2014-08-06T06:44:04-05:00 2013-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2012-10-01 560554222 ST LUKE'S HOSPITAL INC STLU 8288943311 101 HOSPITAL DRIVE COLUMBUS NC 28722 CHRISTINE MARTIN 8288943311 2014-08-06 1 AMY BIBBY P00445891 8282542254 2012 2015-11-30 17:44:51Z CHRISTINE MARTIN 101 HOSPITAL DRIVE COLUMBUS NC 28722 34006554 0 X WWW.SAINTLUKESHOSPITAL.COM X 1928 NC THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES TO ITS PATIENTS. 15 13 365 123 0 0 275920 1887821 29391894 31762954 63316 184792 129911 162177 29861041 33997744 0 0 0 0 12086627 12481684 0 0 0 15807411 16847933 27894038 29329617 1967003 4668127 22098255 29297514 7886003 9539630 14212252 19757884 X TO PROVIDE THE HIGHEST QUALITY FOCUSED HEALTHCARE SERVICES TO THE RESIDENTS OF POLK COUNTY AND SURROUNDING COMMUNITIES IN A SAFE, ETHICAL, COST EFFECTIVE MANNER. 0 0 24677756 0 31789623 ST. LUKE'S HOSPITAL IS COMMITTED TO OPERATE A HEALTH SYSTEM THAT PROVIDES HOSPITAL, ACUTE AND EMERGENCY CARE AND RELATED SERVICES SUCH AS ADVANCED REHABILITATIVE SERVICES, AND RESPECTFUL GERIATRIC-PSYCHIATRIC CARE FOR ADULTS 55+ WHO SUFFER FROM DEPRESSION, DEMENTIA, ALZHEIMER'S AND OTHER MENTAL HEALTH DISORDERS, FOR THE BENEFIT OF THE RESIDENTS OF POLK COUNTY AND SURROUNDING COMMUNITIES. COMMITMENT TO THIS MISSION REQUIRES BOTH AN "INVESTMENT IN" AND A "PARTNERSHIP WITH" THE COMMUNITY WHICH ST. LUKE'S HOSPITAL SERVES. SEE SCHEDULE O FOR CONTINUATION:ST. LUKE'S HOSPITAL DEFINES AND MEASURES THIS "INVESTMENT IN" AND A "PARTNERSHIP WITH" THE COMMUNITY USING THE FOLLOWING CATEGORIES OF COMMUNITY BENEFIT: COMMUNITY BENEFIT PROGRAMS - INCLUDES THE UNREIMBURSED COST OF VARIOUS EDUCATION PROGRAMS, NON-BILLED MEDICAL SERVICES, IN-KIND DONATIONS AND OTHER SERVICES THAT MEET A STRONG COMMUNITY NEED, BUT DO NOT PAY FOR THEMSELVES. EXAMPLES OF THESE COMMUNITY BENEFIT PROGRAMS INCLUDE PERIODIC HEALTHTALK PROGRAMS TO PROVIDE EDUCATION AND UPDATED INFORMATION ON PARTICULAR AND TIMELY HEALTH TOPICS; VARIOUS HEALTH AND CANCER SCREENINGS FOR PEOPLE WHO ARE UNDERINSURED AND UNINSURED; AND FIRST AID AND HAND HYGIENE STATIONS AT VARIOUS COMMUNITY EVENTS AND FESTIVALS. OUR GENEROUS IN-KIND CONTRIBUTIONS TO NUMEROUS POLK COUNTY SOCIAL SERVICES AND CIVIC ENTITIES INCLUDE VOLUNTEER LEADERSHIP ROLES WITH POLK FIT, FRESH, AND FRIENDLY, POLK WELLNESS CENTER, HIGHWOODS APARTMENTS FOR LOW INCOME FAMILIES, MENTAL HEALTH TASK FORCE FOR COMMUNITY HEALTH, THERMAL BELT OUTREACH HEALTH CARE COMMITTEE AND THE POLK COUNTY VISIONING COMMISSION, TO NAME A FEW. CIVIC PARTICIPATION INCLUDES TRYON KIWANIS CLUB, FOOTHILLS CHAMBER OF COMMERCE, TRYON ROTARY CLUB AND THE BLUE RIDGE HUNTER JUMPER ASSOCIATION, AMONG OTHERS. ST. LUKE'S HOSPITAL, OUR MEDICAL STAFF AND OUR EMPLOYEES CONTRIBUTE GENEROUSLY TO THE HEALTH, EDUCATION AMD WELL-BEING OF ALL AGES AND CIRCUMSTANCES IN POLK COUNTY. 