2017-05-15T13:34:42-05:00 2016-06-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2015-07-01 566052117 THE REX HEALTHCARE FOUNDATION INC REXH 9197844424 4420 LAKE BOONE TRAIL RALEIGH NC 27607 ANDREW ZUKOWSKI CFO 9197844424 2017-05-10 1 JOHN NORMAN P01506766 7049985200 2017-05-10 2015 2021-01-29 14:40:06Z REX HOSPITAL FOUNDATION STEPHEN BURRISS 4420 LAKE BOONE TRAIL RALEIGH NC 27607 9135555 0 X WWW.REXHEALTHCAREFOUNDATION.COM X 1958 NC TO PROVIDE OPPORTUNITIES FOR OUR COMMUNITY TO INVEST RESOURCES IN THE EXCELLENT WORK OF UNC REX HEALTHCARE. 13 9 8 9 0 0 2790934 4077373 0 0 453616 333578 -243377 -266498 3001173 4144453 4671891 1806619 0 0 729053 686255 197342 198849 1144448 283471 315006 5881757 3006729 -2880584 1137724 4480204 5173598 80511 99259 4399693 5074339 TO PROVIDE OPPORTUNITIES FOR OUR COMMUNITY TO INVEST RESOURCES IN THE EXCELLENT WORK OF UNC REX HEALTHCARE. 0 0 1806619 1806619 THE REX HEALTHCARE FOUNDATION SUPPORTS UNC REX HOSPITAL THROUGH A VARIETY OF PATIENT ASSISTANCE PROGRAMS, ASSISTS IN UPGRADING FACILITIES AND ACQUIRING THE MEDICAL EQUIPMENT NECESSARY TO CONTINUE EXCELLENT HEALTHCARE SERVICES. THESE PROGRAMS INCLUDE A MOBILE MAMMOGRAPHY UNIT THAT TRAVELS THE REGION PROVIDING FREE MAMMOGRAPHY SCREENING SERVICES TO UNDERSERVED PATIENTS, PATIENT ASSISTANCE THROUGH THE REX CANCER CENTER ANGEL FUND, NURSING EDUCATION, BLANKET WARMERS, PATIENT TRANSPORTATION TO TREATMENT AND MORE. 1806619 1 1 0 0 0 0 0 0 0 1 1 0 1 0 0 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 4 0 1 8 0 0 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X REX CORPORATE ACCOUNTING 9197843100 4420 LAKE BOONE TRAIL RALEIGH NC 27607 CATHARINE B ARROWOOD DIRECTOR 1.00 1.00 X 0 0 0 TERESA C ARTIS DIRECTOR 1.00 1.00 X 0 0 0 ANN S COLLINS MD DIRECTOR (AS OF 5/1/16) 1.00 1.00 X 0 0 0 COURTNEY A CROWDER DIRECTOR 1.00 1.00 X 0 0 0 PETER D HANS DIRECTOR 1.00 1.00 X 0 0 0 VINCENT D HOELLERICH MD DIRECTOR (LEFT 12/31/15) 1.00 1.00 X 0 0 0 STEVEN C LILLY DIRECTOR 1.00 1.00 X 0 0 0 C HOWARD NYE DIRECTOR 1.00 1.00 X 0 0 0 GARY L PARK DIRECTOR 1.00 1.00 X 0 935313 515089 BOBBY T PARKER DIRECTOR (AS OF 5/1/16) 1.00 1.00 X 0 0 0 RIG S PATEL MD DIRECTOR 1.00 1.00 X 0 63450 0 WILLIAM L ROPER MD DIRECTOR 1.00 1.00 X 0 944620 334530 ROBERT S THOMAS DIRECTOR/CHAIRMAN 1.00 1.00 X 0 0 0 STEPHEN W BURRISS DIRECTOR/PRESIDENT 1.00 59.00 X X 0 530972 120830 SYLVIA D HACKETT VICE PRESIDENT 1.00 59.00 X 0 338014 39814 DONALD R ESPOSITO JR SECRETARY (AS OF 1/1/16) 1.00 59.00 X 0 358292 29538 BERNADETTE M SPONG SECRETARY & TREASURER (LEFT 7/31/15) 1.00 59.00 X 0 298377 45485 JOHN E MILLER ASST SEC/ASST TREAS (LEFT 3/25/16) 1.00 59.00 X 0 255878 49114 AMY DANIELS DIRECTOR MAJOR GIFTS 40.00 0.00 X 0 151794 12724 KATHERINE STOKES MAJOR GIFT OFFICER 40.00 0.00 X 0 132747 14986 DAVID W STRONG FORMER PRESIDENT (LEFT 3/31/15) 1.00 59.00 X 0 1226662 16758 0 5236119 1178868 0 1 1 0 CAPITAL DEVELOPMENT SERVICES INC 633 W 4TH ST ST 202 WINSTON SALEM NC 27101 CONSULTING 201047 TCG EVENTS INC 2923 S TRYON ST SUITE 230 CHARLOTTE NC 28203 EVENT PLANNING 126765 GLOBAL GOLF MANAGEMENT 4741 N ARTESIAN AVE 1 CHICAGO IL 60625 EVENT PLANNING 108808 3 855822 755662 2465889 4077373 