2014-05-14T15:34:21-05:00 2013-06-30 410746749 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2012-07-01 561509260 REX HOSPITAL INC DBA REX HEALTHCARE REXH 9197843100 4420 LAKE BOONE TRAIL RALEIGH NC 27607 BERNADETTE SPONG 9197843100 2014-05-14 1 JOHN NORMAN P01506766 7049985200 2012 2015-11-30 17:44:51Z REX HEALTHCARE DAVID STRONG 4420 LAKE BOONE TRAIL RALEIGH NC 27607 808617852 0 X WWW.REXHEALTH.COM X 1986 NC TO PROVIDE THE BEST IN HEALTH SERVICES BY COMBINING COMPASSIONATE CARE AND LEADING-EDGE TECHNOLOGY. 13 10 6135 1306 26804383 -88548 1299788 975759 644337655 687457216 7670039 12242463 670719 380143 653978201 701055581 1299739 1602202 0 0 323961798 348242512 0 0 0 287746484 343955728 613008021 693800442 40970180 7255139 671610346 707307283 220279220 231549288 451331126 475757995 X SEE SCHEDULE OREX HEALTHCARE PROVIDES THE BEST IN HEALTH SERVICES BY COMBINING COMPASSIONATE CARE AND LEADING-EDGE TECHNOLOGY. REX PROVIDES SERVICES AT FACILITIES ACROSS WAKE COUNTY TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. REX ALSO SEEKS TO IMPROVE THE HEALTH OF THE COMMUNITY BY PROVIDING EDUCATION, DIAGNOSTIC AND PREVENTATIVE CARE, OFTEN BY JOINING FORCES WITH OTHER COMMUNITY GROUPS. IN ADDITION TO ITS MAIN RALEIGH CAMPU 0 0 44258626 66770682 CARDIOLOGY SERVICES: THE REX HEART & VASCULAR CENTER PERFORMS MORE THAN 22,000 PROCEDURES A YEAR, INCLUDING CORONARY ARTERY BYPASS GRAFTING, ECHOCARDIOGRAPHY, VALVE REPLACEMENT AND REPAIR, ANGIOPLASTY, CARDIAC CATHETERIZATION AND STENT PLACEMENT. REX PROVIDES COMPASSIONATE CARE TO ALL PATIENTS, INCLUDING THOSE ON MEDICARE, MEDICAID AND THE UNINSURED OR UNDERINSURED. REX HAS BEEN A CHEST PAIN ACCREDITED HOSPITAL FOR NINE YEARS, REINFORCING THE ORGANIZATION'S DEDICATION TO COMMUNITY OUTREACH AND INNOVATION IN THE CARE OF CHEST PAIN PATIENTS. IN ADDITION, HOSPITAL COMPARE RATED REX BEST FOR HEART ATTACK SURVIVAL IN WAKE COUNTY. 43585706 83321716 GENERAL SURGERY: REX SURGERY CENTERS IN RALEIGH, CARY AND WAKEFIELD ARE USED BY MORE THAN 425 PHYSICIANS AND PROVIDE IN- AND OUTPATIENT SERVICES TO 40,000 PATIENTS A YEAR, REGARDLESS OF THEIR ABILITY TO PAY. THE THREE LOCATIONS HAVE IMPROVED ACCESS TO SPECIALIZED CARE FOR PATIENTS ACROSS THE REGION. SURGEONS MAKE SUBSTANTIAL USE OF MINIMALLY INVASIVE TECHNOLOGY FOR DIAGNOSIS AND TREATMENT, REDUCING PATIENTS' RECOVERY TIME AND HOSPITAL STAY. FOR EXAMPLE, REX HAS THREE DAVINCI SURGICAL ROBOTS USED FOR UROLOGY, GYNECOLOGY AND GENERAL SURGERIES. THE CENTERS INCLUDE 34 OPERATING SUITES, EIGHT MINOR PROCEDURE ROOMS, AND VARIOUS PERIOPERATIVE AND ANCILLARY SUPPORT SPACES. REX IS INCREASINGLY PERFORMING SURGERIES ON AN OUTPATIENT BASIS, AND CONTINUING TO LOOK FOR OTHER WAYS TO REDUCE OVERALL COSTS FOR PATIENTS. SOME OF THE TOP PROCEDURES INCLUDE HERNIA REPAIR, GALLBLADDER REMOVAL, BARIATRIC SURGERY, BOWEL SURGERY AND BREAST SURGERIES. 36872571 71349280 ORTHOPEDICS: REX HEALTHCARE'S ORTHOPEDIC SERVICES PROVIDE IMPORTANT CARE FOR AN INCREASING NUMBER OF PATIENTS. THAT GROWTH IS DRIVEN BY THIS REGION'S AGING POPULATION, MORE SPORTS MEDICINE PATIENTS, IMPROVEMENTS IN TREATMENT AND TECHNOLOGY, AND OTHER FACTORS. REX FACILITIES IN RALEIGH, CARY AND WAKEFIELD SAW MORE THAN 9,500 ORTHOPEDIC PATIENTS DURING THE FISCAL YEAR. THE MOST COMMON PROCEDURES INCLUDE REPLACEMENT OF TOTAL JOINTS (HIPS, KNEES, SHOULDERS), ARTHROSCOPIES AND REPAIRING FRACTURES OR DISLOCATIONS). REX WORKS CLOSELY WITH ITS AFFILIATED SURGEONS AND COMMUNITY PHYSICIANS TO ENSURE THAT IT PROVIDES ACCESS TO ALL PATIENTS REQUIRING ORTHOPEDIC CARE, REGARDLESS OF THEIR ABILITY TO PAY. 505719140 1602202 434828056 OTHER