2012-05-15T12:58:17-05:00 2011-06-30 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2010-07-01 561509260 REX HOSPITAL INC REXH 9197843100 4420 LAKE BOONE TRAIL RALEIGH NC 27607 BERNADETTE SPONG 9197843100 2012-05-15 1 KATHERINE BLOOMER 7049985200 2010 2016-02-24 21:20:13Z REX HEALTHCARE DAVID STRONG 4420 LAKE BOONE TRAIL RALEIGH NC 27607 714203507 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 5313 1310 23845151 -988295 1180129 1249901 550987719 592507390 3441733 8582253 351544 557399 555961125 602896943 1250870 1263428 0 0 270398500 291184054 0 0 0 246341112 264094603 517990482 556542085 37970643 46354858 502387601 635551442 164066983 229349688 338320618 406201754 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 65774093 79346340 GENERAL SURGERY: REX SURGERY CENTERS IN RALEIGH, CARY AND WAKEFIELD ARE USED BY MORE THAN 350 PHYSICIANS AND PROVIDE IN AND OUTPATIENT SERVICES TO 36,000 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 NON-INVASIVE TECHNOLOGY FOR DIAGNOSIS AND TREATMENT, REDUCING PATIENTS' RECOVERY TIME AND HOSPITAL STAY. FOR EXAMPLE, REX HAS TWO DAVINCI SURGICAL ROBOTS USED FOR UROLOGIC AND GYNECOLOGIC SURGERIES. THE CENTERS INCLUDE 35 OPERATING SUITES, FIVE MINOR PROCEDURE ROOMS, 56 RECOVERY BEDS AND VARIOUS 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 REPAIRING HERNIAS, REMOVING GALLBLADDERS AND TREATING BREAST CANCERS. 58232572 64687330 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 10,000 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 ALL PATIENTS REQUIRING ORTHOPEDIC CARE, REGARDLESS OF THEIR ABILITY TO PAY. 57898382 59896802 CARDIOLOGY SERVICES: THE REX HEART & VASCULAR CENTER PERFORMS MORE THAN 17,000 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 SEVEN 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. 313724265 1263428 358624985 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 PROVIDED MORE THAN 18,400 RADIATION ONCOLOGY TREATMENTS, 8,500 CHEMOTHERAPY TREATMENTS AND 15,500 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 THE ABILITY TO PAY. THE WOMEN'S CENTER DELIVERED MORE THAN 5,800 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. 313724265 1263428 358624985 495629312 1 1 0 1 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 1 328 0 5313 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 JEAN W CARTER MD 2.00 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 2.00 X X 0 662552 196256 ORAGE QUARLES III 2.00 X 0 0 0 WILLIAM L ROPER MD 2.00 X 0 728809 155179 MARK A STRIEBEL 2.00 X 0 0 0 ROBERT S THOMAS 2.00 X 0 0 0 TERESA ARTIS 2.00 X 0 0 0 DAVID STRONG 40.00 X X 724732 0 203123 BERNADETTE SPONG 40.00 X 343226 0 41217 MARY LOU POWELL 40.00 X 318528 0 80008 STEPHEN BURRISS 40.00 X 305706 0 42132 NOVLET BRADSHAW 40.00 X 274556 0 29277 LINDA BUTLER 40.00 X 234959 0 22670 DONALD ESPOSITO JR 40.00 X 260932 0 29941 SYLVIA HACKETT 40.00 X 229070 0 53043 R ERICK HAWKINS 40.00 X 239249 0 23426 CHAD LEFTERIS 40.00 X 195906 0 17218 LISA SCHILLER 40.00 X 184612 0 30237 ROBERT B LIVERMAN JR 40.00 X 148063 0 26122 JEFFREY CRANE 40.00 X 887111 0 54674 