2013-05-14T10:49:32-05:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2011-07-01 561509260 REX HOSPITAL INC DBA REX HEALTHCARE REXH 9197843100 4420 LAKE BOONE TRAIL RALEIGH NC 27607 BERNADETTE SPONG 9197843100 2013-05-14 1 JOHN NORMAN P01506766 7049985200 2011 2016-02-24 21:20:13Z REX HEALTHCARE DAVID STRONG 4420 LAKE BOONE TRAIL RALEIGH NC 27607 802648539 0 X WWW.REXHEALTH.COM X 1986 NC TO PROVIDE THE BEST IN HEALTH SERVICES.TO PROVIDE THE BEST IN HEALTH SERVICES BY BRINGING TOGETHER COMPASSIONATE CARE AND LEADING-EDGE TECHNOLOGY. 13 10 5769 1383 27781863 0 1249901 1299788 592507390 644337655 8582253 7670039 557399 670719 602896943 653978201 1263428 1299739 0 0 291184054 323961798 0 0 0 264094603 287746484 556542085 613008021 46354858 40970180 635551442 671610346 229349688 220279220 406201754 451331126 X REX HEALTHCARE PROVIDES THE BEST IN HEALTH SERVICES BY COMBINING COMPASSIONATE CARE AND LEADING-EDGE TECHNOLOGY. REX PROVIDES SERVICES AT FACILITIES ACROSS WAKE COUNTY TO ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. REX ALSO SEEKS TO IMPROVE THE HEALTH OF THE COMMUNITY BY PROVIDING EDUCATION, DIAGNOSTIC AND PREVENTATIVE CARE, OFTEN BY JOINING FORCES WITH OTHER COMMUNITY GROUPS. IN ADDITION TO ITS MAIN RALEIGH CAMPUS, REX OFFERS MUCH-NEEDED CARE AND PATIENT SUPPORT AT FACILITIES IN APEX, CARY, GARNER, HOLLY SPRINGS, KNIGHTDALE, DOWNTOWN RALEIGH AND WAKEFIELD. 0 0 72844462 86120814 GENERAL SURGERY: REX SURGERY CENTERS IN RALEIGH, CARY AND WAKEFIELD ARE USED BY MORE THAN 425 PHYSICIANS AND PROVIDE IN AND OUTPATIENT SERVICES TO 40,000 PATIENTS A YEAR, REGARDLESS OF THEIR ABILITY TO PAY. THE THREE LOCATIONS HAVE IMPROVED ACCESS TO SPECIALIZED CARE FOR PATIENTS ACROSS THE REGION. SURGEONS MAKE SUBSTANTIAL USE OF MINIMALLY INVASIVE TECHNOLOGY FOR DIAGNOSIS AND TREATMENT, REDUCING PATIENTS' RECOVERY TIME AND HOSPITAL STAY. FOR EXAMPLE, REX HAS THREE DAVINCI SURGICAL ROBOTS USED FOR UROLOGY, GYNECOLOGY AND GENERAL SURGERIES. THE CENTERS INCLUDE 34 OPERATING SUITES, EIGHT MINOR PROCEDURE ROOMS AND VARIOUS PERIOPERATIVE AND ANCILLARY SUPPORT SPACES. REX IS INCREASINGLY PERFORMING SURGERIES ON AN OUTPATIENT BASIS, AND CONTINUING TO LOOK FOR OTHER WAYS TO REDUCE OVERALL COSTS FOR PATIENTS. SOME OF THE TOP PROCEDURES INCLUDE HERNIA REPAIR, GALLBLADDER REMOVAL AND ENT, EYE AND BREAST SURGERIES. 56185889 64519518 ORTHOPEDICS: WITH THIS REGION'S AGING POPULATION, REX HEALTHCARE'S ORTHOPEDIC SERVICES PROVIDE IMPORTANT CARE FOR AN INCREASING NUMBER OF PATIENTS. REX FACILITIES IN RALEIGH, CARY AND WAKEFIELD SAW NEARLY 9,000 ORTHOPEDIC PATIENTS DURING THE FISCAL YEAR, INCLUDING MANY MEDICARE AND MEDICAID PATIENTS. THE MOST COMMON PROCEDURES INCLUDE REPLACEMENT OF TOTAL JOINTS (HIPS, KNEES AND SHOULDERS), ARTHROSCOPIES AND REPAIRING FRACTURES OR DISLOCATIONS. REX WORKS CLOSELY WITH ITS AFFILIATED SURGEONS AND COMMUNITY PHYSICIANS TO ENSURE THAT IT PROVIDES ACCESS TO PATIENTS REQUIRING ORTHOPEDIC CARE, REGARDLESS OF THEIR ABILITY TO PAY. 54168535 57883055 CARDIOLOGY: THE REX HEART & VASCULAR CENTER PERFORMS MORE THAN 16,000 PROCEDURES A YEAR, INCLUDING CORONARY ARTERY BYPASS GRAFTING, ECHOCARDIOGRAPHY, VALVE REPLACEMENT AND REPAIR, ANGIOPLASTY, CARDIAC CATHETERIZATION AND STENT PLACEMENT. REX PROVIDES COMPASSIONATE CARE TO ALL PATIENTS, INCLUDING THOSE ON MEDICARE, MEDICAID AND THE UNINSURED OR UNDERINSURED. REX HAS BEEN A CHEST PAIN ACCREDITED HOSPITAL FOR EIGHT YEARS, REINFORCING THE ORGANIZATION'S DEDICATION TO COMMUNITY OUTREACH AND INNOVATION IN THE CARE OF CHEST PAIN PATIENTS. IN ADDITION, HOSPITAL COMPARE RATED REX BEST FOR HEART ATTACK SURVIVAL IN WAKE COUNTY. 