2012-11-15T15:22:26-06:00 2011-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2011-01-01 570314409 SISTERS OF CHARITY PROVIDENCE HOSPITALS SIST 8038654850 2435 FOREST DRIVE COLUMBIA SC 29204 DAVID K STEWART 8038654850 2012-11-15 1 AMY BIBBY P00445891 8282542254 2011 2016-02-24 21:20:13Z GEORGE A ZARA 2435 FOREST DRIVE COLUMBIA SC 29204 312477268 0 0928 X WWW.PROVIDENCEHOSPITALS.COM X 1938 SC SUPPORT OF THE SISTERS OF CHARITY OF ST. AUGUSTINE & EXTENDED THE HEALING MINISTRY 23 20 2543 248 0 0 21505868 350644 291966251 306409229 1575080 1596262 2108028 3544875 317155227 311901010 212430 331783 0 0 111620721 126063343 0 0 0 177303468 192488108 289136619 318883234 28018608 -6982224 281224947 273632095 172523907 181003586 108701040 92628509 X OUR MISSION IS TO MEET THE HEALTH CARE NEEDS OF THE COMMUNITY BY AN EXPRESSION OF CHRISTIAN CONCERN FOR THE SICK, SUFFERING AND DYING; TO MANIFEST LOVE, TRUTH, AND JUSTICE IN HEALTH CARE; AND TO PROMOTE THE ADVANCEMENT AND APPLICATION OF NEW KNOWLEDGE ABOUT HEALTH CARE. 0 1 277750585 331783 306409229 SISTERS OF CHARITY PROVIDENCE HOSPITALS (SCPH) PROVIDES QUALITY MEDICAL CARE IN THE COLUMBIA, SOUTH CAROLINA COMMUNITY TO ALL REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. IN MEETING THIS COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, SCPH OFFERS CHARITY CARE, SUBSIDIZED CARE AND CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT RATES BELOW COST. SCPH ALSO PROVIDES COMMUNITY HEALTH EDUCATION AND SCREENINGS AND PARTICIPATES IN OTHER COMMUNITY PROGRAMS AND ACTIVITIES THAT PROMOTE GOOD HEALTH. IN MEETING ITS COMMITMENT TO THE COMMUNITY, SCPH SERVICED 12,091 INPATIENTS AND PROVIDED CARE TO 55,458 EMERGENCY ROOM PATIENTS. PLEASE SEE THE CONTINUATION OF OUR PROGRAM SERVICE ACCOMPLISHMENTS ON SCHEDULE O. 277750585 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 1 308 0 1 2543 1 0 0 0 0 0 0 0 0 0 0 X 23 20 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 SC X X DAVID K STEWART 8032565315 2435 FOREST DRIVE COLUMBIA SC 29204 J MICHAEL KAPP 1.00 X X 0 0 0 D CHRISTIAN GOODALL 1.00 X X 0 0 0 PETER M BROWN 1.00 X X 0 0 0 M STEVENSON SMITH 1.00 X X 0 0 0 MELISSA ROGERS 1.00 X X 0 0 0 JOAN ASSEY 1.00 X 0 0 0 PETER M BRISTOW 1.00 X 0 0 0 JILL R DAVIS 1.00 X 0 0 0 SISTER MARIAN DURKIN 1.00 X 0 0 0 SISTER MIRIAM ERB 1.00 X 0 0 0 JOHN W FOLSOM 1.00 X 0 0 0 S STANLEY JUK 1.00 X 0 0 0 SISTER JUDITH ANN KARAM 1.00 X 0 0 0 MONSIGNOR LEIGH LEHOCKY 1.00 X 0 0 0 MARY ANN PARSONS 1.00 X 0 0 0 JOHN STOVER 1.00 X 0 0 0 THOMAS E SUGGS 1.00 X 0 0 0 RACHEL VIDAL MD 1.00 X 208971 0 11384 JESSE WASHINGTON 1.00 X 0 0 0 ANDREW W WEISINGER MD 1.00 X 0 0 0 DENNIS WILSON MD 1.00 X 0 0 0 KEN BEASLEY 40.00 X 128886 0 3532 FRAMPTON HENDERSON MC 1.00 X 0 0 0 GEORGE A ZARA 40.00 X 0 551114 34046 DAVID K STEWART 40.00 X 292597 0 17199 CAROLYN CATTON 40.00 X 278155 0 21153 RICHARD GROOMS 40.00 X 205860 0 23982 JOHN KESSLER 40.00 X 213746 0 24113 W RYAN HALL 40.00 X 173912 0 17003 PAMELA WILLIAMS 40.00 X 132447 0 6711 CINDY BLAKENEY 40.00 X 116962 0 3374 JOAN BUMPUS 40.00 X 72900 0 4374 WAYNE SRIBNICK MD 40.00 X 279896 0 38500 KEN OWENS 40.00 X 122716 0 15260 DAVID B FULTON 40.00 X 1249906 