2018-04-19T06:30:46-05:00 2017-06-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2016-07-01 631058174 CULLMAN REGIONAL MEDICAL CENTER INC CULL 2567372598 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 NESHA DONALDSON CFO 2567372595 2018-02-15 true JACQUELINE G ATKINS P00861721 2298837878 2018-02-09 3DB754BF4A86932C7270BAD44D636E9B352C5FAB 3DB754BF4A86932C7270BAD44D636E9B352C5FAB 2016 2021-01-29 14:40:06Z JAMES CLEMENTS 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 121548678 false X CULLMANREGIONAL.COM X 1939 AL CULLMAN REGIONAL MEDICAL CENTER, LICENSED FOR 145 BEDS, OPERATES A 115-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF CULLMAN, ALABAMA AND SURROUNDING AREAS REGARDLESS OF A PATIENT'S ABILITY TO PAY. 14 13 1240 70 1558344 338680 530636 945113 106740195 112050356 1343421 2937411 4498171 5511960 113112423 121444840 76800 1699627 0 49224260 50902132 0 0 51502871 52987460 100803931 105589219 12308492 15855621 124637035 133449055 95265672 90165586 29371363 43283469 X CULLMAN REGIONAL MEDICAL CENTER, LICENSED FOR 145 BEDS, OPERATES A 115-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF CULLMAN, ALABAMA AND SURROUNDING AREAS REGARDLESS OF A PATIENT'S ABILITY TO PAY. false false 92644364 1699627 114815979 CRMC PROVIDES ACUTE CARE PATIENT SERVICES WHICH ARE RENDERED TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. CRMC USES CHARITY APPLICATIONS BASED UPON FEDERAL POVERTY GUIDELINES AND FAMILY SIZE TO DETERMINE ELIGIBILITY FOLLOWING SERVICES PROVIDED. CRMC PROVIDES CARE 24 HOURS PER DAY, SEVEN DAYS A WEEK AND HAS PROVIDED 28,812 INPATIENT DAYS CARE, 7.92% WERE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN; 45,052 EMERGENCY ROOM VISITS, 22.03% WERE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN; AND 96,452 OUTPATIENT VISITS, 16.39% NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN. THE TOTAL UNREIMBUSED COST OF MEDICAL SERVICES PROVIDED TO THOSE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN IS REPORTED ON SCHEDULE H. CRMC ALSO PROVIDES COMMUNITY EDUCATION AND WELLNESS ACTIVITIES TO THE COMMUNITY AND IS A MAJOR CONTRIBUTOR TO A LOCAL INDIGENT CLINIC SERVICING CULLMAN COUNTY. 92644364 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true false true true false false false false false false false false false false false false false false false true false false false true 247 0 1240 true true true false false false false false false false false false X 14 13 false false false false true true true true true false false false true true true true true true false true false X NESHA DONALDSON 2567372598 1912 ALABAMA HWY 157 CULLMAN AL 350580609 JAMES CLEMENTS CEO 40.00 2.00 X X 443389 0 21067 TODD MCLEROY PAST CHAIRMA 2.00 X 0 0 0 JUDY BUTLER PATTERSON CHAIRMAN 2.00 2.00 X X 0 0 0 GREG BARKSDALE SECRETARY 2.00 X X 0 0 0 BETH ANDERSON VICE CHAIRMA 2.00 X X 0 0 0 LIONEL POWELL TREASURER 2.00 X X 0 0 0 ROGER HUMPHREY MEMBER 2.00 X 0 0 0 MARK BUSSMAN MEMBER 2.00 X 0 0 0 STEPHEN DONALDSON MEMBER 2.00 X 0 0 0 DENNIS RICHARD MEMBER 2.00 X 0 0 0 BILLY FAULK MEMBER 2.00 X 0 0 0 TYLER RODEN MEMBER 2.00 