24677756 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 32 0 1 365 1 0 0 0 0 0 0 0 0 0 0 X 15 13 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X CHRISTINE MARTIN 8288940954 101 HOSPITAL DRIVE COLUMBUS NC 28722 FRED FOY 1.00 X X 0 0 0 CLARK BENSON 1.00 X X 0 0 0 BILL HILLHOUSE 1.00 X X 0 0 0 BECKY COLLINS PHD 1.00 X X 0 0 0 AUSTIN CHAPMAN 1.00 X 0 0 0 JAMES HOLLEMAN MD 1.00 X 0 233332 33620 SANDRA MCCORMACK MD 1.00 X 0 0 0 TOMMY MELTON 1.00 X 0 0 0 WARREN CARSON 1.00 X 0 0 0 NORM POWERS 1.00 X 0 0 0 MARION MCMILLIAN 1.00 X 0 0 0 BRIAN ROSENBERG MD 1.00 X 0 979793 34727 JEAN SHUMWAY 1.00 X 0 0 0 WENDY FIELD 1.00 X 0 0 0 JUDY LAIR 1.00 X 0 0 0 CHRISTINE MARTIN 40.00 X 233416 0 27525 KEN SHULL 40.00 X 239257 0 37375 KEVIN REYNOLDS 40.00 X 110255 0 0 LYNN CROCKER 40.00 X 109656 0 0 692584 1213125 133247 4 0 1 0 BRASFIELD & GORRIE 3700 GLENWOOD AVE SUITE 300 RALEIGH NC 27612 CONSTRUCTION 3517441 CAROLINAS HEALTHCARE SYSTEM PO BOX 32861 CHARLOTTE NC 28232 MANAGEMENT CONTRACT 1274289 BIOMET INC 75 REMITTANCE DR SUITE 3283 CHICAGO IL 60675 ORTHO MEDICAL SUPPLIES 938417 VMAX ASSOCIATION PA 72 ALPINE WAY ASHEVILLE NC 28805 ANESTHESIA SERVICES 824311 HORIZON CSA LLC PO BOX 550 SKYLAND NC 28776 BIOMEDICAL EQUIPMENT REPAIR 645916 26 1652105 235716 28000 1887821 PATIENT SERVICE REVENUE 621990 30027122 30027122 OTHER PATIENT SERVICES 621990 1733147 1733147 BEHAVIORAL HEALTH CRISI 621990 2000 2000 PHYSICAL THERAPY FEES 900099 685 685 31762954 193602 193602 26669 0 26669 26669 26669 8810 -8810 -8810 -8810 PURCHASE DISCOUNTS 900099 59867 59867 CAFETERIA/MEALS 900099 45623 45623 VENDING 900099 30018 30018 135508 33997744 31789623 0 320300 X 574446 574446 8375308 7499574 875734 2826367 2368395 457972 705563 591237 114326 500000 500000 35532 35532 12500 12500 4921627 3378252 1543375 138 138 1544223 1179039 365184 1343118 1203534 139584 48009 14939 33070 103042 103042 1035247 1035247 158640 158640 MEDICAL SUPPLIES 4060358 4060358 BAD DEBT EXPENSE 3085499 3085499 29329617 24677756 4651861 0 5324681 3435267 3337073 2548106 706686 616836 178135 297737 27139193 16091203 6777666 11047990 3274851 7057278 553276 579942 1945887 3714358 22098255 29297514 4076127 4392815 21587 8890 382057 2318379 3406232 2819546 7886003 9539630 X 13497823 18966589 609547 686413 104882 104882 14212252 19757884 22098255 29297514 X 4668127 596415 281090 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3340 3340 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL PAID DUES TO NCHA, OF WHICH $1,945 WAS DETERMINED AS LOBBYING EXPENDITURES DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2013. THE HOSPITAL PAID DUES TO AHA, OF WHICH $1,395 WAS DETERMINED AS LOBBYING EXPENDITURES DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2013. 