2013-08-13T09:56:44-05:00 2012-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2011-10-01 570341194 GEORGETOWN MEMORIAL HOSPITAL GEOR 8435277100 PO DRAWER 1718 GEORGETOWN SC 294421718 BRUCE P BAILEY 8435277100 2013-08-06 1 AMY BIBBY P00445891 8282542254 2011 2016-02-24 21:20:13Z BRUCE P BAILEY PO DRAWER 1718 GEORGETOWN SC 294421718 135619957 0 X WWW.GEORGETOWNHOSPITALSYSTEM.ORG X 1946 SC TO PROVIDE HIGH QUALITY HEALTHCARE TO THE CITIZENS OF GEORGETOWN CO. AND SURROUNDING AREAS 7 6 0 135 0 0 400826 584053 119039930 129369249 4770645 4280302 1269547 1232254 125480948 135465858 258705 118083 0 0 58556725 59272409 0 0 415333 58324299 70821991 117139729 130212483 8341219 5253375 283539480 305120886 75026602 80705840 208512878 224415046 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 111721784 118083 129369249 GEORGETOWN MEMORIAL HOSPITAL PROVIDES QUALITY HEALTH CARE AND PROMOTES HEALTH AND WELLNESS TO GEORGETOWN COUNTY AND SURROUNDING AREAS. GEORGETOWN MEMORIAL HOSPITAL IS A 131 BED ACUTE FACILITY LOCATED IN THE CITY OF GEORGETOWN, SOUTH CAROLINA. THE HOSPITAL WAS ORGANIZED UNDER THE LAWS OF THE STATE OF SOUTH CAROLINA IN 1946 FOR THE PURPOSE OF OPERATING A COMMUNITY HOSPITAL IN 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 RULING 69-545, 1969-2 C.B. 117, AS MODIFIED BY REV. RUL. 83-157, 1983-2 C.B. 94, SETS FORTH THE FACTORS THE INTERNAL REVENUE SERVICES WILL CONSIDER IN DETERMINING WHETHER A NONPROFIT HOSPITAL QUALIFIED FOR TAX EXEMPT STATUS.THE HOSPITAL OPERATES ITS FACILITIES IN A MANNER DESCRIBED IN REV. RUL. 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, 2012, THE HOSPITAL FURNISHED CHARITY CARE IN THE AMOUNT OF $14,506,438. 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 WEEKLY CHOLESTEROL AND BLOOD PRESSURE SCREENINGS, AN ANNUAL HEALTH FAIR HELD AT TWO COUNTY LOCATIONS WHICH OFFERS 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 OPEN TO THE PUBLIC, INCLUDING CPR, WEIGHT CONTROL, SMOKING CESSATION, CHILDBIRTH EDUCATION, PRE-NATAL AND INFANT NUTRITION, AND OTHERS. 111721784 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 X 102 0 1 0 0 0 0 0 0 1 1 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 1 1 SC X X TERRY KISER 8435277100 606 BLACK RIVER RD GEORGETOWN SC 29440 H MCROY SKIPPER 1.00 X X 0 0 0 ALAN S ALTMAN 1.00 X X 0 0 0 JULIAN A REYNOLDS 1.00 X X 0 0 0 MARTHENA MORANT 1.00 X 0 0 0 FRANCIS B FORD JR 1.00 X 0 0 0 WALTER F JOHNSON III 1.00 X 0 0 0 VICTOR M DIAZ-GONZALEZ MD 1.00 X 6650 0 0 BRUCE BAILEY 18.00 X 246014 287985 55668 TERRY KISER 18.00 X 163032 190848 34229 GAYLE RESETAR 18.00 X 158295 185301 36476 RICK KAYLOR 18.00 X 119877 140330 58323 FRANK SCAFIDI 18.00 X 90169 105553 51218 SUZANNE DOSCHER 40.00 X 178847 0 22695 ANN WATERS 40.00 X 223117 0 55142 JAMES F HARPER 23.00 X 124781 94631 53520 ROY E GILBREATH III 18.00 X 173262 202823 85354 1484044 1207471 452625 43 0 1 1 SODEXHO PO BOX 536922 ATLANTA GA 30353 FOOD SERVICE 2917488 PALMETTO EMERGENCY PHYSICIANS 86 SHOREBIRD LOOP PAWLEYS ISLAND SC 29585 ER PHYSICIANS 2538867 ARAMARK HEALTHCARE (SERVICE MASTER) 22506 NETWORK PLACE CHICAGO IL 60673 HOUSEKEEPING 2159304 EAGLE HOSPITAL PHYSICIANS 5901-C PEACHTREE DUNWOODY RD 350 ATLANTA GA 30328 