X 0 0 0 JEFF KROUT MEMBER 2.00 X 0 0 0 CHRISTOPHER COCCIA DO MEMBER 2.00 X 0 0 0 JEFF STANLEY COO 40.00 X 207788 0 1851 NESHA DONALDSON CFO 40.00 1.00 X 160223 0 7578 WILLIAM SMITH MD CHIEF MEDICA 15.00 X 112286 0 0 EDWARD MAHAN MD CARDIOLOGIST 40.00 X 408308 0 19909 MAN WAI PANG PHARMACY DIR 40.00 X 228588 0 10733 CHERYL BAILEY EXEC DIRECTO 40.00 X 156928 0 4723 CHARNA BROWN CNO 40.00 X 144933 0 16575 JOHN LEE REVENUE CYCL 40.00 X 136412 0 8328 1998855 90764 24 false true false DOSTER CONSTRUCTION COMPANY 2100 INTERNATIONAL PARK DRIVE BIRMINGHAM AL 35243 CONSTRUCTION 3312030 NTHRIVE SOLUTIONS P O BOX 733492 DALLAS TX 75373 BUS OFC SVCS 1661813 CROTHALL HEALTHCARE INC 13028 COLLECTION CENTER DRIVE CHICAGO IL 606930130 ENVIRONMENTAL S 1086667 PERSEUS LLC C/O ISLAND MEDICAL MGMT 5700 DARROW ROAD HUDSON OH 44236 HOSPITALISTS 885833 FREDERICK SWANSTON INC 2400 LAKEVIEW PARKWAY BLDG 3 STE 17 ALPHARETTA GA 30009 ADVERTISING 766944 43 880578 64535 945113 PATIENT SERVICE REVENUES 623000 110492012 110492012 OUTREACH LAB SERVICES 621500 820650 820650 CPAP MEDICAL EQUIPMENT 621990 702940 702940 CONFERENCE CENTER 532000 19642 19642 SPORTS MEDICINE 713940 15112 15112 112050356 2947993 2947993 176746 181085 176746 181085 357831 181085 176746 93256 103838 -10582 -10582 -10582 EMS MANAGEMENT FEES 621910 2726656 2726656 HERITAGE DIAGNOSTIC 621500 828206 828206 CAFETERIA/CATERING 722210 555400 555400 1043867 588020 455847 5154129 121444840 114815979 1558344 4125404 1699627 1699627 954182 954182 40192009 36459745 3732264 1106967 998967 108000 5704588 5068564 636024 2944386 2611082 333304 4706823 4162804 544019 457046 457046 128580 128580 112051 112051 9182978 7590981 1591997 558667 4463 554204 7532098 6520546 1011552 3555 3555 6358464 5992852 365612 468642 416596 52046 113196 28038 85158 793 793 5240574 4939241 301333 978880 978880 MEDICAL SUPPLIES 13059941 13059941 REPAIRS & MAINTENANCE 3259801 2047263 1212538 PHYSICIAN LOAN FORGIVEN 224123 224123 MISCELLANEOUS 170199 170199 431049 64774 366275 105589219 92644364 12944855 0 23561668 23783833 10976858 10727555 374225 368093 775933 744279 876702 982757 115640752 69154327 39076248 46486425 42979927 44735531 2618059 1858838 3397415 3761744 124637035 133449055 13387245 13048822 59635 49517 60818142 59517513 86247 54042 20914403 17495692 95265672 90165586 X 29371363 43283469 29371363 43283469 124637035 133449055 X 15855621 -971484 -972031 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5657 5657 false SCHEDULE C, PART II-B, LINE 1 THE HOSPITAL BELONGS TO NATIONAL AND STATE INDUSTRY ASSOCIATIONS AND, AS PART OF THEIR ANNUAL DUES, PAYS A SMALL PERCENTAGE TO SUPPORT THE LOBBYING EFFORTS BY THESE ASSOCIATIONS. 