Y E A R I N R E V I E W

2 0 1 2 Y E A R I N R E V I E W I N T E R N AT I O N A L M E D I C A L O U T R E A C H P R O G R A M Sustainabe Heathcare through Donations and Education

O U R M I S S I O N The Internationa Medica Outreach (IMO) program provides medica and educationa assistance gobay to promote sustainabe heathcare and improved iving standards in underserved communities. O U R I M P A C T For more than 50 years, IMO has touched the ives of thousands of patients and famiies in 29 countries. Ongoing support from institutions, individuas and non-profit partners aows IMO to offer free educationa opportunities to internationa medica personne and free equipment to hospitas and cinics in need wordwide. O U R C O M M I T M E N T Unike most charitabe organizations, IMO spends 100 percent of donated funds on designated projects. There are neither fundraising costs nor administrative expenses.

I N T E R N A T I O N A L M E D I C A L O U T R E A C H P R O G R A M A N N U A L R E P O R T Dear Reader: We are excited to update you on our accompishments and ongoing projects in 2012. The year was marked by contributions to and participation in miestone events in Centra America, where we are heping change the face of heathcare, provide specific cardiac services, and promote pubic education. In Beize, we are sending vounteer cardioogy and cardiac surgery teams to perform diagnostic studies. As a resut, we assisted the oca medica team in performing the first heart catheterizations and first open heart operations in the country. These successfu interventions were ony part of our ongoing efforts to deveop a sustainabe, muti-faceted cardioogy program in Beize City. In December, we donated a second cardiac catheterization aboratory to the Nationa Cardioogy Center in Managua, Nicaragua. It is the country's first pubic mobie cath ab and wi hep fi the region's growing need for cardiac services by doubing the number of procedures the Center performs. We aso assisted in opening a computer aboratory in a pubic schoo in Chimatenango, Guatemaa. In 2012, we donated more than 6,000 computers to Technoogy to Educate, an initiative that seeks to equip 19,000 pubic schoos with computers and modernize pubic education in Guatemaa. At home in Charotte, NC, we hosted 20 internationa visitors and trainees, who traveed from countries such as Tanzania, Liberia and Haiti to observe and deiver care in our medica faciities. Our Charotte-based medica personne continues to trave abroad to teach and assist with heart operations and other medica procedures. We hope you enjoy this report, which provides a gimpse of our activities in 2012. Francis Robicsek, MD, PhD Vice President, Internationa Medica Outreach, Caroinas HeathCare System President, Heineman Foundation of Charotte 1

A YEAR IN REVIEW Donated neary 390 pieces of medica equipment in 11 countries, worth $ 4 miion if purchased new O U R 2 0 1 2 B E N E F I C I A R I E S : BELIZE Kar Heusner Memoria Hospita, Beize City CONGO Knights of Mata, St. Pau Boyange COSTA RICA FUNDIPAM, San José GHANA Gimpse of Hope-Abert Doku, Kintampo GUATEMALA Guatemaan Heart Institute (UNICAR), Guatemaa City GUATEMALA Guatemaan Pubic Schoo System HAITI Cambry Orphanage Heath Cinic, Les Cayes HONDURAS Cinic Ixche, Copan Ruinas NICARAGUA Centro Naciona de Cardioogía, Managua NORTH CAROLINA, USA Diworth Soup Kitchen, Charotte SYRIA MedWish, rura Damascus, Idib and Aeppo TANZANIA Muhimbii Nationa Hospita Emergency Department, Dar es Saaam 2

A YEAR IN REVIEW Donated neary 13,200 pieces of computer equipment and materias, enough to assembe more than 6,000 computers, worth $ 2 miion if purchased new O U R G R E E N I M P A C T We beieve that good heath is aso the outcome of a cean environment. Part of our mission is to provide sustainabe heathcare whie heping reduce the impact of medica waste. In 2012, the IMO program recyced more than 44,000 pounds of medica equipment 3

