2013-08-12T14:10:58-05:00 2012-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2011-10-01 570343398 TUOMEY TUOM 8037748616 129 NORTH WASHINGTON STREET SUMTER SC 29150 MARK LOVELL 8037748616 2013-08-12 1 AMY BIBBY P00445891 8282542254 2011 2016-02-24 21:20:13Z TUOMEY HEALTHCARE SYSTEM R JAY COX 129 NORTH WASHINGTON STREET SUMTER SC 29150 191187040 0 X WWW.TUOMEY.COM X 1914 SC OPERATION OF NONPROFIT HEALTHCARE FACILITY IN SUMTER, SC 14 9 1971 251 0 0 1527556 0 194996473 187206374 3209230 1321613 2424136 2641431 202157395 191169418 41134 45000 0 0 85987062 88836640 0 0 293293 102940366 100689812 188968562 189571452 13188833 1597966 275718221 262910417 152177610 160056368 123540611 102854049 X THE MISSION OF TUOMEY HEALTHCARE SYSTEM IS TO PROMOTE GOOD HEALTH AND WELL-BEING AND TO PROVIDE EXCELLENT HEALTHCARE FOR EVERYONE IN SUMTER AND SURROUNDING COUNTIES. 0 0 174584412 187206374 TUOMEY HEALTHCARE SYSTEM IS A 301 BED ACUTE CARE FACILITY LOCATED IN SUMTER, SOUTH CAROLINA. TUOMEY WAS ESTABLISHED AS A NON-PROFIT ACUTE CARE HOSPITAL TO ADVANCE OR SUPPORT THE PROVISIONS OF HEALTHCARE SERVICES WITHIN THE SUMTER COMMUNITY. TUOMEY'S MAIN OBJECTIVE IS THE PROMOTION OF HEALTH FOR ALL RESIDENTS OF SUMTER AND ITS OUTLYING AREAS.TUOMEY HAS OPERATED ITS FACILITIES IN A MANNER DESCRIBED BY REV. RUL. 69-545, SUPRA. THE BOARD OF TRUSTEES IS COMPRISED OF INDEPENDENT CIVIC LEADERS. AN OPEN MEDICAL STAFF IS MAINTAINED BY TUOMEY, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS. ALSO, TUOMEY OPERATES A FULL-TIME EMERGENCY ROOM OPEN TO ANYONE WITHOUT THE ABILITY TO PAY AND PROVIDES NON-EMERGENCY MEDICAL SERVICES TO ANYONE WITH THE ABILITY TO PAY, EITHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. DURING THE YEAR, TUOMEY PROVIDED 67,628 ADULT PATIENT DAYS, 1,399 BIRTHS, 3,973 NURSERY PATIENT DAYS, 60,243 ER VISITS AND 38,758 OTHER OUTPATIENT VISITS. IT ALSO PROVIDED APPROXIMATELY $38 MILLION DOLLARS OF CHARITY CARE. 174584412 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 265 0 1 1971 1 0 0 0 0 0 0 0 0 0 0 X 14 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 SC X X MARK LOVELL CFO 8037748604 129 N WASHINGTON STREET SUMTER SC 29150 CHALMERS GLENN 1.00 X X 0 0 0 JOHN BRABHAM 1.00 X X 0 0 0 PHIL PALMER 1.00 X X 0 0 0 MITCH WILLIAMS 1.00 X X 0 0 0 CYNTHIA REESE MD 1.00 X 0 0 0 KIM HARVIN 1.00 X 0 0 0 ANSEL MCFADDIN MD 1.00 X 0 0 0 LEROY CREECH 1.00 X 0 0 0 NICOLE NORRIS 1.00 X 0 0 0 HENRY MOSES MD 1.00 X 0 418800 34437 SAMUEL RIDDLE MD 1.00 X 0 275848 20975 BEN GRIFFITH 1.00 X 0 0 0 KAY RAFFIELD PHD 1.00 X 0 0 0 R JAY COX 40.00 X X 838646 0 172427 J GREGG MARTIN 40.00 X 508955 0 123042 MARK LOVELL STARTED 412 40.00 X 0 0 0 GENE F DICKERSON MD 40.00 X 482424 0 79184 WILLIAM RENWICK 40.00 X 250095 0 80534 MICHELLE LOGAN-OWENS 40.00 X 189281 0 32773 TERESA M