JOHN D ARCHBOLD MEMORIAL HOSPITAL INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
JOHN D ARCHBOLD MEMORIAL HOSPITAL INC (EIN 58-0566121)
Tax period
2016-10-01 to 2017-09-30
Filed
2018-08-08
IRS object ID
201802209349301270
Schema version
2016v3.1
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)
Return2018-08-08T16:11:56-04:00ReturnTs
Tax Period End2017-09-30TaxPeriodEndDt

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 Begin2016-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN580566121EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JOHN D ARCHBOLD MEMORIALBusinessNameLine1Txt
Business Name Line2HOSPITAL INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlJOHNBusinessNameControlTxt
Phone2292282853PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1P O BOX 1018AddressLine1Txt
CityTHOMASVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP317991018ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJ PERRY MUSTIANPersonNm
Person TitlePRESIDENT/CEOPersonTitleTxt
Phone2292282737PhoneNum
Signature2018-08-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJACQUELINE G ATKINSPreparerPersonNm
PTINP00861721PTIN
Phone2298837878PhoneNum
Preparation2018-08-02PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJ PERRY MUSTIANPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1P O BOX 1018AddressLine1Txt
CityTHOMASVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP317991018ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$343,381,208GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.ARCHBOLD.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1923FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionHEALTHCARE SERVICESActivityOrMissionDesc
Voting Members Governing Body19VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers91TotalVolunteersCnt
Total Gross UBI$1,032,438TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$40,384NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$5,796,587PYContributionsGrantsAmt
CY Contributions Grants$6,197,535CYContributionsGrantsAmt
PY Program Service Revenue$320,481,788PYProgramServiceRevenueAmt
CY Program Service Revenue$330,676,117CYProgramServiceRevenueAmt
PY Investment Income$2,279,780PYInvestmentIncomeAmt
CY Investment Income$3,160,768CYInvestmentIncomeAmt
PY Other Revenue$2,679,176PYOtherRevenueAmt
CY Other Revenue$2,506,966CYOtherRevenueAmt
PY Total Revenue$331,237,331PYTotalRevenueAmt
CY Total Revenue$342,541,386CYTotalRevenueAmt
PY Grants And Similar Paid$558,097PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$501,147CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$128,238,139PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$130,453,826CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$172,221,034PYOtherExpensesAmt
CY Other Expenses$186,489,093CYOtherExpensesAmt
PY Total Expenses$301,017,270PYTotalExpensesAmt
CY Total Expenses$317,444,066CYTotalExpensesAmt
PY Revenues Less Expenses$30,220,061PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$25,097,320CYRevenuesLessExpensesAmt
Total Assets BOY$652,733,673TotalAssetsBOYAmt
Total Assets EOY$671,768,073TotalAssetsEOYAmt
Total Liabilities BOY$160,043,559TotalLiabilitiesBOYAmt
Total Liabilities EOY$153,598,861TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$492,690,114NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$518,169,212NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionHEALTHCARE SERVICESMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$211,127,584ExpenseAmt
Grant$501,147GrantAmt
Revenue$267,972,561RevenueAmt
DescJOHN D. ARCHBOLD MEMORIAL HOSPITAL (JDAMH) IN THOMASVILLE GEORGIA OPERATES WITH 264 LICENSED BEDS; OF WHICH 204 ARE MED/SURG, 40 BEDS ARE DESIGNATED TO A PSYCH UNIT, 20 BEDS ARE REHAB. IN ADDITION, THEY OPERATE A 64 BED SKILLED NURSING FACILITY. JDAMH IS A RURAL REFERRAL CENTER COVERING THOMAS COUNTY AND SURROUNDING COUNTIES IN SOUTHERN GEORGIA AND NORTHERN FLORIDA. 69% OF PATIENTS WERE COVERED BY MEDICARE AND MEDICAID, AND 3.0% OF PATIENT REVENUE WAS PROVIDED AS INDIGENT CARE. IN 2017, JDAMH PROVIDED OVER 26.2 MILLION IN INDIGENT CARE CHARGES. JDAMH TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION JDAMH PROVIDED APPROXIMATELY 41.9 MILLION IN ADDITIONAL UNCOMPENSATED CARE. THROUGHOUT THE YEAR, JDAMH PRODUCES OR SPONSORS MANY SPECIAL PROGRAMS FOR THE COMMUNITY TO EDUCATE THEM ON IMPORTANT HEALTH NEEDS. JDAMH, INC. ALSO MAINTAINS HOSPITALS IN GRADY COUNTY, BROOKS COUNTY, AND MITCHELL COUNTY, FILING UNDER EIN 58-0566121.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$16,643,733ExpenseAmt
Revenue$25,766,983RevenueAmt
DescGRADY GENERAL HOSPITAL (GGH) IN CAIRO, GEORGIA OPERATES A 60 LICENSED BED ACUTE CARE FACILITY. TEN BEDS CAN BE USED AS SWING BEDS. IT SERVES GRADY COUNTY AND 62% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2017, GGH PROVIDED OVER 1.8 MILLION IN INDIGENT CARE. IN ADDITION, GRADY GENERAL HOSPITAL PROVIDED OVER 8.6 MILLION IN ADDITIONAL UNCOMPENSATED CARE. EIN 58-1646537 FILED UNDER EIN 58-0566121.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$8,754,916ExpenseAmt
Revenue$9,507,303RevenueAmt
DescBROOKS COUNTY HOSPITAL OPERATES IN QUITMAN, GEORGIA AS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE CARE BEDS. IT SERVES BROOKS COUNTY AND 71% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2017, OVER 3.5 MILLION OF INDIGENT CARE WAS PROVIDED TO THE COMMUNITY. IN ADDITION, BROOKS COUNTY HOSPITAL PROVIDED OVER 1.4 MILLION IN ADDITIONAL UNCOMPENSATED CARE. EIN 58-6002830 FILED UNDER EIN 58-0566121.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$19,958,114ExpenseAmt
Revenue$27,379,800RevenueAmt
DescMITCHELL COUNTY HOSPITAL AND NURSING HOMES OPERATE IN CAMILLA, GEORGIA AS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE CARE BEDS AND 156 NURSING HOME BEDS. IT SERVES MITCHELL COUNTY AND 64% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2017, OVER 5.3 MILLION OF INDIGENT CARE WAS PROVIDED TO THE COMMUNITY. IN ADDITION, MITCHELL COUNTY HOSPITAL PROVIDED OVER 2.8 MILLION ADDITIONAL UNCOMPENSATED CARE. EIN 58-6001207 FILED UNDER EIN 58-0566121.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$19,958,114TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue$27,379,800TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$256,484,347TotalProgramServiceExpensesAmt
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 EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
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 IndividualsYes (true)GrantsToIndividualsInd
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 MemYes (true)BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (true)BusinessRlnWithOfficerEntInd
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 Document242IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
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 Members19GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
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 CEOfalseCompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonGREG HEMBREEPersonNm
Phone2292282853PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1018AddressLine1Txt
CityTHOMASVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP317991018ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (38 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
J PERRY MUSTIAN
PRESIDENT/CE1.0050.00Yes (X)Yes (X)$0$3,197,177$256,910
DARYL CRENSHAW MD
TRUSTEE1.0040.00Yes (X)$0$738,926$21,020
JASON NESMITH MD
TRUSTEE40.00Yes (X)$305,722$0$16,742
JAMES S KARAS MD
PAST TRUSTEE1.001.00Yes (X)$0$9,400$0
HAILE MCCOLLUM
CHAIRMAN1.001.00Yes (X)Yes (X)$0$0$0
CHARLES R SANDERS JR MD
VICE CHAIRMA1.00Yes (X)Yes (X)$0$0$0
IMOGENE CONYERS
SECRETARY1.001.00Yes (X)Yes (X)$0$0$0
NATHANIEL H ABRAMS JR
TREASURER1.001.00Yes (X)Yes (X)$0$0$0
VICTOR MCMILLAN MD
TRUSTEE1.001.00Yes (X)$0$0$0
CORDELL BRAGG MD
TRUSTEE1.001.00Yes (X)$0$0$0
JOE BROWN
TRUSTEE1.00Yes (X)$0$0$0
MELISSA S BRUHN
TRUSTEE1.001.00Yes (X)$0$0$0
CLARK CONNELL MD
TRUSTEE1.00Yes (X)$0$0$0
JAMES TREY W FALCONER III MD
TRUSTEE1.00Yes (X)$0$0$0
DEBORAH GASKINS
TRUSTEE1.00Yes (X)$0$0$0
GREG HAMIL
TRUSTEE1.00Yes (X)$0$0$0
CRAIG WENTWORTH
TRUSTEE1.00Yes (X)$0$0$0
SUE STEPHENSON
TRUSTEE1.001.00Yes (X)$0$0$0
WILLIAM ELLIS MD
TRUSTEE1.001.00Yes (X)$0$0$0
ALSTON WATT
TRUSTEE1.001.00Yes (X)$0$0$0
SUZANNE ANDERSON
PAST TRUSTEE1.00Yes (X)$0$0$0
THOMAS J CALLAWAY III
PAST TRUSTEE1.001.00Yes (X)$0$0$0
CHARLES D HIGHTOWER JR
PAST ASST SE1.0050.00Yes (X)$0$484,898$27,265
JIM CARTER
COO40.001.00Yes (X)$320,151$0$49,598
GREG HEMBREE
ASST SEC/SR1.0050.00Yes (X)$0$19,904$0
KEN BROOKER
VP CLINICAL40.00$250,616$0$21,034Yes (X)
AMY GRIFFIN
VP PATIENT C40.00$248,895$0$32,788Yes (X)
LADON TOOLE
VP NETWORK O40.00$217,359$0$32,463Yes (X)
JIM BUE
VP FACILITY40.00$204,967$0$9,314Yes (X)
CHRIS NEWMAN
ASST VP PHAR40.00$202,838$0$7,239Yes (X)
JOSH MOORE
VP OPERATION40.00$202,837$0$24,933Yes (X)
JOE BARRON
ASST VP HEAR40.00$181,766$0$19,586Yes (X)
RAMESAN NAIR MD
PHYSICIAN40.00$264,799$0$23,290Yes (X)
LISSA MURPHY MD
PHYSICIAN40.00$255,422$0$13,394Yes (X)
SHANE HERRIN MD
PHYSICIAN40.00$236,515$0$19,155Yes (X)
EUGENE SUN MD
PHYSICIAN40.00$234,105$0$17,952Yes (X)
JOHN SPONAUGLE MD
PHYSICIAN40.00$227,032$0$14,104Yes (X)
MEL HARTSFIELD MD
FRMR VP MEDI40.00$386,474$0$20,640Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$3,739,498TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$4,450,305TotReportableCompRltdOrgAmt
Total Other Compensation$627,427TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K77IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
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/ZIPCdServicesServicesDescCompensationCompensationAmt
RED HILLS RADIOLOGY
714 N DAWSON STREETTHOMASVILLEGA317924451RADIOLOGY SVC$7,394,816
MORRISON MANAGEMENT SPECIALISTS
5801 PEACHTREE DUNWOODY RDATLANTAGA303421503DIETARY SVCS$6,551,688
THOMASVILLE PHYSICAL THERAPY
P O BOX 2476THOMASVILLEGA317992476REHAB SVCS$6,118,582
SOUTHLAND HOSPITALIST GROUP
PO BOX 1276THOMASVILLEGA317991276HOSPITALIST SVC$3,578,399
SOUTH GEORGIA EMERGENCY MEDICINE
P O BOX 1913THOMASVILLEGA317991913ER PHYSICIAN$2,566,086
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K58CntrctRcvdGreaterThan100KCnt
Related Organizations$2,283,432RelatedOrganizationsAmt
Government Grants$3,914,103GovernmentGrantsAmt
Total Contributions$6,197,535TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT SERVICE REVENUE623000$329,643,679$329,643,679
LAB SERVICES621500$1,032,438$1,032,438
FieldValueIRS element (for citing)
Total Program Service Revenue$330,676,117TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,261,919TotalRevenueColumnAmt
Exclusion$3,261,919ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$967,807RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$99,304RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$868,503RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$868,503TotalRevenueColumnAmt
Exclusion$868,503ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$356,799OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$457,950OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$101,151OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$101,151TotalRevenueColumnAmt
Exclusion-$101,151ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$407,534GrossSalesOfInventoryAmt
Cost Of Goods Sold$282,568CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$124,966TotalRevenueColumnAmt
Exclusion$124,966ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
VHA REBATES623000$551,252$551,252
DRUG SALES621990$530,504$530,504
MEDICAL RECORD TRANSCRIPT FEE621990$178,558$178,558