2971426 47323 329448 3348197 2546063 40350 385013 2971426 2456039 161049 -71025 2546063 2271465 34103 150471 2456039 1983824 153474 134167 2271465 0.75680 0.10400 0.13920 0 1 1 59433 59433 8492302 6826129 1666173 445696 377537 68159 12908426 8887537 4020889 5233336 5233336 11047990 INTERCOMPANY NOTES RECEIVABLE 3714358 3714358 THIRD PARTY PAYABLE 2658008 CEDRIC SEAMAN CHARITABLE TRUST 59378 CAPITAL LEASES 102160 2819546 X 29719464 596415 596415 29123049 4874695 4874695 33997744 26238622 0 26238622 3090995 3090995 29329617 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ORGANIZATION'S ENDOWMENT FUNDS ARE ORGANIZED TO PROVIDE FUNDS FOR GENERAL PURPOSES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: INCOME TAXES- THE HOSPITAL, ST. LUKE'S FOUNDATION, INC., COMMUNITY HEALTH CONNECTIONS, INC., AND ST. LUKE'S PHYSICIAN NETWORK, INC. ARE EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE PROFESSIONAL BUILDING IS A FOR-PROFIT CORPORATION SUBJECT TO FEDERAL AND STATE INCOME TAXES. THE HOSPITAL AND THE AFFILIATES HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: TEMPORARY RESTRICTED CONTRIBUTIONS 1,783,700. SWINGBED REVENUE IN EXPENSES 5,496. PROVISION FOR UNCOLLECTIBLE ACCOUNTS 3,085,499. PART XII, LINE 4B - OTHER ADJUSTMENTS: SWINGBED REVENUE IN EXPENSES 5,496. PROVISION FOR UNCOLLECTIBLE ACCOUNTS 3,085,499. 1 1 1 X 1 X 1 1 1 0 1 1 388171 388171 0.01480 1674190 1531590 142600 0.00540 2062361 1531590 530771 0.02020 57055 57055 0.00220 4584220 3124605 1459615 0.05560 4641275 3124605 1516670 0.05780 6703636 4656195 2047441 0.07800 0 1095507 1325197 1586050 -260853 X 1 0 1 1 ST LUKE'S HOSPITAL

101 HOSPITAL DRIVE COLUMBUS NC 28722

X X X X ST LUKE'S HOSPITAL INC 1 1 X X X X X X 12 1 0 1 X X X X X X X X X X X 1 0 1 1 200.000000000000 1 200.000000000000 1 X X X 0 1 X X X X 1 0 1 X 0 0 PART I, LINE 7: THE ORGANIZATION UTILIZED THE IRS WORKSHEETS TO DETERMINE THE COST TO CHARGE RATIO PART I, LINE 7G: EMERGENCY DEPARTMENT OPERATED AT A LOSS PART I, L7 COL(F): THE TOTAL EXPENSE ON FORM 990 PART XI, LN 25 CONTAINS A BAD DEBT EXPENSE OF 3,085,499 THAT HAS BEEN REMOVED FOR THE CALCULATION OF CHARITY CARE PERCENTAGE. PART II: *COMMUNITY BENEFIT PROGRAMS-INCLUDES THE UNREIMBURSED COST OF VARIOUS EDUCATION PROGRAMS, NON-BILLED MEDICAL SERVICES, IN-KIND DONATIONS AND OTHER SERVICES THAT MEET A STRONG COMMUNITY NEED, BUT DO NOT PAY FOR