CARLTON 40.00 X 204732 0 39027 TEXIN LI 40.00 X 205786 0 24019 MICHAEL SAND 40.00 X 168947 0 21683 JUDY LYNN ROBERTS 40.00 X 188776 0 33283 JEFF FAW 40.00 X 194000 0 28728 ANTHONY W CABALLERO 40.00 X 174856 0 26282 MIKE WINIARSKI FROM 411 TO 811 40.00 X 170551 0 36517 PAUL JOHNSON THROUGH 411 40.00 X 179318 0 43765 3756367 694648 796676 39 1 1 0 CARDINAL PHARMACY PO BOX 402603 ATLANTA GA 30384 MEDICAL SERVICES 8618855 MIDLANDS EMERGENCY PHYSICIANS PA 129 NORTH WASHINGTON ST SUMTER SC 29150 MEDICAL SERVICES 6614324 AMERICAN RED CROSS PO BOX 905890 CHARLOTTE NC 28290 MEDICAL SERVICES 1761574 REHABCARE GROUP PO BOX 502096 ST LOUIS MO 63150 MEDICAL SERVICES 1728877 GHA TECHNOLOGIES PO BOX 29661 PHOENIX AZ 85038 MEDICAL SERVICES 1376233 62 NET PROGRAM SERVICE RE 621400 175950115 175950115 DISPROPORTIONATE SHARE 900099 8303631 8303631 ANCILLARY SERVICES 900099 2952628 2952628 187206374 689140 689140 75653 75653 991014 0 991014 991014 991014 574442 0 17622 574442 -17622 556820 556820 CAFETERIA & VENDING 722210 1136830 1136830 MEDICAL RECORD TRANSC 900099 150241 150241 AFFILIATE MANAGEMENT 561000 145575 145575 217771 217771 1650417 191169418 187206374 0 3963044 45000 45000 2956120 1478062 1478058 375541 375541 65588259 60364020 4996704 227535 3082696 2782774 289745 10177 11998993 10833391 1125983 39619 4835031 4364621 454448 15962 491871 491871 90000 90000 105545 105545 12884 12884 17868452 16400086 1468366 547544 4352 543192 14746436 13840706 905730 1265346 1067788 197558 2738601 2738601 4071559 4071559 11764669 11764669 1233818 1233818 MEDICAL SUPPLIES 28429000 28429000 BAD DEBT EXPENSE 9420432 9420432 HOSPITAL TAX 5369869 5369869 LEGAL ISSUES 2527983 2527983 5803 123 5680 189571452 174584412 14693747 293293 9342420 3401695 28876650 30576162 4465863 4708810 7145114 7800811 178812791 86912564 96159320 91900227 100737536 102726941 28991318 21795771 275718221 262910417 55077581 66531272 95310029 92104822 1790000 1420274 152177610 160056368 X 118499468 97812906 5041143 5041143 123540611 102854049 275718221 262910417 X 1597966 -22284528 X 0 1 1 X 0 X X 0 0 0 0 0 0 0 0 1 3450 3450 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE SOUTH CAROLINA HOSPITAL ASSOCIATION (SCHA). THESE ORGANIZATIONS ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBERSHIP BODIES, AND EACH YEAR A PORTION OF THE DUES PAID ARE ALLOCATED TO LOBBYING EXPENDITURES. 5523695 675353 75000 6124048 5647997 -49302 75000 5523695 5341581 381416 75000 5647997 5157328 259253 75000 5341581 0.17680 0.82320 0 0 9419642 9419642 44411354 14254018 30157336 865925 819463 46462 123816817 71839083 51977734 299053 299053 91900227 DUE FROM AFFILIATES 21795771 21795771 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 1420274 1420274 191169418 189571452 1597966 3521064 -25805592 -22284528 -20686562 159565597 3521063 -36901227 -33380164 192945761 -1776343 -1776343 191169418 178702319 226502 226502 178475817 11095635 11095635 189571452 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE EARNINGS OF THE ENDOWMENT FUND ARE DIRECTED TO THE BOARD'S DISCRETION. FOR THE PAST FIVE YEARS, THE EARNINGS HAVE BEEN USED TO FUND THE HOSPITAL'S HEALTH REACH PROGRAM. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE MEDICAL CENTER (TUOMEY) IS EXEMPT FROM INCOME TAX UNDER SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE;ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2012. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN PENSION OBLIGATION -9,832,133. INTERCOMPANY EQUITY TRANSFER -15,204,671. INTERCOMPANY INCOME TRANSFER -768,788. TOTAL TO SCHEDULE D, PART XI, LINE 8: -25,805,592. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN NET PENSION OBLIGATION -9,832,133. EXPENSES IN REVENUES -1,675,203. INTERCOMPANY EQUITY TRANSFER -15,204,671. INTERCOMPANY INCOME TRANSFER -768,788. BAD DEBT EXPENSE -9,420,432. PART XII, LINE 4B - OTHER ADJUSTMENTS: TIMOTHY J. TUOMEY TRUST REVENUES -1,758,721. GAIN/LOSS ON THE SALE OF ASSETS -17,622. PART XIII, LINE 2D - OTHER ADJUSTMENTS: TIMOTHY J. TUOMEY TRUST INVESTMENT EXPENSES 208,880. GAIN/LOSS ON THE SALE OF ASSETS 17,622. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 9,420,432. EXPENSES IN REVENUES 1,675,203. 1 1 X 1 X 1 X 1 1 1 0 0 17508937 8314494 9194443 0.05100 27700681 25237863 2462818 0.01370 45209618 33552357 11657261 0.06470 379052 379052 0.00210 32444 32444 0.00020 411496 411496 0.00230 45621114 33552357 12068757 0.06700 1 45000 45000 0.00020 1 728469 728469 0.00400 2 773469 773469 0.00420 1 9420432 50660057 62746244 -12086187 X 1 1 1 1 TUOMEY REGIONAL MEDICAL CENTER

129 NORTH WASHINGTON ST SUMTER SC 29150

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

130 N WASHINGTON STREET SUMTER SC 29150

RADIATION/ CHEMOTHERAPY CENTER TUOMEY MEDICAL PARK

ALICE DR WESTMONT BLVD SUMTER SC 29150

OUTPATIENT IMAGING, REHAB, OTHER PART I, LINE 7: THE ORGANIZATION UTILIZED THE IRS WORKSHEETS TO DETERMINE THE COST TO CHARGE RATIO PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 9420432. PART II: ECONOMIC DEVELOPMENT - SUMTER SMARTER GROWTH INITIATIVE IS A SUMTER ECONOMIC DEVELOPMENT DONATION MADE TO ASSIST IN SUMTER DEVELOPMENT BOARD'S EFFORTS AT RECRUITING INSUDTRY, MARKETING THE SUMNTER COMMUNITY AND DEVELOPING SUMTER COUNTY'S INDUSTRIAL DEVELOPMENT PRODUCTS.WORKFORCE DEVELOPMENT - TUOMEY WORKS TO RECRUIT PHYSICIANS THAT WILL MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. PART III, LINE 4: ALTHOUGH NOT DESCRIBED IN THE FOOTNOTES TO THE HOSPITAL'S FINANCIAL STATEMENTS, THE PRACTICE OF THE HOSPITAL IS TO RECORD BAD DEBT EXPENSE AT THE UNPAID BALANCES AFTER CONTRACTUAL DISCOUNTS FOR PATIENT'S WITH