2012-11-15T12:58:27-06:00 2011-12-31 420714325 MCGLADREY LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2011-01-01 581667166 MAYO CLINIC HEALTH SYSTEM IN WAYCROSS INC FKA SATILLA HEALTH SERVICES INC MAYO 9122833030 1900 TEBEAU STREET WAYCROSS GA 31501 ROBERT TRIMM 9122833030 2012-11-14 1 JOHN J ROMANO P00227323 6123324300 2011 2016-02-24 21:20:13Z X ROBERT TRIMM 1900 TEBEAU STREET WAYCROSS GA 31501 147340226 0 X WWW.SATILLA.ORG X 1985 GA TO PROVIDE HEALTHCARE THAT MEETS THE NEEDS OF THE COMMUNITY. 14 13 1660 118 6975 5637 781089 617736 143993215 142211068 1506206 1424746 2042915 2793220 148323425 147046770 88092 2500 0 0 63960145 64514704 0 0 0 77598435 79462469 141646672 143979673 6676753 3067097 165415523 171139807 51211564 61321394 114203959 109818413 TO CARE FOR AND IMPROVE THE QUALITY OF LIFE OF THE COMMUNITY THROUGH A SERVICE NETWORK OF MODERN HEALTHCARE FACILITIES, CARING AND COMPETENT STAFF, AND PRUDENT MANAGEMENT OF RESOURCES, REGARDLESS OF ABILITY TO PAY. 0 0 112597690 144617783 HOSPITAL AND NURSING HOME SERVICES; SHORT-TERM ACUTE CARE FOR INPATIENT AND OUTPATIENT SERVICES FOR THE LOCAL COUNTY AND SURROUNDING COUNTIES. PATIENT DAYS FOR THE YEAR ENDED 12/31/2011 WERE 38,873 FOR THE HOSPITAL AND 59,554 FOR THE NURSING HOME. 112597690 1 1 0 1 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 169 0 1 1660 1 1 1 0 0 0 0 0 0 0 0 0 X 14 13 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 GA X THE ORGANIZATION 9122872700 410 DARLING AVENUE WAYCROSS GA 31501 X OWEN HERRIN 4.00 X X 0 0 0 STEPHEN WATERS 2.00 X X 0 0 0 WADE DYE MD 2.00 X X 0 0 0 ROBERT TRIMM 40.00 X X 651643 313754 18369 LEWIS ALTMAN 2.00 X 0 0 0 ASHLEY DENTON 2.00 X 0 0 0 BETTY GANT 2.00 X 0 0 0 DR HA GRIFFIN JR 2.00 X 0 0 0 ZA MUSIC 2.00 X 0 0 0 ROBERT LANDRUM 2.00 X 0 0 0 FRANKLIN PINCKNEY 2.00 X 0 0 0 ANGELA ROWE 2.00 X 0 0 0 CC STEPHENS 2.00 X 0 0 0 DONALD WATERS MD 2.00 X 0 0 0 KATRINA WHEELER 40.00 X 120397 57968 14654 WINDELL SMITH JR 40.00 X 129016 62118 15073 RANDOLPH WHEELER 40.00 X 263277 0 12129 HOLLI SWEAT 40.00 X 152430 0 13332 JOHN LINDSEY 40.00 X 147362 0 13013 JOHN PHARR 40.00 X 130654 0 12350 KEN TYRE 40.00 X 124490 0 12245 1719269 433840 111165 50 0 1 0 ADVANCED ICU CARE INC 999 EXECUTIVE PARKWAY ST LOUIS MO 63141 ICU SERVICES 1447300 SOUTHEAST GEORGIA ANESTHESIA ASSOCIATES 1900 TEBEAU STREET WAYCROSS GA 31501 ANESTHESIA SERVICES 1419520 DIAGNOSTIC PET LLC 1256 SHILOH ROAD ELLAVILLE GA 31806 DIAGNOSTIC SERVICES 1103636 EXECUTIVE HEALTH RESOURCES INC PO BOX 822688 PHILADELPHIA PA 19182 PHYSICIAN ADVISOR 542443 QUEST DIAGNOSTIC NICHOLS INST FILE NO 51048 LOS ANGELES CA 90074 DIAGNOSTIC SERVICES 537851 28 6300 38250 397038 176148 617736 NET PATIENCE SERVICE R 621110 139241553 139241553 REFERENCE LAB 621500 2872504 2872504 MISC LAB FEES 621500 97011 97011 142211068 1683202 1683202 482067 0 482067 482067 