2022-06-09T08:15:23-05:00 2021-07-31 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2020-08-01 263975185 PHOEBE SUMTER MEDICAL CENTER INC PHOE 2299246011 126 HWY 280 WEST AMERICUS GA 317198645 BRIAN CHURCH BOARD MEMBER/CFO 2299246011 2022-06-07 true BRIAN CHURCH 999009999 STEPHEN D HARRELL P01554887 2298837878 2022-06-07 X 2020 2022-09-23 18:48:47Z SUSAN BRUNS 126 HWY 280 WEST AMERICUS GA 317198645 114218867 false X WWW.PHOEBEHEALTH.COM X 2009 GA PROVIDING CHARITABLE HEALTHCARE ACTIVITIES. 13 9 605 67 0 1422368 7711958 82576326 88269998 1350632 3425788 2709093 5333996 88058419 104741740 17674 18745 0 27138995 33029501 0 0 55621142 62380613 82777811 95428859 5280608 9312881 148052662 158309975 23573767 18207954 124478895 140102021 X PROVIDING CHARITABLE HEALTHCARE ACTIVITIES. false false 74869212 18745 92681945 TO BE THE LEADING PROVIDER OF QUALITY, COST EFFECTIVE, PATIENT-CENTERED HEALTH CARE SERVICES TO RESIDENTS OF THE COMMUNITY, REGARDLESS OF ABILITY TO PAY. PSMC PURSUES ITS MISSION THROUGH A PATIENT-CENTERED ENVIRONMENT OF CARE REFLECTING HIGH STANDARDS AND PROMOTING A BALANCE OF PROFESSIONAL PREPARATION AND SERVICE, CONTINUOUS IMPROVEMENT BASED ON OUR CORE VALUES OF PEOPLE, RELATIONSHIPS, REPUTATION, EXCELLENCE, EFFICIENCY AND COMMITMENT. AS A RESULT OF THE COVID PANDEMIC, PSMC RECORDED THE VALUE OF DONATED SERVICES IN THE AMOUNT OF 1,638,980, AMOUNTS WHICH ARE NOT RECOGNIZED IN THE STATEMENT OF REVENUES OR STATEMENT OF FUNCTIONAL EXPENSES FOR TAX PURPOSES. 74869212 true true false true false false false false false true true false false false true true true true false false false false false false false false true true true false true false false false false false false false true false false false false false true false false false true 46 0 605 true false false false false false false false false false false false false X 13 9 false false false false true true true true true false false true true true true true true false false false GA X X BRIAN CHURCH 2293124068 PO BOX 3770 ALBANY GA 317063770 SCOTT STEINER BD MEMBER/PP 1.00 40.00 X X 0 820295 218327 JOE AUSTIN BD MBR LEFT 40.00 X 0 1356139 140990 BRIAN CHURCH BOARD MEMBER 1.00 55.00 X X 0 614157 163484 BRANDI LUNNEBORG CEO-LEFT 12/ 50.00 X 0 309043 98285 MICHELLE DOGGETT DIRECTOR OF 50.00 X 102889 0 26680 SUSAN BRUNS CNO/PSMC CEO 50.00 X 0 140533 21134 ROBBIE LATIMORE EDD CHAIRMAN 1.00 X X 0 0 0 FREDRICK MCLAUGHLIN EDD VICE CHAIR 1.00 X X 0 0 0 KRISTIN COLLIER MD BD MEM/CHF O 1.00 40.00 X 0 431279 30916 DALE LAWSON MD BOARD MEMBER 1.00 X 102960 314068 0 SANDRA LEE ZORNES MD BOARD MEMBER 1.00 X 0 0 0 EDWARD F JACKSON JR BOARD MEMBER 1.00 X 0 0 0 SANDRA DANIEL BOARD MEMBER 1.00 X 0 0 0 G BARDIN HOOKS JR BOARD MEMBER 1.00 X 0 0 0 JOHN CRISP BOARD MEMBER 1.00 X 0 0 0 TARANG VIC PATEL BOARD MEMBER 1.00 X 0 0 0 ALTON MARCUS SR BOARD MEMBER 1.00 X 0 0 0 DARRYL HAWKINS PHARMACY DIR 40.00 1.00 X 148832 5460 31992 CHRISTY HARDIN ASST. DIR PH 40.00 X 161153 0 4465 LORI PAYNE PHARMACIST 40.00 1.00 X 149159 750 25410 SUSAN JOHNSON PHARMACIST 40.00 X 146478 0 29666 DEBORAH MCWILLIAMS REGISTERED N 40.00 X 168513 0 4949 979984 3991724 796298 18 true true false MEDICAL SOLUTIONS LLC PO BOX 310737 DES MOINES IA 50331 STAFFING SVCS 1417402 INNOVATIVE THERAPY CONCEPTS LLC 2 MASHBURN ST SUITE 102 HAWKINSVILLE GA 31036 THERAPY 1361776 SENTRY ANESTHESIA MANAGEMENT LLC 80 NEWNAN STATION DRIVE SUITE A NEWNAN GA 302653194 ANESTHESIA SVCS 1308211 HEALTH CAROUSEL LLC P O BOX 714216 CINCINNATI OH 452714216 HEALTH STAFF 921521 GEORGIA PREMIER SONOGRAPHY 213 TRADERS PASS WARNER ROBINS GA 310882211 ULTRASOUND SVCS 489886 12 17745 6636630 1057583 7711958 PROGRAM SERVICE REVENUE 623000 88269998 88269998 88269998 871100 871100 1018732 67139 951593 951593 951593 11964676 9409988 2554688 2554688 860286 1694402 340B PROGRAM 621990 2465198 2465198 MIGRANT HEALTH REVENUE 621990 810333 810333 EMPLOYEE PHARMACY REVENUE 621990 495505 495505 611367 276130 335237 4382403 104741740 92681945 4347837 X 18745 18745 232529 102960 129569 22611043 19503128 3107915 457029 394188 62841 8105110 6990657 1114453 1623790 1363765 260025 11200 11200 111980 111980 159636 159636 32493636 22636997 9856639 125067 125067 2442008 2153992 288016 373727 188030 185697 1203625 638884 564741 74345 54584 19761 58011 57543 468 3751459 1991274 1760185 1147256 1147256 MEDICAL SUPPLIES 17229740 17229339 401 REPAIRS & MAINTENANCE 1860761 1456391 404370 PROVIDER TAX 705316 705316 LICENSES 294664 60222 234442 338182 28513 309669 95428859 74869212 20559647 0 46625351 45281308 11869665 12671977 10857 10857 1638282 2093023 196888 318973 84032557 37769801 45679605 46262756 37511307 45663064 4520707 6008017 148052662 158309975 6822497 8506670 1111736 956832 15639534 8744452 23573767 18207954 X 120478895 136102021 4000000 4000000 124478895 140102021 148052662 158309975 X 9312881 5806298 503947 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 4348 4348 false SCHEDULE C, PART II-B, LINE 1 PART II-B, LINE 1I THE ORGANIZATION PAYS MEMBERSHIP DUES TO A NATIONAL HEALTHCARE ORGANIZATION. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THE NATIONAL HEALTHCARE ORGANIZATION PARTICIPATE. 4000000 4000000 4000000 4000000 4000000 4000000 4000000 4000000 4000000 4000000 1.00000 false false 2039360 2039360 52814334 19577062 33237272 27518729 18192739 9325990 617381 617381 45220003 CARES ACT REFUNDABLE ADVANCE 6216939 RELATED PARTY PAYABLES 2527513 8744452 X 112236412 5806298 1638980 7445278 104791134 -49394 -49394 104741740 97134978 1638980 67139 1706119 95428859 95428859 SCHEDULE D, PAGE 2, PART V, LINE 4 DURING FISCAL YEAR 2007, SUMTER REGIONAL HOSPITAL, AS OPERATED BY THE AUTHORITY, WAS DESTROYED IN A TORNADO. THE AMERICUS-SUMTER COUNTY HOSPITAL AUTHORITY (AUTHORITY) ENTERED INTO A LEASE AND TRANSFER AGREEMENT WHICH INCLUDED THE CONSTRUCTION OF A NEW HOSPITAL FACILITY. THE AUTHORITY HAS RECEIVED PROCEEDS FROM THE FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA) AND THE GEORGIA EMERGENCY MANAGEMENT AGENCY (GEMA) FOR A PORTION OF THE CONSTRUCTION COSTS OF THE NEW HOSPITAL AND INTENDS TO PURSUE FURTHER REIMBURSEMENT FROM FEMA AND GEMA TO THE FULLEST EXTENT POSSIBLE. IT IS ANTICIPATED, BASED ON GUIDANCE RECEIVED FROM AN INDEPENDENT CONSULTANT, THAT THE PROJECT AUDITS ARE LIKELY TO BE CONDUCTED BY FEMA AND GEMA ONCE ALL OUTSTANDING CLAIMS ARE CLOSED, WHICH COULD RESULT IN DEMAND(S) TO RECOVER A PORTION OF THE FUNDS PAID TO THE AUTHORITY. EFFECTIVE WITH AN AMENDMENT TO THE LEASE AND TRANSFER AGREEMENT (AMENDMENT) DATED SEPTEMBER 27, 2016, THE AUTHORITY TRANSFERRED APPROXIMATELY 11,745,000 OF RECEIPTS FROM FEMA AND GEMA TO THE HOSPITAL. THE AMENDMENT SPECIFIES THAT THE FEMA AND GEMA FUNDS MAY BE USED FOR THE FOLLOWING PURPOSES: .... FIRST, TO PAY FEMA AND GEMA ALL SUMS DETERMINED TO BE OWED AS A RESULT OF ANY AUDITS. .... SECOND, AND ONLY AFTER ADEQUATE PROVISION FOR THE FUNDING OF THE FIRST BULLET POINT, THE FUNDS CAN BE USED TO FUND PHYSICIAN DEVELOPMENT IN THE HOSPITALS SERVICE AREA. .... THIRD, AND ONLY AFTER ADEQUATE PROVISION FOR THE FIRST TWO BULLET POINTS ABOVE, THE FUNDS CAN BE USED BY THE HOSPITAL FOR ANY PURPOSES PERMITTED UNDER THE LEASE AND TRANSFER AGREEMENT. ALSO IN ACCORDANCE WITH THE AMENDMENT, THE HOSPITAL AGREED TO ESTABLISH A SEPARATE ACCOUNT TO HOLD THE SUM OF 4,000,000 OF THE ABOVE FUNDS UNTIL THE CONCLUSION OF THE EXPECTED FEMA AND GEMA AUDITS TO ENSURE THE IMMEDIATE AVAILABILITY OF FUNDS TO REPAY ANY AMOUNTS FINALLY DETERMINED TO BE OWED TO FEMA AND GEMA AS A RESULT OF THE AUDITS. SHOULD THE 4,000,000 NOT BE SUFFICIENT TO REPAY ANY AMOUNTS DUE TO FEMA AND GEMA, THE HOSPITAL AGREES THAT IT WILL PAY IN FULL AND FULLY INDEMNIFY THE AUTHORITY FOR ALL RELATED SUMS FINALLY DETERMINED TO BE OWED TO FEMA AND GEMA. THE AMENDMENT STATES THAT THE ADEQUATE PROVISION OF BOTH THE FEMA AND GEMA FUND REPAYMENT AND THE ADEQUATE PROVISION TO FUND PHYSICIAN DEVELOPMENT ARE TO BE DETERMINED AT THE SOLE DISCRETION OF THE HOSPITAL. PER A HOSPITAL BOARD OF DIRECTORS RESOLUTION DATED NOVEMBER 1, 2016, THE HOSPITAL BELIEVES THE 4,000,000 IS ADEQUATE PROVISION FOR THE REPAYMENT OF THE FEMA AND GEMA FUNDS. ALSO, BASED ON THE CURRENT AND LONG-TERM PHYSICIAN DEVELOPMENT PLAN, COUPLED WITH THE REQUIREMENT THAT THE HOSPITAL CHIEF EXECUTIVE OFFICER REPORT ON THE EFFORTS AND RESULTS OF PHYSICIAN DEVELOPMENT AT EACH BOARD OF DIRECTORS MEETING, AND THE REQUIREMENT THAT THE HOSPITALS BOARD OF DIRECTORS APPROVE THE BUDGET AND STRATEGIC PLAN EACH YEAR, THE HOSPITAL BELIEVES THIS CONSTITUTES ADEQUATE PROVISION FOR THE FUNDING OF PHYSICIAN DEVELOPMENT. SCHEDULE D, PAGE 3, PART X THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE HOSPITAL ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEETS FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JULY 31, 2021 AND 2020 OR FOR THE YEARS THEN ENDED. THE HOSPITAL'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. SCHEDULE D, PAGE 4, PART XI, LINE 4B RENTAL EXPENSES -67,139 CAPITAL CONTRIBUTION 17,745 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 67,139 true true X true X 1.250000000000 true X true true false true true 4070714 4070714 0.04260 18041586 16291467 1750119 0.01830 22112300 16291467 5820833 0.06090 85667 85667 0.00090 10620204 8686719 1933485 0.02020 239826 239826 0.00250 10945697 8686719 2258978 0.02360 33057997 24978186 8079811 0.08450 true 17872985 13575559 16016128 -2440569 X true true 1 1 PHOEBE SUMTER MEDICAL CENTER INC 126 HIGHWAY 280 WEST AMERICUS GA 31719 WWW.PHOEBEHEALTH.COM 129-663 X X X HOSPICE, RHC PHOEBE SUMTER MEDICAL CENTER INC 1 false false true X X X X X X X X X X 19 true false false true X WWW.PHOEBEHEALTH.COM X true 19 true WWW.PHOEBEHEALTH.COM false false true X 125.000000000000 400.000000000000 X X X X X true true X X X X true X WWW.PHOEBEHEALTH.COM X WWW.PHOEBEHEALTH.COM X WWW.PHOEBEHEALTH.COM X X X X X X true X false X X X X X true X false false FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 