KENNETH ZEITLER 40.00 X 799018 0 50810 SHAHRAM TEHRANI 40.00 X 518030 0 33669 S WAYNE SMITH 40.00 X 459335 0 97635 ROBERT WEHBIE 40.00 X 415591 0 39896 EMILY BARBOUR 40.00 X 168045 0 22074 6706669 1391361 1248607 177 1 1 0 SRISURGICAL EXPRESS PO BOX 405495 ATLANTA GA 30384 MEDICAL 8460450 BBH DESIGN 8208 BROWNLEIGH DRIVE STE 200 RALEIGH NC 27617 ARCHITECTURAL DESIGN 7035456 MAYO COLLABORATIVE SVCS INC PO BOX 9146 MINNEAPOLIS MN 55480 LABORATORY 1734708 THE OUTSOURCE GROUP 39867 TREASURY CENTER CHICAGO IL 60694 COLLECTIONS 1692537 K&L GATES LLP 210 SIXTH AVE PITTSBURGH PA 15222 LEGAL 1337673 91 1225046 24855 1249901 GENERAL SURGERY 625100 79346340 79346340 ORTHOPAEDICS 625100 64687330 64687330 WOMEN'S & CHILDREN 625100 63310733 63310733 CARDIOLOGY 625100 59896802 59896802 ONCOLOGY 625100 54051182 54051182 271215003 243148087 23845151 4221765 592507390 2762851 2762851 659630 126247 533383 533383 533383 113658219 3341500 110430686 749631 3227533 2591869 5819402 5819402 PUBLIC RELATIONS 900099 24016 24016 24016 602896943 564440474 23845151 13361417 1263428 1263428 4634852 4634852 230608308 198847747 31760561 12550343 11104337 1446006 27661733 24324559 3337174 15728818 13052218 2676600 2326131 2326131 91450 91450 100266 100266 711381 711381 31089180 27980262 3108918 5977753 5379978 597775 7932084 7138876 793208 22998531 20698678 2299853 16367783 14731005 1636778 821016 738914 82102 517957 325442 192515 4972654 4475389 497265 5608580 5608580 25024223 22521801 2502422 6826315 6143684 682631 PATIENT SUPPLIES & SERV 117377791 117377791 REPAIRS AND MAINTENANCE 8532577 7679319 853258 MINOR EQUIPMENT 1323882 1191494 132388 5495049 4945544 549505 556542085 495629312 60912773 0 10478617 10544403 52334065 79558352 61334598 73484758 275806 309490 9982827 9584446 5888766 5994979 578774795 350422151 226507264 228352644 105988601 155667458 17079258 49328497 12517799 22726415 502387601 635551442 81535003 95756691 71350 73783 77445401 128132589 13382 19824 5001847 5366801 164066983 229349688 X 337317334 405191524 1003284 1010230 338320618 406201754 502387601 635551442 X 46354858 21526278 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 100266 100266 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 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. 0 1 27030279 27030279 154142499 85218699 68923800 14253659 2676579 11577080 277645207 226420415 51224792 105703151 36106458 69596693 228352644 3484623 C BOND TRUSTEE FUNDS 22000910 F HEDGE FUNDS 23842964 F 49328497 CAPITAL LEASE 1331033 ESTIMATED PROFESSIONAL LIAIBLITY RESERVE 2354681 DEFERRED LEASE LIABILITY 1680591 THIRD PARTY PAYABLE 496 5366801 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: REX HOSPITAL, INC. IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. 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 21883328 21883328 0.03930 28250042 20237633 8012409 0.01440 50133370 20237633 29895737 0.05370 724 724 0.00000 2436821 2436821 0.00440 322871 202047 120824 0.00020 777371 777371 0.00140 3537787 202047 3335740 0.00600 53671157 20439680 33231477 0.05970 0 7583190 0 182997149 230006806 -47009657 X 1 1 1 REX SURGERY CENTER OF CARY LLC AMBULATORY SURGICAL CENTER 0.79500 0.00000 0.20500 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 9 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 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 HEALTHCARE OF KNIGHTDALE

