2012-08-13T08:49:44-05:00 2011-09-30 MARCUM LLP CITY PLACE II 185 ASYLUM STREET HARTFORD CT 06103 990 2010-10-01 050445136 SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM SOUT 4017828000 100 KENYON AVENUE WAKEFIELD RI 02879 THOMAS J BREEN 4017828000 2012-08-09 1 DOUGLAS FARRINGTON 8605498500 2010 2016-02-24 21:20:13Z THOMAS J BREEN 100 KENYON AVENUE WAKEFIELD RI 02879 117287175 0 X SCHOSPITAL.COM X 1920 RI TO OPERATE A NOT FOR PROFIT HOSPITAL. 23 21 1108 320 465449 0 785015 290042 104896763 111471631 490650 908022 5244333 4617480 111416761 117287175 0 0 0 0 51019656 52708574 0 0 0 58756701 61631697 109776357 114340271 1640404 2946904 101963627 104466448 96171915 104737218 5791712 -270770 X SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM PROVIDES COMPREHENSIVE MEDICAL SERVICES TO SOUTHERN RHODE ISLAND WITHOUT REGARD TO RACE, COLOR, CREED OR ABILITY TO PAY. 0 0 86549507 115194224 PATIENT CARE SERVICESSOUTH COUNTY HOSPITAL IS A COMMUNITY HOSPITAL SERVING THE COMMUNITIES OF SOUTHERN RHODE ISLAND. ONE OF THE LARGEST PROGRAMS IN SOUTH COUNTY HOSPITAL IS THE INPATIENT CARE PROGRAM WHICH HAD PATIENT DAYS IN THE FISCAL YEAR ENDING SEPTEMBER 30, 2011 OF 18,075 AND DISCHARGES OF 4,844. SPREAD ACROSS SEVERAL NURSING UNITS, THE HOSPITAL IS ABLE TO PROVIDE A HIGH LEVEL OF CARE TO PATIENTS WITH VARIOUS DIFFERENT NEEDS. THE THREE MEDICAL SURGICAL UNITS ARE IN A RELATIVELY NEW STATE OF THE ART BED TOWER. THE HOSPITAL ALSO HAS A DEDICATED STATE OF THE ART ORTHOPEDIC UNIT THAT PROVIDES FOR EXCELLENT CARE FOR ORTHOPEDIC PATIENTS. THE HOSPITAL ROUTINE CARE PROGRAM ALSO INCLUDES A WOMEN'S WING WITH 416 DELIVERIES IN FISCAL YEAR ENDING SEPTEMBER 30, 2011.SOUTH COUNTY HOSPITAL ALSO HAS AN INTENSIVE CARE UNIT THAT PROVIDES FOR PATIENTS WITH MORE SERIOUS CONDITIONS. IN ADDITION TO THE INPATIENT CARE PROGRAM, THE HOSPITAL'S SURGICAL SERVICES ENCOMPASS A WIDE RANGE OF PROCEDURES RANGING FROM COMPLEX PROCEDURES TO MINOR PROCEDURES. THE HOSPITAL HAS A SURGICAL PAVILION INCLUDING A SAME DAY SURGERY UNIT, CAPABLE OF APPLYING THE LATEST TECHNOLOGY TO PERFORM A BROAD RANGE OF PROCEDURES. THE SURGICAL SERVICES PROGRAM PERFORMED 8,762 PROCEDURES IN FISCAL YEAR ENDING SEPTEMBER 30, 2011. THE HOSPITAL'S LABORATORY SERVICES ARE A MAJOR PROGRAM WITHIN SOUTH COUNTY HOSPITAL. WITH A MAIN LAB WITHIN THE HOSPITAL AS WELL AS FOUR SATELLITE LABS IN SURROUNDING TOWNS THE LAB IS ABLE TO EXTEND BEYOND THE HOSPITAL AND HAVE A CONVENIENT PRESENCE IN A NUMBER OF LOCAL COMMUNITIES. THE HOSPITAL'S LABORATORY IS ACCREDITED BY THE COLLEGE OF AMERICAN PATHOLOGIST, THE AMERICAN ASSOCIATION OF BLOOD BANKS, AND THE U.S. HEALTH CARE FINANCING ADMINISTRATION. OTHER PROGRAM SERVICES INCLUDE ALL OTHER SERVICES INVOLVED IN OPERATING A NOT-FOR-PROFIT COMMUNITY HOSPITAL. SUCH SERVICES INCLUDE: EMERGENCY ROOM CARE, PHARMACY SERVICES, DIAGNOSTIC IMAGING SERVICES, AND OTHER ANCILLARY AND OUTPATIENT SERVICES. 86549507 1 1 0 1 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 1 71 0 1 1108 1 1 1 0 0 0 0 0 0 0 0 0 X 23 21 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 RI X X MARCIA POLHEMUS 4017828000 100 KENYON AVENUE WAKEFIELD RI 02879 IRWIN M BIRNBAUM ESQ 1.00 X 0 0 0 KATHLEEN CASSIN MD 1.00 X 0 0 0 STEPHANIE CHAFEE RN MBA 1.00 X 0 0 0 EDWARD M CIMILLUCA 1.00 X 0 0 0 DUNCAN COCROFT 1.00 X 0 0 0 NITIN S DAMLE MD 1.00 X 0 0 0 LAURA HARRIS 1.00 X 0 0 0 JOHN P HEFFERNAN MD 1.00 X 0 0 0 SUSAN KERMES 1.00 X 0 0 0 DORIS MANGANARO 1.00 X 0 0 0 MAUREEN W MOAKLEY 1.00 X 0 0 0 ROBERT PANOFF 1.00 X 0 0 0 HENRY D SHARPE III 1.00 X 0 0 0 RUSSELL R SHIPPEE 1.00 X 0 0 0 MEG SISCO 1.00 X 0 0 0 JAMES F STONE 1.00 X 0 0 0 BARBARA TATE 1.00 X 0 0 0 THE HONORABLE ERNEST C TORRES 1.00 X 0 0 0 PAULA VIAU 1.00 X 0 0 0 THOMAS WARCUP DO 1.00 X 15000 0 0 LEON D PUPPI 1.00 X 168750 0 0 EVE KEENAN 1.00 X X 0 0 0 M BEVERLY SWAN 1.00 X X 0 0 0 CLAIRE WILCOX 1.00 X X 0 0 0 JOSEPH MATTHEWS 1.00 X X 0 0 0 LOUIS R GIANCOLA 40.00 X 281703 0 60504 THOMAS J BREEN 40.00 X 318614 0 41927 BARBARA SEAGRAVE 40.00 X 156206 0 20347 STEVEN SCHNEIDER 40.00 X 259488 0 27471 ALLISON MCATEER 40.00 X 257950 0 27393 JEFFREY JOSEPH 40.00 X 257373 0 27460 LISA RAMEAKA 40.00 X 255868 0 27480 JILL SAMALE 