2011-05-11T07:11:14-05:00 2010-09-30 LarsonAllen LLP 101 N Tryon Street Suite 1000 Charlotte NC 28246 990 2009-10-01 566011594 Duplin General Hospital Inc DUPL 9102960941 401 NORTH MAIN STREET kenansville NC 28349 susan davis 9102960941 2011-05-10 1 7049985200 2009 2016-02-24 21:20:13Z susan davis 401 NORTH MAIN STREET kenansville NC 28349 32416354 0 X www.uhseast.com/duplin X 1955 NC To enhance the quality of life for the people and communities we serve, touch and support. 10 10 493 13 0 0 521203 316689 29756597 31843976 116520 83760 515706 171929 30910026 32416354 18750 0 0 21181598 21244840 0 0 11132554 11697661 32332902 32942501 -1422876 -526147 27945402 25022132 6883391 6339869 21062011 18682263 To enhance the quality of life for the people and communities we serve, touch and support. 0 0 27597720 31843976 hospital servicesThe organization provides the best possible comprehensive primary and secondary care, including inpatient, outpatient, and emergency care with referral of very specialized secondary and tertiary care to other health care providers. During fiscal year 2010, the organization admitted 3,765 patients for a total of 15,663 inpatient days of care, including newborn nursery days and admissions. The organization provided care for 51,487 outpatient vists, including emergency department visits. The organization provides a significant amount of charity care to members of the surrounding community and expects to continue and to improve its charity program in the coming years. 27597720 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 14 0 493 1 0 0 0 0 0 0 0 0 0 10 10 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NC Lucinda Maready 9102960941 401 NORTH MAIN STREET kenansville NC 28349 X Willie Gillespie 1.00 X 0 0 0 James A Jackson 1.00 X 0 0 0 Glenn Jernigan 1.00 X 0 0 0 C Daniel Pate Jr MD 1.00 X 0 0 0 Murray Roberts 1.00 X 0 0 0 Kenneth L Smith 1.00 X 0 0 0 Franklin Williams 1.00 X 0 0 0 EARL BRINKLEY 1.00 X 0 0 0 thomasine kennedy 1.00 X 0 0 0 wendy murphy 1.00 X 0 0 0 harvey case 40.00 X 0 217956 81747 rebecca ross 40.00 X 0 133363 50655 lucinda maready 40.00 X 0 123387 46884 TAMMI ROOS 40.00 X 330374 0 0 CLARENCE H WAGONER 40.00 X 184312 0 0 TERRENCE KRISS 40.00 X 176444 0 0 ABAYOMI ADEDIRAN 40.00 X 163756 0 0 854886 474706 179286 4 0 1 0 CARDINAL HEALTH GREENSBORO PO BOX 402603 ATLANTA GA 303842603 PHARMACY SUPPLIES 993454 university health systems of eastern car 2100 Stantonsburg Road greenville NC 27835 management services 908552 ALLIANCE HEALTHCARE SERVICES PO BOX 96485 CHICAGO IL 606936485 IMAGING SERVICES 696690 HORIZON MENTAL HEALTH MANAGEMENT PO BOX 840839 DALLAS TX 752840839 MANAGEMENT INPATIENT PSYCHIATRIC SERVICE 681320 WELLS FARGO INSURANCE SERVICES PO BOX 535106 ATLANTA GA 303535106 INSURANCE SERVICES 604645 5 133655 183034 316689 net patient revenue 621400 31725582 31725582 118394 118394 31843976 83760 83760 171929 171929 171929 171929 32416354 31843976 0 255689 17113065 15602072 1510993 607833 547050 60783 2476188 2228570 247618 1047754 942979 104775 166051 166051 107110 107110 2825510 1807376 1018134 88044 27637 60407 234396 7939 226457 4500 4500 609780 609780 110058 74442 35616 1391763 1391763 718452 718452 Program Supplies 3578390 3578390 Program Leases 537496 537496 Collection and Billing 230465 230465 1095646 237726 857920 32942501 27597720 5344781 0 1675 5621267 4602036 4470507 4309311 689824 736939 242800 285358 30729865 20193007 10877437 10536858 6041892 4551630 27945402 25022132 4041424 4051405 1550532 70649 1291435 2217815 6883391 6339869 X 21062011 18682263 21062011 18682263 27945402 25022132 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28302 28302 15229945 8270352 6959593 15471618 11922655 3548963 10536858 other assets 106566 Other Receivables 234562 Prepaid pension liability 3906215 restricted assets 70649 Investment in JV 233638 4551630 Third-Party Settlements 2217815 2217815 1 1 1 X 1 X 1 1 0 1 1 436570 436570 0.01330 24571 24571 0.00070 106890 106890 0.00320 568031 568031 0.01720 568031 568031 0.01720 1 1612 1612 0.00000 2 12 865 865 0.00000 1 74 10019 10019 0.00030 4 86 12496 12496 0.00030 14643024 618940 32103122 28272102 3831020 X 1 1 university health systems of eastern carolina inc management company dgh-ech partnership llc physician practice 0.50000 duplin general hospital inc

401 north main street kenansville NC 28349

X Part I, Line 3c: To be eligible for the charity care adjustment, a patient's income must not exceed 200% of the most current Poverty Income Guidelines issued by the Department of Health and Human Services. If income is greater that 120% of the poverty income guidelines not to exceed 200%, then the patient may be eligible for an adjustment based on a sliding scale (see Table 1 and Table 11), which are updated annually. If a household has a net worth (assets minus liabilities) of $25,000 or more, they are ineligible for charity care. Part I, Line 6a: Separate report and also included in UHS's report. Part I, Line 7: Actual Cost Part I, Line 7g: None Part III, Line 9b: An account balance remaining after a patient has exhausted all efforts to obtain coverage from other programs will