DONALSONVILLE HOSPITAL INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- DONALSONVILLE HOSPITAL INC (EIN 58-0973772)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-04-19
- IRS object ID
- 201811099349300516
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-04-19T09:44:43-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 580914992 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAFFIN & TUCKER LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 71309 | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 317081309 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 580973772 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DONALSONVILLE HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | DONA | BusinessNameControlTxt |
| Phone | 2295245217 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 102 HOSPITAL CIRCLE | AddressLine1Txt |
| City | DONALSONVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 398451100 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HERMAN BROOKINS | PersonNm |
| Person Title | CHAIRMAN/CEO | PersonTitleTxt |
| Phone | 2295245217 | PhoneNum |
| Signature | 2018-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JACQUELINE G ATKINS | PreparerPersonNm |
| PTIN | P00861721 | PTIN |
| Phone | 2298837878 | PhoneNum |
| Preparation | 2018-04-18 | PreparationDt |
Filing Security Information FilingSecurityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| At Submission Creation Device Id | 3DB754BF4A86932C7270BAD44D636E9B352C5FAB | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 3DB754BF4A86932C7270BAD44D636E9B352C5FAB | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | HERMAN BROOKINS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 102 HOSPITAL CIRCLE | AddressLine1Txt |
| City | DONALSONVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 398451100 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $23,953,484 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.DONALSONVILLEHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1977 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | DONALSONVILLE HOSPITAL OPERATES A 65-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF DONALSONVILLE, GEORGIA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 351 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $1,940 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $23,315,748 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $23,221,255 | CYProgramServiceRevenueAmt |
| PY Investment Income | $270,661 | PYInvestmentIncomeAmt |
| CY Investment Income | $35,301 | CYInvestmentIncomeAmt |
| PY Other Revenue | $767,905 | PYOtherRevenueAmt |
| CY Other Revenue | $625,925 | CYOtherRevenueAmt |
| PY Total Revenue | $24,354,314 | PYTotalRevenueAmt |
| CY Total Revenue | $23,884,421 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $918,311 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $13,974,875 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $13,686,306 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,769,253 | PYOtherExpensesAmt |
| CY Other Expenses | $11,308,602 | CYOtherExpensesAmt |
| PY Total Expenses | $25,745,128 | PYTotalExpensesAmt |
| CY Total Expenses | $25,913,219 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,390,814 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,028,798 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,447,732 | TotalAssetsBOYAmt |
| Total Assets EOY | $25,685,797 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,719,801 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,858,288 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $22,727,931 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $20,827,509 | NetAssetsOrFundBalancesEOYAmt |
| Mission | DONALSONVILLE HOSPITAL OPERATES A 65-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF DONALSONVILLE, GEORGIA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $20,794,268 | ExpenseAmt |
| Grant | $918,311 | GrantAmt |
| Revenue | $23,238,525 | RevenueAmt |
| Desc | DONALSONVILLE HOSPITAL PROVIDES PRIMARY HEALTHCARE TO RESIDENTS OF SEMINOLE COUNTY AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. | Desc |