66878 66878 4753977 4487277 266700 266700 266700 237327 855822 503825 -266498 -266498 4144453 0 0 67080 1806619 1806619 569963 569963 15369 15369 65870 65870 35053 35053 198849 198849 28126 28126 155626 15563 140063 17563 1756 15807 43676 4368 39308 51194 5119 46075 3163 316 2847 396 40 356 15262 374 14888 3006729 1806619 55662 1144448 484498 987657 86070 1355526 22988 30194 15226 15226 396 0 3886252 2800221 4480204 5173598 80511 99259 80511 99259 X 0 4399693 5074339 4399693 5074339 4480204 5173598 1137724 -463078 0 X X 0 1 X 1 0 X X 1 REX HOSPITAL INC 561509260 3 0 1806619 0 1 1806619 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 PART IV, LINE 1 THE ORGANIZATION AND THE SUPPORTED ORGANIZATION, REX HOSPITAL, INC., HAVE A HISTORIC RELATIONSHIP THAT HAS BEEN ONGOING FROM THE FORMATION OF REX HEALTHCARE FOUNDATION. REX HOSPITAL, INC. IS THE ONLY SUPPORTED ORGANIZATION OF REX HEALTHCARE FOUNDATION. ALL OF THE FINANCIAL SUPPORT PROVIDED BY THE ORGANIZATION GOES TO REX HOSPITAL, INC. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 403891 403891 403891 403891 377441 26450 403891 323378 54063 377441 332040 16338 25000 323378 1.00000 0 0 15226 15226 0 0 CASH AND CASH EQUIVALENTS 165176 F EQUITIES 2635045 F 2800221 X PART V, LINE 4: THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO FURTHER THE MISSION OF REX HEALTHCARE FOUNDATION. PART X, LINE 2: THE FOLLOWING FOOTNOTE COMES FROM THE CONSOLIDATED FINANCIAL STATEMENTS OF REX HEALTHCARE, INC. AND SUBSIDIARIES, INCLUDING REX HEALTHCARE FOUNDATION, INC. THE FOOTNOTE REFERENCES OTHER MEMBERS OF THE AUDIT CONSOLIDATED GROUP THAT ARE NOT PART OF THIS TAX RETURN. REX, THE HOSPITAL, AND THE FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ENTERPRISES IS A TAXABLE CORPORATION THAT PREVIOUSLY HAD NET OPERATING LOSS CARRYFORWARDS WHICH EXPIRED IN 2012. THE HOSPITAL IS THE SOLE MEMBER OF RHV GP, RHVI, ROV, AND RSCW, AND ENTERPRISES IS THE SOLE MEMBER OF RWE. RWE IS THE SOLE MEMBER OF WELLNESS, MOB AND RHVLLC. AS SUCH THESE ENTITIES ARE CONSIDERED DISREGARDED ENTITIES FOR TAX PURPOSES. X X X X X X 1 CAPITAL DEVELOPMENT SVCS INC 633 W 4TH STREET SUITE 202 WINSTON SALEM NC 27101 CONSULTING 0 0 201047 -201047 201047 -201047 NC REX HOSPITAL OPEN 579229 420550 158679 13867 4474 178374 REX GALA 282715 251820 30895 7425 77973 2660 157491 1 231205 183452 47753 2533 30145 465 28418 1093149 855822 237327 16400 37570 82912 2660 364283 503825 -266498 0 REX HOSPITAL INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509260 501(C)(3) 1806619 GENERAL SUPPORT PART I, LINE 1 REX HEALTHCARE FOUNDATION'S SOLE RECIPIENT OF ASSISTANCE IS REX HOSPITAL, INC. THE TWO ORGANIZATIONS WORK CLOSELY TOGETHER, ALLOWING FOR REAL-TIME AND CONSISTENT MONITORING OF GRANTS. 