3E THE PRIORITIZATION OF SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IS IDENTIFIED AND THE METHODOLOGY FOR PRIORITIZING EACH NEED IS DESCRIBED ON PAGES 28 AND 29 OF THE 2019 CHNA. FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 5 THE INTERNAL ASSESSMENT TEAM, 23 MEMBERS IN ALL, WAS A BLEND OF HOSPITAL STAFF, AND STRATEGIC COMMUNITY PARTNERS LOCATED IN SUMTER COUNTY, GA. EARLY ON, HOSPITAL LEADERSHIP MADE THE DECISION TO USE THE MULTIPLE ORGANIZATION PARTNERSHIP MODEL AS THE APPROACH TO DETERMINE HOW THE COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE CONDUCTED. THIS APPROACH ENGAGES MULTIPLE ORGANIZATIONS, PROVIDES A BROADER FOCUS, AND ALLOWS GREATER INPUT IN NEED IDENTIFICATION AND DETERMINING APPROPRIATE STRATEGY FOR ACTION. MEMBERS OF THE INTERNAL ASSESSMENT TEAM PERFORMED KEY LEADER INTERVIEWS, THE PURPOSE OF WHICH WAS TO GATHER INFORMATION, GAIN KNOWLEDGE AND RECEIVE INPUT REGARDING HEALTH ISSUES FACING THE ORGANIZATION'S SERVICE AREA. THE INTERVIEW SELECTION PROCESS WAS CAREFUL TO INCLUDE REPRESENTATION THAT REFLECTS THE MAKE-UP OF PATIENTS RECEIVING SERVICES IN THE ORGANIZATION'S SERVICE AREA (RELIGIOUS, MEDICAL PRACTICES, COMMUNITY VOLUNTEERS, BUSINESS, POLITICAL, PUBLIC HEALTH, AND THE ELDERLY). FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 11 THE CATHOLIC HEALTH ASSOCIATION'S SELECTION FILTER WAS USED AS A MEANS TO PRIORITIZE COMPETING SIGNIFICANT NEEDS. ANY NEEDS NOT ADDRESSED AS PRIORITIES WERE DUE TO LACK OF RESOURCES OR IS A NEED MORE EFFICIENTLY ADDRESSED BY OTHER COUNTY AGENCIES. SEE PAGE 7 OF THE IMPLEMENTATION STRATEGY FOR MORE DETAILS. A COMPLETE COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY PRIORITIES, AND IMPLEMENTATION PLAN CAN BE FOUND AT HTTP://WWW.PHOEBEHEALTH.COM/LOCATIONS/PHOEBE-SUMTER-MEDICAL-CENTER/PHOEBE- SUMTER-MEDICAL-CENTER-CHNA FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 20E WRITTEN NOTICE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE IS INCLUDED ON HOSPITAL PATIENT STATEMENTS, AND ON WRITTEN COMMUNICATIONS SENT BY CONTRACTED THIRD PARTY COLLECTION AGENCIES. THESE AGENCIES MAY REFER ACCOUNTS FOR REPORTING TO MAJOR CREDIT BUREAUS, AFTER A SERIES OF STATEMENTS AND LETTERS ARE SENT THROUGHOUT MULTIPLE COLLECTION CYCLES. 2 PHOEBE SUMTER HOSPICE 126 HWY 280 WEST AMERICUS GA 31719 HOSPICE ELLAVILLE PRIMARY MEDICINE 72 BROAD STREET ELLAVILLE GA 31806 RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 7, COLUMN (F) IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 95,428,859 ADD: EXPENSES REPORTED IN PART VIII 67,139 DENOMINATOR FOR COLUMN (F) 95,495,998 SCHEDULE H, PART I, LINE 7 THE COST OF MEDICAID AND CHARITY CARE WAS CALCULATED USING THE COST-TO- CHARGE RATIO AS CALCULATED USING WORKSHEET 2 FROM THE IRS FORM 990 INSTRUCTIONS. THE COST OF OTHER BENEFITS WAS THE DIRECT COST OF THE SERVICES. SCHEDULE H, PART III, LINE 2 AMOUNTS INCLUDED ON PART III, LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. SCHEDULE H, PART III, LINE 4 SEE FOOTNOTE 2 PAGES 14-19 ON THE ACCOMPANYING AUDITED FINANCIAL STATEMENTS FOR THE DISCUSSION OF IMPLICIT PRICE CONCESSIONS, BAD DEBT EXPENSE, AND UNINSURED PATIENTS. SCHEDULE H, PART III, LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. SCHEDULE H, PART III, LINE 9B THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES FOR PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENTS HAVE TRADITIONALLY LED TO THE CREATION OF COMMUNITY-BASED DELIVERY SYSTEMS THAT EXPAND ACCESS TO HEALTH CARE, MEET THE NEEDS OF THE PEOPLE AND BUILD HEALTHY COMMUNITIES IN THE BROADEST SENSE BY IMPACTING MAJOR DETERMINANTS, SUCH AS ECONOMIC DEVELOPMENT, EMPLOYMENT, CHILDREN'S SAFETY, EDUCATION AND ADEQUATE HOUSING. THE ORGANIZATION CONDUCTS REGULAR NEEDS ASSESSMENT THROUGH FORMAL AND INFORMAL SURVEYS AND PROCESSES, INCLUDING COLLABORATIONS WITH PUBLIC AND COMMUNITY AGENCIES. THROUGH STRATEGIC PLANNING AND COMMUNITY INTERVIEWS, THE ORGANIZATION DEVELOPS PROGRAMS AND SERVICES THAT CONSIDER THE ECONOMIC IMPERATIVES OF THE REGION, THE EFFECT OF LEGISLATION AND THE INVOLVEMENT OF OTHER COMMUNITY-BASED ORGANIZATIONS AND PARTNERS. THE ORGANIZATION REGULARLY CONDUCTS FOCUS GROUPS IN THE COMMUNITY TO UNDERSTAND ISSUES AFFECTING ITS PATIENTS, AND HAS CREATED PROGRAMS IN RESPONSE TO HEALTH DISPARITIES PREVALENT IN THE AREA. THE ORGANIZATION ALSO COLLECTS HEALTH NEEDS INFORMATION FROM NURSES, WHO PROVIDE DIRECT CARE TO STUDENTS AND STAFF AND WHO COLLABORATE WITH OTHER AGENCIES TO DEVELOP HEALTH AWARENESS AND DISEASE PREVENTION PROGRAMS. THE ORGANIZATION ALSO CONDUCTS REGULAR PHYSICIAN WORKFORCE STUDIES THROUGH ITS STRATEGIC PLANNING ARM TO DETERMINE UNMET PHYSICIAN NEEDS AND BARRIERS TO ACCESSING CARE. THE ORGANIZATION MEASURES THE SUCCESS OF ITS COMMITMENT BY HOW WELL IT KEEPS PEOPLE HEALTHY AND HOW WELL IT IMPACTS THE SOCIAL/CULTURAL BONDS THAT WILL SECURE THE COMMUNITIES OF THE FUTURE. THE HOSPITAL LAST CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2019. A