2013-11-13T08:05:03-06:00 2012-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2012-01-01 570988736 CLEMSON HEALTH CENTER INC CLEM 8646540716 885 TIGER BLVD CLEMSON SC 29631 KEVIN HERBERT 8646540716 2013-11-13 AMY BIBBY P00445891 8282542254 2012 2016-02-25 16:41:14Z JERRY PARRISH 885 TIGER BLVD CLEMSON SC 29631 2456570 0 X WWW.CLEMSONHEALTH.COM X 1993 SC PROVIDE URGENT, OUTPATIENT DIAGNOSTIC AND PRIMARY HEALTH CARE FOR THE CITIZENS OF CLEMSON, SC. 4 0 51 0 0 0 0 268478 2166464 2150352 0 0 33979 34264 2200443 2453094 0 0 0 0 981888 1347319 0 0 0 1262118 1127067 2244006 2474386 -43563 -21292 2190450 2163356 125482 119680 2064968 2043676 TO PROVIDE URGENT, OUTPATIENT DIAGNOSTIC AND PRIMARY HEALTH CARE SERVICES FOR THE CITIZENS OF CLEMSON, SC REGARDLESS OF THEIR ABILITY TO PAY. 0 0 2372025 2184616 PROVIDED URGENT, OUT PATIENT DIAGNOSTIC AND PRIMARY CARE HEALTH CARE, REGARDLESS OF THE ABILITY TO PAY, TO 31,516 PATIENTS AT THE CLINIC LOCATED IN CLEMSON, SC. 2372025 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 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 12 0 1 51 1 0 0 0 0 0 0 0 0 0 0 X 4 0 0 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 SC X JENNIFER SARAFIN 8646546800 885 TIGER BLVD CLEMSON SC 29631 X JEANNE WARD 1.00 40.00 X X 0 343578 68570 KEVIN HERBERT 1.00 40.00 X X 0 178836 9520 JERRY A PARRISH 1.00 40.00 X X 0 65 3549 JOHN A MILLER JR 1.00 40.00 X X 0 4060571 70962 JENNIFER SARAFIN 40.00 X 0 59277 19726 DAVID LIEBMAN MD 40.00 X 122786 0 18780 ALLISON AUSTIN 40.00 X 145961 0 12671 EDMOND JORDAN 40.00 X 177045 0 0 445792 4642327 203778 3 0 1 0 ALLSCRIPTS 24630 NETWORK PLACE CHICAGO IL 60673 MEDICAL RECORD SOFTWARE 124401 1 268478 268478 NET PATIENT SERVICE RE 621400 2150352 2150352 2150352 26738 3476 23262 23262 23262 MISCELLANEOUS 900099 11002 11002 11002 2453094 2184616 0 0 X 1177445 1177445 83606 83606 86268 86268 29277 29277 7900 7900 490907 425723 65184 9752 9752 124667 124667 43701 43701 15859 15859 1715 1715 2001 2001 95620 95620 70828 70828 MEDICAL SUPPLIES 117507 117507 BAD DEBT EXPENSE 117333 117333 2474386 2372025 102361 0 8334 7595 353189 310446 31304 34071 25973 24056 3301771 1515682 1770551 1786089 1099 1099 2190450 2163356 94708 111467 30774 8213 125482 119680 X 2064968 2043676 2064968 2043676 2190450 2163356 -21292 0 X 0 0 0 X X X 0 0 0 ANMED HEALTH 570359174 3 1 0 OCONEE MEDICAL CENTER 570357963 3 1 0 2 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 861945 861945 1438912 893889 545023 60820 37783 23037 940094 584010 356084 1786089 0 1 0 0 0 0 0 0 0 JEANNE WARD 0 341966 0 0 0 1612 0 57858 0 10712 0 412148 0 0 KEVIN HERBERT 0 177224 0 0 0 1612 0 6307 0 3213 0 188356 0 0 JOHN A MILLER JR 0 141764 0 0 0 3918807 0 0 0 70962 0 4131533 0 1432244 ALLISON AUSTIN 145961 0 0 0 0 0 0 0 12671 0 158632 0 0 0 EDMOND JORDAN 177045 0 0 0 0 0 0 0 0 0 177045 0 0 0 PART I, LINE 4B THE FOLLOWING OFFICER RECEIVED DEFERRED COMPENSATION ALLOCATIONS FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN PROVIDED BY OCONEE MEDICAL