2020-11-16T15:38:33-06:00 2019-12-31 621517792 PYA P C 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2019-01-01 650543088 COFFEE REGIONAL MEDICAL CENTER INC COFF 9123841900 1101 OCILLA ROADPO BOX 1287 DOUGLAS GA 315332207 VICKI LEWIS PRESIDENT AND CEO 9123841900 2020-11-16 1 DEBORAH O ERNSBERGER P00364912 8656730844 50.228.55.2 2020-11-16 15:38:26 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AF23F2A68CFF53983216DF8908F842EE3670BFA3 2019 2021-01-29 14:40:06Z VICKI LEWIS 1101 OCILLA ROAD/PO BOX 1287 DOUGLAS GA 315332207 150058208 0 X WWW.COFFEEREGIONAL.ORG X 1995 GA TO BE A LEADING PROVIDER OF A COMPREHENSIVE RANGE OF HIGH-QUALITY, REASONABLY PRICED HEALTH CARE SERVICES IN COFFEE COUNTY, GEORGIA, AND THE SURROUNDING REGION. THESE HEALTH CARE SERVICES ARE PROVIDED TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. 12 11 1100 55 72964 -17524 2361084 1763839 123348885 141271179 3385156 3030734 3775377 3987699 132870502 150053451 3690 0 0 0 68608409 70742454 0 0 0 67185059 77597217 135797158 148339671 -2926656 1713780 81783336 91799404 60526792 66143065 21256544 25656339 TO BE A LEADING PROVIDER OF A COMPREHENSIVE RANGE OF HIGH-QUALITY, REASONABLY PRICED HEALTH CARE SERVICES IN COFFEE COUNTY, GEORGIA, AND THE SURROUNDING REGION. THESE HEALTH CARE SERVICES ARE PROVIDED TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. 0 0 130146134 144182046 HOSPITAL SERVICES - SHORT TERM CARE FOR INPATIENT AND OUTPATIENT SERVICES FOR DOUGLAS AND COFFEE COUNTY. COFFEE REGIONAL MEDICAL CENTER (CRMC) SERVED 5,064 PATIENTS FOR A TOTAL OF 17,959 INPATIENT DAYS IN 2019. NURSERY DAYS WERE 986 IN 2019. COFFEE REGIONAL MEDICAL CENTER PROVIDED APPROXIMATELY $20,873,002 OF INDIGENT AND CHARITY SERVICES IN 2019. 130146134 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 96 0 1 1100 1 1 1 1 CJ 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X JOHN MCLEOD 9123841900 1101 OCILLA ROAD DOUGLAS GA 315332207 MARLENE BALDREE CHAIR 1.00 1.00 X X 0 0 0 ARISTOTLE COCHON MD DIRECTOR 1.00 X 0 0 0 JAMES DENNIS DIRECTOR 1.00 X 0 0 0 GARY EVANS DIRECTOR 1.00 X 0 0 0 ELLEN FITZGERALD DIRECTOR 1.00 X 0 0 0 JESSE KANE MD DIRECTOR 1.00 1.00 X 325399 0 25433 JIMMY KITCHENS DIRECTOR 1.00 X 0 0 0 JON LOTT DIRECTOR 1.00 1.00 X 0 0 0 CARL MCDONALD DIRECTOR 1.00 X 0 0 0 ADAM SMITH SECRETARY 1.00 X X 0 0 0 RUSS STORY DIRECTOR 1.00 1.00 X 0 0 0 BRANDY WILKES DIRECTOR 1.00 X 0 0 0 VICKI LEWIS PRESIDENT/CEO 50.00 2.00 X 572100 0 19259 LAVONDA CRAVEY EXECUTIVE VP/INTERIM CFO 50.00 2.00 X 208750 0 24173 MARTIN HUTSON EXECUTIVE VP/CURRENT CFO 50.00 2.00 X 162666 0 5122 SHERRY THOMAS EXECUTIVE VP/CNE 50.00 2.00 X 260984 0 25149 BENNETT FLOYD EXECUTIVE VP/OPERATIONS 50.00 2.00 X 211843 0 24173 PEGGY KIRKLAND DIRECTOR OF PHARMACY 50.00 X 184468 0 23747 HEWATT SIMS ORTHOPEDIC PHYSICIAN 50.00 X 1216754 0 33743 THOMAS WEHMANN SURGICAL PHYSICIAN 50.00 X 803584 0 13068 JOSHUA VICKERS ORTHOPEDIC PHYSICIAN 50.00 X 745930 0 27920 GLENN EVANS SR CARDIOLOGY PHYSICIAN 50.00 X 735864 0 25433 JOEL FERREE CARDIOLOGY PHYSICIAN 50.00 X 675249 0 5500 BRADLEY GOLDBERG OB/GYN PHYSICIAN 50.00 X 640052 0 19259 ROBERT COLLINS MD FORMER DIRECTOR 20.00 X 266676 0 0 7010319 0 271979 82 1 1 0 COFFEE COUNTY HOSPITALISTS PHYSICIANS L PO BOX 2546 DOUGLAS GA 31533 STAFFING SERVICES 1716419 REHABILITATION SPECIALISTS 169 MEADOWLARK LANE FITZGERALD GA 31750 CONTRACT PHYSICAL THERAPY 680825 SOUTHEASTERN PAIN CONSULTANTS PC 285 HELENS MANOR DRIVE LAWRENCEVILLE GA 30045 PAIN MANAGEMENT 459633 WEATHERBY LOCUMS INC 6451 NORTH FEDERAL HIGHWAY SUITE 7 FORT LAUDERDALE FL 33308 STAFFING SERVICES 326312 RESTORIXHEALTH PO BOX 71849 CHICAGO IL 60694 WOUND CARE SERVICES 308183 90 59029 392454 1312356 1763839 PATIENT REVENUE 621990 141198215 141198215 REFERENCE LAB 621500 72964 72964 141271179 2959673 2959673 284461 0 284461 284461 284461 75818 0 4757 75818 -4757 71061 71061 PHARMACY REVENUE 621990 1635066 1635066 CAFETERIA 722210 719407 719407 EHR PAYMENT 621990 48846 48846 