2020-05-14T08:39:15-05:00 2019-06-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2018-07-01 580973772 DONALSONVILLE HOSPITAL INC DONA 2295245217 102 HOSPITAL CIRCLE DONALSONVILLE GA 398451100 HERMAN BROOKINS CHAIRMAN/CEO 2295245217 2020-05-15 true JACQUELINE G ATKINS P00861721 2298837878 2020-05-14 208.73.87.26 2020-05-14 08:39:15 CD P 3DB754BF4A86932C7270BAD44D636E9B352C5FAB 3DB754BF4A86932C7270BAD44D636E9B352C5FAB 2018 2020-09-23 17:36:50Z HERMAN BROOKINS 102 HOSPITAL CIRCLE DONALSONVILLE GA 398451100 42712642 false X WWW.DONALSONVILLEHOSPITAL.ORG X 1977 GA DONALSONVILLE HOSPITAL OPERATES A 65-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF DONALSONVILLE, GEORGIA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. 5 3 481 8612043 1401963 735498 1246282 34459644 38988698 66226 53539 2230767 2263632 37492135 42552151 1448313 55200 0 16143242 18519764 0 0 19770641 22960539 37362196 41535503 129939 1016648 32052631 32404313 11012148 10228176 21040483 22176137 DONALSONVILLE HOSPITAL OPERATES A 65-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF DONALSONVILLE, GEORGIA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. false false 34982799 55200 32067851 DONALSONVILLE HOSPITAL PROVIDES PRIMARY HEALTHCARE TO RESIDENTS OF SEMINOLE COUNTY AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. 34982799 true true false true false false false false false true true false false false true true true false false false false false false false false false true true true false true false false false false false false true false true false false false false false false false false true 35 0 481 true true true false false false false false false false false false false false X 5 3 false false false false false false false true false false false true true true true false true true true false GA X X JAMES MOODY 2295245217 102 HOSPITAL CIRCLE DONALSONVILLE GA 398451100 HERMAN BROOKINS CHAIRMAN/CEO 40.00 X X 467857 0 38000 CHARLES H ORRICK ADMINISTRATO 40.00 X X 258683 0 29340 BROADDUS SIMPSON SECRETARY 1.00 X X 14004 0 0 MITCH BLANKS DIRECTOR 1.00 X 9299 0 0 WILLIAM BURKE CPA DIRECTOR 1.00 X 9299 0 0 JAMES MOODY CFO 40.00 X 209643 0 37305 JOSEPH WALKER SR MD PHYSICIAN 40.00 X 417259 0 29179 ANDREA ALEXANDER MD PHYSICIAN 40.00 X 316135 0 30836 RYAN SHINGLER MD PHYSICIAN 40.00 X 224994 0 26712 ROYCE CANNINGTON JR CRNA 40.00 X 210018 0 26180 BRIAN BROOKINS PHARMACIST 40.00 X 204873 0 38867 2342064 256419 14 false true false HORIZON HEALTH P O BOX 840839 DALLAS TX 752840839 BEHAVIORAL HLTH 982077 NES GEORGIA INC PO BOX 936451 ATLANTA GA 311936451 ER PHYSICIANS 547330 LABCORP P O BOX 2240 BURLINGTON NC 272162240 OUTSIDE LAB 435757 CPSI PO BOX 850309 MOBILE AL 366850309 IT SUPPORT 398187 CGM CONSTRUCTION GROUP LLC PO BOX 566 COLQUITT GA 398370566 CONSTRUCTION 356355 33 338788 907494 576138 1246282 NET PATIENT SERVICE REVENUE 621990 30376655 30376655 REFERENCE LAB 621500 8612043 8612043 38988698 53539 53539 188526 160491 28035 28035 28035 MISCELLANEOUS REVENUE 621990 1693992 1693992 CAFETERIA 722513 544401 