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$253,183TotalRevenueColumnAmt
Related Or Exempt Func Income$253,158RelatedOrExemptFuncIncomeAmt
Exclusion$25ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,513,497OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$342,541,386TotalRevenueColumnAmt
Related Or Exempt Func Income$330,626,647RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$1,032,438UnrelatedBusinessRevenueAmt
Exclusion$4,684,766ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$96,000TotalAmt
Program Services$96,000ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$405,147TotalAmt
Program Services$405,147ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$2,630,476TotalAmt
Program Services$322,464ProgramServicesAmt
Management And General$2,308,012ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$407,114TotalAmt
Management And General$407,114ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$100,249,393TotalAmt
Program Services$87,234,750ProgramServicesAmt
Management And General$13,014,643ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,324,048TotalAmt
Program Services$1,270,765ProgramServicesAmt
Management And General$53,283ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$16,308,209TotalAmt
Program Services$13,919,816ProgramServicesAmt
Management And General$2,388,393ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$9,534,586TotalAmt
Program Services$8,100,432ProgramServicesAmt
Management And General$1,434,154ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$281,829TotalAmt
Management And General$281,829ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$26,969TotalAmt
Management And General$26,969ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$99,272TotalAmt
Management And General$99,272ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$52,697,312TotalAmt
Program Services$44,365,224ProgramServicesAmt
Management And General$8,332,088ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$206,320TotalAmt
Program Services$33,393ProgramServicesAmt
Management And General$172,927ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$26,999,651TotalAmt
Program Services$14,448,754ProgramServicesAmt
Management And General$12,550,897ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,905,964TotalAmt
Program Services$1,903,574ProgramServicesAmt
Management And General$2,390ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$9,355,984TotalAmt
Program Services$8,301,565ProgramServicesAmt
Management And General$1,054,419ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,045,485TotalAmt
Program Services$737,472ProgramServicesAmt
Management And General$308,013ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$64,216TotalAmt
Program Services$64,216ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$26,353,597TotalAmt
Program Services$23,383,547ProgramServicesAmt
Management And General$2,970,050ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$2,045,181TotalAmt
Program Services$2,045,181ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES JDAMH$42,612,856$42,612,856
LOSS ON BOND DEFEASANCE$9,801,609$9,801,609
PROVIDER FEES$4,638,243$4,638,243
REPAIRS & MAINTENANCE JDA$3,113,155$2,673,760$439,395

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$5,241,450TotalAmt
Program Services$4,565,431ProgramServicesAmt
Management And General$676,019ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$317,444,066TotalAmt
Program Services$256,484,347ProgramServicesAmt
Management And General$60,959,719ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$8,813,003BOYAmt
EOY$8,234,455EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$57,227,238BOYAmt
EOY$55,023,377EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,992,584BOYAmt
EOY$3,961,156EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$3,630,801BOYAmt
EOY$5,373,526EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$508,242,960LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$271,406,038LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$245,072,466BOYAmt
EOY$236,836,922EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$235,615,247BOYAmt
EOY$241,653,058EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$26,572BOYAmt
EOY$1,229,668EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$98,355,762BOYAmt
EOY$119,455,911EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$652,733,673BOYAmt
EOY$671,768,073EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$41,417,812BOYAmt
EOY$36,354,768EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$760,747BOYAmt
EOY$1,074,093EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$117,865,000BOYAmt
EOY$116,170,000EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$160,043,559BOYAmt
EOY$153,598,861EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$488,891,776BOYAmt
EOY$513,834,087EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,798,338BOYAmt
EOY$4,335,125EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$492,690,114BOYAmt
EOY$518,169,212EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$652,733,673BOYAmt
EOY$671,768,073EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$25,097,320ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$381,778NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (true)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
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

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

Total Direct Lobbying TotalDirectLobbyingGrp

FieldValueIRS element (for citing)
Filing Organizations Total$5,484FilingOrganizationsTotalAmt

Total Lobbying Expend TotalLobbyingExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$5,484FilingOrganizationsTotalAmt

Other Exempt Purpose Expend OtherExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$256,393,831FilingOrganizationsTotalAmt

Total Exempt Purpose Expend TotalExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$256,399,315FilingOrganizationsTotalAmt

Lobbying Nontaxable Amount LobbyingNontaxableAmountGrp

FieldValueIRS element (for citing)
Filing Organizations Total$1,000,000FilingOrganizationsTotalAmt

Grassroots Nontaxable GrassrootsNontaxableGrp

FieldValueIRS element (for citing)
Filing Organizations Total$250,000FilingOrganizationsTotalAmt

