2012-08-14T10:39:35-05:00 2011-09-30 Deloitte Tax LLP 191 Peachtree Street Suite 2000 Atlanta GA 30303 990 2010-10-01 202935692 McLeod Physician Associates II MCLE 8437772256 555 E Cheves Street Florence SC 295020551 S FULTON ERVIN III 8437772911 2012-08-14 1 John W Sadoff Jr 4042201500 2010 2016-02-24 21:20:13Z McLeod Physician Associates Robert Colones 555 E Cheves Street Florence SC 29502 64577527 0 X www.mcleodhealth.org X 2005 SC Physician Services 3 0 536 0 0 0 37564 58330 57100376 64582300 -1115 -21374 -196590 -72906 56940235 64546350 0 0 0 0 45078430 53564058 0 0 0 15904384 19659433 60982814 73223491 -4042579 -8677141 8709821 12065445 24011611 36044376 -15301790 -23978931 X McLeod Physician Associates II operates as part of the McLeod Health system. The Mission of McLeod Health is to improve the overall health and well being of people living within South Carolina and eastern North Carolina by providing excellence in health care. 0 0 70142290 64582300 McLeod Physician Associates II's primary goal is to provide physician services to the residents of the Pee Dee Region of South Carolina. 70142290 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 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 0 1 51 0 1 536 1 0 0 0 0 0 0 0 0 0 1 1 0 X 3 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Mark Cameron 8437775304 555 East Cheves Street Florence SC 29505 X Robert L Colones 40.00 X 0 729167 74257 S Fulton Ervin III 40.00 X 0 384170 81706 Michael E Payne 40.00 X 0 190413 59264 Dane P Ficco 40.00 X 0 324164 86078 Christopher G Cunningham MD 40.00 X 634008 0 66857 Albert T Gilpin MD 40.00 X 686697 0 66891 Charles R Tatum MD 40.00 X 749281 0 66788 Christopher N Shaw MD 40.00 X 604014 0 66241 Fred W Holland MD 40.00 X 671673 0 26256 3345673 1627914 594338 79 0 1 0 University Medical Associates PO Box 250619 Charleston SC 29425 Medical Services 700000 Medical Doctor Associates Inc PO Box 277185 Atlanta GA 303847185 Medical Services 297654 Vitera Health Care Solutions 4301 W Boy Scout Blvd Suite 800 Tampa FL 33607 Data Processing Services 252775 Soliant Physician Staffing LLC 1 Independent Drive Suite 800 Jacksonville FL 32202 Medical Services 199140 LabCorp PO Box 12140 Burlington NC 272162140 Medical Services 144405 5 57330 1000 58330 Physician Services 621110 52684346 52684346 Subsidy Fees 621110 11897954 11897954 64582300 9803 31177 -21374 -21374 -21374 Other Revenue 900099 -72906 -72906 -72906 64546350 64582300 0 -94280 46696948 46052495 644453 262793 248630 14163 4897271 4797820 99451 1707046 1659594 47452 1678587 1678587 148643 7500 141143 2325350 2261581 63769 248388 113149 135239 4695629 4615847 79782 395225 392801 2424 3262439 3134773 127666 115427 101748 13679 8204 7919 285 910144 892864 17280 823535 821643 1892 Bad Debt 4949037 4952337 -3300 0 Dues and Subscriptions 41742 35966 5776 0 Licenses and Taxes 27239 24360 2879 0 Other Direct Expenses 22480 13899 8581 0 Contract Labor 7364 7364 0 0 73223491 70142290 3081201 0 -626703 -357976 4408418 5743973 326062 409885 579827 902630 12278348 7948811 3095919 4329537 926298 1037396 8709821 12065445 4355388 5439093 19656223 30605283 24011611 36044376 X -15301790 -23978931 -15301790 -23978931 8709821 12065445 -8677141 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 289677 93291 196386 11988671 7855520 4133151 4329537 Due from Foundation 70361 Other Miscellaneous 11501 Employee Uniforms -2892 Due from Caresouth (Current) 51178 CSV-Life Insurance 614093 Other Assets Due From 293155 1037396 Retirement Liabilities/Split Dollar Plan 898112 Intercompany 29707171 30605283 X X X X X X 0 0 0 0 0 1 1 0 0 Robert L Colones 0 623774 0 98184 0 7209 0 31200 0 43057 0 803424 0 0 S Fulton Ervin III 0 309659 0 55111 0 19400 0 22000 0 59706 0 465876 0 0 Michael E Payne 0 167155 0 19632 0 3626 0 17254 0 42010 0 249677 0 0 Dane P Ficco 0 281320 0 38894 0 3950 0 14700 0 71378 0 410242 0 0 Christopher G Cunningham MD 626862 0 0 0 7146 0 38500 0 28357 0 700865 0 0 0 Albert T Gilpin MD 682135 0 0 0 4562 0 38500 0 28391 0 753588 0 0 0 Charles R Tatum MD 742531 0 0 0 6750 0 38500 0 28288 0 816069 0 0 0 Christopher N Shaw MD 600415 0 0 0 3599 0 38500 0 27741 0 670255 0 0 0 Fred W Holland MD 668707 0 0 0 2966 0 0 0 26256 0 697929 0 0 0 Part I, Line 6 Part I, Line 6a: Incentives are available to employees in leadership positions based on a combination of criteria including financial goals as well as quality initiatives. Part I, Line 6b: Incentives are available to employees in leadership positions of this and related organizations based on a combination of criteria including financial goals as well as quality initiatives. Doing Business As Form 990, Part I, Item C McLeod Physician Associates Form 990, Part VI, Section A, line 6 McLeod Physician Associates II has a sole member which is McLeod Health. Form 990, Part VI, Section A, line 7a The Board of McLeod Health (sole member) has final authority as needed on the makeup and decision-making of McLeod Physician Associates II's Board. Form 990, Part VI, Section A, line 7b The Board of McLeod Health (sole member) has final authority as needed on the makeup and decision-making of McLeod Physician Associates II's Board. Form 990, Part VI, Section B, line 11 The process the organization uses to review the Form 990 consists of providing copies of the Form 990 to the Board of Trustees of McLeod Health (Sole Member of McLeod Physician Associates II) at the May 2012 Board meeting, along with a presentation covering the Form 990 by the preparing firm, Deloitte Tax, to allow for a thorough review by the Sole Member's Board before the filing date of August 15, 2012. Form 990, Part VI, Section B, line 12c McLeod Physician Associates II regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee meeting will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Section B, line 15 In determining compensation of McLeod Health's (sole member's) CEO and the other officers and key employees, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The governance committee reviewed and approved the CEO's compensation. In the review of compensation, the CEO, other officers, and other key employees were compared to other similarly situated organizations and positions. Individuals were not present when their compensation was determined. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy, and financial statements are available to the public upon request. Avg hours devoted to related org(s) when related comp is reported: Form 990, Part VII: Robert L. Colones' compensation is paid by McLeod Health, a related organization of McLeod Physician Associates II. The compensation he receives is for his role as CEO of McLeod Health and not for his role as a Board Member, an uncompensated role, of McLeod Physician Associates II. Hours worked are not tracked on an entity by entity basis. Therefore, all hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week. S. Fulton Ervin, III's compensation is paid by McLeod Health, a related organization of McLeod Physician Associates II. The compensation he receives is for his role as CFO at McLeod Health and not for his role as a Board Member, an uncompensated role, of McLeod Physician Associates II. Hours worked are not tracked on an entity by entity basis. Therefore, all hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week. Michael Payne's compensation is paid by McLeod Health, a related organization of McLeod Physician Associates II. The compensation he receives is for his role as a Vice President at McLeod Health and not for his role as a Board Member, an uncompensated role, of McLeod Physician Associates II. Hours worked are not tracked on an entity by entity basis. Therefore, all hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week. Dane P. Ficco's compensation is paid by McLeod Health, a related organization of McLeod Physician Associates II. The compensation he receives is for his role as a Vice President at McLeod Health and not for his role as a Board Member, an uncompensated role, of McLeod Physician Associates II. Hours worked are not tracked on an entity by entity basis. Therefore, all hours reported on Form 990, Part VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week. Community Benefit Report: Form 990, Part III, Line 4a: The McLeod Health system (of which McLeod Physician Associates II is a part of) conducts or participates in many community programs that help further McLeod Physician Associates II's exempt purpose by promoting the health of the community. This narrative highlights just some of these programs: Recognized nationally for its quality initiatives and methodology, McLeod Health has a leading regional presence in Northeastern South Carolina and Southeastern North Carolina and a reputation for dedication to its patients and their families. McLeod is constantly seeking to improve its patient care with efforts that are physician led, data-driven and evidence-based. The 15-county area McLeod serves has a population more than one million including those who live in Southeastern North Carolina. Founded in 1906, McLeod Health is a locally owned and managed, not for profit organization supported by the strength of nearly 750 members on the medical staff and more than 1,100 full time nurses. In addition to its modern facilities, premier technology and equipment, McLeod is dedicated to improving the health of the residents of those communities served. McLeod Health is composed of more than 4,700 full time employees and over 50 physician practices in eight counties. With five hospitals, McLeod Health also operates a Health and Fitness Center, Sports Medicine and Outpatient Rehabilitation Center, a Behavioral Health Center, Hospice, and Home Health Services. The hospitals within McLeod Health include: McLeod Regional Medical Center, McLeod Darlington, McLeod Dillon, and as of January 2012, McLeod Loris and McLeod Seacoast. The flagship hospital of the McLeod Health organization is McLeod Regional Medical Center in Florence, South Carolina. This regional referral tertiary care center serves patients and families living in the northeastern region of South Carolina. The medical center includes an accredited Cancer Center and Breast Health Center, three dedicated open heart surgery suites and the new Heart & Vascular Institute as well as Centers of Excellence in Heart, Cancer, Surgery, Neurosurgery, Trauma, Children's and Women's Services in addition to a Diabetes Center, Rehabilitation and Sports Medicine Services, and the Center for Advanced Surgery, which all deliver an unmatched level of care and experience to people in the region. One of only five state-designated regional perinatal centers, McLeod Regional Medical Center also offers the region's only Children's Hospital which includes a 40-bed Neonatal Intensive Care Unit and six-bed Pediatric Intensive Care Unit. As the only teaching facility in the region, McLeod also supports a Family Medicine Residency