0 0 WILLIAM T FELMY 40.00 X 1098671 0 0 BRADLEY P PRESNAL 40.00 X 1003169 0 0 SILAS W HOLMES 40.00 X 996482 0 0 EARL B MCFADDEN JR 40.00 X 942768 0 0 7518044 551114 220631 130 0 1 0 CAROLINA CARE 215 RED BAY ROAD ELGIN SC 29045 ED MANAGEMENT 6546998 UNIDINE CORPORATION 75 REMITTANCE DRIVE CHICAGO IL 060756529 DIETARY SERVICES 1972317 NEXSEN PRUET JACOBS & POLLARD PO BOX 2426 COLUMBIA SC 29202 LEGAL FEES 1292105 CRITICAL HEALTH SYSTEMS OF SC 1410 BLANDING ST COLUMBIA SC 29201 MEDICAL SERVICES 1143213 TRANSCENT SERVICES INC PO BOX 740209 ATLANTA GA 30374 TRANSCRIPTION SERVICES 990779 54 17000 203911 129733 350644 NET PATIENT REVENUE 900099 306409229 306409229 306409229 1596262 1596262 621811 576258 45553 45553 45553 REIMBURSEMENTS 900099 1813500 1813500 FOOD SERVICES 722210 967454 967454 OTHER REVENUES 900099 718368 718368 3499322 311901010 306409229 0 5141137 331783 331783 2043986 2043986 53843 53843 101766512 93776828 7989684 3203970 2894455 309515 12017976 10856996 1160980 6977056 6303047 674009 4989409 4989409 1406376 1406376 108195 108195 34039551 28355544 5684007 2283324 1920638 362686 31644910 15633826 16011084 778942 778942 7206934 7206934 362907 362907 64306 64306 4334505 4334505 15926411 15926411 2181165 1788447 392718 MEDICAL SUPPLIES 53907995 53907995 BAD DEBT EXPENSE 32381494 32381494 RECRUITMENT 823189 823189 MISCELLANEOUS 48495 48495 318883234 277750585 41132649 0 28984172 16024128 30392113 36321839 4485839 4198051 4646722 3024628 379903178 243860087 128535299 136043091 80099319 71752837 233024 233024 2719497 3307179 1128962 2727318 281224947 273632095 20985448 25103030 122085000 119020000 29453459 36880556 172523907 181003586 X 105558165 89429219 3142875 3199290 108701040 92628509 281224947 273632095 X -6982224 -9090307 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 15387 15387 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: SISTERS OF CHARITY PROVIDENCE HOSPITALS IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND THE SOUTH CAROLINA HOSPITAL ASSOCIATION. EACH YEAR, THESE ORGANIZATIONS ENGAGE IN LOBBYING ACTIVITIES ON BEHALF OF THEIR MEMBERSHIP BODIES, AND A PORTION OF DUES PAID TO THE ASSOCIATIONS IS ALLOCATED TO THOSE EXPENDITURES. FOR 2011, APPROXIMATELY $15,387 IS ALLOCABLE TO LOBBYING EXPENDITURES. 10350784 10350784 158849678 86886878 71962800 9874703 9056309 818394 194044903 147916900 46128003 6783110 6783110 136043091 INTEREST RATE SWAP INSTRUMENTS 20101993 PATIENT REFUNDS 146021 ESTIMATED THIRD PARTY SETTLEMENTS 1364036 PAYABLE TO SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM 11487466 OTHER LONG TERM LIABILITIES 3781040 36880556 311901010 318883234 -6982224 554941 -9645248 -9090307 -16072531 271005467 554941 -9645248 -9090307 280095774 31805236 31805236 311901010 287077998 -31805236 -31805236 318883234 0 318883234 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER 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 ORGANIZATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2011. FISCAL YEARS ENDING ON OR AFTER DECEMBER 31, 2008 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: UNREALIZED LOSS ON FAIR VALUE OF INTEREST RATE SWAP -8,106,804. LOSS ON DISCONTINUED OPERATIONS -1,538,444. TOTAL TO SCHEDULE D, PART XI, LINE 8: -9,645,248. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED LOSS ON FAIR VALUE OF INTEREST RATE SWAP -8,106,804. LOSS ON DISCONTINUED OPERATIONS -1,538,444. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET WITH REVENUES 32,381,494. DIRECT RENTAL EXPENSES -576,258. PART XIII, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NET WITH REVENUES -32,381,494. DIRECT RENTAL EXPENSES 576,258. 1 1 X 1 X 1 X 1 1 0 1 1 10007100 1546850 8460250 0.02950 19044900 18556400 488500 0.00170 29052000 20103250 8948750 0.03120 756900 30120 726780 0.00250 762300 202820 559480 0.00200 263900 263900 0.00090 1783100 232940 1550160 0.00540 30835100 20336190 10498910 0.03660 0 32381494 7268091 87493128 93569731 -6076603 X 1 0 2 1 PROVIDENCE HOSPITAL

2435 FOREST DRIVE COLUMBIA SC 29204

X X X X 2 PROVIDENCE HOSPITAL NORTHEAST

120 GATEWAY CORPORATE BOULEVARD COLUMBIA SC 29203

X X X X PROVIDENCE HOSPITAL 1 1 1 200.000000000000 1 250.000000000000 1 X X 1 1 X X X X 1 0 1 X 0 0 PROVIDENCE HOSPITAL NORTHEAST 2 1 1 200.000000000000 1 250.000000000000 1 X X 1 1 X X X X 1 0 1 X 0 0 3 AUGUSTINE HEALTH GROUP LLC

2435 FOREST DRIVE COLUMBIA SC 29204

OB/GYN, FAMILY CARE, INTERNAL MED. MOORE CLINIC

2435 FOREST DRIVE COLUMBIA SC 29204

ORTHOPEDIC CLINIC PROVIDENCE PULMONARY SPECIALISTS

2435 FOREST DRIVE COLUMBIA SC 29204

RESPIRATORY, INT. MED., CRITICAL CARE PART I, L7 COL(F): THE AMOUNT OF TOTAL EXPENSE ON FORM 990, PART XI, LINE 25 INCLUDES AN AMOUNT FOR BAD DEBT EXPENSE OF $32,381,494 THAT HAS BEEN REMOVED FOR THE CALCULATION OF COMMUNITY BENEFIT FOR PART I, LINE 7, COLUMN (F). PART III, LINE 4: BECAUSE THE PROVISION FOR BAD DEBTS WAS DISCLOSED SEPARATELY AS AN EXPENSE ON THE INCOME STATEMENT, NO FOOTNOTE WAS PREPARED TO DESCRIBE BAD DEBT. AN ACCOUNT WILL BE CLASSIFIED AS BAD DEBT WHEN IT IS PLACED WITH A COLLECTION AGENCY. ACCOUNTS CLASSIFIED AS "PATIENT RESPONSIBILITY" WILL BEGIN CURRENT PATIENT RESPONSIBILITY CUSTOMER SERVICE AND COLLECTION AT FINAL BILL (REGISTERED) OR AT TIME OF FINAL INSURANCE PAYMENT (RESIDUAL). BETWEEN 120-150 DAYS FOLLOWING ORIGINAL COLLECTION EFFORTS, PAYMENT ARRANGEMENTS ARE DOCUMENTED AND THE ACCOUNT IS PLACED WITH A COLLECTION AGENCY AND DEEMED AS BAD DEBT. ACCOUNTS RETURNING FROM THE 3RD-PARTY COLLECTION AGENCY WILL BE CONSIDERED WORTHLESS AND COLLECTION EFFORTS WILL CEASE. THE ACCOUNT WILL BE ADJUSTED OFF TO ZERO. PART III, LINE 8: SCPH PROVIDES QUALITY MEDICAL CARE REGARDLESS OF ABILITY TO PAY. IN MEETING THIS COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, SCPH OFFERS CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT RATES BELOW COST. THE NUMBERS REPORTED IN SECTION B, MEDICARE, REFLECT THE REIMBURSEMENT RECEIVED BY THE HOSPITAL AND THE COSTS UTILIZED TO PROVIDE THOSE SERVICES. BASED ON THE MISSION OF SCPH, THE ENTIRE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. PART VI, LINE 2: A COMMUNITY NEEDS ASSESSMENT WAS COMPLETED BY THE UNITED WAY OF THE MIDLANDS IN PARTNERSHIP WITH THE SISTERS OF CHARITY FOUNDATION OF SOUTH CAROLINA. THE FOUNDATION, A MINISTRY OF THE SISTERS OF CHARITY HEALTH SYSTEM, STRIVES TO