Avg Lobbying Nontaxable Amount AvgLobbyingNontaxableAmountGrp

FieldValueIRS element (for citing)
Current Year Minus3$1,000,000CurrentYearMinus3Amt
Current Year Minus2$1,000,000CurrentYearMinus2Amt
Current Year Minus1$1,000,000CurrentYearMinus1Amt
Current Year$1,000,000CurrentYearAmt
Total$4,000,000TotalAmt
FieldValueIRS element (for citing)
Lobbying Ceiling$6,000,000LobbyingCeilingAmt

Avg Total Lobbying Expend AvgTotalLobbyingExpendGrp

FieldValueIRS element (for citing)
Current Year Minus3$6,274CurrentYearMinus3Amt
Current Year Minus2$7,061CurrentYearMinus2Amt
Current Year Minus1$8,655CurrentYearMinus1Amt
Current Year$5,484CurrentYearAmt
Total$27,474TotalAmt

Avg Grassroots Nontaxable AvgGrassrootsNontaxableGrp

FieldValueIRS element (for citing)
Current Year Minus3$250,000CurrentYearMinus3Amt
Current Year Minus2$250,000CurrentYearMinus2Amt
Current Year Minus1$250,000CurrentYearMinus1Amt
Current Year$250,000CurrentYearAmt
Total$1,000,000TotalAmt
FieldValueIRS element (for citing)
Grassroots Ceiling$1,500,000GrassrootsCeilingAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,798,338BeginningYearBalanceAmt
Investment Earnings Or Losses$536,787InvestmentEarningsOrLossesAmt
End Year Balance$4,335,125EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,363,351BeginningYearBalanceAmt
Investment Earnings Or Losses$434,987InvestmentEarningsOrLossesAmt
End Year Balance$3,798,338EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,515,803BeginningYearBalanceAmt
Investment Earnings Or Losses-$152,452InvestmentEarningsOrLossesAmt
End Year Balance$3,363,351EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,066,204BeginningYearBalanceAmt
Investment Earnings Or Losses$449,599InvestmentEarningsOrLossesAmt
End Year Balance$3,515,803EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,817,109BeginningYearBalanceAmt
Investment Earnings Or Losses$249,095InvestmentEarningsOrLossesAmt
End Year Balance$3,066,204EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$8,854,639OtherCostOrOtherBasisAmt
Book Value$8,854,639BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$152,688,291OtherCostOrOtherBasisAmt
Depreciation$59,205,865DepreciationAmt
Book Value$93,482,426BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$26,798,408OtherCostOrOtherBasisAmt
Depreciation$14,970,867DepreciationAmt
Book Value$11,827,541BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$318,800,618OtherCostOrOtherBasisAmt
Depreciation$197,229,306DepreciationAmt
Book Value$121,571,312BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,101,004OtherCostOrOtherBasisAmt
Book Value$1,101,004BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$236,836,922TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (8 entries)

DescDescBook ValueBookValueAmt
DUE FROM RELATED PARTIES$90,287,923
OTHER RECEIVABLES$17,531,053
DUE FROM MEDICARE/MEDICAID$5,692,961
PHYSICIAN RECEIVABLES$1,876,964
SCHOLARSHIP/TUITION RECEIVABLE$1,697,001
DUE FROM SELF INSURANCE TRUST$1,409,927
INTEREST RECEIVABLE$737,771
DEFERRED BOND ISSUE COST - 2003$222,311
FieldValueIRS element (for citing)
Total Book Value Other Assets$119,455,911TotalBookValueOtherAssetsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PAGE 2, PART V, LINE 4ENDOWMENT FUNDS RESTRICTED BY DONORS ARE HELD IN A PERMANENT HEALTHCARE ENDOWMENT FUND WHICH WAS ESTABLISHED TO SUPPORT HEALTH CARE SERVICES.
SCHEDULE D, PAGE 3, PART XTHE MEDICAL CENTER, WITH THE EXCEPTION OF ARCHBOLD MEDICAL ENTERPRISES, INC., 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 MEDICAL CENTER APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE CONSOLIDATED 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 MEDICAL CENTER 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 SEPTEMBER 30, 2017 AND 2016 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTER'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.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
Most Hospitals PolicyYes (X)MostHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other3.250000000000DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportfalseAnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,581,447TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$11,581,447NetCommunityBenefitExpnsAmt
Total Expense0.03650TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$36,237,741TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$33,707,147DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,530,594NetCommunityBenefitExpnsAmt
Total Expense0.00800TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$367,136TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$339,266DirectOffsettingRevenueAmt
Net Community Benefit Expns$27,870NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$48,186,324TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$34,046,413DirectOffsettingRevenueAmt
Net Community Benefit Expns$14,139,911NetCommunityBenefitExpnsAmt
Total Expense0.04450TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$627,110TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$627,110NetCommunityBenefitExpnsAmt
Total Expense0.00200TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,345,495TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,345,495NetCommunityBenefitExpnsAmt
Total Expense0.00420TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$21,879,415TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$21,879,415NetCommunityBenefitExpnsAmt
Total Expense0.06890TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$96,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$96,000NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$23,948,020TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$23,948,020NetCommunityBenefitExpnsAmt
Total Expense0.07540TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$72,134,344TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$34,046,413DirectOffsettingRevenueAmt
Net Community Benefit Expns$38,087,931NetCommunityBenefitExpnsAmt
Total Expense0.12000TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,330TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,330NetCommunityBenefitExpnsAmt

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$10NetCommunityBenefitExpnsAmt

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,340TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,340NetCommunityBenefitExpnsAmt
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$54,752,882BadDebtExpenseAmt
Reimbursed By Medicare$85,380,998ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$90,934,181CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$5,553,183MedicareSurplusOrShortfallAmt

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
Hospital Facilities4HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (4 entries)

FacilityFacilityNumAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdWebsite AddressWebsiteAddressTxtState LicenseStateLicenseNumLicensed HospitalLicensedHospitalIndGeneral Medical And SurgicalGeneralMedicalAndSurgicalIndEmergency Room24 HrsEmergencyRoom24HrsIndOtherOtherDescFacility Reporting GroupFacilityReportingGroupCdCritical Access HospitalCriticalAccessHospitalInd
JOHN D ARCHBOLD MEM HOSP
1P O BOX 1018THOMASVILLEGA317991018WWW.ARCHBOLD.ORG136-91Yes (X)Yes (X)Yes (X)PSYCH, REHAB, NURSING HOMEA
GRADY GENERAL HOSPITAL
21155 FIFTH STREET SECAIROGA31728WWW.ARCHBOLD.ORG065-413Yes (X)Yes (X)Yes (X)SWING BED SNFA
BROOKS COUNTY HOSPITAL
3903 N COURT STQUITMANGA31643WWW.ARCHBOLD.ORG014-028Yes (X)Yes (X)RHC; SWING BED SNFAYes (X)
MITCHELL COUNTY HOSPITAL
490 STEPHENS STCAMILLAGA31730WWW.ARCHBOLD.ORG101-120Yes (X)Yes (X)NURSING HOME, RHC, SWING BEDAYes (X)

