2019-11-15T10:35:51-06:00 2018-12-31 621517792 PYA P C 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2018-01-01 650543088 COFFEE REGIONAL MEDICAL CENTER INC COFF 9123841900 1101 OCILLA ROAD/PO BOX 1287 DOUGLAS GA 315332207 VICKI LEWIS PRESIDENT AND CEO 9123841900 2019-11-13 1 DEBORAH O ERNSBERGER P00364912 8656730844 47.200.215.56 2019-11-15 10:35:46 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 AF23F2A68CFF53983216DF8908F842EE3670BFA3 2018 2020-04-17 16:48:07Z VICKI LEWIS 1101 OCILLA ROAD/PO BOX 1287 DOUGLAS GA 315332207 132870502 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. 10 10 1026 45 65368 -27142 320348 2361084 111647875 123348885 2657167 3385156 3278558 3775377 117903948 132870502 2487 3690 0 0 57962299 68608409 0 0 0 66443879 67185059 124408665 135797158 -6504717 -2926656 73466466 81783336 46727531 60526792 26738935 21256544 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 118707599 3690 126173623 HOSPITAL SERVICES - SHORT TERM CARE FOR INPATIENT AND OUTPATIENT SERVICES FOR DOUGLAS AND COFFEE COUNTY. COFFEE REGIONAL MEDICAL CENTER (CRMC) SERVED 4,780 PATIENTS FOR A TOTAL OF 17,209 INPATIENT DAYS IN 2018. NURSERY DAYS WERE 964 IN 2018. COFFEE REGIONAL MEDICAL CENTER PROVIDED APPROXIMATELY $21,321,727 OF INDIGENT AND CHARITY SERVICES IN 2018. 118707599 1 1 0 1 0 0 0 0 0 0 1 1 0 0 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 68 0 1 1026 1 1 1 1 CJ 0 0 0 0 0 0 0 0 0 0 X 10 10 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 ANNIE FARRAR VICE CHAIR 1.00 X X 0 0 0 ADAM SMITH SECRETARY 1.00 X X 0 0 0 TERRELL JACOBS 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 GARY EVANS DIRECTOR 1.00 X 0 0 0 BRANDY WILKES DIRECTOR 1.00 X 0 0 0 SUDHAKAR JONNALAGADDA MD DIRECTOR 1.00 1.00 X 0 0 0 ELLEN FITZGERALD DIRECTOR 1.00 X 0 0 0 JESSE KANE MD DIRECTOR 1.00 X 0 0 0 VICKI LEWIS PRESIDENT/CEO 50.00 2.00 X 391313 0 13759 SHERRY THOMAS EXECUTIVE VP/CNE 50.00 2.00 X 248327 0 19933 LAVONDA CRAVEY EXECUTIVE VP/CFO 50.00 2.00 X 201536 0 19933 PEGGY KIRKLAND DIRECTOR OF PHARMACY 50.00 X 179044 0 19933 HEWATT SIMS ORTHOPEDIC PHYSICIAN 50.00 X 1383805 0 21457 THOMAS WEHMANN SURGICAL PHYSICIAN 50.00 X 797235 0 13759 GLENN EVANS SR CARDIOLOGY PHYSICIAN 50.00 X 767268 0 19933 JOEL FERREE CARDIOLOGY PHYSICIAN 50.00 X 675249 0 0 BRADLEY GOLDBERG OB/GYN PHYSICIAN 50.00 X 623908 0 13759 ROBERT COLLINS MD FORMER DIRECTOR 20.00 X 297000 0 0 5564685 0 142466 71 1 1 0 COFFEE COUNTY HOSPITALISTS PHYSICIANS L PO BOX 2546 DOUGLAS GA 31533 STAFFING SERVICES 1214167 REHABILITATION SPECIALISTS 169 MEADOWLARK LANE FITZGERALD GA 31750 CONTRACT PHYSICAL THERAPY 771500 SOUTHEASTERN PAIN CONSULTANTS 285 HELENS MANOR DRIVE LAWRENCEVILLE GA 30045 PAIN MANAGEMENT 531300 HEALTHCARE SERVICES GROUP PO BOX 829677 PHILADELPHIA PA 19182 JANITORIAL 484464 RESTORIXHEALTH PO BOX 71849 CHICAGO IL 60694 WOUND CARE SERVICES 