Program. In addition, the McLeod Hospice House, an inpatient facility which will soon expand to 24-beds, is located on the campus. McLeod Health has been recognized numerous times for its outstanding work in quality care, best practices and clinical outcomes as well as its physician's dedication to quality improvement. The efforts to improve quality and patient safety are physician led, data-driven and evidence-based. Because of this commitment by strong, active physician and staff participation, McLeod has received national recognition for quality including the 2010 American Hospital Association-McKesson Quest for Quality Prize. Awarded annually to one hospital in the country, McLeod is the first hospital in South Carolina to receive this prestigious honor since the inception of the national Quest for Quality Prize in 2002. The mission of McLeod Health is to improve the overall health and well being of people living within South Carolina and eastern North Carolina by providing excellence in healthcare. Through the years, the facility has expanded, developed and created milestones in the areas of cancer services, advanced surgery, pediatrics, heart and vascular, hospice, radiology, women's services and orthopedics. The medical center has championed this mission for more than a century - celebrating 105 years of exceptional medical service to the region. The mission of McLeod Health is anchored by the core values that the institution was built upon in 1906: the values of caring, the person, integrity, and quality. These values are exemplified by the willing and compassionate service to others that is evident in the hospital operations, continuous long-range planning, and the men and women who have chosen to be a part of the McLeod team of talent in their individual fields of expertise. This group of physicians, nurses, staff members, board members and volunteers are dedicated to caring for the community with much more than medical care. Their commitment extends past the medical center's brick and mortar and into the service areas of South Carolina and eastern North Carolina in an effort to build a stronger and healthier place for patients, co-workers, children and neighbors to live and work. The medical community, both nationally and on a state/ local level, has made cut backs due to shrinking reimbursements. McLeod Health is no exception. Shrinking reimbursements and healthcare reform have been the drivers for initiating changes that improve the ability for healthcare providers to reduce cost while maintaining quality. At McLeod, we have continued to provide and grow essential services to care for patients in our region with a commitment to quality and operational efficiency. These treatments and programs address significant disease processes prevalent in our state's population - including heart disease, cancer, diabetes, and premature births. Some of these critical patient care services are located only at McLeod for the people living in the Northeastern region of South Carolina. McLeod Health continues to explore more meaningful and productive ways to meet its mission, offering programs and activities which are a community benefit. Community benefits are defined as programs that respond to public health needs and supply services that would likely be discontinued - or would need to be provided by another not-for-profit or government provider - if the decision was made on a purely financial basis. McLeod Health provides community benefits that promote prevention, healing and treatment including health education, support groups, health screenings and immunizations, free and discounted medical supplies, health education and research, and financial and in-kind contributions. In Fiscal Year 2011, McLeod Health provided the region with $104.1 Million dollars worth of Charity Care to benefit community families. McLeod Health not only provides community benefit through the services offered but also by stimulating the local economy. Last year we contributed more than $10 Million in sales tax, approximately $814,000 in Property Taxes, and more than $12.7 Million in hospital provider taxes to benefit the communities where its employees and patients live and work. These benefits to the community demonstrate the spirit of willing and compassionate service that is at the heart, and the legacy, of McLeod Health. McLeod Regional Medical Center of Pee Dee Inc 555 East Cheves Street Florence SC 295020551 570370242 To operate a hospital SC 501(c)(3) Line 3 N/A 0 McLeod Health Foundation 555 East Cheves Street Florence SC 295020551 570818672 To raise money for McLeod Entities SC 501(c)(3) Line 11a, I N/A 0 McLeod Medical Center - Dillon 555 East Cheves Street Florence SC 295020551 510473471 To operate a hospital SC 501(c)(3) Line 3 N/A 0 McLeod Health 555 East Cheves Street Florence SC 295020551 510473500 To operate a healthcare system SC 501(c)(3) Line 3 N/A 0 McLeod Medical Partners LLC 4401 Barclay Down Dr STE 300 Charlotte NC 282094670 570812002 Rental SC N/A 0.00000 McLeod Physician Associates Inc 555 East Cheves Street Florence SC 29501 582279897 Physician Services SC N/A C 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 McLeod Health L 1678587 Actual Cost of Services Provided McLeod Health Foundation C 57330 Actual Cash Transferred McLeod Regional Medical Center of the Pee Dee Inc K 8200340 Actual Cost of Services Provided McLeod Medical Center - Dillon K 707193 Actual Cost of Services Provided