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THE AMERICUS-SUMTER COUNTY HOSPITAL AUTHORITY (AUTHORITY) ENTERED INTO A LEASE AND TRANSFER AGREEMENT WHICH INCLUDED THE CONSTRUCTION OF A NEW HOSPITAL FACILITY. THE AUTHORITY HAS RECEIVED PROCEEDS FROM THE FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA) AND THE GEORGIA EMERGENCY MANAGEMENT AGENCY (GEMA) FOR A PORTION OF THE CONSTRUCTION COSTS OF THE NEW HOSPITAL AND INTENDS TO PURSUE FURTHER REIMBURSEMENT FROM FEMA AND GEMA TO THE FULLEST EXTENT POSSIBLE. IT IS ANTICIPATED, BASED ON GUIDANCE RECEIVED FROM AN INDEPENDENT CONSULTANT, THAT THE PROJECT AUDITS ARE LIKELY TO BE CONDUCTED BY FEMA AND GEMA ONCE ALL OUTSTANDING CLAIMS ARE CLOSED, WHICH COULD RESULT IN DEMAND(S) TO RECOVER A PORTION OF THE FUNDS PAID TO THE AUTHORITY. EFFECTIVE WITH AN AMENDMENT TO THE LEASE AND TRANSFER AGREEMENT (AMENDMENT) DATED SEPTEMBER 27, 2016, THE AUTHORITY TRANSFERRED APPROXIMATELY 11,745,000 OF RECEIPTS FROM FEMA AND GEMA TO THE HOSPITAL. THE AMENDMENT SPECIFIES THAT THE FEMA AND GEMA FUNDS MAY BE USED FOR THE FOLLOWING PURPOSES: .... FIRST, TO PAY FEMA AND GEMA ALL SUMS DETERMINED TO BE OWED AS A RESULT OF ANY AUDITS. .... SECOND, AND ONLY AFTER ADEQUATE PROVISION FOR THE FUNDING OF THE FIRST BULLET POINT, THE FUNDS CAN BE USED TO FUND PHYSICIAN DEVELOPMENT IN THE HOSPITALS SERVICE AREA. .... THIRD, AND ONLY AFTER ADEQUATE PROVISION FOR THE FIRST TWO BULLET POINTS ABOVE, THE FUNDS CAN BE USED BY THE HOSPITAL FOR ANY PURPOSES PERMITTED UNDER THE LEASE AND TRANSFER AGREEMENT. ALSO IN ACCORDANCE WITH THE AMENDMENT, THE HOSPITAL AGREED TO ESTABLISH A SEPARATE ACCOUNT TO HOLD THE SUM OF 4,000,000 OF THE ABOVE FUNDS UNTIL THE CONCLUSION OF THE EXPECTED FEMA AND GEMA AUDITS TO ENSURE THE IMMEDIATE AVAILABILITY OF FUNDS TO REPAY ANY AMOUNTS FINALLY DETERMINED TO BE OWED TO FEMA AND GEMA AS A RESULT OF THE AUDITS. SHOULD THE 4,000,000 NOT BE SUFFICIENT TO REPAY ANY AMOUNTS DUE TO FEMA AND GEMA, THE HOSPITAL AGREES THAT IT WILL PAY IN FULL AND FULLY INDEMNIFY THE AUTHORITY FOR ALL RELATED SUMS FINALLY DETERMINED TO BE OWED TO FEMA AND GEMA. THE AMENDMENT STATES THAT THE ADEQUATE PROVISION OF BOTH THE FEMA AND GEMA FUND REPAYMENT AND THE ADEQUATE PROVISION TO FUND PHYSICIAN DEVELOPMENT ARE TO BE DETERMINED AT THE SOLE DISCRETION OF THE HOSPITAL. PER A HOSPITAL BOARD OF DIRECTORS RESOLUTION DATED NOVEMBER 1, 2016, THE HOSPITAL BELIEVES THE 4,000,000 IS ADEQUATE PROVISION FOR THE REPAYMENT OF THE FEMA AND GEMA FUNDS. ALSO, BASED ON THE CURRENT AND LONG-TERM PHYSICIAN DEVELOPMENT PLAN, COUPLED WITH THE REQUIREMENT THAT THE HOSPITAL CHIEF EXECUTIVE OFFICER REPORT ON THE EFFORTS AND RESULTS OF PHYSICIAN DEVELOPMENT AT EACH BOARD OF DIRECTORS MEETING, AND THE REQUIREMENT THAT THE HOSPITALS BOARD OF DIRECTORS APPROVE THE BUDGET AND STRATEGIC PLAN EACH YEAR, THE HOSPITAL BELIEVES THIS CONSTITUTES ADEQUATE PROVISION FOR THE FUNDING OF PHYSICIAN DEVELOPMENT. SCHEDULE D, PAGE 3, PART X THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE HOSPITAL ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENTS EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JULY 31, 2017 AND 2016 OR FOR THE YEARS THEN ENDED. THE HOSPITALS TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. SCHEDULE D, PAGE 4, PART XI, LINE 4B RENTAL EXPENSES -32,868 CAPITAL CONTRIBUTIONS 4,000,000 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 32,868 true true X true X 1.250000000000 true X true true false true true 4361641 518174 3843467 0.05700 13814903 11959087 1855816 0.02750 18176544 12477261 5699283 0.08450 5723 221308 105108 116200 0.00170 14 11000 11000 0.00020 7807 7807 0.00010 5737 240115 105108 135007 0.00200 5737 18416659 12582369 5834290 0.08650 true 11393676 14323728 16538449 -2214721 X true true 1 1 PHOEBE SUMTER MEDICAL CENTER INC 126 HIGHWAY 280 WEST AMERICUS GA 31719 WWW.PHOEBEHEALTH.COM 129-663 X X X HOSPICE, RHC PHOEBE SUMTER MEDICAL CENTER INC 1 false false true X X X X X X X X X 16 true false false true X WWW.PHOEBEHEALTH.COM X true 17 true WWW.PHOEBEHEALTH.COM