THE REX HEALTHCARE FOUNDATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
THE REX HEALTHCARE FOUNDATION INC (EIN 56-6052117)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-14
IRS object ID
201321349349302612
Schema version
2011v1.5
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-14T10:49:32-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1101 N TRYON STREET SUITE 1000AddressLine1
CityCHARLOTTECity
StateNCState
ZIP Code28246ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN566052117EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE REX HEALTHCARE FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlREXHNameControl
Phone9197844424Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line14420 LAKE BOONE TRAILAddressLine1
CityRALEIGHCity
StateNCState
ZIP Code27607ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBERNADETTE SPONGName
TitleCFOTitle
Phone9197843100Phone
Date Signed2013-05-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJOHN NORMANName
PTINP01506766PTIN
Phone7049985200Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAVID STRONGNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line14420 LAKE BOONE TRAILAddressLine1
CityRALEIGHCity
StateNCState
ZIP Code27607ZIPCode
FieldValueIRS element (for citing)
Gross Receipts6529889GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.REXHEALTH.COM/FOUNDATIONWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1958YearFormation
State Legal DomicileNCStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE OPPORTUNITIES FOR OUR COMMUNITY TO INVEST RESOURCES IN THE EXCELLENT WORK OF REX HEALTHCARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees7TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1243136ContributionsGrantsPriorYear
Contributions Grants Current Year1643045ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year319099InvestmentIncomePriorYear
Investment Income Current Year78033InvestmentIncomeCurrentYear
Other Revenue Prior Year661108OtherRevenuePriorYear
Other Revenue Current Year652921OtherRevenueCurrentYear
Total Revenue Prior Year2223343TotalRevenuePriorYear
Total Revenue Current Year2373999TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1225046GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1291083GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year606149SalariesEtcPriorYear
Salaries Etc Current Year653089SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year34683TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY65137TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year798146TotalFundrsngExpCurrentYear
Other Expense Prior Year231125OtherExpensePriorYear
Other Expenses Current Year204265OtherExpensesCurrentYear
Total Expenses Prior Year2097003TotalExpensesPriorYear
Total Expenses Current Year2213574TotalExpensesCurrentYear
Revenues Less Expenses Prior Year126340RevenuesLessExpensesPriorYear
Revenues Less Expenses CY160425RevenuesLessExpensesCY
Total Assets BOY5166927TotalAssetsBOY
Total Assets EOY5181495TotalAssetsEOY
Total Liabilities BOY159429TotalLiabilitiesBOY
Total Liabilities EOY75914TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY5007498NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5105581NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE OPPORTUNITIES FOR OUR COMMUNITY TO INVEST RESOURCES IN THE EXCELLENT WORK OF REX HEALTHCARE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense1291083Expense
Grants1291083Grants
Revenue1643045Revenue
DescriptionTHE 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.Description
Total Program Service Expense1291083TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest1ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising1ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees7NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonBERNADETTE SPONGNamePerson
Telephone Number9197843100TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14420 LAKE BOONE TRAILAddressLine1
CityRALEIGHCity
StateNCState
ZIP Code27607ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
A DALE JENKINS
DIRECTOR5.00X000
VINCENT L HOELLERICH MD
DIRECTOR2.00X000
JAMES B HYLER
DIRECTOR2.00X000
DARLEEN M JOHNS
DIRECTOR2.00X000
JEFFREY J LYASH
DIRECTOR2.00X000
GARY L PARK
DIRECTOR5.00X0700383222525
ORAGE QUARLES III
DIRECTOR2.00X000
WILLIAM ROPER MD
DIRECTOR5.00X0748460159639
MARK A STRIEBEL
DIRECTOR2.00X000
ROBERT S THOMAS
DIRECTOR2.00X000
TERESA ARTIS
DIRECTOR2.00X000
DAVID STRONG
PRESIDENT60.00X01002936243305X
C HOWARD NYE
DIRECTOR2.00X000
BERNADETTE SPONG
SVP/FINANCE AND CFO, TREAS60.00038803647100X
SYLVIA HACKETT
VP/HR AND DEVELOPMENT60.00024988547019X
ROBERT B LIVERMAN JR
ASSISTANT TREASURER60.00014810933605X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs3237809TotalReportableCompFrmRltdOrgs
Total Other Compensation753193TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations678659RelatedOrganizations
All Other Contributions964386AllOtherContributions
Total Contributions1643045TotalContributions

