2013-11-08T08:23:23-06:00 2012-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 Ridgefield Court Asheville NC 28806 990 2012-01-01 570360499 Roper St Francis Mt Pleasant Hospital ROPE 8437891704 1483 Tobias Gadson Blvd No 101 Charleston SC 29407 Bret D Johnson 8437891704 2013-11-07 1 Amy Bibby P00445891 8282542254 2012 2016-02-24 21:20:13Z X David L Dunlap 1483 Tobias Gadson Blvd No 101 Charleston SC 29407 49556227 0 X www.ropersaintfrancis.com X 2005 SC Operation of nonprofit hospital facility in Mt. Pleasant, South Carolina 13 7 255 20 0 0 242502 484110 35827969 48085137 67766 7573 251492 979407 36389729 49556227 50593 47236 0 0 19502296 19327620 0 0 0 27817872 29352481 47370761 48727337 -10981032 828890 142500513 136951464 162589719 156580029 -20089206 -19628565 X Healing all people with compassion, faith, and excellence. 0 0 42153980 47236 48857060 Roper St. Francis Mount Pleasant Hospital is certainly growing. In the two years it has been available to the community, the staff and facilities have made a positive impact on east-of-the-Cooper communities. In 2012, Mount Pleasant Hospital contributed 319 volunteer staff hours. The hospital also provided events such as free breast cancer screenings and sponsored community events that focused on fun, family-focused activities including the annual Pregnancy Celebration, which was attended by approximately 300 expecting moms and their families. The hospital also offered free parenting classes to new parents and financial counseling for patients in need. For more information on how the healthcare system supports the Lowcountry community in Charitable Care and sponsorships, see Schedule H. Please see Schedule O for a detailed statement of Program Service Accomplishments.Please visit our website for a detailed community benefit report at: http://www.ropersaintfrancis.com/about_us/mission_and_community_activities/annualreport.aspx. 42153980 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 1 255 1 0 0 0 0 0 0 0 0 0 0 X 13 7 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 SC X X The Finance Department 8437891704 1483 Tobias Gadson Blvd 101 Charleston SC 29407 John M Jordan 0.50 2.50 X 0 305450 29397 W Blount Ellison MD 0.50 2.50 X 0 0 0 Sister Anne Lutz 0.50 2.50 X 0 0 0 Richard Statuto 0.50 2.50 X 0 0 0 Joseph G Piemont 0.50 2.50 X 0 0 0 Stanley Wilson MD 0.50 49.50 X 0 648105 52878 Perry Keith Waring 0.50 2.50 X 0 0 0 Brantley D Thomas Phd 0.50 2.50 X 0 0 0 Katherine Duffy Phd 0.50 2.50 X 0 0 0 David M Ellison MD 0.50 2.50 X 0 31375 0 Shannon Honney MD 0.50 49.50 X 0 288946 8956 Julius R Ivester MD 0.50 2.50 X 0 0 0 Alison E Dillon MD 0.50 2.50 X 0 11000 0 Angress Walker 0.50 2.50 X 0 0 0 David Dunlap 1.00 49.00 X 0 985469 245506 Matthew J Severance 1.00 49.00 X 0 666527 191772 Steven D Shapiro MD 1.00 49.00 X 0 572302 127610 Bret Johnson 1.00 49.00 X 0 583226 186548 Allen Carroll 1.00 49.00 X 0 550171 148501 Douglas W Bowling 1.00 49.00 X 0 463263 127901 John Sullivan 47.00 3.00 X 391404 0 97131 Gregory T Edwards 1.00 49.00 X 0 417618 122777 H Douglas Harrison 1.00 49.00 X 0 379598 71611 Michael Taylor 1.00 49.00 X 0 376205 95022 Lisa Schafer 1.00 49.00 X 0 280687 40490 Pennie L Peralta 1.00 49.00 X 0 237771 62881 Diana Topjian 47.00 3.00 X 161443 0 45754 Mark Dickson 1.00 49.00 X 0 149923 43652 Admiral James Flatley USN Ret 1.00 0.00 X 0 0 0 George P Waters 1.00 0.00 X 0 0 0 Wanda Brockmeyer 1.00 10.40 X 0 167694 15322 Maria Sample 7.20 0.00 X 23607 141475 14389 Michael Ricciardone 1.00 2.00 X 0 158612 14021 Peter DiNicola 1.00 49.00 X 0 224711 10631 Robert Lowery MD 0.70 49.30 X 18000 1272161 43089 John Graham MD 0.60 49.40 X 12000 1043903 65541 Harry Rudolph MD 1.00 49.00 X 19500 924303 37357 John Mccrosson MD 0.20 49.80 X 4500 919329 49544 James Demarco MD 1.00 49.00 X 15550 801800 53598 Ellen Brown 0.00 0.00 X 0 130061 15035 Francis Wyckoff Jr 1.00 49.00 X 0 196599 36469 Stephanie Tucker 1.00 49.00 X 0 177755 32717 646004 13106039 2086100 6 1 1 1 Roper Emergency Physicians 639 McCutchen Street Charleston SC 29412 Physician Fees 1845060 Anesthesia Associates of Charleston PO Box 22206 Charleston SC 29413 Anesthesia Services 1588418 Cogdell Spencer Advisors LLC 125 Doughty St STE 620 Charleston SC 29403 Property Management 1231218 Carolinas Healthcare Systems PO Box 32861 Charlotte NC 28232 Management Fees 262374 Allied Barton Security Services PO Box 534265 Atlanta GA 30353 Security Services 230707 12 484110 484110 Net Patient Service Revenue 624100 48085137 48085137 48085137 1872 1872 5701 0 5701 5701 5701 Incentive Payments 900099 771923 771923 Cafeteria Revenue 722210 147586 147586 Gift Shop 900099 43334 43334 16564 16564 979407 49556227 48857060 0 215057 X 47236 47236 576455 576455 15684712 12186846 3497866 328635 246294 82341 1586051 1191337 394714 1151767 863186 288581 812073 478341 333732 70588 70588 23473 23473 4143064 3905510 237554 269466 173401 96065 2420447 1716050 704397 59974 59974 2305334 2246679 58655 26823 26823 46940 46940 8088240 8088240 145352 103143 42209 Medical Supplies 6340791 6340791 Bad Debt Expense 3424783 3424783 DSH Taxes 1028425 1028425 Miscellaneous Expenses 146708 113718 32990 48727337 42153980 6573357 0 725 725 5621813 6194650 1505875 1075467 208433 200840 145298023 17610470 135142777 127687553 20890 1792229 142500513 136951464 107912 89740 198336 275919 162283471 156214370 162589719 156580029 X -20089206 -19628565 -20089206 -19628565 142500513 136951464 X 828890 -368249 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 15467846 15467846 101662918 9786029 91876889 2939189 593805 2345384 25228070 7230636 17997434 127687553 Due to Affiliates 154950982 Third Party Reserves 1263388 156214370 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Roper St. Francis Mt. Pleasant Hospital is a not-for-profit organization as described in Section 501(c)(3) of the Internal Revenue Code and is generally exempt from federal and state income taxes. Accordingly, no provision for income taxes is made in the consolidated financial statements. Although [the consolidated group] is