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 566052117 THE REX HEALTHCARE FOUNDATION INC REXH 9197844424 4420 LAKE BOONE TRAIL RALEIGH NC 27607 BERNADETTE SPONG 9197843100 2012-05-15 1 GREGORY W JOHNS 7049985200 2010 2016-02-24 21:20:13Z DAVID STRONG 4420 LAKE BOONE TRAIL RALEIGH NC 27607 6096412 0 X WWW.REXHEALTH.COM/FOUNDATION X 1958 NC TO PROVIDE OPPORTUNITIES FOR OUR COMMUNITY TO INVEST RESOURCES IN THE EXCELLENT WORK OF REX HEALTHCARE. 13 10 0 0 0 0 1617600 1243136 0 0 59981 319099 449965 661108 2127546 2223343 1130581 1225046 0 0 723710 606149 37405 34683 750641 409214 231125 2300910 2097003 -173364 126340 4516342 5166927 101004 159429 4415338 5007498 TO PROVIDE OPPORTUNITIES FOR OUR COMMUNITY TO INVEST RESOURCES IN THE EXCELLENT WORK OF REX HEALTHCARE. 0 0 1225046 1225046 1243136 SUPPORT, BY FINANCIAL ASSISTANCE, THE EXCELLENT WORK OF REX HEALTHCARE, INC. 1225046 1 1 0 0 0 0 0 0 1 1 0 1 0 0 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 12 0 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 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 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 0 662552 196256 ORAGE QUARLES III 2.00 X 0 0 0 WILLIAM 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 0 724732 203123 BERNADETTE SPONG 40.00 X 0 343226 41217 SYLVIA HACKETT 40.00 X 0 229070 53043 ROBERT B LIVERMAN JR 40.00 X 0 148063 26122 0 2836452 674940 0 0 1 0 0 671042 572094 1243136 116460 116460 3698812 3496173 202639 202639 202639 1038004 376896 661108 661108 2223343 0 0 980207 1225046 1225046 510486 51049 459437 13020 1302 11718 48487 4849 43638 34156 3415 30741 8568 8568 34683 34683 33197 33197 63067 6307 56760 3601 360 3241 51722 5172 46550 44702 4470 40232 10329 1033 9296 1524 152 1372 14415 1442 12973 2097003 1225046 121316 750641 663697 608744 184195 128930 1000 14595 15226 9405 7346 5821 0 0 0 0 3660104 4408837 4516342 5166927 101004 159429 101004 159429 X 4415338 5007498 4415338 5007498 4516342 5166927 X 126340 465820 X X 0 1 1 X 0 X X X 0 0 0 REX HOSPITAL INC 561509260 3 1 1 1 1225046 1 1225046 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 330250 1790 332040 1.00000 0 0 0 0 15226 9405 5821 0 5821 INVESTMENTS 4408837 F 4408837 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO FURTHER THE MISSION OF REX HEALTHCARE FOUNDATION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: REX HEALTHCARE FOUNDATION, 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. X X X X X X 1 WITZLEBEN ASSOCIATES 610 WEST MAIN STREET LOFT 207 DURHAM NC 27701 CONSULTING 0 0 0 0 NC GOLF TOURNAMENT 587509 587509 175801 GALA 235953 235953 140594 4 214542 214542 60501 1038004 1038004 376896 376896 661108 EXPLANATION OF FUNDRAISING PAYMENTS SCHEDULE G, PART I, LINE 2B, COLUMN (V) PAID FOR CONSULTING 0 REX HOSPITAL INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509260 501(C)(3) 1225046 GENERAL SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: REX HEALTHCARE FOUNDATION'S SOLE RECIPIENT OF ASSISTANCE IS REX HOSPITAL, INC. THE TWO ORGANIZATIONS WORK CLOSELY TOGETHER, SO THEREFORE MONITORING IS REAL-TIME AND CONSISTENT. 1 1 0 0 0 0 0 0 0 GARY L PARK 0 655141 0 0 0 7411 0 188994 0 7262 0 858808 0 0 WILLIAM ROPER MD 0 715759 0 0 0 13050 0 150417 0 4762 0 883988 0 0 DAVID STRONG 0 425759 0 121765 0 177208 0 188617 0 14506 0 927855 0 151304 BERNADETTE SPONG 0 260143 0 69962 0 13121 0 27911 0 13306 0 384443 0 0 SYLVIA HACKETT 0 174735 0 48734 0 5601 0 44430 0 8613 0 282113 0 0 ROBERT B LIVERMAN JR 0 126245 0 12965 0 8853 0 21263 0 4859 0 174185 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 MEMBERSHIPS IS TREATED AS TAXABLE COMPENSATION AND IS REPORTED ON THE INDIVIDUALS W-2. PART I, LINES 4A-B PART I, LINE 4A, DURING CALENDAR YEAR 2010, EMILY BARBOUR RECEIVED SEVERANCE PAYMENTS TOTALING $115,444, WHICH IS REPORTED IN PART II, LINE 7, COLUMN B(III). PART I, LINE 4B, DURING CALENDAR YEAR 2010, DAVID STRONG PARTICIPATED IN A NON QUALIFIED SUPPLEMENTAL RETIREMENT PLAN AND RECEIVED PAYMENTS TOTALING $154,568, WHICH IS REPORTED IN PART II, LINE 3, COLUMN B(III). HE ALSO EARNED COMPENSATION UNDER THIS PLAN TOTALING $166,853, WHICH IS REPORTED IN PART II, LINE 3, COLUMN C. THE CURRENT YEAR EARNINGS ARE PAYABLE IN THE FUTURE. PART I, LINE 5 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 PERFORMANCE MEASURES USED TO DETERMINE INCENTIVE COMPENSATION ARE PHYSICIAN SATISFACTION, PATIENT CARE QUALITY OUTCOMES, EFFECTIVE USE OF TECHNOLOGY AND INDIVIDUAL GOALS. 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: CHANGE IN UNRESTRICTED FUNDS 465,820. TOTAL TO FORM 990, PART XI, LINE 5: 465,820. 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. 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) LINE 11A, I UNC 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 HOSPITAL INC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 561509260 HOSPITAL NC 501(C)(3) LINE 3 REX HEALTHCARE 0 REX SURGERY CENTER OF CARY LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 273684056 ASC NC REX HOSPITAL INC RELATED 0 0 0.00000 JRH VENTURES LLC 4420 LAKE BOONE TRAIL RALEIGH NC 27607 274092967 MED CAMPUS DVLT NC REX HOSPITAL INC RELATED 0 0 0.00000 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 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 REX HOSPITAL INC B 1225046 FMV REX HOSPITAL INC J 44702 FMV REX HOSPITAL INC O 606509 FMV