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 | |||||
| (A)
GEORGETOWN MEMORIAL HOSPITAL |
570341194 | 3 | Yes | 0 | 44,098,136 | |
| (B)
WACCAMAW COMMUNITY HOSPITAL |
043633263 | 3 | Yes | 0 | 53,897,722 | |
|
Total 2
|
0 | 97,995,858 | ||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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 2021 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-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| FORM 990, SCHEDULE A, PART 1, LINE 11 | SUPPORT PROVIDED TO SUPPORTED ORGANIZATIONS: THE PURPOSE OF THE GEORGETOWN HOSPITAL SYSTEM AND ALL DISREGARDED ENTITES IS TO FACILITATE THE PROVISION OF HEALTH CARE SERVICES IN GEORGETOWN AND HORRY COUNTIES. THE SYSTEM PROVIDES STRATEGIC AND OPERATIONAL PLANNING, DIRECTION AND OVERSIGHT, AND DEVELOPS COMMON STRATEGIES AND OPERATIONAL PLANS FOR GEORGETOWN MEMORIAL HOSPITAL, WACCAMAW COMMUNITY HOSPITAL AND OTHER RELATED ENTITIES. THE SYSTEM ALSO PROVIDES CENTRALIZED ADMINISTRATIVE AND HUMAN RESOURCE FUNCTIONS TO ITS ENTITIES BY HIRING ALL EMPLOYEES AND PROVIDING ALL EMPLOYEE BENEFITS WITHIN THE SYSTEM. THE SYSTEM PROVIDES ADMINISTRATIVE SERVICES AND LEASES ITS EMPLOYEES TO ENTITIES AND IN RETURN SUCH ENTITIES REIMBURSE THE SYSTEM FOR THE COST OF THE ADMINISTRATIVE SERVICES AND EMPLOYEES EACH UTILIZES. |
| 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 V, LINE 2A: | GEORGETOWN HOSPITAL SYSTEM, FILES PAYROLL FOR ITSELF AND TWO RELATED ORGANIZATIONS (GEORGETOWN MEMORIAL HOSPITAL AND WACCAMAW COMMUNITY HOSPITAL). THE NUMBER OF EMPLOYEES RELATED TO THE FILING ORGANIZATION IS 948. |
| FORM 990, PART VI, SECTION A, LINE 1A | THE BOARD OF TRUSTEES SHALL DESIGNATE FROM AMONG ITS MEMBERS AN EXECUTIVE COMMITTEE, WHICH SHALL CONSIST OF FIVE OR MORE TRUSTEES, INCLUDING THE CHAIRMAN, THE VICE CHAIRMAN, THE SECRETARY, AND THE TREASURER OF THE CORPORATION, WHICH EXECUTIVE COMMITTEE, TO THE EXTENT PROVIDED IN A RESOLUTION TO THE BOARD, SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD OF TRUSTEES IN OVERSEEING OR GUIDING THE MANAGEMENT OF THE AFFAIRS OF THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE CORPORATION SHALL HAVE MEMBERS WITHIN THE MEANING OF THE ACT. THE CORPORATION'S MEMBERS SHALL BE DIVIDED INTO TWO (2) CLASSES: THE CLASS T MEMBER AND THE CLASS M MEMBER (COLLECTIVELY, THE "MEMBERS"). TIDELANDS HEALTH HOLDINGS ("TIDELANDS PARENT") SHALL BE THE SOLE CLASS T MEMBER (THE "CLASS T MEMBER") AND SHALL HAVE A SEVENTY (70%) PERCENT MEMBERSHIP INTEREST (AS DEFINED IN MEMBERSHIP AGREEMENT) AS OF THE EFFECTIVE DATE, AND MAINSAIL HEALTH PARTNERS ("MAINSAIL") SHALL BE THE SOLE CLASS M MEMBER (THE "CLASS M MEMBER") AND SHALL HAVE A THIRTY (30%) PERCENT MEMBERSHIP INTEREST. