2017-05-12T06:10:52-05:00 2016-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2015-07-01 320090450 SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE INC SOUT 7708977600 11 UPPER RIVERDALE ROAD RIVERDALE GA 30274 BENNY WHITMORE VICE CHAIRMAN 7708977600 2017-05-11 1 AMY BIBBY P00445891 8282542254 2017-05-11 2015 2021-01-29 14:40:06Z BENNY WHITMORE 11 UPPER RIVERDALE ROAD RIVERDALE GA 30274 8005832 0 X N/A X 2002 GA TO PROVIDE HIGH-QUALITY, LONG-TERM ACUTE CARE TO THE COMMUNITIES WE SERVE. 6 6 125 0 0 0 0 0 10378611 7999381 2149 400 5439 6051 10386199 8005832 15369 5798 0 0 5225171 4312729 0 0 0 5711986 4742792 10952526 9061319 -566327 -1055487 4750902 3725785 1679201 1709571 3071701 2016214 X THE MISSION OF SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE IS TO PROVIDE HIGH-QUALITY, LONG-TERM ACUTE CARE TO THE COMMUNITIES WE SERVE. 0 0 7698924 5798 7999381 THE GOSPEL VALUES UNDERLYING THE MISSION STATEMENT CHALLENGES SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE TO MAKE CHOICES WHICH RESPOND TO THE PATIENT'S NEEDS IN PROVIDING THE NECESSARY SETTING FOR THE APPROPRIATE CONTINUUM OF CARE. SPECIAL CONSIDERATION IS GIVEN TO THOSE WHO ARE ECONOMICALLY DISADVANTAGED AND UNDERSERVED. THE HOSPITAL CARES FOR PATIENTS WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING; VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. THE MEDICAL AND THERAPEUTIC NEEDS OF THE PATIENTS ARE MET USING AN INTERDISCIPLINARY, HOLISTIC TEAM APPROACH INCORPORATING MEDICAL MANAGEMENT, PHYSICAL, RESPIRATORY, OCCUPATIONAL AND SPEECH THERAPIES IN AN EFFORT TO RESTORE INDIVIDUAL QUALITY OF LIFE TO AS HIGH A DEGREE AS POSSIBLE AND TO PROMOTE SELF-HELP AND INDEPENDENCE TO THE EXTENT FEASIBLE. THE SPIRITUAL NEEDS OF THE PATIENTS, FAMILIES AND SIGNIFICANT OTHERS ARE PROVIDED FOR AS WELL. THE GROWTH AND DEVELOPMENT OF SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE IS DETERMINED BY THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT IT SERVES, AVAILABLE RESOURCES, AND THE INTERRELATIONSHIP OF THOSE SERVING AND THOSE BEING SERVED. RESPONSIBLE STEWARDSHIP MANDATES THAT SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE SEARCH OUT NEW, EFFECTIVE MEANS TO DELIVER QUALITY HEALTH CARE AND TO PROMOTE WHOLENESS IN THE HUMAN PERSON FOR THOSE WHO REQUIRE THIS LONG-TERM ACUTE CONTINUUM OF CARE.THE VISION OF SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE IS TO PROVIDE HEALTH CARE THAT IS SPIRITUALLY ROOTED, FULLY INTEGRATED IN THE CONTINUUM OF CARE, SUPPORTIVE OF HEALTHIER COMMUNITIES, INNOVATIVE AND INTERDISCIPLINARY IN A HOLISTIC APPROACH TO CARE, AND COMPASSIONATE IN RESPONSE TO THE NEEDS OF PATIENTS IN THEIR LIFE JOURNEY. SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE'S APPROACH TO STRENGTHEN CURRENT MINISTRIES; TO IMPLEMENT INNOVATIVE APPROACHES TO CARING FOR THE WHOLE PERSON; TO INCREASE ACCESS TO HEALTH CARE FOR THE POOR AND UNDERSERVED THROUGH ADVOCACY AND OTHER INITIATIVES; TO MAKE A CONTRIBUTION TO CREATING HEALTHY COMMUNITIES; AND TO CREATE A WORK ENVIRONMENT FILLED WITH HOPE, DIGNITY, AND MUTUAL RESPECT.COMMUNITY BENEFITSIN SUPPORT OF ITS MISSION AND PHILOSOPHY REGARDING