40.00 X 241281 0 27159 2212233 0 259741 31 0 1 0 EMERGENCY PHYSICIANS ASSOCIATION 307 SO EVERGREEN AVE WOODBURY NJ 08096 ER PHYSICIANS 787909 SCOT GROUP 110-112 TIERNAN AVE WARWICK RI 02886 HOUSEKEEPING SERVICES 548549 SOUTH COUNTY PULMONARY MEDICINE 360 KINGSTOWN RD NARRAGANSETT RI 02882 PULMONARY SERVICES- PULMONARY EVALUATION 196100 LEON PUPPI MD 22 LEONARD BODWELL DR NARRAGANSETT RI 02882 PULMONARY INTENSIVIST SERVICES 168750 SOUTH COUNTY ORTHOPEDICS & PT 1 HIGH ST WAKEFIELD RI 02879 ORTHOPEDICS AND PHYSICAL THERAPY 123331 6 290042 290042 PATIENT SERVICE REVENU 621500 111471631 111006182 465449 111471631 902484 902484 894887 894887 894887 894887 5538 5538 5538 5538 HOSPITALIST 621500 1646964 1646964 JV RADIATION 621500 485950 485950 CAFETERIA 621500 271982 271982 1317697 1317697 3722593 117287175 114728775 465449 1802909 1014819 183750 831069 41784673 31700065 10084608 922958 704922 218036 6057568 4568817 1488751 2928556 2183226 745330 255032 255032 126000 126000 38478 38478 87898 87898 5617241 3521277 2095964 460150 428 459722 3196409 2456121 740288 1234326 948456 285870 2894550 2224172 670378 42422 19553 22869 224706 72056 152650 3008090 3008090 6536169 5022392 1513777 3400931 575528 2825403 MEDICAL SUPPLIES & DRUG 19730678 19078701 651977 PROVISION FOR BAD DEBTS 7540486 7540486 STATE LICENSE FEE 4887188 4887188 PHYSICIAN ADMIN 1048080 152427 895653 MAINTENANCE & REPAIR 920832 445024 475808 382031 264918 117113 114340271 86549507 27790764 0 6366 5961 11339799 6505960 6933657 7104439 1752283 1873152 2596203 2462436 129908695 74318765 57086529 55589930 18755158 25013653 2461292 2197641 1032340 3713276 101963627 104466448 12275273 13105816 53784629 50518221 327730 241735 29784283 40871446 96171915 104737218 X 5746712 -315770 45000 45000 5791712 -270770 101963627 104466448 X 2946904 -9009386 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 0 0 1 0 1 38478 38478 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE ORGANIZATION PAID OUTSIDE VENDORS FOR THE PERFORMANCE OF LOBBYING ACTIVITIES. 18755158 8167639 -1709144 200000 25013653 11068232 6539170 1147756 18755158 0.99820 0.00180 0.00000 1 0 266821 266821 53051705 21807609 31244096 640955 243410 397545 72726174 50070760 22655414 3223040 2196986 1026054 55589930 UNITS OF POOLED ENDOWMENT INVESTMENTS 17983536 F ASSETS HELD IN SELF INSURANCE TRUST 5839136 F HELD IN TRUST UNDER BOND INDENTURE 1190981 F 25013653 OTHER CURRENT LIABILITIES 30251 POSTRETIREMENT BENEFIT OBLIGATION 477973 ACCRUED PENSION COST 16596171 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 6267162 OTHER LIABILITIES 6336229 FAIR VALUE OF SWAP AGREEMENTS 11163660 40871446 117287175 114340271 2946904 -1801063 -7208323 -9009386 -6062482 115398214 -1801063 -1801063 117199277 87898 87898 117287175 114252373 0 114252373 87898 87898 114340271 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE NOT-FOR-PROFIT ENTITIES (SOUTH COUNTY HEALTHCARE SYSTEM ENDOWMENT, SOUTH COUNTY HOSPITAL AND VNS HOMECARE, INC.) OPERATE AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE TAX PROVISIONS AND RELATED LIABILITIES FOR SILVER SPRING HEALTH CARE MANAGEMENT WHICH IS TAXABLE ENTITY WHICH IS CONTROLLED BY THE HOSPITAL ARE NOT SIGNIFICANT. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN FIFTY PERCENT LIKELY TO BE REALIZED UPON SETTLEMENT. CHANGES IN RECOGNITION IN MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. THE HOSPITAL DID NOT RECOGNIZE THE EFFECT OF ANY INCOME TAX POSITIONS IN EITHER 2011 OR 2010. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN FUNDED STATUS OF EMPLOYEE BENEFIT PLANS -7,080,646. NET ASSETS RELEASED FOR CAPITAL EXPENDITURES 1,957,766. UNREALIZED LOSS ON INTEREST RATE SWAP -1,815,772. UNREALIZED CHANGE IN EQUITY INTERESTS IN LIMITED PARTNERSHIPS -269,671. 1 1 1 X 1 X 1 1 1 0 1 1 4945535 3212405 1733130 0.01520 1184275 1297551 -113276 0.00000 4191857 4133531 58326 0.00050 10321667 8643487 1678180 0.01570 205210 197472 7738 0.00010 7140 7140 0.00010 212350 197472 14878 0.00020 10534017 8840959 1693058 0.01590 0 2438593 23685194 30656385 -6971191 X 1 1 1 SOUTH COUNTY RADIATION THERAPY LLC RADIATION ONCOLOGY 0.35000 0.00000 0.00000 2 1 SOUTH COUNTY HOSPITAL