INSURANCE AND AT THE 70% DISCOUNTED CHARGE LEVEL FOR THOSE WHO DO NOT HAVE INSURANCE. THE HOSPITAL NEGOTIATES WITH PAYERS TO COME UP WITH A FAIR DISCOUNTED RATE TO BE PAID FOR SERVICES RENDERED. THESE DISCOUNTS ARE NOT RECORDED AS BAD DEBT EXPENSES. SIMILARLY FOR PATIENTS WITHOUT ANY INSURANCE, THE HOSPITAL OFFERS SEVERAL DIFFERENT DISCOUNT PROGRAMS, BASED UPON FINANCIAL NEED, TO THESE PATIENTS AND ONCE AGAIN THESE DISCOUNTS ARE NOT RECORDED AS BAD DEBTS. FOR PATIENTS WHO DO NOT MEET OR DO NOT FOLLOW-THROUGH TO DEMONSTRATE FINANCIAL HARDSHIP, THE HOSPITAL DOES EXPECT TO BE REIMBURSED AT 70% OF ITS CHARGES. ALL OF THE REMAINING BALANCES THAT ARE NOT PAID ARE RECORDED AS BAD DEBTS. THE HOSPITAL HAS COSTED THE BAD DEBTS EXPENSE IN LINE 2 OF THIS SECTION AT THE FULL UNPAID CONTRACTED RATE FOR PATIENTS WITH INSURANCE AS THIS REPRESENTS THE "CONTRACTED COST" FOR THE SERVICE AND THUS NOT APPLICABLE TO AN OVERALL COST-TO-CHARGE RATIO. FOR PATIENS WITH NO INSURANCE, THE COST ON LINE 2 REPRESENTS THE 70% OF CHARGE FIGURES MULTIPLIED BY THE OVERALL COST-TO-CHARGE RATIO FROM THE AUDITED FINANCIAL STATEMENTS. THE CRITERIA THE HOSPITAL USES FOR DISTINGUISHING BETWEEN CHARITY CARE AND BAD DEBT IS THAT IN ORDER FOR A PATIENT TO QUALIFY AS CHARITY CARE, THEY MUST SHARE THEIR FINANCIAL INFORMATION AND SHOW THAT THEY FALL WITHIN THE FEDERAL POVERTY GUIDELINES. THUS THE HOSPITAL BELIEVES THAT 50% OF THE FIGURE RECORDED AS BAD DEBT EXPENSE ON LINE 2 WOULD QUALIFY FOR CHARITY CARE IF THE PATIENTS HAD SHARED THEIR FINANCIAL INFORMATION. THIS PERCENTAGE WAS DERRIVED FROM DEMOGRAPHIC STUDIES OF THE COMMUNITY FOR FAMILIES FALLING BELOW THE HOSPITAL'S CHARITY CARE GUIDELINES, WHICH ARE BASED ON THE FEDERAL POVERTY GUIDELINES, IN THE MARKET AREA. PART III, LINE 8: THE ORGANIZATION UTILIZED A COST-TO-CHARGE RATIO IN DETERIMINING THE COSTING FOR THIS SECTION. PART III, LINE 9B: ALL SELF PAY PATIENTS ARE INFORMED ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND ARE GIVEN THE OPPORTUNITY TO COMPLETE THE APPLICATION. OTHERWISE PRIOR TO THE PROCEDURE AN ATTEMPT IS MADE TO COLLECT A PORTION OF THE COST OF THE PROCEDURE BASED ON A GOOD FAITH ESTIMATE. AFTER THE PROCEDURE THE HOSPITAL WILL SEND OUT ONE STATEMENT WITH THE AMOUNT OWED BY THE PATIENT. AFTER THIS, THE ACCOUNT IS TURNED OVER TO OUR IN-HOUSE COLLECTIONS DEPARTMENT. THEY CALL THE PATIENT TO DISCUSS PAYMENT TERMS AND OUR FINANCIAL ASSISTANCE PROGRAMS TO TRY AND FIND OUT IF THE PATIENT HAS A 3RD PARTY PAYER. AFTER 120 DAYS THE ACCOUNT IS THEN TURNED OVER TO OUR OUTSIDE 3RD PARTY COLLECTOR. THE COLLECTOR WILL CALL AND SEND STATEMENTS IN AN ATTEMPT TO COLLECT THE FUNDS. AFTER 120 DAYS FROM THIS PLACEMENT, IF THERE HAS BEEN NO ACTIVITY ON THE ACCOUNT, IT IS RETURNED TO THE HOSPITAL. TUOMEY REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 