SOCIAL ACCOUNTABILITY, SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PROVIDES CARE TO PATIENTS WHO BEAR A SIGNIFICANT HEALTH-CARE FINANCIAL BURDEN RELATIVE TO THEIR FINANCIAL RESOURCES. SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE CLASSIFIES THE RESOURCES UTILIZED FOR THE CARE OF PATIENTS BEARING A SIGNIFICANT HEALTH CARE FINANCIAL BURDEN AS COMPARED TO THEIR RESOURCES AS CHARITY CARE. CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF THE FINANCIAL BURDEN OF THE HEALTH CARE SERVICES AND/OR WHO ARE UNINSURED OR UNDERINSURED. CHARITY CARE IS PROVIDED WITHOUT CHARGE OR AT A CHARGE THAT IS LESS THAN THE USUAL CHARGE FOR SUCH SERVICES. THE DETERMINATION AS TO THE AMOUNT TO BE CHARGED, IF ANY, IS MADE ACCORDING TO A PATIENT'S ABILITY TO PAY, CONSIDERATION OF THE PATIENT'S ASSETS AND LIABILITIES, AND DETERMINED BY THE ESTABLISHED ELIGIBILITY CRITERIA BASED ON THE MOST CURRENT FEDERAL POVERTY GUIDELINES. A FINANCIALLY INDIGENT PATIENT IS ONE WHO IS UNINSURED OR UNDERINSURED AND WHOSE ECONOMIC CIRCUMSTANCES PLACE THEM AT OR UNDER 200% OF THE FEDERAL POVERTY GUIDELINES. A MEDICALLY INDIGENT PATIENT IS A PERSON WHO'S MEDICAL OR HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEEDS 25% OF THEIR ANNUAL GROSS INCOME. NO PATIENT IS REFUSED NECESSARY MEDICAL CARE ON THE BASIS OF THEIR INABILITY TO PAY.IN ADDITION TO UNCOMPENSATED COSTS, SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE SUPPORTS AND PARTICIPATES IN COMMUNITY BENEFIT PROGRAMS DESIGNED TO POSITIVELY IMPACT THE HEALTH STATUS OF THE COMMUNITIES SERVED.REIMBURSED GOVERNMENT SPONSORED PROGRAMSIN ADDITION TO THE PROVISION OF CARE WITHOUT EXPECTATION OF PAYMENT (CHARITY CARE), SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PROVIDES SERVICES TO PERSONS COVERED UNDER GOVERNMENT SPONSORED PROGRAMS, INCLUDING MEDICARE, TRICARE (FORMERLY CHAMPUS WHICH PROVIDES CIVILIAN HEALTH CARE BENEFITS TO MILITARY PERSONNEL, MILITARY RETIREES AND THEIR DEPENDENTS, AND SOME MEMBERS OF THE RESERVE COMPONENT) AND TRICARE FOR LIFE (A MEDICARE SUPPLEMENT INSURANCE PROGRAM AVAILABLE TO INDIVIDUALS WHO HAD BEEN ELIGIBLE FOR TRICARE). AS ALREADY CITED, SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PROVIDED MEDICAL SERVICES TO PERSONS COVERED UNDER THE FEDERAL MEDICARE PROGRAM WHICH, IN FACT, COMPRISED THE LARGEST SINGLE PAYER CLASSIFICATION OF PATIENTS SERVED BY THIS HEALTH SYSTEM. THE PAYMENT RATE FOR INPATIENT SERVICES IS ON A PER DISCHARGE RATE, CALCULATED BASED ON THE DIAGNOSTIC-RELATED GROUP INTO WHICH THE PATIENT IS CATEGORIZED. NUMBER OF PATIENTS SERVED BY THE HOSPITAL 206NUMBER OF PATIENT DAYS OF CARE PROVIDED BY THE HOSPITAL: 5,848NUMBER OF CHARITY PATIENTS SERVED BY THE HOSPITAL: 1CHARITY CARE COST: $187,730TOTAL PROGRAM SERVICE EXPENSES (GRANTS $5,798) $7,698,924 7698924 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 21 0 1 125 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 GA X MIKE MURRAY 4692822299 919 HIDDEN RIDGE IRVING TX 75038 BENNY R WHITMORE CHAIRMAN/PRESIDENT 2.00 X X 7877 0 0 RONALD M DODSON VICE CHAIRMAN/SECRETARY 1.00 X X 3700 0 0 LISA EICHENBERGER BOARD MEMBER 1.00 X 2300 0 0 GARY LAGGIS