Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: | TO OPERATE AN INDEPENDENT, NON-PROFIT, ACUTE CARE HOSPITAL COMMITTED TO ITS COMMUNITY AND GUIDED BY THE VALUES OF INTEGRITY, CARING, RESPECT, EXCELLENCE, PARTNERSHIP, AND STEWARDSHIP. |
| FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: | SOUTH COUNTY HEALTHCARE SYSTEM IS DEDICATED TO ENRICHING THE QUALITY OF LIFE OF SOUTHERN RHODE ISLAND COMMUNITY MEMBERS AND VISITORS THROUGH THE DELIVERY OF QUALITY HEALTHCARE SERVICES, THE DEVELOPMENT OF COOPERATIVE RELATIONSHIPS WITH OTHER HEALTHCARE PROVIDERS AND THE PROMOTION OF WELLNESS THROUGH HEALTH EDUCATION AND AWARENESS. |
| FORM 990, PART III, LINE 4A, DESCRIPTION OF PROGRAM SERVICE: | SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM (THE HOSPITAL) IS AN INDEPENDENT, NON-PROFIT, ACUTE-CARE HOSPITAL, SERVING THE COMMUNITIES OF SOUTHERN RHODE ISLAND OFFERING THE LATEST ADVANCES IN TECHNOLOGY AND A COMPREHENSIVE RANGE OF MEDICAL AND SURGICAL SERVICES DELIVERED BY EXPERT PHYSICIANS AND HIGHLY TRAINED STAFF. THE SOUTH COUNTY HOSPITAL HEALTHCARE SYSTEM IS COMMITTED TO ITS COMMUNITY AND GUIDED BY THE VALUES OF INTEGRITY, CARING, RESPECT, EXCELLENCE, PARTNERSHIP AND STEWARDSHIP. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2021, THE HOSPITAL REPORTED 6,518 DISCHARGES AND 20,569 INPATIENT DAYS. THE DISCHARGES INCLUDED 734 DELIVERIES AND 2,141 INPATIENT SURGERIES. THE HOSPITAL PROVIDED 232,000 OUTPATIENT VISITS; INCLUDING 19,918 OUTPATIENT EMERGENCY ROOM VISITS AND 26,332 EXPRESS CARE VISITS. THE PROVIDERS IN THE HOSPITAL MEDICAL GROUP PROVIDED 145,444 VISITS. WHILE PATIENT VOLUMES IMPROVED OVER FY2020, THE HOSPITAL DID NOT EXPERIENCE THE RETURN TO PRE-PANDEMIC LEVELS AS ANTICIPATED; RESULTING IN SIGNIFICANT REVENUE SHORTFALLS. ADDITIONAL CHALLENGES DURING FY2021 WERE REALIZED FROM INCREASED LABOR COSTS BROUGHT BY THE INDUSTRY-WIDE SHORTAGE OF CLINICAL PERSONNEL AND THE RESULTING NEED FOR MORE EXPENSIVE CONTRACT LABOR, INCENTIVE PAY AND WAGE INCREASES ABOVE INFLATION TO BE ABLE TO RETAIN/RECRUIT STAFF. AT THE ONSET OF THE COVID-19 PANDEMIC, SOUTH COUNTY HOSPITAL OPENED THE BORDA UNIT, AN 11-BED UNIT DEDICATED TO THE GROWING NUMBER OF COVID-19 PATIENTS. THE UNIT WAS EQUIPPED WITH NEGATIVE PRESSURE ROOMS, PERSONAL PROTECTIVE EQUIPMENT, AND EMERGENCY MEDICAL MANAGEMENT SUPPLIES. THE FLOOR WAS ALSO STAFFED WITH A DEVOTED GROUP OF NURSES, RESPIRATORY THERAPISTS, AND PATIENT CARE TECHNICIANS, WITH SECRETARIAL SUPPORT. WE ARE PROUD THAT WE HAVE CONTINUED TO SUPPORT THE SOUTH COUNTY COMMUNITY THROUGHOUT THE PANDEMIC THROUGH TREATMENT AND PREVENTION. ON DECEMBER 18, 2020, SOUTH COUNTY HOSPITAL DELIVERED ITS FIRST DOSE OF COVID VACCINE TO STAFF. ALTHOUGH VACCINES WERE SCARCE, THE CENTERS FOR DISEASE CONTROL AND THE RHODE ISLAND DEPARTMENT OF HEALTH ENSURED THAT OUR HEALTHCARE WORKERS RECEIVED INITIAL DOSES. AS A COMMUNITY PARTNER, SOUTH COUNTY HOSPITAL ALSO EXTENDED DOSES TO OTHERS IN THE COMMUNITY AND TO OUR MOST VULNERABLE PATIENTS. WE ALSO PLAYED A KEY ROLE IN COMMUNITY HEALTH EDUCATION WHEN, IN MARCH OF 2021, SOUTH COUNTY HEALTH HELD ITS FIRST VIRTUAL PUBLIC TOWN HALL MEETING. MEMBERS OF THE COMMUNITY WERE INVITED TO PARTICIPATE IN DISCUSSIONS ON COVID, THE VACCINE, AND SOUTH COUNTY HEALTH'S FUTURE GROWTH AND SUCCESS - ALL VIA VIRTUAL TECHNOLOGY TO ENSURE THE SAFETY OF THOSE PARTICIPATING. |