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ABusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1234FacilityNum
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 FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.ARCHBOLD.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLWWW.ARCHBOLD.ORGStrategyWebsiteURLTxt
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 Care325.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.ARCHBOLD.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.ARCHBOLD.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.ARCHBOLD.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
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 Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 5INPUT FROM COMMUNITY MEMBERS REPRESENTING THE BROADER INTERESTS OF THE COUNTY WAS GATHERED THROUGH A COMBINATION OF WRITTEN SURVEYS, TELEPHONE INTERVIEWS AND IN-PERSON MEETINGS. WE RELIED MORE ON WRITTEN SURVEYS FOR THIS CHNA THAN IN THE 2013-2014 CHNA TO BE ABLE TO HAVE A TOOL THAT WAS MORE COMPARABLE. SURVEY QUESTIONS INCLUDED MULTIPLE CHOICE AND OPEN-ENDED ANSWERS. INPUT WAS GATHERED FROM THE FOLLOWING SOURCES FROM JUNE 3JULY 25, 2016: . DOUGLASS HIGH SCHOOL ALUMNI ASSOCIATIONGROUP MEETING AND WRITTEN SURVEYS . GEORGIA DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES WRITTEN SURVEYS . MAGNOLIA HIGH SCHOOL ALUMNIWRITTEN SURVEYS . SOUTHWEST GEORGIA TECHNICAL COLLEGE NURSING AND FACULTY MEMBERSWRITTEN SURVEYS . THOMAS COUNTY FAMILY CONNECTION WRITTEN SURVEYS . THOMAS COUNTY HEALTH DEPARTMENT(TYPICALLY REPRESENTING LOW- INCOME/MINORITY/MEDICALLY UNDERSERVED POPULATION)WRITTEN SURVEYS AND TELEPHONE INTERVIEW
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 6ATHE NEEDS ASSESSMENT WAS CONDUCTED FOR JOHN D. ARCHBOLD MEMORIAL HOSPITAL ALONG WITH GRADY GENERAL HOSPITAL, BROOKS COUNTY HOSPITAL AND MITCHELL COUNTY HOSPITAL.
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 7DDISTRIBUTED COPIES TO THE COMMUNITY; AVAILABLE ONLINE
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 11QUALITATIVELY, THE GREATEST MEDICAL NEEDS ACCORDING TO COMMUNITY PERCEPTION INCLUDED: 1. HIGH BLOOD PRESSURE 2. OBESITY 3. DIABETES 4. MENTAL HEALTH ISSUES 5. HEART DISEASE 6. BACK/JOINT PAIN 7. STROKE 8. DRUG ADDICTION 9. LUNG DISEASE 10. ALCOHOL ABUSE SETTING PRIORITIES OUR FIRST STEP WAS TO DETERMINE HOW WE COULD HAVE THE MOST IMPACT ON IMPROVING THE HEALTH OF OUR COMMUNITY GIVEN AVAILABLE RESOURCES, GREATER FINANCIAL CONSTRAINTS, AND NOT TAKING ON COMMITMENTS THAT WERE BEST SERVED BY OTHER COMMUNITY ENTITIES. IN THE 2013-14 CHNA, WE NOTED THAT THE COMMUNITIES WE SERVE REPRESENT THE SOME OF UNHEALTHIEST COUNTIES IN THE COUNTRY. WE ALSO NOTED THAT OBESITY IS THE COMMON DENOMINATOR WITH MANY OF THE SAME DISEASE STATES WE ALREADY IDENTIFIED AS AREAS TO ADDRESS. IF WE REDUCE OBESITY, WE HAVE GREAT POTENTIAL TO REVERSE NEGATIVE TRENDS IN HEART DISEASE, STROKE, COPD, SLEEP DISORDERS, VASCULAR DISEASE, DIABETES, CANCER, ARTHRITIS, SPINE PROBLEMS AND OTHER CONDITIONS. WE PLAN TO CONTINUE PREVENTION AND EARLY DETECTION EFFORTS, BUT PRIMARILY THROUGH FOCUSING ON OBESITY. AND ALTHOUGH OBESITY WILL BE OUR FOCUS, THERE IS STILL A NEED TO ADDRESS OTHER KEY HEALTH ISSUES INDIVIDUALLY WITH SIMILAR TACTICS. WE WILL CONTINUE TO USE DOCTORS, MID-LEVELS, NURSES AND OTHER CLINICIANS FOR EDUCATION AND SCREENINGS AS NEEDED. IN ADDITION TO A FULL-TIME CLINICAL OUTREACH MANAGER, WE WILL PROVIDE PART-TIME CLINICAL STAFF, LABORATORY USE CLINICAL SUPPLIES AND RESOURCES FOR OTHER CONTINGENCIES. ULTIMATELY, THOUGH, WE WISH TO CHANGE THE CULTURE IN THOMAS COUNTY TO THE POINT THAT THE CONCEPTS, PROGRAMS AND LIFESTYLES PROMOTED AND DELIVERED THROUGH LIVE BETTER BECOME THE NORM, AND NOT A DEFINED HEALTH INITIATIVE. NEEDS NOT ADDRESSED NOT ALL HEALTH NEEDS ARE EASILY ADDRESSED BY ARCHBOLD. FURTHER, KEEPING TOO BROAD OF A FOCUS WILL DILUTE THE IMPACT WE CAN HAVE ON EACH HEALTH NEED. THESE ARE SOME OF THE PRIMARY REASONS WE ARE NO LONGER INCLUDING TEEN PREGNANCY AND SUBSTANCE ABUSE IN OUR IMPLEMENTATION PLAN. OUR BIGGEST OPPORTUNITY IS TO HELP WITH IMPROVING DISEASE STATES, REMAINING AVAILABLE FOR ASSISTANCE WITH OTHER HEALTH NEEDS AS REQUESTED AND AS TIME AND FINANCES PERMIT. WE WILL ADDRESS MENTAL HEALTH ISSUES, BUT MORE FROM OUR PSYCHIATRIC SERVICE LINE THAN THROUGH CLINICAL OUTREACH/COMMUNITY BENEFIT.
FieldValueIRS element (for citing)
Facility13FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (13 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
GLENN-MOR NURSING HOME
10629 U S HIGHWAY 19 STHOMASVILLEGA31792SKILLED NURSING HOME
JDA PSYCHIATRIC UNIT
P O BOX 1018THOMASVILLEGA31792PSYCHIATRIC UNIT
JDA REHABILITATION UNIT
P O BOX 1018THOMASVILLEGA31792REHABILITATION UNIT
DECATUR COUNTY DIALYSIS FACILITY
P O BOX 1018THOMASVILLEGA31792DIALYSIS FACILITY
MITCHELL COUNTY DIALYSIS FACILITY
P O BOX 1018THOMASVILLEGA31792DIALYSIS FACILITY
BROOKS COUNTY DIALYSIS FACILITY
P O BOX 1018THOMASVILLEGA31792DIALYSIS FACILITY
GRADY COUNTY DIALYSIS FACILITY
P O BOX 1018THOMASVILLEGA31792DIALYSIS FACILITY
SOUTHWEST GA DIALYSIS FACILITY
P O BOX 1018THOMASVILLEGA31792DIALYSIS FACILITY
BROOKS MEDICAL ASSOCIATES
P O BOX 5000QUITMANGA31643RURAL HEALTH CLINIC
MITCHELL CO CONVALESCENT CENTER
90 STEPHENS STREETCAMILLAGA31728SKILLED NURSING HOME
CAMILLA PEDIATRICS CENTER
P O BOX 360CAMILLAGA31728RURAL HEALTH CLINIC
MEDICAL GROUP OF MITCHELL COUNTY
P O BOX 360CAMILLAGA31728RURAL HEALTH CLINIC
ARCHBOLD PELHAM PRIMARY CARE CLINIC
P O BOX 360CAMILLAGA31728RURAL HEALTH CLINIC