COMPLETE COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY PRIORITIES, AND IMPLEMENTATION PLAN CAN BE FOUND AT HTTP://WWW.PHOEBEHEALTH.COM/LOCATIONS/PHOEBE-SUMTER-MEDICAL-CENTER/PHOEBE- SUMTER-MEDICAL-CENTER-CHNA SCHEDULE H, PART VI, LINE 3 THE BOARD HAS CLEARLY WRITTEN FINANCIAL ASSISTANCE POLICY THAT IS AVAILABLE ON THE ORGANIZATION'S WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND CHARITY CARE. PATIENT EDUCATION ON THE ORGANIZATION'S FINANCIAL ASSISTANCE IS CONDUCTED DURING PRE-REGISTRATION, THROUGH FLOOR VISITS BY BUSINESS OFFICE REPRESENTATIVES FOR PATIENTS THAT STRESS CONCERN IN MEETING THE FINANCIAL OBLIGATIONS FOR THEIR SERVICES, AND THROUGH OUR CUSTOMER SERVICE DEPARTMENT. BROCHURES ARE PROMINENTLY DISPLAYED AT EACH REGISTRATION BOOTH. THE BUSINESS OFFICE CONTINUOUSLY PROVIDES UPDATED MATERIAL TO PHYSICIAN OFFICES FOR ISSUANCE TO THEIR PATIENTS THAT HIGHLIGHT THE FINANCIAL ASSISTANCE PROGRAM AND POLICIES. THE PATIENT STATEMENTS HIGHLIGHT THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND ENCOURAGES PATIENTS TO CALL FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART VI, LINE 4 PSMC IS LOCATED IN SUMTER COUNTY, GEORGIA. THERE ARE APPROXIMATELY 32,819 RESIDENTS OF SUMTER COUNTY WITH A RACIAL MIX OF 52% AFRICAN AMERICAN AND 42% CAUCASIAN. POPULATION PROJECTIONS FOR SUMTER COUNTY SHOW OVERALL POPULATION LOSS IN THE NEXT FEW YEARS, WITH AGES 65+ HAVING THE GREATEST GROWTH RATE. THE HOUSEHOLD MEDIAN INCOME FOR SUMTER COUNTY AVERAGED 32,430 IN 2010, AND ABOUT 21.7% OF FAMILIES AND 26.9% OF THE POPULATION WERE BELOW THE POVERTY LINE. IN ADDITION TO SUMTER COUNTY, PSMC HAS A SERVICE AREA THAT INCLUDES MARION, MACON, DOOLY, STEWART, WEBSTER, SCHLEY AND TAYLOR COUNTIES. PSMC HAS A GOOD RELATIONSHIP WITH THESE COUNTIES, AND IMPLEMENTED A REGIONAL ADVISORY COUNCIL IN 2015 TO BETTER SERVE THE NEEDS OF THESE COMMUNITIES AND THEREFORE PRACTICE A TRUE POPULATION HEALTH METHODOLOGY. SCHEDULE H, PART VI, LINE 5 THE ORGANIZATION AND ITS VOLUNTEER BOARD IS COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS, AS WELL AS PHYSICIAN MEMBERS. THE ORGANIZATION'S EMERGENCY CENTER IS OPERATED 24/7 AND OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. THE BOARD MAINTAINS OPEN MEDICAL STAFF POLICIES WITH PRIVILEGES AVAILABLE TO ALL QUALIFYING PHYSICIANS. THE BOARD HAS A CLEARLY WRITTEN FINANCIAL ASSISTANCE POLICY THAT IS AVAILABLE ON THE ORGANIZATION'S WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND CHARITY CARE. THE ORGANIZATION HAS A MULTI-PRONGED APPROACH TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES: INCREASING ACCESS, BUILDING CAPACITY, INVESTING IN "UPSTREAM" PROGRAMS THAT GET AT THE CAUSE OF DISEASE AND ILLNESS, BUILDING COMMUNITY PARTNERSHIPS, ADVOCATING CHANGE, AND DEVELOPING LEADERSHIP. SURPLUS FUNDS ARE REINVESTED IN RESOURCES TO IMPROVE THE DELIVERY OF MEDICAL AND HEALTH CARE SERVICES. PRIMARY CARE IS FIRST AND CREATES A PROFOUND IMPACT ON THE COMMUNITIES SERVED. PRIMARY CARE SERVICES ARE ESTABLISHED IN AREAS WHERE RESIDENTS ARE MOST LIKELY TO SUFFER FROM SEVERE MANPOWER SHORTAGES, HIGH POVERTY LEVELS AND A LACK OF ACCESS TO CARE. SCHEDULE H, PART VI, LINE 6 PHOEBE PUTNEY HEALTH SYSTEM, INC. (PPHS) IS THE NOT-FOR-PROFIT PARENT COMPANY OF PHOEBE PUTNEY MEMORIAL HOSPITAL, INC. (PPMH), A NOT-FOR-PROFIT ENTITY, PHOEBE PUTNEY HEALTH VENTURES, INC. (PPHV), A FOR-PROFIT CORPORATION, PHOEBE PHYSICIAN GROUP, INC. (PPG), A NOT-FOR-PROFIT CORPORATION, PHOEBE WORTH MEDICAL CENTER, INC. (PWMC), A NOT-FOR-PROFIT ENTITY, PHOEBE SUMTER MEDICAL CENTER, INC. (PSMC), A NOT-FOR-PROFIT ENTITY, PHOEBE PUTNEY INDEMNITY, LTD. (PPI), A WHOLLY-OWNED SUBSIDIARY,AND PHOEBE FOUNDATION, INC. (PF), A NOT-FOR-PROFIT ENTITY. PPMH IS LOCATED IN ALBANY, GEORGIA, IS AN ACUTE CARE HOSPITAL, WHICH OPERATES SATELLITE CLINICS IN THE SURROUNDING COUNTIES. IT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SOUTHWEST GEORGIA. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. PPHV ENGAGES IN HEALTHCARE AND RELATED ACTIVITIES IN FURTHERANCE OF THE EXEMPT PURPOSES OF PPHS AND PPMH. PWMC, LOCATED IN SYLVESTER, GEORGIA, IS A 25 BED RURAL CRITICAL ACCESS HOSPITAL. IT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WORTH COUNTY, GEORGIA. PSMC, LOCATED IN AMERICUS, GEORGIA, IS AN ACUTE CARE HOSPITAL. IT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SUMTER COUNTY, GEORGIA. PPG WAS ESTABLISHED TO ORGANIZE AND OPERATE MEDICAL PRACTICES EXCLUSIVELY FOR THE BENEFIT OF PPMH, PWMC, AND PSMC. PPI WAS INCORPORATED ON NOVEMBER 14, 2018 AS AN EXEMPTED COMPANY UNDER THE COMPANIES LAW OF THE CAYMAN ISLANDS. PPI IS A WHOLLY-OWNED SUBSIDIARY OF PPHS ESTABLISHED TO PROVIDE GENERAL LIABILITY, PROFESSIONAL LIABILITY, PERSONAL INJURY LIABILITY, ADVERTISING INJURY LIABILITY, CONTRACTUAL LIABILITY, AND AUTO PHYSICAL DAMAGE COVERAGE TO PPHS. PF WAS ESTABLISHED TO RAISE FUNDS OF ANY KIND OR CHARACTER TO BE USED EXCLUSIVELY FOR CHARITABLE, MEDICAL, EDUCATIONAL AND SCIENTIFIC