2021-06-11T12:37:29-05:00 2020-07-31 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2019-08-01 263975185 PHOEBE SUMTER MEDICAL CENTER INC PHOE 2299246011 126 HWY 280 WEST AMERICUS GA 317198645 BRIAN CHURCH BOARD MEMBER/CFO 2299246011 2021-06-10 true STEPHEN HARRELL P01554887 2298837878 2021-06-10 X 2019 2022-09-23 18:48:47Z BRANDI LUNNEBORG 126 HWY 280 WEST AMERICUS GA 317198645 92510219 false X WWW.PHOEBEHEALTH.COM X 2009 GA PROVIDING CHARITABLE HEALTHCARE ACTIVITIES. 11 6 567 74 0 3221426 1422368 78071115 82576326 1693518 1350632 2560352 2709093 85546411 88058419 58943 17674 0 27577519 27138995 0 0 48584137 55621142 76220599 82777811 9325812 5280608 130344545 148052662 12771332 23573767 117573213 124478895 PROVIDING CHARITABLE HEALTHCARE ACTIVITIES. false false 64603635 17674 83580401 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. 64603635 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 68 0 567 true false false false false false false false false false false false false X 11 6 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 JOEL WERNICK PAST BD MEM/ X 0 1358367 17551 SCOTT STEINER BD MEMBER/PP 1.00 54.00 X X 0 751780 169937 JOE AUSTIN BD MBR LEFT 1.00 53.00 X X 0 618459 166974 BRIAN CHURCH BOARD MEMBER 1.00 54.00 X X 0 600343 129233 BRANDI LUNNEBORG CEO 50.00 1.00 X 0 415959 69975 MICHELLE DOGGETT DIRECTOR OF 50.00 1.00 X 108505 0 21536 SUSAN BRUNS CNO 50.00 0.00 X 0 166923 18563 ROBBIE LATIMORE EDD CHAIRMAN 1.00 0.00 X X 0 0 0 FREDRICK MCLAUGHLIN EDD VICE CHAIR 1.00 0.00 X X 0 0 0 KRISTIN COLLIER MD BD MEM/CHF O 40.00 0.00 X 0 497542 19174 DALE LAWSON MD BOARD MEMBER 40.00 0.00 X 102960 0 0 SANDRA LEE ZORNES MD BOARD MEMBER 1.00 0.00 X 0 0 0 SANDRA DANIEL BOARD MEMBER 1.00 0.00 X 0 0 0 G BARDIN HOOKS JR BOARD MEMBER 1.00 1.00 X 0 0 0 JOHN CRISP BOARD MEMBER 1.00 0.00 X 0 0 0 TARANG VIC PATEL BOARD MEMBER 1.00 0.00 X 0 0 0 RANDY JONES BD MBR (LEFT 1.00 0.00 X 0 0 0 JEREMY JOYNER PAST BD MEM 1.00 40.00 X 0 497173 32221 REGINA MCDUFFIE PAST BD MEM 1.00 0.00 X 0 0 0 DARRYL HAWKINS PHARMACY DIR 40.00 0.00 X 144468 16980 23030 CHRISTY HARDIN ASST. DIR PH 40.00 0.00 X 154101 0 5205 LORI PAYNE PHARMACIST 40.00 0.00 X 146875 0 20648 SUSAN JOHNSON PHARMACIST 40.00 0.00 X 143054 0 23526 DEBORAH MCWILLIAMS REGISTERED N 40.00 0.00 X 157188 0 4613 957151 4923526 722186 17 true true false INNOVATIVE THERAPY CONCEPTS LLC 2 MASHBURN ST SUITE 102 HAWKINSVILLE GA 31036 THERAPY 961489 SENTRY ANESTHESIA MANAGEMENT LLC 80 NEWNAN STATION DRIVE SUITE A NEWNAN GA 302653194 ANESTHESIA SVCS 945497 MEDICAL SOLUTIONS LLC PO BOX 310737 DES MOINES IA 50331 STAFFING SVCS 674692 GEORGIA PREMIER SONOGRAPHY 213 TRADERS PASS WARNER ROBINS GA 310882211 ULTRASOUND SVCS 485188 DIALYSIS CLINIC INC 404 E POPE STREET SYLVESTER GA 31791 DIALYSIS SVCS 276334 13 431791 410528 580049 1422368 PROGRAM SERVICE REVENUE 623000 82576326 82576326 82576326 