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ST LUKES HOSPITAL INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
ST LUKES HOSPITAL INC (EIN 56-0554222)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-05-13
IRS object ID
201121339349300912
Schema version
2009v1.7
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)
Timestamp2011-05-13T09:59:04-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2009-10-01TaxPeriodBeginDate

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 Signed2011-05-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAmy BibbyName
Phone8282542254Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
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 Receipts28857810GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
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 Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees391TotalNbrEmployees
Total Nbr Volunteers111TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year423912ContributionsGrantsPriorYear
Contributions Grants Current Year134393ContributionsGrantsCurrentYear
Program Service Revenue Prior Year27641371ProgramServiceRevenuePriorYear
Program Service Revenue CY28475294ProgramServiceRevenueCY
Investment Income Prior Year295189InvestmentIncomePriorYear
Investment Income Current Year166345InvestmentIncomeCurrentYear
Other Revenue Prior Year139460OtherRevenuePriorYear
Other Revenue Current Year81778OtherRevenueCurrentYear
Total Revenue Prior Year28499932TotalRevenuePriorYear
Total Revenue Current Year28857810TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year12863486SalariesEtcPriorYear
Salaries Etc Current Year11859645SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year15519671OtherExpensePriorYear
Other Expenses Current Year15163124OtherExpensesCurrentYear
Total Expenses Prior Year28383157TotalExpensesPriorYear
Total Expenses Current Year27022769TotalExpensesCurrentYear
Revenues Less Expenses Prior Year116775RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1835041RevenuesLessExpensesCY
Total Assets BOY16291534TotalAssetsBOY
Total Assets EOY16682019TotalAssetsEOY
Total Liabilities BOY7749532TotalLiabilitiesBOY
Total Liabilities EOY6567781TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8542002NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10114238NetAssetsOrFundBalancesEOY
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
Expense23404074Expense
Revenue28423590Revenue
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, A REGIONAL CENTER FOR WOUND AND HYPERBARIC CARE, 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 COMMUNTIY 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. 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 Expense23404074TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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
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
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109625NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees391NumberOfEmployees
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
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
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
CLARK BENSON
VICE CHAIR1.00XX000
BECKY COLLINS
SECRETARY1.00XX000
FRED FOY
TRUSTEE1.00X000
BILL HILLHOUSE
TREASURER1.00XX000
DR JAMES HOLLEMAN
TRUSTEE1.00X02123889431
DR SANDRA MCCORMACK
TRUSTEE1.00X000
SUSAN MCHUGH
CHAIR1.00XX000
TOMMY MELTON
TRUSTEE1.00X000
PILAR PACE
TRUSTEE1.00X000
NORM POWERS
TRUSTEE1.00X000
DR HOBART ROGERS
TRUSTEE1.00X000
DR BRIAN ROSENBERG
TRUSTEE1.00X056307632182
JEAN SHUMWAY
TRUSTEE1.00X000
WOODY WOODHAM
TRUSTEE1.00X000
ALEXANDER BELL
INTERIM CEO40.00X72515022500
ROBERT CRESS
CFO40.00X112800013530
CHRISTINE MARTIN
CFO40.00X000
LYNN CROCKER
DIRECTOR OF PHARMACY40.00112607019595X
KEVIN REYNOLDS
ASSISTANT DIRECTOR OF PHAR40.00116159018438X
FieldValueIRS element (for citing)
Total Reportable Comp From Org414081TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs775464TotalReportableCompFrmRltdOrgs
Total Other Compensation115676TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources1CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
CAROLINAS HEALTHCARE SYSTEM
PO BOX 32861CHARLOTTENC28232MANAGEMENT CONTRACT1213499
VMAX ASSOCIATION PA
72 ALPINE WAYASHEVILLENC28805ANESTHESIA SERVICES986928
HORIZON CSA LLC
PO BOX 550SKYLANDNC28776BIOMEDICAL EQUIPMENT REPAIR501510
EMCARE PHYSICIAN SERVICES
7032 COLLECTION CENTER DRCHICAGOIL60673ER PHYSICIANS498870
WOUND CARE SYSTEMS LLC
2881 NC HWY 108ECOLUMBUSNC28722HYPERBARIC, WOUND CARE393300
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
All Other Contributions134393AllOtherContributions
Total Contributions134393TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
PATIENT SERVICE REVENU6219902833297328332973
SALE OF DRUGS9000998275582755
CAFETERIA/MEALS90009947612$47,612
OTHER PATIENT SERVICES62199067626762
VENDING9000992892$2,892