BOARD MEMBER 1.00 X 1700 0 0 MAGDA GONZALEZ BOARD MEMBER 1.00 X 0 0 0 ABDULFATAI O ODEMUYIWA MD BOARD MEMBER 1.00 X 3100 0 0 JEFF DENNEY CEO 40.00 X 130881 0 21397 MIKE MURRAY CFO 2.00 X 9810 0 1070 RUBY VILLAFRANCA CHARGE RN 40.00 X 132972 0 14891 GAIL SNOWDEN PHARMACY MANAGER 40.00 X 128950 0 5951 TERESA GASTON CHARGE RN 40.00 X 106363 0 21397 MA MANESTEL TOBIA-CABANOG CHARGE RN 40.00 X 126784 0 0 654437 0 64706 5 0 1 1 SOUTHERN REGIONAL MEDICAL CENTER 11 UPPER RIVERDALE ROAD RIVERDALE GA 30274 ANCILLIARY HOSPITAL SERVICES 1825562 PRECISE HEALTHCARE SOLUTIONS LLC 5300 MEMORIAL DRIVE SUITE 201C STONE MOUNTAIN GA 30083 CONTRACT LABOR 256695 FRESENIUS KABI USA LLC THREE CORPORATE DRIVE LAKE ZURICH IL 60047 ANCILLIARY HOSPITAL SERVICES 182841 3 NET PATIENT SERVICE 623000 7999381 7999381 7999381 400 400 TRANSCRIPTION FEES 561499 6051 6051 6051 8005832 7999381 0 6451 X 5798 5798 18677 18677 3499423 3139398 360025 537616 479769 57847 257013 229358 27655 642936 642936 6946 6946 1845055 1784949 60106 15494 5764 9730 376392 321777 54615 678671 676557 2114 71664 5010 66654 21459 13369 8090 114879 114879 109495 82121 27374 MEDICAL SUPPLIES 787226 787226 MISCELLANEOUS EXPENSE 52520 32894 19626 BAD DEBT 20055 20055 9061319 7698924 1362395 0 2301998 1990613 1405627 1178447 82771 84639 63071 74466 2076333 1678713 512499 397620 384936 0 4750902 3725785 854348 648706 824853 1060865 1679201 1709571 X 3071701 2016214 3071701 2016214 4750902 3725785 -1055487 0 X 0 0 0 X 0 0 0 0 0 0 0 0 1 1626 1626 0 PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE NATIONAL ASSOCIATION OF LONG TERM HOSPITALS AND THE GEORGIA HOSPITAL ASSOCIATION. THESE ORGANIZATIONS ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBERSHIP BODIES, AND EACH YEAR, A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING EXPENDITURES. 21250 17181 4069 2055083 1661532 393551 397620 DUE TO SOUTHERN REGIONAL 125567 DUE TO CHRISTUS DUBUIS CONTINUING CARE 725698 THIRD PARTY PAYOR SETTLEMENT 209600 1060865 1 1 1 X 1 X 1 1 1 0 1 1 326585 326585 0.03600 326585 326585 0.03600 5500 5500 0.00060 5500 5500 0.00060 332085 332085 0.03660 8 237 4735 4735 0.00050 8 237 4735 4735 0.00050 1 20055 0 5428523 7225019 -1796496 X 1 1 1 1 SOUTHERN CRESCENT HOSP FOR SPEC CARE 11 UPPER RIVERDALE ROAD RIVERDALE GA 30274 X LONG-TERM ACUTE CARE HOSPITAL SOUTHERN CRESCENT HOSP FOR SPEC CARE 1 0 0 1 X X X X X X X X X 14 1 1 0 1 X HTTP://WWW.CHRISTUSHEALTH.ORG/CHNA-CHIP X 1 14 1 HTTP://WWW.CHRISTUSHEALTH.ORG/CHNA-CHIP 1 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X 1 X X 1 X 0 X 0 X X 0 0 SOUTHERN CRESCENT HOSP. FOR SPEC. CARE PART V, SECTION B, LINE 5: SEVENTEEN INDIVIDUAL COMMUNITY STAKEHOLDERS WERE INTERVIEWED AND ONE FOCUS GROUP OF NINE PATIENTS AND FAMILY ADVISORS (PFA) WAS CONDUCTED BY THE STRATEGIC PLANNING OFFICE. THESE STAKEHOLDERS INCLUDED A MIX OF INTERNAL AND EXTERNAL REPRESENTATIVES TO SRMC, PASTORS, PUBLIC HEALTH OFFICIALS, HEALTH CARE PROVIDERS, SOCIAL AGENCY REPRESENTATIVES, GOVERNMENT LEADERS, AND BOARD MEMBERS. SEE APPENDIX B OF THE CHNA FOR INDIVIDUAL STAKEHOLDER NAMES. SOUTHERN CRESCENT HOSP. FOR SPEC. CARE PART V, SECTION B, LINE 6A: SOUTHERN