2011-08-15T10:50:03-05:00 2010-09-30 LarsonAllen LLP 101 N Tryon Street Suite 1000 Charlotte NC 28246 990 2009-10-01 560585243 Pitt County Memorial Hospital Inc PITT 2528475129 2100 Stantonsburg Road Greenville NC 27835 David S Hughes 2528478988 2011-08-15 1 7049985200 2009 2016-02-24 21:20:13Z Steve Lawler 2100 Stantonsburg Road Greenville NC 27835 927874189 0 X www.uhseast.com X 1953 NC TO PROVIDE ACCESS TO QUALITY MEDICAL SERVICE TO all CITIZENS OF PITT COUNTY AND EASTERN NC. 20 17 7533 832 299281 -29269 1968978 782420 856056581 913172094 10675345 13778680 -111827 140995 868589077 927874189 2040944 1677366 0 408841132 421987304 0 0 430060161 455568434 840942237 879233104 27646840 48641085 995278195 1022702998 529287836 529612998 465990359 493090000 IN AFFILIATION WITH THE Brody SCHOOL OF MEDICINE, pitt county memorial hospital, inc. ("PCMH") IS COMMITTED TO PROVIDING ACCESS TO QUALITY MEDICAL SERVICEs TO ALL CITIZENS OF PITT COUNTY AND EASTERN NORTH CAROLINA. see also schedule O. 0 0 228553810 336917853 Cancer and clinical servicesPCMH Cancer Services include the most advanced treatments for the people of eastern North Carolina. We use the latest technologies, including Gamma Knife Radiosurgery, available to our expert medical staff, nurses and therapists. Combining national treatment protocols and the highest standards of clinical quality, our team of specialists take care of thousands of patients each year. In Cancer and Clinical Services during 2010, PCMH performed 2,187,435 lab tests, 137,260 radiology procedures, 1,321 PET scans, 71 Gamma Knife procedures, and 297,995 respiratory treatments. 220289495 218240615 Surgical ServicesSurgeons at Pitt County Memorial Hospital are leaders in their fields. Our bariatric surgeons were pioneers of gastric bypass surgery and now perform gastric banding as well. Other areas of surgical emphasis include: Orthopedics, Cardiothoracic, Gynecology, Trauma and General Surgery. PCMH surgical services performed 19,969 surgeries in 2010. 101915880 118804974 Cardiovascular ServicesPitt County Memorial Hospital provides patients with the latest treatments and technology available. We have nationally and internationally recognized physicians at the East Carolina Heart Institute, performing delicate heart surgeries and procedures using the daVinci robot. Our heart and vascular services include: stents, imaging studies, pacemaker placement, ablation, robot-assisted heart surgery, and heart failure programs. These and many more services are provided at the East Carolina Heart Institute at Pitt County Memorial Hospital, the first facility in North Carolina devoted exclusively to education, research, treatment and prevention of cardiovascular diseases. Cardiovascular services performed 58,873 EKGs, 6,296 Cardiac Cath Visits. 238039830 239208652 Other programs. 238039830 239208652 788799015 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 7533 1 1 1 0 0 0 0 0 0 0 0 20 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X chris townsend 2528475129 2100 Stantonsburg Road Greenville NC 27835 A Ray Rogers 2.00 X 0 0 0 Allan Harvin MD 2.00 X 0 0 0 Arthur H Keeney III 2.00 X 0 0 0 Bruce E Gray 2.00 X 0 0 0 Bruce N Austin 2.00 X 0 0 0 David H Womack 2.00 X 0 0 0 Janet M Bullock 2.00 X 0 0 0 Janice H Faulkner 2.00 X 0 0 0 Jeffery B Turner 2.00 X 0 0 0 Joanne K Burgdorff 2.00 X 0 0 0 Marcus S Albernaz MD 2.00 X 0 0 0 Melvin C McLawhorn 2.00 X 0 0 0 Noel L Baucom 2.00 X 0 0 0 Phillip K Flowers 4.00 X 0 0 0 R Kelly Barnhill 2.00 X 0 0 0 Ralph R Hall Jr 2.00 X 0 59516 59516 Thomasine Kennedy 2.00 X 0 0 0 W David Harris 2.00 X 0 0 0 Walter E Pofahl II MD 2.00 X 0 0 0 William J Jones Jr PhD 2.00 X 0 0 0 Dave C McRae 40.00 X X 0 1556548 271792 David Hughes 40.00 X 0 284768 80046 Diane Poole 40.00 X 370164 0 330240 Jack Holsten 40.00 X 0 478967 287642 LINda Hofler 40.00 X 178638 0 151377 Stephen Lawler 40.00 X 620586 0 202841 WILLIAM FLOYD 40.00 X 218154 0 36940 bRENT MALLEK 40.00 X 176731 0 144294 RYAN HICKEY 40.00 X 200037 0 26310 sAnjay Saha 40.00 X 201295 0 31119 ANNA Weaver 40.00 X 164235 0 125031 James Worden Jr 40.00 X 175682 0 18048 jOHN RANDALL 40.00 X 180282 0 18355 nANCY hART 40.00 X 167881 0 93659 STEPHEN KOSKA 40.00 X 174175 0 17217 2827860 2379799 1894427 257 0 1 0 ECU SCHOOL OF MEDICINE PO Box 75514 Charlotte NC 28275 Various 18024724 PITT COUNTY ANESTHESIA 2080 B