0 1 0 0 0 0 1 0 0 GARY L PARK DIRECTOR 0 768891 0 142263 0 24159 0 496220 0 18869 0 1450402 0 0 WILLIAM L ROPER MD DIRECTOR 0 772345 0 140416 0 31859 0 315353 0 19177 0 1279150 0 0 STEPHEN W BURRISS DIRECTOR/PRESIDENT 0 387941 0 101197 0 41834 0 105286 0 15544 0 651802 0 0 SYLVIA D HACKETT VICE PRESIDENT 0 228607 0 73234 0 36173 0 30697 0 9117 0 377828 0 0 DONALD R ESPOSITO JR SECRETARY (AS OF 1/1/16) 0 358292 0 0 0 0 0 0 0 0 0 358292 0 0 BERNADETTE M SPONG SECRETARY & TREASURER (LEFT 7/31/15) 0 239842 0 0 0 58535 0 39295 0 6190 0 343862 0 0 JOHN E MILLER ASST SEC/ASST TREAS (LEFT 3/25/16) 0 209357 0 19394 0 27127 0 43721 0 5393 0 304992 0 0 AMY DANIELS DIRECTOR MAJOR GIFTS 0 134689 0 13419 0 3686 0 4784 0 7940 0 164518 0 0 DAVID W STRONG FORMER PRESIDENT (LEFT 3/31/15) 0 153361 0 0 0 1073301 0 13919 0 2839 0 1243420 0 246929 PART I, LINE 4B DURING THE CALENDAR YEAR 2015, DAVID STRONG, FORMER PRESIDENT, RECEIVED DISTRIBUTIONS FROM A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN TOTALING $246,929, FROM A RELATED ORGANIZATION. DURING THE CALENDAR YEAR 2015, STEVE BURRISS PARTICIPATED IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN FUNDED AND CONTROLLED BY A RELATED ORGANIZATION, UNC HEALTH CARE SYSTEM. HE EARNED COMPENSATION UNDER THIS PLAN TOTALING $47,346. THE CURRENT YEAR EARNINGS ARE PAYABLE IN THE FUTURE. DURING THE CALENDAR YEAR 2015, GARY PARK PARTICIPATED IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN FUNDED AND CONTROLLED BY A RELATED ORGANIZATION, UNC HEALTH CARE SYSTEM. HE EARNED COMPENSATION UNDER THIS PLAN TOTALING $350,913. THE CURRENT YEAR EARNINGS ARE PAYABLE IN THE FUTURE. DURING THE CALENDAR YEAR 2015, WILLIAM ROPER PARTICIPATED IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN FUNDED AND CONTROLLED BY A RELATED ORGANIZATION, UNC HEALTH CARE SYSTEM. HE EARNED COMPENSATION UNDER THIS PLAN TOTALING $191,592. THE CURRENT YEAR EARNINGS ARE PAYABLE IN THE FUTURE. PART I, LINE 6 EMPLOYEES IN MANAGERIAL ROLES PARTICIPATE IN AN ANNUAL INCENTIVE COMPENSATION PLAN. THE COMPENSATION EARNED UNDER THIS PLAN IS BASED PARTLY ON THE COMBINED EARNINGS OF REX HEALTHCARE, INC. AND ITS SUBSIDIARIES. ADDITIONALLY, THE INCENTIVE COMPENSATION OF THE PRESIDENT AND CFO IS BASED PARTLY ON THE EARNINGS OF THE UNC HEALTH CARE SYSTEM. OTHER PERFORMANCE MEASURES USED TO DETERMINE INCENTIVE COMPENSATION ARE PHYSICIAN SATISFACTION, PATIENT CARE QUALITY OUTCOMES, EFFECTIVE USE OF TECHNOLOGY AND INDIVIDUAL GOALS. FORM 990, PART VI, SECTION A, LINE 7A THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM APPOINTS ALL DIRECTORS ON THE ORGANIZATION'S BOARD OF TRUSTEES, WHICH SHALL NOT BE LESS THAN 9 NOR MORE THAN 13. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S BOARD REQUIRES PRIOR APPROVAL OF THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM FOR CERTAIN POWERS, INCLUDING BUT NOT LIMITED TO ADDITION OR DELETION OF A HEALTH CARE SERVICE, PARTICIPATION, DIRECTLY OR INDIRECTLY, IN A JOINT VENTURE, INDEBTEDNESS AND CAPITAL BUDGETS, OPERATING BUDGETS AND NON-BUDGETED MATERIAL EXPENDITURES. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S EXECUTIVE TEAM DISCUSSES AND REVIEWS THE FORM 990 AND ALL ASSOCIATED SCHEDULES THROUGHOUT THE INFORMATION GATHERING STAGE. THE FORM 990 AND ASSOCIATED SCHEDULES ARE THEN REVIEWED AND APPROVED BY THE BOARD AS A WHOLE. A COPY OF THE APPROVED FORM 990 ALONG WITH THE ASSOCIATED SCHEDULES IS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REQUIRING ALL BOARD MEMBERS TO ANNUALLY COMPLETE AND SIGN A QUESTIONNAIRE DOCUMENTING ANY AREA OF CONFLICT OF INTEREST. THE BOARD MEMBERS ARE REQUIRED TO REPORT AND DOCUMENT ANY NEW AREAS OF CONFLICT OF INTEREST AS THEY ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES AN INDEPENDENT CONSULTANT TO MEASURE FAIR VALUE OF COMPENSATION FOR THE ORGANIZATION'S PRESIDENT AND OTHER TOP MANAGEMENT. BOTH REX AND UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM BOARDS REVIEW AND APPROVE THE COMPENSATION FOR ALL OFFICERS EXCEPT THE ASSISTANT SECRETARY AND ASSISTANT TREASURER. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST AND ON GUIDESTAR'S WEBSITE AND THE FINANCIAL STATEMENTS ARE AVAILABLE ON MUNICIPAL SECURITIES RULEMAKING BOARD'S WEBSITE. THE ORGANIZATION DOES NOT MAKE OTHER GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. UNC HEALTH CARE SYSTEM 101 MANNING DRIVE CHAPEL HILL NC 27514 562206970 HEALTHCARE NC SECTION 115 UNC HEALTH CARE 0 UNC HOSPTIALS AT CHAPEL HILL 211 FRIDAY CENTER DR SUITE 2029 CHAPEL HILL NC 27517 561118388 HEALTHCARE NC SECTION 115 UNC HEALTH CARE 0 CALDWELL MEMORIAL HOSPITAL PO BOX 1890 LENIOR NC 28645 560554204 HEALTHCARE NC 501(C)(3) LINE 3 UNC HEALTH CARE 0 CALDWELL MEMORIAL HOSPITAL FOUNDATION PO BOX 1890 LENIOR NC 28645 581935514 SUPPORT OF CALDWELL NC 501(C)(3) LINE 7 CALDWELL MEMORIAL HOSPITAL 0 CHATHAM HOSPITAL INC PO BOX 649 SILER CITY NC 27344 560611546 HEALTHCARE NC 501(C)(3) LINE 3 UNC HEALTH CARE 0 HIGH POINT REGIONAL HEALTH 601 N ELM STREET HIGH POINT NC 27261 560632309 HEALTHCARE NC 501(C)(3) LINE 3 UNC HEALTH CARE 0 HIGH POINT REGIONAL HEALTH SERVICES 601 N ELM STREET HIGH POINT NC 27261 561497163 HEALTHCARE NC 501(C)(3) LINE 11B, II UNC HEALTH CARE 0 HIGH POINT REGIONAL HEALTH SERVICES FOUNDATION 601 N ELM STREET HIGH POINT NC 27261 272854711 SUPPORT OF HIGH POINT NC 501(C)(3) LINE 11A, I HIGH POINT REGIONAL HEALTH 0 REX HEALTHCARE INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509129 HEALTHCARE NC 501(C)(3) LINE 11A, I UNC HEALTH CARE 0 REX HOSPITAL INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509260 HEALTHCARE NC 501(C)(3) LINE 3 UNC HEALTH CARE 0 UNC PHYSICIANS NETWORK 1600 PERIMETER PARK DRIVE SUITE 225 MORRISVILLE NC 27560 271081647 HEALTHCARE NC 501(C)(3) LINE 9 UNC HEALTH CARE 0 REX SURGERY CENTER OF CARY 4420 LAKE BOONE TRAIL RALEIGH NC 27607 273684056 ASC NC N/A JRH VENTURES LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 274092967 MED CAMPUS DVLT NC N/A REX HEALTH VENTURES I LP 4420 LAKE BOONE TRAIL RALEIGH NC 27607 371690478 VENTURE CAPITAL INVEST NC N/A HIGH POINT SURGERY CENTER 600 NORTH LINDSAY STREET HIGH POINT NC 27260 561867005 HIGH POINT REGIONAL HEALTH NC N/A ORTHOPAEDIC SURGERY CENTER OF RALEIGH LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 271740526 ORTHOPAEDIC SURGERY NC N/A REGIONAL WELLNESS LLC 861 OLD WINSTON ROAD KERNERSVILLE NC 27284 204475769 HEALTHCARE NC RELATED 0 0 REX ENTERPRISES COMPANY INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561553957 OPERATIONS SUPPORT NC N/A C 0 HIGH POINT HEALTHCARE VENTURES 601 N ELM STREET HIGH POINT NC 27261 561343468 HOLDING COMPANY NC N/A C 0 UNC PHYSICIANS NETWORK GROUP PRACTICES LLC 1600 PERIMETER PARK DRIVE SUITE 225 MORRISVILLE NC 27560 461416986 HEALTHCARE NC N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0