STEPHENS COUNTY HOSPITAL AUTHORITY: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
STEPHENS COUNTY HOSPITAL AUTHORITY (EIN 58-6001667)
Tax period
2015-10-01 to 2016-09-30
Filed
2017-08-14
IRS object ID
201712269349300231
Schema version
2015v3.0
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-08-14T08:46:51-05:00ReturnTs
Tax Period End2016-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN560747981PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1Txt
CityASHEVILLECityNm
State AbbreviationNCStateAbbreviationCd
ZIP28806ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN586001667EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1STEPHENS COUNTY HOSPITAL AUTHORITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlSTEPBusinessNameControlTxt
Phone7062824200PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1163 HOSPITAL DRIVEAddressLine1Txt
CityTOCCOACityNm
State AbbreviationGAStateAbbreviationCd
ZIP30577ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJEFFREY LAIRDPersonNm
Person TitleCFOPersonTitleTxt
Phone7062824200PhoneNum
Signature2017-08-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAmy BibbyPreparerPersonNm
PTINP00445891PTIN
Phone8282542254PhoneNum
Preparation2017-08-09PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerEDWARD C GAMBRELL JRPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1163 HOSPITAL DRIVEAddressLine1Txt
CityTOCCOACityNm
State AbbreviationGAStateAbbreviationCd
ZIP30577ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$53,423,151GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.STEPHENSCOUNTYHOSPITAL.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1945FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionPROVIDES INPATIENT, OUTPATIENT, OCCUPATIONAL, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF STEPHENS COUNTY, GEORGIA AND SURROUNDING AREAS.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee707TotalEmployeeCnt
Total Volunteers29TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$14,741PYContributionsGrantsAmt
CY Contributions Grants$36,932CYContributionsGrantsAmt
PY Program Service Revenue$55,355,924PYProgramServiceRevenueAmt
CY Program Service Revenue$52,390,532CYProgramServiceRevenueAmt
PY Investment Income$25,665PYInvestmentIncomeAmt
CY Investment Income$30,158CYInvestmentIncomeAmt
PY Other Revenue$865,964PYOtherRevenueAmt
CY Other Revenue$965,529CYOtherRevenueAmt
PY Total Revenue$56,262,294PYTotalRevenueAmt
CY Total Revenue$53,423,151CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$26,454,290PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$27,287,491CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$28,662,656PYOtherExpensesAmt
CY Other Expenses$30,706,890CYOtherExpensesAmt
PY Total Expenses$55,116,946PYTotalExpensesAmt
CY Total Expenses$57,994,381CYTotalExpensesAmt
PY Revenues Less Expenses$1,145,348PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$4,571,230CYRevenuesLessExpensesAmt
Total Assets BOY$40,189,169TotalAssetsBOYAmt
Total Assets EOY$36,700,408TotalAssetsEOYAmt
Total Liabilities BOY$14,173,431TotalLiabilitiesBOYAmt
Total Liabilities EOY$15,255,900TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$26,015,738NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$21,444,508NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$54,076,077ExpenseAmt
Revenue$52,390,532RevenueAmt
DescSTEPHENS COUNTY HOSPITAL OPERATES 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 SERVICES BASED ON THE ABILITY TO PAY FOR SUCH SERVICES.Desc
Total Program Service Expenses$54,076,077TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (1)BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document21IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee707EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JEFFREY B LAIRD CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7062824281PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1163 HOSPITAL DRIVEAddressLine1Txt
CityTOCCOACityNm
State AbbreviationGAStateAbbreviationCd
ZIP30577ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
MARK G WILKINSON
CHAIRMAN2.00Yes (X)$0$0$0
ROBERT W SLATE MD
VICE CHAIRMAN2.00Yes (X)$0$0$0
STANLEY W ROBERTS
SECRETARY/TREASURER2.00Yes (X)$0$0$0
PAULA M DICKERSON
BOARD MEMBER2.00Yes (X)$0$0$0
JON C WEST
BOARD MEMBER2.00Yes (X)$0$0$0
GEORGE SANDERS
BOARD MEMBER2.00Yes (X)$0$0$0
MAX BROCK
BOARD MEMBER2.00Yes (X)$0$0$0
EDWARD C GAMBRELL
CEO/ADMINISTRATOR50.00$283,755$0$29,574Yes (X)
JEFFREY B LAIRD
CFO/CONTROLLER50.00$93,153$0$27,290Yes (X)
RUTH LYNNE M ANDERSON
CEO/ADMINISTRATOR50.00$60,738$0$2,086Yes (X)
ANGELA R KING
REHAB SERVICES MANAGER40.00$118,653$0$20,236Yes (X)
KELLY R HART
PHARMACY MANAGER40.00$119,930$0$20,274Yes (X)
JAMES W FORDYCE DO
ORTHOPEDIC SURGEON40.00$202,271$0$13,589Yes (X)
STEPHEN T SMALL
NURSE PRACTITIONER40.00$127,327$0$3,820Yes (X)
Ginie Chan
Internal Med Physician40.00$229,884$0$21,097Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,235,711TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$137,966TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K17IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
HD SMITH WHOLESALE DRUGS
6001 GLOBAL DISTRIBUTION WAYLOUISVILLEKY40228WHOLESALE DRUG$1,726,262
MEDLINE INDUSTRIES
DEPT CH 14400PALATINEIL600554400MEDICAL SUPPLY DISTRIBUTOR$1,245,037
Apogee Medical Management