GLOBAL IMPACT 4 O U R R E A C H BELIZE* Bugaria Cameroon China Congo Costa Rica Dominican Repubic E Savador Engand France Germany GUATEMALA* HAITI* HONDURAS* Hungary Israe Itay KENYA* Liberia Lithuania Macedonia MEXICO* Modova NICARAGUA* Panama Romania Russia Syria TANZANIA* * ONGOING PROJECTS G U A T E M A L A Donation of Cardiac Catheterization Laboratories The donations of two aboratories have increased access to cardiac care for thousands of patients in urban and rura areas. A aboratory donations are made possibe through the support of the Bisse Famiy Foundation and the Bowen famiy. Donation of Medica and Denta Equipment Medica faciities of a sizes have benefited from equipment and suppies such as operating room tabes, respirators, surgica suppies and echocardiography machines. Echocardiography Training and Network Expansion With hep from the Dickson Foundation, IMO is in process of estabishing and equipping at east 12 echocardiographic stations throughout Guatemaa that can transfer test resuts to the Guatemaan Heart Institute in Guatemaa City. Physician Training in Cardioogy/Surgery Since the 1970s, IMO in partnership with Caroinas HeathCare System s Sanger Heart & Vascuar Institute has heped train cardioogists and surgeons from Centra America. Such training resuted in the country s first heart catheterizations and open heart surgery. Technoogy to Educate Initiative IMO has partnered with a oca organization (Fundación Sergio Paiz Andrade) to estabish computer aboratories for students in thousands of rura schoos in Guatemaa.

GLOBAL IMPACT H O N D U R A S Donation of Hospita Equipment and Suppies Such donations have heped hospitas create and maintain specia departments and intensive care units. Physician Training in Cardioogy/Surgery IMO and Sanger Heart & Vascuar Institute physicians continue to train medica personne and physicians from hospitas and cinics in Honduras. N I C A R A G U A Donation of Catheterization Laboratories IMO's two aboratory donations have heped rebuid the country's Nationa Center of Cardioogy. Prior to the first donation, Nicaragua s 6 miion residents had no pubic heart catheterization aboratories. Today, one aboratory can perform 40 catheterizations per week. Donation of Medica Equipment and Suppies Medica faciities of a sizes have benefited from the equipment, suppies and fuy functiona outpatient faciities avaiabe to underserved popuations, among other things. M E X I C O Donation of Equipment and Suppies to Schoo for Deaf Chidren IMO continues to donate suppies such as hearing aids and books to the IREE Schoo for the Deaf in San Migue de Aende. The schoo is the ony one of its kind in the region and serves ow-income chidren. B E L I Z E Catheterization Training Since the catheterization aboratory donation at KHMH, the IMO program has faciitated catheterization training for Beizean medica personne. Physician Training in Cardioogy/Surgery Over the past three years, IMO has heped train Beizean technicians to perform echocardiography and heart catheterizations. Today, it is heping KHMH s ony cardiac surgeon to perform open heart surgeries. H A I T I Estabishing Infirmary and Heath Cinic In partnership with other organizations, IMO is taking steps to estabish a major infirmary and heath cinic in Haiti through the donation of medica equipment and suppies. K E N Y A Donation of Medica Equipment and Suppies IMO is heping provide medica equipment and suppies to the Jubiee Viage Project in Kager. The goa is to create a fuy stocked cinic that wi provide muchneeded medica services to residents in rura areas. T A N Z A N I A Deveopment of Emergency Medicine Residency Program Caroinas Medica Center (in Charotte), in coordination with University of Caifornia-San Francisco and the University of Chicago, is deveoping a sister emergency medicine residency program in Dar es Saaam. IMO generousy supports this initiative. Estabishment of a Cardioogy and Cardiac Surgery Program In an effort to create sustainabe cardiac services at the pubic Kar Heusner Memoria Hospita (KHMH) in Beize City, IMO is heping estabish a cardioogy program that ensures ongoing echocardiography services, catheterizations and open heart surgeries. 5