482067 35000 0 293456 35000 -293456 -258456 -258456 CAFETERIA/CATERING REV 900099 1158219 1158219 JOINT VENTURE REVENUE 900099 528758 521783 6975 PHYSICIAN APPLICATION 900099 82250 82250 541926 541926 2311153 147046770 144515246 6975 1906813 2500 2500 1382992 1009584 373408 43500518 31775488 11725030 560373 409072 151301 15444494 11274481 4170013 3626327 2647219 979108 2514454 2514454 317635 317635 11514 11514 211393 211393 14147562 8630013 5517549 544200 59862 484338 281760 236678 45082 7195698 6691999 503699 176674 45935 130739 1636137 1636137 6562105 6102758 459347 1363432 40903 1322529 BAD DEBT 18023848 18023848 MEDICAL SUPPLIES 13915488 13915488 DRUG EXPENSE 5458156 5458156 ALL OTHER EXPENSES 4997962 4169255 828707 2104451 2104451 143979673 112597690 31381983 0 4954 4801 12505624 53817 22706052 22934624 1673679 1709667 1319490 1163222 130296631 70333315 57552608 59963316 41384191 47205429 -205125 -171203 28474050 38276134 165415523 171139807 16411475 20258732 140816 7223 31213778 30657416 27753 25248 1333507 2217828 10239182 51211564 61321394 X 114203959 109818413 114203959 109818413 165415523 171139807 X 3067097 -7452643 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11514 11514 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: 24% OF THE DUES PAID TO GEORGIA HOSPITAL ASSOCIATION (GHA), OF WHICH THE ORGANIZATION IS A MEMBER, ARE USED BY GHA FOR LOBBYING ACTIVITIES. 0 1 947742 947742 71571017 29845924 41725093 3187640 3250351 -62711 54590232 37237040 17353192 59963316 INTERCOMPANY RECEIVABLES 37718260 OTHER ASSETS 557874 38276134 THIRD PARTY SETTLEMENTS 5900000 FIN 48 LIABILITY 2225710 PY COST REPORT SETTLEMENTS 562210 UNEARNED INDIGENT CARE FUND 1280016 CONTINGENCY RESERVE 271246 10239182 PART IV, LINE 2B: THE ORGANIZATION HOLDS FUNDS IN ESCROW ON BEHALF OF ITS NURSING HOME RESIDENTS IN ORDER TO PAY THE RESIDENT'S PERSONAL BILLS, SUCH AS A HAIR STYLIST, CABLE, INSURANCE, AND CASH FOR SHOPPING TRIPS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION HAS ADOPTED THE ACCOUNTING STANDARD ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, WHICH ADDRESSES THE DETERMINATION OF WHETHER TAX BENEFITS CLAIMED OR EXPECTED TO BE CLAIMED ON A TAX RETURN SHOULD BE RECORDED IN THE FINANCIAL STATEMENTS. UNDER THIS GUIDANCE, THE ORGANIZATION MAY RECOGNIZE THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE-LIKELY-THAN-NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ALSO ADDRESSES DE-RECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES ON INCOME TAXES, AND ACCOUNTING IN INTERIM PERIODS. TAX POSITIONS ARE NOT OFFSET OR AGGREGATED WITH OTHER POSITIONS. TAX POSITIONS THAT MEET THE "MORE LIKELY THAN NOT" RECOGNITION THRESHOLD ARE MEASURED AS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS MORE THAN 50% LIKELY TO BE REALIZED ON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE IS REFLECTED AS A LIABILITY FOR UNCERTAIN TAX POSITIONS IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEET ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. THE PORTION OF LIABILITY THAT MANAGEMENT ANTICIPATES SETTLING IN 2012 IS CLASSIFIED AS A CURRENT LIABILITY AND THE REMAINING BALANCE IS CLASSIFIED AS OTHER LONG-TERM LIABILITIES. A RECONCILIATION OF THE UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2011 IS AS FOLLOWS BALANCE, BEGINNING OF YEAR, AS RESTATED - $1,842,040 ADDITIONS FOR TAX POSITIONS OF PRIOR YEARS - $383,670 REDUCTIONS FOR TAX POSITIONS OF PRIOR YEARS AS A RESULT OF LAPSE OF THE APPLICABLE STATUTE OF LIMITATIONS - $0 SETTLEMENTS - $0 BALANCE, END OF YEAR - $2,225,710 FOR THE YEAR ENDED DECEMBER 31, 2011, THE TOTAL AMOUNT OF UNCERTAIN TAX POSITIONS HAVE REDUCED INCOME TAX EXPENSE AND HAVE REDUCED THE DEFICIT OF REVENUE OVER EXPENSES BY $383,670 INTEREST EXPENSE AND PENALTIES ASSOCIATED WITH UNCERTAIN TAX POSITIONS FOR THE YEAR ENDED DECEMBER 31, 2011 ARE APPROXIMATELY $134,000 AND $65,000, RESPECTIVELY. 1 1 X 1 X 125.000000000000 1 X 1 1 0 1 1 12741825 2645081 10096744 0.08020 22247333 21083139 1164194 0.00920 34989158 23728220 11260938 0.08940 804323 480 803843 0.00640 861034 147790 713244 0.00570 322313 322313 0.00260 68605 68605 0.00050 2056275 148270 1908005 0.01520 37045433 23876490 13168943 0.10460 12105 12105 0.00010 24347 24347 0.00020 67857 67857 0.00050 377082 377082 0.00300 414 414 0.00000 481805 481805 0.00380 1 18023848 0 43617838 53981914 -10364076 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM IN WAYCROSS

410 DARLING AVENUE WAYCROSS GA 31501

X X X MAYO CLINIC HEALTH SYSTEM IN WAYCROSS 1 1 1 125.000000000000 1 200.000000000000 1 X X 1 1 X X X 1 X X 0 1 X 0 0 4 SATILLA CARE CENTER

1600 RIVERSIDE AVE WAYCROSS GA 31501

SKILLED NURSING FACILTY PIERCE COUNTY NURSING HOME

221 EAST CARTER AVE BLACKSHEAR GA 31516

SKILLED NURSING FACILTY SATILLA REHAB INSTITUTE

2500 SATILLA PARKWAY WAYCROSS GA 31501

REHAB UNIT SATILLA PSYCH

410 DARLING AVE WAYCROSS GA 31501

PSYCHIATRIC UNIT PART I, LINE 7: THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". COST IS CALCULATED BY APPLYING A COST TO CHARGE RATIO WHICH IS COMPUTED BY DIVIDING TOTAL EXPENSES LESS BAD DEBT BY GROSS CHARGES. PART I, LINE 7G: SATILLA ADVOCACY SERVICES IS A RAPE CRISIS AND CHILD ADVOCACY CENTER THAT OPERATES UNDER THE UMBRELLA OF MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. FKA SATILLA HEALTH SERVICES AND SERVES VICTIMS OF SEXUAL ASSAULT AND OTHER VIOLENT CRIMES IN THE SIX COUNTIES THAT MAKE UP THE WARE COUNTY JUDICIAL CIRCUIT. A FULL RANGE OF SERVICES IS OFFERED FROM THE TIME A VICTIM REPORTS AN INCIDENT, INCLUDING EMERGENCEY DEPARTMENT SERVICES, FOLLOW UP AT THE RAPE CRISIS/CHILD ADVOCACY CENTER, THERAPY, AND SUPPORT BY OUR LEGAL ADVOCACY PERSONNEL. IN 2011, SATILLA ADVOCACY SERVED 8,244 VICTIMS RESULTING IN A $466,000 BENEFIT TO OUR COMMUNITY. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 18023848. PART II: THE FOLLOWING IS A SUMMARY OF THE COMMUNITY BENEFIT ACTIVITIES AND HEALTH IMPROVEMENT SERVICES OF THE ORGANIZATION AND ILLUSTRATES THE ACTIVITIES AND DONATIONS DURING CALENDAR YEAR 2011.MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. PROVIDED HEALTH EDUCATION AND HEALTH SUPPORT SERVICES THAT REACHED 4,506 PEOPLE IN 2011 AT A COST OF $742,000. THESE SERVICES INCLUDED THE FOLLOWING CLASSES AND SEMINARS:- SIBLING SCHOOL- EPIDURAL CLASSES- CHILDBIRTH CLASSES- BREASTFEEDING CLASSES- BIRTHING CENTER TOURS- LACTATION CONSULTATION- CAMP HUFF N PUFF- SENIOR SAFETY DAY- SMOKING CESSATION- WOMEN'S HEALTH BLITZMAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. IS ALSO INVOLVED IN MANY ACTIVITIES AIMED AT EDUCATING THE COMMUNITY ABOUT HEALTH-RELATED TOPICS. EXAMPLES OF THESE ACTIVITIES INCLUDE A MONTHLY CALENDAR OF EVENTS AND CLASSES OFFERED AT THE HOSPITAL THAT IS DISTRIBUTED VIA EMAIL AND ADVERTISED IN LOCAL NEWSPAPERS.THE MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. STAFF PROVIDED BLOOD PRESSURE SCREENINGS, EDUCATIONAL PROGRAMS AND HEALTH SEMINARS TO RESIDENTS IN SCHOOLS, SENIOR CITIZEN CENTERS, AND SOCIAL CLUBS AND AT HEALTH FAIRS THROUGHOUT THE SERVICE AREA, INCLUDING SENIOR SAFETY DAY, SWAMPFEST AND PIERCE, BRANTLY AND WARE COUNTY HIGH SCHOOL FOOTBALL GAMES.MEDICATION ASSISTANCE PROGRAMMAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. PROVIDED STAFF TIME AND SUPPLIES IN THE AMOUNT OF $30,000 TO HELP 82 PATIENTS ACCESS FREE MEDICATIONS THROUGH THE PHARMACEUTICAL COMPANIES' PRESCRIPTION ASSISTANCE PROGRAM. IN ADDITION, THE ORGANIZATION ALSO PROVIDED $46,000 IN MEDICATIONS THROUGH THE INDIGENT PRESCRIPTION PROGRAM. PATIENTS WHO ARE UNABLE TO PAY FOR THEIR MEDICATIONS UPON DISCHARGE FROM THE HOSPITAL CAN ACCESS THE PROGRAM ONE TIME PER YEAR TO RECEIVE UP TO FIVE QUALIFYING MEDICATIONS. THE AVERAGE PHARMACY CHARGE PER PATIENT FUNDED BY MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. THROUGH THIS PROGRAM WAS $94.ENROLLMENT ASSISTANCEMAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. OFFERED ENROLLMENT ASSISTANCE TO 455 PEOPLE IN THE COMMUNITY SO THEY WOULD BE ABLE TO ACCESS PUBLIC HEALTH PROGRAMS SUCH AS MEDICAID.INDIGENT FINANCIAL ASSISTANCEPATIENTS WHOSE INCOME IS BELOW 125% OF THE FEDERAL POVERTY LEVEL ARE CLASSIFIED AS INDIGENT AND RECEIVE CARE AT NO COST. CHARITY FINANCIAL ASSISTANCEPATIENTS WHOSE INCOME LEVEL IS BETWEEN 126% AND 200% OF THE FEDERAL POVERTY LEVEL ARE CLASSIFIED AS CHARITY. THESE PATIENTS ARE RESPONSIBLE FOR A PERCENTAGE OF THEIR HOSPITAL CHARGES. THIS PERCENTAGE IS BASED ON A SLIDING CALCULATION TAKING INTO CONSIDERATION INCOME AND FAMILY SIZE. HEALTH PROFESSIONS EDUCATIONIN 