2017-08-08T10:55:27-04:00 2016-09-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2015-10-01 580566121 JOHN D ARCHBOLD MEMORIAL HOSPITAL INC JOHN 2292282853 P O BOX 1018 THOMASVILLE GA 317991018 J PERRY MUSTIAN PRESIDENT/CEO 2292282737 2017-08-15 true JACQUELINE G ATKINS P00861721 2298837878 2017-08-02 2015 2021-01-29 14:40:06Z J PERRY MUSTIAN P O BOX 1018 THOMASVILLE GA 317991018 332099708 false X WWW.ARCHBOLD.ORG X 1923 GA HEALTHCARE SERVICES 20 5 0 112 1066028 8951237 5796587 310010448 320481788 1627490 2279780 2801737 2679176 323390912 331237331 578106 558097 0 119343852 128238139 0 0 163590637 172221034 283512595 301017270 39878317 30220061 616656098 652733673 155175929 160043559 461480169 492690114 X HEALTHCARE SERVICES false false 206845580 558097 260859359 JOHN D. ARCHBOLD MEMORIAL HOSPITAL (JDAMH) IN THOMASVILLE GEORGIA OPERATES WITH 264 LICENSED BEDS; OF WHICH 204 ARE MED/SURG, 40 BEDS ARE DESIGNATED TO A PSYCH UNIT, 20 BEDS ARE REHAB. IN ADDITION, THEY OPERATE A 64 BED SKILLED NURSING FACILITY. JDAMH IS A RURAL REFERRAL CENTER COVERING THOMAS COUNTY AND SURROUNDING COUNTIES IN SOUTHERN GEORGIA AND NORTHERN FLORIDA. 70% OF PATIENTS WERE COVERED BY MEDICARE AND MEDICAID, AND 4.0% OF PATIENT REVENUE WAS PROVIDED AS INDIGENT CARE. IN 2016, JDAMH PROVIDED OVER 22.4 MILLION IN INDIGENT CARE CHARGES. JDAMH TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION JDAMH PROVIDED APPROXIMATELY 45.4 MILLION IN ADDITIONAL UNCOMPENSATED CARE. THROUGHOUT THE YEAR, JDAMH PRODUCES OR SPONSORS MANY SPECIAL PROGRAMS FOR THE COMMUNITY TO EDUCATE THEM ON IMPORTANT HEALTH NEEDS. JDAMH, INC. ALSO MAINTAINS HOSPITALS IN GRADY COUNTY, BROOKS COUNTY, AND MITCHELL COUNTY, FILING UNDER EIN 58-0566121. 16210345 24024888 GRADY GENERAL HOSPITAL (GGH) IN CAIRO, GEORGIA OPERATES A 60 LICENSED BED ACUTE CARE FACILITY. TEN BEDS CAN BE USED AS SWING BEDS. IT SERVES GRADY COUNTY AND 60% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2016, GGH PROVIDED OVER 1.9 MILLION IN INDIGENT CARE. IN ADDITION, GRADY GENERAL HOSPITAL PROVIDED OVER 9.2 MILLION IN ADDITIONAL UNCOMPENSATED CARE. EIN 58-1646537 FILED UNDER EIN 58-0566121. 9178944 9562555 BROOKS COUNTY HOSPITAL OPERATES IN QUITMAN, GEORGIA AS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE CARE BEDS. IT SERVES BROOKS COUNTY AND 68% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2016, OVER 3.5 MILLION OF INDIGENT CARE WAS PROVIDED TO THE COMMUNITY. IN ADDITION, BROOKS COUNTY HOSPITAL PROVIDED OVER 1.4 MILLION IN ADDITIONAL UNCOMPENSATED CARE. EIN 58-6002830 FILED UNDER EIN 58-0566121. 19646303 25735537 MITCHELL COUNTY HOSPITAL AND NURSING HOMES OPERATE IN CAMILLA, GEORGIA AS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE CARE BEDS AND 156 NURSING HOME BEDS. IT SERVES MITCHELL COUNTY AND 64% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2016, OVER 5.8 MILLION OF INDIGENT CARE WAS PROVIDED TO THE COMMUNITY. IN ADDITION, MITCHELL COUNTY HOSPITAL PROVIDED OVER 3.0 MILLION ADDITIONAL UNCOMPENSATED CARE. EIN 58-6001207 FILED UNDER EIN 58-0566121. 19646303 25735537 251881172 true true false true false false false false false true true false false true false true false true false false false false false false false false true true true true true true false false false false false false false true true true false false false false false true false false false true 212 0 0 true true false false false false false false false false false X 20 5 true false false false true true true true true false false false true true true true true false true false GA X GREG HEMBREE 2292282853 PO BOX 1018 THOMASVILLE GA 317991018 J PERRY MUSTIAN PRESIDENT/CE 1.00 49.00 X X 0 805868 915117 DARYL CRENSHAW MD TRUSTEE 1.00 40.00 X 0 744241 14952 JASON NESMITH MD TRUSTEE 1.00 40.00 X 0 316705 12632 JAMES S KARAS MD TRUSTEE 1.00 1.00 X 9400 0 0 JOHN B CARICO MD PAST TRUSTEE 1.00 1.00 X 0 1000 0 HAILE MCCOLLUM CHAIRMAN 1.00 2.00 X X 0 0 0 CHARLES R SANDERS JR MD VICE CHAIRMA 1.00 X X 0 0 0 IMOGENE CONYERS SECRETARY 1.00 1.00 X X 0 0 0 NATHANIEL H ABRAMS JR TREASURER 1.00 1.00 X X 0 0 0 VICTOR MCMILLAN TRUSTEE 1.00 1.00 X 0 0 0 SUZANNE ANDERSON TRUSTEE 1.00 X 0 0 0 CORDELL BRAGG MD TRUSTEE 1.00 1.00 X 0 0 0 JOE BROWN TRUSTEE 1.00 X 0 0 0 MELISSA S BRUHN TRUSTEE 1.00 1.00 X 0 0 0 THOMAS J CALLAWAY III