2012-08-14T11:04:58-05:00 2011-09-30 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-10-01 570343398 TUOMEY TUOM 8037748616 129 NORTH WASHINGTON STREET SUMTER SC 29150 MARK LOVELL 8037748616 2012-08-14 1 AMY BIBBY 8282542254 2010 2016-02-24 21:20:13Z TUOMEY HEALTHCARE SYSTEM R JAY COX 129 NORTH WASHINGTON STREET SUMTER SC 29150 202157395 0 X WWW.TUOMEY.COM X 1914 SC OPERATION OF NONPROFIT HEALTHCARE FACILITY IN SUMTER, SC 14 7 1901 272 0 0 589603 1527556 199784518 194996473 3281523 3209230 2556039 2424136 206211683 202157395 73407 41134 0 0 84427408 85987062 0 0 409416 114558868 102940366 199059683 188968562 7152000 13188833 280563026 275718221 159480256 152177610 121082770 123540611 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 168473709 41134 194996473 TUOMEY HEALTHCARE SYSTEMS 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 PROMOTION OF HEALTH HAS BEEN ESTABLISHED AS A CHARITABLE PURPOSE UNDER INTERNAL REVENUE CODE (IRC) SECTION 501 (C) (3). REV. RUL. 69-545, 1969-2 C.B. 94, SETS FOR THE FACTORS THE INTERNAL REVENUE SERVICE WILL CONSIDER IN DETERMINING WHETHER A NON-PROFIT HOSPITAL QUALIFIES FOR TAX-EXEMPT STATUS. 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 OPERATED 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 71,291 ADULT PATIENT DAYS, 1,299 BIRTHS, 3,463 NURSERY PATIENT DAYS, 59,359 ER VISITS AND 73,980 OTHER OUTPATIENT VISITS. IT ALSO PROVIDED $33 MILLION DOLLARS WORTH OF CHARITY CARE. 168473709 1 1 0 1 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 1 302 0 1901 1 1 1 0 0 0 0 0 0 0 0 0 X 14 7 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 ROBERT BOYKIN 1.00 X 0 0 0 CHAL GLENN 1.00 X X 0 0 0 KIM HARVIN 1.00 X 0 0 0 DR ANDY MCFADDIN 1.00 X 14483 0 0 REV JAMES BLASSINGAME 1.00 X 0 0 0 NICOLE NORRIS 1.00 X 0 0 0 DR HENRY MOSES 1.00 X 51800 0 0 PHIL PALMER 1.00 X X 0 0 0 KAY RAFFIELD PHD 1.00 X X 0 0 0 DR SAM RIDDLE 1.00 X 32300 0 0 DR MURRELL SMITH 1.00 X X 10417 0 0 GREG THOMPSON 1.00 X 0 0 0 MITCH WILLIAMS 1.00 X X 0 0 0 R JAY COX 40.00 X 655102 0 185520 J GREGG MARTIN 40.00 X 409323 0 122280 W PAUL JOHNSON THROUGH 411 40.00 X 504586 0 50806 MIKE WINIARSKI FROM 411 TO 811 40.00 X 0 0 0 DR GENE F DICKERSON MD 40.00 X 396230 0 94349 WILLIAM RENWICK 40.00 X 208245 0 67987 MICHELLE LOGAN-OWENS 40.00 X 159812 0 35432 TERESA M CARLTON 40.00 X 156588 0 35626 TEXIN LI 40.00 X 203093 0 23322 MICHAEL SAND 40.00 X 183767 0 21175 JUDY LYNN ROBERTS 40.00 X 183794 0 32775 SANDRA M LAWRENCE 40.00 X 183848 0 32771 ANTHONY W CABALLERO 40.00 X 238527 0 31698 3591915 0 733741 48 0 1 0 MIDLANDS EMERGENCY PHYSICIANS PA 129 NORTH WASHINGTON ST SUMTER SC 29150 MEDICAL SERVICES 6614324 REHABCARE GROUP 7733 FORSYTH BLVD SUITE 2300 ST LOUIS MO 63150 MEDICAL SERVICES 1728877 NEXSUNPRUET PO DRAWER 2426 COMLUMBIA SC 29202 CONSULTING SERVICES 1018806 BMA SUMTER DIALYSIS PO BOX 101518 ATLANTA GA 30392 CONSULTING SERVICES 995487 PRICE WATERHOUSE COOPERS LLP PO BOX 932011 ATLANTA GA 31193 CONSULTING SERVICES 852911 31 399363 1128193 1527556 NET PROGRAM SERVICE RE 621400 184933078 184933078 DISPROPORTIONATE SHARE 900099 9822617 9822617 ANCILLARY SERVICES 900099 240778 240778 194996473 79013 79013 1023270 1023270 1023270 1023270 2796715 333502 2796715 333502 3130217 3130217 CAFETERIA & VENDING 722210 1164993 1164993 AFFILIATE MANAGEMENT 561000 209900 209900 