1004221 1004221 924765 85271 839494 839494 839494 4712940 4366529 346411 346411 346411 MIGRANT HEALTH REVENUE 621990 754655 754655 EMPLOYEE PHARMACY REVENUE 621990 503464 503464 NUTRITION SERVICE REVENUE 722513 362060 362060 249420 249420 1869599 88058419 83580401 3055650 X 15229 15229 2445 2445 233001 102960 130041 20737189 17524113 3213076 424346 358597 65749 4233601 3475635 757966 1510858 1259872 250986 104518 104518 129450 129450 30765137 22721403 8043734 21023 21023 1924844 1612857 311987 336299 97744 238555 1043733 551859 491874 94275 63685 30590 3717069 1965348 1751721 1106951 1106951 MEDICAL SUPPLIES 14102578 14102578 REPAIRS & MAINTENANCE 989088 641484 347604 PROVIDER TAX 891766 891766 MISCELLANEOUS 220999 2082 218917 173412 105744 67668 82777811 64603635 18174176 0 37462602 46625351 10429711 11869665 13302 10857 1269739 1638282 1975130 196888 82425466 36745861 45097506 45679605 30028372 37511307 4068183 4520707 130344545 148052662 6884061 6822497 1111736 5887271 15639534 12771332 23573767 X 113573213 120478895 4000000 4000000 117573213 124478895 130344545 148052662 X 5280608 1510535 114539 X X false true X true true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3967 3967 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 1.00000 false false 2022703 2022703 51742664 17897697 33844967 27362938 18848164 8514774 94655 94655 44477099 MEDICARE ADVANCE PAYMENTS 12702145 RELATED PARTY PAYABLES 2515329 THIRD PARTY SETTLEMENTS 422060 15639534 X 89247924 1510535 1510535 87737389 321030 321030 88058419 82863082 85271 85271 82777811 82777811 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 MANAGEMENTS EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JULY 31, 2020 AND 2019 OR FOR THE YEARS THEN ENDED. THE HOSPITALS 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 -85,271 CAPITAL CONTRIBUTION 406,301 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 85,271 true true X true X 1.250000000000 true X true true false true true 3711610 3711610 0.04480 15861528 14879511 982017 0.01190 19573138 14879511 4693627 0.05670 1206 154177 64740 89437 0.00110 11 32201 32201 0.00040 9268275 8126217 1142058 0.01380 15229 15229 0.00020 1217 9469882 8190957 1278925 0.01550 1217 29043020 23070468 5972552 0.07220 true 18412516 15897073 17331571 -1434498 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 82,777,811 ADD: EXPENSES REPORTED IN PART VIII 85,271 DENOMINATOR FOR COLUMN (F) 82,863,082 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 PAGE 18 ON THE ACCOMPANYING AUDITED FINANCIAL STATEMENTS FOR THE FOOTNOTE DISCLOSURE RELATING TO 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, 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. 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 EACH AND EVERY NON-PROFIT ORGANIZATION OF WHICH PPHS IS THE SOLE MEMBER, AND ANY OTHER NON-PROFIT HOSPITAL WHICH IS MANAGED OR CONTROLLED BY PPHS WHETHER THROUGH OWNERSHIP, MANAGEMENT CONTRACT OR OTHERWISE. 