TRUSTEE 1.00 1.00 X 0 0 0 CLARK CONNELL MD TRUSTEE 1.00 X 0 0 0 JAMES TREY W FALCONER III MD TRUSTEE 1.00 X 0 0 0 DEBORAH GASKINS TRUSTEE 1.00 X 0 0 0 GREG HAMIL TRUSTEE 1.00 1.00 X 0 0 0 JANET SCHMIDT TRUSTEE 1.00 1.00 X 0 0 0 ALSTON WATT TRUSTEE 1.00 X 0 0 0 BENJAMIN WILDS MD PAST TRUSTEE 1.00 1.00 X 0 0 0 GARY BONVILLIAN PHD PAST TRUSTEE 1.00 1.00 X 0 0 0 BRYANT BEADLES PAST TRUSTEE 1.00 1.00 X 0 0 0 TIMOTHY GRAYSON MD PAST TRUSTEE 1.00 X 0 0 0 MARTA TURNER PAST TRUSTEE 1.00 1.00 X 0 0 0 WALLACE GOODMAN PAST TRUSTEE 1.00 2.00 X 0 0 0 STEPHEN R AVERA PAST TRUSTEE 1.00 1.00 X 0 0 0 CHARLES D HIGHTOWER JR ASST SEC/CFO 1.00 49.00 X 0 499921 27955 JIM CARTER COO 40.00 X 297299 0 41423 MEL HARTSFIELD MD VP MEDICAL A 40.00 X 384049 0 45125 KEN BROOKER VP CLINICAL 40.00 X 259825 0 26021 AMY GRIFFIN VP PATIENT C 40.00 X 248418 0 30552 LADON TOOLE VP NETWORK O 40.00 X 219959 0 27893 JIM BUE VP FACILITY 40.00 X 207857 0 9471 JOSH MOORE VP OPERATION 40.00 X 199027 0 23471 JOE BARRON ASST VP HEAR 40.00 X 186814 0 9651 STEPHEN RUBENDALL MD PHYSICIAN 40.00 X 355251 0 12809 DINESH B PATEL MD PHYSICIAN 40.00 X 326523 0 15585 JASON H SMITH MD PHYSICIAN 40.00 X 285909 0 38983 MICHAEL K SOPT MD PHYSICIAN 40.00 X 273380 0 10785 RAMESAN NAIR MD PHYSICIAN 40.00 X 272771 0 12585 3526482 2367735 1275010 102 false true false RED HILLS RADIOLOGY 714 N DAWSON STREET THOMASVILLE GA 317924451 RADIOLOGY SVC 6986807 MORRISON MANAGEMENT SPECIALISTS 5801 PEACHTREE DUNWOODY RD ATLANTA GA 303421503 DIETARY SVCS 6333247 THOMASVILLE PHYSICAL THERAPY P O BOX 2476 THOMASVILLE GA 31799 REHAB SVCS 3217106 SOUTH GEORGIA EMERGENCY MEDICINE P O BOX 1913 THOMASVILLE GA 317991913 ER PHYSICIAN 2591935 SOUTHLAND HOSPITALIST GROUP PO BOX 1276 THOMASVILLE GA 317991276 HOSPITALIST SVC 2425340 45 351745 5444842 5796587 PATIENT SERVICE REVENUE 623000 319415760 319415760 LAB SERVICES 621500 1066028 1066028 320481788 2590130 2590130 977349 110161 867188 867188 867188 180150 490500 -310350 -310350 -310350 421180 261716 159464 159464 DRUG SALES 621990 884304 884304 RESEARCH STUDIES 722210 274709 274709 MISCELLANOUS REVENUE 623000 222051 222051 271460 269819 1641 1652524 331237331 320182339 1066028 4192377 X 96000 96000 462097 462097 2361080 10400 2350680 100427822 86421838 14005984 1662334 1544654 117680 14732042 12456383 2275659 9054861 7630344 1424517 364266 364266 32363 32363 99456 99456 47351377 39630535 7720842 271088 32278 238810 24955386 13961452 10993934 1799059 1785010 14049 9590474 8506750 1083724 991789 730193 261596 68363 68363 24854249 22045719 2808530 2092017 2092017 MEDICAL SUPPLIES JDAMH 46561967 46561967 PROVIDER FEES 4529836 4529836 REPAIRS & MAINTENANCE JDA 2833107 2543057 290050 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PARTIES 67462871 OTHER RECEIVABLES 16271511 DUE FROM MEDICARE/MEDICAID 4809637 DUE FROM SELF INSURANCE TRUST 3559129 PHYSICIAN RECEIVABLES 2258458 DEFERRED BOND ISSUE COST - 2003 1699674 SCHOLARSHIP/TUITION RECEIVABLE 1678128 INTEREST RECEIVABLE 616354 98355762 X SCHEDULE D, PAGE 2, PART V, LINE 4 ENDOWMENT FUNDS RESTRICTED BY DONORS ARE HELD IN A PERMANENT HEALTHCARE ENDOWMENT FUND WHICH WAS ESTABLISHED TO SUPPORT HEALTH CARE SERVICES. SCHEDULE D, PAGE 3, PART X THE MEDICAL CENTER, WITH THE EXCEPTION OF ARCHBOLD MEDICAL ENTERPRISES, INC., IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX- EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE CONSOLIDATED 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 MEDICAL CENTER 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 MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2016 AND 2015 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTER'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. true true X true X true X 3.250000000000 true true true false false 10200893 10200893 0.03380 32540840 32381846 158994 0.00050 405579 348594 56985 0.00020 43147312 32730440 10416872 0.03450 609133 609133 0.00200 1393242 1393242 0.00460 16881798 16881798 0.05600 96000 96000 0.00030 18980173 18980173 0.06290 62127485 32730440 29397045 0.09740 27662 27662 0.00010 27662 27662 0.00010 true 59025013 84565900 91518232 -6952332 X true true 4 1 JOHN D ARCHBOLD MEM HOSP P O BOX 1018 THOMASVILLE GA 317991018 WWW.ARCHBOLD.ORG 136-91 X X X PSYCH, REHAB, NURSING HOME A 2 GRADY GENERAL HOSPITAL 