2013-11-14T15:06:11-06:00 2012-12-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2012-01-01 582460001 MEMORIAL HEALTH INC MEMO 9123508000 PO BOX 20389 SAVANNAH GA 314033089 LAURA DOW 9123508000 2013-11-14 1 AMY BIBBY P00445891 8282542254 2012 2016-02-25 16:41:14Z MARGARET GILL PO BOX 20389 SAVANNAH GA 314033089 506882 0 X WWW.MEMORIALHEALTH.COM X 1997 GA TO SUPPORT MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER, INC. 17 15 0 0 0 0 0 0 0 506882 0 0 0 0 0 506882 0 0 0 0 0 0 0 0 0 0 506882 0 506882 0 0 0 6631414 0 3985578 0 2645836 X TO PROVIDE ADMINISTRATIVE SUPPORT BY ENGAGING IN SUCH OTHER ACTIVITIES THAT BENEFIT, PERFORM THE FUNCTIONS OF, OR CARRY OUT THE PURPOSES OF MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER, INC. 1 0 506882 506882 TO PROVIDE ADMINISTRATIVE SUPPORT BY ENGAGING IN SUCH OTHER ACTIVITIES THAT BENEFIT, PERFORM THE FUNCTIONS OF, OR CARRY OUT THE PURPOSES OF MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER, INC. 506882 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 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 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 17 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 GA X LAURA DOW 9123508613 4600 WATERS AVENUE SAVANNAH GA 31404 CURTIS LEWIS III 1.00 2.00 X X 0 0 0 KAY A FORD 1.00 1.00 X X 0 0 0 HELEN DOWNING 1.00 1.00 X X 0 0 0 J HARRY HASLAM JR 1.00 1.00 X X 0 0 0 IRA BERMAN 1.00 1.00 X 0 0 0 ROBERT F BROWN JR MD 1.00 40.00 X 0 404085 23971 MARILYN BUCK EDD 1.00 1.00 X 0 0 0 GERALD CAPLAN 1.00 1.00 X 0 0 0 WILLIAM T DANIEL 1.00 1.00 X 0 0 0 MICHAEL A KAIGLER 1.00 1.00 X 0 0 0 WILLIAM LD LYGHT 1.00 1.00 X 0 0 0 CHARLES F MCMILLAN SR 1.00 1.00 X 0 0 0 MARK E MURPHY MD 1.00 1.00 X 0 0 0 CHRISTOPHER L WIXON MD 1.00 1.00 X 0 0 0 ARTHUR B DANA CPA CVA 1.00 1.00 X 0 0 0 JACKIE RABINOWITZ 1.00 2.00 X 0 0 0 FRANK ROSSITER JR 1.00 1.00 X 0 0 0 W REX TEMPLETON 1.00 1.00 X 0 0 0 0 404085 23971 0 0 1 0 0 INFORMATION TECHNOLOGY 900099 506882 506882 506882 506882 506882 0 0 317640 317640 143239 143239 46003 46003 506882 506882 0 0 429403 6157501 0 6157501 0 44510 0 6631414 3985 3981593 0 3985578 X 0 2645836 0 2645836 0 6631414 X 0 2645836 X X 0 1 X 1 0 X X X 0 0 0 MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER 311126469 3 1 0 1 0 6157501 6157501 6157501 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HEALTH SYSTEM IS PARTIALLY COMPRISED OF ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX PURSUANT TO SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. WITH RESPECT TO ANY UNRELATED BUSINESS INCOME GENERATED BY ITS FOR-PROFIT SUBSIDIARIES, THE HEALTH SYSTEM RECORDS INCOME TAXES USING THE LIABILITY METHOD UNDER WHICH THE DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL ACCOUNTING