2011, MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. WORKED WITH LOCAL COLLEGES AND TECHNICAL SCHOOLS TO OFFER CLINICAL ROTATIONS FOR A VARIETY OF HEALTH CARE PROFESSIONALS THAT INCLUDED PROVIDING A CLINICAL SETTING FOR 822 STUDENTS THAT INCLUDED SIX HOURS PER STUDENT OF STAFF MENTORING.ORIENTATION, DRUG SCREENS, CRIMINAL BACKGROUND CHECKS AND SOCIAL SECURITY CHECKS WERE PROVIDED FOR ALL STUDENTS. IN ADDITION, RENT-FREE CLASSROOM SPACE WAS PROVIDED. PART III, LINE 4: THE CARRYING AMOUNT OF PATIENT RECEIVABLES ARE REDUCED BY ALLOWANCES THAT REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. PATIENT RECEIVABLES, WHERE A THIRD-PARTY PAYOR IS RESPONSIBLE FOR PAYING THE AMOUNT, ARE CARRIED AT A NET AMOUNT DETERMINED BY THE ORIGINAL CHARGE FOR THE SERVICES PROVIDED, LESS AN ESTIMATE MADE FOR CONTRACTUAL ADJUSTMENTS OR DISCOUNTS PROVIDED TO THIRD-PARTY PAYORS. PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. PATIENT RECEIVABLES ARE WRITTEN OFF AS BAD DEBT EXPENSE WHEN DEEMED UNCOLLECTABLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. BAD DEBT EXPENSE IS NOT REPORTED AT COST. PART III, LINE 8: THE MEDICARE COST REPORT USES A FUNCTIONAL COST FINDING METHODOLOGY TO ALLOCATE GENERAL-SERVICE (ADMINISTRATIVE OVERHEAD) DEPARTMENT COSTS TO PATIENT CARE DEPARTMENTS. THE STATISTICAL BASIS FOR ALLOCATION IS PRE-DETERMINED BY MEDICARE INSTRUCTIONS AND VARIES BY TYPE OF GENERAL SERVICE COST CENTER. EXAMPLES INCLUDE SQUARE FOOTAGE TO ALLOCATE CAPITAL-RELATED COSTS AND FTES FOR CAFETERIA. PATIENT CARE DEPARTMENTS ARE GROUPED SIMILARLY ACCORDING TO SERVICE TYPE (I.E., OPERATING ROOM, LABORATORY, PHYSICAL THERAPY, ETC.). FULLY ALLOCATED COSTS ARE THEN DIVIDED BY DEPARTMENTAL CHARGES AT THE GROUP LEVEL TO DETERMINE A GROUP SPECIFIC COST-TO-CHARGE RATIO. TO DETERMINE MEDICARE'S SHARE OF COSTS, MEDICARE COVERED CHARGES ARE MULTIPLIED AGAINST THE SPECIFIC COST-TO-CHARGE RATIOS. PART III, LINE 9B: THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES FOR PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS. MAYO CLINIC HEALTH SYSTEM IN WAYCROSS PART V, SECTION B, LINE 19D: GROSS CHARGES ARE THE SAME FOR ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY; HOWEVER DISCOUNTS ARE PROVIDED FOR INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE. RATES ARE ESTABLISHED BY COMPARING COMPETITIVE RATES IN THE REGION. PART VI, LINE 2: MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. FKA SATILLA HEALTH SERVICES, INC. IMPROVES THE HEALTH AND WELL BEING OF THE NINE COUNTY SERVICE AREA IN SOUTHEAST GEORGIA THAT IT SERVES THROUGH CLINICAL SERVICES, EDUCATION, AND PARTNERSHIPS THAT BUILD HEALTH CAPACITY IN THE COMMUNITY. COMMUNITY BENEFITS ARE PROVIDED FOR ALL CITIZENS AS WELL AS FOR THE MEDICALLY UNDERSERVED. THE ORGANIZATION PAYS CLOSE ATTENTION TO THE NEEDS OF LOW INCOME AND OTHER VULNERABLE PERSONS AND