395133 15 48742 392344 1919998 2361084 PATIENT REVENUE 621990 123283517 123283517 REFERENCE LAB 621500 65368 65368 123348885 2746527 2746527 289520 0 289520 289520 289520 617629 21000 0 0 617629 21000 638629 638629 PHARMACY REVENUE 621990 1620073 1620073 CAFETERIA 722210 661119 661119 EHR PAYMENT 621990 136000 136000 1068665 1068665 3485857 132870502 126108255 65368 4335795 3690 3690 391313 63958 327355 52034088 46612269 5421819 916397 817143 99254 12086161 10553150 1533011 3180450 2751445 429005 43960 43960 171568 171568 236972 236972 20535 20535 142967 142967 6965137 4974658 1990479 255606 72831 182775 4550871 3972110 578761 2435582 2108727 326855 161403 131514 29889 66234 63937 2297 975765 975765 4889390 4233234 656156 3533142 590112 2943030 BAD DEBT 18753294 18753294 SUPPLIES 13377283 13377283 DEVELOPMENT 4589186 4589186 PHARMACY EXPENSE 1622491 1622491 4393673 2420267 1973406 135797158 118707599 17089559 0 768052 3423271 13026255 12936941 1690375 1997072 653444 485193 104508418 83099962 24107760 21408456 31913939 27872940 11508324 1306641 2151139 73466466 81783336 18900920 22206502 339653 278820 24358080 32018790 3109947 5961709 18931 60971 46727531 60526792 X 26738935 21256544 26738935 21256544 73466466 81783336 X -2926656 -1782720 -773015 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 20535 20535 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. 402926 402926 56537354 36798028 19739326 146203 123420 22783 47421935 46178514 1243421 21408456 OTHER INVESTMENTS 11508324 C 11508324 DUE TO AFFILIATES 60971 60971 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, 2018 AND 2017 OR FOR THE YEARS 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 9225938 1 1 0 0 1 1 9225938 0 9225938 0 0 1 0 0 0 1 1 1 X 125.000000000000 1 X 1 1 1 0 1 1 6028140 6028140 0.05150 16258730 11595677 4663053 0.03980 22286870 11595677 10691193 0.09130 18185 18185 0.00020 10890 10890 0.00010 29075 29075 0.00030 22315945 11595677 10720268 0.09160 1500 1500 0.00000 12480 12480 0.00010 3900 3900 0.00000 17880 17880 0.00010 1 18753294 14064971 20444346 20469232 -24886 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 16 1 0 0 1 X WWW.COFFEEREGIONAL.ORG 1 16 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 2016, 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 WHO PRESENTED TO THE THREE LARGEST PRIMARY CARE CLINICS: COFFEE WOMEN'S CARE CENTER, CRH OB/GYN, AND CRH PEDIATRICS. PATIENTS WERE INCENTIVIZED TO PARTICIPATE.