2011-08-15T13:56:32-05:00 2010-09-30 Cherry Bekaert & Holland LLP 1029 Greene Street Augusta GA 30901 990 2009-10-01 571017988 HAMPTON REGIONAL MEDICAL CENTER HAMP 8039432771 503 CAROLINA AVENUE WEST PO BOX 338 VARNVILLE SC 29944 DAVID h HAMILL 8039432771 2011-08-12 1 7067243557 2011-08-11 2009 2016-02-24 21:20:13Z david h hamill 503 carolina avenue varnville SC 29944 21009432 0 X WWW.HAMPTONREGIONAL.ORG X 1950 SC Hampton Regional Medical Center's mission statement is to provide: Compassion, Commitment, & Excellence, Every Person, Every Time. 7 7 259 0 0 0 153680 41184 19925224 20542490 86672 92147 990472 333611 21156048 21009432 0 0 8120011 8256731 0 67886 12686119 13175973 20806130 21432704 349918 -423272 45837429 44784741 40810708 40284154 5026721 4500587 COMPASSION, COMMITMENT AND EXCELLENCE. EVERY PERSON, EVERY TIME. 0 0 16234828 20704588 HAMPTON REGIONAL MEDICAL CENTER PROVIDEs extensive community benefits in many forms, including charity care, health education, community sponsorships, and numerous community outreach programs that directly benefit the people in the service area of the hospital. HAMPTON REGIONAL MEDICAL CENTER PROVIDED MEDICAL SERVICES TO OVER 30,000 PATIENTS IN FY 2009. THAT TOTAL INCLUDED 11,230 EMERGENCY ROOM PATIENTS AND 1,317 INPATIENTS.The hospital sponsors Hampton County Seniors, a monthly educational program that features topics of interest to seniors and their families such as breast cancer awareness, home gardening, protection against fraud, advanced directives and living wills, flu, diabetes education, economic updates, and many more health-related topics. Local and regional physicians and providers donate their time each month, which has helped make this the largest ongoing community meeting in the County. The hospital's sponsorship of this program also includes free blood sugar and blood pressure screenings and lunch to all in attendance. In 2010, this program benefited over 2,000 members of the community and, since its inception in 2005, has benefited more than 12,000 members. HRMC founded this program and provides all human and financial resources necessary to promote, facilitate, and sustain the program.Hamption Regional employees share their time and expertise with over 3,000 members of the community through local health fairs. The largest health fair had more than 800 in attendance and over 50 vendors present. Children were entertained by clowns, jumping castle, face painting, petting zoo and other fun activities. Attendees received numerous health screenings including discounted or free blood work. HRMC nursing staff held Grime Scene Investigation workshops at local schools to teach proper hand washing techniques, H1N1 and flu presentations were held on campus, as well as diabetes and breast cancer education classes. HRMC hosted a Heat Stroke Prevention campaign handing out free bottled water and distributing over 2,000 hand fans to members of the community. Hampton Regional and its employees donated medical supplies to the Haiti Relief effort. One employee, a certified nurse anesthetist, spent 2 weeks in Haiti donating her services to the relief effort.The hospital supports the local Rotary Club, Lions Club, Chamber of Commerce and a variety of other community organizations. The hospital also provides free public health education programs on a variety of health topics.HRMC provides updated, reasearchable health education services through its website which is linked to hundreds of sites such as WebMD, the American Cancer Society, Center for Disease Control (CDC) and others. HRMC's website has over 40,000 hits per month.The hospital actively participates with the local technical college and provides clinical rotations for nursing students, surgical tech students and radiology tech students. The hospital also provides clinical rotations for students enrolled in the University of South Carolina Bachelors Nursing Program. The hospital participates in school career events throughout the area. Each year we sponsor the local high schools health careers program participation in state and national competitions.The hospital is affiliated with the AT School of Osteopathic Medicine's Beaufort campus and has agreed to serve, at no cost, as a rural training hospital for medical students.The hospital is an integral part of the Hampton County Leadership program sponsored by the USC Salkehatchie Leadership Institute and the Hampton County Chamber of Commerce.HRMC provides human and financial support to community events such as flu shot clinics, blood pressure screenings, cholesterol screenings, Red Cross blood mobile, relay for life, local festivals, and adopt a child program.The hospital also provides meeting rooms for various community organizations such as rotary, bosom buddies, weight watchers, hampton county leadership, and relay for life. The hospital also provides meeting room space to be used as a distant learning center. 