100 KENYON AVE WAKEFIELD RI 02879

X X X 2 SCH MEDICAL & WELLNESS CENTER

3461 SOUTH COUNTY TRAIL EAST GREENWICH RI 02852

X URGENT CARE CENTER NA 1 NA 2 8 SOUTH COUNTY HOSPITAL CENTER FOR WOMEN'S

70 KENYON AVE SUITE 103 WAKEFIELD RI 02879

OB/GYN PRACTICE SOUTH COUNTY HOSPITAL FAMILY MEDICINE

3461 SOUTH COUNTY TRAIL EAST GREENWICH RI 02818

PRIMARY CARE PRACTICE SOUTH COUNTY SURGERY

70 KENYON AVE SUITE 325 WAKEFIELD RI 02879

SURGICAL PRACTICE SOUTH COUNTY ONCOLOGYHEMATOLOGY

85 KENYON AVE WAKEFIELD RI 02879

ONCOLOGY/HEMATOLOGY PRACTICE SOUTH COUNTY HOSPITAL LAB

24 SALT POND ROAD SUITE H4 SOUTH KINGSTOWN RI 02879

OUTPATIENT LAB SOUTH COUNTY HOSPITAL LAB

360 KINGSTOWN RD SUITE 103 NARRAGANSETT RI 02882

OUTPATIENT LAB SOUTH COUNTY HOSPITAL LAB

3461 SOUTH COUNTY TRAIL EAST GREENWICH RI 02818

OUTPATIENT LAB SOUTH COUNTY HOSPITAL LAB

4099 OLD POST ROAD CHARLESTOWN RI 02813

OUTPATIENT LAB PART I, LINE 6A: THE ORGANIZATION PREPARES AN ANNUAL REPORT DETAILING MAJOR ACCOMPLISHMENTS AND COMMUNITY BENEFITS. IN ADDITION, THE ORGANIZATION MAINTAINS A COMPREHENSIVE WEBSITE INCLUDING INFORMATION ON AVAILABLE SERVICES, RESULTS OF VARIOUS QUALITY SURVEYS, AND GENERAL HEALTH EDUCATIONAL INFORMATION FOR THE COMMUNITY. PART II: SOUTH COUNTY HOSPITAL PROVIDES VARIOUS PROGRAMS FREE OF CHARGE OR FOR A NOMINAL FEE TO PROMOTE THE HEALTH OF THE COMMUNITY IT SERVES. THESE PROGRAMS INCLUDE FREQUENT SEMINARS AND PRESENTATIONS ON VARIOUS HEALTH TOPICS, WELLNESS SCREENINGS, LECTURES, AND SUPPORT GROUPS. THESE PROGRAMS ARE PROVIDED TO THE COMMUNITY EITHER FREE OF CHARGE OR FOR A NOMINAL FEE.IN ADDITION, THE HOSPITAL HAS EMBARKED ON THE CREATION OF A "PATIENT CENTERED MEDICAL COMMUNITY" AS DESCRIBED BELOW. PART III, LINE 4: SOUTH COUNTY HOSPITAL RECORDS BAD DEBT EXPENSE IN ACCORDANCE WITH U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPALS (GAAP). THE HOSPITAL UTILIZED A COST TO CHARGE RATIO AS A COSTING METHOD FOR THE AMOUNTS REPORTED IN LINES 2 AND 3. PART III, LINE 8: SOUTH COUNTY HOSPITAL UTILZED THE COST TO CHARGES RATIO AS REPORTED IN THE FY 2011 MEDICARE COST REPORT FOR INPATIENT CHARGES AND OUTPATIENT CHARGES. PART VI, LINE 2: THE ORGANIZATION CONDUCTS PERIODIC COMMUNITY HEALTH NEEDS ASSESSMENTS OF THE COMMUNITY IT SERVES. THIS ASSESSMENT INCLUDES INPUTS FROM COMMUNITY MEMBERS AND PHYSICIANS. THE RHODE ISLAND DEPARTMENT OF HEALTH SERVES AS AN IMPORTANT SOURCE OF INFORMATION ON POPULATION BASED DISEASE INCIDENCE AND HEALTHCARE NEEDS IN RHODE ISLAND AND IN WASHINGTON COUNTY. PART VI, LINE 3: PATIENT FINANCIAL SERVICES SPEAK DIRECTLY WITH EVERY EMERGENCY ROOM SELF-PAY PATIENT AT THE TIME OF SERVICE AND EVERY INPATIENT SELF PAY PATIENT DURING THEIR STAY TO DISCUSS ELIGIBILITY FOR ASSISTANCE. IN ADDITION, ALL SELF-PAY INVOICES ADVISE PATIENTS TO CONTACT THE HOSPITAL REGARDING FINANCIAL ASSISTANCE ELIGIBILITY. PART VI, LINE 4: THE CITIES AND TOWNS THAT COMPRISE THE PRIMARY SERVICE AREA OF SOUTH COUNTY HOSPITAL INCLUDE THE TOWNS OF CHARLESTOWN, EXETER, JAMESTOWN, NARRAGANSETT, NORTH KINGSTOWN, AND SOUTH KINGSTOWN. THE TOWNS THAT COMPRISE THE SECONDARY SERVICE AREA INCLUDE THE TOWNS OF BLOCK ISLAND, HOPKINTON, RICHMOND, WESTERLY, AS WELL AS, THE POPULATION FROM ADJOINING COMMUNITIES IN KENT COUNTY (EAST GREENWICH AND WEST GREENWICH).THE 2000 TOTAL POPULATION FOR THE APPLICANT'S PRIMARY AND SECONDARY SERVICE AREA FOR ALL AGES, TAKEN FROM THE 2000 CENSUS IS 147,201. THE SERVICE AREA POPULATION IS EXPECTED TO CONTINUE TO GROW TO 163,063 (10.8%) BY THE YEAR 2015. THIS