2019-11-13T13:00:48-06:00 2018-12-31 861065772 Deloitte Tax LLP 695 Town Center Drive Suite 1000 Costa Mesa CA 92626 990 2018-01-01 570360499 Roper St Francis Mt Pleasant Hospital ROPE 8437242958 8536 Palmetto Commerce Pkwy No 201 Ladson SC 29456 Bret Johnson SVP and CFO 8437242958 2019-11-13 1 John W Sadoff Jr P00540589 7048871810 74.138.49.181 2019-11-13 13:00:03 ES P BB12664BE1E3D4BC08488640412F20C0F7A39D48 2B300E1FC09CCA321063079848B1E489E0A7BF4B 2018 2020-03-31 21:24:44Z Lorraine Lutton 8536 Palmetto Commerce Pkwy No 201 Ladson SC 29456 88843744 0 X www.rsfh.com X 2005 SC Operation of nonprofit hospital facility in Mt. Pleasant, SC. 13 7 0 74 83 -748 14571 27900 77467914 88439109 -73499 -130417 303517 337557 77712503 88674149 61341 46954 0 0 26879700 28851610 0 0 0 42077559 45375074 69018600 74273638 8693903 14400511 138623184 141945060 109050913 110328845 29572271 31616215 X Healing all people with compassion, faith, and excellence. 0 0 56919339 46954 88439109 Roper St. Francis Mount Pleasant Hospital opened in November of 2010 and has become a true community hospital. The hospital places an emphasis on comfort, communication and care with a personal touch.Roper St. Francis Mount Pleasant Hospital contributed $4.2 million in community benefit in 2018. This benefit included charity care, unreimbursed Medicaid, and numerous sponsorships and community outreach programs (see Schedule H for additional details). The hospital also volunteered over 300 staff hours in 2018.Some of the national accolades Roper St. Francis Mount Pleasant Hospital received in 2018 include:- Outstanding Patient Experience Award from Healthgrades. The award is based on data gathered from 10 patient experience measures, including data collected from a 32-question survey of the hospitals' patients. - Re-designated as a Baby-Friendly Hospital, which is a prestigious internal recognition sponsored by the World Health Organization and the United Nations Children's Fund that recognizes birth facilities that offer breastfeeding mothers information, confidence and skills needed to successfully initiate and continue breastfeeding.- BlueCross BlueShield Blue Distinction Center+ designation for the quality and cost of its maternity care Please see Schedule O for a detailed statement of Program Service accomplishments. 56919339 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 7 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 SC X The Finance Department 8437242958 8536 Palmetto Commerce Parkway Ladson SC 29456 X Brian Cuddy MD See Sch O Chairperson 0.50 49.50 X 0 984944 67183 Alison Dillon MD Vice-Chairperson (Thru 6/2018) 0.50 3.50 X 0 0 0 Susan Datta MD See Sch O Vice-Chairperson (Start 7/01/18) 0.50 49.50 X 0 267238 65415 Katherine Duffy PhD Board Member 0.50 3.50 X 0 0 0 Wills C Geils MD See Sch O Board Member 0.50 3.50 X 0 26876 0 John Holloway See Sch O Board Member 0.50 3.50 X 0 430000 31212 Sister Anne Lutz Board Member 0.50 3.50 X 0 0 0 Edward McKelvey Board Member 0.50 3.50 X 0 0 0 Mark Nantz Board Member 0.50 3.50 X 0 0 0 Roberta Pinckney Board Member 0.50 3.50 X 0 0 0 John Spratt MD See Sch O Board Member 0.50 49.50 X 0 799374 65768 Kent Stock MD See Sch O Board Member (Start 7/1/18) 0.50 3.50 X 0 44345 0 Michael Tarwater Board Member 0.50 3.50 X 0 0 0 Mary Thornley Board Member 0.50 3.50 X 0 0 0 Lorraine Lutton President & CEO - RSFH 1.00 49.00 X 0 891334 122984 Anthony Jackson VP & CEO - MPH & BSSF 10.00 40.00 X 0 443090 79535 Bret D Johnson SVP & CFP - RSFH 1.00 49.00 X 0 619642 95562 Pennie Peralta VP System CNO 10.00 40.00 X 0 322798 56986 Stephen Porter CEO - Roper & Berkeley Hosp 5.00 45.00 X 0 452039 80907 James Demarco MD Physician 5.00 0.00 X 0 799407 64236 John McCrosson MD Physician 1.00 47.00 X 0 1283628 54135 Patrick Murray MD Physician 1.00 49.00 X 0 993882 45436 Robert Lowery MD Physician 1.00 49.00 X 0 1126047 64615 Robert Schoderbek MD Physician 5.00 45.00 X 0 808335 32982 Matthew Severance COO - RSFH & CEO - Roper Hospital 0.00 0.00 X 0 724460 0 Peter DiNicola Dir Plant & BioMed Engrng 0.00 45.00 X 0 100628 6883 Stephanie McKoin Dir of Perioperative Svcs 0.00 47.00 X 0 204097 32459 Vanessa Shamrock Director of Lab 0.00 30.00 X 0 153210 17451 0 11475374 983749 0 1 1 0 Roper Emergency Physicians 639 McCutchen Street Charleston SC 29412 Physician Fees 2512926 Anesthesia Associates of Charleston PO Box 22206 Charleston SC 29413 Anesthesia Services 1067804 Morrison Management Specialists PO Box 102289 Atlanta GA 30368 Dietary Management Fees 816081 Rightsourcing Inc 999 Steward Ave Ste 100 Bethpage NY 11714 Temp Labor 590347 NBM Construction Co Inc PO Box 31027 Charleston SC 29417 General Contractor 414787 13 27900 12500 27900 Net Patient Service 624100 88428400 88428400 EHR Meaningful Use 611210 10709 10709 88439109 3646 3646 2150 136213 -134063 -134063 -134063 65014 33382 31632 31632 Cafeteria Revenue 722210 240510 240510 Miscellaneous Revenue 900099 65415 83 65332 305925 88674149 88439109 83 207057 X 46954 46954 125273 14500 110773 24412198 19408759 5003439 708629 560933 147696 2343823 1855313 488510 1261687 998720 262967 860489 860489 168559 168559 99885 99885 8993535 2428255 