2024-08-14T11:59:38-05:00 2023-09-30 991856619 GRANT THORNTON ADVISORS LLC 75 STATE ST 13TH FLOOR BOSTON MA 02109 990 2022-10-01 208817905 CONWAY HOSPITAL EMERGENCY PROFESSIONAL SERVICES CONW 8433478037 300 SINGLETON RIDGE ROAD CONWAY SC 29526 DAVID MIER CFO 8433478037 2024-08-14 1 1 ERIN COUTURE P01390592 6177237900 2022 2024-08-08 14:25:15Z BRIAN ARGO 300 SINGLETON RIDGE ROAD CONWAY SC 29526 5283471 0 X WWW.CONWAYMEDICALCENTER.COM X 2007 SC PROVIDES EMERGENCY ROOM PHYSICIAN SUPPORT TO CONWAY HOSPITAL, INC. 2 0 0 0 0 0 813010 0 4496941 5283471 0 0 0 0 5309951 5283471 1000 0 0 0 0 0 0 0 0 6997591 6953139 6998591 6953139 -1688640 -1669668 753459 922282 13635640 15474131 -12882181 -14551849 CONWAY HOSPITAL EMERGENCY PROFESSIONAL SERVICES PROVIDES EMERGENCY ROOM PHYSICIAN SUPPORT TO CONWAY HOSPITAL, INC., A NON-PROFIT ACUTE CARE HOSPITAL SYSTEM THAT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR HORRY AND SURROUNDING COUNTIES OF SOUTH CAROLINA. 0 0 6572701 5283471 AS A SUPPORTING ORGANIZATION OF CONWAY HOSPITAL, INC., CONWAY HOSPITAL EMERGENCY PROFESSIONAL SERVICES PROVIDES EMERGENCY ROOM PHYSICIANS AND RELATED ADMINISTRATIVE SUPPORT TO THE HOSPITAL BY INCREASING THE EFFICIENCY AND ACCURACY OF BILLING FOR EMERGENCY ROOM SPECIALISTS USED BY THE HOSPITAL. THIS LEADS TO A BETTER QUALITY OF CARE AND BETTER EXPERIENCE FOR PATIENTS OF CONWAY HOSPITAL. 6572701 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 2 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 SC X DAVID MIER 8433478037 300 SINGLETON RIDGE ROAD CONWAY SC 29526 BRET BARR PRESIDENT (TO 12/22) 1.00 43.00 X X 0 848609 48857 BRIAN ARGO TREAS (TO 12/22); PRES (AS OF 01/23) 1.00 43.00 X X 0 454044 48149 DAVID MIER TREASURER/SECRETARY (AS OF 01/23) 1.00 43.00 X X 0 250029 10107 0 1552682 107113 0 0 1 0 CONWAY EMERGENCY GROUP 300 SINGLETON RIDGE ROAD CONWAY SC 29526 ER PHYSICIAN FEES 6576705 GOTTLIEB LLC 4932 SUNBEAM ROAD JACKSONVILLE FL 32507 BILLING SERVICES 358308 2 NET PATIENT REVENUE 621110 5283471 5283471 5283471 5283471 5283471 0 0 X 23519 23519 12355 12355 6891291 6546727 344564 25974 25974 6953139 6572701 380438 0 328393 434636 425066 487646 753459 922282 63060 57994 13572580 15416137 13635640 15474131 X -12882181 -14551849 -12882181 -14551849 753459 922282 -1669668 0 X 0 1 X 1 0 X X X 1 CONWAY HOSPITAL INC 570314381 3 1 6953139 0 1 6953139 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 DUE TO CONWAY HOSPITAL 15416137 15416137 X PART X, LINE 2: LIABILITY FOR UNCERTAIN TAX POSITION (ASC 740) THE HOSPITAL CONTINUES TO EVALUATE TAX POSITIONS RELATED TO ASC 740, "INCOME TAXES," WHICH PRESCRIBES FINANCIAL STATEMENT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTES FOR TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN TAX RETURNS. AS OF SEPTEMBER 30, 2023, THE TAX YEARS ENDED SEPTEMBER 30, 2023, 2022, 2021, AND 2020 FOR FEDERAL JURISDICTION REMAIN OPEN TO EXAMINATION. 