REGIONAL MEDICAL CENTER SOUTHERN CRESCENT HOSP. FOR SPEC. CARE PART V, SECTION B, LINE 11: FOR FISCAL YEAR 2016, THE HOSPITAL WILL FOCUS ON THE FOLLOWING POPULATIONS OR INDIVIDUALS WITH SPECIFIC DISEASES AS IDENTIFIED IN THE CHNA:HEART DISEASEDIABETESACCESS TO SERVICES/MEDICAL CARERESPIRATORY/ASTHMAOBESITY/OVERWEIGHTTHERE WERE MANY NEEDS IDENTIFIED, BUT THE HOSPITAL IS LIMITED IN SCOPE AND AVAILABLE RESOURCES, THEREFORE IT WILL FOCUS ITS ENERGIES ON THESE TWO DISEASE POPULATIONS. THE LONG TERM ACUTE CARE HOSPITAL WILL FOCUS EFFORTS TO IMPROVE CONDITIONS RELATED TO INDIVIDUALS WITH HEART DISEASE, DIABETES, ACCESS TO CARE, RESPIRATORY/ASTHMA, AND/OR OBESITY/OVERWEIGHT. THE PROGRAM OBJECTIVES ARE TO HAVE BETTER EDUCATED COMMUNITIES RELATED TO PREVENTION AND ACCESS. THE GOAL IS THAT THROUGH THE EFFORTS OF THE HOSPITAL, THERE WILL BE A LOWER PREVALENCE OF HEART DISEASE, DIABETES, RESPIRATORY/ASTHMA, OBESITY/OVERWEIGHT AND IMPROVED ACCESS TO CARE/SERVICES IN THE COMMUNITIES SERVED. PART I, LINE 3C: IN ADDITION TO PROVIDING CHARITY CARE BASED ON THE FEDERAL POVERTY GUIDELINES, THE HOSPITAL PROVIDES CARE TO MEDICALLY INDIGENT PATIENTS WHOSE MEDICAL OR HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEED 25% OF THE PATIENT'S ANNUAL GROSS INCOME AND THE PATIENT IS UNABLE TO PAY THE REMAINING BILL. PART I, LINE 7: WORKSHEET 2 OF THE 2015 SCHEDULE H INSTRUCTIONS WAS USED TO DERIVE A COST-TO-CHARGES RATIO USED TO CALCULATE AMOUNTS OF COMMUNITY BENEFIT EXPENSE AT COST FOR PART I, LINE 7. PART III, LINE 2: THE ORGANIZATION USES FORM 990, SCHEDULE H, WORKSHEET A TO DETERMINE THE BAD DEBT EXPENSE AT COST REPORTED AT SCHEDULE H, PART III, SECTION A, LINE 2 USING THE COST-TO-CHARGE RATIO CALCULATED AT FORM 990, SCHEDULE H, WORKSHEET 2, LINE 11. THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENT CHARGES (TOTAL OF ALL HOSPITAL FACILITIES) IS IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL STATEMENTS. BAD DEBT EXPENSE IS NET OF: (1) CONTRACTUAL ALLOWANCES, (2) PAYMENTS RECEIVED AND (3) RECOVERIES OF BAD DEBT PREVIOUSLY WRITTEN OFF. PART III, LINE 3: ALL UNPAID PATIENT BALANCES ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY OR PATIENTS FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE A DETERMINATION OF THEIR ELIGIBILITY ARE WRITTEN OFF AS CHARITY CARE AND NOT TO BAD DEBT EXPENSE. THEREFORE NO AMOUNT OF BAD EXPENSE IS ATTRIBUTABLE TO PATIENTS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE. PART III, LINE 4: SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE FOLLOWS IN PRINCIPLE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. THE SYSTEM HAS ADOPTED AN UNCOMPENSATED CARE POLICY WHERE REVENUE FROM SERVICES PROVIDED TO THE UNINSURED IS RECOGNIZED AT THE TIME OF SERVICE, AND AN OFFSETTING ALLOWANCE FOR VOLUNTARY FREE CARE IS RECORDED. ACCORDINGLY, ALL ACCOUNTS RECEIVABLE FROM THE UNINSURED HAVE BEEN FULLY RESERVED IN THE ALLOWANCE FOR VOLUNTARY FREE CARE. THE ORGANIZATION DOES NOT ISSUE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE ORGANIZATION USED THE MEDICARE COST REPORT TO DETERMINE COSTS OF CARE RELATING TO MEDICARE PATIENTS. PART III, LINE 9B: SOUTHERN CRESCENT