2012-10-10T15:00:32-05:00 2011-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2011-01-01 621518342 METHODIST EXTENDED CARE HOSPITAL INC METH 9015162595 225 SOUTH CLAYBROOK MEMPHIS TN 38104 SANDRA BAILEY-DE LEEUW 9015162595 2012-10-10 1 AMY BIBBY P00445891 8282542254 2011 2016-02-24 21:20:13Z SANDRA BAILEY-DE LEEUW 225 SOUTH CLAYBROOK MEMPHIS TN 38104 15687805 0 X WWW.METHODISTHEALTH.ORG X 1993 TN OUR 36-BED ACUTE CARE HOSPITAL FOCUSES ON THE TREATMENT OF LONG-TERM PATIENTS WHO ARE MEDICALLY STABLE BUT REQUIRE INTENSE MEDICAL ATTENTION. 6 5 183 0 0 0 0 0 15411667 15680524 0 0 7507 7281 15419174 15687805 0 0 0 0 7958437 8075744 0 0 0 6380298 6500771 14338735 14576515 1080439 1111290 2925119 2444982 1330004 1298790 1595115 1146192 X METHODIST LE BONHEUR HEALTHCARE, IN PARTNERSHIP WITH ITS MEDICAL STAFFS, WILL COLLABORATE WITH PATIENTS AND THEIR FAMILIES TO BE THE LEADER IN PROVIDING HIGH QUALITY, COST-EFFECTIVE PATIENT-AND FAMILY-CENTERED CARE. SERVICES WILL BE PROVIDED IN A MANNER WHICH SUPPORTS THE HEALTH MINISTRIES AND SOCIAL PRINCIPLES OF THE UNITED METHODIST CHURCH TO BENEFIT THE COMMUNITIES WE SERVE. 0 0 12104203 15680524 OFTEN REFERRED TO AS A "HOSPITAL WITHIN A HOSPITAL," METHODIST EXTENDED CARE HOSPITAL (MECH) OPERATES AS A SEPARATE FACILITY LOCATED ON THE CAMPUS OF METHODIST HEALTHCARE IN MEMPHIS, TN. MOST CARE IS DELIVERED AT THE PATIENT'S BEDSIDE USING INNOVATIVE TREATMENT PROGRAMS, HIGHLY TRAINED STAFF AND AN INTERDISCIPLINARY MODEL OF CARE.AT MECH, AGGRESSIVE MEDICAL MANAGEMENT - WITH A FOCUS ON REHABILITATION - HELPS PROGRESS THE CARDIAC PATIENT TO THE NEXT LEVEL OF CARE. CARDIAC REHABILITATION CONSISTS OF SEVERAL INDIVIDUALIZED INTERVENTIONS. CARDIAC EDUCATION, PHYSICAL REHABILITATION, PHARMACOLOGICAL INTERVENTION, RESPIRATORY THERAPY AND REMOTE TELEMETRY MONITORING ARE ALL PART OF A PATIENT'S PROGRAM. THERE IS ALSO CONTINUOUS CARDIOVASCULAR ASSESSMENT SUPERVISED BY AN ADVANCED CARDIAC LIFE SUPPORT-QUALIFIED NURSING STAFF.THE LOW-INTENSITY REHABILITATION PROGRAM'S FOCUS IS ON MEETING THE NURSING CARE NEEDS WHILE STRENGTHENING AND INCREASING THE PATIENT'S TOLERANCE FOR INTENSE THERAPY. MECH'S VENTILATOR WEANING PROGRAM TAKES AN AGGRESSIVE, PROGRESSIVE APPROACH CUSTOMIZED FOR THE PATIENT. WE PROVIDE INDIVIDUALIZED PROGRAMS FOR PATIENTS WITH ACUTE OR CHRONIC RESPIRATORY DISORDERS WHO MAY HAVE ARTIFICIAL AIRWAYS, VENTILATORS OR REQUIRE EXTENSIVE RESPIRATORY TREATMENTS TO MAINTAIN NORMAL BREATHING WITHOUT MECHANICAL SUPPORT.THE WOUND CARE PROGRAM TREATS PATIENTS WITH IMPAIRED TISSUE INTEGRITY WHO ARE AT HIGH RISK FOR COMPLICATIONS. TREATMENT INCLUDES AN EVALUATION, ASSESSMENT AND PLAN FOR TREATMENT PERFORMED AT THE PATIENT'S BEDSIDE BY A WOUND CARE NURSE. IN ADDITION, PATIENTS RECEIVE PHYSICAL REHABILITATION, WOUND MANAGEMENT EDUCATION AND GUIDANCE FROM A NUTRITIONIST. 