PROJECTION IS BASED ON INFORMATION IN THE STATEWIDE PLANNING PROGRAM TECHNICAL PAPER, NUMBER 154, DATED AUGUST 2004. THE RI STATEWIDE PLANNING PROGRAM TECHNICAL PAPER IDENTIFIES AN IMPORTANT DEMOGRAPHIC TREND THAT WILL HAVE A POTENTIAL IMPACT ON SOUTH COUNTY HOSPITAL - THE AGING POPULATION IN ITS PRIMARY AND SECONDARY SERVICE AREA. THE NUMBER OF INDIVIDUALS IN THE PRIMARY AND SECONDARY SERVICE AREA THAT ARE 65 YEARS AND OLDER IS PROJECTED TO INCREASE FROM 18,709 RECORDED IN THE 2000 CENSUS TO 24,761 BY 2015, WHICH REPRESENTS A 32.3% INCREASE. IN 2000, THE PERCENT OF INDIVIDUALS OVER 65 YEARS OF AGE COMPARED TO THE TOTAL NUMBER OF INDIVIDUALS IN THE PRIMARY AND SECONDARY SERVICE AREA WAS 12.7% (18,709/147,201). IN 2015, THIS PERCENTAGE IS PROJECTED TO INCREASE TO 15.2% (24,761/163,063). INDIVIDUALS 65 YEARS AND OLDER TEND TO UTILIZE HEALTHCARE SERVICES AT A RATE HIGHER THAN INDIVIDUALS 64 YEARS AND YOUNGER. PART VI, LINE 6: THE HOSPITAL AND ITS PHYSICIAN AND COMMUNITY PARTNERS HAVE EMBARKED ON THE CREATION OF A "PATIENT CENTERED MEDICAL COMMUNITY." THE PATIENT CENTERED MEDICAL COMMUNITY (PCMC) WILL OFFER AN INTEGRATED SYSTEM OF CARE THAT IMPROVES THE HEALTH STATUS OF THE POPULATION WE SERVE, PARTICULARLY THOSE WITH AND AT RISK FOR CHRONIC CONDITIONS. TO ACHIEVE THIS VISION, THE PCMC WILL:1. BE BUILT UPON A FOUNDATION OF STRONG PRIMARY CARE PRACTICES WITH ENHANCED LINKAGES TO THE HOSPITAL, SPECIALISTS AND COMMUNITY-BASED RESOURCES2. ADOPT AND IMPLEMENT THE PATIENT CENTERED MEDICAL HOME (PCMH) MODEL BASED ON THE NCQA RECOGNITION STANDARDS AND GUIDELINES, SUPPORTED BY LOCAL MULTIDISCIPLINARY TEAMS AND CHRONIC CARE SERVICES3. FACILITATE ADOPTION OF HEALTH INFORMATION TECHNOLOGY TO ENSURE ELECTRONIC INFORMATION SHARING EIGHTEEN (18) PRIMARY CARE PHYSICIANS IN SEVEN (7) SOUTH COUNTY BASED PRACTICES HAVE ADOPTED AND IMPLEMENTED THE PATIENT CENTERED MEDICAL HOME (PCMH) MODEL. THE SOUTH COUNTY "MEDICAL COMMUNITY" INITIATIVE (PCMC) WILL ADVANCE THAT CONCEPT INTO A BROADER SYSTEM OF COMMUNITY-BASED HEALTHCARE THAT LINKS PRIMARY CARE PHYSICIANS AND THEIR PATIENTS TO DISEASE MANAGEMENT SERVICES, SPECIALISTS, EMERGENCY SERVICES AND INPATIENT HOSPITAL SERVICES, SO THAT CARE IS OPTIMALLY COORDINATED AND INFORMATION FLOWS TO SUPPORT THE BEST OUTCOMES FOR PATIENTS AND SYSTEM EFFICIENCY.THE SOUTH COUNTY CONTINGENT IS A PARTICIPANT IN THE RI CHRONIC CARE SUSTAINABILITY INITIATIVE (CSI) WHICH IS A DEMONSTRATION PILOT OF THE PCMH MODEL. THIS PROVIDES A FOUNDATION BASED ON AN INTEGRATED COLLABORATIVE APPROACH THAT WILL ASSIST PHYSICIAN PRACTICES AND THE HOSPITAL TOWARD ENHANCING THE MANAGEMENT OF PATIENTS WITH CHRONIC DISEASES. PART VI, LINE 7: THE HOSPITAL IS PART OF AN AFFILIATED HEALTHCARE SYSTEM INCLUDING VNS HOMECARE, INC. (D/B/A VNS HOME HEALTH SERVICES) THE AFFILIATE'S MISSION IS TO PROVIDE HEALTHCARE, EDUCATION, OTHER THERAPEUTIC AND SUPPORT SERVICES TO MEMBERS OF THE COMMUNITY WITHOUT REGARD TO RACE, COLOR, CREED, OR ABILITY TO PAY.FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2011, VNS HOME HEALTH SERVICES PROVIDED 66,060 VISITS TO 4,023 CLIENTS IN THEIR HOMES. IN ADDITION TO THIS VNS ALSO PROVIDES AT NO CHARGE BLOOD PRESSURE CHECKS AT HEALTH CARE CLINICS AROUND THE SOUTH COUNTY COMMUNITY. OTHER SERVICES SUCH AS CHOLESTEROL SCREENINGS ARE PROVIDED AT A NOMINAL CHARGE. X X X X X 0 1 0 0 0 0 0 0 0 LEON D PUPPI 0 0 0 0 168750 0 0 0 0 0 168750 0 0 0 LOUIS R GIANCOLA 279209 0 0 0 2494 0 43694 0 16810 0 342207 0 0 0 THOMAS J BREEN 318614 0 0 0 0 0 22622 