2012-11-12T15:15:30-06:00 2011-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 Ridgefield Court Asheville NC 28806 990 2011-01-01 570360499 Roper St Francis Mt Pleasant Hospital ROPE 8437891704 315 Calhoun Street No 107 Charleston SC 29401 Bret D Johnson 8437891704 2012-11-09 1 Amy Bibby P00445891 8282542254 2011 2016-02-24 21:20:13Z David L Dunlap 315 Calhoun Street No 107 Charleston SC 29401 36389729 0 X www.ropersaintfrancis.com X 2005 SC Operation of nonprofit hospital facility in Mt. Pleasant, South Carolina 13 7 268 32 15 0 34295 242502 5393670 35827969 0 67766 44271 251492 5472236 36389729 5514 50593 0 0 3194240 19502296 0 0 0 6413974 27817872 9613728 47370761 -4141492 -10981032 147764220 142500513 156581762 162589719 -8817542 -20089206 X Healing all people with compassion, faith, and excellence. 0 0 41282705 50593 35827969 Actively demonstrating Roper St. Francis Healthcare's commitment to heal all people with faith, compassion and excellence, Roper St. Francis Mt. Pleasant Hospital contributed $3,823,000 million in Community Benefit in 2011. This benefit included $2,086,000 in Charity Care, $1,509,000 in unreimbursed Medicaid, and $228,000 in numerous sponsorships and community outreach programs (see Schedule H for additional details). In 2011, Mount Pleasant Hospital contributed 466 volunteer staff hours and impacted 39 individuals. The hospital also provided events such as free breast cancer screenings and sponsored community events that focused on fun, family-focused activities including Splash Days and The Trot for Tots family-friendly run/walk that raises money to purchase car seats for new, underserved parents and families. The hospital also offered free parenting classes to new parents and financial counseling. For more information on how the healthcare system supports the Lowcountry community in Charitable Care and sponsorships, see Schedule H. Please see Schedule O for a detailed statement of Program Service Accomplishments.Please visit our website for a detailed community benefit report at: http://www.ropersaintfrancis.com/about_us/mission_and_community_activities/annualreport.aspx. 41282705 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 1 268 1 0 0 0 0 0 0 0 0 0 0 X 13 7 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 SC X X The Finance Department 8437891704 315 Calhoun Street 107 Charleston SC 29401 John M Jordan 1.00 X 0 332573 23167 W Blount Ellison 1.00 X 0 0 0 Stanley Wilson MD 1.00 X 0 567091 55850 Richard Statuto 1.00 X 0 0 0 Michael C Tarwater 1.00 X 0 0 0 G Frederick Worsham MD 1.00 X 0 0 0 Perry Keith Waring 1.00 X 0 0 0 Brantley D Thomas Phd 1.00 X 0 0 0 Sister Anne Lutz 1.00 X 0 0 0 David M Ellison MD 1.00 X 0 29025 0 Katherine Duffy Phd 1.00 X 0 0 0 Julius R Ivester MD 1.00 X 0 0 0 Alison E Dillon MD 1.00 X 0 10500 0 Angress Walker 1.00 X 0 0 0 Joseph G Piemont 1.00 X 0 0 0 David Dunlap 1.00 X 0 1000085 187803 Matthew J Severance 1.00 X 0 659875 169576 Bret Johnson 1.00 X 0 577927 168182 Steven D Shapiro 1.00 X 0 584528 110606 Allen Carroll 1.00 X 0 554527 141872 John Sullivan 50.00 X 421106 0 139574 Douglas W Bowling 1.00 X 0 463622 110458 Michael Taylor 1.00 X 0 402977 91527 H Douglas Harrison 1.00 X 0 386285 74074 Gregory T Edwards 1.00 X 0 367601 109170 Ellen Brown 1.00 X 0 298193 50312 Lisa Irvin 1.00 X 0 300850 73734 Father Terence K Fleming 1.00 X 0 180985 47849 Pennie L Peralta 1.00 X 0 251740 59908 Diana Topjian 50.00 X 165146 0 34608 James Flatley III 1.00 X 0 0 0 George P Waters 1.00 X 0 0 0 Mark Dickson 1.00 X 0 98234 24031 Francis Wyckoff Jr 3.00 X 10592 197107 39628 Michael Ricciardone 4.00 X 11923 149192 19648 Wanda Brockmeyer 1.00 X 0 166759 18292 Maria Sample 25.00 X 83234 84575 17186 Robert Lowery MD 0.40 X 8472 1201842 63030 John Mccrosson MD 0.30 X 5589 926001 35877 John Graham MD 0.50 X 8864 877530 57653 Harry Rudolph MD 1.30 X 18554 723594 32798 Blake Ohlson MD 0.80 X 11615 714350 37376 Peter DiNicola 1.00 X 0 217251 16080 Stephanie Tucker 1.00 X 0 167724 39987 745095 12492543 2049856 7 1 1 1 BE & K Building Group Inc 5605 Carnegie Blvd 200 Charlotte NC 28209 Contractor Services 3658485 Roper Emergency Physicians 639 McCutchen Street Charleston SC 29412 Physician Fees 1624761 Anesthesia Associates of Charleston PO Box 22206 Charleston SC 29413 Anesthesia Services 1526695 McKesson Information Solutions PO Box 98347 Chicago IL 606938347 Technology Services 808153 Morrison Management Specialists PO Box 102289 Atlanta GA 30368 Cafeteria Management 336243 15 242502 242502 Net Patient Service Re 624100 35827969 35827969 35827969 2193 2193 65573 0 65573 65573 65573 Cafeteria Revenue 722210 168312 168312 Miscellaneous Revenue 900099 83180 15 83165 251492 36389729 35827969 15 319243 50593 50593 692000 692000 15498141 12278040 3220101 341296 283276 58020 1657342 1372158 285184 1313517 1090219 223298 854780 543880 310900 90598 90598 35834 35834 4267217 4121050 146167 224781 179074 45707 2326392 1818226 508166 59374 59374 2247204 2205984 41220 23395 23395 127393 127393 8017545 8017545 160666 123925 36741 Medical Supplies 5091256 5091256 Bad Debt Expense 3006187 3006187 DSH Taxes 1046569 1046569 Miscellaneous Expenses 238681 54723 183958 47370761 41282705 6088056 0 650 725 4127199 5621813 1501516 1505875 355651 208433 144637663 9494886 141753406 135142777 25798 20890 147764220 142500513 12883 107912 99168 198336 156469711 162283471 156581762 162589719 X -8817542 -20089206 -8817542 -20089206 147764220 142500513 X -10981032 -290633 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 15467846 15467846 101589893 5261544 96328349 2933333 295782 2637551 24646591 3937560 20709031 135142777 Due to Affiliates 162283471 162283471 Description of Uncertain Tax Positions Under FIN 48: Part X: Roper St. Francis Mt. Pleasant Hospital is a not-for-profit organization as described in Section 501(c)(3) of the Internal Revenue Code and is generally exempt from federal and state income taxes. Accordingly, no provision for income taxes is made in the consolidated financial statements. Although [the consolidated group] is generally exempt from federal and state income taxes, it evaluates whether there are any uncertain tax positions that fail to meet the more-likely-than-not threshold for recognition in the consolidated financial statements. Uncertain tax positions may include the characterization of income, such as a characterization of income as passive, a decision to exclude reporting taxable income in a tax return, or a decision to classify a transaction, entity, or other position in a tax return as tax exempt. The tax return benefit from an uncertain tax position is recognized when it is more likely than not that the position will be sustained upon examination, including resolutions of any related appeals or litigation processes, based on the technical merits. The organization has no unrecognized tax positions as of December 31, 2011 and 2010, and does not expect that unrecognized tax benefits will materially increase within the next 12 months. Tax years 2008 through 2010 are subject to examination by the federal and state taxing authorities, respectively. There are no income tax examinations currently in process. Interest and penalties related to uncertain tax positions, if any, would be recognized in the consolidated financial statements as income tax expense. 