false false true X 125.000000000000 200.000000000000 X X X X X X true true X X X X true X WWW.PHOEBEHEALTH.COM X WWW.PHOEBEHEALTH.COM X WWW.PHOEBEHEALTH.COM X X X X X X true X false X X X X X true X false false FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 5 MEMBERS OF THE INTERNAL ASSESSMENT TEAM PERFORMED NINE (9) KEY LEADER INTERVIEWS. THE PURPOSE OF THE KEY LEADER INTERVIEWS WAS TO GATHER INFORMATION, GAIN KNOWLEDGE AND RECEIVE INPUT REGARDING HEALTH ISSUES FACING THE ORGANIZATION'S SERVICE AREA. THE INTERVIEW SELECTION PROCESS WAS CAREFUL TO INCLUDE REPRESENTATION THAT REFLECTS THE MAKE-UP OF PATIENTS RECEIVING SERVICES IN THE ORGANIZATION'S SERVICE AREA (RELIGIOUS, BUSINESS, POLITICAL, PUBLIC HEALTH, THE ELDERLY, PHYSICIANS AND AFTERSCHOOL PROGRAMS). ELEVEN (11) OTHER PARTICIPANTS, ALL MEMBERS OF THE AMERICUS ROTARY CLUB, RECEIVED MODIFIED WRITTEN VERSIONS OF A SURVEY AND COMPLETED DURING AN OFFICIAL MEETING. ALSO, APPROXIMATELY 100 INVITATIONS WERE SENT OUT TO INDIVIDUALS IN THE COMMUNITY WITH ALMOST HALF ACCEPTING AND PARTICIPATING IN ONE OF TWO INPUT SESSIONS. THE COMMUNITY INPUT SESSIONS WERE ALSO HELD TO REVIEW DATA AND PROVIDE FEEDBACK ON THE COMMUNITYS VIEW OF PRIORITIES. PARTICIPANTS WERE ASKED TO MAKE A LIST OF IDEAS THAT COULD IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. THE PARTICIPANTS WERE THEN PUT INTO SMALL GROUPS TO DISCUSS AND DEVELOP 8 TO 10 IDEAS TO BRING TO THE WHOLE GROUP. FINALLY, ONCE ALL THE IDEAS WERE GATHERED AND PLACED ON A STICKY WALL, EACH PARTICIPANT HAD TO MARK 2 IDEAS THAT THEY CONSIDERED TO BE SIGNIFICANT ISSUES FACING THE COMMUNITY. COMMUNITY PARTICIPANTS INCLUDED PHYSICIANS AND OTHER MEDICAL PROFESSIONALS; EDUCATORS; PROFESSIONALS; REPRESENTATIVES FROM THE THE BOYS AND GIRLS CLUB, THE CITY OF AMERICUS, CHAMBER OF COMMERCE, AND THE SUMTER COUNTY HEALTH DEPARTMENT; RELIGIOUS LEADERS. FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 11 USING THE CATHOLIC HEALTH ASSOCIATIONS SELECTION FILTER AS A MEANS TO PRIORITIZE COMPETING SIGNIFICANT NEEDS, BELOW IS A LIST OF NEEDS THAT WERE NOT INCLUDED AS PRIORITIES BUT REMAIN A CONCERN TO THE COMMUNITY. 1) ACCESS TO HEALTHY FOODS: THIS PRIORITY IS BEING ADDRESSED WITH OTHER PRIORITIES, SUCH AS OBESITY AND DIABETES. 2) SMOKING CESSATION: THIS PRIORITY IS NOT ALIGNED WITH PSMC'S CURRENT STRENGTHS AND PRIORITIES. 3) ALZHEIMER'S DISEASE: OTHER AGENCIES IN THE COMMUNITY ARE CURRENTLY PROVIDING EDUCATION AND SUPPORT FOR CAREGIVERS. 4) SEXUALLY TRANSMITTED DISEASES (STD): COMPLEX ISSUE FOR PSMC TO ADDRESS IN REGARDS TO OUR CURRENT STRENGTHS AND PRIORITIES. 5) HEALTH LITERACY AND EDUCATION: ALTHOUGH EDUCATION IS IMPORTANT TO PSMC, IT IS NOT ONE OF OUR STRENGTHS AT THIS TIME. 6) PROSTATE CANCER: THIS PRIORITY IS ALREADY BEING ADDRESSED THROUGH OUR MEN'S HEALTH FAIR, WHICH IS HOSTED ANNUALLY. 7) SPECIALTY CARE: PSMC IS CURRENTLY SEARCHING FOR SPECIALIST TO BRING INTO THE COMMUNITY. A COMPLETE COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY PRIORITIES, AND IMPLEMENTATION PLAN CAN BE FOUND AT HTTP://WWW.PHOEBEHEALTH.COM/LOCATIONS/PHOEBE-SUMTER-MEDICAL-CENTER/PHOEBE- SUMTER-MEDICAL-CENTER-CHNA FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 13B HOUSEHOLD INCOMES OVER 200% OF FPG WHERE THE PATIENT HAS A CATASTROPHIC ILLNESS IS ELIGIBLE FOR CASTASTROPHIC STATUS WHICH PROVIDES FOR DISCOUNTED CHARGES FOR CARE. FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 20E WRITTEN NOTICE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE IS INCLUDED ON HOSPITAL PATIENT STATEMENTS, AND ON WRITTEN COMMUNICATIONS SENT BY CONTRACTED THIRD PARTY COLLECTION AGENCIES. THESE AGENCIES MAY REFER ACCOUNTS FOR REPORTING TO MAJOR CREDIT BUREAUS, AFTER A SERIES OF STATEMENTS AND LETTERS ARE SENT THROUGHOUT MULTIPLE COLLECTION CYCLES. 