2018-08-15T09:03:13-05:00 2017-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2016-10-01 586001667 STEPHENS COUNTY HOSPITAL AUTHORITY STEP 7062824200 163 HOSPITAL DRIVE TOCCOA GA 30577 JEFFREY LAIRD CFO 7062824200 2018-08-15 1 Amy Bibby P00445891 8282542254 2016 2022-09-23 18:48:47Z ROGER FORGEY 163 HOSPITAL DRIVE TOCCOA GA 30577 52616641 0 X WWW.STEPHENSCOUNTYHOSPITAL.COM X 1945 GA Provides inpatient, outpatient, occupational and emergency care services for the residents of Stephens County, Georgia and surrounding areas. Dedicated to excellence in healthcare with compassion for every life we touch. 7 6 694 18 0 0 36932 203361 52390532 51484368 30158 20943 965529 907969 53423151 52616641 0 0 0 0 27287491 26567395 0 0 0 30706890 31340789 57994381 57908184 -4571230 -5291543 36700408 41130711 15255900 24977746 21444508 16152965 X THE MISSION OF STEPHENS COUNTY HOSPITAL AUTHORITY IS TO PROVIDE HEALTH CARE AND RELATED SERVICES TO ENHANCE INDIVIDUAL HEALTH AND WELL BEING IN A MANNER THAT MEETS THE EXPECTATIONS OF PATIENTS AND OTHER CUSTOMERS; PRESERVES THE RIGHTS OF PATIENTS, EMPLOYEES AND OTHERS TO BE TREATED WITH DIGNITY, RESPECT AND CONCERN; PROVIDES PROFESSIONALLY AND TECHNICALLY PROFICIENT PERSONNEL IN AN EFFECTIVE AND RESOURCE EFFICIENT MANNER; UTILIZES ALL RESOURCES APPROPRIATELY TO CONTAIN COSTS AND TO PROVIDE FOR ADDITIONAL SERVICE OPPORTUNITIES; AND ALL PHASES OF OPERATIONS MUST BE CARRIED OUT IN AN ETHICAL MANNER. Dedicated to excellence in healthcare with compassion for every life we touch. 0 0 53768086 0 51484368 Stephens County Hospital is license to operate 96 inpatient beds and provides outpatient services to a service area that extends beyond Stephens County into the surrounding counties of Franklin, Hart, Habersham, Rabun and Banks in Georgia and into neighboring Oconee County in South Carolina. Stephens County Hospital also operates a 92 bed personal care home. The hospital participates in several employer sponsored health fairs and also supports the local employers in the "Drugs Don't Work" program. The hospital provides free diagnostic testing to the Open Arms Clinic (a free clinic operating in Stephens County). The hospital does not turn anyone down for emergency and/or medically necessary services based on the ability to pay for such services. In addition to the Internal Medicine and Orthopedic Surgeon Office practices, there was a general surgery and OB/GYN practice added this year. 53768086 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 22 0 1 694 1 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X JEFFREY B LAIRD CFO 7062824281 163 HOSPITAL DRIVE TOCCOA GA 30577 MARK G WILKINSON CHAIRMAN 2.00 X 0 0 0 JON C WEST VICE CHAIRMAN 2.00 X 0 0 0 STANLEY W ROBERTS SECRETARY/TREASURER 2.00 X 0 0 0 PAULA M DICKERSON BOARD MEMBER 2.00 X 0 0 0 STEPHEN PINKERTON BOARD MEMBER 2.00 X 0 0 0 GEORGE SANDERS BOARD MEMBER 2.00 X 0 0 0 MAX BROCK BOARD MEMBER 2.00 X 0 0 0 RUTH LYNNE M ANDERSON CEO/ADMINISTRATOR 50.00 X 222641 0 4195 JEFFREY B LAIRD CFO/CONTROLLER 50.00 X 92585 0 23612 DEARL V BIRDSONG MD GENERAL SURGEON 40.00 X 355792 0 21275 KELLY R HART PHARMACY MANAGER 40.00 X 117583 0 19194 MARK D HERNDON MD GENERAL SURGEON 40.00 X 356294 0 21275 STEPHEN T SMALL NURSE