2021-08-12T11:06:01-05:00 2020-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2019-10-01 471345819 PRISMA HEALTH MEDICAL GROUP-MIDLANDS PRIS 8039070350 15 MEDICAL PARK NO 300 COLUMBIA SC 29203 MICHAEL BURKE EVP-CHIEF FINANCIAL OFFICER 8039070350 2021-08-12 1 AMY BIBBY P00445891 8282542254 2021-08-12 2019 2022-09-23 18:48:47Z MICHAEL BURKE 15 MEDICAL PARK NO 300 COLUMBIA SC 29203 456948831 0 X N/A X 2014 SC INSPIRE HEALTH. SERVE WITH COMPASSION. BE THE DIFFERENCE. 3 0 2691 0 0 0 0 0 403992385 431090166 0 0 65996 25858665 404058381 456948831 0 0 0 0 319954254 352480877 0 0 0 87925664 97908038 407879918 450388915 -3821537 6559916 49468716 114338547 25274061 66025793 24194655 48312754 INSPIRE HEALTH. SERVE WITH COMPASSION. BE THE DIFFERENCE. 0 0 437352436 431090166 PRISMA HEALTH MEDICAL GROUP-MIDLANDS IS A MEDICAL GROUP THAT OPERATES MEDICAL OFFICES. THERE ARE HEALTH CARE PROVIDERS SPECIALIZING IN PHYSICAL MEDICINE AND REHABILITATION, SPORT MEDICINE, OBSTETRICS/GYNECOLOGY, INFECTIOUS DISEASE, INTERNAL MEDICINE, GENERAL SURGERY, DIAGNOSTIC RADIOLOGY, FAMILY PRACTICE, CARDIOVASCULAR DISEASE (CARDIOLOGY), OPHTHALMOLOGY AND MORE, BEING REPORTED AS MEMBERS OF THE MEDICAL GROUP. MEDICAL TAXONOMIES WHICH ARE COVERED BY PRISMA HEALTH MEDICAL GROUP-MIDLANDS INCLUDE PEDIATRIC ORTHOPEDIC SURGERY, REGISTERED NURSE, GYNECOLOGY, CLINICAL CHILD & ADOLESCENT, ORTHOPEDIC TRAUMA, CLINICAL CARDIAC ELECTROPHYSIOLOGY, CLINICAL NUCLEAR RADIOLOGY, PSYCHOANALYSIS AND MANY MORE. 437352436 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 213 0 1 2691 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 SC X KEVIN HODGE 8647977611 300 EAST MCBEE AVE STE 302 GREENVILLE SC 29601 CAUGHMAN TAYLOR MD CHAIR 1.00 0.00 X X 0 0 0 GREGORY J RUSNAK VICE CHAIR 1.00 40.00 X X 0 663568 163458 TERRI T NEWSOM TREASURER AND SECRETARY 1.00 40.00 X X 0 684387 167816 EDWARD WALTON MANAGER 1.00 0.00 X 0 0 0 JULIAN KIM MD MANAGER 40.00 0.00 X 481394 0 55050 CHERYL ADDY MANAGER 1.00 0.00 X 0 0 0 JEFF PERKINS MANAGER 1.00 0.00 X 0 0 0 GARY B BELL MD MANAGER 40.00 0.00 X 161158 0 42912 SCOTT SASSER MD MANAGER 1.00 40.00 X 0 530564 92516 KEVIN A BOGGS CHIEF OPERATIONS EXECUTIVE 40.00 0.00 X 335669 0 58849 MATTHEW RM FOWLER GENERAL COUNSEL 1.00 40.00 X 0 277573 79122 WILLIAM D ANDERSON III MD PRES. OF MIDLANDS MEDICAL GROUP- MONTH OF JAN 2020 40.00 0.00 X 0 12212 3084 LES HALL PRES. OF MIDLANDS MEDICAL GROUP- UNTIL JAN 2020 40.00 0.00 X 0 54382 0 JAMES ELLIS MD PRES. OF MIDLANDS MEDICAL GROUP- START FEB 2020 40.00 0.00 X 0 629574 139059 DARRELL C COVEN CFO UNTIL JAN 2020 40.00 0.00 X 220132 0 62037 MARK S O'HALLA PRESIDENT AND CEO OF PRISMA HEALTH 1.00 40.00 X 0 752796 86436 MALCOLM W ISLEY EVP CHIEF