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSEIN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 317,444,066 ADD: EXPENSES REPORTED IN PART VIII 381,872 DENOMINATOR FOR COLUMN (F) 317,825,938
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATIONTHE ORGANIZATION USES THE COST TO CHARGE RATIO USING THE IRS' RECOMMENDED FORMAT IN WORKSHEET 2. OTHER COSTS IN PART I LINES 7E THROUGH 7I WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS.
PART II - COMMUNITY BUILDING ACTIVITIESECONOMIC AND WORKFORCE DEVELOPMENT THROUGH HEALTH EDUCATION IMPROVES LEVEL OF CARE IN COMMUNITIES SERVED. OPPORTUNITIES TO REALIZE ACCESS TO CARE ARE MADE KNOWN TO SCREENING PARTICIPANTS.
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 STATEMENTSSEE THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
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 EXPLANATIONPATIENTS THAT ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE APPROVED FOR A PERIOD OF 6 MONTHS. THE PATIENTS ARE REQUIRED TO CONTACT THE FINANCIAL ASSISTANCE OFFICE DURING THIS POINT IF THEY INCUR ADDITIONAL CHARGES THAT QUALIFY FOR FINANCIAL ASSISTANCE DURING THIS TIME PERIOD. THE SAME PROCESS IS IN EFFECT FOR THE PATIENTS WHO QUALIFY FOR THE SLIDING FEE DISCOUNT. THIS DISCOUNT WILL LIMIT THE PATIENTS TO AN OUT OF POCKET MAXIMUM AMOUNT IN THE GIVEN TIME PERIOD. WE DO NOT HAVE ANY AUTOMATIC ADJUSTMENTS OR AN AUTOMATED SYSTEM TO TRACK THE PREVIOUSLY APPROVED PATIENTS.
PART VI, LINE 2 - NEEDS ASSESSMENTREVIEW OF ASSESSMENTS OF OTHER ORGANIZATIONS THAT IDENTIFY NEEDS AND HAVE ON-GOING PARTICIPATION WITH THOSE ORGANIZATIONS. COLLECT, REVIEW AND USE PRIMARY,SECONDARY AND QUALITATIVE DATA IN DETERMINING NEEDS. UPDATE COMMUNITY HEALTH STATUS AS LOCAL, STATE AND FEDERAL DATA IS REPORTED. REVIEW INTERNAL DATA SUCH AS SCREENING OUTCOMES AND PATIENT VOLUMES FOR SERVICES. RESPONSE TO REQUESTS FROM COMMUNITY, INPUT FROM A GROUP MEETING OF THE DOUGLASS HIGH SCHOOL ALUMNI ASSOCIATION, SEVERAL WRITTEN SURVEYS AND A TELEPHONE INTERVIEW. THE ORGANIZATION ANALYZES QUANTITATIVE FEDERAL, STATE AND LOCAL DATA AS WELL AS SEEKS QUALITATIVE INPUT FROM MEMBERS OF THE COMMUNITY, ESPECIALLY THE UNDERSERVED. THE ORGANIZATION ALSO ASSESSES THE NEEDS OF THE COMMUNITY THROUGH UTILIZING ASSESSMENTS CONDUCTED BY OTHER COMMUNITY ORGANIZATIONS, REVIEWING INTERNAL DATA ON PATIENT VOLUMES AND SCREENING OUTCOMES, PARTICIPATING IN COMMUNITY ORGANIZATIONS THAT IDENTIFY NEEDS, SPONSORING COMMUNITY EDUCATION TASK FORCES THAT PROVIDE INPUT AND RESPONDING TO SPECIFIC REQUESTS FROM COMMUNITY MEMBERS. COPIES OF THE 2016-2017 CHNA'S AND THE RELATED IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING WEB ADDRESSES: HTTPS://ARCHBOLD.ORG/UPLOADS/GROUPS/3/DOCUMENTS/BROOKS-KEYHEALTHISSUES- 2016-AUG18.PDF HTTPS://ARCHBOLD.ORG/UPLOADS/GROUPS/3/DOCUMENTS/GRADY-KEYHEALTHISSUES-2016 -AUG18.PDF HTTPS://ARCHBOLD.ORG/UPLOADS/GROUPS/3/DOCUMENTS/MITCHELL-KEYHEALTHISSUES- 2016-AUG18.PDF HTTPS://ARCHBOLD.ORG/UPLOADS/GROUPS/3/DOCUMENTS/THOMAS-KEYHEALTHISSUES- 2016-AUG18.PDF
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEANNUAL NOTICES ARE PLACED IN THE NEWSPAPERS FOR THE COUNTIES WE SERVE WITH HEALTHCARE. NOTICE OF THE FAP PROGRAM IS CONTAINED IN THE PATIENT HANDBOOK, SIGNS AND BROCHURES OUTLINING THE AVAILABILITY OF THE FAP PROGRAM ARE AVAILABLE AT POINTS OF ACCESS FOR PATIENTS, PAPER APPLICATIONS ARE AVAILABLE AT ALL ADMISSION AREAS AND BUSINESS OFFICES, ELECTRONIC VERSION OF THE APPLICATION CAN BE DOWNLOADED FREE OF CHARGE VIA WEBSITE AND THE ASSISTANCE PROGRAM IS DISCUSSED IN DETAIL DURING COLLECTION CALLS WITH PATIENTS.
PART VI, LINE 4 - COMMUNITY INFORMATIONCOUNTIES SERVED IN GEORGIA INCLUDE BROOKS, GRADY, MITCHELL, THOMAS. DISPROPORTIONATE HEALTHCARE NEEDS, FEDERALLY DESIGNATED AS MEDICALLY UNDERSERVED AREAS(MUA) OR HEALTH PROFESSIONAL SHORTAGE AREAS(HSPA), LOW- INCOME, PUBLIC HOUSING RESIDENTS, SENIORS, MIGRANT WORKERS, UNINSURED, UNDERINSURED, MIXTURE OF ETHNICITIES, ALL AGES, MIXTURE OF EDUCATIONAL LEVELS. BROOKS COUNTY: ESTIMATED POPULATION 15,587; 61.9% WHITE/35.2% BLACK; MEDIAN HOUSEHOLD INCOME 34,547; 25.9% LIVING IN POVERTY; 19.9% UNDER 65 UNINSURED. GRADY COUNTY: ESTIMATED POPULATION 24,819; 67.1% WHITE/29.2% BLACK; MEDIAN HOUSEHOLD INCOME 35,518; 21.0% LIVING IN POVERTY; 19.6% UNDER 65 UNINSURED. MITCHELL COUNTY: ESTIMATED POPULATION 22,292; 49.9% WHITE/47.9% BLACK; MEDIAN HOUSEHOLD INCOME 31,111; 29.9% LIVING IN POVERTY; 17.2% UNDER 65 UNINSURED. THOMAS COUNTY: ESTIMATED POPULATION 44,779; 60.3% WHITE/36.7% BLACK; MEDIAN HOUSEHOLD INCOME 38,241; 21.1% LIVING IN POVERTY; 16.0% UNDER 65 UNINSURED. INFORMATION OBTAINED FROM WWW.CENSUS.GOV
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTHLIVE BETTER IS THE NAME THAT REPRESENTS AN ARCHBOLD-LED EFFORT OF KEY COMMUNITY LEADERS AND COMMUNITY FOCUSED ON IMPROVING THE HEALTH OF THE CITIZENS OF THOMAS COUNTY. LIVE BETTER IS STEERED BY LEADERS OF MAJOR SECTORS OF THE COMMUNITY (GOVERNMENT, EDUCATION, MEDIA, BUSINESS) THAT ARE WORKING TOGETHER WITH ARCHBOLD TO LEVERAGE THE STRENGTHS OF THEIR ORGANIZATIONS TO ACHIEVE MEASURED HEALTH GOALS. THE GROUP HAS MEASURABLE GOALS TO REDUCE THE OBESITY RATE IN THOMAS COUNTY, THE BIGGEST COMMON DENOMINATOR OF POOR HEALTH. OBESITY IS A PREVENTABLE CONDITION, YET THE COMMON RISK FACTOR WITH THE MOST PROMINENT HEALTH ISSUES IN THOMAS COUNTY: HEART DISEASE, HYPERTENSION, STROKE, COPD, VASCULAR DISEASE, DIABETES AND CANCER. THE GOVERNING BODIES OF ALL JDAMH'S HOSPITAL FACILITIES ARE PRIMARILY COMPRISED OF PERSONS WHO ARE NOT EMPLOYEES OR CONTRACTORS (NOR FAMILY MEMBERS THEREOF) AND WHO REPRESENT A BROAD SPECTRUM OF THE COMMUNITY. THE HOSPITALS' MEDICAL STAFFS ARE OPEN TO ALL QUALIFIED PHYSICIANS IN THE REGION. SURPLUS FUNDS ARE REINVESTED IN THE FACILITIES AND OPERATIONS.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEMARCHBOLD MEDICAL CENTER, INC. (MEDICAL CENTER) AS THE PARENT CORPORATION HAS SOLE CONTROL OVER ITS NONPROFIT SUBSIDIARIES, JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC., ARCHBOLD HEALTH SERVICES, INC., ARCHBOLD FOUNDATION, INC., ARCHBOLD MEDICAL GROUP, INC. AND SOLE OWNERSHIP OF ITS FOR-PROFIT SUBSIDIARY, ARCHBOLD MEDICAL ENTERPRISES, INC. JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC. OPERATES JOHN D. ARCHBOLD MEMORIAL HOSPITAL, GRADY GENERAL HOSPITAL, BROOKS COUNTY HOSPITAL, AND MITCHELL COUNTY HOSPITAL AND NURSING HOMES. ARCHBOLD HEALTH SERVICES, INC. PROVIDES FACILITIES AND SUPPORT FOR HOME HEALTH CARE AND AMBULATORY HEALTH CARE SERVICES. ARCHBOLD FOUNDATION, INC. SOLICITS CONTRIBUTIONS AND MANAGES FUNDS FOR THE BENEFIT OF JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC. AND ARCHBOLD HEALTH SERVICES, INC. ARCHBOLD MEDICAL GROUP, INC. EMPLOYS PHYSICIANS AND OTHER SUPPORT PERSONNEL TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES ESSENTIAL TO THE PREVENTION AND TREATMENT OF DISEASE FOR THE BENEFIT OF ALL INDIVIDUALS IN THE SERVICE AREA. ARCHBOLD MEDICAL GROUP, INC. ALSO SERVES AS THE SOLE MEMBER OF CCSG, INC. AND AMGIR, INC., BOTH 501(C)(3) ORGANIZATIONS WHICH OPERATE MEDICAL CLINICS.