I N T E R N A T I O N A L M E D I C A L BELIZE O U T R E A C H P R O G R A M A N N U A L R E P O R T F I R S T O P E N H E A R T S U R G E R Y I N B E L I Z E Heart disease is the eading cause of death in the Centra American Repubic of Beize. Unti 2011, when IMO began providing support, the country acked modern cardiac diagnostic and interventiona faciities. IMO donated and instaed Beize s first heart catheterization aboratory and started to seect patients for cardiac interventions. In Juy 2012, physicians from the Kar Heusner Memoria Hospita (KHMH) in Beize City and from Caroinas HeathCare System performed the country s first open heart surgery. Since then, vounteer cardioogy and surgica teams from Sanger Heart & Vascuar Institute have been ending their time and taents to assist the physicians of the Kar Heusner Memoria Hospita to perform cardiac interventions. This activity makes it possibe for Beize's pubic medica faciities to offer advanced cardiac services. IMO wi continue to send teams unti a oca interventiona cardioogist is abe to perform catheterizations aone. Procedures performed in the cath ab have heped identify severa patients in need of open heart surgery. Today is the best day, the best day. I don't know how to describe it, but it means a ot to me because I'm so happy. I wi be free. Emir Afaro First Open Heart Surgery Patient Beize City, Beize Physicians from Caroinas HeathCare System and from KHMH perform the first open heart surgery in Beize. A Caroinas HeathCare System nurse assists a KHMH nurse in the operating room. 6

I N T E R N A T I O N A L M E D I C A L O U T R E A C H P R O G R A M A N N U A L R E P O R T BELIZE I went to get an operation for my badder, then I found out I had a probem with my heart. We prayed to the good Lord, and he opened door for us. Dr. Coye and the doctors in [Kar Heusner Memoria Hospita] et you fee at home. The nurses, everything, was just perfect. The speciaist that came down and taked to you so cam and nice that you get to trust them. Manue Afredo Acosta Open Heart Surgery Patient Beize City, Beize A cardioogy team from Charotte performs catheterizations on Beizean patients. These cath abs are donated with support from the Bisse Famiy Foundation. Dr. Francis Robicsek checks in on an open heart surgery patient in recovery. 7

GUATEMALA Guatemaa has aways been a focus of the IMO program, in particuar the deveopment and the support of the Guatemaan Heart Institute (UNICAR) in Guatemaa City, the most comprehensive cardiac care institute in Centra America. Over the years, there has been a continued fow of support from Charotte to Guatemaa, incuding the shipping of fuy equipped heart diagnostic aboratories capabe of being used as a mobie unit or to be stationed at UNICAR to reieve overoaded faciities. The units are used extensivey with severa hundred heart catheterizations and other compex cardiac studies performed. V I R T U A L C O M M U N I C A T I O N P O R T A L The IMO program has taken on the task of bringing Guatemaan cardiac care into the digita age. It donated a picture archiving and communication system (PACS) that was used to estabish a virtua communication porta between UNICAR and Sanger Heart & Vascuar Institute in Charotte. The porta is the first of its kind for the pubic hospita system in Centra America and wi enabe cardioogists from each institute to consut with one another in rea-time on compex cardiac diagnostic cases, 24 hours a day, seven days a week. Pans incude extending the communication porta in 2013 to Beize as we. 8 Dr. Geoffrey Rose, from Sanger Heart & Vascuar Institute, taks about the new communication porta with Caroinas HeathCare System physicians and administrators. First open heart surgery in Guatemaa in 1972.