be eligible for charity care; however, a patient must make a good faith effort to obtain coverage from available public assistance programs (i.e., Medicaid, Vocational Rehabilitation, etc.), and provide documentation of application denial, and the reason for denial. A patient who refuses to apply or follow through with applications for other assistance will not be eligible for charity care. Part VI, Line 2: The hospital assesses the health care needs of the communities it serves by utilizing the Community Needs Assessment obtained by the Duplin County Health Department. The Community Services Coordinator also attends meetings of the Duplin Partners for Health, the Duplin Partnership for Children, the Health Advisory Committee at the Board of Education (D.A.I.S.Y), and the National Children's Study advisory board meetings. Information sharing occurs at these meetings which helps the hospital prioritize initiatives and participate in projects to meet the needs of community members. By being involved with other committees in the community, joint efforts can be made to help improved the health of our citizens. Frequently, support for grants are obtained from coordinating facilities so that additional resources are obtained for our citizens. Part VI, Line 3: Health screenings and educational programs are provided to help educate the community on prevention of chronic diseases and management of acute diseases. Part VI, Line 4: Duplin County is the 9th largest county in the state in land area, 819 square miles. The 2000 population was 49,063. There are 10 incorporated towns in the county: Calypso, Faison, Warsaw, Kenansville, Magnolia, Rose Hill, Teachey, Wallace, Greenevers and Beulaville. The county is served by Interstate 40, U.S. Highway 117, NC Highways 11, 24, 50, 403 and 903. Rail service is available through CSX Rail service and the Duplin County Airport provides a 6,001-foot paved, lighted runway. Part VI, Line 5: Community outreach education program; community screenings by employee health nurse. Part VI, Line 7: As of 9/30/10 affiliated with UHS. UHS assists DGH in community outreach & promotions. NC X 0 0 0 0 0 1 0 0 0 harvey case 0 188662 0 26246 0 3048 0 76132 0 5615 0 299703 0 0 rebecca ross 0 122947 0 8444 0 1972 0 46049 0 4606 0 184018 0 0 lucinda maready 0 116697 0 6690 0 0 0 43576 0 3308 0 170271 0 0 TAMMI ROOS 330374 0 0 0 0 0 0 0 0 0 330374 0 0 0 CLARENCE H WAGONER 184312 0 0 0 0 0 0 0 0 0 184312 0 0 0 TERRENCE KRISS 176444 0 0 0 0 0 0 0 0 0 176444 0 0 0 ABAYOMI ADEDIRAN 163756 0 0 0 0 0 0 0 0 0 163756 0 0 0 Part I, Line 6 bonuses were awarded contingent upon the hospital's net income. Form 990, Part VI, Section A, line 2 Earl Brinkley, board member, and C. Daniel Pate, Jr., board member, have a family relationship. Form 990, Part VI, Section A, line 3 Effective January 1, 2007, the Hospital and University Health Systems of Eastern Carolina, INc. ("UHS") entered into a management service agreement for a period of five years. Under this agreement, UHS provides the Hospital the servies of certain key management personnel, including the Hospital Administrator, Chief Financial Officer, Chief nursing officer, and such other high level management personnel as the hospital and UHS may agree to in writing. UHS will be reimbursed for its direct expenses, including the salaries and benefits of the key employees. under the terms of the agreement, uhs has a responsibility to effectively manage the operations of the hospital in conjunction with the hospital's senior management under the overall direction and control of the hospital's board of directors. Form 990, Part VI, Section B, line 11 A copy of the draft is emailed to all board members. The CFO reviews the return prior to filing. Form 990, Part VI, Section B, line 12c The conflict of interest policy is reviewed in depth with all new employees upon their date of hire. Additionally, the policy is reviewed in departmental meetings, as appropriately on a regular and consistent basis throughout the year. Form 990, Part VI, Section B, line 15 Compensation of top management and key employees are determined through a comparison of salaries in the industry. This process was last performed in 2008. Form 990, Part VI, Section C, line 18 The organization does not make these documents available to the public. Form 990, Part VI, Section C, line 19 The organization does not make these documents available to the public. Form 990, part xi, line 2c: This process has not changed from the prior year. duplin general hospital foundation inc 401 north main street kenansville NC 28349 561380174 fundraising NC 501(c)(3) 170(b)(1)(A)(vi) N/A university health systems of eastern carolina inc 2100 Stantonsburg Road Greenville NC 27835 562141073 healthcare NC 501(c)(3) 509(a)(3) N/A 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 university health systems of eastern carolina inc L 1054679 university health systems of eastern carolina inc O 1054679 DUPLIN GENERAL HOSPITAL FOUNDATION B 1854659 university health systems of eastern carolina inc - UHSP O 72037 university health systems of eastern carolina inc - Pitt Professional O 195951