2017-07-07T07:18:05-05:00 2016-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2015-10-01 570341194 GEORGETOWN MEMORIAL HOSPITAL GEOR 8435277100 PO DRAWER 1718 GEORGETOWN SC 294421718 ELIZABETH WARD CFO 8435277100 2017-07-07 1 Amy Bibby P00445891 8282542254 2017-07-06 2015 2021-01-29 14:40:06Z TIDELANDS GEORGETOWN MEMORIAL HOSPITAL BRUCE P BAILEY PO DRAWER 1718 GEORGETOWN SC 294421718 162730463 0 X WWW.TIDELANDSHEALTH.ORG X 1946 SC TO PROVIDE HIGH QUALITY HEALTHCARE TO THE CITIZENS OF GEORGETOWN CO. AND SURROUNDING AREAS 8 6 0 86 0 0 995280 1298662 154363676 155994895 13433408 4139826 1130941 1064719 169923305 162498102 165868 278414 0 0 70210120 67039153 72000 64800 333668 83846161 82085688 154294149 149468055 15629156 13030047 333377828 355514624 119028667 144702082 214349161 210812542 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 127960991 278414 155994895 GEORGETOWN MEMORIAL HOSPITAL PROVIDES QUALITY HEALTH CARE AND PROMOTES HEALTH AND WELLNESS TO GEORGETOWN COUNTY AND SURROUNDING AREAS. GEORGETOWN MEMORIAL HOSPITAL IS A 131 BED ACUTE FACILITY LOCATED IN THE CITY OF GEORGETOWN, SOUTH CAROLINA. THE HOSPITAL WAS ORGANIZED UNDER THE LAWS OF THE STATE OF SOUTH CAROLINA IN 1946 FOR THE PURPOSE OF OPERATING A COMMUNITY HOSPITAL IN 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 RULING 69-545, 1969-2 C.B. 117, AS MODIFIED BY REV. RUL. 83-157, 1983-2 C.B. 94, SETS FORTH THE FACTORS THE INTERNAL REVENUE SERVICES WILL CONSIDER IN DETERMINING WHETHER A NONPROFIT HOSPITAL QUALIFIED FOR TAX EXEMPT STATUS.THE HOSPITAL OPERATES ITS FACILITIES IN A MANNER DESCRIBED IN REV. RUL. 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, 2016, THE HOSPITAL FURNISHED CHARITY CARE IN THE AMOUNT OF $17,447,087. 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 OPEN TO THE PUBLIC, INCLUDING CPR, WEIGHT CONTROL, SMOKING CESSATION, CHILDBIRTH EDUCATION, PRE-NATAL AND INFANT NUTRITION, AND OTHERS. 127960991 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 X 302 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 8 6 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 SC X X BETH WARD 8435277102 606 BLACK RIVER RD GEORGETOWN SC 29440 Mr Julian A Reynolds Jr Chairman 1.00 2.00 X X 150 0 0 Mr Francis B Ford Jr Vice Chairman 1.00 2.00 X X 50 0 0 Dr Marthena Morant Secretary/Treasurer 1.00 2.00 X X 150 0 0 Mr Tony Jordan Trustee 1.00 2.00 X 150 0 0 Mr Mark Nash Trustee 1.00 2.00 X 100 0 0 Mr Dan Stacy Trustee 1.00 2.00 X 100 0 0 Dr Christine Gerber Trustee & PHYSICIAN 9.00 2.00 X 81577 26070 0 Dr William Richmond Chief of Staff & PHYSICIAN 1.00 2.00 X 3747 0 0 Bruce Bailey President & CEO 19.00 21.00 X 281044 316033 57615 Gayle Resetar Executive Vice President & COO 19.00 21.00 X 189480 213069 37664 Terry Kiser Executive Vice President & CFO 19.00 21.00 X 194394 218595 33314 Rick Kaylor GPS President & SVP System 19.00 21.00 X 171376 192710 20295 Philip Dulberger SVP & Chief Medical Office 19.00 21.00 X 235541 264865 39222 James F Harper SVP & Chief Human Resource 19.00 21.00 X 120389 135376 37832 TODD ROWLAND SVP & CHIEF INFORMATION OFFICER 19.00 21.00 X 129723 145874 36479 Virginia Hunt MUSC Affiliation Executive 19.00 21.00 X 112939 127000 19118 PAM MAXWELL SVP & CHIEF NURSING OFFICER 19.00 21.00 X 108568 122085 29824 1629478 1761677 311363 72 0 1 1 Coastal Structures Corporation PO Box 937 Georgetown SC 29442 