IMPACT THE LIVES OF THE POOR AND BE A VOICE FOR THE UNDERSERVED IN ALL 46 SOUTH CAROLINA COUNTIES. THIS COLLABORATIVE ASSESSMENT REVEALED ONE OF THE HIGHEST CONCERNS OF RESIDENTS IN THE MIDLANDS IS THAT OF ACCESS TO AFFORDABLE HEALTH CARE. SCPH IS LOCATED WITHIN RICHLAND COUNTY WHICH HAS AN UNINSURED RATE IN EXCESS OF 16%. STUDIES HAVE SHOWN EMERGENCY ROOM CARE IS THE CHOICE FOR THOSE WHO DO NOT HAVE HEALTH CARE OR CANT AFFORD CARE. PART OF THE MISSION OF THE HOSPITAL IS TO PROVIDE QUALITY MEDICAL CARE TO ALL REGARDLESS ABILITY TO PAY. SCPH ALSO RELIES ON THE HEALTHY PEOPLE INITIATIVE, MANAGED BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, TO DEVELOP PROGRAMS TO IMPROVE HEALTH. COMMUNITY DEMOGRAPHICS ALSO PLAY A PART IN DETERMINING WHICH OUTREACH SERVICES TO OFFER. THE GOAL OF OUR OUTREACH SERVICES IS TO PROMOTE A HEALTHIER LIFESTYLE WITHIN OUR IMMEDIATE AND SURROUNDING COMMUNITIES. WE ARE TEACHING THE COMMUNITY TO FIGHT OBESITY, DIABETES, HEART DISEASE AND STROKE BY SIMPLE LIFESTYLE CHANGES. PART VI, LINE 3: AS PART OF ITS MISSION, THE HOSPITAL MAKES ITS CHARITY CARE APPLICATIONS AVAILABLE TO ANYONE WHO REQUESTS THEM. THE HOSPITAL ALSO POSTS NOTICES AS REQUIRED BY LAW REGARDING THE AVAILABILITY OF CHARITY CARE. PATIENTS RECEIVING INPATIENT CARE OR EMERGENT MEDICAL CARE RECEIVE PRIORITY CONSIDERATION FOR CHARITY CARE. THOSE PATIENTS THOUGHT TO REQUIRE SUCH CARE ARE REFERRED FOR FINANCIAL COUNSELING. THE HOSPITAL COMPLETES A SERIES OF DUE DILIGENCE STEPS WHICH INCLUDE VERIFICATION OF ALL FINANCIAL RESOURCES AVAILABLE TO THE PATIENT, INCLUDING PRIVATE HEALTH INSURANCE, PUBLIC ASSISTANCE, MEDICARE AND MEDICAID, AND LEGAL SETTLEMENTS. ONCE IT HAS BEEN PROVED THAT THE PATIENT DOES NOT HAVE SUFFICIENT INCOME TO COVER THE OUTSTANDING BALANCE FOR RECEIVED MEDICAL CARE AND THE APPLICATION HAS BEEN COMPLETED AND APPROVED, THE REMAINING BALANCE IS ADJUSTED TO $0. DETERMINATION OF ELIGIBILITY FOR CHARITY CARE ALSO COVERS SUBSEQUENT EMERGENT AND NON-ELECTIVE SERVICES FOR A PERIOD OF SIX (6) MONTHS. PART VI, LINE 4: SISTERS OF CHARITY PROVIDENCE HOSPITALS (SCPH) PROVIDES QUALITY MEDICAL CARE IN THE COLUMBIA, SOUTH CAROLINA COMMUNITY TO ALL REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. IN MEETING THIS COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, SCPH OFFERS CHARITY CARE, SUBSIDIZED CARE, AND CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT RATES BELOW COST. SCPH ALSO PROVIDES COMMUNITY HEALTH EDUCATION AND SCREENINGS AND PARTICIPATES IN OTHER COMMUNITY PROGRAMS AND ACTIVITIES THAT PROMOTE GOOD HEALTH. IN MEETING ITS COMMITMENT TO THE COMMUNITY, SCPH SERVICED 12,091 INPATIENTS AND PROVIDED CARE TO 55,458 EMERGENCY ROOM PATIENTS. PART VI, LINE 5: SISTERS OF CHARITY PROVIDENCE HOSPITALS (SCPH) PROVIDES QUALITY MEDICAL CARE IN THE COLUMBIA, SOUTH CAROLINA COMMUNITY TO ALL REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. IN MEETING THIS COMMITMENT TO SERVE ALL MEMBERS OF THE COMMUNITY, SCPH OFFERS CHARITY CARE, SUBSIDIZED CARE, AND CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT RATES BELOW COST. SCPH ALSO PROVIDES COMMUNITY HEALTH EDUCATION AND SCREENINGS AND PARTICIPATES IN