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 COUNTY BOARD OF COMMISSIONERS, DFACS TECHNICAL COLLEGE, ENTREPRENEURS, COMMUNITY VOLUNTEERS AND MINISTRY. COFFEE REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 11: COFFEE REGIONAL MEDICAL CENTER IDENTIFIED THE FOUR TOP AREAS TO FOCUS ON OUT OF ALL NEEDS IDENTIFIED BY THE COMMUNITY HEALTH NEEDS ASSESSMENT. THESE FOUR 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 HEALTH ISSUE #1: ADDITIONAL PRIMARY CARE RESOURCESTHE RATIO OF THE NUMBER OF PRIMARY CARE PHYSICIANS TO POPULATION IN THE AREA IS LOW COMPARED TO NATIONAL AND GEORGIA AVERAGES.HOSPITAL STRATEGYCRMC WILL BE HEAVILY INVOLVED IN MEETING THE PRIMARY CARE NEEDS IN COFFEE AND ATKINSON COUNTIES THROUGH CONTINUED RECRUITMENT EFFORTS. IN THE PAST 24 MONTHS, CRMC HAS RECRUITED AND EMPLOYED PRIMARY CARE PHYSICIANS INTO THE CRH PHYSICIAN PRACTICES MODEL. WITH THESE ADDITIONS, THE HOSPITAL IS ABLE TO ENHANCE THE STABILITY OF PRIMARY CARE BY ENCOURAGING PATIENTS TO REMAIN WITHIN THE COMMUNITY AND ASSURE GREATER AVAILABILITY OF ACCESS POINTS.ACCORDING TO THE LATEST PHYSICIAN TO POPULATION MANPOWER STUDY, THE PRIMARY SERVICE AREA FOR COFFEE REGIONAL MEDICAL CENTER WILL BE UNDERSERVED DUE TO A DEFICIT OF SIXTEEN INTERNAL MEDICINE PHYSICIANS, NINE FAMILY PRACTICE PHYSICIANS, THREE OB/GYN PHYSICIANS, AND THREE PEDIATRICIANS. COFFEE REGIONAL RECOGNIZES THE DEFICIT AND HAS A PHYSICIAN RECRUITER ON STAFF TO ASSIST IN BRINGING ADDITIONAL MEDICAL EXPERTISE TO THE AREA.PRIORITY HEALTH ISSUE #2: ACCESS TO CARE/TRANSPORTATIONTHROUGH THE CHNA PROCESS, ACCESS TO CARE AND TRANSPORTATION WAS IDENTIFIED AS A PREVALENT NEED IN THE COMMUNITY. ACCESS FOR SOME INDIVIDUALS IS LIMITED DUE TO INCOME OR INSURANCE STATUS.HOSPITAL STRATEGYSEVERAL ORGANIZATIONS IN THE COMMUNITY ARE WORKING TO IMPROVE ACCESS TO CARE, INCLUDING CRMC. AS AN ORGANIZATION, CRMC WILL EDUCATE THE PUBLIC ON HEALTHCARE ACCESS AND MEANS OF TRANSPORTATION AVAILABLE TO AND FROM APPOINTMENTS. CRMC WILL CONTINUE TO WORK WITH PARTNERS OUTSIDE OF THE HOSPITAL TO EVALUATE THE FEASIBILITY OF COMBINING RESOURCES TO OPEN A FREE HEALTH CLINIC TO PROVIDE FREE AND/OR REDUCED COST TO PATIENTS IN THE COMMUNITY AND SURROUNDING COUNTIES.PRIORITY HEALTH ISSUE #3: HEALTH EDUCATION/OBESITY/DIET AND NUTRITION/PREVENTIVE CARETHROUGH THE CHNA PROCESS, EDUCATION AND PREVENTATIVE CARE WERE IDENTIFIED AS NEEDS IN THE COMMUNITY. PREVENTATIVE DISEASES AND OBESITY ARE ASSOCIATED WITH LIFESTYLE, EDUCATION-LEVEL, AND INCOME-LEVELS OF THE LOCAL POPULATION.HOSPITAL STRATEGYCRMC OFFERS A DIABETES SUPPORT GROUP, DIETITIAN CONSULTS, AND EDUCATION AND WELLNESS PROGRAMS THROUGH THE WELLNESS CENTER. CARDIAC REHAB IS ALSO AN AVAILABLE SERVICE. CRMC THROUGH INDUSTRIAL MEDICINES IS OFFERING AND ENCOURAGING LOCAL INDUSTRY TO PROVIDE EDUCATION AND PREVENTATIVE CARE FOR THEIR EMPLOYEES. THROUGH THE INDUSTRIAL MEDICINE PROGRAM, EMPLOYEES ARE REWARDED FOR HEALTHY LIFESTYLES. COFFEE COUNTY OFFERS A NUMBER OF FREE OR REDUCED COST PROGRAMS FOR EDUCATION AND PREVENTION. OUR GOAL IS TO REACH MORE OF THE POPULATION WITH THESE PROGRAMS AND ENCOURAGE GREATER PARTICIPATION.PRIORITY HEALTH ISSUE #4: CANCER TREATMENT OPTIONSTHROUGH THE CHNA PROCESS, THE AVAILABILITY OF CANCER TREATMENT OPTIONS WAS IDENTIFIED AS A PREVALENT NEED IN THE COMMUNITY.HOSPITAL STRATEGYCRMC CURRENTLY OFFERS PROGRAMS THAT PROVIDE SCREENING AND EDUCATION FOR EARLY CANCER DETECTION. SOME OF THESE SERVICES ARE PROVIDED AT EITHER A FREE OR REDUCED RATE. CRMC'S GOAL IS TO INCREASE THE PERCENTAGE OF COMMUNITY MEMBERS THAT UTILIZE THESE SERVICES.