STRATEGY OFFICER 1.00 40.00 X 0 722482 143161 AMY LINSIN EVP CHIEF HR AND DIVERSITY OFFICER 1.00 40.00 X 0 404497 113285 RICH ROGERS SVP CHIEF INFORMATION OFFICER 1.00 40.00 X 0 497338 130635 ANGELO SINOPOLI MD EVP CHIEF CLINICAL OFFICER 1.00 40.00 X 0 770555 165387 CAROLYN SWINTON MN SVP CHIEF NURSING OFFICER 1.00 40.00 X 0 422254 68724 HOWARD P WEST EVP CHIEF LEGAL OFFICER 1.00 40.00 X 0 687751 68164 DAVID WILLIAMS MD CEO, PRISMA HEALTH MEDICAL GROUP 1.00 40.00 X 0 652157 90209 DAVID B FULTON PHYSICIAN 40.00 0.00 X 1668110 0 64332 ROHAM MOFTAKHAR PHYSICIAN 40.00 0.00 X 1642771 0 69880 MICHAEL PEELLE PHYSICIAN 40.00 0.00 X 1197555 0 87449 ERWIN Z MANGUBAT PHYSICIAN 40.00 0.00 X 1213181 0 56740 MICKEY PLYMALE PHYSICIAN 40.00 0.00 X 1834703 0 76721 8754673 7762090 2085026 549 0 1 0 ATHENAHEALTH INC PO BOX 415615 BOSTON MA 02241 NETWORK SERVICES 1866497 NAVIGANT CONSULTING INC 4511 PAYSPHERE CIRCLE CHICAGO IL 60674 REVENUE CYCLE CONSULTING 1366922 HAYES LOCUMS LLC 6700 N ANDREWS AVENUE STE 600 FORT LAUDERDALE FL 33309 STAFFING AGENCY 1051791 GASTROINTESTINAL AND ALIMENTAR 722 ELMBROOK DR SIMPSONVILLE SC 29681 GI MD 762470 NTHRIVE INC PO BOX 733492 DALLAS TX 75373 REVENUE CYCLE CONSULTING 752706 8 NET PATIENT SERVICE RE 621110 208907028 208907028 MISSION SUPPORT 621110 136463500 136463500 SERVICE REVENUE 621110 37525549 37525549 TEACHING REVENUE 621110 20525809 20525809 EMPLOYEE LEASE AGREEME 621110 1673301 1673301 25994979 25994979 431090166 181424 0 181424 181424 181424 USC TRUST WITHDRAWAL 900099 24194661 24194661 MISCELLANEOUS 900099 1482580 1482580 25677241 456948831 431090166 0 25858665 1417201 1417201 300261176 295541093 4720083 6369498 6161255 208243 33530609 32433910 1096699 10902393 10491011 411382 51649 51649 7330817 5546376 1784441 51398 51398 5098622 3267368 1831254 1977194 1467038 510156 17785976 17304351 481625 296233 293953 2280 3243357 3223056 20301 6407424 6222397 185027 MEDICAL SUPPLIES 29239295 29239295 BAD DEBT 24446010 24446010 MINOR EQUIPMENT 1006217 741477 264740 SUPPLIES 973846 973846 450388915 437352436 13036479 0 X 18027684 -14277386 17177402 26645538 1174 556867 821563 18430794 10191474 9532587 8239320 4174176 92908338 49468716 114338547 20880661 31856758 3607442 134731 785958 34034304 25274061 66025793 X 24194655 48312754 24194655 48312754 49468716 114338547 X 6559916 17558183 X X 0 1 X 1 0 X 172836225 319913201 403992385 431090166 1327831977 172836225 319913201 403992385 431090166 1327831977 0 0 0 1327831977 10866 65996 181424 258286 10866 65996 181424 258286 779754 25677241 26456995 173615979 319924067 404058381 456948831 1354547258 0.98030 0.00020 X 3102529 1224327 1878202 13992333 8967147 5025186 1335932 1335932 8239320 DUE