| FORM 990, PART VI, SECTION B, LINE 11B | SOUTH COUNTY HOSPTIAL HEALTHCARE SYSTEM AND ITS AFFILIATED ENTITIES ARE KNOWN AS SOUTH COUNTY HEALTH ("SCH") WHICH HAS POLICIES AND PROCEDURES ADOPTED BY ALL ENTITIES IN THE SYSTEM. ALL ENTITIES HAVE MIRROR BOARDS. THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S AUDIT COMMITTEE APPROXIMATELY 30 DAYS PRIOR TO THE FILING DEADLINE. THE AUDIT COMMITTEE THEN REVIEWS THE FORM 990 AND PROVIDES QUESTIONS AND COMMENTS TO THE ORGANIZATION'S ACCOUNTING DEPARTMENT. BEFORE IT IS FILED, A COPY OF THE FINAL FORM 990, INCLUDING REQUIRED SCHEDULES, IS PROVIDED TO THE MEMEBERS OF THE BOARD OF TRUSTEES FOR REVIEW AND DISCUSSION WITH THE CHAIRMAN OF THE AUDIT COMMITTEE AT A BOARD MEETING PRIOR TO THE FILING DEADLINE. |
| FORM 990, PART VI, SECTION B, LINE 12C | SCH HAS POLICIES AND PROCEDURES ADOPTED BY ALL ENTITIES IN THE SYSTEM. MEMBERS OF THE GOVERNING BODY, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. IT IS PERIODICALLY REVIEWED AND DISCUSSED AT BOARD MEETINGS. IF A POTENTIAL CONFLICT IS IDENTIFIED, THE BOARD WOULD DISCUSS THE ITEM TO DETERMINE IF A CONFLICT EXISTS. IF A CONFLICT EXISITS, THE INDIVIDUAL WOULD RECUSE THEMSELVES FROM DISCUSSIONS. ALL DISCUSSIONS ARE CONTEMPORANEOUSLY DOCUMENTED. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION'S CEO'S COMPENSATION IS DETERMINED BY THE GOVERNING BODY. THE CEO'S SALARY IS COMPARED TO OTHER CEO'S SALARIES OF SIMILAR ORGANIZATIONS. IN DETERMINING COMPENSATION, THE ORGANIZATION USES FORM 990 OF OTHER ORGANIZATIONS AND A COMPENSATION SURVEY. THE REVIEW IS DONE BY INDEPENDENT INDIVIDUALS OF THE GOVERNING BODY AND ALL DISCUSSIONS ARE CONTEMPORANEOUSLY DOCUMENTED. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VI, SECTION B, LINE 16B: | THE HOSPITAL'S JOINT VENTURE AGREEMENTS ARE FULLY REVIEWED BY HOSPITAL LEGAL COUNSEL TO ASSURE FULL TAX COMPLIANCE. THE HOSPITAL DOES NOT HAVE A FORMAL POLICY BUT IN PRACTICE ALL JOINT VENTURE AGREEMENTS ARE FULLY REVIEWED BY HOSPITAL LEGAL COUNSEL TO ASSURE THE JOINT VENTURE DOES NOT JEOPARDIZE THE TAX STATUS OF THE ORGANIZATION. |
| FORM 990, PART XI, LINE 9: | CHANGE IN FUNDED STATUS OF EMPLOYEE BENEFIT PLANS 7,478,377. UNREALIZED CHANGE IN EQUITY INTERESTS ON INTEREST RATE SWAP 2,566,419. NET ASSETS RELEASED FOR CAPITAL EXPENDITURES 360,157. UNREALIZED CHANGE IN EQUITY INTERESTS IN L.P. 888,497. NET SERVICE COST COMPONENTS OF NET PENSION COST -603,713. FORGIVENESS OF SCSS INTERCOMPANY LOAN -310,668. |
| FORM 990, PART XII, LINE 2C: | FINANCIAL STATEMENTS AND REPORTING THE ORGANIZATION'S AUDIT COMMITTEE IS RESPONSIBLE FOR SELECTING AN INDEPENDENT ACCOUNTANT TO AUDIT THE ORGANIZATION'S FINANCIAL STATEMENTS AND FOR OVERSEEING THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS. |
| Software ID: | |
| Software Version: |