HOSPITAL DOES NOT OUTSOURCE PATIENT BALANCES TO A THIRD PARTY DEBT COLLECTION AGENCY. ALL COLLECTIONS ARE DONE BY IN-HOUSE COLLECTORS USING COLLECTION LETTERS. PATIENTS ARE NOT SUBJECT TO HARASSMENT OR LEGAL ACTION DUE TO THEIR INCAPACITY TO PAY. PATIENTS THAT ARE UNABLE TO PAY ARE SENT CHARITY CARE INFORMATION.UPON ADMISSION, PATIENTS WHO HAVE NO INSURANCE COVERAGE AND NO ABILITY TO PAY WILL BE GIVEN CONSIDERATION FOR CHARITY CARE. EVERY EFFORT WILL BE MADE TO OBTAIN THE APPROPRIATE FINANCIAL DOCUMENTATION TO DETERMINE THE ABILITY TO PAY FOR SERVICES. PATIENTS RECEIVE PRIVATE LETTERS/BILLS EACH MONTH INDICATING THEIR BALANCE DUE. PATIENTS WHO HAVE NOT MADE PAYMENTS FOR A 30-DAY PERIOD WILL RECEIVE A LETTER REQUESTING PAYMENT. PATIENTS WHO ARE UNABLE TO PAY THEIR BALANCE WILL BE CONSIDERED FOR CHARITY CARE IF APPROPRIATE. COLLECTION EFFORTS WILL CONTINUE FOR 120 DAYS WITH THE PATIENT/GUARANTOR RECEIVING AT LEAST THREE LETTERS REQUESTING PAYMENT WITHIN SAID 120 DAY PERIOD. ACCOUNTS THAT ARE NOT DEEMED ELIGIBLE FOR CHARITY CARE OR MEDICAL INDIGENCE WILL BE WRITTEN OFF AS BAD DEBT FOLLOWING THE 120 DAY COLLECTION PERIOD. PART VI, LINE 2: SOUTHERN CRESCENT HOSPITAL OF SPECIALTY CARE HAS DEVELOPED THE 2015 COMMUNITY BENEFIT PLAN BASED UPON PRIORITIZATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND STRIVES TO ENSURE BEST PRACTICES AND STANDARDS OF CARE ARE MET. HEALTHCARE PRIORITIES INCLUDE: 1) PRIMARY CARE ACCESS, 2) GEOGRAPHIC DISPARITIES, 3) UNDER/UNINSURED/WORKING POOR, 4) ACCESS TO INFORMATION/REFERRALS, 5) CARDIOVASCULAR DISEASE, DIABETES, RESPIRATORY CANCER AND OTHER CHRONIC DISEASES, 6) SENIOR POPULATION, AND 7) 45-64 YEAR OLD POPULATION GROUPAN ADDITIONAL AREA OF FOCUS OVERLAPPING MANY OF THESE PRIORITIES IS THE ALREADY HIGH AND INCREASING PERCENTAGE OF CONSOLIDATED METROPOLITAN STATISTICAL AREA (CMSA) RESIDENTS OF HISPANIC DESCENT. BARRIERS TO ACCESS HEALTHCARE INCLUDE: 1) LIMITED ACCESS, 2) INABILITY TO PAY FOR SERVICES, 3) LACK OF TRANSPORTATION, AND 4) LANGUAGE BARRIERS AND CULTURAL DIFFERENCES SOCIOECONOMIC FACTORS IMPACTING ACCESS TO HEALTHCARE INCLUDE: 1) LACK OF EMPLOYMENT OPPORTUNITIES, 2) INCREASED NUMBER OF RESIDENTS WITH MEDIAN INCOME OF < $25,000, 3) OVER-UTILIZATION OF EMERGENCY DEPARTMENT (ED) FOR PRIMARY CARE SERVICES, AND 4) DIMINISHED HEALTH COVERAGE PART VI, LINE 3: ALL PATIENTS ARE ASSESSED DURING THE REGISTRATION PROCESS. PATIENTS IDENTIFIED AS POSSIBLE CHARITY CASES WILL BE ASKED TO COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE. PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM BUT ARE NOT CURRENTLY ENROLLED ARE REFERRED TO THE APPROPRIATE PROGRAM. PATIENTS WHO CAN PROVE ELIGIBILITY FOR MEDICAID BUT ARE NOT PATIENTS IN A MEDICAID-APPROVED HOSPITAL WILL BE DEEMED AS INDIGENT AND AUTOMATICALLY QUALIFY FOR CHARITY CARE. PATIENTS ADMITTED TO THE HOSPITAL WITH MEDICARE AS THE ONLY INSURANCE WILL BE MONITORED AS MEDICARE DAYS NEAR DEPLETION. THIRTY DAYS PRIOR TO THE END OF THE MEDICARE COVERAGE, AN INTERVIEW AND AN APPLICATION FOR FINANCIAL ASSISTANCE WILL BE REQUESTED AS APPROPRIATE. THESE PATIENTS ARE ASSESSED AS TO MEETING THE GUIDELINES FOR RECEIVING