2018-08-06T09:48:30-05:00 2017-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2016-10-01 043633263 WACCAMAW COMMUNITY HOSPITAL WACC 8436521000 PO BOX 3350 MURRELLS INLET SC 29576 ELIZABETH WARD CFO 8436521000 2018-08-06 1 Amy Bibby P00445891 8282542254 2018-08-06 2016 2022-09-23 18:48:47Z TIDELANDS WACCAMAW COMMUNITY HOSPITAL BRUCE P BAILEY PO BOX 3350 MURRELLS INLET SC 29576 178753370 0 X WWW.TIDELANDSHEALTH.ORG X 2002 SC TO PROVIDE HIGH QUALITY HEALTHCARE TO THE CITIZENS OF GEORGETOWN CO. AND SURROUNDING AREAS. 7 4 0 119 0 0 0 50000 177100459 177783902 9068 -1381 892625 889586 178002152 178722107 0 0 0 0 46222063 45077390 0 0 0 118696345 133631920 164918408 178709310 13083744 12797 194374199 192152854 82875502 80641360 111498697 111511494 X GEORGETOWN HOSPITAL SYSTEM IS COMMITTED TO PROVIDING HIGH QUALITY HEALTHCARE TO THE CITIZENS OF GEORGETOWN COUNTY AND SURROUNDING AREAS. OUR MISSION IS TO CONTINUOUSLY IMPROVE THE CARE WE ARE ABLE TO RENDER TO EXCEED THE EXPECTATIONS OF OUR PATIENTS AND CUSTOMERS. 0 0 140750381 177783902 WACCAMAW COMMUNITY HOSPITAL PROVIDES QUALITY HEALTH CARE AND PROMOTES HEALTH AND WELLNESS TO THE RESIDENTS OF GEORGETOWN COUNTY AND SURROUNDING AREAS. WACCAMAW COMMUNITY HOSPITAL IS A 124 BED ACUTE CARE AND 43 BED INPATIENT REHABILITATION FACILITY LOCATED IN MURRELLS INLET, SOUTH CAROLINA. THE HOSPITAL WAS ORGANIZED UNDER THE LAWS OF THE STATE OF SOUTH CAROLINA IN 2002 FOR THE PURPOSE OF OPERATING A COMMUNITY SATELLITE HOSPITAL IN THE NORTHERN PART OF GEORGETOWN COUNTY. PLEASE SEE SCHEDULE O FOR A CONTINUATION OF PROGRAM SERVICE ACCOMPLISHMENTS.THE HOSPITAL WAS CREATED FOR THE PURPOSE OF PROMOTING HEALTH FOR ALL RESIDENTS OF GEORGETOWN COUNTY AND ITS OUTLYING AREAS. THE PROMOTION OF HEALTH HAS BEEN ESTABLISHED AS A CHARITABLE PURPOSE UNDER INTERNAL REVENUE CODE (IRC) SECTION 501 (C)(3). REVENUE RULE 69-545, 1969-2 C.B. 117, AS MODIFIED BY REC. RUL. 83-157, 1983-2 C.B. 94, SETS FORTH THE FACTORS THE INTERNAL REVENUE SERVICES WILL CONSIDER IN DETERMINING WHETHER A NONPROFIT HOSPITAL QUALIFIES FOR TAX EXEMPT STATUS.THE HOSPITAL OPERATES ITS FACILITIES IN A MANNER DESCRIBED IN REV. RULING 69-545, SUPRA. THE HOSPITAL HAS A BOARD OF TRUSTEES COMPOSED OF INDEPENDENT CIVIC LEADERS AND PHYSICIANS. AN OPEN MEDICAL STAFF IS MAINTAINED BY THE HOSPITAL, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS. ALSO, THE HOSPITAL PROVIDES EMERGENCY AND NON-EMERGENCY CARE TO ANYONE REGARDLESS OF THEIR ABILITY TO PAY, EITHER DIRECTLY OR THROUGH THIRD PARTY REIMBURSEMENT, INCLUDING MEDICARE AND MEDICAID.DURING THE YEAR ENDED SEPTEMBER 30, 2017, THE HOSPITAL FURNISHED CHARITY CARE IN THE AMOUNT OF $14,633,838. IN ADDITION TO PROVIDING PATIENT CHARITY CARE, AND IN FURTHERANCE OF ITS EXEMPT PURPOSE TO BENEFIT THE COMMUNITY, THE HOSPITAL PROVIDES CAR SEATS TO FAMILIES AND NEWBORN INFANTS WHO DO NOT PRESENTLY HAVE OR CANNOT AFFORD TO PURCHASE ONE. IN ADDITION, THE HOSPITAL PROVIDES FREE TAXI SERVICE THROUGH AN AUXILIARY ORGANIZATION FOR INDIVIDUALS THAT CANNOT AFFORD OR ARRANGE FOR TRANSPORTION TO THEIR RESIDENCE OR HEALTHCARE SERVICE. THE HOSPITAL ALSO PARTICIPATES IN STATE PROGRAMS SUCH AS THE BEST CHANCE NETWORK, WHICH TARGETS LOW-INCOME WOMEN FOR PREVENTATIVE HEALTHCARE TESTING.THE HOSPITAL IS PART OF THE GEORGETOWN HOSPITAL SYSTEM WHICH PERIODICALLY CONDUCTS VARIOUS COMMUNITY OUTREACH, SCREENING, AND EDUCATIONAL PROGRAMS. AMONG THESE ARE CHOLESTEROL AND BLOOD PRESSURE SCREENINGS, PERIODIC HEALTH FAIRS HELD THROUGHOUT THE SERVICE AREA WHICH OFFER A VARIETY OF HEALTH-RELATED INFORMATION AND SCREENINGS, SUCH AS GLUCOSE, CHOLESTEROL, BLOOD PRESSURE, BODY FAT ANALYSIS, AND A LABORATORY BLOOD PROFILE. THE HOSPITAL SYSTEM'S COMMUNITY EDUCATION PROGRAM CONDUCTS A VARIETY OF CLASSES AND LECTURE SERIES OPEN TO THE PUBLIC, INCLUDING CPR, WEIGHT CONTROL, SMOKING CESSATION, CHILDBIRTH EDUCATION, PRE-NATAL AND INFANT NUTRITION, AND OTHERS. 