| Total Program Service Expenses | $20,794,268 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 27 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 351 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | false | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES MOODY | PersonNm |
| Phone | 2295245217 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 102 HOSPITAL CIRCLE | AddressLine1Txt |
| City | DONALSONVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 398451100 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| HERMAN BROOKINS | ||||||||
| CHAIRMAN/CEO | 40.00 | 0.00 | Yes (X) | Yes (X) | $443,972 | $0 | $0 | |
| CHARLES H ORRICK | ||||||||
| ADMINISTRATO | 40.00 | 0.00 | Yes (X) | Yes (X) | $210,701 | $0 | $23,992 | |
| BROADDUS SIMPSON | ||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $13,557 | $0 | $0 | |
| MITCH BLANKS | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $8,920 | $0 | $0 | ||
| WILLIAM BURKE CPA | ||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $8,920 | $0 | $0 | ||
| JAMES MOODY | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $196,014 | $0 | $22,725 | ||
| JOSEPH WALKER SR MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $395,971 | $0 | $11,545 | Yes (X) | ||
| ANDREA ALEXANDER MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $346,002 | $0 | $11,856 | Yes (X) | ||
| LUKE WILLIAMS MD | ||||||||
| PHYSICIAN | 40.00 | 0.00 | $212,160 | $0 | $11,545 | Yes (X) | ||
| ROYCE CANNINGTON JR | ||||||||
| CRNA | 40.00 | 0.00 | $210,018 | $0 | $11,545 | Yes (X) | ||
| BRIAN BROOKINS | ||||||||
| PHARMACIST | 40.00 | 0.00 | $204,145 | $0 | $24,255 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,250,380 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $117,463 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CGM CONSTRUCTION GROUP LLC | |||||
| PO BOX 566 | COLQUITT | GA | 39837 | CONSTRUCTION | $1,527,542 |
| NES GEORGIA INC | |||||
| PO BOX 277001 | ATLANTA | GA | 303847001 | ER PHYSICIANS | $937,639 |
| MEDICAL DOCTOR ASSOCIATES | |||||
| PO BOX 277185 | ATLANTA | GA | 303847185 | PHYSICIANS | $388,568 |
| SHERIDAN RADIOLOGY | |||||
| PO BOX 452796 | SUNRISE | FL | 333452796 | TELERADIOLOGY | $330,858 |
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 366850309 | IT SUPPORT | $279,348 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $1,940 | AllOtherContributionsAmt |
| Total Contributions | $1,940 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $23,221,255 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,221,255 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $23,221,255 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,024 | TotalRevenueColumnAmt |
| Exclusion | $34,024 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $144,207 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $69,063 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $75,144 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $75,144 | TotalRevenueColumnAmt |
| Exclusion | $75,144 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,277 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,277 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,277 | TotalRevenueColumnAmt |
| Exclusion | $1,277 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA | 722513 | $533,511 | $533,511 | |
| MISCELLANEOUS REVENUE | 621990 | $10,706 | $10,706 | |
| MEDICAL RECORD FEES | 621990 | $6,124 | $6,124 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $440 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $440 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $550,781 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,884,421 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,238,525 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $643,956 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $918,311 | TotalAmt |
| Program Services | $918,311 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $904,809 | TotalAmt |
| Management And General | $904,809 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,305,408 | TotalAmt |
| Program Services | $9,304,012 | ProgramServicesAmt |
| Management And General | $1,001,396 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $375,206 | TotalAmt |
| Program Services | $312,038 | ProgramServicesAmt |
| Management And General | $63,168 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,483,960 | TotalAmt |