generally exempt from federal and state income taxes, it evaluates whether there are any uncertain tax positions that fail to meet the more-likely-than-not threshold for recognition in the consolidated financial statements. Uncertain tax positions may include the characterization of income, such as a characterization of income as passive, a decision to exclude reporting taxable income in a tax return, or a decision to classify a transaction, entity, or other position in a tax return as tax exempt. The tax return benefit from an uncertain tax position is recognized when it is more likely than not that the position will be sustained upon examination, including resolutions of any related appeals or litigation processes, based on the technical merits. The organization has no unrecognized tax positions as of December 31, 2012 and 2011, and does not expect that unrecognized tax benefits will materially increase within the next 12 months. Tax years 2009 through 2011 are subject to examination by the federal and state taxing authorities, respectively. There are no income tax examinations currently in process. Interest and penalties related to uncertain tax positions, if any, would be recognized in the consolidated financial statements as income tax expense. 1 1 X 1 X 299.000000000000 1 X 399.000000000000 1 1 0 1 1 3118941 1303141 1815800 0.04010 2836248 2240491 595757 0.01320 5955189 3543632 2411557 0.05330 39085 39085 0.00090 141604 141604 0.00310 44 44 0.00000 81103 11809 69294 0.00150 261836 11809 250027 0.00550 6217025 3555441 2661584 0.05880 3395 3395 0.00010 3395 3395 0.00010 0 3424783 1369913 7496960 11089242 -3592282 X 1 1 1 1 Roper StFrancis Mt Pleasant Hospital

3500 Highway 17 North Mt Pleasant SC 29466

X X X Roper St Francis Mt Pleasant Hospital 1 1 1 299.000000000000 1 399.000000000000 1 X X X X X 1 1 X X X X 1 0 1 X 0 0 2 Mount Pleasant Hospital Breast Care

3510 Highway 17 N Ste 205 Mt Pleasant SC 29466

Bone Density, Mammography, Breast Ultrasound Mount Pleasant Hospital Imaging

3510 Highway 17 N Ste 140 Mt Pleasant SC 29466

X-Ray Part I, Line 3c: In addition to using the federal poverty guidelines to determine free and discounted care (see Part I, Lines 3a and 3b), the hospital system offers a 35% discount for patients who are uninsured. A 10% prompt payment discount is offered to all self-pay or self-pay-after-insurance patients who pay the balance at one time. Medical indigency adjustments are available to those that meet the established guidelines.The Hospital will provide free care for patients with a signed charity care application who have income between 0 - 299% of FPG. If a signed charity care application is not obtained, after 120 days of collection efforts, the hospital will use the Health Care Advisory Board's self pay compass program to automatically qualify patients for charity care through the use of an electronic scoring technique. The hospital will provide free care for patients who have income of 350% and below of FPG as determined by the self pay compass program.The Hospital will provide a 90% discount for patients with a signed charity care application who have income between 300 - 399% of FPG. If a signed charity care application is not obtained, the hospital will not provide discounted care. Part I, Line 6a: The organization's community benefit report is made available through its corporate parent, CareAlliance Health Services d/b/a Roper St. Francis Healthcare. Part I, Line 7: Worksheet 2 of the 2012 Schedule H instructions was used to compute a cost-to-charges ration used to calculate charity care and unreimbursed Medicaid at cost. Part I, L7 Col(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 $3,424,783. Details of Community Health Services (net): Part I, line 7(e): Advantage programs - $ 1,770 Community calendars and newsletters - 728 CHNA - 12 Enrollment assistance in public programs - 639 Health education and lectures by staff - 52 Health fairs and career days - 547 House calls magazine - 27,158 Costs to oversee community program - 8,180 Total to Line 7(e), col (e) - 39,085 Part II: In 2012, the Hospital performed the following activities to build up the community.1. Habitat for Humanity2. Participation in economic development council and chamber of commerce on issues impacting the community's health and safety.3. Collaborative partnerships with community groups to improve economic stability of the community.4. TUW Day of Caring (Habitat for Humanity and Halo bags)5. HeartSave AED6. WISE Program (Mt. Plesant Imaging) - Group of local educators that came into the MPH to shadow different modalities to enhance their knowledge7. Seat Belt Counts and high school injury prevention program - ER nurses partner with local high schools year around to discuss seat belt safety and drunk driving.8. Lifelink EMS Service for Charleston Race Week and Try Charleston Triathlon.9. Cooper River Bridge Run and SE Wheelchair Games.10. Dragon Boat Charleston Cancer Survivor Programs, Barrier Island Free Clinic, Spirit of Caring Golf Tournament to benefit nursing scholarships.11. Back Pack Buddies - partnered with the Lowcountry Foodbank to eliminate hunger by assisting with gathering and distributing food to local school age children. Part III, Line 4: Bad debts reported on Part III, Line 2 are reported at gross charges per the organization's audited financial statements.Please refer to the second footnote of the organization's audited financial statements for a description of receivables and bad debts.For patients who do not turn in a signed charity care application, the organization uses the Health Care Advisory Board's self pay compass program to automatically qualify patients for charity care through the use of an electronic scoring technique. The data received through this software is believed to err on the side of denying charity. The estimate of bad debt that could have been charity is based on the system error rate. Please note that patients who complete a full charity care application and qualify for charity under our policy are granted