15059 N ScottsdaleScottsdaleAZ85254HOSPITALISTS$966,080
Diversified Clinical Services
PO Box 636981CincinnatiOH45263WOUND CARE$522,107
BECKMAN COULTER INC
DEPT CH 10164PALATINEIL300550164LABORATORY EQUIPMENT & SUPPLIES$385,821
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K27CntrctRcvdGreaterThan100KCnt
All Other Contributions$36,932AllOtherContributionsAmt
Total Contributions$36,932TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT REVENUE622000$49,498,822$49,498,822
RESIDENT REVENUE623000$2,216,374$2,216,374
AMBULANCE SERVICE SUBSIDY BY COUN621910$675,336$675,336
FieldValueIRS element (for citing)
Total Program Service Revenue$52,390,532TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$25,373TotalRevenueColumnAmt
Exclusion$25,373ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$4,785OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$4,785OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,785TotalRevenueColumnAmt
Exclusion$4,785ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
CAFETERIA SALES900099$607,421$607,421
MISCELLANEOUS900099$210,832$210,832
PHARMACY - EMPLOYEE COPAYS900099$147,276$147,276
FieldValueIRS element (for citing)
Other Revenue Total$965,529OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$53,423,151TotalRevenueColumnAmt
Related Or Exempt Func Income$52,390,532RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$995,687ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$460,116TotalAmt
Management And General$460,116ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$21,647,663TotalAmt
Program Services$20,003,300ProgramServicesAmt
Management And General$1,644,363ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$483,873TotalAmt
Program Services$437,812ProgramServicesAmt
Management And General$46,061ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$3,228,582TotalAmt
Program Services$2,921,248ProgramServicesAmt
Management And General$307,334ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,467,257TotalAmt
Program Services$1,327,586ProgramServicesAmt
Management And General$139,671ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$4,991TotalAmt
Management And General$4,991ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$80,595TotalAmt
Management And General$80,595ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$7,229,466TotalAmt
Program Services$6,851,495ProgramServicesAmt
Management And General$377,971ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$83,210TotalAmt
Management And General$83,210ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,648,518TotalAmt
Program Services$894,537ProgramServicesAmt
Management And General$753,981ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,646,855TotalAmt
Program Services$1,646,855ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$49,613TotalAmt
Program Services$31,382ProgramServicesAmt
Management And General$18,231ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$238,498TotalAmt
Program Services$238,498ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,113,052TotalAmt
Program Services$2,113,052ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$584,052TotalAmt
Program Services$584,052ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
BAD DEBT EXPENSE$9,436,721$9,436,721
MEDICAL SUPPLIES$6,318,392$6,318,392
FOOD$765,489$765,489
MEDICAID PROVIDER FEE T$488,216$488,216

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$19,222TotalAmt
Program Services$17,442ProgramServicesAmt
Management And General$1,780ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$57,994,381TotalAmt
Program Services$54,076,077ProgramServicesAmt
Management And General$3,918,304ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$864,035BOYAmt
EOY$1,282,924EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$3,067,719BOYAmt
EOY$2,276,388EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$11,879,423BOYAmt
EOY$9,932,710EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,794,737BOYAmt
EOY$1,704,287EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$321,824BOYAmt
EOY$334,749EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$68,039,978LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$47,807,366LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$20,504,164BOYAmt
EOY$20,232,612EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$13,511BOYAmt
EOY$3,754EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,743,756BOYAmt
EOY$932,984EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$40,189,169BOYAmt
EOY$36,700,408EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$6,753,795BOYAmt
EOY$8,215,697EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,980,000BOYAmt
EOY$4,000,000EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$2,439,636BOYAmt
EOY$3,040,203EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$14,173,431BOYAmt
EOY$15,255,900EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$24,832,176BOYAmt
EOY$20,996,295EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,183,562BOYAmt
EOY$448,213EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$26,015,738BOYAmt
EOY$21,444,508EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$40,189,169BOYAmt
EOY$36,700,408EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$4,571,230ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$4,185OtherActivitiesAmt