- CRMC PROVIDES THE LATEST IN TECHNOLOGY TO AIDE IN THE EARLY DETECTION OF BREAST CANCER THROUGH THEIR RECENT PURCHASE OF THE HOLOGIC 3D MAMMOGRAPHY TECHNOLOGY, KNOWN AS "TOMOSYNTHESIS." AS THE NEXT GENERATION OF MAMMOGRAPHY, TOMOSYNTHESIS ENABLES CLINICIANS TO IDENTIFY AND CHARACTERIZE INDIVIDUAL BREAST STRUCTURES WITH CLARITY AND CERTAINTY NEVER BEFORE POSSIBLE. TOMOGRAPHY USES PRECISE, 3-DIMENSIONAL, DIGITAL IMAGERY TO CREATE A COMPLETE RECONSTRUCTION OF THE BREAST. THIS TECHNOLOGY ALLOWS A PHYSICIAN TO SEE MASSES AND DISTORTIONS ASSOCIATED WITH CANCERS MUCH MORE CLEARLY AND MUCH EARLIER.- CRMC SUPPORTS EVIDENCE BASED PROSTATE CANCER SCREENINGS AND EARLY DETECTION THROUGH ANNUAL, REDUCED FEE PROSTATE SCREENING FOR THE MEMBERS OF THE COMMUNITY, AS WELL AS PSA SCREENING THROUGH LOCAL PHYSICIANS.- CRMC CONTINUES TO ACTIVELY RECRUIT PHYSICIANS IN A MULTI-SPECIALTY FACET IN ORDER TO PROVIDE A LARGER SPECTRUM OF CANCER TREATMENT AND SCREENING SERVICES FOR THE COMMUNITY. 1 1 - COFFEE REGIONAL FIRST CARE 1101 OCILLA ROAD DOUGLAS GA 31533 RURAL HEALTH CLINIC PART I, LN 7 COL(F): THERE IS $18,753,294 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 2018COFFEE REGIONAL'S ANNUAL FALL FITNESS 5K RUN/FUN WALK WAS HELD IN FEBRUARY 2018 WITH OVER 150 PARTICIPANTS. IN ADDITION TO THE 5K EVENT, A ONE MILE FUN RUN WAS HELD FOR THE YOUTH IN OUR COMMUNITY. A CHECK FOR $6,000 WAS DONATED TO THE CARDIAC REHAB AWARENESS PROGRAM. (APPROXIMATELY 40 MAN HOURS AT A COST OF $1,600)2018 WEAR RED CAMPAIGNTHE 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 $3,690 WAS MADE TO THE PROGRAM.HEALTH FAIR - OCTOBER 6, 2018THE ANNUAL HEALTH & SAFETY FESTIVAL HELD OCTOBER 6, 2018, ATTRACTED OVER 1,200 VISITORS. WITH OVER 75 EXHIBITORS, DEMONSTRATIONS AND HEALTH SCREENS, THE FESTIVAL OFFERED WONDERFUL, INTERACTIVE WAYS TO PROMOTE A HEALTHY LIFESTYLE. 333 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 $241,425. (APPROXIMATELY 100 MAN HOURS AT A COST OF $2,000)PROSTATE CANCER SCREENING - OCTOBER 6, 2018THE 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 2018, 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 $8,400. IN 2018, 43 MEN TOOK ADVANTAGE OF THIS LIFE-SAVING SCREEN. (APPROXIMATELY 13.5 PHYSICIAN HOURS AT $150/HR AND 36 STAFF HOURS AT $20/HR AT A COST OF $2,745)SPORTS PHYSICALS - APRIL 2018ATHLETIC 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 560 SPORTS PHYSICALS TO STUDENTS PARTICIPATING IN INTERSCHOLASTIC SPORTS DURING THE SUMMER AND THROUGHOUT THE FOLLOWING YEAR. THIS EVENT RESULTED IN A TOTAL COST SAVINGS