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBER ORGANIZATIONS WILL APPOINT THE BOARD OF DIRECTORS IN RELATIONSHIP TO THEIR MEMBERSHIP INTEREST. TIDELANDS HEALTH HOLDINGS WILL APPOINT 70% OF THE GOVERNING BODY WHILE MAINSAIL HEALTH PARTNERS WILL APPOINT 30% OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBERS WILL HAVE THE FOLLOWING RIGHTS: TO ELECT, SOLELY BY CLASS THE NUMBER OF TRUSTEES, TO REMOVE TRUSTEES, TO INITIATE THE CORPORATION, TO INITIATE THE AMENDMENT OF GOVERNING DOCUMENTS, ADDITION OF NEW MEMBERS, AND FUNDING OF THE CORPORATION |
| FORM 990, PART VI, SECTION B, LINE 11B | THE RETURN WAS PREPARED BY AN OUTSIDE ACCOUNTING FIRM WITH THE ASSISTANCE AND OVERSIGHT OF MANAGEMENT. A COPY OF THE RETURN WAS PROVIDED TO EACH VOTING BOARD MEMBER. EACH MEMBER WAS PROVIDED THE OPPORTUNITY TO ASK QUESTIONS OF THE EVP & CFO PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY WHICH IS REVIEWED, ACCEPTED, AND SIGNED BY EACH OFFICER AND VOTING BOARD MEMBER ON AN ANNUAL BASIS. PURSUANT TO THIS POLICY, EACH OFFICER AND BOARD MEMBER WILL RECUSE HIMSELF OR HERSELF FROM ANY DISCUSSIONS AND VOTES FOR WHICH A CONFLICT EXISTS. DETERMINATION OF WHETHER A CONFLICT EXISTS IS MADE AT A MANAGEMENT, BOARD MEMBER, OFFICER, AND INDIVIDUAL LEVEL. ACTUAL CONFLICTS ARE REVIEWED BY MANAGEMENT AND THE BOARD WITHOUT THE PRESENCE OF THE INTERESTED PARTY. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION USES OUTSIDE AGENCIES TO ESTABLISH, ASSESS THE REASONABLENESS OF, REVIEW, AND APPROVE THE COMPENSATION OF DIRECTORS, SENIOR MANAGEMENT & PHYSICIANS. SENIOR MANAGEMENT PROVIDES OVERSIGHT ON DIRECTOR COMPENSATION, THE BOARD COMPENSATION COMMITTEE PROVIDES OVERSIGHT ON PHYSICIAN COMPENSATION AND THE CEO PROVIDES OVERSIGHT (WITH THE ASSISTANCE OF THE CFO AND CHRO) ON SENIOR MANAGEMENT COMPENSATION. CEO COMPENSATION IS EVALUATED AND APPROVED BY THE FULL BOARD AND BOARD COMPENSATION COMMITTEE. FAIR MARKET VALUATIONS ARE COMPLETED FOR ALL COMPENSATION AT LEAST ANNUALLY AND MONTHLY COMPENSATION MEETINGS ARE HELD TO REVIEW ANY AND ALL COMPENSATION RELATED ACTIVITIES. |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,244,564. MANAGEMENT AND GENERAL EXPENSES 7,846,215. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,090,779. |
| FORM 990, PART XI, LINE 9: | EQUITY TRANSFER 54,038,713. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| FORM 990, PART V, LINE 1A: | THE ORGANIZATION DID NOT DIRECTLY ISSUE ANY 1099'S DURING THE TAX PERIOD. GEORGETOWN MEMORIAL HOSPITAL, A RELATED ORGANIZATION, FILES THE FORMS 1099'S FOR THE ORGANIZATION. THE NUMBER OF 1099'S REPORTED BY GEORGETOWN MEMORIAL HOSPITAL THAT ARE RELATED TO THE ORGANIZATION IS 44. |
| Software ID: | |
| Software Version: |