2011-11-14T08:53:18-06:00 2010-12-31 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-01-01 570314409 SISTERS OF CHARITY PROVIDENCE HOSPITALS SIST 8038654850 2435 FOREST DRIVE COLUMBIA SC 29204 DAVID K STEWART 8038654850 2011-11-14 1 AMY BIBBY 8282542254 2010 2016-03-07 17:11:31Z GEORGE A ZARA 2435 FOREST DRIVE COLUMBIA SC 29204 318129356 0 X WWW.PROVIDENCEHOSPITALS.COM X 1938 SC SUPPORT OF THE SISTERS OF CHARITY OF ST. AUGUSTINE & EXTENDED THE HEALING MINISTRY 21 18 2527 372 0 0 457730 21505868 271697048 291966251 1983205 1575080 1162486 2108028 275300469 317155227 210655 212430 0 0 98569798 111620721 0 0 149263 165535305 177303468 264315758 289136619 10984711 28018608 254687684 281224947 171379056 172523907 83308628 108701040 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 0 251444498 212430 291966251 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 12,978 INPATIENTS AND PROVIDED CARE TO 56,641 EMERGENCY ROOM PATIENTS. PLEASE SEE THE CONTINUATION OF OUR PROGRAM SERVICE ACCOMPLISHMENTS ON SCHEDULE O. 251444498 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 298 0 1 2527 1 0 0 0 0 0 0 0 0 0 0 X 21 18 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 PATRICK MCMAHON 1.00 X X 0 505214 36168 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 288639 0 0 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 GEORGE A ZARA 40.00 X 0 693437 32844 DAVID K STEWART 40.00 X 361930 0 16955 CAROLYN CATTON 40.00 X 162053 0 9266 RICHARD GROOMS 40.00 X 242766 0 21328 STEPHEN CREECH 40.00 X 233768 0 16500 JOHN KESSLER 40.00 X 255899 0 18603 NANCY HENDERSHOT 40.00 X 0 0 0 W RYAN HALL 40.00 X 208763 0 16904 PAMELA WILLIAMS 40.00 X 166641 0 7111 CINDY BLAKENEY 40.00 X 126923 0 3735 LORAN AUGUST 40.00 X 135927 0 7523 WAYNE SRIBNICK MD 40.00 X 315014 0 37725 KEN OWENS 40.00 X 122831 0 14045 WILLIAM T FELMLY 40.00 X 604388 0 0 DAVID B FULTON 40.00 X 578186 0 0 EARL B MCFADDEN JR 40.00 X 542133 0 0 MARK D LOCKE 40.00 X 533355 0 0 SILAS W HOLMES 40.00 X 469377 0 0 5348593 1198651 238707 101 0 1 0 UNIDINE CORPORATION 75 REMITTANCE DRIVE CHICAGO IL 060756529 DIETARY SERVICES 2982216 NEXSEN PRUET JACOBS & POLLARD PO BOX 2426 COLUMBIA SC 29202 LEGAL FEES 1233369 CRITICAL HEALTH SYSTEMS OF SC 1410 BLANDING ST COLUMBIA SC 29201 MEDICAL SERVICES 1167084 TRANSCENT SERVICES INC PO BOX 740209 ATLANTA GA 30374 TRANSCRIPTION SERVICES 942593 HOSPITAL SERVICES INC 2751 THE BOULEVARD COLUMBIA SC 29209 LINEN SERVICES 879220 47 21000000 399569 106299 21505868 NET PATIENT REVENUE 900099 291966251 291966251 291966251 1291303 1291303 702972 613924 89048 89048 89048 17926 626056 360205 17926 265851 283777 283777 FOOD SERVICES 722210 1014710 1014710 OTHER REVENUES 900099 984034 984034 BRUNER HOUSE REVENUE 900099 20236 20236 2018980 317155227 291966251 0 3683108 212430 212430 2332515 2332515 89784739 82558696 7226043 1950447 1748059 202388 11106439 9953978 1152461 6446581 5777651 668930 4829685 4680422 149263 1334784 1334784 120626 120626 46047 46047 23801132 19706477 4094655 1962737 1731074 231663 31498710 16370289 15128421 1056256 1056256 5903535 5903535 515008 515008 65057 65057 4253446 4253446 13849869 13849869 2696089 2372186 323903 MEDICAL SUPPLIES 55411703 55411703 BAD DEBT EXPENSE 29352414 