19D: THE ORGANIZATION IS IN THE PROCESS OF ADOPTING A METHOD TO COMPUTE AMOUNTS GENERALLY BILLED THAT WILL BE IN COMPLIANCE WITH REG. SEC. 1.501(R)-5 WHEN FINAL GUIDANCE IS RELEASED. PART VI, LINE 2: TUOMEY PROCURES AN ANNUAL ASSESSMENT IN REGARDS TO DETERMINING THE PHYSICIAN NEEDS OF THE SUMTER COMMUNITY. THE ANNUAL ASSESSMENT WAS PERFORMED IN 2012 BY AMERIMED CONSULTING. TUOMEY PARTICIPATED IN THE DEVELOPMENT OF THE MEDICAL STAFF DEVELOPMENT PLAN BASED ON THE HEALTHCARE NEEDS OF ITS MEDICAL SERVICE AREA. TUOMEY STRIVES TO MAKE IT UNNECESSARY AND UNREASONABLE FOR ANYONE TO GO OUTSIDE OF THE COMMUNITY TO OBTAIN HEALTHCARE SERVICES THAT WE CAN PROVIDE IN A QUALITY, COST EFFECTIVE MANNER. PART VI, LINE 3: PER TUOMEY POLICY, PUBLIC NOTICE OF THE AVAILABILITY OF ASSISTANCE IS PROVIDED THROUGH THE POSTING OF NOTICES IN LOCATIONS OF HIGH VOLUME SUCH AS INPATIENT/OUTPATIENT ADMITTING/REGISTRATION, ER, BILLING OFFICES, ADMITTING OFFICES AND HOSPITAL OUTPATIENT SERVICE SETTINGS. IN ADDITION, NOTICE OF THE AVAILABILITY OF ASSISTANCE AND CONTACT INFORMATION IS LOCATED ON THE HOSPITAL WEBSITE. PATIENT LIABILITY STATEMENTS SENT TO PATIENTS ALSO INCLUDE LANGUAGE INDICATING THE PATIENT MAY BE ELIGIBLE FOR ASSISTANCE IF THEY MEET CERTAIN INCOME REQUIREMENTS. PART VI, LINE 4: SUMTER COUNTY IS HOME TO 107,456 RESIDENTS, WITH 18.3% OF THESE RESIDENTS AT OR BELOW THE POVERTY LEVEL. SUMTER'S RACIAL DEMOGRAPHICS ARE COMPRISED OF 49.4% WHITE, 47.0% AFRICAN-AMERICAN, 1.2% ASIAN, AND 4.6% OTHER. THE AVERAGE INCOME FOR A SUMTER HOUSEHOLD IS $29,915. CURRENTLY, SUMTER'S UNEMPLOYMENT RATE EQUALS 10.2%. SUMTER HAS A MILITARY BASE WHICH HOUSES U.S. AIR FORCE AND U.S. ARMY TROOPS. PART VI, LINE 5: TUOMEY HEALTHCARE SYSTEM IS A 301 BED ACUTE CARE FACILITY LOCATED IN SUMTER, SOUTH CAROLINA. TUOMEY WAS ESTABLISHED AS A NON-PROFIT ACUTE CARE HOSPITAL TO ADVANCE OR SUPPORT THE PROVISIONS OF HEALTHCARE SERVICES WITHIN THE SUMTER COMMUNITY. TUOMEY'S MAIN OBJECTIVE IS THE PROMOTION OF HEALTH FOR ALL RESIDENTS OF SUMTER AND ITS OUTLYING AREAS. THE ORGANIZATION UTILIZES SURPLUS FUNDS TO MAKE IT NOT ONLY UNNECESSARY, BUT UNREASONABLE FOR ANYONE TO GO ELSEWHERE FOR HEALTHCARE SERVICES THAT WE CAN PROVIDE IN A HIGH-QUALITY, COST-EFFECTIVE MANNER.A MAJORITY OF THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND ARE NOT EMPLOYEES, FAMILY MEMBERS OF EMPLOYEES, OR CONTRACTORS OF THE ORGANIZATION. TUOMEY EXTENDS MEDICAL STAFF PRIVILEDGES TO ALL LOCAL PHYSICIANS IN MOST OF OUR DEPARTMENTS. REPORTS FILED WITH STATES PART VI, LINE 7 SC 0 SUMTER SMARTER GROWTH INITIATIVE 32 EAST CALHOUN SUMTER SC 29150 264385624 501(C)(3) 45000 TO BRING JOBS AND CAPITAL INVESTMENT TO SUMTER COUNTY 1 X 0 0 X X 0 1 0 0 0 0 0 0 0 HENRY MOSES MD 0 277848 0 0 0 140952 0 22000 0 12437 0 453237 0 0 SAMUEL RIDDLE MD 0 