Total Lobbying Expenditures$4,185TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart II-B, Line 1:FormAndLineReferenceDesc
ExplanationTHIS AMOUNT REPRESENTS THE APPROXIMATE LOBBYING PORTION OF DUES PAID TO THE AMERICAN HOSPTIAL ASSOCIATION.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$398,788OtherCostOrOtherBasisAmt
Book Value$398,788BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$33,476,693OtherCostOrOtherBasisAmt
Depreciation$17,717,774DepreciationAmt
Book Value$15,758,919BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$32,689,494OtherCostOrOtherBasisAmt
Depreciation$29,520,555DepreciationAmt
Book Value$3,168,939BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,475,003OtherCostOrOtherBasisAmt
Depreciation$569,037DepreciationAmt
Book Value$905,966BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$20,232,612TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$43,122,571TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$43,122,571RevenueSubtotalAmt
Other Revenues Not Included$10,300,580OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$10,300,580RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$53,423,151TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$47,693,801TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$47,693,801ExpensesSubtotalAmt
Other Expenses Not Included$10,300,580OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$10,300,580ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$57,994,381TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part X, Line 2:INCOME TAXES- THE HOSPITAL AND SCEP 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 CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL AND SCEP HAVE EVALUATED THEIR TAX POSITIONS AND HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OBLIGATIONS AS OF SEPTEMBER 30, 2015. NOTHING IS CURRENTLY UNDER REVIEW. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2012 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.
Part XI, Line 4b - Other Adjustments:EXPENSES NET WITH REVENUE 9,436,721. BAD DEBT EXPENSE NET WITH REVENUE 863,859.
Part XII, Line 4b - Other Adjustments:EXPENSES NET WITH REVENUE 9,436,721. BAD DEBT EXPENSE NET WITH REVENUE 863,859.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other125.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other200.000000000000DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,624,395TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,762,934DirectOffsettingRevenueAmt
Net Community Benefit Expns$861,461NetCommunityBenefitExpnsAmt
Total Expense0.01770TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,658,923TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,298,161DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,360,762NetCommunityBenefitExpnsAmt
Total Expense0.04860TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,283,318TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,061,095DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,222,223NetCommunityBenefitExpnsAmt
Total Expense0.06630TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,283,318TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,061,095DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,222,223NetCommunityBenefitExpnsAmt
Total Expense0.06630TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$3,998,339BadDebtExpenseAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1STEPHENS COUNTY HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1163 HOSPITAL DRIVEAddressLine1Txt
CityTOCCOACityNm
State AbbreviationGAStateAbbreviationCd
ZIP30577ZIPCd
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherDISPROPORTIONATE SHARE HOSPITALOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1STEPHENS COUNTY HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts0CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTP://STEPHENSCOUNTYHOSPITAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/OwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt15ImplementationStrategyAdptYr
Strategy Posted Website0StrategyPostedWebsiteInd
Strategy AttachedYes (1)StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care125.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care200.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLhttp://stephenscountyhospital.com/patients/patient-visitor-resources/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLhttp://stephenscountyhospital.com/patients/patient-information-forms/financFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLhttp://stephenscountyhospital.com/fullpanel/uploads/files/2-financial-assisFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Average Negotiated RatesYes (X)AverageNegotiatedRatesInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
STEPHENS COUNTY HOSPITALPart V, Section B, Line 5: THE HOSPITAL FACILITY USED COMMUNITY-BASED SURVEYS AND FOCUS GROUPS TO GATHER INPUT.
STEPHENS COUNTY HOSPITALPart 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.
FieldValueIRS element (for citing)
Facility2FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - THE CLARY CARE CENTER
249 HOSPITAL DRIVETOCCOAGA30577ADVANCED PERSONAL CARE FACILITY
2 - THE WILKINSON CENTER
269 HOSPITAL DRIVETOCCOAGA30577PERSONAL CARE FACILITY

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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 $ 9,436,721.