140750381 1 0 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 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 96 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 4 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 SC X X ELIZABETH WARD EVP & CFO 8435277102 PO DRAWER 1718 GEORGETOWN SC 29442 Mr J Edward Norris III Chairman 1.00 2.00 X X 0 250 0 Mr Robert L Jones Vice Chairman 1.00 2.00 X X 0 100 0 Ms Judith K Ingle Secretary/Treasurer 1.00 2.00 X X 0 100 0 Mr Daniel Scheffing Trustee 1.00 2.00 X 0 250 0 Mr Willie Shelley Trustee 1.00 2.00 X 0 400 0 Dr T Scott Ellison Trustee & PHYSICIAN 1.00 42.00 X 0 658153 34421 Dr Gayle Richmond Chief of Staff & PHYSICIAN 1.00 2.00 X 23257 67214 0 Bruce Bailey President & CEO 21.00 19.00 X 363345 329136 46277 Terry Kiser EVP & CFO (RETIRED MARCH) 21.00 19.00 X 247688 224369 28467 Elizabeth Ward EVP & CFO 21.00 19.00 X 0 0 0 Gayle Resetar EVP & COO 21.00 19.00 X 249632 226129 33100 Rick Kaylor GPS President & Senior Vice President System Devel 21.00 19.00 X 199896 181077 21778 Philip Dulberger SVP & Chief Medical Officer 21.00 19.00 X 279141 252860 38619 James F Harper SVP & Chief Human Resource Officer 21.00 19.00 X 151899 137598 33766 Todd Rowland SVP & Chief Information Officer 21.00 19.00 X 175799 159247 35148 Virginia Hunt MUSC Affiliation Executive 21.00 19.00 X 149769 135669 18204 Pam Maxwell SVP & Chief Nursing Officer 21.00 19.00 X 141050 127770 31743 1981476 2500322 321523 70 0 1 1 Sodexo Inc PO Box 536922 Atlanta GA 30353 Food & Housekeeping 4067464 Palmetto Emergency Physicians 86 Shorebird Loop Pawleys Island SC 29585 Emergency Physician Services 3930673 Inlet Anesthesia Consultants 130 Preservation Circle Pawleys Island SC 29585 Anesthesia Services 1980933 Coastal Structures Corporation PO Box 937 Georgetown SC 29442 Construction 1941954 Nelson Mullins Riley & Scarborough PO Box 11009 Columbia SC 29211 Legal Services 1610571 65 50000 50000 Net Patient Service Revenue 621400 174569661 174569661 Pharmacy 446110 2846372 2846372 Cafeteria 722210 363442 363442 OTHER RELATED SERVICES 900099 4427 4427 177783902 2617 2617 872543 0 872543 872543 872543 3998 -3998 -3998 -3998 44308 27265 17043 17043 178722107 177783902 0 888205 X 1233819 23257 1210562 166828 136316 30512 33473528 32650104 823424 794811 747759 47052 6992396 6578457 413939 2416008 2272984 143024 2237269 2237269 58111 58111 58045395 32446667 25598728 460033 460033 3038599 2867724 170875 1754163 1710135 44028 178513 176333 2180 1956115 1956115 9052531 9052531 505970 505970 Medical Supplies 28837918 28837918 Bad Debt Expense 21210724 21210724 Pension termination 5853216 5853216 RECRUITMENT 337396 337396 105967 83357 22610 178709310 140750381 37958929 0 3500 15993 2668246 2029366 22613935 23454762 2630877 2775289 1725944 2503002 204556544 91657204 110463390 112899340 1000000 1000000 1352298 1072513 51916009 46402589 194374199 192152854 8953773 7890902 71821729 68708409 2100000 4042049 82875502 80641360 X 111460559 111460356 38138 51138 111498697 111511494 194374199 192152854 12797 0 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 3858 3858 0 Part II-B, Line 1: THE HOSPITAL IS A MEMBER OF BOTH THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE SOUTH CAROLINA HOSPITAL ASSOCIATION (SCHA). THESE ORGANIZATIONS ENGAGE IN LOBBYING FOR THE BENEFIT OF THEIR MEMBERSHIP BODIES, AND A PORTION OF THE MEMBERSHIP DUES PAID TO THE ORGANIZATIONS IS ATTRIBUTABLE TO LOBBYING EXPENDITURES. FOR THE YEAR, THE PORTION OF DUES ATTRIBUTABLE TO LOBBYING EXPENDITURES WAS $1,359 FOR AHA AND $2,499 FOR SCHA. 3143954 3143954 118756119 32471899 86284220 1785813 1266897 518916 70727353 57918408 12808945 10143305 10143305 112899340 Other Receivables 13708 DUE FROM AFFILIATES 46388881 46402589 Estimated Third-Party Settlements 4042049 4042049 X 157538648 -21210724 -21210724 178749372 -27265 -27265 178722107 151672635 -21210724 -21210724 172883359 5825951 5825951 178709310 Part X, Line 2: WACCAMAW COMMUNITY HOSPITAL HAS BEEN GRANTED EXEMPTION FROM INCOME TAXES AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT INCLUDE A PROVISION FOR INCOME TAXES. THE HOSPITAL HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2017. Part XI, Line 2d - Other Adjustments: BAD DEBT NET WITH REVENUE -21,210,724. Part XI, Line 4b - Other Adjustments: COST OF GOODS SOLD NET WITH REVENUE -27,265. Part XII, Line 2d - Other Adjustments: BAD DEBT NET WITH REVENUE -21,210,724. Part XII, Line 4b - Other Adjustments: COST OF GOODS SOLD NET WITH REVENUE -27,265. PENSION TERMINATION EXPENSE 5,853,216. 1 1 X 1 X 0 1 1 0 1 1 4831067 1719383 3111684 0.02050 10931103 9763791 1167312 0.00770 15762170 11483174 4278996 0.02820 1494457 178192 1316265 0.00870 2506493 1137000 1369493 0.00900 383007 67913 315094 0.00210 4383957 1383105 3000852 0.01980 20146127 12866279 7279848 0.04800 154304 154304 0.00100 154304 154304 0.00100 0 5224201 2778707 70307741 84178386 -13870645 X 1 1 1 1 WACCAMAW COMMUNITY HOSPITAL 4070 HIGHWAY 17 BYPASS MURRELLS INLET SC 29576 X X X WACCAMAW COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X 15 1 1 1 1 X SEE PART V, SECTION C X X 1 15 1 SEE PART V, SECTION C 0 1 X 200.000000000000 X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X 1 X 0 X X X X 1 X 0 0 WACCAMAW COMMUNITY HOSPITAL Part V, Section B, Line 5: Through two surveys, Tidelands solicited the input of individuals falling into five categories: 1) Public Health expertise, 2) Departments and Agencies, 3) Priority Population leaders/representatives, 4) Representatives of Chronic Disease Groups, 5) other individuals, volunteers, civic leaders, or medical personnel that represent the broad interest of the community. Thirty three individuals representing these five areas of expertise completed the surveys. In addition, a meeting on the TCCN Advisory Committee was held to offer feedback on health issues and factors impacting health to gain the perspective of community members. Members of Tidelands Health, the local FQHC, the free clinic, and DHEC met to develop the CHNA implementation plan. WACCAMAW COMMUNITY HOSPITAL Part V, Section B, Line 6a: GEORGETOWN MEMORIAL HOSPITAL WACCAMAW COMMUNITY HOSPITAL Part V, Section B, Line 6b: Quorum Health Resources provided the expertise to complete the CHNA in partnership with Tidelands Health representatives. WACCAMAW COMMUNITY HOSPITAL Part V, Section B, Line 7d: ALL TCCN PARTNERS WERE SENT AN ELECTONIC COPY. WACCAMAW COMMUNITY HOSPITAL Part V, Section B, Line 11: Tidelands presented the CHNA findings and implementation plan to the TCCN Partners Group, which includes leadership from multiple community and medical partners, including DHEC. Strategies to address the top five significant needs were discussed. 