365599851 1299739 403496358 REX PROVIDES A FULL RANGE OF ONCOLOGY THERAPY AND SUPPORT SERVICES TO ALL PATIENTS IN WAKE COUNTY AND BEYOND, REGARDLESS OF THEIR ABILITY TO PAY. AT THE MAIN RALEIGH CANCER CENTER AND A SATELLITE FACILITY IN WAKEFIELD, REX PROVIDES MORE THAN 20,000 RADIATION ONCOLOGY TREATMENTS, 10,000 CHEMOTHERAPY TREATMENTS AND 17,000 HEMATOLOGY TREATMENTS. THE CENTERS ALSO HELP PATIENTS NAVIGATE THEIR CARE AND OFFER COUNSELING, REHABILITATION AND MORE. AT REX'S WOMEN'S AND CHILDREN'S CENTER, CAREGIVERS SEEK TO PROVIDE FAMILY-CENTERED CARE TO THE NEW MOTHER, BABY AND EXTENDED FAMILY, WITHOUT REGARD TO ABILITY TO PAY. THE WOMEN'S CENTER DELIVERED MORE THAN 5,500 BABIES AND PROVIDES 24/7 ANESTHESIOLOGY, NEONATOLOGY AND LACTATION SERVICES AND AN IN-HOUSE RETAIL CENTER FOR INFANT NUTRITION. THERE ARE PRE- AND POST-NATAL SUPPORT GROUPS, EXERCISE CLASSES AND MORE. 365599851 1299739 403496358 548798737 1 1 0 1 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 322 0 5769 1 1 1 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X BERNADETTE SPONG 9197843100 4420 LAKE BOONE TRAIL RALEIGH NC 27607 X A DALE JENKINS 5.00 X 0 0 0 VINCENT L HOELLERICH MD 2.00 X 0 0 0 JAMES B HYLER JR 2.00 X 0 0 0 DARLEEN M JOHNS 2.00 X 0 0 0 JEFFREY J LYASH 2.00 X 0 0 0 GARY L PARK 5.00 X X 0 700383 222525 ORAGE QUARLES III 2.00 X 0 0 0 WILLIAM L ROPER MD 5.00 X 0 748460 159639 MARK A STRIEBEL 2.00 X 0 0 0 ROBERT S THOMAS 2.00 X 0 0 0 DAVID STRONG 60.00 X X 1002936 0 243305 TERESA C ARTIS 2.00 X 0 0 0 HOWARD NYE 2.00 X 0 0 0 BERNADETTE SPONG 60.00 X 388035 0 47100 MARY LOU POWELL 60.00 X 342455 0 57123 STEPHEN BURRISS 60.00 X 359988 0 43954 NOVLET BRADSHAW 60.00 X 317817 0 33248 LINDA BUTLER 60.00 X 260057 0 32025 DONALD ESPOSITO JR 60.00 X 284745 0 35772 SYLVIA HACKETT 60.00 X 249884 0 47019 R ERICK HAWKINS 60.00 X 288085 0 29418 CHAD LEFTERIS 60.00 X 210199 0 17181 LISA SCHILLER 60.00 X 200185 0 33375 ROBERT B LIVERMAN JR 60.00 X 148109 0 33605 JEFFREY CRANE 60.00 X 728080 0 61280 SHAHRAM TEHRANI 60.00 X 542897 0 36587 S WAYNE SMITH 60.00 X 540184 0 108576 ROBERT WEHBIE 60.00 X 728660 0 38927 OLUDAMILOLA OLAJIDE 60.00 X 630047 0 31243 7222363 1448843 1311902 207 0 1 0 SKANSKA USA BUILDING INC 4309 EMPEROR BLVD STE 200 DURHAM NC 27703 CONSTRUCTION 8816057 SRISURGICAL EXPRESS PO BOX 405495 ATLANTA GA 30384 MEDICAL 8328600 BBH DESIGN 8208 BROWNLEIGH DRIVE STE 200 RALEIGH NC 27617 ARCHITECTURAL DESIGN 5139300 THE OUTSOURCE GROUP 39867 TREASURY CENTER CHICAGO IL 60694 COLLECTIONS 2510464 CUSTOM CRAFT PAINTING 9329 HOLLY SPRINGS ROAD APEX NC 27539 REPAIRS/REMODELING 2133835 68 1291083 8705 1299788 GENERAL SURGERY 625100 86120814 86120814 ORTHOPAEDICS 625100 64519518 64519518 