HOSPITALISTS 1940379 GEORGETOWN ANESTHESIA CONSULTANTS PC 130 PRESERVATION CIRCLE PAWLEYS ISLAND SC 29585 ANESTHESIA SERVICES 1147225 35 149363 434690 584053 NET PATIENT SERVICES 621400 123266357 123266357 MEANINGFUL USE 900099 2519886 2519886 FITNESS CENTER 900099 1634213 1634213 PHARMACY 446110 1115249 1115249 MEALS 722210 442819 442819 390725 390725 129369249 2626709 2626709 1228033 0 1228033 1228033 1228033 1632431 21162 0 0 1632431 21162 1653593 1653593 16570 149363 64688 -48118 -48118 87166 89411 -2245 -2245 DISCOUNTS/REBATES 900099 54584 54584 54584 135465858 129369249 0 5512556 118083 118083 778956 6650 772306 43393189 35239269 7910752 243168 1706187 1361673 335120 9394 10260229 8188478 2015257 56494 3133848 2501060 615533 17255 417972 417972 1497202 1497202 42315 42315 4205538 3255997 871783 77758 559862 12807 547055 5135112 3877754 1250646 6712 1957699 1929007 28692 581475 266046 310877 4552 1390900 1390900 10178053 10178053 468073 468073 MEDICAL SUPPLIES 21866688 21866688 BAD DEBT EXPENSE 21392150 21392150 RECRUITMENT 663775 663775 MISCELLANEOUS EXPENSE 465177 137169 328008 130212483 111721784 18075366 415333 3765 3990 49515515 43098435 11367012 15780544 4664171 4885164 2729623 2509292 209176249 115830391 88790950 93345858 87261343 104646377 35149966 36636283 583838 4057135 3631105 283539480 305120886 16569496 17396990 40711714 44964785 17745392 18344065 75026602 80705840 X 207786022 223443605 726856 971441 208512878 224415046 283539480 305120886 X 5253375 10648793 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 50 0 0 0 0 1 4020 4070 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 $1,274 FOR AHA AND $2,746 FOR SCHA. 16937678 16937678 89330540 39119888 50210652 2953018 2217082 735936 95339155 74493421 20845734 4615858 4615858 93345858 DUE FROM AFFILIATE 36636283 C 36636283 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1242802 ACCRUED PENSION LIABILITY 17101263 18344065 135465858 130212483 5253375 13740673 -3091880 10648793 15902168 146179339 13740673 -3027192 10713481 135465858 0 135465858 130277171 64688 64688 130212483 0 130212483 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: GEORGETOWN MEMORIAL 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, 2012. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN ADDITIONAL PENSION LIABILITY -3,091,880. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN ADDITIONAL PENSION LIABILITY -3,091,880. FUNDRAISING EVENT DIRECT EXPENSES 64,688. PART XIII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT DIRECT EXPENSES 64,688. 2012 SNOW BALL GALA 74577 69477 5100 303 15344 9065 2011 BREAST CANCER AWARENESS 40035 40035 200 12800 3 51321 39851 11470 1190 12943 5049 7794 165933 149363 16570 1493 12943 20393 200 29659 64688 -48118 1 1 X 1 X 1 X 1 1 0 1 1 4552286 1293428 3258858 0.02990 17122182 12163155 4959027 0.04560 21674468 13456583 8217885 0.07550 632223 632223 0.00580 64379 64379 0.00060 247978 39160 208818 0.00190 944580 39160 905420 0.00830 22619048 13495743 9123305 0.08380 561532 561532 0.00520 561532 561532 0.00520 1 6713101 3675806 34797526 40228079 -5430553 X 1 1 1 WACCAMAW ENDOSCOPY CENTER HEALTHCARE SERVICES 0.50000 0.50000 1 1 GEORGETOWN MEMORIAL HOSPITAL