CENTER, A RELATED ORGANIZATION: JEANNE WARD - 49,922 THE PURPOSE OF THE OCONEE MEDICAL CENTER EXECUTIVE DEFERRED COMPENSATION PLAN IS TO PROVIDE RETIREMENT BENEFITS FOR CERTAIN EXECUTIVE LEVEL EMPLOYEES IN ADDITION TO THE BENEFITS PROVIDED THROUGH THE OTHER RETIREMENT PLANS THAT ARE SPONSORED BY THE COMPANY. ELIGIBILITY TO PARTICIPATE IN THE PLAN IS CURRENTLY LIMITED TO THE CEO, JEANNE WARD. EMPLOYER CONTRIBUTIONS SHALL BECOME FULLY VESTED ON THE PARTICIPANT'S VESTING DATE AS LONG AS THE PARTICIPANT IS EMPLOYED WITH THE EMPLOYER ON THE VESTING DATE AND SATISFIES THE REQUIREMENTS OF THE PLAN. THE DEFERRED VESTING DATE IS SUBJECT TO A VESTING SCHEDULE THAT REQUIRES A MINIMUM DEFERRAL OF 2 YEARS TO BECOME VESTED. THERE ARE NO LIMITS ON CONTRIBUTIONS TO THE PLAN. IF THE PARTICIPANT'S EMPLOYMENT WITH THE ORGANIZATION IS TERMINATED "WITHOUT CAUSE," THE FULL VALUE OF HIS ACCOUNT SHALL BECOME FULLY VESTED. IN THE CASE OF A VOLUNTARY TERMINATION OF EMPLOYMENT BY THE EXECUTIVE OR INVOLUNTARY TERMINATION OF EMPLOYMENT FOR CAUSE BY THE COMPANY, THE NON-VESTED FUNDS ARE FORFEITED. SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: COMPENSATION OF BOARD MEMBERS JEANNE WARD AND KEVIN HERBERT IS PAID BY OCONEE MEDICAL CENTER (OMC), A RELATED ORGANIZATION. ALL COMPENSATION RECEIVED BY THESE BOARD MEMBERS IS FOR THEIR SERVICES RENDERED TO OMC AS OFFICERS OF THAT ORGANIZATION. THE BOARD OF DIRECTORS OF OMC UTILIZED THE FOLLOWING METHODS TO DETERMINE APPROPRIATE COMPENSATION FOR THE INDIVIDUALS THAT HAD INFLUENCE OVER THE ORGANIZATION'S ACTIVITIES: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE COMPENSATION OF BOARD MEMBERS JOHN A. MILLER AND JERRY A. PARRISH, AND OFFICER JENNIFER SARAFIN IS PAID BY ANMED HEALTH, A RELATED ORGANIZATION. ALL COMPENSATION RECEIVED BY THESE TWO BOARD MEMBERS IS FOR THEIR SERVICES RENDERED TO ANMED HEALTH AS OFFICERS OF THAT ORGANIZATION. THE BOARD OF DIRECTORS OF ANMED HEALTH UTILIZED THE FOLLOWING METHODS TO DETERMINE APPROPRIATE COMPENSATION FOR THE INDIVIDUALS THAT HAD INFLUENCE OVER THE ORGANIZATION'S ACTIVITIES: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACTS - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART II, COLUMN (B)(III): THE FOLLOWING INDIVIDUAL RECEIVED A PAYOUT FROM A DEFERRED COMPENSATION PLAN BY A RELATED ORGANIZATION THAT IS TAXABLE IN THE CURRENT PERIOD: JOHN A. MILLER - $ 3,871,706 THE PAYOUT LISTED ABOVE IS COMPRISED OF $ 1,194,980 OF DEFERRED COMPENSATION REPORTED ON A PRIOR FORM 990 AND $2,676,726 OF MARKET ADJUSTMENTS AND AMOUNTS ACCRUED PRIOR TO THE REVISED REPORTING REQUIREMENTS OF 990 SCHEDULE J. FORM 990, PART VI, SECTION A, LINE 1 THE ORGANIZATION IS MANAGED BY A TWO PERSON EXECUTIVE COMMITTEE CONSISITNG OF THE CEO OR OTHER EXECUTIVE OFFICER OF EACH MEMBER. THE FOLLOWING ACTIONS BY THE ORGANIZATION SHALL REQUIRE APPROVAL OF BOTH MEMBERS OF THE EXECUTIVE COMMITEE: -ADOPTION OF AN ANNUAL OPERATING BUDGET -CAPITAL EXPENDITURES IN EXCESS OF $5,000 -DEVELOPMENT OF ANY NEW SERVICES OR INCURRING ANY