THE COMMUNITY AT LARGE. MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. WORKS WITH COMMUNITY GROUPS TO IDENTIFY NEEDS, STRENGTHEN EXISTING COMMUNITY PROGRAMS, AND PLAN NEWLY NEEDED SERVICES. MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. PROVIDES A WIDE ARRAY OF COMMUNITY BENEFIT SERVICES DESIGNED TO IMPROVE COMMUNITY HEALTH AND THE HEALTH OF INDIVIDUALS.MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. ALSO WORKS TO INCREASE ACCESS TO HEALTH CARE, IN ADDITION TO PROVIDING FREE AND DISCOUNTED SERVICES TO PEOPLE WHO ARE UNINSURED AND UNDERINSURED. THE ORGANIZATION'S COMMUNITY BENEFIT PROGRAMS ARE DESIGNED TO RESPOND TO ASSESSED NEEDS AND ARE FOCUSED ON PREVENTION AND EDUCATION. PART VI, LINE 3: THE BOARD HAS CLEAR WRITTEN INDIGENT AND CHARITY CARE POLICIES THAT ARE AVAILABLE ON THE ORGANIZATION'S WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND CHARITY CARE. PATIENT EDUCATION ON THE ORGANIZATION'S INDIGENT AND CHARITY CARE PROGRAMS ARE CONDUCTED DURING PRE-REGISTRATION, THROUGH FLOOR VISITS BY BUSINESS OFFICE REPRESENTATIVES FOR PATIENTS THAT EXPRESS CONCERN IN MEETING THE FINANCIAL OBLIGATIONS FOR THEIR SERVICES, AND THROUGH OUR CUSTOMER SERVICE DEPARTMENT. BROCHURES ARE PROMINENTLY DISPLAYED AT EACH REGISTRATION BOOTH. THE BUSINESS OFFICE CONTINUOUSLY PROVIDES UPDATED MATERIAL TO PHYSICIAN OFFICES FOR ISSUANCE TO THEIR PATIENTS THAT HIGHLIGHT OUR FINANCIAL ASSISTANCE PROGRAM AND POLICIES. PATIENT STATEMENTS HIGHLIGHT THE ORGANIZATION'S CHARITY PROGRAM AND ENCOURAGE PATIENTS TO CALL FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. IS A NON-PROFIT, MISSION DRIVEN, ACUTE CARE COMMUNITY HOSPITAL LICENSED FOR 231 BEDS. OUR TRADITION OF CARE BEGAN OVER FIFTY YEARS AGO AND CONTINUES TODAY WITH MORE THAN 1,600 EMPLOYEES, PHYSICIANS, AND VOLUNTEERS. THE HOSPITAL SERVES AS A REGIONAL REFERRAL CENTER FOR MORE THAN 155,000 SOUTHEAST GEORGIANS IN A 9-COUNTY AREA AND IS ACCREDITED BY THE JOINT COMMISSION, THE HIGHEST NATIONAL ACCREDITATION BODY FOR HEALTHCARE SERVICES IN THE UNITED STATES. PART VI, LINE 5: AS A CORPORATE CITIZEN, MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. WAS INVOLVED IN A VARIETY OF COMMUNITY BUILDING ACTIVITIES THROUGHOUT THE YEAR INCLUDING ECONOMIC DEVELOPMENT, LEADERSHIP DEVELOPMENT AND TRAINING, WORKFORCE DEVELOPMENT, CRISIS PREVENTION AND INTERVENTION TRAINING, DISASTER PREPAREDNESS AND SUPPORT OF OUR CHAMBERS OF COMMERCE. IN 2011, MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. CONTRIBUTED $482,000 TO COMMUNITY BUILDING ACTIVITIES. FINANCIAL AND IN-KIND SUPPORTIN 2011, MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. PROVIDED $69,000 IN CASH DONATIONS AND IN-KIND SUPPORT TO NOT-FOR-PROFIT ORGANIZATIONS IN THE WAYCROSS-WARE COUNTY REGION. THE FOLLOWING ARE SOME EXAMPLES:- THE AMERICAN CANCER SOCIETY RELAY FOR LIFE RECEIVED $2,500 TO SUPPORT RESEARCH AND THE NEEDS OF CANCER PATIENTS IN OUR COMMUNITY.