charity regardless of the score in the self-pay compass system. Part III, Line 8: The entire amount of Medicare shortfall qualifies as community benefit. Our treatment of Medicare patients, as described in IRS Rev. Rul. 69-545, indicates that Mt. Pleasant Hospital operates to promote the health of the community. By taking Medicare patients, the hospital promotes access to healthcare services, which is a community benefit.The Medicare cost report was used to compute amounts for Part III, lines 5 and 6. Had we included revenues and costs from all Medicare programs including Medicare Part C and physicians practices this would have resulted in an additional shortfall of $1,254,397. Part III, Line 9b: The hospital uses the Health Care Advisory Board's self pay compass program to identify a patient's propensity to pay. Accounts with an FPL of 350% and below will be identified once the self pay accounts receivable billing process has been completed and prior to the account being referred to a collection agency. Accounts with FPL of 350% and below will be given a charity adjustment. Once an account has been referred to bad debt, the organization will make every effort to ensure that all self-pay collectors demonstrate consistent, compassionate, and professional service while conducting business on behalf of the health system. This will include, but is not limited to: guarantor notification and contact/collection attempts, discount opportunities, payment plan arrangements, account balance notifications, face to face meetings, and detailed bill generation. An outsourced self-pay billing agency will contact the guarantor to set up payment arrangements. Financial assistance discounts are offered to guarantors who meet the charity guidelines.Self pay patients receive a 35% discount off total charges. They are also eligible for a 10% prompt payment discount if they pay the balance during the discussion. Discounts may be combined if all requirements are met. In pursuit of collections, the hospital and its agents will not: attach liens on property, garnish wages, pursue legal actions (unless recommended by the self pay billing entities), sell accounts, or send bankrupt guarantors to collection agencies. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 10: The Hospital will provide free care for patients with a signed charity care application who have income between 0 - 299% of FPG. If a signed charity care application is not obtained, after 120 days of collection efforts, the hospital will use the Health Care Advisory Board's self pay compass program to automatically qualify patients for charity care through the use of an electronic scoring technique. The hospital will provide free care for patients who have income of 350% and below of FPG as determined by the self pay compass program. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 11: The Hospital will provide a 90% discount for patients with a signed charity care application who have income between 300 - 399% of FPG. If a signed charity care application is not obtained, the hospital will not provide discounted care. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 12h: In addition to using the Federal Poverty Guidelines to determine free and discounted care (see Part I, lines 3a and 3b), the hospital offers a 35% discount to all uninsured patients regardless of income. A 10% prompt payment discount is also offered to all self-pay patients who pay their balance at one time. Medical indigency adjustments are available to those that meet the established guidelines. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 14g: The patient handbook provided with registration references the policy and includes contact information for patients who need assistance. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 20d: The hospital's FAP provides a minimum discount of 90% for individuals that qualify under the policy's provisions. The hospital has made plans to implement a method of determining Amounts Generally Billed (AGB) per the recently released Proposed Regulations under IRC Section 501(r), however given the high level of discount available under the current policy, the organization is confident that its policies are well within guidelines. Part VI, Line 2: The hospital participates in periodic needs assessment projects to assess the healthcare needs of the community. The most recent needs assessment titled "Health System Profile for the Tricounty Area of Berkeley, Charleston, & Dorchester Counties" was performed in 2010. This report was a collaboration between the South Carolina Hospital Association and the South Carolina Rural Health Research Center in the Arnold School of Public Health, University of South Carolina. A number of data sets were examined in partnership with the office of research and statistics at the South Carolina Budget and Control Board. The majority of the information delineated in this report was drawn from a series of interviews and focus groups with healthcare professionals, community leaders, and uninsured residents. the purpose of this report was to assess local healthcare infrastructure including location, service availability, business rules, and workforce issues as well as to describe health service utilization issues such as the types of care uninsured people are seeking, the degree of unmet healthcare needs, and perceived reasons for needs going unmet. Data suggest that resources available to uninsured in the tricounty area are moderately effective in preventing potentially avoidable emergency room visits but lacks impact on the same type of inpatient hospitalizations. Diabetes, bacterial pneumonia, congestive heart failure, kidney/urinary tract infections, and dental conditions are among the most prevalent reasons for an avoidable hospital visit. Dental care remains a significant unmet healthcare need among the uninsured. Access to specialty care for the uninsured is unanimously the biggest obstacle for the tricounty key stakeholders. The participants in the needs assessment will engage