2014-08-15T14:50:13-05:00 2013-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2012-10-01 570343398 TUOMEY HEALTHCARE SYSTEM TUOM 8037748616 129 NORTH WASHINGTON STREET SUMTER SC 29150 MICHAEL J SCHWARTZ 8037748616 2014-08-15 1 AMY BIBBY P00445891 8282542254 2012 2015-11-30 17:44:51Z TUOMEY HEALTHCARE SYSTEM MICHAEL J SCHWARTZ 129 NORTH WASHINGTON STREET SUMTER SC 29150 200831599 0 X WWW.TUOMEY.COM X 1914 SC OPERATION OF NONPROFIT HEALTHCARE FACILITY IN SUMTER, SC 14 8 1946 250 0 0 0 0 187206374 194394421 1321613 3388714 2641431 3048464 191169418 200831599 45000 0 0 0 88836640 88829868 0 0 291759 100689812 113112001 189571452 201941869 1597966 -1110270 262910417 260048671 160056368 144052098 102854049 115996573 X THE MISSION OF TUOMEY HEALTHCARE SYSTEM IS TO PROMOTE GOOD HEALTH AND WELL-BEING AND TO PROVIDE EXCELLENT HEALTHCARE FOR EVERYONE IN SUMTER AND SURROUNDING COUNTIES. 0 0 182676054 0 194394421 TUOMEY HEALTHCARE SYSTEMS IS A 301 BED ACUTE CARE FACILITY LOCATED IN SUMTER, SOUTH CAROLINA. TUOMEY WAS ESTABLISHED AS A NON-PROFIT ACUTE CARE HOSPITAL TO ADVANCE OR SUPPORT THE PROVISIONS OF HEALTHCARE SERVICES WITHIN THE SUMTER COMMUNITY. TUOMEY'S MAIN OBJECTIVE IS THE PROMOTION OF HEALTH FOR ALL RESIDENTS OF SUMTER AND ITS OUTLYING AREAS. THE PROMOTION OF HEALTH HAS BEEN ESTABLISHED AS A CHARITABLE PURPOSE UNDER INTERNAL REVENUE CODE (IRC) SECTION 501 (C) (3). REV. RUL. 69-545, 1969-2 C.B. 94, SETS FOR THE FACTORS THE INTERNAL REVENUE SERVICE WILL CONSIDER IN DETERMINING WHETHER A NON-PROFIT HOSPITAL QUALIFIES FOR TAX-EXEMPT STATUS. TUOMEY HAS OPERATED ITS FACILITIES IN A MANNER DESCRIBED BY REV. RUL. 69-545, SUPRA. THE BOARD OF TRUSTEES IS COMPRISED OF INDEPENDENT CIVIC LEADERS. AN OPEN MEDICAL STAFF IS MAINTAINED BY TUOMEY, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS. ALSO, TUOMEY OPERATED A FULL-TIME EMERGENCY ROOM OPEN TO ANYONE WITHOUT THE ABILITY TO PAY AND PROVIDES NON-EMERGENCY MEDICAL SERVICES TO ANYONE WITH THE ABILITY TO PAY, EITHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. DURING THE YEAR, TUOMEY PROVIDED 66,026 ADULT PATIENT DAYS, 1,315 BIRTHS, 3,785 NURSERY PATIENT DAYS, 58,849 ER VISITS AND 84,577 OTHER OUTPATIENT VISITS. IT ALSO PROVIDED $36,471,236 MILLION WORTH OF CHARITY CARE. 182676054 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 754 0 1 1946 1 0 0 0 0 0 0 0 0 0 0 X 14 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 SC X X LISA C LEUCK CONTROLLER 8037748617 129 N WASHINGTON STREET SUMTER SC 29150 JOHN BRABHAM 1.00 X X 0 0 0 LEROY CREECH 1.00 X X 0 0 0 PHIL PALMER 1.00 X X 0 0 0 NICOLE NORRIS 1.00 X X 0 0 0 CYNTHIA REESE MD 1.00 X 18624 0 0 KIM HARVIN 1.00 X 0 0 0 ANSEL MCFADDIN MD 1.00 X 0 0 0 CHALMERS GLENN 1.00 X 0 0 0 MITCHELL WILLIAMS 1.00 X 0 0 0 SAMUEL RIDDLE MD 1.00 X 0 439819 15381 