| Program Services | $1,233,185 | ProgramServicesAmt |
| Management And General | $250,775 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $616,923 | TotalAmt |
| Program Services | $497,332 | ProgramServicesAmt |
| Management And General | $119,591 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,373 | TotalAmt |
| Management And General | $15,373 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $196,793 | TotalAmt |
| Management And General | $196,793 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,826 | TotalAmt |
| Management And General | $12,826 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,540,760 | TotalAmt |
| Program Services | $2,367,443 | ProgramServicesAmt |
| Management And General | $173,317 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,339 | TotalAmt |
| Management And General | $58,339 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,811,886 | TotalAmt |
| Program Services | $1,167,704 | ProgramServicesAmt |
| Management And General | $644,182 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $279,348 | TotalAmt |
| Management And General | $279,348 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $442,047 | TotalAmt |
| Program Services | $412,474 | ProgramServicesAmt |
| Management And General | $29,573 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,777 | TotalAmt |
| Program Services | $28,562 | ProgramServicesAmt |
| Management And General | $20,215 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,550 | TotalAmt |
| Program Services | $34,286 | ProgramServicesAmt |
| Management And General | $1,264 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,250 | TotalAmt |
| Management And General | $61,250 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $977,403 | TotalAmt |
| Program Services | $912,015 | ProgramServicesAmt |
| Management And General | $65,388 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $148,455 | TotalAmt |
| Program Services | $66,389 | ProgramServicesAmt |
| Management And General | $82,066 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $3,146,434 | $3,146,434 | |
| REPAIR AND MAINTENANCE | $681,721 | $110,419 | $571,302 |
| MISCELLANEOUS EXPENSE | $323,509 | $1,679 | $321,830 |
| PROVIDER FEE | $275,480 | $275,480 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $252,651 | TotalAmt |
| Program Services | $6,505 | ProgramServicesAmt |
| Management And General | $246,146 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,913,219 | TotalAmt |
| Program Services | $20,794,268 | ProgramServicesAmt |
| Management And General | $5,118,951 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,299 | BOYAmt |
| EOY | $8,902 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,169,353 | BOYAmt |
| EOY | $359,745 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,428,302 | BOYAmt |
| EOY | $7,472,793 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,753,585 | BOYAmt |
| EOY | $1,815,291 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $883,178 | BOYAmt |
| EOY | $934,197 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $400,562 | BOYAmt |
| EOY | $423,697 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $30,909,368 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,149,572 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,298,818 | BOYAmt |
| EOY | $11,759,796 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,341,303 | BOYAmt |
| EOY | $2,438,859 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $115,332 | BOYAmt |
| EOY | $472,517 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,447,732 | BOYAmt |
| EOY | $25,685,797 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,618,786 | BOYAmt |
| EOY | $2,858,288 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,000,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,015 | BOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,719,801 | BOYAmt |
| EOY | $4,858,288 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,727,931 | BOYAmt |
| EOY | $20,827,509 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,727,931 | BOYAmt |
| EOY | $20,827,509 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,447,732 | BOYAmt |