12104203 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 9 0 1 183 1 0 0 0 0 0 0 0 0 0 0 X 6 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X X SUE WAUGH 9015160656 1211 UNION AVE MEMPHIS TN 38104 X MARTAVIUS D JONES 2.00 X X 0 0 0 DENNIS HIGDON 2.00 X 0 0 0 GEORGE LEWIS 2.00 X X 0 0 0 EVA E MOSBY 2.00 X 0 0 0 WILLIAM H TETTELBACH 2.00 X 0 0 0 MICHAEL WASHINGTON 2.00 X 0 0 0 STANLEY DOWELL 2.00 X 0 0 0 SANDRA BAILEY-DE LEEUW 50.00 X X 208578 0 48587 WILLIAM ERSKINE 2.00 X 0 118048 20867 KRIS SANDERS 2.00 X 0 106106 17849 SANDRA HUGUELEY 50.00 X 130811 0 25660 LYDIA HUTCHISON 50.00 X 117274 0 11707 BETH TROWBRIDGE 50.00 X 100275 0 8383 556938 224154 133053 4 0 1 0 MORRISON MANAGEMENT SPECIALISTS INC PO BOX 102289 ATLANTA GA 30368 FOOD SERVICE 143194 1 NET PATIENT SERVICE 623000 15680524 15680524 15680524 MEDICAL TRANSCRIPTION 900099 3781 3781 MISCELLANEOUS REVENUES 900099 3500 3500 7281 15687805 15680524 0 7281 208578 208578 6374738 5917018 457720 321163 288658 32505 709006 637247 71759 462259 415474 46785 3627 3627 2191357 2191357 1963027 1864798 98229 2400 2400 362404 362404 13540 13540 11376 11376 101309 101309 42386 31245 11141 CORPORATE OVERHEAD 1516968 1516968 BAD DEBT EXPENSE 267377 267377 OTHER EXPENSE 25000 25000 14576515 12104203 2472312 0 -69607 -21644 1593695 886604 99949 109130 8139 7427 1180788 580252 628577 600536 664366 862929 2925119 2444982 1330004 1298790 1330004 1298790 X 1595115 1146192 1595115 1146192 2925119 2444982 X 1111290 -1560213 X X 0 1 1 X 1 1 X 4400 610 3790 19067 16322 2745 1157321 563320 594001 600536 DUE FROM AFFILIATES 862929 862929 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION CONSOLIDATES ITS AUDIT WITH ITS CORPORATE PARENT AND OTHER SUBSIDIARIES OF THE PARENT. THE FOLLOWING STATEMENT REFLECTS THE FIN 48 FOOTNOTE OF THE CONSOLIDATED GROUP. THE INTERNAL REVENUE SERVICE HAS DETERMINED THAT THE SYSTEM AND ALL OF THE NONPROFIT AFFILIATES FOR WHICH THE SYSTEM OR ITS BOARD OF DIRECTORS IS CONTROLLING MEMBER ARE EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3). AS QUALIFIED TAX-EXEMPT ORGANIZATIONS, THE SYSTEM'S NONPROFIT AFFILIATES MUST OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THEIR TAX-EXEMPT STATUS. INCOME TAX FROM THE OPERATIONS OF THE SYSTEM'S WHOLLY OWNED FOR-PROFIT SUBSIDIARY, AMBULATORY OPERATIONS, INC., AND ITS SUBSIDIARIES IS NOT SIGNIFICANT. THE SYSTEM APPLIES FASB ASC TOPIC 740 (TOPIC 740), ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. TOPIC 740 CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS AND PROVIDES GUIDANCE ON WHEN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND HOW THE VALUES OF THESE POSITIONS ARE DETERMINED. THERE HAS BEEN NO IMPACT ON THE SYSTEM'S COMBINED FINANCIAL STATEMENTS AS A RESULT OF TOPIC 740. 1 0 X 1 X 1 X 1 1 0 1 1 375231 375231 0.02620 68243 5315 62928 0.00440 443474 5315 438159 0.03060 443474 5315 438159 0.03060 14155 14155 0.00100 14155 14155 0.00100 0 101818 50909 13263422 12711095 552327 X 1 0 1 1 METHODIST EXTENDED CARE HOSPITAL

225 SOUTH CLAYBROOK MEMPHIS TN 38104