6565280 312077 249662 62415 2955205 1979987 975218 2029063 2029063 2006134 1604907 401227 25629 25629 56181 56181 4321254 4321254 7900162 7900162 275163 220130 55033 Medical Supplies 13703064 13703064 Medicaid DSH Taxes 1443710 1443710 224964 183029 41935 74273638 56919339 17354299 0 2638 2638 11285072 12994204 1393895 1547605 340463 245277 157245784 61710485 101847191 95535299 23145883 0 608042 31620037 138623184 141945060 147869 265594 107124087 106938887 1778957 3124364 109050913 110328845 X 29572271 31616215 29572271 31616215 138623184 141945060 X 14400511 -12356567 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 15467846 15467846 108124610 38269044 69855566 1571387 1279364 292023 32064133 22162077 9902056 17808 17808 95535299 Third Party Receivable 697617 Other Assets 136660 Intercompany Receivables 30785760 31620037 Due to Affiliates 1108810 Third Party Reserve 1911906 Other Liabilities 103648 3124364 X Part X, Line 2: Mt. Pleasant Hospital is a not-for-profit organization as described in Section 501(c)(3) of the Internal Revenue Code and is generally exempt from federal and state income taxes. Accordingly, no provision for income taxes is made on the consolidated financial statements. Although (the consolidated group) is generally exempt from federal and state income taxes, it evaluates whether there are any uncertain tax positions that fail to meet the more-likely-than-not threshold for recognition in the consolidated financial statements. Uncertain tax positions may include the characterization of income, such as a characterization of income as passive, a decision to exclude reporting taxable income in a tax return, or a decision to classify a transaction, entity, or other position in a tax return as tax exempt. The tax benefit from an uncertain tax position is recognized when it is more likely than not that the position will be sustained upon examination, including resolutions of any related appeals or litigation processes, based on the technical merits. The organization had no unrecognized tax positions as of December 31, 2018 and 2017, and does not expect that unrecognized tax benefits will materially increase within the next 12 months. Interest and penalties related to uncertain tax positions, if any, would be recognized in the consolidated financial statements as income tax expense. 1 1 X 1 X 1 X 1 1 0 1 1 3652279 354844 3297435 0.04440 3961561 3100394 861167 0.01160 7613840 3455238 4158602 0.05600 11566 11566 0.00020 46093 46093 0.00060 15998 15998 0.00020 73657 73657 0.00100 7687497 3455238 4232259 0.05700 1247 1247 0.00000 140 140 0.00000 1387 1387 0.00000 0 4220794 1688318 8489775 12276065 -3786290 X 1 1 1 1 Roper St Francis Mt Pleasant Hospital 3500 Highway 17 North Mt Pleasant SC 29466 http://www.rsfh.com/mount-pleasant-hos HTL-0909 X X X Roper St Francis Mt Pleasant Hospital 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X http://www.rsfh.com/mission-department/ X 1 16 1 http://www.rsfh.com/mission-department/ 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X http://www.rsfh.com/billing-financial-assistance/ X http://www.rsfh.com/billing-financial-assistance/ X http://www.rsfh.com/billing-financial-assistance/ X X X X X X X 1 X 0 X X X X X 1 X 0 0 Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 5: In an effort to create a greater impact on the community and address the greatest needs, Roper St. Francis produced a joint CHNA in collaboration with the Medical University of South Carolina and the Trident United Way. To gather community input the Community Health Needs Assessment team disseminated a community survey with the purpose of identifying a general overview of the most concerning health topics. The survey included over 900 respondents, a 173% increase over the last CHNA cycle and an immediate benefit of collaborating with community partners. In addition, the team hosted two health forums, facilitated 7 community focus groups, and conducted eight interviews with local healthcare, social service, and civic leaders. Respondents who participated in this phase included experts in the field of public health, hospital administration members, community outreach groups, and other local organizations. Using feedback from the survey, interviews and focus groups, a summary of community input was created. This summary would eventually be used to help focus in on priorities and ultimately, implementation strategies. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 6a: Roper St. Francis Hospital Healthcare produced a joint CHNA report in collaboration with its three Charleston area hospitals, as well as the Medical University of South Carolina and the Trident United Way. A major accomplishment of this collaborative effort was to recognize a set of common priorities, design programs that address the greatest needs, and create the greatest impact to improve the health and wellbeing of our community. Given different missions, goals and government requirements, the organizations individually prioritized health needs and corresponding support programs and services. The Roper St. Francis facilities include Roper Hospital, Bon Secours St. Francis Hospital, and Mount Pleasant Hospital. Each of these hospitals files a Schedule H and has a customized implementation plan. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 6b: See response above to question 6a. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 11: Roper St. Francis used the Healthy People 2020 rankings reported in the survey and qualitative data collection methods to establish its current priorities. To ensure the priorities selected were strategically aligned with Roper St. Francis's mission and vision, priority was determined based on the System's ability to impact an identified need to the significance of the need in the community. As part of the prioritization process, Roper St. Francis Healthcare conducted an inventory of existing system-based outreach programs, community partnerships, and other collaborative resources that currently address each of the priority areas:After examining the range of services currently available, the expertise, outreach, and capacity of the RSFH System, and the resources available to best address needs through other community organizations, Roper St. Francis Healthcare senior leadership chose the following 5 issues as priorities to implement for its current CHNA: Access to Care; Clinical Preventive Services; Mental Health; Obesity/Nutrition/Physical Activity; Social Determinants; and Maternal, Infant, and Child Health.For the Healthy People 2020 topics that were not identified through the CHNA as strategic priority areas of need (Injury and Violence; Substance Abuse; Environmental Quality; Oral Health; Sexual Health; Tobacco Use), Roper St. Francis Healthcare is committed to providing support and collaboratively working with local partners, new and existing, to ensure these needs are acknowledged.The Roper St. Francis Community Needs Assessment Team developed implementation strategies for each health issue identified as a strategic priority. This implementation plan will be rolled out over the next 3 years. Strategies are be clearly defined with a matrix of which areas each RSFH hospital will address. Some strategies may be addressed by more than one RSFH hospital or the System as a whole. The team will develop a monitoring method at the conclusion of the implementation planning process to provide status updates to community partners, stakeholders, and the community-at-large. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 13h: A 10% prompt payment discount is also offered to all self-pay and self-pay-after-insurance patients who pay the account balance at one time. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 16j: The patient handbook provided with registration references the Policy and includes contact information for patients who need assistance. In addition, signs are posted at all Hospital registration sites that reference our financial assistance policies and how they are accessed. Roper St. Francis Mt. Pleasant Hospital Part V, Section B, Line 20e: We also send the patient a letter when they complete an application - either approving or denying their application. Part I, Line 3c: In addition to using the FPG to determine eligibility for free or discounted care, the system offers a 35% discount for patients who are uninsured. A 10% prompt payment discount is offered to all self-pay or self-pay-after-insurance patients who pay the balance at one time. Medical indigency adjustments are available to those that meet the established guidelines.Full charity care will be provided to patients with income 200% or less of FPG. Patients with an FPG of 201% - 400% will receive a discount based upon a sliding scale. Patients who qualify and are receiving benefits from the following programs may be presumed eligible for 100 percent financial assistance - food stamps, county and state relief programs, homelessness, deceased patients, and religious organizations. Patients who meet presumptive eligibility criteria may be granted financial assistance without completing the financial assistance application. In order to determine the appropriate level of financial assistance to apply to a patient's account, the facility will utilize a scoring mechanism, with the assistance of a third party vendor that provides a patient profile, or require the patient to complete a financial assistance application.Household income, as defined for federal tax guidelines, will be considered in determining whether a patient is eligible for financial assistance. Part I, Line 6a: The Organization's community benefit report is made available through its corporate parent, CareAlliance Health Services d/b/a Roper St. Francis Healthcare. Part I, Line 7: A cost to charge ratio was used to report financial assistance costs and actual expenses were used to report other community benefit costs. Part II, Community Building Activities: Collaborative partnerships with community groups to improve community health. Part III, Line 2: Estimated bad debt expense is based on the historical collection rate for patients without insurance and for the patient balance once insurance has settled the account. Bad debt expense does not include discounts to patients