| EOY | $25,685,797 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,028,798 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $128,376 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $2,760 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,760 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION BELONGS TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS. A PORTION OF THE MEMBERSHIP DUES PAID TO THE ASSOCIATIONS ARE DEDICATED TO LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,834,489 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $19,902 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $12,826 | AdministrativeExpensesAmt |
| End Year Balance | $1,841,565 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,717,887 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $128,532 | InvestmentEarningsOrLossesAmt |
| Administrative Expenses | $11,930 | AdministrativeExpensesAmt |
| End Year Balance | $1,834,489 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,528,700 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $153,274 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $948,672 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $15,415 | AdministrativeExpensesAmt |
| End Year Balance | $1,717,887 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $19,475,699 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $3,479,857 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $20,346,937 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $79,919 | AdministrativeExpensesAmt |
| End Year Balance | $2,528,700 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $19,404,875 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $3,456,495 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $3,305,000 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $80,671 | AdministrativeExpensesAmt |
| End Year Balance | $19,475,699 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $686,053 | OtherCostOrOtherBasisAmt |
| Book Value | $686,053 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $3,416,817 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $12,341,920 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,878,452 | DepreciationAmt |
| Book Value | $5,880,285 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $343,388 | OtherCostOrOtherBasisAmt |
| Depreciation | $337,166 | DepreciationAmt |
| Book Value | $6,222 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,918,680 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,933,954 | DepreciationAmt |
| Book Value | $2,984,726 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,202,510 | OtherCostOrOtherBasisAmt |
| Book Value | $2,202,510 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $11,759,796 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $22,472,677 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $22,472,677 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,411,744 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,411,744 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $23,884,421 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $24,501,475 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $24,501,475 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,411,744 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,411,744 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $25,913,219 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 2, PART V, LINE 4 | ENDOWMENT FUNDS CONSIST OF INVESTMENTS FOR THE DEFERRED COMPENSATION PLAN, AND MALPRACTICE INSURANCE. THE ORGANIZATION HAS ESTABLISHED A FUNDED DEFERRED COMPENSATION PLAN FOR CERTAIN KEY EMPLOYEES. MALPRACTICE INSURANCE IS A TRUST SET UP TO FUND POTENTIAL LIABILITIES UNDER THE HOSPITAL'S SELF INSURANCE PROGRAM. THE TRUSTEE IS SYNOVUS TRUST COMPANY, N.A. |
| SCHEDULE D, PAGE 3, PART X | THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION 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 ORGANIZATION 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 ORGANIZATIONS 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 THESE RETURNS. |