LAUNDRY & HOUSEKEEPING 812300 19474 19474 6499 6499 1400866 202157395 194996473 0 5633366 41134 41134 4325656 301214 4024442 61605775 55535998 5860916 208861 2634650 2213106 395198 26346 12765430 10722961 1914815 127654 4655551 3910663 698333 46555 459875 459875 90000 90000 600 600 11655215 9147810 2507405 428387 4452 423935 50803885 47247671 3556214 1199984 1054098 145886 2632496 2632496 4580007 4580007 11962659 11962659 784963 740595 44368 BAD DEBT EXPENSE 12578924 12578924 HOSPITAL TAX 5369055 5369055 MISCELLANEOUS EXPENSES 357697 430866 -73169 RECRUITMENT 36619 36619 188968562 168473709 20085437 409416 64968298 9342420 34615332 28876650 5031800 4465863 6756468 7145114 185564630 89405310 99395070 96159320 44902160 100737536 24893898 28991318 280563026 275718221 51804873 55077581 105885383 95310029 1790000 1790000 159480256 152177610 X 116041627 118499468 5041143 5041143 121082770 123540611 280563026 275718221 X 13188833 -10730992 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 0 0 0 0 0 0 1 4375 4375 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 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. 5647997 -49302 75000 5523695 5341581 381416 75000 5647997 5157328 259253 75000 5341581 0.08740 0.91260 0 0 9419642 9419642 44480352 65183922 -20703570 40844899 24221388 16623511 90819737 90819737 96159320 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 4609 DUE FROM AFFILIATES 28986709 28991318 OTHER LONG-TERM LIABILITIES 1790000 1790000 202157395 188968562 13188833 -2663719 -8067273 -10730992 2457841 191595160 -2663719 -7781360 -10445079 202040239 117156 117156 202157395 190090450 1121888 1121888 188968562 0 188968562 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, 2011. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2008 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN PENSION OBLIGATION -8,067,273. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN NET PENSION OBLIGATION -8,067,273. TUOMEY TRUST REVENUES 285,913. PART XII, LINE 4B - OTHER ADJUSTMENTS: TIMOTHY J. TUOMEY TRUST CONTRIBUTION 117,156. PART XIII, LINE 2D - OTHER ADJUSTMENTS: TIMOTHY J. TUOMEY TRUST INVESTMENT EXPENSES 1,121,888. 1 1 1 X 1 X 1 1 1 0 0 10002451 9822617 179834 0.00100 31725182 27333652 4391530 0.02320 41727633 37156269 4571364 0.02420 452409 452409 0.00240 69351 69351 0.00040 521760 521760 0.00280 42249393 37156269 5093124 0.02700 1 30000 30000 0.00020 1 394266 394266 0.00210 2 424266 424266 0.00230 1 3804175 63764787 68979074 -5214287 X 1 1 1 1 TUOMEY

129 NORTH WASHINGTON ST SUMTER SC 29150

X X X DISPROPORTIONATE SHARE HOSPITAL NOT REQUIRED 1 PART I, LINE 7: THE ORGANIZATION UTILIZED THE IRS WORKSHEETS TO DETERMINE THE COST TO CHARGE RATIO 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 PATIENTS 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 HOSPITALS 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. SCHEDULE H PART VI LINE 8: TUOMEY DOES NOT COMPLETE ITS OWN FORMAL COMMUNITY BENEFIT REPORT THUS WE DO NOT SEND ANY FORMAL REPORT TO ANY STATE BUT WE DO REPORT OUR RAW DATA TO THE SC HOSPITAL ASSOCIATION'S WEBSITE WHICH THEY USE TO FILE A FORMAL REPORT WITH SC AS A COMBINED REPORT COVERING ALL HOSPITALS IN THE STATE PART VI, LINE 2: TUOMEY PROCURES AN ANNUAL ASSESSMENT IN REGARDS TO DETERMINING THE PHYSICIAN NEEDS OF THE SUMTER COMMUNITY. 