PRACTITIONER 40.00 X 139801 0 0 Ginie Chan Internal Med Physician 40.00 X 224165 0 17528 1508861 0 107079 17 0 1 0 HD SMITH WHOLESALE DRUGS 6001 GLOBAL DISTRIBUTION WAY LOUISVILLE KY 40228 WHOLESALE DRUG 1602425 MEDLINE INDUSTRIES DEPT CH 14400 PALATINE IL 600554400 MEDICAL SUPPLY DISTRIBUTOR 1061196 Apogee Medical Management 15059 N Scottsdale Scottsdale AZ 85254 HOSPITALISTS 932115 Diversified Clinical Services PO Box 636981 Cincinnati OH 45263 WOUND CARE 515830 BECKMAN COULTER INC DEPT CH 10164 PALATINE IL 300550164 LABORATORY EQUIPMENT & SUPPLIES 350856 23 203361 203361 NET PATIENT REVENUE 621400 48335928 48335928 RESIDENT REVENUE 623000 2460993 2460993 AMBULANCE SERVICE SUBSIDY BY COUN 621910 687447 687447 51484368 19008 19008 1935 0 1935 1935 1935 CAFETERIA SALES 900099 571947 571947 MISCELLANEOUS 900099 192256 192256 PHARMACY - EMPLOYEE COPAYS 900099 143766 143766 907969 52616641 51484368 0 928912 X 338362 33836 304526 76742 76742 21953251 20335048 1618203 286144 261548 24596 2473136 2260551 212585 1439760 1316002 123758 55074 55074 127630 127630 8245554 7529287 716267 111172 111172 1697968 871648 826320 1529913 1529913 47570 28755 18815 658852 658852 2007620 2007620 766645 766645 BAD DEBT EXPENSE 8955014 8955014 MEDICAL SUPPLIES 5827050 5827050 FOOD 787298 787298 MEDICAID PROVIDER FEE T 516707 516707 6722 5570 1152 57908184 53768086 4140098 0 1282924 2483036 2276388 6941384 9932710 10159214 1704287 1687881 334749 249690 68213242 49178038 20232612 19035204 3754 0 932984 574302 36700408 41130711 8215697 7623403 4000000 15089049 3040203 2265294 15255900 24977746 X 20996295 10846100 448213 5306865 21444508 16152965 36700408 41130711 -5291543 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4200 4200 0 Part II-B, Line 1: THIS AMOUNT REPRESENTS THE APPROXIMATE LOBBYING PORTION OF DUES PAID TO THE AMERICAN HOSPTIAL ASSOCIATION. 348788 348788 32845095 17368447 15476648 32939443 30686402 2253041 2079916 1123189 956727 19035204 X 42714514 0 42714514 9902127 9902127 52616641 48006057 0 48006057 9902127 9902127 57908184 Part X, Line 2: INCOME TAXES- The Hospital, SCEP, and SCHPG are not-for-profit organizations as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Accordingly, no provision for state or federal income taxes has been presented in the accompanying combined financial statements. The Hospital SCEP, and SCHPG have evaluated their tax positions and have determined that they do not have any material unrecognized tax benefits obligations as of September 30, 2017. Part XI, Line 4b - Other Adjustments: EXPENSES NET WITH REVENUE 947,113. BAD DEBT EXPENSE NET WITH REVENUE 8,955,014. Part XII, Line 4b - Other Adjustments: EXPENSES NET WITH REVENUE 947,113. BAD DEBT EXPENSE NET WITH REVENUE 8,955,014. 1 1 1 X 125.000000000000 1 X 1 1 1 0 0 2172129 412675 1759454 0.03590 7391637 4951039 2440598 0.04990 9563766 5363714 4200052 0.08580 9563766 5363714 4200052 0.08580 1 3844371 2691060 9818395 11486131 -1667736 X 1 1 1 1 STEPHENS COUNTY HOSPITAL 163 HOSPITAL DRIVE TOCCOA GA 30577 X X X DISPROPORTIONATE SHARE HOSPITAL STEPHENS COUNTY HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X HTTP://STEPHENSCOUNTYHOSPITAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 15 0 1 0 1 X 125.