without insurance. Part III, Line 3: For patients who do not turn in a signed charity care application, after 120 days of collection efforts, RSFH uses the Health Care Advisory Board's self pay compass program to automatically qualify patients for charity care through the use of an electronic scoring technique. The data received through this software is believed to err on the side of denying charity. The estimate of bad debt that could have been charity is based on the system error rate. Please note that patients who complete a full charity care application and qualify for charity under our policy are granted charity regardless of the score in the self-pay compass system. Part III, Line 4: From the consolidated audited financial statements of CareAlliance Health Services (d/b/a Roper St. Francis Healthcare) which includes the activity of Roper St. Francis Mt. Pleasant Hospital:The process of estimating the allowance for doubtful accounts requires CareAlliance to estimate the collectibility of patient accounts receivable, which is primarily based on collection history, adjusted for expected recoveries. CareAlliance collects substantially all of its third-party insured receivables, which include receivables from governmental agencies. Collections are impacted by the economic ability of patients to pay and the effectiveness of collection efforts. Significant changes in payor mix, business office operations, economic conditions, or trends in federal and state governmental healthcare coverage could affect the collection of accounts receivable. CareAlliance also continually reviews overall reserve adequacy by monitoring historical cash collections as a percentage of trailing net revenue, as well as by analyzing current-period gross charges and admissions by payor classification, aged accounts receivable by payor, and days revenue outstanding. Part III, Line 8: The entire amount of Medicare shortfall qualifies as community benefit. Our treatment of Medicare patients, as described in IRS Rev. Rul. 69-545, indicates that Mt. Pleasant operates to promote the health of the community. By Taking Medicare patients, the hospital promotes access to healthcare services, which is a community benefit. New Paragraph - The organization uses the Medicare cost report to determine the costs reported on Part III, Line 5 and 6. Had we included revenues and costs from all Medicare programs including Medicare Part C this would have resulted in an additional shortfall of $2,940,300. Part III, Line 9b: Roper St. Francis Mt. Pleasant Hospital uses the same reasonable efforts and follows the same reasonable process for collecting amounts due for services provided to all patients, including insured, underinsured or uninsured patients. Collection activities may occur during the pre-registration process and will continue until account resolution, a determination the account is uncollectible, or determination of eligibility for financial assistance. The collection process may include the use of deposits, the implementation of payment plans or discretionary settlements. The collection process may involve the use of outside collection agencies. The collection process is documented in the patient's account files accessible to the Hospital and its business associates involved in the collection process. Collection will not, however, be pursued against patients who fall within populations exempt from collection action by law. Part VI, Line 2: The Community Needs Assessment Team used the 12 topic areas highlighted within the Healthy People 2020 framework to guide the discussion and research for the 2016 Community Health Needs Assessment. Healthy People 2020 is consistently recognized as a national benchmark for healthcare goals and standards. The 12 topic areas include Access to Public Health; Clinical Preventative Services; Environmental Quality; Injury and Violence; Maternal, Infant, and Child Health; Mental Health; Nutritional, Physical Activity and Obesity; Oral Health; Reproduction and Sexual Health; Social Determinants; Substance Abuse; and Tobacco. We used the following secondary sources in the data assessment process to provide a framework and foundation for subsequent primary data collection and analysis as it relates to our community: Nielson Claritas, 2016 County Health Rankings, Health Indicators Warehouse, The Advisory Board Company, Kids Count Data Center, Truven Health Analytics, and the USDA. Data from these sources was used to identify at-risk populations, underserved populations, health need areas, and professional shortage areas.In addition, the Community Needs Assessment Team entered into dialogue with community leaders, key hospital administrators, physicians, those with knowledge/expertise in public health, and those serving underserved and chronic disease populations. Collection and analysis of results from the CHNA data assessment, survey, interviews, and focus groups provided a strong foundation for identifying health needs and service gaps. Part VI, Line 3: The Hospital shall send anyone who requests information on the Hospital's financial assistance program a letter outlining required