THEMSELVES. EXAMPLES OF THESE COMMUNITY BENEFIT PROGRAMS INCLUDE PERIODIC HEALTHTALK PROGRAMS TO PROVIDE EDUCATION AND UPDATED INFORMATION ON PARTICULAR AND TIMELY HEALTH TOPICS; VARIOUS HEALTH AND CANCER SCREENINGS FOR THE COMMUNITY, SCHOOLS, CHURCHES; AND FIRST AID AND HAND HYGIENE STATIONS AT VARIOUS COMMUNITY EVENTS AND FESTIVALS.OUR GENEROUS IN-KIND CONTRIBUTIONS TO NUMEROUS POLK COUNTY SOCIAL SERVICES AND CIVIC ENTITIES INCLUDE VOLUNTEER LEADERSHIP ROLES WITH POLK FIT, FRESH, FRIENDLY, POLK COUNTY WELLNESS COALITION, POLK WELLNESS CENTER, HIGHWOODS APARTMENTS FOR LOW INCOME FAMILIES, THERMAL BELT OUTREACH HEALTH CARE COMMITTEE AND THE POLK COUNTY VISIONING COMMISSION, TO NAME A FEW. CIVIC PARTICIPATION INCLUDES TRYON KIWANIS CLUB, FOOTHILLS CHAMBER OF COMMERCE, TRYON ROTARY CLUB AND THE BLUE RIDGE HUNTER JUMPER ASSOCIATION, AMONG OTHERS. PART III, LINE 4: THE PATIENT FINANCIAL ADVISOR REVIEWED THE FINANCIAL ASSISTANCE SPREADSHEETS FOR THE 2013 TAX PERIOD AND TOOK INTO ACCOUNT ALL ACCOUNTS THAT LEFT PATIENT RESPONSIBILITY. THE ACCOUNTS WERE THEN REVIEWED TO SEE IF THE PATIENT PAID OR IF THE ACCOUNTS CYCLED TO BAD DEBT. PART III, LINE 8: AN INTERNAL COST-TO-CHARGE RATIO WAS USED TO COMPUTE MEDICARE ALLOCABLE COSTS OF CARE ON PART III, LN 6. PART III, LINE 9B: THE ORGANIZATION APPLIES THE SAME PROCEDURE TO ALL ACCOUNTS WHICH PROVIDE FOR THE MAILING OF TWO STATEMENTS, TWO LETTERS, AND TWO PHONE CALLS PRIOR TO MOVING THE ACCOUNT TO THE COLLECTION PROCESS. ST. LUKE'S HOSPITAL, INC. PART V, SECTION B, LINE 3: MARKETING/PUBLIC RELATIONS DIRECTOR REPRESENTED ST. LUKE'S HOSPITAL WITH WNC HEALTHY IMPACT FOR COLLABORATING/GENERATING/ANALYZING DEMOGRAPHIC AND HEALTH DATA. THE DIRECTOR ALSO SERVES ON BOARD OF POLK COUNTY'S LOCAL HEALTH COALITION, POLK FIT, FRESH, FRIENDLY. WE COLLABORATED WITH RUTHERFORD-POLK-MCDOWELL HEALTH DISTRICT TO ORGANIZE A COMMUNITY HEALTH FORUM AND DEVELOPED CHIP FROM THOSE RESULTS. ST. LUKE'S HOSPITAL, INC. PART V, SECTION B, LINE 4: THE HOSPITAL MADE THE CHNA AVAILABLE TO THE LOCAL NEWS MEDIA/NEWSLETTERS. ST. LUKE'S HOSPITAL, INC. PART V, SECTION B, LINE 6I: UTILIZING DATA COLLECTED THROUGH WNC HEALTHY IMPACT AND IN COLLABORATION WITH LOCAL HEALTH DEPARTMENT, ST. LUKE'S HOSPITAL'S SENIOR TEAM DEVELOPED CHIP TO ADDRESS HEALTH ISSUES WITHIN OUR CAPABILITIES AND COMMUNITY PARTNERSHIPS. WE ALSO REVIEWED OUR STRATEGIC PLAN AND RESOURCES IN ADDRESSING COMMUNITY HEALTH. ST. LUKE'S HOSPITAL, INC. PART V, SECTION B, LINE 20D: THEY USED THE MAXIMUM DISCOUNT AMOUNT GIVEN TO COMMERCIAL/MANAGED CARE PAYORS. PART VI, LINE 2: EVERY FOUR YEARS THE STATE OF NORTH CAROLINA REQUIRES EVERY LOCAL HEALTH DEPARTMENT AND NORTH