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X See Schedule H Part V Stmt X See Schedule H Part V Stmt X See Schedule H Part V Stmt X X X X X X 1 X 0 X X X X 1 X 0 0 STEPHENS COUNTY HOSPITAL Part V, Section B, Line 5: THE HOSPITAL FACILITY USED COMMUNITY-BASED SURVEYS AND FOCUS GROUPS TO GATHER INPUT. STEPHENS COUNTY HOSPITAL Part V, Section B, Line 11: The Hospital has followed the implementation plan by holding educational classes, participating with area events and organizations organized to fight a health related issue including fundraising for March of Dimes, Relay 4 Life and United Way through allowing payroll deductions (was the highest fundraising employer in the area in on event and supported an employee as the local annual chairman of another, provided free diagnostic assistance for the local free clinic as well as having several healthcare professional that volunteer time with the clinic, provided assistance where possible in recruiting industry and provided educational materials not only at discharge but at many different events held in the community, provided healthcare professionals including physicians to speak to area civic organizations on a variety of topics, and continue to evaluate other programs that might assist in meeting needs identified. The Hospital has not been able to provide much assistance in the mental health initiative since mental health is not within the scope of our state license, nor has it been able to address accessible and affordable transportation as it is out of the realm of our mission. Part V Section B LN 16a-b The organizations documents relating to its financial assistance policy can be found at the following:Financial Assistance Policy: http://stephenscountyhospital.com/patients/patient-information-forms/financial-assistance/Financial Assistance Policy Application: http://www.stephenscountyhospital.com/fullpanel/uploads/files/4-itf-application.pdfFinancial Assistance Policy Plain Languare Summary: http://stephenscountyhospital.com/fullpanel/uploads/files/financial-assistance-program---plain-language-00003.pdf 2 1 - THE CLARY CARE CENTER 249 HOSPITAL DRIVE TOCCOA GA 30577 ADVANCED PERSONAL CARE FACILITY 2 - THE WILKINSON CENTER 269 HOSPITAL DRIVE TOCCOA GA 30577 PERSONAL CARE FACILITY Part I, Line 7g: THE HOSPITAL OPERATES A COUNTY AMBULANCE. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 8,955,014. Part II, Community Building Activities: THE ORGANIZATION PARTICIPATES IN THE FOLLOWING COMMUNITY BUILDING ACTIVITIES:1. PARTICIPATION ON LEADERSHIP TOCCOA-STEPHENS COUNTY PROGRAM CHAIRED BY THE CHAMBER OF COMMERCE.2. COPD COMMUNITY WORKSHOPS, DIABETES COMMUNITY WORKSHOPS, VARIOUS HEALTH FAIRS BY COMMUNITY ORGANIZATIONS AND AREA BUSINESS. Part III, Line 4: THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE OF BAD DEBT EXPENSE. THE BAD DEBT EXPENSE AT COST ON PART III, LINE 2 WAS COMPUTED BY USING THE PERCENTAGE OF THE AUDITED FINANCIAL STATEMENT EXPENSES DIVIDED BY TOAL GROSS PATIENT REVENUE. THE ORGANIZATION ESTIMATED THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY CARE BASED ON PRIOR EXPERIENCE. Part III, Line 8: A VERY HIGH PERCENTAGE OF THOSE PATIENTS COVERED BY MEDICARE DUE TO AGE OR DISABILITY ARE ALSO MEDICALLY INDIGENT