16234828 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 14 0 1 259 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 SC X X DAVID HAMILL 8039432771 PO BOX 338 VARNVILLE SC 29944 allan swofford 2.00 X X 0 0 0 WILLIAM R KOGER JR 2.00 X X 0 0 0 PAT SENTMAN 2.00 X X 0 0 0 DEBBIE BULLARD 2.00 X 0 0 0 ROY HOLLINGSWORTH 2.00 X 0 0 0 ADELAIDE JOSSELSON 2.00 X 0 0 0 DR BO WARREN 2.00 X 0 0 0 DAVE HAMILL 40.00 X 197529 0 12289 DONALD TUCKER 40.00 X 97290 0 9248 JULIE ALLEN 40.00 X 79714 0 6992 KATHY JARRELL 40.00 X 81775 0 8725 LYNN BOWERS 40.00 X 71663 0 3749 SONNY PARK 40.00 X 173077 0 8923 MALCOLM HORRY 40.00 X 124585 0 1365 BRENT ALAN ARMSTRONG 40.00 X 242837 0 8451 itai mupanduki 40.00 X 166384 0 486 1234854 0 60228 5 0 1 0 carmen marflak 1709 acres drive beaufort SC 29902 ANESTHESIA SERVICES 158000 TRIDENT CONSTRUCTION 2245 TECHNICAL PARKWAY CHARLESTON SC 294034931 CONSTRUCTION 105241 2 3163 38021 41184 NET PATIENT SERVICE RE 621990 20542490 20542490 20542490 92147 92147 other income 621990 152139 152139 dietary revenue 621990 136328 136328 medical transcripts 621990 35185 35185 9959 9959 333611 21009432 20704588 0 263660 1622173 1622173 5343081 5343081 72544 55859 16685 654215 506103 148112 564718 434833 129885 55316 55316 37090 37090 380 380 169234 78297 90937 1142331 968836 172678 817 25704 11050 7874 6780 1991865 1991865 2284294 2284294 187111 187111 BAD DEBTS 3817750 3817750 supplies 1641564 1513692 124614 3258 OUTSIDE SERVICES 1120817 877114 186672 57031 TAXES AND LICENSE 648735 147233 501502 MISCELLANEOUS 53782 9575 44207 21432704 16234828 5129990 67886 1865 872 2200312 2132585 73506 65384 2824761 3186804 375554 342710 210372 140437 37774458 7727523 32107948 30046935 5245943 4994973 2797168 3874041 45837429 44784741 2155516 2316365 38655192 37967789 40810708 40284154 X 4913621 4490349 102862 0 10238 10238 5026721 4500587 45837429 44784741 X 0 0 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2728127 2728127 25345383 7179122 18166261 9700948 548401 9152547 30046935 REGIONS BANK CERTIFICATE OF DEPOSIT 10238 F OTHER INVESTMENTS 12687 F debt service reserve fund 2838792 F bond issues cost net of amortization of loan cost 662541 C DEBT service CONTRIBUTIONS 1470715 C 4994973 OTHER RECEIVABLES 25736 INTERCOMPANY RECEIVABLE 3848305 3874041 Part X: Description of Uncertain Tax Positions Under FIN 48: Hampton regional medical center is a not-for-profit corporation and has been recoganized as tax-exempt pursuant to section 501(c)(3) of the internal revenue code. management has evaluated the effect of the guidance provided by u.s. generally accepted accounting principals on accounting for uncertainty in Income taxes that became effective this year. management believes that the hospital continues to satisfy the requirements of a tax-exempt organization at september 30, 2010. management has evaluated all other tax positions that could have a significant effect on the financial statements and determined the hospital had no uncertain income tax positions at September 30, 2010. 1 1 1 X 1 X 1 1 1 0 0 1 369 743603 0 743603 0.03470 1 5689 3005981 3389244 -383263 0.00000 0 0 0 0 0.00000 2 6058 3749584 3389244 360340 0.03470 93 5350 45024 0 45024 0.00210 34 72 74153 0 74153 0.00350 0 0 0 0 0.00000 0 0 0 0 0.00000 50 1140 1000 0 1000 0.00000 177 6562 120177 120177 0.00560 179 12620 3869761 3389244 480517 0.04030 0 0 0 0 0.00000 60 1 2530 0 2530 0.00010 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 4 0 327 0 327 0.00000 5 0 1071 0 1071 0.00010 1 0 85158 0 85158 0.00400 0 0 0 0 0.00000 70 1 89086 89086 0.00420 1 1675679 876174 4683419 5658633 -975214 X 1 1 HAMPTON REGIONAL MEDICAL CENTER

P O BOX 338 VARNVILLE SC 29944

X X X Part I, Line 3c: In addition to using the Federal Poverty Level (FPL) to determine free and discounted care, (See Part I, lines 3A and 3B) the hospital also offers a 15% discount for uninsured patients. Part III, Line 4: The Organization's financial statements do not include a footnote on bad debt. The Organization uses Worksheet 2 (Ratio of Patient Care Cost to Charges) to determine bad debt expense at cost. Worksheet 2 uses total operating expenses from the audited financial statements. Gross patient revenue was obtainted from hospital records since only net patient revenue is listed in the audited statements. To estimate the cost of bad debt attributable to patients eligible under our charity care policy, we took patient level detail reports as of FYE 9/30/10 and sorted the report by SP financial class only. We then used a percentage allocation based on the percent of the population below the Federal proverty level in our service area. Part III, Line 8: The Medicare shortfall should be allowed as a community benefit since providers cannot negotiate rates with Medicare. Medicare was 45.4% of our payor mix in 2010, making it our largest payor for the facility. By treating Medicare patients, we are promoting access to healthcare services. The Medicare cost report was used to report cost on Part III, lines 5 and 6. Part III, Line 9b: Hampton Regional Medical Center (HRMC) makes every effort to identify patients that are potentially eligible for financial assistance by meeting with patients face-to-face, contacting them by phone and by mail. Financial assistance applications are available at all registration areas within our facility. A full-time staff member is available M-F from 8:30 - 5:00 to assist patients in completing the applications. Our outsourced self pay billing agency also has applications available to mail patients when they are identified as potential candidates for financial assistance. In-house reports are also screened to identify patients that may qualify for assistance. If a patient does not meet charity care guidelines or neglects to complete the required charity care application, the patient will still receive a 15% discount off total charges and will also be eligible for a 10% prompt pay discount. It is not the collection practice of HRMC or its agents to attach liens on property, garnish wages, or pursue legal action on the debts owed by our patients. Part VI, Line 2: Part VI question 2: Needs Assessment. Describe how the Organization assesses the healthcare needs of the communities it serves.HRMC partnered with a local physician practice in 2008 to conduct a needs assessment that determined a need for additional primary care and access to specialty care in our service area. HRMC has been actively involved in the recruitment of a full-time pediatrician, orthopedic surgeon, general surgeon, and a cardiologist to the rural area. HRMC has also worked with ophthalmology, podiatry, and neurology specialists to provide weekly clinics for patients locally.HRMC works continuously to recruit physicians to the area. HRMC works with 3 local colleges to provide clinical rotations for nursing students, surgical techs, radiology students, and medical students. In addition, HRMC also collects emergency room survey data to determine needs from patients seeking help through the ER. This survey process continues to show patient needs of primary care physicians, patients who cannot afford prescription medications, and patients who do not have the financial recources to be seen in a physician's office. The service area has one clinic designated as a Federally Qualified Community Health Center (FQHC). Rural Hampton County is a Medically Underserved Area and is designated as a Health Professional Shortage Area (HPSA). In addition to this, HRMC also relies on national data for other opportunities to support the community such as offering various health screenings throughout the year.Part VI question 3: Patient education of eligibility for assistance. Describe how the Organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the Organization's charity care policy.Information concerning financial assistance is available on our hospital website, patient information pamphlets and signage located in registration areas. Patients are also offered assistance at registration if they indicate they cannot afford to pay the bill. Patients are referred to our FT Financial Counselor for assistance with the applications and guidance on applying for the state Medicaid program.Part VI question 4: Community information. Describe the community the organization serves, taking into account the geographic area and the demographic constituents it serves.Hampton Regional Medical Center resides in Hampton County, SC. Hampton County is the primary service area with a population of approximately 21,000 residents. Allendale, Colleton, and Jasper counties are secondary service areas. Hampton County is a Medically Underserved Area and a Federally designated Health Professional Shortage Area (HPSA). The unemployment rate for Hampton County is 16.3%, with 22% of the population living below the Federal Poverty Level (FPL). In 2010, 23.9% of households within the primary service area earned income less than $15k. Poverty, unemployment, and lack of health insurance coverage continue to be issues in the area. Our largest market share from our secondary service area is Allendale County. Allendale County is in the top 10 in the nation with the highest unemployment rate at 23.6%, meaning almost 1 out of every 4 people is out of work, according to the U.S. Bureau of Labor & Statistics. Thirty-five percent (35%) of Allendale's population is living below the FPL.Part VI question 5: Community Building Activities. Describe how the Organization's community building activites, as reported in Part II, promote the health of the communities we serve.The community building activities reported are support for the Rotary Club, Chamber of Commerce, and local schools and colleges in the communities we serve. In supporting these organizations we can support the development of our community by bringing in new industries and jobs, increasing the average household income, and improving living conditions and the overall general health of the community. To promote workforce development, we participate with local high schools in hosting their health