2012-08-14T10:45:57-05:00 2011-09-30 Deloitte Tax LLP 191 Peachtree Street Suite 2000 Atlanta GA 30303 990 2010-10-01 510473471 McLeod Medical Center - Dillon 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 Robert L Colones 555 E Cheves St Florence SC 295020551 53061829 0 X www.mcleodhealth.org X 2003 SC Acute Care Hospital 4 1 427 95 0 0 184922 488152 49643838 51852205 -30067 8288 626319 649227 50425012 52997872 0 0 0 0 17544111 18105055 0 0 0 30786073 32045290 48330184 50150345 2094828 2847527 25753212 29517184 11067496 11983941 14685716 17533243 Organization is part of the McLeod Health system. The mission of McLeod Health is to improve the overall health and well being of people living within SC and Eastern NC by providing excellence in healthcare. 0 0 41598282 51852205 McLeod Medical Center-Dillon is a 79-bed Community Hospital located in Dillon, South Carolina. McLeod Medical Center-Dillon operates as part of the overall McLeod Health system. See also the community benefit report for McLeod Health at Schedule H. 41598282 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 53 0 1 427 1 0 0 0 0 0 0 0 0 0 1 1 0 X 4 1 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X Mark W Cameron 8437775304 555 East Cheves Street Florence SC 295010551 X Robert L Colones 40.00 X 0 729167 74257 S Fulton Ervin III 40.00 X 0 384170 81706 Deborah D Locklair 40.00 X 0 200464 49369 Walter B Blum MD 1.00 X 0 0 0 Timothy Idiaghe MD 40.00 X 242955 0 22883 Emery J Villenueve 40.00 X 204233 0 55558 Lionel D Rajotte 40.00 X 177109 0 49780 Loren D Harter MD 40.00 X 185603 0 14263 Elizabeth J Ziegler 40.00 X 179084 0 44210 988984 1313801 392026 5 0 1 0 Emcare Inc 7032 Collection Drive Chicago IL 606930000 Physician Services 1073188 CompHealth Associates Inc P O Box 972625 Dallas TX 753972625 Physician Services 124499 Staff Care Inc P O Box 281923 Atlanta GA 303841923 Medical Services 103275 3 488152 488152 Net Patient Revenue 624100 51852205 51852205 51852205 1142 1142 418622 49748 368874 368874 368874 21355 14209 7146 7146 7146 Cafeteria 722210 218103 218103 Gift Shop 453220 27246 27246 Vending 722210 8707 8707 26297 26297 280353 52997872 51852205 0 657515 14215113 12249487 1965626 3889942 3889942 55571 55571 4871291 971381 3899910 40743 3383 37360 4829055 4388592 440463 66254 66254 732098 732098 46527 43810 2717 16054 10288 5766 2038634 2038634 292719 24713 268006 Bad Debts 15065256 15065256 0 0 Physician Fees 2747217 2747217 0 0 Miscellaneous Expenses 1115812 44970 1070842 0 Management and Consulti 128059 54355 73704 0 50150345 41598282 8552063 0 875 875 5191637 5522682 556713 472749 394045 390787 44697648 22591311 18955060 22106337 654882 1023754 25753212 29517184 226146 410550 84854 10841350 11488537 11067496 11983941 X 14685716 17533243 14685716 17533243 25753212 29517184 2847527 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2309327 2309327 26794560 10754418 16040142 14735441 11290488 3444953 858320 546405 311915 22106337 Intercompany 8054566 Third Party Payors Reserve Estimates 2441584 Wages and Benefits Payable 992387 11488537 1 1 X 1 X 1 X 1 1 0 1 1 4763579 1959389 2804190 0.05590 12633138 7118227 5514911 0.11000 17396717 9077616 8319101 0.16590 176398 10552 165846 0.00330 60304 435 59869 0.00120 236702 10987 225715 0.00450 17633419 9088603 8544816 0.17040 57856 30000 27856 0.00060 2625 2625 0.00010 7200 7200 0.00010 4280 4280 0.00010 71961 30000 41961 0.00090 0 5331142 375882 9955071 9126128 828943 1 1 1 1 McLeod Medical Center - Dillon

301 East Jackson Street Dillon SC 29536

X X X McLeod Medical Center - Dillon 1 1. Part I, Item 6a - Community Benefit report for McLeod Health (Sole Member of McLeod Medical Center - Dillon) is filed annually with South Carolina Hospital Association. Highlights are published in McLeod Magazine which is a publication that is distributed free to the public. Entire report is available to anyone upon request. Part II - The main example of a Community-Building activity performed by McLeod Medical Center - Dillon (MMC-D) in Fiscal Year 2011 was that there was a Disaster Coordinator that helped Dillon County for a few hours per week with Emergency Planning. He worked with the school systems and all public safety within the county