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
THOMAS UNIVERSITY
1501 MILLPOND ROADTHOMASVILLEGA31792580644897501C3$11,000MEDICAL TECH ED PROG
THOMAS UNIVERSITY
1501 MILLPOND ROADTHOMASVILLEGA31792580644897501C3$85,000NURSG LEADERSHIP ED
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmtNon Cash AssistanceNonCashAssistanceAmtValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDesc
SCHOLARSHP/TUITION PROG140$311,485
MED STUDENT HOUSING73$93,662FMVHOUSING/UTIL.

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION OFFERS A TUITION/SCHOLARSHIP REIMBURSEMENT PROGRAM FOR QUALIFIED EMPLOYEES ON SATISFACTORY COMPLETION OF APPROVED COURSES. THE PURPOSE IS TO ENCOURAGE AND ENABLE EMPLOYEES TO ACQUIRE ADDITIONAL EDUCATION IN A HEALTH CARE OR JOB RELATED FIELD WHICH WILL PROMOTE CAREER ADVANCEMENT AND/OR PROVIDE ADVANCED CREDENTIALING OF EMPLOYEES IN AREAS OF NEED. CONDITIONS OF ELIGIBILITY: FULL-TIME EMPLOYMENT OF AT LEAST SIX MONTHS WITH SATISFACTORY WORK RECORD AND PERFORMANCE EVALUATION. COMPLETION OF THE RELEVANT EDUCATION PROGRAM REQUIRES THE APPLICANT TO COMMIT TO OBTAIN STATUS AS A FULL-TIME EMPLOYEE EQUAL TO THE AMOUNT OF TIME SPENT IN EDUCATION. FAILURE TO COMPLY WITH THE REQUIREMENTS OF ELIGIBILITY WOULD SUBJECT THE EMPLOYEE TO FULL OR PARTIAL REIMBURSEMENT OF THE FUNDS RECEIVED TO THE ORGANIZATION. FOR REIMBURSEMENT THE EMPLOYEE MUST PROVIDE A COPY OF A RECEIPT SHOWING ACTUAL PAYMENT OF TUITION FEES. APPLICANT MUST MAINTAIN A C OR HIGHER GRADE AND AN OFFICIAL RECORD OF GRADES AND HOURS CREDIT MAILED DIRECTLY TO THE ORGANIZATION.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
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 (18 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt
J PERRY MUSTIAN
PRESIDENT/CEO$610,115$177,050$2,410,012$242,900$14,010$3,454,087$2,390,936
DARYL CRENSHAW MD
TRUSTEE$552,599$185,832$495$10,600$10,420$759,946
JASON NESMITH MD
TRUSTEE$196,035$109,536$151$6,082$10,660$322,464
CHARLES D HIGHTOWER JR
PAST ASST SEC/CFO$335,495$102,765$46,638$19,875$7,390$512,163$39,780
JIM CARTER
COO$239,823$75,000$5,328$39,243$10,355$369,749
KEN BROOKER
VP CLINICAL SERVICES$187,426$43,080$20,110$13,747$7,287$271,650$16,546
AMY GRIFFIN
VP PATIENT CARE$206,085$42,000$810$27,333$5,455$281,683
LADON TOOLE
VP NETWORK OPS$180,339$36,210$810$21,935$10,528$249,822
JIM BUE
VP FACILITY SERVICES$155,235$36,255$13,477$8,672$642$214,281$11,155
CHRIS NEWMAN
ASST VP PHARMACY/LAB$191,391$11,199$248$6,522$717$210,077
JOSH MOORE
VP OPERATIONAL SVCS$163,237$39,168$432$17,873$7,060$227,770
JOE BARRON
ASST VP HEART SERVIC$162,737$17,214$1,815$12,352$7,234$201,352
RAMESAN NAIR MD
PHYSICIAN$261,153$2,634$1,012$15,900$7,390$288,089
LISSA MURPHY MD
PHYSICIAN$248,971$5,500$951$12,514$880$268,816
SHANE HERRIN MD
PHYSICIAN$230,306$6,000$209$8,495$10,660$255,670
EUGENE SUN MD
PHYSICIAN$233,894$211$7,292$10,660$252,057
JOHN SPONAUGLE MD
PHYSICIAN$206,705$20,000$327$3,711$10,393$241,136
MEL HARTSFIELD MD
FRMR VP MEDICAL AFFR$277,877$108,597$13,250$7,390$407,114$101,801

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PAGE 1, PART I, LINE 1ASOCIAL CLUB DUES ARE PAID BY THE ORGANIZATION ON BEHALF OF OFFICERS AND EXECUTIVES OF THE FILING ORGANIZATION. THESE AMOUNTS ARE INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME AND REPORTED ON THEIR W-2. THE ORGANIZATION'S POLICY FOR COMPANION TRAVEL INCLUDES THE REIMBURSEMENT OF REGISTRATION, TRAVEL, AND ENTERTAINMENT EXPENSES FOR GUESTS WHO ACCOMPANY BOARD TRUSTEES TO EITHER OF TWO ANNUAL TRUSTEE CONFERENCES. RECEIPTS MUST BE SUBMITTED PRIOR TO REIMBURSEMENT AND THE AMOUNTS ARE NOT INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME.
SCHEDULE J, PAGE 1, PART I, LINE 3THE FILING ORGANIZATION RELIES ON THE METHODS USED BY ARCHBOLD MEDICAL CENTER, INC. (AMC), THE SOLE MEMBER, TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY AMC INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AS WELL AS BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED.
SCHEDULE J, PAGE 1, PART I, LINE 4J. PERRY MUSTIAN 0 227,000 0 JIM CARTER 0 28,800 0 AMY GRIFFIN 0 16,800 0 LADON TOOLE 0 14,484 0 JIM BUE 0 1,239 0 JOSH MOORE 0 13,056 0
SCHEDULE J, PART IIITHE IRS RULES & REGULATIONS REQUIRE THAT CERTAIN NON-CURRENT, NON-CASH ITEMS ARE REPORTED IN PART VII OF FORM 990 REGARDLESS OF THE CURRENT BENEFIT TO THE EMPLOYEE. THESE SAME RULES, IN SOME CASES, REQUIRE THE COMPENSATION AND BENEFITS TO BE REPORTED TWICE IN PART VII, ONCE WHEN THE ENTITY ACCRUES FOR A FUTURE PAYMENT AND ONCE WHEN THE PAYMENT IS ACTUALLY MADE TO THE EMPLOYEE. THEREFORE, AN EMPLOYEE'S STATED TOTAL COMPENSATION AND BENEFITS REPORTED ON PART VII ARE SUBSTANTIALLY HIGHER THAN THE ACTUAL CASH COMPENSATION RECEIVED IN THE CURRENT YEAR. AMOUNTS REPORTED AS BENEFITS INCLUDE AMOUNTS FOR LIFE INSURANCE, HEALTH INSURANCE, THRIFT PLAN CONTRIBUTIONS, AND PENSION CONTRIBUTIONS. BENEFITS RELATED TO PENSION AND RETIREMENT PLANS REFLECT AMOUNTS ACCUMULATED, BUT NOT PAID, TO THE INDIVIDUAL IN RECOGNITION OF TOTAL YEARS OF EMPLOYMENT, NOT JUST THE CURRENT YEAR. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TWO OF AMC'S TOP EXECUTIVES PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS ACCRUED BUT UNFUNDED IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON-QUALIFIED RETIREMENT PLAN. THE CURRENT YEAR'S VALUE OF THE SERP DECREASED DUE TO CHANGES IN THE ASSUMPTIONS USED IN THE ACTUARIAL VALUATION OF THE ESTIMATED ACCRUED LIABILITY. AMC 457(F) RETIREMENT PLAN CERTAIN EXECUTIVES WHO ARE NOT ELIGIBLE FOR THE SERP MAY BE ELIGIBLE TO PARTICIPATE IN A 457(F) PLAN TO HELP THEM ACCUMULATE FUNDS FOR THEIR LONG TERM FINANCIAL NEEDS. THE ORGANIZATION MAY CONTRIBUTE A PERCENTAGE OF BASE SALARY INTO AN INDIVIDUAL EXECUTIVES ACCOUNT IF THE ORGANIZATION MEETS CERTAIN FINANCIAL TARGETS. THE ORGANIZATION OWNS ANY PLAN ASSETS UNTIL THEY ARE PAID TO THE EMPLOYEE AND ALL FUNDS ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. VESTING BEGINS AT AGE 55 WITH FIVE YEARS OF SERVICE AT A RATE OF 90% AND THEN INCREASES TO 100% AT AGE 60. PAYMENTS ARE MADE ANNUALLY UPON VESTING. BONUS AWARDS: OFFICERS AND PHYSICIANS ARE AWARDED BONUSES/INCENTIVES CONTINGENT IN PART ON MEETING MANAGEMENT-BY-OBJECTIVE INCENTIVE PLAN GOALS AND EXCESS OF REVENUE OVER EXPENSES.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)