1299919 1299919 3703238 150053451 144182046 72964 4034602 1926210 314830 1611380 54194538 48547606 5646932 968571 863666 104905 10253280 8952752 1300528 3399855 2941255 458600 47641 47641 122278 122278 150172 150172 19327 19327 128256 128256 8130567 6401191 1729376 241495 68810 172685 4211213 3675648 535565 2528916 2189536 339380 220851 179954 40897 129213 124732 4481 1502271 1502271 4160795 3602416 558379 3880769 648174 3232595 BAD DEBT 23551865 23551865 SUPPLIES 16131148 16131148 DEVELOPMENT 6121201 6121201 PHARMACY EXPENSE 1638822 1638822 4680417 2670930 2009487 148339671 130146134 18193537 0 3423271 5918579 12936941 11710991 1997072 2417201 485193 714174 98620469 81479698 21408456 17140771 27872940 25460419 11508324 16105635 2151139 12331634 81783336 91799404 22206502 25117739 278820 217987 32018790 29738291 5961709 3547980 60971 7521068 60526792 66143065 X 21256544 25656339 21256544 25656339 81783336 91799404 X 1713780 1783337 902678 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 19327 19327 0 SCHEDULE C, PART II-B, LINE 1 A PORTION OF THE ANNUAL DUES PAID TO THE GEORGIA HOSPITAL ASSOCIATION AND THE GEORGIA ALLIANCE OF COMMUNITY HOSPITALS IS ALLOCATED TO THE LOBBYING ACTIVITIES OF THE ASSOCIATION. 860771 860771 56271363 40401607 15869756 146203 124144 22059 41342132 40953947 388185 17140771 OTHER INVESTMENTS 16105635 C 16105635 DUE FROM RELATED PARTIES 132098 RIGHT OF USE ASSETS - LEASES 7559855 OTHER ASSETS 4639681 12331634 DUE TO AFFILIATES 147396 ESTIMATED THIRD PARTY PARTY SETTLEMENTS 1003294 LEASE LIABILITY 6370378 7521068 X PART X, LINE 2: CRH HEALTH CARE, INC., EXCLUDING COFFEE REGIONAL MEDICAL CENTER SEGREGATED PORTFOLIO, CRH VENTURES, INC. AND SOUTHEASTERN MANAGED CARE, INC. IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. COFFEE REGIONAL MEDICAL CENTER SEGREGATED PORTFOLIO IS AN EXEMPTED SEGREGATED PORTFOLIO COMPANY THAT WAS INCORPORATED UNDER THE PROVISIONS OF THE COMPANIES LAW OF THE CAYMAN ISLANDS AND HAS RECEIVED AN UNDERTAKING FROM THE CAYMAN ISLANDS GOVERNMENT EXEMPTING IT FROM ALL LOCAL INCOME, PROFITS AND CAPITAL GAINS TAXES. CRH VENTURES, INC. AND SOUTHEASTERN MANAGED CARE, INC. ARE TAXABLE ENTITIES AND ARE, THEREFORE, SUBJECT TO FEDERAL INCOME TAXES. CRH VENTURES, INC. AND SOUTHEASTERN MANAGED CARE, INC. FILE SEPARATE FEDERAL INCOME TAX RETURNS. THE CORPORATION 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 CORPORATION 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 MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF DECEMBER 31, 2019 OR FOR THE YEAR THEN ENDED. THE CORPORATION'S 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 THOSE RETURNS. CENTRAL AMERICA AND THE CARIBBEAN 1 1 INVESTMENTS 9824846 1 1 0 0 1 1 9824846 0 9824846 0 0 1 0 0 0 PART III ACCOUNTING METHOD: 1 1 1 X 125.000000000000 1 X 1 1 1 0 1 1 5461729 5461729 0.04380 17320910 12801343 4519567 0.03620 22782639 12801343 9981296 0.08000 409455 409455 0.00330 4823 4823 0.00000 414278 414278 0.00330 23196917 12801343 10395574 0.08330 7400 7400 0.00010 14240 14240 0.00010 3900 3900 0.00000 25540 25540 0.00020 1 23551865 17663899 21695831 21135778 560053 X 1 1 1 1 COFFEE REGIONAL MEDICAL CENTER 1101 OCILLA ROAD PO BOX 1287 DOUGLAS GA 31533 034-490 X X X PHYSICIAN OFFICES, RURAL HEALTH CLINIC COFFEE REGIONAL MEDICAL CENTER INC 0 0 1 X X X X X X X X 19 1 0 0 1 X WWW.COFFEEREGIONAL.ORG 1 19 1 WWW.COFFEEREGIONAL.ORG 0 1 X 100.000000000000 200.000000000000 1 1 X X X X 1 X WWW.COFFEEREGIONAL.ORG X WWW.COFFEEREGIONAL.ORG X WWW.COFFEEREGIONAL.ORG X X X X X X 1 X 0 X 1 X 0 0 COFFEE REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 5: IN 2019, CRMC DEVELOPED A COMMUNITY SURVEY QUESTIONNAIRE TO PROVIDE TO PERSONS WITHIN ITS SERVICE AREA. PAPER COPIES AS WELL AS AN ONLINE SURVEY WERE MADE AVAILABLE IN BOTH ENGLISH AND SPANISH. CRMC PROVIDED THE SURVEY TO ALL PATIENTS WHO PRESENTED TO CRMC THROUGH FRONT ADMISSIONS AND TO ALL PATIENTS THAT PRESENTED TO THE THREELARGEST PRIMARY CARE CLINICS: COFFEE WOMEN'S CARE CENTER, CRH OB-GYN, AND CRH PEDIATRICS. PATIENTS WERE INCENTIVIZED TO PARTICIPATE.THE SURVEY QUESTIONNAIRE INCLUDED 24 TOPIC QUESTIONS RELATED TO DEMOGRAPHICS, SOCIOECONOMIC STATUS, AND INDIVIDUAL HEALTHCARE. CRMC RECEIVED 334 RETURNED RESPONSES. THE PARTICIPANTS' RACES CLOSELY REFLECT THE RACIAL MAKE-UP OF COFFEE COUNTY; HOWEVER, THE HOUSEHOLD INCOME OF THE MAJORITY OF THE RESPONDENTS WAS BELOW THE MEDIAN HOUSEHOLD INCOME FOR COFFEE COUNTY. RESPONDENTS WERE PREDOMINATELY FEMALE, NOT ATYPICAL FOR THIS TYPE OF SURVEY.IN ADDITION, A WRITTEN SURVEY WAS PROVIDED TO PHYSICIANS AND LEADERS WITHIN THE COMMUNITY TO ASSESS THE HEALTH OF THE COMMUNITY, AS WELL AS ITS SPECIFIC NEEDS. THE LEADER BASE WAS DRAWN FROM LOCAL GOVERNMENT, SOUTH GEORGIA STATE COLLEGE, ENTREPRENEURS, COMMUNITY VOLUNTEERS AND MINISTRY. COFFEE REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 11: COFFEE REGIONAL MEDICAL CENTER IDENTIFIED THE FIVE TOP AREAS TO FOCUS ON OUT OF ALL NEEDS IDENTIFIED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT. THESE FIVE ARE CONSIDERED THE MOST SIGNIFICANT HEALTH NEEDS IN THE COMMUNITY AND WILL BE COVERED BY THE IMPACT INITIATIVES. OTHER HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT BUT NOT DEEMED SIGNIFICANT MAY BE INDIRECTLY IMPACTED BY THE INITIATIVES, BUT RESOURCE CONSTRAINTS PREVENT CRMC FROM DIRECTLY ADDRESSING THESE INITIATIVES.PRIORITY #1 ADDITIONAL PRIMARY CARE RESOURCESCRMC RECOGNIZES THAT ADDITIONAL PRIMARY CARE PHYSICIANS ARE NEEDED IN COFFEE AND ATKINSON COUNTIES TO PROVIDE APPROPRIATE ACCESS POINTS TO CARE.PRIORITY #2 ACCESS TO CARE/TRANSPORTATIONCRMC RECOGNIZES THAT LIMITED ACCESS TO FREE AND REDUCED COST CARE AND TRANSPORTATION KEEPS THE CITIZENS OF COFFEE AND ATKINSON COUNTIES FROM RECEIVING THE CARE.PRIORITY #3 HEALTH EDUCATION/OBESITY/DIET AND NUTRITION/PREVENTIVE CARECRMC RECOGNIZES THAT EDUCATION AND PREVENTATIVE CARE ARE VITAL RESOURCES TO A HEALTHIER COMMUNITY. COMBINED WITH LOCAL COMMUNITY ORGANIZATIONS, WE WILL ATTEMPT TO OFFER MORE EDUCATION AND RESOURCES ABOUT PREVENTATIVE CARE FOR A HEALTHIER COMMUNITY.PRIORITY #4 HEART HEALTH AND PREVENTION OF HEART DISEASE CRMC RECOGNIZES THAT HEART DISEASE IS THE LEADING CAUSE OF DEATH IN THE UNITED STATES. CRMC AND LOCAL PHYSICIANS KNOW THAT HEART HEALTH AND PREVENTATIVE CARE ARE THE BEST METHODS TO COMBAT HEART DISEASE.PRIORITY #5 CANCER TREATMENT OPTIONSCRMC RECOGNIZES THAT CANCER IS THE SECOND LEADING CAUSE OF DEATH IN THE UNITED STATES. CRMC AND LOCAL PHYSICIANS KNOW THAT EARLY DETECTION IS THE BEST FORM OF TREATMENT. 1 1 - COFFEE REGIONAL FIRST CARE 1101 OCILLA ROAD DOUGLAS GA 31533 RURAL HEALTH CLINIC PART I, LN 7 COL(F): THERE IS $23,551,865 OF BAD DEBT EXPENSE WHICH IS INCLUDED IN FORM 990, PART IX, LINE 24(A). THIS AMOUNT WAS REMOVED IN THE CALCULATION OF THE PERCENT OF TOTAL EXPENSE ON SCHEDULE H LINE 7F. PART II, COMMUNITY BUILDING ACTIVITIES: HEART TO HEART 5K RUN - FEBRUARY, 2019COFFEE REGIONAL'S ANNUAL FALL FITNESS 5K RUN/FUN WALK WAS HELD FEBRUARY 2019 WITH OVER 100 PARTICIPANTS. IN ADDITION TO THE 5K EVENT, A ONE MILE FUN RUN WAS HELD FOR THE YOUTH IN OUR COMMUNITY. A CHECK FOR $3,200 WAS DONATED TO THE CARDIAC REHAB AWARENESS PROGRAM. (APPROXIMATELY 40 MAN HOURS AT A COST OF $1,600)2019 WEAR RED CAMPAIGN - FEBRUARYTHE ANNUAL WEAR RED CAMPAIGN IS A COMMUNITY EDUCATION AND AWARENESS PROGRAM THAT ENCOMPASSES THE IMPORTANCE OF HEART DISEASE PREVENTION. EDUCATION IS PROVIDED TO THE COMMUNITY, AT NO COST, WITH EDUCATIONAL LECTURES AND MATERIALS THROUGHOUT THE MONTH OF FEBRUARY. FEBRUARY IS RECOGNIZED AS HEART DISEASE AWARENESS MONTH. IT ALSO SERVICES A "WEAR RED T-SHIRT" FUNDRAISER FOR THE CARDIAC REHAB SCHOLARSHIP TO PROVIDE FINANCIAL ASSISTANCE FOR CARDIAC PATIENTS ENTERING INTO THE PROGRAM, CARDIAC EDUCATION MATERIAL, AND CARDIAC EQUIPMENT FOR THE PATIENTS. A DONATION OF $1,623 WAS MADE TO THE PROGRAM.DISCUSSIONS WITH THE DOC - THROUGHOUT YEARIN 2019, WE BEGAN OUR DISCUSSIONS WITH THE