AS EVIDENCED BY A LARGE PERCENTAGE OF THAT POPULATION WITH MEDICAID AS THE SECONDARY COVERAGE. Part III, Line 9b: Those patients known to qualify or to have qualified for financial assistance are contacted to assertain their ability of pay and placement on the indigent/charity care policy guidelines or to confirm whether or not there has been a change in their financial situation. If the previous qualification was within the last three months or there is a historical long-term qualification pattern, a patient can be 'assumed' indigent or in need of charity. Part VI, Line 2: The organization has completed a formalized Community Health Needs Assessment in 2013 and 2016. Prior to the, the needs were determined by management from outside requests, internal ideas, statistical data ganerated from the HIS and published by the government and other sources. Part VI, Line 3: Everyone receives notification at registration that there are assistance programs available and that the hospital staff is available to assist in the exploration of their eligibility. All uninsured patients are checked against the Medicaid database for eligibility and encouraged to complete the process if indications are they would be eligible. Part VI, Line 4: The community served has been continuing to lose industry and jobs evenas the rest of the country seems to be rebounding. A majority of the population of 30,000 lives at or below poverty levels. Unemployment for the county runs higher than that of the state and surrounding counties. 2016 has seen a slight increase in industry and there are committments of additional industry for the 2016 year. Those employed and receiving health insurance benefits are experiencing doubling and more of out-of-pocket expenses related to deductibles and co-pays. Unemployment while still dragging behind that of the state and surrounding area has seen a small drop. Part VI, Line 5: STEPHENS COUNTY HOSPITAL AUTHORITY APPLIES ALL FUNDS AVAILABLE TO THE PROVISION OF PATIENT CARE, PATIENT AND COMMUNITY HEALTH EDUCATION, RETIREMENT OF DEBT RELATED TO THE PURCHASE OF FIXED ASSETS UTILIZED IN THE PROVISION OF PATIENT CARE AND THE OUTRIGHT PURCHASE OF EQUIPMENT FOR THE EXPRESSED PURPOSE OF HEALTH CARE FOR OUR COMMUNITY AND SUROUNDING SERVICE AREA. THE STEPHENS COUNTY HOSPITAL AUTHORITY'S GOVERNING BODY INCLUDES INDIVIDUALS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE ORGANIZATION NOR FAMILY MEMBERS THEREOF. THE STEPHENS COUNTY HOSPITAL AUTHORITY EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. THE HOSPITAL ER DEPARTMENT SERVES AS THE PRIMARY CARE CENTER FOR MANY PEOPLE IN THE COMMUNITY AS THE PRIVATE MEDICAL STAFF IN THE COMMUNITY WILL NOT SEE PATIENTS WITH OUTSTANDING BILLS AND NO MEANS OF PAYMENT. THE STEPHENS COUNTY HOSPITAL AUTHORITY PROVIDES CARE AND EDUCATION TO ANY INDIVIDUAL IN THE COMMUNITY AND SURROUNDING SERVICE AREA THAT SEEKS IT WITHOUT REGARD TO THAT PERSON'S ABILITY TO PAY FOR SUCH SERVICES. X X X 0 0 0 0 0 0 0 0 0 RUTH LYNNE M ANDERSON CEO/ADMINISTRATOR 222641 0 0 0 0 0 3403 0 792 0 226836 0 0 0 DEARL V BIRDSONG MD GENERAL SURGEON 355792 0 0 0 0 0 5403 0 15872 0 377067 0 0 0 MARK D HERNDON MD GENERAL SURGEON 356294 0 0 0 0 0 5403 0 15872 0 377569 0 0 0 Ginie Chan