| SCHEDULE D, PAGE 4, PART XI, LINE 4B | MEALS EXPENSE FOR SNF PATIENTS 493,433 GRANTS/ASSISTANCE 918,311 |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | GRANTS/ASSISTANCE 918,311 MEALS EXPENSE FOR SNF PATIENTS 493,433 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 1.250000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,363,670 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,363,670 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05250 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,642,043 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,577,813 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $64,230 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $56,398 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $24,701 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $31,697 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,062,111 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,602,514 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,459,597 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05620 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $55,537 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $55,537 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $918,311 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $918,311 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03530 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $973,848 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $973,848 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03740 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,035,959 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,602,514 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,433,445 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09360 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,378,359 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $2,796,938 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,283,610 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$486,672 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DONALSONVILLE HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 102 HOSPITAL CIRCLE | AddressLine1Txt |
| City | DONALSONVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 398451100 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.DONALSONVILLEHOSPITAL.ORG | WebsiteAddressTxt |
| State License | 125-318 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | SNF | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DONALSONVILLE HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.DONALSONVILLEHOSPITAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.DONALSONVILLEHOSPITAL.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.DONALSONVILLEHOSPITAL.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.DONALSONVILLEHOSPITAL.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 5 | THE CHNA PANEL WAS SELECTED, STARTING WITH THE FIVE HOSPITAL BOARD MEMBERS. THE BOARD MEMBERS HAVE A BROAD RANGE OF COMMUNITY INVOLVEMENT AND LEADERSHIP ROLES, INCLUDING TWO WHO ARE INVOLVED WITH LOCAL COUNTY AND CITY GOVERNMENTS; TWO WHO ARE ACTIVE WITH OTHER NONPROFIT ORGANIZATIONS AND ARE COMMUNITY LEADERS; AND ONE WITH A VAST KNOWLEDGE AND EXPERIENCE IN THE AGRICULTURAL AREA, A MAJOR INDUSTRY OF SEMINOLE COUNTY. THE CHNA PANEL INCLUDED ALL FIVE MEMBERS OF THE BOARD PLUS TWO ADDITIONAL MEMBERS - A LOCAL COUNTY COMMISSIONER WHO ALSO SERVES AS CO-PASTOR IN A LOCAL MINISTRY, AND THE LOCAL HEALTH DEPARTMENT DIRECTOR. THE DONALSONVILLE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT PANEL REVIEWED AND DISCUSSED DATA GATHERED FROM OUTSIDE SOURCES, INPUT FROM LOCAL MEDICAL STAFF, EMPLOYEE MEETINGS, INPUT FROM LOCAL GOVERNMENT, INPUT FROM LOCAL BUSINESSES AS WELL AS INTERNAL DATA. IN UTILIZING THESE SOURCES, THE PANEL ESTABLISHED THE SPECIFIC NEEDS OF THE COMMUNITY BASED ON THE FOLLOWING CRITERIA: SEVERITY, OF CASES, IMPACT ON COMMUNITY AND THE ORGANIZATION'S ABILITY TO IMPLEMENT A SOLUTION TO IMPROVE THE NEED. |
| FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 11 | THE 2016 COMMUNITY NEEDS ASSESSMENT AND IMPLEMENTATION PLAN IDENTIFY THE FOLLOWING AREAS AS NEEDS IN THE COMMUNITY THAT COULD BE IMPROVED BY THE HOSPITAL INPUT: 1.DIABETES/HYPERTENSION DISEASE - THE HOSPITAL PROVIDES FUNDING AND SUPPORT TO THE LOCAL HEALTH DEPARTMENT'S DIABETES AND HYPERTENSION PROGRAM. THE HOSPITAL HAS IN THE PAST AND WILL CONTINUE TO HOST AND PARTICIPATE IN HEALTH FAIRS FOR LOCAL BUSINESSES AND THE GENERAL POPULATION. 2.OBESITY IN ADULTS - THE HOSPITAL WORKS TO PROMOTE A WELLNESS PROGRAM AMONG THEIR EMPLOYEES AND COMMUNITY RESIDENTS. 3.CANCER - FREE MAMMOGRAPHY SCREENINGS AND PSA LAB TESTS ARE OFFERED TO THE PUBLIC. 4.MENTAL HEALTH - THE HOSPITAL FUNDS A LOCAL PSYCHOTHERAPIST TO OFFER MEDICAL STAFF ADVICE AND ASSISTANCE. A CERTIFICATE OF NEED WAS APPROVED FOR THE ADDITION OF 20 MENTAL HEALTH BEDS. 20 MEDICAL/SURGICAL BEDS WILL BE CONVERTED TO 12 ADULT PSYCHIATRIC AND 8 CHILD/ADOLESCENT PSYCHIATRIC BEDS. THE DONALSONVILLE HOSPITAL BOARD IS PLANNING TO HAVE THE UNIT OPEN AND OPERATIONAL BY JUNE 1, 2017. BOTH 2016 COMMUNITY HEALTH NEEDS ASSESSMENT AND THE 2016 CHNA IMPLEMENTATION PLAN ARE WIDELY PUBLICIZED ON THE ORGANIZATION'S WEBSITE AND CAN BE FOUND AT HTTP://WWW.DONALSONVILLEHOSPITAL.ORG/DONALSONVILLEHOSPITAL_HEALTHNEEDSASSES SMENT.PDF AND HTTP://WWW.DONALSONVILLEHOSPITAL.ORG/DONALSONVILLEHOSPITAL_HEALTHNEEDSIMPLE MENTATION.PDF, RESPECTIVELY. |
| FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 13H | ALL PATIENTS ARE CHARGED EQUALLY REGARDLESS OF ANY OF THE ABOVE. THOSE INDIVIDUALS WITHOUT THIRD PARTY COVERAGE ARE GIVEN A 15% DISCOUNT IF THEY DO NOT QUALIFY FOR FREE CARE. THEY ARE ALSO GIVEN THE OPPORTUNITY TO RECEIVE A 50% DISCOUNT IF BILL IS PAID WITHIN 1 YEAR OF DISCHARGE. ALSO, FREE CARE IS OFFERED FOR PATIENTS MEETING CHARITY GUIDELINES - RANGING FROM 125% TO 200% OF FEDERAL POVERTY GUIDELINES. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEMINOLE MANOR NURSING HOME | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 102 HOSPITAL CIRCLE | AddressLine1Txt |
| City | DONALSONVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 317451100 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | SNF | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE | IN 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 25,913,219 ADD: EXPENSES REPORTED IN PART VIII 69,063 DENOMINATOR FOR COLUMN (F) 25,982,282 |
| PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION | COSTS FOR PART I, LINE 7A, 7B AND 7C WERE COMPUTED USING THE RATIO OF PATIENT CARE COST TO CHARGES CALCULATED ON WORKSHEET 2. OTHER COSTS WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. |
| 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 | SEE PAGES 8 AND 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| 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 | OUR PATIENT FINANCIAL SERVICES DEPARTMENT VISITS PATIENTS WHO HAVE NO INSURANCE TO DISCUSS ASSISTANCE AND REFER THOSE PATIENTS TO OUR LOCAL DFCS OFFICE TO OBTAIN ASSISTANCE WITH APPLYING FOR MEDICAID OR OTHER FINANCIAL ASSISTANCE. OUR PATIENT FINANCIAL SERVICES DEPARTMENT, WHICH DOES SELF-PAY BILLING AND COLLECTION, INFORMS PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND ASSISTS THEM IN COMPLETING AN APPLICATION. BILLING STATEMENTS PROVIDE A MESSAGE AND TELEPHONE NUMBER TO CALL IF THE PATIENT IS HAVING DIFFICULTIES MAKING PAYMENTS. FOR PATIENTS WHO QUALIFY AS INDIGENT OR CHARITY PATIENTS, THERE IS NO FINANCIAL OBLIGATION. THOSE PATIENTS WHO DO NOT QUALIFY AS INDIGENT OR CHARITY ARE SENT MULTIPLE STATEMENTS FOR 30, 60, AND 90 DAYS PAST DUE. THOSE PATIENTS WILL ALSO BE SENT TWO LETTERS REGARDING PAST DUE ACCOUNTS. ONCE AN ACCOUNT HAS NO ACTIVITY FOR 180 DAYS, IT WILL BE SENT TO AN OUTSIDE COLLECTION AGENCY. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | A COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN FISCAL YEAR 2016. INFORMATION WAS SOLICITED FROM VARIOUS INDIVIDUALS REPRESENTING THE INTERESTS OF THE COMMUNITY BY MEANS OF FOCUS GROUPS, EXTERNAL STATISTICS, AND INTERNAL DATA. THE ORGANIZATION CONDUCTS VARIOUS TYPES OF ASSESSMENTS TO DETERMINE THE COMMUNITY'S NEEDS FOR HEALTH SERVICES AND COLLABORATES WITH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TO IDENTIFY THE NEEDS OF THE COMMUNITY. COMMUNITY RESEARCH HAS SHOWN THAT THE SERVICES FOR WHICH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TURN TO THE ORGANIZATION ARE EMERGENCY SERVICES, DIAGNOSTIC TESTS AND X-RAYS, AND ALSO GENERAL MEDICAL CARE. OTHER SERVICES FOR WHICH THEY TURN TO US AS A MAJOR PROVIDER ARE MINOR SURGERY, PEDIATRIC CARE, GENERAL SURGERY, AND OBSTETRICAL CARE. THIS INFORMATION, COMBINED WITH OUR EXTENSIVE COLLABORATIONS AND OUR ROLE AS A LEADER IN THE COMMUNITY, PROVIDES US THE MEANS