PROGRAM SERVICES: REX PROVIDES A FULL RANGE OF ONCOLOGY THERAPY AND SUPPORT SERVICES TO ALL PATIENTS IN WAKE COUNTY AND BEYOND, REGARDLESS OF THEIR ABILITY TO PAY. AT THE MAIN RALEIGH CANCER CENTER AND A SATELLITE FACILITY IN WAKEFIELD, REX PROVIDED MORE THAN 25,500 RADIATION ONCOLOGY TREATMENTS, 12,000 CHEMOTHERAPY TREATMENTS AND 19,500 HEMATOLOGY ONCOLOGY VISITS. THE CENTERS ALSO HELP PATIENTS NAVIGATE THEIR CARE AND OFFER COUNSELING, REHABILITATION AND MORE. THROUGH REX'S PARTNERSHIP WITH JOHNSTON HEALTH, WE PROVIDED ABOUT 5,500 RADIATION ONCOLOGY TREATMENTS AT CLINICS IN SMITHFIELD AND CLAYTON.AT REX'S WOMEN'S AND CHILDREN'S CENTER, CAREGIVERS SEEK TO PROVIDE FAMILY-CENTERED CARE TO THE NEW MOTHER, BABY AND EXTENDED FAMILY, WITHOUT REGARD TO ABILITY TO PAY. MORE THAN 5,300 BABIES ARE BORN IN THE REX WOMEN'S CENTER EACH YEAR. THESE BIRTHS ARE SUPPORTED BY 24/7 ANESTHESIOLOGY AND NEONATOLOGY SERVICES, HIGH RISK OBSTETRICS PROVIDED BY UNC MATERNAL FETAL MEDICINE, LACTATION SUPPORT SERVICES PROVIDED BY A TEAM OF CERTIFIED LACTATION CONSULTANTS AND AN IN-HOUSE RETAIL CENTER FOR INFANT NUTRITION. REX ALSO OFFERS A WIDE VARIETY OF PRE- AND POST-NATAL CLASSES, SCREENING FOR POSTPARTUM DEPRESSION AND PSYCHOLOGICAL SERVICES. 505719140 1602202 434828056 630436043 1 1 0 1 0 0 0 0 1 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 324 0 6135 1 1 1 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X BERNADETTE SPONG 9197843100 4420 LAKE BOONE TRAIL RALEIGH NC 27607 A DALE JENKINS 4.00 1.00 X 0 0 0 VINCENT L HOELLERICH MD 1.00 1.00 X 0 0 0 JAMES B HYLER JR 1.00 1.00 X 0 0 0 DARLEEN M JOHNS 1.00 1.00 X 0 0 0 JEFFREY J LYASH 1.00 1.00 X 0 0 0 GARY L PARK 4.00 56.00 X X 0 708034 238791 ORAGE QUARLES III 1.00 1.00 X 0 0 0 WILLIAM L ROPER MD 4.00 56.00 X 0 758827 157629 MARK A STRIEBEL 1.00 1.00 X 0 0 0 ROBERT S THOMAS 1.00 1.00 X 0 0 0 DAVID STRONG 59.00 1.00 X X 1312317 0 267356 TERESA C ARTIS 1.00 1.00 X 0 0 0 C HOWARD NYE 1.00 1.00 X 0 0 0 STEVEN C LILLY 1.00 1.00 X 0 0 0 RIG S PATEL MD 1.00 1.00 X 0 0 0 BERNADETTE SPONG 59.00 1.00 X 410959 0 37434 MARY LOU POWELL 59.00 1.00 X 350256 0 80610 STEPHEN W BURRISS 59.00 1.00 X 367091 0 47597 NOVLET M BRADSHAW 59.00 1.00 X 266827 0 31943 LINDA H BUTLER MD 59.00 1.00 X 280325 0 32983 DONALD ESPOSITO JR 59.00 1.00 X 308315 0 41989 SYLVIA HACKETT 59.00 1.00 X 272634 0 57600 R ERICK HAWKINS 59.00 1.00 X 305927 0 32866 CHAD T LEFTERIS 59.00 1.00 X 232910 0 22269 LISA SCHILLER 59.00 1.00 X 212372 0 38114 JAYNE R BYRD 59.00 1.00 X 229807 0 148636 MICHELLE L GRAY 59.00 1.00 X 164508 0 25481 ROBERT D RICKER 59.00 1.00 X 241157 0 77449 TAMMIE T STANTON 59.00 1.00 X 0 248245 40217 TOM G WILLIAMS 59.00 1.00 X 197486 0 43575 JOHN STORMENT 59.00 1.00 X 0 179177 31923 JEFFREY CRANE MD 60.00 X 674308 0 63759 ROBERT WEHBIE MD 60.00 X 584309 0 61365 LANCE LANDVATER MD 60.00 X 1208273 0 28691 O ROBERT MENDES MD 60.00 X 826314 0 23598 ROBERT PEYTON MD 60.00 X 797093 0 21393 9243188 1894283 1653268 255 0 1 0 SRISURGICAL EXPRESS PO BOX 405495 ATLANTA GA 30384 MEDICAL 7705319 SKANSKA USA BUILDING INC 4309 EMPEROR BLVD STE 200 DURHAM NC 27703 CONSTRUCTION 7024529 WHR DESIGN PC 1111 LOUISIANA 26TH FLOOR HOUSTON TX 77002 ARCHITECTURAL DESIGN 2753902 CUSTOM CRAFT PAINTING 9329 HOLLY SPRINGS ROAD APEX NC 27539 REPAIRS/REMODELING 2490247 THE OUTSOURCE GROUP 39867 TREASURY CENTER CHICAGO IL 60694 COLLECTIONS 2354620 71 968359 7400 975759 GENERAL SURGERY 625100 83321716 83321716 ORTHOPEDICS 625100 71349280 71349280 CARDIOLOGY 625100 66770682 66770682 WOMEN'S & CHILDREN 625100 60978592 60978592 ONCOLOGY 625100 51544345 51544345 353492601 