Arlington Blvd Greenville NC 27834 CRNA Staff 7959999 GE MEDICAL SYSTEMS PO Box 402076 Atlanta GA 30384 Radiology Equipment Maintanence 2521373 CARILLION LAUNDRY SERVICE 2823 Franklin Rd SW Bld C Roanoke VA 24014 Laundry Services 1945387 QUEST DIAGNOSTICS 12436 Collections Center Drive Chicago IL 60693 Outside Lab Testing Service 1715615 95 782420 782420 PATIENT REVENUE 621400 913172094 913172094 913172094 13778680 13778680 Outside SErvices 900099 299281 299281 equity investment 900099 -158286 -158286 140995 927874189 913172094 299281 13620394 1677366 1677366 2888726 2888726 314048516 281432101 32616415 23013845 20482322 2531523 59571637 53660801 5910836 22464580 19993476 2471104 2471833 2471833 682347 564683 117664 120625698 103391907 17233791 826206 661014 165192 2486626 1904457 582169 592192 490656 101536 31616451 26275536 5340915 727815 462921 264894 17661056 17661056 57489437 47716233 9773204 12201687 5490758 6710929 program supplies 196748673 196748673 transplants costs 2969818 2969818 county taxes 2225927 2225927 vehicle expenses 827220 686593 140627 recruiting 767017 636624 130393 4648431 3420187 1228244 879233104 788799015 90434089 0 4961477 8502010 163169721 160399308 18977528 21944169 7509855 4561768 919419141 488862065 452786870 430557076 347872744 396738667 995278195 1022702998 106937000 104785320 422350836 424827678 529287836 529612998 X 465990359 493090000 465990359 493090000 995278195 1022702998 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 23345 23345 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: 23.25% of dues to NCHA are allocated to lobbying. 23302944 23302944 441341069 240766663 200574406 432465829 235924916 196540913 22309299 12170486 10138813 430557076 Other Receivables 24386383 trustee held funds - bonds 21803850 due from third party payors 35014388 trustee held funds - capital expenditures 276393000 investments in subsidiaries 20791152 trustee funds pension 14616367 Current Due from Affiliates 514383 other investments in subsidiaries 199550 Bond amortization 3019594 396738667 due to affiliates 391358830 due to third party payors 18861003 asset retirement obligation 350000 deferred gain 819883 serp payable 12889672 InterCompany A/P Due 548290 424827678 1 1 1 X 1 X 1 1 1 0 1 1 40783000 40783000 0.05060 17767607 17767607 0.02200 58550607 58550607 0.07260 29 173473 9626910 71917 9554993 0.01190 6 2810 546226 546226 0.00070 1 0 411549 411549 0.00050 6 4255 4493938 4493938 0.00560 42 180538 15078623 71917 15006706 0.01870 42 180538 73629230 71917 73557313 0.09130 3979 3979 0.00000 3000 3000 0.00000 1140559 1140559 0.00140 4680 4680 0.00000 22607 22607 0.00000 2351900 2351900 0.00290 3526725 3526725 0.00430 1 29865000 0 318368708 334313574 -15944866 X 1 1 SurgiCenter of Eastern Carolina LLC Ambulatory Surgery Center 0.55000 0.00000 0.00000 Onslow Radiation Oncology LLC Outpatient Radiation and Chemotherapy 0.50000 0.00000 0.00000 Moye Medical Endoscopy Center LLC Outpatient Endoscopy Services 0.50000 0.00000 0.00000 PITT COUNTY MEMORIAL HOSPITAL INC

2100 STANTONSBURG ROAD greenville NC 27835

X X X X X Part I, Line 3c: N/A. Part I, Line 6a: In addition to the community benefit report for PCMH, information regarding this entity is found in the annual report for University Health Systems of Eastern Carolina. Part I, Line 7: Costs were calculated using the cost to charge ratio from the Medicare Cost Report. Part I, Line 7g: N/A. Part III, Line 4: Line 2 costs were calculated using the cost to charge ratio from the Medicare Cost Report. Part III, Line 8: the shortfall of medicare revenue to medicare allowable costs of care could be considered community benefit because in the area served by the organization other providers would not be available to provide the services required. Therefore, the care would become a government obligation. Part III, Line 9b: PCMH does not pursue collection of amounts determined to qualify as charity care or determined to qualify for financial assistance. Part VI, Line 2: The organization assesses community need in conjunction with the state affiliated county health departments and other local health care organizations. See also Schedule O. Part VI, Line 3: Information is available on the organization's website and at registration for patients. In addition, face to face financial counseling is available to patients and their families in the