATIENT CENTERED MEDICAL COMMUNITY (PCMC) WILL OFFER AN INTEGRATED SYSTEM OF CARE THAT IMPROVES THE HEALTH STATUS OF THE POPULATION WE SERVE, PARTICULARLY THOSE WITH AND AT RISK FOR CHRONIC CONDITIONS. TO ACHIEVE THIS VISION, THE PCMC WILL:1. BE BUILT UPON A FOUNDATION OF STRONG PRIMARY CARE PRACTICES WITH ENHANCED LINKAGES TO THE HOSPITAL, SPECIALISTS AND COMMUNITY-BASED RESOURCES.2. ADOPT AND IMPLEMENT THE PATIENT CENTERED MEDICAL HOME (PCMH) MODEL BASED ON THE NCQA RECOGNITION STANDARDS AND GUIDELINES, SUPPORTED BY LOCAL MULTIDISCIPLINARY TEAMS AND CHRONIC CARE SERVICES.3. FACILITATE ADOPTION OF HEALTH INFORMATION TECHNOLOGY TO ENSURE ELECTRONIC INFORMATION SHARING EIGHTEEN (18) PRIMARY CARE PHYSICIANS IN SEVEN (7) SOUTH COUNTY BASED PRACTICES HAVE ADOPTED AND IMPLEMENTED THE PATIENT CENTERED MEDICAL HOME (PCMH) MODEL. THE SOUTH COUNTY "MEDICAL COMMUNITY" INITIATIVE (PCMC) WILL ADVANCE THAT CONCEPT INTO A BROADER SYSTEM OF COMMUNITY-BASED HEALTHCARE THAT LINKS PRIMARY CARE PHYSICIANS AND THEIR PATIENTS TO DISEASE MANAGEMENT SERVICES, SPECIALISTS, EMERGENCY SERVICES AND INPATIENT HOSPITAL SERVICES, SO THAT CARE IS OPTIMALLY COORDINATED AND INFORMATION FLOWS TO SUPPORT THE BEST OUTCOMES FOR PATIENTS AND SYSTEM EFFICIENCY.THE SOUTH COUNTY CONTINGENT IS A PARTICIPANT IN THE RI CHRONIC CARE SUSTAINABILITY INITIATIVE (CSI) WHICH IS A DEMONSTRATION PILOT OF THE PCMH MODEL. THIS PROVIDES A FOUNDATION BASED ON AN INTEGRATED COLLABORATIVE APPROACH THAT WILL ASSIST PHYSICIAN PRACTICES AND THE HOSPITAL TOWARD ENHANCING THE MANAGEMENT OF PATIENTS WITH CHRONIC DISEASES.THE CHNA IMPLEMENTATION PLAN, INCLUDED WITH THIS RETURN, PROVIDES ADDITIONAL DETAILS OF THE HOSPITALS CONTINUED COMMITTMENT TO ADDRESS THE HEALTH NEEDS OF THE COMMUNITY. PART VI, LINE 6: THE HOSPITAL IS PART OF AN AFFILIATED HEALTHCARE SYSTEM OFFERING A COMPREHENSIVE RANGE OF ADVANCED INPATIENT, OUTPATIENT, AND HOME HEALTH SERVICES. ACCREDITED BY THE JOINT COMMISSION, THE HEALTHCARE SYSTEM IS MADE UP OF THE HOSPITAL, VNS HOME HEALTH SERVICES, SOUTH COUNTY QUALITY CARE, AND SOUTH COUNTY SURGICAL SUPPLY. THE HOSPITAL IS DEDICATED TO ENRICHING THE QUALITY OF LIFE OF SOUTHERN RHODE ISLAND COMMUNITY MEMBERS AND VISITORS THROUGH THE DELIVERY OF QUALITY HEALTHCARE SERVICES, THE DEVELOPMENT OF COOPERATIVE RELATIONSHIPS WITH OTHER HEALTHCARE PROVIDERS AND THE PROMOTION OF WELLNESS THROUGH HEALTH EDUCATION AND AWARENESS. PART VI, LINE 7, REPORTS FILED WITH STATES RI X X X X X 1 0 0 0 0 0 0 0 0 LISA RAMEAKA VP OF THE MEDICAL STAFF / PHYSICIAN 265614 0 39114 0 0 0 8925 0 17732 0 331385 0 0 0 AARON WEISBORD VP OF THE MEDICAL STAFF / PHYSICIAN 169508 0 80786 0 0 0 0 0 17632 0 267926 0 0 0 LOUIS R GIANCOLA PRESIDENT AND CEO 341008 0 0 0 1584 0 8925 0 14986 0 366503 0 0 0 THOMAS J BREEN CHIEF FINANCIAL OFFICER 359903 0 0 0 0 0 8925 0 17577 0 386405 0 0 0 ANNE SCHMIDT VP OF PATIENT CARE SERVICES 158702 0 0 0 0 0 3757 0 1382 0 163841 0 0 0 FREDERICK A BROWNE VP OF MEDICAL AFFAIRS 345088 0 0 0 0 0 6945 0 8183 0 360216 0 0 0 MATTHEW JONES PHYSICIAN 313101 0 0 0 0 0 8925 0 29621 0 351647 0 0 0 JAMES L SMYTHE PHYSICIAN 308959 0 0 0 0 0 8925 0 17543 0 335427 0 0 0 JEFFREY F JOSEPH PHYSICIAN 262869 0 39998 0 0 0 8925 0 17740 0 329532 0 0 0 STEVEN H SCHNEIDER PHYSICIAN 259090 0 43268 0 0 0 8925 0 17750 0 329033 0 0 0 DAVID BADER PHYSICIAN 165421 0 124004 0 0 0 0 0 17873 0 307298 0 0 0 BARBARA SEAGRAVE FORMER VP OF PATIENT CARE SERVICES 0 0 0 0 201574 0 6435 0 14645 0 222654 0 0 0 PART I, LINE 4A FORMER CNO BARBARA SEAGRAVE WAS GIVEN HER ANNUAL SALARY, $184,100, AS A SEVERANCE. THE SEVERANCE AGREEMENT WAS