544401 MEDICAL RECORD FEES 621990 6810 6810 -9606 -9606 2235597 42552151 32067851 8612043 625975 X 55200 55200 1073430 1073430 13737575 12527927 1209648 505807 430883 74924 2338469 1992075 346394 864483 726524 137959 56169 56169 177990 177990 14262 14262 10833084 10624939 208145 116018 116018 1958265 1422854 535411 435757 435757 480057 409921 70136 54979 34367 20612 59224 57601 1623 289844 289844 1157290 988210 169080 205818 118207 87611 MEDICAL SUPPLIES 5116192 5116192 REPAIR AND MAINTENANCE 780101 200222 579879 INCOME TAX EXPENSE 381085 381085 MISCELLANEOUS EXPENSE 326143 2783 323360 518261 274894 243367 41535503 34982799 6552704 0 88292 65656 2694594 2751075 11170032 10863337 1427190 1413738 1058703 1101946 143867 519073 33623344 21306911 12115672 12316433 2322082 2687324 1032199 685731 32052631 32404313 5762148 3962059 5250000 5250000 1016117 11012148 10228176 X 21040483 22076137 100000 21040483 22176137 32052631 32404313 1016648 119006 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2860 2860 false SCHEDULE C, PART II-B, LINE 1 THE ORGANIZATION BELONGS TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS. A PORTION OF THE MEMBERSHIP DUES PAID TO THE ASSOCIATIONS ARE DEDICATED TO LOBBYING ACTIVITIES. 1639148 100000 208601 14262 1933487 1841565 -188471 13946 1639148 1834489 19902 12826 1841565 1717887 128532 11930 1834489 2528700 153274 948672 15415 1717887 0.94830 0.05170 false false 686053 686053 3740244 14905290 9869900 8775634 351110 338992 12118 13939642 11098019 2841623 1005 1005 12316433 DUE TO THIRD PARTY PAYORS 1016117 1016117 X 40274002 119006 -2129757 -2010751 42284753 267398 267398 42552151 39138348 -1748672 -1748672 40887020 648483 648483 41535503 SCHEDULE D, PAGE 2, PART V, LINE 4 ENDOWMENT FUNDS CONSIST OF INVESTMENTS FOR THE DEFERRED COMPENSATION PLAN AND MALPRACTICE INSURANCE. THE ORGANIZATION HAS ESTABLISHED A FUNDED DEFERRED COMPENSATION PLAN FOR CERTAIN KEY EMPLOYEES. MALPRACTICE INSURANCE IS A TRUST SET UP TO FUND POTENTIAL LIABILITIES UNDER THE HOSPITAL'S SELF INSURANCE PROGRAM. THE TRUSTEE IS SYNOVUS TRUST COMPANY, N.A. WALTER SCOTT FOUNDATION ENDOWMENT IS ESTABLISHED TO GENERATE INVESTMENT INCOME WHICH CAN BE SPENT ON GENERAL HOSPITAL OPERATIONS. SCHEDULE D, PAGE 3, PART X THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. HOWEVER, THE ORGANIZATION IS SUBJECT TO TAX ON ITS UNRELATED BUSINESS INCOME WHICH CONSISTS PRIMARILY OF INCOME FROM THE COMMUNITY OUTREACH PROGRAM. PREPAID TAXES ARE INCLUDED ON THE BALANCE SHEET. THE ORGANIZATION APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE ORGANIZATION ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENTS EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JUNE 30, 2019 AND 2018 OR FOR THE YEARS THEN ENDED. THE ORGANIZATIONS TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THESE RETURNS. SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSE OFFSET TO REVENUE ON AFS -72,424 INCOME TAX EXPENSE -381,085 RELATED PARTY EXPENSES OFFSET TO REVENUE -1,676,248 SCHEDULE D, PAGE 4, PART XI, LINE 4B MEALS