CAROLINA HEALTHY CAROLINIANS PARTNERSHIPS TO CONDUCT A COMMUNITY HEALTH ASSESSMENT. A COMMUNITY HEALTH ASSESSMENT IS A PROCESS THAT ALLOWS THE MEMBERS OF THE COMMUNITY AND STAKEHOLDERS TO GAIN A BETTER UNDERSTANDING OF THE COUNTY'S HEALTH NEEDS AND CONCERNS.IN 2013, WE COLLABORATED WITH WNC HEALTHY IMPACT FOR A COMPREHENSIVE COMMUNITY HEALTH ASSESSMENT (CHA). USING AVAILABLE DATA AND A CROSS-SECTION OF COUNTY RESIDENTS, WE SURVEY MEMBERS OF THE COMMUNITY REGARDING THEIR PERCEIVED HEALTHCARE NEEDS AND DISPARITIES. WE UTILIZE NC DATA AND HOST A HEALTH FORUM EVERY THREE YEARS DURING WHICH WE PRESENT THE SURVEY FINDINGS TO THE COMMUNITY. THE CHA IS PRESENTED DURING A PUBLIC MEETING, PRESENTED TO OUR BOARD OF COMMISSIONERS, INCLUDED ON WEBSITES AND PUBLISHED IN AREA NEWS MEDIA. THE HEALTH FORUM HELPS BRING PEOPLE WITH DIVERSE BACKGROUNDS AND DEMOGRAPHICS TO THE TABLE TO REACH CONSENSUS ON POLK COUNTY'S TOP HEALTHCARE NEEDS AND WORK TOGETHER TO CREATE SOLUTIONS. FROM THE DATA, PUBLIC MEETING AND THE HOSPITAL'S STRATEGIC PLAN, WE CREATED A COMMUNITY HEALTH IMPROVEMENT PLAN IN CONJUNCTION WITH OUR LOCAL HEALTH DEPARTMENT. PART VI, LINE 3: ST. LUKE'S HOSPITAL ADVISES ALL UNDERINSURED/UNINSURED PATIENTS THRU VERBAL OR WRITTEN NOTIFICATION OF ASSISTANCE OFFERED BY OUR PATIENT FINANCIAL COUNSELOR TO ASSESS ANY POSSIBLE THIRD PARTY ASSISTANCE THROUGH FEDERAL, STATE, LOCAL GOVERNMENT PROGRAMS OR FINANCIAL ASSISTANCE. ALL PATIENT INFORMATION PACKETS GIVEN TO INPATIENT AND OUTPATIENT PATIENTS INCLUDE AN INFORMATION SHEET WITH DETAILED DIRECTIONS ON FINANCIAL ASSISTANCE PROCESSES AND HOW TO CONTACT THE SLH FINANCIAL COUNSELOR. THE INFORMATION INCLUDES DETAILED DESCRIPTIONS OF THE PAPERWORK REQUIRED AND APPROPRIATE TIMEFRAMES TO COMPLETE FULL APPLICATIONS. ALL STATEMENTS DIRECT PATIENTS TO CONTACT CUSTOMER SERVICE FOR FINANCIAL ASSISTANCE OPTIONS. THE ED REGISTRATION EMPLOYEE ASKS UNINSURED PATIENTS TO COMPLETE A FLOW SHEET WHICH IS GIVEN TO THE PATIENT FINANCIAL COUNSELOR TO REVIEW FOR THIRD PARTY PROGRAMS OR FINANCIAL ASSISTANCE. PART VI, LINE 4: ST. LUKE'S HOSPITAL IS A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL THAT PROVIDES A WIDE RANGE OF ACUTE CARE SERVICES, 24/7 EMERGENCY CARE GERIATRIC-PSYCHIATRIC INPATIENT CARE, ADVANCED ORTHOPEDIC AND REHAB SERVICES AND GENERAL SURGERY. THE 25-BED HOSPITAL IS LOCATED IN WESTERN NORTH CAROLINA AT THE FOOT OF THE BLUE RIDGE MOUNTAINS RIGHT AT THE NC/SC STATE LINE. THE PRIVATE, NOT-FOR-PROFIT COMMUNITY HOSPITAL PROVIDES PRIMARY AND ACUTE HEALTHCARE SERVICES TO POLK COUNTY AND ITS SURROUNDING COMMUNITIES. ST. LUKE'S IS SITUATED 40 MILES SOUTHEAST OF ASHEVILLE, NC, AND 25 MILES NORTH