in strategic planning and implementation of activities that will improve access to care for the uninsured. A project database will inform on the group's progress. The University of South Carolina team will continue to monitor progress as a project evaluator.The organization has recently completed a CHNA that complies with IRS Section 501(r) and it is posted on the organization's website: http://www.rsfh.com/About_Us/Mission_and_Community_Activities/Needs_Assessment.aspx Part VI, Line 3: The Hospital shall send anyone who requests information on the hospital's financial assistance program a letter outlining required information and a financial assistance application form. Requests for financial assistance may be proposed by sources other than the patient, such as the patient's physician, family members, social service organizations, community or religious groups, or hospital personnel. Statements to patients from the Hospital outline our charity care policy and our charity care policy is posted on our website. If patients indicate they are not able to pay their bill, we will provide the patient with a charity care application.Patients can also meet with a member or our financial counseling department to learn about their financial assistance options. Brochures are printed in English and Spanish telling patients to contact the financial counseling department. The Hospital wants its patients focus to be on health and recovery and not financial worry. There is absolutely no additional cost for our financial counseling assistance.Additionally, patients can meet with staff of the Medicaid program. The program staff will meet with patients individually to help them apply for publicly supported programs such as Medicaid, Medicare, and disability. Counselors meet with patients in the hospital as well as making home visits as appropriate. The staff can also help identify resources to help pay for medication. All of this information is posted on our website with the appropriate contact information. Part VI, Line 4: The System's primary service area consists of Charleston, Berkeley, and Dorchester counties, and includes the major municipalities of Charleston, North Charleston, Mount Pleasant, and Summerville. Approximately 703,000 residents live within the primary service area, based on Nielsen Claritas estimates for 2013. Population in the primary service area is projected to grow 8.1% between 2013 and 2018 based on Nielsen Claritas projections. In 2013, 14% of households within the primary service area had income less than $15K, 12% had income between $15K and $25K, 26% had income between $25K and $50K, 18% between $50K and $75K, 12% between $75K and $100K, and 18% above $100K compared to the national rates of 14%, 12%, 25%, 18%, 12%, and 19%, respectively. Within the primary service area, poverty continues to be an issue. According to the US Census Bureau's 2010 Small Area Health Insurance Estimates (SAHIE), an estimated 108,943 Tri-county residents lack health insurance. There is a vast overrepresentation of the uninsured living at or below the Federal Poverty Level. The US Department of Health and Human Services designated 6 medically underserved areas and 1 medically underserved population within our primary service area. From April 2012 to April 2013, the unemployment rate in the primary service area decreased from 7.1% to 5.9%. This is a lower unemployment rate than the national average, which was 7.7% in April 2012 declining to 7.1% in April 2013.The secondary service area includes Colleton, Orangeburg, Georgetown, Hampton, Beaufort, Williamsburg, and Horry counties. In addition to the system's facilities, there are three other non-military hospitals in the primary service area. Part VI, Line 5: We are the lowcountry's only non-governmental, not-for-profit healthcare system. With this distinction, we believe it is our responsibility to advocate for and respond to our neighbors needs through community benefit. In keeping with our mission of healing all people with compassion, faith, and excellence, Roper St. Francis Healthcare (RSFH) strives to enrich the health of our community. We do this by offering charity care to those in need, reaching out to our neighbors with health fairs and educational materials, sponsoring organizations and events that promote wellness and community well-being, and marshalling our resources to advance the health and dignity of each person with whom we come in contact.RSFH is committed to the enrichment of healthcare in our community as evidenced by the composition of our board of directors and open medical staff. Our governing body is comprised of a 13 member board of directors. At least nine directors must have their primary residence in a community served by the system. Five directors must be physicians actively engaged in the full time practice of medicine. RSFH extends medical staff privileges to all qualified physicians in the area for most of our departments.Surplus funds are returned to our community through the development of new facilities to serve population growth, the expansion or existing facilities, subsidizing care for those who are unable to pay, sponsorship of healthcare related activities including outreach clinics and programs for the uninsured, and investing in technology to improve the quality of patient care. Part VI, Line 6: CareAlliance Health Services (d/b/a Roper St. Francis Healthcare (RSFH)) is a charitable health care delivery system based in Charleston, South Carolina. The 657-bed health system provides services at 90 facilities and doctors' offices conveniently located throughout our region. One of these facilities is Roper St. Francis Mount Pleasant Hospital, an acute care hospital with 85 licensed beds. CareAlliance was formed effective August 1, 1998, through the execution of an affiliation agreement between the following founding members: The Medical Society of South Carolina, Bon-Secours Health System, Inc., and Carolinas Healthcare System. CareAlliance is the sole corporate member and, through its