2011-08-15T16:13:15-05:00 2010-09-30 LarsonAllen LLP 101 N Tryon Street Suite 1000 Charlotte NC 28246 990 2009-10-01 911997979 East Carolina Health Inc EAST 2528475129 2100 Stantonsburg Road Greenville NC 27835 Jack Holsten 2528478988 2011-08-15 1 7049985200 2009 2016-02-24 21:20:13Z roger robertson 2100 Stantonsburg Road Greenville NC 27835 180645922 1 1 8242 X www.uhseast.com X 1996 NC TO ENHANCE THE QUALITY AND MANAGEMENT OF NON-PROFIT HOSPITALS AND HEALTH CARE SYSTEM SERVICES. 7 6 2222 100 0 0 682500 476833 189470447 172503746 459728 369959 7883432 7267107 198496107 180617645 55000 25000 0 103455630 95371673 0 0 90150779 86240572 193661409 181637245 4834698 -1019600 170826277 162359398 129910206 137271693 40916071 25087705 TO ENHANCE THE QUALITY AND MANAGEMENT OF NON-PROFIT HOSPITALS AND HEALTH CARE SYSTEM SERVICES BY THE OPERATION OF COMMUNITY HEALTH SYSTEMS FOR THE BENEFIT OF THE CITIZENS OF NORTHEAST AND EASTERN NORTH CAROLINA.ABOVE ALL ELSE, WE ARE COMMITTED TO CARE AND IMPROVEMENT OF HUMAN LIFE. IN RECOGNITION OF THIS COMMITMENT, WE STRIVE TO DELIVER HIGH QUALITY, COST EFFECTIVE HEALTHCARE IN THE COMMUNITY WE SERVE. IN PURSUIT OF OUR MISSION, WE BELIEVE THE FOLLOWING VALUE STATEMENTS ARE ESSENTIAL AND timeless:-we recOGNIZE AND AFFIRM THE UNIQUE AND INTRINSIC WORTH OF EACH INDIVIDUAL-WE TREAT ALL THOSE WE SERVE WITH COMPASSION AND KINDNESS-WE ACT WITH ABSOLUTE HONESTY, INTEGRITY, AND FAIRNESS IN THE WAY WE CONDUCT OUR BUSINESS AND THE WAY WE LIVE OUR LIVES 0 0 15585842 16312477 Bertie Memorial HospitalBertie Memorial Hospital is a six-bed hospital in Windsor that provides surgical, emergency and diagnostic services, specialty clinics and primary care clinics. Our primary care physician practice operates the Cashie Medical Center, and we have a telemedicine link with the Brody School of Medicine at East Carolina University. 43992243 44375926 Chowan HospitalChowan Hospital is a 89 bed hospital that has been growing and expanding to serve your health needs for more than 60 years. Today, this modern facility, located in historic Edenton, provides services and programs to 45,000 people in four counties. We offer a wide range of services and health care specialties to residents of Chowan and surrounding counties. Chowan Hospital's partnership with University Health Systems of Eastern North Carolina gives our patients access to state-of-the-art services provided by an academic medical center. 60234028 63965619 Roanoke-Chowan HospitalRoanoke-Chowan Hospital is a 114-bed, not-for-profit hospital located in Ahoskie, NC. This modern facility provides a wide range of health services to about 39,000 residents in the four-county area. As part of University Health Systems, our hospital offers a wide range of services at its facilities in Ahoskie and in other Hertford County locations. 