0 19305 0 360541 0 0 0 BARBARA SEAGRAVE 156206 0 0 0 0 0 5467 0 14880 0 176553 0 0 0 STEVEN SCHNEIDER 228599 0 30889 0 0 0 8575 0 18896 0 286959 0 0 0 ALLISON MCATEER 257950 0 0 0 0 0 8575 0 18818 0 285343 0 0 0 JEFFREY JOSEPH 226484 0 30889 0 0 0 8575 0 18885 0 284833 0 0 0 LISA RAMEAKA 224979 0 30889 0 0 0 8575 0 18905 0 283348 0 0 0 JILL SAMALE 210392 0 30889 0 0 0 8445 0 18714 0 268440 0 0 0 PART I, LINE 4B LOUIS GIANCOLA - DEFERRED COMPENSATION PLAN - $14,286 THOMAS BREEN - DEFERRED COMPENSATION PLAN - $5,714 2006 RI HEALTH AND EDUCATIONAL BUILDING CORPORATION 521300173 762243ST1 2009-09-15 44950000 BLDG CONSTRUCTION / REFINANCE EXISTING DEBT 0 0 0 2003 RI HEALTH AND EDUCATIONAL BUILDING CORPORATION SERIES B 521300173 762243EF6 2007-11-15 7060000 BLDG CONSTRUCTION / REFINANCE EXISTING DEBT 0 0 0 2003 RI HEALTH AND EDUCATIONAL BUILDING CORPORATION SERIES C 521300173 762243EG4 2007-11-15 6025000 BLDG CONSTRUCTION / REFINANCE EXISTING DEBT 0 0 0 38630000 44950000 2009 0 1 1 1 6460000 7060000 1999 0 1 1 1 5585000 6025000 1997 0 1 1 1 0 0 1 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 1 MERRILL LYNCH CAPITAL SERVICES 30.000000000000 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 LEON D PUPPI TRUSTEE & VICE PRESIDENT OF THE MEDICAL STAFF 168750 LEON D. PUPPI PROVIDES PULMONARY INTENSIVIST PHYSICIAN SERVICES TO SOUTH COUNTY HOSPITAL AND IS THE VICE PRESIDENT OF THE MEDICAL STAFF. 0 SUSAN KERMES TRUSTEE 226094 SUSAN KERMES IS MARRIED TO KEN KERMES, A TRUSTEE OF HOME & HOSPICE CARE OF RHODE ISLAND. HOME & HOSPICE CARE OF RI UTILIZES TWO ROOMS IN THE HOSPITAL TO PROVIDE INPATIENT HOSPICE CARE. 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S AUDIT COMMITTEE APPROXIMATELY 30 DAYS PRIOR TO THE FILING DEADLINE. THE AUDIT COMMITTEE THEN REVIEWS THE FORM 990 AND PROVIDES QUESTIONS AND COMMENTS TO THE ORGANIZATION'S ACCOUNTING DEPARTMENT. BEFORE IT IS FILED, A COPY OF THE FINAL FORM 990, INCLUDING REQUIRED SCHEDULES, IS PROVIDED TO THE MEMBERS OF THE BOARD OF TRUSTEES FOR REVIEW AND DISCUSSION WITH THE CHAIRMAN OF THE AUDIT COMMITTEE AT A BOARD MEETING PRIOR TO THE FILING DEADLINE. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF THE GOVERNING BODY, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. IT IS PERIODICALLY REVIEWED AND DISCUSSED AT BOARD MEETINGS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S CEO'S COMPENSATION IS DETERMINED BY THE GOVERNING BODY. THE CEO'S SALARY IS COMPARED TO OTHER CEO'S SALARIES OF SIMILAR ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,801,063. CHANGE IN FUNDED STATUS OF EMPLOYEE BENEFIT PLANS -7,080,646. NET ASSETS RELEASED FOR CAPITAL EXPENDITURES 1,957,766. UNREALIZED LOSS ON INTEREST RATE SWAP -1,815,772. UNREALIZED CHANGE IN EQUITY INTERESTS IN LIMITED PARTNERSHIPS -269,671. TOTAL TO FORM 990, PART XI, LINE 5: -9,009,386. FORM 990, PART XII, LINE 2C: FINANCIAL STATEMENTS AND REPORTING THE ORGANIZATION'S AUDIT COMMITTEE IS RESPONSIBLE FOR SELECTING AN INDEPENDENT ACCOUNTANT TO AUDIT THE ORGANIZATION'S FINANCIAL STATEMENTS AND FOR OVERSEEING THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS. DESCRIPTION OF ORGANIZATION MISSION FORM 990, PART III, LINE 1: SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM ("THE HOSPITAL") IS DEDICATED TO ENRICHING THE QUALITY OF LIFE OF SOUTHERN RHODE ISLAND COMMUNITY MEMBERS AND VISITORS THROUGH THE DELIVERY OF QUALITY HEALTHCARE SERVICES, THE DEVELOPMENT OF COOPERATIVE RELATIONSHIPS WITH OTHER HEALTH CARE PROVIDERS, AND THE PROMOTION