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column2300TotalRevenueColumn
Related Or Exempt Function Income1100RelatedOrExemptFunctionIncome
Exclusion$1,200ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue28475294TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column166345TotalRevenueColumn
Exclusion$166,345ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionPURCHASE DISCOUNTSDescription
Business Code900099BusinessCode
Total Revenue Column81778TotalRevenueColumn
Exclusion$81,778ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue81778TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column28857810TotalRevenueColumn
Related Or Exempt Function Income28423590RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$299,827ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total221345Total
Management And General221345ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8499190Total
Program Services7490321ProgramServices
Management And General1008869ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2433573Total
Program Services2115502ProgramServices
Management And General318071ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total705537Total
Program Services613817ProgramServices
Management And General91720ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1213499Total
Management And General1213499ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total29677Total
Management And General29677ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3172971Total
Program Services2740384ProgramServices
Management And General432587ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total63192Total
Program Services2074ProgramServices
Management And General61118ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4604105Total
Program Services4408171ProgramServices
Management And General195934ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1615459Total
Program Services1591644ProgramServices
Management And General23815ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total51121Total
Program Services29061ProgramServices
Management And General22060ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total129587Total
Program Services129587ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total905336Total
Program Services905336ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total138833Total
Program Services138833ProgramServices

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionBAD DEBT EXPENSEDescription
Total3239344Total
Program Services3239344ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total27022769Total
Program Services23404074ProgramServices
Management And General3618695ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY897338BOY
EOY1196235EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2631730BOY
EOY2580425EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY545845BOY
EOY565228EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY106278BOY
EOY129466EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis20143480LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec15496267LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4590828BOY
EOY4647213EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY6025341BOY
EOY6282876EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY537745BOY
EOY554312EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY956429BOY
EOY726264EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY16291534BOY
EOY16682019EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2953942BOY
EOY2376131EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY55514BOY
EOY44903EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY3573221BOY
EOY1197516EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1166855BOY
EOY2949231EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7749532BOY
EOY6567781EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY8012717BOY
EOY9525292EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY424403BOY
EOY484064EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY104882BOY
EOY104882EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8542002BOY
EOY10114238EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY16291534BOY
EOY16682019EOY
FieldValueIRS element (for citing)
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$3,810OtherActivitiesAmount
Total Lobbying Expenditures IIB3810TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1i:Identifier
Return ReferenceExplanation of Other Lobbying Activities:ReturnReference
ExplanationTHE HOSPITAL PAID DUES TO NCHA, OF WHICH $3,810 WAS DETERMINED AS LOBBYING EXPENDITURES DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2010.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

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

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1983824BeginningOfYearBalance
Contributions153474Contributions
Investment Earnings Or Losses134167InvestmentEarningsOrLosses
End Of Year Balance2271465EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.79300BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.04300PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.16400TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

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

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6933057OtherCostOrOtherBasis
Depreciation4971993Depreciation
Book Value1961064BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis482089OtherCostOrOtherBasis
Depreciation411079Depreciation
Book Value71010BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis12668901OtherCostOrOtherBasis
Depreciation10113195Depreciation
Book Value2555706BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4647213TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
THIRD PARTY PAYABLE$2,440,774
CEDRIC SEAMAN CHARITABLE TRUST$81,407
CAPITAL LEASES$427,050
FieldValueIRS element (for citing)
Total Of Amounts2949231TotalOfAmounts
Total Revenue28857810TotalRevenue
Total Expenses27022769TotalExpenses
Excess Or Deficit For Year1835041ExcessOrDeficitForYear
Net Unrealized GL On Investments176177NetUnrealizedGLOnInvestments
Prior Period Adjustments1821PriorPeriodAdjustments
Other-$440,804OtherAmount
Total Adjustments-262806TotalAdjustments
Excess Or Deficit Per FS1572235ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt28977128TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments176177NetUnrealizedGainsInvestments
Other Revenues6866OtherRevenues
Revenue Not Rptd F990183043RevenueNotRptdF990
Revenue Subtotal28794085RevenueSubtotal
Other Revenues Not Included63725OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt63725RevenueNotRptdOnFinStmt
Total Revenue Per Form99028857810TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt27022769TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal27022769ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99027022769TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part V, Line 4:Description of Intended Use of Endowment Funds:THE ORGANIZATION'S ENDOWMENT FUNDS ARE ORGANIZED TO PROVIDE FUNDS FOR GENERAL PURPOSES.
Part XI, Line 8 - Other Adjustments:EQUITY TRANSFER FROM AFFILIATES: -750000. CHANGE IN VALUE OF UNITRUST: 9161. UNREALIZED GAIN ON KIMBERLY TRUST: 27178. ASSETS RELEASED FROM RESTRICTION: 272857.
Part XII, Line 2d - Other Adjustments:ASSETS RELEASED FROM RESTRICTION: 6866.
Part XII, Line 4b - Other Adjustments:contributions not reflected on financial statements: 63725.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy0WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
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 Expense534203TotalCommunityBenefitExpense
Net Community Benefit Expense534203NetCommunityBenefitExpense
Percent Of Total Expense0.02250PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense2935070TotalCommunityBenefitExpense
Direct Offsetting Revenue1205447DirectOffsettingRevenue
Net Community Benefit Expense1729623NetCommunityBenefitExpense
Percent Of Total Expense0.07270PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense3469273TotalCommunityBenefitExpense
Direct Offsetting Revenue1205447DirectOffsettingRevenue
Net Community Benefit Expense2263826NetCommunityBenefitExpense
Percent Of Total Expense0.09520PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense17934TotalCommunityBenefitExpense
Net Community Benefit Expense17934NetCommunityBenefitExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense17934TotalCommunityBenefitExpense
Net Community Benefit Expense17934NetCommunityBenefitExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense3487207TotalCommunityBenefitExpense
Direct Offsetting Revenue1205447DirectOffsettingRevenue
Net Community Benefit Expense2281760NetCommunityBenefitExpense
Percent Of Total Expense0.09600PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs28NumberOfActivitiesOrPrograms
Total Community Building Expense12956TotalCommunityBuildingExpense
Net Community Building Expense12956NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs28NumberOfActivitiesOrPrograms
Total Community Building Expense12956TotalCommunityBuildingExpense
Net Community Building Expense12956NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,075,958BadDebtExpenseAmount
Amount Attributable To19785AmountAttributableTo
Amount Reimbursed By Medicare11567186AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare3842076CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall7725110MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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