PURPOSES AT OR IN CONNECTION WITH PPMH OR THE HOSPITAL AUTHORITY OF ALBANY-DOUGHERTY COUNTY, GEORGIA (AUTHORITY). SUMTER REGIONAL HOSPITAL FOUNDATION, INC. WAS ESTABLISHED TO RAISE FUNDS TO SUPPORT PSMC. SUMTER REGIONAL HOSPITAL FOUNDATION, INC.'S BYLAWS PROVIDE THAT THE MAJORITY OF ALL FUNDS RAISED, EXCEPT FOR FUNDS ACQUIRED FOR THE OPERATION OF THE FOUNDATION, BE DISTRIBUTED TO OR BE HELD FOR THE BENEFIT OF THE HOSPITAL. SCHEDULE H, PART VI, LINE 7 GEORGIA SCHEDULE H, PART VI PHOEBE SUMTER MEDICAL CENTER, INC. (PSMC), FORMERLY SUMTER REGIONAL HOSPITAL, IS A NOT-FOR-PROFIT HEALTH CARE ORGANIZATION THAT EXISTS TO SERVE THE COMMUNITY. PSMC OPENED IN 1953 TO SERVE THE COMMUNITY BY CARING FOR THE SICK REGARDLESS OF THEIR ABILITY TO PAY. AS A NOT-FOR-PROFIT HOSPITAL, PSMC HAS NO STOCKHOLDERS OR OWNERS. ALL REVENUE AFTER EXPENSES IS REINVESTED IN THE MISSION TO CARE FOR THE CITIZENS OF THE COMMUNITY - INTO CLINICAL CARE, HEALTH PROGRAMS, STATE-OF-THE-ART TECHNOLOGY AND FACILITIES, RESEARCH, AND TEACHING AND TRAINING OF MEDICAL PROFESSIONALS NOW AND FOR THE FUTURE. PSMC OPERATES AS A CHARITABLE ORGANIZATION CONSISTENT WITH THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(C)(3) AND THE "COMMUNITY BENEFIT STANDARD" OF IRS REVENUE RULING 69-545. PSMC TAKES SERIOUSLY ITS RESPONSIBILITY AS THE COMMUNITY'S SAFETY NET HOSPITAL AND HAS A STRONG RECORD OF MEETING AND EXCEEDING THE CHARITABLE CARE AND THE ORGANIZATIONAL AND OPERATIONAL STANDARDS REQUIRED FOR FEDERAL TAX-EXEMPT STATUS. PSMC DEMONSTRATES A CONTINUED AND EXPANDING COMMITMENT TO MEETING ITS MISSION AND SERVING THE CITIZENS BY PROVIDING COMMUNITY BENEFITS. A COMMUNITY BENEFIT IS A PLANNED, MANAGED, ORGANIZED, AND MEASURED APPROACH TO MEETING IDENTIFIED COMMUNITY HEALTH NEEDS, REQUIRING A PARTNERSHIP BETWEEN THE HEALTHCARE ORGANIZATION AND THE COMMUNITY TO BENEFIT RESIDENTS THROUGH PROGRAMS AND SERVICES THAT IMPROVE HEALTH STATUS AND QUALITY OF LIFE. PSMC IMPROVES THE HEALTH AND WELL BEING OF SOUTHWEST GEORGIA THROUGH CLINICAL SERVICES, EDUCATION, RESEARCH, AND PARTNERSHIPS THAT BUILD HEALTH CAPACITY IN THE COMMUNITY. PSMC PROVIDES COMMUNITY BENEFITS FOR ALL CITIZENS, AS WELL AS FOR THE MEDICALLY UNDERSERVED. PSMC CONDUCTS COMMUNITY NEEDS ASSESSMENTS AND PAYS CLOSE ATTENTION TO THE NEEDS OF LOW INCOME AND OTHER VULNERABLE PERSONS AND THE COMMUNITY AT LARGE. PSMC OFTEN WORKS WITH COMMUNITY GROUPS TO IDENTIFY NEEDS, STRENGTHEN EXISTING COMMUNITY PROGRAMS, AND PLAN NEWLY NEEDED SERVICES. IT PROVIDES A WIDE- RANGING ARRAY OF COMMUNITY BENEFIT SERVICES DESIGNED TO IMPROVE COMMUNITY HEALTH AND THE HEALTH OF INDIVIDUALS AND TO INCREASE ACCESS TO HEALTH CARE, IN ADDITION TO PROVIDING FREE AND DISCOUNTED SERVICES TO PEOPLE WHO ARE UNINSURED AND UNDERINSURED. DRAWING ON A DYNAMIC AND FLEXIBLE STRUCTURE, THE COMMUNITY BENEFIT PROGRAMS ARE DESIGNED TO RESPOND TO ASSESSED NEEDS AND ARE FOCUSED ON UPSTREAM PREVENTION. PSMC PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS AND IS ONE OF THE LEADING PROVIDERS OF MEDICAID SERVICES IN GEORGIA. THE FOLLOWING TABLE SUMMARIZES THE AMOUNTS OF CHARGES FOREGONE (I.E., CONTRACTUAL ADJUSTMENTS) AND ESTIMATES THE LOSSES (COMPUTED BY APPLYING A TOTAL COST FACTOR TO CHARGES FOREGONE) INCURRED BY PSMC DUE TO INADEQUATE PAYMENTS BY THESE PROGRAMS AND FOR INDIGENT/CHARITY SERVICES. THIS TABLE DOES NOT INCLUDE DISCOUNTS OFFERED BY PSMC UNDER MANAGED CARE AND OTHER AGREEMENTS: CHARGES ESTIMATED FOREGONE UNREIMBURSED COST MEDICARE 114,000,000 35,000,000 MEDICAID 46,000,000 14,000,000 INDIGENT/CHARITY 15,000,000 4,000,000 175,000,000 53,000,000 THE FOLLOWING IS A SUMMARY OF THE COMMUNITY BENEFIT ACTIVITIES AND HEALTH IMPROVEMENT SERVICES OFFERED BY PSMC AND ILLUSTRATES THE ACTIVITIES AND DONATIONS DURING FISCAL YEAR 2021. I. COMMUNITY HEALTH IMPROVEMENT SERVICES DUE TO THE COVID-19 PANDEMIC, MANY OF PSMC'S ANNUAL COMMUNITY HEALTH EDUCATION PROGRAMS WERE CANCELLED. HOWEVER, PSMC DID HOST THE FOLLOWING EVENT: NUMBER OF EVENT DATE PARTICIPANTS BACK TO SCHOOL MINI HEALTH 7/24/2021 100 DURING 2020/2021, PSMC KICKED OFF THE HEALTHY SUMTER INITIATIVE. HEALTHY SUMTER IS HEALTH AND WELLNESS CAMPAIGN THAT IS A COLLABORATIVE EFFORT CO- CONVENED BY PSMC AND THE ONE SUMTER ECONOMIC DEVELOPMENT FOUNDATION. WITH MORE THAN 25 ORGANIZATIONS AND COUNTING, HEALTHY SUMTER IS A SIMPLE BRAND, ALIGNED WITH THE SUMTER COUNTY BRAND, UNDER WHICH EFFORTS OF MANY NON- PROFITS AND AGENCIES CAN BE ORGANIZED TO RAISE PUBLIC AWARENESS. AREAS OF FOCUS FALL UNDER 3 CATEGORIES: HEALTHY MINDS (I.E. MENTAL HEALTH AWARENESS, LITERACY, ETC.); HEALTHY BODIES (COLORECTAL CANCER AWARENESS, OVERALL FITNESS, ETC.); HEALTHY COMMUNITY (BIKE & TRAIL ACCESS AND OTHER TRANSPORTATION, JOBS AVAILABILITY, HOUSING, CRIME PREVENTION, ETC.). THE HEALTHY SUMTER INITIATIVE HAS CREATED A NUMBER OF ACTIVITIES AND CAUSES SO FAR, INCLUDING THE MASK UP SUMTER CAMPAIGN AND THE FOOD DISTRIBUTION CAMPAIGN TO COMMUNITIES IN NEED. SO FAR, MORE THAN 600 INDIVIDUALS HAVE