CULLMAN REGIONAL MEDICAL CENTER INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
CULLMAN REGIONAL MEDICAL CENTER INC (EIN 63-1058174)
Tax period
2017-07-01 to 2018-06-30
Filed
2019-04-26
IRS object ID
201921169349300922
Schema version
2017v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2019-04-26T14:41:50-05:00ReturnTs
Tax Period End2018-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN580914992PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DRAFFIN & TUCKER LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 71309AddressLine1Txt
CityALBANYCityNm
State AbbreviationGAStateAbbreviationCd
ZIP317081309ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN631058174EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CULLMAN REGIONAL MEDICAL CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCULLBusinessNameControlTxt
Phone2567372598PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HIGHWAY 157AddressLine1Txt
CityCULLMANCityNm
State AbbreviationALStateAbbreviationCd
ZIP350580609ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonNESHA DONALDSONPersonNm
Person TitleCFO/COO (1/19)PersonTitleTxt
Phone2567372595PhoneNum
Signature2019-04-26SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJACQUELINE G ATKINSPreparerPersonNm
PTINP00861721PTIN
Phone2298837878PhoneNum
Preparation2019-04-26PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address208.73.87.26IPv4AddressTxt
FieldValueIRS element (for citing)
IP2019-04-26IPDt
IP Tm14:41:50IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id3DB754BF4A86932C7270BAD44D636E9B352C5FABAtSubmissionCreationDeviceId
At Submission Filing Device Id3DB754BF4A86932C7270BAD44D636E9B352C5FABAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJAMES CLEMENTSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HIGHWAY 157AddressLine1Txt
CityCULLMANCityNm
State AbbreviationALStateAbbreviationCd
ZIP350580609ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$121,148,521GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressCULLMANREGIONAL.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1939FormationYr
Legal Domicile StateALLegalDomicileStateCd
Activity Or MissionCULLMAN REGIONAL MEDICAL CENTER, LICENSED FOR 145 BEDS, OPERATES A 145-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF CULLMAN, ALABAMA AND SURROUNDING AREAS REGARDLESS OF A PATIENT'S ABILITY TO PAY.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent14VotingMembersIndependentCnt
Total Employee1335TotalEmployeeCnt
Total Volunteers31TotalVolunteersCnt
Total Gross UBI$1,900,052TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$578,579NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$945,113PYContributionsGrantsAmt
CY Contributions Grants$271,159CYContributionsGrantsAmt
PY Program Service Revenue$112,050,356PYProgramServiceRevenueAmt
CY Program Service Revenue$114,182,013CYProgramServiceRevenueAmt
PY Investment Income$2,937,411PYInvestmentIncomeAmt
CY Investment Income$1,593,835CYInvestmentIncomeAmt
PY Other Revenue$5,511,960PYOtherRevenueAmt
CY Other Revenue$5,096,004CYOtherRevenueAmt
PY Total Revenue$121,444,840PYTotalRevenueAmt
CY Total Revenue$121,143,011CYTotalRevenueAmt
PY Grants And Similar Paid$1,699,627PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$1,376,757CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$50,902,132PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$54,614,987CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$52,987,460PYOtherExpensesAmt
CY Other Expenses$53,959,057CYOtherExpensesAmt
PY Total Expenses$105,589,219PYTotalExpensesAmt
CY Total Expenses$109,950,801CYTotalExpensesAmt
PY Revenues Less Expenses$15,855,621PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$11,192,210CYRevenuesLessExpensesAmt
Total Assets BOY$133,449,055TotalAssetsBOYAmt
Total Assets EOY$138,154,457TotalAssetsEOYAmt
Total Liabilities BOY$90,165,586TotalLiabilitiesBOYAmt
Total Liabilities EOY$83,624,465TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$43,283,469NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$54,529,992NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionCULLMAN REGIONAL MEDICAL CENTER, LICENSED FOR 145 BEDS, OPERATES A 145-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF CULLMAN, ALABAMA AND SURROUNDING AREAS REGARDLESS OF A PATIENT'S ABILITY TO PAY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$96,453,490ExpenseAmt
Grant$1,376,757GrantAmt
Revenue$115,662,426RevenueAmt
DescCRMC PROVIDES ACUTE CARE PATIENT SERVICES WHICH ARE RENDERED TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. CRMC USES CHARITY APPLICATIONS BASED UPON FEDERAL POVERTY GUIDELINES AND FAMILY SIZE TO DETERMINE ELIGIBILITY FOLLOWING SERVICES PROVIDED. CRMC PROVIDES CARE 24 HOURS PER DAY, SEVEN DAYS A WEEK AND HAS PROVIDED 30,879 INPATIENT DAYS CARE, 8.54% WERE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN; 44,917 EMERGENCY ROOM VISITS, 22.86% WERE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN; AND 95,731 OUTPATIENT VISITS, 19.40% NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN. THE TOTAL UNREIMBUSED COST OF MEDICAL SERVICES PROVIDED TO THOSE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN IS REPORTED ON SCHEDULE H. CRMC ALSO PROVIDES COMMUNITY EDUCATION AND WELLNESS ACTIVITIES TO THE COMMUNITY AND IS A MAJOR CONTRIBUTOR TO A LOCAL INDIGENT CLINIC SERVICING CULLMAN COUNTY.Desc