29352414 RECRUITMENT 588751 588751 MISCELLANEOUS 17619 17619 289136619 251444498 37542858 149263 32529957 28984172 25823940 30392113 4544055 4485839 3643281 4646722 356459107 227923808 130592442 128535299 56172106 80099319 233024 233024 2719497 1148879 1128962 254687684 281224947 18492753 20985448 124975000 122085000 27911303 29453459 171379056 172523907 X 80183414 105558165 3125214 3142875 83308628 108701040 254687684 281224947 X 28018608 -2626196 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 30000 0 1 16047 46047 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 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 2010, APPROXIMATELY $16,047 IS ALLOCABLE TO LOBBYING EXPENDITURES. 9673516 9673516 153134995 81451789 71683206 9697633 8884332 813301 179044271 137587687 41456584 4908692 4908692 128535299 INTEREST RATE SWAP INSTRUMENTS 11995189 PATIENT REFUNDS 533094 ESTIMATED THIRD PARTY SETTLEMENTS 932920 PAYABLE TO SISTERS OF CHARITY OF ST. AUGUSTINE HEALTH SYSTEM 12636216 OTHER LONG TERM LIABILITIES 3356040 29453459 317155227 289136619 28018608 367371 -2993567 -2626196 25392412 314877104 367371 -2993567 -2626196 317503300 -348073 -348073 317155227 289484692 348073 348073 289136619 0 289136619 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, 2010. FISCAL YEARS ENDING ON OR AFTER DECEMBER 31, 2007 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 -3,033,586. GAIN ON DISCONTINUED OPERATIONS 40,019. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED LOSS ON FAIR VALUE OF INTEREST RATE SWAP -3,033,586. GAIN ON DISCONTINUED OPERATIONS 40,019. PART XII, LINE 4B - OTHER ADJUSTMENTS: GAIN ON SALE OF FIXED ASSETS 265,851. RENTAL EXPENSES -613,924. PART XIII, LINE 2D - OTHER ADJUSTMENTS: GAIN ON SALE OF FIXED ASSETS -265,851. RENTAL EXPENSES 613,924. 1 1 X 1 X 1 X 1 1 0 1 1 9803759 2489767 7313992 0.02820 21654830 19584981 2069849 0.00800 31458589 22074748 9383841 0.03620 235660 30731 204929 0.00080 176881 176881 0.00070 212430 212430 0.00080 624971 30731 594240 0.00230 32083560 22105479 9978081 0.03850 0 29352414 8679509 87493128 93569731 -6076603 X 1 0 2 2 PROVIDENCE HOSPITAL

2435 FOREST DRIVE COLUMBIA SC 29204

X X X X 3 PROVIDENCE HOSPITAL NORTHEAST

120 GATEWAY CORPORATE BOULEVARD COLUMBIA SC 29203

X X X X NA FOR 2010 1 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 $29,352,414 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. 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. THE HOSPITAL 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 6: 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 13,475 INPATIENTS AND PROVIDED CARE TO 56,641 EMERGENCY ROOM PATIENTS.DURING 2010, THE COMMUNITY CONTRIBUTED APPROXIMATELY 34,388 HOURS TOWARD PROVIDING HEALTH CARE AT SCPH. THE VALUE OF THIS CONTRIBUTION IS APPROXIMATELY $258,000, 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 $28,021,000 IN 2010. THE CHARITY CARE DELIVERED AT COST WAS $9,804,000 AND PROVIDED COMMUNITY SERVICES OF $382,000.