WOMEN'S & CHILDREN 625100 61803894 61803894 CARDIOLOGY 625100 57883055 57883055 ONCOLOGY 625100 51730844 51730844 322279530 289961620 27781863 4536047 644337655 3755826 3755826 758626 87907 670719 670719 670719 148223823 4272821 147686530 895901 537293 3376920 3914213 3914213 653978201 612019745 27781863 12876805 1299739 1299739 4578401 4578401 257574739 223198772 34375967 13853727 12289416 1564311 30561406 25426672 5134734 17393525 15500223 1893302 831975 831975 91450 91450 125296 125296 970245 970245 35783353 32205017 3578336 6793485 6114137 679348 8106756 7296081 810675 25398155 22858339 2539816 15879048 14291143 1587905 1173794 1056415 117379 508659 316144 192515 5007214 4506492 500722 12982009 12982009 31930699 28737629 3193070 PATIENT SUPPLIES & SERV 126473011 126473011 REPAIRS AND MAINTENANCE 10864746 9778272 1086474 MINOR EQUIPMENT 2485320 2236788 248532 2341269 2107142 234127 613008021 548798737 64209284 0 10544403 4580508 79558352 54375903 73484758 87574839 309490 257469 9584446 10102069 5994979 6913094 634080627 376328112 228352644 257752515 155667458 185366410 49328497 45179714 22726415 19507825 635551442 671610346 95756691 87141044 73783 116637 128132589 124858924 19824 14683 5366801 8147932 229349688 220279220 X 405191524 450333869 1010230 997257 406201754 451331126 635551442 671610346 X 40970180 4159192 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 125296 125296 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: REX HEALTHCARE BELIEVES IN MAINTAINING STRONG, OPEN AND EFFECTIVE RELATIONSHIPS WITH ELECTED OFFICIALS AND POLICY MAKERS AT THE LOCAL, STATE AND NATIONAL LEVELS. THE OBJECTIVE IS TO EDUCATE THESE GROUPS ON HEALTHCARE ISSUES, TO SERVE AS A RESOURCE, AND TO COMMUNICATE REX'S POSITION IN SUPPORT OF ITS MISSION. AS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND NCHA, A PERCENTAGE OF REX'S MEMBERSHIP DUES ARE ATTRIBUTED TO LOBBYING ACTIVITIES. 0 1 25782584 25782584 154142499 89364000 64778499 17393360 3577659 13815701 306293924 241433961 64859963 130468260 41952492 88515768 257752515 4300317 C BOND TRUSTEE FUNDS 7332770 F HEDGE FUNDS 33546627 F 45179714 CAPITAL LEASE 3254748 ESTIMATED PROFESSIONAL LIAIBLITY RESERVE 2152266 DEFERRED LEASE LIABILITY 2740760 THIRD PARTY PAYABLE 158 8147932 PART IV, LINE 2B: THE ORGANIZATION HOLDS CASH IN TRUST FOR THE RESIDENTS OF THE NURSING HOME FACILITIES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, ENTERPRIES 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. PART VII, LINE 2: CLOSELY-HELD EQUITY INTERESTS ARE VALUED ACCORDING TO THE EQUITY METHOD OF ACCOUNTING UNDER US GAAP WHICH REPRESENTS INITIAL COSTS ADJUSTED FOR OUR ALLOCABLE SHARE OF THE NET EARNINGS OR LOSSES OF THE INVESTMENT. 1 1 X 1 X 250.000000000000 0 1 1 1 0 1 1 26317111 26317111 0.04290 26692979 19724160 6968819 0.01140 53010090 19724160 33285930 0.05430 18431 18431 0.00000 1160201 1160201 0.00190 601823 216210 385613 0.00060 611075 611075 0.00100 2391530 216210 2175320 0.00350 55401620 19940370 35461250 0.05780 0 11555245 221676588 271617729 -49941141 X 1 1 1 REX SURGERY CENTER OF CARY LLC AMBULATORY SURGICAL CENTER 0.55000 0.00000 0.45000 1 1 REX HOSPITAL INC