2 PHOEBE SUMTER HOSPICE 126 HWY 280 WEST AMERICUS GA 31719 HOSPICE ELLAVILLE PRIMARY MEDICINE 72 BROAD STREET ELLAVILLE GA 31806 RURAL HEALTH CLINIC PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 67,399,931 ADD: EXPENSES REPORTED IN PART VIII 32,868 DENOMINATOR FOR COLUMN (F) 67,432,799 PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE COST OF MEDICAID AND CHARITY CARE WAS CALCULATED USING THE COST-TO- CHARGE RATIO AS CALCULATED USING WORKSHEET 2 FROM THE IRS FORM 990 INSTRUCTIONS. THE COST OF OTHER BENEFITS WAS THE DIRECT COST OF THE SERVICES. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY AMOUNTS INCLUDED ON PART III, LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS SEE PAGES 9 AND 10 ON THE ACCOMPANYING AUDITED FINANCIAL STATEMENTS FOR THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE DISCLOSURE. PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES FOR PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS. PART VI, LINE 2 - NEEDS ASSESSMENT NEEDS ASSESSMENTS HAVE TRADITIONALLY LED TO THE CREATION OF COMMUNITY-BASED DELIVERY SYSTEMS THAT EXPAND ACCESS TO HEALTH CARE, MEET THE NEEDS OF THE PEOPLE AND BUILD HEALTHY COMMUNITIES IN THE BROADEST SENSE BY IMPACTING MAJOR DETERMINANTS, SUCH AS ECONOMIC DEVELOPMENT, EMPLOYMENT, CHILDREN'S SAFETY, EDUCATION AND ADEQUATE HOUSING. THE ORGANIZATION CONDUCTS REGULAR NEEDS ASSESSMENT THROUGH FORMAL AND INFORMAL SURVEYS AND PROCESSES, INCLUDING COLLABORATIONS WITH PUBLIC AND COMMUNITY AGENCIES. THROUGH STRATEGIC PLANNING AND COMMUNITY INTERVIEWS, THE ORGANIZATION DEVELOPS PROGRAMS AND SERVICES THAT CONSIDER THE ECONOMIC IMPERATIVES OF THE REGION, THE EFFECT OF LEGISLATION AND THE INVOLVEMENT OF OTHER COMMUNITY-BASED ORGANIZATIONS AND PARTNERS. THE ORGANIZATION REGULARLY CONDUCTS FOCUS GROUPS IN THE COMMUNITY TO UNDERSTAND ISSUES AFFECTING ITS PATIENTS, AND HAS CREATED PROGRAMS IN RESPONSE TO HEALTH DISPARITIES PREVALENT IN THE AREA. THE ORGANIZATION ALSO COLLECTS HEALTH NEEDS INFORMATION FROM NURSES, WHO PROVIDE DIRECT CARE TO STUDENTS AND STAFF AND WHO COLLABORATE WITH OTHER AGENCIES TO DEVELOP HEALTH AWARENESS AND DISEASE PREVENTION PROGRAMS. THE ORGANIZATION ALSO CONDUCTS REGULAR PHYSICIAN WORKFORCE STUDIES THROUGH ITS STRATEGIC PLANNING ARM TO DETERMINE UNMET PHYSICIAN NEEDS AND BARRIERS TO ACCESSING CARE. THE ORGANIZATION MEASURES THE SUCCESS OF ITS COMMITMENT BY HOW WELL IT KEEPS PEOPLE HEALTHY AND HOW WELL IT IMPACTS THE SOCIAL/CULTURAL BONDS THAT WILL SECURE THE COMMUNITIES OF THE FUTURE. THE HOSPITAL LAST CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2016. A COMPLETE COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY PRIORITIES, AND IMPLEMENTATION PLAN CAN BE FOUND AT HTTP://WWW.PHOEBEHEALTH.COM/LOCATIONS/PHOEBE-SUMTER-MEDICAL-CENTER/PHOEBE- SUMTER-MEDICAL-CENTER-CHNA PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE BOARD HAS CLEARLY WRITTEN FINANCIAL ASSISTANCE POLICY THAT IS AVAILABLE ON THE ORGANIZATION'S WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND CHARITY CARE. PATIENT EDUCATION ON THE ORGANIZATION'S FINANCIAL ASSISTANCE IS CONDUCTED DURING PRE-REGISTRATION, THROUGH FLOOR VISITS BY BUSINESS OFFICE REPRESENTATIVES FOR PATIENTS THAT STRESS CONCERN IN MEETING THE FINANCIAL OBLIGATIONS FOR THEIR SERVICES, AND THROUGH OUR CUSTOMER SERVICE DEPARTMENT. BROCHURES ARE PROMINENTLY DISPLAYED AT EACH REGISTRATION BOOTH. THE BUSINESS OFFICE CONTINUOUSLY PROVIDES UPDATED MATERIAL TO PHYSICIAN OFFICES FOR ISSUANCE TO THEIR PATIENTS THAT HIGHLIGHT THE FINANCIAL ASSISTANCE PROGRAM AND POLICIES. THE PATIENT STATEMENTS HIGHLIGHT THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND ENCOURAGES PATIENTS TO CALL FOR FINANCIAL ASSISTANCE. PART VI, LINE 4 - COMMUNITY INFORMATION PSMC IS LOCATED IN SUMTER COUNTY, GEORGIA. THERE ARE APPROXIMATELY 32,819 RESIDENTS OF SUMTER COUNTY WITH A RACIAL MIX OF 52% AFRICAN AMERICAN AND 42% WHITE. POPULATION PROJECTIONS FOR SUMTER COUNTY SHOW OVERALL POPULATION LOSS IN THE NEXT FEW YEARS, WITH AGES 65+ HAVING THE GREATEST GROWTH RATE. THE HOUSEHOLD MEDIAN INCOME FOR SUMTER COUNTY AVERAGED 32,430 IN 2010, AND ABOUT 21.7% OF FAMILIES AND 26.9% OF THE POPULATION WERE BELOW THE POVERTY LINE. IN ADDITION TO SUMTER COUNTY, PSMC HAS A SERVICE AREA THAT INCLUDES MARION, MACON, DOOLY, STEWART, WEBSTER, SCHLEY AND TAYLOR COUNTIES. PSMC HAS A GOOD RELATIONSHIP WITH THESE COUNTIES, AND IMPLEMENTED A REGIONAL ADVISORY COUNCIL IN 2015 TO BETTER SERVE THE NEEDS OF THESE COMMUNITIES AND THEREFORE PRACTICE A TRUE POPULATION HEALTH METHODOLOGY. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH THE ORGANIZATION AND ITS VOLUNTEER BOARD IS COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS, AS WELL AS PHYSICIAN MEMBERS. THE ORGANIZATION'S EMERGENCY CENTER IS OPERATED 24/7 AND OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. THE BOARD MAINTAINS OPEN MEDICAL STAFF POLICIES WITH PRIVILEGES AVAILABLE TO ALL QUALIFYING PHYSICIANS. THE BOARD HAS A CLEARLY WRITTEN FINANCIAL ASSISTANCE POLICY THAT IS AVAILABLE ON THE ORGANIZATION'S WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND CHARITY CARE. THE ORGANIZATION HAS A MULTI-PRONGED APPROACH TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES: INCREASING ACCESS, BUILDING CAPACITY, INVESTING IN "UPSTREAM" PROGRAMS THAT GET AT THE CAUSE OF DISEASE AND ILLNESS, BUILDING COMMUNITY PARTNERSHIPS, ADVOCATING CHANGE, AND DEVELOPING LEADERSHIP. SURPLUS FUNDS ARE REINVESTED IN RESOURCES TO IMPROVE THE DELIVERY OF MEDICAL AND HEALTH CARE SERVICES. PRIMARY CARE IS FIRST AND CREATES A PROFOUND IMPACT ON THE COMMUNITIES SERVED. PRIMARY CARE SERVICES ARE ESTABLISHED IN AREAS WHERE RESIDENTS ARE MOST LIKELY TO SUFFER FROM SEVERE MANPOWER SHORTAGES, HIGH POVERTY LEVELS AND A LACK OF ACCESS TO CARE. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM PHOEBE PUTNEY HEALTH SYSTEM, INC. (PPHS) IS THE NOT-FOR-PROFIT PARENT COMPANY OF PHOEBE PUTNEY MEMORIAL HOSPITAL, INC. (PPMH), A NOT-FOR-PROFIT ENTITY, PHOEBE PUTNEY HEALTH VENTURES, INC. (PPHV), A FOR-PROFIT CORPORATION, PHOEBE PHYSICIAN GROUP, INC. (PPG), A NOT-FOR-PROFIT CORPORATION, PHOEBE WORTH MEDICAL CENTER, INC. (PWMC), A NOT-FOR-PROFIT ENTITY, PHOEBE SUMTER MEDICAL CENTER, INC. (PSMC), A NOT-FOR-PROFIT ENTITY, AND PHOEBE FOUNDATION, INC. (PF), A NOT-FOR-PROFIT ENTITY. PPMH IS LOCATED IN ALBANY, GEORGIA, IS AN ACUTE CARE HOSPITAL, WHICH OPERATES SATELLITE CLINICS IN THE SURROUNDING COUNTIES. IT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SOUTHWEST GEORGIA. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. PPHV ENGAGES IN HEALTHCARE AND RELATED ACTIVITIES IN FURTHERANCE OF THE EXEMPT PURPOSES OF PPHS AND PPMH. PWMC IS LOCATED IN SYLVESTER, GEORGIA, IS A 25 BED RURAL CRITICAL ACCESS HOSPITAL. IT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WORTH COUNTY, GEORGIA. PSMC IS LOCATED IN AMERICUS, GEORGIA, IS AN ACUTE CARE HOSPITAL. IT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SUMTER COUNTY, GEORGIA. PPG WAS ESTABLISHED TO ORGANIZE AND OPERATE MEDICAL PRACTICES EXCLUSIVELY FOR THE BENEFIT OF PPMH, PWMC, AND PSMC. PF WAS ESTABLISHED TO RAISE FUNDS OF ANY KIND OR CHARACTER TO BE USED EXCLUSIVELY FOR CHARITABLE, MEDICAL, EDUCATIONAL AND SCIENTIFIC PURPOSES AT OR IN CONNECTION WITH EACH AND EVERY NON-PROFIT ORGANIZATION OF WHICH PPHS IS THE SOLE MEMBER, AND ANY OTHER NON-PROFIT HOSPITAL WHICH IS MANAGED OR CONTROLLED BY PPHS WHETHER THROUGH OWNERSHIP, MANAGEMENT CONTRACT OR OTHERWISE. SUMTER REGIONAL HOSPITAL FOUNDATION, INC. WAS ESTABLISHED TO RAISE FUNDS TO SUPPORT PSMC. SUMTER REGIONAL HOSPITAL FOUNDATION, INC.'S BYLAWS PROVIDE THAT THE MAJORITY OF ALL FUNDS RAISED, EXCEPT FOR FUNDS ACQUIRED FOR THE OPERATION OF THE FOUNDATION, BE DISTRIBUTED TO OR BE HELD FOR THE BENEFIT OF THE HOSPITAL. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT GEORGIA ADDITIONAL INFORMATION PHOEBE SUMTER MEDICAL CENTER, INC. (PSMC), FORMERLY SUMTER REGIONAL HOSPITAL (SRH), IS A NOT-FOR-PROFIT HEALTH CARE ORGANIZATION THAT EXISTS TO SERVE THE COMMUNITY. SRH OPENED IN 1953 TO SERVE THE COMMUNITY BY CARING FOR THE SICK REGARDLESS OF THEIR ABILITY TO PAY, A MISSION THAT CONTINUES AS PSMC. AS A NOT-FOR-PROFIT HOSPITAL, PSMC HAS NO STOCKHOLDERS OR OWNERS. ALL REVENUE AFTER EXPENSES IS REINVESTED IN THE MISSION TO CARE FOR THE CITIZENS OF THE COMMUNITY INTO CLINICAL CARE, HEALTH PROGRAMS, STATE-OF- THE-ART