X LONG-TERM TREATMENT METHODIST EXTENDED CARE HOSPITAL 1 1 1 150.000000000000 1 400.000000000000 1 X 0 0 1 0 0 X X 0 0 PART I, LINE 6A: METHODIST EXTENDED CARE HOSPITAL'S COMMUNITY BENEFIT REPORT IS PREPARED PRIMARILY BY THE COMMUNICATIONS AND MARKETING DEPARTMENT, WITH SUPPORT FROM THE ACCOUNTING AND FINANCE DEPARTMENTS, OF METHODIST LE BONHEUR HEALTHCARE, THE HOME OFFICE/CORPORATE PARENT ENTITY OF THE HOSPITAL. MECH'S COMMUNITY BENEFIT REPORT CAN BE FOUND ON THE COMPANY'S WEBSITE AT WWW.METHODISTHEALTH.ORG UNDER THE "ABOUT US" SECTION. PART I, LINE 7: WORKSHEET 2 OF THE 2011 SCHEDULE H INSTRUCTIONS WAS USED TO COMPUTE A COST-TO-CHARGES RATIO THAT WAS USED TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID AT COST. PART I, L7 COL(F): THE AMOUNT ON FORM 990, PART IX, LINE 25 CONTAINS A BAD DEBT EXPENSE OF $ 267,377 THAT HAS BEEN REMOVED FOR PURPOSES OF CALCULATING PERCENT OF TOTAL EXPENSE ON SCHEDULE H, PART I, LINE 7, COLUMN (F). PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBTS, ACCOUNTS RECEIVABLE, OR ALLOWANCE FOR UNCOLLECTABLE ACCOUNTS. WORKSHEET 2 OF THE 2011 SCHEDULE H INSTRUCTIONS WAS USED TO COMPUTE A COST-TO-CHARGES RATIO THAT WAS USED TO CALCULATE BAD DEBT AT COST.WHEN A PORTION OF PATIENT CHARGES BECOME PATIENT RESPONSIBILITY, THE AMOUNT IS WRITTEN OFF TO BAD DEBTS AND THEN SENT TO OUR COLLECTION GROUP. ANY PAYMENTS RECOUPED BY OUR COLLECTIONS GROUP ARE THEN APPLIED AGAINST THE BAD DEBT EXPENSE. IT IS OUR ESTIMATION BASED ON HISTORICAL EXPERIENCE THAT ABOUT 50% OF THE REMAINING PORTION OF BAD DEBTS (AFTER RECOVERIES) COULD BE APPLICABLE TO PATIENTS WHO, ON ADDITIONAL REVIEW AND PROVIDING ALL RELEVANT INFORMATION, WOULD QUALIFY FOR FINANCIAL ASSISTANCE. PART III, LINE 8: AMOUNTS PRESENTED ON PART III, LINES 5 AND 6 ARE DERIVED FROM THE ORGANIZATION'S MEDICARE COST REPORT. PART III, LINE 9B: METHODIST LE BONHEUR HEALTHCARE'S COLLECTION PROCESS BEGINS WITH THE ORGANIZATION'S REVENUE CYCLE TEAM MAKING INITIAL COLLECTION EFFORTS TO RECOUP ALL MONIES DUE FROM THE PATIENTS' INSURANCE PROVIDERS. WHEN THE AMOUNT DUE IS SOLELY THE PATIENT'S PORTION, THE ACCOUNT IS TRANSFERRED TO ANOTHER TEAM THAT SPECIALIZES IN PATIENT PORTION ACCOUNTS (EARLY-OUT PROGRAM). IT IS THIS PROGRAM THAT INITIALLY DETERMINES IF A PATIENT QUALIFIES FOR CHARITY CARE UNDER THE ORGANIZATION'S POLICY. IF QUALIFICATION IS UNCLEAR, THIS PROGRAM ATTENDS TO THE ACCOUNT FOR A PREDETERMINED TIME THROUGH LETTERS AND PHONE CALLS. THE DURATION IS DEPENDENT ON VARIOUS SCENARIOS THAT AFFECT ITS LENGTH, SUCH AS PAYMENT ARRANGEMENTS, DISPUTES, ETC. AFTER THE EARLY-OUT TIME PERIOD HAS EXPIRED, THE ACCOUNT IS THEN SENT TO OUR COLLECTIONS GROUP. AN ACCOUNT PLACED WITH OUR COLLECTION GROUP EXPERIENCES A CONTINUED AND THOROUGH COLLECTION PHASE. ONCE ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED AND IT IS DETERMINED THAT THE REMAINING BALANCE WILL NOT BE COLLECTED, THE ACCOUNT IS REEVALUATED ON THE CRITERIA USED TO DETERMINE FINANCIAL AID ELIGIBILITY. METHODIST EXTENDED CARE HOSPITAL PART V, SECTION B, LINE 19D: THE ORGANIZATION IS IN PROCESS OF ADOPTING PROCEDURES OUTLINES IN PROP. REG. 1.501(R)-5 TO DETERMINE THE AMOUNTS GENERALLY BILLED FOR THE FACILITY. UNTIL SUCH TIME AS THOSE PROCEDURES ARE ADOPTED, THE ORGANIZATION IS CONFIDENT THAT ITS DISCOUNTS UNDER ITS FINANCIAL ASSISTANCE POLICY ARE SUBSTANTIALLY LARGE ENOUGH TO BE IN COMPLIANCE OF SEC. 501(R)(5) AND THE LIMITS SET ON CHARGES THEREUNDER. PART VI, LINE 2: METHODIST EXTENDED CARE HOSPITAL, INC.