Central Business Office. Part VI, Line 4: See Schedule O Part VI, Line 5: For additional information see Schedule O. Part VI, Line 6: For additional information see Schedule O. Part VI, Line 7: For additional information see schedule o. NC 1 Pitt Memorial Hospital Foundation PO Box 8469 greenville NC 27835 581399266 501(c)(3) 1652965 charity Outer Banks Hospital 4800 S Croatan Highway nags head NC 27959 562112733 501(c)(3) 6639 net book value Lobby Furniture charity Roanoke Chowan Hospital PO Box 1385 Ahoskie NC 27910 562003393 501(c)(3) 6639 net book value Lobby Furniture charity 3 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Grant Monitoring Primary oversight responsibility for all grants received by UHS organizations rests with the entity receiving the funds. Each entity is responsible for documenting the receipt of funds, assigning a cost center to track expenses and/or creating a restricted liability for deposit of the funds, documenting expenditures and completing all grantor required reporting. The compliance with the terms of the agreement related to project implementation and management, fund expenditures and reporting is monitored by the granting agency's designated contact person with assistance from the UHS Grants Office. Note: The majority of the grant funds received for programs at PCMH are acquired through the PMH Foundation which has a compliance audit completed each year. Grant Funds for UHS are sent to the UHS Foundation and have the same audit procedures. All grant funds are recorded/monitored by the Corporate Accountant and the Assistant Vice President of Financial Services. Selection Criteria/process Grants provided by the UHS and PMH Foundations require the applicant to be a 501(c)(3) or government entity and recipients are required to provide proof of their status by submitting a copy of their IRS letter of determination. Requests must be related to disease prevention and disease management or wellness. There are different health related focus areas for each of the hospital's community benefits grant programs. Each hospital's program has their own local community benefits grants review committee comprised of local representatives from their respective communities. These committees review letters of intent, decide which organizations are to be invited to submit a grant application, then review the grant applications and make funding recommendations. Their funding recommendations are then reviewed by the UHS Foundation Community Benefits Committee and final decisions are confirmed by the UHS Foundation Board. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 Dave C McRae 0 1023847 0 226290 0 306411 0 257929 0 13863 0 1828340 0 294157 David Hughes 0 265394 0 18785 0 589 0 73679 0 6367 0 364814 0 0 Diane Poole 342849 0 25134 0 2181 0 318701 0 11539 0 700404 0 0 0 Jack Holsten 0 413574 0 62776 0 2617 0 274997 0 12645 0 766609 0 0 LINda Hofler 166614 0 11669 0 355 0 146678 0 4699 0 330015 0 0 0 Stephen Lawler 523938 0 91653 0 4995 0 196474 0 6367 0 823427 0 0 0 WILLIAM FLOYD 203762 0 14175 0 217 0 36698 0 242 0 255094 0 0 0 bRENT MALLEK 164448 0 12000 0 283 0 131736 0 12558 0 321025 0 0 0 RYAN HICKEY 181000 0 15385 0 3652 0 26108 0 202 0 226347 0 0 0 sAnjay Saha 189270 0 12025 0 0 0 26419 0 4700 0 232414 0 0 0 ANNA Weaver 151366 0 12503 0 366 0 119851 0 5180 0 289266 0 0 0 James Worden Jr 175682 0 0 0 0 0 13414 0 4634 0 193730 0 0 0 jOHN RANDALL 180282 0 0 0 0 0 13606 0 4749 0 198637 0 0 0 nANCY hART 167881 0 0 0 0 0 90591 0 3068 0 261540 0 0 0 STEPHEN KOSKA 174175 0 0 0 0 0 13284 0 3933 0 191392 0 0 0 Part I, Line 1a Housing allowance consisted of $3,600 to Todd Hickey. Part I, Line 4b: dave c mcrae was a participant in a supplemental non-qualified retirement plan during the year. Surgicenter of Eastern Carolina LLC Surgicenter of Eastern Carolina, LLC is 55% owned by pcmh. 6116167 officers of PCMH are also officers of this LLC. Several transactions took place during the year between PCMH and Surgicenter of Eastern Carolina, LLC. See Schedule R for details. 