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ObjectId: 201442239349300104 - Submission: 2014-08-11
TIN: 57-0341194
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
Attach to Form 990.
See separate instructions.
OMB No. 1545-0047
20
12
Open to Public
Inspection
Name of the organization
GEORGETOWN MEMORIAL HOSPITAL
Employer identification number
57-0341194
Part I
Bond Issues
(a)
Issuer name
(b)
Issuer EIN
(c)
CUSIP #
(d)
Date issued
(e)
Issue price
(f)
Description of purpose
(g)
Defeased
(h)
On
behalf of
issuer
(i)
Pool
financing
Yes
No
Yes
No
Yes
No
A
SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY
57-0960018
12-22-2010
30,000,000
CAPITAL ACQUISITION
X
X
X
B
SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY
57-0960018
09-22-2011
25,565,000
CURRENT REFUNDING
X
X
X
C
SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY
57-0960018
12-22-2011
12,165,620
CURRENT REFUNDING
X
X
X
D
SC JOBS - ECONOMIC DEVELOPMENT AUTHORITY
57-0960018
05-30-2012
34,099,717
CURRENT REFUNDING
X
X
X
Part II
Proceeds
A
B
C
D
1
Amount of bonds retired
.
.
.
.
.
.
.
.
.
.
.
.
.
.
361,305
1,652,964
2
Amount of bonds legally defeased
.
.
.
.
.
.
.
.
.
.
.
3
Total proceeds of issue
.
.
.
.
.
.
.
.
.
.
.
.
.
.
10,000,000
9,350,748
12,190,000
14,664,291
4
Gross proceeds in reserve funds
.
.
.
.
.
.
.
.
.
.
.
.
5
Capitalized interest from proceeds
.
.
.
.
.
.
.
.
.
.
.
6
Proceeds in refunding escrows
.
.
.
.
.
.
.
.
.
.
.
.
7
Issuance costs from proceeds
.
.
.
.
.
.
.
.
.
.
.
.
82,807
94,698
123,522
163,692
8
Credit enhancement from proceeds
.
.
.
.
.
.
.
.
.
.
.
46,050
46,050
345,599
9
Working capital expenditures from proceeds
.
.
.
.
.
.
.
.
.
10
Capital expenditures from proceeds
.
.
.
.
.
.
.
.
.
.
.
9,917,193
11
Other spent proceeds
.
.
.
.
.
.
.
.
.
.
.
.
.
.
9,210,000
9,210,000
12,066,478
14,155,000
12
Other unspent proceeds
.
.
.
.
.
.
.
.
.
.
.
.
.
.
13
Year of substantial completion
.
.
.
.
.
.
.
.
.
.
.
.
2012
2001
1999
2001
Yes
No
Yes
No
Yes
No
Yes
No
14
Were the bonds issued as part of a current refunding issue?
.
.
.
.
.
X
X
X
X
15
Were the bonds issued as part of an advance refunding issue?
.
.
.
.
.
X
X
X
X
16
Has the final allocation of proceeds been made?
.
.
.
.
.
.
.
.
X
X
X
X
17
Does the organization maintain adequate books and records to support the final allocation of proceeds?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
X
X
X
X
Part III
Private Business Use
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
1
Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds?
.
.
.
.
.
.
.
X
X
X
X
2
Are there any lease arrangements that may result in private business use of bond-financed property?
.
.
.
.
.
.
.
.
.
X
X
X
X
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2012
Page 2
Schedule K (Form 990) 2012
Page
2
Part III
Private Business Use
(Continued)
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
3a
Are there any management or service contracts that may result in private business use of bond-financed property?
.
.
.
.
.
.
.
.
.
.
.
.
X
X
X
X
b
If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed
property?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
c
Are there any research agreements that may result in private business use of bond-financed property?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
X
X
X
X
d
If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
.
4
Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government
.
.
0.00000
%
0.00000
%
0.00000
%
0.00000
%
5
Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government
.
.
.
.
.
.
.
0.00000
%
0.00000
%
0.00000
%
0.00000
%
6
Total of lines 4 and 5
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
0.00000
%
0.00000
%
0.00000
%
0.00000
%
7
Does the bond issue meet the private security or payment test?
.
.
.
.
.
X
X
X
X
8a
Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were
issued?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
X
X
X
X
b
If “Yes” to line 8a, enter the percentage of bond-financed property sold or disposed of.
%
%
%
%
c
If “Yes” to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2?
.
.
.
.
.
.
.
.
.
.
.
.
.
9
Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X
X
X
X
Part IV
Arbitrage
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
1
Has the issuer filed Form 8038-T?
.
.
.
.
.
X
X
X
X
2
If "No" to line 1, did the following apply?
.
.
.
.
a
Rebate not due yet?
.
.
.
.
.
.
.
.
X
X
X
X
b
Exception to rebate?
.
.
.
.
.
.
.
.
X
X
X
X
c
No rebate due?
.
.
.
.
.
.
.
.
.
.
X
X
X
X
If you checked "No rebate due" in line 2c, provide in Part VI
the date the rebate computation was performed
3
Is the bond issue a variable rate issue?
.
.
.
.
X
X
X
X
4a
Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?
X
X
X
X
b
Name of provider
.
.
.
.
.
.
.
.
.
c
Term of hedge
.
.
.
.
.
.
.
.
.
.
d
Was the hedge superintegrated?
.
.
.
.
.
.
e
Was a hedge terminated?
.
.
.
.
.
.
.
Schedule K (Form 990) 2012
Page 3
Schedule K (Form 990) 2012
Page
3
Part IV
Arbitrage
(Continued)
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
5a
Were gross proceeds invested in a guaranteed investment contract (GIC)?
.
.
.
.
.
.
.
.
.
X
X
X
X
b
Name of provider
.
.
.
.
.
.
.
.
.
c
Term of GIC
.
.
.
.
.
.
.
.
.
.
d
Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied?
.
.
.
.
.
6
Were any gross proceeds invested beyond an available temporary period?
.
.
.
.
.
.
.
.
X
X
X
X
7
Has the organization established written procedures to monitor the requirements of section 148?
.
.
.
X
X
X
X
Part V
Procedures To Undertake Corrective Action
A
B
C
D
Yes
No
Yes
No
Yes
No
Yes
No
1
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?
X
X
X
X
Part VI
Supplemental Information.
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier
Return Reference
Explanation
FORM 990, SCH K, PART II, LINE 11
THE AMOUNTS ON THIS LINE WERE USED TO REFUND PRIOR ISSUE BONDS. THE AMOUNTS IN COLUMN B WERE USED TO REFUND BONDS THAT WERE ISSUED ON 8/15/1999 AND 8/1/2001. THE AMOUNTS IN COLUMN C WERE USED TO REFUND BONDS THAT WERE ISSUED ON 3/15/1998 AND 8/15/1999. THE AMOUNTS IN COLUMN D WERE USED TO REFUND BONDS THAT WERE ISSUED ON 3/15/1998 AND 8/23/2001.
Schedule K (Form 990) 2012
Additional Data
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