1875781 1875781 49579918 26765179 22814739 7059551 6606880 452671 49494408 35782268 13712140 7631094 7631094 46486425 MINIMUM PENSION LIABILITY 10985074 COST REPORT SETTLEMENTS 3848912 ACCRUED INTEREST 1662729 DEFERRED PENSION EXPENSE 863824 INTERCOMPANY LIABILITY 135153 17495692 X SCHEDULE D, PAGE 3, PART X THE AUTHORITY IS A GOVERNMENTAL ENTITY AND IS EXEMPT FROM INCOME TAXES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN CONSIDERED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL IS REQUIRED TO FILE A FORM 990 WITH THE INTERNAL REVENUE SERVICE. ANY INCOME EARNED FROM NON-RELATED BUSINESS SERVICES IS SUBJECT TO TAXATION. THE HOSPITAL APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE HOSPITAL ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENTS EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JUNE 30, 2017 AND 2016 OR FOR THE YEARS THEN ENDED. THE HOSPITALS TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. true true X true X true X true true false true true 1421 1383126 1383126 0.01310 16287 9943119 5191851 4751268 0.04500 17708 11326245 5191851 6134394 0.05810 19 6343 1261658 1261658 0.01190 2 2100 16483 16483 0.00020 3 8550 78719 78719 0.00070 24 16993 1356860 1356860 0.01290 24 34701 12683105 5191851 7491254 0.07090 1 12557 12557 0.00010 10 51644 57284 57284 0.00050 1 118 3375 3375 12 51762 73216 73216 0.00070 true 33841559 45724332 35529309 10195023 X true true HERITAGE DIAGNOSTICS IMAGING SERVICES 0.20000 0.80000 1 1 CULLMAN REGIONAL MEDICAL CENTER 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 CULLMANREGIONAL.COM H2201 X X X HOSPICE, CLINICS & HOME HEALTH CULLMAN REGIONAL MEDICAL CENTER 1 false false true X X X X X X X X 16 true false false true X CULLMANREGIONAL.COM X true 16 false true false true X 200.000000000000 300.000000000000 X X true true X X X X true X HTTP://WWW.CULLMANREGIONAL.COM X HTTP://WWW.CULLMANREGIONAL.COM X X X X true X false X X X X true X false false FACILITY 1, CULLMAN REGIONAL MEDICAL CENTER - PART V, LINE 5 CULLMAN REGIONAL MEDICAL CENTER, INC. (CRMC) CONTRACTED WITH ALEXANDER CONSULTING GROUP, INC. (ACG) TO ASSIST IN CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AS REQUIRED BY INTERNAL REVENUE CODE. DURING THE CHNA PROCESS, CRMC SOLICITED AND TOOK INTO ACCOUNT INPUT RECEIVED FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF CULLMAN COUNTY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF AND EXPERTISE IN PUBLIC HEALTH THROUGH MULTIPLE METHODS. INTERVIEWS AND FOCUS GROUPS WERE CONDUCTED WITH A BROAD RANGE OF COMMUNITY REPRESENTATIVES WHO REPRESENT THE BROAD INTERESTS OF CULLMAN COUNTY. MANY OF THE INTERVIEW AND FOCUS GROUP PARTICIPANTS HAVE SPECIAL KNOWLEDGE OF AND EXPERTISE IN PUBLIC HEALTH, AND REPRESENTED THE INTERESTS OF THE MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS OF CULLMAN COUNTY. IN TOTAL, 39 COMMUNITY REPRESENTATIVES PARTICIPATED IN EITHER INTERVIEWS OR FOCUS GROUPS, INCLUDING A REPRESENTATIVE FROM THE CULLMAN COUNTY HEALTH DEPARTMENT. THE PURPOSE OF THE INTERVIEWS AND FOCUS GROUPS WAS TO GAIN DIRECT INPUT FROM THESE INDIVIDUALS REGARDING IDENTIFYING AND PRIORITIZING HEALTH NEEDS, INCLUDING THE HEALTH ISSUES ASSOCIATED WITH THE MEDICALLY UNDERSERVED, LOW INCOME, AND MINORITY POPULATIONS, AS WELL AS IDENTIFYING RESOURCES POTENTIALLY AVAILABLE TO ADDRESS THOSE HEALTH NEEDS. IN ADDITION TO CONDUCTING INTERVIEWS AND FOCUS GROUPS, COMMUNITY INPUT WAS GARNERED FROM PARTICIPANTS IN A COMMUNITY ADVISORY COMMITTEE (CAC), AS WELL AS CRMCS CHNA ADVISORY