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column176318TotalRevenueColumn
Exclusion$176,318ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities3625033Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities3723318Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-98285Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-98285TotalRevenueColumn
Exclusion-$98,285ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events1085493GrossIncomeFundraisingEvents
Fundraising Direct Expenses432572FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column652921TotalRevenueColumn
Exclusion$652,921ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2373999TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$730,954ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1291083Total
Program Services1291083ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total537308Total
Management And General53731ManagementAndGeneral
Fundraising483577Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total14946Total
Management And General1494ManagementAndGeneral
Fundraising13452Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total64759Total
Management And General6476ManagementAndGeneral
Fundraising58283Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total36076Total
Management And General3608ManagementAndGeneral
Fundraising32468Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total8568Total
Management And General8568ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total65137Total
Fundraising65137Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total34331Total
Management And General34331ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total70360Total
Management And General7036ManagementAndGeneral
Fundraising63324Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total2847Total
Management And General285ManagementAndGeneral
Fundraising2562Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total58503Total
Management And General5850ManagementAndGeneral
Fundraising52653Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total7760Total
Management And General776ManagementAndGeneral
Fundraising6984Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total12331Total
Management And General1233ManagementAndGeneral
Fundraising11098Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1397Total
Management And General140ManagementAndGeneral
Fundraising1257Fundraising

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total8168Total
Management And General817ManagementAndGeneral
Fundraising7351Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2213574Total
Program Services1291083ProgramServices
Management And General124345ManagementAndGeneral
Fundraising798146Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY608744BOY
EOY738424EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY128930BOY
EOY29188EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY14595BOY
EOY7990EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis15226LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10929LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5821BOY
EOY4297EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY4408837BOY
EOY4401596EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY5166927BOY
EOY5181495EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY159429BOY
EOY75914EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY159429BOY
EOY75914EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY5007498BOY
EOY5105581EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5007498BOY
EOY5105581EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5166927BOY
EOY5181495EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses160425ReconcilationRevenueExpenses
Reconcilation Other Changes-62342ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1REX HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
EIN561509260EIN
Type Of Organization3TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$1,291,083Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts1291083SumOfAmounts

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance332040BeginningOfYearBalance
Contributions16338Contributions
Other Expenditures25000OtherExpenditures
End Of Year Balance323378EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance330250BeginningOfYearBalance
Contributions1790Contributions
End Of Year Balance332040EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis15226OtherCostOrOtherBasis
Depreciation10929Depreciation
Book Value4297BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4297TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
DescriptionINVESTMENTSDescription
Book Value4401596BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Program Related4401596TotalOfBookValueProgramRelated

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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: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. AS OF JUNE 30, 2012, ENTERPRISES EXHAUSTED THEIR NET OPERATING LOSS CARRYFORWARDS. 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 2012 AND 2011. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN REFLECTED IN THE COMBINED FINANCIAL STATEMENTS.

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Mail SolicitationsXMailSolicitations
Email SolicitationsXEmailSolicitations
Phone SolicitationsXPhoneSolicitations
In Person SolicitationsXInPersonSolicitations
Solicitation Of Non Govt GrantsXSolicitationOfNonGovtGrants
Special Fundraising EventsXSpecialFundraisingEvents
Agreement Ref Fundraising1AgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation

Name Of Organization NameOfOrganization

FieldValueIRS element (for citing)
Business Name Line1CAPITAL DEVELOPMENT SERVICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1633 WEST 4TH STREET SUITE 202AddressLine1
CityWINSTONSALEMCity
StateNCState
ZIP Code27101ZIPCode
FieldValueIRS element (for citing)
ActivityCONSULTINGActivity
Fundraiser Control Of Funds0FundraiserControlOfFunds
Gross Receipts0GrossReceipts
Amount Retained By Contractor0AmountRetainedByContractor
Net To Organization0NetToOrganization
FieldValueIRS element (for citing)
Licensed StatesNCLicensedStates

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1GOLF TOURNAMENTNameOfEvent1
Gross Receipts Event1604217GrossReceiptsEvent1
Gross Revenue Event1604217GrossRevenueEvent1
Other Direct Expenses Event1184361OtherDirectExpensesEvent1
Name Of Event2GALANameOfEvent2
Gross Receipts Event2280395GrossReceiptsEvent2
Gross Revenue Event2280395GrossRevenueEvent2
Other Direct Expenses Event2181333OtherDirectExpensesEvent2
Total Number Of Other Events4TotalNumberOfOtherEvents
Gross Receipts Other Events200881GrossReceiptsOtherEvents
Gross Revenue Other Events200881GrossRevenueOtherEvents
Other Direct Expenses Other Events66878OtherDirectExpensesOtherEvents
Gross Receipts Total1085493GrossReceiptsTotal
Gross Revenue Total Events1085493GrossRevenueTotalEvents
Other Direct Expenses Total Events432572OtherDirectExpensesTotalEvents
Direct Expense Summary Events432572DirectExpenseSummaryEvents
Net Income Summary652921NetIncomeSummary