EXPENSE FOR SNF PATIENTS 514,813 GRANTS/ASSISTANCE 55,200 RENTAL EXPENSES OFFSET TO REVENUE -160,491 INSURANCE PROCEEDS OFFSET TO EXPENSE -142,124 SCHEDULE D, PAGE 4, PART XII, LINE 2D RELATED PARTY EXPENSES OFFSET TO REVENUE -1,676,248 RENTAL EXPENSE OFFSET TO REVENUE ON AFS -72,424 SCHEDULE D, PAGE 4, PART XII, LINE 4B GRANTS/ASSISTANCE 55,200 MEALS EXPENSE FOR SNF PATIENTS 514,813 UBI INCOME TAX EXPENSE 381,085 INSURANCE PROCEEDS OFFSET TO EXPENSE -142,124 RENTAL EXPENSES OFFSET TO REVENUE -160,491 true true X true X 1.250000000000 true X true true false true true 1867059 1867059 0.04480 4800689 4931575 78990 48438 30552 0.00070 6746738 4980013 1897611 0.04550 33478 33478 0.00080 55200 55200 0.00130 88678 88678 0.00210 6835416 4980013 1986289 0.04770 true 8319860 415993 5413806 5709462 -295656 X true true 1 1 DONALSONVILLE HOSPITAL INC 102 HOSPITAL CIRCLE DONALSONVILLE GA 398451100 WWW.DONALSONVILLEHOSPITAL.ORG 125-318 X X X SNF, REHAB DONALSONVILLE HOSPITAL INC 1 false false true X X X X X X X X X X 19 true false false true X WWW.DONALSONVILLEHOSPITAL.ORG X true 19 true WWW.DONALSONVILLEHOSPITAL.ORG false false true X 125.000000000000 200.000000000000 X true true X X X X true X WWW.DONALSONVILLEHOSPITAL.ORG X WWW.DONALSONVILLEHOSPITAL.ORG X WWW.DONALSONVILLEHOSPITAL.ORG X X X X X true X false X X X X true X false false FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 3E THE PRIORITIZATION OF SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IS IDENTIFIED AND THE METHODOLOGY FOR PRIORITIZING EACH NEED IS DESCRIBED ON PAGE 15 OF THE 2019 CHNA. FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 5 THE CHNA PANEL WAS SELECTED, STARTING WITH FIVE HOSPITAL BOARD MEMBERS. THE BOARD MEMBERS HAVE A BROAD RANGE OF COMMUNITY INVOLVEMENT AND LEADERSHIP ROLES, INCLUDING ONE WHO IS INVOLVED WITH LOCAL COUNTY AND CITY GOVERNMENTS; THREE WHO ARE ACTIVE WITH OTHER NONPROFIT ORGANIZATIONS AND ARE COMMUNITY LEADERS; AND ONE WITH A VAST KNOWLEDGE AND EXPERIENCE IN THE AGRICULTURAL AREA, A MAJOR INDUSTRY OF SEMINOLE COUNTY. THE CHNA PANEL INCLUDED ALL FIVE MEMBERS OF THE BOARD PLUS TWO ADDITIONAL MEMBERS - A LOCAL COUNTY COMMISSIONER WHO ALSO SERVES AS CO-PASTOR IN A LOCAL MINISTRY, AND THE LOCAL HEALTH DEPARTMENT DIRECTOR. THE DONALSONVILLE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT PANEL REVIEWED AND DISCUSSED DATA GATHERED FROM OUTSIDE SOURCES, INPUT FROM LOCAL MEDICAL STAFF, EMPLOYEE MEETINGS, INPUT FROM LOCAL GOVERNMENT, INPUT FROM LOCAL BUSINESSES AS WELL AS INTERNAL DATA. IN UTILIZING THESE SOURCES, THE PANEL ESTABLISHED THE SPECIFIC NEEDS OF THE COMMUNITY BASED ON THE FOLLOWING CRITERIA: SEVERITY, OF CASES, IMPACT ON COMMUNITY AND THE ORGANIZATION'S ABILITY TO IMPLEMENT A SOLUTION TO IMPROVE THE NEED. FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 11 AFTER LOOKING AT ALL OF THE DATA GATHERED, THE 2019 CHNA PANEL DETERMINED THAT THE HEALTH NEEDS THAT COULD BE IMPROVED BY THE HOSPITAL INPUT WERE AS FOLLOWS: 1. DIABETES/HYPERTENSION DISEASE 2. OBESITY IN ADULTS 3. CANCER 4. MENTAL