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ST LUKES HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ST LUKES HOSPITAL INC (EIN 56-0554222)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-05-10
IRS object ID
201321309349300122
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-10T05:59:20-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN560747981EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1
CityASHEVILLECity
StateNCState
ZIP Code28806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN560554222EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST LUKE'S HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTLUNameControl
Phone8288943311Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1101 HOSPITAL DRIVEAddressLine1
CityCOLUMBUSCity
StateNCState
ZIP Code28722ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCHRISTINE MARTINName
TitleCFOTitle
Phone8288943311Phone
Date Signed2013-05-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL RAUCHWARGName
PTINP00439551PTIN
Phone8282542254Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCHRISTINE MARTINNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1101 HOSPITAL DRIVEAddressLine1
CityCOLUMBUSCity
StateNCState
ZIP Code28722ZIPCode
FieldValueIRS element (for citing)
Gross Receipts29928779GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SAINTLUKESHOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1928YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionTHE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES TO ITS PATIENTS, MOST OF WHOM ARE RESIDENTS OF POLK COUNTY, NORTH CAROLINA AND THE UPSTATE REGION OF SOUTH CAROLINA.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees363TotalNbrEmployees
Total Nbr Volunteers176TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year438035ContributionsGrantsPriorYear
Contributions Grants Current Year275920ContributionsGrantsCurrentYear
Program Service Revenue Prior Year28690860ProgramServiceRevenuePriorYear
Program Service Revenue CY29391894ProgramServiceRevenueCY
Investment Income Prior Year173318InvestmentIncomePriorYear
Investment Income Current Year63316InvestmentIncomeCurrentYear
Other Revenue Prior Year123759OtherRevenuePriorYear
Other Revenue Current Year129911OtherRevenueCurrentYear
Total Revenue Prior Year29425972TotalRevenuePriorYear
Total Revenue Current Year29861041TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12187483SalariesEtcPriorYear
Salaries Etc Current Year12086627SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year15449265OtherExpensePriorYear
Other Expenses Current Year15807411OtherExpensesCurrentYear
Total Expenses Prior Year27636748TotalExpensesPriorYear
Total Expenses Current Year27894038TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1789224RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1967003RevenuesLessExpensesCY
Total Assets BOY17815499TotalAssetsBOY
Total Assets EOY22098255TotalAssetsEOY
Total Liabilities BOY5987337TotalLiabilitiesBOY
Total Liabilities EOY7886003TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY11828162NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY14212252NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO PROVIDE THE HIGHEST QUALITY FOCUSED HEALTHCARE SERVICES TO THE RESIDENTS OF POLK COUNTY AND SURROUNDING COMMUNITIES IN A SAFE, ETHICAL, COST EFFECTIVE MANNER.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense23421277Expense
Revenue29391894Revenue
DescriptionST. 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, NC AND UPSTATE, SC. COMMITMENT TO THIS MISSION REQUIRES BOTH AN "INVESTMENT IN" AND A "PARTNERSHIP WITH" THE COMMUNITY WHICH ST. LUKE'S HOSPITAL SERVES. 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 AND RESEARCH 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 MONTHLY 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, HEALTHPOLK COUNTY COUNCIL ON AGING, 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.Description
Total Program Service Expense23421277TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109630NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees363NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledNCStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CHRISTINE MARTINBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8288940892TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1101 HOSPITAL DRIVEAddressLine1
CityCOLUMBUSCity
StateNCState
ZIP Code28722ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
FRED FOY
CHAIR1.00XX000
BILL HILLHOUSE
TREASURER1.00XX000
BECKY COLLINS PHD
SECRETARY1.00XX000
DR WARREN CARSON
TRUSTEE1.00X000
DR JAMES HOLLEMAN
TRUSTEE1.00X01742159823
DR SANDRA MCCORMACK
TRUSTEE1.00X000
SUSAN MCHUGH
TRUSTEE1.00X000
TOMMY MELTON
TRUSTEE1.00X000
CLARK BENSON
TRUSTEE1.00X000
NORM POWERS
TRUSTEE1.00X000
MARION MCMILLIAN
TRUSTEE1.00X000
DR BRIAN ROSENBERG
TRUSTEE1.00X061273713569
JEAN SHUMWAY
TRUSTEE1.00X000
WENDY FIELD
TRUSTEE1.00X000
JUDY LAIR
TRUSTEE1.00X000
CHRISTINE MARTIN
CFO40.00X146671017899
KEN SHULL
CEO40.00X238998035057
KEVIN REYNOLDS
ASSISTANT DIRECTOR OF PHAR40.0011405800X
LYNN CROCKER
DIRECTOR OF PHARMACY40.0010901000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org608737TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs786952TotalReportableCompFrmRltdOrgs
Total Other Compensation76348TotalOtherCompensation
Number Individuals GT100 K4NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CAROLINAS HEALTHCARE SYSTEM
PO BOX 32861CHARLOTTENC28232MANAGEMENT CONTRACT1234418
VMAX ASSOCIATION PA
72 ALPINE WAYASHEVILLENC28805ANESTHESIA SERVICES971064
HORIZON CSA LLC
PO BOX 550SKYLANDNC28776BIOMEDICAL EQUIPMENT REPAIR531447
EMCARE PHYSICIAN SERVICES
7032 COLLECTION CENTER DRCHICAGOIL60673ER PHYSICIANS516940