OF SPARTANBURG, SC. POLK COUNTY IS A WELL-KNOWN AFFLUENT RETIREMENT COMMUNITY, WITH SEVERAL INDEPENDENT AND ASSISTED LIVING COMMUNITIES THAT ALSO PROVIDE NURSING HOME CARE, REHAB, PERSONAL CARE AND TRAVEL, LEISURE AND ENTERTAINMENT OPPORTUNITIES. IN THE PAST DECADE, POLK COUNTY EXPERIENCED PHENOMENAL GROWTH OF GOLF AND EQUESTRIAN COMMUNITIES UNDER DEVELOPMENT, HOWEVER, THE ECONOMIC DOWNTURN HALTED A NUMBER OF PROJECTS. WHILE POPULATION GROWTH AND DEVELOPMENT IN THE COUNTY HAS STALLED, CITIZENS AND COUNTY LEADERS ARE GRAPPLING WITH ZONING AND GROWTH ISSUES IN THE RURAL COMMUNITY. LEADERS HAVE GIVEN MUCH TIME AND ATTENTION TO A COMPREHENSIVE COUNTYWIDE VISIONING PROCESS THAT INDICATES THE IMPORTANCE OF PLANNING AND LAND USE TO MAINTAIN THE INTEGRITY OF THE COUNTY'S RURAL/AGRICULTURAL/EQUESTRIAN HISTORY.ACCORDING TO ISOTHERMAL PLANNING AND DEVELOPMENT COMMISSION, THE STATE DATA CENTER PROJECTS THAT ALMOST 38 PERCENT OF THE REGION'S POPULATION WILL BE AGED 50 OR OLDER IN 2015. THIS TREND IS EVEN MORE PRONOUNCED IN POLK COUNTY-WHICH HAS BECOME A MAJOR RETIREMENT DESTINATION-WHERE THE PERCENTAGE OF THE POPULATION AGED 50 AND OLDER IS PROJECTED TO GROW TO 46.5 PERCENT BY 2015.THE REGION HAS PROVEN TO BE AN ATTRACTIVE DESTINATION FOR RETIREES. THIS IS PARTICULARLY TRUE FOR POLK COUNTY AND RUTHERFORD COUNTY (ESPECIALLY AROUND LAKE LURE). RETIREE ATTRACTION HAS BROUGHT NEW SOURCES OF WEALTH, DEMAND FOR HOUSING, AND POTENTIAL ENTREPRENEURS TO THE REGION. . . . THIS INFLUX OF IN-MIGRANTS HAS RESULTED IN POLITICAL AND PHILOSOPHICAL CONFLICTS BETWEEN WEALTHIER NEWCOMERS AND THOSE WHO HAVE LIVED IN THE REGION FOR MANY GENERATIONS.WHILE THERE ARE A NUMBER OF SMALL INDUSTRIAL PLANTS IN THE AREA, INCLUDING MILLIKEN AND TIMKEN, THE INDUSTRIAL BASE IS LIMITED. ST. LUKE'S HOSPITAL IS CURRENTLY THE LARGEST PRIVATE EMPLOYER IN POLK COUNTY AVERAGING OVER 300 EMPLOYEES. THE POLK COUNTY SCHOOL SYSTEM IS THE COUNTY'S LARGEST WITH MORE THAN 300 FULL-TIME EMPLOYEES.CURRENTLY, ST. LUKE'S SERVICE AREA ENCOMPASSES ALL OF POLK COUNTY (POPULATION-19,461). *PRIMARY SERVICE AREA --COLUMBUS AND TRYON (POP. 12,965)*SECONDARY SERVICE AREA-NORTH --SALUDA AND MILL SPRING (POP. 6,496) *SECONDARY SERVICE AREA-SOUTH -- LANDRUM AND CAMPOBELLO, SC, (POP. 17,780)ST. LUKE'S TOTAL SERVICE AREA POPULATION IS 37,241, OF WHICH 55 PERCENT ARE COVERED BY MEDICARE, 26 PERCENT AS PRIVATE PAY, AND 19 PERCENT DESCRIBED AS MEDICAID/SELF-PAY.RESIDENTS 65 AND OLDER COMPRISE 23.4 PERCENT OF THE POPULATION IN POLK COUNTY. THE LARGEST POPULATION GROUPS ARE THE 35-54 AND 55-74 YEAR OLDS, MAKING UP 26 PERCENT AND 24 PERCENT RESPECTIVELY. MEDIAN HOUSEHOLD INCOME IS $38,184, AND THE