DOC SERIES. THESE EVENTS ARE OPEN TO THE PUBLIC, AND FEATURE A LOCAL CRHPP PHYSICIAN. THESE EDUCATIONAL DISCUSSIONS HAVE BEEN VERY WELL RECEIVED WITH THE PUBLIC. THESE EVENTS WERE PROMOTED THROUGHOUT THE COMMUNITY AND WERE OPEN AND FREE TO THE PUBLIC. EACH EVENT HAD 25-50 ATTENDEES. THERE WERE 4 SEPARATE EVENTS IN 2019: 04/30, 06/18, 11/07, AND 12/05. EACH EVENT INCLUDED 4 PHYSICIAN HOURS AND 8 STAFF HOURS, AS BOTH PHYSICIANS AND STAFF HAD TO PREPARE THE TOPICS, PRESENTATIONS, AND DETAILS OF THE EVENTS - $3,040.HEALTH FAIR - OCTOBER 5, 2019THE ANNUAL HEALTH & SAFETY FESTIVAL HELD OCTOBER 5, 2019 ATTRACTED OVER 1,500 VISITORS. THE FAIR INCLUDED 50 EXHIBITORS. THE FESTIVAL OFFERED INTERACTIVE WAYS TO PROMOTE A HEALTHY LIFESTYLE WHICH INCLUDED OUTDOOR ACTIVITIES FOR CHILDREN, HEALTHY FOODS AND A PINK HIPPIE WALK & PEACE PEDAL TO SUPPORT PASSIONATELY PINK HOSTED BETA SIGMA PHI AND SUPPORTED BY THE CRMC WELLNESS CENTER. THE WALK HAD APPROXIMATELY 120 PARTICIPANTS. 412 VISITORS TOOK ADVANTAGE OF THE COMPLETE BIOCHEMICAL BLOOD PROFILES OFFERED AT A REDUCED FEE OF $30 (ACTUAL CHARGE OF $755.00) RESULTING IN A COMMUNITY SAVINGS OF $311,060. CRMC'S LAB PROVIDED 18 VOLUNTEERS WHO, COMBINED, WORKED APPROXIMATELY 72 HOURS DURING THE HEALTH FAIR RESULTING IN AN APPROXIMATE LABOR COST OF $2,000.BREAST CANCER SCREENING - OCTOBER 2019OUR 1ST ANNUAL FREE CLINICAL BREAST EXAM EVENT WAS HELD 10/17/19 & 10/24/19 AT THE OFFICE OF CRH ONCOLOGY GROUP. THE EARLIER BREAST CANCER IS DISCOVERED, THE BETTER THE OUTCOME FOR THE PATIENT. PARTICIPANTS WERE GIVEN RESOURCES AND EDUCATION REGARDING BREAST HEALTH INCLUDING A GOODY BAG THAT INCLUDED A SHOWER SCREENING CARD FOR BOTH MEN AND WOMEN (BREAST SELF-EXAM INSTRUCTIONS). MARKETING MATERIALS WERE CREATED AND DISTRIBUTED THROUGHOUT THE COMMUNITY ENCOURAGING WOMEN WITHOUT HEALTH INSURANCE TO SIGN UP AND RECEIVE THIS FREE BREAST SCREENING. CRMC MAMMOGRAPHY, COFFEE COUNTY HEALTH DEPARTMENT AND THE LOCAL BETA SIGMA ORGANIZATION SHARED RESOURCES WITH THE ATTENDEES. WE WERE PLEASED TO HAVE A TOTAL OF 88 WOMEN THAT TOOK ADVANTAGE OF THIS TWO-NIGHT EVENT. OF THOSE, 29 PATIENTS SCHEDULED MAMMOGRAMS WITH THE CRMC MAMMOGRAPHY DEPARTMENT AND 28+ WERE TO FOLLOW UP WITH THE COFFEE COUNTY HEALTH DEPARTMENT FOR FURTHER ASSISTANCE WITH SCREENINGS.(APPROXIMATELY 16 PHYSICIAN HOURS AND 40 STAFF HOURS AT A COST OF $3,500)PROSTATE CANCER SCREENING - DECEMBER 7, 2019THE EARLIER PROSTATE CANCER IS DISCOVERED, THE BETTER THE CHANCES ARE THAT IT CAN BE TREATED EFFECTIVELY. WHEN PROSTATE CANCER IS IN ITS EARLIEST STAGES (STILL CONFINED TO THE PROSTATE GLAND), IT USUALLY CAUSES NO PAIN OR OTHER SYMPTOMS. IN 2019, AT THE HEALTH FAIR, COFFEE REGIONAL MEDICAL CENTER OFFERED LOW COST PROSTATE CANCER SCREENINGS (DRE AND PSA BLOOD TEST) TO OUR COMMUNITY FOR A REDUCED LAB FEE OF ONLY $10.00 (ACTUAL CHARGE $210.00) RESULTING IN A COMMUNITY SAVINGS OF $19,800. IN 2019, 99 MEN TOOK ADVANTAGE OF THIS LIFE-SAVING SCREEN. (APPROXIMATELY 5 PHYSICIAN HOURS AND 36 STAFF HOURS AT A COST OF $1,470)SPORTS PHYSICALS - 2019ATHLETIC PHYSICALS ARE REQUIRED BY BOTH THE GEORGIA HIGH SCHOOL AND GEORGIA INDEPENDENT SCHOOL ASSOCIATION FOR STUDENTS PLANNING ON PARTICIPATING IN SCHOOL ATHLETIC PROGRAMS. EACH YEAR COFFEE REGIONAL PROVIDES OVER 500 SPORTS PHYSICALS TO STUDENTS PARTICIPATING IN INTERSCHOLASTIC SPORTS DURING THE SUMMER AND THROUGHOUT THE FOLLOWING YEAR AT NO COST (NORMALLY $25). FOR 2019, 505 PHYSICALS WERE DONE OVER A 4 HOUR PERIOD WITH 5 PHYSICIANS, 8 MID-LEVEL PROVIDERS, AND 20 STAFF MEMBERS. THIS EVENT RESULTED IN A TOTAL COST SAVINGS TO THE COMMUNITY OF OVER $12,625. (APPROXIMATELY 52 PHYSICIAN HOURS AND 80 STAFF HOURS AT A COST OF $9,400, PLUS EXPENSES)PROJECT SEARCH 2019PROJECT SEARCH IS A ONE-YEAR EDUCATIONAL PROGRAM FOR STUDENTS WITH DISABILITIES IN THEIR LAST YEAR OF HIGH SCHOOL. IT IS TARGETED FOR STUDENTS WHOSE MAIN GOAL IS COMPETITIVE EMPLOYMENT. COFFEE REGIONAL MEDICAL CENTER PROVIDES THE SETTING FOR TWELVE