information and a financial assistance application form. Requests for financial assistance may be proposed by sources other than the patient, such as the patient's physician, family members, social service organizations, community or religious groups, or Hospital personnel. Statements to patients from the Hospital outline our charity care policy and our charity care policy is posted on our website. If patients indicate they are not able to pay their bill, we will provide the patient with a charity care application.Patients can also meet with a member or our financial counseling department to learn about their financial assistance options. Brochures are printed in English and Spanish telling patients to contact the financial counseling department. The Hospital wants its patients focus to be on health and recovery and not financial worry. There is absolutely no additional cost for our financial counseling assistance.Additionally, patients can meet with staff of the Medicaid program. The program staff will meet with patients individually to help them apply for publicly supported programs such as Medicaid, Medicare, and disability. Counselors meet with patients in the Hospital as well as making home visits as appropriate. The staff can also help identify resources to help pay for medication. All of this information is posted on our website with the appropriate contact information. Part VI, Line 4: The System's primary service area consists of Charleston, Berkeley, and Dorchester counties, and includes the major municipalities of Charleston, North Charleston, Mount Pleasant, and Summerville. Approximately 783,000 residents live within the primary service area, based on Esri estimates for 2018. According to Esri's forecasts, population in the primary service area is projected to grow 10.1% between 2018 and 2023. The 2018 - 2023 population growth rate is projected to be 1.95% annually compared to 2.01% for the period 2010 - 2018.In 2018, 11% of households within the primary service area had income less than $15,000, 8% had income between $15,000 and $25,000, 23% had income between $25,000 and $50,000, 19% between $50,000 and $75,000, 13% between $75,000 and $100,000, and 26% above $100,000. Within the primary service area, poverty continues to be an issue. According to the US Census Bureau's 2017 Small Area Health Insurance Estimates (SAHIE), an estimated 12.6% of Tri-county residents lack health insurance. This is higher than the national average of 10.6%. The US Department of Health and Human Services designated 6 medically underserved areas and 1 medically underserved population within our primary service area. From December 2017 to December 2018, the unemployment rate in the primary service area decreased from 3.6% to 2.8% and dropped below the national average rate of 3.9%.The secondary service area includes Colleton, Orangeburg, Georgetown, Hampton, Beaufort, Williamsburg, and Horry counties. In addition to the System's facilities, there are four other non-military hospitals in the primary service area. Part VI, Line 5: In keeping with our mission of healing all people with compassion, faith, and excellence, Roper St. Francis Healthcare strives to enrich the health of our community. We do this by offering charity care to those in need, reaching out to our neighbors with health fairs and educational materials,sponsoring organizations and events that promote wellness and community well-being, and marshalling our resources to advance the health and dignity of each person with whom we come in contact. We are the lowcountry's only non-governmental, not for profit healthcare system.With this distinction, we believe it is our responsibility to advocate for and respond to our neighbors needs through community benefit.Surplus funds are returned to our community through the development of new facilities to serve population growth, the expansion of existing facilities, subsidizing care for those who are unable to pay, sponsorship of healthcare related activities including outreach clinics and programs for the uninsured, and investing in technology to improve the quality ofpatient care.The Organization is committed to the enrichment of healthcare in our community as evidenced by the composition of our Board of Directors and Open Medical Staff. Our governing body is comprised of a 13-member Boardof Directors. At least nine directors must have their primary residence in a community served by the System. Five directors must be physicians actively engaged in the full time practice of medicine. The hospital extends medical staff privileges to all qualified physicians in the area for most of our departments. Part VI, Line 6: CareAlliance Health Services (d/b/a) Roper St. Francis Healthcare (RSFH) is a charitable health care delivery system based in Charleston, South Carolina. The 657-bed health system provides services at 90 facilities and doctors' offices conveniently located throughout our region. One ofthese facilities is Roper Hospital, Inc., an acute care hospital with 368 licensed beds. CareAlliance was formed effective August 1, 1998, through the execution of an affiliation agreement between the