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.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
EDWARD C GAMBRELL
CEO/ADMINISTRATOR$275,427$0$0$0$8,328$0$8,513$0$21,061$0$313,329$0$0$0
JAMES W FORDYCE DO
ORTHOPEDIC SURGEON$202,271$0$0$0$0$0$6,068$0$7,521$0$215,860$0$0$0
Ginie Chan
Internal Med Physician$229,884$0$0$0$0$0$6,897$0$14,200$0$250,981$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 6FormAndLineReferenceDesc
ExplanationPER CONTRACTUAL EMPLOYMENT AGREEMENT, THE CEO RECEIVES A YEAR-END BONUS OF 1% OF NET EARNINGS AS SHOWN ON THE STEPHENS COUNTY HOSPITAL AUTHORITY'S AUDITED CONSOLIDATED STATEMENTS OF REVENUES, EXPENSES, AND CHANGES IN NET ASSETS. DURING THE CALENDAR YEAR 2015, THE CEO RECEIVED A BONUS OF $851 BASED ON THIS FORMULA.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
HOSPITAL AUTHORITY OF STEPHENS COUNTY GEORGIA SERIES 2006
A586001667858753DE32006-10-10$4,000,000CONSTRUCTION & RENOVATION OF PATIENT ROOMS000
HoSPITAL AUTHORITY OF STEPHENS COUNTY GEORGIA SERIES 2010
B5860016672010-12-16$4,740,000CURRENT REFUNDING000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCapital ExpendituresCapitalExpendituresAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintIndOther Spent ProceedsOtherSpentProceedsAmt
A$4,000,000$858,233$168,861$3,831,139200700Yes (1)Yes (1)
B$4,740,000$814,586$135,3182001Yes (1)0Yes (1)Yes (1)$4,604,682

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A0000000
B0000000

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A00000000Yes (1)
B00Yes (1)00000Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
A0
B0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II, LINE 11, OTHER SPENT PROCEEDSFormAndLineReferenceDesc
ExplanationTHE AMOUNTS PRESENTED ON PART II, LINE 11 REPRESENT PROCEEDS SPENT TO REFUND SERIES 2001A AND 2001B ISSUES.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonCONSTANCE RICEPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionSISTER OF GEORGE SANDERS (BOARD MEMBER)RelationshipDescriptionTxt
Transaction$81,942TransactionAmt
TransactionEMPLOYMENTTransactionDesc
Sharing Of Revenues0SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 7aSERVICE 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 11A 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 12cTHE ORGANIZATION CONDUCTS PERIODIC REVIEWS OF EXISTING BUSINESS RELATIONSHIPS AND INITIAL REVIEWS OF ANY NEW BUSINESS RELATIONSHIPS.
Form 990, Part VI, Section B, line 15THE 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 18RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG.
Form 990, Part VI, Section C, line 19THE 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 11gPURCHASED SERVICES: Program service expenses 5,879,156. Management and general expenses 27,432. Fundraising expenses 0. Total expenses 5,906,588. CONSULTING: Program service expenses 0. Management and general expenses 18,627. Fundraising expenses 0. Total expenses 18,627. MAINTENANCE CONTRACT: Program service expenses 972,339. Management and general expenses 331,912. Fundraising expenses 0. Total expenses 1,304,251.
FORM 990, PART XII, LINE 2CTHIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
STEPHENS COUNTY EMERGENCY PHYSICIANS INC
163 HOSPITAL DRIVETOCCOAGA30577020692996PROVIDE EMERGENCY ROOM PHYSICIANS TO STEPHENS COUNTY HOSPITALGA501(C)(3)7STEPHENS COUNTY HOSPITAL AUTHORITYYes (1)
STEPHENS COUNTY HOSPITAL FOUNDATION INC
163 HOSPITAL DRIVETOCCOAGA30577208089919FUNDRAISING ACTIVITIES FOR STEPHENS COUNTY HOSPITALGA501(C)(3)11STEPHENS COUNTY HOSPITAL AUTHORITYYes (1)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1STEPHENS COUNTY EMERGENCY PHYSICIANS INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeMTransactionTypeTxt
Involved$1,472,946InvolvedAmt
Method Of Amount DeterminationCASHMethodOfAmountDeterminationTxt

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.