2014-08-11T06:15:06-05:00 2013-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2012-10-01 043633263 WACCAMAW COMMUNITY HOSPITAL WACC 8436521000 PO BOX 3350 MURRELLS INLET SC 29576 BRUCE P BAILEY 8436521000 2014-08-11 1 AMY BIBBY P00445891 8282542254 2012 2015-11-30 17:44:51Z BRUCE P BAILEY PO BOX 3350 MURRELLS INLET SC 29576 164115500 0 X WWW.GEORGETOWNHOSPITALSYSTEM.ORG X 2002 SC TO PROVIDE HIGH QUALITY HEALTHCARE TO THE CITIZENS OF GEORGETOWN CO. AND SURROUNDING AREAS. 7 6 0 150 0 0 0 102272 154912819 163023504 1102662 4127 707812 951374 156723293 164081277 0 0 0 0 45326421 45971404 0 0 0 99930097 105259099 145256518 151230503 11466775 12850774 149033910 159274879 98260718 95650913 50773192 63623966 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 128398463 163023504 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. 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, 2013, THE HOSPITAL FURNISHED CHARITY CARE IN THE AMOUNT OF $12,813,843. 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. 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. 128398463 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 42 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 SC X X TERRY KISER 8435277100 606 BLACK RIVER RD GEORGETOWN SC 29440 J EDWARD NORRIS III 1.00 2.00 X X 0 200 0 ROBERT L JONES 1.00 2.00 X X 0 0 0 JUDITH K INGLE 1.00 2.00 X X 0 100 0 TONY JORDAN 1.00 2.00 X 0 0 0 DANIEL SCHEFFING 1.00 2.00 X 0 350 0 WILLIE SHELLEY 1.00 2.00 X 0 0 0 MITCHELL DEVLIN DO 1.00 2.00 X 18970 0 0 BRUCE BAILEY 21.00 19.00 X 307838 265418 63044 TERRY KISER 21.00 19.00 X 215915 186162 35609 GAYLE RESETAR 21.00 19.00 X 208412 179691 36694 RICK KAYLOR 21.00 19.00 X 151872 130944 19461 ROY E GILBREATH III 21.00 19.00 X 221499 190976 27974 ANN L WATERS 6.00 34.00 X 35779 202751 20873 JAMES F HARPER 18.00 22.00 X 103349 129262 37643 FRANK SCAFIDI 21.00 19.00 X 116229 100213 32681 SUZANNE C DOSCHER 20.00 20.00 X 102121 102121 22136 1481984 1488188 296115 48 0 1 1 ROBINS & MORTON GROUP PO BOX 59289 BIRMINGHAM AL 35259 CONSTRUCTION 10092984 SODEXHO PO BOX 536922 ATLANTA GA 30353 FOOD SERVICES 4180691 COASTAL STRUCTURES CORPORATION 407 CHURCH STREET SUITE J GEORGETOWN SC 29442 CONSTRUCTION 4072345 PALMETTO EMERGENCY PHYSICIANS 86 SHOREBIRD LOOP PAWLEYS ISLAND SC 29585 EMERGENCY ROOM SERVICES 3253806 EAGLE HOSPITAL PHYSICIANS 16000 NORTH DALLAS PARKWAY SUITE 45 DALLAS TX 75248 HOSPITALISTS 1648842 40 102272 102272 NET PATIENT SERVICE REVENUE 621400 158842749 158842749 EHR INCENTIVE PAYMENT 900099 1947758 1947758 PHARMACY 446110 1607267 1607267 CAFETERIA 722210 382719 382719 OTHER RELATED SERVICES 900099 243011 243011 163023504 2200 2200 928289 0 928289 928289 928289 1927 0 1927 1927 1927 57308 34223 23085 23085 164081277 163023504 0 955501 X 986138 18970 967168 86544 86544 34484395 33721271 763124 939839 919093 20746 6938820 6785651 153169 2535668 2479695 55973 591728 591728 1888190 1888190 66897 66897 39236561 23106552 16130009 566718 566718 3012870 2824471 188399 1469596 1443872 25724 114200 94866 19334 2307012 2307012 8137676 8137676 392736 392736 BAD DEBT EXPENSE 23897915 23897915 MEDICAL SUPPLIES 22553854 22553854 RECRUITMENT 936481 936481 MISCELLANEOUS EXPENSE 86665 21021 65644 151230503 128398463 22832040 0 3235 3620 2007404 2675855 18277772 20803703 2542270 2468890 1501828 1558973 178068812 58111362 113036020 119957450 8128865 6700069 2471440 2191655 1065076 2914664 149033910 159274879 4737073 4531994 68923781 80307284 24599864 10811635 98260718 95650913 X 50625161 63431760 148031 192206 50773192 63623966 149033910 159274879 12850774 0 X X 0 1 X 1 0 X 0 0 0 1 50 0 0 0 0 1 4770 4820 0 EXPLANATION OF LOBBYING ACTIVITIES: 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 $1,309 FOR AHA AND $3,461 FOR SCHA. 3143954 3143954 113630968 19648576 93982392 1266800 822279 444521 59386825 37640507 21746318 640265 640265 119957450 DUE TO AFFILIATES 8782371 ESTIMATED THIRD-PARTY SETTLEMENTS 2029264 10811635 X 140217585 -23863692 -23863692 164081277 0 164081277 127366811 -23863692 -23863692 151230503 0 151230503 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD NET WITH REVENUE 34,223. BAD DEBT NET WITH REVENUE -23,897,915. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD NET WITH REVENUE 34,223. BAD DEBT NET WITH REVENUE -23,897,915. 1 1 X 1 X 1 X 1 1 1 0 1 1 4463739 891528 3572211 0.02810 10201778 9397971 803807 0.00630 14665517 10289499 4376018 0.03440 641114 641114 0.00500 144418 144418 0.00110 211598 45645 165953 0.00130 997130 45645 951485 0.00740 15662647 10335144 5327503 0.04180 907553 907553 0.00710 907553 907553 0.00710 0 6874539 3759399 56402763 66380396 -9977633 X 1 1 1 1 WACCAMAW COMMUNITY HOSPITAL