EXPENDITURE WHICH REQUIRES A CONTRACT -DECISION TO SELL ALL OR SUBSTANTIALLY ALL OF THE ASSETS -DISSOLUTION OR LIQUIDATION -AMENDING OR MODIFYING THE BYLAWS -ADOPTION OF CLINICAL AND MEDICAL PRIVILEGE AND GUIDELINE POLICIES. FORM 990, PART VI, SECTION A, LINE 3 ON MARCH 1, 2002, CLEMSON HEALTH CENTER ENTERED INTO A MANAGEMNT SERVICES AGREEMNT WITH ANMED HEALTH PLAN, INC. A SOUTH CAROLINA CORPORATION. AS PART OF THE AGREEMENT, CLEMSON HEALTH CENTER GRANTS ANMED HEALTH PLAN THE RESPONSABILITY FOR PRACTICE MANAGEMENT SERVICES, SUBJECT TO THE GENERAL APPROVAL OF THE BOARD OF DIRECTORS OF CLEMSON HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO MEMBERS: ANMED HEALTH, AND OCONEE MEDICAL CENTER. BOTH OF THE MEMBERS ARE SOUTH CAROLINA 501(C)(3) ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION AND REVIEW BY MANAGEMENT, THE FORM 990 IS REVIEWED BY THE GOVERNING BODY AT A SCHEDULED MEETING PRIOR TO ITS FILING. IF NO MEETING IS SCHEDULED, THE FORM 990 IS EMAILED TO THE GOVERNING BODY FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD ANNUALLY REVIEWS THE CONFLICT OF INTEREST POLICY AND COMPLIANCE WITH THE POLICY. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION SHOWN FOR OFFICERS OF CLEMSON HEALTH CENTER IS FOR SERVICES PERFORMED FOR RELATED ORGANIZATIONS. THE COMPENSATION IS DETERMINED BY METHODS EMPLOYED BY THE RELATED ORGANIZATIONS WHICH INCLUDES UTILIZING AN OUTSIDE COMPENSATION CONSULTANT, USE OF COMPENSATION STUDIES, AND APPROVAL BY COMPENSATION COMMITTEE OR BOARD. MANAGEMENT IS PROVIDED AND COMPENSATED IN ACCORDANCE WITH THE MANAGEMENT AGREEMENT BETWEEN THE ORGANIZATION AND ANMED HEALTH, A SUPPORTED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE CORPORATION'S ARTICLES OF INCORPORATION ARE AVAILABLE FROM THE SC SECRETARY OF STATE. OTHER GOVERNING DOCUMENTS INCLUDING THE BY-LAWS AND OPERATING POLICIES, SUCH AS THE CONFLICT OF INTEREST POLICY, ARE BY STATE LAW NOT SUBJECT TO PUBLIC DISCLOSURE. THIS FORM 990 CONSTITUTES THE CORPORATION'S PUBLIC DISCLOSURE OF ITS FINANCIAL STATEMENTS. COMPENSATION FOR DIRECTORS: FORM 990 PART VII, SECTION A, LINE 1A, COLUMN E AND F: COMPENSATION INCLUDED FOR DIRECTORS OF CLEMSON HEALTH CENTER IS FOR SERVICES PERFORMED TO RELATED ORGANIZATIONS. IN ADHERENCE TO A SERVICES AFFILIATION AGREEMENT BETWEEN RELATED ORGANIZATION ANMED HEALTH AND UNRELATED ORGANIZATION CAROLINAS HEALTH SYSTEM, DIRECTORS JOHN A. MILLER AND JERRY A. PARRISH RECEIVED COMPENSATION FROM THE UNRELATED ORGANIZATION FOR THEIR SERVICES AS OFFICERS OF ANMED HEALTH WHICH IS NOT REPORTED ON THIS FORM 990. OTHER FEES FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 425,723. MANAGEMENT AND GENERAL EXPENSES 65,184. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 490,907. ANMED HEALTH 800 NORTH FANT STREET ANDERSON SC 29621 570359174 HOSPITAL SC 501(C)(3) LINE 3 ANMED HEALTH SYSTEM 0 OCONEE MEDICAL CENTER 298 MEMORIAL DRIVE SENECA SC 29672 570357963 HOSPITAL SC 501(C)(3) LINE 3 N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 1 0