OTHER COMMUNITY PROGRAMS AND ACTIVITIES THAT PROMOTE GOOD HEALTH. IN MEETING ITS COMMITMENT TO THE COMMUNITY, SCPH SERVICED 12,091 INPATIENTS AND PROVIDED CARE TO 55,458 EMERGENCY ROOM PATIENTS.DURING 2011, THE COMMUNITY CONTRIBUTED APPROXIMATELY 30,993 HOURS TOWARD PROVIDING HEALTH CARE AT SCPH. THE VALUE OF THIS CONTRIBUTION IS APPROXIMATELY $232,446 WHICH IS GIVEN BACK TO THE COMMUNITY THROUGH LOWER COSTS IN PATIENT SERVICES.IN MEETING ITS COMMITMENT TO PROVIDE HEALTH CARE TO THE ENTIRE COMMUNITY, SCPH PROVIDES CARE TO PERSONS WITHOUT INSURANCE COVERAGE AND ESTABLISHES PAYMENT TERMS BASED ON ABILITY TO PAY. THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER SCPHS CHARITY CARE POLICY TOTALED APPROXIMATELY $9,984,000 IN 2011. THE CHARITY CARE DELIVERED AT COST WAS $9,891,000 AND PROVIDED COMMUNITY SERVICES OF $1,061,000.IN ADDITION TO TRADITIONAL MEDICAL SUPPLIES, SCPH PROVIDES OTHER BENEFIT PROGRAMS TO MEET COMMUNITY AND PATIENT NEEDS. SUCH PROGRAMS WERE OFFERED AT NO COST OR AT REDUCED PRICES AND INCLUDED THE FOLLOWING: SENIOR ASSISTANCE, WOUND TREATMENT SERVICES, SUPPORT GROUPS / SPECIAL PROGRAMS, HEALTH SCREENINGS, COMMUNITY EDUCATION, POISON CENTER, PASTORAL CARE SERVICES, AND WOMEN AND CHILDREN'S SERVICES.COMMUNITY OUTREACH EVENTS TOTALED 232 AND SERVED 8,724 INDIVIDUALS WITHIN THE COMMUNITY. PARTICIPANTS ARE ASKED AT THE END OF EACH EVENT WHAT OTHER OPPORTUNITIES THEY WOULD LIKE OFFERED TO THEM. FUTURE EVENTS, SCREENINGS, AND EDUCATION SESSIONS ARE PLANNED FOR THE COMMUNITY BASED ON THESE RESPONSES. SISTERS OF CHARITY PROVIDENCE HOSPITALS ALSO OFFERED HEALTH PROFESSIONS EDUCATION CLASSES. THESE OPPORTUNITIES WERE ATTENDED BY 5,773 INDIVIDUALS. THE DETAILS FOR THE EVENTS AND EDUCATION CLASSES ARE LISTED IN THE TABLE BELOW:NAME OF CLASS/EVENT # SERVED # OF EVENTS HOURS NET BENEFITHEALTH FAIRS 3,674 9 31 $ 3,560CARDIAC/OTHO/WEIGHT EDU 357 28 425 15,442NUTRITION CLASSES 438 12 1,666 53,243DIETITIAN ON DEMAND 150 123 151 7,176SPEAKING OF YOUR HEALTH 989 35 1,484 176,341 CARDIOVASCULAR SCREEN PRO 385 23 199 (7,634)SC MISSIONS 2011 2,650 1 36 127,718FLU SHOT CLINICSA 81 1 1 2,469PARISH NURSE PROGRAM - - - 73,863BERYL CALL CENTER - - - 49,707 TOTAL CMMTY. OUTREACH 8,724 232 3,993 501,885NAME OF CLASS/EVENT # SERVED # OF EVENTS HOURS NET BENEFITADV. CARDIAC LIFE SPPT. 447 36 3,576 $ -PEDIATRIC ADV. LIFE. SPPT. 128 11 1,024 -CORE INSTRUCTOR 43 24 129 -HRSA GERIATRIC GRANT 825 30 60 374,155HEARTSAVER CERTIFICATION 3,605 780 10,815 -STUDENT PROGRAMS 540 116 2,430 93,889SC FATHERS & FAMILIES 185 5 16 51,439PASO PROGRAMS & GONZALESGARDENS/BENEFIT COURT - - - 40,000TOTAL HEALTH PROF. EDUC. 5,773 1,002 18,050 559,483 PART VI, LINE 6: SCPH IS AFFILIATED WITH THE SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM (CSAHS) HEADQUARTERED IN CLEVELAND, OH. CSAHS PROVIDES OVERSIGHT TO ORGANIZATIONS LOCATED IN CANTON AND CLEVELAND, OH AND COLUMBIA, SC AND IS DEDICATED TO THE MEETING THE NEEDS OF EACH COMMUNITY IN WHICH IT SERVES. THE HOSPITALS IN OHIO FILE ANNUAL COMMUNITY BENEFITS REPORTS JUST AS SCPH DOES IN SOUTH CAROLINA. WHILE SCPH BELONGS TO THE CSAHS SYSTEM, ITS OPERATIONS AND MEETING OF COMMUNITY NEEDS ARE DIRECTED