BEN GRIFFITH 1.00 X 0 0 0 KAY RAFFIELD PHD 1.00 X 0 0 0 R JAY COX 40.00 X X 820583 0 170879 MARK M CRABBE MD 1.00 X 0 733923 43935 HENRY MOSES MD 1.00 X 0 678390 42719 J GREGG MARTIN 40.00 X 493659 0 121372 MARK LOVELL 40.00 X 191025 0 52193 GENE F DICKERSON MD 40.00 X 494102 0 29253 WILLIAM RENWICK 40.00 X 241166 0 13512 MICHELLE LOGAN-OWENS 40.00 X 198156 0 8859 TERESA M CARLTON 40.00 X 208520 0 39008 TEXIN LI 40.00 X 207938 0 26043 MICHAEL SAND 40.00 X 195810 0 17779 JUDY LYNN ROBERTS 40.00 X 190736 0 20477 ETNA C GRIFFIN 40.00 X 176107 0 7814 SHERRI J BABB 40.00 X 178107 0 27504 3614533 1852132 636728 29 0 1 0 CARDINAL PHARMACY PO BOX 402603 ATLANTA GA 30384 MEDICAL SERVICES 8906355 MIDLANDS EMERGENCY PHYSICIANS PA 129 NORTH WASHINGTON ST SUMTER SC 29150 MEDICAL SERVICES 6589526 CARDINAL HEALTH MEDICAL PRODUCTS PO BOX 905867 CHARLOTTE NC 28290 MEDICAL SERVICES 5935593 VARIAN MEDICAL SYSTEMS INC 70140 NETWORK PLACE CHICAGO IL 606731701 MEDICAL SERVICES 3071296 MEDICAL DOCTOR ASSOCIATES INC PO BOX 277185 ATLANTA GA 303847185 MEDICAL SERVICES 2445313 162 NET PROGRAM SERVICE REVENUE 621400 180119357 180119357 DISPROPORTIONATE SHARE POOL 900099 7360637 7360637 ANCILLARY SERVICES 900099 3529837 3529837 MEANINGFUL USE REVENUE 900099 3384590 3384590 194394421 1106495 1106495 13698 13698 1066993 0 1066993 1066993 1066993 2195027 73494 0 0 2195027 73494 2268521 2268521 CAFETERIA & VENDING 722210 1162762 1162762 MEDICAL RECORD TRANSC 900099 172644 172644 AFFILIATE MANAGEMENT 561000 135600 135600 510465 510465 1981471 200831599 194394421 0 6437178 1467640 733821 733819 67938865 61778281 5934534 226050 2095763 1887583 201354 6826 12453288 11216257 1196472 40559 4874312 4390129 468308 15875 499088 499088 90000 90000 109941 109941 29888 29888 19742988 18236867 1506121 509581 4959 504622 19246099 18247349 998750 1431499 1370752 60747 2717491 2717491 4002169 4002169 11808243 11808243 846190 846190 MEDICAL SUPPLIES 28368938 28368938 BAD DEBT EXPENSE 11848282 11848282 LEGAL ISSUES 6636200 6636200 HOSPITAL TAX 5218240 5218240 7164 503 4212 2449 201941869 182676054 18974056 291759 3401695 5938408 30576162 31492562 4708810 4985828 7800811 6391922 184168725 94484496 91900227 89684229 102726941 90120984 21795771 31434738 262910417 260048671 66531272 54816403 92104822 88739614 1420274 496081 160056368 144052098 X 97812906 110955430 5041143 5041143 102854049 115996573 262910417 260048671 X -1110270 1352190 12900604 X 0 1 X 1 0 X X 0 0 0 0 0 0 0 0 1 14429 14429 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE SOUTH CAROLINA HOSPITAL ASSOCIATION (SCHA). THESE ORGANIZATIONS ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBERSHIP BODIES, AND EACH YEAR A PORTION OF THE DUES PAID ARE ALLOCATED TO LOBBYING EXPENDITURES. 