Construction 11825158 Sodexo Inc PO Box 536922 Atlanta GA 30353 Food & Housekeeping 4468638 Palmetto Emergency Physicians 86 Shorebird Loop Pawleys Island SC 29585 Emergency Physician Services 2945736 Nelson Mullins Riley & Scarborough PO Box 11009 Columbia SC 29211 Legal Services 1402616 Georgetown Anesthesia Consultants PC 130 Preservation Circle Pawleys Island SC 29585 Anesthesia Services 1350626 61 165261 1133401 1298662 Net Patient Service Revenue 621400 151585918 151585918 Fitness Center 900099 1656520 1656520 Pharmacy 446110 1641102 1641102 Other Related Services 900099 596738 596738 Meals 722210 383682 383682 130935 130935 155994895 3402229 3402229 1100795 0 1100795 1100795 1100795 828835 0 91238 828835 -91238 737597 737597 37775 165261 87857 -50082 -50082 55183 53266 1917 1917 Discounts/Rebates 900099 12089 12089 12089 162498102 155994895 0 5204545 278414 278414 991699 85324 906375 26149 26149 49132677 38672765 10252401 207511 2224911 1726634 498277 11236424 8719985 2516439 3427293 2659738 767555 445331 445331 1502274 1502274 41563 41563 64800 64800 2053134 2038079 15055 527238 527238 7562992 5963630 1565616 33746 1939958 1878806 61152 904718 387901 504261 12556 834449 834449 11039652 11039652 567310 567310 Medical Supplies 33108173 33108173 Bad Debt expense 20378141 20378141 Miscellaneous expense 801460 189300 612160 Recruitment 379295 379295 149468055 127960991 21173396 333668 3790 4190 58415534 65132631 17360024 19192741 4609536 4522204 4166096 4465484 275367510 139450463 121017845 135917047 123742659 123351746 533838 533838 3528506 2394743 333377828 355514624 20428961 21287061 40937339 60611398 57662367 62803623 119028667 144702082 X 212729160 208483081 1620001 2329461 214349161 210812542 333377828 355514624 X 13030047 3879018 -20445684 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 100 0 0 0 0 1 7920 8020 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 $1,195 FOR AHA, $2,018 FOR SCHA, AND DWIGHT F DRAKE $4,707. 2010666 19456629 21467295 114972399 53096111 61876288 3476236 2696494 779742 106292289 83657858 22634431 29159291 29159291 135917047 Accrued Pension Liability 9082954 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1900000 DUE TO AFFILIATE 51820669 62803623 X 125553295 3879018 -40823825 -36944807 162498102 0 162498102 129089914 0 129089914 20378141 20378141 149468055 Part X, Line 2: GEORGETOWN MEMORIAL 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, 2016. Part XI, Line 2d - Other Adjustments: BAD DEBT NET WITH REVENUE -20,378,141. EQUITY TRANSFER -14,989,066. CHANGE IN NET PENSION OBLIGATION -5,456,618. Part XII, Line 4b - Other Adjustments: BAD DEBT NET WITH REVENUE 20,378,141. X X X 1 PRIDE PHILANTHROPY 885 WOODSTOCK RD STE 430 ROSWELL GA 300752374 CAPITAL CAMPAIGN 0 482650 64800 417850 482650 64800 417850 BREAST CANCER AWARENESS WALK & DUCK 79541 79541 1700 1350 20173 GALA 76525 50190 26335 1464 23450 5361 12824 1 46970 35530 11440 3407 5720 819 11589 203036 165261 37775 3407 8884 24269 6711 44586 87857 -50082 1 1 X 1 X 1 X 1 1 0 0 4984827 1313952 3670875 0.02840 15563806 14485186 1078620 0.00840 20548633 15799138 4749495 0.03680 1075591 1075591 0.00830 191104 191104 0.00150 333552 58838 274714 0.00210 1600247 58838 1541409 0.01190 22148880 15857976 6290904 0.04870 312115 312115 0.00240 312115 312115 0.00240 0 4986531 3478577 51801799 54615459 -2813660 X 1 1 1 1 GEORGETOWN