322054119 26804383 4634099 687457216 4172367 4172367 879527 181116 698411 698411 698411 115451251 107381155 8070096 8070096 8070096 -318268 -318268 -318268 701055581 656018734 26804383 17256705 1602202 1602202 5885705 5885705 271275734 240951842 30323892 17536989 16109845 1427144 34492954 30649791 3843163 19051130 16678895 2372235 1075333 1075333 156748 156748 68943 68943 1057032 1057032 39267995 35341196 3926799 6515696 5864126 651570 8423091 7580782 842309 29669496 26702546 2966950 17957256 16161531 1795725 1513896 1362506 151390 738194 730812 7382 3197727 2877954 319773 38017074 38017074 29796561 26816905 2979656 4243640 3819276 424364 PATIENT SUPPLIES & SERV 130684748 130684748 REPAIRS AND MAINTENANCE 9125589 8213030 912559 MINOR EQUIPMENT 1371173 1234056 137117 21075536 18967983 2107553 693800442 630436043 63364399 0 4580508 18160406 54375903 48053150 87574839 79254361 257469 152348 10102069 11249476 6913094 4531455 659067663 405852531 257752515 253215132 185366410 195088183 45179714 50844894 19507825 46757878 671610346 707307283 87141044 103509812 116637 686721 124858924 119988994 14683 10719 8147932 7353042 220279220 231549288 X 450333869 474746039 997257 1011956 451331126 475757995 671610346 707307283 7255139 17171730 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 68943 68943 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: REX HEALTHCARE BELIEVES IN MAINTAINING STRONG, OPEN AND EFFECTIVE RELATIONSHIPS WITH ELECTED OFFICIALS AND POLICY MAKERS AT THE LOCAL, STATE AND NATIONAL LEVELS. THE OBJECTIVE IS TO EDUCATE THESE GROUPS ON HEALTHCARE ISSUES, TO SERVE AS A RESOURCE, AND TO COMMUNICATE REX'S POSITION IN SUPPORT OF ITS MISSION. AS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND NCHA, A PERCENTAGE OF REX'S MEMBERSHIP DUES ARE ATTRIBUTED TO LOBBYING ACTIVITIES. 0 1 X 25788332 25788332 154142499 93427773 60714726 17819620 4649400 13170220 333252001 259872975 73379026 128065211 47902383 80162828 253215132 6099349 C BOND TRUSTEE FUNDS 18 F HEDGE FUNDS 44745527 F 50844894 INTERCOMPANY 45285837 RETIREMENT PLAN ASSET 91160 BOND ISSUE COST 1163390 DEFERRED LEASE ASSET 217491 46757878 CAPITAL LEASE 1643846 ESTIMATED PROFESSIONAL LIABILITY RESERVE 623687 DEFERRED LEASE LIABILITY 3186431 CONTRACT COMMITMENT 1899078 7353042 X PART IV, LINE 2B: THE ORGANIZATION HOLDS CASH IN TRUST FOR THE RESIDENTS OF THE NURSING HOME FACILITIES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE FOLLOWING FOOTNOTE COMES FROM THE CONSOLIDATED FINANCIAL STATEMENTS OF REX HOSPITAL, INC. D/B/A REX HEALTHCARE. THE FOOTNOTE REFERENCES OTHER MEMBERS OF THE AUDIT CONSOLIDATED GROUP THAT ARE NOT PART OF THIS TAX RETURN: REX, THE HOSPITAL, THE FOUNDATION, AND HOME SERVICES 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. PHYSICIANS IS A SINGLE MEMBER LIMITED LIABILITY COMPANY THAT HAS ELECTED TO BE TAXED AS A FOR-PROFIT CORPORATION. PHYSICIANS HAD A NET OPERATING LOSS IN 2013 AND 2012. PART VII, LINE 2: CLOSELY-HELD EQUITY INTERESTS ARE VALUED ACCORDING TO THE EQUITY METHOD OF ACCOUNTING UNDER US GAAP WHICH REPRESENTS INITIAL COSTS ADJUSTED FOR OUR ALLOCABLE SHARE OF THE NET EARNINGS OR LOSSES OF THE INVESTMENT. 1 1 X 1 X 250.000000000000 1 X 250.000000000000 1 1 1 0 1 1 28583689 28583689 0.04120 31258761 24374859 6883902 0.00990 59842450 24374859 35467591 0.05110 2713 2713 0.00000 1355360 1355360 0.00200 341542 341542 0.00050 736934 736934 0.00110 2436549 2436549 0.00360 62278999 24374859 37904140 0.05470 0 11719317 240720390 303378127 -62657737 X 1 1 1 REX SURGERY CENTER OF CARY LLC AMBULATORY SURGICAL CENTER 0.55000 0.00000 0.45000 1 1 REX HOSPITAL INC