TECHNOLOGY AND FACILITIES, RESEARCH, AND TEACHING AND TRAINING OF MEDICAL PROFESSIONALS NOW AND FOR THE FUTURE. PSMC OPERATES AS A CHARITABLE ORGANIZATION CONSISTENT WITH THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(C)(3) AND THE COMMUNITY BENEFIT STANDARD OF IRS REVENUE RULING 69-545. PSMC TAKES SERIOUSLY ITS RESPONSIBILITY AS THE COMMUNITYS SAFETY NET HOSPITAL AND HAS A STRONG RECORD OF MEETING AND EXCEEDING THE CHARITABLE CARE AND THE ORGANIZATIONAL AND OPERATIONAL STANDARDS REQUIRED FOR FEDERAL TAX-EXEMPT STATUS. PSMC DEMONSTRATES A CONTINUED AND EXPANDING COMMITMENT TO MEETING ITS MISSION AND SERVING THE CITIZENS BY PROVIDING COMMUNITY BENEFITS. A COMMUNITY BENEFIT IS A PLANNED, MANAGED, ORGANIZED, AND MEASURED APPROACH TO MEETING IDENTIFIED COMMUNITY HEALTH NEEDS, REQUIRING A PARTNERSHIP BETWEEN THE HEALTHCARE ORGANIZATION AND THE COMMUNITY TO BENEFIT RESIDENTS THROUGH PROGRAMS AND SERVICES THAT IMPROVE HEALTH STATUS AND QUALITY OF LIFE. PSMC IMPROVES THE HEALTH AND WELL BEING OF SOUTHWEST GEORGIA THROUGH CLINICAL SERVICES, EDUCATION, RESEARCH, AND PARTNERSHIPS THAT BUILD HEALTH CAPACITY IN THE COMMUNITY. PSMC PROVIDES COMMUNITY BENEFITS FOR ALL CITIZENS, AS WELL AS FOR THE MEDICALLY UNDERSERVED. PSMC CONDUCTS COMMUNITY NEEDS ASSESSMENTS AND PAYS CLOSE ATTENTION TO THE NEEDS OF LOW INCOME AND OTHER VULNERABLE PERSONS AND THE COMMUNITY AT LARGE. PSMC OFTEN WORKS WITH COMMUNITY GROUPS TO IDENTIFY NEEDS, STRENGTHEN EXISTING COMMUNITY PROGRAMS, AND PLAN NEWLY NEEDED SERVICES. IT PROVIDES A WIDE-RANGING ARRAY OF COMMUNITY BENEFIT SERVICES DESIGNED TO IMPROVE COMMUNITY HEALTH AND THE HEALTH OF INDIVIDUALS AND TO INCREASE ACCESS TO HEALTH CARE, IN ADDITION TO PROVIDING FREE AND DISCOUNTED SERVICES TO PEOPLE WHO ARE UNINSURED AND UNDERINSURED. DRAWING ON A DYNAMIC AND FLEXIBLE STRUCTURE, THE COMMUNITY BENEFIT PROGRAMS ARE DESIGNED TO RESPOND TO ASSESSED NEEDS AND ARE FOCUSED ON UPSTREAM PREVENTION. PSMC PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS AND IS ONE OF THE LEADING PROVIDERS OF MEDICAID SERVICES IN GEORGIA. THE FOLLOWING TABLE SUMMARIZES THE AMOUNTS OF CHARGES FOREGONE (I.E., CONTRACTUAL ADJUSTMENTS) AND ESTIMATES THE LOSSES (COMPUTED BY APPLYING A TOTAL COST FACTOR TO THE CHARGES FOREGONE) INCURRED BY PPMH DUE TO INADEQUATE PAYMENTS BY THESE PROGRAMS AND FOR INDIGENT/CHARITY. THIS TABLE DOES NOT INCLUDE DISCOUNTS OFFERED BY THE CORPORATION UNDER MANAGED CARE AND OTHER AGREEMENTS: CHARGES ESTIMATED FOREGONE UNREIMBURSED COST MEDICARE 86,000,000 23,000,000 MEDICAID 38,000,000 10,000,000 INDIGENT/CHARITY 17,000,000 5,000,000 141,000,000 38,000,000 THE FOLLOWING IS A SUMMARY OF THE COMMUNITY BENEFIT ACTIVITIES AND HEALTH IMPROVEMENT SERVICES OFFERED BY PSMC AND ILLUSTRATES THE ACTIVITIES AND DONATIONS DURING FISCAL YEAR 2017. I. COMMUNITY HEALTH IMPROVEMENT SERVICES A. COMMUNITY HEALTH EDUCATION MENS HEALTH CONFERENCES PSMC HELD THE 8TH ANNUAL MENS HEALTH CONFERENCE ON SEPTEMBER 24, 2016 AND THE 9TH ANNUAL MENS HEALTH CONFERENCE ON JUNE 3, 2017 THAT PROVIDED HEALTH SCREENINGS FOR PSA, CHOLESTEROL, BLOOD PRESSURE, HEARING AND VISION, HEALTH INFORMATION, SPEAKERS, AND FELLOWSHIP TO MORE THAN 250 ATTENDEES IN SEPTEMBER AND 125 ATTENDEES IN JUNE. THE HEALTH CONFERENCE PROGRAMS PROVIDE OUTREACH, HEALTH SCREENINGS, EDUCATIONAL PROGRAMS, AND HEALTH CONFERENCES AND EVENTS. THESE PROGRAMS TARGET MEN AT RISK OF POOR HEALTH STATUS. THE PROGRAMS TARGET UNINSURED OR UNDERINSURED MEN WITHOUT A PRIMARY CARE PHYSICIAN OR KNOWLEDGE OF RECOMMENDED PREVENTIVE HEALTH CARE SERVICES. PSMC INCURRED EXPENSES OF 7,792 FOR BOTH EVENTS. CHILDRENS HEALTH FAIR PSMC HELD A CHILDRENS HEALTH FAIR ON JULY 22, 2017 THAT PROVIDED HEALTH SCREENINGS FOR WEIGHT, BMI, BLOOD PRESSURE AND BLOOD SUGAR, HEALTH INFORMATION, SPEAKERS AND FELLOWSHIP TO MORE THAN 500 ATTENDEES. SOIL SCREENING FOR LEAD WERE ALSO AVAILABLE FROM RURAL GEORGIA HEALTHY HOUSING. THE HEALTH CONFERENCE PROGRAMS PROVIDE OUTREACH, HEALTH SCREENINGS AND EDUCATIONAL PROGRAMS ABOUT NUTRITION AND PHYSICAL ACTIVITY. THESE PROGRAMS TARGET CHILDREN