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Related Organizations184313RelatedOrganizations
All Other Contributions91607AllOtherContributions
Noncash Contributions8947NoncashContributions
Total Contributions275920TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REVENU6219902933465529334655
SALE OF DRUGS9000994751447514
BEHAVIORAL HEALTH CRIS62199058005800
OTHER PATIENT SERVICES62199032253225
PHYSICAL THERAPY FEES900099700700
FieldValueIRS element (for citing)
Total Program Service Revenue29391894TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column131054TotalRevenueColumn
Exclusion$131,054ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other67738Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-67738Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-67738TotalRevenueColumn
Exclusion-$67,738ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
PURCHASE DISCOUNTS90009961224$61,224
CAFETERIA/MEALS90009950011$50,011
VENDING90009918176$18,176

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column500TotalRevenueColumn
Exclusion$500ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue129911TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column29861041TotalRevenueColumn
Related Or Exempt Function Income29391894RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$193,227ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total438625Total
Management And General438625ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8548341Total
Program Services7514808ProgramServices
Management And General1033533ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2367672Total
Program Services1979847ProgramServices
Management And General387825ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total731989Total
Program Services612089ProgramServices
Management And General119900ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total25714Total
Management And General25714ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total20936Total
Management And General20936ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4479898Total
Program Services2673301ProgramServices
Management And General1806597ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total2701Total
Program Services1747ProgramServices
Management And General954ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2963221Total
Program Services2589837ProgramServices
Management And General373384ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1376748Total
Program Services1241872ProgramServices
Management And General134876ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total144454Total
Program Services14037ProgramServices
Management And General130417ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total81992Total
Program Services81992ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total957367Total
Program Services957367ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total142800Total
Program Services142800ProgramServices

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
BAD DEBT EXPENSE33125483312548
MEDICAL SUPPLIES22990322299032

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total27894038Total
Program Services23421277ProgramServices
Management And General4472761ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4394066BOY
EOY5324681EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2710331BOY
EOY3337073EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY546515BOY
EOY706686EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY162349BOY
EOY178135EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis21739965LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec14962299LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5067482BOY
EOY6777666EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2813066BOY
EOY3274851EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY512329BOY
EOY553276EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1609361BOY
EOY1945887EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY17815499BOY
EOY22098255EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3109338BOY
EOY4076127EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY33579BOY
EOY21587EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY604218BOY
EOY382057EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY2240202BOY
EOY3406232EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5987337BOY
EOY7886003EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY11201086BOY
EOY13497823EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY522194BOY
EOY609547EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY104882BOY
EOY104882EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11828162BOY
EOY14212252EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY17815499BOY
EOY22098255EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1967003ReconcilationRevenueExpenses
Reconcilation Other Changes417087ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$2,046OtherActivitiesAmount
Total Lobbying Expenditures IIB2046TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHE HOSPITAL PAID DUES TO NCHA, OF WHICH $3,525 WAS DETERMINED AS LOBBYING EXPENDITURES DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2012. THE HOSPITAL PAID DUES TO AHA, OF WHICH $2,046 WAS DETERMINED AS LOBBYING EXPENDITURES DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2012.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance2546063BeginningOfYearBalance
Contributions40350Contributions
Investment Earnings Or Losses385013InvestmentEarningsOrLosses
End Of Year Balance2971426EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance2456039BeginningOfYearBalance
Contributions161049Contributions
Investment Earnings Or Losses-71025InvestmentEarningsOrLosses
