2017-11-15T07:51:31-06:00 2016-12-31 742900215 MAXWELL LOCKE & RITTER LLP 401 CONGRESS AVENUE SUITE 1100 AUSTIN TX 787019682 990 2016-01-01 742865171 GEORGETOWN HEALTHCARE COMMUNITY SERVICES GEOR 5129312221 2425 WILLIAMS DRIVE NO 101 GEORGETOWN TX 786283206 SCOTT ALARCON CEO 5129312221 2017-11-13 1 SEAN HOLCOMB P01249221 5123703200 2017-11-13 168.215.174.114 2017-11-13 22:30:57 CS P 3FE05A933AB24BF812E94A4299775645CECC4085 4E7B285EF54255559246988FB61A8B86C7A1B977 2016 2021-01-29 14:40:06Z SCOTT ALARCON 2425 WILLIAMS DRIVE NO 101 GEORGETOWN TX 786283206 2541725 0 X N/A X 1997 TX ASSISTS COMMUNITY NON-PROFITS THAT PROVIDE SAFETY NET SERVICES TO THE GEORGETOWN COMMUNITY. 17 17 0 0 0 0 0 0 2463027 1363137 398449 9856 -120326 -117635 2741150 1255358 219480 0 0 0 712202 0 0 0 0 1092152 870444 2023834 870444 717316 384914 16303833 15563653 15653999 14471607 649834 1092046 ASSISTS COMMUNITY NON-PROFITS THAT PROVIDE SAFETY NET SERVICES TO THE GEORGETOWN COMMUNITY. 0 0 811791 1363137 UTILIZE REAL ESTATE HOLDINGS TO ASSIST OTHER COMMUNITY NON-PROFIT ORGANIZATIONS THAT PROVIDE SAFETY NET SERVICES FOR THE GEORGETOWN COMMUNITY BY PROVIDING LEASE SPACE AT LESS THAN FAIR MARKET VALUE. 55800 EXPENSES RELATED TO THE MANAGEMENT OF ASSETS HELD BY THE ORGANIZATION AND UTILIZED TO FURTHER THE GRANT MAKING ACTIVITIES OF GEORGETOWN HEALTHCARE SYSTEM. 867591 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 28 0 0 0 0 0 0 0 0 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X RICHARD SCHULTZ CFO 5129312221 2425 WILLIAMS DRIVE NO 101 GEORGETOWN TX 786283206 KAREN COLE CHAIR 2.00 X 0 0 0 DARRICK MCGILL CHAIR-ELECT 1.50 X 0 0 0 DOAK FLING PAST CHAIR 1.50 X 0 0 0 ALMA GUZMAN SECRETARY 1.50 X 0 0 0 JOAN MAIER BOARD MEMBER 1.50 X 0 0 0 CARRIE BRADSHAW BOARD MEMBER 1.00 X 0 0 0 AUSTIN BRYAN BOARD MEMBER 1.00 X 0 0 0 J BRAD CURLEE BOARD MEMBER 1.00 X 0 0 0 JIM DONOVAN MD BOARD MEMBER 1.00 X 0 0 0 DALE ILLIG BOARD MEMBER 1.00 X 0 0 0 ASHLIE KOENIG BOARD MEMBER 1.00 X 0 0 0 CINDY LOCKE BOARD MEMBER 1.00 X 0 0 0 SCOTT MATTHEW BOARD MEMBER 1.00 X 0 0 0 STACEY MATHEWS BOARD MEMBER 1.00 X 0 0 0 LINDA MEIGS BOARD MEMBER 1.00 X 0 0 0 RICHARD PEARCE MD BOARD MEMBER 1.00 X 0 0 0 JOHN STOCK BOARD MEMBER 1.00 X 0 0 0 M SCOTT ALARCON CEO 40.00 X 0 271682 22172 RICHARD SCHULTZ CFO 40.00 X 0 209073 11435 0 480755 33607 0 0 1 0 0 FACILITY RENTAL TO COMM HEALTH SE 900099 1363137 1363137 1363137 9856 9856 1168732 1286367 -117635 -117635 -117635 1255358 1363137 0 -107779 275 275 17 17 1099 900 199 224770 224645 125 107 107 635820 633566 2254 7975 7975 MISC EXPENSES 381 381 870444 867591 2853 0 224000 694609 174882 147797 66409 60950 26391329 11731032 15838542 14660297 16303833 15563653 523890 559904 4525065 4056659 10605044 9855044 15653999 14471607 X 649834 1092046 649834 1092046 16303833 15563653 X 384914 57298 X X 0 1 X 1 0 X X 1 GEORGETOWN HEALTHCARE SYSTEM INC 742427148 3 1 0 0 1 0 0 0.67700 0.32300 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART I, CHANGE IN REASON FOR PUBLIC CHARITY STATUS FROM LINE 10 TO LINE 12: UNDER IRC SEC. 509(A)(3), AN ORGANIZATION CAN QUALIFY FOR NONPRIVATE FOUNDATION STATUS IF IT IS ORGANIZED AND OPERATED TO PROVIDE SUPPORT TO ANOTHER EXEMPT ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. TO QUALIFY UNDER THIS PROVISION, THE SUPPORTING ORGANIZATION MUST BE ORGANIZED (ORGANIZATIONAL TEST") AND OPERATE ("OPERATIONAL TEST") EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF AN ORGANIZATION QUALIFYING FOR NONPRIVATE FOUNDATION STATUS UNDER IRC SEC. 509(A)(1) OR (A)(2). THE SUPPORTING ORGANIZATION MUST BE OPERATED, SUPERVISED, CONTROLLED BY, OR IN CONNECTION WITH THE BENEFICIARY ORGANIZATION ("RELATIONSHIP TEST"), AND MUST NOT BE CONTROLLED DIRECTLY OR INDIRECTLY BY A DISQUALIFIED PERSON (OTHER THAN A FOUNDATION MANAGER OR A PUBLIC CHARITY). THE ORGANIZATION SATISFIES ALL TESTS REFERENCED ABOVE AND ITS BENEFICIARY ORGANIZATION, GEORGETOWN HEALTHCARE SYSTEM, INC. IS ORGANIZED IN THE UNITED STATES. 