FROM AFFILIATES 74499615 OTHER ASSETS 18408723 92908338 OTHER LIABILITIES 34034304 34034304 X PART X, LINE 2: PRISMA HEALTH MEDICAL GROUP-MIDLANDS IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF PRISMA HEALTH AND SUBSIDIARIES. PRISMA HEALTH QUALIFIES AS AN ORGANIZATION EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). AS OF SEPTEMBER 30, 2020, PRISMA HEALTH HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS. X X X X 0 1 0 0 0 0 0 0 0 GREGORY J RUSNAK VICE CHAIR 0 658658 0 0 0 4910 0 133251 0 30207 0 827026 0 0 TERRI T NEWSOM TREASURER AND SECRETARY 0 680204 0 0 0 4183 0 133625 0 34191 0 852203 0 0 JULIAN KIM MD MANAGER 476809 0 0 0 4585 0 28269 0 26781 0 536444 0 0 0 GARY B BELL MD MANAGER 154152 0 0 0 7006 0 17125 0 25787 0 204070 0 0 0 SCOTT SASSER MD MANAGER 0 485238 0 42856 0 2470 0 53625 0 38891 0 623080 0 0 KEVIN A BOGGS CHIEF OPERATIONS EXECUTIVE 332937 0 0 0 2732 0 32278 0 26571 0 394518 0 0 0 MATTHEW RM FOWLER GENERAL COUNSEL 0 236579 0 36923 0 4071 0 48562 0 30560 0 356695 0 0 JAMES ELLIS MD PRES. OF MIDLANDS MEDICAL GROUP- STA 0 585275 0 43858 0 441 0 106625 0 32434 0 768633 0 0 DARRELL C COVEN CFO UNTIL JAN 2020 219571 0 0 0 561 0 30211 0 31826 0 282169 0 0 0 MARK S O'HALLA PRESIDENT AND CEO OF PRISMA HEALTH 0 603033 0 140030 0 9733 0 75001 0 11435 0 839232 0 0 MALCOLM W ISLEY EVP CHIEF STRATEGY OFFICER 0 491061 0 214692 0 16729 0 105876 0 37285 0 865643 0 0 AMY LINSIN EVP CHIEF HR AND DIVERSITY OFFICER 0 399428 0 1264 0 3805 0 91665 0 21620 0 517782 0 0 RICH ROGERS SVP CHIEF INFORMATION OFFICER 0 483187 0 0 0 14151 0 99306 0 31329 0 627973 0 0 ANGELO SINOPOLI MD EVP CHIEF CLINICAL OFFICER 0 749828 0 0 0 20727 0 151346 0 14041 0 935942 0 0 CAROLYN SWINTON MN SVP CHIEF NURSING OFFICER 0 381932 0 0 0 40322 0 39294 0 29430 0 490978 0 0 HOWARD P WEST EVP CHIEF LEGAL OFFICER 0 495015 0 29775 0 162961 0 44000 0 24164 0 755915 0 0 DAVID WILLIAMS MD CEO, PRISMA HEALTH MEDICAL GROUP 0 589524 0 53707 0 8926 0 53625 0 36584 0 742366 0 0 DAVID B FULTON PHYSICIAN 1664252 0 0 0 3858 0 58168 0 6164 0 1732442 0 0 0 ROHAM MOFTAKHAR PHYSICIAN 1640992 0 0 0 1779 0 42081 0 27799 0 1712651 0 0 0 MICHAEL PEELLE PHYSICIAN 1195559 0 0 0 1996 0 53445 0 34004 0 1285004 0 0 0 ERWIN Z MANGUBAT PHYSICIAN 1211864 0 0 0 1317 0 27500 0 29240 0 1269921 0 0 0 MICKEY PLYMALE PHYSICIAN 1833185 0 0 0 1518 0 42430 0 34291 0 1911424 0 0 0 PART I, LINE 4B THE 457(F) PLAN IS PROVIDED TO 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) OF PRISMA HEALTH AND SUBSIDIARIES WHO CONTRIBUTE SIGNIFICANTLY TO THE FUTURE BUSINESS SUCCESS OF THE COMPANY WITH SUPPLEMENTAL RETIREMENT INCOME THROUGH COMPANY CONTRIBUTIONS. EMPLOYEES ELIGIBLE FOR THE PROGRAM ARE APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. THOSE ELIGIBLE RECEIVE A 10 - 20 PERCENT CONTRIBUTION ON AN ANNUAL BASIS BASED ON THE PRIOR FISCAL YEAR BASE COMPENSATION. SPLIT DOLLAR LIFE INSURANCE PARTICIPANTS ARE MALCOLM ISLEY, AMY LINSIN, MARK O'HALLA, GREGORY RUSNAK AND ANGELO SINOPOLI. THE ORGANIZATION DEPOSITED FUNDS INTO LIFE INSURANCE POLICIES ON THE PARTICIPANT'S LIFE. DURING LIFE, AND SUBJECT TO THE POLICIES GENERATING SUFFICIENT VALUES, THE PARTICIPANT CAN BORROW FROM ONE OF THE POLICIES. THE BORROWING IS MONITORED AND LIMITED SO THE POLICIES DO NOT LAPSE. AT THE PARTICIPANT'S DEATH, THE ORGANIZATION RECOVERS AN AMOUNT GENERALLY EQUAL TO ITS PREMIUMS OR PREMIUMS PLUS INTEREST. PARTICIPANTS IN THE PLAN HAVE SIGNED WRITTEN REPRESENTATIONS UNDER REG. 1.78782.15(D)(2) AND THOSE REPRESENTATIONS ARE MAINTAINED ON FILE BY PRISMA HEALTH. FORM 990, PART VI, SECTION A, LINE 4 THE BOARD OF MANAGERS OF PRISMA HEALTH MEDICAL GROUP- MIDLANDS (THE "MEDICAL GROUP") AMENDED AND RESTATED THE ARTICLES OF INCORPORATION AND BYLAWS TO REFLECT PRISMA HEALTH-MIDLANDS AS THE SOLE MEMBER OF THE MEDICAL GROUP. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAD TWO MEMBERS- PRISMA HEALTH- MIDLANDS AND THE UNIVERSITY OF SOUTH CAROLINA SCHOOL OF MEDICINE TRUST (THE "TRUST"). EFFECTIVE FEBRUARY 12, 2020, THE TRUST RESIGNED AS A MEMBER AND ITS REPRESENTATIVES ON THE BOARD OF MANAGERS ALSO RESIGNED. WITH THE RESIGNATION OF THE TRUST MEMBER, PRISMA HEALTH MIDLANDS IS THE REMAINING SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER APPOINTS FOUR MANAGERS (BOARD TRUSTEE). EFFECTIVE FEBRUARY 12, 2020, THE TRUST RESIGNED AS A MEMBER AND ITS REPRESENTATIVES ON THE BOARD OF MANAGERS ALSO RESIGNED. THE REMAINING BOARD MANAGERS ARE REPRESENTATIVES OF PRISMA HEALTH- MIDLANDS. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND OVERSIGHT BY PRISMA HEALTH MANAGEMENT. THE RETURN WAS REVIEWED BY PRISMA HEALTH MANAGEMENT AND IN-HOUSE LEGAL COUNSEL PRIOR TO FILING WITH THE IRS. IN ADDITION, A COPY OF THE RETURN WAS PROVIDED TO ALL CURRENT BOARD MEMBERS AND THE PRISMA HEALTH BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER OF THE BOARD OF DIRECTORS SHALL COMPLETE AN ANNUAL ACKNOWLEDGEMENT STATEMENT THAT EACH OF THEM (A) HAS RECEIVED A COPY OF THE RULES OF CONDUCT (CONFLICTS OF INTEREST POLICY), (B) HAS READ AND UNDERSTANDS THE POLICY, (C) AGREES TO COMPLY WITH THE POLICY, (D) UNDERSTANDS THAT THE POLICY APPLIES TO ALL COMMITTEES, AND (E) UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND MUST CONTINUOUSLY ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. THESE ACKNOWLEDGEMENT STATEMENTS ARE RETURED TO THE FINANCE, AUDIT AND COMPLIANCE COMMITTEE FOR REVIEW AND FOLLOW-UP