- PROVIDED RENT-FREE SPACE TO VARIOUS NOT-FOR-PROFIT AND HEALTH CARE-RELATED ORGANIZATIONS. IN 2011, THE ESTIMATED FORGONE RENT WAS $41,000. REPORTS FILED WITH STATES PART VI, LINE 7 GA X X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 ROBERT TRIMM 246750 118805 0 0 404893 194949 6458 3109 5941 2861 664042 319724 0 0 KATRINA WHEELER 119553 57562 0 0 844 406 4250 2047 5641 2716 130288 62731 0 0 WINDELL SMITH JR 128172 61712 0 0 844 406 4513 2173 5661 2726 139190 67017 0 0 RANDOLPH WHEELER 144181 0 0 0 119096 0 4071 0 8058 0 275406 0 0 0 HOLLI SWEAT 145045 0 0 0 7385 0 5193 0 8139 0 165762 0 0 0 JOHN LINDSEY 146112 0 0 0 1250 0 4939 0 8074 0 160375 0 0 0 PART I, LINE 1A CLUB DUES FOR THE CEO AND DISCRETIONARY AMOUNT FOR CEO, COO AND CFO. ALL AMOUNTS ARE INCLUDED IN TAXABLE INCOME. BLACKSHEAR FAMILY PRACTICE PC DON WATERS - DIRECTOR OF THE FILING ORGANZATION & AN OFFICER OF BLACKSHEAR 103200 MEDICAL DIRECTOR FEES, EKG READINGS & WORKMAN'S COMP VISITS 0 FORM 990, PART VI, SECTION A, LINE 2 DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT BY RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS HAVE A BUSINESS RELATIONSHIP: ROBERT M. TRIMM LEWIS ALTMAN WINDELL SMITH KATRINA WHEELER OWEN HERRIN FRANKLIN PICKNEY JOY PETERSON BRENDA TAYLOR FORM 990, PART VI, SECTION A, LINE 4 THE BOARD OF DIRECTORS APPROVED A NAME CHANGE OF THE FILING ORGANZATION FROM SATILLA HEALTH SERVICES, INC. TO MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. BY FILING AN AMENDMENT TO THE ARTICLES OF INCORPORATION DATED MARCH 28, 2012. THE AMENDMENT TO THE ARTICLES OF INCORPORATION WAS FILED WITH THE STATE OF GEORGIA APRIL 2, 2012. THE IRS WAS NOTIFIED OF THE NAME CHANGE BY CORRESPONDANCE DATED FEBRUARY 24, 2012 AND ACKNOWLEDGED THE NAME CHANGE IN CORRESPONDANCE DATED APRIL 18, 2012. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 WILL BE REVIEWED BY THE BOARD OF DIRECTORS OF MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC. (FORMERLY SATILLA HEALTH SERVICES, INC.) PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS AND ADMINISTRATIVE STAFF MEMBERS. THE DETERMINATION AND REVIEW OF WHETHER A CONFLICT EXISTS OR NOT IS DONE AT THE BOARD OR COMMITTEE LEVEL IN WHICH THE MEMBER IS INVOLVED. IN THE EVENT OF A CONFLICT, MEMBERS ARE EXCLUDED FROM DISCUSSION AND THE RIGHT TO VOTE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S GOVERNING BODY UTILIZES DATA FROM MULTIPLE SOURCES INCLUDING WATSON/WYATT COMPENSATION SURVEY, CHATTAHOOCHEE HEALTH RESOURCES EXECUTIVE COMPENSATION SURVEY, AND COUNSEL WITH HUMAN RESOURCES LEADER TO ESTABLISH COMPENSATION OF THE CEO AND ASSURE THAT CEO COMPENSATION IS REASONABLE AND MARKET-BASED. THE CEO/PRESIDENT, ALONG WITH THE HUMAN RESOURCES LEADER, UTILIZE THE COMPENSATION SURVEYS MENTIONED ABOVE TO SET COMPENSATION FOR ALL OTHER OFFICERS, SUCH AS THE CFO, CONTROLLER OR KEY EMPLOYEES. THE EVALUATION PROCESS OCCURS ANNUALLY FOR ALL EXECUTIVE STAFF. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL MAKE ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ADMINISTRATIVE OFFICE. JOINT VENTURE WRITTEN POLICY FORM 990, PART VI, SECTION B, LINE 16B CURRENTLY THE ORGANIZATION HAS NOT ADOPTED A FORMAL WRITTEN POLICY OR PROCEDURE REQUIRING EVALUATION OF PARTICIPATION IN JOINT VENTURE ARRANGEMENTS UNDER APPLICABLE FEDERAL TAX LAW. HOWEVER, ANY JOINT VENTURE ARRANGEMENTS ARE THOROUGHLY EVALUATED BY THE BOARD, LEGAL COUNSEL, AND MANAGEMENT STAFF PRIOR TO PARTICIPATION IN AN EFFORT TO SAFEGUARD THE ORGANIZATION'S EXEMPT STATUS WITHIN SUCH BUSINESS ARRANGEMENTS. AVERAGE HOURS PER WEEK FOR RELATED ORGANIZATIONS FORM 990, PART VII, COLUMN B CERTAIN INDIVIDUALS LISTED IN PART VII SPLIT THEIR TIME BETWEEN MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC.(MCHS-WAYCROSS), THE FILING ORGANIZATION AND ITS RELATED ORGANIZATIONS; SATILLA HEALTH FOUNDATION (SHF), SATILLA HEALTH MANAGEMENT (SHM), SATILLA HEALTH ENTERPRISES (SHE), AND SATILLA REGIONAL SPECIALTY PHYSICIANS (SRSP), AS FOLLOWS; OWEN HERRIN, 1-SHF STEVE WATERS, 1-SHM ROBERT M. TRIMM, 1-SHM, 1-SHF, 1-SHE, 10-SRSP LEWIS ALTMAN, 1-SHM, 1-SHF ASHLEY DENTON, 1-SHM DR. H.A. GRIFFIN, JR., 1-SHM ROBERT LANDRUM, 1-SHM FRANKLIN PICKNEY, 1-SHF C.C. STEPHENS, 1-SHM WINDELL SMITH, 1-SHM, 1-SHF, 1-SHE, 10-SRSP KATRINA WHEELER, 1-SHM, 1-SHF, 1-SHE, 10-SRSP CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PRIOR PERIOD ADJUSTMENTS: -7,452,643. SATILLA HEALTH MANAGEMENT INC 1900 TEBEAU STREET WAYCROSS GA 31501 581717889 HEALTHCARE SERVICES GA 501(C)(3) LINE 3 MAYO CLINIC HEALTH SYSTEM IN WAYCROSS INC 1 SATILLA HEALTH FOUNDATION INC 1900 TEBEAU STREET WAYCROSS GA 31501 582008998 FOUNDATION GA 501(C)(3) LINE 11C, III-FI MAYO CLINIC HEALTH SYSTEM IN WAYCROSS INC 1 SATILLA REGIONAL MEDICAL CENTER AUXILARY 1900 TEBEAU STREET WAYCROSS GA 31501 586066381 PROMOTE & COMPLEMENT HEALTHCARE GA 501(C)(3) LINE 11A, I N/A 0 SATILLA REGIONAL SPECIALTY PHYSICIANS INC 1900 TEBEAU STREET WAYCROSS GA 31501 204363143 PHYSICIAN OFFICES GA MAYO CLINIC HEALTH SYSTEM IN WAYCROSS INC C 20543390 1907044 1.00000 SATILLA HEALTH ENTERPRISES INC 1900 TEBEAU STREET WAYCROSS GA 31501 581717222 HEALTHCARE GA MAYO CLINIC HEALTH SYSTEM IN WAYCROSS INC C 3567930 1090296 1.00000 1 1 1 0 0 0 0 0 1 0 1 1 1 1 1 1 0 1 SATILLA HEALTH MANAGEMENT INC A 23274 ACTUAL AMOUNT SATILLA HEALTH ENTERPRISES INC A 18809 ACTUAL AMOUNT SATILLA REGIONAL SPECIALTY PHYSICIANS INC A 140923 ACTUAL AMOUNT SATILLA HEALTH MANAGEMENT INC K 143654 ACTUAL AMOUNT SATILLA HEALTH ENTERPRISES INC A 5400 ACTUAL AMOUNT SATILLA REGIONAL SPECIALTY PHYSICIANS INC A 90162 ACTUAL AMOUNT SATILLA HEALTH FOUNDATION INC N 74481 ACTUAL AMOUNT