4420 LAKE BOONE TRAIL RALEIGH NC 27607

WWW.REXHEALTH.COM X REX HOSPITAL INC 1 1 X X X X X X X X 12 1 1 1 X X X X X X X X 0 0 1 1 250.000000000000 1 250.000000000000 1 X X X X X X X X 1 1 X X X X 1 X 1 X X X X X 1 X 0 0 12 REX HEALTHCARE OF WAKEFIELD

11200 GOVERNOR MANLY WAY RALEIGH NC 27614

HEALTHCARE REX HEALTHCARE OF CARY

1505 SW CARY PARKWAY CARY NC 27511

HEALTHCARE REX HEALTHCARE OF KNIGHTDALE

6602 KNIGHTDALE BOULEVARD 102 KNIGHTDALE NC 27545

HEALTHCARE REX REHABILITATION AND NURSING CARE CENT

4210 LAKE BOONE TRAIL RALEIGH NC 27607

NURSING FACILITY REX REHABILITATION AND NURSING CARE CENT

911 SOUTH HUGHES STREET APEX NC 27502

NURSING FACILITY REX WELLNESS CENTER OF WAKEFIELD

11200 GALLERIA AVENUE RALEIGH NC 27614

WELLNESS CENTER REX WELLNESS CENTER OF RALEIGH

4200 LAKE BOONE TRAIL RALEIGH NC 27607

WELLNESS CENTER REX WELLNESS CENTER OF CARY

1515 SW CARY PARKWAY CARY NC 27511

WELLNESS CENTER REX WELLNESS CENTER OF GARNER

1400 TIMBER DRIVE EAST GARNER NC 27529

WELLNESS CENTER REX WELLNESS CENTER OF KNIGHTDALE

6602 KNIGHTDALE BOULEVARD KNIGHTDALE NC 27545

WELLNESS CENTER REX HEALTHCARE OF GARNER

300 HEALTH PARK DRIVE GARNER NC 27529

HEALTHCARE REX HEALTHCARE OF HOLLY SPRINGS

781 AVENT FERRY ROAD HOLLY SPRINGS NC 27540

HEALTHCARE PART III, LINE 4: NET PATIENT SERVICE REVENUE IS RECORDED AT ESTABLISHED RATES WHEN SERVICES ARE PROVIDED WITH CONTRACTUAL ADJUSTMENTS, ESTIMATED BAD DEBT EXPENSES, AND SERVICES QUALIFYING AS CHARITY CARE DEDUCTED TO ARRIVE AT NET PATIENT SERVICE REVENUE. CONTRACTUAL ADJUSTMENTS ARISE UNDER REIMBURSEMENT AGREEMENTS WITH CERTAIN INSURANCE CARRIERS, HEALTH MAINTENANCE ORGANIZATIONS AND PREFERRED PROVIDER ORGANIZATIONS, WHICH PROVIDE FOR PAYMENTS THAT ARE GENERALLY LESS THAN ESTABLISHED BILLING RATES. CONTRACTUAL ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN THE FUTURE AS FINAL SETTLEMENTS ARE DETERMINED.THE COSTING METHODOLOGY USED TO DETERMINE PAYER COSTS IS THE ANDI METHODOLOGY, WHICH USES A FACILITY-WIDE RATIO OF COST TO CHARGES AS DESCRIBED IN THE NCHA COMMUNITY BENEFITS GUIDELINES.WHILE THE COSTS OF BAD DEBTS ARE PRESENT FOR ESSENTIALLY EVERY BUSINESS ORGANIZATION, FEW OTHER THAN HOSPITALS ARE EXPECTED TO CONTINUE TO PROVIDE SERVICES TO THOSE WITH MEANS WHO HAVE PREVIOUSLY FAILED TO PAY. CONTINUATION OF SERVICE TO PATIENTS WITH THE MEANS TO PAY BUT WHO HAVE FAILED TO DO SO IS A FURTHER COMMUNITY BENEFIT RELATED TO THE ORGANIZATION'S MISSION. THEREFORE, WE BELIEVE THAT THE COST OF BAD DEBTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 8: HOSPITALS TREAT PATIENTS COVERED BY MEDICARE, JUST AS THEY DO ANY PATIENT. AMOUNTS THAT HOSPITALS ARE ELIGIBLE TO RECEIVE IN PAYMENT FOR SERVICES PROVIDED TO PATIENTS COVERED BY MEDICARE ARE NOT NEGOTIABLE. AS MEDICARE REIMBURSEMENT RATES DECLINE RELATIVE TO THE COSTS OF PROVIDING CARE, HOSPITALS CONTINUE TO SERVE THE MEDICARE POPULATION. WITHOUT THE SERVICES PROVIDED BY HOSPITALS, THE GOVERNMENT WOULD BECOME OBLIGATED FOR THE SERVICES REQUIRED BY THESE PATIENTS. THEREFORE, WE BELIEVE THAT ANY UNREIMBURSED COSTS OF PROVIDING THIS CARE ARE A BENEFIT PROVIDED BY THE HOSPITAL TO THE COMMUNITY AND GOVERNMENT. PART III, LINE 9B: PATIENTS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE APPROVED FOR FULL FORGIVENESS TO 250% OF THE FPG. THERE IS NO ASSESSMENT OF CO-PAYMENTS, THEREFORE THERE IS NO PATIENT FINANCIAL RESPONSIBILITY FOR THE APPLICATION OF COLLECTION POLICY. REX HOSPITAL, INC. PART V, SECTION B, LINE 3: THE ORGANIZATION TOOK INTO ACCOUNT INPUT FROM PERSONS REPRESENTING THE COMMUNITY THROUGH PARTICIPATION IN BOTH A COMMUNITY WIDE HEALTH OPINION SURVEY AND FOCUS GROUPS. THE HEALTH OPINION SURVEY WAS CONDUCTED DOOR-TO-DOOR AT RANDOMLY SELECTED HOUSEHOLDS. THE NINE FOCUS GROUPS, INCLUDING 2 IN SPANISH, CONSISTED OF RECRUITED PARTICIPANTS REPRESENTING SPECIFIC GROUPS. REX HOSPITAL, INC. PART V, SECTION B, LINE 4: THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED WITH THE FOLLOWING HOSPITAL FACILITIES: WAKEMED HEALTH AND HOSPITALS AND DUKE RALEIGH HOSPITAL. REX HOSPITAL, INC. PART V, SECTION B, LINE 7: THE ORGANIZATION DID NOT ADDRESS THE FOLLOWING FOCUS AREAS