2021-08-12T11:06:02-05:00 2020-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2019-10-01 811723202 PRISMA HEALTH-UPSTATE PRIS 8647977611 300 EAST MCBEE AVENUE NO 302 GREENVILLE SC 29601 MICHAEL BURKE EVP-CHIEF FINANCIAL OFFICER 8647977611 2021-08-12 1 AMY BIBBY P00445891 8282542254 2021-08-12 2019 2022-09-23 18:48:47Z MICHAEL BURKE 300 EAST MCBEE AVENUE NO 302 GREENVILLE SC 29601 2535522399 0 X WWW.PRISMAHEALTH.ORG X 2016 SC INSPIRE HEALTH. SERVE WITH COMPASSION. BE THE DIFFERENCE. 12 12 15129 0 986068 0 10483239 10047225 2274714901 2451459542 5368759 12141661 53717220 61873971 2344284119 2535522399 19402013 15459015 0 0 861556533 973675133 0 0 0 1145141169 1166812085 2026099715 2155946233 318184404 379576166 1196689439 1524763402 804820694 1169630292 391868745 355133110 INSPIRE HEALTH. SERVE WITH COMPASSION. BE THE DIFFERENCE. 0 0 1703416018 15459015 2512347445 PLEASE READ THE ANNUAL REPORT FOR MORE DETAIL ABOUT NEW AND EXPANDED SERVICES AND INNOVATIVE COLLABORATIONS AT THIS WEBSITE: HTTPS://PRISMAHEALTH.ORG/PDFS/PRISMA-HEALTH-FY2020-HIGHLIGHTS-AND-STATISTICS 1703416018 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 1 0 1 0 0 0 1 1 1 0 0 0 1 935 0 1 15129 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 SC X KEVIN HODGE 8647977611 300 EAST MCBEE AVE STE 302 GREENVILLE SC 29601 ANDREW J WHITE BOARD MEMBER 1.00 0.00 X 0 0 0 ANNMARIE HIGGINS BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERT T NITTO BOARD MEMBER 1.00 0.00 X 0 0 0 BENJAMIN B WATERS III BOARD MEMBER 1.00 0.00 X 0 0 0 CHARLES E DALTON BOARD MEMBER 1.00 0.00 X 0 0 0 DAVID M LOMINACK BOARD MEMBER 1.00 0.00 X 0 0 0 MARGARET L JENKINS BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL CUMBY BOARD MEMBER 1.00 0.00 X 0 0 0 W MICHAEL ELLISON BOARD MEMBER 1.00 0.00 X 0 0 0 PRASHANT PRABHU BOARD 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NEWSOM EVP CHIEF FINANCIAL OFFICER (UNTIL 4/20) 1.00 40.00 X 0 684387 167816 JEANNE WARD EXECUTIVE 40.00 0.00 X 726343 0 39047 JAMES M ELLIS JR VP CLINICAL AFFAIRS 40.00 0.00 X 629574 0 139059 PAUL F JOHNSON VP CHIEF OPERATIONS EXECUTIVE 40.00 0.00 X 514091 0 121053 CHRISTOPHER C WRIGHT CHIEF MEDICAL STAFF 40.00 0.00 X 567336 0 60896 MARTIN E LUTZ PHYSICIAN 40.00 0.00 X 401840 0 68210 T CHAD MOSES FORMER OFFICER 40.00 0.00 X 291043 0 89357 SPENCE M TAYLOR MD FORMER PRESIDENT, UPSTATE AFF'L (UNTIL 9/19) 0.00 0.00 X 0 716328 105155 JOSEPH J BLAKE JR FORMER SECRETARY 0.00 0.00 X 0 141181 64464 CHARLES D BEAMAN JR FORMER CO-CEO OF PRISMA HEALTH (UNTIL 7/19) 0.00 0.00 X 0 1569772 61472 MICHAEL C RIORDAN FORMER CO-CEO OF PRISMA HEALTH (UNTIL 5/19) 0.00 0.00 X 0 939610 83777 3711703 9380302 2142733 882 1 1 0 INTERNAL MEDICINE ASSOCIATES 1025 VERDAE BLVD STE A GREENVILLE SC 29607 MANAGEMENT CONTRACT FEES 18608900 EPIC SYSTEMS CORPORATION 1979 MILKY WAY VERONA WI 53593 EPIC SERVICES 11945175 QUALIVIS LLC PO BOX 123847 DALLAS TX 75312 CLINICAL STAFFING SERVICES 11298394 BRASFIELD & GORRIE LLC 1 N MAIN ST SUITE 904 GREENVILLE SC 29601 CONSTRUCTION SERVICES 11244159 INTERNETWORK ENGINEERING INC 13777 BALLANTYNE CORPORATE PLACE S CHARLOTTE NC 28277 IT SERVICES 10225559 775 10047225 279243 10047225 NET PATIENT SERVICE 621400 2238436800 2237688787 748013 CARES RELIEF FUND 900099 94162883 94162883 PHARMACY SALES 446110 48010559 48010559 OTHER REVENUE 900099 25119539 24881484 238055 BAD DEBT RECOVERIES 900099 10551860 10551860 35177901 35177901 2451459542 12141661 12141661 3581615 0 3581615 3581615 3581615 NON-OPERATING INCOME 900099 58292356 58292356 58292356 2535522399 2512347445 986068 12141661 15459015 15459015 747266 747266 555115 174715 380400 755446575 594732272 160714303 20756115 14829718 5926397 153083000 119949751 33133249 43087062 33905141 9181921 2378796 73532 2305264 46000 4296 41704 179351397 126283425 53067972 14432507 5793658 8638849 49903151 812677 49090474 75901439 59631375 16270064 1971626 1219762 751864 22612750 7376596 15236154 104391964 71285001 33106963 6380981 5932199 448782 MEDICAL SUPPLIES 432778654 409266902 23511752 BAD DEBT EXPENSE 192053421 192053421 MEDICAID TAX 30969762 30969762 MIAP ASSESSMENT 7264512 7264512 46375125 6398288 39976837 2155946233 1703416018 452530215 0 -14737629 82277798 -883253 -1167734 256936660 272782611 5427000 200179 -17530 43594778 47347094 10389207 12673918 2197746964 1422057133 828379356 775689831 236000 33 12342763 13291714 10787541 10787541 49443837 305671126 1196689439 1524763402 251751697 209636333 96791398 101505968 32711065 14052868 352570848 340750416 70995686 503684707 804820694 1169630292 X 362525717 322350076 29343028 32783034 391868745 355133110 1196689439 1524763402 X 379576166 -2275794 -414036007 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 103991 103991 0 PART II-B, LINE 1: PRISMA HEALTH-UPSTATE PAYS ANNUAL MEMBERSHIP DUES AS PART OF ITS MEMBERSHIP WITH THE AMERICAN HOSPITAL ASSOCIATION AND 23.32% ($46,991) OF THESE DUES ARE USED FOR LOBBYING ACTIVITIES. THE ORGANIZATION ALSO PAID LOBBYING COSTS OF $57,000 TO PUBLIC STRATEGY LLC. IN ADDITION, A PORTION OF PRISMA HEALTH-UPSTATE'S SC HOSPITAL ASSOCIATION DUES ARE USED FOR LOBBYING EXPENSES, WHICH WERE PAID BY PRISMA HEALTH ON PRISMA HEALTH UPSTATE'S BEHALF. 