Total Program Service Expenses$96,453,490TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document218IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee1335EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members15GoverningBodyVotingMembersCnt
Independent Voting Member14IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonNESHA DONALDSONPersonNm
Phone2567372598PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HWY 157AddressLine1Txt
CityCULLMANCityNm
State AbbreviationALStateAbbreviationCd
ZIP350580609ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
JAMES CLEMENTS
CEO40.002.00Yes (X)Yes (X)$542,497$0$26,301
TODD MCLEROY
MEMBER1.00Yes (X)$0$0$0
JUDY BUTLER PATTERSON
CHAIRMAN1.001.00Yes (X)Yes (X)$0$0$0
GREG BARKSDALE
SECRETARY1.00Yes (X)Yes (X)$0$0$0
BETH ANDERSON
VICE CHAIRMA1.00Yes (X)Yes (X)$0$0$0
LIONEL POWELL
TREASURER1.00Yes (X)Yes (X)$0$0$0
ROGER HUMPHREY
MEMBER1.00Yes (X)$0$0$0
JIM HOOVER MD
MEMBER1.00Yes (X)$0$0$0
MARK BUSSMAN
MEMBER1.00Yes (X)$0$0$0
STEPHEN DONALDSON
MEMBER1.00Yes (X)$0$0$0
DENNIS RICHARD
MEMBER1.00Yes (X)$0$0$0
BILLY FAULK
MEMBER1.00Yes (X)$0$0$0
TIM CULPEPPER
MEMBER1.00Yes (X)$0$0$0
TYLER RODEN
MEMBER1.00Yes (X)$0$0$0
JEFF KROUT
MEMBER1.00Yes (X)$0$0$0
CHRISTOPHER COCCIA DO
PAST MEMBER1.00Yes (X)$0$0$0
NESHA DONALDSON
CFO/COO (1/140.002.00Yes (X)$222,840$0$12,106
WILLIAM SMITH MD
CHIEF MEDICA40.00Yes (X)$120,037$0$0
JEFF STANLEY
COO40.00Yes (X)$115,601$0$4,449
EDWARD MAHAN MD
CARDIOLOGIST40.00$406,424$0$27,312Yes (X)
TRACEY NEAL MD
CARDIOLOGIST40.00$343,069$0$22,595Yes (X)
MAN WAI PANG
PHARMACY DIR40.00$249,619$0$19,587Yes (X)
CHARNA BROWN
CNO40.001.00$189,623$0$22,073Yes (X)
CHERYL BAILEY
EXEC DIRECTO40.00$174,337$0$3,587Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,364,047TotalReportableCompFromOrgAmt
Total Other Compensation$138,010TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K28IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmtBusiness Name Line2ContractorName/BusinessName/BusinessNameLine2Txt
DOSTER CONSTRUCTION COMPANY
2100 INTERNATIONAL PARK DRIVEBIRMINGHAMAL35243CONSTRUCTION$7,543,975
EIDSON AND ASSOCIATES
135 BIRMINGHAM ST SWCULLMANAL350554975CONSTRUCTION$3,154,212
NTHRIVE SOLUTIONS
P O BOX 733492DALLASTX75373BUS OFC SVCS$1,902,436
PERSEUS LLC
5700 DARROW ROADHUDSONOH44236HOSPITALISTS$1,090,000C/O ISLAND MEDICAL MGMT
ANESTHESIA SERVICES OF BHAM PC
2151 OLD ROCKY RIDGE RD SUITE 106BIRMINGHAMAL35216ANESTHESIA$846,751
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K33CntrctRcvdGreaterThan100KCnt
Related Organizations$203,457RelatedOrganizationsAmt
Government Grants$67,702GovernmentGrantsAmt
Total Contributions$271,159TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT SERVICE REVENUES623000$112,281,961$112,281,961
OUTREACH LAB SERVICES621500$953,116$953,116
CPAP MEDICAL EQUIPMENT621990$894,381$894,381
CONFERENCE CENTER532000$34,755$34,755
SPORTS MEDICINE713940$17,800$17,800
FieldValueIRS element (for citing)
Total Program Service Revenue$114,182,013TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,570,655TotalRevenueColumnAmt
Exclusion$1,570,655ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$206,596RealAmt
Personal$240,808PersonalAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$206,596RealAmt
Personal$240,808PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$447,404TotalRevenueColumnAmt
Related Or Exempt Func Income$240,808RelatedOrExemptFuncIncomeAmt
Exclusion$206,596ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$28,690OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$5,510OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$23,180OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$23,180TotalRevenueColumnAmt
Exclusion$23,180ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
EMS MANAGEMENT FEES621910$2,760,954$2,760,954
EMPLOYEE PHARMACY621990$897,155$897,155
CAFETERIA/CATERING722210$558,296$558,296

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$432,195TotalRevenueColumnAmt
Related Or Exempt Func Income$378,703RelatedOrExemptFuncIncomeAmt
Exclusion$53,492ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$4,648,600OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$121,143,011TotalRevenueColumnAmt
Related Or Exempt Func Income$115,662,426RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$1,900,052UnrelatedBusinessRevenueAmt
Exclusion$3,309,374ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$1,376,757TotalAmt
Program Services$1,376,757ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,043,831TotalAmt
Management And General$1,043,831ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$42,482,554TotalAmt
Program Services$37,824,752ProgramServicesAmt
Management And General$4,657,802ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$991,538TotalAmt
Program Services$902,042ProgramServicesAmt
Management And General$89,496ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$7,023,030TotalAmt
Program Services$6,252,143ProgramServicesAmt
Management And General$770,887ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,074,034TotalAmt
Program Services$2,729,435ProgramServicesAmt
Management And General$344,599ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$4,844,664TotalAmt
Program Services$4,396,452ProgramServicesAmt
Management And General$448,212ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$504,836TotalAmt