PROJECT SEARCH STUDENTS, THUS ALLOWING TOTAL IMMERSION IN THE WORKPLACE TO FACILITATE THE TEACHING AND LEARNING PROCESS THROUGH CONTINUOUS FEEDBACK AND APPLICATION OF NEW SKILLS. INDIVIDUALIZED JOB DEVELOPMENT AND PLACEMENT BEGINS AFTER ROTATIONS AT ONE OR MORE WORKSTATIONS ARE COMPLETED. STUDENTS RECEIVE SUPPORT THROUGH ON-THE-JOB COACHING AND WORKSITE ACCOMMODATIONS PROVIDED BY COFFEE REGIONAL. THE PROGRAM IS DEDICATED TO WORKFORCE DEVELOPMENT THAT BENEFITS THE INDIVIDUAL, COMMUNITY AND WORKPLACE. (CLASSROOM SPACE AT $300/MONTH TOTAL OF $2700 AND APPROXIMATELY 60 STAFF HOURS OF TRAINING, MENTORING AND EDUCATION OF 12 STUDENTS/YR AT A COST OF $1,200) COMMUNITY CHILDBIRTH CLASSES - BIMONTHLY 2019CRMC PROVIDES 2 CHILDBIRTH CLASSES EACH MONTH FOR THE COMMUNITY. THE SESSIONS ARE FACILITATED BY CRMC'S PERINATAL INSTRUCTOR AND RN. THE CLASSES PROVIDE EDUCATIONAL LESSONS ABOUT NUTRITIONAL NEEDS OF MOTHER AND FETUS, ANESTHESIA, DELIVERY, BREASTFEEDING AND MANY OTHER INFORMATIVE TOPICS. (STAFF MEMBER, 8 HOURS PER MONTH FOR 12 MONTHS AT $25 PER HOUR FOR A TOTAL ANNUAL COST OF $2400).SIDELINE SERVICE - 2019CRMC PROVIDES SIDELINE SERVICE FOR EACH HIGH SCHOOL FOOTBALL GAME IN COFFEE COUNTY. A FULLY EQUIPPED AMBULANCE, EMT, AND PARAMEDIC ARE PROVIDED FOR EACH HOME FOOTBALL GAME AS A COURTESY TO THE SCHOOL SYSTEM AND SPECTATORS. (AT A COST OF $250 PER GAME AND 1500/YEAR)COFFEE COUNTY CHAMBER OF COMMERCE LEADERSHIP COFFEE - 2019PARTICIPANTS IN LEADERSHIP COFFEE COMMIT TO AN EIGHT-MONTH PROJECT THAT ALLOWS THEM TO TAKE A CLOSE LOOK AT GOVERNMENT, EDUCATION, ECONOMIC DEVELOPMENT, AND ALL ISSUES DEALING WITH QUALITY OF LIFE ON A LOCAL AND STATE LEVEL. THE PROGRAM IS DESIGNED TO HELP PARTICIPANTS DEVELOP LEADERSHIP SKILLS FOR THE WORKPLACE AND THE COMMUNITY. CRMC SPONSORED 2 EMPLOYEES IN 2018 FOR THE NEW CENTURY LEADER PROGRAM. STAFF TIME, TRAVEL AND EXPENSES FOR THE PROGRAM IS APPROXIMATELY $3,840. (2 EMPLOYEES, 12 DAYS OF TRAINING AT 8 HOURS PER DAY = 192 STAFF HOURS/$20=$3840)GEORGIA HOSPITAL ASSOCIATION - 2019LEADERSHIP GHA IS A SIX-MONTH PROGRAM DESIGNED TO IDENTIFY, DEVELOP AND INSPIRE NEW LEADERS IN HEALTH CARE THROUGHOUT THE STATE OF GEORGIA. THE PROGRAM INCLUDES WORKSHOPS, CONFERENCES, PANEL DISCUSSIONS AND FIELD TRIPS TO A VARIETY OF HOSPITALS AND HEALTH SYSTEMS THROUGHOUT THE STATE. TO QUALIFY FOR PARTICIPATION IN THE LEADERSHIP GHA PROGRAM, INDIVIDUALS FROM GEORGIA HOSPITALS AND HEALTH SYSTEMS ARE NOMINATED BY GHA-MEMBER CEOS. STAFF TIME, TRAVEL AND EXPENSES FOR THE PROGRAM IS APPROXIMATELY $10,400. (2 EMPLOYEES, 16 HOURS/MONTH X 6 MONTHS =192 HOURS X $45/HOUR = $8,640 PLUS EXPENSES)OPEN ARMS CLINIC - OPENED IN LATE SUMMER 2019AN OUTREACH PROJECT OF COFFEE REGIONAL MEDICAL CENTER, THE GOAL OF THIS CLINIC IS TO REDUCE HEALTH DISPARITIES WITHIN OUR COMMUNITY (COFFEE & ATKINSON COUNTIES), HELPING FULFILL OUR MISSION TO CLOSE THE GAP IN HEALTHCARE. OUR PRIMARY GOAL IS PREVENTION OF CHRONIC DISEASE THROUGH THE TREATMENT OF HYPERTENSION, DIABETES, AND HEART DISEASE. IN THE FIRST (APPROX.) 6 MONTHS OF BEING OPEN, THE OPEN ARMS CLINIC SERVED 336 UNINSURED PATIENTS. EACH MONTH, APPROXIMATELY 56 UNINSURED PATIENTS HAVE BEEN ABLE TO RECEIVE HEALTHCARE FROM A PHYSICIAN AND A REGISTERED NURSE. (VALUE OF PHYSICIAN & TWO SUPPORT STAFF TIME BASED ON 56 PATIENTS PER MONTH FOR 4 MONTHS OF 2019: $42,560)RISE-UP PROGRAM - BEGAN JUNE 2019AS PART OF OUR EMPLOYEE CAREER LADDER PROGRAM, PARTICIPANTS WERE REQUIRED TO HAVE A MINIMUM OF 20 VOLUNTEER HOURS. THESE HOURS ENCOURAGE EMPLOYEES TO GIVE OF THEIR TIME BY VOLUNTEERING AT COMMUNITY EVENTS AND WITH NON-PROFIT ORGANIZATIONS SUCH AS THE LOCAL FOOD BANK. THERE IS A MONETARY PAYOUT TO THOSE PARTICIPANTS WHO COMPLETE THE PROGRAM. THIS PROGRAM RESULTED IN A $5,900 COMMUNITY BENEFIT.STUDENTS - 2019IN 2019 CRMC SUPPORTED HEALTHCARE EXCELLENCE BY TRAINING OVER 250 STUDENTS. PART III, LINE 2: AMOUNTS ON PART III, LINES 2 AND 3 REPRESENT CHARGES WRITTEN OFF AS UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT AND WRITTEN OFF TO BAD DEBT EXPENSE. LINE 3 IS ESTIMATED AT 75% OF THE AMOUNT ON LINE 2. PART III, LINE 4: FOLLOWING IS THE TEXT FROM THE AUDIT REPORT ADDRESSING BAD DEBTS:"USING A PORTFOLIO APPROACH, THE CORPORATION ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. IN ADDITION, FOR UNINSURED PATIENTS, THE CORPORATION REDUCES CHARGES FROM CURRENT RATES BASED ON AVERAGE DISCOUNTS PROVIDED TO CERTAIN THIRD-PARTY PAYERS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUES IN THE PERIOD OF THE CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. NO SIGNIFICANT AMOUNT OF BAD DEBT WAS REPORTED FOR THE YEAR ENDED DECEMBER 31, 2019." PART III, LINE 8: 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: THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES THAT QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS AGAINST THOSE BALANCES. PART VI, LINE 2: COFFEE REGIONAL MEDICAL CENTER EVALUATES THE NEEDS OF ITS PATIENT BASE THROUGH THE NUMBER OF PATIENTS REFERRED TO OTHER FACILITIES FOR SERVICES NOT PROVIDED BY THE FACILITY ITSELF AND THROUGH OTHER INDICATORS. IN 2019, THE HOSPITAL ORGANIZATION COMPLETED ITS COMMUNITY HEALTH NEEDS ASSESSMENT. THE FINAL REPORT CAN BE FOUND AT THE FOLLOWING LINK:HTTP://WWW.COFFEEREGIONAL.ORG/THE IMPLEMENTATION STRATEGY PLAN IS INCLUDED AS A PART OF THE CHNA ON PAGES 28 THROUGH 34. PART VI, LINE 3: THE FINANCIAL COUNSELING DEPARTMENT WILL PROVIDE INFORMATION AND APPLICATIONS TO ALL PATIENTS OR GUARANTORS SEEKING FINANCIAL ASSISTANCE FOR SERVICES RENDERED AT COFFEE REGIONAL MEDICAL CENTER THAT ARE DEEMED MEDICALLY NECESSARY.FINANCIAL COUNSELORS WILL DISCUSS ELIGIBILITY FOR MEDICAL ASSISTANCE PROGRAMS THROUGH THE DEPARTMENT OF FAMILY & CHILDREN SERVICES AND THE SOCIAL SECURITY ADMINISTRATION. IF ELIGIBILITY IS NOT MET FOR ANY MEDICAL ASSISTANCE PROGRAM, THE FINANCIAL COUNSELING DEPARTMENT WILL SEEK ELIGIBILITY THROUGH COFFEE REGIONAL MEDICAL CENTER'S INDIGENT CARE TRUST FUND PROGRAM.PATIENTS OR GUARANTORS REQUESTING FINANCIAL ASSISTANCE ARE REFERRED TO THE FINANCIAL COUNSELORS (FC) OR THE BENEFIT SPECIALISTS CONTACT THE PATIENT AT THE TIME OF REGISTRATION FOR OUTPATIENT SERVICES OR IN THE EMERGENCY DEPARTMENT (AFTER MEDICAL SCREENING HAS BEEN COMPLETED). THE FC WILL ALSO CONTACT AN INDIVIDUAL IF THERE IS A REQUEST FROM SOCIAL SERVICES, A PHYSICIAN OFFICE, OR THE PATIENT FINANCIAL SERVICES DEPARTMENT. PATIENTS ADMITTED FOR INPATIENT OR OBSERVATION SERVICES MAY BE VISITED BY THE FC AFTER THE PATIENT HAS BEEN PLACED IN A ROOM AND STABILIZED.THE FC WILL DISCUSS WITH THE PATIENT OR GUARANTOR THE INDIGENT CARE TRUST FUND PROGRAM REQUIREMENTS AND APPLICATION PROCESS. THE PATIENT OR GUARANTOR WILL BE REQUIRED TO COMPLETE AN INDIGENT APPLICATION, PROVIDE PROOF OF IDENTITY, PROVIDE BIRTH CERTIFICATES OR PROOF OF DEPENDENCY FOR CHILDREN WITH NO IDENTITY, AND PROVIDE VERIFICATION OF INCOME (I.E. W-2'S, FEDERAL TAX RETURN, PAY STUBS, ETC.). IF VERIFICATION IS NOT PROVIDED AT THE TIME OF THE INTERVIEW, THE PATIENT OR GUARANTOR WILL BE REQUIRED TO PROVIDE WITHIN 30 DAYS. APPLICATIONS MADE ON BEHALF OF DECEASED PATIENTS MUST HAVE VERIFICATION OF INCOME AND INFORMATION CONCERNING THE VALUE OF THE PATIENT'S ESTATE.PATIENTS WHO CHOOSE NOT TO UTILIZE CURRENT BENEFITS THEY ARE ELIGIBLE FOR (I.E. VETERANS BENEFITS, MEDICARE, AND COMMERCIAL INSURANCE) WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM. UPON RECEIPT OF THE COMPLETED APPLICATION INCLUDING NECESSARY DOCUMENTATION, CALCULATION OF THE HOUSEHOLD SIZE AND ANNUAL HOUSEHOLD INCOME IS COMPUTED AND COMPARED TO THE FEDERAL POVERTY GUIDELINES (FPG) TO DETERMINE THE PERCENTAGE OF ASSISTANCE A PATIENT OR GUARANTOR IS ELIGIBLE TO RECEIVE. PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW THE GROSS INCOME CEILING FOR POTENTIAL MEDICAID ELIGIBILITY ARE REQUIRED TO APPLY FOR MEDICAID. ASSISTANCE IS PROVIDED TO PATIENTS IN FILING FOR OTHER BENEFITS AND COMPLETING MEDICAID APPLICATIONS. PATIENTS