1 1 X 1 X 299.000000000000 1 X 399.000000000000 1 1 1 0 1 1 2571808 486163 2085645 0.04700 3149726 1640538 1509188 0.03400 5721534 2126701 3594833 0.08100 42709 42709 0.00100 40097 40097 0.00090 135 135 0.00000 149494 8606 140888 0.00320 232435 8606 223829 0.00510 5953969 2135307 3818662 0.08610 4341 4341 0.00010 4341 4341 0.00010 0 3006187 1202475 7076173 11777280 -4701107 X 1 1 1 1 Roper StFrancis Mt Pleasant Hospital

3500 Highway 17 North Mt Pleasant SC 29466

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

3510 Highway 17 N Ste 205 Mt Pleasant SC 29466

Bone Density, Mammography Mount Pleasant Hospital Imaging

3510 Highway 17 N Ste 140 Mt Pleasant SC 29466

X-Ray Part I, Line 3c: In addition to using the federal poverty guidelines to determine free and discounted care (see Part I, Lines 3a and 3b), the hospital system offers a 35% discount for patients who are uninsured. A 10% prompt payment discount is offered to all self-pay or self-pay-after-insurance patients who pay the balance at one time. Medical indigency adjustments are available to those that meet the established guidelines.The Hospital will provide free care for patients with a signed charity care application who have income between 0 - 299% of FPG. If a signed charity care application is not obtained, the hospital will use the Health Care Advisory Board's self pay compass program to automatically qualify patients for charity care through the use of an electronic scoring technique. The hospital will provide free care for patients who have income of 350% and below of FPG as determined by the self pay compass program.The Hospital will provide a 90% discount for patients with a signed charity care application who have income between 300 - 399% of FPG. If a signed charity care application is not obtained, the hospital will not provide discounted care. Part I, Line 6a: The organization's community benefit report is made available through its corporate parent, CareAlliance Health Services d/b/a Roper St. Francis Healthcare. Part I, Line 7: Worksheet 2 of the 2011 Schedule H instructions was used to compute a cost-to-charges ration used to calculate charity care and unreimbursed Medicaid at cost. Part I, L7 Col(f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 3,006,187. Details of Community Health Services (net): Part I, line 7(e): Advantage programs - $ 1,000 Community calendars and newsletters - 700 Enrollment assistance in public programs - 4,370 Health education and lectures by staff - 119 Health fairs and career days - 383 House calls magazine - 27,285 Community benefit program oversight costs - 8,852 Total to Line 7(e), col (e) - 42,709 Part II: In 2011, Mount Pleasant Hospital contributed 466 volunteer staff hours and impacted 39 individuals. The hospital also provided events such as free breast cancer screenings and sponsored community events that focused on fun, family-focused activities including Splash Days and The Trot for Tots family-friendly run/walk that raises money to purchase car seats for new, underserved parents and families. The organization further supported the community by providing $33,857 in sponsorships to several local organizations. Part III, Line 4: Bad debts reported on Part III, Line 2 are reported at gross charges per the organization's audited financial statements.Receivables are reported at the net realizable amounts from patients, third-party payors, and others for services rendered, including estimated retroactive adjustments under reimbursement agreements. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods as final settlements are determined.The organization provides care to patients who meet certain criteria under its charity care policies without charge or at amount less than its established rates. Because the organization does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. During 2010, the organization enhanced its efforts to qualify patients for charity care through the use of an electronic credit scoring technique, which resulted in substantially more charity care and substantially less bad debt expense recognized in future periods. Part III, Line 8: The entire amount of Medicare shortfall qualifies as community benefit. Our treatment of Medicare patients, as described in IRS Rev. Rul. 69-545, indicates that Mt. Pleasant Hospital operates to promote the health of the community. By taking Medicare patients, the hospital promotes access to healthcare services, which is a community benefit.The Medicare cost report was used to compute amounts for Part III, lines 5 and 6. Had we included revenues and costs from all Medicare programs including Medicare Part C and physicians practices this would have resulted in an additional shortfall of $1,346,265. Part III, Line 9b: The hospital uses the Health Care Advisory Boards self pay compass program to identify a patients propensity to pay. Accounts with an FPL of 350% and below will be identified once the self pay accounts receivable billing process has been completed and prior to the account being referred to a collection agency. Accounts with FPL of 350% and below will be given a charity adjustment. Once an account has been referred to bad debt, the organization will make every effort to ensure that all self-pay collectors demonstrate consistent, compassionate, and professional service while conducting business on behalf of the health system. This will include, but is not limited to: guarantor notification and contact/collection attempts, discount opportunities, payment plan arrangements, account balance notifications, face to face meetings, and detailed bill generation. An outsourced self-pay billing agency will contact the guarantor to set up payment arrangements. Financial assistance discounts are offered to guarantors who meet the charity guidelines.Self pay patients receive a 35% discount off total charges. They are also eligible for a 10% prompt payment discount if they pay the balance during the discussion. Discounts may be combined if all requirements are met. In pursuit of collections, the hospital and its agents will not: attach liens on property, garnish wages, pursue legal actions (unless recommended by the self pay billing entities), sell accounts, or send bankrupt guarantors to collection agencies. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 9: The Hospital will provide free care for patients with a signed charity care application who have income between 0 - 299% of FPG. If a signed charity care application is not obtained, the hospital will use the Health Care Advisory Board's self pay compass program to automatically qualify patients for charity care through the use of an electronic scoring technique. The hospital will provide free care for patients who have income of 350% and below of FPG as determined by the self pay compass program. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 10: The Hospital will provide a 90% discount for patients with a signed charity care application who have income between 300 - 399% of FPG. If a signed charity care application is not obtained, the hospital will not provide discounted care. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 13g: The patient handbook provided with registration references the policy and includes contact information for patients who need assistance. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 19d: The hospital's FAP provides a minimum discount of 90% for individuals that qualify under the policy's provisions. The hospital has made plans to implement a method of determining Amounts Generally Billed (AGB) per the recently released Proposed Regulations under Section 1.501(r), however given the high level of discount available under the current policy, the organization is confident that its policies are well within guidelines. Part VI, Line 2: The hospital participates in periodic needs assessment projects to assess the healthcare needs of the community. The most recent needs assessment titled "Health System Profile for the Tricounty Area of Berkeley, Charleston, & Dorchester Counties" was performed in 2010. This report was a collaboration between the South Carolina Hospital Association and the South Carolina Rural Health Research Center in the Arnold School of Public Health, University of South Carolina. A number of data sets were examined in partnership with the office of research and statistics at the South Carolina Budget and Control Board. The majority of the information delineated in this report was drawn from a series of interviews and focus groups with healthcare professionals, community leaders, and uninsured residents. the purpose of this report was to assess local healthcare infrastructure including location, service availability, business rules, and workforce issues as well as to describe health service utilization issues such as the types of care uninsured people are seeking, the degree of unmet healthcare needs, and perceived reasons for needs going unmet. Data suggest that resources available to uninsured in the tricounty area are moderately effective in preventing potentially avoidable emergency room visits but lacks impact on the same type of inpatient hospitalizations. Diabetes, bacterial pneumonia, congestive heart failure, kidney/urinary tract infections, and dental conditions are among the most prevalent reasons for an avoidable hospital visit. Dental care remains a significant unmet healthcare need among the uninsured. Access to specialty care for the uninsured is unanimously the biggest obstacle for the tricounty key stakeholders. The participants in the needs assessment will engage in strategic planning and implementation of activities that will improve access to care for the uninsured. A project database will inform on the group's progress. The University of South Carolina team will continue to monitor progress as a project evaluator. Part VI, Line 3: The Hospital shall send anyone who requests information on the hospital's financial assistance program a letter outlining required information and a financial assistance application form. Requests for financial assistance may be proposed by sources other than the patient, such as the patient's physician, family members, social service organizations, community or religious groups, or hospital personnel. Statements to patients from the Hospital outline our charity care policy and our charity care policy is posted on our website. If patients indicate they are not able to pay their bill, we will provide the patient with a charity care application.Patients can also meet with a member or our financial counseling department to learn about their financial assistance options. Brochures are printed in English and Spanish telling patients to contact the financial counseling department. The Hospital wants its patients focus to be on health and recovery and not financial worry. There is absolutely no additional cost for our financial counseling assistance.Additionally, patients can meet with staff of the Medicaid program. The program staff will meet with patients individually to help them apply for publicly supported programs such as Medicaid, Medicare, and disability. Counselors meet with patients in the hospital as well as making home visits as appropriate. The staff can also help identify resources to help pay for medication. All of this information is posted on our website with the appropriate contact information. Part VI, Line 4: The system's primary service area consists of Charleston, Berkeley, and Dorchester counties, and includes the major municipalities of Charleston, North Charleston, Mount Pleasant, and Summerville. Approximately 682,000 residents live within the primary service area. Population in the primary service area is projected to grow 5.4% between 2010 and 2015. In 2010, income levels in the primary service area were estimated as follows: Income less than $ 15,000 - 14.0% Between $ 15,000 and $ 25,000 - 12.0% Between $ 25,000 and $ 50,000 - 26.0% Between $ 50,000 and $ 75,000 - 18.0% Between $ 75,000 and $100,000 - 12.0% Income above $100,000 - 18.0%Compared to the national averages of 14.0%, 12.0%, 25.0%, 18.0%, 11.0%, and 