4070 HIGHWAY 17 BYPASS MURRELLS INLET SC 29576

X X X WACCAMAW COMMUNITY HOSPITAL 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X X X 1 X 0 1 X 0 0 9 IMAGING CENTER AT WACCAMAW MEDICAL PARK

4181 HWY 17 BYPASS SOUTH MURRELLS INLET SC 29576

IMAGING CENTER NEXTSTEP PAIN MANAGEMENT CENTER

4040 HWY 17 BYPASS SUITE 206 MURRELLS INLET SC 29576

PAIN MANAGEMENT NEXTSTEP WOUND HEALING CENTER

4033 HWY 17 BYPASS SOUTH 107 MURRELLS INLET SC 29576

REHABILITATION WACCAMAW ENDOSCOPY CENTER

4040 HWY 17 BYPASS SUITE 102 MURRELLS INLET SC 29576

ENDOSCOPY WACCAMAW IMAGING SUITE

4040 HWY 17 BYPASS SUITE 103 MURRELLS INLET SC 29576

IMAGING CENTER WACCAMAW SURGERY CENTER

3911 HWY 17 BYPASS MURRELLS INLET SC 29576

SURGERY CENTER WACCAMAW WOMEN'S IMAGING

4017 HWY 17 BYPASS SUITE 101 MURRELLS INLET SC 29576

IMAGING CENTER NEXTSTEP REHABILITATION SERVICES

198 VILLAGE CENTER BLVD MYRTLE BEACH SC 29579

ADULT REHABILITATION NEXTSTEP REHABILITATION SERVICES

543 HIGHWAY 17 NORTH NORTH MYRTLE BEACH SC 29582

ADULT REHABILITATION PART I, LINE 6A: THE HOSPITAL PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT AND DISTRIBUTES TO RESIDENTS OF THE SURROUNDING COUNTIES. THE REPORT OFFERS STATISTICAL, FINANCIAL AND INFORMATIONAL DATA, TARGETED TO PORTRAY THE VITAL COMMITMENT THE ORGANIZATION HAS TO THE COMMUNITY. THE REPORT IS MAILED TO HOMES THROUGHOUT THE COMMUNITY AND CAN BE ACCESSED BY VISITING OUR WEBSITE AT WWW.GEORGETOWNHOSPITALSYSTEM.ORG. PART I, LINE 7: THE ORGANIZATION USED WORKSHEET 2 OF THE 2012 SCHEDULE H INSTRUCTIONS TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID AT COST. PART I, L7 COL(F): TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25 CONTAINS A BAD DEBT EXPENSE OF $23,897,915 THAT HAS BEEN REMOVED FOR PURPOSES OF COMPUTING PERCENTAGE OF TOTAL EXPENSE ON COLUMN (F). PART II: $908,000 WAS SPENT TO RECRUIT PHYSICIANS WITH THE SKILLS AND TRAINING NECESSARY TO BEST SERVE THE NEEDS OF THE COMMUNITY IN AREAS SUCH AS ORTHOPEDICS, FAMILY AND INTERNAL MEDICINE, PEDIATRICS, NEUROLOGY, AND SURGERY. PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE ON BAD DEBT EXPENSE.WORKSHEET 2 OF THE 2012 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. 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. WACCAMAW COMMUNITY HOSPITAL PART V, SECTION B, LINE 3: WACCAMAW COMMUNITY HOSPITAL FACILITY TOOK INTO ACCOUNT THE REPRESENTATION OF GEORGETOWN COMMUNITY CARE NETWORK AND THE ASSOCIATED COMMUNITY CARE NETWORKS: GEORGETOWN HOSPITAL SYSTEMST. JAMES-SANTEE FQHCTHE SMITH MEDICAL CLINICAREA PRIMARY CARE PHYSICIANSHORRY-GEORGETOWN TECHNICAL COLLEGE DENTAL CLINICHELPING HANDSFRIENDSHIP PLACESALVATION ARMYHABITAT FOR HUMANITYGEORGETOWN HOUSING AUTHORITYDIABETES CORE GROUPHEALTHY LEARNERSWACCAMAW CENTER FOR MENTAL HEALTHTHE S.C. DEPARTMENT OF SOCIAL SERVICES