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 38% OF THESE RESIDENTS AT OR BELOW THE POVERTY LEVEL. SUMTER'S RACIAL DEMOGRAPHICS ARE COMPRISED OF 48.2% WHITE, 46.9% BLACK, 1.1% ASIAN, AND 3.8% OTHER. THE AVERAGE INCOME FOR A SUMTER HOUSE HOLD IS $37,113. CURRENTLY, SUMTER'S UNEMPLOYMENT RATE EQUALS 11.8%. SUMTER HAS A MILITARY BASE WHICH HOUSES US AIR FORCE AND US ARMY TROOPS. PART VI, LINE 6: TUOMEY HEALTHCARE SYSTEMS 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. PART VI, LINE 7: TUOMEY IS THE ANCHOR OF THE TUOMEY HEALTHCARE SYSTEM. TUOMEY SERVES AS THE MEDICAL FACILITY OF THE SYSTEM THAT CONSISTS OF 301 BEDS PROVIDING A WIDE RANGE OF INPATIENT/OUTPATIENT SERVICES, SURGICAL SERVICES, EMERGENCY, DAY SURGERY, INTENSIVE CARE AND WOMEN'S AND INFANTS CARE SERVICES TO THE SUMTER AND SURROUNDING COMMUNITIES. REPORTS FILED WITH STATES PART VI, LINE 7 SC 0 SUMTER SMARTER GROWTH INITIATIVE 32 EAST CALHOUN SUMTER SC 29150 264385624 501(C)(3) 30000 TO BRING JOBS AND CAPITAL INVESTMENT TO SUMTER COUNTY 1 X X X 0 1 0 0 0 0 0 0 0 R JAY COX 538720 0 0 0 116382 0 151405 0 34115 0 840622 0 0 0 J GREGG MARTIN 331718 0 0 0 77605 0 110561 0 11719 0 531603 0 0 0 W PAUL JOHNSON THROUGH 411 290014 0 0 0 214572 0 38500 0 12306 0 555392 0 0 0 DR GENE F DICKERSON MD 323731 0 0 0 72499 0 81206 0 13143 0 490579 0 0 0 WILLIAM RENWICK 168419 0 0 0 39826 0 66290 0 1697 0 276232 0 0 0 MICHELLE LOGAN-OWENS 147758 0 0 0 12054 0 28577 0 6855 0 195244 0 0 0 TERESA M CARLTON 147758 0 0 0 8830 0 19192 0 16434 0 192214 0 0 0 TEXIN LI 203093 0 0 0 0 0 8124 0 15198 0 226415 0 0 0 MICHAEL SAND 146088 0 0 0 37679 0 10400 0 10775 0 204942 0 0 0 JUDY LYNN ROBERTS 171007 0 0 0 12787 0 22000 0 10775 0 216569 0 0 0 SANDRA M LAWRENCE 160776 0 0 0 23072 0 21996 0 10775 0 216619 0 0 0 ANTHONY W CABALLERO 130070 0 5000 0 103457 0 16500 0 15198 0 270225 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN (457(B)) AND/OR DEFINED BENEFIT PLAN FOR 2010, AS FOLLOWS. THE AMOUNTS ARE REPRESENTED IN PART II, COLUMN (C): R. JAY COX $ 112,905 J. GREGG MARTIN 72,061 WILLIAM RENWICK 35,490 DR. GENE DICKERSON 68,198 TERESA M. CARLTON 12,798 MICHELLE LOGAN-OWENS 22,118 SOUTH CAROLINA JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 83703EKE4 2006-01-12 76542284 QUALIFIED HOSPITAL BOND 0 0 0 SOUTH CAROLINA JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 83703FBT8 2008-12-01 16440000 QUALIFIED HOSPITAL BOND 0 0 0 36255000 76542284 5467276 2996712 1164871 2068065 21288949 7301411 2007 0 1 1 1 16200000 16470799 270799 0 1 1 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 0 CHERYL MARTIN FAMILY RELATIONSHIP WITH OFFICER J. GREGG MARTIN 140244 COMPENSATION AS EMPLOYEE 0 SHANNON BOYKIN FAMILY RELATIONSHIP WITH BOARD MEMBER ROBERT BOYKIN 67442 COMPENSATION AS EMPLOYEE 0 JOSEPH DURANT FAMILY RELATIONSHIP WITH BOARD MEMBER KAY RAFFIELD 47998 COMPENSATION AS EMPLOYEE 0 MACAULAY SMITH FAMILY RELATIONSHIP WITH BOARD MEMBER CHARLES WHITE 58629 COMPENSATION AS EMPLOYEE 0 MARY DEAKIN FAMILY RELATIONSHIP WITH BOARD MEMBER HENRY MOSES 96934 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 REVIEWD 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 LOSSES ON INVESTMENTS: -2,663,719. CHANGE IN PENSION OBLIGATION -8,067,273. TOTAL TO FORM 990, PART XI, LINE 5: -10,730,992. 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