HEALTH BOTH 2019 COMMUNITY HEALTH NEEDS ASSESSMENT AND THE 2019 CHNA IMPLEMENTATION PLAN ARE WIDELY PUBLICIZED ON THE ORGANIZATION'S WEBSITE AND CAN BE FOUND AT HTTPS://WWW.DONALSONVILLEHOSPITAL.ORG/DOCS/5A_2020_COMMUNITY_HEALTH_NEEDS_A SSESSMENT.PDF AND HTTPS://WWW.DONALSONVILLEHOSPITAL.ORG/DOCS/5B_2020_COMMUNITY_HEALTH_NEEDS_I MPLEMENTATION.PDF, RESPECTIVELY. FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 13H ALL PATIENTS ARE CHARGED EQUALLY REGARDLESS OF ANY OF THE ABOVE. THOSE INDIVIDUALS WITHOUT THIRD PARTY COVERAGE ARE GIVEN A 15% DISCOUNT IF THEY DO NOT QUALIFY FOR FREE CARE. THEY ARE ALSO GIVEN THE OPPORTUNITY TO RECEIVE A 50% DISCOUNT IF BILL IS PAID WITHIN 1 YEAR OF DISCHARGE. ALSO, FREE CARE IS OFFERED FOR PATIENTS MEETING CHARITY GUIDELINES - RANGING FROM 125% TO 200% OF FEDERAL POVERTY GUIDELINES. 2 SEMINOLE MANOR NURSING HOME 102 HOSPITAL CIRCLE DONALSONVILLE GA 317451100 SNF DONALSONVILLE HOSP BEHAV HLTH UNIT 102 HOSPITAL CIRCLE DONALSONVILLE GA 317451100 BEHAVIORAL HLTH UNIT PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 41,535,503 ADD: EXPENSES REPORTED IN PART VIII 160,491 DENOMINATOR FOR COLUMN (F) 41,695,994 PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION COSTS FOR PART I, LINE 7A, 7B AND 7C WERE COMPUTED USING THE RATIO OF PATIENT CARE COST TO CHARGES CALCULATED ON WORKSHEET 2. OTHER COSTS WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE THE FIGURE ON PART III LINE 3 REPRESENTS MANAGEMENT'S ESTIMATE (APPROXIMATELY 5%) BASED ON AN ANALYSIS OF SELF PAY PATIENTS' ABILITY TO PAY THEIR OUTSTANDING ACCOUNT. THIS ANALYSIS INCLUDES REVIEWING THE PATIENT'S CREDIT HISTORY, INCOME LEVELS AND OVERALL COLLECTIBILITY OF THE ACCOUNT. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS SEE PAGE 16 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION OUR PATIENT FINANCIAL SERVICES DEPARTMENT VISITS PATIENTS WHO HAVE NO INSURANCE TO DISCUSS ASSISTANCE AND REFER THOSE PATIENTS TO OUR LOCAL DFCS OFFICE TO OBTAIN ASSISTANCE WITH APPLYING FOR MEDICAID OR OTHER FINANCIAL ASSISTANCE. OUR PATIENT FINANCIAL SERVICES DEPARTMENT, WHICH DOES SELF-PAY BILLING AND COLLECTION, INFORMS PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND ASSISTS THEM IN COMPLETING AN APPLICATION. BILLING STATEMENTS PROVIDE A MESSAGE AND TELEPHONE NUMBER TO CALL IF THE PATIENT IS HAVING DIFFICULTIES MAKING PAYMENTS. FOR PATIENTS WHO QUALIFY AS INDIGENT OR CHARITY PATIENTS, THERE IS NO FINANCIAL OBLIGATION. THOSE PATIENTS WHO DO NOT QUALIFY AS INDIGENT OR CHARITY ARE SENT MULTIPLE STATEMENTS FOR 30, 60, AND 90 DAYS PAST DUE. THOSE PATIENTS WILL ALSO BE SENT TWO LETTERS REGARDING PAST DUE ACCOUNTS. ONCE AN ACCOUNT HAS NO ACTIVITY FOR 180 DAYS, IT WILL BE SENT TO AN OUTSIDE COLLECTION AGENCY. PART VI, LINE 2 - NEEDS ASSESSMENT A COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN FISCAL YEAR 2019. INFORMATION WAS SOLICITED FROM VARIOUS INDIVIDUALS REPRESENTING THE INTERESTS OF THE COMMUNITY BY MEANS OF FOCUS GROUPS, EXTERNAL STATISTICS, AND INTERNAL DATA. THE ORGANIZATION CONDUCTS VARIOUS