Management And General$504,836ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$144,567TotalAmt
Management And General$144,567ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$126,857TotalAmt
Management And General$126,857ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$8,761,016TotalAmt
Program Services$7,846,429ProgramServicesAmt
Management And General$914,587ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$460,543TotalAmt
Program Services$20,422ProgramServicesAmt
Management And General$440,121ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$7,648,384TotalAmt
Program Services$6,462,890ProgramServicesAmt
Management And General$1,185,494ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$750TotalAmt
Management And General$750ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$6,288,097TotalAmt
Program Services$5,956,085ProgramServicesAmt
Management And General$332,012ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$513,886TotalAmt
Program Services$449,098ProgramServicesAmt
Management And General$64,788ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$66,114TotalAmt
Program Services$11,005ProgramServicesAmt
Management And General$55,109ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,710TotalAmt
Management And General$1,710ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$5,642,969TotalAmt
Program Services$5,345,020ProgramServicesAmt
Management And General$297,949ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$387,825TotalAmt
Program Services$387,825ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$14,203,770$14,203,770
REPAIRS & MAINTENANCE$3,586,902$2,221,682$1,365,220
SPECIAL EVENTS$220,586$67,625$152,961
TAXES AND LICENSE$214,278$214,278

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$341,303TotalAmt
Program Services$58ProgramServicesAmt
Management And General$341,245ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$109,950,801TotalAmt
Program Services$96,453,490ProgramServicesAmt
Management And General$13,497,311ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$23,783,833BOYAmt
EOY$15,019,768EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$10,727,555BOYAmt
EOY$11,147,620EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$368,093BOYAmt
EOY$361,583EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$744,279BOYAmt
EOY$892,149EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$982,757BOYAmt
EOY$1,093,396EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$132,615,641LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$74,305,060LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$46,486,425BOYAmt
EOY$58,310,581EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$44,735,531BOYAmt
EOY$46,000,074EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,858,838BOYAmt
EOY$1,858,495EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$3,761,744BOYAmt
EOY$3,470,791EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$133,449,055BOYAmt
EOY$138,154,457EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$13,048,822BOYAmt
EOY$11,106,653EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$49,517BOYAmt
EOY$90,628EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$59,517,513BOYAmt
EOY$57,592,821EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$54,042BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$17,495,692BOYAmt
EOY$14,834,363EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$90,165,586BOYAmt
EOY$83,624,465EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$43,283,469BOYAmt
EOY$54,529,992EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$43,283,469BOYAmt
EOY$54,529,992EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$133,449,055BOYAmt
EOY$138,154,457EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$11,192,210ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$251,597NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$305,910OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$6,415OtherActivitiesAmt
Total Lobbying Expenditures$6,415TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE C, PART II-B, LINE 1FormAndLineReferenceDesc
ExplanationTHE HOSPITAL BELONGS TO NATIONAL AND STATE INDUSTRY ASSOCIATIONS AND, AS PART OF THEIR ANNUAL DUES, PAYS A SMALL PERCENTAGE TO SUPPORT THE LOBBYING EFFORTS BY THESE ASSOCIATIONS.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,875,781OtherCostOrOtherBasisAmt
Book Value$1,875,781BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$63,582,299OtherCostOrOtherBasisAmt
Depreciation$28,626,822DepreciationAmt
Book Value$34,955,477BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,411,420OtherCostOrOtherBasisAmt
Depreciation$6,688,600DepreciationAmt
Book Value$722,820BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$55,412,441OtherCostOrOtherBasisAmt
Depreciation$38,989,638DepreciationAmt
Book Value$16,422,803BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,333,700OtherCostOrOtherBasisAmt
Book Value$4,333,700BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$58,310,581TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
MINIMUM PENSION LIABILITY$9,317,963
COST REPORT SETTLEMENTS$3,582,861
ACCRUED INTEREST$1,624,229
DEFERRED PENSION EXPENSE$174,157
INTERCOMPANY LIABILITY$135,153
FieldValueIRS element (for citing)
Total Liability$14,834,363TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PAGE 3, PART XFormAndLineReferenceDesc