COMMITTEE. THE CAC WAS COMPRISED OF A BROAD RANGE OF COMMUNITY REPRESENTATIVES, INCLUDING THE CULLMAN COUNTY HEALTH DEPARTMENT, CULLMAN COUNTY DEPARTMENT OF HUMAN RESOURCES, GOOD SAMARITAN HEALTH CLINIC, CHURCH CLERGY, BANKERS, EDUCATORS, HEALTHCARE PERSONNEL, CULLMAN COUNTY CAREER CENTER, QUALITY OF LIFE HEALTH SERVICES, CULLMAN ECONOMIC DEVELOPMENT AGENCY, CULLMAN COUNTY COOPEATIVE EXTENSION AGENCY, USA HEALTHCARE, JUDICIAL CIRCUIT JUDGE, THE LINK OF CULLMAN COUNTY, CULLMAN COUNTY CHAMBER OF COMMERCE, AND VARIOUS CULLMAN COUNTY AND CITY GOVERNMENT OFFICIALS. THE CHNA ADVISORY COMMITTEE WAS RESPONSIBLE FOR OVERSEEING THE CHNA PROCESS, INCLUDING IDENTIFYING AND PRIORITIZING THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY. SECONDARY DATA WAS COLLECTED FROM A VARIETY OF RESPECTED ORGANIZATIONS ON A BROAD ARRAY OF HEALTH INDICATORS AND OTHER INFORMATION, AND ANALYZED AND SUMMARIZED. THE TYPES OF DATA COLLECTED INCLUDED DEMOGRAPHIC, SOCIOECONOMIC, MORTALITY AND MORBIDITY, HEALTH STATUS INDICATORS, HEALTH BEHAVIORS, MATERNAL AND CHILD HEALTH, INSURANCE STATUS, AND GENERAL COMMUNITY/ENVIRONMENTAL INFORMATION. FACILITY 1, CULLMAN REGIONAL MEDICAL CENTER - PART V, LINE 11 AS A RESULT OF THE 2016 CHNA, THE FOLLOWING SIX CATEGORIES OF HEALTH NEEDS AND CONCERNS WERE IDENTIFIED AND PRIORITIZED. 1. HEART DISEASE 2. OBESITY 3. ACCESS TO CARE/CONTINUITY OF CARE 4. CANCER 5. SMOKING (AS PRIMARY CAUSE OF LUNG DISEASE AND LUNG CANCER) 6. SUBSTANCE ABUSE/MENTAL HEALTH THE FIRST FIVE HEALTH NEEDS ARE ADDRESSED IN THE 2016 CHNA IMPLEMENTATION STRATEGY, A COPY OF WHICH IS ATTACHED. THE LAST NEED IDENTIFIED IN THE 2016 CHNA, SUBSTANCE ABUSE/MENTAL HEALTH, WILL NOT BE SPECIFICALLY ADDRESSED BY CRMC. THIS ISSUE IS MORE APPROPRIATELY ADDRESSED BY THE VARIOUS HEALTH PARTNERS WITHIN THE COMMUNITY DUE TO CRMC'S LACK OF EXPERTISE AND LIMITED RESOURCES. FACILITY 1, CULLMAN REGIONAL MEDICAL CENTER - PART V, LINE 16J THE HOSPITAL HAS CLEARLY WRITTEN FINANCIAL AID POLICIES THAT ARE AVAILABLE ON THE ORGANIZATION WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED IN THE ER ABOUT THE AVAILABILITY OF FINANCIAL AID. A REPRESENTATIVE IS ALSO AVAILABLE TO DISCUSS ELIGIBILITY TO GOVERNMENT PROGRAMS. FACILITY 1, CULLMAN REGIONAL MEDICAL CENTER - PART V, LINE 20E PATIENT BILLING STATEMENTS INCLUDE A PARAGRAPH EXPLAINING THE AVAILABILITY OF FINANCIAL AID AND THE PROCESS FOR COMPLETING AN APPLICATION. 1 HOSPICE OF CULLMAN COUNTY 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 HOSPICE PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE FEDERAL POVERTY GUIDELINES (200%) ARE USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. DISCOUNTED CARE WILL BE BASED ON MEDICARE REIMBURSEMENT. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". THE HOSPITAL UTILIZES EPSI SOFTWARE FOR COST ACCOUNTING PURPOSES. SEE ALSO THE DESCRIPTION FOR PART III, LINE 2. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY AMOUNTS 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 STATEMENTS THE AUTHORITY PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE. AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE, THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE. PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL AID POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS FINANCIAL AID, THEY ARE NOT REPORTED AS REVENUE. PART VI, LINE 2 - NEEDS ASSESSMENT THE HOSPITAL PARTICIPATES IN THE CULLMAN COUNTY HEALTH COALITION. THIS ORGANIZATION, COMPRISED OF VARIOUS HEALTH CARE PROVIDERS AND COMMUNITY LEADERS, ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY AND STRIVES TO PROVIDE RESOURCES THAT BEST MEET THOSE NEEDS. THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT IS WIDELY PUBLICIZED ON THE HOSPITAL'S WEBSITE WWW.CULLMANREGIONAL.COM. THE IMPLEMENTATION PLAN IS ATTACHED TO THIS FORM 990. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE HOSPITAL HAS CLEARLY WRITTEN FINANCIAL AID POLICIES THAT ARE AVAILABLE ON THE ORGANIZATION WEB SITE AND THROUGHOUT THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED IN THE ER ABOUT THE AVAILABILITY OF FINANCIAL AID. A REPRESENTATIVE IS ALSO AVAILABLE TO DISCUSS ELIGIBILITY TO GOVERNMENT PROGRAMS. PART VI, LINE 4 - COMMUNITY INFORMATION THE HOSPITAL DRAWS PATIENTS PRINCIPALLY FROM CULLMAN COUNTY AND THE NEIGHBORING COUNTIES OF WALKER, WINSTON, MARSHALL, MORGAN, AND BLOUNT. CRMC IS THE ONLY HOSPITAL IN ITS PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREA INCLUDES THE CITY OF CULLMAN, POPULATION 15,350, AND CULLMAN COUNTY, POPULATION 82,000. PER CAPITA INCOME FOR THIS AREA IS SLIGHTLY BELOW THE PER CAPITA INCOME FOR THE STATE OF ALABAMA. CULLMAN IS SERVED BY I-65, AND IS LOCATED BETWEEN HUNTSVILLE AND BIRMINGHAM. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH THE ORGANIZATION AND ITS VOLUNTEER BOARDS ARE COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS, AS WELL AS PHYSICIAN MEMBERS. THE EMERGENCY DEPARTMENT IS OPEN 24 HOURS PER DAY, 7 DAYS PER WEEK, AND IS OPEN TO ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY. CULLMAN REGIONAL PROVIDES FREE HEALTH SCREENINGS FOR THE COMMUNITY. THESE SCREENINGS ARE SET UP AT THE HOSPITAL AND AT VARIOUS LOCATIONS AROUND THE COUNTY. DURING FISCAL YEAR 2017, OVER 3,000 COMMUNITY MEMBERS PARTICIPATED AND RECEIVED THE FREE HEALTH SCREENING. HOSPITAL EMPLOYEES, IN CONJUNCTION WITH OUR LOCAL JUDGES, HAVE DEVELOPED A TRAUMA PREVENTION PROGRAM. THIS PROGRAM IS PROVIDED BY CRMC EMPLOYEES ON A VOLUNTARY BASIS. OUR LOCAL JUDGES REFER TEENAGE DRIVING OFFENDERS TO THE PROGRAM TO TEACH THEM THE IMPORTANCE OF VEHICLE SAFETY. WHILE THEY ARE HERE, THEY ACTUALLY GET TO WITNESS THE VARIOUS STAGES OF A TRAUMA ACCIDENT, FROM THE TIME THEY ARRIVE AT THE ER, UNTIL THEY LEAVE THE HOSPITAL. COMMUNITY BUILDING ACTIVITIES ALSO INCLUDE PROVIDING AMBULANCE SUPPORT FOR VARIOUS COMMUNITY ACTIVITIES AND PROVIDING COMMUNITY SUPPORT GROUPS. THESE SUPPORT GROUPS (ALZHEIMER'S, BREAST CANCER, ETC) PROMOTE THE PHYSICAL AND MENTAL HEALTH OF THE COMMUNITY THAT WE SERVE. CULLMAN REGIONAL PROVIDES THE HEALTHY LIFE PROGRAM. THIS PROGRAM OFFERS SEMINARS AND EDUCATION ON HEALTH AND LIFESTYLE ISSUES AND ALSO OFFERS DISCOUNT ADMISSION TO WORKSHOPS AND HEALTH