2020-07-15T14:39:58-05:00 2019-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2018-10-01 560583151 SCOTLAND MEMORIAL HOSPITAL INC SCOT 9102917920 500 LAUCHWOOD DRIVE LAURINBURG NC 28352 MATTHEW PRACHT SENIOR VP OF FINANCE 9102917920 2020-07-15 1 AMY BIBBY P00445891 8282542254 2020-07-15 99.47.28.203 2020-07-15 14:30:25 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 48FB394F9AA065459641371F168D9F2AFFFBB473 2018 2021-01-29 14:40:06Z MATTHEW D PRACHT 500 LAUCHWOOD DRIVE LAURINBURG NC 28352 192337467 0 X WWW.SCOTLANDHEALTH.ORG X 1945 NC TO OFFER A FULL RANGE OF ACUTE CARE AND INPATIENT SERVICES TO THE RESIDENTS OF SCOTLAND COUNTY, NORTH CAROLINA AND THE SURROUNDING AREA. 17 14 1266 103 0 0 949453 552616 175385121 185406682 2905427 4852651 951485 1386475 180191486 192198424 190762 77541 0 0 76015671 86366346 0 0 0 86778492 95415583 162984925 181859470 17206561 10338954 196786140 201520904 55794865 64430285 140991275 137090619 TO PROVIDE HIGH QUALITY, COMPASSIONATE HEALTH CARE. 0 0 159938623 552616 185406682 SEE SCHEDULE O 159938623 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 136 0 1 1266 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 17 14 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NC X MELINDA BRISSON 9102917393 500 LAUCHWOOD DR LAURINBURG NC 28352 X MARK HANSMAN MD CHIEF, MEDICAL STAFF 40.00 X 80775 0 0 SCOTT ANDREWS BOARD MEMBER 1.00 X 0 0 0 TIM BROOKS BOARD MEMBER 1.00 X 0 0 0 SYBIL BULLSARD BOARD MEMBER 1.00 X 0 0 0 KYLE CHAVIS BOARD MEMBER 1.00 X 0 0 0 BRAD FAULKENBERRY MD BOARD MEMBER 1.00 X 0 0 0 DAVID HARLING CHAIR, BOT 2.00 X 0 0 0 GLENN HARRIS MD CHAIR, PHYSICIAN NETWORK LEADERSHIP COUNCIL 40.00 X 282038 0 58505 BETTY HASTY BOARD MEMBER 1.00 X 0 0 0 BOBBY HINSON BOARD MEMBER 1.00 X 0 0 0 BECCA HUGHES BOARD MEMBER 1.00 X 0 0 0 JOSHUA MALCOLM BOARD MEMBER 1.00 X 0 0 0 ALLEN MCCLAURIN BOARD MEMBER 1.00 X 0 0 0 DOUGLAS NEDEROSTEK MD PAST CHIEF, MEDICAL STAFF 40.00 X 0 0 0 KEN NICHOLS BOARD MEMBER 1.00 X 0 0 0 JOHN NOBLES MD BOARD MEMBER 1.00 X 298733 0 36064 JANE ROGERS PAST CHAIR, BOT 2.00 X 0 0 0 JESSICA SCOTT BOARD MEMBER 1.00 X 0 0 0 MIKE VINSON BOARD MEMBER 1.00 X 0 0 0 BRADLEY WILLIAMS BOARD MEMBER 1.00 X 0 0 0 CHIP SHYTLE VICE-CHAIR, BOT 2.00 X X 0 0 0 MARK WARD TREASURER 2.00 X X 0 0 0 GREGORY C WOOD PRESIDENT/CEO 40.00 X 500066 0 48796 MATTHEW D PRACHT CFO/VP FINANCE ASST. TREAS. 35.00 X 259073 0 47789 LYNN THOMPSON SECRETARY OF BOT NON BOT 2.00 X 48722 0 18160 CHERYL DAVIS MD VP/CMO 40.00 X 273092 0 44099 BEATRICE HOLT VP/PATIENT CARE SERVICES, CNO 40.00 X 153008 0 16143 ANN LOCKLEAR VP/ HUMAN RESOURCES 40.00 X 183943 0 41012 GRAY MILLS VP/STRATEGIC DEVELOPMENT 40.00 X 196126 0 49839 PAT PHILLIPS SR. VP/OPERATIONS 40.00 X 242616 0 50874 LINDA MITCHELL-FRYE MD PHYSICIAN 40.00 X 530356 0 79296 CHI-DAI CHEN MD PHYSICIAN 40.00 X 345683 0 52623 JEROME PONDER MD PHYSICIAN 40.00 X 297711 0 53099 MATTHEW MANZO MD PHYSICIAN 40.00 X 287739 0 53605 PATRICIA MIDDLETON MD PHYSICIAN 40.00 X 222964 0 39543 4202645 0 689447 100 0 1 0 CAROLINAS HEALTHCARE SYSTEM 1000 BLYTHE BLVD CHARLOTTE NC 28203 MANAGEMENT SERVICES 4059302 LIBERTY ANESTHESIA 16101 CADDIE COURT WAGRAM NC 28396 PROFESSIONAL