224486 0 0 0 51362 0 16498 0 4477 0 296823 0 0 R JAY COX 541415 0 167003 0 130228 0 156631 0 15796 0 1011073 0 0 0 J GREGG MARTIN 333414 0 77125 0 98416 0 116681 0 6361 0 631997 0 0 0 GENE F DICKERSON MD 325348 0 75268 0 81808 0 77901 0 1283 0 561608 0 0 0 WILLIAM RENWICK 170158 0 26153 0 53784 0 80534 0 0 0 330629 0 0 0 MICHELLE LOGAN-OWENS 164507 0 23561 0 1213 0 32773 0 0 0 222054 0 0 0 TERESA M CARLTON 164507 0 23561 0 16664 0 23231 0 15796 0 243759 0 0 0 TEXIN LI 205586 0 200 0 0 0 8223 0 15796 0 229805 0 0 0 MICHAEL SAND 147881 0 200 0 20866 0 10400 0 11283 0 190630 0 0 0 JUDY LYNN ROBERTS 188576 0 200 0 0 0 22000 0 11283 0 222059 0 0 0 JEFF FAW 180000 0 13834 0 166 0 12932 0 15796 0 222728 0 0 0 ANTHONY W CABALLERO 136669 0 200 0 37987 0 10486 0 15796 0 201138 0 0 0 MIKE WINIARSKI FROM 411 TO 811 114561 0 0 0 55990 0 33337 0 3180 0 207068 0 0 0 PAUL JOHNSON THROUGH 411 96671 0 0 0 82647 0 38500 0 5265 0 223083 0 0 0 PART I, LINE 1A MIKE WINIARSKI RECEIVED AN HOUSING ALLOWANCE OF $10,260. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN (457(F)) AND/OR DEFINED BENEFIT PLAN FOR 2011, AS FOLLOWS. THE AMOUNTS ARE REPRESENTED IN PART II, COLUMN (C): R. JAY COX $ 112,631 J. GREGG MARTIN 72,681 WILLIAM RENWICK 36,534 DR. GENE DICKERSON 68,301 TERESA M. CARLTON 15,824 MICHELLE LOGAN-OWENS 26,054 MIKE WINIARSKI 33,337 SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 83703EKE4 2006-01-12 76542284 SEE PART VI 0 0 0 SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 83703FBT8 2008-12-01 16440000 SEE PART VI 0 0 0 21580000 76542284 36255000 2007 1 0 1 1 16440000 240000 16200000 1995 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 1 0 0 0 0 0 1 1 0 0 0 1 SCHEDULE K, PART I, COLUMN (F), DESCRIPTION OF PURPOSE, BOND (A) - THE PROJECT CONSISTS OF THE EXPANSION OF THE PATIENT TOWER TO INCLUDE 35 ADDITIONAL BEDS AT AN ESTIMATED COST OF $30,000,000. SIGNIFICANT ASPECTS OF THE PROJECT INCLUDED THE TUOMEY WOMEN'S CENTER, THE TUOMEY HEALTHCARE SYSTEM NURSERIES, AND EXPANDED INPATIENT CAPACITY OF 22 PRIVATE INPATIENT ROOMS THROUGH A RELOCATION OF CERTAIN DEPARTMENTS. BOND (B) - NET PROCEEDS FROM THE SALE OF THE BONDS WERE APPLIED TO THE PAYMENT UPON REDEMPTION OF THE SERIES 1995B VARIABLE RATE BONDS. SCHEDULE K, PART II, LINE 11, OTHER SPENT PROCEEDS: AMOUNTS ON LINE 11 REPRESENT BOND PROCEEDS USED TO REFUND PRIOR ISSUES DATED AS FOLLOWS: BOND (A) - $ 36,255,000: SERIES 1995A, REFUNDED ON FEBRUARY 16, 2006 BOND (B) - $ 16,200,000: SERIES 1995B, REFUNDED ON DECEMBER 1, 2008 SCHEDULE K, PART III, BOND (B) WAS USED TO CURRENTLY REFUND AN ISSUE DATED BEFORE JANUARY 1, 2003; THEREFORE, PART III OF SCHEDULE K IS NOT APPLICABLE TO THIS BOND. CHERYL MARTIN FAMILY RELATIONSHIP WITH OFFICER J. GREGG MARTIN 156023 COMPENSATION AS EMPLOYEE 0 SYLVESTER OWENS FAMILY