606 BLACK RIVER ROAD GEORGETOWN SC 29442

X X X DISPROPORTIONATE SHARE HOSPITAL GEORGETOWN MEMORIAL HOSPITAL 1 1 1 200.000000000000 1 300.000000000000 1 X X X X 1 1 X X X X 1 X 1 X X X X 1 X 0 0 9 NEXTSTEP PHYSICAL THERAPY & PAIN MGMT CE

219 CHURCH STREET GEORGETOWN SC 29440

ADULT REHAB/PAIN MGMT HEALTHPOINT CENTER FOR HEALTH & FITNESS

12965 OCEAN HIGHWAY PAWLEYS ISLAND SC 29585

FITNESS CLUB/ADULT REHAB NEXTSTEP REHABILITATION SERVICES

3515 CADUCEUS DRIVE MYRTLE BEACH SC 29588

ADULT & PEDIATRIC REHAB NEXTSTEP REHABILITATION SERVICES

4040 HWY 17 SUITE 201 MURRELLS INLET SC 29576

ADULT REHABILITATION & NEUROLOGICAL REHAB NEXTSTEP REHABILITATION SERVICES

701 S MORGAN AVE ANDREWS SC 29510

ADULT REHABILITATION NEXTSTEP REHABILITATION SERVICES

407 CHURCH ST SUITE E GEORGETOWN SC 29440

PEDIATRIC REHABILITATION GEORGETOWN INFUSION SERVICES MURRELS

4181 HIGHWAY 17 BYPASS MURRELLS INLET SC 29576

INFUSION SERVICES GEORGETOWN INFUSION SERVICES GEORGETOW

2405 NORTH FRASER ST GEORGETOWN SC 29442

INFUSION SERVICES GEORGETOWN ENDOSCOPY CENTER

2361 NORTH FRASER ST GEORGETOWN SC 29440

ENDOSCOPY CENTER 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 2011 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 $21,392,150 THAT HAS BEEN REMOVED FOR PURPOSES OF COMPUTING PERCENTAGE OF TOTAL EXPENSE ON COLUMN (F). PART II: IN ADDITION, $560,000 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 2011 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. 50% 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. 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 A POPULATION OF APPROXIMATELY 282,000. 18% OF THE POPULATION IS OVER THE AGE OF 65 AND THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $43,000. IN ADDITION, AN ESTIMATED 17% OF THE POPULATION IS BELOW THE POVERTY LEVEL. GEORGETOWN COUNTY (815 SQ. MILES) HAS A POPULATION OF APPROXIMATELY 60,000 PEOPLE AND AN ESTIMATED 21% OF THE POPULATION IS OVER THE AGE OF 65. THE MEDIAN HOUSEHOLD INCOME IS APPROXIMATELY $43,000 AND AN ESTIMATED 21% OF THE POPULATION IS BELOW THE POVERTY LEVEL. COMPETING HOSPITALS ARE LOCATED APPROXIMATELY 40-45 MILES NORTH AND NORTHWEST AND 60 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: GEORGETOWN MEMORIAL 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 1 AMERICAN CANCER SOCIETY 950 48TH AVE N SUITE 101 MYRTLE BEACH SC 29577 131788491 501(C)(3) 5000 OPERATIONAL SUPPORT AMERICAN HEART ASSOCIATION (MID-ATLANTIC AFFILIATE) 4217 PARK PLACE COURT GLEN ALLEN VA 23060 135613797 501(C)(3) 13000 OPERATIONAL SUPPORT ANDREWS HIGH SCHOOL ATHLETICS 12890 COUNTY LINE RD ANDREWS SC 29510 10000 OPERATIONAL SUPPORT CARVERS BAY SCHOOL ALL SPORTS BOOSTER CLUB 13002 CHOPEE ROAD HEMINGWAY SC 29554 5000 