I N T E R N A T I O N A L M E D I C A L O U T R E A C H P R O G R A M A N N U A L R E P O R T GUATEMALA An echo tech in Escuinta performs an echocardiography on a patient. E C H O N E T W O R K I N C E N T R A L A M E R I C A Guatemaan Heart Institute (UNICAR) Regiona Hospita Escuinta Regiona Hospita Quetzatenango T H E E C H O P R O J E C T With the support of the Dickson Foundation, the program is in the process of estabishing and equipping a network of 12 echocardiography stations throughout Guatemaa, which wi revoutionize heart care services in that country. IMO is continuousy training technicians in Charotte to perform the test in rura hospitas ordered by oca genera practitioners. The resuts are transferred to UNICAR, the Guatemaan Heart Institute in Guatemaa City, for interpretation and resuts are reayed back to the oca physician for consutation. In 2012, the program ceebrated the opening of echo aboratories at the Regiona Hospitas in Escuinta and in Cuiapa-Santa Rosa. So far, four of the panned 12 echo stations are fuy functiona. In addition to the Guatemaan echo-stations, IMO wi estabish and equip echo stations in San Savador, E Savador, in 2013. Regiona Hospita Cuiapa-Santa Rosa Regiona Hospita Coatepeque* Regiona Hospita San Benito Petén* Regiona Hospita Huehuetenango* Regiona Hospita Quiché* Regiona Hospita Izaba* Regiona Hospita Cobán* Regiona Hospita San Marcos* Regiona Hospita Zacapa* Hospita Pro-Famiia, San Savador, E Savador* *In Progress An echo tech from Caroinas HeathCare System works with an echo tech at Regiona Hospita Cuiapa-Santa Rosa. 9

NICARAGUA O P E N I N G O F A S E C O N D P U B L I C C A T H E T E R I Z A T I O N L A B O R A T O R Y In December, IMO donated a second cardiac catheterization aboratory to the Nationa Cardioogy Center in Managua, Nicaragua. It is the country's first pubic mobie cath ab and wi aow cardioogists to potentiay doube the number of cardiac procedures they are abe to perform, meeting the high heathcare demands of the region. Since 2007, IMO has ed projects aimed at improving the heath of adut and pediatric patients in Nicaragua. It has repaired the oder equipment of the intensive care unit at Manue de Jesús Rivera (La Mascota) Pediatric Hospita, the country's argest pediatric faciity. It aso heped rebuid the country's ony pubic cath ab, which had broken and remained unused for at east one year. Young girs greet visitors from IMO and Charotte with a Nicaraguan fokore dance. 10

CARDIAC CATH LAB PROJECT IMO has donated six cardiac catheterization aboratories in Centra America. These cath abs are aso used to diagnose and perform ife-saving procedures on patients experiencing heart attacks, chest pain or other symptoms of heart disease. The vast majority are mobie cath abs, which can be depoyed to rura areas if needed. The cath abs treat hundreds of patients each year who previousy had imited or no access to this unique cardiac care service. Last year, I had a heart attack. I thank God for the donors they gave me an opportunity to ive. I had ony a few hours to ive, but the cardioogy center was open and the doctors were abe to do a procedure on me. I thank God because [the donors and the center] provided me one more opportunity of ife. Gerónimo Ramírez Heart Catheterization Patient Managua, Nicaragua A crowd of cinicians and community members joined to ceebrate the opening of the catheterization aboratory at the Nationa Cardioogy Center. 11

VISITORS & TRAINEES Mike Martinez Beize [Echo Tech Trainee] For de Lourdes Orantes Franco Guatemaa [Echo Tech Trainee] Liian Portio Beize [Cath Lab Tech Trainee] Mariyn Aspina Beize [Cath Lab Manager Trainee] Emmanue Ekyinabah, MD Liberia [Oncoogy Physician] Humphrey Totoe Liberia [Oncoogy Nurse] Adrian Coye, MD Beize [Cardioogy, Surgery] Fernando Cardona Guatemaa [Information Technoogy] Irma Yoanda Tax García Guatemaa [Echo Tech Trainee] Jessica Hammer Guatemaa [FUNSEPA Coordinator] Tanya Marissa Bennett Beize [Cardiovascuar Recovery Unit Nurse] Mara Aisha Swaso Beize [Cardiovascuar Recovery Unit Nurse] Frankin Dawkins, MD Costa Rica [Anesthesioogy] Hui Xu, MD China [Orthopaedics Feow] James Kigera, MD Kenya [Orthopaedics Feow] Jean Jacky, MD Haiti [Orthopaedics Feow] Upendo George, MD Tanzania [Emergency Medicine Resident] 12 Dr. Adrian Coye, from Kar Heusner Memoria Hospita, Beize. Theresa Johnson, Coordinator of IMO, with For de Lourdes Orantes Franco in Cuiapa, Guatemaa.