CHARITY CARE IF THE STAY SHOULD EXCEED MEDICARE COVERAGE LIMITS. AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENT'S FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENT ASSISTANCE, A DETERMINATION IS MADE CONCERNING THE PATIENT'S ELIGIBILITY FOR CHARITY. NO COLLECTION EFFORT IS PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATIONS ARE MADE. PART VI, LINE 4: THE ORGANIZATION SERVES THE PATIENTS IN THE SOUTHERN CRESCENT OF THE METRO ATLANTA AREA. OUR PRIMARY SERVICE AREA INCLUDES CLAYTON COUNTY, FAYETTE COUNTY, HENRY COUNTY AND PORTIONS OF SOUTH FULTON COUNTY. THE SOUTHERN CRESCENT IS A LARGE DIVERSE COMMUNITY AND THE ORGANIZATION OFFERS SERVICES TO MEET THESE VARIED NEEDS. THE STATE OF GEORGIA HAS 12.8% PERSONS 65 YEARS AND OVER AND 17.0% PERSONS BELOW POVERTY LEVEL. CLAYTON COUNTY HAS 8.5% PERSONS 65 YEARS AND OVER AND 23.3% PERSONS BELOW POVERTY LEVEL. FAYETTE COUNT COUNTY HAS 16.9% PERSONS 65 YEARS AND OVER AND 7.0% PERSONS BELOW POVERTY LEVEL. HENRY COUNTY HAS 10.9% PERSONS 65 YEARS AND OVER AND 9.9% PERSONS BELOW POVERTY LEVEL. FULTON COUNTY HAS 10.8% PERSONS 65 YEARS AND OVER AND 16.0% PERSONS BELOW POVERTY LEVEL. PART VI, LINE 5: SURPLUS FUNDS ARE APPLIED EITHER TO COMMUNITY CHARITY CARE NEEDS OR TO OTHER EXEMPT ORGANIZATIONS IN THEIR MISSION TO SUPPORT COMMUNITY NEEDS. ADDITIONALLY, A MAJORITY OF THE GOVERNING BOARD OF THE HOSPITAL IS COMPRISED OF LOCAL PEOPLE FROM THE COMMUNITY TO ENSURE THAT RESIDENTS ARE REPRESENTED. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTHCARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES GA X 0 1 0 0 0 1 0 0 0 JEFF DENNEY CEO 127689 0 0 0 3192 0 0 0 21397 0 152278 0 0 0 PART I, LINE 4B DEFERRED COMPENSATION INCLUDES EXECUTIVE DEFERRED INCOME ACCOUNT, SUPPLEMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN, AND PENSION RESTORATION PLAN. ESTIMATED PENSION BENEFITS WERE CALCULATED BASED ON THE PROVISIONS OF THE CURRENT PENSION RESTORATION PLAN AT 6% OF PENSIONABLE EARNINGS WHICH ARE OVER THE IRS LEGISLATIVE COMPENSATION LIMIT. SOME ASSOCIATES ARE GRANDFATHERED UNDER AN EARLIER LEGACY PENSION PLAN. IF A PARTICIPANT HAS PROTECTED PENSION BENEFITS UNDER SUCH LEGACY PLANS HIS/HER PERCENTAGE IS ZERO UNDER THE SUPPLMENTAL EXECUTIVE RETIREMENT AND RETENTION PLAN, AS THE PROTECTED BENEFIT IS ALREADY EQUAL TO OR BETTER THAN CURRENT MARKET. PART I, LINE 6 CHRISTUS CONTINUING CARE (CCC), THE MANAGEMENT ORGANIZATION, MAINTAINS A PAY FOR PERFORMANCE PLAN APPLICABLE TO EMPLOYEES OF CDHC. AWARDS ARE DETERMINED AT THE END OF EACH FISCAL YEAR. TO BE ELIGIBLE TO RECEIVE AN AWARD, A PARTICIPANT MUST: 1) HAVE BEEN A PLAN PARTICIPANT DURING THE FISCAL YEAR ON WHICH THE AWARDS ARE BASED; 2) HAVE MET BASIC BEHAVORIAL EXPECTATIONS OF MANAGEMENT PERSONNEL; 3) HAVE RECEIVED A "PERFORMING WELL" OVERALL RATING ON HIS/HER ANNUAL PERFORMANCE FEEDBACK/REVIEW FOR THAT FISCAL YEAR; AND 4)EITHER BE EMPLOYED IN A MANAGERIAL POSITION ON THE LAST DAY OF THE FISCAL YEAR OR HAVE TERMINATED EMPLOYMENT WITH CCC DURING THE FISCAL YEAR DUE TO DEATH, DISABILITY, RETIREMENT ON OR AFTER AGE 55, INVOLUNTARY TERMINATION AS A RESULT OF ELIMINATION OF SUCH PARTICIPANT'S