AS APPROPRIATE. THE CHAIR OF THE FINANCE, AUDIT AND COMPLIANCE COMMITTEE REPORTS TO THE FULL BOARD THAT THE ABOVE-REFERENCED PROCESS HAS BEEN COMPLETED. UPON HIRE, EACH EMPLOYEE IS EDUCATED ON THE POTENTIAL CONFLICTS OF INTEREST POLICY AND IS ASKED TO DOCUMENT ANY RELATIONSHIPS THAT MAY CREATE A POTENTIAL CONFLICT OF INTEREST ON A FORM THAT IS REVIEWED BY CORPORATE COMPLIANCE AND RETAINED IN THE EMPLOYEE'S HUMAN RESOURCES FILE. ANNUALLY, THE POLICY IS REVIEWED VIA COMPUTER-BASED TRAINING THAT IS MANDATORY FOR ALL EMPLOYEES. SITUATIONS THAT ARE BELIEVED TO BE ACTUAL CONFLICTS ARE ADDRESSED BY CORPORATE COMPLIANCE, DEPARTMENT MANAGEMENT AND SENIOR LEADERSHIP AS NECESSARY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR EXECUTIVES IS ESTABLISHED WITH THE ASSISTANCE OF PRISMA HEALTH-MIDLANDS AND THE ORGANIZATION'S MANAGEMENT COMMITTEE. COMPENSATION IS BASED ON COMPARABILITY DATA AND MARKET RATES TO ENSURE REASONABLE COMPENSATION IS PAID. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART X, LINE 1 THE AMOUNT OF NEGATIVE CASH REPORTED ON LINE 1 IS A NET AMOUNT DUE TO A RELATED ENTITY. FORM 990, PART XI, LINE 9: EQUITY TRANSFER 17,558,183. FORM 990, PART XII, LINE 2C: STARTING IN FY2020 PRISMA HEALTH MEDICAL GROUP-MIDLANDS FINANCIALS WERE INCLUDED IN THE CONSOLIDATED AUDITED FINANCIALS OF PRISMA HEALTH. PRISMA HEALTH 300 EAST MCBEE AVENUE SUITE 302 GREENVILLE SC 29601 822595551 HEALTHCARE SC 501(C)(3) LINE 12C, III-FI N/A 0 PRISMA HEALTH-UPSTATE 300 EAST MCBEE AVENUE SUITE 302 GREENVILLE SC 29601 811723202 HOSPITAL SC 501(C)(3) LINE 3 PRISMA HEALTH 0 PRISMA HEALTH-MIDLANDS PO BOX 2266 COLUMBIA SC 29202 582296052 HOSPITAL SC 501(C)(3) LINE 3 PRISMA HEALTH 0 PRISMA HEALTH-UNIVERSITY MEDICAL GROUP 300 EAST MCBEE AVENUE SUITE 302 GREENVILLE SC 29601 571004971 PHYSICIAN PRACTICES SC 501(C)(3) LINE 10 PRISMA HEALTH-UPSTATE 0 GREENVILLE HEALTH CORPORATION 300 EAST MCBEE AVENUE SUITE 302 GREENVILLE SC 29601 570835816 HEALTHCARE SC 501(C)(3) LINE 10 PRISMA HEALTH-UPSTATE 0 CCI LABS 300 EAST MCBEE AVENUE SUITE 302 GREENVILLE SC 29601 813849641 HEALTHCARE SC 501(C)(3) LINE 7 PRISMA HEALTH-UPSTATE 0 BAPTIST EASLEY HOSPITAL 300 EAST MCBEE AVENUE SUITE 302 GREENVILLE SC 29601 352363050 HOSPITAL SC 501(C)(3) LINE 3 PRISMA HEALTH-UPSTATE 0 PRISMA HEALTH TUOMEY 129 N WASHINGTON STREET SUMTER SC 29150 474914917 HOSPITAL SC 501(C)(3) LINE 3 PRISMA HEALTH-MIDLANDS 0 RADIATION ONCOLOGY 7 RICHLAND MEDICAL PARK ROAD COLUMBIA SC 29203 364542465 HEALTHCARE SC N/A CAROLINA HOME THERAPEURICS 1528 UNION ROAD GASTONIA NC 28054 570880120 HEALTHCARE NC N/A HEALTHSOURCE INC PO BOX 2266 COLUMBIA SC 29202 570938686 HEALTHCARE SC N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0