54841650 54841650 843398081 412710655 430687426 1245506004 972403914 273102090 54001229 36942564 17058665 775689831 OTHER RECEIVABLES 25952359 DUE FROM RELATED ORGANIZATION 39862762 RIGHT OF USE ASSET 239856005 305671126 OTHER LIABILITIES 65726349 FINANCE LEASE OBLIGATION 280427464 ESTIMATED THIRD PARTY OBLIGATIONS 157530894 503684707 X PART X, LINE 2: PRISMA HEALTH-UPSTATE 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 99136931 33763828 65373103 0.03330 254031397 241562893 12468504 0.00630 353168328 275326721 77841607 0.03960 5356778 454578 4902200 0.00250 72106023 45799800 26306223 0.01340 46784682 32901689 13882993 0.00710 832499 832499 0.00040 9000453 9000453 0.00460 134080435 79156067 54924368 0.02800 487248763 354482788 132765975 0.06760 1 36143426 5009137 567435016 679545901 -112110885 X 1 1 8 1 GREENVILLE MEMORIAL HOSPITAL 701 GROVE ROAD GREENVILLE SC 29605 WWW.PRISMAHEALTH.ORG HTL0936 X X X X X A 2 GREER MEMORIAL HOSPITAL 830 S BUNCOMBE RD GREER SC 29650 WWW.PRISMAHEALTH.ORG HTL0934 X X X A 3 HILLCREST MEMORIAL HOSPITAL 729 SE MAIN ST SIMPSONVILLE SC 29681 WWW.PRISMAHEALTH.ORG HTL0931 X X X X A 4 LAURENS COUNTY MEMORIAL HOSPITAL 22725 HWY 76 EAST CLINTON SC 29325 WWW.PRISMAHEALTH.ORG HTL0932 X X X A 5 NORTH GREENVILLE HOSPITAL 807 N MAIN ST TRAVELERS REST SC 29690 WWW.PRISMAHEALTH.ORG HTL0935 X X X A 6 OCONEE MEMORIAL HOSPITAL 298 MEMORIAL DRIVE SENECA SC 29672 WWW.PRISMAHEALTH.ORG HTL0937 X X X A 7 PATEWOOD MEMORIAL HOSPITAL 175 PATEWOOD DRIVE GREENVILLE SC 29615 WWW.PRISMAHEALTH.ORG HTL0933 X X X X A 8 BAPTIST EASLEY HOSPITAL 200 FLEETWOOD DR EASLEY SC 29640 WWW.PRISMAHEALTH.ORG HTL0945 X X X A FACILITY REPORTING GROUP A 0 0 1 X X X X X X X X X 18 1 1 0 1 X SEE DISCLOSURE X 1 18 1 SEE DISCLOSURE 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X X 1 X SEE DISCLOSURE X SEE DISCLOSURE X SEE DISCLOSURE X X X X X X X 1 X 0 X X X X X 1 X 0 0 PART V, SECTION B, LINE 16A HTTPS://WWW.PRISMAHEALTH.ORG/PATIENTS-AND-GUESTS/BILL-PAY/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16B HTTPS://WWW.PRISMAHEALTH.ORG/PATIENTS-AND-GUESTS/BILL-PAY/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16C HTTPS://WWW.PRISMAHEALTH.ORG/PATIENTS-AND-GUESTS/BILL-PAY/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 7A AND 10A: WEBSITE FOR COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY:HTTPS://WWW.PRISMAHEALTH.ORG/SERVICES/OTHER-SERVICES/COMMUNITY-HEALTH-HUB/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: GREENVILLE MEMORIAL HOSPITAL, - FACILITY 2: GREER MEMORIAL HOSPITAL, - FACILITY 3: HILLCREST MEMORIAL HOSPITAL, - FACILITY 4: LAURENS COUNTY MEMORIAL HOSPITAL, - FACILITY 5: NORTH GREENVILLE HOSPITAL, - FACILITY 6: OCONEE MEMORIAL HOSPITAL, - FACILITY 7: PATEWOOD MEMORIAL HOSPITAL, - FACILITY 8: BAPTIST EASLEY HOSPITAL FACILITY REPORTING GROUP A PART V, SECTION B, LINE 5: PRISMA HEALTH FORMED A MULTI-STAKEHOLDER TEAM TO CARRY OUT THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. TOGETHER, THE TEAM IDENTIFIED SEVEN COUNTIES TO FOCUS ON IN COLLECTING DATA FOR PRISMA HEALTH'S 2019 CHNA. THESE COUNTIES WERE: GREENVILLE, LAURENS, LEXINGTON, OCONEE, PICKENS, RICHLAND AND SUMTER.A TOTAL OF 5,572 SURVEYS WERE COMPLETED ACROSS THE SEVEN COUNTIES. DATA AND INFORMATION GATHERING USED BOTH QUALITATIVE AND QUANTITATIVE METHODS. PRIMARY RESEARCH-QUALITATIVE AND QUANTITATIVE- WAS COLLECTED THROUGH INTERNAL DATA SOURCES, FOCUS GROUPS, COMMUNITY STAKEHOLDER INTERVIEWS AND COMMUNITY MEMBER SURVEYS. COMMUNITY AGENCIES PROVIDED SECONDARY RESEARCH.PUBLIC HEALTH EXPERTS GUIDED THE TEAM'S OBJECTIVES IN DEVELOPING TOOLS, ANALYZING DATA AND PRIORITIZING NEEDS. FACILITY REPORTING GROUP A PART V, SECTION B, LINE 6A: PRISMA HEALTH-MIDLANDS, PRISMA HEALTH-UPSTATE, PRISMA HEALTH TUOMEY, AND THE SHRINER'S HOSPITAL OF GREENVILLE ALL CONDUCTED THE CHNA JOINTLY FACILITY REPORTING GROUP A PART V, SECTION B, LINE 11: THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT RESULTS INDICATED THREE DISTINCTIVE HEALTH ISSUES AND PRIORITY AREAS FOR INTERVENTION IN LEXINGTON, RICHLAND, SUMTER, GREENVILLE, OCONEE, PICKENS AND LAURENS COUNTY. THOSE NEEDS ARE:1. MENTAL HEALTH2. OBESITY3. DRUG USEDURING THE NEXT THREE YEARS, PRISMA HEALTH IS COMMITTED TO PARTNERING WITH HEALTH CARE AND COMMUNITY LEADERS TO PRIORITIZE AND SELECT CRITICAL AREAS FOR INTERVENTION AND ACTION PLANNING. WE HAVE OUTLINED STRATEGIES FOR PRIORITY AREAS IN PARTNERSHIP WITH VARIOUS COMMUNITY PARTNERS. FACILITY REPORTING GROUP A PART V, SECTION B, LINE 13H: THERE IS A CATASTROPHIC CLAUSE WHICH ALLOWS FOR AN ALTERNATIVE MEANS OF QUALIFYING BASED A SIGNIFICANT FINANCIAL HARDSHIP. FACILITY REPORTING GROUP A PART V, SECTION B, LINE 15E: THE FINANCIAL ASSISTANCE POLICY EXPLAINS DIFFERENT METHODS FOR APPLYING FOR FINANCIAL ASSISTANCE BY: VISITING PRISMA HEALTH WEBSITE WITH ADDRESS LISTED, CONTACTING PRISMA HEALTH PATIENT FINANCIAL SERVICES WITH PHONE NUMBERS LISTED, MAILING A REQUEST WITH ADDRESSES LISTED OR VISITING A PRISMA HEALTH FACILITY FACILITY REPORTING GROUP A PART V, SECTION B, LINE 16J: COMMUNITY CLINICS ARE AWARE OF AND HAVE ACCESS TO THE HOSPITAL'S FINANCIAL ASSISTANCE APPLICATIONS. FACILITY REPORTING GROUP A PART V, SECTION B, LINE 20E: THE ORGANIZATION WIDELY PUBLICIZES THE FINANCIAL ASSISTANCE POLICY. 