(MECH), IN CONJUNCTION WITH METHODIST HEALTHCARE - MEMPHIS HOSPITALS (MHMH), COMMISSIONED THE NATIONAL RESEARCH CORPORATION TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. THE ASSESSMENT WAS BASED ON SURVEYS MADE IN 2009 AND EARLY 2010. THE REPORT ENABLES MECH AND MHMH TO STRENGTHEN THE HEALTH OF THE COMMUNITY BY ASSISTING IN THE FOLLOWING:(1) MEASUREMENT AND EVALUATION OF HEALTH STATUS AND HEALTHCARE UTILIZATION WITHIN THE COMMUNITY,(2) IDENTIFICATION OF THE PREVALENCE OF CHRONIC CONDITIONS WITHIN VARIOUS DEMOGRAPHIC AND GEOGRAPHIC SEGMENTS WITHIN THE COMMUNITY,(3) PROFILING OF HIGH-RISK POPULATIONS,(4) IDENTIFICATION OF GAPS IN CARE AND PREVENTIVE HEALTH BEHAVIORS AMONG VARIOUS DEMOGRAPHIC AND GEOGRAPHIC SEGMENTS WITHIN THE COMMUNITY.FINDINGS ARE REVIEWED WITH SENIOR LEADERSHIP AND THE BOARD OF DIRECTORS TO BE INCLUDED IN FUTURE DEPLOYMENT MAPS AND BUDGETS. PART VI, LINE 3: METHODIST EXTENDED CARE HOSPITAL UTILIZES THE FEDERAL POVERTY GUIDELINES (FPG) TO DETERMINE THE LEVEL OF DISCOUNT UNINSURED PATIENTS MAY RECEIVE. THE LEVEL BY WHICH ASSISTANCE IS DETERMINED IS THROUGH THE SCALE SET BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS), WHICH INCLUDES FACTORS SUCH AS RESIDENTS PER HOUSEHOLD AND INCOME. MECH COMMUNICATES AND PROVIDES ASSISTANCE CONCERNING ELIGIBILITY FOR FINANCIAL ASSISTANCE IN SEVERAL WAYS. CHARITY CARE POLICIES ARE POSTED AND UPDATED AS PART OF THE ORGANIZATION'S SYSTEM POLICIES AND ARE AVAILABLE TO ALL STAFF THROUGH THE COMPANY INTRANET CONNECTIONS. IN ADDITION, PATIENT-FRIENDLY SUMMARIES OF THESE POLICIES ARE POSTED IN VISIBLE LOCATIONS THROUGHOUT ALL PUBLIC AREAS OF THE FACILITY. AT THE TIME OF PATIENT REGISTRATION, MECH PROVIDES FINANCIAL COUNSELING BASED ON THE AVAILABLE INSURANCE AND "ABILITY TO PAY" INFORMATION PROVIDED. MECH ALSO SUPPLIES CHARITY CARE APPLICATIONS AND OFFERS ASSISTANCE IN THE COMPLETION OF FORMS IN ALL INSTANCES WHERE THE "FINANCIAL PICTURE AS PRESENTED TO US" APPEARS TO WARRANT THAT SERVICE.FINALLY, THE HOSPITAL DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENTAL BENEFITS, SUCH AS MEDICAID OR OTHER STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, AS APPLICABLE. LANGUAGE BARRIERS ARE TAKEN INTO ACCOUNT WITH ALL PATIENT COMMUNICATION. ALL STAFF WITH PATIENT CONTACT, INCLUDING ADMISSION AND BILLING CLERKS, NURSES AND THE MEDICAL STAFF, SOCIAL WORKERS, CHAPLAINS, AND PATIENT ADVOCATES, ARE KNOWLEDGEABLE ABOUT THE CHARITY CARE POLICY AND ASSIST PATIENTS WHEN NECESSARY. PART VI, LINE 4: METHODIST EXTENDED CARE HOSPITAL HELPS SERVE THE MISSION OF THE MEMPHIS, ARKANSAS, AND MISSISSIPPI CONFERENCES OF THE UNITED METHODIST CHURCH TO PROVIDE FAITH-BASED HEALTHCARE TO THE POPULATION OF THE MISSION AREA, WHICH IS PRIMARILY SHELBY COUNTY, TENNESSEE, WITH AN URBAN POPULATION OF APPROXIMATELY ONE MILLION. MECH IS PHYSICALLY LOCATED IN URBAN MEMPHIS WITHIN THE UNIVERSITY HOSPITAL LOCATION OF METHODIST HEALTHCARE - MEMPHIS HOSPITALS (MHMH), A RELATED ORGANIZATION. MHMH ALSO FURNISHES TERTIARY SERVICES TO RURAL AREAS IN EASTERN ARKANSAS, WEST TENNESSEE, AND NORTH MISSISSIPPI. THE POPULATION OF THE AREA IS EXPECTED TO GROW BY 4 PERCENT OVER THE NEXT 5 YEARS. MHMH IS THE LARGEST MEDICAID PROVIDER