20.0%, respectively (most recent data available).Within the primary service area, poverty continues to be an issue. An estimated 113,131 Tricounty residents lack health insurance. There is a vast over-representation of the uninsured living at or below the federal poverty level. The US Department of Health and Human Services designated six medically underserved areas and one medically underserved population within our primary service area. From April 2011 to April 2012, the unemployment rate in the primary service area decreased from 8.0% to 7.1%. This is a lower unemployment rate than the national average, which was 8.7% in April 2011 declining to 7.7% in April 2012. The secondary service area includes Colleton, Orangeburg, Georgetown, Hampton, Beaufort, Williamsburg, and Horry counties. In addition to the system's facilities, there are three other non-military hospitals in the primary service area. Part VI, Line 5: We are the lowcountry's only non-governmental, not-for-profit healthcare system. With this distinction, we believe it is our responsibility to advocate for and respond to our neighbors needs through community benefit. In keeping with our mission of healing all people with compassion, faith, and excellence, Roper St. Francis Healthcare (RSFH) strives to enrich the health of our community. We do this by offering charity care to those in need, reaching out to our neighbors with health fairs and educational materials, sponsoring organizations and events that promote wellness and community well-being, and marshalling our resources to advance the health and dignity of each person with whom we come in contact.RSFH is committed to the enrichment of healthcare in our community as evidenced by the composition of our board of directors and open medical staff. Our governing body is comprised of a 13 member board of directors. At least nine directors must have their primary residence in a community served by the system. Five directors must be physicians actively engaged in the full time practice of medicine. RSFH extends medical staff privileges to all qualified physicians in the area for most of our departments.Surplus funds are returned to our community through the development of new facilities to serve population growth, the expansion or existing facilities, subsidizing care for those who are unable to pay, sponsorship of healthcare related activities including outreach clinics and programs for the uninsured, and investing in technology to improve the quality of patient care. Part VI, Line 6: CareAlliance Health Services (d/b/a Roper St. Francis Healthcare (RSFH)) is a charitable health care delivery system based in Charleston, South Carolina. The 657-bed health system provides services at 90 facilities and doctors' offices conveniently located throughout our region. One of these facilities is Roper St. Francis Mount Pleasant Hospital, an acute care hospital with 85 licensed beds. CareAlliance was formed effective August 1, 1998, through the execution of an affiliation agreement between the following founding members: The Medical Society of South Carolina, Bon-Secours Health System, Inc., and Carolinas Healthcare System. CareAlliance is the sole corporate member and, through its by-laws, has the power to control the financial and business affairs of Roper St. Francis Mt. Pleasant Hospital. Reports Filed With States Part VI, Line 7 SC 1 X Schedule I, Part I The majority of the grants expense shown on page 10 of the 990 is an allocation from the parent company, CareAlliance Health Services. All grants meeting disclosure requirements for 2011 have been listed on CareAlliance Health Service's Form 990. X X X X 0 1 0 0 0 1 1 1 0 John M Jordan 0 262573 0 70000 0 0 0 12564 0 10603 0 355740 0 0 Stanley Wilson MD 0 566497 0 0 0 594 0 29064 0 26786 0 622941 0 0 David Dunlap 0 511752 0 405684 0 82649 0 157885 0 29918 0 1187888 0 76753 Matthew J Severance 0 387609 0 245588 0 26678 0 136108 0 33468 0 829451 0 26369 Bret Johnson 0 291943 0 214879 0 71105 0 132264 0 35918 0 746109 0 65514 Steven D Shapiro 0 353282 0 203839 0 27407 0 103182 0 7424 0 695134 0 14267 Allen Carroll 0 318981 0 212427 0 23119 0 116460 0 25412 0 696399 0 21774 John Sullivan 223463 0 167609 0 30034 0 119147 0 20427 0 560680 0 0 0 Douglas W Bowling 0 289576 0 154054 0 19992 0 91212 0 19246 0 574080 0 19605 Michael Taylor 0 243327 0 132696 0 26954 0 74164 0 17363 0 494504 0 12605 H Douglas Harrison 0 230973 0 125475 0 29837 0 62019 0 12055 0 460359 0 10396 Gregory T Edwards 0 265465 0 92221 0 9915 0 85159 0 24011 0 476771 0 0 Ellen Brown 0 181535 0 101955 0 14703 0 26444 0 23868 0 348505 0 11837 Lisa Irvin 0 181781 0 101929 0 17140 0 62807 0 10927 0 374584 0 10745 Father Terence K Fleming 0 72625 0 96432 0 11928 0 45252 0 2597 0 228834 0 10628 Pennie L Peralta 0 156520 0 85568 0 9652 0 45576 0 14332 0 311648 0 9265 Diana Topjian 125981 0 38662 0 503 0 20145 0 14463 0 199754 0 0 0 Francis Wyckoff Jr 8567 159413 1523 28348 502 9346 1457 27104 564 10503 12613 234714 0 0 Michael Ricciardone 9476 118572 1575 19705 872 10915 706 8836 748 9358 13377 167386 0 0 Wanda Brockmeyer 0 136503 0 19549 0 10707 0 9564 0 8728 0 185051 0 0 Maria Sample 67611 68701 12361 12560 3262 3314 3565 3623 4959 5039 91758 93237 0 0 Robert Lowery MD 8468 1201261 0 0 4 581 203 28861 238 33728 8913 1264431 0 0 John Mccrosson MD 5574 923468 0 0 15 2533 75 12489 140 23173 5804 961663 0 0 John Graham MD 8859 877013 0 0 5 517 291 28773 286 28303 9441 934606 0 0 Harry Rudolph MD 18548 723367 0 0 6 227 314 12250 506 19728 19374 755572 0 0 Blake Ohlson MD 11614 714270 0 0 1 80 201 12363 397 24415 12213 751128 0 0 Peter DiNicola 0 184172 0 30642 0 2437 0 10464 0 5616 0 233331 0 0 Stephanie Tucker 0 138858 0 25863 0 3003 0 25879 0 14108 0 207711 0 0 Part I, Line 4b The following participants received compensation through a 457(f) plan: Matthew Severance - 30,458 (from a related organization) Lisa Irvin - 11,130 (from a related organization) Allen Carroll - 22,750 (from a related organization) Ellen Brown - 11,430 (from a related organization) Douglas Bowling - 19,760 (from a related organization) Steven Shapiro - 25,831 (from a related organization) Michael Taylor - 14,970 (from a related organization) Pennie Peralta - 9,630 (from a related organization) Part I, Line 6 Goals are developed each year to support the organization's strategic initiatives for people, quality, financial, growth and service. The Ad Hoc Compensation Committee approves the system goals annually and reports