TO THE COMMUNITY OF OVER $13,750. (APPROXIMATELY 40 PHYSICIAN HOURS AT $150/HR AND 32 STAFF HOURS AT $20/HR AT A COST OF $6,640)PROJECT SEARCH - 2018PROJECT 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 $2,700 AND APPROXIMATELY 60 STAFF HOURS OF TRAINING, MENTORING AND EDUCATION OF 12 STUDENTS/YEAR AT A COST OF $1,200)DIABETES SUPPORT GROUP - MONTHLY 2018COFFEE REGIONAL OFFERS A FREE MONTHLY DIABETES SUPPORT GROUP FOR THE GENERAL PUBLIC. CRMC'S CLINICAL EDUCATION DEPARTMENT LEADS AND ORGANIZES EACH MEETING PROVIDING SUPPORT, EDUCATION, RESOURCES AND EXPERT SPEAKERS AT EACH MEETING. EXPERTS SUCH AS DIETICIANS AND PHYSICIANS PROVIDE VALUABLE EDUCATION TO THE COMMUNITY REGARDING DIABETES. APPROXIMATELY 30 PEOPLE ATTEND EACH MONTHLY MEETING. (144 MAN HOURS PER YEAR AT A COST OF $2,800)COMMUNITY CHILDBIRTH CLASSES - BIMONTHLY 2018CRMC PROVIDES WEEKLY CHILDBIRTH CLASSES EVERY OTHER MONTH FOR THE COMMUNITY. THE WEEKLY SESSIONS ARE FACILITATED BY THE LABOR AND DELIVERY RN STAFF. THE CLASSES PROVIDE EDUCATIONAL LESSONS ABOUT NUTRITIONAL NEEDS OF MOTHER AND FETUS, ANESTHESIA, DELIVERY, BREASTFEEDING AND MANY OTHER INFORMATIVE TOPICS. (2 RN STAFF, 8 HOURS PER MONTH FOR 6 MONTHS AT $25 PER HOUR FOR A TOTAL ANNUAL COST OF $2,400).COFFEE COUNTY CHILDHOOD CANCER SUPPORT GROUP - 2018CRMC PROVIDES SPACE MONTHLY FOR THE COFFEE COUNTY CHILDHOOD CANCER SUPPORT GROUP AT NO COST TO THEM. THE CHILDHOOD CANCER SUPPORT GROUP IS A NON-PROFIT ORGANIZATION THAT PROVIDES FAMILIES AND PATIENTS WITH CHILDHOOD CANCER SUPPORT, EDUCATION, RESOURCES AND EXPERT SPEAKERS AT EACH MONTHLY MEETING. (CLASSROOM SPACE $100 PER MONTH FOR A TOTAL OF $1,200 ANNUALLY)SIDELINE SERVICE - 2018CRMC 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 $1,500/YEAR)COFFEE COUNTY CHAMBER OF COMMERCE LEADERSHIP COFFEE - 2018 PARTICIPANTS 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 AT $20 PER HOUR FOR $3,840)GEORGIA HOSPITAL ASSOCIATION - 2018LEADERSHIP 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 $8,640. (2 EMPLOYEES, 16 HOURS PER MONTH, FOR 6 MONTHS =192 HOURS AT $45 PER HOUR = $8,640)STUDENTS - 2018IN 2018 THE MEDICAL CENTER SUPPORTED HEALTHCARE EXCELLENCE THROUGHOUT GEORGIA BY TRAINING OVER 250 STUDENTS IN THE FOLLOWING PROGRAMS. - ABAC (TIFTON, GA): NURSING (RN) - ALBANY STATE UNIVERSITY (ALBANY, GA): MASTERS IN NURSING - COFFEE HIGH SCHOOL (DOUGLAS, GA): HEALTH OCCUPATION STUDENTS , PROJECT SEARCH, STEM STUDENTS- GA HEALTH SCIENCE UNIVERSITY (AUGUSTA, GA): PHYSICIAN ASSISTANT - GA SOUTHERN UNIVERSITY (STATESBORO, GA): NURSING, NURSE PRACTITIONER, DIETICIAN - MERCER (MACON, GA): MEDICAL STUDENTS - OKEFENOKEE TECHNICAL COLLEGE (WAYCROSS, GA): LAB, NURSING (LPN), RADIOLOGY TECHNOLOGY, RESPIRATORY THERAPY- SOUTHEASTERN TECH (VIDALIA, GA): SURGICAL TECHNOLOGY- SOUTH GEORGIA STATE COLLEGE (DOUGLAS, GA): NURSING (RN) 1ST YR & 2ND YR - SOUTH UNIVERSITY (SAVANNAH, GA): PHARMACY, PHYSICIAN ASSISTANT - VALDOSTA STATE UNIVERSITY: NURSING (RN), EXERCISE PHYSIOLOGY, HEALTHCARE ADMINISTRATION - WALDEN UNIVERSITY (ONLINE): MASTERS IN NURSING - WIREGRASS (DOUGLAS, GA): CNA, EMT, HIT CODING, LPN, PHLEBOTOMY, RADIOLOGY 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 RECODED 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." 