SCREENINGS. THIS PROGRAM CURRENTLY HAS 6,906 MEMBERS. CRMC ALSO PROVIDES A COMMUNITY EDUCATION CENTER WHICH OFFERS MEETING ROOMS AND CATERING SERVICES FOR LOCAL BUSINESSES, CHURCHES, CIVIC ORGANIZATIONS AND EDUCATIONAL GROUPS. ALL OF OUR AMBULANCES ARE EQUIPPED WITH 12 LEAD EKG TECHNOLOGY, WHICH TRANSMITS THE INFORMATION DIRECTLY TO THE EMERGENCY ROOM PHYSICIAN, ALLOWING THEM TO GET THE INFORMATION WHILE THE PATIENT IS IN TRANSIT. THIS PROGRAM HAS REDUCED THE TIME FROM DOOR TO ANGIOPLASTY, BY GETTING THE CARDIOLOGY TEAM IN PLACE BEFORE THE PATIENT ARRIVES. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT ALABAMA true GOOD SAMARITAN CLINIC 401 ARNOLD ST NE CULLMAN AL 35055 200149215 3 82000 CURRENT OPERATIONS GOOD SAMARITAN CLINIC 401 ARNOLD ST NE CULLMAN AL 35055 200149215 3 241977 FMV LAB SVCS CURRENT OPERATIONS GOOD SAMARITAN CLINIC 401 ARNOLD ST NE CULLMAN AL 35055 200149215 3 558828 FMV DIAGNOSTIC SVCS CURRENT OPERATIONS GOOD SAMARITAN CLINIC 401 ARNOLD ST NE CULLMAN AL 35055 200149215 3 816822 FMV MED SUPPLIES CURRENT OPERATIONS 1 SCHEDULE I, PAGE 1, PART I, LINE 2 THE HOSPITAL CONTINUOUSLY EVALUATES COMMUNITY ORGANIZATIONS (AS IDENTIFIED IN PART II ABOVE) PROVIDING HEALTHCARE NEEDS TO THE MEDICALLY UNDERSERVED WHO ALSO ARE MOST LIKELY UNABLE TO PAY. THE HOSPITAL EVALUATES THE NEEDS ON AN INDIVIDUAL BASIS BASED ON DOCUMENTED REQUESTS FOR SERVICES PROVIDED. X true true X X X X false false false false false false false false false JAMES CLEMENTS CEO 332664 101725 9000 12000 9067 464456 JEFF STANLEY COO 174735 33053 173 1678 209639 NESHA DONALDSON CFO 145639 14584 7345 233 167801 EDWARD MAHAN MD CARDIOLOGIST 408103 205 12300 7609 428217 MAN WAI PANG PHARMACY DIRECTOR 148467 55811 24310 7536 3197 239321 CHERYL BAILEY EXEC DIRECTOR EDUCAT 142532 14396 4439 284 161651 CHARNA BROWN CNO 131341 13592 2743 13832 161508 SCHEDULE J, PAGE 1, PART I, LINE 1A THE ORGANIZATION PROVIDES A MEMBERSHIP TO THE LOCAL COUNTRY CLUB FOR THE CEO. ANY AMOUNTS NOT DOCUMENTED AS BUSINESS RELATED ARE INCLUDED IN THE RECIPIENT'S TAXABLE INCOME AND REPORTED ON THE FORM W-2. SCHEDULE J, PART III BONUS/INCENTIVES CERTAIN EXECUTIVE OFFICERS AND DEPARTMENT DIRECTORS ARE ELIGIBLE FOR BONUS/INCENTIVE PAYMENTS. THESE PAYMENTS ARE RELIANT ON VARIOUS ORGANIZATIONAL AND PERSONAL GOALS ESTABLISHED BY THE GOVERNING BODY. WHETHER A BONUS/INCENTIVE PAYMENT IS AWARDED IS DEPENDENT UPON THE NET PROFIT OF THE ORGANIZATION. A HEALTH CARE AUTHORITY OF CULLMAN CT 631149220 230186AMO 2009-12-03 70225000 DEFEASE 1993/2007 BONDS. false false false A 11035000 68624416 61819381 1352854 5452182 2009 true false true true A false false false false false true 0.01100 true false A false true false false false true MERRILL LYNCH 26.000000000000 false false false false false A false SCHEDULE K - ADDITIONAL INFORMATION HEALTH CARE AUTHORITY OF CULLMAN CTY THE ONLY BONDS ISSUED BY THE AUTHORITY FOR THE BENEFIT OF CRMC ARE THE BONDS WHICH WERE ISSUED DECEMBER 3, 2009. A PORTION OF THE BONDS IS ALLOCABLE TO CAPITAL EQUIPMENT (THE "BOND- FINANCED EQUIPMENT") FINANCED BY CRMC AND THE AUTHORITY FOR USE AT A