RELATIONSHIP WITH KEY EMPLOYEE MICHELLE LOGAN-OWNES 97513 COMPENSATION AS EMPLOYEE 0 JOSEPH DURANT FAMILY RELATIONSHIP WITH BOARD MEMBER KAY RAFFIELD 48085 COMPENSATION AS EMPLOYEE 0 MACAULAY SMITH FAMILY RELATIONSHIP WITH CHIEF OF MEDICAL STAFF MURREL SMITH 61191 COMPENSATION AS EMPLOYEE 0 SHARRY WILLIAMS FAMILY RELATIONSHIP WITH BOARD MEMBER MITCH WILLIAMS 12729 COMPENSATION AS EMPLOYEE 0 FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND DISCUSSED WITH THE BOARD OF DIRECTORS OF THE ORGANIZATION BY THE CFO AND TAX PREPARER BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH YEAR THE CORPORATE COMPLIANCE OFFICER DISTRIBUTES A CONFLICT OF INTEREST POLICY QUESTIONNAIRE REQUIRING ALL PERSONS MANAGER AND ABOVE TO DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST. OFFICERS, KEY EMPLOYEES, AND TRUSTEES OF THE BOARD COMPLETE THIS QUESTIONNAIRE. BEFORE MAJOR VOTES AND DECISIONS, THE POLICY IS CONSIDERED AND ANY MEMBER WITH A CONFLICT IS EXCUSED FROM THE DISCUSSION OR VOTE. DOCUMENTATION OF THE CONSIDERATION IS KEPT IN THE MINUTES. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION ENGAGES AN INDEPENDENT COMPENSATION CONSULTANT TO DETERMINE THE FAIR MARKET VALUE OF TOP EXECUTIVES. FINDINGS OF THE STUDY ARE REVEIWED BY THE BOARD OF TRUSTEES AND USED IN THE SELECTION AND APPROVAL OF COMPENSATION PACKAGES FOR THE CEO AND OTHER OFFICERS AND KEY EMPLOYEES, INCLUDING THE COO, CFO, CNO, CHIEF MEDICAL OFFICER, AND VICE PRESIDENTS. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILING OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 3,521,064. CHANGE IN PENSION OBLIGATION -9,832,133. INTERCOMPANY EQUITY TRANSFER -15,204,671. INTERCOMPANY INCOME TRANSFER -768,788. TOTAL TO FORM 990, PART XI, LINE 5: -22,284,528. THE TUOMEY FOUNDATION 115 N SUMTER ST SUITE 120 SUMTER SC 29150 571041691 SUPPORT AND FUNDRAISING SC 501(C)(3) LINE 11A, I N/A 0 TUOMEY MEDICAL PROFESSIONALS INC 129 NORTH WASHINGTON ST SUMTER SC 29150 571012488 HEALTHCARE SC 501(C)(3) LINE 11A, I N/A 0 TIMOTHY J TUOMEY TRUST 129 NORTH WASHINGTON ST SUMTER SC 29150 237127466 SUPPORT AND FUNDRAISING SC 501(C)(3) LINE 11A, I N/A 0 TUOMEY PROFESSIONAL SERVICES LLC 129 NORTH WASHINGTON ST SUMTER SC 29150 201691464 HEALTH CARE SERVICES SC N/A C 3843605 1210203 1.00000 CORE POSSIBILITIES 129 NORTH WASHINGTON ST SUMTER SC 29150 208372814 HEALTH CARE SERVICES SC N/A C 1 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 TUOMEY MEDICAL PROFESSIONALS A 558816 CASH TUOMEY PROFESSIONAL SERVICES LLC A 88302 CASH THE TUOMEY FOUNDATION C 257604 CASH TUOMEY MEDICAL PROFESSIONALS K 145575 CASH TUOMEY PROFESSIONAL SERVICES LLC K 9975 CASH TUOMEY MEDICAL PROFESSIONALS N 104589 CASH TUOMEY MEDICAL PROFESSIONALS Q 8376621 CASH TUOMEY PROFESSIONAL SERVICES LLC Q 768789 CASH THE TUOMEY FOUNDATION N 91488 CASH