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 CHILDRENS SERVICES.COMMUNITY OUTREACH EVENTS TOTALED 158 AND SERVED 8,013 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 5,462 INDIVIDUALS. THE DETAILS FOR THE EVENTS AND EDUCATION CLASSES ARE LISTED BELOW:NAME OF CLASS/EVENT # SERVED # OF EVENTS HOURS NET BENEFITFRIENDS & FAMILY CPR 40 7 75 $ 4,149HEALTH FAIRS 2,161 4 18 3,418CARDIAC EDUCATION 2,074 15 92 5,416NUTRITION CLASSES 230 21 283 9,823SPEAKERS BUREAU 387 14 472 15,664CARDIOVASCULAR SCREENING 2,189 47 416 -14,400FATHERS & FAMILIES IN-KIND SERVICES 141 12 35 34,315SPEAKING OF YOUR HEALTH 791 38 984 146,544TOTAL COMM. OUTREACH 8,013 158 2,374 204,929NAME OF CLASS/EVENT # SERVED # OF EVENTS HOURS NET BENEFITCOMMUNITY CPR EDUC. 1,456 304 5,824 $ -ACLS 411 40 6,576 -PALS 123 10 1,230 -CORE INSTRUCTOR 10 1 80 -BLS CERTIFICATION 2,459 525 19,672 -STUDENT PROGRAMS 651 128 2,930 116,899WORKFORCE DEVELOP. 352 511 1,408 59,982TOTAL PROF. EDUCATION 5,462 1,519 37,720 176,881 PART VI, LINE 7: 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 OH FILE ANNUAL COMMUNITY BENEFITS REPORTS JUST AS SCPH DOES IN SC. 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. 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) 29000 SPONSORSHIP CATHOLIC RELIEF SERVICES 228 LEXINGTON STREET BALTIMORE MD 21201 135563422 501(C)(3) 10000 DONATION EDVENTURE CHILDREN'S MUSEUM PO BOX 1638 COLUMBIA SC 29202 571013857 501(C)(3) 20000 DONATION SC NURSES FOUNDATION 1821 GADSDEN STREET COLUMBIA SC 29201 570772080 501(C)(3) 5750 NURSE SCHOLARSHIP PROGRAM GREATER COLUMBIA CHAMBER OF COMMERCE 930 RICHLAND STREET COLUMBIA SC 29202 570144900 501(C)(6) 18200 PROGRAM SPONSORSHIPS SOUTH CAROLINA RESEARCH FOUNDATION 901 SUMTER STREET COLUMBIA SC 29208 570967350 501(C)(3) 7500 DONATION AMERICAN RED CROSS PO BOX 905890 CHARLOTTE NC 28290 501(C)(3) 5000 DONATION 8 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE RECIPIENT ORGANIZATION IS GIVEN FUNDS TO BE USED AS APPROVED BY THE ORGANIZATION. OTHER INFORMATION: PART IV: GRANTS AND ASSISTANCE PAYMENTS ARE APPROVED BY OFFICERS OF THE ORGANIZATION AND ARE PROVIDED TO NONPROFIT ORGANIZATIONS WHOSE EXEMPT PURPOSES ALLIGN CLOSELY WITH THE CORE VALUES AND MISSION OF THE ORGANIZATION. X X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 PATRICK MCMAHON 0 394874 0 93840 0 16500 0 25128 0 11040 0 541382 0 0 RACHEL VIDAL MD 0 0 0 0 288639 0 0 0 0 0 288639 0 0 0 GEORGE A ZARA 0 535812 0 157625 0 0 0 25128 0 7716 0 726281 0 0 DAVID K STEWART 289828 0 72102 0 0 0 16500 0 455 0 378885 0 0 0 CAROLYN CATTON 132676 0 0 0 29377 0 9266 0 0 0 171319 0 0 0 RICHARD GROOMS 203887 0 38879 0 0 0 20101 0 1227 0 264094 0 0 0 STEPHEN CREECH 208327 0 25441 0 0 0 16500 0 0 0 250268 0 0 0 JOHN KESSLER 213636 0 42263 0 0 0 16500 0 2103 0 274502 0 0 0 W RYAN HALL 175595 0 33168 0 0 0 16484 0 420 0 225667 0 0 0 PAMELA WILLIAMS 142223 0 24418 0 0 0 0 0 7111 0 173752 0 0 0 WAYNE SRIBNICK MD 282260 0 32754 0 0 0 37725 0 0 0 352739 0 0 0 WILLIAM T FELMLY 474830 0 129558 0 0 0 0 0 0 0 604388 0 0 0 DAVID B FULTON 564652 0 13534 0 0 0 0 0 0 0 578186 0 0 0 EARL B MCFADDEN JR 318668 0 223465 0 0 0 0 0 0 0 542133 0 0 0 MARK D LOCKE 263171 0 270184 0 0 0 0 0 0 0 533355 0 0 0 SILAS W HOLMES 380761 0 88616 0 0 0 0 0 0 0 469377 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 407969 INTERESTED PERSON PROVIDES LEASING, PROPERTY MANAGEMENT, CONSTRUCTION MANAGEMENT, AND CONSULTING SERVICES TO THE HOSPITAL. 