Form990 Schedule H Part V Form990ScheduleHPartV

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 VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Costing Method UsedPart I, Line 7: THE ORGANIZATION UTILIZED THE IRS WORKSHEETS TO DETERMINE THE COST TO CHARGE RATIOCostingMethodUsed
Percent Of Total Expense ExplnPart I, Line 7f: THE TOTAL EXPENSE ON FORM 990 PART XI, LN 25 CONTAINS A BAD DEBT EXPENSE OF 3,239,344 THAT HAS BEEN REMOVED FOR CALCULATION OF CHARITY CARE PERCENTAGE.PercentOfTotalExpenseExpln
Bad Debt FootnotePart III, Line 4: THE PATIENT FINANCIAL ADVISOR REVIEWED THE FINANCIAL ASSISTANCE SPREADSHEETS FOR THE 2010 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.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: AN INTERNAL COST-TO-CHARGE RATIO WAS USED TO COMPUTE MEDICARE ALLOCABLE COSTS OF CARE ON PART III, LN 6.ShortfallAsCommunityBenefit
Debt Collection PolicyPart 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.DebtCollectionPolicy
Needs AssessmentPart 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 2010 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.NeedsAssessment
Patient Education AssistancePart 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.PatientEducationAssistance
Community InformationPart 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.CommunityInformation
Community Building ActivitiesPart VI, Line 5: *COMMUNITY BENEFIT PROGRAMSINCLUDES 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.CommunityBuildingActivities
Other InformationPart VI, Line 6: 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.OtherInformation
Reports Filed With StatesNCReportsFiledWithStates

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
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
021238800000009431022181900
DR BRIAN ROSENBERG
046200000010107600032182059525800
ALEXANDER BELL
517630207520001520807292095015000
ROBERT CRESS
1128000000010800027300126330000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 5THE ORGANIZATION'S CEO, CFO, AND COO PARTICIPATE IN ANNUAL INCENTIVE AWARD PROGRAM BASED ON VARIOUS PERFORMANCE BENCHMARKS INCLUDING: FINANCIAL PERFOMANCE, PATIENT SATISFACTION, AND PATIENT SERVICE DAYS.
Part I, Line 6THE ORGANIZATION'S CEO, CFO, AND COO 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 (6 entries)

IdentifierIdentifierExplanationExplanation
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 ON 04/27/11 TO COMPLETE A COMPREHENSIVE REVIEW OF THE FORM 990. THE ORGANIZATION HELD A FULL BOARD MEETING ON 04/28/11, 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 ON 04/28/11. 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.

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 NADirectControllingEntityNABusiness Name Line1DirectControllingEntityName/BusinessNameLine1
ST LUKE'S HEALTH CARE INC
101 HOSPITAL DRIVECOLUMBUSNC28722561423318CONTROLLING ENTITYNC501(c)(3)PFN/A
ST LUKE'S FOUNDATION INC
101 HOSPITAL DRIVECOLUMBUSNC28722561757097RAISES FUNDS TO HELP SUPPORT ST. LUKE'S HOSPITALNC501(c)(3)Line 7ST 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 3ST LUKE'S HEALTHCARE INC
COMMUNITY HEALTH CONNECTIONS
101 HOSPITAL DRIVECOLUMBUSNC28722561722387TO PROVIDE HOME BASED MEDICAL TREATMENT IN AND AROUND COLUMBUS, NCNC501(c)(3)Line 9ST 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 Org1LoansOrGuaranteesToOtherOrg
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 Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
ST LUKE'S FOUNDATION INC
D100329
ST LUKE'S PHYSICIAN NETWORK INC
D531207
COMMUNITY HEALTH CONNECTIONS
D6800
ST LUKE'S PROFESSIONAL BUILDING INC
D3183