LOCALLY BY THOSE LIVING AND SERVING THE MIDLANDS COMMUNITY ON A DAILY BASIS. REPORTS FILED WITH STATES PART VI, LINE 7 SC 1 HEALTHY LEARNERS 2711 MIDDLEBURG DRIVE COLUMBIA SC 29204 571127197 501(C)(3) 53000 DONATION FREE MEDICAL CLINIC 1875 HARDEN STREET COLUMBIA SC 29204 570779279 501(C)(3) 40000 FINANCIAL SUPPORT AMERICAN HEART ASSOCIATION 520 GERVAIS STREET COLUMBIA SC 29201 135613797 501(C)(3) 6000 SPONSORSHIP GREATER COLUMBIA CHAMBER OF COMMERCE 930 RICHLAND STREET COLUMBIA SC 29202 570144900 501(C)(6) 15250 PROGRAM SPONSORSHIPS AMERICAN RED CROSS PO BOX 905890 CHARLOTTE NC 28290 501(C)(3) 5000 DONATION CAROLINA MARATHON 1214 ANTHONY AVE COLUMBIA SC 29201 570989561 501(C)(3) 16000 DONATION SC RESEARCH FOUNDATION 901 SUMTER STREET STE 501 COLUMBIA SC 29208 570967350 501(C)(3) 17500 DONATION SC STATE MUSEUM 301 GERVAIS STREET COLUMBIA SC 29201 501(C)(3) 5000 DONATION ST MARTIN DEPORRES 501(C)(3) 6750 DONATION UNITED WAY 501(C)(3) 26976 DONATION WELVISTA INC PO BOX 186 COLUMBIA SC 29202 562034627 501(C)(3) 33333 DONATION YMCA OF COLUMBIA 1420 SUMTER ST COLUMBIA SC 29201 570314423 501(C)(3) 19500 DONATION 11 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE RECIPIENT ENTITY IS GIVEN FUNDS TO BE USED AS APPROVED BY THE ORGANIZATION. GRANTS AND ASSISTANCE PAYMENTS ARE APPROVED BY OFFICERS OF THE ORGANIZATION AND ARE PROVIDED TO OTHER NONPROFIT ORGANIZATIONS WHOSE EXEMPT PURPOSES ALLIGN CLOSELY WITH THE CORE VALUES AND MISSION OF SISTERS OF CHARITY PROVIDENCE HOSPITALS. X X 1 1 X X X 0 0 0 0 0 0 0 0 0 RACHEL VIDAL MD 138461 0 70510 0 0 0 11217 0 167 0 220355 0 0 0 GEORGE A ZARA 0 511344 0 23270 0 16500 0 25128 0 8918 0 585160 0 0 DAVID K STEWART 292597 0 0 0 0 0 16500 0 699 0 309796 0 0 0 CAROLYN CATTON 278155 0 0 0 0 0 21153 0 0 0 299308 0 0 0 RICHARD GROOMS 205860 0 0 0 0 0 22745 0 1237 0 229842 0 0 0 JOHN KESSLER 213746 0 0 0 0 0 22000 0 2113 0 237859 0 0 0 W RYAN HALL 173912 0 0 0 0 0 16484 0 519 0 190915 0 0 0 WAYNE SRIBNICK MD 279896 0 0 0 0 0 38500 0 0 0 318396 0 0 0 DAVID B FULTON 957945 0 291961 0 0 0 0 0 0 0 1249906 0 0 0 WILLIAM T FELMY 789857 0 308814 0 0 0 0 0 0 0 1098671 0 0 0 BRADLEY P PRESNAL 529009 0 474160 0 0 0 0 0 0 0 1003169 0 0 0 SILAS W HOLMES 625048 0 371434 0 0 0 0 0 0 0 996482 0 0 0 EARL B MCFADDEN JR 514574 0 428194 0 0 0 0 0 0 0 942768 0 0 0 PART I, LINE 1A THE BENEFITS ABOVE WERE PROVIDED TO CERTAIN OFFICERS AND BOARD MEMBERS. THESE EXPENDITURES ARE MONITORED REGULARLY AND INCLUDED IN TAXABLE INCOME WHEN APPROPRIATE. ALL EMPLOYEE REIMBURSEMENTS FOLLOW THE ORGANIZATION'S POLICY FOR REIMBURSEMENT OF MONTHLY EXPENSES. THIS ADHERENCE INCLUDES PROPER AUTHORIZATION FROM THE EMPLOYEE'S SUPERVISOR, VP, OR CFO. AUTHORIZATION FOLLOWS THE DOLLAR LIMITS SET FORTH IN THE POLICY AND PROPER DOCUMENTATION MUST BE SUBMITTED PRIOR TO REIMBURSEMENT IN ACCORDANCE WITH IRS REGULATIONS. COLLIERS KEENAN INC JOHN W. FOLSOM, BOARD MEMBER, IS PRESIDENT/CEO OF COLLIERS KEENAN, INC 370208 INTERESTED PERSON PROVIDES LEASING, PROPERTY MANAGEMENT, CONSTRUCTION MANAGEMENT, AND CONSULTING SERVICES TO THE HOSPITAL. 0 DANIELLE RODER FAMILY MEMBER OF W. RYAN HALL, OFFICER 30509 COMPENSATION PAID AS HOSPITAL EMPLOYEE. 