Bond ReferenceBondReferenceCdBusiness Name Line2IssuerName/BusinessNameLine2TxtBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
HOSP AUTH OF THE CITY OF THOMASVILL
A2017C REVENUE BONDS581719301NONENONEN2017-07-12$82,750,000CONSTRUCTION BLDG AND EQUIPMENTfalseYes (true)false
HOSP AUTH OF THE CITY OF THOMASVILL
B2017A REVENUE BONDS581719301NONENONEN2017-07-12$17,985,000CONSTRUCTION PROJECT DEPOSITfalseYes (true)false
HOSP AUTH OF THE CITY OF THOMASVILL
C2017B REVENUE BONDS581719301NONENONEN2017-07-12$15,435,000CONSTRUCTION PROJECT DEPOSITfalseYes (true)false

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)

Bond ReferenceBondReferenceCdTotal ProceedsTotalProceedsAmtRefunding EscrowRefundingEscrowAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintIndOther Spent ProceedsOtherSpentProceedsAmtSubstantial CompletionSubstantialCompletionYr
A$82,850,000$82,522,324$327,676falseYes (true)falseYes (true)
B$17,985,000falsefalseYes (true)Yes (true)$17,985,0002017
C$15,435,000falsefalseYes (true)Yes (true)$15,435,0002017

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
AfalsefalsefalsefalsefalsefalseYes (true)
Bfalsefalsefalsefalsefalsefalsefalse
Cfalsefalsefalsefalsefalsefalsefalse

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
AfalsefalsefalsefalsefalsefalsefalsefalseYes (true)
BfalsefalsefalsefalseYes (true)falsefalsefalseYes (true)
CfalsefalsefalsefalseYes (true)falsefalsefalseYes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (true)
BYes (true)
CYes (true)

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE K - DIFFERENCES IN ISSUE PRICE EXPLANATIONFormAndLineReferenceDesc
ExplanationHOSP AUTH OF THE CITY OF THOMASVILLE ORIGINAL ISSUE PRICE INCLUDES A PREMIUM OF 100,000.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (14 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
CORDELL L BRAGG III MD
BOARD TRUSTEE$2,278,573PROFESSIONAL MED SVCfalse
GREG HAMIL
BOARD TRUSTEE$6,747,281DIRECTOR OF BANKfalse
CHARLES R SANDERS JR MD
BOARD TRUSTEE$209,730RENTAL; PATIENT SVCSfalse
JAMES S KARAS MD
BOARD TRUSTEE$3,874,060RENTAL; PATIENT SVCSfalse
LAURA C KARAS
FAMILY MEMBER$57,502COMPENSATIONfalse
LINDSEY SLIGER
FAMILY MEMBER$43,562COMPENSATIONfalse
HAILE MCCOLLUM
BOARD TRUSTEE$291,581,443DIRECTOR OF BANKfalse
ALSTON WATT
BOARD TRUSTEE$6,747,281DIRECTOR OF BANKfalse
MELISSA BRUHN MD
BOARD TRUSTEE$324,704PROFESSIONAL MED SVCfalse
W CLARK CONNELL MD
BOARD TRUSTEE$2,917,587PROFESSIONAL MED SVCfalse
JAMES W FALCONER III MD
BOARD TRUSTEE$508,413RENTAL, PATIENT SVCSfalse
DEBORAH GASKINS
BOARD TRUSTEE$6,259,272INVESTMENT MANAGERfalse
VICTOR MCMILLAN MD
BOARD TRUSTEE$508,413RENTAL; PATIENT SVCSfalse
WILLIAM W ELLIS MD
BOARD TRUSTEE$4,092,376PROFESSIONAL MED SVCfalse