1) Affordability/Accessibility: Tidelands Community Care Network (TCCN) continues to enable individuals with barriers to accessing care affordable and accessible treatment. 2) Mental Health/Substance Abuse: partnerships with Georgetown County Alcohol and Drug and Waccamaw Mental Health are in place. Mental health services are offered to qualifying TCCN participants at no charge. Tidelands has partnered with Waccamaw Mental Health to cost share a behavioral health specialist to work in Tidelands Health emergency departments. 3) Obesity: Tidelands continues to screen and provide education to individuals at community events and through education to TCCN participants and hospital patients. TCCN has also partnered with local industries to provide care pathways and education regarding obesity. Lactation education is also emphasized as obesity prevention. 4) Diabetes: Tidelands continues to screen and provide education to individuals at community events and through education to TCCN participants and hospital patients. TCCN RNs are in the process of becoming certified Diabetic Educators. TCCN has also partnered with local industries to provide care pathways and education regarding diabetes. Tidelands has begun Diabetes Prevention Classes (DPP). 5) Physical Inactivity: Tidelands has begun programs to promote physical activity for those who have difficulty exercising due to physical conditions/recovery from illness/surgery. Tidelands provides access to local fitness centers. Through the industry partnership program, Tidelands provides 12 free one-on-one gym sessions with a personal training to help individuals develop a sustainable practice of physical activity. PART V, LINE 7A, CHNA WEBSITE: http://www.tidelandshealth.org/discover/our-community-commitment/ PART V, LINE 10A: IMPLEMENTATION STRATEGY WEBSITE: http://www.tidelandshealth.org/discover/our-community-commitment/ PART V, LINE 16B & C, FAP, FAP APPLICATION & PLAIN LANGUAGE SUMMARY: http://www.tidelandshealth.org/patients-visitors/billing-insurance/financial-assistance/ 8 1 - IMAGING CENTER 4181 HIGHWAY 17 BYPASS MURRELLS INLET SC 29576 IMAGING CENTER 2 - NEXTSTEP PAIN MANAGEMENT CENTER 4040 HIGHWAY 17 BYPASS SUITE 206 MURRELLS INLET SC 29576 PAIN MANAGEMENT 3 - WACCAMAW ENDOSCOPY CENTER 4040 HIGHWAY 17 BYPASS SUITE 102 MURRELLS INLET SC 29576 ENDOSCOPY CENTER 4 - WACCAMAW IMAGING SUITE 4040 HIGHWAY 17 BYPASS SUITE 103 MURRELLS INLET SC 29576 IMAGING CENTER 5 - NEXTSTEP REHABILITATION SERVICES 198 VILLAGE CENTER BOULEVARD MYRTLE BEACH SC 29579 ADULT REHABILITATION 6 - WACCAMAW SURGERY CENTER 3911 HIGHWAY 17 BYPASS SUITE B MURRELLS INLET SC 29576 SURGERY CENTER 7 - NEXTSTEP REHABILITATION SERVICES 543 HIGHWAY 17 NORTH NORTH MYRTLE BEACH SC 29582 ADULT REHABILITATION 8 - WACCAMAW WOMEN'S IMAGING 4017 HIGHWAY 17 BYPASS SUITE 101 MURRELLS INLET SC 29576 IMAGING CENTER Part I, Line 7: THE ORGANIZATION USED WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID AT COST. Part I, Ln 7 Col(f): TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25 CONTAINS A BAD DEBT EXPENSE OF $21,210,724 THAT HAS BEEN REMOVED FOR PURPOSES OF COMPUTING PERCENTAGE OF TOTAL EXPENSE ON COLUMN (F). Part II, Community Building Activities: $154,304 WAS SPENT TO RECRUIT PHYSICIANS WITH THE SKILLS AND TRAINING NECESSARY TO BEST SERVE THE NEEDS OF THE COMMUNITY IN AREAS SUCH AS PRIMARY CARE, OBSTETRICS/GYNECOLOGY, AND PULMONOLOGY. Part III, Line 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT EXPENSE.WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS WAS