End Of Year Balance2546063EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2271465BeginningOfYearBalance
Contributions34103Contributions
Investment Earnings Or Losses150471InvestmentEarningsOrLosses
End Of Year Balance2456039EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1983824BeginningOfYearBalance
Contributions153474Contributions
Investment Earnings Or Losses134167InvestmentEarningsOrLosses
End Of Year Balance2271465EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.75520BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.14360PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.10120TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis59433OtherCostOrOtherBasis
Book Value59433BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis7216842OtherCostOrOtherBasis
Depreciation6541917Depreciation
Book Value674925BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis422190OtherCostOrOtherBasis
Depreciation369955Depreciation
Book Value52235BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis13700275OtherCostOrOtherBasis
Depreciation8050427Depreciation
Book Value5649848BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis341225OtherCostOrOtherBasis
Book Value341225BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6777666TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionINTERCOMPANY NOTES RECEIVABLEDescription
Book Value1945887BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets1945887TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
THIRD PARTY PAYABLE$1,718,098
CEDRIC SEAMAN CHARITABLE TRUST$64,508
CAPITAL LEASES$1,623,626
FieldValueIRS element (for citing)
Total Of Amounts3406232TotalOfAmounts
Total Revenue29861041TotalRevenue
Total Expenses27894038TotalExpenses
Excess Or Deficit For Year1967003ExcessOrDeficitForYear
Net Unrealized GL On Investments354734NetUnrealizedGLOnInvestments
Other$62,353OtherAmount
Total Adjustments417087TotalAdjustments
Excess Or Deficit Per FS2384090ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt30190775TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments354734NetUnrealizedGainsInvestments
Revenue Not Rptd F990354734RevenueNotRptdF990
Revenue Subtotal29836041RevenueSubtotal
Other Revenues Not Included25000OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt25000RevenueNotRptdOnFinStmt
Total Revenue Per Form99029861041TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt27894038TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal27894038ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99027894038TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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: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 DON NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2012. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.
PART XI, LINE 8 - OTHER ADJUSTMENTS:CHANGE IN VALUE OF UNITRUST 8,487. UNREALIZED GAIN ON KIMBERLY TRUST 52,939. OTHER CHANGE IN NET ASSETS 927. TOTAL TO SCHEDULE D, PART XI, LINE 8: 62,353.
PART XII, LINE 4B - OTHER ADJUSTMENTS:TEMPORARY RESTRICTED CONTRIBUTIONS 25,000.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense415559TotalCommunityBenefitExpense
Net Community Benefit Expense415559NetCommunityBenefitExpense
Percent Of Total Expense0.01690PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense1594416TotalCommunityBenefitExpense
Direct Offsetting Revenue1235252DirectOffsettingRevenue
Net Community Benefit Expense359164NetCommunityBenefitExpense
Percent Of Total Expense0.01460PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense2009975TotalCommunityBenefitExpense
Direct Offsetting Revenue1235252DirectOffsettingRevenue
Net Community Benefit Expense774723NetCommunityBenefitExpense
Percent Of Total Expense0.03150PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense67637TotalCommunityBenefitExpense
Net Community Benefit Expense67637NetCommunityBenefitExpense
Percent Of Total Expense0.00280PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense2399749TotalCommunityBenefitExpense
Direct Offsetting Revenue2101530DirectOffsettingRevenue
Net Community Benefit Expense298219NetCommunityBenefitExpense
Percent Of Total Expense0.01210PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2467386TotalCommunityBenefitExpense
Direct Offsetting Revenue2101530DirectOffsettingRevenue
Net Community Benefit Expense365856NetCommunityBenefitExpense
Percent Of Total Expense0.01490PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense4477361TotalCommunityBenefitExpense
Direct Offsetting Revenue3336782DirectOffsettingRevenue
Net Community Benefit Expense1140579NetCommunityBenefitExpense
Percent Of Total Expense0.04640PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,081,878BadDebtExpenseAmount
Amount Reimbursed By Medicare12430947AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare12311895CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall119052MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ST LUKE'S HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1101 HOSPITAL DRIVEAddressLine1
CityCOLUMBUSCity
StateNCState
ZIP Code28722ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
Critical Access HospitalXCriticalAccessHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ST LUKE'S HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent200.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Uninsured DiscountXUninsuredDiscount
Explains Application Method0ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 7: THE ORGANIZATION UTILIZED THE IRS WORKSHEETS TO DETERMINE THE COST TO CHARGE RATIO
PART I, L7 COL(F): THE TOTAL EXPENSE ON FORM 990 PART XI, LN 25 CONTAINS A BAD DEBT EXPENSE OF 3,312,548 THAT HAS BEEN REMOVED FOR CALCULATION OF CHARITY CARE PERCENTAGE.