IDENTIFIED IN THE CHNA: DISABILITY AND CARE-GIVING, EDUCATION AND LIFELONG LEARNING, HOUSING AND HOMELESSNESS, NUTRITION, PHYSICIAL ACTIVITY AND OBESITY PREVENTION, POPULATION GROWTH AND RISKY YOUTH BEHAVIOR. THE COMMUNITY VOTED ON THE THREE PRIORITY AREAS TO BE ADDRESSED OVER THE NEXT THREE YEARS AND THE TOP THREE PRIORITY AREAS DID NOT INCLUDE THE NEEDS LISTED ABOVE. WHILE THE ORGANIZATION IS WORKING CLOSELY WITH ITS CHNA PARTNERS ON THE TOP THREE IDENTIFIED PRIORITY AREAS, REX ALSO PLANS TO PLACE EMPHASIS ON THE CLOSELY IDENTIFIED PRIORITY AREAS, REX ALSO PLANS TO PLACE EMPHASIS ON THE CLOSELY IDENTIFIED FOURTH ITEM WHICH IS NUTRITION, PHYSICIAL ACTIVITY AND OBESITY PREVENTION. AS A HEALTHCARE ORGANIZATION, RESOURCES ARE READILY AVAILABLE TO ADDRESS THIS AREA IN GREATER SCOPE. REX HOSPITAL, INC. PART V, SECTION B, LINE 20D: THE ORGANIZATION PROVIDES AN AUTOMATIC 15% DISCOUNT OFF OF CHARGES FOR PATIENTS WHO DO NOT HAVE INSURANCE. ADDITIONAL DISCOUNTS ARE AVAILABLE BASED ON MEANS TESTING AND PROMPT PAYMENT ARRANGEMENTS. PART VI, LINE 2: AS THE COUNTY CONTINUES TO GROW, NECESSARY STEPS MUST BE TAKEN TO ENSURE THAT THE NEEDS OF ALL OF OUR CITIZENS ARE BEING MONITORED AND EVALUATED. WAKE COUNTY HUMAN SERVICES WORKS WITH ALL LOCAL HOSPITALS, INCLUDING REX, TO CONDUCT A COMMUNITY-WIDE HEALTH ASSESSMENT. THIS ASSESSMENT, CONDUCTED EVERY FOUR YEARS, IDENTIFIES OPPORTUNITIES AND CHALLENGES IN THE MARKET. REX COLLABORATES WITH COMMUNITY PARTNERS REGULARLY TO ENSURE OUR EFFORTS ARE PROPERLY ALIGNED BASED ON WAKE COUNTY'S SOCIOECONOMIC AND DEMOGRAPHIC INFORMATION. REX ALSO RELIES ON INPUT FROM OUR PHYSICIANS AND CLINICAL STAFF, PATIENT OUTCOMES AS WELL AS QUALITATIVE AND QUANTITATIVE RESEARCH TO IDENTIFY AREAS OF OPPORTUNITY TO IMPROVE THE HEALTH OF OUR COMMUNITY. PART VI, LINE 3: REX PROVIDES A WIDE RANGE OF TOOLS AND EDUCATION TO HELP PATIENTS WHO NEED FINANCIAL ASSISTANCE. THE REX ASSIST PROGRAM IS DESIGNED TO MAKE IT EASY FOR PATIENTS TO APPLY FOR FINANCIAL ASSISTANCE, CHARITY CARE AND OTHER AID PROGRAMS. REX POSTS DETAILED INFORMATION ABOUT ITS GENEROUS CHARITY CARE POLICY, THE REX ASSIST PROGRAM AND OTHER FINANCIAL AID INFORMATION AT VARIOUS POINTS IN THE HOSPITAL AND ON ITS WEBSITE. DURING PATIENT REGISTRATION, STAFF WILL DISTRIBUTE THE "YOUR REX HOSPITAL BILL" FLYER TO ANYONE WHO DOES NOT HAVE INSURANCE OR ASKS FOR ASSISTANCE. THAT FLYER INCLUDES USEFUL INFORMATION AND HELPFUL RESOURCES. REX FINANCIAL COUNSELORS WILL BEGIN WORKING WITH PATIENTS NEEDING ASSISTANCE AT REGISTRATION, OR VISIT THE ROOMS OF PATIENTS WHO ASK FOR HELP. THE COUNSELORS WILL ASSIST WITH DETERMINING MEDICAID ELIGIBILITY AND WITH FILLING OUT A REX ASSIST APPLICATION. FINALLY, REX ALSO WORKS WITH VARIOUS COMMUNITY GROUPS THAT HELP PROVIDE ASSISTANCE TO THE UNINSURED OR UNDERINSURED, INCLUDING PROJECT ACCESS, PRETTY IN PINK AND OTHERS. THE ANGEL FUND OF THE REX HEALTHCARE FOUNDATION ALSO SUPPORTS CANCER PATIENTS WITH UNIQUE FINANCIAL NEEDS, INCLUDING TRANSPORTATION, LIVING EXPENSES AND PRESCRIPTIONS. PART VI, LINE 4: THE ORGANIZATION SERVES AN AREA THAT ENCOMPASSES A FOUR-COUNTY AREA CONSISTING OF WAKE COUNTY AS THE PRIMARY SERVICE AREA WITH HARNETT, FRANKLIN AND JOHNSTON COUNTIES, COMPRISING THE SECONDARY SERVICE AREA. WAKE COUNTY AND ITS SURROUNDING COMMUNITIES ARE AMONG THE FASTEST GROWING REGIONS IN THE NATION. UNEMPLOYMENT RATES IN THE PRIMARY SERVICE AREA ARE LESS THAN THE UNEMPLOYMENT RATES FOR THE NATION AND THE STATE. AVERAGE HOUSEHOLD INCOME AND EDUCATION LEVEL ALSO COMPARE FAVORABLY WITH BOTH THE NATION AND THE STATE. PART VI, LINE 5: THERE ARE MANY WAYS REX WORKS WITH COMMUNITY PARTNERS TO ADDRESS HEALTH ISSUES AND CONCERNS IDENTIFIED WITHIN THE COMMUNITY. THROUGH BOTH FINANCIAL, IN-KIND AND STAFF SUPPORT, REX PROVIDES ASSISTANCE IN HOSTING COMMUNITY HEALTH SCREENINGS, MOBILE MAMMOGRAPHY SCREENINGS AND ON-SITE MEDICAL CARE THROUGH THE REX EMERGENCY RESPONSE TEAM. ADDITIONALLY, COMMUNITY RELATIONS ACTIVITIES REGULARLY DEMONSTRATE PROMOTING HEALTH AND WELLNESS INITIATIVES. "ASK THE EXPERT" FORUMS ARE FREE AND OFFERED THROUGHOUT WAKE COUNTY BY PHYSICIANS AND STAFF. REX HAS BEEN DILIGENT IN