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 020598440 GEORGETOWN HOSPITAL SYSTEM GEOR 8435277100 PO DRAWER 1718 GEORGETOWN SC 29442 ELIZABETH WARD CFO 8435277100 2018-08-06 1 Amy Bibby P00445891 8282542254 2018-08-06 2016 2022-09-23 18:48:47Z TIDELANDS HEALTH BRUCE P BAILEY PO DRAWER 1718 GEORGETOWN SC 29442 23889396 0 X www.TIDELANDSHEALTH.ORG X 2002 SC HEALTHCARE 16 10 2132 16 0 0 0 0 20673814 23740375 0 0 383290 149021 21057104 23889396 0 0 0 0 24455445 31405427 0 0 0 10386923 10547028 34842368 41952455 -13785264 -18063059 10251334 12275606 4324539 5766696 5926795 6508910 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 38434978 23889396 TO ASSIST IN THE PROVISION OF HEALTH CARE TO RESIDENTS OF GEORGETOWN COUNTY BY PROVIDING PAYROLL AND MANAGEMENT SERVICES TO WACCAMAW COMMUNITY HOSPITAL AND GEORGETOWN MEMORIAL HOSPITAL, BOTH 501(C)(3) TAX EXEMPT HOSPITALS.THE PROGRAM SERVICE REVENUE RECORDED ON PAGE 9 OF THE FORM 990, AS WELL AS THE FUNCTIONAL EXPENSES ON PAGE 10, REPRESENTS THE ACTIVITIES OF GEORGETOWN PHYSICIAN SERVICES, LLC, A WHOLLY-OWNED DISREGARDED NONPROFIT ENTITY. THESE ACTIVITIES ARE NOT RELATED TO PROVIDING PAYROLL AND MANAGEMENT SERVICES TO GEORGETOWN MEMORIAL HOSPITAL AND WACCAMAW COMMUNITY HOSPITAL. 38434978 1 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 2132 1 0 0 0 0 0 0 0 0 0 0 X 16 10 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 SC X X ELIZABETH WARD EVP & CFO 8435277102 PO DRAWER 1718 GEORGETOWN SC 29442 Mr H McRoy Skipper Chairman 4.00 X X 0 250 0 Mr J Edward Norris III Vice Chairman 2.00 1.00 X X 0 250 0 Mr Julian A Reynolds Jr Secretary/Treasurer 2.00 1.00 X X 0 250 0 Mr Tony Jordan Trustee 2.00 1.00 X 0 200 0 Mr Francis B Ford Jr Trustee 2.00 1.00 X 0 250 0 Mr Robert L Jones Trustee 2.00 1.00 X 0 100 0 Ms Judith K Ingle Trustee 2.00 1.00 X 0 100 0 Mr Daniel Scheffing Trustee 2.00 1.00 X 0 250 0 Dr Marthena Morant Trustee 2.00 1.00 X 0 250 0 Mr Willie Shelley Trustee 2.00 1.00 X 0 400 0 Mr Mark Nash Trustee 2.00 1.00 X 0 250 0 Mr Dan Stacy Trustee 2.00 1.00 X 0 100 0 Dr T Scott Ellison Trustee & PHYSICIAN 42.00 1.00 X 658153 0 34421 Dr Christine Gerber Trustee & PHYSICIAN 2.00 9.00 X 0 85437 0 Dr Willilam Richmond Chief of Staff & PHYSICIAN 2.00 1.00 X 0 14780 0 Dr Gayle Richmond Chief of Staff & PHYSICIAN 2.00 1.00 X 0 90471 0 Bruce Bailey President & CEO 2.00 40.00 X 0 692482 46277 Terry Kiser Executive Vice President & CFO (Retired MARCH) 2.00 40.00 X 0 472057 28467 Gayle Resetar Executive Vice President & COO 2.00 40.00 X 0 475762 33100 Elizabeth Ward Executive Vice President & CFO 2.00 40.00 X 0 0 0 Rick Kaylor GPS President & Senior Vice President System Devel 2.00 40.00 X 0 380974 21777 Dr Sara Adams Physician 40.00 X 680712 600 37249 Dr Daniel Single Physician 40.00 X 674999 19500 34368 Dr David L Milling Physician 40.00 X 670214 6337 34534 Dr Carol Bogdan Physician 40.00 X 694048 0 26409 Dr William Greer Physician 40.00 X 640673 56336 34926 4018799 2297386 331528 48 0 1 1 Mark E Triana DO PA 2185 North Fraser Street Georgetown SC 29440 Physician Services 2016083 Omega Medical Solutions LLC 3926 Wesley Street Unit 502 Myrtle Beach SC 29579 Billing Services 889323 eClinicalworks LLC 2 Technology Drive Wesborough MA 01581 Information Technology 454816 Hayes Locums LLC 6700 North Andrews Avenue Suite 600 Ft Lauderdale FL 33309 Physician Services 346971 Locumtenens Holding LLC 2655 Northwinds Parkway Alpharetta GA 30009 Physician Services 310750 7 Net Patient Service Revenue 621400 23730531 23730531 EHR REIMBURSEMENT PAYMENT 621400 9844 9844 23740375 