USED TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE BAD DEBT EXPENSE AT COST FOR PURPOSES OF LINE PART III, LINES 2 AND 3.THE PERCENTAGE OF FAMILIES BELOW THE POVERTY LEVEL IN THE AREA SERVED IS USED TO ESTIMATE THE PERCENTAGE OF NET REVENUE EXPECTED TO BE AWARDED CHARITY CARE. THE VARIANCE WITH ACTUAL CHARITY CARE ADJUSTMENTS IS THE AMOUNT OF THE ORGANIZATION'S BAD DEBT ATTRIBUTED TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. Part III, Line 8: THE MEDICARE COST REPORT WAS USED TO CALCULATE THE OVERALL SHORTFALL. THE ORGANIZATION BELIEVES THE ENTIRE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT. APPROXIMATELY 60% OF THE ORGANIZATION'S PAYER MIX IS DEVOTED TO MEDICARE. Part III, Line 9b: GEORGETOWN HOSPITAL SYSTEM HAS A PROCESS IN PLACE TO ASSIST PATIENTS IN UNDERSTANDING THEIR FINANCIAL RESPONSIBILITY, BEGINNING WITH SCHEDULING AND REGISTRATION. SIGNAGE AND FINANCIAL RESPONSIBILITY BROCHURES ARE CLEARLY DISPLAYED THROUGHOUT THE REGISTRATION AREAS OF THE SYSTEM. THIS INFORMATION DETAILS THE POTENTIAL PATIENT RESPONSIBILITY AND ALSO PROVIDES INFORMATION ON THE AVAILABLE PROGRAMS IN THE EVENT THE PATIENT CAN NOT PAY THE BILL. IF THE PATIENT COMMUNICATES THEIR INABILITY TO PAY, THE FINANCIAL ASSISTANCE PROGRAM IS REVIEWED AND THE PATIENT IS DIRECTED TO THE FINANCIAL ASSISTANCE DEPARTMENT. UPON APPLICATION FOR FINANCIAL ASSISTANCE, COLLECTION PRACTICES ARE HALTED UNTIL THE APPLICATION HAS BEEN REVIEWED AND PROCESSED. IF FINANCIAL ASSISTANCE IS APPROVED, COLLECTION PRACTICES WILL CEASE. IF FINANCIAL ASSISTANCE IS DENIED, COLLECTION PRACTICES WILL CONTINUE. Part VI, Line 2: THE ORGANIZATION ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY WITH THE ASSISTANCE OF STATE AND INTERNAL REPORTING INFORMATION. THE INFORMATION IS INTERPRETED, REVIEWED AND ANALYZED. IF A NEED IS PRESENT, A STRATEGIC PLAN IS DEVELOPED, WITH THE GOAL OF PROVIDING AS MANY LOCAL SERVICES AS POSSIBLE. THE PLAN IS THEN PRESENTED TO THE BOARD FOR APPROVAL. ONCE BOARD APPROVAL IS RECEIVED, THE IMPLEMENTATION PROCESS BEGINS. THE ORGANIZATION'S COMMUNITY HEALTH PROGRAM'S OBJECTIVE IS TO ENHANCE THE HEALTH CARE STATUS OF THE COMMUNITY, PROVIDING EDUCATION, SCREENINGS, AND REGULAR FOLLOW UP TO ENSURE READY ACCESS TO QUALITY HEALTHCARE. Part VI, Line 3: THE ORGANIZATION REGULARLY ADVERTISES THE AVAILABLE STATE, FEDERAL, AND LOCAL FINANCIAL ASSISTANCE PROGRAMS. ALL PATIENTS WITHOUT INSURANCE ARE SCREENED FOR AVAILABLE STATE AND FEDERAL PROGRAMS. PATIENTS NOT MEETING STATE AND FEDERAL PROGRAM GUIDELINES ARE PROVIDED A ONE ON ONE CONSULTATION FOR LOCAL FINANCIAL ASSISTANCE, IF DESIRED. THE HOSPITAL FEATURES SIGNAGE AND BROCHURES THROUGHOUT THE REGISTRATION AREAS THAT OUTLINE RESPONSIBILITIES AND OPTIONS. Part VI, Line 4: The organization serves the South Carolina counties of Horry and Georgetown, as well as outlying areas. Horry County (1,100 sq. miles) has an estimated 2016 population of 322,000. 22% of the population is over the age of 65 and the median household income is approximately $45,000. In addition, an estimated 15% of the population is below the poverty level. Finally, 17% of the population under the age of 65 is estimated to be without health insurance. Georgetown county (815 sq. miles) has a population of approximately 61,000 people and an estimated 26% of the population is over the age of 65. The median household income is approximately $45,000 and an estimated 15% of the population is below the poverty level. Finally, 14% of the population under the age of 65 is estimated to be