0 Form 990, Part VI, Section B, line 11 The 990 is made available to board members by posting to a board member's website. Any board member who does not have the ability to access the return in this manner will receive a copy via electronic or regular mail. The return is also reviewed by the Chief Financial Officer, Chief General Counsel and the Chief Audit and Compliance officer of University Health Systems prior to filing. Form 990, Part VI, Section B, line 12c All board members are required to complete a comprehensive conflict of interest questionnaire. These are reviewed by legal counsel and any potential or actual conflicts are brought to the board for disposition. Board members are required to recuse themselves from voting on issues in which they are deemed to have a conflict. Form 990, Part VI, Section B, line 15 The top management official is the president who is an employee of Pitt County Memorial Hospital. The compensation is determined by the UHSEC board using comparative data from like organizations and input from consultants. This process is performed every three years, the last year being 2010. It will be performed again in 2013. 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. Form 990, Part XI Line 2c: No changes for approving audited financial statements or selection of independent accountants have occurred from the prior year. form 990, part 1, line 1: Overview of University Health Systems of Eastern Carolina At University Health Systems of Eastern Carolina (UHS), we are committed to improving the health of our communities. Eastern North Carolina residents look to our hospitals for quality health care. We work hard to uphold the trust that our communities place in us. Through a clear vision, disciplined leadership and committed employees, UHS serves the needs of the region, including those who are underserved and need us the most. Our mission at UHS - to enhance the quality of life for the people and communities we serve, touch and support - drives us far beyond caring for patients within the confines of our hospital walls. It calls us to help make eastern North Carolina a better, healthier place to live. UHS is a North Carolina non-profit corporation with headquarters in Greenville, North Carolina. UHS and its affiliates operate an integrated health care delivery system that serves a total market of approximately 1.3 million people in 29 contiguous counties in eastern North Carolina. The Health System includes hospitals, physician practices, outpatient services, long-term care, home health, hospice, and wellness services. The Health System's owned hospitals are Pitt County Memorial Hospital (PCMH), which is a tertiary care hospital and an academic medical center, and five other acute care hospitals: Roanoke-Chowan Hospital, Heritage Hospital, Chowan Hospital, Bertie Memorial Hospital, and The Outer Banks Hospital. UHS also manages Albemarle Hospital and Duplin General Hospital. PCMH serves as the teaching hospital for the Brody School of Medicine, East Carolina Schools of Nursing and Allied Health and Pitt Community College. The system also serves as a regional referral center for eastern North Carolina. The System's six owned acute care hospitals are licensed to operate 1,208 beds. Each hospital is licensed by the Division of Facility Services of the North Carolina Department of Health and Human Services and approved as a provider by the Medicare and Medicaid programs. UHS and its hospitals and affiliate organizations provide services to patients without regard to their ability to pay. In fiscal year 2010 UHS' combined patient care statistics were: inpatient admissions, 56,622; inpatient days of care, 318,144; surgeries, 41,101; births, 5,397; and outpatient visits, 399,337. Our System's workforce included 11,215 employees. Each of UHS' hospitals operates an emergency room, which is open 24 hours a day. PCMH also offers a full spectrum of trauma services. Emergent and trauma services are provided to patients without regard to their ability to pay. In fiscal year 2010 UHS provided care to 194,408 emergency room patients. UHS and PCMH have the same governing board, which is comprised of 20 voting members that meet monthly. The Board of Commissioners of Pitt County appoints 11 members, and 9 members are appointed by the Board of Governors of the University of North Carolina. The board members have diverse backgrounds and are selected to represent the citizens of eastern Carolina. PCMH, in affiliation with the Brody School of Medicine, which is owned by the State of North Carolina, operates 30 resident-training programs with over 340 medical residents. This relationship enables PCMH and