57 1 - PRISMA HEALTH CANCER INSTITUTE - FARIS 900 W FARIS ROAD GREENVILLE SC 29605 OUTPATIENT CANCER TREATMENT 2 - PRISMA HEALTH PATEWOOD OUTPATIENT CENTER 200 PATEWOOD DRIVE BLDG A GREENVILLE SC 296153593 OUTPATIENT SURGERY AND DIAGNOSTIC 3 - PRISMA HEALTH CANCER INSTITUTE - SENECA 132 LILA DOYLE DRIVE SENECA SC 29672 OUTPATIENT CANCER TREATMENT 4 - PRISMA HEALTH CANCER INSTITUTE - GROVE 3 BUTTERNUT DRIVE SUITE B GREENVILLE SC 29605 OUTPATIENT CANCER TREATMENT 5 - PRISMA HEALTH CANCER INSTITUTE - SPARTAN 120 DILLON DRIVE SPARTANBURG SC 29307 OUTPATIENT CANCER TREATMENT 6 - PRISMA HEALTH OUTPATIENT RADIOLOGY 701 GROVE ROAD GREENVILLE SC 296054210 OUTPATIENT IMAGING 7 - PRISMA HEALTH CROSS CREEK SURGERY CENTER 9 DOCTORS DRIVE GREENVILLE SC 296054266 AMBULATORY SURGERY 8 - PRISMA HEALTH CANCER INSTITUTE - GREER 340 MEDICAL PARKWAYSUITE 100 GREER SC 29650 OUTPATIENT CANCER TREATMENT 9 - PRISMA HEALTH MARSHALL I PICKENS HOSPIT 701 GROVE ROAD GREENVILLE SC 296054210 INPATIENT PSYCHIATRIC 10 - PRISMA HEALTH ROGER C PEACE REHABILITAT 701 GROVE ROAD GREENVILLE SC 296054210 INPATIENT REHABILITATION 11 - PRISMA HEALTH CARDIOVASCULAR SERVICES - 3 BUTTERNUT DRIVE GREENVILLE SC 29605 CARDIOVASCULAR DIAGNOSTIC 12 - PRISMA HEALTH VASCULAR HEALTH ALLIANCE 200 PATEWOOD ROAD SUITE 300-C GREENVILLE SC 296153593 OUTPATIENT DIAGNOSTIC SERVICES; WOUND CARE; VENOUS 13 - PRISMA HEALTH KIDNETICS 29 NORTH ACADEMY ST GREENVILLE SC 296012629 PEDIATRIC OCCUPATIONAL, PHYSICAL AND SPEECH THERAPIES 14 - PRISMA HEALTH LILA DOYLE 101 LILA DOYLE DRIVE SENECA SC 296729495 SKILLED NURSING 15 - PRISMA HEALTH CENTER FOR PEDIATRIC MEDIC 20 MEDICAL RIDGE DRIVE GREENVILLE SC 29605 PEDIATRIC PRIMARY CARE 16 - PRISMA HEALTH OBGYN CLINIC 1120 GROVE ROAD GREENVILLE SC 296054652 PRIMARY CARE - OB/GYN 17 - PRISMA HEALTH EMS 1315 GROVE ROAD GREENVILLE SC 296054717 AMBULANCE SERVICE 18 - PRISMA HEALTH OCONEE MEMORIAL HOSPITAL E 298 MEMORIAL DRIVE SENECA SC 296729443 EMERGENCY SERVICES AND TRANSPORTATION 19 - PRISMA HEALTH HOME HEALTH UPSTATE 440 ROPER MOUNTAIN ROAD SUITE C GREENVILLE SC 296154235 HOME HEALTH AGENCY 20 - PRISMA HEALTH PEDIATRIC HEMATOLOGYONCOL 900 W FARIS ROAD GREENVILLE SC 296054255 DIAGNOSTIC SERVICES AND TREATMENTS FOR CHILDREN 21 - PRISMA HEALTH ROGER C PEACE OUTPATIENT 701 GROVE ROAD GREENVILLE SC 296054210 OUTPATIENT REHABILITATION 22 - PRISMA HEALTH CANCER INSTITUTE - EASLEY 109 FLEETWOOD DRIVE SUITE A EASLEY SC 29640 OUTPATIENT CANCER TREATMENT 23 - PRISMA HEALTH LAURENS FAMILY MEDICINE - 106 PARKVIEW DRIVE LAURENS SC 293602652 PRIMARY CARE 24 - PRISMA HEALTH ROGER C PEACE TBI 100 AUGUSTA STREET GREENVILLE SC 296013504 OUTPATIENT BRAIN INJURY REHABILITATION 25 - PRISMA HEALTH SURGERYORTHOPEDICS CLINI 13 EDGEWOOD DRIVE GREENVILLE SC 296054235 OUTPATIENT ORTHOPEDIC/SURGERY DIAGNOSTIC, REFERRAL 26 - PRISMA HEALTH SURGERY CENTER - SPARTANBU 1413 JOHN B WHITE SR BLVD SUITE D SPARTANBURG SC 293063995 AMBULATORY SURGERY 27 - PRISMA HEALTH OCONEE PAIN MANAGEMENT 102 B OMNI DRIVE SENECA SC 296729448 PAIN MANAGEMENT 28 - PRISMA HEALTH INTERNAL MEDICINESUBSPECI 701 GROVE ROAD GREENVILLE SC 296054210 PRIMARY CARE 29 - PRISMA HEALTH ADVANCED FAMILY MEDICINE 210 SOUTH BROAD STREET CLINTON SC 29325 PRIMARY CARE 30 - PRISMA HEALTH CENTER FOR FAMILY MEDICINE 877 W FARIS RD GREENVILLE SC 296054289 PRIMARY CARE 31 - PRISMA HEALTH HOSPICE OF THE FOOTHILLS 390 KEOWEE SCHOOL ROAD SENECA SC 296726743 HOSPICE - OUTPATIENT 32 - PRISMA HEALTH CLEMSONSENECA PEDS - CLEM 450 OLD GREENVILLE HIGHWAY CLEMSON SC 296311671 PRIMARY CARE PEDIATRIC 33 - PRISMA HEALTH MARSHALL I PICKENS CHILDR 701 GROVE ROAD GREENVILLE SC 296054210 CHILD AND ADOLESCENT RESIDENTIAL TREATMENT CENTER 34 - PRISMA HEALTH CLEMSONSENECA PEDS - SENE 109 OMNI DRIVE B SENECA SC 296729448 PRIMARY CARE PEDIATRIC 35 - PRISMA HEALTH LAURENS FAMILY MEDICINE - 9100 HWY14 GRAY COURT SC 296454152 PRIMARY CARE 36 - PRISMA HEALTH SLEEP DISORDERS CENTER - V 1025 VERDAE BLVD SUITE D GREENVILLE SC 296074032 SLEEP STUDIES/DIAGNOSTIC 37 - PRISMA HEALTH MARSHALL I PICKENS OUTPAT 701 GROVE ROAD GREENVILLE SC 296054210 OUTPATIENT PSYCHIATRIC 38 - PRISMA HEALTH DIABETES SELF-CARE MGMT P 875 WEST FARIS ROAD GREENVILLE SC 296054254 OUTPATIENT DIABETES CARE 39 - PRISMA HEALTH CARDIOVASCULAR SERVICES SI 719 SE MAIN STREET SIMPSONVILLE SC 29681 CARDIOVASCULAR DIAGNOSTIC 40 - PRISMA HEALTH CANCER INSTITUTE - LAURENS 22725 HWY 76 EAST THIRD FLOOR