without health insurance. Competing hospitals are located approximately 25 miles north and northwest and 75 miles south. Major surrounding cities include: Charleston, SC (60 miles), Columbia, SC (150 miles) and Charlotte, NC (215 miles). Part VI, Line 5: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR MANY OF ITS DEPARTMENTS.USAGE OF THE ORGANIZATION'S SURPLUS OF FUNDS IS DESCRIBED ON FORM 990, PART III; HOWEVER IN GENERAL, A SURPLUS OF FUNDS IS USED TO REINVEST IN PROPERTY AND EQUIPMENT IN ORDER TO CONTINUE PROVIDING TO THE PUBLIC THE BEST IN PATIENT CARE AND TECHNOLOGY. Part VI, Line 6: WACCAMAW COMMUNITY HOSPITAL IS PART OF GEORGETOWN HOSPITAL SYSTEM. GEORGETOWN HOSPITAL SYSTEM IS A RELATED 501(C)(3) HEALTHCARE ORGANIZATION. Part VI, Line 7, Reports Filed With States SC X X X X 0 0 0 1 1 1 1 0 0 Dr T Scott Ellison Trustee & PHYSICIAN 0 554687 0 66715 0 36751 0 4638 0 29783 0 692574 0 0 Bruce Bailey President & CEO 231906 210072 76296 69112 55143 49952 4867 4408 19415 17587 387627 351131 0 0 Terry Kiser EVP & CFO (RETIRED MARCH) 122755 111198 50520 45764 74413 67407 4867 4408 10070 9122 262625 237899 0 0 Gayle Resetar EVP & COO 188591 170835 50950 46153 10091 9141 4867 4408 12501 11324 267000 241861 0 0 Rick Kaylor GPS President & Senior Vice Presiden 140537 127306 44314 40142 15045 13629 4533 4106 6894 6245 211323 191428 0 0 Philip Dulberger SVP & Chief Medical Officer 206270 186850 59812 54181 13059 11829 4806 4354 15457 14002 299404 271216 0 0 James F Harper SVP & Chief Human Resource Officer 100405 90952 21817 19763 29677 26883 4078 3694 13639 12355 169616 153647 0 0 Todd Rowland SVP & Chief Information Officer 124504 112782 28534 25847 22761 20618 2616 2370 15826 14336 194241 175953 0 0 Virginia Hunt MUSC Affiliation Executive 112199 101636 23526 21311 14044 12722 3705 3356 5847 5296 159321 144321 0 0 Pam Maxwell SVP & Chief Nursing Officer 95572 86574 22237 20143 23241 21053 4867 4408 11789 10679 157706 142857 0 0 Part I, Line 4 BRUCE BAILEY AND TERRY KISER MAKE CONTRIBUTIONS TO A NON-QUALIFIED 409A PLAN. Part I, Line 5 ANY INCENTIVE COMPENSATION PAID TO THE OFFICERS AND OTHER ADMINISTRATORS OF THE ORGANIZATION IS CONTINGENT UPON QUALITY INDICATORS, NET REVENUES, AND THE OVERALL PROFITABILITY OF THE ORGANIZATION. IF PREDETERMINED GOALS ARE MET, INCENTIVE COMPENSATION IS PAID TO THE OFFICER OR ADMINISTRATOR IN ACCORDANCE WITH AN INCENTIVE COMPENSATION PROGRAM. SEE PART II, COLUMN (B)(II). Part I, Line 6 SEE THE RESPONSE TO LINE 5A AND 5B. PART I, LINE 3 THE ORGANIZATION RELIES ON THE BOARD OF ITS SOLE MEMBER ORGANIZATION TO NEGOTIATE AND ESTABLISH THE COMPENSATION AGREEMENTS FOR ITS CEO AND OTHER OFFICERS. THE BOARD OF GEORGETOWN HOSPITAL SYSTEM USES THE FOLLOWING METHODS TO DETERMINE COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANTS - COMPENSATION STUDY/SURVEY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE BOARD OF GEORGETOWN HOSPITAL SYSTEM IS A MAJORITY INDEPENDENT. PART II COMPENSATION FROM UNRELATED ORGANIZATION: COMPENSATION PAID TO BRUCE BAILEY, TERRY KISER, AND GAYLE RESETAR WAS PAID THROUGH QUORUM HEALTH RESOURCES (QHR), AN UNRELATED MANAGEMENT COMPANY. SEE THE RESPONSE TO PART VI, LINE 3 ON SCHEDULE O FOR DETAILS ON THE ARRANGEMENT. ALL AMOUNTS LISTED ON SCHEDULE J, PART II, LINES (I) AND (II) FOR EACH INDIVIDUAL ARE FROM QHR, EXCEPT FOR SMALL AUTOMOTIVE STIPENDS PAID DIRECTLY BY THE ORGANIZATION OR RELATED ORGANIZATION. IN ADDITION, BRUCE BAILEY, TERRY KISER, GAYLE RESETAR, RICK KAYLOR, PHILIP DULBERGER, JAMES HARPER, TODD ROWLAND, VIRGINIA