Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
McLeod Physician Associates II
Employer identification number
20-2935692
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
McLeod Physician Associates II
Employer identification number
20-2935692
Identifier
Return Reference
Explanation
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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.