RECEIVED A BAG OF FRESH FRUITS AND VEGETABLES UNDER THIS INITIATIVE, AND THERE ARE MORE PLANS IN THE FUTURE. THE WELLABLE APP IS AN OPPORTUNITY FOR LOCAL COMMUNITY MEMBERS TO TRACK THEIR PHYSICAL ACTIVITIES AS WELL AS LEARN ABOUT AND ENGAGING IN BEHAVIORS ASSOCIATED WITH A NEW HOLISTIC WELLNESS TOPIC EACH MONTH. PARTICIPANTS ALSO HAVE AN OPPORTUNITY TO EARN POINTS THAT CAN BE REDEEMED FOR HEALTHY SUMTER SWAG SUCH AS WATER BOTTLES, TUMBLERS AND T-SHIRTS. SUMTER COUNTY HAS A HIGH RATE OF FOOD INSECURITY, WHICH IS ASSOCIATED WITH CHRONIC HEALTH PROBLEMS IN ADULTS INCLUDING DIABETES, HEART DISEASE, HIGH BLOOD PRESSURE, OBESITY AND MENTAL HEALTH ISSUES INCLUDING MAJOR DEPRESSION. ALSO, SUMTER COUNTY A HIGH NUMBER OF FOOD DESERTS, MEANING THAT RESIDENTS IN THOSE RESPECTIVE AREAS HAVE LITTLE OR NO ACCESS TO FRESH FRUITS AND VEGETABLES. WITH THESE FACTS IN MINDS, THE IDEA OF CREATING COMMUNITY GARDENS IN SUMTER AND SURROUNDING AREAS CAME TO PASS. ON OCTOBER 31, 2020, PSMC WAS ABLE TO HOLD A RIBBON CUTTING FOR ITS FIRST HEALTHY SUMTER COMMUNITY GARDEN, AT BROOKDALE PARK. THE GARDEN HAS PRODUCED A NUMBER OF CROPS SUCH AS TOMATOES, BROCCOLI AND COLLARDS, AND MANY MEMBERS OF THE COMMUNITIES AROUND THE GARDEN HAVE PARTAKEN IN USING THE HARVEST. IT IS HARD TO QUANTIFY A NUMBER AS THE GARDEN IS OPEN ALL THE TIME BUT IT IS SAFE TO SAY THE NUMBER IS IN THE HUNDREDS. IN THE FUTURE, PSMC'S PLAN IS TO HAVE ADDITIONAL GARDENS IN SUMTER COUNTY AS WELL AS GARDENS IN NEIGHBORING COUNTIES. THE TOTAL COST OF THESE PROJECTS FOR FY2021 WAS 239,826.36. II. HEALTH CARE SUPPORT SERVICES PSMC WILL EXTEND FREE OR DISCOUNTED CARE TO ELIGIBLE INDIVIDUALS FOR ALL URGENT, EMERGENT, OR OTHERWISE MEDICALLY NECESSARY SERVICES. PATIENTS WHOSE HOUSEHOLD INCOME IS AT OR BELOW 125% OF THE FEDERAL POVERTY GUIDELINES ARE ELIGIBLE FOR FREE CARE. PATIENTS WHOSE HOUSEHOLD INCOME IS BETWEEN 126% AND 400% OF THE FEDERAL POVERTY GUIDELINES QUALIFY FOR DISCOUNTED CHARGES BASED ON A SLIDING FEE SCHEDULE IN THE FAP. PSMC WILL NOT CHARGE ELIGIBLE INDIVIDUALS MORE FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE THAN THE AMOUNT GENERALLY BILLED (AGB) TO INDIVIDUALS WHO HAVE INSURANCE COVERAGE, AND IS COMPLIANT WITH THE REQUIREMENTS FOR A NOT- FOR-PROFIT CHARITABLE CORPORATION IN ACCORDANCE WITH INTERNAL REVENUE SERVICE REGULATION 1.501(R). DURING FISCAL YEAR 2021, 349 PATIENTS WERE APPROVED FOR FINANCIAL ASSISTANCE. III. COMMUNITY BENEFIT OPERATIONS PSMC INCURRED 85,667 IN SUPPORT STAFF COSTS TO SUPPORT ITS COMMUNITY BENEFIT EFFORTS. true ONE SUMTER ECONOMIC DEVLPMT FND INC PO BOX 6714 AMERICUS GA 317096714 471453325 501C3 15000 COLLEGE/CAREER ACDMY 1 SCHEDULE I, PAGE 1, PART I, LINE 2 THE ORGANIZATION PROVIDES OVERSIGHT AND MONITORS THE PROGRAM BASED ON UTILIZATION EACH BUDGET YEAR. false true false false false false false false false SCOTT STEINER BD MEMBER/PPHS CEO 698914 100000 21381 191151 27176 1038622 JOE AUSTIN BD MBR LEFT 2019/CEO 511411 844728 117052 23938 1497129 821323 BRIAN CHURCH BOARD MEMBER/CFO 593963 20194 134024 29460 777641 BRANDI LUNNEBORG CEO-LEFT 12/21 308560 483 71877 26408 407328 SUSAN BRUNS CNO/PSMC CEO 140041 492 4354 16780 161667 KRISTIN COLLIER MD BD MEM/CHF OF STAFF 382649 48233 397 8550 22366 462195 DALE LAWSON MD BOARD MEMBER 102960 314068 102960 314068 DARRYL HAWKINS PHARMACY DIRECTOR 147663 5460 600 569 3981 28011 180824 5460 CHRISTY HARDIN ASST. DIR PHARMACY 160375 600 178 4465 165618 LORI PAYNE PHARMACIST 147048 715 1838 35 273 1563 23847 174569 750 SUSAN JOHNSON PHARMACIST 145759 600 119 4192 25474 176144 DEBORAH MCWILLIAMS REGISTERED NURSE 155385 13040 88 4949 173462 SCHEDULE J, PAGE 1, PART I, LINE 4 SCOTT STEINER 0 182,601 0 JOE AUSTIN 0 108,502 0 BRIAN CHURCH 0 125,474 0 BRANDI LUNNEBORG 0 63,595 0 SCHEDULE J, PART III SCHEDULE J, PART I, LINE 4 - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: DEFERRED COMPENSATION PLAN 457(B): THE DEFERRED COMPENSATION PLAN IS AN ADDITIONAL RETIREMENT PLAN OFFERED THROUGH PHOEBE PUTNEY. THE 457(B) PLAN IS AN ELIGIBLE DEFERRED COMPENSATION PLAN THAT ALLOWS ONE TO DEFER ADDITIONAL DOLLARS TOWARDS RETIREMENT. HIGHLIGHTS INCLUDE: O NOT LIMITED BY THE AMOUNTS DEFERRED INTO THE PHOEBE 403(B) O PLAN IS SUBJECT TO ANNUAL DEFERRAL LIMITS SET BY THE IRS O PER IRS REGULATIONS, EACH PARTICIPANT IS A GENERAL UNSECURED CREDITOR OF THE PLAN SPONSOR. AN ELIGIBLE EMPLOYEE IS ONE WHO IS DETERMINED BY THE EMPLOYER TO BE A MEMBER OF A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES WITHIN THE MEANING OF SECTIONS 201(2), 301(A)(3), AND 401(A)(1) OF ERISA. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) 457(F): PPHS RELIES ON AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, SURVEYS, WELL DOCUMENTED METHODS AND BOARD APPROVAL TO ESTABLISH TOTAL COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. CERTAIN BOARD APPROVED EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN A SERP THAT PROVIDES CERTAIN DEFINED ANNUAL PAY CREDITS THAT ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. THE PURPOSE OF THE SERP IS TO PROVIDE A LONG-TERM INCENTIVE AND RETIREMENT BENEFIT FOR AFFECTED EXECUTIVES CONSISTENT WITH THE BENEFIT AVAILABLE TO EMPLOYEES NOT IMPACTED BY IRS COMPENSATION LIMITS ON DEFINED BENEFIT PLANS. THE AMOUNTS REPORTED AS SUPPLEMENTAL EXECUTIVE RETIREMENT COMPENSATION FOR ELIGIBLE EMPLOYEES IN SCHEDULE J REPRESENT CREDITED, BUT NOT VESTED, BENEFITS, AND THE AMOUNTS ARE AVAILABLE IN FUTURE PERIODS TO THE EMPLOYEE SUBJECT TO CONTINUING EMPLOYMENT. PPHS MAINTAINS OWNERSHIP OF THE FUNDS ALLOCATED TO EACH PARTICIPANT UNTIL VESTING AND PAYMENT. FOR A PARTICIPANT IN THE SERP PRIOR TO 1/1/2017 (A "GRANDFATHERED PARTICIPANT"), WITH PAY CREDITS FOR PLAN YEARS BEGINNING PRIOR TO 1/1/2020, THE INITIAL VESTING DATE WILL OCCUR ON THE DATE THE PARTICIPANT ATTAINS FIVE YEARS OF PARTICIPATION UNDER THE PLAN. AFTER THE INITIAL VESTING DATE, A GRANDFATHERED PARTICIPANT SHALL HAVE A NEW VESTING DATE ONCE EVERY 5 YEARS. THESE ADDITIONAL VESTING DATES WILL OCCUR ON THE 5TH ANNIVERSARY OF EACH VESTING DATE AFTER THE INITIAL VESTING DATE. ON EACH VESTING DATE, A GRANDFATHERED PARTICIPANT WILL BECOME 100% VESTED IN AN AMOUNT EQUAL TO THE PARTICIPANT'S ACCOUNT BALANCE REDUCED BY ANY PAY CREDITS CREDITED TO THE ACCOUNT FOR THE 2 MOST RECENT PLAN YEARS. GRANDFATHERED PARTICIPANTS WITH PAY CREDITS FOR PLAN YEARS BEGINNING ON OR AFTER 1/1/2020, EACH YEAR'S ANNUAL PAY CREDIT PLUS SUBSEQUENT EARNINGS AND/OR LOSSES WILL VEST AFTER 5 YEARS OF CONTINUOUS EMPLOYMENT. EACH CONTRIBUTION IS SUBJECT TO A SEPARATE AND INDEPENDENT 5 YEAR CONTINUOUS EMPLOYMENT REQUIREMENT. FOR PARTICIPANTS INITIALLY PARTICIPATING IN THE SERP AFTER 12/31/2016 (A "CONTEMPORARY PARTICIPANT"), EACH YEAR'S ANNUAL PAY CREDIT PLUS SUBSEQUENT EARNINGS AND/OR LOSSES WILL 100% VEST ON THAT PAY CREDITS' 5TH ANNIVERSARY, PROVIDED THAT THE PARTICIPANT REMAINS IN THE CONTINUOUS EMPLOYMENT THROUGHOUT THE 5-YEAR PERIOD FOR EACH ANNUAL PAY CREDIT. IF ANY ELIGIBLE PARTICIPANT ATTAINS NORMAL RETIREMENT AGE PRIOR TO SEPARATION FROM SERVICE, THEY SHALL VEST IN 100% OF THE ACCOUNT BALANCE. ONCE VESTED, EACH PARTICIPANT SHALL RECEIVE A DISTRIBUTION OF THEIR ENTIRE VESTED AMOUNT WITHIN A REASONABLE PERIOD NOT TO EXCEED 2.5 MONTHS. THIS DISTRIBUTION IS TREATED AS REPORTABLE COMPENSATION TO THE PARTICIPANT AND IS INCLUDED IN PART II, COLUMN B(III). THEREFORE, PART II, COLUMN B(III) INCLUDES PRIOR YEAR SERP DEFERRALS PREVIOUSLY REPORTED IN PART II, COLUMN C. ANY DISTRIBUTION AMOUNT INCLUDED IN PART II, COLUMN B(III) THAT WAS PREVIOUSLY REPORTED IN PRIOR PERIODS AS DEFERRED COMPENSATION IN PART II, COLUMN C IS DISCLOSED IN PART II, COLUMN F. SCHEDULE J, PART II, COLUMN B(II) CERTAIN EXECUTIVE OFFICERS AND PHYSICIANS ARE ELIGIBLE FOR BONUS/INCENTIVE PAYMENTS. THESE BONUSES ARE DETERMINED BASED ON THE ACHIEVEMENT OF VARIOUS ORGANIZATIONAL AND PERSONAL PERFORMANCE GOALS ESTABLISHED BY A FORMAL PROCESS IN KEEPING WITH THE ORGANIZATION'S TAX-EXEMPT STATUS. COMPENSATION PROCESS FOR TOP OFFICIAL AS DETERMINED BY PPHS THE ORGANIZATION'S FORMAL PROCESS FOR DETERMINING TOTAL COMPENSATION FOR THE CEO IS INTENDED TO PROVIDE REASONABLE COMPENSATION FOR ACCOMPLISHING THE ORGANIZATION'S MISSION, ACHIEVE ITS STRATEGIC GOALS, TO RECOGNIZE PERFORMANCE, AND TO OPERATE IN KEEPING WITH THE ORGANIZATION'S OBLIGATIONS AS A TAX-EXEMPT CHARITABLE ORGANIZATION. THE EXECUTIVE COMPENSATION COMMITTEE OF THE PPHS'S BOARD OF DIRECTORS CONDUCTS AN ANNUAL REVIEW OF THE COMPENSATION OF THE CEO. THE COMMITTEE RETAINS A QUALIFIED INDEPENDENT COMPENSATION CONSULTANT TO CONDUCT COMPETITIVE MARKET ANALYSIS OF THE MARKET RANGES OF BASE, INCENTIVE AND TOTAL CASH COMPENSATION. THE INFORMATION THE COMMITTEE MAY CONSIDER CAN INCLUDE BUT IS NOT LIMITED TO THE PERFORMANCE OF AN INDIVIDUAL, THE PERFORMANCE OF THE ORGANIZATION, AN INDIVIDUAL'S LENGTH OF SERVICE, CREDENTIALS AND EXPERIENCE, THE ELEMENTS OF TOTAL COMPENSATION AND SALARY HISTORY, THE ORGANIZATION'S COMPENSATION TARGETS, AND COMPARABILITY DATA, INCLUDING THE DATA PREPARED BY THE INDEPENDENT CONSULTANT AND REVIEWED WITH THE COMMITTEE. THE COMMITTEE INCORPORATES A FORMAL PERFORMANCE APPRAISAL PROCESS IN THE CEO COMPENSATION REVIEW. IT UTILIZES A MULTI-PERSPECTIVE APPROACH AND PERFORMANCE MEASURES WHICH ARE LINKED TO THE ORGANIZATION'S LONG-TERM STRATEGIC PLAN AND ACHIEVEMENT OF ANNUAL SYSTEM OBJECTIVES. THE CEO IS NOT PRESENT WHEN THE COMMITTEE DISCUSSES AND ESTABLISHES HIS COMPENSATION. SOUTHERN PATHOLOGY AND LABORATORY SERVICES PC CONTROL ENTITY 145467 LAB DIRECTOR FEE false SCHEDULE L, PART V SANDRA ZORNES, M.D., A BOARD MEMBER, OWNS SOUTHERN PATHOLOGY AND LABORATORY SERVICES, P.C. THE FILING ORGANIZATION CONTRACTS WITH SOUTHERN PATHOLOGY AND LABORATORY SERVICES, P.C. FOR DR. ZORNES' SERVICES AS LAB DIRECTOR. FORM 990, PAGE 2, PART III, LINE 4A TO BE THE LEADING PROVIDER OF QUALITY, COST EFFECTIVE, PATIENT-CENTERED HEALTH CARE SERVICES TO RESIDENTS OF THE COMMUNITY, REGARDLESS