GAIN ON RELATED INVESTMENT 900099 149021 149021 149021 23889396 23889396 0 0 X 26393775 25208318 1185457 745661 711766 33895 2953297 2820652 132645 1312694 1253735 58959 4482515 2565594 1916921 650 650 2569267 2457615 111652 297890 297890 151287 136858 14429 604496 604496 683324 619805 63519 Medical Supplies 1543972 1543972 Miscellaneous Expense 213627 213627 41952455 38434978 3517477 0 210259 291826 1985201 2381918 280795 389233 5634607 2472972 1819106 3161635 2519668 2908426 1557801 1557801 1878504 1584767 10251334 12275606 2292171 3788328 2032368 1978368 4324539 5766696 X 5926795 6508910 5926795 6508910 10251334 12275606 X -18063059 18645174 X X 0 1 X 1 0 X X 2 GEORGETOWN MEMORIAL HOSPITAL 570341194 3 1 0 17295740 WACCAMAW COMMUNITY HOSPITAL 043633263 3 1 0 21139238 2 0 38434978 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 FORM 990, SCHEDULE A, PART 1, LINE 11 SUPPORT PROVIDED TO SUPPORTED ORGANIZATIONS: THE PURPOSE OF THE GEORGETOWN HOSPITAL SYSTEM IS TO FACILITATE THE PROVISION OF HEALTH CARE SERVICES IN GEORGETOWN COUNTY AND SURROUNDING AREAS. THE SYSTEM PROVIDES STRATEGIC AND OPERATIONAL PLANNING, DIRECTION AND OVERSIGHT, AND DEVELOPS COMMON STRATEGIES AND OPERATIONAL PLANS FOR GEORGETOWN MEMORIAL HOSPITAL, WACCAMAW COMMUNITY HOSPITAL AND OTHER RELATED ENTITIES. THE SYSTEM ALSO PROVIDES CENTRALIZED ADMINISTRATIVE AND HUMAN RESOURCE FUNCTIONS TO ITS ENTITIES BY HIRING ALL EMPLOYEES AND PROVIDING ALL EMPLOYEE BENEFITS WITHIN THE SYSTEM. THE SYSTEM PROVIDES ADMINISTRATIVE SERVICES AND LEASES ITS EMPLOYEES TO ENTITIES AND IN RETURN SUCH ENTITIES REIMBURSE THE SYSTEM FOR THE COST OF THE ADMINISTRATIVE SERVICES AND EMPLOYEES EACH UTILIZES. 444879 125934 318945 249206 49184 200022 4500452 2297854 2202598 440070 440070 3161635 INVESTMENT IN GEORGETOWN RADIATION THERAPY CENTER, LLC 1398554 F INVESTMENT IN TIDELANDS 511291 F INVESTMENT IN AMEDISYS 949581 F INVESTMENT IN HEALTHSOUTH 49000 F 2908426 DUE FROM AFFILIATE 1584767 1584767 DUE TO AFFILIATES 1978368 1978368 X 42534570 18645174 18645174 23889396 0 23889396 41952455 0 41952455 0 41952455 Part X, Line 2: GEORGETOWN HOSPITAL SYSTEM 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. GEORGETOWN RADIATION THERAPY CENTER IS A PARTNERSHIP AND THE RESULTS OF ITS OPERATIONS ARE REPORTED ON THE INCOME TAX RETURNS OF THE PARTNERS. GEORGETOWN PHYSICIAN SERVICES LLC AND GHS TRANSITIONAL CARE LLC ARE 509(A)(3) ORGANIZATIONS OF THE SYSTEM AND ARE EXEMPT FROM INCOME TAXES THROUGH THE SYSTEM. ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT INCLUDE A PROVISION FOR INCOME TAXES. THE SYSTEM 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: EQUITY TRANSFER 18,645,174. X X X X 0 0 0 1 1 1 1 1 0 Dr T Scott Ellison Trustee & PHYSICIAN 554687 0 66715 0 36751 0 4638 0 29783 0 692574 0 0 0 Bruce Bailey President & CEO 0 441979 0 145408 0 105095 0 9275 0 37002 0 738759 0 0 Terry Kiser Executive Vice President & CFO (Reti 0 233953 0 96284 0 141820 0 9275 0 19192 0 500524 0 0 Gayle Resetar Executive Vice President & COO 0 359427 0 97104 0 19231 0 9275 0 23825 0 508862 0 0 Rick Kaylor GPS President & Senior Vice Presiden 0 267843 0 84457 0 28674 0 8639 0 13138 0 402751 0 0 Dr Sara Adams Physician 375880 600 268079 0 36753 0 4315 0 32934 0 717961 600 0 0 Dr Daniel Single Physician 505404 19500 140000 0 29595 0 4638 0 29730 0 709367 19500 0 0 Dr David L Milling Physician 379412 6337 254580 0 36222 0 4599 0 29935 0 704748 6337 0 0 Dr Carol Bogdan Physician 235407 0 415179 0 43462 0 4289 0 22120 0 720457 0 0 0 Dr William Greer Physician 586482 56336 24707 0 29484 0 4638 0 