PART II: *COMMUNITY BENEFIT PROGRAMS-INCLUDES THE UNREIMBURSED COST OF VARIOUS EDUCATION AND RESEARCH 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 MONTHLY HEALTHTALK PROGRAMS TO PROVIDE EDUCATION AND UPDATED INFORMATION ON PARTICULAR AND TIMELY HEALTH TOPICS; VARIOUS HEALTH AND CANCER SCREENINGS FOR THE COMMUNITY, SCHOOLS, CHURCHES; BREAST CANCER AND PROSTATE CANCER SCREENINGS FOR PEOPLE WHO ARE UN-AND UNDERINSURED; 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 COUNTY WELLNESS COALITION, POLK WELLNESS CENTER, HIGHWOODS APARTMENTS FOR LOW INCOME FAMILIES, POLK COUNTY COUNCIL ON AGING, 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 2012 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 ACOUNTS WHICH PROVIDE FOR THE MAILING OF TWO STATEMENTS, TWO LETTERS, AND TWO PHONE CALLS PRIOR TO MOVING THE ACCOUNT TO THE COLLECTION PROCESS.
PART V, SECTION B, LINE 19D: THEY USED THE MAXIMUM DISCOUNT AMOUNT GIVEN TO COMMERCIAL/MANAGED CARE PAYORS.ST. LUKE'S HOSPITAL, INC.
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.DURING THE THREE INTERIM YEARS, THE LOCAL HEALTH DEPARTMENTS AND HEALTHY CAROLINIAN PARTNERSHIPS ARE RESPONSIBLE FOR ISSUING THE STATE OF THE COUNTY HEALTH (SOTCH) REPORT. THE 2011 POLK COUNTY SOTCH REPORT IS AN ANNUAL REVIEW OF THE PRIORITY HEALTH ISSUES THAT WERE CHOSEN IN THE 2008 POLK COUNTY COMMUNITY HEALTH ASSESSMENT. THE REPORT SERVES TO INFORM THE COMMUNITY AND STAKEHOLDERS ABOUT THE HEALTH STATUS OF OUR RESIDENTS AND PROVIDE AN UPDATE OF THE PAST YEAR'S PROGRESS IN ADDRESSING THE HEALTHISSUES IDENTIFIED IN THE 2008 COMMUNITY HEALTH ASSESSMENT.THE POLK COUNTY WELLNESS COALITION, IN PARTNERSHIP WITH ST. LUKE'S HOSPITAL AND RUTHERFORD-POLK-MCDOWELL HEALTH DISTRICT, CONDUCTED A COMPREHENSIVE COMMUNITY HEALTH ASSESSMENT AND HEALTH SUMMIT IN 2009. PAPER AND ONLINE SURVEYS WERE DISTRIBUTED THROUGHOUT THE COUNTY, CROSSING ALL DEMOGRAPHICS. RESULTS WERE REPORTED DURING A COMMUNITY-WIDE HEALTH SUMMIT, WHICH SUBSEQUENTLY CREATED FOUR ACTION TEAMS TO ADDRESS THE FOLLOWING HEALTH ISSUES: OBESITY AND PHYSICAL ACTIVITYACCESS TO CARE MENTAL HEALTH AND SUBSTANCE ABUSE PREVENTION EDUCATIONTHE POLK COUNTY WELLNESS COALITION AND THE ACTIONS TEAMS MEET MONTHLY TO IMPLEMENT SOLUTIONS TO HEALTH DISPARITIES.
PART VI, LINE 3: LITERATURE ON ASSISTANCE IS OFFERED AT ALL REGISTRATION AREAS, INFORMATION IS ALSO INCLUDED IN ALL INPATIENT AND OUTPATIENT PACKETS, A DISCLOSURE IS PRINTED ON ALL OUTGOING INVOICES, AND ADDITIONAL INFORMATION CAN BE FOUND ON THE PRIMARY PAGE OF THE HOSPITAL WEB SITE.