to the full Board of Directors. Progress on each metric is reported to the board each month on the corporate scorecard. At year end, the Ad Hoc Compensation Committee approves the final scorecard number and reports results to the full board. Annual incentives for the executives are based on 60% on the corporate scorecard and 40% on individual performance. Executives maintain an individual scorecard on the leader evaluation manager and discuss results monthly with the President/CEO. The President/CEO approves the individual executive scorecard. System Vice Presidents and the system CEO are eligible to participate in a long term incentive plan (LTIP). An LTIP typically takes place over a three year period and does not vest until the end of the third year. To receive payment, executives must still be employed by the system at the end of the plan period. Each LTIP has a financial and clinical objective that is aligned with the organization's strategic goals. Threshold, target, and maximum performance ranges are established for these objectives and are measured based on performance against similar organizations or compared to an internal metric such as an improvement over prior performance. These targets and objectives are approved by the Ad Hoc Compensation Committee. The incentive is earned based on the satisfaction of the threshold, target, or maximum performance ranges. The Ad Hoc Compensation Committee also approves the final LTIP performance score and the amount paid to executives under the plan. Results are reported to the full board annually. Part I, Line 7 See the response to line 6 above. Supplemental Information Part III Part II, Line 1: Compensation from unrelated organizations Carolinas Healthcare System provides the compensation of David L. Dunlap, CEO, CareAlliance Health Services; Bret D. Johnson, CFO, CareAlliance Health Services; and John Sullivan, CEO, Roper St. Francis Mt. Pleasant Hospital. Mr. Dunlap and Mr. Johnson are employees of Carolinas Healthcare System and their compensation is paid by CareAlliance Healthcare Services, a related organization, through a management fee to Carolinas Healthcare System. Mr. Sullivan is also an employee of Carolinas Healthcare System, and his compensation is paid by Roper St. Francis Mt. Pleasant Hospital through a management fee to Carolinas Healthcare System. Additional information: CareAlliance Health Services has board representations from the 3 founding organizations: The Medical Society of SC (6 board members), Bon-Secours Health System, Inc. (6 board members), and Carolinas Healthcare System (1 board member). None of the 13 appointed board members receive compensation for their membership. Additionally, 4 of the 6 board members appointed by the Medical Society of South Carolina also serve on the Board of the Medical Society. None receive compensation for their services as a board member. It is the founding members' intent that the members of the Board of Directors are appointed to such positions because they have a willingness to serve the needs of the system as a whole and not the needs of any individual founding member. Anesthesia Associates of Charleston The President of this organization is Board Member Dr. Julius Invester 1603675 Provision of anesthesia services 0 Charleston Pathology PA Organization owned in part by Board Member Dr. G. Frederick Worsham 102625 Provision of Pathology services 0 Form 990, Part VI, Section A, line 3 Carolinas Healthcare System (CHS), an unrelated organization, provides the compensation of Mr. David L. Dunlap, CEO, CareAlliance Health Services; Mr. Bret D. Johnson, CFO, CareAlliance Health Services; and Mr. John Sullivan, CEO, Roper St. Francis Mt. Pleasant Hospital. Mr. Dunlap and Mr. Johnson are employees of CHS and their compensation is paid by CareAlliance Health Services, a related organization, through a management fee to CHS. Mr. Sullivan is also an employee of CHS, and his compensation is paid through a management fee by Roper St. Francis Mt. Pleasant Hospital. Form 990, Part VI, Section A, line 6 The sole member of the corporation is CareAlliance Health Services, a South Carolina nonprofit, nonstock Corporation, d/b/a Roper St. Francis Healthcare. CareAlliance Health Services is in turn governed by a Board of Directors appointed by the "founding members". Please see the response to Line 7a below. The bylaws of the organization specify certain qualifications of the thirteen member Board of Directors. At least nine directors must have their primary residence in a community served by the system. Five directors must be physicians actively engaged in the full time practice of medicine. Five of the directors are appointed to the Board of Directors by virtue of positions held within MSSC, BSHSI and CHS (ex-officio directors). Each of the five ex-officio directors serves as a director of the organization for so long as such person holds his or her respective elected or appointed office in his or her respective founding member organization. Directors serve three-year terms and are limited to three consecutive terms. After an absence of at least one year, directors are again eligible for appointment to the Board of Directors for two consecutive complete terms. Form 990, Part VI, Section A, line 7a The organization is governed by a thirteen member board of directors appointed by the founding members. Subject to certain nominating and governance committee approvals, six directors are appointed by the Medical Society of South Carolina (MSSC), Bon Secours Health Systems, Inc. (BHSHI) and one director is appointed by Carolinas Healthcare Systems (CHS). It is the founding members' intent that the members of the organization's board of directors are appointed to such positions because they have a willingness to serve the needs of the system as a whole and not the needs of any individual founding member. Form 990, Part VI, Section A, line 7b The following actions shall require the unanimous affirmative approval of all of the founding members: (a) to amend the Articles of Incorporation or by-laws, including without limitation, any change in the corporation's purposes; provided, however, that, subject to the procedures and voting requirements with respect to the admission of non-founding members, Schedule 3.1 may be amended with the approval of two (2) of the founding members to reflect the admission of a non-founding member; (b) to dissolve or liquidate the corporation and to determine the distribution of