2012-08-14T10:54:42-05:00 2011-09-30 Deloitte Tax LLP 191 Peachtree Street Suite 2000 Atlanta GA 30303 990 2010-10-01 510473500 McLeod Health 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 Colones 555 East Cheves St Florence SC 295020551 96666086 0 X www.mcleodhealth.org X 2003 SC To operate a Health Care System. 19 18 667 19 0 0 0 0 90603849 96929858 0 0 40899 -263772 90644748 96666086 0 0 0 0 78208976 83795637 0 0 0 12394873 13134223 90603849 96929860 40899 -263774 3452628 3681324 11245117 11737587 -7792489 -8056263 X To operate a health care system serving the Pee Dee Region of South Carolina. 0 0 37459470 96929858 McLeod Health is a supporting organization to McLeod Regional Medical Center of the Pee Dee, Inc. and McLeod Medical Center-Dillon. On a daily basis, McLeod Health coordinates the delivery of quality acute care services to the residents of the Pee Dee Region of South Carolina. See also the community benefit report for McLeod Health at Schedule O. 37459470 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 49 0 1 667 1 0 0 0 0 0 0 0 0 0 1 1 0 X 19 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Mark W Cameron 8437775304 555 East Cheves St Florence SC 295020551 Kaye Floyd-Parris 1.00 X X 0 0 0 Charles J Bethea 1.00 X X 0 0 0 James C McLeod Jr 1.00 X X 0 0 0 J Ronald Ward 1.00 X 0 0 0 John R Braddy 1.00 X 0 0 0 Leander Crawford 1.00 X 0 0 0 Dewey N Ervin MD 1.00 X 0 0 0 Larry Geddie 1.00 X 0 0 0 E Daniel Guyton Jr MD 1.00 X 0 0 0 Mellany F Isom 1.00 X 0 0 0 William N Boulware MD 1.00 X 0 0 0 W Crawford Moore 1.00 X 0 0 0 John D Orr 1.00 X 0 0 0 John C Pittard MD 1.00 X 0 0 0 Michael R Rose MD 40.00 X 243580 0 8067 Steven R Ross MD 1.00 X 0 0 0 Gerald T Rosenlund 1.00 X 0 0 0 J Givens Young 1.00 X 0 0 0 Benjamin T Zeigler 1.00 X 0 0 0 Robert L Colones 40.00 X 729167 0 74257 S Fulton Ervin III 40.00 X 384170 0 81706 Ronald L Boring 40.00 X 0 0 0 Donna C Isgett 40.00 X 401929 0 83236 Jeannette C Glenn 40.00 X 247776 0 80608 Charles M Jordan 40.00 X 276707 0 53406 Jenean M Blackmon 40.00 X 227951 0 52649 John Bruyere 40.00 X 205476 0 47333 2716756 0 481262 27 0 1 0 Siemens Medical Solutions 1640 Phoenix Blvd Suite 110 Atlanta GA 311920065 Data Processing 2485145 Lesnik Himmel Wilson etc 3005 Hwy 17 N Bypass Myrtle Beach SC 29577 Advertising 709670 Ogletree Deakins PC PO Box 167 Greenville SC 29602 Legal/Consulting 396814 Deloitte & Touche LLP PO Box 403568 Atlanta GA 303843568 Accounting 354036 MedAssets Net Revenue Systems 200 North Point Center East Suite 2 Alpharetta GA 30022 Revenue Cycle System 230324 6 Allocated Benefits 524298 53167920 53167920 Health System Manageme 900099 37811720 37811720 Laundry Allocation 812300 1658106 1658106 Internal Phys Billing 624100 1009688 1009688 Patient Revenue 624100 558989 558989 2723435 2723435 96929858 Loss in subsidiary 900099 -263772 -263772 -263772 96666086 96929858 0 -263772 26272601 9983588 16289013 7157974 2720030 4437944 34197406 13217620 20979786 16167656 6143709 10023947 377416 377416 296553 296553 48208 18319 29889 3886804 1512526 2374278 984639 984639 2102831 799076 1303755 4181505 1588972 2592533 100399 38151 62248 161374 61322 100052 104469 39698 64771 247595 94086 153509 Other Direct 423984 170953 253031 0 Dues & Subscriptions 139782 53117 86665 0 Medical 42241 16052 26189 0 Contract Labor 30341 11530 18811 0 Bad Debt 6082 6082 0 0 96929860 37459470 59470390 0 873 491 148550 147534 674741 1169008 2628464 2364291 3452628 3681324 11245117 11737587 11245117 11737587 X -7792489 -8056263 -7792489 -8056263 3452628 3681324 -263774 0 X 0 1 1 X 0 X X 0 0 0 McLeod Regional Medical