IN THE AREA, WITH OVER 13,000 INPATIENTS SERVED EACH YEAR. AS AN ACADEMIC MEDICAL CENTER, MHMH TRAINS HEALTH PROFESSIONALS AND FURNISHES SPECIALIZED HEALTHCARE SERVICES NOT OTHERWISE AVAILABLE TO THE REGION. MHMH IS THE PRIMARY PRACTICE LOCATION FOR THE UNIVERSITY OF TENNESSEE SCHOOL OF MEDICINE. THIS DISTINCTION ALONG WITH THE ACCOMPANYING RESEARCH BENEFITS THE ENTIRE METROPOLITAN COMMUNITY. PART VI, LINE 5: MECH GIVES BACK TO THE COMMUNITY IN A VARIETY OF WAYS. ITS ASSOCIATES PARTICIPATE IN UNITED WAY, THE AMERICAN HEART ASSOCIATION'S HEART WALK, AND THE MEMPHIS FOOD BANK'S ANNUAL FOOD DRIVE. MECH IS ALSO INVOLVED IN A SMOKING CESSATION PROGRAM AT CUMMINGS STREET BAPTIST CHURCH. MECH IS REPRESENTED AT WHITEHAVEN HIGH CAREER DAY AND MECH RESPIRATORY IS ALSO ACTIVE WITH THE OCCUPATIONAL ADVISORY COMMITTEE THROUGH CONCORDE CAREER COLLEGE. THEY PROVIDE A FOOD BASKET FOR CHRISTMAS TO NEEDY FAMILIES ASSOCIATED WITH THE METROPOLITAN INTERFAITH ASSOCIATION.A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES OF NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. PART VI, LINE 6: METHODIST EXTENDED CARE HOSPITAL, INC., THE FILING ORGANIZATION, IS A SUBSIDIARY OF METHODIST LE BONHEUR HEALTHCARE (MLH). ALTHOUGH THIS FORM 990 ONLY INCLUDES THE CHARITY CARE AND COMMUNITY BENEFIT OF THIS ORGANIZATION, MLH INCLUDES THE FOLLOWING ENTITIES THAT ALSO PROVIDE CHARITY CARE AND COMMUNITY BENEFIT: - METHODIST HEALTHCARE - MEMPHIS HOSPITALS - METHODIST HEALTHCARE - FAYETTE HOSPITAL - ALLIANCE HEALTH SERVICES, INC. - METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATESIN ADDITION, METHODIST HEALTHCARE FOUNDATION AND LE BONHEUR CHILDREN'S HOSPITAL FOUNDATION PROIVDE VALUABLE FINANCIAL SUPPORT TO THE OPERATIONS OF THE GROUP, ALLOWING IT TO PURSUE RESEARCH AND CONSTRUCTION PROJECTS TO PROVIDE ADDITIONAL BENEFITS TO THE COMMUNITY. METHODIST HEALTHCARE - MEMPHIS HOSPITALS ALSO HAS A TEACHING AND RESEARCH AFFILIATION WITH THE UNIVERSITY OF TENNESSEE. THE UNIVERSITY HAS A CLINICAL REACH THAT EXTENDS BEYOND THE LOCAL SERVICE AREA, PROVIDING HIGHLY SPECIALIZED SERVICES THAT ATTRACT PATIENTS FROM A MULTI-STATE SERVICE AREA. MHMH HAD OVER 225 RESIDENTS, PLUS FELLOWS, NURSES, AND ALLIED HEALTH PROFESSIONALS THAT TRAINED IN OUR FACILITIES DURING 2011. REPORTS FILED WITH STATES PART VI, LINE 7 TN 0 1 0 0 0 0 0 0 0 SANDRA BAILEY-DE LEEUW 170549 0 31055 0 6974 0 34926 0 13661 0 257165 0 5716 0 SANDRA HUGUELEY 121544 0 9267 0 0 0 12359 0 13301 0 156471 0 0 0 PART I, LINE 4B THE PURPOSE OF THE METHODIST LE BONHEUR HEALTHCARE CONSOLIDATED EXECUTIVE DEFERRED COMPENSATION PLAN IS TO PROVIDE RETIREMENT BENEFITS FOR CERTAIN EXECUTIVE LEVEL EMPLOYEES IN ADDITION TO THE BENEFITS PROVIDED THROUGH THE OTHER RETIREMENT PLANS THAT ARE SPONSORED BY THE COMPANY. IT IS INTENDED THAT THIS PLAN COMPLY WITH INTERNAL REVENUE CODE SECTION 457(F) AND QUALIFY FOR THE SHORT TERM DEFERRAL EXCEPTION TO CODE SECTION 409A. UNDER THE PLAN, CORPORATE EXECUTIVES AT OR ABOVE THE VICE PRESIDENT LEVEL ARE ELIGIBLE TO RECEIVE EXECUTIVE DEFERRED COMPENSATION CREDITS DEPENDING ON THEIR POSITION CLASSIFICATION [6%,8%,10%,12% OF BASE SALARY]. EACH