SERVICES 2395142 PRIVATE DIAGNOSTICS CLINIC PLLC 4825 CREEKSTONE DRIVE STE 160 DURHAM NC 27703 DIAGNOSTIC SERVICES 1799052 FUSION MEDICAL STAFFING LLC P O BOX 82674 LINCOLN NE 68501 MEDICAL STAFFING SERVICES 845813 CROTHALL LAUNDRY SERVICES INC 13028 COLLECTIONS CENTER DR CHICAGO IL 60693 LAUNDRY SERVICES 432473 18 552616 552616 NET PATIENT SERVICE REVENUE 621500 176625086 176625086 OTHER OPERATING REVENUE 624100 8779271 8779271 HOSPICE IT CONTRACT 624100 2325 2325 185406682 3711822 3711822 342191 0 342191 342191 342191 1279872 0 139043 1279872 -139043 1140829 1140829 CAFETERIA 722210 663105 663105 MISCELLANEOUS REVENUE 900099 386640 386640 PURCHASE DISCOUNTS 900099 -5461 -5461 1044284 192198424 185406682 0 6239126 X 60398 60398 17143 17143 839914 839914 67120235 60059413 7060822 4564558 4033903 530655 9930111 8775682 1154429 3911528 3456792 454736 2018601 2018601 176478 176478 205985 205985 108778 108778 19059930 15806697 3253233 310687 11873 298814 6334644 5034129 1300515 640504 640504 2429309 2106369 322940 916065 533883 382182 10181 9450 731 335101 335101 10648105 10648105 151268 151268 BAD DEBT 25178638 25178638 MEDICAL SUPPLIES 22041364 22041364 PROVIDER TAX 3812034 3812034 MISCELLANEOUS EXPENSE 827609 827609 210302 210302 181859470 159938623 21920847 0 139960 525126 45873491 30492258 11309421 10906868 1354084 1789422 2528119 1255335 204011441 121481515 66133375 82529926 62125388 66438996 733510 983475 3953892 3054593 2634900 3544905 196786140 201520904 18955799 21457341 5280564 4967204 31558502 38005740 55794865 64430285 X 140111666 136223026 879609 867593 140991275 137090619 196786140 201520904 X 10338954 -2227838 -12011772 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 12827 12827 0 PART II-B, LINE 1: SCOTLAND MEMORIAL HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND NORTH CAROLINA HOSPITAL ASSOCIATION. A PORTION OF MEMBERSHIP DUES PAID TO THESE ASSOCIATIONS IS ALLOCATED TO LOBBYING EXPENSES. 1839156 1839156 103240131 64345730 38894401 4455504 2776950 1678554 87216562 54358835 32857727 7260088 7260088 82529926 CAPITAL LEASE OBLIGATIONS 319005 ACCRUED INTEREST PAYABLE 144175 ESTIMATED 3RD PARTY SETTLEMENTS 10876705 PENSION PLAN LIABILITY 26665855 38005740 X 152476137 -2227838 -2227838 154703975 37494449 37494449 192198424 156482272 0 156482272 25377198 25377198 181859470 PART X, LINE 2: THE CORPORATION AND ITS NONPROFIT AFFILIATES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE LLC IS TREATED AS A PARTNERSHIP AND AS SUCH, THE INCOME FLOWS THROUGH TO THE OWNERS OF THE LLC. THE CORPORATION HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2019. PART XI, LINE 2D - OTHER ADJUSTMENTS: PENSION PLAN ADJUSTMENT PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 25,178,638. TRANSFER OF EQUITY 3,005,088. COUNSELING CENTER INCOME 84,025. EXPENSE INCLUDED IN REVENUE 108,778. PENSION PLAN ADJUSTMENT 9,117,920. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 25,178,638. COUNSELING CENTER EXPENSES 89,782. EXPENSE INCLUDED IN REVEUNE 108,778. 