AT RISK OF POOR HEALTH STATUS. THE PROGRAMS TARGET UNINSURED OR UNDERINSURED CHILDREN WITHOUT A PRIMARY CARE PHYSICIAN OR KNOWLEDGE OF RECOMMENDED PREVENTIVE HEALTH CARE SERVICES. PSMC INCURRED EXPENSES OF 9,616 FOR THIS EVENT. B. COMMUNITY BASED CLINICAL SERVICES FLU SHOTS AND HEALTH SCREENINGS PSMC PROVIDES FREE FLU SHOTS TO VOLUNTEERS AND STUDENTS. IN FY 2017, PSMC ADMINISTERED 63 FLU SHOTS AT AN UNREIMBURSED COST OF 1,046. SCHOOL NURSE PROGRAM PSMC PLACES A NURSE AND TWO TECHS IN THE SUMTER COUNTY SCHOOL SYSTEM. DURING THE 2016/2017 SCHOOL YEAR, THE SCHOOL NURSE PROGRAM HAD 18,462 CLINIC VISITS AND ADMINISTERED 29,686 DOSES OF MEDICATION AT A COST OF 19,766. NURSES/NURSING STUDENTS IN FY 2017, PSMC PROVIDED AN ESTIMATED 11,000 REPRESENTING 1,528 HOURS IN CLINICAL SUPERVISION AND TRAINING OF 14 NURSING STUDENTS. INDIGENT FINANCIAL ASSISTANCE PATIENTS WHOSE HOUSEHOLD INCOME IS BELOW 125% OF THE FEDERAL POVERTY GUIDELINES ARE CLASSIFIED AS INDIGENT AND RECEIVE CARE AT NO COST. CHARITY FINANCIAL ASSISTANCE PATIENTS WHOSE HOUSEHOLD INCOME IS BETWEEN 126% - 200% OF THE FEDERAL POVERTY GUIDELINES WILL BE CLASSIFIED AS CHARITY. THESE PATIENTS WILL BE RESPONSIBLE FOR A PERCENTAGE OF THE HOSPITAL CHARGES. THIS PERCENTAGE WILL BE BASED ON CALCULATIONS USING THE FEDERAL POVERTY GUIDELINES THAT ARE PUBLISHED IN THE FEDERAL REGISTER EACH YEAR. IF IT IS DETERMINED THE PATIENT RESPONSIBILITY WILL BE AN UNDUE HARDSHIP ON THE PATIENT/GUARANTOR, THESE CASES WILL BE REVIEWED ON AN INDIVIDUAL BASIS WITH THE PHOEBE CARES SUPERVISOR FOR POSSIBLE CATASTROPHIC CHARITY BASED ON SLIDING SCALE GUIDELINES. CATASTROPHIC FINANCIAL ASSISTANCE PATIENTS WHOSE INCOME EXCEEDS 200% OF THE FEDERAL POVERTY GUIDELINES, AND WHOSE HOSPITAL CHARGES EXCEED 25% OF THEIR ANNUAL INCOME, RESULTING IN EXCESSIVE HARDSHIP, ARE ELIGIBLE FOR A DISCOUNT UP TO 75% OF THE PATIENT BALANCE. THE PATIENT MAY PAY THE REMAINING BALANCE OVER 24 MONTHS. DURING FY 2017, 459 PATIENTS WERE APPROVED FOR FINANCIAL ASSISTANCE. II. COMMUNITY BENEFIT OPERATIONS PSMC INCURRED 77,980 IN SUPPORT STAFF COSTS TO SUPPORT ITS COMMUNITY BENEFIT EFFORTS. true SCHOLARSHIPS 3 55822 SCHEDULE I, PAGE 1, PART I, LINE 2 THE ORGANIZATION PROVIDES OVERSIGHT AND MONITORS THE PROGRAM BASED ON UTILIZATION EACH BUDGET YEAR. THE APPROPRIATE APPLICATION, APPROVAL AND GRADES MUST BE SUBMITTED AND VERIFIED PRIOR TO DISPERSAL OF FUNDS TO EACH RECIPIENT. EACH RECIPIENTS BALANCE IS COMPARED TO APPROVAL AMOUNT AND PROCESSED ACCORDINGLY. false true false false false false false false false JOEL WERNICK BD MEMBER/PPHS CEO 765840 5976516 365415 17993 7125764 5497409 JOE AUSTIN BD MEMBER/PPHS COO 442064 22732 132200 19755 616751 BRIAN CHURCH BD MEMBER/PPHS CFO 322892 18325 54150 17177 412544 BRANDI LUNNEBORG CEO 228014 10016 36000 16380 290410 DEBORAH MCWILLIAMS RN 172276 88 3410 175774 LORI PAYNE PHARMACIST 138920 163 1499 16623 157205 DARRYL HAWKINS PHARMACY DIRECTOR 136841 272 19673 156786 SUSAN JOHNSON PHARMACIST 134219 93 2646 14673 151631 SCHEDULE J, PAGE 1, PART I, LINE 3 NONE OF THE INDIVIDUAL BOARD MEMBERS OR OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION AND THE ORGANIZATION MUST RELY ON THE METHODS USED BY PPHS, THE SOLE MEMBER, TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY PPHS INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. SCHEDULE J, PAGE 1, PART I, LINE 4 JOEL WERNICK 0 360,115 0 JOE AUSTIN 0 126,900 0 BRIAN CHURCH 0 50,400 0 BRANDI LUNNEBORG 0 32,239 0 SCHEDULE J, PART III SCHEDULE J, PART I, LINE 4 - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: DEFERRED COMPENSATION PLAN 457(B): THE DEFERRED COMPENSATION PLAN IS AN ADDITIONAL RETIREMENT PLAN OFFERED THROUGH PHOEBE PUTNEY. THE 457(B) PLAN IS AN ELIGIBLE DEFERRED COMPENSATION PLAN THAT ALLOWS ONE TO DEFER ADDITIONAL DOLLARS TOWARDS RETIREMENT. HIGHLIGHTS INCLUDE: O NOT LIMITED BY THE AMOUNTS DEFERRED INTO THE PHOEBE 403(B) O PLAN IS SUBJECT TO ANNUAL DEFERRAL LIMITS SET BY THE IRS O PER IRS REGULATIONS, EACH PARTICIPANT IS A GENERAL UNSECURED CREDITOR OF THE PLAN SPONSOR. SENIOR VICE PRESIDENTS AND ABOVE AND PHYSICIANS MAKING OVER 120,000 ARE ELIGIBLE TO PARTICIPATE IN THE 457(B) PLAN. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) 457(F): PPHS RELIES ON AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, SURVEYS, WELL DOCUMENTED METHODS AND BOARD APPROVAL TO ESTABLISH TOTAL COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. CERTAIN BOARD APPROVED EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN A SERP THAT PROVIDES CERTAIN DEFINED ANNUAL PAY CREDITS THAT ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. THE PURPOSE OF THE SERP IS TO PROVIDE A LONG-TERM INCENTIVE AND RETIREMENT BENEFIT FOR AFFECTED EXECUTIVES CONSISTENT WITH THE BENEFIT AVAILABLE TO EMPLOYEES NOT IMPACTED BY IRS COMPENSATION LIMITS ON DEFINED BENEFIT PLANS. THE AMOUNTS REPORTED AS SUPPLEMENTAL EXECUTIVE RETIREMENT COMPENSATION FOR ELIGIBLE EMPLOYEES IN SCHEDULE J REPRESENT CREDITED, BUT NOT VESTED, BENEFITS, AND THE AMOUNTS ARE AVAILABLE IN FUTURE PERIODS TO THE EMPLOYEE SUBJECT TO CONTINUING EMPLOYMENT. PPHS MAINTAINS OWNERSHIP OF THE FUNDS ALLOCATED TO EACH PARTICIPANT UNTIL VESTING AND PAYMENT. FOR A PARTICIPANT IN THE SERP PRIOR TO 1/1/2017 (A "GRANDFATHERED PARTICIPANT"), THE FIRST VESTING DATE WILL OCCUR ON THE DATE THE PARTICIPANT ATTAINS FIVE YEARS OF PARTICIPATION UNDER THE PLAN. AFTER THE INITIAL VESTING DATE, A GRANDFATHERED PARTICIPANT SHALL HAVE A NEW VESTING DATE ONCE EVERY 5 YEARS. THESE ADDITIONAL VESTING DATES WILL OCCUR ON THE 5TH ANNIVERSARY OF EACH VESTING DATE AFTER THE INITIAL VESTING DATE. ON EACH VESTING DATE, A GRANDFATHERED PARTICIPANT WILL BECOME 100% VESTED IN AN AMOUNT EQUAL TO THE PARTICIPANT'S ACCOUNT BALANCE REDUCED BY ANY PAY CREDITS CREDITED TO THE ACCOUNT FOR THE 2 MOST RECENT PLAN YEARS. FOR PARTICIPANTS INITIALLY PARTICIPATING IN THE SERP AFTER 12/31/2016, EACH YEAR'S ANNUAL PAY CREDIT PLUS SUBSEQUENT EARNINGS AND/OR LOSSES WILL 100% VEST ON THAT PAY CREDITS' 5TH ANNIVERSARY, PROVIDED THAT THE PARTICIPANT REMAINS IN THE CONTINUOUS EMPLOYMENT THROUGHOUT THE 5-YEAR PERIOD FOR EACH ANNUAL PAY CREDIT. IF ANY ELIGIBLE PARTICIPANT ATTAINS NORMAL RETIREMENT AGE PRIOR TO THIS SEPARATION FROM SERVICE, THEY SHALL VEST IN 100% OF THE ACCOUNT BALANCE. ONCE VESTED, EACH PARTICIPANT SHALL RECEIVE A DISTRIBUTION OF THEIR ENTIRE VESTED AMOUNT WITHIN A REASONABLE PERIOD NOT TO EXCEED 2.5 MONTHS. THIS DISTRIBUTION IS TREATED AS REPORTABLE COMPENSATION TO THE PARTICIPANT AND IS INCLUDED IN PART II, COLUMN B(III). THEREFORE, PART II, COLUMN B(III) INCLUDES PRIOR YEAR SERP DEFERRALS PREVIOUSLY REPORTED IN PART II, COLUMN C. ANY DISTRIBUTION AMOUNT INCLUDED IN PART II, COLUMN B(III) THAT WAS PREVIOUSLY REPORTED IN PRIOR PERIODS AS DEFERRED COMPENSATION IN PART II, COLUMN C IS DISCLOSED IN PART II, COLUMN F. THE FOLLOWING PARTICIPANT VESTED AND RECEIVED PAYMENT OF SERP BENEFITS IN THE 2016 CALENDAR YEAR. JOEL WERNICK 5,947,873 (MULTI-YEAR VESTED AMOUNT)(NORMAL RETIREMENT AGE) SCHEDULE J, PART II, COLUMN B(II) CERTAIN EXECUTIVE OFFICERS AND PHYSICIANS ARE ELIGIBLE FOR BONUS/INCENTIVE PAYMENTS. THESE BONUSES ARE DETERMINED BASED ON THE ACHIEVEMENT OF VARIOUS ORGANIZATIONAL AND PERSONAL PERFORMANCE GOALS ESTABLISHED BY A FORMAL PROCESS IN KEEPING WITH THE ORGANIZATION'S TAX-EXEMPT STATUS. COMPENSATION PROCESS FOR TOP OFFICIAL AS DETERMINED BY PPHS THE ORGANIZATION'S FORMAL PROCESS FOR DETERMINING TOTAL COMPENSATION FOR THE CEO IS INTENDED TO PROVIDE REASONABLE COMPENSATION FOR ACCOMPLISHING THE ORGANIZATION'S MISSION, ACHIEVE ITS STRATEGIC GOALS, TO RECOGNIZE PERFORMANCE, AND TO OPERATE IN KEEPING WITH THE ORGANIZATION'S OBLIGATIONS AS A TAX-EXEMPT CHARITABLE ORGANIZATION. THE EXECUTIVE COMPENSATION COMMITTEE OF THE PPHS'S BOARD OF DIRECTORS CONDUCTS AN ANNUAL REVIEW OF THE COMPENSATION OF THE CEO. THE COMMITTEE RETAINS A QUALIFIED INDEPENDENT COMPENSATION CONSULTANT TO CONDUCT COMPETITIVE MARKET ANALYSIS OF THE MARKET RANGES OF BASE, INCENTIVE AND TOTAL CASH COMPENSATION. THE INFORMATION THE COMMITTEE MAY CONSIDER CAN INCLUDE BUT IS NOT LIMITED TO THE