TO UNDERSTAND AND ADDRESS THE COMMUNITY'S NEEDS AND ENSURES OUR OUTREACH PROGRAMS ARE FOCUSED ON THE POPULATIONS WHO NEED OUR SERVICES THE MOST. OUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS, ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | THE BOARD HAS CLEARLY WRITTEN INDIGENT AND FINANCIAL AID POLICIES THAT ARE AVAILABLE THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND FINANCIAL AID. PATIENT EDUCATION ON THE ORGANIZATIONS INDIGENT/CHARITY AND FINANCIAL AID PROGRAMS ARE CONDUCTED DURING PRE-REGISTRATION, THROUGH OUR PATIENT FINANCIAL SERVICES DEPARTMENT FOR PATIENTS THAT DO NOT HAVE ANY 3RD PARTY COVERAGE. BROCHURES ARE PROMINENTLY DISPLAYED AT EACH REGISTRATION BOOTH. THE BUSINESS OFFICE CONTINUOUSLY PROVIDES INFORMATION TO THE BUSINESS OFFICE MANAGERS OF OUR LOCAL PHYSICIAN'S PRACTICES. PHONE CALLS AND LETTERS ARE SENT TO ALL PATIENTS THAT ARE NOT INTERVIEWED AT THE TIME OF ADMISSION EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAMS. OUR EMERGENCY DEPARTMENT IS OPERATED 24/7 AND OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | THE ORGANIZATION SERVES A PREDOMINATELY RURAL AREA IN SEMINOLE COUNTY, IN ITS BROADEST BOUNDARIES. DONALSONVILLE IS THE ECONOMIC AND MEDICAL HUB FOR THE REGION, AND THE ORGANIZATION DRAWS FROM A POPULATION OF APPROXIMATELY 9,000 RESIDENTS FOR MAJOR HEALTH CARE SERVICES. THE REGION IS MARKED BY VAST DICHOTOMIES OF WEALTH, EDUCATION, AND HEALTH STATUS. THE ORGANIZATION SERVES A POPULATION THAT HAS A HIGH PROPORTION OF LOW-INCOME INDIVIDUALS. ABOUT 22.01% OF FAMILIES AND 25.49% OF THE POPULATION WERE BELOW THE POVERTY LINE. |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | OUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS, ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY. WE HAVE PARTICIPATED IN VARIOUS LOCAL HEALTH FAIRS TO PROMOTE GOOD HEALTH AND PROVIDE SCREENING MECHANISMS FOR DETECTING HIGH BLOOD PRESSURE, ABNORMAL BLOOD SUGAR LEVELS AND HIGH CHOLESTEROL. THESE ARE THE MOST PRESSING AND PREVENTABLE DISEASES IN OUR COMMUNITY. WE WORK CLOSELY WITH THE LOCAL HEALTH DEPARTMENT TO ASSIST THEM WITH THE PROGRAMS THAT THEY FACILITATE THROUGHOUT THE YEAR. OUR BOARD HAS HAD IN PLACE FOR 20 YEARS, A SCHOLARSHIP PROGRAM FOR PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS. WE HAVE BEEN FORTUNATE TO HAVE MANY OF OUR LOCAL RESIDENTS FINISH MEDICAL SCHOOL, NURSING SCHOOL AND OTHER PROFESSIONAL CERTIFICATIONS, AND COME BACK TO DONALSONVILLE TO PRACTICE AND WORK IN OUR LOCAL HEALTHCARE COMMUNITY. THE PHYSICIAN SCHOLARSHIP PROGRAM HAS PRODUCED 7 OF OUR CURRENT 12 MEMBER MEDICAL STAFF. WE ALSO HAVE 3 IN THE PROGRAM THAT ARE SCHEDULED TO COME BACK TO OUR COMMUNITY OVER THE NEXT FEW YEARS. THIS TYPE OF PROGRAM HAS HELPED KEEP HEALTHCARE AVAILABLE AND ACCESSIBLE TO OUR RURAL COMMUNITY. IT HAS ENABLED US TO START NEW SERVICES THAT WOULD NOT HAVE EXISTED OTHERWISE. OUR BOARD IS DEDICATED TO PLANNING AND PREPARING FOR THIS RURAL COMMUNITY TO HAVE EASILY ACCESSIBLE HEALTHCARE FOR MANY YEARS TO COME. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHWEST GA HEALTHCARE CLINICS INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 205 BRESEE ST | AddressLine1Txt |
| City | DONALSONVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 398451134 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 475012525 | RecipientEIN |
| IRC Section | 501C3 | IRCSectionDesc |
| Cash Grant | $918,311 | CashGrantAmt |
| Purpose Of Grant | OPERATIONS | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PAGE 1, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | DURING 2017, CERTAIN PHYSICIANS PREVIOUSLY OPERATING AS EMPLOYEES OF THE ORGANIZATION BEGAN PRACTICING UNDER A NEW FEDERALLY QUALIFIED HEALTH CENTER (FQHC) AND ARE NO LONGER EMPLOYEES OF THE ORGANIZATION. HOWEVER, THE ORGANIZATION AGREED TO COVER THE LOSSES THE PHYSICIANS INCURRED ON AN ANNUAL BASIS. THE ORGANIZATION REQUIRES MONTHLY FINANCIAL STATEMENTS FROM THE FQHC AND APPROVAL BY THE BOARD PRIOR TO REIMBURSEMENT. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt |
|---|---|---|---|---|---|---|
| HERMAN BROOKINS | ||||||
| CHAIRMAN/CEO | $420,052 | $15,000 | $8,920 | $443,972 | ||
| CHARLES H ORRICK | ||||||
| ADMINISTRATOR | $191,781 | $10,000 | $8,920 | $234,693 | $23,992 | |
| JAMES MOODY | ||||||