0 SHEREE FRAVEL FAMILY MEMBER OF W. RYAN HALL, OFFICER 23334 COMPENSATION PAID AS HOSPITAL EMPLOYEE. 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 DURING THE YEAR, THE ORGANIZATION CLOSED THE WOMEN'S HEALTH CENTER, NEWBORN NURSERY, AND THE OB/GYN UNIT LOCATED AT THE PROVIDENCE HOSPITAL NORTHEAST FACILITY. PROGRAM SERVICE STATEMENT FORM 990, PART III, LINE 4A DURING 2011, THE COMMUNITY CONTRIBUTED APPROXIMATELY 30,993 HOURS TOWARD PROVIDING HEALTH CARE AT SCPH. THE VALUE OF THIS CONTRIBUTION IS APPROXIMATELY $232,446, WHICH IS GIVEN BACK TO THE COMMUNITY THROUGH LOWER COSTS IN PATIENT SERVICES. IN MEETING ITS COMMITMENT TO PROVIDE HEALTH CARE TO THE ENTIRE COMMUNITY, SCPH PROVIDES CARE TO PERSONS WITHOUT INSURANCE COVERAGE AND ESTABLISHES PAYMENT TERMS BASED ON ABILITY TO PAY. THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER SCPH'S CHARITY CARE POLICY TOTALED APPROXIMATELY $9,984,000 IN 2011. THE CHARITY CARE DELIVERED AT COST WAS $9,891,000 AND PROVIDED COMMUNITY SERVICES OF $1,061,000. IN ADDITION TO TRADITIONAL MEDICAL SUPPLIES, SCPH PROVIDES OTHER BENEFIT PROGRAMS TO MEET COMMUNITY AND PATIENT NEEDS. SUCH PROGRAMS WERE OFFERED AT NO COST OR AT REDUCED PRICES AND INCLUDED THE FOLLOWING: SENIOR ASSISTANCE, WOUND TREATMENT SERVICES, SUPPORT GROUPS / SPECIAL PROGRAMS, HEALTH SCREENINGS, COMMUNITY EDUCATION, POISON CENTER, PASTORAL CARE SERVICES, AND WOMEN AND CHILDREN'S SERVICES. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL INCLUDE THE CHAIRPERSON, THE VICE CHAIRPERSON, AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE CORPORATION, THE SECRETARY, THE TREASURER AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE MEMBER, OR HIS/HER DESIGNEE. AT LEAST ONE MEMBER OF THE EXECUTIVE COMMITTEE SHALL BE A SISTER OF CHARITY OF ST. AUGUSTINE. WHEN THE BOARD OF TRUSTEES IS NOT IN SESSION, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE ALL OF THE AUTHORITY OF THE BOARD. ALL ACTIONS OF THE COMMITTEE SHALL BE REPORTED TO THE BOARD OF TRUSTEES NOT LATER THAN THE TIME OF ITS NEXT SUCCEEDING MEETING. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS THE SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM, AN OHIO NONPROFIT CORPORATION. PLEASE SEE ARTICLE III OF THE BYLAWS FOR DETAILS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER OF SISTERS OF CHARITY PROVIDENCE HOSPITALS MAY ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B RESERVED POWERS OF THE MEMBER OF THE ORGANIZATION INCLUDE THE POWER AND AUTHORITY TO BORROW OR LEND MONEY, THE PURCHASE AND SALE OF CERTAIN PROPERTY, THE AMENDMENT OF THE ARTICLES OF INCORPORATION, THE ELECTION OF TRUSTEES, AND THE DETERMINATION OF CORPORATE MISSION AND PHILOSOPHY. FORM 990, PART VI, SECTION B, LINE 11 SISTERS OF CHARITY PROVIDENCE HOSPITALS WILL SEND COPIES OF THE FORM 990 VIA FEDEX TO THE PERSONAL RESIDENCE OF EACH MEMBER OF THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES. THE ORGANIZATION WILL ALLOW EACH MEMBER AMPLE TIME TO REVIEW THE FORM 990 AS IT STANDS, AND WILL ALLOW EACH MEMBER AN OPPORTUNITY TO MAKE INQUIRIES REGARDING THE FORM 990. DURING THIS TIME, THE EXECUTIVE COMMITTEE WILL THOROUGHLY REVIEW THE FORM 990. AT