PERFORMANCE OF AN INDIVIDUAL, THE PERFORMANCE OF THE ORGANIZATION, AN INDIVIDUAL'S LENGTH OF SERVICE, CREDENTIALS AND EXPERIENCE, THE ELEMENTS OF TOTAL COMPENSATION AND SALARY HISTORY, THE ORGANIZATION'S COMPENSATION TARGETS, AND COMPARABILITY DATA, INCLUDING THE DATA PREPARED BY THE INDEPENDENT CONSULTANT AND REVIEWED WITH THE COMMITTEE. THE COMMITTEE INCORPORATES A FORMAL PERFORMANCE APPRAISAL PROCESS IN THE CEO COMPENSATION REVIEW. IT UTILIZES A MULTI-PERSPECTIVE APPROACH AND PERFORMANCE MEASURES WHICH ARE LINKED TO THE ORGANIZATION'S LONG-TERM STRATEGIC PLAN AND ACHIEVEMENT OF ANNUAL SYSTEM OBJECTIVES. THE CEO IS NOT PRESENT WHEN THE COMMITTEE DISCUSSES AND ESTABLISHES HIS COMPENSATION. SOUTHERN PATHOLOGY AND LABORATORY SERVICES PC CONTROL ENTITY 120000 LAB DIRECTOR FEE false SCHEDULE L, PART V SANDRA ZORNES, M.D. IS A BOARD MEMBER AND THE LAB DIRECTOR OF THE FILING ORGANIZATION. DR. ZORNES IS ALSO THE OWNER OF SOUTHERN PATHOLOGY AND LABORATORY SERVICES, P.C. THE FILING ORGANIZATION CONTRACTS WITH SOUTHERN PATHOLOGY AND LABORATORY SERVICES, P.C. FOR DR. ZORNES' SERVICES AS LAB DIRECTOR. FORM 990, PAGE 6, PART VI, LINE 6 THE SOLE MEMBER OF PHOEBE SUMTER MEDICAL CENTER, INC. SHALL BE PHOEBE PUTNEY HEALTH SYSTEM, INC. (PPHS). FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD OF DIRECTORS OF PPHS, THE SOLE MEMBER, SHALL APPOINT ALL DIRECTORS OF THE FILING ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 7B THE SOLE MEMBER, PPHS, SHALL HAVE THE FOLLOWING RESPONSIBILITIES: - THE MEMBER SHALL APPOINT OR REMOVE THE ORGANIZATION'S DIRECTORS. - THE MEMBER SHALL SELECT OR REMOVE THE ORGANIZATION'S OFFICERS. - THE MEMBER SHALL APPROVE ALL AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY MAY BECOME EFFECTIVE. - THE MEMBER SHALL APPROVE ANY ANNUAL OPERATING OR CAPITAL BUDGETS. - THE MEMBER SHALL APPOINT OR REMOVE THE INDEPENDENT AUDITORS. FORM 990, PAGE 6, PART VI, LINE 11B THE INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 (BASED UPON INFORMATION PROVIDED BY THE ORGANIZATION) PROVIDES A COMPLETE COPY OF THE RETURN WITH APPLICABLE SCHEDULES TO BE REVIEWED BY MANAGEMENT. MANAGEMENT PERFORMS A DETAILED REVIEW WHICH CONSISTS OF REVIEWING THE FINANCIAL DATA, THE NARRATIVES DISCLOSED, AND OTHER FACTS PRESENTED ON THE RETURN. UPON REVIEW, THE FORM 990 IS THEN FORWARDED TO THE FINANCE COMMITTEE FOR THEIR REVIEW, TO GAIN THEIR COMMENTS AND APPROVAL. UPON APPROVAL FROM THE FINANCE COMMITTEE, THE FORM 990 AND RELATED SCHEDULES ARE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND FEEDBACK. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES, A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PAGE 6, PART VI, LINE 12C ON AN ANNUAL BASIS, PHOEBE SUMTER MEDICAL CENTER, INC. (PSMC) BOARD MEMBERS AS WELL AS ALL OFFICERS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. THIS QUESTIONNAIRE IS ADMINISTERED BY THE PHOEBE PUTNEY HEALTH SYSTEM (PPHS) COMPLIANCE DEPARTMENT AND THE DOCUMENT ASKS EACH INDIVIDUAL TO DISCLOSE ANY PERSONAL, BUSINESS, OR OTHER AFFILIATIONS AND MONETARY AMOUNT IF APPLICABLE THAT THEY OR THEIR IMMEDIATE FAMILY MEMBERS HAVE HAD WITHIN THE PAST 12 MONTHS WITH PSMC OR ANY RELATED ENTITIES. ALL RESPONSES ARE THEN EVALUATED BY THE PPHS COMPLIANCE DEPARTMENT. IN THE CASE OF AN EXISTING CONFLICT, THE INDIVIDUAL WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL TO SUCH TRANSACTIONS. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES AVAILABLE TO THE PUBLIC ITS CONFLICT OF INTEREST AND AUDITED FINANCIAL STATEMENTS ON THE ORGANIZATION'S WEBSITE, BY PROVIDING COPIES UPON REQUEST, AND BY INSPECTION AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION. FORM 990, PART IX, LINE 11G PHYSICIAN FEES 7,032,477 0 0 CONTRACT LABOR 4,711,984 0 0 COLLECTION FEES 0 447,269 0 PURCHASED SERVICES 4,013,197 4,474,433 0 TOTAL 15,757,658 4,921,702 0 FORM 990, PART XI, LINE 9 INTEREST IN NET ASSETS OF SUMTER FOUNDATION 116,952 THE CHANGE IN NET ASSETS IS THE RESULT OF NONCASH TRANSACTIONS WHICH ARE DETAILED ABOVE. 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