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 566052117 THE REX HEALTHCARE FOUNDATION INC REXH 9197844424 4420 LAKE BOONE TRAIL RALEIGH NC 27607 BERNADETTE SPONG 9197844424 2014-05-13 1 JOHN NORMAN P01506766 7049985200 2012 2015-11-30 17:44:51Z DAVID STRONG 4420 LAKE BOONE TRAIL RALEIGH NC 27607 5932576 0 X WWW.REXHEALTH.COM/FOUNDATION X 1958 NC TO PROVIDE OPPORTUNITIES FOR OUR COMMUNITY TO INVEST RESOURCES IN THE EXCELLENT WORK OF REX HEALTHCARE. 13 10 7 0 0 0 1643045 2758568 0 0 78033 392284 652921 -35119 2373999 3115733 1291083 968359 0 0 653089 739459 65137 50376 900335 204265 251642 2213574 2009836 160425 1105897 5181495 6458432 75914 121691 5105581 6336741 TO PROVIDE OPPORTUNITIES FOR OUR COMMUNITY TO INVEST RESOURCES IN THE EXCELLENT WORK OF REX HEALTHCARE. 0 0 968359 968359 THE REX HEALTHCARE FOUNDATION SUPPORTS 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. 968359 1 1 0 0 0 0 0 0 0 1 1 0 1 0 0 1 1 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 0 0 7 1 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X BERNADETTE SPONG 9197843100 4420 LAKE BOONE TRAIL RALEIGH NC 27607 A DALE JENKINS 1.00 4.00 X 0 0 0 ORAGE QUARLES III 1.00 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 1.00 59.00 X 0 708034 238791 WILLIAM L ROPER MD 1.00 59.00 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 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 DAVID W STRONG 1.00 59.00 X X 0 1312317 267356 SYLVIA D HACKETT 1.00 59.00 X 0 272634 57600 BERNADETTE M SPONG 1.00 59.00 X 0 410959 37434 JOHN STORMENT 1.00 59.00 X 0 179177 31923 0 3641948 790733 0 0 1 0 0 845684 838217 1074667 2758568 134782 134782 2640415 2382913 257502 257502 257502 398811 845684 433930 -35119 -35119 3115733 0 0 357165 968359 968359 614314 61431 552883 18430 1843 16587 65357 6536 58821 41358 4136 37222 9021 9021 50376 50376 37681 37681 79307 7931 71376 51499 5150 46349 37245 3725 33520 14012 1401 12611 1524 152 1372 21353 2135 19218 2009836 968359 141142 900335 738424 1404763 29188 174234 7990 29893 15226 12453 4297 2773 4401596 4846769 5181495 6458432 75914 121691 75914 121691 X 5105581 6336741 5105581 6336741 5181495 6458432 1105897 125263 0 X X 0 1 X 1 0 X X X 0 0 0 REX HOSPITAL INC 561509260 3 1 1 1 968359 1 968359 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 323378 54063 377441 332040 16338 25000 323378 330250 1790 332040 1.00000 0 0 15226 12453 2773 2773 INVESTMENTS 4846769 F 4846769 X 3852634 75761 215391 11819 302971 3549663 -433930 -433930 3115733 2621476 215391 433930 649321 1972155 37681 37681 2009836 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO FURTHER THE MISSION OF REX HEALTHCARE FOUNDATION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE FOUNDATION HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS A NOT-FOR-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAX ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE FOUNDATION ADOPTED THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. MANAGEMENT BELIEVES THE FOUNDATION HAS NO UNCERTAIN TAX POSITIONS AS OF JUNE 30, 2013. PART XI, LINE 2D: PLEDGES RECEIVABLE OF $49,500 WAS INCLUDED IN INCOME AND INVESTMENT EXPENSE OF $37,681 WAS NETTED WITH INVESTMENT INCOME ON THE AUDITED FINANCIAL STATEMENTS. THE NET OF THE ITEMS IS $11,819. PART XI, LINE 4B: DIRECT FUNDRAISING EXPENSE OF $433,930 WAS NETTED AGAINST FUNDRAISING INCOME ON FORM 990, PART VIII, LINE 8B AND INCLUDE IN TOTAL EXPENSES ON THE AUDITED FINANCIAL STATEMENTS. PART XII, LINE 2D: DIRECT FUNDRAISING EXPENSES OF $433,930 WAS INCLUDED IN TOTAL EXPENSES ON THE AUDITED FINANCIAL STATEMENTS AND WAS NETTED AGAINST FUNDRAISING INCOME ON THE FORM 990, PART VIII, LINE 8B. X X X X X X 1 CAPITAL DEVELOPMENT SVCS INC 633 W 4TH STREET SUITE 202 WINSTON SALEM NC 27101 CONSULTING 0 0 50376 -50376 50376 -50376 NC GOLF TOURNAMENT 652696 356299 296397 191498 GALA 348119 251969 96150 182977 4 243680 237416 6264 59455 1244495 845684 398811 433930 433930 -35119 0 REX HOSPITAL INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509260 501(C)(3) 968359 GENERAL SUPPORT 1 PART 1, LINE2: REX HEALTHCARE FOUNDATION'S SOLE RECIPIENT OF ASSISTANCE IS REX HOSPITAL, INC. THE TWO ORGANIZATIONS WORK CLOSELY TOGETHER, SO THEREFORE MONITORING IS REAL-TIME AND CONSISTENT. 0 1 0 0 0 0 0 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 W STRONG 0 524539 0 226405 0 561373 0 252208 0 15148 0 1579673 0 529812 SYLVIA D HACKETT 0 190702 0 61214 0 20718 0 46147 0 11453 0 330234 0 0 BERNADETTE M SPONG 0 295122 0 91465 0 24372 0 34546 0 2888 0 448393 0 0 JOHN STORMENT 0 161585 0 12830 0 4762 0 30723 0 1200 0 211100 0 0 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 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 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 OF 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: THE AUDIT COMMITTEE'S PROCESS FOR OVERSIGHT OF THE AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANTS HAS NOT CHANGED FROM THE PRIOR YEAR. REX HEALTHCARE INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509129 HEALTHCARE NC 501(C)(3) LINE 11A, I UNC HEALTH CARE 0 UNC HEALTH CARE SYSTEM 101 MANNING DRIVE CHAPEL HILL NC 27514 562206970 HEALTHCARE NC 501(C)(3) LINE 11A, I UNC HEALTH CARE 0 REX HOSPITAL INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509260 HOSPITAL NC 501(C)(3) LINE 3 REX HEALTHCARE 0 REX SURGERY CENTER OF CARY 4420 LAKE BOONE TRAIL RALEIGH NC 27607 273684056 ASC NC REX HOSPITAL RELATED 0 0 JRH VENTURES LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 274092967 MED CAMPUS DVLT NC REX HOSPITAL RELATED 0 0 REX HEALTH VENTURES I LP 371690478 VENTURE CAPITAL INVEST NC REX HEALTH VE RELATED 0 0 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 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 REX HOSPITAL INC B 968359 FMV REX HOSPITAL INC K 37245 FMV REX HOSPITAL INC P 838217 FMV PART V, LINE 1 N & O: REX HOSPITAL, INC. PERSONNEL PROVIDES ADMINISTRATIVE SUPPORT, SUCH AS EXECUTIVE MANAGEMENT, LEGAL, ACCOUNTING, HUMAN RESOURCES, PURCHASING AND IT FUNCTIONS UTILIZING REX HOSPITAL FACILITIES AND OTHER ASSETS. ESTIMATING THE VALUE OF THESE SHARED PERSONNEL AND ASSETS CANNOT BE READILY DETERMINED.