PART VI, LINE 4: 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.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.ST. LUKE'S HOSPITAL IS A SMALL, RURAL HOSPITAL IN WESTERN NOL1H CAROLINA AT THE FOOT OF THE BLUE RIDGE MOUNTAINS. THE PRIVATE, NOT-FAR-PROFIT COMMUNITY HOSPITAL PROVIDES PRIMARY AND ACUTE HEALTHCARE SERVICES TO POLK COUNTY AND UPSTATE SOUTH CAROLINA. ST. LUKE'S IS SITUATED 40 MILES SOUTHEAST OF ASHEVILLE, NC, AND 25 MILES NORTH OF SPARTANBURG, SC.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.
PART VI, LINE 5: THE ORGANIZATION USES SURPLUS FUNDS IN EDUCATION AND TRAINING OF CLINICAL AND NON CLINICAL STAFF, TUITION ASSISTANCE, WEBINARS, NURSING EDUCATION GRANTS TO IMPROVE THE PROVISION OF HEALTH CARE IN THE COMMUNITY.
NCREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org1CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DR JAMES HOLLEMAN
017421500000009823018403800
DR BRIAN ROSENBERG
0612737000000013569062630600
CHRISTINE MARTIN
145936000735010060078390164570000
KEN SHULL
188166046816040160215210135360274055000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 5THE ORGANIZATION'S CEO AND CFO PARTICIPATE IN ANNUAL INCENTIVE AWARD PROGRAM BASED ON VARIOUS PERFORMANCE BENCHMARKS INCLUDING: FINANCIAL PERFORMANCE, PATIENT SATISFACTION, AND PATIENT SERVICE DAYS.
PART I, LINE 6THE ORGANIZATION'S CEO AND CFO PARTICIPATE IN ANNUAL INCENTIVE AWARD PROGRAM BASED ON VARIOUS PERFORMANCE BENCHMARKS INCLUDING: FINANCIAL PERFOMANCE, PATIENT SATISFACTION, AND PATIENT SERVICE DAYS.
PART IIIST. LUKE'S HEALTH CARE, INC., THE CONTROLLING ENTITY OF THE HOSPITAL, ENGAGED IN A MANAGEMENT SERVICE AGREEMENT IN CALENDAR YEAR 2009 WITH THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY D/B/A CAROLINAS HEALTHCARE SYSTEM (CHS). THEREFORE, COMPENSATION AMOUNTS REPORTED IN PART VII OF FORM 990 AND SCHEDULE J FOR TOP MANAGEMENT OFFICIALS ARE COMBINED AMOUNTS FROM ST. LUKE'S HOSPITAL COMPENSATION AND CHS COMPENSATION.SUPPLEMENTAL INFORMATION

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3EFFECTIVE 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.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12COFFICERS, 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 15CAROLINAS 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 18RECENT 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 19PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON WRITTEN REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 354,734. CHANGE IN VALUE OF UNITRUST 8,487. UNREALIZED GAIN ON KIMBERLY TRUST 52,939. OTHER CHANGE IN NET ASSETS 927. TOTAL TO FORM 990, PART XI, LINE 5: 417,087.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
ST LUKE'S HEALTH CARE INC
101 HOSPITAL DRIVECOLUMBUSNC28722561423318CONTROLLING ENTITYNC501(C)(3)PFN/A0
ST LUKE'S FOUNDATION INC
101 HOSPITAL DRIVECOLUMBUSNC28722561757097RAISES FUNDS TO HELP SUPPORT ST. LUKE'S HOSPITALNC501(C)(3)LINE 70ST LUKE'S HEALTHCARE INC
ST LUKE'S PHYSICIAN NETWORK INC
101 HOSPITAL DRIVECOLUMBUSNC28722263082073PROVIDE HEALTH CARE SERVICES TO THE CITIZENS OF POLK COUNTY, NCNC501(C)(3)LINE 30ST LUKE'S HEALTHCARE INC
COMMUNITY HEALTH CONNECTIONS
101 HOSPITAL DRIVECOLUMBUSNC28722561722387TO PROVIDE HOME BASED MEDICAL TREATMENT IN AND AROUND COLUMBUS, NCNC501(C)(3)LINE 90ST LUKE'S HEALTHCARE INC

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1ST LUKE'S PROFESSIONAL BUILDING INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1101 HOSPITAL DRIVEAddressLine1
CityCOLUMBUSCity
StateNCState
ZIP Code28722ZIPCode
FieldValueIRS element (for citing)
EIN561423404EIN
Primary ActivityRENTAL REAL ESTATEPrimaryActivity
Legal Domicile StateNCLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
ST LUKE'S FOUNDATION INC
C159313
ST LUKE'S HOSPITAL AUXILIARY
C25000