1 1 1 X 1 X 1 1 1 0 1 1 3794791 3794791 0.02090 31520365 30891537 628828 0.00350 35315156 30891537 4423619 0.02440 35315156 30891537 4423619 0.02440 1 6212355 4845637 58855637 65543010 -6687373 X 1 1 1 1 SCOTLAND MEMORIAL HOSPITAL INC 500 LAUCHWOOD DRIVE LAURINBURG NC 28352 X X X DISPROPORTIONATE SHARE HOSPITAL SCOTLAND MEMORIAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X SEE DISCLOSURE X 1 18 1 SEE DISCLOSURE 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X 1 X SEE PART V X SEE PART V X HTTP://WWW.SCOTLANDHEALTH.ORG/FINANCIAL-ASSISTANCE-148 X X X X X 1 X 0 X X X X 1 X 0 0 SCOTLAND MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 5: IDENTIFIED PUBLIC HEALTH OFFICIALS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY, AND COMMUNITY MEMBERS WITH KNOWLEDGE AND INTEREST IN ASSESSING AND IMPROVING THE HEALTH OF SCOTLAND COUNTY RESIDENTS. THE COMMUNITY HEALTH NEEDS ASSESSMENT TEAM WAS COMPRISED OF SCOTLAND HEALTH CARE SYSTEM COMMUNITY HEALTH PROFESSIONALS, SCOTLAND COUNTY HEALTH DEPARTMENT LEADERS, REPRESENSTATIVES OF SCOTLAND COUNTY FAITH-BASED ORGANIZATIONS, AND COMMUNITY MEMBERS WITH KNOWLEDGE OF COUNTY HEALTH NEEDS AND A DEEP INTEREST IN IMPROVING THE STATE OF HEALTH WITHIN THE LOCAL COMMUNITIES. SCOTLAND MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: THE TOP PRIORITIES ADDRESSED IN THIS CHNA WERE IDENTIFIED AS: 1) OBESITY RELATED HYPERTENSION, HEART DISEASE, AND DIABETES. 2) MENTAL HEALTH ISSUES, INCLUDING SUBSTANCE MISUSE. 3) LACK OF POSITIVE YOUTH ENGAGEMENT ACTIVITIES AND HEALTHY BEHAVIORS.TO ADDRESS THESE NEEDS, PLANNED ACTIONS INCLUDE FOCUS ON RISK FACTORS OF OBESITY, SMOKING, HYPERLIIDEMIA, ELEVATED GLUCOSE LEVELS, INCREASING POSITIVE AWARENESS OF MENTAL HEALTH PROGRAMS, AND PROMOTING POSITIVE HEALTH BEHAVIORS. PART V, SECTION B, LINE 16B: HTTPS://WWW.SCOTLANDHEALTH.ORG/-/MEDIA/SCOTLANDHEALTH/DOCUMENTS/FINANCIAL-ASSISTANCE/SMH-FINANCIAL-ASSISTANCE-HARDSHIP-SETTLEMENT-APPLICATION2.PDF?LA=EN&HASH=FC4FDACD88386C0A082CA6BFC30F139723A4BEB8 PART V, SECTION B, LINE 16A: HTTPS://WWW.SCOTLANDHEALTH.ORG/-/MEDIA/SCOTLANDHEALTH/DOCUMENTS/FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE-POLICY_2016.PDF?LA=EN&HASH=8ABC8B9E20EBA8D6CA088FA77F6D74A53D305266 PART V, SECTION B, LINE 16C: HTTPS://WWW.SCOTLANDHEALTH.ORG/-/MEDIA/SCOTLANDHEALTH/DOCUMENTS/FINANCIAL-ASSISTANCE/PLAIN-LANGUAGE-SUMMARY2016.PDF?LA=EN&HASH=E3B2CA8324A01409AA69A6325F589EC27DDD916C PART V, SECTION B, LINE 7A: HTTPS://WWW.SCOTLANDHEALTH.ORG/-/MEDIA/SCOTLANDHEALTH/DOCUMENTS/CHNA/SCOTLAND-HEALTH-CARE-SYSTEM-COMMUNITY-HEALTH-ASSESSMENT-AND-IMPROVEMENT-PLAN-2019---FINAL---COPY.PDF?LA=EN&HASH=13903520342CB85DDEE4A4A67E5C10132248F061 9 1 - MARLBORO FAMILY PRACTICE AND URGENT CARE 957 CHERAW STREET BENNETTSVILLE SC 29512 PHYSICIAN PRACTICE-FAMILY PRACTICE 2 - MAXTON FAMILY PRACTICE CENTER 1001 W DR MARTIN LUTHER KING JR DRIVE MAXTON NC 28364 PHYSICIAN PRACTICE-FAMILY PRACTICE 3 - PEMBROKE FAMILY PRACTICE CENTER 410-D SOUTH JONES STREET PEMBROKE NC 28372 PHYSICIAN PRACTICE-FAMILY PRACTICE 4 - WAGRAM FAMILY PRACTICE CENTER 24420 MARLBORO STREET WAGRAM NC 28396 PHYSICIAN PRACTICE-FAMILY PRACTICE 5 - WOLONICK FAMILY PRACTICE 106 MCALPINE LANE LAURINBURG NC 28352 PHYSICIAN PRACTICE-FAMILY PRACTICE 6 - MARLBORO SURGICAL ASSOCIATES 957 CHERAW STREET BENNETTSVILLE SC 29512 PHYSICIAN