Form990 Schedule G Part IV Form990ScheduleGPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF FUNDRAISING PAYMENTSIdentifier
Return ReferenceSCHEDULE G, PART I, LINE 2B, COLUMN (V)ReturnReference
ExplanationPAID FOR CONSULTINGExplanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1REX HOSPITAL INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14420 LAKE BOONE TRAILAddressLine1
CityRALEIGHCity
StateNCState
ZIP Code27607ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient561509260EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant1291083AmountOfCashGrant
Purpose Of GrantGENERAL SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.:PART I, LINE 2:SCHEDULE I, PART I, LINE 2: 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.
PART II, LINE 1, COLUMN AREX HOSPITAL, INC. 4420 LAKE BOONE TRAIL, RALEIGH, NC 27607

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
GARY L PARK
06930510007332021559506930092290800
WILLIAM ROPER MD
073646000012000015470904930090809900
DAVID STRONG
0473828018923803398700230960012345012462410308940
BERNADETTE SPONG
0288082078113021841031620015480043513600
SYLVIA HACKETT
01903830520130748903737609643029690400
ROBERT B LIVERMAN JR
012502701173501134702585207753018171400

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1ATHE 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 11 INDIVIDUALS LISTED THAT RECEIVE COMPLIMENTARY MEMBERSHIPS. THE VALUE OF THE COMPLIMENTARY MEMBERSHIPS IS TREATED AS TAXABLE COMPENSATION AND IS REPORTED ON THE INDIVIDUAL'S W-2.
PART I, LINE 4BPART I, LINE 4B, DURING CALENDAR YEAR 2011, DAVID STRONG PARTICIPATED IN A NON QUALIFIED SUPPLEMENTAL RETIREMENT PLAN AND RECEIVED AMOUNTS TOTALING $308,940. HE ALSO EARNED COMPENSATION UNDER THIS PLAN TOTALING $207,533. THE CURRENT YEAR EARNINGS ARE PAYABLE IN THE FUTURE.
PART I, LINE 5EMPLOYEES 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.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 7ATHE 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 7BTHE 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 11THE 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 12CTHE 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 15THE ORGANIZATION USES AN INDEPENDENT CONSULTANT TO MEASURE FAIR VALUE OF COMPENSATION FOR THE ORGANIZATION'S PRESIDENT AND OTHER TOP MANAGEMENT. THE ORGANIZATION'S BOARD REVIEWS AND APPROVES THE COMPENSATION FOR ALL OFFICERS EXCEPT THE ASSISTANT TREASURER AND ASSISTANT SECRETARY.
FORM 990, PART VI, SECTION C, LINE 19THE 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 VII, SECTION A, COLUMN BDUE TO THE TREMENDOUS OVERLAP OF DIRECTORS BETWEEN THE ORGANIZATION AND ALL RELATED ORGANIZATIONS, THE RELATED ORGANIZATIONS' HOURS ARE INCLUDED IN THE HOURS LISTED.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -62,342.CHANGES IN NET ASSETS OR FUND BALANCES:
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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
REX HEALTHCARE INC
4420 LAKE BOONE TRAILRALEIGHNC27607561509129HEALTHCARENC501(C)(3)LINE 11A, IUNC HEALTHCARE0
REX HOME SERVICES INC
4420 LAKE BOONE TRAILRALEIGHNC27607561636242HEALTHCARENC501(C)(3)LINE 11A, IREX HOSPITAL0
UNC HEALTH CARE SYSTEM
101 MANNING DRIVECHAPEL HILLNC27514562206970HEALTHCARENC501(C)(3)LINE 3UNC HEALTHCARE0
REX HOSPITAL INC
4420 LAKE BOONE TRAILRALEIGHNC27607561509260HOSPITALNC501(C)(3)LINE 3REX HEALTHCARE0

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
REX SURGERY CENTER OF CARY LLC
4420 LAKE BOONE TRAILRALEIGHNC27607273684056ASCNCREX HOSPITAL INCRELATED00
JRH VENTURES LLC
4420 LAKE BOONE TRAILRALEIGHNC27607274092967MED CAMPUS DVLTNCREX HOSPITAL INCRELATED00
REX HEALTH VENTURES GPI LLC
4420 LAKE BOONE TRAILRALEIGHNC27607VENTURE CAPITAL INVESTMENTNCRELATED00

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntity
REX ENTERPRISES COMPANY INC
4420 LAKE BOONE TRAILRALEIGHNC27607561553957OPERATIONS SUPPORTNCREX HEALTHCAREC
REX PHYSICIANS LLC
4420 LAKE BOONE TRAILRALEIGHNC27607264594963HEALTHCARENCREX HOLDINGSC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
REX HOSPITAL INC
B1291083FMV
REX HOSPITAL INC
J7760FMV
REX HOSPITAL INC
O678659FMV

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
Return ReferencePART V, LINE 1 M&N:ReturnReference
ExplanationREX 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.Explanation

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