4420 LAKE BOONE TRAIL RALEIGH NC 27607

X REX HOSPITAL INC 1 1 1 250.000000000000 1 250.000000000000 1 X X X X X X 1 1 X X X X 1 X 1 X X X X X 1 X 0 0 10 REX HEALTHCARE OF WAKEFIELD

11200 GOVERNOR MANLY WAY RALEIGH NC 27614

HEALTHCARE REX HEALTHCARE OF CARY

1505 SW CARY PARKWAY CARY NC 27511

HEALTHCARE REX HEALTHCARE OF KNIGHTDALE

6602 KNIGHTDALE BOULEVARD 102 KNIGHTDALE NC 27545

HEALTHCARE REX REHABILITATION AND NURSING CARE CENT

4210 LAKE BOONE TRAIL RALEIGH NC 27607

NURSING FACILITY REX REHABILITATION AND NURSING CARE CENT

911 SOUTH HUGHES STREET APEX NC 27502

NURSING FACILITY REX WELLNESS CENTER OF WAKEFIELD

11200 GALLERIA AVENUE RALEIGH NC 27614

WELLNESS CENTER REX WELLNESS CENTER OF RALEIGH

4200 LAKE BOONE TRAIL RALEIGH NC 27607

WELLNESS CENTER REX WELLNESS CENTER OF CARY

1515 SW CARY PARKWAY CARY NC 27511

WELLNESS CENTER REX WELLNESS CENTER OF GARNER

1400 TIMBER DRIVE EAST GARNER NC 27529

WELLNESS CENTER REX WELLNESS CENTER OF KNIGHTDALE

6602 KNIGHTDALE BOULEVARD KNIGHTDALE NC 27545

WELLNESS CENTER PART III, LINE 4: NET PATIENT SERVICE REVENUE IS RECORDED AT ESTABLISHED RATES WHEN SERVICES ARE PROVIDED WITH CONTRACTUAL ADJUSTMENTS, ESTIMATED BAD DEBT EXPENSES, AND SERVICES QUALIFYING AS CHARITY CARE DEDUCTED TO ARRIVE AT NET PATIENT SERVICE REVENUE. CONTRACTUAL ADJUSTMENTS ARISE UNDER REIMBURSEMENT AGREEMENTS WITH CERTAIN INSURANCE CARRIERS, HEALTH MAINTENANCE ORGANIZATIONS AND PREFERRED PROVIDER ORGANIZATIONS, WHICH PROVIDE FOR PAYMENTS THAT ARE GENERALLY LESS THAN ESTABLISHED BILLING RATES. CONTRACTUAL ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN THE FUTURE AS FINAL SETTLEMENTS ARE DETERMINED.THE COSTING METHODOLOGY USED TO DETERMINE PAYER COSTS IS THE ANDI METHODOLOGY, WHICH USES A FACILITY-WIDE RATIO OF COST TO CHARGES AS DESCRIBED IN THE NCHA COMMUNITY BENEFITS GUIDELINES.WHILE THE COSTS OF BAD DEBTS ARE PRESENT FOR ESSENTIALLY EVERY BUSINESS ORGANIZATION, FEW OTHER THAN HOSPITALS ARE EXPECTED TO CONTINUE TO PROVIDE SERVICES TO THOSE WITH MEANS WHO HAVE PREVIOUSLY FAILED TO PAY. CONTINUATION OF SERVICE TO PATIENTS WITH THE MEANS TO PAY BUT WHO HAVE FAILED TO DO SO IS A FURTHER COMMUNITY BENEFIT RELATED TO THE ORGANIZATION'S MISSION. THEREFORE, WE BELIEVE THAT THE COST OF BAD DEBTS SHOULD BE CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 8: HOSPITALS TREAT PATIENTS COVERED BY MEDICARE, JUST AS THEY DO ANY PATIENT. AMOUNTS THAT HOSPITALS ARE ELIGIBLE TO RECEIVE IN PAYMENT FOR SERVICES PROVIDED TO PATIENTS COVERED BY MEDICARE ARE NOT NEGOTIABLE. AS MEDICARE REIMBURSEMENT RATES DECLINE RELATIVE TO THE COSTS OF PROVIDING CARE, HOSPITALS CONTINUE TO SERVE THE MEDICARE POPULATION. WITHOUT THE SERVICES PROVIDED BY HOSPITALS, THE GOVERNMENT WOULD BECOME OBLIGATED FOR THE SERVICES REQUIRED BY THESE PATIENTS. THEREFORE, WE BELIEVE THAT ANY UNREIMBURSED COSTS OF PROVIDING THIS CARE ARE A BENEFIT PROVIDED BY THE HOSPITAL TO THE COMMUNITY AND GOVERNMENT. PART III, LINE 9B: PATIENTS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE APPROVED FOR FULL FORGIVENESS TO 250% OF THE FPG. THERE IS NO ASSESSMENT OF CO-PAYMENTS, THEREFORE THERE IS NO PATIENT FINANCIAL RESPONSIBILITY FOR THE APPLICATION OF COLLECTION POLICY. REX HOSPITAL, INC. PART V, SECTION B, LINE 19D: THE ORGANIZATION PROVIDES AN AUTOMATIC 15% DISCOUNT OFF OF CHARGES FOR PATIENTS WHO DO NOT HAVE INSURANCE. ADDITIONAL DISCOUNTS ARE AVAILABLE BASED ON MEANS TESTING AND PROMPT PAYMENT ARRANGEMENTS. PART VI, LINE 2: AS THE COUNTY CONTINUES TO GROW, NECESSARY STEPS MUST BE TAKEN TO ENSURE THAT THE NEEDS OF ALL OF OUR CITIZENS ARE BEING MONITORED AND EVALUATED. WAKE COUNTY HUMAN SERVICES WORKS WITH ALL LOCAL HOSPITALS, INCLUDING REX, TO CONDUCT A COMMUNITY-WIDE HEALTH ASSESSMENT. THIS ASSESSMENT IDENTIFIES OPPORTUNITIES AND CHALLENGES IN THE MARKET. REX COLLABORATES WITH COMMUNITY PARTNERS REGULARLY TO ENSURE OUR EFFORTS ARE PROPERLY ALIGNED BASED ON