OPERATIONAL SUPPORT GEORGETOWN COUNTY UNITED WAY PO BOX 1065 GEORGETOWN SC 29442 570526145 501(C)(3) 5000 OPERATIONAL SUPPORT HEALTHY LEARNERS PROGRAM 2711 MIDDLEBURG DRIVE SUITE 206 COLUMBIA SC 29204 571127197 501(C)(3) 50000 OPERATIONAL SUPPORT HELPING HANDS OF GEORGETOWN INC 1813 HIGHMARKET ST GEORGETOWN SC 29440 570883461 501(C)(3) 12200 OPERATIONAL SUPPORT MARCH OF DIMES FOUNDATION 314 LAUREL STREET SUITE 201 CONWAY SC 29526 131846366 501(C)(3) 5000 OPERATIONAL SUPPORT SMITH MEDICAL CLINIC PO BOX 1740 PAWLEYS ISLAND SC 29585 570786699 501(C)(3) 25000 OPERATIONAL SUPPORT ST JAMES HIGH SCHOOL SHARKS BOOSTER CLUB PO BOX 4140 MURRELLS INLET SC 29576 331022599 501(C)(3) 5000 OPERATIONAL SUPPORT WACCAMAW HIGH SCHOOL ATHLETICS 2412 KINGS RIVER RD PAWLEYS ISLAND SC 29585 10000 OPERATIONAL SUPPORT 8 3 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION SELECTS GRANT RECIPIENTS BASED ON COMMUNITY NEEDS AND INDIVIDUAL PROJECT MERIT. FOLLOW-UP ON GRANTS AND ASSISTANCE VARIES DEPENDING ON THE TYPE OF ASSISTANCE AND TYPE OF PROJECT. MANY SMALLER GRANTS ARE PROVIDED FOR LOCAL SCHOOLS AND PUBLIC CHARITIES BASED ON A DEMONSTRATED NEED FOR OPERATIONAL FUNDS AND REQUIRE NO MONITORING. LARGER GRANTS, REQUIRE PRE-ESTABLISHED PROJECT MILESTONES TO BE REACHED BEFORE EACH DISBURSEMENT OF THE GRANT IS PAID OUT. 0 0 0 1 1 1 1 0 0 BRUCE BAILEY 189424 221741 43116 50472 13474 15772 3951 4624 21696 25397 271661 318006 0 0 TERRY KISER 120973 141612 28512 33377 13547 15859 3951 4624 11819 13835 178802 209307 0 0 GAYLE RESETAR 122393 143274 28543 33413 7359 8614 3951 4624 12854 15047 175100 204972 0 0 RICK KAYLOR 85615 100222 21884 25618 12378 14490 2143 2509 24726 28945 146746 171784 0 0 FRANK SCAFIDI 70128 82093 9420 11027 10621 12433 1847 2162 21749 25460 113765 133175 0 0 SUZANNE DOSCHER 138736 0 23794 0 16317 0 6341 0 16354 0 201542 0 0 0 ANN WATERS 154436 0 28979 0 39702 0 4518 0 50624 0 278259 0 0 0 JAMES F HARPER 85408 64773 17046 12927 22327 16931 2169 1645 28268 21438 155218 117714 0 0 ROY E GILBREATH III 131406 153825 23436 27435 18420 21563 2136 2500 37187 43531 212585 248854 0 0 PART I, LINE 5 INCENTIVE COMPENSATION PAID TO THE OFFICERS 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 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, GAYLE RESETAR, AND SUZANNE DOSCHER WAS PAID THROUGH QUORUM HEALTH RESOURCES (QHR), AN UNRELATED MANAGEMENT COMPANY. SEE THE RESPONSE TO PART VI, LINE 3 ON SCHEDULE O FOR DETAILS ON THE ARRANGEMENT. ALL AMOUNTS LISTED ON SCHEDULE J, PART II, LINE (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, JAMES F. HARPER, ROY E. GILBREATH III, AND FRANK SCAFIDI ARE COMPENSATED BY A COMMON PAYING AGENT FOR SERVICES PERFORMED FOR BOTH GEORGETOWN MEMORIAL HOSPITAL AND A RELATED