MEMORIAL HOSPITAL 606 BLACK RIVER ROAD GEORGETOWN SC 29440 X X X MEDICARE DISPROPORTIONATE SHARE HOSPITAL GEORGETOWN MEMORIAL 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 0 1 X 200.000000000000 300.000000000000 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 GEORGETOWN MEMORIAL 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. GEORGETOWN MEMORIAL HOSPITAL Part V, Section B, Line 6a: WACCAMAW COMMUNITY HOSPITAL GEORGETOWN MEMORIAL HOSPITAL Part V, Section B, Line 6b: Quorum Health Resources provided the expertise to complete the CHNA in partnership with Tidelands Health representatives. GEORGETOWN MEMORIAL HOSPITAL Part V, Section B, Line 7d: ALL TCCN PARTNERS WERE SENT AN ELECTONIC COPY. GEORGETOWN MEMORIAL 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 10B, IMPLEMENTATION STRATEGY WEBSITE: http://www.tidelandshealth.org/discover/our-community-commitment/ PART V, LINE 16B & C, FAP, FAP APPLICATION & PLAIN LANGUAGE SUMMARY WEBSITE: http://www.tidelandshealth.org/patients-visitors/billing-insurance/financial-assistance/ 14 1 - HEALTHPOINT CENTER FOR HEALTH & FITNESS 12965 OCEAN HIGHWAY PAWLEYS ISLAND SC 29585 FITNESS CLUB/ADULT REHAB 2 - NEXTSTEP REHABILITATION SERVICES 4040 HWY 17 SUITE 201 MURRELLS INLET SC 29576 ADULT REHABILITATION 3 - NEXTSTEP REHABILITATION & PAIN MANAGEMEN 219 CHURCH STREET GEORGETOWN SC 29440 ADULT REHAB/PAIN MGMT 4 - NEXTSTEP REHABILITATION SERVICES 3650 COALITION DRIVE MYRTLE BEACH SC 29588 ADULT REHABILITATION 5 - NEXTSTEP WOUND & INFUSION cENTER 4367 RIVERWOOD DRIVE SUITE 140 MURRELLS INLET SC 29576 INFUSION SERVICES & WOUND CLINIC 6 - NEXTSTEP REHABILITATION SERVICES 3515 CADUCEUS DRIVE MYRTLE BEACH SC 29588 ADULT & PEDIATRIC REHAB 7 - INFUSION SERVICES MURRELLS 4181 HIGHWAY 17 BYPASS MURRELLS INLET SC 29576 INFUSION SERVICES 8 - NEXTSTEP REHABILITATION SERVICES 4033 HWY 17 SUITE 102 MURRELLS INLET SC 29576 NEUROLOGICAL REHABILITATION 9 - GEORGETOWN ENDOSCOPY CENTER 2361 NORTH FRASER ST GEORGETOWN SC 29440 ENDOSCOPY CENTER 10 - NEXTSTEP REHABILITATION SERVICES 407 CHURCH ST SUITE E GEORGETOWN SC 29440 PEDIATRIC REHABILITATION 11 - NEXTSTEP REHABILITATION SERVICES 106 WACCAMAW MEDICAL PARK COURT CONWAY SC 29526 ADULT REHABILITATION 12 - INFUSION SERVICES GEORGETOWN 2405 NORTH FRASER ST GEORGETOWN SC 29440 INFUSION SERVICES 13 - INFUSION SERVICES MYRTLE BEACH 1220 21ST AVENUE NORTH MYRTLE BEACH SC 29577 INFUSION SERVICES 14 - NEXTSTEP REHABILITATION SERVICES 701 S MORGAN AVE ANDREWS SC 29510 ADULT REHABILITATION Part I, Line 7: THE ORGANIZATION USED WORKSHEET 2 OF THE 2015 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 $20,378,141 THAT HAS BEEN REMOVED FOR PURPOSES OF COMPUTING PERCENTAGE OF TOTAL EXPENSE ON COLUMN (F). Part II, Community Building Activities: IN ADDITION, $312,115 WAS SPENT TO RECRUIT PHYSICIANS WITH THE SKILLS AND TRAINING NECESSARY TO BEST SERVE THE NEEDS OF THE COMMUNITY IN AREAS SUCH AS PEDIATRICS AND CARDIOLOGY. Part III, Line 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT EXPENSE.WORKSHEET 2 OF THE 2015 SCHEDULE H INSTRUCTIONS WAS USED TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE BAD DEBT EXPENSE AT COST FOR PURPOSES OF 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 55% 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. COLLECTION PRACTICES WILL CONTINUE AS NORMAL UNTIL THE PATIENT PROVIDES ALL NECESSARY PAPERWORK TO BE OFFICIALLY CONSIDERED FOR FINANCIAL ASSISTANCE. ONCE FINANCIAL ASSISTANCE IS GRANTED, COLLECTION PRACTICES WILL EITHER CEASE, OR CONTINUE AT A REDUCED PATIENT RESPONSIBILITY. 