ExplanationTHE AUTHORITY IS A GOVERNMENTAL ENTITY AND IS EXEMPT FROM INCOME TAXES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN CONSIDERED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL IS REQUIRED TO FILE A FORM 990 WITH THE INTERNAL REVENUE SERVICE. ANY INCOME EARNED FROM NON-RELATED BUSINESS SERVICES IS SUBJECT TO TAXATION. THE HOSPITAL 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 HOSPITAL 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, 2018 AND 2017 OR FOR THE YEARS THEN ENDED. THE HOSPITALS 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.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served1603PersonsServedCnt
Total Community Benefit Expns$1,545,156TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,545,156NetCommunityBenefitExpnsAmt
Total Expense0.01410TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served14568PersonsServedCnt
Total Community Benefit Expns$9,094,358TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,753,944DirectOffsettingRevenueAmt
Net Community Benefit Expns$4,340,414NetCommunityBenefitExpnsAmt
Total Expense0.03950TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Persons Served16171PersonsServedCnt
Total Community Benefit Expns$10,639,514TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,753,944DirectOffsettingRevenueAmt
Net Community Benefit Expns$5,885,570NetCommunityBenefitExpnsAmt
Total Expense0.05350TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Persons Served7090PersonsServedCnt
Total Community Benefit Expns$1,651,194TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,651,194NetCommunityBenefitExpnsAmt
Total Expense0.01500TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Persons Served200PersonsServedCnt
Total Community Benefit Expns$25,042TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$25,042NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Persons Served15000PersonsServedCnt
Total Community Benefit Expns$204,933TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$204,933NetCommunityBenefitExpnsAmt
Total Expense0.00190TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Persons Served3590PersonsServedCnt
Total Community Benefit Expns$97,694TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$97,694NetCommunityBenefitExpnsAmt
Total Expense0.00090TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Persons Served25880PersonsServedCnt
Total Community Benefit Expns$1,978,863TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,978,863NetCommunityBenefitExpnsAmt
Total Expense0.01800TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Persons Served42051PersonsServedCnt
Total Community Benefit Expns$12,618,377TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,753,944DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,864,433NetCommunityBenefitExpnsAmt
Total Expense0.07150TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Total Community Benefit Expns$2,427TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,427NetCommunityBenefitExpnsAmt

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Activities Or Programs11ActivitiesOrProgramsCnt
Persons Served26408PersonsServedCnt
Total Community Benefit Expns$73,425TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$73,425NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs12ActivitiesOrProgramsCnt
Persons Served26408PersonsServedCnt
Total Community Benefit Expns$75,852TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$75,852NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$36,837,547BadDebtExpenseAmt
Reimbursed By Medicare$42,520,393ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$33,777,505CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$8,742,888MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

FieldValueIRS element (for citing)
Business Name Line1SURGERY CENTER OF CUBusinessNameLine1Txt
FieldValueIRS element (for citing)
Primary ActivitiesSURGERY CENTERPrimaryActivitiesTxt
Org Profit Or Ownership0.51000OrgProfitOrOwnershipPct
Physicians Profit Or Ownership0.49000PhysiciansProfitOrOwnershipPct
FieldValueIRS element (for citing)
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CULLMAN REGIONAL MEDICAL CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HIGHWAY 157AddressLine1Txt
CityCULLMANCityNm
State AbbreviationALStateAbbreviationCd
ZIP350580609ZIPCd
FieldValueIRS element (for citing)
Website AddressCULLMANREGIONAL.COMWebsiteAddressTxt
State LicenseH2201StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherHOSPICE, CLINICS & HOME HEALTHOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1CULLMAN REGIONAL MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLCULLMANREGIONAL.COMOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLHTTPS://CULLMANREGIONAL.COM/COMMUNITY/StrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLHTTP://WWW.CULLMANREGIONAL.COMFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLHTTP://WWW.CULLMANREGIONAL.COMFAPAppAvailableOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back MedicareYes (X)LookBackMedicareInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FACILITY 1, CULLMAN REGIONAL MEDICAL CENTER - PART V, LINE 3ETHE PROCESS OF PRIORITIZING THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IS DESCRIBED ON PAGE 43 OF THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH CAN BE FOUND ON THE ORGANIZATION'S WEBSITE.