following founding members:- The Medical Society of South Carolina,- Bon-Secours Health System, Inc., and- Atrium Health (formerly Carolinas Healthcare System).CareAlliance is the sole corporate member and, through its by-laws, has the power to control the financial and business affairs of Roper Hospital, Inc. Part VI, Line 7, Reports Filed With States SC 1 1 0 0 0 1 1 0 0 Brian Cuddy MD See Sch O Chairperson 0 922396 0 50891 0 11657 0 35182 0 32001 0 1052127 0 0 Susan Datta MD See Sch O Vice-Chairperson (Start 7/01/18) 0 233434 0 28202 0 5602 0 33245 0 32170 0 332653 0 0 John Holloway See Sch O Board Member 0 330000 0 100000 0 0 0 13932 0 17280 0 461212 0 0 John Spratt MD See Sch O Board Member 0 772188 0 25332 0 1854 0 35182 0 30586 0 865142 0 0 Lorraine Lutton President & CEO - RSFH 0 635904 0 231778 0 23652 0 95144 0 27840 0 1014318 0 0 Anthony Jackson VP & CEO - MPH & BSSF 0 353694 0 87253 0 2143 0 45435 0 34100 0 522625 0 42400 Bret D Johnson SVP & CFP - RSFH 0 421003 0 142376 0 56263 0 70818 0 24744 0 715204 0 50074 Pennie Peralta VP System CNO 0 247461 0 57576 0 17761 0 36213 0 20773 0 379784 0 42480 Stephen Porter CEO - Roper & Berkeley Hosp 0 422820 0 26744 0 2475 0 52545 0 28362 0 532946 0 0 James Demarco MD Physician 0 545470 0 253256 0 681 0 32432 0 31804 0 863643 0 0 John McCrosson MD Physician 0 1025778 0 257092 0 758 0 35182 0 18953 0 1337763 0 0 Patrick Murray MD Physician 0 911373 0 82188 0 321 0 13932 0 31504 0 1039318 0 0 Robert Lowery MD Physician 0 596838 0 525126 0 4083 0 32432 0 32183 0 1190662 0 0 Robert Schoderbek MD Physician 0 647933 0 160312 0 90 0 9402 0 23580 0 841317 0 0 Matthew Severance COO - RSFH & CEO - Roper Hospital 0 0 0 86013 0 638447 0 0 0 0 0 724460 0 337578 Peter DiNicola Dir Plant & BioMed Engrng 0 80140 0 11904 0 8584 0 5082 0 1801 0 107511 0 0 Stephanie McKoin Dir of Perioperative Svcs 0 187185 0 14441 0 2471 0 10008 0 22451 0 236556 0 0 Vanessa Shamrock Director of Lab 0 143304 0 9312 0 594 0 6769 0 10682 0 170661 0 0 Part I, Line 3 A related organization of Roper St. Francis Mt. Pleasant Hospital determined the compensation of the Organization's CEO using the following methods: - Compensation Committee - Independent Compensation Consultant - Compensation Survey or Study - Approval by the Board or Compensation Committee Part I, Line 4a: Matthew Severance - $386,882 Part I, Line 4b: The Roper St. Francis Healthcare 457(f) Plan's purpose is to offer eligible employees of the employer deferred compensation benefits to supplement Eligible Employees' retirement income. The Plan is intended to be a top-hat plan (i.e. an unfunded deferred compensation plan maintained for certain members of a select group of management or highly compensation employees. The Vice-Presidents, CFO, and CEO participate in the 457f Plan. The following participants received compensation through a 457(f) Plan: Bret D. Johnson - $53,095 Pennie Peralta - $14,284 Matthew Severance - $251,565 Part I, Line 6: Goals are developed each year to support the Organization's strategic initiatives for people, quality, financial, growth and service. The Ad Hoc Compensation Committee approves the system goals annually and reports it to the full Board of Directors. Progress on each metric is reported to the board each month on the corporate scorecard. At year-end, the Ad Hoc Compensation Committee approves the final scorecard number and reports results to the full board. Annual incentives for the executives are based 60% on the corporate scorecard and 40% on individual performance. Executives maintain an individual scorecard on the leader evaluation manager and discuss results monthly with the President/CEO. The President/CEO approves the individual executive scorecard. System Vice Presidents and the System CEO are eligible to participate in a long term incentive plan (LTIP). An LTIP typically takes place over a three year period and does not vest until the end of the third year. To receive payment, executives must still be employed by the system at the end of the plan period. Each LTIP has a financial and clinical objective that is aligned with the Organization's strategic goals. Threshold, target, and maximum performance ranges are established for these objectives and are measured based on performance against similar organizations or compared to an internal metric such as an improvement over prior performance. These targets and objectives are approved by the Ad Hoc Compensation Committee. The incentive is earned based on the satisfaction of the threshold, target, or maximum performance ranges. The Ad Hoc Committee also approves the final LTIP performance score and the amount paid to executives under the plan. Results are reported to the full board annually. Form 990, Part VI, Section A, line 3 Atrium Health, formerly, Carolinas Healthcare System, an unrelated organization, provides management oversight services. Lorraine Lutton, RSFH President and CEO, and Bret D. Johnson, RSFH CFO, are employees of Atrium and their compensation is paid by CareAlliance Health Services, a related organization, through a management fee to Atrium. Form 990, Part VI, Section A, line 6 The sole