the Brody School of Medicine to combine their resources for the provision of quality patient care, medical education and research for the residents of eastern North Carolina. The Brody School of Medicine has three important goals: educating primary care physicians, making medical care more readily available to the people of eastern North Carolina, and providing opportunities to minority and disadvantaged students. As a non-profit organization, UHS reinvests all excess of revenues over expenses in programs, services, and facilities that provide access to patient care and health services to the citizens of eastern Carolina. Overview of University Health Systems of Eastern Carolina Community Benefit Programs 1. Eastern North Carolina is comprised of 1.3 million people living in 14,000 square miles. Boundaries are from I-95 East to the coast, and from the Virginia line up to and including Onslow County. The area is largely rural and largely poor, with higher than state or national average rates for poverty and uninsured. Health status indicators show increased incidence of disease in the region, especially cancer, heart disease and stroke. UHS determines priorities for target populations by working in concert with medical and community agency partners in ongoing assessment of the most pressing health care needs. Many efforts over the past decade have focused on diabetes, pediatric asthma, school health, injury prevention, access to care, nutrition enhancement, physical activities and chronic disease screenings. Also, special programs to manage the care of Medicaid enrollees, address access to both medical care and medications for the uninsured, and coordination of services for Children with obesity have been undertaken. The populations that are served by addressing these issues are largely the poor, the underserved, and minorities. Determination of specific populations to address occurs when partners such as the North Carolina Department of Health and Human Services, local health departments, county Healthy Carolinian task forces, and physicians identify a quantifiable need, and community partners are engaged to work together with the health system. 2. Funding for community health programs is obtained from both the operating funds of UHS entities and external grant-awarding organizations. The UHS Board annually provides financial support for the Community Benefit Initiatives program of its foundation. These funds are then awarded to community agencies that successfully demonstrate both need and a well-designed plan to address one of the Foundation's priority categories. In addition, each UHS hospital financially supports community health resources within its operating budget. Programs vary according to the hospital's financial ability and community need, but all include collaborative efforts with local health departments, including health screenings and education to targeted populations. UHS also has a successful track record of obtaining community health program support from external agencies that award grant funding to approved projects. The UHS Grants Office was established in 2008 and serves as the central point for grant mining, acquisition and management of grants awarded to UHS hospitals for community-based programs. Grant funds are utilized to demonstrate the effectiveness of a proposed community program, measure the outcomes achieved, and garner long-term sustainability from either the health system, other community agencies or as a collaborative program. Many community health programs are collaborative in nature with local service agencies, and often a portion of the grant funds are used to support resources or services in these agencies. 3. Community health priorities are determined in several ways. In partnership with the local health departments, the results of state-mandated community health assessments are studied by each local Healthy Carolinians task force. Those task force groups then compile a list of the most pressing issues in their communities based on data community input. Both established resources within various agencies and potential opportunities to garner new support are reviewed. 