PRACTICE-GENERAL SURGERY 7 - MARLBORO OBGYN 1007 CHERAW HIGHWAY BENNETTSVILLE SC 29512 PHYSICIAN PRACTICE-OB/GYN 8 - WOMENS HEALTH OF THE CAROLINAS 105 MCALPINE LANE LAURINBURG NC 28352 PHYSICIAN PRACTICE-OB/GYN 9 - HARRIS FAMILY PRACTICE 700-A PROGRESS PLACE LAURINBURG NC 28352 PHYSICIAN PRACTICE-FAMILY PRACTICE PART I, LINE 7G: CARDIAC REHABILITATION AND PULMONARY REHABILITATION SERVICES ARE PROVIDED BY THE HOSPITAL TO ALLOW PATIENTS TO ACCESS MAINTENANCE SESSIONS WITHOUT TRAVELING LONG DISTANCES. PATIENTS ARE CHARGED NOMINAL AMOUNTS AS INSURANCES DO NOT ROUTINELY COVER THE CARE. THEREFORE, THE COSTS THAT EXCEED PATIENT PAYMENTS ARE PROVIDED BY THE HOSPITAL AS A COMMUNITY BENEFIT. PART II, COMMUNITY BUILDING ACTIVITIES: SCOTLAND MEMORIAL HOSPITAL PLAYS A VERY ACTIVE ROLE IN RECRUITING PHYSICIANS AND MID-LEVEL PROVIDERS TO SERVE THE PATIENTS IN OUR SERVICE AREA. SCOTLAND AND ROBESON COUNTY, NC AND MARLBORO COUNTY, SC ROUTINELY HAVE SHORTAGES IN HEALTHCARE PROVIDERS. BY ITS EFFORTS, THE HOSPITAL ENSURES A NETWORK OF PROVIDERS IS AVAILABLE FOR THE CARE OF THOSE IN NEED OUR RURAL SETTING. PART III, LINE 4: THE ANDI METHODOLOGY, WHICH USES A FACILITY-WIDE RATIO OF COST TO CHARGES AS DESCRIBED IN NCHA COMMUNITY BENEFITS GUIDELINES WAS USED.SCOTLAND COUNTY HAS A CURRENT UNEMPLOYMENT RATE OF 6.2%, WELL OVER THE STATE-WIDE AVERAGE OF 3.8%. THE PAYOR MIX DATA FOR FISCAL YEAR 2018 SHOWED MEDICARE AT 45% AND MEDICAID AT 20%. IT IS BELIEVED THAT 6% OF UNEMPLOYED AND 9% OF MEDICARE AND MEDICAID WOULD QUALIFY FOR CHARITY SHOULD PATIENTS COMPLETE THE APPLICATION PROCESS PART III, LINE 8: PARTICIPATING IN THE MEDICARE PROGRAM QUALIFIES THE HOSPITAL FOR REIMBURSEMENT AT PREDETERMINED RATES FOR INPATIENT AND OUTPATIENT SERVICES. AS A CONDITION OF PARTICIPATION, THE HOSPITAL ACCEPTS PAYMENT FROM CMS (CENTERS FOR MEDICARE AND MEDICAID SERVICES), AND WRITES OFF THE DIFFERENCE BETWEEN THE AMOUNT PATIENT BILLED CHARGES AND MEDICARE PAYMENT. MEDICARE ALSO PAYS FOR CERTAIN "PASS-THROUGH" ITEMS, SUCH AS BAD DEBTS. TOTAL MEDICARE PAYMENTS DO NOT FULLY COVER THE COST OF PROVIDING SERVICES TO BENEFICIARIES. PART III, LINE 9B: THE ORGANIZATION HAS A BILLING AND COLLECTION POLICY WITH PROVISIONS FOR COLLECTING AMOUNTS DUE FROM THOSE PATIENTS WHO HAVE OUTSTANDING BALANCES. A DETERMINATION HAS ALREADY BEEN MADE REGARDING FINANCIAL ASSISTANCE PRIOR TO THE COLLECTION PROCESS. ONLY PATIENTS THAT ARE NOT ELIGIBLE FOR FINANCIAL ASSISTANCE ARE PURSUED. PART VI, LINE 2: SCOTLAND MEMORIAL IS A MEMBER OF CAROLINAS COASTAL HEALTH ALLIANCE, WHICH HAS PREPARED COMMUNITY HEALTH ASSESSMENTS FOR ITS MEMBER HOSPITALS AND THE COMMUNITIES SERVED.HEALTH CARE NEEDS ARE ASSESSED ALSO BY INTERACTION WITH PATIENTS, PHYSICIANS, OTHER HEALTH CARE PROVIDERS, AND RESIDENTS ON AN ON-GOING BASIS. ADDITIONALLY, COMMUNITY NEEDS ARE DETERMINED BASED ON TYPES OF PATIENTS SERVED AND FINANCIAL LEVEL OF FINANCIAL ASSISTANCE PROVIDED IN PRIOR YEARS. PART VI, LINE 3: PATIENTS AND THOSE BILLED FOR CARE MAY BE INFORMED ABOUT ASSISTANCE ELIGIBILITY AT TIME OF REGISTRATION, AT DISCHARGE, AT TIME OF BILLING, AND/OR IN DISCUSSION WITH HOSPITAL BILLING STAFF. SCOTLAND MEMORIAL HOSPITAL'S FINANCIAL ASSISTANCE POLICY IS AVAILABLE FOR ACCESS BY PATIENTS AND THE PUBLIC ON THE WEBSITE AT WWW.SCOTLANDHEALTH.ORG. PART VI, LINE 4: ALTHOUGH SCOTLAND MEMORIAL HOSPITAL SERVES THE NORTH CAROLINA COUNTIES OF SCOTLAND AND ROBESON, AND THE SOUTH CAROLINA COUNTY OF MARLBORO, THE PRIMARY FOCUS OF THE COMMUNITY-BASED SURVEY WAS ON SCOTLAND COUNTY, NORTH CAROLINA. 