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE L, PART IVJAMES W. FALCONER, III, M.D. 508,413 BOARD TRUSTEE RENTAL, PATIENT SVCS DEBORAH GASKINS 6,259,272 BOARD TRUSTEE INVESTMENT MANAGER VICTOR MCMILLAN, MD 508,413 BOARD TRUSTEE RENTAL; PATIENT SVCS WILLIAM W. ELLIS, MD 4,092,376 BOARD TRUSTEE PROFESSIONAL MED SVC
SCHEDULE L, PART VGREG HAMIL - DIRECTOR WITH COMMERCIAL BANK. AMOUNT REFLECTS TOTAL FEES AND BALANCES AT 9/30/17 FOR THE FILING AND ALL RELATED ORGANIZATIONS. CHARLES R. SANDERS, JR., MD - RENT OF PROPERTY; MEDICAL SERVICES TO PRACTICE; PAYMENTS TO TREAT UNINSURED EMERGENCY PATIENTS. JAMES S. KARAS, MD - OUTREACH SERVICES; MEDICAL SERVICES; PAYMENT TO TREAT UNINSURED EMERGENCY PATIENTS; CLAIMS SETTLEMENT GUARANTEE PAYMENTS; MEDICAL STAFF LEADERSHIP COMPENSATION; PROFESSIONAL SERVICES AGREEMENT. LAURA C. KARAS IS THE SPOUSE OF BOARD TRUSTEE, JAMES S. KARAS, MD, AND IS EMPLOYED AND COMPENSATED BY JDAMH. LINDSEY SLIGER IS THE STEPDAUGHTER OF BOARD TRUSTEE, JAMES S. KARAS, MD, AND IS EMPLOYED AND COMPENSATED BY JDAMH. HAILE MCCOLLUM - DIRECTOR WITH THOMASVILLE NATIONAL BANK. AMOUNT REFLECTS TOTAL FEES AND BALANCES AT 9/30/17 FOR THE FILING AND ALL RELATED ORGANIZATIONS. CORDELL L. BRAGG, III, MD - HOSPITAL BASED ANESTHESIOLOGY SERVICES THROUGH PROFESSIONAL CORPORATION OF WHICH HE IS A PARTNER; STATE TRAUMA CENTER UNCOMPENSATED CARE; PAYMENT TO TREAT UNINSURED EMERGENCY PATIENTS; MEDICAL DIRECTOR; MISCELLANEOUS PATIENT CARE PAYMENTS; INCENTIVE COMPENSATION; MEDICAL STAFF LEADERSHIP COMPENSATION; PROFESSIONAL SERVICES AGREEMENT. ALSTON WATT - DIRECTOR WITH COMMERCIAL BANK. AMOUNT REFLECTS TOTAL FEES AND BALANCES AT 9/30/17 FOR THE FILING AND ALL RELATED ORGANIZATIONS. MELISSA BRUHN, MD, A BOARD TRUSTEE, IS A PARTNER IN A MEDICAL PRACTICE WHICH IS COMPENSATED FOR SERVICES PROVIDED AS MEDICAL DIRECTOR; PAYMENTS TO TREAT UNINSURED EMERGENCY PATIENTS; MEDICAL STAFF LEADERSHIP COMPENSATION, HEALTH PLAN PAYMENTS. W. CLARK CONNELL, MD, A BOARD TRUSTEE, IS PARTNER IN A GROUP WHICH PROVIDES EMERGENCY MEDICAL SERVICES. JAMES W. FALCONER, III, MD - RENT OF PROPERTY; MEDICAL SERVICES TO PRACTICE; PAYMENTS TO TREAT UNINSURED EMERGENCY PATIENTS. VICTOR MCMILLAN, MD - RENT OF PROPERTY; MEDICAL SERVICES TO PRACTICE; PAYMENTS TO TREAT UNINSURED EMERGENCY PATIENTS. DEBORAH GASKINS - INVESTMENT MANAGER WITH WELLINGTON, SHIELDS & CO, LLC WHICH MANAGES A PORTION OF THE SELF INSURANCE TRUST. AMOUNT REFLECTS TOTAL FEES AND BALANCES AT 9/30/17 FOR THE FILING AND ALL RELATED ORGANIZATIONS. WILLIAM W. ELLIS, MD - OUTREACH SERVICES; MEDICAL SERVICES; PAYMENT TO TREAT UNINSURED EMERGENCY PATIENTS; CLAIMS SETTLEMENT GUARANTEE PAYMENTS; MEDICAL STAFF LEADERSHIP COMPENSATION; PROFESSIONAL SERVICES AGREEMENT.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 2, PART III, LINE 4ACOMMUNITY TO EDUCATE THEM ON IMPORTANT HEALTH NEEDS. JDAMH, INC. ALSO MAINTAINS HOSPITALS IN GRADY COUNTY, BROOKS COUNTY, AND MITCHELL COUNTY, FILING UNDER EIN 58-0566121.
FORM 990, PAGE 2, PART III, LINE 4DMITCHELL COUNTY HOSPITAL AND NURSING HOMES OPERATE IN CAMILLA, GEORGIA AS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE CARE BEDS AND 156 NURSING HOME BEDS. IT SERVES MITCHELL COUNTY AND 64% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2017, OVER 5.3 MILLION OF INDIGENT CARE WAS PROVIDED TO THE COMMUNITY. IN ADDITION, MITCHELL COUNTY HOSPITAL PROVIDED OVER 2.8 MILLION ADDITIONAL UNCOMPENSATED CARE. EIN 58-6001207 FILED UNDER EIN 58-0566121.
FORM 990, PAGE 6, PART VI, LINE 2JAMES FALCONER III, MD VICTOR MCMILLAN, MD TRUSTEE TRUSTEE BUSINESS RELATIONSHIP
FORM 990, PAGE 6, PART VI, LINE 6THE ORGANIZATION HAS A SOLE MEMBER, ARCHBOLD MEDICAL CENTER, INC. (AMC) WITH THE POWER TO ELECT OR REPLACE AND TO REMOVE THE TRUSTEES OF THE GOVERNING BODY, AS WELL AS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY.
FORM 990, PAGE 6, PART VI, LINE 7ATHE BOARD OF TRUSTEES OF THE FILING ENTITY ARE ELECTED ANNUALLY BY THE SOLE MEMBER, AMC. IN ADDITION, AMC HAS THE POWER TO ELECT OR REPLACE AND TO REMOVE THE TRUSTEES OF THE GOVERNING BODY. THE CEO OF AMC SHALL BE A MEMBER OF THE BOARD WITH THE POWER TO VOTE.
FORM 990, PAGE 6, PART VI, LINE 7BTHE SOLE MEMBER, AMC HAS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY, INCLUDING BUT NOT LIMITED TO, CAPITAL AND OPERATING BUDGETS, MERGERS OR ACQUISITIONS, CONTRACTS AND TRANSACTIONS OVER A CERTAIN AMOUNT, DISSOLUTION, ETC.
FORM 990, PAGE 6, PART VI, LINE 11BTHE ORGANIZATION'S CFO PRESENTED THE FORM 990 TO TRUSTEES IN ATTENDANCE DURING THE BOARD MEETING PRIOR TO FILING THE RETURN WITH THE IRS. THE TRUSTEES HAD THE OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. A COPY OF THE RETURN WAS MADE AVAILABLE TO THOSE BOARD MEMBERS WHO WERE UNABLE TO ATTEND THE MEETING.
FORM 990, PAGE 6, PART VI, LINE 12CON AN ANNUAL BASIS, THE ORGANIZATION DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE AND DISCLOSURE STATEMENT TO EACH TRUSTEE. THIS QUESTIONNAIRE INCLUDES QUESTIONS RELATED TO FINANCIAL INTERESTS, OUTSIDE INTERESTS OR ACTIVITIES, AND GIFTS, MEALS, AND ENTERTAINMENT. IN ADDITION TO DISCLOSING ANY APPLICABLE INFORMATION ON THE QUESTIONNAIRE, THE TRUSTEE ACKNOWLEDGES THAT (S)HE HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ, UNDERSTANDS, AND AGREES TO COMPLY WITH IT, AND UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. RESPONSES ARE SUMMARIZED AND COLLECTIVELY REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE OF AMC, THE SOLE MEMBER. DURING EACH BOARD MEETING, THE CHAIRMAN INQUIRES IF ANY TRUSTEE HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST RELATED TO ANY AGENDA ITEM. IF THE TRUSTEE DISCLOSES ANY SUCH INTEREST, THE TRUSTEE IS EXCUSED FROM THE MEETING WHILE THE DETERMINATION AS TO WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS IS DISCUSSED AND VOTED UPON BY DISINTERESTED MEMBERS OF THE BOARD AND COMMITTEE. IF INVITED TO DO SO, THE TRUSTEE WITH A POTENTIAL CONFLICT MAY RESPOND TO QUESTIONS PUT FORTH BY FELLOW DISINTERESTED TRUSTEES REGARDING ANY PROPOSED TRANSACTION OR ARRANGEMENT. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS DOCUMENTS THE NAME OF ANY INTERESTED PERSON/TRUSTEE WHO DISCLOSED OR WAS FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH A TRANSACTION OR ARRANGEMENT RESULTING IN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; AND THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATED TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSIONS, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH.
FORM 990, PAGE 6, PART VI, LINE 15BARCHBOLD MEDICAL CENTER'S PRESIDENT PRESENTS RECOMMENDATIONS FOR ALL SENIOR VICE PRESIDENTS AND VICE PRESIDENTS AND OTHER KEY EMPLOYEES TO THE COMPENSATION COMMITTEE. IN 2008, INTEGRATED HEALTHCARE SOLUTIONS (IHS) WAS ENGAGED BY THE BOARD TO REVIEW THE EXECUTIVE COMPENSATION PROGRAM AND MAKE RECOMMENDATIONS REGARDING PLAN DESIGN AND ACTUAL COMPENSATION INCLUDING BENEFITS. IN 2009, IHS PROVIDED UPDATED RECOMMENDATIONS ON COMPENSATION TO THE COMPENSATION COMMITTEE. FOR YEARS 2010-2017, THE BOARD CONTINUED TO UTILIZE IHS TO PERFORM MARKET ANALYSIS, REVIEW EXECUTIVE COMPENSATION, AND MAKE RECOMMENDATIONS.
FORM 990, PAGE 6, PART VI, LINE 19NO DOCUMENTS ARE OR WILL BE MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART IX, LINE 11GCONSULTANT FEES JDAMH 0 300,076 0 CONTRACT SERVICES JDAMH 17,898,565 5,682,754 0 CONTRACT SERVICES BROOKS 1,315,688 0 0 CONTRACT SERVICES GRADY 2,568,289 0 0 CONTRACT SERVICES MITCHELL 3,812,960 0 0 OUTSIDE LAB REFERRAL FEES JDA 944,909 0 0 OUTSIDE LAB REFERRAL GRADY 127,974 0 0 OUTSIDE LAB REFERRAL BROOKS 365 0 0 PROFESSIONAL FEES JDAMH 13,936,067 2,349,258 0 PROFESSIONAL FEES GRADY 2,101,951 0 0 PROFESSIONAL FEES BROOKS 719,730 0 0 PROFESSIONAL FEES MITCHELL 938,726 0 0 TOTAL 44,365,224 8,332,088 0

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtBusiness Name Line2DirectControllingEntityName/BusinessNameLine2TxtControlled OrganizationControlledOrganizationInd
ARCHBOLD FOUNDATION INC
PO BOX 620THOMASVILLEGA317990620581559677FOUNDATIONGA501C312BAMCARCHBOLD MEDICAL CENTER INCfalse
ARCHBOLD HEALTH SERVICES INC
PO BOX 620THOMASVILLEGA317990620581376434HEALTHCAREGA501C310AMCARCHBOLD MEDICAL CENTER INCfalse
ARCHBOLD MEDICAL CENTER INC
PO BOX 1018THOMASVILLEGA317991018581552650H/C MGMTGA501C312CNAfalse
ARCHBOLD MEDICAL GROUP INC
P O BOX 620THOMASVILLEGA317990620262988454PHYSICIANSGA501C33AMCARCHBOLD MEDICAL CENTER INCfalse
CCSG INC
915 GORDON AVENUETHOMASVILLEGA317926614473501366MED CLINICGA501C33AMGfalse
AMGIR INC
915 GORDON AVENUETHOMASVILLEGA317926614821188691MED CLINICGA501C33AMGfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1ARCHBOLD MEDICAL ENTERPRISESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1400 OLD ALBANY ROADAddressLine1Txt
CityTHOMASVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP317924013ZIPCd
FieldValueIRS element (for citing)
EIN581494513EIN
Primary ActivitiesHEALTHCAREPrimaryActivitiesTxt
Legal Domicile StateGALegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Controlled OrganizationfalseControlledOrganizationInd
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 OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
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 OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

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