by-laws, has the power to control the financial and business affairs of Roper St. Francis Mt. Pleasant Hospital. Reports Filed With States Part VI, Line 7 SC X X X X 0 1 0 0 0 1 1 1 0 John M Jordan 0 270450 0 35000 0 0 0 12564 0 16833 0 334847 0 0 Stanley Wilson MD 0 647361 0 0 0 744 0 24664 0 28214 0 700983 0 0 Shannon Honney MD 0 288440 0 0 0 506 0 2309 0 6647 0 297902 0 0 David Dunlap 0 544054 0 363688 0 77727 0 219829 0 25677 0 1230975 0 14064 Matthew J Severance 0 399048 0 239877 0 27602 0 160254 0 31518 0 858299 0 21813 Steven D Shapiro MD 0 362449 0 182320 0 27533 0 117819 0 9791 0 699912 0 12708 Bret Johnson 0 306873 0 192243 0 84110 0 157008 0 29540 0 769774 0 40768 Allen Carroll 0 331037 0 199086 0 20048 0 131414 0 17087 0 698672 0 18685 Douglas W Bowling 0 294801 0 151575 0 16887 0 107814 0 20087 0 591164 0 16500 John Sullivan 222042 0 138150 0 31212 0 74135 0 22996 0 488535 0 0 0 Gregory T Edwards 0 277833 0 138504 0 1281 0 94610 0 28167 0 540395 0 0 H Douglas Harrison 0 235959 0 115155 0 28484 0 62614 0 8997 0 451209 0 14130 Michael Taylor 0 255446 0 106710 0 14049 0 82474 0 12548 0 471227 0 9095 Lisa Schafer 0 187890 0 78339 0 14458 0 27114 0 13376 0 321177 0 10184 Pennie L Peralta 0 161847 0 67980 0 7944 0 44294 0 18587 0 300652 0 7557 Diana Topjian 126741 0 34195 0 507 0 26207 0 19547 0 207197 0 0 0 Mark Dickson 0 126086 0 21226 0 2611 0 17438 0 26214 0 193575 0 0 Wanda Brockmeyer 0 142122 0 16178 0 9394 0 6325 0 8997 0 183016 0 0 Maria Sample 20521 122984 2650 15879 436 2612 602 3611 1455 8721 25664 153807 0 0 Michael Ricciardone 0 130722 0 19817 0 8073 0 6111 0 7910 0 172633 0 0 Peter DiNicola 0 189959 0 30725 0 4027 0 6688 0 3943 0 235342 0 0 Robert Lowery MD 18000 1271576 0 0 0 585 0 24664 0 18425 18000 1315250 0 0 John Graham MD 12000 1043168 0 0 0 735 0 42664 0 22877 12000 1109444 0 0 Harry Rudolph MD 19500 924096 0 0 0 207 0 7664 0 29693 19500 961660 0 0 John Mccrosson MD 4500 919029 0 0 0 300 0 18164 0 31380 4500 968873 0 0 James Demarco MD 15550 801336 0 0 0 464 0 24664 0 28934 15550 855398 0 0 Ellen Brown 0 130061 0 0 0 0 0 0 0 15035 0 145096 0 0 Francis Wyckoff Jr 0 167642 0 25198 0 3759 0 25472 0 10997 0 233068 0 0 Stephanie Tucker 0 148277 0 25527 0 3951 0 23541 0 9176 0 210472 0 0 Part I, Line 4b The following participants received compensation through a 457(f) plan: Allen Carroll - $ 18,685 (from a related organization) Pennie Peralta - 7,557 (from a related organization) Lisa Schafer - 10,184 (from a related organization) Douglas Bowling - 16,500 (from a related organization) Matthew Severance - 21,813 (from a related organization) Steven Shapiro - 12,708 (from a related organization) Michael Taylor - 9,095 (from a related organization) Howard Harrison - 14,130 (from a related organization) David Dunlap - 28,673 (from a related organization) Bret Johnson - 66,209 (from a related organization) Part I, Line 6 Goals are developed each year to support the organization's strategic initiatives for people, quality, financial, growth and service. The Ad Hoc Compensation Committee approves the system goals annually and reports to the full Board of Directors. Progress on each metric is reported to the board each month on the corporate scorecard. At year end, the Ad Hoc Compensation Committee approves the final scorecard number and reports results to the full board. Annual incentives for the executives are based on 60% on the corporate scorecard and 40% on individual performance. Executives maintain an individual scorecard on the leader evaluation manager and discuss results monthly with the President/CEO. The President/CEO approves the individual executive scorecard. System Vice Presidents and the system CEO are eligible to participate in a long term incentive plan (LTIP). An LTIP typically takes place over a three year period and does not vest until the end of the third year. To receive payment, executives must still be employed by the system at the end of the plan period. Each LTIP has a financial and clinical objective that is aligned with the organization's strategic goals. Threshold, target, and maximum performance ranges are established for these objectives and are measured based on performance against similar organizations or compared to an internal metric such as an improvement over prior performance. These targets and objectives are approved by the Ad Hoc Compensation Committee. The incentive is earned based on the satisfaction of the threshold, target, or maximum performance ranges. The Ad Hoc Compensation Committee also approves the final LTIP performance score and the amount paid to executives under the plan. Results are reported to the full board annually. Part I, Line 7 See the response to line 6 above. Supplemental Information Part III Part II, Line 1: Compensation from unrelated organizations Carolinas Healthcare System provides the compensation of David L. Dunlap, CEO, CareAlliance Health Services; Bret D. Johnson, CFO, CareAlliance Health Services; and John Sullivan, CEO, Roper St. Francis Mt. Pleasant Hospital. Mr. Dunlap and Mr. Johnson are employees of Carolinas Healthcare System and their compensation is paid by CareAlliance Healthcare Services, a related organization, through a management fee to Carolinas Healthcare System. Mr. Sullivan is also an employee of Carolinas Healthcare System, and his compensation is paid by Roper St. Francis Mt. Pleasant Hospital through a management fee to Carolinas Healthcare System. Additional information: CareAlliance Health Services has board representations from the 3 founding organizations: The Medical Society of SC (6 board members), Bon-Secours Health System, Inc. (6 board members), and Carolinas Healthcare System (1 board member). None of the 13 appointed board members receive compensation for their membership. Additionally, 4 of the 6 board members appointed by the Medical Society of South Carolina also serve on the Board of the Medical Society. None receive compensation for their services as a board member. It is the founding members' intent that the members of the Board of Directors