HUNT, AND PAM MAXWELL ARE COMPENSATED BY A COMMON PAYING AGENT FOR SERVICES PERFORMED FOR BOTH GEORGETOWN MEMORIAL HOSPITAL AND A RELATED ORGANIZATION. COMPENSATION FOR THESE INDIVIDUALS IS PRESENTED TO REFLECT AN ALLOCATION OF SERVICES PERFORMED FOR THESE ORGANIZATIONS. A SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 NONEAVAIL 2011-09-22 25565000 CURRENT REFUNDING 0 0 0 B SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 NONEAVAIL 2012-02-23 30850000 CAPITAL ACQUISITION 0 0 0 C SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 NONEAVAIL 2016-09-09 87890000 REFUND PRIOR ISSUE 0 0 0 D SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 NONEAVAIL 2016-11-03 35050000 CURRENT REFUNDING 0 0 0 A 10478637 16214252 164252 16050000 2001 1 0 1 1 B 3872837 30850000 172596 30614582 62822 2012 0 0 1 1 C 847090 16925130 16925130 1 0 1 1 D 25977 20233524 97411 20136113 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 0 B 0 0 1 0 1 0 0 0 0 C 0 1 1 0 1 0 0 0 0 D 0 0 1 0 0 0 0 0 0 A 0 B 0 C 0 D 0 FORM 990, SCH K, PART II, LINE 11 THE AMOUNTS ON THIS LINE WERE USED TO REFUND PRIOR ISSUE BONDS. THE AMOUNTS IN COLUMN A WERE USED TO REFUND BONDS THAT WERE ISSUED ON 8/15/1999 AND 8/1/2001. THE AMOUNTS IN COLUMN C WERE USED TO REFUND BONDS THAT WERE ISSUED ON 12/22/2010. THE AMOUNTS IN COLUMN D WERE USED TO REFUND BONDS THAT WERE ISSUED ON 5/30/2012. BECCA KAYLOR FAMILY MEMBER OF OFFICER RICK KAYLOR 30512 COMPENSATION AS EMPLOYEE OF ORGANIZATION. AMOUNT SHOWN ON SCHEDULE L REPRESENTS WCH'S ALLOCATED PORTION OF TOTAL SALARY PAID FROM A RELATED ORGANIZATION. THE INDIVIDUAL RECEIVED $58,152 IN TOTAL FOR SERVICES RENDERED TO ALL RELATED ORGANIZATIONS. 0 dana kiser FAMILY MEMBER OF OFFICER TERRY KISER 100066 COMPENSATION AS EMPLOYEE OF ORGANIZATION. AMOUNT SHOWN ON SCHEDULE L REPRESENTS WCH'S ALLOCATED PORTION OF TOTAL SALARY PAID FROM A RELATED ORGANIZATION. 0 casey maier FAMILY MEMBER OF BOARD MEMBER WILLIE SHELLEY 36250 COMPENSATION AS EMPLOYEE OF ORGANIZATION. AMOUNT SHOWN ON SCHEDULE L REPRESENTS WCH'S ALLOCATED PORTION OF TOTAL SALARY PAID FROM A RELATED ORGANIZATION. 0 Form 990, Part VI, Section A, line 1 THE ORGANIZATION HAS AN EXECUTIVE COMMITTEE, FINANCE COMMITTEE, AND COMPENSATION COMMITTEE THAT HAVE LIMITED POWERS DELEGATED FROM THE FULL VOTING BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE IS COMPRISED OF FIVE OR MORE MEMBERS, INCLUDING FOUR WHO ARE ALSO MEMBERS OF THE MEMBER ORGANIZATION'S BOARD OF DIRECTORS. THE FINANCE COMMITTEE CONTAINS FOUR OR MORE MEMBERS INCLUDING THE TREASURER OF THE MEMBER ORGANIZATION. THE COMPENSATION COMMITTEE IS AS APPOINTED BY THE CHAIRMAN OF THE BOARD. Form 990, Part VI, Section A, line 3 THE BOARD OF DIRECTORS HAS ENTERED A MANAGEMENT AGREEMENT WITH QUORUM HEALTH RESOURCES TO PROVIDE KEY MANAGEMENT SERVICES FOR THE ORGANIZATION. THE CEO, CFO, AND COO ARE EMPLOYEES OF QUORUM AND ARE COMPENSATED DIRECTLY BY THAT ORGANIZATION. THE QUORUM EMPLOYEES ARE ACCOUNTABLE TO THE BOARD OF DIRECTORS OF THE HOSPITAL. Form 990, Part VI, Section A, line 6 THE ORGANIZATION IS A MEMBER ORGANIZATION WITHIN THE MEANING OF THE SOUTH CAROLINA NONPROFIT CORPORATION ACT OF 1994. THE SOLE MEMBER OF THE CORPORATION IS GEORGETOWN HOSPITAL SYSTEM. Form 990, Part VI, Section A, line 7a THE SOLE MEMBER HAS THE SOLE AUTHORITY TO APPOINT OR REMOVE A TRUSTEE OR THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7b THE SOLE MEMBER HAS THE SOLE AUTHORITY TO (1) DIRECT HEALTHCARE SERVICES UNDERTAKEN BY THE ORGANIZATION, INCLUDING THE ADDITION OR DELETION OF CLINICAL