2607577 2607577 23254563 11517876 11736687 271258 113561 157697 123605 99595 24010 134326 134326 14660297 DUE TO AFFILIATED ENTITIES 9855044 9855044 X PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT ORGANIZATION THAT IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, EXCEPT FOR ANY UNRELATED BUSINESS ACTIVITIES. NO EXPENSE HAS BEEN PROVIDED FOR INCOME TAXES IN THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS. THE ORGANIZATION WAS INCLUDED IN GEORGETOWN HEALTHCARE SYSTEM, INC'S COMBINED INDEPENDENT AUDITED FINANCIAL STATEMENTS FOR THE TAX YEAR. 0 0 0 0 0 0 0 0 0 M SCOTT ALARCON CEO 0 264482 0 0 0 7200 0 13062 0 9110 0 293854 0 0 RICHARD SCHULTZ CFO 0 207873 0 0 0 1200 0 9935 0 1500 0 220508 0 0 PART I, LINE 3 GEORGETOWN HEALTHCARE COMMUNITY SERVICES DOES NOT HAVE EMPLOYEES, BUT IS ADMINISTERED AND RUN BY EMPLOYEES OF GEORGETOWN HEALTHCARE SYSTEM, INC. SCHEDULE J, PART II, ROW (II): RELATED ORGANIZATION: GEORGETOWN HEALTHCARE SYSTEM, INC. 74-2427148 FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S TAX RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. AN INITIAL DRAFT OF THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS AND MANAGEMENT PRIOR TO FINALIZATION. AFTER ANY CHANGES RESULTING FROM THE REVIEW HAVE BEEN MADE, THE FINAL VERSION OF FORM 990 IS FILED AND A COPY OF THE FILED FORM IS DISTRIBUTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S BOARD OF DIRECTORS AND KEY EMPLOYEES REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY. EACH INDIVIDUAL IS REQUIRED TO COMPLETE AND SIGN A DOCUMENT PROVIDED BY THE ORGANIZATION DISCLOSING ANY INTEREST THEY MAY HAVE WHICH COULD GIVE RISE TO A CONFLICT OF INTEREST. THE ORGANIZATION COMPILES A LIST OF ALL DISCLOSURES AND REPORTS IT TO ALL MEMBERS OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 GEORGETOWN HEALTHCARE COMMUNITY SERVICES DOES NOT HAVE EMPLOYEES, BUT IS ADMINISTERED AND RUN BY EMPLOYEES OF GEORGETOWN HEALTHCARE SYSTEM (GHS). THE ORGANIZATION'S COMPENSATION COMMITTEE FOLLOWS AN EXECUTIVE COMPENSATION PLAN DEVELOPED AND RATIFIED BY THE BOARD OF DIRECTORS WHEN DETERMINING EXECUTIVE COMPENSATION. THIS PHILOSOPHY IS UTILIZED TO DETERMINE THE ANNUAL COMPENSATION OF THE CHIEF EXECUTIVE OFFICER (CEO) AND THE CHIEF FINANCIAL OFFICER (CFO). AS PART OF THIS PROCESS, THE BOARD CONTRACTED WITH SMITHPILOT IN 2015 TO ASSIST IN THE DEVELOPMENT OF FAIR MARKET VALUE EXECUTIVE COMPENSATION. SMITHPILOT IS A COMPANY THAT SPECIALIZES IN EXECUTIVE COMPENSATION ISSUES IN THE NON-PROFIT AREA. SMITHPILOT CREATED AN EXECUTIVE COMPENSATION GUIDELINE FOR THE CEO AND CFO USING COMPARATIVE DATA FROM MULTIPLE NATIONAL PUBLIC INFORMATION SECTORS. THOSE SOURCES INCLUDED: THE GUIDESTAR NONPROFIT COMPENSATION REPORT, PRM'S MANAGEMENT COMPENSATION REPORT FOR NOT-FOR-PROFITS ORGANIZATIONS, COUNCIL ON FOUNDATIONS, GRANTMAKERS SALARY AND BENEFITS SURVEY AND REPORT, INSIDENGO SALARY AND BENEFITS SURVEY AND TOWERS WATSON'S SURVEYS OF TOP MANAGEMENT COMPENSATION; OFFICE AND BUSINESS SUPPORT. MARKET SALARY AVERAGES (GEOGRAPHICALLY FACTORED) FOR BOTH THE CEO AND CFO WERE ESTABLISHED USING THIS DATA. THE COMPENSATION COMMITTEE'S RECOMMENDATIONS FOR THE CEO AND CFO WERE RATIFIED BY THE FULL BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE REPORTING ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: UNREALIZED GAIN/-LOSS ON INTEREST RATE SWAP 57,298. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S OVERSIGHT PROCESS AND ITS PROCESS FOR SELECTION OF AN INDEPENDENT ACCOUNTANT DID NOT CHANGE DURING THE TAX YEAR. GEORGETOWN HEALTHCARE SYSTEM 2425 WILLIAMS DRIVE GEORGETOWN TX 78628 742427148 HOSPITAL TX 501(C)(3) LINE 3 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0