FACILITY 1, CULLMAN REGIONAL MEDICAL CENTER - PART V, LINE 5CULLMAN REGIONAL MEDICAL CENTER, INC. (CRMC) CONTRACTED WITH ALEXANDER CONSULTING GROUP, INC. (ACG) TO ASSIST IN CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AS REQUIRED BY INTERNAL REVENUE CODE. DURING THE CHNA PROCESS, CRMC SOLICITED AND TOOK INTO ACCOUNT INPUT RECEIVED FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF CULLMAN COUNTY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF AND EXPERTISE IN PUBLIC HEALTH THROUGH MULTIPLE METHODS. INTERVIEWS AND FOCUS GROUPS WERE CONDUCTED WITH A BROAD RANGE OF COMMUNITY REPRESENTATIVES WHO REPRESENT THE BROAD INTERESTS OF CULLMAN COUNTY. MANY OF THE INTERVIEW AND FOCUS GROUP PARTICIPANTS HAVE SPECIAL KNOWLEDGE OF AND EXPERTISE IN PUBLIC HEALTH, AND REPRESENTED THE INTERESTS OF THE MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS OF CULLMAN COUNTY. IN TOTAL, 39 COMMUNITY REPRESENTATIVES PARTICIPATED IN EITHER INTERVIEWS OR FOCUS GROUPS, INCLUDING A REPRESENTATIVE FROM THE CULLMAN COUNTY HEALTH DEPARTMENT. THE PURPOSE OF THE INTERVIEWS AND FOCUS GROUPS WAS TO GAIN DIRECT INPUT FROM THESE INDIVIDUALS REGARDING IDENTIFYING AND PRIORITIZING HEALTH NEEDS, INCLUDING THE HEALTH ISSUES ASSOCIATED WITH THE MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AS WELL AS IDENTIFYING RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THOSE HEALTH NEEDS. IN ADDITION TO CONDUCTING INTERVIEWS AND FOCUS GROUPS, COMMUNITY INPUT WAS GARNERED FROM PARTICIPANTS IN A COMMUNITY ADVISORY COMMITTEE (CAC), AS WELL AS CRMCS CHNA ADVISORY COMMITTEE. THE CAC WAS COMPRISED OF A BROAD RANGE OF COMMUNITY REPRESENTATIVES, INCLUDING THE CULLMAN COUNTY HEALTH DEPARTMENT, CULLMAN COUNTY DEPARTMENT OF HUMAN RESOURCES, GOOD SAMARITAN HEALTH CLINIC, CHURCH CLERGY, BANKERS, EDUCATORS, HEALTHCARE PERSONNEL, CULLMAN COUNTY CAREER CENTER, QUALITY OF LIFE HEALTH SERVICES, CULLMAN ECONOMIC DEVELOPMENT AGENCY, CULLMAN COUNTY COOPEATIVE EXTENSION AGENCY, USA HEALTHCARE, JUDICIAL CIRCUIT JUDGE, THE LINK OF CULLMAN COUNTY, CULLMAN COUNTY CHAMBER OF COMMERCE, AND VARIOUS CULLMAN COUNTY AND CITY GOVERNMENT OFFICIALS. THE CHNA ADVISORY COMMITTEE WAS RESPONSIBLE FOR OVERSEEING THE CHNA PROCESS, INCLUDING IDENTIFYING AND PRIORITIZING THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. SECONDARY DATA WAS COLLECTED FROM A VARIETY OF RESPECTED ORGANIZATIONS ON A BROAD ARRAY OF HEALTH INDICATORS AND OTHER INFORMATION, AND ANALYZED AND SUMMARIZED. THE TYPES OF DATA COLLECTED INCLUDED DEMOGRAPHIC, SOCIOECONOMIC, MORTALITY AND MORBIDITY, HEALTH STATUS INDICATORS, HEALTH BEHAVIORS, MATERNAL AND CHILD HEALTH, INSURANCE STATUS, AND GENERAL COMMUNITY/ENVIRONMENTAL INFORMATION.
FACILITY 1, CULLMAN REGIONAL MEDICAL CENTER - PART V, LINE 11AS A RESULT OF THE 2016 CHNA, THE FOLLOWING SIX CATEGORIES OF HEALTH NEEDS AND CONCERNS WERE IDENTIFIED AND PRIORITIZED. 1. HEART DISEASE 2. OBESITY 3. ACCESS TO CARE/CONTINUITY OF CARE 4. CANCER 5. SMOKING (AS PRIMARY CAUSE OF LUNG DISEASE AND LUNG CANCER) 6. SUBSTANCE ABUSE/MENTAL HEALTH THE FIRST FIVE HEALTH NEEDS ARE ADDRESSED IN THE 2016 CHNA IMPLEMENTATION STRATEGY. THE LAST NEED IDENTIFIED IN THE 2016 CHNA, SUBSTANCE ABUSE/MENTAL HEALTH, WILL NOT BE SPECIFICALLY ADDRESSED BY CRMC. THIS ISSUE IS MORE APPROPRIATELY ADDRESSED BY THE VARIOUS HEALTH PARTNERS WITHIN THE COMMUNITY DUE TO CRMC'S LACK OF EXPERTISE AND LIMITED RESOURCES.
FACILITY 1, CULLMAN REGIONAL MEDICAL CENTER - PART V, LINE 16JTHE HOSPITAL HAS CLEARLY WRITTEN FINANCIAL AID POLICIES THAT ARE AVAILABLE ON THE ORGANIZATION WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED IN THE ER ABOUT THE AVAILABILITY OF FINANCIAL AID. A REPRESENTATIVE IS ALSO AVAILABLE TO DISCUSS ELIGIBILITY TO GOVERNMENT PROGRAMS.
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF CULLMAN COUNTYBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HIGHWAY 157AddressLine1Txt
CityCULLMANCityNm
State AbbreviationALStateAbbreviationCd
ZIP350580609ZIPCd
FieldValueIRS element (for citing)
FacilityHOSPICEFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CAREFEDERAL POVERTY GUIDELINES (200%) ARE USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. DISCOUNTED CARE WILL BE BASED ON MEDICARE REIMBURSEMENT.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATIONTHE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". THE HOSPITAL UTILIZES EPSI SOFTWARE FOR COST ACCOUNTING PURPOSES. SEE ALSO THE DESCRIPTION FOR PART III, LINE 2.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGYAMOUNTS 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.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTSTHE AUTHORITY PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE. AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE, THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE.
PART III, LINE 8 - MEDICARE EXPLANATIONMEDICARE 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 EXPLANATIONTHE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL AID POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS FINANCIAL AID, THEY ARE NOT REPORTED AS REVENUE.