30288 0 675599 56336 0 0 Part I, Line 4 BRUCE BAILEY AND TERRY KISER MAKE CONTRIBUTIONS TO A NON-QUALIFIED 409A PLAN. Part I, Line 5 INCENTIVE COMPENSATION PAID IS CONTINGENT UPON QUALITY INDICATORS, NET REVENUES, AND THE OVERALL PROFITABILITY OF THE ORGANIZATION. IF PREDETERMINED GOALS ARE MET, INCENTIVE COMPENSATION IS PAID 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 7 Georgetown Physician Services physician incentive compensation includes, but is not limited to sign on, productivity and patient quality bonuses. Quality bonuses are based on the physician employment contract, but may be amended in advance at the discretion of Georgetown Physician Services. PART II COMPENSATION FROM UNRELATED ORGANIZATION: COMPENSATION PAID TO BRUCE BAILEY, GAYLE RESETAR, AND TERRY KISER 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, LINE (I) FOR EACH OF THE ABOVE LISTED INDIVIDUALS ARE FROM QHR, EXCEPT FOR SMALL AUTOMOTIVE STIPENDS PAID DIRECTLY BY THE ORGANIZATION OR RELATED ORGANIZATIONS. Form 990, Part VI, Section A, line 1 THE BOARD OF TRUSTEES SHALL DESIGNATE FROM AMONG ITS MEMBERS AN EXECUTIVE COMMITTEE, WHICH SHALL CONSIST OF FIVE OR MORE TRUSTEES, INCLUDING THE CHAIRMAN, THE VICE CHAIRMAN, THE SECRETARY, AND THE TREASURER OF THE CORPORATION, WHICH EXECUTIVE COMMITTEE, TO THE EXTENT PROVIDED IN A RESOLUTION TO THE BOARD, SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD OF TRUSTEES IN OVERSEEING OR GUIDING THE MANAGEMENT OF THE AFFAIRS OF THE CORPORATION. Form 990, Part VI, Section A, line 2 BOARD MEMBERS DR. GAYLE RICHMOND AND DR. WILLIAM RICHMOND SHARE A FAMILY RELATIONSHIP. BOARD MEMBERS DR. CHRISTINE GERBER, DR. GAYLE RICHMOND, AND DR. WILLIAM RICHMOND SHARE A BUSINESS RELATIONSHIP. 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 SYSTEM. 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 PRESENSE 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 Purchased SERVICES: Program service expenses 1,267,992. Management and general expenses 1,916,921. Fundraising expenses 0. Total expenses 3,184,913. PHYSICIAN FEES: Program service expenses 1,297,602. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,297,602. Form 990, Part XI, line 9: EQUITY TRANSFER 18,645,174. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VII, LINE 1A: FORMER CHIEFS OF STAFF MAY CONTINUE TO BE COMPENSATED FOR EMERGENCY ROOM CALL PAY, COMMITTEE PAY, ETC. GEORGETOWN PHYSICIAN SERVICES LLC 606 BLACK RIVER ROAD GEORGETOWN SC 29440 261306753 HEALTHCARE SC 23740373 6224613 GEORGETOWN HOSPITAL SYSTEM GHS TRANSITIONAL CARE LLC 606 BLACK RIVER ROAD GEORGETOWN SC 29440 462161616 HEALTHCARE SC 41060 3067673 GEORGETOWN HOSPITAL SYSTEM GEORGETOWN MEMORIAL HOSPITAL PO BOX 1718 GEORGETOWN SC 29442 570341194 HEALTHCARE SC 501(c)(3) Line 3 GEORGETOWN HOSPITAL SYSTEM 1 WACCAMAW COMMUNITY HOSPITAL PO BOX 3350 MURRELLS INLET SC 29576 043633263 HEALTHCARE SC 501(c)(3) Line 3 GEORGETOWN HOSPITAL SYSTEM 1 GEORGETOWN RADIATION THERAPY CENTER 2405 N FRASER STREET GEORGETOWN SC 29440 200131459 HEALTHCARE SC GEORGETOWN HOSPITAL SYSTEM RELATED 540796 1398553 0 0 0.51000 0 0 0 0 1 0 0 0 1 1 1 1 0 1 1 1 1 0 1 WACCAMAW COMMUNITY HOSPITAL O 43728131 I/C ALLOCATION GEORGETOWN MEMORIAL HOSPITAL O 67408932 I/C ALLOCATION GEORGETOWN RADIATION THERAPY CENTER O 309218 I/C ALLOCATION WACCAMAW COMMUNITY HOSPITAL E 393600 END OF YEAR BALANCE WACCAMAW COMMUNITY HOSPITAL K 420803 COST GEORGETOWN MEMORIAL HOSPITAL K 619186 COST GEORGETOWN MEMORIAL HOSPITAL S 18645174 COST GEORGETOWN MEMORIAL HOSPITAL P 481872 COST waCCAMAW COMMUNITY HOSPITAL Q 688294 cOST