WAKE COUNTY'S SOCIOECONOMIC AND DEMOGRAPHIC INFORMATION. REX ALSO RELIES ON INPUT FROM OUR PHYSICIANS AND CLINICAL STAFF, PATIENT OUTCOMES AS WELL AS QUALITATIVE AND QUANTITATIVE RESEARCH TO IDENTIFY AREAS OF OPPORTUNITY TO IMPROVE THE HEALTH OF OUR COMMUNITY. PART VI, LINE 3: REX PROVIDES A WIDE RANGE OF TOOLS AND EDUCATION TO HELP PATIENTS WHO NEED FINANCIAL ASSISTANCE. THE REX ASSIST PROGRAM IS DESIGNED TO MAKE IT EASY FOR PATIENTS TO APPLY FOR FINANCIAL ASSISTANCE, CHARITY CARE AND OTHER AID PROGRAMS. REX POSTS DETAILED INFORMATION ABOUT ITS GENEROUS CHARITY CARE POLICY, THE REX ASSIST PROGRAM AND OTHER FINANCIAL AID INFORMATION AT VARIOUS POINTS IN THE HOSPITAL AND ON ITS WEBSITE. DURING PATIENT REGISTRATION, STAFF WILL DISTRIBUTE THE "YOUR REX HOSPITAL BILL" FLYER TO ANYONE WHO DOES NOT HAVE INSURANCE OR ASKS FOR ASSISTANCE. THAT FLYER INCLUDES USEFUL INFORMATION AND HELPFUL RESOURCES. REX FINANCIAL COUNSELORS WILL BEGIN WORKING WITH PATIENTS NEEDING ASSISTANCE AT REGISTRATION, OR VISIT THE ROOMS OF PATIENTS WHO ASK FOR HELP. THE COUNSELORS WILL ASSIST WITH DETERMINING MEDICAID ELIGIBILITY AND WITH FILLING OUT A REX ASSIST APPLICATION. FINALLY, REX ALSO WORKS WITH VARIOUS COMMUNITY GROUPS THAT HELP PROVIDE ASSISTANCE TO THE UNINSURED OR UNDERINSURED, INCLUDING PROJECT ACCESS, PRETTY IN PINK AND OTHERS. THE ANGEL FUND OF THE REX HEALTHCARE FOUNDATION ALSO SUPPORTS CANCER PATIENTS WITH UNIQUE FINANCIAL NEEDS, INCLUDING TRANSPORTATION, LIVING EXPENSES AND PRESCRIPTIONS. PART VI, LINE 4: THE ORGANIZATION SERVES AN AREA THAT ENCOMPASSES A FOUR-COUNTY AREA CONSISTING OF WAKE COUNTY AS THE PRIMARY SERVICE AREA WITH HARNETT, FRANKLIN AND JOHNSTON COUNTIES, COMPRISING THE SECONDARY SERVICE AREA. WAKE COUNTY AND ITS SURROUNDING COMMUNITIES ARE AMONG THE FASTEST GROWING REGIONS IN THE NATION. UNEMPLOYMENT RATES IN THE PRIMARY SERVICE AREA ARE LESS THAN THE UNEMPLOYMENT RATES FOR THE NATION AND THE STATE. AVERAGE HOUSEHOLD INCOME AND EDUCATION LEVEL ALSO COMPARE FAVORABLY WITH BOTH THE NATION AND THE STATE. PART VI, LINE 5: THERE ARE MANY WAYS REX WORKS WITH COMMUNITY PARTNERS TO ADDRESS HEALTH ISSUES AND CONCERNS IDENTIFIED WITHIN THE COMMUNITY. THROUGH BOTH FINANCIAL, IN-KIND AND STAFF SUPPORT, REX PROVIDES ASSISTANCE IN HOSTING COMMUNITY HEALTH SCREENINGS, MOBILE MAMMOGRAPHY SCREENINGS AND ON-SITE MEDICAL CARE THROUGH THE REX EMERGENCY RESPONSE TEAM. ADDITIONALLY, COMMUNITY RELATIONS ACTIVITIES REGULARLY DEMONSTRATE PROMOTING HEALTH AND WELLNESS INITIATIVES. "ASK THE EXPERT" FORUMS ARE FREE AND OFFERED THROUGHOUT WAKE COUNTY BY PHYSICIANS AND STAFF. REX HAS BEEN DILIGENT IN AWARDING GRANTS TO COMMUNITY GROUPS TO ASSIST THEM WHERE NEEDS ARE GREATEST. TWICE A YEAR WE HOST A COLLABORATIVE BREAKFAST INVITING COMMUNITY PARTNERS, ORGANIZATIONS AND HEALTHCARE PROVIDERS WHO WORK WITH UNINSURED WOMEN TO DISCUSS AND ADDRESS CURRENT HARDSHIPS AND RESOURCES -- TRULY A COMMITMENT TO THE NONPROFIT COMMUNITY. PART VI, LINE 6: REX HEALTHCARE IS A SUBSIDIARY OF THE UNC HEALTH CARE SYSTEM IN CHAPEL HILL. THAT SYSTEM SERVES PATIENTS FROM ALL 100 COUNTIES, REGARDLESS OF THEIR ABILITY TO PAY, PROVIDING MORE THAN $300 MILLION A YEAR IN UNCOMPENSATED CARE. AS PART OF THE INTEGRATED SYSTEM, REX STRIVES TO IMPROVE ACCESS AND SERVICES IN WAKE COUNTY'S GROWING AND UNDERSERVED AREAS. REX CAREGIVERS ALSO WORK CLOSELY WITH THEIR COUNTERPARTS AT UNC HEALTH TO FIND MORE WAYS TO IMPROVE CARE AND QUALITY, REACH MORE UNINSURED PATIENTS AND MORE. REX'S BOARD REPRESENTS A CROSS-SECTION OF THE COMMUNITY, WITH VOLUNTEERS THAT INCLUDE BUSINESS LEADERS, COMMUNITY PHYSICIANS AND OTHERS. THAT BOARD WORKS CLOSELY WITH THE BOARD AT UNC HEALTH TO DETERMINE THE BEST WAYS TO PLAY A LARGER ROLE IN IMPROVING THE COMMUNITY'S HEALTH, AND REX'S ROLE IN THE BIGGER SYSTEM'S MISSION. PART VI LINE 7 THE ORGANIZATION SUBMITS AN ANNUAL COMMUNITY BENEFIT REPORT TO THE NORTH CAROLINA HOSPITAL ASSOCIATION AND THE NORTH CAROLINA MEDICAL CARE COMMISSION. 