6124048 401911 75000 6450959 5523695 675353 75000 6124048 5647997 -49302 75000 5523695 5341581 381416 75000 5647997 5157328 259253 75000 5341581 0.21850 0.78150 0 0 9419642 9419642 41890992 15251335 26639657 3142506 1358338 1784168 128141582 77874823 50266759 1574003 1574003 89684229 DUE FROM AFFILIATES 31434738 31434738 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 496081 496081 X 202791498 1352190 14263544 15615734 187175764 13655835 13655835 200831599 188533169 247135 247135 188286034 13655835 13655835 201941869 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE EARNINGS OF THE ENDOWMENT FUND ARE DIRECTED TO THE BOARD'S DISCRETION. FOR THE PAST FIVE YEARS, THE EARNINGS HAVE BEEN USED TO FUND THE HOSPITAL'S HEALTH REACH PROGRAM. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE MEDICAL CENTER (TUOMEY) IS EXEMPT FROM INCOME TAX UNDER SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE;ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN NET PENSION OBLIGATION 13,992,568. TIMOTHY J. TUOMEY TRUST REVENUES 270,976. PART XI, LINE 4B - OTHER ADJUSTMENTS: EXPENSES IN REVENUES 1,807,553. BAD DEBT EXPENSE 11,848,282. PART XII, LINE 2D - OTHER ADJUSTMENTS: TIMOTHY J. TUOMEY TRUST EXPENSES 247,135. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 11,848,282. EXPENSES IN REVENUES 1,807,553. 1 1 X 1 X 1 X 1 1 1 0 0 15449298 15449298 0.08130 24538900 24044860 494040 0.00260 39988198 24044860 15943338 0.08390 74805 74805 0.00040 74805 74805 0.00040 40063003 24044860 16018143 0.08430 1 12983579 9088505 71353577 68201464 3152113 X 1 1 1 1 TUOMEY REGIONAL MEDICAL CENTER

129 NORTH WASHINGTON ST SUMTER SC 29150

X X X DISPROPORTIONATE SHARE HOSPITAL TUOMEY REGIONAL MEDICAL CENTER 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 1 X X X 1 0 1 X 1 1 2 CANCER TREATMENT CENTER

130 N WASHINGTON STREET SUMTER SC 29150

RADIATION/ CHEMOTHERAPY CENTER TUOMEY MEDICAL PARK

ALICE DR WESTMONT BLVD SUMTER SC 29150

OUTPATIENT IMAGING, REHAB, OTHER PART I, LINE 7: THE ORGANIZATION UTILIZED THE IRS WORKSHEETS TO DETERMINE THE COST TO CHARGE RATIO PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 11848282. PART II: ECONOMIC DEVELOPMENT - SUMTER SMARTER GROWTH INITIATIVE IS A SUMTER ECONOMIC DEVELOPMENT DONATION MADE TO ASSIST IN SUMTER DEVELOPMENT BOARD'S EFFORTS AT RECRUITING INSUDTRY, MARKETING THE SUMNTER COMMUNITY AND DEVELOPING SUMTER COUNTY'S INDUSTRIAL DEVELOPMENT PRODUCTS.WORKFORCE DEVELOPMENT - TUOMEY WORKS TO RECRUIT PHYSICIANS THAT WILL MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. PART III, LINE 4: ALTHOUGH NOT DESCRIBED IN THE FOOTNOTES TO THE HOSPITAL'S FINANCIAL STATEMENTS, THE PRACTICE OF THE HOSPITAL IS TO RECORD BAD DEBT EXPENSE AT THE UNPAID BALANCES AFTER CONTRACTUAL DISCOUNTS FOR PATIENT'S WITH INSURANCE AND AT THE 65% DISCOUNTED CHARGE LEVEL FOR THOSE WHO DO