GEORGETOWN AND HORRY COUNTY HEALTH DEPARTMENTSTHE BUNNELLE FOUNDATIONTHE WACCAMAW COMMUNITY FOUNDATIONGEORGETOWN COUNTY UNITED WAYWELLVISTANEIGHBOR TO NEIGHBORIN ADDITION THE FACILITY USED AN INTERNET-BASED SURVEY TO IDENTIFY POTENTIAL COMMUNITY NEEDS FROM LOCAL EXPERTS WITH AN ASSOCIATED RANKING OF THOSE POTENTIAL NEEDS. WACCAMAW COMMUNITY HOSPITAL PART V, SECTION B, LINE 4: GEORGETOWN MEMORIAL HOSPITAL WACCAMAW COMMUNITY HOSPITAL PART V, SECTION B, LINE 7: WACCAMAW COMMUNITY HOSPITAL IDENTIFIED POTENTIAL NEEDS FROM THE EXPERT PANEL MEMBERS FOR WHICH THE RESPECTIVE CHNA IDENTIFIES COMMUNITY/LOCAL RESOURCES AND THESE ARE LISTED IN THE CHNA. THE CHNA IDENTIFIES ONE NEED (MENTAL HEALTH/SUICIDE) FOR WHICH THE HOSPITAL FACILITY DOES NOT INTEND TO DEVELOP AN IMPLEMENTATION PLAN. THE REASONS FOR NOT ADDRESSING SUCH NEED INCLUDE THE LACK OF UNIT AND SPECIALTY EXPERTISE WITHIN THE HOSPITAL AND THE LACK OF AREA PHYSICIANS TO RESPOND TO THE SPECIFIC NEED. THE CHNA NOTES THERE ARE MULTIPLE OTHER LOCAL RESOURCES RESPONDING TO THE NEED. 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 ARE EDUCATED AT THE TIME OF REGISTRATION ON FINANCIAL ASSISTANCE PROGRAMS AVAILABLE. IN ADDITION, 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 2013 POPULATION OF 290,000. 19% OF THE POPULATION IS OVER THE AGE OF 65 AND THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $42,000. IN ADDITION, AN ESTIMATED 18% OF THE POPULATION IS BELOW THE POVERTY LEVEL. GEORGETOWN COUNTY (815 SQ. MILES) HAS A POPULATION OF APPROXIMATELY 60,000 PEOPLE AND AN ESTIMATED 22% OF THE POPULATION IS OVER THE AGE OF 65. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $42,000 AND AN ESTIMATED 20% OF THE POPULATION IS BELOW THE POVERTY LEVEL. 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. REPORTS FILED WITH STATES PART VI, LINE 7 SC 0 0 0 1 1 1 1 0 0 BRUCE BAILEY 203971 175863 64916 55971 38951 33584 4699 4051 29156 25138 341693 294607 0 0 TERRY KISER 153238 132122 46503 40095 16174 13945 4699 4051 14423 12436 235037 202649 0 0 GAYLE RESETAR 153970 132752 44975 38777 9467 8162 4699 4051 15006 12938 228117 196680 0 0 RICK KAYLOR 102971 88782 31916 27518 16985 14644 5316 4584 5134 4427 162322 139955 0 0 ROY E GILBREATH III 166088 143200 33667 29028 21744 18748 5316 4584 9706 8368 236521 203928 0 0 ANN L WATERS 24082 136466 5585 31648 6112 34637 1398 7924 1733 9818 38910 220493 0 0 JAMES F HARPER 68859 86124 16587 20746 17903 22392 4073 5094 12652 15824 120074 150180 0 0 FRANK SCAFIDI 83947 72379 13886 11973 18396 15861 4533 3908 13017 11223 133779 115344 0 0 SUZANNE C DOSCHER 79577 79577 15227 15227 7317 7317 3577 3577 7491 7491 113189 113189 0 0 PART I, LINE 5 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. SUPPLEMENTAL INFORMATION PART III 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, SUZANNE DOSCHER, AND GAYLE RESETAR WAS PAID THROUGH QUORUM HEALTH RESOURCES (QHR), AN UNRELATED MANAGEMENT COMPANY, ON BEHALF OF THE SOLE MEMBER, GEORGETOWN HOSPITAL SYSTEM. 