CLINTON SC 293257527 OUTPATIENT CANCER TREATMENT 41 - PRISMA HEALTH SLEEP DISORDERS CENTER - H 741 SOUTHEAST MAIN ST SIMPSONVILLE SC 296813237 SLEEP STUDIES/DIAGNOSTIC 42 - PRISMA HEALTH CANCER INSTITUTE - EASTSID 65 INTERNATIONAL DRIVE GREENVILLE SC 29615 OUTPATIENT CANCER TREATMENT 43 - PRISMA HEALTH SLEEP DISORDERS CENTER - F 890 WEST FARIS ROAD SUITE 560 GREENVILLE SC 296054253 SLEEP STUDIES/DIAGNOSTIC 44 - PRISMA HEALTH WONDER CENTER 29 NORTH ACADEMY STREET GREENVILLE SC 296012629 DAY TREATMENT CENTER FOR MEDICALLY FRAGILE CHILDREN 45 - PRISMA HEALTH CENTER FOR PEDIATRIC MEDIC 5 WEST MAIN STREET GREENVILLE SC 29611 PRIMARY CARE PEDIATRIC 46 - PRISMA HEALTH INFUSION CENTER 701 GROVE ROAD GREENVILLE SC 296054210 OUTPATIENT CANCER TREATMENT 47 - PRISMA HEALTH WOMEN'S AND CHILDREN'S PRO 701 GROVE ROAD GREENVILLE SC 296054210 CHILDBIRTH EDUCATION 48 - PRISMA HEALTH CENTER FOR FAMILY MEDICINE 139 LILA DOYLE DRIVE SENECA SC 29672 PRIMARY CARE 49 - PRISMA HEALTH CTR FOR PERIOP OPTIMIZATIO 905 VERDAE BLVD SUITE 102 GREENVILLE SC 296074029 SURGICAL PREASSESSMENT 50 - PRISMA HEALTH BAPTIST EASLEY OP SERVICES 1807-A EAST MAIN STREET EASLEY SC 29640 OUTPATIENT SURGERY AND DIAGNOSTIC 51 - PRISMA HEALTH BAPTIST EASLEY OP SERVICES 11404 ANDERSON ROAD GREENVILLE SC 29611 OUTPATIENT SURGERY AND DIAGNOSTIC 52 - PRISMA HEALTH BAPTIST EASLEY THERAPY SVS 11402 ANDERSON ROAD SUITE B GREENVILLE SC 29611 OUTPATIENT THERAPY 53 - PRISMA HEALTH BAPTIST EASLEY THERAPY SVS 112 JOHN STREET STE 104 EASLEY SC 29640 OUTPATIENT THERAPY 54 - PRISMA HEALTH HILLCREST HOSP VASCULAR LA 729 SE MAIN ST SIMPSONVILLE SC 296813218 LAB 55 - PRISMA HEALTH FAMILY MEDICINE BISHOPVILL 116 HOSPITAL SQ BISHOPVILLE SC 290107081 PRIMARY CARE 56 - PRISMA HEALTH FAMILY MEDICINE WINNSBORO 56 US HIGHWAY 321 BYP N WINNSBORO SC 291807100 PRIMARY CARE 57 - PRISMA HEALTH WALK-IN CARE NORTH GREENVI 807 NORTH MAIN STREET TRAVELERS REST SC 296901551 PRIMARY CARE PART I, LINE 3C: FPG IS USED BUT IN ADDITION, THERE IS CONSIDERATION FOR CATASTROPHIC EVENTS:WHEN THE PATIENT'S HOSPITAL ACCOUNT(S) EXCEED TWO (2) TIMES THE HOUSEHOLD ANNUAL GROSS INCOME THE FOLLOWING CRITERIA WILL BE CONSIDERED WHEN DETERMINING SPONSORSHIP ELIGIBILITY:THE TAX APPRAISED VALUE OF THE PRIMARY PLACE OF RESIDENCE MAY EXCEED THE TWO HUNDRED THOUSAND DOLLARS ($200,000).EQUITY VALUE OF THE PRIMARY PLACE OF RESIDENCE MAY EXCEED THIRTY-FIVE THOUSAND ($35,000) DOLLARS.LIQUID ASSETS MAY BE CONSIDERED WHEN DETERMINING SPONSORSHIP.SPONSORSHIP FOR A CATASTROPHIC EVENT MAY BE APPROVED FOR OUTSTANDING ACCOUNTS FOR DATES OF SERVICE WITHIN EIGHT (8) MONTHS FROM THE DATE OF APPLICATION. CHARITY/SPONSORSHIP WILL NOT BE ADDED TO THE PATIENT'S RECORD FOR FUTURE DATES OF SERVICE BUT MAY REAPPLY WHEN ADDITIONAL SERVICES ARE RECEIVED. PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES INCLUDE:1. CENTER FOR FAMILY MEDICINE2. MEDICAL CENTER CLINICS3. HOSPICE SERVICES4. MARSHALL I. PICKENS HOSPITAL5. HOME HEALTH6. LILA DOYLE NURSING CARE7. GMMC SUBACUTE8. ROGER C. PEACE REHABILITATION9. MOBILE CARE AMBULANCE SERVICE10. DIABETES SELF MANAGEMENT PROGRAM11. PALLATIVE CARE PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 192,053,421. PART III, LINE 2: BAD DEBT EXPENSE IS CALCULATED BY APPLYING THE ORGANIZATION'S COST-TO-CHARGE RATIO TO THE BAD DEBT WRITE-OFFS AS PRESENTED IN THE AUDITED FINANCIAL STATEMENTS. THIS AMOUNT IS THEN REDUCED BY A PORTION OF THE NET MEDICAID DSH REVENUE. PART III, LINE 3: OF THE ACCOUNTS IN BAD DEBT, AN INTERNAL REVIEW SHOWED THAT 65.43% WERE SELF-PAY WITH LOW PROPENSITY TO PAY SCORES. OF THESE, OUR ESTIMATE IS THAT 67.5% OF THESE WOULD QUALIFY FOR CHARITY. PART III, LINE 4: SEE THE FY2020 FINANCIALS, NOTE 2 - NET PATIENT SERVICE REVENUE AND PATIENT ACCOUNTS RECEIVABLE. PART III, LINE 8: ONE CRITERION FOR QUALIFIYING AS A COMMUNITY BENEFIT IS THAT THE SERVICE, IF NOT PROVIDED BY THE HOSPITAL, WOULD OTHERWISE BE PROVIDED BY THE GOVERNMENT. PRISMA HEALTH IS REQUIRED TO PROVIDE CARE TO ALL, REGARDLESS OF ABILITY TO PAY. A FOR-PROFIT ENTITY WOULD NOT KNOWINGLY OFFER A PROGRAM THAT GENERATES A LOSS OF THIS MAGNITUDE. PART III, LINE 9B: IF IT IS DETERMINED THAT A PATIENT HAS NO AVAILABLE MEANS TO PAY FOR SERVICES AND IS DECLARED ELIGIBLE FOR HOSPITAL CHARITY OR HOSPITAL SPONSORSHIP, CHARGES WILL BE ADJUSTED ACCORDING TO THE LEVEL OF CHARITY OR SPONSORSHIP DOCUMENTED ON THE PATIENT'S ACCOUNT. SPECIFIC TO PATIENTS SEEN AT COMPONENTS OF THE GREENVILLE MEMORIAL HOSPITAL PROVIDER, AND FOR PURPOSES OF THE 340B DRUG PROGRAM, THE CONTRACT PHARMACIES WILL EXTEND DISCOUNTS TO PATIENTS UNDER THE HOSPITAL SPONSORSHIP PROGRAM. HOSPITAL CHARITY AND HOSPITAL SPONSORSHIP CONSTITUTES A SATISFACTORY FINANCIAL ARRANGEMENT. PART VI, LINE 2: A DESCRIPTION OF HOW PRISMA HEALTH-UPSTATE CONDUCTS ITS NEEDS ASSESSMENT CAN BE FOUND AT THE FOLLOWING LINK: HTTPS://WWW.PRISMAHEALTH.ORG/SERVICES/OTHER-SERVICES/COMMUNITY-HEALTH-HUB/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART VI, LINE 3: THE ORGANIZATION INFORMS AND EDUCATES PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY BY:- POSTING THE HOSPITALS FINANCIAL ASSISTANCE POLICY ON THEIR WEBSITE- POSTING AN APPLICATION FOR FINANCIAL ASSISTANCE ON THEIR WEBSITE- POSTING A PLAIN LANGUAGE SUMMARY ON THEIR WEBSITE- THE FINANCIAL ASSISTANCE IS MADE AVAILABLE UPON REQUEST AND WITHOUT CHARGE- THE FINANCIAL ASSISTANCE APPLICATION IS MADE AVAILABLE UPON REQUEST AND WITHOUT CHARGE- THE PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE UPON REQUEST AND WITHOUT CHARGE- THE ORGANIZATION NOTIFIES MEMBERS OF THE COMMUNITY WHO ARE MOST LIKELY TO REQUIRE FINANCIAL ASSISTANCE OF THE FINANCIAL ASSISTANCE POLICY- THE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAGE SUMMARY WERE TRANSLATED INTO THE PRIMARY LANGUAGES SPOKEN BY LEP POPULATION PART VI, LINE 4: ALTHOUGH PRISMA HEALTH-UPSTATE SERVES PATIENTS FROM THE ENTIRE 10-COUNTY UPSTATE AREA OF SOUTH CAROLINA, FOR THE PURPOSE OF THIS COMMUNITY HEALTH NEEDS ASSESSMENT, WE CHOSE THE COMMUNITIES WITH THE CLOSEST PROXIMITY TO A PRISMA HEALTH-UPSTATE FACILITY. THESE COMMUNITIES LIE WITHIN FOUR COUNTIES: GREENVILLE COUNTY, LAURENS COUNTY, OCONEE COUNTY, AND PICKENS COUNTY. PART VI, LINE 5: INFORMATION ON WAYS PRISMA HEALTH-UPSTATE PROMOTES COMMUNITY HEALTH CAN BE FOUND AT THE FOLLOWING LINK: HTTPS://WWW.PRISMAHEALTH.ORG/SERVICES/OTHER-SERVICES/COMMUNITY-HEALTH-HUB/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART VI, LINE 6: THE ORGANIZATION IS A COMPONENT OF AN AFFILIATED HEALTH CARE SYSTEM IN THE STATE OF SOUTH CAROLINA. THE SYSTEM HAS MULTIPLE HOSPITAL SYSTEMS THAT PROVIDE HOSPITALS SERVICES TO THE RESPECTIVE COMMUNITIES. 1 AMERICAN HEART ASSOCIATION 3535 PELHAM ROAD GREENVILLE SC 29615 135613797 501(C)(3) 7500 OPERATIONAL/COMMUNITY ENGAGEMENT CANCER SOCIETY OF GREENVILLE 113 MILLS AVENUE GREENVILLE SC 29605 570471686 501(C)(3) 15000 OPERATIONAL/COMMUNITY ENGAGEMENT CITY OF GREENVILLE SC 206 SOUTH MAIN STREET GREENVILLE SC 29601 GOVERNMENTAL 10000 OPERATIONAL/COMMUNITY ENGAGEMENT CLEMSON SCHOOL OF NURSING 607 GROVE RD GREENVILLE SC 29605 576000254 GOVERNMENTAL 750000 OPERATIONAL/COMMUNITY ENGAGEMENT CLEMSON UNIVERSITY FOUNDATION PO BOX 1889 CLEMSON SC 29631 570426335 509(A)(1) 10000 OPERATIONAL/COMMUNITY ENGAGEMENT FOOTHILLS AREA YMCA 621 N TOWNVILLE ST SENECA SC 29678 570934024 501(C)(3) 100000 OPERATIONAL/COMMUNITY ENGAGEMENT FURMAN UNIVERSITY 3300 POINSETT HIGHWAY GREENVILLE SC 29613 570314395 509(A)(1) 525000 OPERATIONAL/COMMUNITY ENGAGEMENT FURMAN UNIVERSITY - RILEY 3300 POINSETT HIGHWAY GREENVILLE SC 29613 570314395 509(A)(1) 30000 OPERATIONAL/COMMUNITY ENGAGEMENT GREATER GREENVILLE SCOTTISH GAMES AND HIGHLAND FESTIVAL 225 S PLEASANTBURG DR SUITE B12-1 GREENVILLE SC 29607 501(C)(3) 15000 OPERATIONAL/COMMUNITY ENGAGEMENT GREATER GREER CHAMBER OF COMME 111 TRADE STREET GREER SC 29651 570174128 501(C)(6) 12000 OPERATIONAL/COMMUNITY ENGAGEMENT GREENVILLE AREA PARKINSON 2501 WADE HAMPTON BLVD STE 115-204 TAYLORS SC 29687 264732316 509(A)(1) 30000 OPERATIONAL/COMMUNITY ENGAGEMENT GREENVILLE CHAMBER OF COMMERCE 24 CLEVELAND STREET GREENVILLE SC 29601 570173240 501(C)(6) 80000 OPERATIONAL/COMMUNITY ENGAGEMENT GREENVILLE COUNTY REC 4806 OLD SPARTANBURG ROAD TAYLORS SC 29687 576000356 501(C)(3) 150000 OPERATIONAL/COMMUNITY ENGAGEMENT GREENVILLE FREE MEDICAL CLINIC PO BOX 8993 GREENVILLE SC 29604 570855205 509(A)(1) 10000 OPERATIONAL/COMMUNITY ENGAGEMENT HABITAT FOR HUMANITY PO BOX 1206 GREENVILLE SC 29602 570827063 509(A)(1) 5000 OPERATIONAL/COMMUNITY ENGAGEMENT JULIE VALENTINE CENTER 2905 WHITE HORSE ROAD GREENVILLE SC 29611 570655611 509(A)(1) 20000 OPERATIONAL/COMMUNITY ENGAGEMENT LAURENS CO FUTURE SCHOLARSHIP PO BOX 248 LAURENS SC 29360 501(C)(3) 10000 OPERATIONAL/COMMUNITY ENGAGEMENT LIVEWELL GREENVILLE 225 S PLEASANTBURG DRIVE SUITE A7 GREENVILLE SC 29607 811376760 509(A)(1) 10000 OPERATIONAL/COMMUNITY ENGAGEMENT LOAVES & FISHES 25 WOODS LAKE ROAD SUITE 810 GREENVILLE SC 29607 570931804 501(C)(3) 5000 OPERATIONAL/COMMUNITY ENGAGEMENT MARCH OF DIMES 37 VILLA ROAD B-123 GREENVILLE SC 29615 131846366 501(C)(3) 25000 OPERATIONAL/COMMUNITY ENGAGEMENT MIDDLE TYGER YMCA 720 SHOALS RD DUNCAN SC 29334 570314425 501(C)(3) 100000 OPERATIONAL/COMMUNITY ENGAGEMENT OCONEE CO CHAMBER OF COMMERCE 135 C EAGLES NEST DRIVE PO BOX 8102 8102 SENECA SC 29678 570286871 501(C)(6) 10000 OPERATIONAL/COMMUNITY ENGAGEMENT OUR UPSTATE SC 150 EXECUTIVE CENTER DR SUITE 202 GREENVILLE SC 29615 451842000 501(C)(3) 15000 OPERATIONAL/COMMUNITY ENGAGEMENT PROJECT HOST INC 525 S ACADEMY ST GREENVILLE SC 29601 570728041 501(C)(3) 5000 OPERATIONAL/COMMUNITY ENGAGEMENT RAINBOW PUSH COALITION 110 SOUTH CALHOUN STREET GREENVILLE SC 29601 341447977 509(A)(1) 7500 OPERATIONAL/COMMUNITY ENGAGEMENT SAFE HARBOR INC PO BOX 174 GREENVILLE SC 29609 571014137 509(A)(1) 15000 OPERATIONAL/COMMUNITY ENGAGEMENT SAMARITAN HEALTH CLINIC OF 303 DACUSVILLE HWY EASLEY SC 29640 570947115 