NOT HAVE INSURANCE. THE HOSPITAL NEGOTIATES WITH PAYERS TO COME UP WITH A FAIR DISCOUNTED RATE TO BE PAID FOR SERVICES RENDERED. THESE DISCOUNTS ARE NOT RECORDED AS BAD DEBT EXPENSES. SIMILARLY FOR PATIENTS WITHOUT ANY INSURANCE, THE HOSPITAL OFFERS SEVERAL DIFFERENT DISCOUNT PROGRAMS, BASED UPON FINANCIAL NEED, TO THESE PATIENTS AND ONCE AGAIN THESE DISCOUNTS ARE NOT RECORDED AS BAD DEBTS. FOR PATIENTS WHO DO NOT MEET OR DO NOT FOLLOW-THROUGH TO DEMONSTRATE FINANCIAL HARDSHIP, THE HOSPITAL DOES EXPECT TO BE REIMBURSED AT 65% OF ITS CHARGES. ALL OF THE REMAINING BALANCES THAT ARE NOT PAID ARE RECORDED AS BAD DEBTS. THE HOSPITAL HAS COSTED THE BAD DEBTS EXPENSE IN LINE 2 OF THIS SECTION AT THE FULL UNPAID CONTRACTED RATE FOR PATIENTS WITH INSURANCE AS THIS REPRESENTS THE "CONTRACTED COST" FOR THE SERVICE AND THUS NOT APPLICABLE TO AN OVERALL COST-TO-CHARGE RATIO. FOR PATIENS WITH NO INSURANCE, THE COST ON LINE 2 REPRESENTS THE 65% OF CHARGE FIGURES MULTIPLIED BY THE OVERALL COST-TO-CHARGE RATIO FROM THE AUDITED FINANCIAL STATEMENTS. THE CRITERIA THE HOSPITAL USES FOR DISTINGUISHING BETWEEN CHARITY CARE AND BAD DEBT IS THAT IN ORDER FOR A PATIENT TO QUALIFY AS CHARITY CARE, THEY MUST SHARE THEIR FINANCIAL INFORMATION AND SHOW THAT THEY FALL WITHIN THE FEDERAL POVERTY GUIDELINES. THUS THE HOSPITAL BELIEVES THAT 50% OF THE FIGURE RECORDED AS BAD DEBT EXPENSE ON LINE 2 WOULD QUALIFY FOR CHARITY CARE IF THE PATIENTS HAD SHARED THEIR FINANCIAL INFORMATION. THIS PERCENTAGE WAS DERRIVED FROM DEMOGRAPHIC STUDIES OF THE COMMUNITY FOR FAMILIES FALLING BELOW THE HOSPITAL'S CHARITY CARE GUIDELINES, WHICH ARE BASED ON THE FEDERAL POVERTY GUIDELINES, IN THE MARKET AREA. PART III, LINE 8: THE ORGANIZATION UTILIZED A COST-TO-CHARGE RATIO IN DETERIMINING THE COSTING FOR THIS SECTION. PART III, LINE 9B: ALL SELF PAY PATIENTS ARE INFORMED ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND ARE GIVEN THE OPPORTUNITY TO COMPLETE THE APPLICATION. OTHERWISE, PRIOR TO THE PROCEDURE, AN ATTEMPT IS MADE TO COLLECT A PORTION OF THE COST OF THE PROCEDURE BASED ON AN GOOD FAITH ESTIMATE. AFTER THE PROCEDURE, THE HOSPITAL WILL SEND OUT ONE STATEMENT WITH THE AMOUNT OWED BY THE PATIENT. AFTER THIS STATEMENT, THE ACCOUNT IS TURNED OVER TO OUR IN-HOUSE SP COLLECTIONS DEPARTMENT. THEY CALL THE PATIENT TO DISCUSS PAYMENT TERMS AND OUR FA PROGRAM AND IF THE PATIENT HAS A 3RD PARTY PAYER. AFTER 120 DAYS, THE ACCOUNT IS THEN TURNED OVER TO OUR 3RD PARTY COLLECTOR. THE COLLECTOR WILL CALL AND SEND STATEMENTS IN AN ATTEMPT TO COLLECT THE FUNDS. AFTER 120 DAYS FROM PLACEMENT, AND THERE HAS BEEN NO ACTIVITY, THE ACCOUNT IS RETURNED TO THE HOSPITAL AND THE ACCOUNT IS WRITTEN OFF. TUOMEY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 3: THE INTERNET-BASED SURVEY WAS PROMOTED THROUGH