SERVICE LINES, AND AUDIT COMPLIANCE WITH SUCH DIRECTIVES, (2) VETO POLICIES AND PROCEDURES, (3) REQUIRE DISTRIBUTION OF INCOME, ASSETS, OR OTHER PROPERTY FROM, OR MAKE CONTRIBUTIONS TO THE ORGANIZATION TO ACHIEVE THE MUTUAL OBJECTIVES OF THE ORGANIZATION AND THE SOLE MEMBER, (4) APPROVE BUDGETS, (5) AUTHORIZE CAPITAL TRANSACTIONS, (6) ADOPT A PLAN OF DISSOLUTION, (7) ADMIT NEW MEMBERS TO THE ORGANIZATION, (8) AMEND THE ARTICLES OF THE ORGANIZATION, AND (9) NEGOTIATE AND AUTHORIZE MANAGEMENT AGREEMENTS WITH THIRD PARTIES. Form 990, Part VI, Section B, line 11b THE RETURN WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE ASSISTANCE AND OVERSIGHT OF MANAGEMENT. A REPRESENTATIVE OF THE ACCOUNTING FIRM PRESENTED THE RETURN TO THE FINANCE COMMITTEE WITH MANAGEMENT AND ANSWERED QUESTIONS FROM BOARD MEMBERS. THE CEO AND CFO THEN REVIEWED THE FORM WITH ALL BOARD MEMBERS, AS EVIDENCED IN THE BOARD MINUTES. A COPY OF THE RETURN WAS PROVIDED TO EACH VOTING BOARD MEMBER. AFTER A DISCUSSION PERIOD, THE BOARD VOTED TO APPROVE THE FILING OF THE FORM 990 WITH THE IRS AS PRESENTED. THE CFO/CEO MET IN PERSON WITH ANY MEMBERS ABSENT FROM THE MEETING TO DISCUSS THE RETURN. Form 990, Part VI, Section B, line 12c THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY WHICH IS REVIEWED, ACCEPTED, AND SIGNED BY EACH OFFICER AND VOTING BOARD MEMBER ON AN ANNUAL BASIS. PURSUANT TO THIS POLICY, EACH OFFICER AND BOARD MEMBER WILL RECUSE HIMSELF OR HERSELF FROM ANY DISCUSSIONS AND VOTES FOR WHICH A CONFLICT EXISTS. DETERMINATION OF WHETHER A CONFLICT EXISTS IS MADE AT A MANAGEMENT, BOARD MEMBER, OFFICER, AND INDIVIDUAL LEVEL. ACTUAL CONFLICTS ARE REVIEWED BY MANAGEMENT AND THE BOARD WITHOUT THE PRESENCE OF THE INTERESTED PARTY. Form 990, Part VI, Section B, line 15 THE ORGANIZATION USES OUTSIDE AGENCIES TO ESTABLISH, ASSESS THE REASONABLENESS OF, REVIEW, AND APPROVE THE COMPENSATION OF DIRECTORS AND KEY MANAGEMENT. THE INDIVIDUAL COMPENSATION PACKAGE OF EACH PERSON IS BASED ON COMPARABILITY FACTORS INCLUDING, BUT NOT LIMITED TO, THE SIZE OF THE ORGANIZATION, THE GEOGRAPHICAL LOCATION OF THE ORGANIZATION, AND THE EMPLOYEE'S LENGTH OF SERVICE. COMPENSATION IS THEN REVIEWED AND APPROVED BY OFFICERS OF THE ORGANIZATION. OFFICER COMPENSATION IS APPROVED BY THE BOARD OR CEO THROUGH CONTRACT NEGOTIATION WITH THE OUTSIDE MANAGMENT CORPORATION. Form 990, Part VI, Section C, line 18 PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. Form 990, Part VI, Section C, line 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. Form 990, Part IX, line 11g OTHER FEES: Program service expenses 32,446,667. Management and general expenses 25,598,728. Fundraising expenses 0. Total expenses 58,045,395. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART V, LINE 2A: THE ORGANIZATION HAS NO DIRECT EMPLOYEES. GEORGETOWN HOSPITAL SYSTEM, A RELATED ORGANIZATION, FILES PAYROLL FOR THE ORGANIZATION. THE NUMBER OF EMPLOYEES REPORTED BY GEORGETOWN HOSPITAL SYSTEM THAT ARE RELATED TO THE ORGANIZATION IS 1,217. FORM 990, PART VII, LINE 1A FORMER CHIEFS OF STAFF MAY CONTINUE TO BE COMPENSATED FOR EMERGENCY ROOM CALL PAY, COMMITTEE PAY, ETC. GEORGETOWN HOSPITAL SYSTEM PO DRAWER 1718 GEORGETOWN SC 29442 020598440 HEALTHCARE SC 501(c)(3) Line 12b, II N/A 0 GEORGETOWN MEMORIAL HOSPITAL PO DRAWER 1718 GEORGETOWN SC 29442 570341194 HEALTHCARE SC 501(c)(3) Line 3 GEORGETOWN HOSPITAL SYSTEM 0 GEORGETOWN RADIATION THERAPY CENTER 2405 N FRASER STREET GEORGETOWN SC 29440 200131459 HEALTHCARE SC N/A 0 0 0 1 0 0 0 0 1 1 1 0 1 1 1 1 1 0 0