| CFO | $180,424 | $15,590 | $218,739 | $22,725 | ||
| JOSEPH WALKER SR MD | ||||||
| PHYSICIAN | $292,000 | $85,971 | $18,000 | $407,516 | $11,545 | |
| ANDREA ALEXANDER MD | ||||||
| PHYSICIAN | $227,530 | $100,472 | $18,000 | $357,858 | $11,856 | |
| LUKE WILLIAMS MD | ||||||
| PHYSICIAN | $205,860 | $6,300 | $223,705 | $11,545 | ||
| ROYCE CANNINGTON JR | ||||||
| CRNA | $210,018 | $221,563 | $11,545 | |||
| BRIAN BROOKINS | ||||||
| PHARMACIST | $188,555 | $15,590 | $228,400 | $24,255 | ||
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART III | FormAndLineReferenceDesc |
| Explanation | PART I, LINE 4 - DEFERRED COMPENSATION PLAN 457(B) THE ORGANIZATION HAS ESTABLISHED A DEFERRED COMPENSATION PLAN FOR CERTAIN KEY EMPLOYEES. THE 457(B) PLAN IS A NON-QUALIFIED RETIREMENT PLAN THAT ALLOWS A MAXIMUM SALARY DEFERRAL OF THE LESSER OF 18,000 OR ONE-THIRD OF AN EMPLOYEE'S SALARY. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRIAN BROOKINS | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY BD MMBR | RelationshipDescriptionTxt |
| Transaction | $228,400 | TransactionAmt |
| Transaction | COMPENSATION | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | BRIAN BROOKINS, AN EMPLOYEE OF THE ORGANIZATION, IS THE SON OF HERMAN BROOKINS, WHO IS THE CHAIRMAN OF THE BOARD AND CEO. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 8B | THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 (BASED UPON INFORMATION PROVIDED BY THE ORGANIZATION) PROVIDES A COPY OF THE RETURN TO BE REVIEWED BY MANAGEMENT. MANAGEMENT PERFORMS A DETAILED REVIEW WHICH CONSISTS OF REVIEWING THE FINANCIAL DATA, THE NARRATIVES DISCLOSED, AND OTHER FACTS PRESENTED ON THE RETURN. UPON REVIEW, THE FORM 990 AND RELATED SCHEDULES ARE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND FEEDBACK. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES, A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE ORGANIZATION HAS A WRITTEN POLICY RESPECTING CONFLICTS OF INTEREST AND DISCLOSURE OF SAME. GENERALLY SPEAKING, THE POLICY REQUIRES ANY "COVERED PERSON" WHO BELIEVES HE HAS A CONFLICT OF INTEREST TO: -DISCLOSE THE EXISTENCE AND NATURE OF THE CONFLICT OF INTEREST (INCLUDING ALL FACTS KNOWN RESPECTING THE SUBJECT MATTER) TO THE CHAIRMAN OF THE BOARD; -PLAY NO PART, DIRECTLY OR INDIRECTLY, IN THE DELIBERATION OR VOTE OF THE BOARD OF DIRECTORS WITH RESPECT TO THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS; AND -RECUSE HIMSELF FROM THAT PORTION OF THE MEETING AT WHICH THE CONFLICT OF INTEREST IS DISCUSSED. THE DEFINITION OF A "COVERED PERSON" INCLUDES ALL BOARD MEMBERS, OFFICERS AND MEMBERS OF SENIOR MANAGEMENT OF THE ORGANIZATION. WHEN A COVERED PERSON DISCLOSES A POTENTIAL CONFLICT OF INTEREST TO THE BOARD CHAIRMAN, THE CHAIRMAN IS OBLIGED TO BRING THE MATTER TO THE ATTENTION OF THE FULL BOARD WHO DETERMINES WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. IF A CONFLICT OF INTEREST EXISTS, THE TRANSACTION OR MATTER GIVING RISE TO THE CONFLICT OF INTEREST MAY NOT PROCEED UNLESS THE BOARD DETERMINES, BY A MAJORITY VOTE, THAT, DESPITE THE CONFLICT OF INTEREST, THE TRANSACTION/MATTER IS NEVERTHELESS IN THE ORGANIZATION'S BEST INTEREST AND IS FAIR AND REASONABLE TO THE ORGANIZATION. IN ADDITION TO THE REQUIREMENT TO DISCLOSE A POTENTIAL CONFLICT OF INTEREST AT THE TIME IT ARISES, EACH MUST SUBMIT ANNUALLY A `CONFLICT AND DISCLOSURE OF INTEREST QUESTIONNAIRE'. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE COMPENSATION FOR THE CEO. THE BOARD USES COMPARABLE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS AT SIMILARLY SIZED ORGANIZATIONS AND SALARY SURVEYS TO DETERMINE THE COMPENSATION FOR THE CEO. THE CEO, A VOTING MEMBER OF THE BOARD, IS DISMISSED FROM THE MEETING DURING THE REVIEW OF HIS COMPENSATION. THE LAST DETERMINATION USING COMPARABLE COMPENSATION DATA AND SALARY SURVEYS WAS IN 2006. HOWEVER, COST OF LIVING ADJUSTMENTS ARE GIVEN ANNUALLY AND ARE APPROVED BY THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE BOARD OF DIRECTORS MEETS ON A MONTHLY BASIS, AND THE SALARY DECISIONS ARE REVIEWED BY THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION WILL MAKE AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO ANY MEMBER OF THE PUBLIC WHO MAKES THEIR REQUEST AT THE ADMINISTRATIVE OFFICE OF THE FILING ENTITY. |