2015 CENSUS DATA REPORTS THAT SCOTLAND COUNTY IS THE POOREST COUNTY IN NORTH CAROLINA, WITH A MEDIAN HOUSEHOLD INCOME OF $30,958 AND WITH 29% OF PEOPLE LIVING IN POVERTY, SUBSTANTIALLY LOWER THAN THE STATE AND NATIONAL MEDIAN HOUSEHOLD INCOMES. THE COUNTY'S JOB MARKET WAS 6.2% FOR SEPTEMBER 2018, CONSIDERABLY HIGHER THAN THE STATE-WIDE AVERAGE OF 3.8%. WHILE OVER 33% OF AMERICANS HAD AT LEAST A BACHELOR'S DEGREE IN 2015, ONLY 15.8% OF SCOTLAND COUNTY RESIDENTS HAD SUCH A DEGREE. ETHNICALLY, THE COUNTY IS COMPRISED OF 45.7% WHITE, 39.1% BLACK, 11.8% AMERICAN INDIAN, AND 2.9% HISPANIC. PART VI, LINE 5: SCOTLAND MEMORIAL HOSPITAL FULFILLS ITS TAX EXEMPT PURPOSE BY THE PROVISION OF HEALTH CARE SERVICES WITHIN ITS SERVICE AREA TO PATIENTS WITH LITTLE OR NO RESOURCES TO PAY FOR CARE, AND BY THE ACCEPTANCE OF PAYMENTS FROM MEDICARE AND MEDICAID AT SUBSTANTIALLY REDUCED RATES.THE HOSPITAL'S BOARD IS COMPRISED OF UNRELATED, LOCAL MEMBERS OF THE COMMUNITY AND LOCAL PHYSICIANS HAVE PRIVILEDGES IN A MAJORITY OF THE HOSPITAL'S DEPARTMENTS.ALL EXCESS FUNDS ARE APPLIED TO PATIENT CARE THROUGH THE ANNUAL BUDGET PROCESS, WHEREBY ALL AVAILABLE FUNDS ARE ALLOCATED BASED ON NEEDS HIERARCHY. PART VI, LINE 6: AS THE LARGEST EMPLOYER IN SCOTLAND COUNTY, SCOTLAND MEMORIAL HOSPITAL TAKES A LEADERSHIP ROLE IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES, AND IN THE COORDINATION OF STRATEGIES TO MEET THE IDENTIFIED NEEDS. PART VI, LINE 7, REPORTS FILED WITH STATES NC,SC 0 SHOLARSHIPS 17043 X X X X 0 1 0 0 0 0 0 0 0 GLENN HARRIS MD CHAIR, PHYSICIAN NETWORK LEADERSHIP 227429 0 54609 0 0 0 36500 0 22005 0 340543 0 0 0 JOHN NOBLES MD BOARD MEMBER 284158 0 14575 0 0 0 16042 0 20022 0 334797 0 0 0 GREGORY C WOOD PRESIDENT/CEO 331899 0 137728 0 30439 0 20323 0 28473 0 548862 0 0 0 MATTHEW D PRACHT CFO/VP FINANCE ASST. TREAS. 193956 0 55773 0 9344 0 21338 0 26451 0 306862 0 0 0 CHERYL DAVIS MD VP/CMO 224826 0 48266 0 0 0 17259 0 26840 0 317191 0 0 0 BEATRICE HOLT VP/PATIENT CARE SERVICES, CNO 118797 0 34211 0 0 0 0 0 16143 0 169151 0 0 0 ANN LOCKLEAR VP/ HUMAN RESOURCES 151767 0 32176 0 0 0 4131 0 36881 0 224955 0 0 0 GRAY MILLS VP/STRATEGIC DEVELOPMENT 161998 0 34128 0 0 0 11923 0 37916 0 245965 0 0 0 PAT PHILLIPS SR. VP/OPERATIONS 197176 0 45440 0 0 0 17385 0 33489 0 293490 0 0 0 LINDA MITCHELL-FRYE MD PHYSICIAN 494798 0 35558 0 0 0 15798 0 63498 0 609652 0 0 0 CHI-DAI CHEN MD PHYSICIAN 296368 0 49315 0 0 0 15854 0 36769 0 398306 0 0 0 JEROME PONDER MD PHYSICIAN 264260 0 33451 0 0 0 0 0 53099 0 350810 0 0 0 MATTHEW MANZO MD PHYSICIAN 136170 0 151569 0 0 0 15776 0 37829 0 341344 0 0 0 PATRICIA MIDDLETON MD PHYSICIAN 222964 0 0 0 0 0 15983 0 23560 0 262507 0 0 0 PART I, LINE 4B THE ORGANIZATION HAD OFFICERS WHO PARTICIPATED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE APPROXIMATE AMOUNT OF DEFERRED