OF WELLNESS THROUGH HEALTH EDUCATION AND AWARENESS. GUIDED BY THIS MISSION, IT IS THE HOSPITAL'S HIGHEST AIM TO BENEFIT THE COMMUNITY. THE HOSPITAL IS MAKING EVERY EFFORT TO:(1) PROVIDE EXCELLENT MEDICAL CARE WITH DIGNITY AND RESPECT IN A TIMELY AND COST-EFFECTIVE MANNER; (2) RESPOND WITH INNOVATION TO THE CHANGING NEEDS OF OUR GOVERNING COMMUNITY; (3) ENCOURAGE TRUSTING PARTNERSHIPS WITH EMPLOYEES, PHYSICIANS, TRUSTEES, VOLUNTEERS, AND OTHERS THROUGHOUT OUR COMMUNITY. THE HOSPITAL IS FULLY ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS. THE HOSPITAL'S FACILITIES AND PROGRAMS ARE LICENSED BY THE STATE OF RHODE ISLAND. THE HOSPITAL'S LABORATORY IS ALSO ACCREDITED BY THE COLLEGE OF AMERICAN PATHOLOGISTS AND THE AMERICAN ASSOCIATION OF BLOOD BANKS. THE ULTRASOUND, MAMMOGRAPHY, AND MRI SERVICES OF SOUTH COUNTY HOSPITAL ARE ALSO ACCREDITED BY THE AMERICAN COLLEGE OF RADIOLOGY. THE CT SCAN SERVICES AND CANCER PROGRAM ARE ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS. DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2011, THE HOSPITAL ADMITTED 4,844 ADULT AND PEDIATRIC PATIENTS; HAD 23,107 OUTPATIENT EMERGENCY ROOM VISITS, AND 9,983 URGENT CARE VISITS. THE HOSPITAL ALSO PROVIDED $9,000,000 OF FREE CHARITY CARE AND UNCOMPENSATED CARE TO INDIVIDUALS WHO WERE UNABLE TO PAY THE HOSPITAL FOR ITS SERVICES AS PRESENTED IN THE AUDITED FINANCIAL STATEMENTS. THE HOSPITALS MODERN FACILITIES INCLUDE: - NURSING UNITS PROVIDING MEDICAL AND SURGICAL SERVICES INCLUDING GENERAL MEDICINE, CARDIOLOGY, GASTROENTEROLOGY, PULMONARY, UROLOGY, GYNECOLOGY AND OTHERS AS WELL AS THOSE OFFERING SPECIALIZED SERVICES SUCH AS MATERNITY, INTENSIVE CARE, ORTHOPEDICS, AND CHEMOTHERAPY TREATMENT FOR CANCER PATIENTS. THE NEW 3 STORY 60 PRIVATE INPATIENT ROOMS INCLUDING 2 HOSPICE ROOMS OPENED JANUARY 2008. THE COMPLETION OF THE BED REPLACEMENT TOWERS ALLOWS THE HOSPITAL TO OPERATE ALL 100 LICENSED BEDS, MAKING AN ADDITIONAL 22 BEDS AVAILABLE TO THE REGION TO MEET THE DEMAND PROJECTED IN A PREVIOUSLY PUBLISHED STATE PLANNING ASSESSMENT STUDY. THE RENOVATIONS TO THE EMERGENCY ROOM, DIAGNOSTIC IMAGING, LAB AND THE BED TOWER WERE DESIGNED TO PROVIDE EFFICIENCIES TO THE PATIENT CARE AND ENHANCED PRIVACY. - A TEN-BED INPATIENT CARE UNIT (INCLUDED IN THE 100 BEDS ABOVE) DEVOTED TO ORTHOPEDIC PATIENTS TO MEET THE NEEDS OF THE PATIENT POPULATION. THIS UNIT OFFERS A "HOSPITAL WITHIN A HOSPITAL" CONCEPT AND WAS DEVELOPED IN COLLABORATION WITH THE ORTHOPEDIC SURGEONS AND CARE GIVERS. THE HOSPITAL WAS THE FIRST HOSPITAL IN RHODE ISLAND TO OFFER FDA APPROVED BIRMINGHAM HIP RESURFACING PROCEDURES AND THE FIRST HOSPITAL TO OFFER GENDER SPECIFIC KNEE IMPLANTS. ALSO, THIS UNIT IS THE STATE'S ONLY AIRBORNE INFECTION ISOLATION UNIT (AIIU) AND RESPONDS TO THE DOH IMPERATIVE TO IDENTIFY A 10-BED AIIU FOR THE STATE. - A SURGICAL PAVILION INCLUDING A SAME-DAY SURGERY UNIT, CAPABLE OF APPLYING THE LATEST TECHNOLOGY TO PERFORM A BROAD RANGE OF PROCEDURES. WITH SUCH INNOVATIONS AS LAPAROSCOPIC SURGERY AND NO-STITCH CATARACT SURGERY, PATIENTS' HOSPITALIZATION RECOVERY PERIODS HAVE BEEN SHORTENED DRAMATICALLY. - THE HOSPITAL'S MEDICAL STAFF INCLUDES MORE THAN 230 BOARD CERTIFIED AND BOARD ELIGIBLE PHYSICIANS REPRESENTING MORE THAN 40 SPECIALTIES. - LABORATORY, NEWLY RENOVATED IN THE SPRING OF 2006, AND DIAGNOSTIC IMAGING CENTER, NEW FACILITY COMPLETED IN FEBRUARY 2004, SERVING INPATIENTS AND OUTPATIENTS WITH THE CAPACITY TO PERFORM A WIDE VARIETY OF SOPHISTICATED PROCEDURES, INCLUDING MAGNETIC