0 1 0 0 0 0 0 0 0 BRET BARR PRESIDENT (TO 12/22) 0 740635 0 92907 0 15067 0 16517 0 32340 0 897466 0 0 BRIAN ARGO TREAS (TO 12/22); PRES (AS OF 01/23) 0 406681 0 21500 0 25863 0 14486 0 33663 0 502193 0 0 DAVID MIER TREASURER/SECRETARY (AS OF 01/23) 0 184279 0 65750 0 0 0 1938 0 8169 0 260136 0 0 PART I, LINE 3 CONWAY HOSPITAL INC. USES THE FOLLOWING METHODS WHEN ESTABLISHING THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN CONWAY HOSPITAL PROVIDES A NON-QUALIFIED SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN, A CAPITAL ACCUMULATION PLAN AND AN ENVISION PLUS PLAN TO SENIOR EXECUTIVES SUBJECT TO CERTAIN VESTING REQUIREMENTS AND/OR SUBSTANTIAL RISKS OF FORFEITURE. THE FOLLOWING EXECUTIVES PARTICIPATED IN ONE OR MORE OF THE PLANS DURING THE YEAR: BRET BARR AND BRIAN ARGO. DURING THE CALENDAR YEAR REPORTED WITHIN THIS YEAR, THE FOLLOWING INDIVIDUALS RECEIVED PAYOUTS FROM THE PLAN: BRET BARR $15,067 BRIAN ARGO $10,841 THESE AMOUNTS ARE INCLUDED IN THE WAGES REPORTED ON THIS FORM 990. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS CONWAY HOSPITAL, INC. IS THE SOLE MEMBER OF CONWAY HOSPITAL EMERGENCY PROFESSIONAL SERVICES. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR STOCKHOLDERS WHO MAY ELECT THE TRUSTEES OF CONWAY HOSPITAL EMERGENCY PROFESSIONAL SERVICES ARE APPOINTED BY CONWAY HOSPITAL INC.'S BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL CONWAY HOSPITAL EMERGENCY PROFESSIONAL SERVICES' BOARD OF TRUSTEES SHALL MAKE OR OVERSEE MANAGEMENT AND OPERATIONAL MATTERS OF THE CORPORATION. CONWAY HOSPITAL, INC. RESERVES TO ITS OWN BOARD OF TRUSTEES THE AUTHORITY TO DIRECT ALL FINANCIAL MATTERS AND MATTERS AFFECTING THE PURPOSE OF THE CORPORATION. APPROVAL BY THE CONWAY HOSPITAL, INC. GROUP OF TRUSTEES IS REQUIRED FOR ALL AMENDMENTS TO THE BY-LAWS OF THIS ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS THE CONWAY HOSPITAL, INC. ACCOUNTING DEPARTMENT PREPARES THE 990 INFORMATION IN CONSULTATION WITH THE VP OF FISCAL SERVICES. AN OUTSIDE ACCOUNTING FIRM PREPARES THE IRS FORM 990 AND SENDS IT TO THE ACCOUNTING DEPARTMENT AND VP OF FISCAL SERVICES WHO REVIEW THE FORM IN DETAIL. THE FORM 990 IS PROVIDED TO ALL BOARD OF TRUSTEE MEMBERS BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY MONITORING & ENFORCEMENT THE POLICY IS DISTRIBUTED TO ALL COVERED PERSONS AFFILIATED WITH THIS ENTITY AND CONWAY HOSPITAL, INC. (BOARD OF TRUSTEES AND KEY MANAGEMENT PERSONNEL) AND EACH COVERED PERSON MUST SIGN AN ANNUAL STATEMENT THAT HE OR SHE: RECEIVED A COPY OF THE POLICY, READ AND UNDERSTANDS THE POLICY, AGREES TO COMPLY WITH THE POLICY, AND UNDERSTANDS THE POLICY APPLIES TO THE BOARD AND ALL BOARD COMMITTEES. DISCLOSURE OF POTENTIAL CONFLICT OF INTEREST: EVERY COVERED PERSON MUST SUBMIT IN WRITING TO THE CHIEF EXECUTIVE OFFICER A CONFLICT OF INTEREST DISCLOSURE STATEMENT LISTING ALL FINANCIAL AND/OR POTENTIAL CONFLICTING INTERESTS. INDIVIDUALS RESUBMIT UPDATED STATEMENTS EACH YEAR WITH ANY NECESSARY CHANGES OR AS ANY ADDITIONAL CONFLICTING OR FINANCIAL INTEREST ARISES. ALL BOARD MEMBERS WILL RECEIVE