are appointed to such positions because they have a willingness to serve the needs of the system as a whole and not the needs of any individual founding member. Anesthesia Associates of Charleston The President of this organization is Board Member Dr. Julius Invester 1588418 Provision of anesthesia services 0 Form 990, Part VI, Section A, line 3 Carolinas Healthcare System (CHS), an unrelated organization, provides the compensation of Mr. David L. Dunlap, CEO, CareAlliance Health Services; Mr. Bret D. Johnson, CFO, CareAlliance Health Services; and Mr. John Sullivan, CEO, Roper St. Francis Mt. Pleasant Hospital. Mr. Dunlap and Mr. Johnson are employees of CHS and their compensation is paid by CareAlliance Health Services, a related organization, through a management fee to CHS. Mr. Sullivan is also an employee of CHS, and his compensation is paid through a management fee by Roper St. Francis Mt. Pleasant Hospital. Form 990, Part VI, Section A, line 6 The sole member of the corporation is CareAlliance Health Services, a South Carolina nonprofit, nonstock Corporation, d/b/a Roper St. Francis Healthcare. CareAlliance Health Services is in turn governed by a Board of Directors appointed by the "founding members". Please see the response to Line 7a below. The bylaws of the organization specify certain qualifications of the thirteen member Board of Directors. At least nine directors must have their primary residence in a community served by the system. Five directors must be physicians actively engaged in the full time practice of medicine. Five of the directors are appointed to the Board of Directors by virtue of positions held within MSSC, BSHSI and CHS (ex-officio directors). Each of the five ex-officio directors serves as a director of the organization for so long as such person holds his or her respective elected or appointed office in his or her respective founding member organization. Directors serve three-year terms and are limited to three consecutive terms. After an absence of at least one year, directors are again eligible for appointment to the Board of Directors for two consecutive complete terms. Form 990, Part VI, Section A, line 7a The organization is governed by a thirteen member board of directors appointed by the founding members. Subject to certain nominating and governance committee approvals, six directors are appointed by the Medical Society of South Carolina (MSSC), Bon Secours Health Systems, Inc. (BHSHI) and one director is appointed by Carolinas Healthcare Systems (CHS). It is the founding members' intent that the members of the organization's board of directors are appointed to such positions because they have a willingness to serve the needs of the system as a whole and not the needs of any individual founding member. Form 990, Part VI, Section A, line 7b The following actions shall require the unanimous affirmative approval of all of the founding members: (a) to amend the Articles of Incorporation or by-laws, including without limitation, any change in the corporation's purposes; provided, however, that, subject to the procedures and voting requirements with respect to the admission of non-founding members, Schedule 3.1 may be amended with the approval of two (2) of the founding members to reflect the admission of a non-founding member; (b) to dissolve or liquidate the corporation and to determine the distribution of assets upon dissolution; (c) to merge or consolidate the corporation or to sell, convey, transfer, lease, or otherwise dispose of all or substantially all of its assets; (d) to appoint the President and Chief Executive Officer of the corporation in a manner other than that established within the by-laws; (e) to alter or amend the corporation's ethical performance standards (defined below); or (f) to enter into any material agreement whereby a third party will: (i) become an equity owner in any joint venture with the corporation or any system participant and will not be legally obligated to support the corporation's ethical performance standards; or (ii) manage a substantial part of the facilities, assets, or operations of the system and will not be legally obligated to comply with and support the corporation's ethical performance standards. Form 990, Part VI, Section B, line 11 The 2012 Form 990 was prepared by an independent accounting firm with assistance and oversight by management. Reviews were then conducted by the assistant controller, director of finance, and chief financial officer of CareAlliance Health Services, the sole member, before presentation and review with the organization's governing body. Highlights of the 2012 Form 990 were presented to the organization's board of directors. In addition to the organization's executive management, representatives of Dixon Hughes Goodman, LLP participated in this review with board members. The board meeting was held prior to the filing of the Form 990 with the internal revenue service. A final version of the Form 990 was sent to all members of the governing body prior to filing. Form 990, Part VI, Section B, line 12c The directors shall complete and return to the secretary an annual statement that each: (a) has received a copy of the conflict of interest policy; (b) has read and understands the policy; (c) agrees to comply with this policy; (d) understands that the policy applies to all committees; and (e) understands that the organization is a charitable organization and must continuously engage primarily in activities which accomplish one or more of its tax-exempt purposes. Form 990, Part VI, Section B, line 15 An independent company, Towers Watson, provides research, advice and guidance to the compensation committee and senior leadership to ensure the organization's compensation programs for executives covered by the "Intermediate Sanctions Legislation" (IRC Section 4958) are aligned with its stated philosophy: Base salaries are targeted at the 50th percentile of the established comparator market; Total cash compensation (base salary plus annual incentive payments) are targeted