0 KIMBERLY HALL FAMILY MEMBER OF W. RYAN HALL, OFFICER 32067 COMPENSATION PAID AS HOSPITAL EMPLOYEE. 0 DANIELLE RODER FAMILY MEMBER OF W. RYAN HALL, OFFICER 45542 COMPENSATION PAID AS HOSPITAL EMPLOYEE. 0 RICHARD SRIBNICK FAMILY MEMBER OF WAYNE SRIBNICK, MD, OFFICER 38188 COMPENSATION PAID FOR MEDICAL SERVICES RENDERED. 0 SHEREE FRAVEL FAMILY MEMBER OF W. RYAN HALL, OFFICER 24970 COMPENSATION PAID AS HOSPITAL EMPLOYEE. 0 PROGRAM SERVICE STATEMENT FORM 990, PART III, LINE 4A DURING 2010, THE COMMUNITY CONTRIBUTED APPROXIMATELY 32,073 HOURS TOWARD PROVIDING HEALTH CARE AT SCPH. THE VALUE OF THIS CONTRIBUTION IS APPROXIMATELY $232,500, 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 $28,021,000 IN 2010. THE CHARITY CARE DELIVERED AT COST WAS $9,804,000 AND PROVIDED COMMUNITY SERVICES OF $382,000. 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 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: 367,371. UNREALIZED LOSS ON FAIR VALUE OF INTEREST RATE SWAP -3,033,586. GAIN ON DISCONTINUED OPERATIONS 40,019. TOTAL TO FORM 990, PART XI, LINE 5: -2,626,196. 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. AUGUSTINE HEALTH GROUP LLC 2435 FOREST DRIVE COLUMBIA SC 29204 900074301 PHYSICIAN PRACTICES SC 6640499 2281863 MOORE ORTHOPEDIC CLINIC 2435 FOREST DRIVE COLUMBIA SC 29204 270743476 ORTHOPAEDIC TREATMENTS SC 29965660 6474129 HEALTHTOUCH LLC 2435 FOREST DRIVE COLUMBIA SC 29204 570314409 PHYSICAL THERAPY/REHAB SC 7780291 1535619 SISTERS OF CHARITY OF ST AUGUSTINE ROMAN CATHOLIC CHURCH 2351 EAST 22ND STREET CLEVELAND OH 44115 340714763 CHURCH OH 501(C)(3) LINE 1 N/A 0 SISTERS OF CHARITY OF ST AUGUSTINE HEALTH SYSTEM INC 2351 EAST 22ND STREET CLEVELAND OH 44115 341379356 SUPPORTING ORGANIZATION OH 501(C)(3) LINE 11A, I N/A 0 CSA HEALTH NETWORK 2351 EAST 22ND STREET CLEVELAND OH 44115 341405976 SUPPORTING ORGANIZATION OH 501(C)(3) LINE 11A, I N/A 0 SISTERS OF CHARITY MINISTY DEVELOPMENT CORPORATION 2351 EAST 22ND STREET CLEVELAND OH 44115 571127197 SUPPORTING ORGANIZATION OH 501(C)(3) LINE 11A, I N/A 0 CSA MERCY MINISTRIES 2351 EAST 22ND STREET CLEVELAND OH 44115 340714462 SUPPORTING ORGANIZATION OH 501(C)(3) LINE 11A, I N/A 0 ST JOHNS MEDICAL CENTER 2351 EAST 22ND STREET CLEVELAND OH 44115 340714756 HEALTHCARE OH 501(C)(3) LINE 3 N/A 0 JOSEPH'S HOME 2351 EAST 22ND STREET CLEVELAND OH 44115 341901676 TEMP HOUSING/HEALTHCARE OH 501(C)(3) LINE 9 N/A 0 SISTERS OF CHARITY FOUNDATION OF CANTON 2351 EAST 22ND STREET CLEVELAND OH 44115 341832697 SUPPORTING ORGANIZATION OH 501(C)(3) LINE 11A, I N/A 0 SISTERS OF CHARITY FOUNDATION OF CLEVELAND 2351 EAST 22ND STREET CLEVELAND OH 44115 341832698 SUPPORTING ORGANIZATION OH 501(C)(3) LINE 11A, I N/A 0 SISTERS OF CHARITY FOUNDATION OF SOUTH CAROLINA 2351 EAST 22ND STREET CLEVELAND OH 44115 570708391 SUPPORTING ORGANIZATION OH 501(C)(3) LINE 11A, I N/A 0 REGINA HEALTH CENTER 5232 BROADVIEW ROAD RICHFIELD OH 44286 341722394 LONG TERM CARE OH 501(C)(3) LINE 9 N/A 0 SOUTH CAROLINA CENTER FOR FATHERS AND FAMILIES 2351 EAST 22ND STREET CLEVELAND OH 44115 364506347 SUPPORT FATHERHOOD INITIATIVES OH 501(C)(3) LINE 7 N/A 0 MERCY MEDICAL CENTER INC 1320 MERCY DR NW CANTON OH 44708 341893439 HEALTHCARE OH 501(C)(3) LINE 3 N/A 0 1 0 0 0 1 0 0 0 0 1 0 0 0 1 1 1 0 0