WHO CHOOSE NOT TO APPLY FOR OTHER BENEFITS TO WHICH THEY MAY BE ENTITLED (I.E. MEDICAID) WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM. PATIENTS WHO CHOOSE TO APPLY COFFEE REGIONAL MEDICAL CENTER'S ACCOUNTS FOR THE PURPOSE OF MEETING MEDICALLY NEEDY SPEND DOWN TO RECEIVE ONGOING MEDICAID WILL NOT BE ALLOWED TO APPLY FOR THE INDIGENT PROGRAM FOR THAT ACCOUNT.PATIENTS OR GUARANTORS OVER 18 YEARS OF AGE BUT CLASSIFIED AS DEPENDENTS FOR TAX PURPOSES DUE TO STUDENT ELIGIBILITY WILL HAVE A TOTAL HOUSEHOLD SIZE THAT INCLUDES PARENTS AND SUBSEQUENT INCOME. PATIENTS OR GUARANTORS NOT ELIGIBLE FOR OTHER MEDICAL ASSISTANCE PROGRAMS WILL BE PROCESSED UNDER THE INDIGENT CARE TRUST FUND GUIDELINES USING THE FOLLOWING CATEGORIES:- INDIGENT - FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW 125% OF THE FPG, THE APPLICABLE ACCOUNTS WILL BE ADJUSTED TO ZERO BALANCES.- CHARITY - FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN OR EQUAL TO 125% BUT NOT GREATER THAN 200% OF THE FPG, THE APPLICABLE ACCOUNTS WILL BE ADJUSTED BY THE APPROPRIATE PERCENTAGES. - AN ADJUSTMENT OF 85% OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 125% AND 150% OF FPG - AN ADJUSTMENT OF 70% OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 150% AND 175% OF FPG - AN ADJUSTMENT OF 62% OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 175% AND 200% OF FPG- CATASTROPHIC - PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN 200% FPG MAY QUALIFY FOR CHARITY ADJUSTMENTS ON APPLICABLE ACCOUNTS, IF CONSIDERATION OF THE CRMC PATIENT OBLIGATIONS REDUCES THE ANNUAL HOUSEHOLD INCOME TO THE APPROPRIATE FPG.NOTIFICATION OF STATUS OF COMPLETED APPLICATION IS PROVIDED TO THE PATIENT OR GUARANTOR WITHIN 5 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION. APPROVED APPLICATIONS ARE VALID FOR 180 DAYS FROM DATE OF SIGNATURE. INCOMPLETE APPLICATIONS ARE HELD FOR 30 DAYS. IF NO DOCUMENTATION IS PROVIDED TO COMPLETE THE APPLICATION, A DENIAL LETTER IS SENT TO THE PATIENT OR GUARANTOR. THE APPLICATION MAY BE COMPLETED IF THE PATIENT OR GUARANTOR PROVIDES THE REQUESTED INFORMATION WITHIN 15 WORKING DAYS OF THE DENIAL. NOTIFICATION OF STATUS OF COMPLETED APPLICATION WILL BE MAILED WITHIN 15 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION.THE APPLICATION AND DOCUMENTATION WILL BECOME PROPERTY OF COFFEE REGIONAL MEDICAL CENTER AND IS TO BE KEPT CONFIDENTIAL IN THE SAME MANNER AS MEDICAL RECORDS. HOWEVER, THIS INFORMATION WILL BE USED FOR AGGREGATE REPORTING PURPOSES ONLY. PART VI, LINE 4: COFFEE REGIONAL MEDICAL CENTER'S PRIMARY SERVICE AREA IS COFFEE COUNTY, GEORGIA. THE COUNTY HAD A POPULATION OF 43,093 CITIZENS IN 2018, OF WHICH APPROXIMATELY 24.9% FALL BELOW GOVERNMENTAL DEFINED POVERTY GUIDELINES. COFFEE COUNTY'S UNEMPLOYMENT RATE AT 2019 YEAR-END WAS 4.3%. PART VI, LINE 5: COFFEE REGIONAL MEDICAL CENTER IS GOVERNED BY A BOARD OF DIRECTORS CONSISTING OF 12 MEMBERS. CRH HEALTHCARE, INC., THE SOLE MEMBER, ELECTS ALL BOARD MEMBERS OF CRMC. THE BOARD IS MADE UP OF TEN COMMUNITY MEMBERS REFLECTING THE DIVERSITY OF THE COMMUNITY. THE REMAINING TWO MEMBERS ARE THE CHIEF OF STAFF OF CRMC AND THE CHIEF OF STAFF ELECT. IT IS THE PHILOSOPHY OF CRMC TO ASSURE THE CONTINUATION AND ENHANCEMENT OF PATIENT CARE BY REINVESTING EXCESS FUNDS BACK INTO THE OPERATIONS OF THE FACILITY.THIS INCLUDES GREATER ACCESSIBILITY OF CARE THROUGH THE CREATION OF A RURAL HEALTH CENTER, IMPLEMENTATION OF A TELEMEDICINE PROGRAM AND RECRUITMENT OF PHYSICIANS TO THE UNDERSERVED ENVIRONMENT. ENHANCEMENT OF TECHNOLOGY IS ALSO IMPERATIVE TO ASSURE APPROPRIATE DIAGNOSTIC AND THERAPEUTIC OPTIONS FOR THE COMMUNITY. UPDATING THE AMBULANCE FLEET IS CONSISTENTLY HIGH ON THE FUNDING PRIORITY LIST TO ASSURE SERVICE TO THE MOST REMOTE AREAS OF THE COUNTY, WHICH IN SQUARE MILES IS THE SECOND LARGEST COUNTY IN THE STATE OF GEORGIA. CRMC HAS AN OPEN MEDICAL STAFF POLICY EXTENDING PRIVILEGES TO PROFESSIONALLY COMPETENT PRACTITIONERS WHO CONTINUOUSLY MEET THE QUALIFICATIONS, STANDARDS AND REQUIREMENTS OF CRMC. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES GA X 0 0 X X X X X 0 0 0 0 0 1 0 0 0 JESSE KANE MD DIRECTOR 304526 0 3873 0 17000 0 5500 0 19933 0 350832 0 0 0 VICKI LEWIS PRESIDENT/CEO 535100 0 37000 0 0 0 5500 0 13759 0 591359 0 0 0 LAVONDA CRAVEY EXECUTIVE VP/INTERIM CFO 201906 0 6844 0 0 0 4240 0 19933 0 232923 0 0 0 MARTIN HUTSON EXECUTIVE VP/CURRENT CFO 154666 0 8000 0 0 0 1800 0 3322 0 167788 0 0 0 SHERRY THOMAS EXECUTIVE VP/CNE 254140 0 6844 0 0 0 5216 0 19933 0 286133 0 0 0 BENNETT FLOYD EXECUTIVE VP/OPERATIONS 204999 0 6844 0 0 0 4240 0 19933 0 236016 0 0 0 PEGGY KIRKLAND DIRECTOR OF PHARMACY 177624 0 6844 0 0 0 3814 0 19933 0 208215 0 0 0 HEWATT SIMS ORTHOPEDIC PHYSICIAN 807385 0 409369 0 0 0 5500 0 28243 0 1250497 0 0 0 THOMAS WEHMANN SURGICAL PHYSICIAN 512779 0 290805 0 0 0 5500 0 7568 0 816652 0 0 0 JOSHUA VICKERS ORTHOPEDIC PHYSICIAN 660930 0 85000 0 0 0 5500 0 22420 0 773850 0 0 0 GLENN EVANS SR CARDIOLOGY PHYSICIAN 705801 0 30063 0 0 0 5500 0 19933 0 761297 0 0 0 JOEL FERREE CARDIOLOGY PHYSICIAN 675249 0 0 0 0 0 5500 0 0 0 680749 0 0 0 BRADLEY GOLDBERG OB/GYN PHYSICIAN 457968 0 182084 0 0 0 5500 0 13759 0 659311 0 0 0 ROBERT COLLINS MD FORMER DIRECTOR 0 0 0 0 266676 0 0 0 0 0 266676 0 0 0 PART I, LINE 1A UPON REVIEW OF PERSONNEL RECORDS AND THE COMPENSATION CONTRACT FOR THE CEO, IT WAS DETERMINED THAT THERE WAS AN AMOUNT DUE TO THE CEO FOR PRIOR SERVICES PROVIDED IN ACCORDANCE WITH THE COMPENSATION WRITTEN CONTRACT FOR THE YEARS 2014-2018. THE BOARD REVIEWED THE COMPENSATION CONTRACT AND THE PERSONNEL RECORDS AND APPROVED PAYMENT. AS A RESULT, THE PAYMENT WAS MADE IN 2019 AND WAS GROSSED-UP FOR INCOME TAX PURPOSES AS APPROVED BY THE BOARD. THE $47,975 PAYMENT AND GROSS-UP WERE RECOGNIZED AS A TAXABLE EVENT AT THE TIME OF PAYMENT AND REPORTED ACCORDINGLY ON THE CEO'S ANNUAL WAGE STATEMENT. PART I, LINE 6 CERTAIN EXECUTIVE OFFICERS AND PHYSICIANS ARE ELIGIBLE FOR BONUS/INCENTIVE PAYMENTS. THESE PAYMENTS ARE RELIANT ON VARIOUS ORGANIZATIONAL AND PERSONAL GOALS ESTABLISHED BY THE GOVERNING BODY. WHETHER A BONUS/INCENTIVE PAYMENT IS AWARDED IS DEPENDENT UPON THE NET PROFIT OF THE ORGANIZATION. A COFFEE COUNTY HOSPITAL AUTHORITY 586003116 192137DW4 2016-12-22 24367008 DEFEASANCE OF PREVIOUS BONDS 0 0 0 B COFFEE COUNTY HOSPITAL AUTHORITY 586003116 000000000 2018-12-14 11500000 CONSTRUCT AND EQUIP HOSPITAL FACILITIES 0 0 0 A 24963471 24367008 2171000 24963471 468262 2016 0 1 1 1 B 11500000 161260 1545191 0 0 0 0 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 1 0 1 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION A, LINE 6 CRH HEALTHCARE, INC., THE PARENT ORGANIZATION, HAS THE AUTHORITY TO APPOINT OR REMOVE BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS OF THE ORGANIZATION ARE APPOINTED, AND CAN BE REMOVED, BY CRH HEALTHCARE, INC., THE PARENT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE BOARD ARE SUBJECT TO APPROVAL BY CRH HEALTHCARE, INC., THE PARENT ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY AN INDEPENDENT FIRM AND IS PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. THE MANAGEMENT OF COFFEE REGIONAL MEDICAL CENTER, INC. PERFORMS A REVIEW OF FORM 990 BEFORE THE FILING DATE AND INCLUDES A REVIEW OF FINANCIAL DATA AND OTHER DETAILS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS ANNUALLY. THIS IS REVIEWED BY THE CEO AND BOARD CHAIRMAN, IF NEEDED. MEMBERS RECUSE THEMSELVES FROM CERTAIN DISCUSSIONS/DECISIONS AS A RESULT OF ANY CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS OF CRMC IS DETERMINED BY AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS OF THE ORGANIZATION ARE ALL AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S CORPORATE HEADQUARTERS. FORM 990, PART XI, LINE 9: PARTNERSHIP INCOME -13,068. EQUITY TRANSFER FROM SUBSIDIARIES 430,000. USDA IMPUTED DISCOUNT - INTEREST 485,856. OTHER ADJUSTMENT -110. 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