EMPLOYMENT POSITION, OR THE ACCEPTANCE OF AN INVOLUNTARY TRANSFER TO AN INELIGIBLE POSITION. FINALLY, ANY PREREQUISITE TARGET (I.E. REGIONAL TRIGGERS) ESTABLISHED MUST BE ACHIEVED BEFORE AWARDS ARE GRANTED. FORM 990, PART VI, SECTION A, LINE 1 AN EXECUTIVE COMMITTEE MAY BE FORMED AND, IF SO, SHALL ACT IN ACCORDANCE WITH THIS SECTION 5-2.1. THE EXECUTIVE COMMITTEE SHALL CONSIST OF AT LEAST THREE (3) MEMBERS OF THE BOARD ELECTED BY THE BOARD AT ITS ANNUAL MEETING. A CHAIRPERSON SHALL BE DESIGNATED BY THE BOARD FROM AMONG THE VOTING MEMBERS. THE EXECUTIVE COMMITTEE, WHEN THE BOARD IS NOT IN SESSION SHALL HAVE AND EXERCISE ALL OF THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE CORPORATION EXCEPT AS SUCH AUTHORITY IS LIMITED BY STATUTE, ARTICLES OF INCORPORATION OR MAY BE LIMITED BY RESOLUTION OF THE BOARD APPOINTING THE EXECUTIVE COMMITTEE. THE SECRETARY OF THE CORPORATION SHALL KEEP MINUTES OF ALL EXECUTIVE COMMITTEE ACTIONS. IT SHALL SUBMIT ITS MINUTES TO THE FULL BOARD QUARTERLY FOR RATIFICATION AND FOR ITS INFORMATION. THE EXECUTIVE COMMITTEE SHALL ALSO FUNCTION AS A FINANCE COMMITTEE, AND IT SHALL DETERMINE THE FINANCIAL FEASIBILITY OF PROJECTS REFERRED TO IT BY THE BOARD. IT MAY CONSIDER MATTERS RELATIVE TO RATE STRUCTURE, CREDIT AND COLLECTIONS, COSTS, CAPITAL FINANCING, FINANCIAL REPORTING, INTERNAL CONTROLS AND INTERNAL AND EXTERNAL AUDITS. IN ADDITION, IT SHALL REVIEW THE CORPORATION'S COMPLIANCE WITH THE BUDGETS APPROVED BY THE BOARD AND QUARTERLY BUGET EXPERIENCE, AND MAKE APPROPRIATE RECOMMENDATIONS TO THE BOARD. IT SHALL REVIEW PERIODIC FINANCIAL STATEMENTS AND APPRISE THE BOARD OF THE CORPORATION'S OFFICERS AND AGENTS ON BOTH CURRENT AND LONG TERM FISCAL AFFAIRS AND PERFORM SUCH OTHER DUTIES AS MAY BE ASSIGNED TO IT BY THE BOARD. FORM 990, PART VI, SECTION A, LINE 3 SOUTHERN CRESCENT HOSPITAL IS MANAGED BY CHRISTUS CONTINUING CARE (D/B/A "CHRISTUS DUBUIS HEALTH SYSTEM"). THE EMPLOYEES OF CHRISTUS CONTINUING CARE ARE LEASED TO SOUTHERN CRESCENT HOSPITAL TO PERFORM SERVICES. ALL EMPLOYEE POLICIES OF CHRISTUS CONTINUING CARE APPLY TO EMPLOYEES WORKING WITHIN CHRISTUS CONTINUING CARE AND EMPLOYEES LEASED TO SOUTHERN CRESCENT HOSPITAL. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE MANAGEMENT ORGANIZATION, CCC, REVIEWS THE PREPARED RETURN FOR ACCURACY. UPON COMPLETION OF THE FINAL FORM BY THE INDEPENDENT ACCOUNTING FIRM, THE FORM 990 IS SUBMITTED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPOVAL PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MAINTAINS SEPARATE CONFLICT OF INTEREST POLICIES FOR EMPLOYEES OF THE ORGANIZATION AND FOR THE MEMBERS OF THE BOARD OF DIRECTORS. BOTH POLICIES REQUIRE ANNUAL DISCLOSURE OF ANY CONFLICTS OF INTEREST. THE EMPLOYEE POLICY INCLUDES OFFICERS, MEDICAL DIRECTORS AND OTHER DIRECTORS, AND ALL OTHER ASSOCIATES. THE EMPLOYEE DISCLOSURE IS REVIEWED BY THE EMPLOYEE'S IMMEDIATE SUPERVISOR. IN ADDITION, KEY LEADERS MUST CERTIFY ANNUALLY THEIR RECEIPT AND UNDERSTANDING OF THE CONFLICT OF INTEREST POLICY. IF ANY CONFLICTS ARE PRESENT, THE EMPLOYEE AND THE ORGANIZATION'S ADMINISTRATION WILL IMPLEMENT A MUTUALLY AGREED UPON PLAN TO RESOLVE