PLAN YEAR, THE EXECUTIVE MUST ELECT A DEFERRED VESTING DATE TO BE APPLIED TO THE DEFERRED COMPENSATION CREDIT THAT WILL BE EARNED IN THAT PLAN YEAR. THE DEFERRED VESTING DATE IS SUBJECT TO A VESTING SCHEDULE THAT REQUIRES A MINIMUM DEFERRAL OF 5 YEARS TO BECOME VESTED. UPON REACHING AGE 55, THE MINIMUM DEFERRAL IS REDUCED TO 3 YRS. UPON REACHING AGE 60, THE MINIMUM DEFERRAL IS REDUCED TO 2 YRS. AT AGE 64, A CASH EQUIVALENT IS PROVIDED TO THE EXECUTIVE AND NO ADDITIONAL DEFERRALS ARE MADE UNDER THIS PLAN. THE PLAN IS UNFUNDED WITH ALL BENEFITS PAID FROM THE COMPANY'S GENERAL ASSETS. HOWEVER, THE EXECUTIVE IS ALLOWED TO DIRECT THE INVESTMENTS OF HIS DEFERRED COMPENSATION CREDIT IN A MENU OF INVESTMENT ALTERNATIVES MADE AVAILABLE BY THE COMPANY. UPON VESTING, A DISTRIBUTION IS PROVIDED LESS APPLICABLE TAX. IN THE CASE OF A VOLUNTARY TERMINATION OF EMPLOYMENT BY THE EXECUTIVE OR INVOLUNTARY TERMINATION OF EMPLOYMENT FOR CAUSE BY THE COMPANY, THE NON-VESTED FUNDS ARE FORFEITED. ACCELERATED VESTING (100%) IS ALLOWED UPON DEATH, DISABILITY OR AN INVOLUNTARY TERMINATION BY THE COMPANY WITHOUT CAUSE. ALLOCATIONS TO THE PLAN FOR 2011 INCLUDE THE FOLLOWING: SANDRA BAILEY-DE LEEUW - $ 13,427 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: THE BOARD OF METHODIST LE BONHEUR HEALTHCARE, A RELATED ORGANIZATION AND CORPORATE OVERSIGHT ENTITY, CONDUCTS THE FOLLOWING METHODS TO ESTABLISH COMPENSATION FOR ITS OFFICERS AND KEY EMPLOYEES: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION STUDY / SURVEY - APPROVAL BY THE BOARD / COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 6 METHODIST EXTENDED CARE HOSPITAL, INC. IS A SUBSIDIARY OF METHODIST LE BONHEUR HEALTHCARE (MLH, 58-1454711), WITH THE BOARD MEMBERS OF MLH SERVING AS THE MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A AS THE MEMBERS OF THE ORGANIZATION, THE MLH BOARD OF DIRECTORS ELECTS ALL MEMBERS OF THE GOVERNING BODY FOR METHODIST EXTENDED CARE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS SHALL FROM TIME TO TIME ADOPT AND PROMULGATE SUCH AMENDMENTS AS THEY SHALL DEEM APPROPRIATE TO THE BYLAWS, ALL OF WHICH SHALL BE CONSISTENT WITH THE PURPOSES OF THE CORPORATION. UPON REQUEST BY THE BOARD OF DIRECTORS AND AT SUCH OTHER TIMES AS THE MEMBERS MAY SELECT, THE MEMBERS SHALL REVIEW THE AFFAIRS OF THE CORPORATION AND TAKE SUCH ACTION AS THEY MAY DEEM APPROPRIATE IN ACCORDANCE WITH THE BYLAWS. THE FOLLOWING ITEMS, AFTER BEING REVIEWED AND ADOPTED BY THE BOARD OF DIRECTORS, SHALL BE SUBMITTED TO THE MEMBERS FOR APPROVAL: - ANY SALE, EXCHANGE, GIFT, MORTGAGE, OPTION, LEASE WITH A TERM IN EXCESS OF ONE (1) YEAR (EXCEPT TO DOCTORS FOR OFFICE SPACE), OR OTHER DISPOSITION OF ANY REAL PROPERTY (INCLUDING IMPROVEMENTS THEREON) OR INTERESTS THEREIN OWNED BY THE CORPORATION, OR ANY OTHER ASSET OR ASSETS OWNED BY THE CORPORATION WITH A VALUE IN EXCESS OF FIVE HUNDRED THOUSAND DOLLARS ($500,000); - ANY AMENDMENT OR RESTATEMENT OF THE CORPORATE CHARTER OR ANY PLAN OF MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION; - ANY INDEMNIFICATION OF PERSONS BY THE CORPORATION EXCEPT AS SPECIFIED IN THE BYLAWS; - ANY RELEASE OR CANCELLATION