21927608 52392528 Heritage Hospitalheritage hospital is a full-service, 117-bed acute care facility where the residents of Tarboro, Edgecombe county and surrounding communities receive a wide range of health services close to home. 21927608 52392528 141739721 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 2222 1 0 0 0 0 0 0 0 0 0 7 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC X chris townsend 2528475129 2100 Stantonsburg Road Greenville NC 27835 Dave C McRae 40.00 X X 0 1556548 271792 Eli Anderson Warren 2.00 X 0 0 0 Ernest L Evans 2.00 X 0 0 0 Frances Duke Moye 2.00 X 0 0 0 Larkin Little 2.00 X 0 0 0 Mark W Owens jr 2.00 X 0 0 0 W David Harris 2.00 X 0 0 0 Jack Holsten 40.00 X 0 478967 287642 Lynn Lanier 40.00 X 0 179742 65004 Roger Robertson 40.00 X 0 293485 132820 Susan Lassiter 40.00 X 206763 0 107572 Jefferey Sackrison 40.00 X 237198 0 78424 Wendell Baker Jr 40.00 X 203156 0 60999 Edouard Misse 40.00 X 431570 0 330 Elizabeth Locascio 40.00 X 308091 0 4362 Jamie Udwadia 40.00 X 369809 0 3130 Rajinder Sidhu 40.00 X 307593 0 4368 Madhu Parmar 40.00 X 295733 0 3132 2359913 2508742 1019575 80 0 1 0 bunn medical associates 606 Ashburton Drive Greenvilee NC 27858 Physician 1694342 Alliance Imaging Inc PO Box 96485 Chicago IL 60693 Contract MRI Group 1125538 Diamond Healthcare Corp Federal Reserve Bank Bldg PO Box 85 richmond VA 23285 Contract Nurses 900090 Rehabcare Group Inc PO Box 502096 St Louis MO 63150 Rehab Management 711006 GE Healthcare PO Box 640200 Pittsburgh PA 15264 Equipment Services 554205 44 93728 135168 247937 476833 patient revenue 621400 172503746 172503746 172503746 369959 369959 0 93728 28277 -28277 -28277 intercompany revenue 900099 1919382 1919382 cafeteria revenue 900099 833198 833198 4542804 4542804 7295384 180617645 177046550 0 3094262 25000 25000 26652199 20877526 5774673 49540498 43151475 6389023 4131333 3414301 717032 9869379 8133136 1736243 5178264 4336150 842114 3518279 2424091 1094188 152460 95888 56572 172144 82718 89426 18166830 15032933 3133897 357841 224896 132945 4576568 3955815 620753 25276 3076 22200 3643019 2889171 753848 285517 199505 86012 105444 102633 2811 4470546 827780 3642766 6545810 2551748 3994062 8875693 5183851 3691842 3166061 1192274 1973787 program supplies 23918725 21844650 2074075 equipment costs 3258281 2881028 377253 recruiting 225333 101056 124277 accredidation expense 96844 66460 30384 4679901 2142560 2537341 181637245 141739721 39897524 0 15670515 15255257 215604 215604 35771498 28713566 5293913 5613446 904351 560262 169890572 97712743 73415437 72177829 39554959 39823434 170826277 162359398 19769269 16776495 7150936 6563225 102990001 113931973 129910206 137271693 X 32294411 16822050 8621660 8265655 40916071 25087705 170826277 162359398 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 801042 801042 93133037 50274608 42858429 69785738 44250103 25535635 6170755 3188032 2982723 72177829 intercompany receivable 1663700 other receivables 937844 DUE FROM RCA 7068051 ESTIMATED SETTLEMENTS FROM THIRD PARTY 1620688 TRUSTEE HELD FUNDS 4691635 restricted assets 235327 GOODWILL 22405850 BOND ISSUE COSTS, NET 1200339 39823434 THIRD PARTY PAYABLE 19058156 LEASE OBLIGATION 6600429 DUE TO AFFILIATES 88273388 113931973 60th anniversary capital campaign 93728 93728 600 27677 93728 93728 600 27677 28277 -28277 1 1 X 1 X 1 X 1 1 1 0 1 1 7711302 3174372 4536930 0.02500 9287591 9287591 0.05110 16998893 3174372 13824521 0.07610 3273471 770367 2503104 0.01380 343815 13859 329956 0.00180 241560 241560 753330 753330 0.00410 4612176 1025786 3586390 0.01970 21611069 4200158 17410911 0.09580 1 5 13502 13502 0.00010 6 41389 41389 0.00020 2 11794 11794 0.00010 6 78454 78454 0.00040 20 145139 145139 0.00080 1 11815139 0 72772187 79509119 -6736932 X 1 1 BERTIE MEMORIAL HOSPITAL