OF ABILITY TO PAY. PSMC PURSUES ITS MISSION THROUGH A PATIENT-CENTERED ENVIRONMENT OF CARE REFLECTING HIGH STANDARDS AND PROMOTING A BALANCE OF PROFESSIONAL PREPARATION AND SERVICE, CONTINUOUS IMPROVEMENT BASED ON OUR CORE VALUES OF PEOPLE, RELATIONSHIPS, REPUTATION, EXCELLENCE, EFFICIENCY AND COMMITMENT. AS A RESULT OF THE COVID PANDEMIC, PSMC RECORDED THE VALUE OF DONATED SERVICES IN THE AMOUNT OF 1,638,980, AMOUNTS WHICH ARE NOT RECOGNIZED IN THE STATEMENT OF REVENUES OR STATEMENT OF FUNCTIONAL EXPENSES FOR TAX PURPOSES. FORM 990, PAGE 6, PART VI, LINE 6 THE SOLE MEMBER OF PHOEBE SUMTER MEDICAL CENTER, INC. SHALL BE PHOEBE PUTNEY HEALTH SYSTEM, INC. (PPHS). FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD OF DIRECTORS OF PPHS, THE SOLE MEMBER, SHALL APPOINT ALL DIRECTORS OF THE FILING ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 7B THE SOLE MEMBER, PPHS, SHALL HAVE THE FOLLOWING RESPONSIBILITIES: - THE MEMBER SHALL APPOINT OR REMOVE THE ORGANIZATION'S DIRECTORS. - THE MEMBER SHALL SELECT OR REMOVE THE ORGANIZATION'S OFFICERS. - THE MEMBER SHALL APPROVE ALL AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY MAY BECOME EFFECTIVE. - THE MEMBER SHALL APPROVE ANY ANNUAL OPERATING OR CAPITAL BUDGETS. - THE MEMBER SHALL APPOINT OR REMOVE THE INDEPENDENT AUDITORS. FORM 990, PAGE 6, PART VI, LINE 11B THE INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 (BASED UPON INFORMATION PROVIDED BY THE ORGANIZATION) PROVIDES A COMPLETE COPY OF THE RETURN WITH APPLICABLE SCHEDULES TO BE REVIEWED BY MANAGEMENT. MANAGEMENT PERFORMS A DETAILED REVIEW WHICH CONSISTS OF REVIEWING THE FINANCIAL DATA, THE NARRATIVES DISCLOSED, AND OTHER FACTS PRESENTED ON THE RETURN. UPON REVIEW, THE FORM 990 IS THEN FORWARDED TO THE FINANCE COMMITTEE FOR THEIR REVIEW, TO GAIN THEIR COMMENTS AND APPROVAL. UPON APPROVAL FROM THE FINANCE COMMITTEE, THE FORM 990 AND RELATED SCHEDULES ARE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND FEEDBACK. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES, A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PAGE 6, PART VI, LINE 12C ON AN ANNUAL BASIS, PHOEBE SUMTER MEDICAL CENTER, INC. (PSMC) BOARD MEMBERS AS WELL AS ALL OFFICERS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. THIS QUESTIONNAIRE IS ADMINISTERED BY THE PHOEBE PUTNEY HEALTH SYSTEM (PPHS) COMPLIANCE DEPARTMENT AND THE DOCUMENT ASKS EACH INDIVIDUAL TO DISCLOSE ANY PERSONAL, BUSINESS, OR OTHER AFFILIATIONS AND MONETARY AMOUNT IF APPLICABLE THAT THEY OR THEIR IMMEDIATE FAMILY MEMBERS HAVE HAD WITHIN THE PAST 12 MONTHS WITH PSMC OR ANY RELATED ENTITIES. ALL RESPONSES ARE THEN EVALUATED BY THE PPHS COMPLIANCE DEPARTMENT. IN THE CASE OF AN EXISTING CONFLICT, THE INDIVIDUAL WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL TO SUCH TRANSACTIONS. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES AVAILABLE TO THE PUBLIC ITS CONFLICT OF INTEREST AND AUDITED FINANCIAL STATEMENTS ON THE ORGANIZATION'S WEBSITE, BY PROVIDING COPIES UPON REQUEST, AND BY INSPECTION AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION. FORM 990, PART IX, LINE 11G PHYSICIAN FEES 8,684,754 1,382,827 0 CONTRACT LABOR 6,958,753 1,052,781 0 COLLECTION FEES 0 394,502 0 PURCHASED SERVICES 6,992,047 6,068,806 0 INTERCOMPANY ALLOCATED COST 1,443 957,723 0 TOTAL 22,636,997 9,856,639 0 FORM 990, PART XI, LINE 9 INTEREST IN NET ASSETS OF SUMTER FOUNDATION 503,947 THE CHANGE IN NET ASSETS IS THE RESULT OF NONCASH TRANSACTIONS WHICH ARE DETAILED ABOVE. PHOEBE PUTNEY HEALTH SYSTEMS INC PO BOX 3770 ALBANY GA 317063770 582001014 HEALTHCARE GA 501C3 12C NA false PHOEBE PHYSICIAN GROUP INC PO BOX 3770 ALBANY GA 317063770 263792403 HEALTHCARE GA 501C3 10 PPHS false SUMTER REGIONAL HOSPITAL FOUNDATION INC 126 HIGHWAY 280 WEST AMERICUS GA 317198645 581607727 FOUNDATION GA 501C3 12A PSMC true PHOEBE PUTNEY MEMORIAL HOSPITAL INC PO BOX 3770 ALBANY GA 317063770 581928247 HEALTHCARE GA 501C3 3 PPHS false PHOEBE WORTH MEDICAL CENTER INC PO BOX 545 SYLVESTER GA 317910545 383647394 HEALTHCARE GA 501C3 3 PPHS false PHOEBE FOUNDATION INC PO BOX 3770 ALBANY GA 317063770 581847104 FOUNDATION GA 501C3 12A PPHS false PHOEBE DORMINY MEDICAL CENTER INC PO BOX 3770 ALBANY GA 317063770 452041878 HEALTHCARE GA 501C3 3 PPHS false PHOEBE PUTNEY HEALTH VENTURES INC PO BOX 3770 ALBANY GA 317063770 581963401 HEALTHCARE GA N/A false PHOEBE PUTNEY INDEMNITY LTD 113 S CHURCH ST 5TH FL QUEENSGATE GRAND CAYMAN CJ KY1-1102 981492026 INSURANCE CJ N/A false false false true false true false false false false false false false true true true true true false false SUMTER REGIONAL HOSPITAL FOUNDATION C 17745 CASH SUMTER REGIONAL HOSPITAL FOUNDATION M VALUE UNDETERMINED SUMTER REGIONAL HOSPITAL FOUNDATION N VALUE UNDETERMINED SUMTER REGIONAL HOSPITAL FOUNDATION O VALUE UNDETERMINED SUMTER REGIONAL HOSPITAL FOUNDATION P VALUE UNDETERMINED SUMTER REGIONAL HOSPITAL FOUNDATION Q VALUE UNDETERMINED SUMTER REGIONAL HOSPITAL FOUNDATION E 47544 G/L DETAIL