Center of the Pee Dee Inc 570370242 3 1 0 McLeod Medical Center - Dillon 510473471 3 1 0 McLeod Physician Associates II 202935692 3 1 0 3 0 0 0 0 0 0 1 48208 0 0 0 48208 0 Part IV, Supplemental Information: Part II-B, Line 1(i), Other Lobbying Activities: McLeod Health pays dues to Capitol Consultants to lobby on McLeod Health's behalf on certain South Carolina legislative issues that impact McLeod Health's health care activities. In addition, a portion of dues paid to South Carolina Hospital Association are allocated to lobbying activities that SCHA engages in to represent the interests of member hospitals in South Carolina. 0 Investments in Affiliates 2362969 Employee Uniform -678 Rental Security Deposit Rcvble 2000 2364291 X 1 1 X X X X X X 0 1 0 0 0 1 1 0 0 Michael R Rose MD 219672 0 22825 0 1083 0 0 0 8067 0 251647 0 0 0 Robert L Colones 623774 0 98184 0 7209 0 31200 0 43057 0 803424 0 0 0 S Fulton Ervin III 309659 0 55111 0 19400 0 22000 0 59706 0 465876 0 0 0 Donna C Isgett 313672 0 83688 0 4569 0 16500 0 66736 0 485165 0 0 0 Jeannette C Glenn 206991 0 34794 0 5991 0 38500 0 42108 0 328384 0 0 0 Charles M Jordan 270790 0 0 0 5917 0 22000 0 31406 0 330113 0 0 0 Jenean M Blackmon 191674 0 31997 0 4280 0 9570 0 43079 0 280600 0 0 0 John Bruyere 176455 0 25658 0 3363 0 22000 0 25333 0 252809 0 0 0 Part I, Line 1a Ronald L. Boring was provided a Housing Allowance upon his relocation to Florence, SC when he began his employment at McLeod Health. Part I, Line 4b Jeanette C. Glenn received $16,973 from a supplemental nonqualified retirement plan. 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. 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. Dr Michael R Rose Board Member 372556 Independent 0 (a) Name of Person: Dr. Michael R. Rose (b) Relationship Between Interested Person and Organization: Board Member (c ) Amount of Transaction $ 372,556 (d) Description of Transaction: Independent contractor arrangement for Anesthesia Services, board member is partner (e) Sharing of Organization Revenues? No 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 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 Board before the filing date of August 15, 2012. Form 990, Part VI, Section B, line 12c McLeod Health 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 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 othe key employees, was 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. Community Benefit Report: Form 990, Part III, Line 4a: The McLeod Health system (of which McLeod Health entity is a sole member or parent company) conducts or participates in many community programs that help further McLeod Health'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 Health Foundation 555 East Cheves Street Florence SC 295020551 570818672 To raise money for McLeod SC 501(c)(3) Line 11a, I N/A 0 McLeod Regional Medical Center of the 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 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 Physician Associates II 555 East Cheves Street Florence SC 295020551 202935692 Physician Services 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 McLeod Physician Associates Inc 555 East Cheves Street Florence SC 29501 582279897 Physician Services SC N/A C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 McLeod Regional Medical Center of the Pee Dee Inc K 34611853 Actual Cost of Services Provided McLeod Medical Center-Dillon K 3038068 Actual Cost of Services Provided McLeod Physician Associates II K 1678587 Actual Cost of Services Provided McLeod Health Foundation K 181185 Actual Cost of Services Provided