PERCENT OF POVERTY FOR POLK COUNTY IS 11.2 PERCENT, BELOW NC AND US RATES. PART VI, LINE 5: IN THE EVENT OF SURPLUS FUNDS THE ORGANIZATION USES THE MAJORITY OF THESE AMOUNTS TO INVEST IN HEALTHCARE TECHNOLOGY TO IMPROVE THE QUALITY OF CARE PROVIDED. REPORTS FILED WITH STATES PART VI, LINE 7 NC X X 0 0 0 1 0 1 0 0 0 JAMES HOLLEMAN MD 0 224101 0 9231 0 0 0 19753 0 13867 0 266952 0 0 BRIAN ROSENBERG MD 0 703277 0 274631 0 1885 0 17492 0 17235 0 1014520 0 0 CHRISTINE MARTIN 199406 0 32965 0 1045 0 16367 0 11158 0 260941 0 0 0 KEN SHULL 194984 0 38741 0 5532 0 22056 0 15319 0 276632 0 0 0 PART I, LINE 5 THE ORGANIZATION'S CEO AND CFO PARTICIPATE IN ANNUAL INCENTIVE AWARD PROGRAM BASED ON VARIOUS PERFORMANCE BENCHMARKS INCLUDING: FINANCIAL PERFORMANCE, PATIENT SATISFACTION, PATIENT SERVICE DAYS, AND QUALITY METRICS. PART I, LINE 6 THE ORGANIZATION'S CEO AND CFO PARTICIPATE IN ANNUAL INCENTIVE AWARD PROGRAM BASED ON VARIOUS PERFORMANCE BENCHMARKS INCLUDING: FINANCIAL PERFOMANCE, PATIENT SATISFACTION, AND VARIOUS QUALITY METRICS. X EQUIPMENT 1 28000 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIRMAN OF THE BOARD WHO SHALL ACT AS CHAIRMAN OF THE COMMITTEE, THE VICE-CHAIRMAN, THE SECRETARY, THE TREASURER AND THE CHIEF OF THE MEDICAL STAFF. WHEN THE BOARD IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER AND AUTHORITY OF THE BOARD TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OR BY STATUTE. THE EXECUTIVE COMMITTEE SHALL NOT TAKE ANY ACTION THAT CONFLICTS WITH ESTABLISHED POLICIES OF THE BOARD AND IT SHALL DEFER, WHEN POSSIBLE, ALL MATTERS OF MAJOR IMPORTANCE TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE JULY 1, 2008, THE HOSPITAL AND AFFILIATES ENTERED INTO A TEN-YEAR MANAGEMENT SERVICES AGREEMENT (THE MSA) WITH THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY WHICH DOES BUSINESS AS CAROLINAS HEALTHCARE SYSTEM (CHS) TO MANAGE THE HOSPITAL AND AFFILIATES ON A DAY-TO-DAY BASIS. THE TERMS OF THE MSA CALL FOR THE HOSPITAL AND AFFILIATES TO PAY CHS AN ANNUAL MANAGEMENT FEE. IN ADDITION, CHS IS REQUIRED TO FURNISH THE HOSPITAL AND AFFILIATES A CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, AND A CHIEF NURSING OFFICER. THE HOSPITAL AND AFFILIATES REIMBURSE CHS THE SALARY AND BENEFITS COST OF THESE INDIVIDUALS. THE ORGANIZATION IS UTILIZING PART VII AND SCHEDULE J OF THE FORM 990 TO REPORT THE COMPENSATION PAID TO THE CFO AND CFO BY THE MANAGEMENT FOR SERVICES PROVIDED TO THE FILING ORGANIZATION. THE COMPENSATION HAS BEEN REPORTED IN THE FILING ORGANIZATION'S COMPENSATION COLUMNS. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE HAD A MEETING TO COMPLETE A COMPREHENSIVE REVIEW OF THE FORM 990. THE ORGANIZATION HELD A FULL BOARD MEETING, WHERE THE FINANCE COMMITTEE PRESENTED THE FORM 990 TO THE ENTIRE BOARD. A COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH VOTING BOARD MEMBER FOR REVIEW PRIOR TO THE MEETING. ADDITIONALLY, EACH MEMBER RECEIVED A COPY OF THE 990 AT THE BOARD MEETING. AFTER A QUESTION & ANSWER PERIOD, THE VOTING BOARD VOTED TO APPROVE THE FORM 990 AS PRESENTED. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT UPON HIRE OR APPOINTMENT. THE CONFLICTS OF INTEREST STATEMENT IS SIGNED ANNUALLY. THE CONFLICT OF INTEREST POLICY IS EXPLAINED DURING NEW EMPLOYEE ORIENTATION AND ALTHOUGH ALL EMPLOYEES ARE NOT TO SIGN THE STATEMENT THE EMPLOYEES ARE ENCOURAGED TO REPORT CONFLICT OF INTEREST ISSUES. FORM 990, PART VI, SECTION B, LINE 15 CAROLINAS HEALTHCARE SYSTEM HAS AN APPROVED COMPENSATION COMMITTEE THAT RETAINS INDEPENDENT EXPERTS TO DESIGN COMPLETE COMPENSATION PACKAGES. THE COMPENSATION COMMITTEE REVIEWS COMPARABILITY DATA, REVIEWS EXECUTIVE OFFICERS' PERFORMANCE AND RECOMMENDATIONS FOR SENIOR OFFICERS. EXECUTIVE COMPENSATION IS APPROVED AND AN OFFICIAL REPORT IS GIVEN TO THE BOARD ALONG WITH DOCUMENTATION IN THE MINUTES OF MEETINGS. FORM 990, PART VI, SECTION C, LINE 18 RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. OTHER FEES FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 464,904. MANAGEMENT AND GENERAL EXPENSES 592,422. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,057,326. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,686,103. MANAGEMENT AND GENERAL EXPENSES 950,953. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,637,056. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,227,245. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,227,245. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF UNITRUST 46,132. UNREALIZED GAIN ON KIMBERLY TRUST 22,590. OTHER CHANGE IN NET ASSETS -20,366. TRANSFER FROM AFFILIATE 232,734. ST LUKE'S HEALTH CARE INC 101 HOSPITAL DRIVE COLUMBUS NC 28722 561423318 CONTROLLING ENTITY NC 501(C)(3) PF N/A 0 ST LUKE'S FOUNDATION INC 101 HOSPITAL DRIVE COLUMBUS NC 28722 561757097 RAISES FUNDS TO HELP SUPPORT ST. LUKE'S HOSPITAL NC 501(C)(3) LINE 7 ST LUKE'S HEALTHCARE INC 0 ST LUKE'S PHYSICIAN NETWORK INC 101 HOSPITAL DRIVE COLUMBUS NC 28722 263082073 PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF POLK COUNTY, NC NC 501(C)(3) LINE 3 ST LUKE'S HEALTHCARE INC 0 ST LUKE'S PROFESSIONAL BUILDING INC 101 HOSPITAL DRIVE COLUMBUS NC 28722 561423404 RENTAL REAL ESTATE NC N/A C 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 1 1 1 ST LUKE'S FOUNDATION INC C 1652105 ST LUKE'S HOSPITAL AUXILIARY C 33656