ORGANIZATION. COMPENSATION FOR THESE INDIVIDUALS IS PRESENTED TO REFLECT AN ALLOCATION OF SERVICES PERFORMED FOR THESE ORGANIZATIONS. SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 2010-12-22 30000000 CAPITAL ACQUISITION 0 0 0 SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 2011-09-22 25565000 CURRENT REFUNDING 0 0 0 SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 2011-12-22 12165620 CURRENT REFUNDING 0 0 0 SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY 570960018 2012-05-30 34099717 CURRENT REFUNDING 0 0 0 10000000 82807 9761312 155881 2012 0 0 0 1 621690 9350748 94698 46050 9210000 2001 1 0 1 1 12190000 123522 12066478 1999 1 0 1 1 14664291 163692 345599 14155000 2001 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 1 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 C WERE USED TO REFUND BONDS THAT WERE ISSUED ON 3/15/1998 AND 8/15/1999. THE AMOUNTS IN COLUMN D WERE USED TO REFUND BONDS THAT WERE ISSUED ON 3/15/1998 AND 8/23/2001. BEVERLY SUE SKIPPER FAMILY MEMBER OF BOARD TRUSTEE H. MCROY SKIPPER 27469 COMPENSATION AS EMPLOYEE OF ORGANIZATION. AMOUNT SHOWN ON SCHEDULE L REPRESENTS GMH'S ALLOCATED PORTION OF TOTAL SALARY PAID FROM A RELATED ORGANIZATION. THE INDIVIDUAL RECEIVED $59,624 IN TOTAL FOR SERVICES RENDERED TO ALL RELATED ORGANIZATIONS. 0 BECCA KAYLOR FAMILY MEMBER OF OFFICER RICK KAYLOR 21012 COMPENSATION AS EMPLOYEE OF ORGANIZATION. AMOUNT SHOWN ON SCHEDULE L REPRESENTS GMH'S ALLOCATED PORTION OF TOTAL SALARY PAID FROM A RELATED ORGANIZATION. THE INDIVIDUAL RECEIVED $45,609 IN TOTAL FOR SERVICES RENDERED TO ALL RELATED ORGANIZATIONS. 0 0 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 995. 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 13,740,673. CHANGE IN ADDITIONAL PENSION LIABILITY -3,091,880. TOTAL TO FORM 990, PART XI, LINE 5: 10,648,793. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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. AVERAGE HOURS PER WEEK: FORM 990, PART VII, LINE 1A: OFFICERS BRUCE BAILEY, TERRY KISER, GAYLE RESETAR, RICK KAYLOR, AND HIGHEST COMPENSATED EMPLOYEES JAMES HARPER, FRANK SCAFIDI AND ROY GILBREATH DEVOTE A PORTION OF THEIR WORK WEEK TO WACCAMAW COMMUNITY HOSPITAL, AN AFFILIATED NON-PROFIT ORGANIZATION. HOURS LISTED ON PART VII, LINE 1A REPRESENT THE AVERAGE TIME SPENT FOR GEORGETOWN MEMORIAL HOSPITAL. GEORGETOWN HOSPITAL SYSTEM PO DRAWER 1718 GEORGETOWN SC 29442 020598440 HEALTHCARE SC 501(C)(3) LINE 11A, I 0 WACCAMAW COMMUNITY HOSPITAL PO BOX 3350 MURRELLS INLET SC 29576 043633263 HEALTHCARE SC 501(C)(3) LINE 3 GEORGETOWN HOSPITAL SYSTEM 0 GEORGETOWN RADIATION THERAPY CENTER 2307 N FRASIER STREET GEORGETOWN SC 29440 200131459 HEALTHCARE SC N/A 0 0 0 1 0 0 0 0 1 0 0 0 1 1 1 1 0 0