to aid in emergency preparedness work. Also, the McLeod Health organization financially participates each year in the nursing programs at two local higher education schools, Francis Marion University and Florence-Darlington Technical College, to help maintain and expand their nursing programs. These two programs are the cornerstone for recruiting, retention and cultivation of exceptional nurses by the McLeod Health facilities including McLeod Medical Center - Dillon, as well as other health care providers in the region. Part III, Line 4 - Net patient service revenues are reported at the estimated net realizable amounts received, or to be received, from patients, third-party payors, and others for the specific services and supplies rendered, including estimated retroactive adjustments under reimbursement agreements with third-party payors. For the amounts reported in Lines 2 and 3, we used the IRS method to calculate the Ratio of Patient Care Cost to Charges, as shown on page 8 of the Instructions for Schedule H (Worksheet 2). The calculated ratio was then applied to the gross charges written off to bad debt (net of recoveries). Part III, Line 9b - MMC-D is an organization in the McLeod Health system. McLeod Health's charity policy outlines the criteria used to determine patients who qualify for charity. When patients have furnished the required information, it is reviewed and a determination is made. If approved for charity care, their account balances are adjusted based on the percentage they qualify for using a charity adjustment code. If all required information is not furnished, the patient is notified that their charity application was not approved due to failure to provide the necessary information. Following that notification, the account generally transfers to bad debt for further collection action. 2. McLeod Medical Center- Dillon has a 20-member Community Advisory Board consisting of physicians and influential leaders in the community. It meets quarterly to assess the health care needs of the community. Additionally, McLeod Medical Center-Dillon along with the rest of the McLeod Health system is actively involved in agencies like United Way, American Heart Association, American Cancer Society, Children's Miracle Network to further stay on the pulse of the health needs of the community.3. Uninsured patients are screened at the time of registration for their ability to pay for their health care services. If the patient has no ability to pay and is deemed ineligible for governmental programs (Medicare, Medicaid, etc.) then they are informed of the Hospital Charity program. They are provided with an application and a listing of the appropriate documents necessary to establish eligibility for the Hospital Charity program.4. McLeod Medical Center- Dillon (MMC-D),together with its related organizations McLeod Regional Medical Center of the Pee Dee, Inc. and McLeod Physician Associates II, considers its primary service area (PSA) as the South Carolina counties of Florence, Darlington, Chesterfield, Dillon,Marion, and Marlboro, and its secondary service area (SSA) as the South Carolina counties of Clarendon, Georgetown, Horry, Lee, Sumter, andWilliamsburg. These twelve counties make up the northeastern corner of South Carolina. MMC-D has the great majority of its discharges from the County of Dillon with those patients comprising approximately 76% of all MMC-D discharges in the most recent year with statistics available, FY 11.As for some demographics of the PSA and the main County served by MMC-D,the total population of Dillon County in 2010 was 32,062 and the totalpopulation of the PSA that same year was 346,357. The median age in Dilloncounty was 36.7.5. With a strong history in the Dillon community since 1943, McLeod Dillon has continued to grow and expand to serve residents of Dillon (SC) and Robeson (NC) counties with excellence in patient care. The Joint Commissionaccredited medical center employs 350 and has the strength of 100 physicians on its medical staff. McLeod Dillon offers general and orthopedic surgery, women's services, emergency services, intensive care, rehabilitative services and cardiac rehabilitation. Investments in state of the art