AWARDING GRANTS TO COMMUNITY GROUPS TO ASSIST THEM WHERE NEEDS ARE GREATEST. TWICE A YEAR WE HOST A COLLABORATIVE BREAKFAST INVITING COMMUNITY PARTNERS, ORGANIZATIONS AND HEALTHCARE PROVIDERS WHO WORK WITH UNINSURED WOMEN TO DISCUSS AND ADDRESS CURRENT HARDSHIPS AND RESOURCES -- TRULY A COMMITMENT TO THE NONPROFIT COMMUNITY. PART VI, LINE 6: REX HEALTHCARE IS A SUBSIDIARY OF THE UNC HEALTH CARE SYSTEM IN CHAPEL HILL. THAT SYSTEM SERVES PATIENTS FROM ALL 100 COUNTIES, REGARDLESS OF THEIR ABILITY TO PAY, PROVIDING MORE THAN $300 MILLION A YEAR IN UNCOMPENSATED CARE. AS PART OF THE INTEGRATED SYSTEM, REX STRIVES TO IMPROVE ACCESS AND SERVICES IN WAKE COUNTY'S GROWING AND UNDERSERVED AREAS. REX CAREGIVERS ALSO WORK CLOSELY WITH THEIR COUNTERPARTS AT UNC HEALTH TO FIND MORE WAYS TO IMPROVE CARE AND QUALITY, REACH MORE UNINSURED PATIENTS AND MORE. REX'S BOARD REPRESENTS A CROSS-SECTION OF THE COMMUNITY, WITH VOLUNTEERS THAT INCLUDE BUSINESS LEADERS, COMMUNITY PHYSICIANS AND OTHERS. THAT BOARD WORKS CLOSELY WITH THE BOARD AT UNC HEALTH TO DETERMINE THE BEST WAYS TO PLAY A LARGER ROLE IN IMPROVING THE COMMUNITY'S HEALTH, AND REX'S ROLE IN THE BIGGER SYSTEM'S MISSION. PART VI, LINE 7: THE ORGANIZATION SUBMITS AN ANNUAL COMMUNITY BENEFIT REPORT TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE NORTH CAROLINA MEDICAL CARE COMMISSION. 1 WAKE COUNTY MEDICAL SOCIETY 2500 BLUE RIDGE ROAD STE 330 RALEIGH NC 27607 562205175 501(C)(6) 80025 GENERAL SUPPORT, MEDICAL CARE RALEIGH SCHOOL OF NURSE ANESTH 3900 BARRETT DRIVE SUITE 200 RALEIGH NC 27609 561684241 501(C)(3) 24206 EDUCATION SUPPORT NORTH CAROLINA SYMPHONY 4350 LASSITER STE 250 RALEIGH NC 27609 560556755 501(C)(3) 60000 GENERAL SUPPORT AMERICAN HEART ASSOCIATION NORTH CAROLINA AFFILIATEINC 3901 COMPUTER DR STE 110 RALEIGH NC 27609 560529996 501(C)(3) 40000 GENERAL SUPPORT, EDUCATION SUPPORT POE CENTER FOR HEALTH ED 224 SUNNYBROOK ROAD RALEIGH NC 27610 561500678 501(C)(3) 20000 EDUCATION SUPPORT TRIANGLE RACE FOR THE CURE 133 FAYETTEVILLE ST STE 300 RALEIGH NC 27601 751835298 501(C)(3) 10000 GENERAL SUPPORT DEVILS RIDGE CHARITY GOLF CLASSIC PO BOX 98 128 SOUTH MAIN STREET HOLLY SPRINGS NC 27540 562265570 501(C)(3) 5000 GENERAL SUPPORT PAY IT FORWARD FERTILITY FDNT 8311 BRIER CREEK PARKWAY STE 105-111 RALEIGH NC 27617 263906064 501(C)(3) 5000 GENERAL SUPPORT CITY OF OAKS MARATHON 7449 SIX FORKS ROAD RALEIGH NC 27615 260232340 501(C)(3) 15000 GENERAL SUPPORT, MEDICAL CARE LEUKEMIA SOCIETY OF AMERICA 4206 SIX FORKS ROAD STE 220 RALEIGH NC 27609 135644916 501(C)(3) 15000 GENERAL SUPPORT GREATER RALEIGH CHAMBER PO BOX 2978 RALEIGH NC 27602 560370850 501(C)(6) 36125 GENERAL SUPPORT RALEIGH CIVIC VENTURE 120 SOUTH WILMINGTON STREET STE 103 103 RALEIGH NC 27601 562095185 501(C)(3) 10000 GENERAL SUPPORT DOWNTOWN RALEIGH ALLIANCE 120 SOUTH WILMINGTON STREET STE 103 103 RALEIGH NC 27601 561994005 501(C)(6) 6000 GENERAL SUPPORT NORTH CAROLINA CHAMBER 701 CORPORATE CENTER DRIVE STE 400 RALEIGH NC 27607 560340499 501(C)(6) 30000 GENERAL SUPPORT THE FIRST TEE OF THE 5560 MUMFORD ROAD SUITE 201 RALEIGH NC 27612 562266025 501(C)(3) 5000 GENERAL SUPPORT INTERACT INC 1012 OBERLIN ROAD STE 100 RALEIGH NC 27605 581320613 501(C)(3) 32500 GENERAL SUPPORT CAROLINA BALLET 3401-131 ATLANTIC AVENUE RALEIGH NC 27604 561445383 501(C)(3) 20000 GENERAL SUPPORT NC MEDICAL SOCIETY FOUNDATION PO BOX 27167 RALEIGH NC 27611 566088142 501(C)(3) 20000 GENERAL SUPPORT URBAN MINISTRIES 1390 CAPITAL BOULEVARD RALEIGH NC 27603 581422700 501(C)(3) 20000 GENERAL SUPPORT WAKE EDUCATION PARTNERSHIP 706 HILLSBOURGH STREET STE A RALEIGH NC 27603 581518182 501(C)(3) 20000 GENERAL SUPPORT WAKE TECH FOUNDATION 9101 FAYETTEVILLE ROAD RALEIGH NC 27511 237017752 501(C)(3) 16000 GENERAL SUPPORT NC MUSEUM OF ART 4630 MAIL SERVICE CENTER RALEIGH NC 27699 237071511 501(C)(3) 12500 GENERAL SUPPORT LUCY DANIELS CENTER 9003 WESTON PARKWAY CARY NC 27513 581863104 501(C)(3) 10000 GENERAL SUPPORT NAMI WAKE COUNTY PO BOX 12562 RALEIGH NC 27605 561552949 501(C)(3) 10000 GENERAL SUPPORT NEIGHBOR TO NEIGHBOR PO BOX 25628 RALEIGH NC 27611 562016457 501(C)(3) 10000 GENERAL SUPPORT TAMMY LYNN CENTER 