PART VI, LINE 2 - NEEDS ASSESSMENTTHE HOSPITAL PARTICIPATES IN THE CULLMAN COUNTY HEALTH COALITION. THIS ORGANIZATION, COMPRISED OF VARIOUS HEALTH CARE PROVIDERS AND COMMUNITY LEADERS, ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY AND STRIVES TO PROVIDE RESOURCES THAT BEST MEET THOSE NEEDS. THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN IS WIDELY PUBLICIZED ON THE HOSPITAL'S WEBSITE WWW.CULLMANREGIONAL.COM.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHE HOSPITAL HAS CLEARLY WRITTEN FINANCIAL AID POLICIES THAT ARE AVAILABLE ON THE ORGANIZATION WEB SITE AND THROUGHOUT THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED IN THE ER ABOUT THE AVAILABILITY OF FINANCIAL AID. A REPRESENTATIVE IS ALSO AVAILABLE TO DISCUSS ELIGIBILITY TO GOVERNMENT PROGRAMS.
PART VI, LINE 4 - COMMUNITY INFORMATIONTHE HOSPITAL DRAWS PATIENTS PRINCIPALLY FROM CULLMAN COUNTY AND THE NEIGHBORING COUNTIES OF WALKER, WINSTON, MARSHALL, MORGAN, AND BLOUNT. CRMC IS THE ONLY HOSPITAL IN ITS PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREA INCLUDES THE CITY OF CULLMAN, POPULATION 15,385, AND CULLMAN COUNTY, POPULATION 82,755. PER CAPITA INCOME FOR THIS AREA IS SLIGHTLY BELOW THE PER CAPITA INCOME FOR THE STATE OF ALABAMA. CULLMAN IS SERVED BY I-65, AND IS LOCATED BETWEEN HUNTSVILLE AND BIRMINGHAM.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTHTHE ORGANIZATION AND ITS VOLUNTEER BOARDS ARE COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS, AS WELL AS PHYSICIAN MEMBERS. THE EMERGENCY DEPARTMENT IS OPEN 24 HOURS PER DAY, 7 DAYS PER WEEK, AND IS OPEN TO ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY. CULLMAN REGIONAL PROVIDES FREE HEALTH SCREENINGS FOR THE COMMUNITY. THESE SCREENINGS ARE SET UP AT THE HOSPITAL AND AT VARIOUS LOCATIONS AROUND THE COUNTY. DURING FISCAL YEAR 2018, OVER 3,300 COMMUNITY MEMBERS PARTICIPATED AND RECEIVED THE FREE HEALTH SCREENING. HOSPITAL EMPLOYEES, IN CONJUNCTION WITH OUR LOCAL JUDGES, HAVE DEVELOPED A TRAUMA PREVENTION PROGRAM. THIS PROGRAM IS PROVIDED BY CRMC EMPLOYEES ON A VOLUNTARY BASIS. OUR LOCAL JUDGES REFER TEENAGE DRIVING OFFENDERS TO THE PROGRAM TO TEACH THEM THE IMPORTANCE OF VEHICLE SAFETY. WHILE THEY ARE HERE, THEY ACTUALLY GET TO WITNESS THE VARIOUS STAGES OF A TRAUMA ACCIDENT, FROM THE TIME THEY ARRIVE AT THE ER, UNTIL THEY LEAVE THE HOSPITAL. COMMUNITY BUILDING ACTIVITIES ALSO INCLUDE PROVIDING AMBULANCE SUPPORT FOR VARIOUS COMMUNITY ACTIVITIES AND PROVIDING COMMUNITY SUPPORT GROUPS. THESE SUPPORT GROUPS (ALZHEIMER'S, BREAST CANCER, ETC) PROMOTE THE PHYSICAL AND MENTAL HEALTH OF THE COMMUNITY THAT WE SERVE. CULLMAN REGIONAL PROVIDES THE HEALTHY LIFE PROGRAM. THIS PROGRAM OFFERS SEMINARS AND EDUCATION ON HEALTH AND LIFESTYLE ISSUES AND ALSO OFFERS DISCOUNT ADMISSION TO WORKSHOPS AND HEALTH SCREENINGS. THIS PROGRAM CURRENTLY HAS 6,500 MEMBERS. CRMC ALSO PROVIDES A COMMUNITY EDUCATION CENTER WHICH OFFERS MEETING ROOMS AND CATERING SERVICES FOR LOCAL BUSINESSES, CHURCHES, CIVIC ORGANIZATIONS AND EDUCATIONAL GROUPS. ALL OF OUR AMBULANCES ARE EQUIPPED WITH 12 LEAD EKG TECHNOLOGY, WHICH TRANSMITS THE INFORMATION DIRECTLY TO THE EMERGENCY ROOM PHYSICIAN, ALLOWING THEM TO GET THE INFORMATION WHILE THE PATIENT IS IN TRANSIT. THIS PROGRAM HAS REDUCED THE TIME FROM DOOR TO ANGIOPLASTY, BY GETTING THE CARDIOLOGY TEAM IN PLACE BEFORE THE PATIENT ARRIVES.
PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORTALABAMA

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1GOOD SAMARITAN CLINICBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1401 ARNOLD ST NEAddressLine1Txt
CityCULLMANCityNm
State AbbreviationALStateAbbreviationCd
ZIP35055ZIPCd
FieldValueIRS element (for citing)
Recipient EIN200149215RecipientEIN
IRC Section3IRCSectionDesc
Cash Grant$82,000CashGrantAmt
Non Cash Assistance$1,294,757NonCashAssistanceAmt
Valuation Method UsedFMVValuationMethodUsedDesc
Non Cash AssistanceMED SVCSNonCashAssistanceDesc
Purpose Of GrantCURRENT OPERATIONSPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2FormAndLineReferenceDesc
ExplanationTHE HOSPITAL CONTINUOUSLY EVALUATES COMMUNITY ORGANIZATIONS (AS IDENTIFIED IN PART II ABOVE) PROVIDING HEALTHCARE NEEDS TO THE MEDICALLY UNDERSERVED WHO ALSO ARE MOST LIKELY UNABLE TO PAY. THE HOSPITAL EVALUATES THE NEEDS ON AN INDIVIDUAL BASIS BASED ON DOCUMENTED REQUESTS FOR SERVICES PROVIDED.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
JAMES CLEMENTS
CEO$348,150$111,339$83,008$12,000$14,301$568,798
NESHA DONALDSON
CFO/COO (1/19)$175,473$32,283$15,084$8,866$3,240$234,946
EDWARD MAHAN MD
CARDIOLOGIST$406,168$256$12,000$15,312$433,736
TRACEY NEAL MD
CARDIOLOGIST$342,813$256$9,000$13,595$365,664
MAN WAI PANG
PHARMACY DIRECTOR$150,414$72,945$26,260$12,000$7,587$269,206
CHARNA BROWN
CNO$150,688$25,754$13,181$5,331$16,742$211,696
CHERYL BAILEY
EXEC DIRECTOR EDUCAT$92,950$71,562$9,825$2,918$669$177,924

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PAGE 1, PART I, LINE 1ATHE ORGANIZATION PROVIDES A MEMBERSHIP TO THE LOCAL COUNTRY CLUB FOR THE CEO. ANY AMOUNTS NOT DOCUMENTED AS BUSINESS RELATED ARE INCLUDED IN THE RECIPIENT'S TAXABLE INCOME AND REPORTED ON THE FORM W-2.
SCHEDULE J, PAGE 1, PART I, LINE 4JEFF STANLEY 45,900 0 0 CHERYL BAILEY 71,562 0 0
SCHEDULE J, PART IIIBONUS/INCENTIVES CERTAIN EXECUTIVE OFFICERS AND DEPARTMENT DIRECTORS 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.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1HEALTH CARE AUTHORITY OF CULLMAN CTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN631149220BondIssuerEIN
CUSIP230186AMOCUSIPNum
Bond Issued2009-12-03BondIssuedDt
Issue Price$70,225,000IssuePriceAmt
PurposeDEFEASE 1993/2007 BONDS.PurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$12,715,000RetiredAmt
Total Proceeds$68,624,416TotalProceedsAmt
Refunding Escrow$61,819,381RefundingEscrowAmt
Issuance Costs From Proceeds$1,352,854IssuanceCostsFromProceedsAmt
Working Capital Expenditures$5,452,182WorkingCapitalExpendituresAmt
Substantial Completion2009SubstantialCompletionYr
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropYes (true)ChangeInUseBondFinancedPropInd
Change In Use Bond Financed Prop0.01100ChangeInUseBondFinancedPropPct
Remedial Action TakenYes (true)RemedialActionTakenInd
Procs Nonqualified Bond RemdtdfalseProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetYes (true)RebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecYes (true)HedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line1MERRILL LYNCHBusinessNameLine1Txt
FieldValueIRS element (for citing)
Term Of Hedge26.000000000000TermOfHedgePct
Superintegrated HedgefalseSuperintegratedHedgeInd
Hedge TerminatedfalseHedgeTerminatedInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsfalseWrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionfalseProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE K - ADDITIONAL INFORMATIONFormAndLineReferenceDesc
ExplanationHEALTH CARE AUTHORITY OF CULLMAN CTY THE ONLY BONDS ISSUED BY THE AUTHORITY FOR THE BENEFIT OF CRMC ARE THE BONDS WHICH WERE ISSUED DECEMBER 3, 2009. A PORTION OF THE BONDS IS ALLOCABLE TO CAPITAL EQUIPMENT (THE "BOND- FINANCED EQUIPMENT") FINANCED BY CRMC AND THE AUTHORITY FOR USE AT A FREESTANDING RADIATION ONCOLOGY CENTER OPERATED BY CRMC. THE BOND-FINANCED EQUIPMENT WAS SOLD ON DECEMBER 31, 2010 FOR CASH IN THE AMOUNT OF 800,000 TO A NONGOVERNMENTAL PERSON. THE SALE CONSTITUTES A DISPOSITION OF THE BOND-FINANCED EQUIPMENT FOR PURPOSES OF THE CHANGE IN USE RULES. WITHIN 2 YEARS OF THE SALE DATE, THE AUTHORITY USED THE DISPOSITION PROCEEDS FOR ALTERNATE USES COMPLYING WITH THE REQUIREMENTS OF TREAS. REG 1.141-12(E).ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 2, PART III, LINE 4ACOMMUNITY EDUCATION AND WELLNESS ACTIVITIES TO THE COMMUNITY AND IS A MAJOR CONTRIBUTOR TO A LOCAL INDIGENT CLINIC SERVICING CULLMAN COUNTY.