COMPENSATION ACCRUED DURING THE FISCAL YEAR FOR THE PLAN WAS: WOOD $24,500 PRACHT 5,508 FORM 990, PART VI, SECTION A, LINE 3 EFFECTIVE APRIL 1, 2009, SCOTLAND HEALTH CARE SYSTEM IS ENGAGED IN A TEN-YEAR MANAGEMENT SERVICE AGREEMENT WITH THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY D/B/A CAROLINAS HEALTHCARE SYSTEM, SUBSEQUENTLY RENAMED ATRIUM HEALTH, TO MANAGE THE SYSTEM ON A DAY-TO-DAY BASIS. THE MSA HAS BEEN SUBSEQUENTLY AMENDED TO EXTEND THE INITIAL TERM UNTIL MARCH 31, 2026. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING DATE, THE FORM 990 WAS PRESENTED TO THE BOARD OF TRUSTEES FOR REVIEW. AN OPPORTUNITY WAS PROVIDED FOR QUESTIONS AND ANSWERS. FORM 990, PART VI, SECTION B, LINE 12C THE HOSPITAL REQUIRES ALL OFFICERS, DIRECTORS, TRUSTEES TO REVIEW AND SIGN THE CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION FOR CEO AND CFO ENTAILS A REVIEW OF PERFORMANCE BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES, CONDUCTING COMPENSATION BENCHMARK STUDY BY INDEPENDENT RECOGNIZED THIRD PARTY, AND REVIEW OF COMPENSATION BY ATRIUM HEALTH COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. FINAL APPROVAL IS THEN MADE AND DOCUMENTED BY THE SCOTLAND HEALTH CARE SYSTEM BOARD OF TRUSTEES. COMPENSATION FOR OTHER HOSPITAL VICE PRESIDENTS IS DETERMINED BY PERFORMANCE EVALUATION BY CEO, COMPENSATION BENCHMARK STUDY BY INDEPENDENT RECOGNIZED THIRD PARTY, AND FINAL APPROVAL AND DOCUMENTATION BY THE SCOTLAND HEALTH CARE SYSTEM BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. ADDITIONALLY, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST AT THE SCOTLAND MEMORIAL HOSPITAL EXECUTIVE ASSISTANT TO THE PRESIDENT'S OFFICE. THE HOSPITAL MAKES ITS FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE VP, FINANCE OFFICE OR GENERAL ACCOUNTING DEPARTMENT. FORM 990, PART VII & SCHEDULE J THE ORGANIZATION IS UTILIZING PART VII AND SCHEDULE J OF THE FORM 990 TO REPORT THE COMPENSATION PAID TO THE CEO AND CFO BY A MANAGEMENT COMPANY FOR SERVICES PROVIDED TO THE FILING ORGANIZATION. THE COMPENSATION HAS BEEN REPORTED IN THE FILING ORGANIZATION'S COMPENSATION COLUMNS OF THESE SECTIONS. FORM 990, PART IX, LINE 11G EQUIP MAINT CONTRACT FEES: PROGRAM SERVICE EXPENSES 2,445,948. MANAGEMENT AND GENERAL EXPENSES 1,968,323. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,414,271. CONSULTANT FEES: PROGRAM SERVICE EXPENSES 261,543. MANAGEMENT AND GENERAL EXPENSES 690,753. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 952,296. CONTRACT FEES: PROGRAM SERVICE EXPENSES 8,017,434. MANAGEMENT AND GENERAL EXPENSES 487,093. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,504,527. MEDICAL SPEC FEES: PROGRAM SERVICE EXPENSES 4,842,359. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,842,359. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 239,413. MANAGEMENT AND GENERAL EXPENSES 107,064. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 346,477. FORM 990, PART XI, LINE 9: PENSION PLAN ADJUSTMENT -9,117,920. TRANSFER TO AFFILIATES -3,005,088. PRIOR PERIOD ADJUSTMENT 111,236. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART III SCOTLAND MEMORIAL HOSPITAL, INC., LOCATED IN THE CITY OF LAURINBURG, SCOTLAND COUNTY, NORTH CAROLINA IS A NOT-FOR-PROFIT, 501(C)(3), COMMUNITY OWNED HOSPITAL GOVERNED BY A LOCAL BOARD OF TRUSTEES. THE HOSPITAL IS A SUBSIDIARY OF SCOTLAND HEALTH CARE SYSTEM, A NOT-FOR-PROFIT, 501(C)(3) CORPORATION, WHICH ALSO INCLUDES SCOTLAND MEMORIAL FOUNDATION, AND HOSPICE OF SCOTLAND COUNTY. THE MISSION OF SCOTLAND HEALTH CARE SYSTEM "IS TO WORK WITH OUR HEALTH CARE PARTNERS TO CREATE AND OPERATE A PATIENT CENTERED, INTEGRATED SYSTEM TO PROVIDE SAFE, HIGH QUALITY, COMPASSIONATE, AND SUSTAINABLE HEALTH CARE TO THE PEOPLE WE SERVE." THE VISION IS THAT "SCOTLAND HEALTH CARE SYSTEM WILL BE RECOGNIZED AND CHOSEN BY PATIENTS AND THEIR FAMILIES THROUGHOUT OUR REGION FOR THE QUALITY AND VALUE OF THE SERVICES WE PROVIDE. THIS VALUE WILL BE DEMONSTRATED THROUGH THE HIGHEST LEVEL OF QUALITY AND SERVICE, ALONG WITH THE SAFEST ENVIRONMENT. WE WILL LEAD EFFORTS TO IMPROVE THE HEALTH AND WELL-BEING OF THE CITIZENS IN OUR REGION." THE HOSPITAL OFFERS A FULL RANGE OF INPATIENT, SERVICES, INCLUDING INTENSIVE CARE AND INPATIENT REHABILITATION, AND OUTPATIENT ACUTE CARE SERVICES. DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2019, THE HOSPITAL RECORDED 20,074 ADULT AND PEDIATRIC PATIENT DAYS AND 1,209 INPATIENT REHABILITATION DAYS, WITH AN AVERAGE DAILY CENSUS OF 55. THE HOSPITAL PERFORMED OVER 4600 INPATIENT AND OUTPATIENT SURGERIES. OVER 54,000 EMERGENCY ROOM VISITS WERE LOGGED AND 735 BABIES WERE DELIVERED. WITH A STAFF OF APPROXIMATELY 1,000 EMPLOYEES, THE HOSPITAL RANKS AS THE AREA'S LARGEST EMPLOYER. 72 PHYSICIANS PROVIDE A COMPREHENSIVE RANGE OF SPECIALTIES INCLUDING: ANESTHESIOLOGY, CARDIOLOGY, DERMATALOGY, EMERGENCY MEDICINE, FAMILY MEDICINE, GASTROENTEROLOGY, GENERAL SURGERY, GYNECOLOGY AND OBSTETRICS, HOSPITALIST SERVICES, INTERNAL MEDICINE, MEDICAL AND RADIATION ONCOLOGY, NEPHROLOGY, NEUROLOGY, OCCUPATIONAL MEDICINE, OPHTHALMOLOGY, ORTHOPEDICS, OTOLARYNGOLOGY, PAIN MANAGEMENT, PATHOLOGY, PEDIATRICS, PEDICATRIC CARDIOLOGY, PULMONARY MEDICINE, RADIOLOGY, UROLOGY, VASCULAR SURGERY, AND WOUND CARE, WHICH INCLUDES HYPERBARIC OXYGEN THERAPY. AVAILABLE TECHNOLOGIES INCLUDE NUCLEAR MEDICINE, 64-SLICE COMPUTERIZED TOMOGRAPHY (CT) SCANNING, POSITRON EMISSION TOMOGRAPHY (PET), LASER TECHNOLOGY, MAGNETIC RESONANCE IMAGING (MRI), LAPAROSCOPIC CHOLYCYSTECTOMY, ROBOTIC PARTIAL KNEE SURGERY, INTENSITY-MODULATED RADIATION THERAPY, AND LITHOTRIPSY. THE HOSPITAL OPERATES FIVE RURAL HEALTH CLINICS, SEVEN FREE-STANDING PHYSICIAN PRACTICES, AN URGENT CARE CENTER, AND AN OCCUPATIONAL HEALTH CLINIC, ALL LOCATED WITHIN A 30-MILE RADIUS OF THE HOSPITAL. TOTAL VISITS AT THESE PRACTICES WERE APPROXIMATELY 85,000 IN 2019 . THE HOSPITAL'S PRIMARY SERVICE AREA IS SCOTLAND COUNTY AND WESTERN ROBESON COUNTY, WHILE THE SECONDARY SERVICE AREA INLCUDES ROBESON COUNTY AND RICHMOND COUNTY, NORTH CAROLINA, AND MARLBORO COUNTY, SOUTH CAROLINA. SEE SCHEDULE H FOR DETAIL OF ORGANIZATIONS CHARITY CARE AND COMMUNITY BENEFITS POLICIES AND REPORTING. FORM 990, PART III COMMUNITY SPONSORED EVENTS AND ACTIVITIES: THE HOSPITAL IS HEAVILY INVOLVED IN COMMUNITY EVENTS AND SPONSORS NUMEROUS CHARITABLE EVENTS, SUCH AS FUND DRIVES FOR UNITED