739 CHAPPELL DRIVE RALEIGH NC 27606 561949970 501(C)(3) 10000 GENERAL SUPPORT CARY CHAMBER OF COMMERCE 307 NORTH ACADEMY STREET CARY NC 27519 560989726 501(C)(3) 8025 GENERAL SUPPORT EAST WAKE SOCCER ASSOCIATION PO BOX 14960 KNIGHTDALE NC 27545 561388709 501(C)(3) 6500 GENERAL SUPPORT NORTH CAROLINA LUNG CANCER INITIATIVE 4000 BLUE RIDGE ROAD RALEIGH NC 27612 262300885 501(C)(3) 6250 GENERAL SUPPORT NC PHYSICIANS HEALTH PROGRAM INC 220 HORIZON DRIVE STE 201 RALEIGH NC 27615 561846599 501(C)(3) 5500 GENERAL SUPPORT READ AND FEED PO BOX 5865 CARY NC 27512 203246207 501(C)(3) 5250 GENERAL SUPPORT ARTSPLOSURE 313 SOUTH BLOUNT STREET STE 2008 RALEIGH NC 27601 581387567 501(C)(3) 5000 GENERAL SUPPORT EL PUEBLOINC PO BOX 33672 RALEIGH NC 27636 561934310 501(C)(3) 5000 GENERAL SUPPORT JDRF 7721 SIX FORKS ROAD STE 136 RALEIGH NC 27615 231907729 501(C)(3) 5000 GENERAL SUPPORT JUNIOR LEAGUE OF RALEIGH PO BOX 26821 RALEIGH NC 27611 560562849 501(C)(3) 5000 GENERAL SUPPORT KAY YOW CANCER FUND PO BOX 3369 CARY NC 27519 261789695 501(C)(3) 5000 GENERAL SUPPORT NORTH CAROLINA ASSOCIATION OF COUNTY COMMISSIONERS 215 NORTH DAWSON STREET RALEIGH NC 27603 566020249 501(C)(4) 5000 GENERAL SUPPORT RONALD MCDONALD HOUSE OF CHAPEL HILL 101 OLD MASON FARM ROAD CHAPEL HILL NC 27517 561413188 501(C)(3) 5000 GENERAL SUPPORT THE JEWISH FEDERATION OF RALEIGH-CARY 8210 CREEDMOOR ROAD STE 104 RALEIGH NC 27613 561553301 501(C)(3) 5000 GENERAL SUPPORT 34 5 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: REX REQUIRES ALL REQUESTS FOR GRANTS OR OTHER ASSISTANCE TO BE IN WRITING. SUCH REQUESTS ARE TYPICALLY REVIEWED ON AN ANNUAL BASIS FOLLOWING GUIDELINES RELATED TO COMMUNITY NEED AND REX'S MISSION. REX'S PRIORITIES INCLUDE SUPPORTING HEALTH, HUMAN SERVICES, EDUCATION AND ARTS IN THE COMMUNITIES IT SERVES. REX HAS VARIOUS WAYS OF TRACKING THE RESULTS OF ITS CONTRIBUTIONS. BECAUSE REX OFTEN WORKS CLOSELY WITH THE COMMUNITY GROUPS IT SUPPORTS, THE ORGANIZATION RECEIVES FREQUENT UPDATES ON THEIR WORK AND PROGRESS. FOR LARGER GRANTS, REX ALSO RECEIVES ANNUAL OR QUARTERLY REPORTS ON RESULTS. X 1 1 X X X X X 0 1 0 0 0 1 1 0 0 GARY L PARK 0 700135 0 0 0 7899 0 232432 0 6359 0 946825 0 0 WILLIAM L ROPER MD 0 746827 0 0 0 12000 0 153670 0 3959 0 916456 0 0 DAVID STRONG 524539 0 226405 0 561373 0 252208 0 15148 0 1579673 0 529812 0 BERNADETTE SPONG 295122 0 91465 0 24372 0 34546 0 2888 0 448393 0 0 0 MARY LOU POWELL 239011 0 79953 0 31292 0 67157 0 13453 0 430866 0 0 0 STEPHEN W BURRISS 248249 0 81513 0 37329 0 28999 0 18598 0 414688 0 0 0 NOVLET M BRADSHAW 187395 0 74106 0 5326 0 22532 0 9411 0 298770 0 0 0 LINDA H BUTLER MD 195520 0 64434 0 20371 0 17885 0 15098 0 313308 0 0 0 DONALD ESPOSITO JR 216402 0 72222 0 19691 0 21892 0 20097 0 350304 0 0 0 SYLVIA HACKETT 190702 0 61214 0 20718 0 46147 0 11453 0 330234 0 0 0 R ERICK HAWKINS 202870 0 66144 0 36913 0 22723 0 10143 0 338793 0 0 0 CHAD T LEFTERIS 163118 0 51854 0 17938 0 13816 0 8453 0 255179 0 0 0 LISA SCHILLER 156896 0 48198 0 7278 0 22086 0 16028 0 250486 0 0 0 JAYNE R BYRD 172760 0 54611 0 2436 0 140053 0 8583 0 378443 0 0 0 MICHELLE L GRAY 150158 0 14134 0 216 0 19866 0 5615 0 189989 0 0 0 ROBERT D RICKER 176953 0 53031 0 11173 0 68996 0 8453 0 318606 0 0 0 TAMMIE T STANTON 0 223907 0 19338 0 5000 0 36258 0 3959 0 288462 0 0 TOM G WILLIAMS 146623 0 44728 0 6135 0 28477 0 15098 0 241061 0 0 0 JOHN STORMENT 0 161585 0 12830 0 4762 0 30723 0 1200 0 211100 0 0 JEFFREY CRANE MD 613191 0 14306 0 46811 0 53842 0 9917 0 738067 0 0 0 ROBERT WEHBIE MD 490299 0 49386 0 44624 0 41268 0 20097 0 645674 0 0 0 LANCE LANDVATER MD 751997 0 450732 0 5544 0 11250 0 17441 0 1236964 0 0 0 O ROBERT MENDES MD 629474 0 196000 0 840 0 8500 0 15098 0 849912 0 0 0 ROBERT PEYTON MD 756923 0 34626 0 5544 0 11250 0 10143 0 818486 0 0 0 PART I, LINE 1A THE ORGANIZATION OFFERS COMPLIMENTARY MEMBERSHIPS TO REX WELLNESS CENTERS FOR THE EXECUTIVE STAFF, BOTH ACTIVE AND RETIRED BOARD MEMBERS AND MEDICAL DIRECTORS. ALL MEMBERS RECEIVING COMPLIMENTARY MEMBERSHIPS ARE REQUIRED TO COMPLETE THE SAME APPLICATION AND TESTING PROCEDURES AS OTHER MEMBERS. CURRENTLY, THERE ARE 8 INDIVIDUALS LISTED THAT RECEIVE COMPLIMENTARY MEMBERSHIPS. THE VALUE OF THE COMPLIMENTARY MEMBERSHIP IS TREATED AS TAXABLE COMPENSATION AND IS REPORTED ON THE INDIVIDUAL'S W-2. PART I, LINE 4B DURING THE CALENDAR YEAR 2012, DAVID STRONG PARTICIPATED IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN AND RECEIVED DISTRIBUTIONS TOTALING $529,812. HE ALSO EARNED COMPENSATION UNDER THIS PLAN TOTALING $226,442. 