AN EMAIL LIST MAINTAINED BY THE HOSPITAL AND DISTRIBUTED TO LOCAL CIVIC AND HEALTH ORGANIZATIONS WITH A REQUEST FOR PARTICIPATION. TUOMEY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 4: ADVERTISED IN NEWSPAPER TUOMEY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 7: A LACK OF IDENTIFIED EFFECTIVE INTERVENTIONS TO ADDRESS THE NEED AS PREVENTIVE RESPONSES ARE BEST ADDRESSED BY PRIMARY CARE PRACTITIONERS. THE NEEDS THAT WERE IDENTIFIED BUT WERE NOT ADDRESSED WERE:- OBESITY- HYPERTENSION- AFFORDABLE ACCESS TUOMEY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 12H: HOMELESS TUOMEY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 14G: STAFF VISITS AND SCREENS ALL SELF PAY PATIENTS ADMITTED TO THE FACILITY. PART VI, LINE 2: TUOMEY PROCURES AN ANNUAL PHYSICIAN NEEDS ASSESSMENT TO DETERMINING THE PHYSICIAN NEEDS OF SUMTER COMMUNITY.. TUOMEY IS A FULL SEVICE COMMUNITY HOSPITAL, PROVIDING PRIMARY AND SECONDARY LEVELS OF CARE. A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED DURING FY 2013 AND PRESENTED TO THE GOVERNING BOARD. PART VI, LINE 3: PER TUOMEY POLICY, PUBLIC NOTICE OF THE AVAILABILITY OF ASSISTANCE IS PROVIDED THROUGH THE POSTING OF NOTICES IN LOCATIONS OF HIGH VOLUME SUCH AS INPATIENT/OUTPATIENT PATIENT ACCESS/REGISTRATION, ER, BILLING OFFICES, ADMITTING OFFICES AND HOSPITAL OUTPATIENT SERVICE SETTINGS. IN ADDITION, NOTICE OF THE AVAILABILITY OF ASSISTANCE AND CONTACT INFORMATION IS LOCATED ON THE HOSPITAL WEBSITE. PATIENT LIABILITY STATEMENTS SENT TO PATIENTS ALSO INCLUDE LANGUAGE INDICATING THE PATIENT MAY BE ELIGIBLE FOR ASSISTANCE IF THEY MEET CERTAIN INCOME REQUIREMENTS. ADDITIONALLY, PATIENT ACCESS REPRESENTATIVES CONTACT ALL INPATIENT SELF PAY PATIENTS AND ALL OUTPATIENT AND ER PATIENTS WITH ACCOUNT BALANCES OVER A MINIMUM BALANCE, AND THROUGH INTERVIEWS, DETERMINE IF THEY ARE ELIGLIBEL FOR ANY FIANANCIAL ASSISTANCE. PART VI, LINE 4: SUMTER COUNTY IS HOME TO 108,123 RESIDENTS, WITH 18.3% OF THESE RESIDENTS AT OR BELOW THE POVERTY LEVEL. SUMTER'S RACIAL DEMOGRAPHICS ARE COMPRISED OF 49.2% WHITE, 47.1% AFRICAN-AMERICAN, 1.3% ASIAN, AND 2.4% OTHER. THE AVERAGE INCOME FOR A SUMTER HOUSEHOLD IS $29,915. CURRENTLY, SUMTER'S UNEMPLOYMENT RATE EQUALS 10.2%. SUMTER HAS A MILITARY BASE WHICH HOUSES U.S. AIR FORCE AND U.S. ARMY TROOPS. PART VI, LINE 5: TUOMEY HEALTHCARE SYSTEM IS A 301 BED ACUTE CARE FACILITY LOCATED IN SUMTER, SOUTH CAROLINA. TUOMEY WAS ESTABLISHED AS A NON-PROFIT ACUTE CARE HOSPITAL TO ADVANCE OR SUPPORT THE PROVISIONS OF HEALTHCARE SERVICES WITHIN THE SUMTER COMMUNITY. TUOMEY'S MAIN OBJECTIVE IS THE PROMOTION OF HEALTH FOR ALL RESIDENTS OF SUMTER AND ITS OUTLYING AREAS. THE ORGANIZATION UTILIZES SURPLUS FUNDS TO MAKE IT NOT ONLY UNNECESSARY, BUT UNREASONABLE FOR ANYONE TO GO ELSEWHERE FOR HEALTHCARE