assets upon dissolution; (c) to merge or consolidate the corporation or to sell, convey, transfer, lease, or otherwise dispose of all or substantially all of its assets; (d) to appoint the President and Chief Executive Officer of the corporation in a manner other than that established within the by-laws; (e) to alter or amend the corporation's ethical performance standards (defined below); or (f) to enter into any material agreement whereby a third party will: (i) become an equity owner in any joint venture with the corporation or any system participant and will not be legally obligated to support the corporation's ethical performance standards; or (ii) manage a substantial part of the facilities, assets, or operations of the system and will not be legally obligated to comply with and support the corporation's ethical performance standards. Form 990, Part VI, Section B, line 11 The 2011 Form 990 was prepared by an independent accounting firm with assistance and oversight by management. Reviews were then conducted by the assistant controller, director of finance, and chief financial officer of CareAlliance Health Services, the sole member, before presentation and review with the organization's governing body. Highlights of the 2011 Form 990 were presented to the organization's board of directors in October 2012. In addition to the organization's executive management, representatives of Dixon Hughes Goodman, LLP participated in this review with board members. The October board meeting was held prior to the filing of the Form 990 with the internal revenue service. A final version of the Form 990 was sent to all members of the governing body prior to filing. Form 990, Part VI, Section B, line 12c The directors shall complete and return to the secretary an annual statement that each: (a) has received a copy of the conflict of interest policy; (b) has read and understands the policy; (c) agrees to comply with this policy; (d) understands that the policy applies to all committees; and (e) understands that the organization is a charitable organization and must continuously engage primarily in activities which accomplish one or more of its tax-exempt purposes. Form 990, Part VI, Section B, line 15 An independent company, Towers Perrin, provides research, advice, and guidance to the compensation committee and senior leadership to ensure the organization's compensation programs for executives covered by the "intermediate sanctions legislation" (IRC Section 4958) are aligned with its stated philosophy: base salaries are targeted at the 50th percentile of the established comparator market; total cash compensation (base salary plus annual incentive payments) are targeted at the 75th percentile of the established comparator market; total direct compensation (total cash compensation plus long term incentive payments) will not exceed the 90th percentile of the established comparator market; benefits are targeted at market median; and in the aggregate, base salary, total cash compensation, total direct compensation and benefits comprise total compensation for executives. The compensation committee ensures that executive total compensation is reflective of the organization's stated compensation philosophy. The committee, in this process, authorizes and supports an annual three-step process utilizing Towers Perrin's resources: 1) Salary levels, annual bonus targets/payments and long term incentive grants are compared rigorously each year with market data based on comparable positions and organizations. a. Comparable organizations are typically not-for-profit healthcare systems with similar operating revenues. private sector employer data, when available, are also included in the analysis for "transferable skills positions". b. Historically, performance incentive payouts generally track with a normal bonus payout distribution. Incentive goals are primarily based on formally defined quantitative goals. 2) All recommended pay decisions are tested against these data and the organization's stated compensation philosophy. 3) A formal opinion letter is prepared by Towers Perrin, representing that senior executives are compensated within the reasonableness standards mandated by the IRS. A similar process is performed by Watson Wyatt (compensation consulting firm) for the CEO and CFO positions. This letter provides a "safe harbor" for the organization's "directors" relative to the reasonableness of total executive compensation consistent with IRC Section 4958. Form 990, Part VI, Section C, line 18 Photocopies of the Form 990 are available upon request at the organization's administrative office. In addition, recent filings of the Form 990 are available online at www.guidestar.org. Form 990, Part VI, Section C, line 19 The organization's audited financial statements are published annually and are available to the public at www.dacbond.com. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Pension and benefits expense allocation from CAHS -290,633. Total to Form 990, Part XI, Line 5: -290,633. Form 990, Part XII, Line 2C: The process has not changed from the prior year. Compensation of board members: Form 990, Part VII, Line 1: The following board members were compensated for services performed for the organization (or a related organization) not in the capacity of their positions on the board. No board member is compensated for his services as a board member. John M. Jordan was compensated by the Medical Society of South Carolina for services as Chief Executive Officer. David M. Ellison was compensated for medical services rendered to a related organization. Alison E. Dillon was compensated for medical services rendered to a related organization. Stanley Wilson was compensated for medical services rendered to a related organization. -- 2011 COMMUNITY BENEFIT REPORT -- Dear Friends, The spirit of giving is strong at Roper St. Francis. This desire to give back with our time, talent and treasure is something that runs deep within our culture. It is evident in our staff that is always willing to go the extra mile, in our volunteers who serve meals each month at Crisis Ministries and our numerous co-workers reaching out into the community. Even in these challenging economic times and with increasing demands within healthcare, Roper St. Francis continues to excel in providing high levels of quality support in the effort to create healthy communities. I am proud to report that as a system we gave back over $55 million in Community