1155 FIFTH STREET SE CAIRO GA 31728 WWW.ARCHBOLD.ORG 065-413 X X X SWING BED SNF A 3 BROOKS COUNTY HOSPITAL 903 N COURT ST QUITMAN GA 31643 WWW.ARCHBOLD.ORG 014-028 X X X RHC; SWING BED SNF A 4 MITCHELL COUNTY HOSPITAL 90 STEPHENS ST CAMILLA GA 31730 WWW.ARCHBOLD.ORG 101-120 X X X NURSING HOME, RHC, SWING BED A A 1234 false false true X X X X X X X X X X 16 true true false true X WWW.ARCHBOLD.ORG X X true 16 true WWW.ARCHBOLD.ORG false false true X 200.000000000000 325.000000000000 X true true X X X true X WWWARCHBOLDORG X WWWARCHBOLDORG X WWWARCHBOLDORG X X X X X true X true X X X X true X false false GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 5 INPUT FROM COMMUNITY MEMBERS REPRESENTING THE BROADER INTERESTS OF THE COUNTY WAS GATHERED THROUGH A COMBINATION OF WRITTEN SURVEYS, TELEPHONE INTERVIEWS AND IN-PERSON MEETINGS. WE RELIED MORE ON WRITTEN SURVEYS FOR THIS CHNA THAN IN THE 2013-2014 CHNA TO BE ABLE TO HAVE A TOOL THAT WAS MORE COMPARABLE. SURVEY QUESTIONS INCLUDED MULTIPLE CHOICE AND OPEN-ENDED ANSWERS. INPUT WAS GATHERED FROM THE FOLLOWING SOURCES FROM JUNE 3JULY 25, 2016: . DOUGLASS HIGH SCHOOL ALUMNI ASSOCIATIONGROUP MEETING AND WRITTEN SURVEYS . GEORGIA DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES WRITTEN SURVEYS . MAGNOLIA HIGH SCHOOL ALUMNIWRITTEN SURVEYS . SOUTHWEST GEORGIA TECHNICAL COLLEGE NURSING AND FACULTY MEMBERSWRITTEN SURVEYS . THOMAS COUNTY FAMILY CONNECTION WRITTEN SURVEYS . THOMAS COUNTY HEALTH DEPARTMENT(TYPICALLY REPRESENTING LOW- INCOME/MINORITY/MEDICALLY UNDERSERVED POPULATION)WRITTEN SURVEYS AND TELEPHONE INTERVIEW GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 6A THE NEEDS ASSESSMENT WAS CONDUCTED FOR JOHN D. ARCHBOLD MEMORIAL HOSPITAL ALONG WITH GRADY GENERAL HOSPITAL, BROOKS COUNTY HOSPITAL AND MITCHELL COUNTY HOSPITAL. GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 7D DISTRIBUTED COPIES TO THE COMMUNITY; AVAILABLE ONLINE GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 11 QUALITATIVELY, THE GREATEST MEDICAL NEEDS ACCORDING TO COMMUNITY PERCEPTION INCLUDED: 1. HIGH BLOOD PRESSURE 2. OBESITY 3. DIABETES 4. MENTAL HEALTH ISSUES 5. HEART DISEASE 6. BACK/JOINT PAIN 7. STROKE 8. DRUG ADDICTION 9. LUNG DISEASE 10. ALCOHOL ABUSE SETTING PRIORITIES OUR FIRST STEP WAS TO DETERMINE HOW WE COULD HAVE THE MOST IMPACT ON IMPROVING THE HEALTH OF OUR COMMUNITY GIVEN AVAILABLE RESOURCES, GREATER FINANCIAL CONSTRAINTS, AND NOT TAKING ON COMMITMENTS THAT WERE BEST SERVED BY OTHER COMMUNITY ENTITIES. IN THE 2013-14 CHNA, WE NOTED THAT THE COMMUNITIES WE SERVE REPRESENT THE SOME OF UNHEALTHIEST COUNTIES IN THE COUNTRY. WE ALSO NOTED THAT OBESITY IS THE COMMON DENOMINATOR WITH MANY OF THE SAME DISEASE STATES WE ALREADY IDENTIFIED AS AREAS TO ADDRESS. IF WE REDUCE OBESITY, WE HAVE GREAT POTENTIAL TO REVERSE NEGATIVE TRENDS IN HEART DISEASE, STROKE, COPD, SLEEP DISORDERS, VASCULAR DISEASE, DIABETES, CANCER, ARTHRITIS, SPINE PROBLEMS AND OTHER CONDITIONS. WE PLAN TO CONTINUE PREVENTION AND EARLY DETECTION EFFORTS, BUT PRIMARILY THROUGH FOCUSING ON OBESITY. AND ALTHOUGH OBESITY WILL BE OUR FOCUS, THERE IS STILL A NEED TO ADDRESS OTHER KEY HEALTH ISSUES INDIVIDUALLY WITH SIMILAR TACTICS. WE WILL CONTINUE TO USE DOCTORS, MID-LEVELS, NURSES AND OTHER CLINICIANS FOR EDUCATION AND SCREENINGS AS NEEDED. IN ADDITION TO A FULL-TIME CLINICAL OUTREACH MANAGER, WE WILL PROVIDE PART-TIME CLINICAL STAFF, LABORATORY USE CLINICAL SUPPLIES AND RESOURCES FOR OTHER CONTINGENCIES. ULTIMATELY, THOUGH, WE WISH TO CHANGE THE CULTURE IN THOMAS COUNTY TO THE POINT THAT THE CONCEPTS, PROGRAMS AND LIFESTYLES PROMOTED AND DELIVERED THROUGH LIVE BETTER BECOME THE NORM, AND NOT A DEFINED HEALTH INITIATIVE. NEEDS NOT ADDRESSED NOT ALL HEALTH NEEDS ARE EASILY ADDRESSED BY ARCHBOLD. FURTHER, KEEPING TOO BROAD OF A FOCUS WILL DILUTE THE IMPACT WE CAN HAVE ON EACH HEALTH NEED. THESE ARE SOME OF THE PRIMARY REASONS WE ARE NO LONGER INCLUDING TEEN PREGNANCY AND SUBSTANCE ABUSE IN OUR IMPLEMENTATION PLAN. OUR BIGGEST OPPORTUNITY IS TO HELP WITH IMPROVING DISEASE STATES, REMAINING AVAILABLE FOR ASSISTANCE WITH OTHER HEALTH NEEDS AS REQUESTED AND AS TIME AND FINANCES PERMIT. WE WILL ADDRESS MENTAL HEALTH ISSUES, BUT MORE FROM OUR PSYCHIATRIC SERVICE LINE THAN THROUGH CLINICAL OUTREACH/COMMUNITY BENEFIT. GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 22D ALL HOSPITALS - 10% OF THE FAMILY LIMIT OF ONE-SLIDING FEE SCHEDULE. 