AN ANNUAL SUMMARY OF THE DISCLOSURES. IN ADDITION, THE BOARD CHAIR AND CHIEF EXECUTIVE OFFICER SHALL HAVE DISCLOSURE STATEMENTS AVAILABLE AT THE TIME OF ALL BOARD MEETINGS IN CASE A POTENTIAL CONFLICT ARISES. EVERY BOARD MEMBER HAS THE OBLIGATION TO INFORM THE BOARD CHAIR OR THE CHIEF EXECUTIVE OFFICER IF HE/SHE IS AWARE OF AN UNDISCLOSED POTENTIAL FINANCIAL AND/OR CONFLICTING INTEREST OF ANOTHER PERSON COVERED BY THE POLICY. IN THE EVENT OF SUCH NOTIFICATION, THE BOARD CHAIR OR CHIEF EXECUTIVE OFFICER SHALL INVESTIGATE THE POSSIBLE UNDISCLOSED INTEREST. FORM 990, PART VI, SECTION B, LINE 15 PROCESS FOR DETERMINING COMPENSATION COMPENSATION IS PROVIDED BY CONWAY HOSPITAL, INC. THE CONWAY HOSPITAL, INC. BOARD EXECUTIVE COMPENSATION COMMITTEE IS RESPONSIBLE FOR REVIEWING AND APPROVING COMPENSATION FOR THE CEO, CFO AND ALL VICE PRESIDENTS. AT A MINIMUM OF EVERY THREE YEARS (AND MORE FREQUENTLY WHEN THERE IS TURNOVER IN A POSITION), AN INDEPENDENT CONSULTING COMPANY IS UTILIZED TO PROVIDE APPROPRIATE BENCHMARKED DATA FOR COMPARATIVE POSITIONS TO ASSIST IN DETERMINING COMPENSATION. THE CEO AND CFO ARE RESPONSIBLE FOR APPROVING COMPENSATION FOR ALL OTHER POSITIONS. THEY UTILIZE INDEPENDENT BENCHMARK DATA GATHERED BY THE SOUTH CAROLINA HOSPITAL ASSOCIATION IN SETTING APPROPRIATE COMPENSATION FOR THOSE POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC CONWAY HOSPITAL EMERGENCY PROFESSIONAL SERVICES MAKES ITS FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G ER PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 6,375,230. MANAGEMENT AND GENERAL EXPENSES 335,538. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,710,768. ER PHYSICIAN CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 171,497. MANAGEMENT AND GENERAL EXPENSES 9,026. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 180,523. CONWAY HOSPITAL INC 300 SINGLETON RIDGE RD CONWAY SC 29526 570314381 HEALTHCARE SC 501(C)(3) LINE 3 CONWAY HOSPITAL HOLDINGS LLC 0 CONWAY HOSPITAL COMMUNITY SERVICES 300 SINGLETON RIDGE RD CONWAY SC 29526 571119337 HEALTHCARE SC 501(C)(3) LINE 3 CONWAY HOSPITAL INC 0 CONWAY ANESTHESIA PROF SERVICES 300 SINGLETON RIDGE RD CONWAY SC 29526 208817302 ANESTHESIA SC 501(C)(3) LINE 12A, I CONWAY HOSPITAL INC 0 CONWAY HOSPITAL LONG TERM CARE SERVICES 300 SINGLETON RIDGE RD CONWAY SC 29526 570875232 HEALTHCARE SC 501(C)(3) LINE 12A, I CONWAY HOSPITAL INC 0 CONWAY HOSPITAL HOLDINGS LLC 300 SINGLETON RIDGE RD CONWAY SC 29526 933254842 HOLDING COMPANY SC APPLIED CONWAY PARENT INC 0 CONWAY PARENT INC 300 SINGLETON RIDGE RD CONWAY SC 29526 931759006 PARENT SC APPLIED N/A 0 MEDICAL PROPERTIES INC 300 SINGLETON RIDGE RD CONWAY SC 29526 570751357 RENTALS SC N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 NOT REQUIRED SCHEDULE R, PART II, COLUMN (D) CONWAY PARENT, INC. AND CONWAY HOSPITAL HOLDINGS, LLC WERE FORMED EFFECTIVE JUNE AND JULY 2023, RESPECTIVELY, AND ARE IN THE PROCESS OF APPLYING FOR TAX EXEMPTION WITH THE INTERNAL REVENUE SERVICE.