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. IN ADDITION, BRUCE BAILEY, TERRY KISER, GAYLE RESETAR, RICK KAYLOR, ROY GILBREATH, JAMES HARPER, FRANK SCAFIDI, ANN WATERS, AND SUZANNE DOSCHER ARE COMPENSATED BY A COMMON PAYMASTER FOR SERVICES PERFORMED FOR BOTH WACCAMAW COMMUNITY 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 2010-12-22 30000000 CAPITAL ACQUISITION 0 0 0 B SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 2011-09-22 25565000 CURRENT REFUNDING 0 0 0 C SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 2012-02-23 30850000 CAPITAL ACQUISITION 0 0 0 D SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 2012-05-30 34099717 CURRENT REFUNDING 0 0 0 A 723695 20000000 168122 19831878 2012 0 0 1 1 B 2867036 16214252 164252 16050000 2001 1 0 1 1 C 30850000 172596 22177336 8500068 0 0 0 1 D 20025709 223540 471955 19330214 2001 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 1 0 0 0 0 B 0 0 1 0 0 0 0 0 0 C 0 0 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 SCHEDULE K, PART II, LINE 3, COLUMN C: GEORGETOWN HOSPITAL SYSTEM SIGNED A BOND PURCHASE AGREEMENT THAT SOLD THESE BONDS TO A FINANCIAL INSTITUTION. THE AMOUNT ON LINE 3, COLUMN C REPRESENTS THE CURRENT DRAWS OF THE CURRENT $30,850,000 ISSUE. FORM 990, SCH K, PART II, LINE 11 THE AMOUNTS ON THIS LINE WERE USED TO REFUND PRIOR ISSUE BONDS. THE AMOUNTS IN COLUMN B WERE USED TO REFUND BONDS THAT WERE ISSUED ON 8/15/1999 AND 8/1/2001. THE AMOUNTS IN COLUMN D WERE USED TO REFUND BONDS THAT WERE ISSUED ON 3/15/1998 AND 8/23/2001. BECCA KAYLOR FAMILY MEMBER OF OFFICER RICK KAYLOR 25816 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 $48,074 IN TOTAL FOR SERVICES RENDERED TO ALL RELATED ORGANIZATIONS. 0 DANA KISER FAMILY MEMBER OF OFFICER TERRY KISER 60728 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 $60,728 IN TOTAL FOR SERVICES RENDERED TO ALL RELATED ORGANIZATIONS. 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 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 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 1023 AND RECENT FILINGS 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. OTHER FEES FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 23,106,552. MANAGEMENT AND GENERAL EXPENSES 16,130,009. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,236,561. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. EMPLOYEES REPORTED ON FORM W-3: 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 1,123. FORMER CHIEFS OF STAFF 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 11A, I 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 0 1 0 0 0 1 1 1 0 1 1 1 1 1 0 0