13 GLENN-MOR NURSING HOME 10629 U S HIGHWAY 19 S THOMASVILLE GA 31792 SKILLED NURSING HOME JDA PSYCHIATRIC UNIT P O BOX 1018 THOMASVILLE GA 31792 PSYCHIATRIC UNIT JDA REHABILITATION UNIT P O BOX 1018 THOMASVILLE GA 31792 REHABILITATION UNIT DECATUR COUNTY DIALYSIS FACILITY P O BOX 1018 THOMASVILLE GA 31792 DIALYSIS FACILITY MITCHELL COUNTY DIALYSIS FACILITY P O BOX 1018 THOMASVILLE GA 31792 DIALYSIS FACILITY BROOKS COUNTY DIALYSIS FACILITY P O BOX 1018 THOMASVILLE GA 31792 DIALYSIS FACILITY GRADY COUNTY DIALYSIS FACILITY P O BOX 1018 THOMASVILLE GA 31792 DIALYSIS FACILITY SOUTHWEST GA DIALYSIS FACILITY P O BOX 1018 THOMASVILLE GA 31792 DIALYSIS FACILITY BROOKS MEDICAL ASSOCIATES P O BOX 5000 QUITMAN GA 31643 RURAL HEALTH CLINIC MITCHELL CO CONVALESCENT CENTER 90 STEPHENS STREET CAMILLA GA 31728 SKILLED NURSING HOME CAMILLA PEDIATRICS CENTER P O BOX 360 CAMILLA GA 31728 RURAL HEALTH CLINIC MEDICAL GROUP OF MITCHELL COUNTY P O BOX 360 CAMILLA GA 31728 RURAL HEALTH CLINIC ARCHBOLD PELHAM PRIMARY CARE CLINIC P O BOX 360 CAMILLA GA 31728 RURAL HEALTH CLINIC 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 25 301,017,270 ADD: EXPENSES REPORTED IN PART VIII 371,877 DENOMINATOR FOR COLUMN (F) 301,389,147 PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE ORGANIZATION USES THE COST TO CHARGE RATIO USING THE IRS' RECOMMENDED FORMAT IN WORKSHEET 2. OTHER COSTS IN PART I LINES 7E THROUGH 7I WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. PART II - COMMUNITY BUILDING ACTIVITIES ECONOMIC AND WORKFORCE DEVELOPMENT THROUGH HEALTH EDUCATION IMPROVES LEVEL OF CARE IN COMMUNITIES SERVED. OPPORTUNITIES TO REALIZE ACCESS TO CARE ARE MADE KNOWN TO SCREENING PARTICIPANTS. 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 THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE ON PAGE 10 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 PATIENTS THAT ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE APPROVED FOR A PERIOD OF 6 MONTHS. THE PATIENTS ARE REQUIRED TO CONTACT THE FINANCIAL ASSISTANCE OFFICE DURING THIS POINT IF THEY INCUR ADDITIONAL CHARGES THAT QUALIFY FOR FINANCIAL ASSISTANCE DURING THIS TIME PERIOD. THE SAME PROCESS IS IN EFFECT FOR THE PATIENTS WHO QUALIFY FOR THE SLIDING FEE DISCOUNT. THIS DISCOUNT WILL LIMIT THE PATIENTS TO AN OUT OF POCKET MAXIMUM AMOUNT IN THE GIVEN TIME PERIOD. WE DO NOT HAVE ANY AUTOMATIC ADJUSTMENTS OR AN AUTOMATED SYSTEM TO TRACK THE PREVIOUSLY APPROVED PATIENTS. PART VI, LINE 2 - NEEDS ASSESSMENT REVIEW OF ASSESSMENTS OF OTHER ORGANIZATIONS THAT IDENTIFY NEEDS AND HAVE ON-GOING PARTICIPATION WITH THOSE ORGANIZATIONS. COLLECT, REVIEW AND USE PRIMARY,SECONDARY AND QUALITATIVE DATA IN DETERMINING NEEDS. UPDATE COMMUNITY HEALTH STATUS AS LOCAL, STATE AND FEDERAL DATA IS REPORTED. REVIEW INTERNAL DATA SUCH AS SCREENING OUTCOMES AND PATIENT VOLUMES FOR SERVICES. RESPONSE TO REQUESTS FROM COMMUNITY, INPUT FROM A GROUP MEETING OF THE DOUGLASS HIGH SCHOOL ALUMNI ASSOCIATION, SEVERAL WRITTEN SURVEYS AND A TELEPHONE INTERVIEW. THE ORGANIZATION ANALYZES QUANTITATIVE FEDERAL, STATE AND LOCAL DATA AS WELL AS SEEKS QUALITATIVE INPUT FROM MEMBERS OF THE COMMUNITY, ESPECIALLY THE UNDERSERVED. THE ORGANIZATION ALSO ASSESSES THE NEEDS OF THE COMMUNITY THROUGH UTILIZING ASSESSMENTS CONDUCTED BY OTHER COMMUNITY ORGANIZATIONS, REVIEWING INTERNAL DATA ON PATIENT VOLUMES AND SCREENING OUTCOMES, PARTICIPATING IN COMMUNITY ORGANIZATIONS THAT IDENTIFY NEEDS, SPONSORING COMMUNITY EDUCATION TASK FORCES THAT PROVIDE INPUT AND RESPONDING TO SPECIFIC REQUESTS FROM COMMUNITY MEMBERS. COPIES OF THE 2016-2017 CHNA'S AND THE RELATED IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING WEB ADDRESSES: HTTPS://ARCHBOLD.ORG/UPLOADS/GROUPS/3/DOCUMENTS/BROOKS-KEYHEALTHISSUES- 2016-AUG18.PDF HTTPS://ARCHBOLD.ORG/UPLOADS/GROUPS/3/DOCUMENTS/GRADY-KEYHEALTHISSUES-2016 -AUG18.PDF HTTPS://ARCHBOLD.ORG/UPLOADS/GROUPS/3/DOCUMENTS/MITCHELL-KEYHEALTHISSUES- 2016-AUG18.PDF HTTPS://ARCHBOLD.ORG/UPLOADS/GROUPS/3/DOCUMENTS/THOMAS-KEYHEALTHISSUES- 2016-AUG18.PDF PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ANNUAL NOTICES ARE PLACED IN THE NEWSPAPERS FOR THE COUNTIES WE SERVE WITH HEALTHCARE. NOTICE OF THE