WAY, AMERICAN CANCER SOCIETY RELAY FOR LIFE, MARCH OF DIMES WALK AMERICA (AWAREMESS FOR HEALTHIER BABIES), AND NORTH CAROLINA SMART START ( PROVIDING RESOURCES FOR CHILDREN TO ACHIEVE SUCCESS), WITH MANY HOSPITAL EMPLOYEES PARTICIPATING IN THE INITIATIVE. MIDDLE AND HIGH SCHOOL STUDENTS CAN ACCESS FREE ANNUAL PHYSICIALS, AND, FOR THOSE INTERESTED IN A MEDICAL CAREER, JOB-SHADOWING PURSUITS WITH HOSPITAL EMPLOYEES. SPEAKING AT LOCAL JOB FAIRS AND HIGH SCHOOL CAREER DAY EVENTS IS YET ANOTHER AVENUE FOR HOSPITAL STAFF TO SPREAD KNOWLEDGE ON TOPICS OF HEALTH. A VARIETY OF PREVENTIVE HEALTH EDUCATION PROGRAMS ARE AVAILABLE TO THE COMMUNITY AND TO LOCAL INDUSTRY, MANY OF WHICH ARE OFFERED AT NO CHARGE. AMONG THESE ARE SCREENINGS FOR BLOOD PRESSURE, BODY FAT, CHOLESTEROL, DIABETES, BONE DENSITY, AND PROSTATE CANCER. HEALTH EVENTS FOR WOMEN AND MEN ARE OFFERED EACH YEAR WITH LOCAL PHYSICIANS AS KEYNOTE SPEAKERS AND EDUCATORS. "SCOTTY AND "MISSY", 2 MOBILE HEALTHCARE UNITS, VISIT LOCAL SCHOOLS, BUSINESSES, AND INDUSTRY PROVIDING FREE BLOOD PRESSURE AND CHOLESTEROL SCREENINGS AND PHYSICALS. EXAMPLES OF HEALTH EVENTS OFFERED IN THE COMMUNITY ARE: - PHYSICAL EXAMINATIONS PROVIDED TO SPECIAL OLYMPICS ATHLETES, AND SPORTS PHYSICALS TO MIDDLE/HIGH SCHOOL STUDENTS. - HEALTH & FITNESS DAY, PROVIDING FOCUS ON PHYSICAL ACTIVITY, WHERE THE COMMUNITY AND HOSPITAL EMPLOYEES PARTICIPATE IN HEALTHY ACTIVITIES. - "LOOK GOOD FEEL BETTER" PROGRAM IS DESIGNED FOR WOMEN UNDERGOING CANCER TREATMENT, TEACHES FEMALE CANCER PATIENTS BEAUTY TECHNIQUES THAT HELP RESTORE SELF-IMAGE WHILE UNDERGOING CHEMOTHERAPY AND RADIATION TREATMENTS. VOLUNTEER BEAUTY PROFESSIONALS LEAD SMALL GROUPS OF WOMEN THROUGH PRACTICAL, HANDS-ON EXERCIZES USING COSMETICS, CARING FOR SKIN AND NAILS, AND USING WIGS, HATS, TURBANS, AND SCARVES TO DEAL WITH HAIR LOSS. PARTICIPANTS RECEIVE FREE COSMETICS AND CAN CHOOSE FROM A VARIETY OF WIGS AND HATS FROM WHICH TO CHOOSE. - CANCER SURVIVORS DAY IS SPONSORED FOR PATIENTS AND GUESTS, INVITING PARTICIPATATION IN AN ANNUAL NATIONAL CELEBRATION OF LIFE. - HEALTH-RELATED MONTHLY MEETINGS ARE HELD IN HOSPITAL FACILITIES FOR THESE SUPPORT GROUPS: ALZHEIMER'S DISEASE BREASTFEEDING DIABETES MULTIPLE SCLEROSIS PARKINSON'S STROKE WOMENS CANCER SCOTLAND HEALTH CARE SYSTEM INC 500 LAUCHWOOD DRIVE LAURINBURG NC 28352 581847657 OPERATE FOR THE BENEFIT OF, PERFORM FUNCTIONS, AND CARRY OUT PURPOSES OF SMH NC 501(C)(3) LINE 12B, II N/A 0 SCOTLAND MEMORIAL FOUNDATION INC 500 LAUCHWOOD DRIVE LAURINBURG NC 28352 581828201 CONDUCT FUNDRAISING ACTIVITIES FOR SCOTLAND HEALTH CARE SYSTEM NC 501(C)(3) LINE 7 SCOTLAND HEALTH CARE SYSTEM INC 0 HOSPICE OF SCOTLAND COUNTY INC 610 E LAUCHWOOD DRIVE LAURINBURG NC 28352 561468269 HEALTHCARE FOR TERMINALLY ILL PATIENTS NC 501(C)(3) LINE 7 SCOTLAND HEALTH CARE SYSTEM INC 0 SCOTLAND REGIONAL HEALTH NETWORK 500 LAUCHWOOD DRIVE LAURINBURG NC 28352 272187756 OPERATES PHYSICIAN PRACTICES NC 501(C)(3) LINE 7 SCOTLAND HEALTH CARE SYSTEM INC 0 SCOTLAND ENTERPRISES INC 500 LAUCHWOOD DRIVE LAURINBURG NC 28352 561651832 HEALTH CARE NC N/A C 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 SCOTLAND REGIONAL HEALTH NETWORK R 3005087 FMV