1 WAKE COUNTY MEDICAL SOCIETY 2500 BLUE RIDGE ROAD STE 330 RALEIGH NC 27607 562205175 501(C)(6) 75000 GENERAL SUPPORT, MEDICAL CARE RALEIGH SCHOOL OF NURSE ANESTH 3900 BARRETT DRIVE SUITE 200 RALEIGH NC 27609 561684241 501(C)(3) 71646 EDUCATION SUPPORT NORTH CAROLINA SYMPHONY 4350 LASSITER STE 250 RALEIGH NC 27609 560556755 501(C)(3) 105000 GENERAL SUPPORT AMERICAN HEART ASSOCIATION NORTH CAROLINA AFFILIATEINC 3901 COMPUTER DR STE 110 RALEIGH NC 27609 560529996 501(C)(3) 45000 GENERAL SUPPORT, EDUCATION SUPPORT POE CENTER FOR HEALTH ED 224 SUNNYBROOK ROAD RALEIGH NC 27610 561500678 501(C)(3) 21000 EDUCATION SUPPORT KOMEN FOR THE CURE NC TRIANGLE 133 FAYETTEVILLE ST 300 RALEIGH NC 27601 751835298 501(C)(3) 10000 GENERAL SUPPORT BOYS & GIRLS CLUB 701 N RALEIGH BOULEVARD RALEIGH NC 27610 560863051 501(C)(3) 6250 GENERAL SUPPORT NC PREVENTION PARTNERS 88 VILCOM CIRCLE STE 110 CHAPEL HILL NC 27514 311722051 501(C)(3) 12000 EDUCATION SUPPORT DEVILS RIDGE CHARITY GOLF CLASSIC PO BOX 98 128 SOUTH MAIN STREET HOLLY SPRINGS NC 27540 562265570 501(C)(3) 6500 GENERAL SUPPORT PAY IT FORWARD FERTILITY FDNT 8311 BRIER CREEK PARKWAY STE 105-111 RALEIGH NC 27617 263906064 501(C)(3) 5000 GENERAL SUPPORT FRIESEN 5K FUN RUN 1113 BISHOPTON WAY KNIGHTDALE NC 27545 262908988 501(C)(3) 6000 GENERAL SUPPORT AMERICAN CANCER SOCIETY RED SWORD GUILD PO BOX 10144 RALEIGH NC 27605 580659875 501(C)(3) 5100 GENERAL SUPPORT BE ACTIVE NORTH CAROLINA INC 2250 PERIMETER PARK DRIVE STE 120 MORRISVILLE NC 27560 561660333 501(C)(3) 5000 GENERAL SUPPORT CITY OF OAKS MARATHON 7449 SIX FORKS ROAD RALEIGH NC 27615 260232340 501(C)(3) 5000 GENERAL SUPPORT, MEDICAL CARE COLON CANCER COALITION-RALEIGH 8009 34TH AVENUE STE 360 BLOOMINGTON MN 55425 300377727 501(C)(3) 5000 GENERAL SUPPORT ENDING HOMELESSNESS -RALWAKE 324 BLACKWELL STREET STE 1220 DURHAM NC 27701 651267717 501(C)(3) 5000 GENERAL SUPPORT JIMMY V CELEBRITY GOLF CLASSIC 130 EDINBURGH SODR CARY NC 27511 561875773 501(C)(3) 10000 EDUCATION SUPPORT LEUKEMIA SOCIETY OF AMERICA 4206 SIX FORKS ROAD STE 220 RALEIGH NC 27609 135644916 501(C)(3) 5000 GENERAL SUPPORT NC CHILDREN'S PROMISE 88 VILCOM CIRCLE STE L100 CHAPEL HILL NE 27599 566057494 501(C)(3) 15125 GENERAL SUPPORT CED PO BOX 13353 RTP NC 27709 561399587 501(C)(3) 15000 GENERAL SUPPORT FOUNDATION FOR NURSING PO BOX 31824 RALEIGH NC 27622 300105241 501(C)(3) 15000 EDUCATION SUPPORT GREATER RALEIGH CHAMBER PO BOX 2978 RALEIGH NC 27602 560370850 501(C)(6) 12750 GENERAL SUPPORT RALEIGH CIVIC VENTURE 120 SOUTH WILMINGTON STREET RALEIGH NC 27601 562095185 501(C)(3) 10000 GENERAL SUPPORT HOSPICE OF WAKE COUNTY 25 HOSPICE CIRCLE RALEIGH NC 27607 561228779 501(C)(3) 7200 GENERAL SUPPORT HOLLY SPRINGS CULTURAL 300 WEST BALLENTINE STREET HOLLY SPRINGS NC 27540 561143973 GOVERNMENT 6100 GENERAL SUPPORT DOWNTOWN RALEIGH ALLIANCE 120 SOUTH WILMINGTON STREET RALEIGH NC 27601 561994005 501(C)(6) 6000 GENERAL SUPPORT FUTURES FOR KIDS INC 800 ST MARYS STREET SUITE 104 RALEIGH NC 27605 562276012 501(C)(3) 5000 EDUCATION SUPPORT NORTH CAROLINA CHAMBER 701 CORPORATE CENTER DRIVE RALEIGH NC 27607 560340499 501(C)(6) 5000 GENERAL SUPPORT THE FIRST TEE OF THE 5560 MUMFORD ROAD SUITE 201 RALEIGH NC 27612 562266025 501(C)(3) 5000 GENERAL SUPPORT 25 4 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: REX REQUIRES ALL REQUESTS FOR GRANTS OR OTHER ASSISTANCE TO BE IN WRITING. SUCH REQUESTS ARE TYPICALLY REVIEWED ON AN ANNUAL BASIS FOLLOWING GUIDELINES RELATED TO COMMUNITY NEED AND REX'S MISSION. REX'S PRIORITIES INCLUDE SUPPORTING HEALTH, HUMAN SERVICES, EDUCATION AND ARTS IN THE COMMUNITIES IT SERVES. REX HAS VARIOUS WAYS OF TRACKING THE RESULTS OF ITS CONTRIBUTIONS. BECAUSE REX OFTEN WORKS CLOSELY WITH THE COMMUNITY GROUPS IT SUPPORTS, THE ORGANIZATIONS RECEIVES FREQUENT UPDATES ON THEIR WORK AND PROGRESS. FOR LARGER GRANTS, REX ALSO RECEIVES ANNUAL