RESONANCE IMAGING (MRI), CT SCANS, X-RAY, ECHOCARDIOGRAPHY, INTERVENTIONAL RADIOLOGY, NUCLEAR MEDICINE, DIGITAL IMAGING, DIGITAL MAMMOGRAPHY, POSITION EMISSION TOMOGRAPHY SCANNER AND STATE-OF-THE-ART DEXA BONE DENSITOMETER. - A DIAGNOSTIC CARDIAC CATHETERIZATION SERVICE, OPENED IN JANUARY 2009, LOCATED WITHIN THE DIAGNOSTIC IMAGING CENTER. THE SERVICE WAS ADDED TO MEET THE NEEDS OF THE PATIENTS IN THE SERVICE AREA. THE PROGRAM WAS ESTABLISHED IN COLLABORATION WITH RHODE ISLAND HOSPITAL AND IS AFFILIATED WITH ITS CARDIOVASCULAR LABORATORY SERVICES. - OTHER OUTPATIENT SERVICES INCLUDE A WELL EQUIPPED REHABILITATION FACILITY INCLUDING A PHYSICAL THERAPY UNIT AND SPECIAL REHABILITATION PROGRAMS FOR CARDIAC PATIENTS AND DISABLED WORKERS; WOUND CARE CENTER WHICH PROVIDES THE MOST ADVANCED TREATMENTS AND THERAPIES AVAILABLE FOR NON-HEALING WOUNDS CAUSED BY DIABETES, POOR CIRCULATION, PRESSURE OR SURGICAL INCISIONS; SLEEP DISORDER LABORATORY, ANTICOAGULATION MANAGEMENT SERVICE CLINIC, WHICH OFFERS THE VERY LATEST IN ANTICOAGULATION THERAPY; ONCOLOGY AND INFUSION THERAPY, DIABETES & NUTRITION CONSULTING SERVICES, COLONOSCOPY CENTER, AND LYME DISEASE CLINIC. - AN EMERGENCY ROOM FACILITY WITH 24-HOUR AVAILABILITY. THE EMERGENCY DEPARTMENT WAS RENOVATED IN 2003 TO 22 TREATMENT ROOMS, A FOUR-BED OBSERVATION AREA AND A DECONTAMINATION ROOM WITH A SEPARATE EXTERIOR ENTRANCE TO SERVE CHEMICAL OR BIOLOGICAL EXPOSURES. - BESIDES AN EMERGENCY ROOM, AN URGENT CARE SERVICE IS PROVIDED FOR LESS SERIOUS INJURIES AND ILLNESSES AT A SATELLITE LOCATION. IN JANUARY 2009, THE URGENT CARE WAS RELOCATED TO A NEW FACILITY IN THE HOSPITAL'S NORTHERN SERVICE AREA. THE NEW FACILITY INCLUDES DIAGNOSTIC IMAGING, FAMILY MEDICINE, PHYSICAL THERAPY, MEDICAL LABORATORY, AND WOMAN'S HEALTH. - THE HOSPITAL OPENED SOUTH COUNTY RADIATION THERAPY IN COLLABORATION WITH 21ST CENTURY ONCOLOGY, A LEADING DEVELOPER AND RESPECTED NATIONAL PROVIDER OF RADIATION THERAPY SERVICES. BY JOINING WITH 21ST CENTURY ONCOLOGY, THE HOSPITAL IS ABLE TO PROVIDE A FULL SPECTRUM OF PREMIER RADIATION THERAPIES, IMPLEMENTING SOME OF THE MOST ADVANCED RADIATION THERAPY TREATMENTS IN THE STATE INCLUDING INTENSITY MODULATED RADIATION THERAPY, 3-D CONFORMAL BEAM THERAPY, PROSTATE SEED IMPLANTS, AND HDR BRACH THERAPY. THESE VARIOUS MODALITIES ENABLE ONCOLOGISTS TO OPTIMIZE TREATMENT CHOICES BASED ON THE TYPE AND LOCATION OF THE CANCER. - IN ORDER TO STRENGTHEN ITS HOMECARE PROGRAM DURING 1999, THE HOSPITAL AFFILIATED WITH VNS HOME HEALTH SERVICES, A RESPECTED, COMMUNITY BASED HOME HEALTH AGENCY. WITH THIS ADDITION, THE HOSPITAL STRENGTHENED ITS COMMUNITY ROOTS AND FURTHER BRANCHED OUT TO PATIENTS. THE COLLABORATION OF BOTH ORGANIZATIONS IN THIS ACTION WAS FOCUSED ON ENSURING A CONTINUITY OF QUALITY CARE, DELIVERED BY A SKILLED AND MOTIVATED TEAM OF HOME HEALTH PROFESSIONALS. TWENTIETH CENTURY TECHNOLOGY AND THE PROCESS OF MANAGED CARE HAS NOT ONLY INCREASED THE LEVELS OF SERVICE NOW PROVIDED IN THE HOME, BUT ALSO HAS BROADENED THE ROLE OF THE FAMILY AS CAREGIVERS. - IN RESPONSE TO THE CLEAR RECOMMENDATIONS FROM A WIDE CROSS-SECTION OF OUR COMMUNITY, SOUTH COUNTY HOSPITAL REMAINS COMMITTED TO INDEPENDENCE IN FINANCE, OPERATIONS AND GOVERNANCE. COMMUNITY BENEFITS - WE VIEW OUR EFFORTS IN COMMUNITY INVOLVEMENT/COMMUNITY OUTREACH AS A VITAL PART OF OUR MISSION, AND WE BELIEVE IT PLAYS AN ESSENTIAL ROLE IN IMPROVING THE HEALTH OF THE MEMBERS OF OUR COMMUNITY. EDUCATION - THROUGHOUT THE YEAR, SOUTH COUNTY HOSPITAL DEDICATES