6602 KNIGHTDALE BOULEVARD 102 KNIGHTDALE NC 27545

HEALTHCARE 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 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 2010 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 HOSPITAL'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 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, CONDUCTED EVERY FOUR YEARS, 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 6: 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. PART VI, LINE 7: 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) 69578 EDUCATION SUPPORT NORTH CAROLINA SYMPHONY 4350 LASSITER STE 250 RALEIGH NC 27609 560556755 501(C)(3) 45000 GENERAL SUPPORT NC MUSEUM OF ART 4630 MAIL SERVICE CENTER RALEIGH NC 27699 237071511 501(C)(3) 33500 GENERAL SUPPORT AMERICAN HEART ASSOCIATION NORTH CAROLINA AFFILIATEINC 3901 COMPUTER DR STE 110 RALEIGH NC 27609 560529996 501(C)(3) 25000 GENERAL SUPPORT, EDUCATION SUPPORT CITY OF RALEIGH P O BOX 96084 CHARLOTTE NC 282960084 566000236 GOVERNMENT 25000 MEDICAL CARE POE CENTER FOR HEALTH ED 224 SUNNYBROOK ROAD RALEIGH NC 27610 561500678 501(C)(3) 20000 EDUCATION SUPPORT CAROLINA BALLET INC 3401-131 ATLANTIC AVENUE RALEIGH NC 27604 561445383 501(C)(3) 15000 GENERAL SUPPORT UNITED WAY OF THE GRTER TRIANG P O BOX 110387 RALEIGH NC 277095387 561949103 501(C)(3) 11250 GENERAL SUPPORT BAND TOGETHER 3402 HAMPTON ROAD RALEIGH NC 27607 562273756 501(C)(3) 10000 GENERAL SUPPORT KOMEN FOR THE CURE NC TRIANGLE 133 FAYETTEVILLE ST 300 RALEIGH NC 27601 751835298 501(C)(3) 10000 GENERAL SUPPORT RALEIGH CONVENTION CENTER 500 S SALISBURY STREET RALEIGH NC 27601 566000236 501(C)(3) 10000 GENERAL SUPPORT WAKE EDUCATION PARTNERSHIP 706 HILLSBOROUGH ST SUITE A RALEIGH NC 27603 581518182 501(C)(3) 10000 GENERAL SUPPORT BOYS & GIRLS CLUB 701 N RALEIGH BOULEVARD RALEIGH NC 27610 560863051 501(C)(3) 10000 GENERAL SUPPORT NC PREVENTION PARTNERS 88 VILCOM CIRCLE STE 110 CHAPEL HILL NC 27514 311722051 501(C)(3) 10000 EDUCATION SUPPORT DEVILS RIDGE CHARITY GOLF CLASSIC PO BOX 98 128 SOUTH MAIN STREET HOLLY SPRINGS NC 27540 562265570 501(C)(3) 9000 GENERAL SUPPORT TOWN OF KNIGHTDALE 950 STEEPLE SQUARE CT KNIGHTDALE NC 27545 560789285 GOVERNMENT 8530 EDUCATION SUPPORT GIRL SCOUTS-NC COASTAL PINES 6901 PINECREST ROAD RALEIGH NC 27613 562042885 501(C)(3) 8000 GENERAL SUPPORT PAY IT FORWARD FERTILITY FDNT 8311 BRIER CREEK PARKWAY STE 105-111 RALEIGH NC 27617 263906064 501(C)(3) 6000 GENERAL SUPPORT TOWN OF HOLLY SPRINGS NC 128 S MAIN STREET PO BOX 8 HOLLY SPRINGS NC 27540 561143973 GOVERNMENT 5600 GENERAL SUPPORT FRIESEN 5K FUN RUN 1113 BISHOPTON WAY KNIGHTDALE NC 27545 262908988 501(C)(3) 5500 GENERAL SUPPORT NC PHYSICIANS HLTH PROGRAM INC 220 HORIZON DR SUITE 201 RALEIGH NC 27615 561846599 501(C)(3) 5500 GENERAL SUPPORT