member of the Corporation is CareAlliance Health Services, a South Carolina nonprofit, nonstock Corporation, d/b/a Roper St. Francis Healthcare. CareAlliance Health Services is in turn governed by a Board of Directors appointed by the "founding members". Please see the response to Line 7a below. The By-laws of the Organization specify certain qualifications of the thirteen member Board of Directors. At least nine directors must have their primary residence in a community served by the System. Five directors must be physicians actively engaged in the full time practice of medicine. Five of the directors are appointed to the Board of Directors by virtue of positions held within MSSC, BSHSI and Atrium Health (ex-officio directors). Each of the five ex-officio directors serves as a director of the Organization for so long as such person holds his or her respective elected or appointed office in his or her respective founding member organization. Directors serve three-year terms and are limited to three consecutive terms. After an absence of at least one year, directors are again eligible for appointment to the Board of Directors for two consecutive complete terms. Form 990, Part VI, Section A, line 7a The Organization is governed by a thirteen member Board of Directors appointed by the founding members. Subject to certain nominating and governance committee approvals, six directors are appointed by the Medical Society of South Carolina (MSSC), Bon Secours Health System, Inc. (BSHSI), and one director is appointed by Atrium Health. It is the founding members' intent that the members of the Organization's Board of Directors are appointed to such positions because they have a willingness to serve the needs of the System as a whole and not the needs of any individual founding member. Form 990, Part VI, Section A, line 7b The following actions shall require the unanimous affirmative approval of all of the founding members: (a) to amend the Articles of Incorporation or By-laws, including without limitation, any change in the Corporation's purposes; provided, however, that, subject to the procedures and voting requirements with respect to the admission of non-founding members, Schedule 3.1 may be amended with the approval of two (2) of the founding members to reflect the admission of a non-founding member; (b) to dissolve or liquidate the Corporation and to determine the distribution of assets upon dissolution; (c) to merge or consolidate the Corporation or to sell, convey, transfer, lease, or otherwise dispose of all or substantially all of its assets; (d) to appoint the President and Chief Executive Officer of the Corporation in a manner other than that established within the By-laws; (e) to alter or amend the Corporation's ethical performance standards (defined below); or (f) to enter into any material agreement whereby a third party will: (i) become an equity owner in any joint venture with the Corporation or any System participant and will not be legally obligated to support the Corporation's ethical performance standards; or (ii) manage a substantial part of the facilities, assets, or operations of the System and will not be legally obligated to comply with and support the Corporation's ethical performance standards. Form 990, Part VI, Section B, line 11b The Form 990 was prepared by an independent accounting firm with assistance and oversight by management. Reviews were then conducted by senior management before drafts were sent to each member of the Organization's governing body. A transmittal letter accompanied the drafts and provided highlights of the Form 990 to the Organization's Board of Directors. After the governing body approved the Form 990 draft, a final version was filed with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The Directors shall complete and return to the Secretary an annual statement that each of them: (a) has received a copy of the Conflict of Interest Policy; (b) has read and understands the Policy; (c) agrees to comply with this Policy; (d) understands that the Policy applies to all committees; and (e) understands that the Organization is a charitable organization and must continuously engage primarily in activities which accomplish one or more of its tax-exempt purposes. Form 990, Part VI, Section B, line 15 An independent company, Towers Watson, provides research, advice and guidance to the Compensation Committee and senior leadership to ensure the Organization's compensation programs for executives covered by the "Intermediate Sanctions Legislation" (IRC Section 4958) are aligned with its stated philosophy: Base salaries are targeted at the 50th percentile of the established comparator market; Total cash compensation (base salary plus annual incentive payments) are targeted at the 75th percentile of the established comparator market; Total direct compensation (total cash compensation plus long term incentive payments) will not exceed the 90th percentile of the established comparator market; Benefits are targeted at market median; and In aggregate, base salary, total cash compensation, total direct compensation and benefits comprise total compensation