SERVICES THAT WE CAN PROVIDE IN A HIGH-QUALITY, COST-EFFECTIVE MANNER.A MAJORITY OF THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND ARE NOT EMPLOYEES, FAMILY MEMBERS OF EMPLOYEES, OR CONTRACTORS OF THE ORGANIZATION. TUOMEY EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL LOCAL PHYSICIANS IN MOST OF OUR DEPARTMENTS. REPORTS FILED WITH STATES PART VI, LINE 7 SC X 1 1 X X X 0 1 0 0 0 0 0 0 0 SAMUEL RIDDLE MD 0 439819 0 0 0 0 0 0 0 15381 0 455200 0 0 R JAY COX 549500 0 170350 0 100733 0 154550 0 16329 0 991462 0 0 0 MARK M CRABBE MD 0 350294 0 335000 0 48629 0 26300 0 17635 0 777858 0 0 HENRY MOSES MD 0 352958 0 280963 0 44469 0 26300 0 16419 0 721109 0 0 J GREGG MARTIN 338500 0 78701 0 76458 0 113654 0 7718 0 615031 0 0 0 MARK LOVELL 160008 0 0 0 31017 0 40228 0 11965 0 243218 0 0 0 GENE F DICKERSON MD 494102 0 0 0 0 0 9700 0 19553 0 523355 0 0 0 WILLIAM RENWICK 241166 0 0 0 0 0 8987 0 4525 0 254678 0 0 0 MICHELLE LOGAN-OWENS 198156 0 0 0 0 0 6719 0 2140 0 207015 0 0 0 TERESA M CARLTON 208520 0 0 0 0 0 19444 0 19564 0 247528 0 0 0 TEXIN LI 195142 0 0 0 12796 0 8227 0 17816 0 233981 0 0 0 MICHAEL SAND 146699 0 0 0 49111 0 7144 0 10635 0 213589 0 0 0 JUDY LYNN ROBERTS 163594 0 0 0 27142 0 7551 0 12926 0 211213 0 0 0 ETNA C GRIFFIN 150967 0 0 0 25140 0 6901 0 913 0 183921 0 0 0 SHERRI J BABB 150967 0 0 0 27140 0 14574 0 12930 0 205611 0 0 0 PART I, LINE 1A THERE WAS COUNTRY CLUB DUES FOR: JAY COX $ 885 GREGG MARTIN 885 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN (457(F)) AND/OR DEFINED BENEFIT PLAN FOR 2012, AS FOLLOWS. THE AMOUNTS ARE REPRESENTED IN PART II, COLUMN (C): R. JAY COX $ 115,050 J. GREGG MARTIN 74,154 MARK LOVELL 26,228 A SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 83703EKE4 2006-01-12 76542284 SEE PART VI 0 0 0 B SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 83703FBT8 2008-12-01 16440000 SEE PART VI 0 0 0 A 24300000 76542284 36255000 2007 1 0 1 1 B 16440000 240000 16200000 1995 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 1 0 0 0 0 SCHEDULE K, PART I, COLUMN (F), DESCRIPTION OF PURPOSE, BOND (A) - THE PROJECT CONSISTS OF THE EXPANSION OF THE PATIENT TOWER TO INCLUDE 35 ADDITIONAL BEDS AT AN ESTIMATED COST OF $30,000,000. SIGNIFICANT ASPECTS OF THE PROJECT INCLUDED THE TUOMEY WOMEN'S CENTER, THE TUOMEY HEALTHCARE SYSTEM NURSERIES, AND EXPANDED INPATIENT CAPACITY OF 22 PRIVATE INPATIENT ROOMS THROUGH A RELOCATION OF CERTAIN DEPARTMENTS. BOND (B) - NET PROCEEDS FROM THE SALE OF THE BONDS WERE APPLIED TO THE PAYMENT UPON REDEMPTION OF THE SERIES 1995B VARIABLE RATE BONDS. SCHEDULE K, PART II, LINE 11, OTHER SPENT PROCEEDS: AMOUNTS ON LINE 11 REPRESENT BOND PROCEEDS USED TO REFUND PRIOR ISSUES DATED AS FOLLOWS: BOND (A) - $ 36,255,000: SERIES 1995A, REFUNDED ON FEBRUARY 16, 2006 BOND (B) - $ 