Internal Med Physician 224165 0 0 0 0 0 1324 0 16204 0 241693 0 0 0 A STEPHENS COUNTY HOSPITAL AUTHORITY 586001667 2017-06-07 9500000 CURRENT REFUNDING, SERIES 2017A 0 0 0 A 9577905 77905 180500 4445568 4873932 2017 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 A 0 PART II, LINE 11, OTHER SPENT PROCEEDS THE AMOUNTS PRESENTED ON PART II, LINE 11 REPRESENT PROCEEDS SPENT TO REFUND SERIES 2006 ISSUE. CONSTANCE RICE SISTER OF GEORGE SANDERS (BOARD MEMBER) 76742 EMPLOYMENT 0 Form 990, Part VI, Section A, line 7a SERVICE ON THE BOARD OF TRUSTEES FOR THE HOSPITAL AUTHORITY IS A NON-COMPENSATED POSITION. EVERY POSITION ON THE AUTHORITY IS APPOINTED/ELECTED FOR A SIX YEAR TERM. EACH POSITION IS ELECTED BY THE CURRENT TRUSTEES FROM A SLATE OF THREE NOMINATIONS MADE FROM THE COUNTY COMMISSION. THE SAME PROCESS IS UTILIZED IF A POSITION BECOMES VACANT AT ANYTIME PRIOR TO THE COMPLETION OF A SIX YEAR TERM AND IS FOR THE REMAINDER OF SAID TERM. Form 990, Part VI, Section B, line 11b A COPY OF THE FORM 990 WAS REVIEWED BY EACH VOTING BOARD MEMBER. AT A REGULAR SCHEDULED BOARD MEETING, THE GOVERNING BOARD FULLY DISCUSSED THE FORM 990. THE ENTIRE BOARD VOTED AND APPROVED THE FORM 990 AS PRESENTED. Form 990, Part VI, Section B, line 12c THE ORGANIZATION CONDUCTS PERIODIC REVIEWS OF EXISTING BUSINESS RELATIONSHIPS AND INITIAL REVIEWS OF ANY NEW BUSINESS RELATIONSHIPS. Form 990, Part VI, Section B, line 15 THE AUTHORITY SETS AND REVIEWS THE COMPENSATION PACKAGE OF THE CEO USING COMPARABLE DATA PROVIDED BY THE GEORGIA HOSPITAL ASSOCIATION ON CEO COMPENSATION AT SIMILAR SIZED HOSPITALS IN GEORGIA. CONSIDERATION IS ALSO GIVEN TO THE LEVEL OF EXPERIENCE AND OVER ALL PERFORMANCE OF THE HOSPITAL. THIS SAME PROCESS IS USED THROUGHOUT THE ORGANIZATION IN SETTING AND REVIEWING PAY SCALES FOR ALL JOBS INCLUDING THAT OF ANY "KEY EMPLOYEES." COMPARISON DATA IS USED TO SET A PAY SCALE AND THE LEVEL OF EXPERTISE AND EXPERIENCE IN THE JOB DUTIES DETERMINE THE POINT WITHIN THAT SCALE COMPENSATION IS SET. Form 990, Part VI, Section C, line 18 RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. Form 990, Part VI, Section C, line 19 THE STEPHENS COUNTY HOSPITAL AUTHORITY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. Form 990, Part IX, line 11g PURCHASED SERVICES: Program service expenses 6,479,633. Management and general expenses 132,197. Fundraising expenses 0. Total expenses 6,611,830. CONSULTING: Program service expenses 0. Management and general expenses 244,557. Fundraising expenses 0. Total expenses 244,557. MAINTENANCE CONTRACT: Program service expenses 1,049,654. Management and general expenses 339,513. Fundraising expenses 0. Total expenses 1,389,167. FORM 990, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. STEPHENS COUNTY EMERGENCY PHYSICIANS INC 163 HOSPITAL DRIVE TOCCOA GA 30577 020692996 PROVIDE EMERGENCY ROOM PHYSICIANS TO STEPHENS COUNTY HOSPITAL GA 501(C)(3) 7 STEPHENS COUNTY HOSPITAL AUTHORITY 1 STEPHENS COUNTY HOSPITAL FOUNDATION INC 163 HOSPITAL DRIVE TOCCOA GA 30577 208089919 FUNDRAISING ACTIVITIES FOR STEPHENS COUNTY HOSPITAL GA 501(C)(3) 11 STEPHENS COUNTY HOSPITAL AUTHORITY 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 STEPHENS COUNTY EMERGENCY PHYSICIANS INC M 1456516 CASH