4. Community priorities are also established in response to a compelling need identified by health practitioners or community groups. Examples include the pediatric asthma program that has been in place for over 10 years in Pitt County, and expanded to other communities in the region. This major community-based program was established following a plea for assistance by pediatricians and pediatric clinical nurse specialists caring for children with asthma in the acute care setting. The Pitt County School System and local parents identified a lack of health care support in the schools, resulting in an award-winning school nurse program that has been replicated in several counties. Most recently, the focused attention on pediatric obesity and associated diseases has resulted in multiple community-based programs directed at improving nutrition, physical activity, and case management for that population. UHS is fortunate to have a strong collaborative partnership with East Carolina University, and works closely with the schools within the Health Sciences Division, especially the Brody School of Medicine. BSOM is an active participant in almost every community health initiative, supporting the research and evaluation of these programs, and contributes to programs for the under and uninsured in multiple ways. ECU and other educational institutions whose students matriculate through UHS facilities also provide opportunities for collaboration and participation in various community health initiatives. 5. Provided below are a few highlights of the community benefit and education activities: a. Community Health Improvement Services - Community health improvement services are programs and services that meet an identified need and are offered to the community at little or no charge. UHS hospitals sponsor programs that improve access to health care for the underserved and enhance the identification and management of chronic diseases, such as cancer, diabetes and heart disease. Here are a few examples of these programs: -Medication assistance programs for uninsured patients -The Pediatric Healthy Weight Program -Support for Health Carolinians collaboratives, including Pitt Partners for Health, the Hertford Partnership for Health and Three Rivers Healthy Carolinians -School nurse programs -Support for the Community Care Plan of Eastern Carolina for Medicaid recipients and HealthAssist for the uninsured -Support of local Federally Qualified Health Center b. Health Professional Education - Preparing future health care professionals is important to us. Our hospitals provide clinical settings for students of health professions, such as future physicians, nurses and other allied health professionals. We also support students through deferred forgivable loans and internships including resident training, nursing clinic sites, allied health professionals, and financial support of nursing programs. c. Research - East Carolina University (ECU) conducts research to evaluate new treatments and protocols. These studies help health professionals everywhere provide quality care to patients. UHS supports this through various means including supporting the Institutional Review Board at ECU and providing study sites. d. Financial and In-Kind Contributions - UHS donates money and in-kind services to community groups and activities that share our mission of improving health. They include Meals on Wheels, American Red Cross blood drives, medical supplies to emergency medical services, and free medications to qualifying patients. UHS hospitals are key partners in fundraising for organizations such as the United Way, American Heart Association, Juvenile Diabetes Association and the American Cancer Society. UHS contributed $1.6 million to the Community Benefits Grants Program which awards grants to local non-profits for health related programs. e. Community Building - Community-building activities include programs that are not directly related to health care but address underlying issues that impact the health of communities. Poverty, crime, homelessness, workforce development and economic development all affect the overall health of communities. UHS has provided support for our local Chambers of Commerce, financial support for road improvements, investments in communication infrastructure via information technology connections, support for the Teen leadership Academy, recruitment of physicians to our rural communities, and programs that encourage students to pursue health careers. 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