Benefit in 2011. This benefit comes in many forms, including charity care, sponsorships and numerous community outreach programs, many of which are outlined in this Report to Our Community. I hope you enjoy learning about the many ways we touch our community in the year's report. Warm regards, David L. Dunlap, FACHE President and CEO Charity Care: $38,437,116 Unreimbursed Cost of Medicaid: $7,305,167 Community Investment: $706,081 Community Outreach Programs: $8,844,973* Total Community Benefit: $55,293,337 *The $8,844,073 given to community outreach programs went to the following programs: - Support Groups - Families for a Healthy Heart - Access Health - Mental Health Grant - Barrier Island Free Clinic - Our Lady of Mercy Outreach Center Prenatal Clinic - Ryan White Program - Education: Nursing, CPE, Imaging, PT - Disaster Preparedness CHARITY BEGINS AT HOME Trident United Way Roper St. Francis employees continue to show their incredible generosity by donating $513,647 to the Trident United Way in 2011. This is the highest amount raised by employees at a single company in the Lowcountry. Roper St. Francis employees raised $46,000 for the American Heart Association. Healthfairs Bringing lifesaving screenings and preventive tests out into our community is a large part of our outreach mission. In 2011, we sponsored 45 community healthfairs and participated in over 85 requested community healthfairs and screenings. Our staff hours for these and other community initiatives exceeded 88,354. Community Investment Roper St. Francis is proud to support organizations in our community that enhance the overall health and vitality of our community. Monetary donations, contributions of paid employee time and donations of supplies and equipment are just a few of the ways we supported our community. In 2011, we provided $706,081 in sponsorships. The following are just a sampling of the organizations we partnered with: Achieving Wheelchair Equality Alzheimer's Association American Cancer Society American Foundation for Suicide Prevention American Heart Association American Lung Association Arthritis Foundation Barrier Islands Free Medical Clinic Berkeley County Family YMCA Berkeley Seniors Callen Lacy Center for Children Camp Happy Days Charleston County Medical Society Alliance Charleston Ride for Hope Closing the Gap in Healthcare Coastal Crisis Chaplaincy Crisis Ministries Darkness to Light Down Syndrome Association Lowcountry Dragon Boat Charleston Florence Crittenton Program of SC Franklin C. Fetter Family Health Center Inc. HALOS Hemangioma Treatment Foundation Hospice of Charleston, Inc. ITN of Charleston Leukemia and Lymphoma Society Lowcountry Pregnancy Center Lowcountry Food Bank Make a Wish Foundation SC March of Dimes MedShare International Inc. Metanoia Muscular Dystrophy Association NAACP National Kidney Foundation Our Lady of Mercy Outreach Palmetto Project Palmetto Palace Respite Care Ministries Salvation Army Nearly $3 million in Grants Supports Community Health Initiatives The Roper St. Francis Foundation has a simple mission: to secure philanthropic support to fund the programs and activities of Roper St. Francis Healthcare. In 2011, the Foundation received more than $2.9 million in grant support for projects that reach out to help some of the area's most vulnerable residents. These grants provide much-needed support for programs such as: - The Center for Spinal Cord Injury - Ryan White HIV Program - Home Health Telemonitoring TOUCHING COMMUNITIES LOCALLY AND GLOBALLY The Inner City Crisis Ministries Roper St. Francis has been a long time partner of Crisis Ministries, a place where people can go for a warm meal and safe place to sleep. In 2011, our service included many things we have been doing for years and some exciting new partnerships including: - Each month Roper St. Francis employees serve a full, hot dinner at the shelter that has been prepared by the Roper Hospital cafeteria. - The system sponsors an on-site nurse practitioner to care for the homeless. - The system regularly makes in-kind donations of medical equipment, laboratory testing and medication. - In 2011, the Medical Society of South Carolina, one of Roper St. Francis' founding members, completed a $500,000 challenge grant for Crisis Ministries. The Society donated $200,000 in matching funds to complement $300,000 raised by the shelter for its new health clinic. Bringing Hope to Abused and Neglected Children An abused girl receives a surprise birthday party, while a foster child is given clothes for the new school year. These are just a few things that happen because of local nonprofit Charleston HALOS and Roper St. Francis employees. In 2011, Roper St. Francis received the first HALOS/Charleston County DSS Organizational Commitment Award. The honor, named for HALOS close association with the county's Department of Social Services, recognizes an organization that has greatly assisted HALOS in impacting the lives of maltreated children. Throughout the year Roper St. Francis employees collected school supplies along with making sure the program's closet is stocked with items such as diapers, formula and soaps. On the annual Day of Caring, more than 1,000 Hope Bags were created by employees for the children. The Ryan White Program In late 2010, The Ryan White Program opened a new Wellness Center that provides a range of care and support services including vaccines, lab services, medical case management, housing services and physician care in one convenient location. Functioning under a clinic model allows for better coordination of care, improved clinical outcomes, cost containment and increased convenience for clients. In 2011, the Ryan White Program and Wellness Center served 549, largely uninsured and poor, clients. Of these, 117 were newly enrolled. The program is committed to addressing the primary goals of the new National HIV/AIDS Strategy to: 1. Reduce HIV infection rates 2. Increase access to care and optimizing health outcomes 3. Reduce the HIV-related health outcomes for all of those that are enrolled RURAL AREAS Our Lady of Mercy Outreach Center In August of 2011, Roper St. Francis began providing the Pre-natal Clinic at the Wellness House, as part of our on-going relationship with Our Lady of Mercy Outreach Center (OLM). We have partnered with OLM since 1999, providing women access to top quality healthcare including ultrasounds, labs, cultures and vaccines. In fact, last year we helped provide 985 services. Barrier