501(C)(3) 30000 OPERATIONAL/COMMUNITY ENGAGEMENT SCBIO 411 UNIVERSITY RIDGE GREENVILLE SC 29601 200613951 509(A)(1) 23933 OPERATIONAL/COMMUNITY ENGAGEMENT SPARTANBURG COUNTY FOUNDATION 424 E KENNEDY STREET SPARTANBURG SC 29302 570351398 501(C)(3) 10000 OPERATIONAL/COMMUNITY ENGAGEMENT THE ASPEN INSTITUTE 1 DUPONT CIRCLE NW WASHINGTON DC 20036 840399006 501(C)(3) 1243000 OPERATIONAL/COMMUNITY ENGAGEMENT THE TRI GUYS INC PO BOX 6591 GREENVILLE SC 29606 571168218 501(C)(3) 10000 OPERATIONAL/COMMUNITY ENGAGEMENT TOWN GREENVILLE LLC PO BOX 2266 GREENVILLE SC 29602 501(C)(3) 7500 OPERATIONAL/COMMUNITY ENGAGEMENT UPCOUNTRY HISTORY MUSEUM 540 BUNCOMBE STREET GREENVILLE SC 29601 570833796 509(A)(1) 20000 OPERATIONAL/COMMUNITY ENGAGEMENT UPSTATE SC ALLIANCE INC 124 VERDAE BOULEVARD 202 GREENVILLE SC 29607 571095229 501(C)(6) 15000 OPERATIONAL/COMMUNITY ENGAGEMENT URBAN LEAGUE OF THE UPSTATE IN 15 REGENCY HILL DRIVE GREENVILLE SC 29607 570541039 509(A)(1) 20000 OPERATIONAL/COMMUNITY ENGAGEMENT USC SCHOOL OF MEDICINE GREENVILLE 607 GROVE RD GREENVILLE SC 29605 576001153 GOVERNMENTAL 11803582 OPERATIONAL/COMMUNITY ENGAGEMENT YMCA OF GREENVILLE 723 CLEVELAND STREET GREENVILLE SC 29601 570314424 501(C)(3) 200000 OPERATIONAL/COMMUNITY ENGAGEMENT MUSC 18 BEE ST CHARLESTON SC 29425 501(C)(3) 0 104000 COST EARLOOP MASKS COVID-19 SUPPORT 21 17 PART I, LINE 1 ALL ASSISTANCE PROVIDED FITS WITH OUR MISSION OF IMPROVING THE HEALTH OF OUR COMMUNITY AND/OR SUPPORT ECONOMIC GROWTH OF OUR COMMUNITY. PRISMA HEALTH-UPSTATE HAS A FORMAL ONLINE SUBMISSION PROCESS. VARIOUS LEADERS IN THE ORGANIZATION PROVIDE INPUT AND DECISIONS ARE MADE BASED ON ALL INFORMATION RECEIVED. X X X X 1 1 0 0 0 0 0 0 0 GREGORY J RUSNAK EVP CHIEF OPERATING OFFICER 0 658658 0 0 0 4910 0 133251 0 30207 0 827026 0 0 HOWARD P WEST EVP GENERAL COUNSEL 0 495015 0 29775 0 162961 0 44000 0 24164 0 755915 0 0 MATTHEW RM FOWLER SR VP AND DEPUTY GENERAL COUNSEL 0 236579 0 36923 0 4071 0 48562 0 30560 0 356695 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 ANGELO SINOPOLI MD EVP CHIEF CLINICAL OFFICER 0 749828 0 0 0 20727 0 151346 0 14041 0 935942 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 483187 0 0 0 14151 0 99306 0 31329 0 627973 0 0 0 CAROLYN SWINTON MN SVP CHIEF NURSING OFFICER 0 381932 0 0 0 40322 0 39294 0 29430 0 490978 0 0 DAVID WILLIAMS MD CEO, PRISMA HEALTH MEDICAL GROUP 24337 565188 0 53707 272 8653 0 53625 1309 35275 25918 716448 0 0 TERRI T NEWSOM EVP CHIEF FINANCIAL OFFICER (UNTIL 4 0 680204 0 0 0 4183 0 133625 0 34191 0 852203 0 0 JEANNE WARD EXECUTIVE 376716 0 0 0 349627 0 28625 0 10422 0 765390 0 0 0 JAMES M ELLIS JR VP CLINICAL AFFAIRS 585275 0 43858 0 441 0 106625 0 32434 0 768633 0 0 0 PAUL F JOHNSON VP CHIEF OPERATIONS EXECUTIVE 350956 0 0 0 163135 0 100426 0 20627 0 635144 0 0 0 CHRISTOPHER C WRIGHT CHIEF MEDICAL STAFF 515729 0 44379 0 7228 0 28625 0 32271 0 628232 0 0 0 MARTIN E LUTZ PHYSICIAN 362689 0 32984 0 6167 0 37375 0 30835 0 470050 0 0 0 T CHAD MOSES FORMER OFFICER 290776 0 0 0 267 0 58625 0 30732 0 380400 0 0 0 SPENCE M TAYLOR MD FORMER PRESIDENT, UPSTATE AFF'L (UNT 0 526491 0 0 0 189837 0 82400 0 22755 0 821483 0 0 JOSEPH J BLAKE JR FORMER SECRETARY 0 141100 0 0 0 81 0 47030 0 17434 0 205645 0 0 CHARLES D BEAMAN JR FORMER CO-CEO OF PRISMA HEALTH (UNTI 0 1525975 0 0 0 43797 0 37306 0 24166 0 1631244 0 0 MICHAEL C RIORDAN FORMER CO-CEO OF PRISMA HEALTH (UNTI 0 715486 0 0 0 224124 0 47625 0 36152 0 1023387 0 0 PART I, LINES 4A-B THE FOLLOWING EMPLOYEES RECEIVED A SEVERANCE PAYMENT UPON TERMINATION OF THEIR EMPLOYMENT CONTRACT: PAUL F. JOHNSON - $113,729 SPENCE M. TAYLOR - $181,247 JEANNE L. WARD - $349,627 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 PRIOR FISCAL YEAR BASE COMPENSATION. SPLIT DOLLAR LIFE INSURANCE PARTICIPANTS ARE MICHAEL RIORDAN, CHARLES BEAMAN, 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. A SEE PART VI 576007863 396481AA1 2016-10-01 601263556 SEE PART VI 0 0 0 B LAURENS COUNTY HEALTH CARE SYSTEM 570823499 519071CY8 2016-10-01 3880768 SEE PART VI 0 0 0 C GREENVILLE HEALTH AUTHORITY 576007863 396481AA1 2019-05-01 68360000 SEE PART VI 0 0 0 A 336465000 601263556 601263556 1 0 1 1 B 2490000 3880768 3880768 1 0 1 1 C 68360000 68360000 1 0 1 1 A 0 0 1 1 0 0.00000 0.00020 0.00020 0 0 1 B 0 1 0 0 0.00000 0.00010 0.00010 0 0 1 C 0 0 0 0 0.00000 0.00040 0.00040 0 0 1 A 0 0 1 1 1 0 0 0 1 B 0 0 1 1 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 SCHEDULE K, PART I, LINE A, COLUMN A: ISSUER NAME: GREENVILLE HEALTH AUTHORITY, F/K/A GREENVILLE HOSPITAL SYSTEM. SCHEDULE K, PART I, LINE A, COLUMN (F): DESCRIPTION OF PURPOSE: ON 10/1/2016, PRISMA HEALTH - UPSTATE, F/K/A UPSTATE AFFILIATE ORGANIZATION, ("UPSTATE") ENTERED INTO A LEASE AND CONTRIBUTION AGREEMENT WITH GREENVILLE HEALTH AUTHORITY F/K/A GREENVILLE HOSPITAL SYSTEM (THE "ISSUER"), PURSUANT TO WHICH UPSTATE WOULD UNDERTAKE THE OPERATIONS OF ISSUER'S HOSPITAL FACILITIES. AT THE TIME OF THE AGREEMENT, THE