BY THE CORPORATION OF A CLAIM OF RIGHT OF ACTION IN AN AMOUNT IN EXCESS OF FIVE HUNDRED THOUSAND DOLLARS ($500,000); - ANY OTHER MATTERS AS MAY BE REQUIRED BY LAW TO BE SUBMITTED TO THE MEMBERS OF A NOT FOR PROFIT CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH INPUT FROM HUMAN RESOURCES, LEGAL, COMPLIANCE, AND FINANCE DEPARTMENTS AND EXTERNAL FINANCIAL CONSULTANTS. FINANCIAL INFORMATION IS RECONCILED TO AUDITED FINANCIAL STATEMENTS AS APPROPRIATE. THE INFORMATION TO BE DISCLOSED REGARDING COMPENSATION IS REVIEWED WITH THE COMPENSATION COMMITTEE OF THE BOARD. THE RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER OF MLH AND MANAGEMENT OF THE ORGANIZATION AS APPROPRIATE. A COPY OF THE RETURN IS PROVIDED TO EACH BOARD MEMBER VIA E-MAIL PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C METHODIST LE BONHEUR HEALTHCARE, THE PARENT ORGANIZATION, EMPLOYS A COMPLIANCE OFFICER WHO MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY FOR ALL VOTING BOARD MEMBERS AND APPLICABLE OFFICERS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION IS DETERMINED BY THE BOARD OF DIRECTORS OF METHODIST LE BONHEUR HEALTHCARE, THE PARENT ORGANIZATION. AN EXTERNAL INDEPENDENT CONSULTANT ADVISES THE BOARD COMPENSATION COMMITTEE ON EXECUTIVE SALARY AND INCENTIVE COMPENSATION. BENEFITS ARE PERIODICALLY BENCHMARKED BY A SEPARATE EXTERNAL CONSULTANT AND ANY CHANGES ARE APPROVED BY THE BOARD OF DIRECTORS COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE IS COMPRISED OF INDEPENDENT MEMBERS AND IS A SUBGROUP OF THE FULL BOARD OF DIRECTORS. THE COMPENSATION CONSULTANT ANNUALLY DEVELOPS TOTAL CASH COMPENSATION COMPARISONS OF PEER NON-PROFIT SYSTEMS ESTABLISHED BY THE COMPENSATION COMMITTEE. THE COMPENSATION CONSULTANT INTERPRETS THE INFORMATION AND PROVIDES AN OPINION OF REASONABLENESS ON THE TOTAL CASH COMPENSATION PACKAGE. THE COMPENSATION COMMITTEE APPROVES ANY CHANGES TO THE COMPENSATION AND EXECUTIVE BENEFIT STRUCTURE OF THE CEO AND OTHER TOP EXECUTIVES, OTHERWISE KNOWN AS DISQUALIFIED CANDIDATES. ALL OTHER COMPENSATION DECISIONS ARE DETERMINED BY ARRANGEMENT AS DELEGATED BY THE BOARD OF DIRECTORS. THE COMMITTEE DOCUMENTS ALL DETERMINATIONS. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES 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 OUR WEBSITE IN THE "ABOUT US" SECTION, OR AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AUDITED IN A CONSOLIDATION WITH ITS CORPORATE PARENT, METHODIST LE BONHEUR HEALTHCARE, AND RELATED SUBSIDIARIES. INFORMATION ON FINANCIAL STATEMENTS IS AVAILABLE BY CONTACTING THE ORGANIZATION'S CORPORATE OFFICE. PLEASE SEE FORM 990, PART VI, LINE 20 FOR DETAILS. CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS FOR ALL AFFILIATES OF METHODIST LE BONHEUR HEALTHCARE ARE ALSO AVAILABLE BY REQUEST. FORM 990, PART VII, LINE 1: AVERAGE HOURS OF RELATED ORGANIZATIONS: THE FOLLOWING BOARD MEMBERS AND OFFICERS OF THE ORGANIZATION WORK APPROXIMATELY 32 HOURS PER WEEK FOR A RELATED ORGANIZATION: WILLIAM ERSKINE KRIS SANDERS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: EQUITY TRANSFERS TO AFFILIATES -1,560,213. TOTAL TO FORM 990, PART XI, LINE 5: -1,560,213. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. METHODIST LE BONHEUR HEALTHCARE 1211 UNION AVENUE SUITE 700 MEMPHIS TN 38104 581454711 SUPPORTING ORGANIZATION TN 501(C)(3) LINE 11B, II N/A 0 METHODIST HEALTHCARE - MEMPHIS HOSPITALS 1265 UNION AVENUE MEMPHIS TN 38104 620479367 HOSPITALS TN 501(C)(3) LINE 3 METHODIST LE BONHEUR HEALTHCARE 0 METHODIST HEALTHCARE-FAYETTE HOSPITAL 214 LAKEVIEW DRIVE SOMERVILLE TN 38068 620862334 HOSPITAL TN 501(C)(3) LINE 3 METHODIST LE BONHEUR HEALTHCARE 0 METHODIST HEALTHCARE PRIMARY CARE ASSOCIATES 1211 UNION AVENUE SUITE 657 MEMPHIS TN 38104 582078931 OUTPATIENT HEALTHCARE TN 501(C)(3) LINE 9 METHODIST LE BONHEUR HEALTHCARE 0 METHODIST HEALTHCARE COMMUNITY CARE ASSOCIATES 6400 SHELBY VIEW SUITE 101 MEMPHIS TN 38134 621403517 OUTPATIENT HEALTHCARE TN 501(C)(3) LINE 9 METHODIST LE BONHEUR HEALTHCARE 0 ALLIANCE HEALTH SERVICES INC 6400 SHELBY VIEW SUITE 101 MEMPHIS TN 38134 620841121 HEALTHCARE TN 501(C)(3) LINE 9 METHODIST LE BONHEUR HEALTHCARE 0 METHODIST HEALTHCARE FOUNDATION 1211 UNION AVENUE SUITE 450 MEMPHIS TN 38104 237320638 FOUNDATION TN 501(C)(3) LINE 11A, I METHODIST LE BONHEUR HEALTHCARE 0 LE BONHEUR CHILDREN'S HOSPITAL FOUNDATION 850 POPLAR AVENUE BLDG 2 MEMPHIS TN 38105 621872938 FOUNDATION TN 501(C)(3) LINE 11A, I METHODIST LE BONHEUR HEALTHCARE 0 LE BONHEUR COMMUNITY HEALTH AND WELL-BEING 50 PEABODY PLACE MEMPHIS TN 38103 621251288 FOUNDATION TN 501(C)(3) LINE 7 LE BONHEUR CHILDREN'S FOUNDATION 0 METHODIST HEALTHCARE-JONESBORO HOSPITAL 1211 UNION AVENUE SUITE 657 MEMPHIS TN 38104 710499625 INACTIVE HOSPITAL TN 501(C)(3) LINE 3 METHODIST LE BONHEUR HEALTHCARE 0 METHODIST HEALTHCARE-DYERSBURG HOSPITAL 1211 UNION AVENUE SUITE 657 MEMPHIS TN 38104 621155084 INACTIVE HOSPITAL TN 501(C)(3) LINE 3 METHODIST LE BONHEUR HEALTHCARE 0 METHODIST HEALTHCARE CENTRAL MS MEDICAL ASSOCIATES 1211 UNION AVENUE SUITE 657 MEMPHIS TN 38104 640884720 INACTIVE HOSPITAL TN 501(C)(3) LINE 3 METHODIST LE BONHEUR HEALTHCARE 0 METHODIST HEALTHCARE-JACKSON HOSPITAL 1211 UNION AVENUE SUITE 657 MEMPHIS TN 38104 640794199 INACTIVE HOSPITAL TN 501(C)(3) LINE 3 METHODIST LE BONHEUR HEALTHCARE 0 METHODIST HEALTHCARE-MIDDLE MISSISSIPPI HOSPITAL 1211 UNION AVENUE SUITE 657 MEMPHIS TN 38104 640698911 INACTIVE HOSPITAL TN 501(C)(3) LINE 3 METHODIST LE BONHEUR HEALTHCARE 0 DESOTO DIAGNOSTIC LLC 9085 SANDIDGE CTR CV OLIVE BRANCH MS 38654 621802576 RADIOLOGY MS N/A NORTH SURGERY CENTER LP 3960 NEW COVINGTON PIKE MEMPHIS TN 38128 621685756 SURGERY CENTER TN N/A METHODIST SURGERY CENTER-GERMANTOWN LP 1363 S GERMANTOWN ROAD GERMANTOWN TN 38138 621659904 SURGERY CENTER TN N/A HAMILTON EYE INSTITUTE SURGERY CENTER LP 930 MADISON AVE 3RD FLOOR MEMPHIS TN 38103 202873438 SURGERY CENTER TN N/A AMBULATORY OPERATIONS INC 1211 UNION AVENUE SUITE 600 MEMPHIS TN 38104 621157166 MEDICAL SERVICES TN N/A C SOLUS MANAGEMENT SERVICES INC 6400 SHELBY VIEW SUITE 101 MEMPHIS TN 38134 621361349 HEALTH SERVICES MANAGEMENT TN N/A C MEMPHIS PROFESSIONAL BUILDING INC 1211 UNION AVENUE SUITE 600 MEMPHIS TN 38104 621847544 INVESTMENTS TN N/A C 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0