at the 75th percentile of the established comparator market; Total direct compensation (total cash compensation plus long term incentive payments) will not exceed the 90th percentile of the established comparator market; Benefits are targeted at market median; and In aggregate, base salary, total cash compensation, total direct compensation and benefits comprise total compensation for executives. The compensation committee ensures that executive total compensation is reflective of the organization's stated compensation philosophy. The committee, in this process, authorizes and supports an annual three step process utilizing Towers Watson's resources: 1) Salary levels, annual bonus targets/payments and long term incentive grants are compared rigorously each year with market data based on comparable positions and organizations. A. Comparable organizations are typically not-for-profit healthcare systems with similar operating revenues. Private sector employer data, when available, are also included in the analysis for "transferable skills positions". B. Historically, performance incentive payouts generally track with a normal bonus payout distribution. Incentive goals are primarily based on formally defined quantitative goals approved by the ad hoc Compensation Committee of the RSFH Board of Directors. 2) All recommended pay decisions are tested against these data and the organization's stated compensation philosophy. 3) A formal opinion letter is prepared by Towers Watson, representing that senior executives are compensated within the reasonableness standards mandated by the IRS. A similar process is performed by Towers Watson for the CEO and CFO positions. This letter provides a "safe harbor" for the organization's "directors" relative to the reasonableness of total executive compensation consistent with IRC Section 4958. 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 filings of the Form 990 are available online at www.guidestar.org. Form 990, Part VI, Section C, line 19 The organization's audited financial statements are published annually and are available to the public at www.dacbond.com. Form 990, Part IX, Line 1, Grants and Assistance: The majority of the grants expense shown on page 10 of the 990 is an allocation from the parent company, CareAlliance Health Services. All grants meeting disclosure requirements for 2012 have been listed on CareAlliance Health Service's Form 990. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Pension and benefits expense allocation from CAHS -193,131. Close Out Corps -175,118. Form 990, Part XII, Line 2C: The process has not changed from the prior year. Compensation of board members: Form 990, Part VII, Line 1: The following board members were compensated for services performed for the organization (or a related organization) not in the capacity of their positions on the board. No board member is compensated for his services as a board member. John M. Jordan was compensated by the Medical Society of South Carolina for services as Chief Executive Officer. David M. Ellison was compensated for medical services rendered to a related organization. Alison E. Dillon was compensated for medical services rendered to a related organization. Stanley Wilson was compensated for medical services rendered to a related organization. Shannon Honney was compensated for medical services rendered to a related organization. Creating Life Changing Moments in our Community The Roper St. Francis 2012 Community Benefit Report For generations, Roper St. Francis has been trusted with the health of our community. We understand the importance of your health and that of those you love -- it's at the center of everything we do. It's why every moment matters. Why every second saved in the ER is crucial, why every bedside minute gets our full attention, why every moment spent learning about wellness and prevention is time well-spent. We believe that smiles can change lives. We believe in the power of caring. We believe it is the muscle behind medicine and the reason for hope. We believe in the power of community, of reaching out, of extending care and generosity to those who need it most. We believe that every moment matters. Dear Friends, It is with pride that I present to you the Community Benefit Report, reflecting our 2012 initiatives. Our teammates at Roper St. Francis work hard every day to create the best outcome for every patient, every time. This vision of the organization spreads throughout our greater community via the highest quality of preventative services, health education, wellness programs, and direct medical care. In 2013, there are many healthcare developments that we will be focusing on to even better serve our community. They include: Implementation of the Affordable Care Act - the health reform law for the United States. This involves more detailed quality measures, cost containment and advocacy for the uninsured. Conducting a comprehensive Community Health Needs Assessment that will highlight the top needs and work in partnerships with many of the groups you will see in this report. This process will help us create effective implementation plans for the future. Also this year, we celebrate 15 years of this successful affiliation that created Roper St. Francis. My sincere thanks to all of you for your support and active participation in creating truly life changing moments in our community. Sincerely, David L. Dunlap, FACHE President and Chief Executive Officer Our Community Benefit Charity Care at Cost 34,253,491 Unreimbursed Medicaid Cost 9,864,596 Community Outreach Programs 8,993,409 Community Investment 577,628 Total Community Benefit Expense 53,689,123 7.4% of Roper St. Francis Healthcare's Net Operating Revenue goes towards Community Benefit A Teaching Moment We believe that feeling good helps you live every moment to the fullest, that's why we at Roper St. Francis are passionate about reaching out beyond the walls of our facilities to support our communities' health. In 2012, we provided 96,649 hours of staff time in