ISSUER TIMELY UNDERTOOK REMEDIAL ACTION UNDER SECTION 1.141-12(F) OF THE TREASURY REGULATIONS TO CAUSE THE ISSUER BONDS TO BE RE-ISSUED ON 10/01/2016 AS QUALIFIED 501(C)3 BONDS. THE BOND BEING REPORTED ON THIS SCHEDULE K IS THAT RE-ISSUANCE BOND. AS FILED ON FORM 8038, THE RE-ISSUANCE WAS CONSIDERED A CURRENT REFUNDING OF THE ISSUER'S PREVIOUS BONDS WHICH WERE ISSUED ON 06/1/1990 (SERIES 1990); 07/01/2008 (SERIES 2008A); 08/19/2008 (SERIES 2008B); 08/9/2012 (REISSUANCE OF SERIES 2008C); 04/20/2015 (REISSUANCE OF SERIES 2008D); 04/20/2015 (REISSUANCE OF SERIES 2008E); 06/07/2012 (SERIES 2012); 04/01/2014 (SERIES 2014A); 09/23/2014 (SERIES 2014B) SCHEDULE K, PART I, LINE B, COLUMN (F): DESCRIPTION OF PURPOSE: ON 7/1/2013, LAURENS COUNTY HEALTH CARE SYSTEM (THE "ISSUER") ENTERED INTO A LEASE AND CONTRIBUTION AGREEMENT (THE "2013 AGREEMENT") WITH GREENVILLE HEALTH AUTHORITY F/K/A GREENVILLE HOSPITAL SYSTEM ("GHA OR THE "LESSEE"). THE 2013 AGREEMENT TRANSFERRED THE OPERATIONS OF THE LAURENS HOSPITAL TO GHA AS LESSEE. ON 10/1/2016, PRISMA HEALTH - UPSTATE, F/K/A UPSTATE AFFILIATE ORGANIZATION ("UPSTATE") ENTERED INTO A LEASE AND CONTRIBUTION AGREEMENT (THE "2016 AGREEMENT") WITH GHA. UNDER THE TERMS OF THE 2016 AGREEMENT, UPSTATE BECAME A SUBLESSEE UNDER THE 2013 AGREEMENT AND ASSUMED OPERATIONS OF THE LAURENS HOSPITAL. AT THE TIME OF THE 2016 AGREEMENT, THE ISSUER TIMELY UNDERTOOK REMEDIAL ACTION UNDER SECTION 1.141-12(F) OF THE TREASURY REGULATIONS TO CAUSE THE ISSUER BONDS TO BE RE-ISSUED ON 10/01/2016 AS QUALIFIED 501(C)3 BONDS. THE BOND BEING REPORTED ON THIS SCHEDULE K IS THAT RE-ISSUANCE BOND. AS FILED ON FORM 8038, THE RE-ISSUANCE WAS CONSIDERED A CURRENT REFUNDING OF THE ISSUER'S PREVIOUS BONDS WHICH WERE ISSUED ON 2/29/2012. SCHEDULE K, PART II, COLUMN A, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE DEEMED EXPENDED ON THE REISSUANCE DATE. SCHEDULE K, PART II, COLUMN B, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE DEEMED EXPENDED ON THE REISSUANCE DATE. SCHEDULE K, PART II, COLUMN C, LINE 11: THE OTHER SPENT PROCEEDS ARE THE REFUNDING PROCEEDS OF THE ISSUE DEEMED EXPENDED ON THE REISSUANCE DATE. SCHEDULE K, PART III, COLUMN A, LINE 3A: ALL OF THESE CONTRACTS MEET SAFE HARBOR PROVISIONS. SCHEDULE K, PART IV, COLUMN A, LINE 2(A-C) : (1) SERIES 1990 - COMPUTATION DATE 7/1/2015 (NO REBATE DUE); (2) SERIES 2008A - FINAL COMPUTATION DATE 12/5/2018 (NO REBATE DUE); (3) SERIES 2008B, REISSUED SERIES 2008D AND REISSUED SERIES 2008E - FINAL COMPUTATION DATE 12/5/2018 (NO REBATE DUE); (4) REISSUED SERIES 2008C - COMPUTATION DATE 8/9/2017 (NO REBATE DUE); (5) SERIES 2012 - COMPUTATION DATE 6/7/2017 (EXCEPTION TO REBATE); (6) SERIES 2014A - COMPUTATION DATE 4/1/2019 (EXCEPTION TO REBATE): (7) SERIES 2014B - COMPUTATION DATE 9/23/2019 (EXCEPTION TO REBATE); (8) SERIES 2015 - COMPUTATION DATE 5/1/2019 (EXCEPTION TO REBATE) SCHEDULE K, PART IV, COLUMN B, LINE 2(A-C) : (1) SERIES 2015 - COMPUTATION DATE 2/29/2017 (EXCEPTION TO REBATE). MICHAEL RIORDAN FORMER OFFICER SPLIT DOLLAR LIFE INSURANCE X 6063000 5427000 0 1 1 5427000 FRANCES M TAYLOR FAMILY MEMBER OF FORMER OFFICER DR. SPENCE TAYLOR 76424 COMPENSATED AS EMPLOYEE 0 LAURA T WARMAN FAMILY MEMBER OF FORMER OFFICER DR. SPENCE TAYLOR 98290 COMPENSATED AS EMPLOYEE 0 X 5 273743 FMV X MUSEUM TICKETS AND RENTAL SPACE 1 5500 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER IS PRISMA HEALTH. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER, PRISMA HEALTH, SELECTS THE BOARD MEMBERS AND HAS THE POWER TO REMOVE ANY DIRECTOR AT ANY TIME. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER, PRISMA HEALTH, HAS THE AUTHORITY WITH RESPECT TO THE FOLLOWING MATTERS: 1. APPROVE ANY AMENDMENT OR CHANGE TO THE ARTICLES OF INCORPORATION OR ANY CORRELATIVE DOCUMENT OF THE CORPORATION AS TO WHICH THE APPROVAL OF THE CORPORATION IS REQUIRED IN CONNECTION WITH SUCH AMENDMENT OR CHANGE, IN EACH CASE ABOVE TO THE EXTENT SUCH AMENDMENT OR CHANGE IS INTENDED TO OR WOULD ABROGATE OR DIMINISH IN ANY WAY OR OTHERWISE ELIMINATE THE RIGHTS AND PRIVILEGES OF PRISMA HEALTH; 2. APPROVE ANY AMENDMENT OR CHANGE TO, OR THE REPEAL OF, THE BYLAWS OF THE CORPORATION IS REQUIRED IN CONNECTION WITH SUCH AMENDMENT, CHANGE, OR REPEAL, IN EACH CASE ABOVE TO THE EXTENT SUCH AMENDMENT OR CHANGE IS INTENDED TO OR WOULD ABROGATE OR DIMINISH IN ANY WAY OR OTHERWISE ELIMINATE THE RIGHTS AND PRIVILEGES OF PRISMA HEALTH 3. INITIATE ANY MERGER OR CONSOLIDATION, OR THE DISSOLUTION, CONVERSION, OR LIQUIDATION OF (INCLUDING ANY BANKRUPTCY FILING OR INSOLVENCY PROCEEDING BY) THE CORPORATION; 4. INITIATE THE DISSOLUTION, CONVERSION, OR LIQUIDATION OF (INCLUDING ANY BANKRUPTCY FILING OR INSOLVENCY PROCEEDING BY) THE CORPORATION; 5. APPOINT OR REMOVE THE POST-CLOSING CORPORATION DIRECTORS, WITH OR WITHOUT CAUSE; 6. INITIATE THE ESTABLISHMENT OF ANY NEW MATERIAL ACADEMIC AFFILIATION BY THE CORPORATION; 7. INITIATE THE PARTICIPATION, DIRECTLY OR