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. 21% of the population is over the age of 65 and the median household income is approximately $43,000. In addition, an estimated 17% 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 25% of the population is over the age of 65. The median household income is approximately $43,000 and an estimated 19% 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 40-45 miles north and northwest and 60 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: GEORGETOWN MEMORIAL 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 1 Smith Medical Clinic PO Box 1740 Pawleys Island SC 29585 570786699 501(C)(3) 25000 Operational Assistance SCHREF CO Alliance for Healthier SC 1000 Center Point Road Columbia SC 29210 501(C)(3) 15000 Operational Assistance The Long Bay Symphony 1107 48th Avenue North Myrtle Beach SC 29577 570854961 501(C)(3) 5000 Sponsorship Helping Hands of Georgetown Inc 1813 Highmarket Street Georgetown SC 29440 570883461 501(C)(3) 20000 Operational Assistance American Cancer Society 5900 Core Road Suite 504 North Charleston SC 29406 131788491 501(C)(3) 5000 Operational Assistance Georgetown County United Way PO Box 1065 Georgetown SC 29442 570526145 501(C)(3) 10000 Operational Assistance School Specialty 32656 Collection Center Drive Chicago IL 60693 390971239 501(C)(3) 13404 Operational Assistance Horry Georgetown Technical College PO Box 261966 Conway SC 29528 570681224 501(C)(3) 50000 Operational Assistance Myrtle Beach Regional EDC PO Box 261966 Conway SC 29528 570998125 501(C)(6) 10000 Operational Assistance American Heart Association (Mid-Atlantic Affiliate) PO Box 50045 Prescott AZ 86304 135613797 501(C)(3) 5000 Operational Assistance American Legion 715 Church Street Georgetown SC 29440 463814524 501(C)(3) 25000 Operational Assistance Bridge to Bridge Run - Georgetown PO Box 282 Georgetown SC 29442 900517462 501(C)(3) 6000 Sponsorship Georgetown County Chamber 531 Front Street Georgetown SC 29440 570639395 501(C)(6) 5100 Sponsorship Neighbor to Neighbor PO Box 3030 Myrtle Beach SC 29578 203314190 501(C)(3) 8000 Operational Assistance South Carolina Hospital Association 1000 Center Point Road Columbia SC 29210 576026361 501(C)(6) 5000 Sponsorship (BOI) HEALTHY LEARNERS PROGRAM 2711 Middleburg Drive Suite 206 COLUMBIA SC 29204 571127197 501(C)(3) 25000 OPERATIONAL ASSISTANCE 13 3 Part I, Line 2: THE ORGANIZATION SELECTS GRANT RECIPIENTS BASED ON COMMUNITY NEEDS AND INDIVIDUAL PROJECT MERIT. FOLLOW-UP ON GRANTS AND ASSISTANCE VARIES DEPENDING ON THE TYPE OF ASSISTANCE AND TYPE OF PROJECT. MANY SMALLER GRANTS ARE PROVIDED FOR LOCAL SCHOOLS AND PUBLIC CHARITIES BASED ON A DEMONSTRATED NEED FOR OPERATIONAL FUNDS AND REQUIRE NO MONITORING. LARGER GRANTS REQUIRE PRE-ESTABLISHED PROJECT MILESTONES TO BE REACHED BEFORE EACH DISBURSEMENT OF THE GRANT IS PAID OUT. X X X X 0 0 0 1 1 1 1 0 0 Bruce Bailey President & CEO 189563 213163 46623 52427 44858 50443 4366 4909 22754 25586 308164 346528 0 0 Gayle Resetar Executive Vice President & COO 148578 167075 32208 36218 8694 9776 4366 4909 13363 15026 207209 233004 0 0 Terry Kiser Executive Vice President & CFO 111128 124962 30702 