FAP PROGRAM IS CONTAINED IN THE PATIENT HANDBOOK, SIGNS AND BROCHURES OUTLINING THE AVAILABILITY OF THE FAP PROGRAM ARE AVAILABLE AT POINTS OF ACCESS FOR PATIENTS, PAPER APPLICATIONS ARE AVAILABLE AT ALL ADMISSION AREAS AND BUSINESS OFFICES, ELECTRONIC VERSION OF THE APPLICATION CAN BE DOWNLOADED FREE OF CHARGE VIA WEBSITE AND THE ASSISTANCE PROGRAM IS DISCUSSED IN DETAIL DURING COLLECTION CALLS WITH PATIENTS. PART VI, LINE 4 - COMMUNITY INFORMATION COUNTIES SERVED IN GEORGIA INCLUDE BROOKS, GRADY, MITCHELL, THOMAS. DISPROPORTIONATE HEALTHCARE NEEDS, FEDERALLY DESIGNATED AS MEDICALLY UNDERSERVED AREAS(MUA) OR HEALTH PROFESSIONAL SHORTAGE AREAS(HSPA), LOW- INCOME, PUBLIC HOUSING RESIDENTS, SENIORS, MIGRANT WORKERS, UNINSURED, UNDERINSURED, MIXTURE OF ETHNICITIES, ALL AGES, MIXTURE OF EDUCATIONAL LEVELS. BROOKS COUNTY: ESTIMATED POPULATION 15,687; 62.2% WHITE/35.4% BLACK; MEDIAN HOUSEHOLD INCOME 32,663; 25.4% LIVING IN POVERTY; 19.4% UNDER 65 UNINSURED. GRADY COUNTY: ESTIMATED POPULATION 24,808; 67.4% WHITE/29.1% BLACK; MEDIAN HOUSEHOLD INCOME 34,187; 29.3% LIVING IN POVERTY; 22.3% UNDER 65 UNINSURED. MITCHELL COUNTY: ESTIMATED POPULATION 22,459; 49.8% WHITE/48.0% BLACK; MEDIAN HOUSEHOLD INCOME 31,915; 28.0% LIVING IN POVERTY; 17.9% UNDER 65 UNINSURED. THOMAS COUNTY: ESTIMATED POPULATION 45,248; 60.5% WHITE/36.8% BLACK; MEDIAN HOUSEHOLD INCOME 36,641; 21.7% LIVING IN POVERTY; 16.0% UNDER 65 UNINSURED. INFORMATION OBTAINED FROM WWW.CENSUS.GOV PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH LIVE BETTER IS THE NAME THAT REPRESENTS AN ARCHBOLD-LED EFFORT OF KEY COMMUNITY LEADERS AND COMMUNITY FOCUSED ON IMPROVING THE HEALTH OF THE CITIZENS OF THOMAS COUNTY. LIVE BETTER IS STEERED BY LEADERS OF MAJOR SECTORS OF THE COMMUNITY (GOVERNMENT, EDUCATION, MEDIA, BUSINESS) THAT ARE WORKING TOGETHER WITH ARCHBOLD TO LEVERAGE THE STRENGTHS OF THEIR ORGANIZATIONS TO ACHIEVE MEASURED HEALTH GOALS. THE GROUP HAS MEASURABLE GOALS TO REDUCE THE OBESITY RATE IN THOMAS COUNTY, THE BIGGEST COMMON DENOMINATOR OF POOR HEALTH. OBESITY IS A PREVENTABLE CONDITION, YET THE COMMON RISK FACTOR WITH THE MOST PROMINENT HEALTH ISSUES IN THOMAS COUNTY: HEART DISEASE, HYPERTENSION, STROKE, COPD, VASCULAR DISEASE, DIABETES AND CANCER. THE GOVERNING BODIES OF ALL JDAMH'S HOSPITAL FACILITIES ARE PRIMARILY COMPRISED OF PERSONS WHO ARE NOT EMPLOYEES OR CONTRACTORS (NOR FAMILY MEMBERS THEREOF) AND WHO REPRESENT A BROAD SPECTRUM OF THE COMMUNITY. THE HOSPITALS' MEDICAL STAFFS ARE OPEN TO ALL QUALIFIED PHYSICIANS IN THE REGION. SURPLUS FUNDS ARE REINVESTED IN THE FACILITIES AND OPERATIONS. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM ARCHBOLD MEDICAL CENTER, INC. (MEDICAL CENTER) AS THE PARENT CORPORATION HAS SOLE CONTROL OVER ITS NONPROFIT SUBSIDIARIES, JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC., ARCHBOLD HEALTH SERVICES, INC., ARCHBOLD FOUNDATION, INC., ARCHBOLD MEDICAL GROUP, INC. AND SOLE OWNERSHIP OF ITS FOR-PROFIT SUBSIDIARY, ARCHBOLD MEDICAL ENTERPRISES, INC. JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC. OPERATES JOHN D. ARCHBOLD MEMORIAL HOSPITAL, GRADY GENERAL HOSPITAL, BROOKS COUNTY HOSPITAL, AND MITCHELL COUNTY HOSPITAL AND NURSING HOMES. ARCHBOLD HEALTH SERVICES, INC. PROVIDES FACILITIES AND SUPPORT FOR HOME HEALTH CARE AND AMBULATORY HEALTH CARE SERVICES. ARCHBOLD FOUNDATION, INC. SOLICITS CONTRIBUTIONS AND MANAGES FUNDS FOR THE BENEFIT OF JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC. AND ARCHBOLD HEALTH SERVICES, INC. ARCHBOLD MEDICAL GROUP, INC. EMPLOYS PHYSICIANS AND OTHER SUPPORT PERSONNEL TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES ESSENTIAL TO THE PREVENTION AND TREATMENT OF DISEASE FOR THE BENEFIT OF ALL INDIVIDUALS IN THE SERVICE AREA. ARCHBOLD MEDICAL GROUP, INC. ALSO SERVES AS THE SOLE MEMBER OF CCSG, INC. A 501(C)(3) ORGANIZATION WHICH OPERATES A MEDICAL CLINIC. true THOMAS UNIVERSITY 1501 MILLPOND ROAD THOMASVILLE GA 31792 580644897 501C3 11000 MEDICAL TECH ED PROG THOMAS UNIVERSITY 1501 MILLPOND ROAD THOMASVILLE GA 31792 580644897 501C3 85000 NURSG LEADERSHIP ED 1 SCHOLARSHP/TUITION PROG 133 367883 MED STUDENT HOUSING 65 94214 FMV HOUSING/UTIL. SCHEDULE I, PAGE 1, PART I, LINE 2 THE ORGANIZATION OFFERS A TUITION/SCHOLARSHIP REIMBURSEMENT PROGRAM FOR QUALIFIED EMPLOYEES ON SATISFACTORY