INDIRECTLY, IN ANY JOINT VENTURE OR JOINT ENTERPRISE WITH ONE OR MORE THIRD PARTIES, OR APPROVE THE PARTICIPATION, DIRECTLY OR INDIRECTLY, IN SUCH A TRANSACTION TO THE EXTENT IT MAY FALL OUTSIDE THE PARAMETERS FOR ENTRY INTO SUCH TRANSACTIONS ESTABLISHED BY PRISMA HEALTH; 8. ON CONSULTATION WITH THE CORPORATION, DEVELOP THE OPERATING AND CAPITAL BUDGETS AND FORECASTS APPLICABLE TO THE CORPORATION, AND MONITOR THE STATUS OF, AND HOLD IT ACCOUNTABLE FOR ITS PERFORMANCE RELATIVE TO, ITS BUDGET OR FORECAST, AS APPLICABLE; 9. ON CONSULTATION WITH THE CORPORATION, DEVELOP THE STRATEGIC, FINANCIAL, CAPITAL, AND OPERATING PLANS APPLICABLE TO THE CORPORATION AND MONITOR THE STATUS OF, AND HOLD IT ACCOUNTABLE FOR ITS PERFORMANCE RELATIVE TO, ITS STRATEGIC, FINANCIAL, CAPITAL, AND OPERATING PLANS; 10. EXERCISE OVERSIGHT OVER MANAGEMENT OF AND POLICIES WITH RESPECT TO, AND INITIATE THE SALE OF OR ANY LIEN ON, THE REAL OR PERSONAL PROPERTY ASSETS (OR ANY INTEREST THEREIN) OF THE CORPORATION; 11. APPROVE THE PARTICIPATION, DIRECTLY OR INDIRECTLY, BY THE CORPORATION IN A SALE OR LIEN TRANSACTION, TO THE EXTENT SUCH TRANSACTION MAY FALL OUTSIDE THE PARAMETERS FOR ENTRY INTO SUCH TRANSACTIONS WITHOUT THE PRIOR APPROVAL PRISMA HEALTH; 12. INITIATE THE INCURRENCE OF ANY INDEBTEDNESS, ANY OPERATING OR CAPITAL EXPENDITURE, OR ANY INVESTMENT IN (INCLUDING ANY LOAN TO) ANY THIRD PARTY, BY THE CORPORATION, IN EACH CASE TO THE EXTENT THE SAME IS NOT INCLUDED IN AN APPROVED BUDGET OR FORECAST OR OTHER ACTION TAKEN BY PRISMA HEALTH APPLICABLE TO THE CORPORATION; 13. CAUSE OR DIRECT THE PAYMENT, LOAN OR TRANSFER TO PRISMA HEALTH OF SUCH FUNDS, AND IN SUCH AMOUNTS, AS PRISMA HEALTH SHALL DETERMINE FROM TIME TO TIME, FROM THE CORPORATION; AND 14. TO THE EXTENT NOT EXPRESSLY SET FORTH ABOVE, DIRECT OR REQUIRE THAT THE CORPORATION TAKE ANY OTHER LAWFUL ACTS OR ACTIONS WITH RESPECT TO SUCH ENTITY'S BUSINESS, AFFAIRS, MANAGEMENT, PROPERTIES, OR ACTIVITIES AS PRISMA HEALTH SHALL DETERMINE FROM TIME TO TIME. 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 THE PRISMA HEALTH-UPSTATE BOARD OF DIRECTORS AND THE PRISMA HEALTH BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ON AN ANNUAL BASIS ANY CONFLICTS OF INTEREST. THESE ARE REVIEWED BY THE CORPORATE COMPLIANCE AND LEGAL DEPARTMENTS OF PRISMA HEALTH. ADDITIONALLY, CORPORATE COMPLIANCE COMPARES ANNUAL DISCLOSURES BY EMPLOYED PHYSICIANS TO THOSE DISCLOSED BY VENDORS THROUGH THE OPEN PAYMENTS SYSTEMS. ANY EXCEPTIONS ARE REVIEWED AND COMMUNICATED TO THE CONFLICT OF INTEREST COMMITTEE AND THE DEPARTMENT CHAIRPERSON. FORM 990, PART VI, SECTION B, LINE 15 PRISMA HEALTH IS RESPONSIBLE FOR ESTABLISHING THE COMPENSATION PHILOSOPHY. AS PART OF THIS UNDERTAKING, THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF PRISMA HEALTH, WHICH IS COMPOSED SOLELY OF INDEPENDENT DIRECTORS OF PRISMA HEALTH, SETS THE COMPENSATION PAYABLE TO THE EXECUTIVES AND MANAGEMENT LEADERS EMPLOYED BY PRISMA HEALTH AND ITS RELATED ORGANIZATIONS WHO ARE CONSIDERED AS DISQUALIFIED PERSONS IN ACCORDANCE WITH SECTION 4958 OF THE CODE AND THE APPLICABLE COMPENSATION PHILOSOPHY TO MANAGERS, DIRECTORS, AND EMPLOYEES. THIS PROCESS OF INDEPENDENT ESTABLISHMENT AND REVIEW OF COMPENSATION BY THE PARENT ORGANIZATION OR THE SYSTEM IS CONSISTENT WITH THAT UTILIZED BY THE MAJORITY OF LARGE, MULTI-INSTITUTIONAL HEALTHCARE SYSTEMS. THE EXECUTIVE COMPENSATION COMMITTEE UTILIZES AN EXPERT INDEPENDENT COMPENSATION CONSULTANT RETAINED BY THE COMMITTEE TO PROVIDE AND EVALUATE COMPENSATION BASED ON COMPARABILITY DATA, MARKET CONDITIONS, COMPETITION FOR TALENT, AND OTHER SIGNIFICANT FACTORS. BASE COMPENSATION, VARIABLE INCENTIVE COMPENSATION, AND BENEFITS ARE ALL ESTABLISHED AND SET AFTER REVIEW BY THE COMMITTEE OF THIS DATA AND THE PERFORMANCE OF THE ORGANIZATION, AND REPORTS FROM THE INDEPENDENT CONSULTANT ARE INCLUDED IN THE MINUTES OF THE DELIBERATION BY THE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS FORM 990 AND FORM 1023 AVAILABLE UPON REQUEST. 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 XI, LINE 9: EQUITY TRANSFERS -451,966,230. CUMULATIVE EFFECT OF CHANGE IN ACCOUNTING PRINCIPLES 33,233,000. OTHER CHANGES IN NET ASSETS 4,697,223. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VII, SECTION B: THE IMAG MANAGEMENT SERVICE AGREEMENT (MSO) IS AN INDEPENDENT CONTRACTOR RELATIONSHIP WHERE PRISMA HEALTH-UNIVERSITY MEDICAL GROUP PURCHASES ALL NON-MD STAFFING THAT SUPPORTS IMA PROVIDERS. BECAUSE IMA DOES HAVE MD SPECIALISTS AS WELL, IT ALSO HAS BEEN ALLOWED TO PURCHASE ITS PRACTICE PLAN SUPPLIES NEEDED FOR ITS RHEUMATOLOGY PATIENTS. THERE IS ALSO AN ADMINISTRATIVE DOLLAR AMOUNT PER YEAR THAT IS PROVIDED TO IMAG AS THE MANAGEMENT FEE TO OVERSEE ITS NON-MD PORTION OF PRACTICE. PRISMA HEALTH-UNIVERSITY MEDICAL GROUP DOES NOT HAVE ITS OWN DISBURSEMENT CASH ACCOUNT; THEREFORE, ALL PAYMENTS TO IMA ARE MADE BY PRISMA HEALTH-UPSTATE. 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