support of wellness initiatives that directly touched 108,876 of our neighbors. This includes participating in over 100 community healthfairs. A Moment to Give Back Sponsorships Monetary contributions, volunteering our time and donating equipment are among the many ways we support community organizations and events that are consistent with our mission. In 2012, we provided $577,628 in sponsorships. Trident United Way In 2012, Roper St. Francis employees showed their enormous commitment to our Lowcounty community and donated $372,449.60 to the Trident United Way. American Heart Association's Heart Walk We walk the walk! Roper St. Francis employees raised $32,500 for the American Heart Association's Heart Walk. American Lung Association The Roper St. Francis Respiratory Care department coordinated the largest team in event history for the Fight for Air Run/Walk. They were also the second largest fundraisers. A Moment to Serve Our Lady of Mercy Community Outreach Center Roper St. Francis proudly partners with Our Lady of Mercy Community Outreach Center to provide pre-natal and wellness care to women in need and in 2012 we helped welcome 36 healthy babies into the world. Crisis Ministries We create moments of wellness and fellowship through our partnership with Crisis Ministries a place where people can receive a meal, a bed and access to a health clinic. Roper St. Francis serves a hot meal once a month at the shelter. We also sponsor an on-site nurse and make regular donations of medical equipment, lab tests and medication. A Medical Society of South Carolina's challenge grant has helped make the center's new health clinic, which is currently under construction, a reality. Barrier Island Free Clinic Roper St. Francis helps serve hundreds of uninsured people via our partnership with the Barrier Island Free Medical Clinic. In 2012, we provided over half a million dollars in support along with free lab and imaging tests. In addition, several of our nurses and physicians volunteer their time at the clinic. East Cooper Community Outreach Roper St. Francis' sponsorship dollars and support helped East Cooper Community Outreach provide 843 free prescriptions to 359 people. A Moment for Prevention Cancer Screenings When it comes to cancer the earlier you can detect it, the easier it is to fight it. Roper St. Francis Cancer Care offered a series of free cancer screenings last year including: Breast Cancer: 79 people screened Prostate Cancer: 121 people screened Skin Cancer: 108 people screened Roper St. Francis Families for a Healthy Heart Since 2008, over 1300 people have learned to live healthier lives with the Roper St. Francis Families for a Healthy Heart program. This series of free classes, led by a registered dietitian and certified diabetes educator, teaches easy ways to be healthy and active. In 2012, the program partnered with East Cooper Community Outreach to host the programs. Highway to Hope Mental Health Mobile Unit The message on the Charleston Dorchester Mental Health Center mobile unit reads "Hope. Healing. Recovery." Funded by a grant from The Duke Endowment through the Roper St. Francis Foundation, the mobile unit provides professional mental health services to patients in need of outpatient psychiatric care in remote limited access areas of the Tri-county. The Highway to Hope clinical team helps to ensure that an underserved often neglected rural population receives preventative mental health services that keep them out of emergency rooms and on the road to health. Closing the Gap in Healthcare Closing the Gap in Healthcare works to decrease health disparities by providing culturally sensitive and easy to understand health information for African Americans and the underserved. Roper St. Francis' partnership with Closing the Gap helps to provide radio healthcare tips, barber and beauty shop talks led by Dr. Thaddeus Bell and scholarships to help increase the number of minorities going into the healthcare profession. A Moment for Philanthropy Roper St. Francis Foundation In 2012, the charitable arm of Roper St. Francis Healthcare received more than $6 million in gifts and grants. Donations funded advanced patient care, community screenings and education, and outreach and supportive services to Lowcountry residents in need of quality healthcare. Gifts and grants supported nearly 20 departments and outreach programs, including: Supportive services for clients of the Ryan White HIV Program. Advanced care and wellness services for cancer patients. Enhanced quality of life for those living with spinal cord injuries. To learn more about the Roper St. Francis Foundation and how to get involved, visit www.rsfhfoundation.org. CareAlliance Health Services 1483 Tobias Gadson Blvd 101 Charleston SC 29407 570831165 Healthcare SC 501(c)(3) Line 3 N/A 0 Roper Hospital Inc 1483 Tobias Gadson Blvd 101 Charleston SC 29407 570828733 Healthcare SC 501(c)(3) Line 3 CareAlliance Health Services 0 Bon Secours St Francis Xavier Hospital 1483 Tobias Gadson Blvd 101 Charleston SC 29407 571067254 Healthcare SC 501(c)(3) Line 3 CareAlliance Health Services 0 Roper St Francis Hospital - Berkeley 125 Doughty Street 720 Charleston SC 29403 263710229 Healthcare (Future) SC 501(c)(3) Line 3 CareAlliance Health Services 0 Roper St Francis Physicians Network 125 Doughty Street 760 Charleston SC 29403 262946628 Healthcare SC 501(c)(3) Line 3 CareAlliance Health Services 0 Roper St Francis Foundation 125 Doughty Street 790 Charleston SC 29403 571068509 Supporting Org SC 501(c)(3) Line 11a, I CareAlliance Health Services 0 The Medical Society Of South Carolina 69-B Barre Street Charleston SC 29401 570288358 Supporting Org/Founding Member SC 501(c)(3) Line 11c, III-FI N/A 0 Lowcountry Surgery Center LLC (dba Roper St Francis Eye Surgery Center) 1483 Tobias Gadson Blvd 101 Charleston SC 29407 581693021 Ambulatory Surgery Center SC N/A CareAlliance Medical Services Organization 225 Doughty Street Charleston SC 29403 571012837 Inactive SC N/A C 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 0 0