FORM 990, PAGE 6, PART VI, LINE 6THE HEALTH CARE AUTHORITY OF CULLMAN COUNTY (AUTHORITY)IS THE SOLE MEMBER OF CULLMAN REGIONAL MEDICAL CENTER INC.
FORM 990, PAGE 6, PART VI, LINE 7ATHE AUTHORITY APPOINTS THE VOTING MAJORITY OF THE ORGANIZATION'S BOARD AND CONTROLS THE OPERATIONS AS WELL.
FORM 990, PAGE 6, PART VI, LINE 7BTHE AUTHORITY APPOINTS THE VOTING MAJORITY OF THE ORGANIZATION'S BOARD AND CONTROLS THE OPERATIONS OF THE ORGANIZATION.
FORM 990, PAGE 6, PART VI, LINE 11BMANAGEMENT ASSISTS IN PREPARING SCHEDULES, REVIEWS THE ENTIRE DRAFT OF THE FORM 990 FOR CONTENT, AND RECOMMENDS CHANGES, IF ANY. PRIOR TO FILING, THE CFO, AND ACCOUNTING DEPARTMENT REVIEW THE FORM. THE FINAL FORM, AS IT IS ULTIMATELY FILED WITH ALL SCHEDULES AND ATTACHMENTS, IS MADE AVAILABLE TO THE BOARD MEMBERS PRIOR TO FILING WITH THE IRS.
FORM 990, PAGE 6, PART VI, LINE 12CANNUALLY, BOARD MEMBERS, OFFICERS, AND DEPARTMENTAL DIRECTORS MUST IDENTIFY ANY CONFLICT, MANAGEMENT MONITORS AND MAY SUGGEST ANY AREAS OF CONFLICT. THE BOARD CHAIRMAN OR ADMINISTRATION REVIEWS ACTUAL AND PERCEIVED CONFLICTS OF INTEREST. IN THE EVENT OF A CONFLICT, THE MEMBER OR OFFICER WITH THE CONFLICT WILL DISMISS THEMSELVES FROM THE DISCUSSION AND ANY VOTES ON THE ISSUE.
FORM 990, PAGE 6, PART VI, LINE 15AANNUALLY THE BOARD (OR A COMMITTEE CHARGED WITH THE RESPONSIBILITY AND AUTHORITY TO DO SO ON BEHALF OF THE BOARD) REVIEWS THE COMPENSATION PACKAGE AND PROPOSED CONTRACT OF THE CEO. THE REVIEW IS CONDUCTED BY INDEPENDENT BOARD MEMBERS, IS BASED UPON A COMPARATIVE ANALYSIS, AND IS DOCUMENTED IN THE RECORDS OF THE BOARD REFLECTING THE BASIS OF THE DETERMINATION BY THE THE BOARD (OR AUTHORIZED COMMITTEE).
FORM 990, PAGE 6, PART VI, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO ANY MEMBER OF THE PUBLIC WHO MAKES THEIR REQUEST AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION.
FORM 990, PART XI, LINE 9CHANGE IN VALUE OF INTEREST RATE SWAP 306,254 CHANGE IN UNRESTRICTED ASSETS OF AFFILIATE 113,911 CHANGE IN TEMP REST NET ASSETS OF AFFILIATE -114,255 TOTAL 305,910 CHANGE IN THE NET ASSETS IS THE RESULT OF NONCASH TRANSACTIONS AS DETAILED ABOVE.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
CULLMAN REGIONAL MEDICAL CTR FNDN
1912 ALABAMA HIGHWAY 157CULLMANAL350580609630727880FOUNDATIONAL501C37NAfalse
HEALTH CARE AUTHORITY OF CULLMAN CO
1912 ALABAMA HIGHWAY 157CULLMANAL350580609631149220AUTHORITYAL501C16NAfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1SURGERY CENTER OF CULLMANBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11402 WALL STREETAddressLine1Txt
CityCULLMANCityNm
State AbbreviationALStateAbbreviationCd
ZIP35055ZIPCd
FieldValueIRS element (for citing)
EIN203489003EIN
Primary ActivitiesSURG CTRPrimaryActivitiesTxt
Legal Domicile StateALLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CRMCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeTypeTxt
Disproportionate AllocationsfalseDisproportionateAllocationsInd
General Or Managing PartnerfalseGeneralOrManagingPartnerInd
Ownership0.51000OwnershipPct
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (true)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE RFormAndLineReferenceDesc
ExplanationPART III, COLUMN (F) AND (G) - RELATED ORGANIZATIONS TAXED AS PARTNERSHIP THE ORGANIZATION PURCHASED ITS 51% SHARE OF THIS CALENDAR YEAR PARTNERSHIP IN JANUARY 2018.ExplanationTxt

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