TYPES OF ASSESSMENTS TO DETERMINE THE COMMUNITY'S NEEDS FOR HEALTH SERVICES AND COLLABORATES WITH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TO IDENTIFY THE NEEDS OF THE COMMUNITY. COMMUNITY RESEARCH HAS SHOWN THAT THE SERVICES FOR WHICH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TURN TO THE ORGANIZATION ARE EMERGENCY SERVICES, DIAGNOSTIC TESTS AND X-RAYS, AND ALSO GENERAL MEDICAL CARE. OTHER SERVICES FOR WHICH THEY TURN TO US AS A MAJOR PROVIDER ARE MINOR SURGERY, PEDIATRIC CARE, GENERAL SURGERY, AND OBSTETRICAL CARE. THIS INFORMATION, COMBINED WITH OUR EXTENSIVE COLLABORATIONS AND OUR ROLE AS A LEADER IN THE COMMUNITY, PROVIDES US THE MEANS TO UNDERSTAND AND ADDRESS THE COMMUNITY'S NEEDS AND ENSURES OUR OUTREACH PROGRAMS ARE FOCUSED ON THE POPULATIONS WHO NEED OUR SERVICES THE MOST. OUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS, ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE BOARD HAS CLEARLY WRITTEN INDIGENT AND FINANCIAL AID POLICIES THAT ARE AVAILABLE THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND FINANCIAL AID. PATIENT EDUCATION ON THE ORGANIZATIONS INDIGENT/CHARITY AND FINANCIAL AID PROGRAMS ARE CONDUCTED DURING PRE-REGISTRATION, THROUGH OUR PATIENT FINANCIAL SERVICES DEPARTMENT FOR PATIENTS THAT DO NOT HAVE ANY 3RD PARTY COVERAGE. BROCHURES ARE PROMINENTLY DISPLAYED AT EACH REGISTRATION BOOTH. THE BUSINESS OFFICE CONTINUOUSLY PROVIDES INFORMATION TO THE BUSINESS OFFICE MANAGERS OF OUR LOCAL PHYSICIAN'S PRACTICES. PHONE CALLS AND LETTERS ARE SENT TO ALL PATIENTS THAT ARE NOT INTERVIEWED AT THE TIME OF ADMISSION EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAMS. OUR EMERGENCY DEPARTMENT IS OPERATED 24/7 AND OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. PART VI, LINE 4 - COMMUNITY INFORMATION THE ORGANIZATION SERVES A PREDOMINATELY RURAL AREA IN SEMINOLE COUNTY, IN ITS BROADEST BOUNDARIES. DONALSONVILLE IS THE ECONOMIC AND MEDICAL HUB FOR THE REGION, AND THE ORGANIZATION DRAWS FROM A POPULATION OF APPROXIMATELY 9,000 RESIDENTS FOR MAJOR HEALTH CARE SERVICES. THE REGION IS MARKED BY VAST DICHOTOMIES OF WEALTH, EDUCATION, AND HEALTH STATUS. THE ORGANIZATION SERVES A POPULATION THAT HAS A HIGH PROPORTION OF LOW-INCOME INDIVIDUALS. ABOUT 25.2% OF FAMILIES AND 25.49% OF THE POPULATION WERE BELOW THE POVERTY LINE. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH OUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS, ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY. WE HAVE PARTICIPATED IN VARIOUS LOCAL HEALTH FAIRS TO PROMOTE GOOD HEALTH AND PROVIDE SCREENING MECHANISMS FOR DETECTING HIGH BLOOD PRESSURE, ABNORMAL BLOOD SUGAR LEVELS AND HIGH CHOLESTEROL. THESE ARE THE MOST PRESSING AND PREVENTABLE DISEASES IN OUR COMMUNITY. WE WORK CLOSELY WITH THE LOCAL HEALTH DEPARTMENT TO ASSIST THEM WITH THE PROGRAMS THAT THEY FACILITATE THROUGHOUT THE YEAR. OUR BOARD HAS HAD IN PLACE FOR MORE THAN 20 YEARS, A SCHOLARSHIP PROGRAM FOR PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS. WE HAVE BEEN FORTUNATE TO HAVE MANY OF OUR LOCAL