technology to improve patient care have included Open MRI, digitalmammography, 4D ultrasounds, vascular studies, CT Scans and NuclearStudies.McLeod Dillon is a 79-bed community hospital in Dillon, SC, and serves asthe primary healthcare provider in one of the more economically-challengedcounties in South Carolina. McLeod Dillon primarily serves Dillon Countywhich has a population of approximately 32,062. Dillon County is in thenortheastern corner of South Carolina and is a county assigned to the PeeDee Region of the state. The county's per capita income of $15,792 haslagged both the U.S. and South Carolina averages, and it has 25.2% of itspopulation living below the poverty level, much higher than the nationalaverage of 9.9%. The county has an unemployment rate of 8.9% and 34.9% ofthe population has not received a high school diploma. In Dillon County,the number of uninsured has reached 18%. 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.6. McLeod Health is the Sole Member of McLeod Medical Center-Dillon and other related organizations which comprise the regional McLeod Health system. Descriptions of each entity follows:McLeod Regional Medical Center of the Pee Dee, Inc.: McLeod Regional Medical Center of the Pee Dee, Inc. (MRMC) is the largest entity in the McLeod Health system and owns and operates the following organizations, which operate as divisions of MRMC: - McLeod Regional Medical Center, the System's main hospital campus located in Florence, South Carolina, which includes a 453-bed tertiary care facility and a 40-bed neonatal intensive care unit; - McLeod Medical Center-Darlington, a 49-bed community hospital located in Darlington, South Carolina; - McLeod Behavioral Health, a 23-bed psychiatric facility located on the campus of McLeod Medical Center-Darlington; - McLeod Home Care, which consists of McLeod Home Health, a five-county home healthcare organization with offices in Florence, South Carolina, and McLeod Hospice House, a 12-bed inpatient hospice facility located in Florence, South Carolina; - McLeod Health & Fitness Center, a comprehensive health and fitness center located in Florence, South Carolina; - McLeod Ambulatory Surgery Center, a free-standing outpatient service center located on the campus of McLeod Regional Medical Center. Additionally, MRMC is the majority owner in a joint venture, McLeod Medical Partners, LLC, which owns and operates three medical office buildings on the campus.McLeod Medical Center-Dillon: McLeod Medical Center-Dillon is a South Carolina nonprofit corporation and an organization described under Sections 501(c)(3) and 509(a)(1) of the Code. McLeod Medical Center-Dillon owns and operates a 79-bed community hospital located in the City of Dillon in Dillon County, South Carolina. Dillon County borders Florence County to the northeast. McLeod Physician Associates II (MPA II): MPA II is a South Carolina nonprofit corporation and an organization described under Sections 501(c)(3) and 509(a)(2) of the Code that operates a multi-specialty physician group practice of 78 employed physicians providing primary and specialty care services through approximately 36 offices in six South Carolina counties. MPA II supports the mission of McLeod Health, providing comprehensive medical and surgical services, including a wide range of physician specialties, to McLeod's patients from a 12-county service area.McLeod Health Foundation: The Foundation was organized in 1986 as a South Carolina nonprofit corporation and is an organization described under Sections 501(c)(3) and 509(a)(3) of the Code. The Foundation is principally engaged in fundraising activities for the System. In the past five years, the Foundation has received approximately $14 million for the benefit of the System, including approximately 2 million which has been used for Hospice House, $1.3 million for Children's Hospital Block Grants and $810,000 for the Mobile Mammography unit. According to its bylaws, the Foundation's governing body consists of not less than 15 and not more than 30 members, each of which is appointed by the Board of Trustees of McLeod Health (the "McLeod Health Board" or the "Board"). Currently, there are 24 members of the Foundation's