OR QUARTERLY REPORTS ON RESULTS. X 1 1 X X X X X 0 1 0 0 0 1 1 0 0 GARY L PARK 0 693051 0 0 0 7332 0 215595 0 6930 0 922908 0 0 WILLIAM L ROPER MD 0 736460 0 0 0 12000 0 154709 0 4930 0 908099 0 0 DAVID STRONG 473828 0 189238 0 339870 0 230960 0 12345 0 1246241 0 308940 0 BERNADETTE SPONG 288082 0 78113 0 21840 0 31620 0 15480 0 435135 0 0 0 MARY LOU POWELL 237250 0 71175 0 34030 0 45480 0 11643 0 399578 0 0 0 STEPHEN BURRISS 243334 0 71175 0 45479 0 26559 0 17395 0 403942 0 0 0 NOVLET BRADSHAW 226064 0 62963 0 28790 0 21303 0 11945 0 351065 0 0 0 LINDA BUTLER 186050 0 54750 0 19257 0 18130 0 13895 0 292082 0 0 0 DONALD ESPOSITO JR 206306 0 61594 0 16845 0 17327 0 18445 0 320517 0 0 0 SYLVIA HACKETT 190383 0 52013 0 7488 0 37376 0 9643 0 296903 0 0 0 R ERICK HAWKINS 197030 0 57488 0 33567 0 20150 0 9268 0 317503 0 0 0 CHAD LEFTERIS 154875 0 42979 0 12345 0 12004 0 5177 0 227380 0 0 0 LISA SCHILLER 150497 0 41884 0 7804 0 14985 0 18390 0 233560 0 0 0 ROBERT B LIVERMAN JR 125027 0 11735 0 11347 0 25852 0 7753 0 181714 0 0 0 JEFFREY CRANE 639016 0 61520 0 27544 0 48268 0 13012 0 789360 0 0 0 SHAHRAM TEHRANI 478082 0 25000 0 39815 0 23317 0 13270 0 579484 0 0 0 S WAYNE SMITH 434189 0 62150 0 43845 0 98423 0 10153 0 648760 0 0 0 ROBERT WEHBIE 569224 0 64473 0 94963 0 25982 0 12945 0 767587 0 0 0 OLUDAMILOLA OLAJIDE 437442 0 185367 0 7238 0 15848 0 15395 0 661290 0 0 0 PART I, LINE 1A THE ORGANIZATION OFFERS COMPLIMENTARY MEMBERSHIPS TO REX WELLNESS CENTERS FOR THE EXECUTIVE STAFF, BOTH ACTIVE AND RETIRED BOARD MEMBERS AND MEDICAL DIRECTORS. ALL MEMBERS RECEIVING COMPLIMENTARY MEMBERSHIPS ARE REQUIRED TO COMPLETE THE SAME APPLICATION AND TESTING PROCEDURES AS OTHER MEMBERS. CURRENTLY, THERE ARE 6 INDIVIDUALS LISTED THAT RECEIVE COMPLIMENTARY MEMBERSHIPS. THE VALUE OF THE COMPLIMENTARY MEMBERSHIP IS TREATED AS TAXABLE COMPENSATION AND IS REPORTED ON THE INDIVIDUAL'S W-2. PART I, LINE 4B DURING THE CALENDAR YEAR 2011, DAVID STRONG PARTICIPATED IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN AND RECEIVED DISTRIBUTIONS 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 6 EMPLOYEES IN MANAGERIAL ROLES PARTICIPATE IN AN ANNUAL INCENTIVE COMPENSATION PLAN. THE COMPENSATION EARNED UNDER THIS PLAN IS BASED PARTLY ON THE COMBINED EARNINGS OF REX HEALTHCARE, INC. AND ITS SUBSIDIARIES. ADDITIONALLY, THE INCENTIVE COMPENSATION OF THE PRESIDENT AND CFO IS BASED PARTLY ON THE EARNINGS OF THE UNC HEALTH CARE SYSTEM. OTHER PERFOMANCE MEASURES USED TO DETERMINE INCENTIVE COMPENSATION ARE PHYSICIAN SATISFACTION, PATIENT CARE QUALITY OUTCOMES, EFFECTIVE USE OF TECHNOLOGY AND INDIVIDUAL GOALS. NORTH CAROLINA MEDICAL CARE COMMISSIONS 521309402 65821DFJ5 2010-10-26 127456150 CONSTRUCTION 0 0 0 3120000 127456150 572819 1499411 49264482 76034727 7332770 1 0 1 1 0 0 0 0 1 0 0 0 0 0 0 NOVLET BRADSHAW RELOCATION LOAN X 190000 142000 0 0 1 142000 PART I, LINE 6 THE ORGANIZATION'S VOLUNTEER SERVICES DEPARTMENT MAINTAINS A LARGE STAFF OF COMPETENT AND COMPASSIONATE VOLUNTEERS WHO ENHANCE AND EXTEND SERVICES PROVIDED TO PATIENTS, FAMILY MEMBERS, CLIENTS AND RESIDENTS. THE 1,383 VOLUNTEERS PROVIDED A TOTAL OF 137,305 QUALITY SERVICE HOURS TO THE ORGANIZATION. THIS YEAR MARKED THE BEGINNING OF OUR ANIMAL ASSISTED THERAPY PROGRAM INSIDE REX HOSPITAL. THE PROGRAM HAS 9 CANINE VOLUNTEERS AND VISITED NUMEROUS PATIENTS. VOLUNTEERS ALSO VISITED PATIENTS, CONDUCTED HEARING TESTS FOR NEWBORN BABIES, GREETED GUESTS AND DELIVERED FLOWER ARRANGEMENTS AND CARDS. THEY MANNED WAITING ROOMS, ESCORTED PATIENTS, MADE BEDS, DISCHARGED PATIENTS AND SO MUCH MORE TO PROVIDE COMFORT TO OUR COMMUNITY. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S SOLE MEMBER IS REX HEALTHCARE, INC. FORM 990, PART VI, SECTION A, LINE 7A THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM APPOINTS ALL OF THE THIRTEEN SEATS ON THE ORGANIZATION'S BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S BOARD REQUIRES PRIOR APPROVAL OF THE UNIVERSITY OF NORTH CAROLINA HEALTH CARE SYSTEM FOR CERTAIN POWERS, INCLUDING BUT NOT LIMITED TO ADDITION OR DELETION OF A HEALTH CARE SERVICE, PARTICIPATION, DIRECTLY OR INDIRECTLY, IN A JOINT VENTURE, INDEBTEDNESS AND CAPITAL BUDGETS, OPERATING BUDGETS AND NON-BUDGETED MATERIAL EXPENDITURES. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S EXECUTIVE TEAM DISCUSSES AND REVIEWS THE FORM 990 AND ALL ASSOCIATED SCHEDULES THROUGHOUT THE INFORMATION GATHERING STAGE. THE FORM 990 AND ASSOCIATED SCHEDULES ARE THEN REVIEWED AND APPROVED BY THE BOARD AS A WHOLE. A COPY OF THE APPROVED FORM 990 ALONG WITH THE ASSOCIATED SCHEDULES IS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C REX REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REQUIRING ALL BOARD MEMBERS TO ANNUALLY COMPLETE AND SIGN A QUESTIONNAIRE DOCUMENTING ANY AREA OF CONFLICT OF INTEREST. THE BOARD MEMBERS ARE REQUIRED TO REPORT AND DOCUMENT ANY NEW AREAS OF CONFLICT OF INTEREST AS THEY ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES AN INDEPENDENT CONSULTANT TO MEASURE FAIR VALUE OF COMPENSATION FOR THE ORGANIZATION'S PRESIDENT AND OTHER TOP MANAGEMENT. REX'S BOARD REVIEWS AND APPROVES THE COMPENSATION FOR ALL OFFICERS EXCEPT THE ASSISTANT TREASURER AND ASSISTANT SECRETARY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST AND ON GUIDESTAR'S WEBSITE AND THE FINANCIAL STATEMENTS ARE AVAILABLE ON MUNICIPAL SECURITIES RULEMAKING BOARD'S WEBSITE. THE ORGANIZATION DOES NOT MAKE OTHER GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC PART VII, SECTION A, COLUMN B DUE TO THE TREMENDOUS OVERLAP OF DIRECTORS BETWEEN THE ORAGANIZATION AND ALL RELATED ORGANIZATIONS, THE RELATED ORGANIZATIONS' HOURS ARE INCLUDED IN THE HOURS LISTED. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 4,159,192. REX HEALTH VENTURES GP I LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 455070550 VENTURE CAPITAL INVESTMENT NC REX HOSPITAL INC REX HEALTH VENTURES I LP 4420 LAKE BOONE TRAIL RALEIGH NC 27607 371690478 MANAGING INVESTMENTS NC REX HEALTH VENTURES I LP REX HEALTHCARE INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509129 HEALTHCARE NC 501(C)(3) 509(A)(3) UNC HEALTHCARE 0 THE REX HEALTHCARE FOUNDATION INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 566052117 SUPPORT OF REX HOSPITAL NC 501(C)(3) 509(A)(3) REX HEALTHCARE 0 REX HOME SERVICES INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561636242 HEALTHCARE NC 501(C)(3) LINE 3 REX HOSPITAL 0 UNC HEALTH CARE SYSTEM 101 MANNING DRIVE CHAPEL HILL NC 27514 562206970 HEALTHCARE NC 501(C)(3) LINE 3 UNC HEALTHCARE 0 REX SURGERY CENTER OF CARY LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 273684056 ASC NC REX HOSPITAL INC RELATED 5025707 4321975 0 0 0.55000 JRH VENTURES LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 274092967 MED CAMPUS DVLT NC REX HOSPITAL INC RELATED 116016 3531886 0 0 0.50000 REX HEALTH VENTURES 4420 LAKE BOONE TRAIL RALEIGH NC 27607 VENTURE CAPITAL INVESTMENT NC REX HEALTH VENTURES RELATED 500000 0 0 1.00000 REX ENTERPRISES COMPANY INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561553957 OPERATIONS SUPPORT NC REX HEALTHCARE C REX PHYSICIANS LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 264594963 HEALTHCARE NC REX HOLDINGS C 0 1 1 1 0 0 0 0 1 0 1 0 1 1 0 0 0 0 REX HEALTHCARE FOUNDATION INC B 678659 FMV REX HEALTHCARE FOUNDATION INC C 1291083 FMV REX PHYSICIANS LLC D 11899031 FMV REX PHYSICIANS LLC I 2324115 FMV REX PHYSICIANS LLC K 2392256 FMV JRH VENTURES LLC K 997992 FMV PART V, LINE 1 M & N ADMINISTRATIVE SUPPORT; SUCH AS EXECUTIVE MANAGEMENT, LEGAL ACCOUNTING, HUMAN RESOURCES, PURCHASING AND IT FUNCTIONS, FOR EACH OF THESE ENTITIES IS PROVIDED BY REX HOSPITAL, INC. PERSONNEL UTILIZING REX HOSPITAL FACILITIES AND OTHER ASSETS. ESTIMATING THE VALUE OF THESE SHARES PERSONNEL AND ASSETS CANNOT BE READILY DETERMINED.