1403 South King Street windsor NC 27983

X X CHOWAN HOSPITAL

211 Virginia Road edenton NC 27932

X X HERITAGE HOSPITAL

111 Hospital Drive tarboro NC 27886

X X X X rehab ROANOKE CHOWAN HOSPITAL

500 South Academy Street ahoskie NC 27910

X X X physch Part I, Line 3c: To determine financial eligibility, the candidate must meet the Poverty Income Guidelines (200% of poverty), have limited assets and possess no real property other than their immediated dwelling. Part I, Line 6a: Reports are prepared for each individual hospital. Also, information regarding community benefits is included in the report for University Health Systems of Eastern Carolina. Part III, Line 4: in estimating the amount of the organization's bad debt expense account attributable to patients under the organization's charity care policy, operating expenses less community benefits and building expense were divided by gross patient charges. the percentage that resulted was multiplied against bad debt expense from the financial statements. 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: The organization 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 in each area. 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: See Schedule O. Part VI, Line 6: See Schedule O. Part VI, Line 7: See Schedule O. NC 1 Edgecombe Community College 2009 W Wilson St tarboro NC 27886 560897301 501(c)(3) 25000 nursing scholarships 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: according to the coporate policy, the oganization tracks expenses of grant funds and verifies that the grantors requirements are met. 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 Jack Holsten 0 413574 0 62776 0 2617 0 274997 0 12645 0 766609 0 0 Lynn Lanier 0 179367 0 0 0 375 0 61078 0 3926 0 244746 0 0 Roger Robertson 0 292547 0 0 0 938 0 123050 0 9770 0 426305 0 0 Susan Lassiter 206263 0 0 0 500 0 104850 0 2722 0 314335 0 0 0 Jefferey Sackrison 203488 0 32806 0 904 0 75998 0 2426 0 315622 0 0 0 Wendell Baker Jr 202382 0 0 0 774 0 55716 0 5283 0 264155 0 0 0 Edouard Misse 431570 0 0 0 0 0 0 0 330 0 431900 0 0 0 Elizabeth Locascio 308091 0 0 0 0 0 0 0 4362 0 312453 0 0 0 Jamie Udwadia 369809 0 0 0 0 0 0 0 3130 0 372939 0 0 0 Rajinder Sidhu 307593 0 0 0 0 0 0 0 4368 0 311961 0 0 0 Madhu Parmar 295733 0 0 0 0 0 0 0 3132 0 298865 0 0 0 Part I, Line 4b: dave c mcrae was a participant in a supplemental non-qualified retirement plan during the year. 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 East Carolina Health Inc. The compensation is determined by the ECH board using comparative data from like organizations and input from consultants. The compensation of key employees is determined by the ECH board using comparative data from like organizations and input from consultants. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interst policy, and combined financial statements available 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. Pitt Professional Services LLC 2100 Stantonsburg Road greenville NC 27835 383740839 healthcare NC 501(c)(3) University Health Systems of Eastern Carolina Inc 2100 Stantonsburg Road greenville NC 27835 562141073 healthcare NC 501(c)(3) YES PCMH Management Inc 2100 Stantonsburg Road greenville NC 27835 561690740 healthcare NC 501(c)(2) Surgicenter Services of Pitt Inc 2100 Stantonsburg Road greenville NC 27835 561690553 healthcare NC 501(c)(3) The Outer Banks Hospital Inc 2100 Stantonsburg Road greenville NC 27835 562112733 healthcare NC 501(c)(3) HealthAccess 2100 Stantonsburg Road greenville NC 27835 561396133 healthcare NC 501(c)(3) UHS Physicians LLC 2100 Stantonsburg Road greenville NC 27835 383740839 healthcare NC 501(c)(3) PITT COUNTY MEMORIAL HOSPITAL INC 2100 Stantonsburg Road greenville NC 27835 560585243 healthcare NC 501(c)(3) Surgicenter of Eastern Carolina LLC 2100 Stantonsburg Road Greenville NC 27835 262558314 NC 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 1 1 HealthAccess Inc K 108890 Pitt County Memorial Hospital Inc K 598870 The Outer Banks Hospital Inc K 128600 UHS Physicians LLC K 220480 University Health Systems of Eastern Carolina Inc I 78986 University Health Systems of Eastern Carolina Inc I 124129 University Health Systems of Eastern Carolina Inc I 223945 University Health Systems of Eastern Carolina Inc I 233114 University Health Systems of Eastern Carolina Inc I 3378349 University Health Systems of Eastern Carolina Inc K 101486 University Health Systems of Eastern Carolina Inc K 8352089 University Health Systems of Eastern Carolina Inc O 369042 University Health Systems of Eastern Carolina Inc P 53032 University Health Systems of Eastern Carolina Inc P 2018997