FREESTANDING RADIATION ONCOLOGY CENTER OPERATED BY CRMC. THE BOND-FINANCED EQUIPMENT WAS SOLD ON DECEMBER 31, 2010 FOR CASH IN THE AMOUNT OF 800,000 TO A NONGOVERNMENTAL PERSON. THE SALE CONSTITUTES A DISPOSITION OF THE BOND-FINANCED EQUIPMENT FOR PURPOSES OF THE CHANGE IN USE RULES. WITHIN 2 YEARS OF THE SALE DATE, THE AUTHORITY USED THE DISPOSITION PROCEEDS FOR ALTERNATE USES COMPLYING WITH THE REQUIREMENTS OF TREAS. REG 1.141-12(E). FORM 990, PAGE 2, PART III, LINE 4A COMMUNITY EDUCATION AND WELLNESS ACTIVITIES TO THE COMMUNITY AND IS A MAJOR CONTRIBUTOR TO A LOCAL INDIGENT CLINIC SERVICING CULLMAN COUNTY. FORM 990, PAGE 6, PART VI, LINE 6 THE HEALTH CARE AUTHORITY OF CULLMAN COUNTY (AUTHORITY)IS THE SOLE MEMBER OF CULLMAN REGIONAL MEDICAL CENTER INC. FORM 990, PAGE 6, PART VI, LINE 7A THE AUTHORITY APPOINTS THE VOTING MAJORITY OF THE ORGANIZATION'S BOARD AND CONTROLS THE OPERATIONS AS WELL. FORM 990, PAGE 6, PART VI, LINE 7B THE AUTHORITY APPOINTS THE VOTING MAJORITY OF THE ORGANIZATION'S BOARD AND CONTROLS THE OPERATIONS OF THE ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 11B MANAGEMENT ASSISTS IN PREPARING SCHEDULES, REVIEWS THE ENTIRE DRAFT OF THE FORM 990 FOR CONTENT, AND RECOMMENDS CHANGES, IF ANY. PRIOR TO FILING, THE CFO, AND ACCOUNTING DEPARTMENT REVIEW THE FORM. THE FINAL FORM, AS IT IS ULTIMATELY FILED WITH ALL SCHEDULES AND ATTACHMENTS, IS MADE AVAILABLE TO THE BOARD MEMBERS PRIOR TO FILING WITH THE IRS. FORM 990, PAGE 6, PART VI, LINE 12C ANNUALLY, BOARD MEMBERS, OFFICERS, AND DEPARTMENTAL DIRECTORS MUST IDENTIFY ANY CONFLICT, MANAGEMENT MONITORS AND MAY SUGGEST ANY AREAS OF CONFLICT. THE BOARD CHAIRMAN OR ADMINISTRATION REVIEWS ACTUAL AND PERCEIVED CONFLICTS OF INTEREST. IN THE EVENT OF A CONFLICT, THE MEMBER OR OFFICER WITH THE CONFLICT WILL DISMISS THEMSELVES FROM THE DISCUSSION AND ANY VOTES ON THE ISSUE. FORM 990, PAGE 6, PART VI, LINE 15A ANNUALLY THE BOARD (OR A COMMITTEE CHARGED WITH THE RESPONSIBILITY AND AUTHORITY TO DO SO ON BEHALF OF THE BOARD) REVIEWS THE COMPENSATION PACKAGE AND PROPOSED CONTRACT OF THE CEO. THE REVIEW IS CONDUCTED BY INDEPENDENT BOARD MEMBERS, IS BASED UPON A COMPARATIVE ANALYSIS, AND IS DOCUMENTED IN THE RECORDS OF THE BOARD REFLECTING THE BASIS OF THE DETERMINATION BY THE THE BOARD (OR AUTHORIZED COMMITTEE). FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO ANY MEMBER OF THE PUBLIC WHO MAKES THEIR REQUEST AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION. FORM 990, PART XI, LINE 9 CHANGE IN UNRESTRICTED ASSETS OF AFFILIATE 130,059 CHANGE IN VALUE OF INTEREST RATE SWAP -212,811 CHANGE IN TEMP REST NET ASSETS OF AFFILIATE -889,279 TOTAL -972,031 CHANGE IN THE NET ASSETS IS THE RESULT OF NONCASH TRANSACTIONS AS DETAILED ABOVE. CULLMAN REGIONAL MEDICAL CTR FNDN 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 630727880 FOUNDATION AL 501C3 7 NA false HEALTH CARE AUTHORITY OF CULLMAN CO 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 631149220 AUTHORITY AL 501C1 6 NA false false false true true true false false false false false false false true true true false false false false