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 COMMUNITYS 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 104,000,000 29,000,000 MEDICAID 41,000,000 12,000,000 INDIGENT/CHARITY 14,000,000 4,000,000 159,000,000 45,000,000 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 2020. I. COMMUNITY HEALTH IMPROVEMENT SERVICES A. COMMUNITY HEALTH EDUCATION MENS AND WOMEN'S HEALTH CONFERENCES DUE TO THE COVID-19 PANDEMIC, MANY OF PSMCS ANNUAL COMMUNITY HEALTH EDUCATION PROGRAMS WERE CANCELLED. HOWEVER, PSMC DID HOST THE FOLLOWING EVENTS: NUMBER OF EVENT DATE PARTICIPANTS GSW RESOURCE FAIR FOR NEW STUDENTS 8/16/2019 150 WELLNESS CLASS AT ST. PAUL AME 8/21/2019 15 MEN'S HEALTH FAIR 9/14/2019 150 PROSTATE CANCER AWARENESS WALK 9/21/2019 25 AMERICUS & SUMTER COUNTY FAIR 9/25/2019 150 PLAINS COMMUNITY FAIR 11/02/2019 200 MACON COUNTY HEALTH FAIR 11/09/2019 200 SUMTER COUNTY GOV'T EMPLOYEE HEALTH FAIR 1/31/2020 100 HEART WALK/RUN 2/08/2020 75 SUMTER EMC HEALTH FAIR 3/12/2020 100 TOTAL 1,165 B. COMMUNITY BASED CLINICAL SERVICES FLU SHOTS PSMC PROVIDES FREE FLU SHOTS TO VOLUNTEERS AND STUDENTS. IN FISCAL YEAR 2020, PSMC ADMINISTERED 41 FLU SHOTS AT AN UNREIMBURSED COST OF 620. NURSES/NURSING STUDENTS IN FISCAL YEAR 2020, PSMC PROVIDED AN ESTIMATED 32,201 REPRESENTING 924 HOURS IN CLINICAL SUPERVISION AND TRAINING OF 11 NURSING STUDENTS. C. 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). II. COMMUNITY BENEFIT OPERATIONS PSMC INCURRED 88,817 IN SUPPORT STAFF COSTS TO SUPPORT ITS COMMUNITY BENEFIT EFFORTS. true NEW HORIZONS HABITAT FOR HUMANITY 512 MILLARD FULLER BLVD AMERICUS GA 31709 582361522 501C3 10000 NEW CONSTRUCTION 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 JOEL WERNICK PAST BD MEM/PPHS CEO 484128 847462 26777 7873 9678 1375918 SCOTT STEINER BD MEMBER/PPHS CEO 628405 97805 25570 151535 18402 921717 JOE AUSTIN BD MBR LEFT 2019/CEO 474100 120452 23907 144739 22235 785433 BRIAN CHURCH BOARD MEMBER/CFO 469857 110996 19490 105680 23553 729576 BRANDI LUNNEBORG CEO 286201 122308 7450 48631 21344 485934 SUSAN BRUNS CNO 134545 25822 6556 4380 14183 185486 KRISTIN COLLIER MD BD MEM/CHF OF STAFF 356240 121925 19377 19174 516716 JEREMY JOYNER PAST BD MEM (12/19) 375455 121341 377 8400 23821 529394 DARRYL HAWKINS PHARMACY DIRECTOR 143448 16980 467 553 23030 167498 16980 CHRISTY HARDIN ASST. DIR PHARMACY 153456 467 178 4340 865 159306 LORI PAYNE PHARMACIST 146135 467 273 1538 19110 167523 SUSAN JOHNSON PHARMACIST 142472 467 115 4084 19442 166580 DEBORAH MCWILLIAMS REGISTERED NURSE 153355 3745 88 4613 161801 SCHEDULE J, PAGE 1, PART I, LINE 3 NONE OF THE INDIVIDUAL BOARD MEMBERS OR OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION AND THE ORGANIZATION MUST RELY ON THE METHODS USED BY PPHS, THE SOLE MEMBER, TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY PPHS INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. SCHEDULE J, PAGE 1, PART I, LINE 4 SCOTT STEINER 0 143,135 0 JOE AUSTIN 0 136,339 0 BRIAN CHURCH 0 100,626 0 BRANDI LUNNEBORG 0 44,284 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"), THE FIRST 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. FOR PARTICIPANTS INITIALLY PARTICIPATING IN THE SERP AFTER 12/31/2016, 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 THIS 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 120000 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 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 8,956,407 1,602,432 0 CONTRACT LABOR 5,312,531 25,688 0 COLLECTION FEES 0 384,411 0 PURCHASED SERVICES 8,449,525 5,143,812 0 INTERCOMPANY ALLOCATED COST 2,940 887,391 0 TOTAL 22,721,403 8,043,734 0 FORM 990, PART XI, LINE 9 INTEREST IN NET ASSETS OF SUMTER FOUNDATION 181,646 LEASE ACCOUNTING ASC 842 CONVERSION -67,107 TOTAL 114,539 THE CHANGE IN NET ASSETS IS THE RESULT OF NONCASH TRANSACTIONS WHICH ARE DETAILED ABOVE. IN FEBRUARY 2016, THE FASB ISSUED ASU NO. 2016-02, LEASES (TOPIC 842), WHICH IS A NEW COMPREHENSIVE LEASE ACCOUNTING MODEL. THE NEW STANDARD CLARIFIES THE DEFINITION OF A LEASE AND REQUIRES LESSEES TO RECOGNIZE RIGHT-OF-USE ASSETS AND RELATED LEASE LIABILITIES FOR ALL LEASES WITH TERMS GREATER THAN TWELVE MONTHS. AS PART OF THE TRANSITION TO THE NEW STANDARD, PSMC WAS REQUIRED TO MEASURE AND RECOGNIZE LEASES THAT EXISTED AT AUGUST 1, 2019 USING A MODIFIED RETROSPECTIVE APPROACH. PSMC APPLIED THE NEW STANDARD AT THE ADOPTION DATE AND RECOGNIZED A CUMULATIVE- EFFECT ADJUSTMENT TO THE OPENING BALANCE OF NET ASSETS IN THE PERIOD OF ADOPTION. FORM 990, PAGE 12, PART XII, LINE 3B DURING FISCAL YEAR 2020, FEDERAL AWARDS EXPENDED EXCEEDED THE 750,000 THRESHOLD REQUIRING A SINGLE AUDIT (PREVIOUSLY KNOWN AS THE OMB CIRCULAR A-133 AUDIT). THE SUBSTANTIAL PORTION OF THESE FEDERAL EXPENDITURES RELATED TO THE FUNDING ASSOCIATED WITH THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY ACT (CARES ACT). TYPICALLY, THE SINGLE AUDIT DUE DATE WOULD BE NINE MONTHS FROM THE END OF THE FISCAL YEAR BEING REPORTED ON (APRIL 30, 2021). HOWEVER, THE DEADLINE TO SUBMIT THE REQUIRED SINGLE AUDIT HAS BEEN EXTENDED BY THE OFFICE OF MANAGEMENT AND BUDGET (OMB) TO INCLUDE AN ADDITIONAL SIX MONTHS BEYOND THE ORIGINAL NINE-MONTH PERIOD (NOVEMBER 1, 2021). AS SUCH, PSMC HAS NOT UNDERGONE THE SINGLE AUDIT ASSOCIATED WITH ITS FISCAL YEAR 2020, BUT ARRANGEMENTS HAVE BEEN MADE TO UNDERGO THIS SINGLE AUDIT AND TO ENSURE ITS COMPLETION PRIOR TO THE EXTENDED DEADLINE. 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 SOUTH GEORGIA SHARED SERVICES INC 417 WEST THIRD AVENUE ALBANY GA 317011943 462746977 COOPERATIV 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 34243 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 943 G/L DETAIL