COMPLETION OF APPROVED COURSES. THE PURPOSE IS TO ENCOURAGE AND ENABLE EMPLOYEES TO ACQUIRE ADDITIONAL EDUCATION IN A HEALTH CARE OR JOB RELATED FIELD WHICH WILL PROMOTE CAREER ADVANCEMENT AND/OR PROVIDE ADVANCED CREDENTIALING OF EMPLOYEES IN AREAS OF NEED. CONDITIONS OF ELIGIBILITY: FULL-TIME EMPLOYMENT OF AT LEAST SIX MONTHS WITH SATISFACTORY WORK RECORD AND PERFORMANCE EVALUATION. COMPLETION OF THE RELEVANT EDUCATION PROGRAM REQUIRES THE APPLICANT TO COMMIT TO OBTAIN STATUS AS A FULL-TIME EMPLOYEE EQUAL TO THE AMOUNT OF TIME SPENT IN EDUCATION. FAILURE TO COMPLY WITH THE REQUIREMENTS OF ELIGIBILITY WOULD SUBJECT THE EMPLOYEE TO FULL OR PARTIAL REIMBURSEMENT OF THE FUNDS RECEIVED TO THE ORGANIZATION. FOR REIMBURSEMENT THE EMPLOYEE MUST PROVIDE A COPY OF A RECEIPT SHOWING ACTUAL PAYMENT OF TUITION FEES. APPLICANT MUST MAINTAIN A C OR HIGHER GRADE AND AN OFFICIAL RECORD OF GRADES AND HOURS CREDIT MAILED DIRECTLY TO THE ORGANIZATION. X X true true false true false false false false false false false J PERRY MUSTIAN PRESIDENT/CEO 624570 164733 16565 881100 34017 1720985 DARYL CRENSHAW MD TRUSTEE 577037 166664 540 7897 7055 759193 JASON NESMITH MD TRUSTEE 162064 115585 39056 6122 6510 329337 CHARLES D HIGHTOWER JR ASST SEC/CFO 380938 112125 6858 20900 7055 527876 JIM CARTER COO 229697 63250 4352 35192 6231 338722 MEL HARTSFIELD MD VP MEDICAL AFFAIRS 330475 46818 6756 38070 7055 429174 KEN BROOKER VP CLINICAL SERVICES 211595 45908 2322 19069 6952 285846 AMY GRIFFIN VP PATIENT CARE 204808 42800 810 25947 4605 278970 LADON TOOLE VP NETWORK OPS 183919 35500 540 21490 6403 247852 JIM BUE VP FACILITY SERVICES 169079 36456 2322 8829 642 217328 JOSH MOORE VP OPERATIONAL SVCS 166275 32320 432 16746 6725 222498 JOE BARRON ASST VP HEART SERVIC 165866 18968 1980 2768 6883 196465 STEPHEN RUBENDALL MD PHYSICIAN 207273 147816 162 6274 6535 368060 DINESH B PATEL MD PHYSICIAN 181527 144762 234 9138 6447 342108 JASON H SMITH MD PHYSICIAN 180060 95693 10156 4988 33995 324892 MICHAEL K SOPT MD PHYSICIAN 193833 79284 263 4268 6517 284165 RAMESAN NAIR MD PHYSICIAN 271686 1085 5530 7055 285356 SCHEDULE J, PAGE 1, PART I, LINE 1A SOCIAL CLUB DUES ARE PAID BY THE ORGANIZATION ON BEHALF OF OFFICERS AND EXECUTIVES OF THE FILING ORGANIZATION. THESE AMOUNTS ARE INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME AND REPORTED ON THEIR W-2. THE ORGANIZATION'S POLICY FOR COMPANION TRAVEL INCLUDES THE REIMBURSEMENT OF REGISTRATION, TRAVEL, AND ENTERTAINMENT EXPENSES FOR GUESTS WHO ACCOMPANY BOARD TRUSTEES TO EITHER OF TWO ANNUAL TRUSTEE CONFERENCES. RECEIPTS MUST BE SUBMITTED PRIOR TO REIMBURSEMENT AND THE AMOUNTS ARE NOT INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME. SCHEDULE J, PAGE 1, PART I, LINE 3 THE FILING ORGANIZATION RELIES ON THE METHODS USED BY ARCHBOLD MEDICAL CENTER, INC. (AMC), THE SOLE MEMBER, TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY AMC INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AS WELL AS BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. SCHEDULE J, PAGE 1, PART I, LINE 4 J. PERRY MUSTIAN 0 868,000 0 JIM CARTER 0 26,400 0 MEL HARTSFIELD, M.D. 0 24,970 0 KEN BROOKER 0 1,469 0 AMY GRIFFIN 0 16,000 0 LADON TOOLE 0 14,200 0 JIM BUE 0 1,215 0 JOSH MOORE 0 12,800 0 SCHEDULE J, PART III THE IRS RULES & REGULATIONS REQUIRE THAT CERTAIN NON-CURRENT, NON-CASH ITEMS ARE REPORTED IN PART VII OF FORM 990 REGARDLESS OF THE CURRENT BENEFIT TO THE EMPLOYEE. THESE SAME RULES, IN SOME CASES, REQUIRE THE COMPENSATION AND BENEFITS TO BE REPORTED TWICE IN PART VII, ONCE WHEN THE ENTITY ACCRUES FOR A FUTURE PAYMENT AND ONCE WHEN THE PAYMENT IS ACTUALLY MADE TO THE EMPLOYEE. THEREFORE, AN EMPLOYEE'S STATED TOTAL COMPENSATION AND BENEFITS REPORTED ON PART VII ARE SUBSTANTIALLY HIGHER THAN THE ACTUAL CASH COMPENSATION RECEIVED IN THE CURRENT YEAR. AMOUNTS REPORTED AS BENEFITS INCLUDE AMOUNTS FOR LIFE INSURANCE, HEALTH INSURANCE, THRIFT PLAN CONTRIBUTIONS, AND PENSION CONTRIBUTIONS. BENEFITS RELATED TO PENSION AND RETIREMENT PLANS REFLECT AMOUNTS ACCUMULATED, BUT NOT PAID, TO THE INDIVIDUAL IN RECOGNITION OF TOTAL YEARS OF EMPLOYMENT, NOT JUST THE CURRENT YEAR. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TWO OF AMC'S TOP EXECUTIVES PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS ACCRUED BUT UNFUNDED IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON-QUALIFIED RETIREMENT PLAN. THE CURRENT YEAR'S VALUE OF THE SERP DECREASED DUE TO CHANGES IN THE ASSUMPTIONS USED IN THE ACTUARIAL VALUATION OF THE ESTIMATED ACCRUED LIABILITY. AMC 457(F) RETIREMENT PLAN CERTAIN EXECUTIVES WHO ARE NOT ELIGIBLE FOR THE SERP MAY BE ELIGIBLE TO PARTICIPATE IN A 457(F) PLAN TO HELP THEM ACCUMULATE FUNDS FOR THEIR LONG TERM FINANCIAL NEEDS. THE ORGANIZATION MAY CONTRIBUTE A PERCENTAGE OF BASE SALARY INTO AN INDIVIDUAL EXECUTIVES ACCOUNT IF THE ORGANIZATION MEETS CERTAIN FINANCIAL TARGETS. THE ORGANIZATION OWNS ANY PLAN ASSETS UNTIL THEY ARE PAID TO THE EMPLOYEE AND ALL FUNDS ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. VESTING BEGINS AT AGE 55 WITH FIVE YEARS OF SERVICE AT A RATE OF 90% AND THEN INCREASES TO 100% AT AGE 60. PAYMENTS ARE MADE ANNUALLY UPON VESTING. BONUS AWARDS: OFFICERS AND PHYSICIANS ARE AWARDED BONUSES/INCENTIVES CONTINGENT IN PART ON MEETING MANAGEMENT-BY-OBJECTIVE INCENTIVE PLAN GOALS AND EXCESS OF REVENUE OVER EXPENSES. A HOSP AUTH OF THE CITY OF THOMASVILL 581719301 884633AS7 2010-05-11 85000000 BLDG CONSTRUCTION false true false B HOSP AUTH OF THE CITY OF THOMASVILL 581719301 NONENONEN 2013-06-12 17985000 REFUNDING OF SERIES 2009A CERTIFICATES false true false C HOSP AUTH OF THE CITY OF THOMASVILL 581719301 NONENONEN 2013-06-12 22760000 REFUNDING OF SERIES 2009B CERTIFICATES false true false A 2465000 85000000 7374851 10000000 1437504 65537920 2012 false false true true B 17985000 17985000 145000 17840000 2013 true false true true C 5415000 22760000 22760000 145000 22615000 2013 true false true true A false false false false false false true B false false false false false false true C false false false false false false true A false false false false false false false false true B false false false false true false false false true C false false false false true false false false true A true B true C true CORDELL L BRAGG III MD BOARD TRUSTEE 2688342 PROFESSIONAL MED SVC false THOMAS J CALLAWAY III BOARD TRUSTEE 7716923 INVESTMENT MANAGER false MARY ANNE BULLARD GRAYSON MD FAMILY MEMBER 6663176 PROF MED CORP false JOHN B CARICO MD BOARD TRUSTEE 6663176 RADIOLOGY SERVICES false GREG HAMIL BOARD TRUSTEE 6721135 DIRECTOR OF BANK false CHARLES R SANDERS JR MD BOARD TRUSTEE 233577 RENTAL; PATIENT SVCS false JAMES S KARAS MD BOARD TRUSTEE 3785831 RENTAL; PATIENT SVCS false LAURA C KARAS FAMILY MEMBER 60068 COMPENSATION false LINDSEY SLIGER FAMILY MEMBER 44772 COMPENSATION false HAILE MCCOLLUM BOARD TRUSTEE 272036954 DIRECTOR OF BANK false GARY BONVILLIAN BOARD TRUSTEE 315523 TU SCHOLARSHIPS false ALSTON WATT BOARD TRUSTEE 6721135 DIRECTOR OF BANK false MELISSA BRUHN MD BOARD TRUSTEE 318974 PROFESSIONAL MED SVC false W CLARK CONNELL MD BOARD TRUSTEE 2355952 MEDICAL SERVICES false JAMES W FALCONER III MD BOARD TRUSTEE 669054 RENTAL, PATIENT SVCS false DEBORAH GASKINS BOARD TRUSTEE 5939419 INVESTMENT MANAGER false VICTOR MCMILLAN MD BOARD TRUSTEE 669054 RENTAL; PATIENT SVCS false SCHEDULE L, PART IV GARY BONVILLIAN 315,523 BOARD TRUSTEE TU SCHOLARSHIPS ALSTON WATT 6,721,135 BOARD TRUSTEE DIRECTOR OF BANK MELISSA BRUHN, M.D. 318,974 BOARD TRUSTEE PROFESSIONAL MED SVC W. CLARK CONNELL, M.D. 2,355,952 BOARD TRUSTEE MEDICAL SERVICES JAMES W. FALCONER, III, M.D. 669,054 BOARD TRUSTEE RENTAL, PATIENT SVCS DEBORAH GASKINS 5,939,419 BOARD TRUSTEE INVESTMENT MANAGER VICTOR MCMILLAN, MD 669,054 BOARD TRUSTEE RENTAL; PATIENT SVCS SCHEDULE L, PART V JOHN CARICO, MD - PAYMENT TO PROFESSIONAL CORPORATION FOR HOSPITAL-BASED RADIOLOGY SERVICES; TRAUMA READINESS COMPENSATION. THOMAS J. CALLAWAY III - INVESTMENT MANAGER WITH ALLEN, MOONEY & BARNES WHICH MANAGES A PORTION OF THE SERP POOLED ACCOUNT AND SELF INSURANCE TRUST. AMOUNT REFLECTS TOTAL FEES AND BALANCES AT 9/30/16 FOR THE FILING AND ALL RELATED ORGANIZATIONS. MARY ANNE BULLARD GRAYSON, MD, THE SPOUSE OF TIMOTHY GRAYSON, MD, IS COMPENSATED THROUGH HER PROFESSIONAL MEDICAL CORPORATION FOR HOSPITAL-BASED RADIOLOGY SERVICES. GREG HAMIL - DIRECTOR WITH COMMERCIAL BANK. AMOUNT REFLECTS TOTAL FEES AND BALANCES AT 9/30/16 FOR THE FILING AND ALL RELATED ORGANIZATIONS. CHARLES R. SANDERS, JR., MD - RENT OF PROPERTY; MEDICAL SERVICES TO PRACTICE; PAYMENTS TO TREAT UNINSURED EMERGENCY PATIENTS. JAMES