VISITORS & TRAINEES Faith Ringo, MD Tanzania [Emergency Medicine Resident] Sifaei Mgaua, MD Tanzania [Emergency Medicine Resident] Phiip Koka, MD Tanzania [Emergency Medicine Resident] Dr. Michae Runyeon, Caroinas HeathCare System Emergency Medicine, and Phiip Koka, Muhimbii University of Heath and Aied Sciences, Tanzania. Mariyn Aspina, from Beize, earns how to manage a catheterization aboratory at Caroinas Medica Center. Dr. Ekyinahab, from Liberia, speaking with Dr. Derek Raghavan, President of Levine Cancer Institute. SPECIAL GUEST: Dr. Rafae Espada, former Vice President of Guatemaa and cardiothoracic surgeon, made his first trip to Charotte, NC, where he presented at a uncheon hosted by the Word Affairs Counci of Charotte. 13

PARTICIPANTS, OFFICERS & BOARD Thank you to a of our participants and vounteers who have dedicated countess hours to heping the IMO program become what it is today. Heineman Foundation of Charotte Officers Richard E. Thigpen, Jr., Esq., Chairman Francis Robicsek, MD PhD, President Anders Bergendah, Vice President Pau G. Coavita, MD, Vice President Fernando Paiz, Vice President Danie G. Aceti, Secretary/Treasurer Heineman Foundation of Charotte Board of Directors Hoyt Q. Baiey Maria Bergendah James J. Bisse R. Stuart Dickson Thomas K. Fehring, MD Chares F. Furr Mariyn J. Heineman June C. Heineman-Morris James E.S. Hynes W. Duke Kimbre Nancy Lopez-Ibanez John Peter Rostan McBryde, MD Hugh L. McCo, Jr. James C. Osen Steven Robicsek, MD PhD Thomas N. Roboz Geoffrey A. Rose, MD Joceyn S. Rose Karen R. Rossitch Joan E. Heineman-Schur Michae Schur, MD Theodore B. Sumner, Jr. Nan D. Van Every Heineman board members and participants join IMO staff in a catheterization aboratory opening in Managua, Nicaragua. Board of Medica & Technica Advisors John M. Fedor, MD Wiiam L. Aikens John Cedarhom, MD Dennis R. Chadwick Herman A. Godwin, Jr., MD Norris B. Harbod, Jr., MD Kevin W. Lobde, MD 14 Vounteers at the Heineman warehouse, where they assist with sorting and packaging donation equipment.