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 PERFOMANCE MEASURES USED TO DETERMINE INCENTIVE COMPENSATION ARE PHYSICIAN SATISFACTION, PATIENT CARE QUALITY OUTCOMES, EFFECTIVE USE OF TECHNOLOGY AND INDIVIDUAL GOALS. A NORTH CAROLINA MEDICAL CARE COMMISSIONS 521309402 65821DFJ5 2010-10-26 127456150 CONSTRUCTION 0 0 0 A 10452767 127456150 2184840 1499411 47737172 76034727 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 NOVLET BRADSHAW OFFICER RELOCATION X 190000 71106 0 0 1 71106 FORM 990, PART I, LINE 6 THE ORGANIZATION'S VOLUNTEER SERVICES DEPARTMENT MAINTAINS A LARGE STAFF OF COMPETENT AND COMPASSIONATE VOLUNTEERS WHO ENHANCE AND EXTEND SERVICES PROVIDED TO PATIENTS, FAMILY MEMBERS, CLIENTS AND RESIDENTS. THE 1,306 VOLUNTEERS PROVIDED A TOTAL OF 126,825 QUALITY SERVICE HOURS TO THE ORGANIZATION. THE ANIMAL ASSISTED THERAPHY PROGRAM CONTINUED AT REX HOSPITAL WITH 9 CANINE VOLUNTEERS. THE CANINES AND THEIR HANDLERS, VISITED NUMEROUS PATIENTS OFFERING COMFORT AND SUPPORT. THIS YEAR MARKED THE BEGINNING OF OUR PATIENT COMPANION PROGRAM INSIDE REX HOSPITAL WHICH OFFERS A VISIT TO PATIENTS WHO ARE LONELY OR NEED TO TALK TO SOMEONE. VOLUNTEERS ALSO VISITED PATIENTS, CONDUCTED HEARING TESTS FOR NEWBORN BABIES, GREETED GUESTS AND DELIVERED FLOWER ARRANGEMENTS AND CARDS. THEY MANNED WAITING ROOMS, ESCORTED PATIENTS, MADE BEDS, DISCHARGED PATIENTS AND SO MUCH MORE TO PROVIDE COMFORT TO OUR COMMUNITY. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE MEMBER IS REX HEALTHCARE, INC. FORM 990, PART VI, SECTION A, LINE 7A THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM APPOINTS ALL OF THE THIRTEEN SEATS ON THE ORGANIZATION'S BOARD OF TRUSTEES. 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 REX 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 TREASURER AND ASSISTANT SECRETARY. 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 REX HEALTH VENTURES GP I LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 455070550 VENTURE CAPITAL INVESTMENT NC REX HOSPITAL INC REX HEALTHCARE INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509129 HEALTHCARE NC 501(C)(3) 509(A)(3) UNC HEALTHCARE 0 THE REX HEALTHCARE FOUNDATION INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 566052117 SUPPORT OF REX HOSPITAL NC 501(C)(3) 509(A)(3) REX HEALTHCARE 0 UNC HEALTH CARE SYSTEM 101 MANNING DRIVE CHAPEL HILL NC 27514 562206970 HEALTHCARE NC 501(C)(3) LINE 3 UNC HEALTHCARE 0 REX SURGERY CENTER OF CARY LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 273684056 ASC NC REX HOSPITAL INC RELATED 5025707 4321975 0 0 0.55000 JRH VENTURES LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 274092967 MED CAMPUS DVLT NC REX HOSPITAL INC RELATED -436073 3113485 0 0 0.50000 REX HEALTH VENTURES I LP 4420 LAKE BOONE TRAIL RALEIGH NC 27607 371690478 VENTURE CAPITAL INVESTMENT NC REX HEALTH VENTURES RELATED -385267 452239 0 0 1.00000 REX ENTERPRISES COMPANY INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561553957 OPERATIONS SUPPORT NC REX HEALTHCARE C 0 REX PHYSICIANS LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 264594963 HEALTHCARE NC REX HOLDINGS C 0 0 1 1 1 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 REX HEALTHCARE FOUNDATION INC B 838217 FMV REX HEALTHCARE FOUNDATION INC C 968359 FMV REX PHYSICIANS LLC D 38956922 FMV REX PHYSICIANS LLC J 2914620 FMV REX PHYSICIANS LLC L 2639353 FMV JRH VENTURES LLC L 1311958 FMV ADMINISTRATIVE SUPPORT; PART V, LINE 1 N & O: SUCH AS EXECUTIVE MANAGEMENT, LEGAL, ACCOUNTING, HUMAN RESOURCES, PURCHASING AND IT, FOR EACH OF THESE ENTITIES IS PROVIDED BY REX HOSPITAL, INC. PERSONNEL UTILIZING REX HOSPITAL FACILITIES AND OTHER ASSETS. ESTIMATING THE VALUE OF THESE SHARED PERSONNEL AND ASSETS CANNOT BE READILY DETERMINED.