AND TAX BASES OF ASSETS AND LIABILITIES. DEFERRED TAX ASSETS OR LIABILITIES AT THE END OF EACH PERIOD ARE DETERMINED USING THE CURRENTLY ENACTED TAX RATE EXPECTED TO APPLY TO TAXABLE INCOME IN THE PERIOD THAT THE DEFERRED TAX ASSET OR LIABILITY IS EXPECTED TO BE REALIZED OR TO BE SETTLED. THE HEALTH SYSTEM HAS EVALUATED ITS TAX POSITIONS AND HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF DECEMBER 31, 2012. FISCAL YEARS ENDED ON OR AFTER DECEMBER 31, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. 0 0 0 0 0 0 0 0 0 ROBERT F BROWN JR MD 0 279008 0 123924 0 1153 0 0 0 23971 0 428056 0 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 IN 2012, THE ORGANIZATION BEGAN HOLDING THE ASSETS AND RELATED LIABILITIES REQUIRED TO ADMINISTER AN ELECTRONIC MEDICAL RECORDS SOFTWARE PROGRAM INTENDED TO BENEFIT ITS SUPPORTED ORGANIZATION. CURRENTLY, THE SOFTWARE IS BEING INSTALLED AND WILL BE FULLY OPERATIONAL IN 2013. EXPENSES TO BE REPORTED WITHIN THIS ENTITY ARE RELATED TO THE OPERATION AND MAINTENANCE OF THIS SOFTWARE SYSTEM AND ARE ALLOCATED TO THE ORGANIZATION BASED UPON ANNUAL TIME STUDIES. REVENUE TO BE RECOGNIZED IN CONJUNCTION WITH THIS SERVICE IS INTENDED TO DIRECTLY OFFSET OPERATIONAL EXPENSES AND WILL BE RECEIVED FROM SUPPORTED AND RELATED ORGANIZATIONS. FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURN IS PREPARED BY AN UNRELATED, INDEPENDENT ACCOUNTING FIRM AND THEN SUBMITTED TO SENIOR MANAGEMENT WITHIN THE ORGANIZATION'S ACCOUNTING DEPARTMENT FOR INTERNAL REVIEW. A DRAFT IS THEN PROVIDED TO THE FINANCE COMMITTEE AND THE ENTIRE BOARD FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED TO UPDATE AND SUBMIT A NEW CONFLICT OF INTEREST STATEMENT BY JANUARY 31 OF EACH YEAR. THE CHAIRMAN OF THE BOARD, PRESIDENT, AND CHIEF EXECUTIVE OFFICER AND THE CORPORATE COMPLIANCE OFFICER SHALL BECOME FAMILIAR WITH THE STATEMENTS OF THE BOARD MEMBERS IN ORDER TO GUIDE THEIR CONDUCT SHOULD A CONFLICT ARISE AT SUCH TIMES AS ANY MATTER COMES BEFORE THE BOARD THAT MAY POTENTIALLY RESULT IN A CONFLICT OF INTEREST. THE AFFECTED BOARD MEMBER SHALL MAKE KNOWN THE POTENTIAL CONFLICT, WHETHER OR NOT DISCLOSED IN A WRITTEN STATEMENT. THE AFFECTED BOARD MEMBER MAY MAKE A PRESENTATION TO THE BOARD OR A COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE OR SHE MUST LEAVE THE MEETING DURING THE DISCUSSION OF AND THE VOTE ON THE TRANSACTION OR ARRANGEMENT CONSIDERED TO BE A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS OF THE ORGANIZATION ARE HELD AS PUBLIC RECORDS OF THE STATE OF GEORGIA SECRETARY OF STATE OFFICE. AS SUCH, THESE DOCUMENTS ARE OPEN TO THE PUBLIC. THE CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC AS THIS IS NOT A REQUIREMENT. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: NET EQUITY TRANSFERS FROM AFFILIATES 2,645,836. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER FOUNDATION PO BOX 23089 SAVANNAH GA 314033089 581618486 SUPPORT OF MHUMC GA 501(C)(3) LINE 11A, I MEMORIAL HEALTH INC 1 GEORGIA EYE INSTITUTE INC PO BOX 23089 SAVANNAH GA 314033089 582023987 HEALTH CARE PROVIDER (DISSOLVED IN 2012) GA 501(C)(3) LINE 11A, I MEMORIAL HEALTH INC 1 MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER INC PO BOX 23089 SAVANNAH GA 314033089 311126469 HEALTH CARE PROVIDER GA 501(C)(3) LINE 3 MEMORIAL HEALTH INC 1 4600 WATERS AVE PROFESSIONAL CONDO ASSOCIATION INC PO BOX 23089 SAVANNAH GA 314033089 581990705 CONDO ASSOCIATION GA PROVIDENT HEALTH SERVICES INC C 0.52000 1 MEMORIAL HEALTH PARTNERS INC PO BOX 23089 SAVANNAH GA 314033089 581707311 MANAGED CARE GA PROVIDENT HEALTH SERVICES INC C 1.00000 1 MEMORIAL HEALTH ANESTHETISTS INC PO BOX 23089 SAVANNAH GA 314033089 431985441 MEDICAL SERVICES GA PROVIDENT HEALTH SERVICES INC C 1.00000 1 MEMORIAL HEALTH URGENTONE INC PO BOX 23089 SAVANNAH GA 314033089 582203199 MEDICAL SERVICES GA PROVIDENT HEALTH SERVICES INC C 1.00000 1 MPPG INC PO BOX 23089 SAVANNAH GA 314033089 582162071 PHYSICIANS PRACTICE GA PROVIDENT HEALTH SERVICES INC C 1.00000 1 PROVIDENT EYE PHYSICIANS INC PO BOX 23089 SAVANNAH GA 314033089 010601599 MEDICAL SERVICES GA PROVIDENT HEALTH SERVICES INC C 1.00000 1 PROVIDENT HEALTH SERVICES INC PO BOX 23089 SAVANNAH GA 314033089 581611969 MEDICAL SERVICES/ CONSOLIDATING ENTITY GA N/A C 60072033 24114381 1.00000 1 PROVIDENT PROFESSIONAL BUILDING CONDO ASSOCIATION INC PO BOX 23089 SAVANNAH GA 314033089 581845972 CONDO ASSOCIATION GA PROVIDENT HEALTH SERVICES INC C 0.74430 1 SAVANNAH MIDTOWN PROPERTIES INC PO BOX 23089 SAVANNAH GA 314033089 582537941 REAL ESTATE HOLDING GA PROVIDENT HEALTH SERVICES INC C 1.00000 1 PROVIDENT HEALTH SURGICAL ASSOCIATES INC PO BOX 23089 SAVANNAH GA 314033089 262961162 MEDICAL SERVICES GA PROVIDENT HEALTH SERVICES INC C 1.00000 1 MEMORIAL PROFESSIONAL ASSURANCE COMPANY PO BOX 1100 GRAND CAYMAN GRAND CAYMAN CJ KY1-1005 999999999 OTHER INSURANCE CJ N/A C 1.00000 1 SAVANNAH PEDIATRIC SPECIALISTS INC PO BOX 23089 SAVANNAH GA 314033089 270788131 MEDICAL SERVICES GA PROVIDENT HEALTH SERVICES INC C 1.00000 1 MEMORIAL HEALTH CORPORATE SERVICES INC 4700 WATERS AVE SAVANNAH GA 31404 900963434 CORPORATE SERVICES GA PROVIDENT HEALTH SERVICES INC C 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER INC S 506882 SCHEDULE R, PART IV, TAXABLE SUBSIDIARY REPORTING: PROVIDENT HEALTH SERVICES, INC. IS THE CONSOLIDATING PARENT CORPORATION FOR SEVERAL OTHER TAXABLE SUBSIDIARIES. AMOUNTS REPORTED ON SCHEDULE R, PART IV ARE RESPECTIVE OF THE CONSOLIDATED AMOUNTS FOR PROVIDENT HEALTH SERVICES AND SUBSIDIARIES.