AMERICAN CANCER SOCIETY RED SWORD GUILD PO BOX 10144 RALEIGH NC 27605 580659875 501(C)(3) 5000 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) 5000 EDUCATION SUPPORT LEESVILLE ROAD HIGH SCHOOL 8409 LEESVILLE ROAD RALEIGH NC 27613 561787326 501(C)(3) 5000 EDUCATION SUPPORT LEUKEMIA SOCIETY OF AMERICA 4206 SIX FORKS ROAD STE 220 RALEIGH NC 27609 135644916 501(C)(3) 5000 GENERAL SUPPORT WAKE COUNTY MED SOCIETY ALLIAN 2500 WAKE DRIVE RALEIGH NC 27608 560223230 501(C)(3) 5000 GENERAL SUPPORT 31 0 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 1 1 0 0 0 1 1 0 0 GARY L PARK 0 655141 0 0 0 7411 0 188994 0 7262 0 858808 0 0 WILLIAM L ROPER MD 0 715759 0 0 0 13050 0 150417 0 4762 0 883988 0 0 DAVID STRONG 425759 0 121765 0 177208 0 188617 0 14506 0 927855 0 151304 0 BERNADETTE SPONG 260143 0 69962 0 13121 0 27911 0 13306 0 384443 0 0 0 MARY LOU POWELL 220313 0 68369 0 29846 0 70695 0 9313 0 398536 0 0 0 STEPHEN BURRISS 212041 0 59122 0 34543 0 28306 0 13826 0 347838 0 0 0 NOVLET BRADSHAW 209210 0 56652 0 8694 0 18971 0 10306 0 303833 0 0 0 LINDA BUTLER 166972 0 48242 0 19745 0 12364 0 10306 0 257629 0 0 0 DONALD ESPOSITO JR 194944 0 59199 0 6789 0 15735 0 14206 0 290873 0 0 0 SYLVIA HACKETT 174735 0 48734 0 5601 0 44430 0 8613 0 282113 0 0 0 R ERICK HAWKINS 184234 0 46692 0 8323 0 16533 0 6893 0 262675 0 0 0 CHAD LEFTERIS 141712 0 41413 0 12781 0 11159 0 6059 0 213124 0 0 0 LISA SCHILLER 142286 0 42015 0 311 0 14991 0 15246 0 214849 0 0 0 ROBERT B LIVERMAN JR 126245 0 12965 0 8853 0 21263 0 4859 0 174185 0 0 0 JEFFREY CRANE 612562 0 193383 0 81166 0 42008 0 12666 0 941785 0 0 0 KENNETH ZEITLER 640051 0 110359 0 48608 0 44451 0 6359 0 849828 0 0 0 SHAHRAM TEHRANI 449364 0 29000 0 39666 0 22163 0 11506 0 551699 0 0 0 S WAYNE SMITH 415593 0 0 0 43742 0 91576 0 6059 0 556970 0 0 0 ROBERT WEHBIE 162976 0 144641 0 107974 0 24591 0 15305 0 455487 0 0 0 EMILY BARBOUR 52027 0 0 0 116018 0 14661 0 7413 0 190119 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 10 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, LINES 4A-B DURING THE CALENDAR YEAR 2010, EMILY BARBOUR RECEIVED SEVERANCE PAYMENTS TOTALING $115,444. DURING THE CALENDAR YEAR 2010, DAVID STRONG PARTICIPATED IN A NON-QUALIFIED SUPPLEMENTAL RETIREMENT PLAN AND RECEIVED PAYMENTS TOTALING $154,568. HE ALSO EARNED COMPENSATION UNDER THIS PLAN TOTALING $166,853. 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 127456150 246982 1495904 32837139 76034727 16845891 1 0 0 1 0 0 0 0 1 0 0 0 0 0 0 PART I, LINE A, COLUMN (F) TO CONSTRUCT A REPLACEMENT CENTRAL ENERGY PLANT, FUND PURCHASE OF ROUTINE CAPITAL EQUIPMENT, AND REFUND SERIES 1998 BONDS ISSUED 04/21/1998. PART II, LINE 11, COLUMN A THIS AMOUNT REPRESENTS PROCEEDS SPENT TO REFUND OUR SERIES 1998 BONDS. PART II, LINE 12 THIS AMOUNT REPRESENTS PROCEEDS HELD IN TRUSTS AS OF JUNE 30, 2011, FOR FUTURE CAPITAL EXPENDITURES AND CAPITAL INTEREST. NOVLET BRADSHAW RELOCATION LOAN X 190000 161500 0 0 1 161500 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 THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REQUIRING ALL BOARD