THE CONFLICT. IN ADDITION, THE ORGANIZATION IMPLEMENTS AN INTEGRITY PROGRAM TO SUPPORT AND MAINTAIN THE CORPORATE INTEGRITY OF THE ORGANIZATION. THE POLICY FOR THE MEMBERS OF THE BOARD OF DIRECTORS REQUIRES ANY BOARD MEMBER, UPON DETERMINATION OF A CONFLICT OF INTEREST, TO ABSENT HIMSELF OR HERSELF WITHOUT COMMENT FROM NOT ONLY THE VOTE BUT ALSO FROM THE DELIBERATION. BOARD MEMBERS ARE NOT ALLOWED TO BE EMPLOYED BY THE ORGANIZATION UNLESS THEY HAVE FIRST RESIGNED FROM THE BOARD. IN ADDITION, AT THE BEGINNING OF EACH BOARD MEETING, THE BOARD CHAIR ASKS THE BOARD MEMBERS TO REVIEW THE AGENDA AND SHARE ANY POTENTIAL CONFLICTS OF INTEREST PRIOR TO THE BEGINNING OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 15A THE SALARY FOR THE PRESIDENT/CHAIRMAN OF THE BOARD OF DIRECTORS WAS DETERMINED WHEN THE ORGANIZATION WAS INCORPORATED AND WAS BASED ON COMPARATIVE SALARIES FROM PREVIOUS BOARD ASSIGNMENTS. IN DETERMINING THE SALARY FOR THE CEO, THE BOARD APPROVED PROCEDURES USED BY THE MANAGEMENT ORGANIZATION, CHRISTUS CONTINUING CARE (CCC). CCC USES THE SAME PROCEDURE FOR THE CEO AS IS USED FOR ALL OTHER EMPLOYEES. THE HUMAN RESOURCES DEPARTMENT USES CITY AND STATE SALARY SURVEYS AVAILABLE TO THE PUBLIC AND COMPARATIVE SALARY RATES USED IN THE VARIOUS HOST HOSPITALS. THE SALARY RATES ARE PERIODICALLY REVIEWED BY THE HUMAN RESOURCES DEPARTMENT AND REVISED BASED ON CHANGES IN THE MARKET PLACE. A SURVEY WAS CONDUCTED BY SULLIVAN COTTER IN 2010 CONFIRMING CURRENT SALARY LEVELS ARE COMPARABLE TO OTHER ORGANIZATIONS AND REASONABLE. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE MADE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,387,052. MANAGEMENT AND GENERAL EXPENSES 49,494. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,436,546. PHYSICIAN & MEDICAL FEES: PROGRAM SERVICE EXPENSES 40,663. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,663. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 9,057. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,057. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 357,234. MANAGEMENT AND GENERAL EXPENSES 1,555. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 358,789. FORM 990, PART V, LINE 2: SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE ENTERED INTO A MANAGEMENT AGREEMENT WITH CHRISTUS CONTINUING CARE, AN UNRELATED ORGANIZATION. AS PROVIDED BY THE MANAGEMENT AGREEMENT, CHRISTUS CONTINUING CARE AGREES TO PROVIDE TO THE HOSPITAL AN ADMINISTRATOR AND ALL OTHER EMPLOYEES REQUIRED TO STAFF THE HOSPITAL. SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PAYS DIRECTLY FROM THEIR BANK ACCOUNT THE SALARIES OF ALL EMPLOYEES OTHER THAN THE ADMINISTRATOR AND REIMBURSES CHRISTUS CONTINUING CARE FOR THE SALARY EXPENSE OF THE ADMINISTRATOR AND THE PAYROLL TAXES AND EMPLOYEE BENEFITS ASSOCIATED WITH THE ADMINISTRATOR AND ALL OTHER EMPLOYEES. UNDER THIS ARRANGEMENT THERE ARE NO EMPLOYEES OF SOUTHERN CRESCENT HOSPITAL AND THUS NO FORMS W-2 ISSUED BY SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE; HOWEVER, THE EXPENSES RELATED TO THESE EMPLOYEES ARE SHOWN AS SALARY, PAYROLL TAX AND EMPLOYEE BENEFIT EXPENSES ON FORM 990 PART IX.