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 2016, 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 25 THROUGH 29. 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 MEDICALASSISTANCE 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 YEAR-END WAS 4.6%. PART VI, LINE 5: COFFEE REGIONAL MEDICAL CENTER IS GOVERNED BY A BOARD OF DIRECTORS CONSISTING OF 10 MEMBERS. CRH HEALTHCARE, INC., THE SOLE MEMBER, ELECTS ALL BOARD MEMBERS OF CRMC. THE BOARD IS MADE UP OF NINE 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 X X X X 0 0 0 0 0 1 0 0 0 VICKI LEWIS PRESIDENT/CEO 391313 0 0 0 0 0 0 0 13759 0 405072 0 0 0 SHERRY THOMAS EXECUTIVE VP/CNE 248327 0 0 0 0 0 0 0 19933 0 268260 0 0 0 LAVONDA CRAVEY EXECUTIVE VP/CFO 201536 0 0 0 0 0 0 0 19933 0 221469 0 0 0 PEGGY KIRKLAND DIRECTOR OF PHARMACY 176621 0 2423 0 0 0 0 0 19933 0 198977 0 0 0 HEWATT SIMS ORTHOPEDIC PHYSICIAN 811501 0 572304 0 0 0 0 0 21457 0 1405262 0 0 0 THOMAS WEHMANN SURGICAL PHYSICIAN 510764 0 286471 0 0 0 0 0 13759 0 810994 0 0 0 GLENN EVANS SR CARDIOLOGY PHYSICIAN 680986 0 86282 0 0 0 0 0 19933 0 787201 0 0 0 JOEL FERREE CARDIOLOGY PHYSICIAN 675249 0 0 0 0 0 0 0 0 0 675249 0 0 0 BRADLEY GOLDBERG OB/GYN PHYSICIAN 411597 0 212311 0 0 0 0 0 13759 0 637667 0 0 0 ROBERT COLLINS MD FORMER DIRECTOR 0 0 0 0 297000 0 0 0 0 0 297000 0 0 0 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 280780 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 42,042. EQUITY TRANSFER FROM SUBSIDIARIES -815,057. CRH PHYSICIAN PRACTICES LLC 1101 OCILLA ROAD DOUGLAS GA 315332207 205778734 PHYSICIANS OFFICES GA 11899378 2649545 CRMC EMERGENCY PHYSICIANS OF COFFEE CO LLC PO BOX 1287 DOUGLAS GA 315341287 451775790 ER PHYSICIANS GA 1914564 303870 CRMC ORTHOPEDIC SURGEONS OF GEORGIA LLC PO BOX 1287 DOUGLAS GA 315341287 452786844 PHYSICIANS OFFICES GA 2658802 1107793 CRMC COFFEE REGIONAL MEDICAL CENTER SEGREGATED PORTFOLIO 62 FORUM LANE 3RD FLOOR BOX 30600 CAMANA BAY CJ INSURANCE CJ 1486903 10761413 CRMC CRH HEALTHCARE INC 1101 OCILLA ROAD DOUGLAS GA 315332207 582163724 MANAGEMENT SERVICES GA 501(C)(3) LINE 12C, III-FI N/A 0 CRH HEALTH SERVICES INC 1101 OCILLA ROAD DOUGLAS GA 315332207 582165827 FOUNDATION GA 501(C)(3) LINE 12B, II N/A 0 CRH VENTURES INC 1101 OCILLA ROAD DOUGLAS GA 315332207 582165279 OFFICE RENTAL GA N/A C 0 SOUTHEASTERN MANAGED CARE INC 1101 OCILLA ROAD DOUGLAS GA 315332207 582236627 MANAGED CARE GA N/A C 0 0 1 1 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0