FROM SEPTEMBER 23, 2013 UNTIL SEPTEMBER 24, 2014. A 2006 RI HEALTH & EDUCATION BLDG CORP 521300173 762243ST1 2009-09-15 44950000 BLDG CONSTRUCTION/MEDICAL EQUIPMENT/REFINANCE EXISTING BONDS 0 0 0 B 2012 C RI HEALTH & EDUCATION BLDG CORP 521300173 762243EF6 2012-10-01 6280000 BLDG CONSTRUCTION/MEDICAL EQUIPMENT/REFINANCE EXISTING BONDS 0 0 0 C 2012 B RI HEALTH & EDUCATION BLDG CORP 521300173 762243EG4 2012-10-01 5430000 BLDG CONSTRUCTION/MEDICAL EQUIPMENT/REFINANCE EXISTING BONDS 0 0 0 A 10405000 44950000 2009 0 1 1 1 B 380000 6280000 2012 0 1 1 1 C 330000 5430000 2012 0 1 1 1 A 0 0 1 1 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 1 1 1 MERRILL LYNCH CAPITAL SERVICES 30.000000000000 0 0 0 0 1 B 1 1 0 0 0 1 C 1 1 0 0 0 1 A 1 B 1 C 1 WILLIAM SABINA TRUSTEE & PRESIDENT OF THE MEDICAL STAFF 54767 WILLIAM SABINA PROVIDES ADMINISTRATIVE CLINICAL SUPPORT TO SOUTH COUNTY HOSPITAL AND IS THE PRESIDENT OF THE MEDICAL STAFF. 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S AUDIT COMMITTEE APPROXIMATELY 30 DAYS PRIOR TO THE FILING DEADLINE. THE AUDIT COMMITTEE THEN REVIEWS THE FORM 990 AND PROVIDES QUESTIONS AND COMMENTS TO THE ORGANIZATION'S ACCOUNTING DEPARTMENT. BEFORE IT IS FILED, A COPY OF THE FINAL FORM 990, INCLUDING REQUIRED SCHEDULES, IS PROVIDED TO THE MEMBERS OF THE BOARD OF TRUSTEES FOR REVIEW AND DISCUSSION WITH THE CHAIRMAN OF THE AUDIT COMMITTEE AT A BOARD MEETING PRIOR TO THE FILING DEADLINE. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF THE GOVERNING BODY, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. IT IS PERIODICALLY REVIEWED AND DISCUSSED AT BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S CEO'S COMPENSATION IS DETERMINED BY THE GOVERNING BODY. THE CEO'S SALARY IS COMPARED TO OTHER CEO'S SALARIES OF SIMILAR ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 16B: THE HOSPITAL'S JOINT VENTURE WITH 21ST CENTURY ONCOLOGY TO PROVIDE FULL SPECTRUM OF PREMIER RADIATION THERAPIES IN THE COMMUNITY WAS FULLY REVIEWED BY HOSPITAL LEGAL COUNSEL TO ASSURE FULL TAX COMPLIANCE. FORM 990, PART XI, LINE 9: CHANGE IN FUNDED STATUS OF EMPLOYEE BENEFIT PLANS -2,658,125. NET ASSETS RELEASED FOR CAPITAL EXPENDITURES 1,252,770. UNREALIZED LOSS ON INTEREST RATE SWAP -429,646. UNREALIZED CHANGE IN EQUITY INTERESTS IN LIMITED PARTNERSHIPS 171,644. FORM 990, PART XII, LINE 2C: FINANCIAL STATEMENTS AND REPORTING THE ORGANIZATION'S AUDIT COMMITTEE IS RESPONSIBLE FOR SELECTING AN INDEPENDENT ACCOUNTANT TO AUDIT THE ORGANIZATION'S FINANCIAL STATEMENTS AND FOR OVERSEEING THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS. SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM ENDOWMENT 100 KENYON AVE WAKEFIELD RI 02879 050259093 TO SUPPORT ADVANCEMENT OF MEDICINE AND HEALTH CARE RI 501(C)(3) 7 N/A 0 VNS HOMECARE INC 14 WOODRUFF AVE NARRAGANSETT RI 02882 056033975 TO PROVIDE HEALTH CARE RI 501(C)(3) 9 SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM ENDOWMENT 1 SILVER SPRING HEALTH CARE MANAGEMENT 100 KENYON AVENUE WAKEFIELD RI 02879 050459095 HOLDING COMPANY RI SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM C -8258 1720421 1.00000 1 SOUTH COUNTY QUALITY CARE 100 KENYON AVENUE WAKEFIELD RI 02879 050491313 HOME BASED PERSONAL CARE RI SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM C -85692 325558 1.00000 1 SSHM SURGICAL SUPPLY INC 100 KENYON AVENUE WAKEFIELD RI 02879 050478937 RETAIL PROVIDER OF MEDICAL EQUIPMENT RI SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM C -100708 904252 1.00000 1 0 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 SSHM SURGICAL SUPPLY INC O 782356