34525 52564 59108 4366 4909 11315 12724 210075 236228 0 0 Rick Kaylor GPS President & SVP System 125589 141224 28288 31809 17499 19677 4131 4645 5422 6097 180929 203452 0 0 Philip Dulberger SVP & Chief Medical Office 180418 202880 39202 44082 15921 17903 4366 4909 14096 15851 254003 285625 0 0 James F Harper SVP & Chief Human Resource 80104 90076 13774 15489 26511 29811 3792 4265 14015 15760 138196 155401 0 0 TODD ROWLAND SVP & CHIEF INFORMATION OFFICER 109598 123243 0 0 20125 22631 2342 2633 14829 16675 146894 165182 0 0 Virginia Hunt MUSC Affiliation Executive 100756 113300 0 0 12183 13700 3802 4275 5197 5844 121938 137119 0 0 PAM MAXWELL SVP & CHIEF NURSING OFFICER 80207 90193 11942 13429 16419 18463 3438 3866 10600 11920 122606 137871 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, LINE (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 2011-12-22 12165620 CURRENT REFUNDING 0 0 0 C SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 NONEAVAIL 2012-05-30 34099717 CURRENT REFUNDING 0 0 0 D SC JOBS-ECONOMIC DEVELOPMENT AUTHORITY 570960018 NONEAVAIL 2016-09-09 87890000 refund prior issue and construct 0 0 0 A 4904038 9350748 94698 46050 9210000 2001 1 0 1 1 B 12190000 123522 12066478 1999 1 0 1 1 C 57069 14664291 163692 345599 14155000 2001 1 0 1 1 D 70964870 21184832 8464870 41315168 1 0 0 0 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 0 1 0 0 0 0 0 0 D 0 1 0 0 1 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 B WERE USED TO REFUND BONDS THAT WERE ISSUED ON 3/15/1998 AND 8/15/1999. THE AMOUNTS IN COLUMN C WERE USED TO REFUND BONDS THAT WERE ISSUED ON 3/15/1998 AND 8/23/2001. THE AMOUNTS IN COLUMN D WERE USED TO REFUND BONDS THAT WERE ISSUED ON 12/22/2010. BECCA KAYLOR FAMILY MEMBER OF OFFICER RICK KAYLOR 26149 COMPENSATION AS EMPLOYEE OF ORGANIZATION. AMOUNT SHOWN ON SCHEDULE L REPRESENTS GMH'S ALLOCATED PORTION OF TOTAL SALARY PAID FROM A RELATED ORGANIZATION. THE INDIVIDUAL RECEIVED $55,554 IN TOTAL FOR SERVICES RENDERED TO ALL RELATED ORGANIZATIONS. 0 PALMETTO EMERGENCY PHYSCIANS OWNED IN PART BY DR. WILLIAM RICHMOND, CHIEF OF STAFF, GMH 2945736 COMPENSATION FOR EMERGENCY ROOM PHYSICIAN SERVICES PERFORMED. 0 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 999. 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 2 BOARD MEMBERS DR. WILLIAM RICHMOND AND DR. CHRISTINE GERBER 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 EMPLOYEES 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 11 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 XI, line 9: CHANGE IN NET PENSION OBLIGATION -5,456,618. EQUITY TRANSFER -14,989,066. 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. FORM 990, PART VII, SECTION A The Hospital System previously employed a management company employee, and this employee was considered top 5 highest compensated in previous years. Due to the employee's termination, the system is unable to obtain information to accurately complete Schedule J. We feel this employee would likely be a highest compensated employee in the current year but due to the lack of information we have not included. GEORGETOWN HOSPITAL SYSTEM PO DRAWER 1718 GEORGETOWN SC 29442 020598440 HEALTHCARE SC 501(c)(3) Line 11b, II N/A 0 WACCAMAW COMMUNITY HOSPITAL PO BOX 3350 MURRELLS INLET SC 29576 043633263 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 0 1 0 0 0 1 1 1 1 0 1 1 1 1 0 0