Island Free Medical Clinic Hundreds of uninsured people were able to receive free medical care, thanks to numerous volunteer physicians and staff. Retired Roper St. Francis physician, Dr. Jim Hayes, is the chairman of the Barrier Island Board of Directors and our system has long been a partner of the clinic, helping them to obtain their seed money with a $269,000 grant from the Duke Endowment Foundation. In 2011, we provided well over 4,000 free lab and imaging tests in areas such as vascular, sleep lab, neuro diagnostics and many more. AccessHealth Tri-County Network "I think one of the best examples of community building is our leadership role in AccessHealth Tri-County Network. Having served as the Director of the local DHEC district, I have seen many attempts to get healthcare providers to come together to provide our citizens a community-wide system of care. With Roper St. Francis serving as The Duke Endowment grantee and Trident United Way serving as the coordinating agency for this program, we have made a major step forward in improving the life of our citizens." -Dr. Joe Chambers, Roper St. Francis Community Health Consultant Since initiated in 2010 with grant funding from The Duke Endowment, AccessHealth Tri-County Network (AHTN) continues to move towards its goal of providing access to a coordinated, sustainable provider network of care for low-income, uninsured residents of Berkeley, Charleston and Dorchester counties. Made up of 27 partners, AccessHealth navigates uninsured Tri-county residents into a wide range of healthcare and health-related services, from primary care medical homes to specialty care services to supportive services. Roper St. Francis continues to play a leading role in establishing the AHTN infrastructure and providing patient-centered, coordinated care for Tri-county residents who otherwise would forego medical care or end up in emergency rooms. Staff members participating across the system, from case managers to mission coordinators to doctors and operating room staff, have been essential to the success of this community-based effort. GLOBALLY Roper St. Francis Supports Medical Missions Around the World for Those Most In Need China Tanya Lott, RN-BC, MSN, professional development specialist, went to Southeast China with a team from ifMissions. During the trip, the group visited schools in remote villages in the rugged mountains of Southeast China. The team conducted health screenings and eye exams, and children were also given antiparasitics and multivitamins. A World Health Organization study found that if children exposed to parasites - such as those common in an unclean water supply - were given just one dose each of an antiparisitic and multivitamin, it could have lifespan-increasing benefits. (Dr. Philip McGaha and Dr. Taryn Stelter of Plantation Pediatrics provided the anitparasitic and dosing information.) "It was a life-changing, memorable trip," said Lott. Guatemala Kelly Walker, MSN, RNC-MNN, clinical nurse specialist, Women's Services, went to Guatemala on behalf of a national nursing organization to which she belongs. The group had partnered with Save the Children, an international group that supports community health workers in developing countries. Walker and others travelled to remote Central American villages where they saw first hand the challenges that families face in accessing care. Kenya As part of Roper St. Francis' Hands Across the Water project, employees, doctors and volunteers came together to raise more than $27,000. The healthcare system worked with MedShare, an Atlanta-based nonprofit that recovers and redistributes surplus medical supplies to hospitals in developing countries, to send the tractor trailer-sized container of medical supplies and equipment to Kenya. The 1,000 boxes of medical supplies, biomedical equipment and durable medical goods, will support Plateau Mission Hospital's capable professionals and strong leadership by enabling them to provide better healthcare to the community it serves. Scott Broome, director of oncology services, went to Atlanta to see off the shipment. A Shared Statement of Identity for Roper St. Francis Healthcare We are the people of Roper St. Francis Healthcare, continuing the mission of healing all people with compassion, faith and excellence. As provider, employer, advocate, citizen...bringing together people of diverse faiths and backgrounds... our work is an enduring sign of healthcare rooted in our belief that every person is a treasure, every life a sacred gift, every human being a unity of body, mind and spirit. We work to bring alive the vision of justice and peace. We answer the call to foster healing, act with compassion and promote wellness for all persons and communities, with special attention to our neighbors who are poor, underserved and most vulnerable. By our service, we strive to transform hurt into hope. In promoting the mission of healthcare, we commit to: - Defend Human Dignity - Attend to the Whole Person - Care for Poor and Vulnerable Persons - Promote the Common Good - Act on Behalf of Justice - Work in Solidarity and Collaboration with Each Other Carealliance Health Services 315 Calhoun Street 107 Charleston SC 29401 570831165 Healthcare SC 501(c)(3) Line 3 N/A 0 Roper Hospital Inc 315 Calhoun Street 107 Charleston SC 29401 570828733 Healthcare SC 501(c)(3) Line 3 CareAlliance Health Services 0 Bon Secours St Francis Xavier Hospital 315 Calhoun Street 107 Charleston SC 29401 571067254 Healthcare SC 501(c)(3) Line 3 CareAlliance Health Services 0 Roper St Francis Hospital - Berkeley 315 Calhoun Street 107 Charleston SC 29401 263710229 Healthcare (Future) SC 501(c)(3) Line 3 CareAlliance Health Services 0 Roper St Francis Physicians Network 125 Doughty Street 760 Charleston SC 29403 262946628 Healthcare SC 501(c)(3) Line 3 CareAlliance Health Services 0 Roper St Francis Foundation 125 Doughty Street 760 Charleston SC 29403 571068509 Supporting Org SC 501(c)(3) Line 11a, I CareAlliance Health Services 0 The Medical Society Of South Carolina 69-B Barre Street Charleston SC 29401 570288358 Supporting Org/Founding Member SC 501(c)(3) Line 11c, III-FI N/A 0 Lowcountry Surgery Center LLC (dba Roper St Francis Eye Surgery Center) 315 Calhoun Street 107 Charleston SC 29401 581693021 Ambulatory Surgery Center SC N/A CareAlliance Medical Services Organization 225 Doughty Street Charleston SC 29403 571012837 Inactive SC N/A C 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 0