THE BOARD MEETING FOLLOWING THE PROCESS, THERE WILL BE A QUESTION AND ANSWER SESSION REGARDING THE FORM 990. THIS WILL OCCUR AT THE LAST BOARD MEETING BEFORE THE FORM 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C PROVIDENCE HOSPITALS REQUIRES ITS DIRECTORS, CLINICAL MANAGERS, AND SELECTED PERSONNEL WHO HAVE SIGNIFICANT CONTACT WITH VENDORS AND CONTRACTORS TO ATTEST ANNUALLY THAT NEITHER HE/SHE, NOR ANY MEMBER OF HIS/HER IMMEDIATE FAMILY, HAVE A CONFLICT OF INTEREST WITH THE HOSPITAL. MEMBERS OF THE BOARD OF TRUSTEES, PRESIDENT & CEO, VICE PRESIDENTS AND ASSISTANT VICE PRESIDENTS SIGN A SEPARATE, MORE DETAILED CONFLICT OF INTEREST STATEMENT. THE BOARD OF TRUSTEES OF PROVIDENCE HOSPITALS REQUIRES EACH MEMBER OF THE BOARD AND CORPORATE STAFF TO REVIEW THE HOSPITAL'S CONFLICT OF INTEREST POLICY AND TO DISCLOSE ALL INTERESTS THAT COULD RESULT IN A CONFLICT, ON AN ANNUAL BASIS. ALL DISCLOSURES ARE REPORTED TO THE AUDIT & CORPORATE RESPONSIBILITY COMMITTEE OF THE BOARD FOR REVIEW AND FOLLOW-UP, IF DETERMINED TO BE NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. SPECIFICALLY, SECTION 2. ARTICLE IX: ADMINISTRATIVE OFFICERS OF THE AMENDED AND RESTATED BYLAWS OF SISTERS OF CHARITY PROVIDENCE HOSPITALS (PAGE 9) STATES: AN EVALUATION OF THE PERFORMANCE OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER SHALL BE CONDUCTED ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES. THE EXECUTIVE COMMITTEE SHALL REPORT ITS EVALUATION TO THE BOARD OF TRUSTEES AND TO THE MEMBER. THE EXECUTIVE/COMPENSATION COMMITTEE IS CHAIRED BY THE CHAIR OF THE BOARD OF TRUSTEES. IT CONTAINS SIX OTHER BOARD MEMBERS. ALL COMPENSATION ISSUES ARE REVIEWED BY THIS COMMITTEE. (FOR EXAMPLE, A MEETING OF THE EXECUTIVE/COMPENSATION COMMITTEE WAS HELD ON MARCH 31, 2009 TO REVIEW AND APPROVE MARKET RATE SALARY ADJUSTMENTS. A NATIONAL HUMAN RESOURCES CONSULTING FIRM WAS ENGAGED TO COMPLETE A MARKET ANALYSIS OF PROVIDENCE HOSPITALS' TOTAL COMPENSATION AND BENEFITS PROGRAM. ADDITIONAL INFORMATION, RESEARCH AND ANALYSIS WERE PROVIDED TO PROVIDENCE BY A REPRESENTATIVE OF THE SISTERS OF CHARITY HEALTH SYSTEM). FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION PROVIDES COPIES OF ITS FORM 990 AND RELATED SCHEDULES 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 MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC IN ITS OFFICE AND UPON REQUEST. ALL POLICIES ARE AVAILABLE TO ORGANIZATION EMPLOYEES VIA THE LOCAL INTRANET. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 554,941. UNREALIZED LOSS ON FAIR VALUE OF INTEREST RATE SWAP -8,106,804. LOSS ON DISCONTINUED OPERATIONS -1,538,444. TOTAL TO FORM 990, PART XI, LINE 5: -9,090,307. PRINCIPLES OF CONSOLIDATION FOR FINANCIAL STATEMENTS: FORM 990, PART XII, LINE 2D: THE ORGANIZATION CONSOLIDATES ITS AUDITED FINANCIAL STATEMENTS WITH ITS WHOLLY-OWNED SUBSIDIARIES; HOWEVER, DURING THE CURRENT TAX YEAR, ALL SUBSIDIARIES WERE ENTITIES DISREGARDED FOR TAX PURPOSES. FOR THIS REASON, AUDITED FINANCIAL STATMENTS ARE CONSIDERED TO BE SEPARATELY PRESENTED FOR PURPOSES OF THE FORM 990. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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