governing body. At least one member of the Foundation's governing body must be a member of the McLeod Health Board.McLeod Medical Partners, LLC: McLeod Medical Partners, LLC is a for-profit entity that owns and operates three medical office buildings on the McLeod Regional Medical Center campus. The Borrower owns a 61% share in the equity of this company. McLeod Physician Associates, Inc.: McLeod Physician Associates, Inc. is a South Carolina for-profit corporation that formerly operated a multi-specialty physician group practice, but is now inactive. Effective October 1, 2006, substantially all assets and operations of McLeod Physician Associates, Inc. were transferred to MPA II.7. McLeod Health files a community benefit report annually in the state of South Carolina to the SC Hospital Association. 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 Deborah D Locklair 0 169581 0 24502 0 6381 0 22000 0 27369 0 249833 0 0 Timothy Idiaghe MD 241696 0 0 0 1259 0 0 0 22883 0 265838 0 0 0 Emery J Villenueve 190266 0 0 0 13967 0 19959 0 35599 0 259791 0 0 0 Lionel D Rajotte 170616 0 0 0 6493 0 22000 0 27780 0 226889 0 0 0 Loren D Harter MD 184645 0 0 0 958 0 11806 0 2457 0 199866 0 0 0 Elizabeth J Ziegler 176811 0 0 0 2273 0 15909 0 28301 0 223294 0 0 0 Supplemental Information Part III 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. Supplemental Information Part III 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. Form 990, Part VI, Section A, line 6 McLeod Medical Center-Dillon 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 Medical Center-Dillon'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 Medical Center-Dillon'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 Medical Center- Dillon) 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 Medical Center - Dillon 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. Each Board Member signs a Conflict of Interest statement each year. Form 990, Part VI, Section B, line 15a In determining compensation of McLeod Medical Center-Dillon's top management official, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The compensation committee reviewed and approved in the compensation. In the review of compensation, the top management official was compared to other similarly situated organizations and positions. During the review and approval of the compensation, documentation of the decision was recorded in the Board minutes. 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 Medical Center - Dillon. 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 Medical Center - Dillon. 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 Medical Center - Dillon. 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 Medical Center - Dillon. 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. Deborah D. Locklair's compensation is paid by McLeod Health, a related organization of McLeod Medical Center - Dillon. The compensation she receives is for her role as Vice President at McLeod Health and not for her role as a Board Member, an uncompensated role, of McLeod Medical Center - Dillon. Therefore, all hours reported on Form 990, VII, Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors represent aggregate hours worked per week. Medical Regional Medical Center of the Pee Dee Inc 555 E Cheves Street Florence SC 29502 570370242 To operate a hospital SC 501(c)(3) Line 3 N/A 0 McLeod Health Foundation 555 E Cheves Street Florence SC 29502 570818672 To raise money for McLeod entities SC 501(c)(3) Line 11a, I N/A 0 McLeod Physician Associates II 555 E Cheves Street Florence SC 29502 202935692 Physician Services SC 501(c)(3) Line 3 N/A 0 McLeod Health 555 E Cheves Street Florence SC 29502 510473500 To operate a healthcare system SC 501(c)(3) Line 3 N/A 0 McLeod Medical Partners LLC 4401 Barclay Down Dr Suite 300 Charlotte NC 282094670 570812002 Rental SC N/A McLeod Physician Associates Inc 555 East Cheves Street Florence SC 29502 582279897 Physician Services SC N/A C 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 McLeod Health Foundation C 488152 Actual Cash Transferred McLeod Health L 3038068 Actual Cost of Services Provided McLeod Physician Associates II L 707193 Actual Cost of Services Provided