RESIDENTS FINISH MEDICAL SCHOOL, NURSING SCHOOL AND OTHER PROFESSIONAL CERTIFICATIONS, AND COME BACK TO DONALSONVILLE TO PRACTICE AND WORK IN OUR LOCAL HEALTHCARE COMMUNITY. THE PHYSICIAN SCHOLARSHIP PROGRAM HAS PRODUCED 9 OF OUR CURRENT 14 MEMBER MEDICAL STAFF. WE ALSO HAVE 3 IN THE PROGRAM THAT ARE SCHEDULED TO COME BACK TO OUR COMMUNITY OVER THE NEXT FEW YEARS. THIS TYPE OF PROGRAM HAS HELPED KEEP HEALTHCARE AVAILABLE AND ACCESSIBLE TO OUR RURAL COMMUNITY. IT HAS ENABLED US TO START NEW SERVICES THAT WOULD NOT HAVE EXISTED OTHERWISE. OUR BOARD IS DEDICATED TO PLANNING AND PREPARING FOR THIS RURAL COMMUNITY TO HAVE EASILY ACCESSIBLE HEALTHCARE FOR MANY YEARS TO COME. true SOUTHWEST GA HEALTHCARE CLINICS INC 205 BRESEE ST DONALSONVILLE GA 398451134 475012525 501C3 35000 OPERATIONS SPRING CREEK HEALTH CARE COOP 304 WEST PINE ST COLQUITT GA 398370357 300187514 501C3 20200 RX ASSISTANCE PROG 2 SCHEDULE I, PAGE 1, PART I, LINE 2 BEGINNING IN 2017, CERTAIN PHYSICIANS PREVIOUSLY OPERATING AS EMPLOYEES OF THE ORGANIZATION BEGAN PRACTICING UNDER A NEW FEDERALLY QUALIFIED HEALTH CENTER (FQHC) AND ARE NO LONGER EMPLOYEES OF THE ORGANIZATION. HOWEVER, THE ORGANIZATION AGREED TO COVER THE LOSSES THE PHYSICIANS INCURRED ON AN ANNUAL BASIS. THE ORGANIZATION REQUIRES MONTHLY FINANCIAL STATEMENTS FROM THE FQHC AND APPROVAL BY THE BOARD PRIOR TO REIMBURSEMENT. THIS ASSISTANCE WAS DISCONTINUED IN 2019. THE PRESCRIPTION ASSISTANCE PROGRAM WITH SPRING CREEK HEALTH CARE COOPERATIVE REQUIRES A DETAILED SUMMARY BE PROVIDED TO THE HOSPITAL ON A FREQUENT BASIS THROUGHOUT THE YEAR. X X false false false false false false false false false HERMAN BROOKINS CHAIRMAN/CEO 443558 15000 9299 38000 505857 CHARLES H ORRICK ADMINISTRATOR 234384 15000 9299 29340 288023 JAMES MOODY CFO 190139 15590 3914 10446 26859 246948 JOSEPH WALKER SR MD PHYSICIAN 384462 28797 4000 13500 15679 446438 ANDREA ALEXANDER MD PHYSICIAN 244183 71952 13500 17336 346971 RYAN SHINGLER MD PHYSICIAN 202620 22374 11033 15679 251706 ROYCE CANNINGTON JR CRNA 196018 14000 10501 15679 236198 BRIAN BROOKINS PHARMACIST 174138 15590 15145 10478 28389 243740 SCHEDULE J, PART III PART I, LINE 4 - DEFERRED COMPENSATION PLAN 457(B) THE ORGANIZATION HAS ESTABLISHED A DEFERRED COMPENSATION PLAN FOR CERTAIN KEY EMPLOYEES. THE 457(B) PLAN IS A NON-QUALIFIED RETIREMENT PLAN THAT ALLOWS A MAXIMUM SALARY DEFERRAL OF THE LESSER OF 16,500 OR ONE-THIRD OF AN EMPLOYEE'S SALARY. BRIAN BROOKINS FAMILY BD MMBR 246948 COMPENSATION false SCHEDULE L, PART V BRIAN BROOKINS, AN EMPLOYEE OF THE ORGANIZATION, IS THE SON OF HERMAN BROOKINS, WHO IS THE CHAIRMAN OF THE BOARD AND CEO. X MEDICAL EQUIP 2 576138 FMV false false false SCHEDULE M, PAGE 2, PART II THE ORGANIZATION IS REPORTING THE NUMBER OF ITEMS RECEIVED IN PART I, COLUMN (B). FORM 990, PAGE 6, PART VI, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PAGE 6, PART VI, LINE 11B THE INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 (BASED UPON INFORMATION PROVIDED BY THE ORGANIZATION) PROVIDES A COPY OF THE RETURN TO BE REVIEWED BY MANAGEMENT. MANAGEMENT PERFORMS A DETAILED REVIEW WHICH CONSISTS OF REVIEWING THE FINANCIAL DATA, THE NARRATIVES DISCLOSED, AND OTHER FACTS PRESENTED ON THE RETURN. UPON REVIEW, THE FORM 990 AND RELATED SCHEDULES ARE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND FEEDBACK. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES, A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING. FORM 990, PAGE 6, PART VI, LINE 12C THE ORGANIZATION HAS A WRITTEN POLICY RESPECTING CONFLICTS OF INTEREST AND DISCLOSURE OF SAME. GENERALLY SPEAKING, THE POLICY REQUIRES ANY "COVERED PERSON" WHO BELIEVES HE HAS A CONFLICT OF INTEREST TO: -DISCLOSE THE EXISTENCE AND NATURE OF THE CONFLICT OF INTEREST (INCLUDING ALL FACTS KNOWN RESPECTING THE SUBJECT MATTER) TO THE CHAIRMAN OF THE BOARD; -PLAY NO PART, DIRECTLY OR INDIRECTLY, IN THE DELIBERATION OR VOTE OF THE BOARD OF DIRECTORS WITH RESPECT TO THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS; AND -RECUSE HIMSELF FROM THAT PORTION OF THE MEETING AT WHICH THE CONFLICT OF INTEREST IS DISCUSSED. THE DEFINITION OF A "COVERED PERSON" INCLUDES ALL BOARD MEMBERS, OFFICERS AND MEMBERS OF SENIOR MANAGEMENT OF THE ORGANIZATION. WHEN A COVERED PERSON DISCLOSES A POTENTIAL CONFLICT OF INTEREST TO THE BOARD CHAIRMAN, THE CHAIRMAN IS OBLIGED TO BRING THE MATTER TO THE ATTENTION OF THE FULL BOARD WHO DETERMINES WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. IF A CONFLICT OF INTEREST EXISTS, THE TRANSACTION OR MATTER GIVING RISE TO THE CONFLICT OF INTEREST MAY NOT PROCEED UNLESS THE BOARD DETERMINES, BY A MAJORITY VOTE, THAT, DESPITE THE CONFLICT OF INTEREST, THE TRANSACTION/MATTER IS NEVERTHELESS IN THE ORGANIZATION'S BEST INTEREST AND IS FAIR AND REASONABLE TO THE ORGANIZATION. IN ADDITION TO THE REQUIREMENT TO DISCLOSE A POTENTIAL CONFLICT OF INTEREST AT THE TIME IT ARISES, EACH MUST SUBMIT ANNUALLY A `CONFLICT AND DISCLOSURE OF INTEREST QUESTIONNAIRE'. FORM 990, PAGE 6, PART VI, LINE 15A THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE COMPENSATION FOR THE CEO. THE BOARD USES COMPARABLE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS AT SIMILARLY SIZED ORGANIZATIONS AND SALARY SURVEYS TO DETERMINE THE COMPENSATION FOR THE CEO. THE CEO, A VOTING MEMBER OF THE BOARD, IS DISMISSED FROM THE MEETING DURING THE REVIEW OF HIS COMPENSATION. THE LAST DETERMINATION USING COMPARABLE COMPENSATION DATA AND SALARY SURVEYS WAS IN 2006. HOWEVER, COST OF LIVING ADJUSTMENTS ARE GIVEN ANNUALLY AND ARE APPROVED BY THE BOARD. FORM 990, PAGE 6, PART VI, LINE 15B THE BOARD OF DIRECTORS MEETS ON A MONTHLY BASIS, AND THE SALARY DECISIONS ARE REVIEWED BY THE BOARD. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION WILL MAKE AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO ANY MEMBER OF THE PUBLIC WHO MAKES THEIR REQUEST AT THE ADMINISTRATIVE OFFICE OF THE FILING ENTITY. FORM 990, PART IX, LINE 11G CONTRACT FEES 8,288,175 0 0 PROFESSIONAL FEES 2,050,879 72,643 0 PURCHASED SERVICES 144,648 135,502 0 CONSULTING FEES 141,237 0 0 TOTAL 10,624,939 208,145 0