MEMBERS TO ANNUALLY COMPLETE AND SIGN A QUESTIONNAIRE DOCUMENTING ANY AREA OF CONFLICT OF INTEREST. THE BOARD MEMBERS ARE REQUIRED TO REPORT AND DOCUMENT ANY NEW AREAS OF CONFLICT OF INTEREST AS THEY ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES AN INDEPENDENT CONSULTANT TO MEASURE FAIR VALUE OF COMPENSATION FOR THE ORGANIZATION'S PRESIDENT AND OTHER TOP MANAGEMENT. THE ORGANIZATION'S BOARD REVIEWS AND APPROVES THE COMPENSATION FOR ALL OFFICERS EXCEPT THE ASSISTANT TREASURER AND ASSISTANT SECRETARY. FORM 990, PART VI, SECTION C, LINE 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 ORGANIZATION 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: 21,526,278. FORM 990, PART XII, LINE 2C: THE AUDIT COMMITTEE'S PROCESS FOR OVERSIGHT OF THE AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANTS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, 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 1,310 VOLUNTEERS PROVIDED A TOTAL OF 141,407 SERVICE HOURS TO THE ORGANIZATION. CONDUCTING HEARING TESTS FOR BABIES, DELIVERY OF FLOWER ARRANGEMENTS AND CARDS, ESCORTING PATIENTS AND CONDUCTING TOURS ARE JUST A FEW OF THE MANY SERVICES PROVIDED BY THE VOLUNTEERS. SMITHFIELD RADIATION ONCOLOGY LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 200338181 RADIATION THERAPY NC 0 0 REX HOSPITAL INC REX HOLDINGS LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 273434791 HOLDING COMPANY NC 0 0 REX HEALTHCARE INC REX ORTHOPEDIC VENTURES LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 273434805 ORTHOPEDIC SERVICES NC 0 0 REX HOLDINGS LLC REX CDP VENTURES LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 204957241 MEDICAL CAMPUS DEVELOPMENT NC 0 0 REX ENTERPRISES COMPANY INC REX WAKEFIELD WELLNESS LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561533957 MEDICAL CAMPUS DEVELOPMENT NC 0 0 REX CDP VENTURES LLC REX CDP VENTURES - RETAIL LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 273205784 REAL ESTATE DVLPMNT NC 0 0 REX CDP VENTURES LLC REX CDP VENTURES - HT LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 204957241 REAL ESTATE DVLPMNT NC 0 0 REX CDP VENTURES LLC WAKEFIELD REX INVESTORS MOB LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 REAL ESTATE DVLPMNT NC 0 0 REX CDP VENTURES LLC 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 5361720 17174032 0 0 0.79500 JRH VENTURES LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 274092967 MED CAMPUS DVLT NC REX HOSPITAL INC RELATED 41540 41540 0 0 0.50000 REX ENTERPRISES COMPANY INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561553957 OPERATIONS SUP 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 1 0 REX HEALTHCARE FOUNDATION INC B 671042 FMV REX HEALTHCARE FOUNDATION INC C 1225046 FMV REX PHYSICIANS LLC D 11573485 FMV REX PHYSICIANS LLC I 1134428 FMV REX PHYSICIANS LLC K 1538694 FMV REX SURGERY CENTER OF CARY LLC K 452095 FMV JRH VENTURES LLC K 1121158 FMV REX SURGERY CENTER OF CARY LLC Q 3656739 BOOK VALUE 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 SHARED PERSONNEL AND ASSETS CANNOT BE READILY DETERMINED.