PARTNERS & DONORS Individua Donors Mr. & Mrs. Dan Aceti Dr. Firas Akassab Mr. & Mrs. Howard C. Bisse Michae Bair Mr. James Bostick Mr. Caude A. Bridges Mrs. Kathryn L. Bridges Dr. Wiiam Cadwe Dr. John Cedarhom Dr. John Fedor Mr. George Feming, Jr. Mr. Jeff Friedman Ann L. Harry Mr. Duke Kimbre Ms. Amy H. Lipshay Mrs. Frances W. Lumpkin Dr. & Mrs. JP McBryde Dr. John Merri Ms. Gisea Michaski Abert G. Myers, Jr. Mr. & Mrs. Fernando Paiz Dr. Geoffrey A. Rose Mr. & Mrs. Abert F. Soan Mr. Tommy Stephens Mrs. Captain Saem A Van Every, Jr. Mr. Stephen Wise Foundations & Corporations Bassett Furniture Industries Bracco Caroinas Coege of Heath Sciences Caroinas HeathCare Foundation Caroinas HeathCare System Chiquita Cordis Covidien Dickson Foundation Diworth Soup Kitchen Dover Foundation, Inc. Duke Reaty The Edwards Lifesciences Fund Fundación Sergio Paiz Andrade (FUNSEPA) GE Heathcare George W. Baxter Foundation Heineman Foundation for Research, Educationa, Charitabe and Scientific Purposes, Inc. Hendrick Motorsport Harris Teeter The Kittie & Abert Myers Fund Latin American Chamber of Commerce Charotte The Leon Levine Foundation Medtronic Microsoft, Inc. OrthoCaroina Ruth Paz Foundation Saud y Paz Sanger Heart & Vascuar Institute Smith Medica St. Jude Transtate Equipment Company The W. Duke Kimbre Famiy Foundation Pau & Eizabeth Younts Trust The FUNSEPA staff in Guatemaa pays an integra roe in the success of the Technoogy to Educate project. 15

I N T E R N A T I O N A L M E D I C A L O U T R E A C H P R O G R A M A N N U A L R E P O R T TECHNOLOGY TO EDUCATE I M P R O V I N G P U B L I C E D U C A T I O N, O N E S C H O O L A T A T I M E The IMO program s argest non-medica project, Technoogy to Educate, invoves computers. Since 2010, IMO has worked with Fundación Sergio Paiz Andrade (FUNSEPA) and Microsoft Corporation, to coect, donate and insta computers in Guatemaan pubic schoos. This incudes 19,000 pubic schoos, 95 percent of which ack access to technoogy. The computer aboratories instaed in pubic schoos hep both chidren and aduts in rura communities to thrive in today s digita society and workpace. Whie chidren use the computers at schoo during the day, parents and other aduts occupy the aboratories after schoo hours. Savador Paiz, President of FUNSEPA, and Jessica Hammer, Director of FUNSEPA. To receive computer donations, schoos must appy and meet certain criteria, such as having adequate space, eectricity and doors with ocks. The teachers aso must be wiing to participate in computer training. In 2012, IMO has donated more than 6,000 computers, with a goa of donating at east 15,000 more. FUNSEPA staff provide computer training for teachers in rura areas. Attendance at these trainings usuay exceeds 100 percent. One teacher deveoped math software from his trainings and won first pace at the Microsoft Innovative Teachers Forum. 16 A computer aboratory opening took pace in Chimatenango, Guatemaa, in August. Computers donated by IMO arrive to a Guatemaan warehouse, where FUNSEPA techs put fina touches on the equipment before distributing to pubic schoos.

Caroinas HeathCare System, one of the nation s eading and most innovative heathcare organizations, provides a fu spectrum of heathcare and weness programs throughout North and South Caroina. Its diverse network of care ocations incudes academic medica centers, hospitas, freestanding emergency departments, physician practices, surgica and rehabiitation centers, home heath agencies, nursing homes and behaviora heath centers, as we as hospice and paiative care services. Caroinas HeathCare System works to improve and enhance the overa heath and we-being of its communities through high quaity patient care, education and research programs, and numerous coaborative partnerships and initiatives. Since its estabishment in 1943, the Heineman Foundation of Charotte has pursued a variety of oca and internationa research and humanitarian projects focused on providing medica assistance and education. Located on the campus of Caroinas Medica Center in Charotte, NC, Heineman works cosey with Caroinas HeathCare System to provide medica training focused on cardiac care to heath providers overseas, as we as medica equipment and suppies to countries in need. Internationa Medica Outreach Program heineman.org or caroinasheathcare.org/imo 704.374.0505