SUBSTANTIAL RESOURCES TO THE COMMUNITY OUTREACH AT A MULTITUDE OF LOCATIONS THROUGHOUT THE AREA. SOUTH COUNTY HOSPITAL PLACES GREAT IMPORTANCE ON PROVIDING A MULTITUDE OF OPPORTUNITIES FOR MEMBERS OF THE COMMUNITY TO BECOME BETTER INFORMED ABOUT DISEASE PREVENTION, MANAGEMENT, AND TREATMENT AND TO TAKE STEPS TO ACHIEVE AND MAINTAIN OPTIMAL HEALTH. THESE COMMUNITY OUTREACH EVENTS ARE FREE (WITH ONE EXCEPTION), OPEN TO ALL, AND TAKE MANY FORMS. THEY INCLUDE: - MONTHLY LECTURE SERIES (FREE). THE LECTURES ARE GIVEN BY PHYSICIANS AND OTHER CLINICIANS ON THE STAFF, AND ARE HELD AT VARIOUS LOCATIONS THROUGHOUT OUR SERVICE AREA TO REACH THE GREATEST NUMBER OF PEOPLE. TOPICS INCLUDE HEART DISEASE, CANCER (BREAST CANCER, COLON CANCER, PROSTATE CANCER, ETC.), DIABETES & WELLNESS, SLEEP DISORDERS, NUTRITION, ARTHRITIS, CHILDBIRTH AND MUCH, MUCH MORE. AT LEAST THREE LECTURES PER MONTH ARE OFFERED THROUGHOUT THE YEAR (A MINIMUM TOTAL OF 36 FREE LECTURES A YEAR), AND AUDIENCE SIZE RANGES FROM 30 TO MORE THAN 140. - PROSTATE CANCER SCREENING CLINIC (A FREE, ANNUAL EVENT). EACH YEAR THIS IS ATTENDED BY MORE THAN 100 MEN. THE CLINIC IS STAFFED BY UROLOGISTS AND PHLEBOTOMISTS. - WOMEN'S WELLNESS DAY (AN ANNUAL EVENT, WITH A SMALL RESERVATION FEE). THE DAY INCLUDES PRESENTATIONS BY PHYSICIANS ON IMPORTANT HEALTH TOPICS, FREE HEALTH SCREENINGS, FREE LITERATURE, AND MORE. EACH YEAR THIS IS ATTENDED BY CLOSE TO 300 WOMEN. - OUTREACH TO LOCAL SCHOOLS - EVERY YEAR, WE REACH OUT TO AREA ELEMENTARY, MIDDLE AND HIGH SCHOOLS WITH DEMONSTRATIONS ON PROPER HAND WASHING TECHNIQUES, AS WELL AS PRESENTATIONS FROM CLINICIANS ON A VARIETY OF HEALTH AND CAREER TOPICS. - A WEBSITE DESIGNED TO SERVE AS A RESOURCE FOR THE LATEST HEALTH CARE INFORMATION AND PROVIDE INFORMATION ON COMMUNITY OUTREACH. - FREE QUARTERLY NEWSLETTER, YOUR HEALTH MATTERS. THIS HEALTH INFORMATION PACKED 8 PAGE NEWSLETTER IS MAILED TO 31,000 HOUSEHOLDS PER ISSUE. - FREE MONTHLY ELECTRONIC NEWSLETTER, E-HEALTH NEWS. THE MAILING LIST FOR THIS HEALTH INFORMATION ELECTRONIC NEWSLETTER HAS MORE THAN 1,800 SUBSCRIBERS. ACCESS THE HOSPITAL OFFERS FREE TRANSPORATION ALL ACROSS SOUTH COUNTY TO MEDICAL APPOINTMENTS, USING OUR WAVE VAN, FOR INDIVIDUALS WHO ARE UNABLE TO DRIVE OR WHO HAVE NO OTHER MEANS OF TRANSPORATION. FORM 990, SCHEDULE D, PART V, LINE 1B: THE AMOUNT OF $8,167,639 ON LINE 1B REPRESENTS A TRANSFER FROM OPERATIONS. THERE WERE NO CONTRIBUTIONS RECEIVED FOR THE YEAR ENDED SEPTEMBER 30, 2011. FORM 990, PART VI, LINE 16B: THE HOSPITAL'S JOINT VENTURE WITH 21ST CENTURY ONCOLOGY TO PROVIDE FULL SPECTRUM OF PREMIER RADIATION THERAPIES IN THE COMMUNITY WAS FULLY REVIEWED BY HOSPITAL LEGAL COUNSEL TO ASSURE FULL TAX COMPLIANCE. SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM ENDOWMENT 100 KENYON AVE WAKEFIELD RI 02879 050259093 TO SUPPORT ADVANCEMENT OF MEDICINE AND HEALTH CARE RI 501(C)(3) 7 N/A 0 VNS HOMECARE INC 14 WOODRUFF AVE NARRAGANSETT RI 02882 056033975 TO PROVIDE HEALTH CARE RI 501(C)(3) 9 SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM ENDOWMENT 1 SILVER SPRING HEALTH CARE MANAGEMENT 100 KENYON AVENUE WAKEFIELD RI 02879 050459095 HOLDING COMPANY RI N/A C -10206 1454616 1.00000 SOUTH COUNTY QUALITY CARE 100 KENYON AVENUE WAKEFIELD RI 02879 050491313 HOME BASED PERSONAL CARE RI N/A C 123296 750016 1.00000 SSHM SURGICAL SUPPLY INC 100 KENYON AVENUE WAKEFIELD RI 02879 050478937 RETAIL PROVIDER OF MEDICAL EQUIPMENT RI N/A C -186277 919944 1.00000 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0