occupation students, participate in career days, host students for on-the-job shadowing, and participate as a training site for local colleges.Part VI question 6: Provide any other information important to describing how the Organization's hospital further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.)Hampton Regional Medical Center strives to provide the highest quality healthcare to the communities we serve. In 2008, HRMC moved into a new replacement facility equipped with the latest technology. HRMC's new facility replaced a crumbling 1950's facility that could not offer the expanded services we are now capable of offering to the community. HRMC now provides services to the community that were once only available in larger facilities 60-80 miles away. Some of these services include full-time MRI, ICU, cardiac rehab and a sleep lab. The development of our new facility not only serves the growth in population, but also improves the quality of patient care with the new technology offered. HRMC's mission statement of providing Compassion, Commitment, Excellence to Every Person, Every Time is accomplished through providing quality healthcare services to all who present regardless of their ability to pay. HRMC also promotes the health of the community by providing various community services throughout the year. Some of these services includes free health screenings, health education and health fairs.The governing Board of Directors at HRMC is comprised of citizens who reside in the primary and secondary service area of the communities we serve. Board members are active participants in many community programs sponsored by the facility.HRMC extends medical staff privileges to all qualified physicians in our community. X X 0 0 0 0 0 0 0 0 0 DAVE HAMILL 197529 0 0 0 0 0 2206 0 10083 0 209818 0 0 0 SONNY PARK 173077 0 0 0 0 0 4430 0 4493 0 182000 0 0 0 BRENT ALAN ARMSTRONG 242837 0 0 0 0 0 0 0 8451 0 251288 0 0 0 itai mupanduki 166384 0 0 0 0 0 0 0 486 0 166870 0 0 0 hampton regional medical center 571017988 00083703f 2006-11-01 39080000 replacement hospital 0 0 39080000 2838790 39080000 2008 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 Form 990, Part VI, Section B, line 11 AN ELECTRONIC COPY OF THE FORM 990 IS PROVIDED TO THE GOVERNING BODY PRIOR tO FILING FOR THEir APPROVAL. Form 990, Part VI, Section B, line 12c The organization sends conflict-of-interest statements to all Trustees, Directors, and significant members OF THE ORGANIZATION to disclose any possible conflicts. The EXECUTIVE committee regularly reviews any conflicts that may arise throughout the year on a case-by-case basis. Form 990, Part VI, Section B, line 15 IN 2007 HAMPTON REGIONAL MEDICAL CENTER (HRMC) CONTRACTED WITH STEPHAN KIRKLAND OF ATLANTIC EXECUTIVE COMPENSATION GROUP, LLC TO PROVIDE AN INDEPENDENT ANALYSIS OF HRMC'S CEO COMPENSATION AND RENDER AN OPINION AS TO THE FAIR MARKET REASONABLENESS OF THAT COMPENSATION PACKAGE. AGAIN IN 2010 A SIMILAR ENGAGEMENT HAS BEEN MADE WITH THE SAME FIRM. IT IS THE BOARD OF TRUSTEES INTENTION TO HAVE SUCH AN EVALUATION PERFORMED EVERY 2-3 YRS OR SOONER IF NEEDED. Form 990, Part VI, Section C, line 18 FORMS 990 IS POSTED ON ANOTHER WEBSITE AND ALSO AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. Form 990, Part VI, Section C, line 19 ALL GOVERNING DOCUMENTS AND POLICIES ARE PROVIDED for public review UPON REQUEST. PART XI, LINE 2A & 2B AUDITED FINANCIAL STATEMENT HAMPTON REGIONAL MEDICAL CENTER AND SUBSIDIARY HAS A CONSOLIDATED FINANCIAL AUDIT COMPOSED OF HAMPTON REGIONAL MEDICAL CENTER AND COASTAL PLAINS PHYSICIAN ASSOCIATES, WHICH IS AUDITED BY INDEPENDENT AUDITORS. COASTAL PLAINS PHYSICIAN ASSOCIATES FILES A SEPERATE 990 TAX RETURN. Form 990, Part XI, Line 2C REVIEW OF AUDITED CONSOLIDATED FINANCIAL STATEMENTS HRMC is a 32 bed rural facility. The hospital board of directors consist of 7-9 members. The board of directors meets with the auditor after the annual audit to review the audited consolidated financial statements and the management letter; ensuring that management addresses any issues determined in the auditors management letter. The rebidding process for selection of the independent audit firm occurs every 3-5 years. The board approves the selection of the independent audit firm. Form 990, Part V, Lines 2B, 7G and 7H Backup withholding, Form 8899 and 1098-C The organization did not receive contributions of qualified intellectual property and was therefore not required to file form 8899. Likewise, there were no contributions of cars, boats, airplanes, or other vehicles, and Form 1098-C was not required. The organization did not have any reportable gaming (gambling) winnings to prize winners and therefore the backup withholding rules did not apply. COASTAL PLAINS PHYSICIAN ASSOCIATES 595 WEST CAROLINA AVENUE VARVILLE SC 29944 571088306 PHYSICIANS' OFFICE SC 50C(3) HAMPTON REGIONAL MEDICAL CENTER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 COASTAL PLAINS PHYSICIAN ASSOCIATES Q 420233