for executives. The Compensation Committee ensures that executive total compensation is reflective of the Organization's stated compensation philosophy. The committee, in this process, authorizes and supports an annual three step process utilizing Towers Watson's resources: 1) Salary levels, annual bonus targets/payments and long term incentive grants are compared rigorously each year with market data based on comparable positions and organizations. A. Comparable organizations are typically not-for-profit healthcare systems with similar operating revenues. Private sector employer data, when available, are also included in the analysis for "transferable skills positions". B. Historically, performance incentive payouts generally track with a normal bonus payout distribution. Incentive goals are primarily based on formally defined quantitative goals approved by the ad hoc Compensation Committee of the RSFH Board of Directors. 2) All recommended pay decisions are tested against these data and the organization's stated compensation philosophy. 3) A formal opinion letter is prepared by Towers Watson, representing that senior executives are compensated within the reasonableness standards mandated by the IRS. A similar process is performed by Towers Watson for the CEO and CFO positions. This letter provides a "safe harbor" for the Organization's "directors" relative to the reasonableness of total executive compensation consistent with IRC Section 4958. Form 990, Part VI, Section C, line 19 The Organization's audited financial statements are published annually and are available to the public at www.dacbond.com. Form 990, Part VII, Line 1: The following board members were compensated for services performed for the Organization (or a related organization) not in the capacity of their positions on the board. No board member is compensated for his/her services as a board member. Brian Cuddy, MD was compensated for medical services rendered to a related organization. John B. Holloway, Jr. was compensated by the Medical Society of South Carolina for services as Chief Executive Officer. John A. Spratt, MD was compensated for medical services rendered to a related organization. Susan Datta, MD was compensated for medical services rendered to a related organization. Wills C. Geils, MD was compensated for medical services rendered to a related organization. Kent Stock, MD was compensated for medical services rendered to a related organization. Form 990, Part VII, Section B The amounts reported for NBM Construction, Inc. and Morrison Management Specialists represent payments for goods and services. These amounts cannot be separated. Form 990, Part IX, line 11g Purchased Services: Program service expenses 688,306. Management and general expenses 1,860,974. Fundraising expenses 0. Total expenses 2,549,280. Professional Fees: Program service expenses 929,706. Management and general expenses 2,513,649. Fundraising expenses 0. Total expenses 3,443,355. Other Fees: Program service expenses 810,243. Management and general expenses 2,190,657. Fundraising expenses 0. Total expenses 3,000,900. Part IX, Line 1: The grants expense shown on page 10 of the 990 is an allocation from the parent company, CareAlliance Health Services. All grants meeting disclosure requirements have been listed on CareAlliance Health Service's Form 990. Form 990, Part XI, line 9: Pension and Benefit Allocation from CAHS -186,172. Equity Transfer from Affiliate -12,170,395. CareAlliance Health Services 8536 Palmetto Commerce Pkwy Ste 201 Ladson SC 29456 570831165 Healthcare SC 501(c)(3) Line 3 N/A 0 Roper Hospital Inc 8536 Palmetto Commerce Pkwy Ste 201 Ladson SC 29456 570828733 Healthcare SC 501(c)(3) Line 3 CareAlliance Health Services 0 Bon Secours St Francis Xavier Hospital 8536 Palmetto Commerce Pkwy Ste 201 Ladson SC 29456 571067254 Healthcare SC 501(c)(3) Line 3 CareAlliance Health Services 0 Roper St Francis Hospital - Berkeley 8536 Palmetto Commerce Pkwy Ste 201 Ladson SC 29456 263710229 Healthcare (future) SC 501(c)(3) Line 3 CareAlliance Health Services 0 Roper St Francis Physicians Network 8536 Palmetto Commerce Pkwy Ste 201 Ladson SC 29456 262946628 Healthcare SC 501(c)(3) Line 3 CareAlliance Health Services 0 Roper St Francis Foundation 8536 Palmetto Commerce Pkwy Ste 201 Ladson SC 29456 571068509 Supporting Org SC 501(c)(3) Line 12a, I CareAlliance Health Services 0 The Medical Society of South Carolina 69-B Barre St Charleston SC 29401 570288358 Supporting Org/Founding Member SC 501(c)(3) Line 12c, III-FI N/A 0 Clinical Biotechnology Research Institute at RSFH 8536 Palmetto Commerce Pkwy Ste 201 Ladson SC 29456 475407453 Healthcare SC 501(c)(3) Line 3 CareAlliance Health Services 0 Lowcountry Surgery Center LLC (dba Roper St Francis Eye Surgery Center) 8536 Palmetto Commerce Pkwy Ste 201 Ladson SC 29456 581693021 Eye Surgery SC N/A RSFH ATI Physical Therapy LLC 125 Doughty St Ste 760 Charleston SC 29403 474797980 Physical Therapy SC N/A CareAlliance Medical Services Organization 8536 Palmetto Commerce Pkwy Ste 201 Ladson SC 29456 571012837 Inactive SC N/A C 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 0 0