16,200,000: SERIES 1995B, REFUNDED ON DECEMBER 1, 2008 SCHEDULE K, PART III, BOND (B) WAS USED TO CURRENTLY REFUND AN ISSUE DATED BEFORE JANUARY 1, 2003; THEREFORE, PART III OF SCHEDULE K IS NOT APPLICABLE TO THIS BOND. CHERYL MARTIN FAMILY RELATIONSHIP WITH OFFICER J. GREGG MARTIN 158552 COMPENSATION AS EMPLOYEE 0 SYLVESTER OWENS FAMILY RELATIONSHIP WITH KEY EMPLOYEE MICHELLE LOGAN-OWNES 92125 COMPENSATION AS EMPLOYEE 0 JOSEPH DURANT FAMILY RELATIONSHIP WITH BOARD MEMBER KAY RAFFIELD 47775 COMPENSATION AS EMPLOYEE 0 0 SHARRY WILLIAMS FAMILY RELATIONSHIP WITH BOARD MEMBER MITCH WILLIAMS 12349 COMPENSATION AS EMPLOYEE 0 FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY THE CEO, CONTROLLER, AND COPIES OF THE FORM 990 WERE DISTRIBUTED TO THE BOARD MEMBERS.. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR THE CORPORATE COMPLIANCE OFFICER DISTRIBUTES A CONFLICT OF INTEREST POLICY QUESTIONNAIRE REQUIRING ALL PERSONS MANAGER AND ABOVE TO DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST. OFFICERS, KEY EMPLOYEES, AND TRUSTEES OF THE BOARD COMPLETE THIS QUESTIONNAIRE. BEFORE MAJOR VOTES AND DECISIONS, THE POLICY IS CONSIDERED AND ANY MEMBER WITH A CONFLICT IS EXCUSED FROM THE DISCUSSION OR VOTE. DOCUMENTATION OF THE CONSIDERATION IS KEPT IN THE MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE CEO REPORTS TO THE GOVERNING BOARD. CEO COMPENSATION IS REVIEWED BY THE COMPENSATION/PERSONNEL COMMITTEE OF THE BOARD. AN INDEPENDENT HUMAN RESOURCES CONSULTING FIRM, INTEGRATED HEALTHCARE STRATEGIES, PROVIDES COMPARATIVE DATA TO THE BOARD AND CEO FOR THE REVIEW OF THE CEO'S AND THE VICE PRESIDENTS'KEY OFFICERS' COMPENSATION. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILING OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN PENSION OBLIGATION 13,992,568. INTERCOMPANY EQUITY TRANSFER -1,115,805. NET CHANGE IN TIMOTHY J TUOMEY TRUST 23,841. THE TUOMEY FOUNDATION 115 N SUMTER ST SUITE 120 SUMTER SC 29150 571041691 SUPPORT AND FUNDRAISING SC 501(C)(3) LINE 11A, I TUOMEY HEALTHCARE SYSTEM 1 TUOMEY MEDICAL PROFESSIONALS INC 129 NORTH WASHINGTON ST SUMTER SC 29150 571012488 HEALTHCARE SC 501(C)(3) LINE 11A, I TUOMEY HEALTHCARE SYSTEM 1 TIMOTHY J TUOMEY TRUST 129 NORTH WASHINGTON ST SUMTER SC 29150 237127466 SUPPORT AND FUNDRAISING SC 501(C)(3) LINE 11A, I TUOMEY HEALTHCARE SYSTEM 1 TUOMEY PROFESSIONAL SERVICES LLC 129 NORTH WASHINGTON ST SUMTER SC 29150 201691464 HEALTH CARE SERVICES SC N/A C 11367 1.00000 0 1 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 TUOMEY MEDICAL PROFESSIONALS A 1172792 CASH THE TUOMEY FOUNDATION C 643814 CASH TUOMEY MEDICAL PROFESSIONALS L 135600 CASH TUOMEY MEDICAL PROFESSIONALS O 115220 CASH THE TUOMEY FOUNDATION O 91489 CASH TUOMEY MEDICAL PROFESSIONALS R 10626761 CASH THE TUOMEY FOUNDATION R 433513 CASH