S. KARAS, MD - OUTREACH SERVICES; MEDICAL SERVICES; PAYMENT TO TREAT UNINSURED EMERGENCY PATIENTS; CLAIMS SETTLEMENT GUARANTEE PAYMENTS; MEDICAL STAFF LEADERSHIP COMPENSATION; PROFESSIONAL SERVICES AGREEMENT. LAURA C. KARAS IS THE SPOUSE OF BOARD TRUSTEE, JAMES S. KARAS, MD, AND IS EMPLOYED AND COMPENSATED BY JDAMH. LINDSEY SLIGER IS THE STEPDAUGHTER OF BOARD TRUSTEE, JAMES S. KARAS, MD, AND IS EMPLOYED AND COMPENSATED BY JDAMH. HAILE MCCOLLUM - DIRECTOR WITH THOMASVILLE NATIONAL BANK. AMOUNT REFLECTS TOTAL FEES AND BALANCES AT 9/30/16 FOR THE FILING AND ALL RELATED ORGANIZATIONS. CORDELL L. BRAGG, III, MD - HOSPITAL BASED ANESTHESIOLOGY SERVICES THROUGH PROFESSIONAL CORPORATION OF WHICH HE IS A PARTNER; STATE TRAUMA CENTER UNCOMPENSATED CARE; PAYMENT TO TREAT UNINSURED EMERGENCY PATIENTS; MEDICAL DIRECTOR; MISCELLANEOUS PATIENT CARE PAYMENTS; INCENTIVE COMPENSATION; MEDICAL STAFF LEADERSHIP COMPENSATION; PROFESSIONAL SERVICES AGREEMENT. GARY BONVILLIAN, A BOARD TRUSTEE, IS THE UNIVERSITY PRESIDENT OF THOMAS UNIVERSITY. THE FILING ORGANIZATION PROVIDES FINANCIAL SUPPORT FOR CERTAIN MEDICAL PROGRAMS AT THE UNIVERSITY. ALSTON WATT - DIRECTOR WITH COMMERCIAL BANK. AMOUNT REFLECTS TOTAL FEES AND BALANCES AT 9/30/16 FOR THE FILING AND ALL RELATED ORGANIZATIONS. MELISSA BRUHN, MD, A BOARD TRUSTEE, IS A PARTNER IN A MEDICAL PRACTICE WHICH IS COMPENSATED FOR SERVICES PROVIDED AS MEDICAL DIRECTOR; PAYMENTS TO TREAT UNINSURED EMERGENCY PATIENTS; MEDICAL STAFF LEADERSHIP COMPENSATION, HEALTH PLAN PAYMENTS. W. CLARK CONNELL, MD, A BOARD TRUSTEE, IS PARTNER IN A GROUP WHICH PROVIDES EMERGENCY MEDICAL SERVICES. JAMES W. FALCONER, III, MD - RENT OF PROPERTY; MEDICAL SERVICES TO PRACTICE; PAYMENTS TO TREAT UNINSURED EMERGENCY PATIENTS. VICTOR MCMILLAN, MD - RENT OF PROPERTY; MEDICAL SERVICES TO PRACTICE; PAYMENTS TO TREAT UNINSURED EMERGENCY PATIENTS. DEBORAH GASKINS - INVESTMENT MANAGER WITH WELLINGTON, SHIELDS & CO, LLC WHICH MANAGES A PORTION OF THE SELF INSURANCE TRUST. AMOUNT REFLECTS TOTAL FEES AND BALANCES AT 9/30/16 FOR THE FILING AND ALL RELATED ORGANIZATIONS. FORM 990, PAGE 2, PART III, LINE 4A COMMUNITY TO EDUCATE THEM ON IMPORTANT HEALTH NEEDS. JDAMH, INC. ALSO MAINTAINS HOSPITALS IN GRADY COUNTY, BROOKS COUNTY, AND MITCHELL COUNTY, FILING UNDER EIN 58-0566121. FORM 990, PAGE 2, PART III, LINE 4D MITCHELL COUNTY HOSPITAL AND NURSING HOMES OPERATE IN CAMILLA, GEORGIA AS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE CARE BEDS AND 156 NURSING HOME BEDS. IT SERVES MITCHELL COUNTY AND 64% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2016, OVER 5.8 MILLION OF INDIGENT CARE WAS PROVIDED TO THE COMMUNITY. IN ADDITION, MITCHELL COUNTY HOSPITAL PROVIDED OVER 3.0 MILLION ADDITIONAL UNCOMPENSATED CARE. EIN 58-6001207 FILED UNDER EIN 58-0566121. FORM 990, PAGE 6, PART VI, LINE 2 JAMES FALCONER III, MD VICTOR MCMILLAN, MD TRUSTEE TRUSTEE BUSINESS RELATIONSHIP FORM 990, PAGE 6, PART VI, LINE 6 THE ORGANIZATION HAS A SOLE MEMBER, ARCHBOLD MEDICAL CENTER, INC. (AMC) WITH THE POWER TO ELECT OR REPLACE AND TO REMOVE THE TRUSTEES OF THE GOVERNING BODY, AS WELL AS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY. FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD OF TRUSTEES OF THE FILING ENTITY ARE ELECTED ANNUALLY BY THE SOLE MEMBER, AMC. IN ADDITION, AMC HAS THE POWER TO ELECT OR REPLACE AND TO REMOVE THE TRUSTEES OF THE GOVERNING BODY. THE CEO OF AMC SHALL BE A MEMBER OF THE BOARD WITH THE POWER TO VOTE. FORM 990, PAGE 6, PART VI, LINE 7B THE SOLE MEMBER, AMC HAS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY, INCLUDING BUT NOT LIMITED TO, CAPITAL AND OPERATING BUDGETS, MERGERS OR ACQUISITIONS, CONTRACTS AND TRANSACTIONS OVER A CERTAIN AMOUNT, DISSOLUTION, ETC. FORM 990, PAGE 6, PART VI, LINE 11B THE ORGANIZATION'S CFO PRESENTED THE FORM 990 TO TRUSTEES IN ATTENDANCE DURING THE BOARD MEETING PRIOR TO FILING THE RETURN WITH THE IRS. THE TRUSTEES HAD THE OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. A COPY OF THE RETURN WAS MADE AVAILABLE TO THOSE BOARD MEMBERS WHO WERE UNABLE TO ATTEND THE MEETING. FORM 990, PAGE 6, PART VI, LINE 12C ON AN ANNUAL BASIS, THE ORGANIZATION DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE AND DISCLOSURE STATEMENT TO EACH TRUSTEE. THIS QUESTIONNAIRE INCLUDES QUESTIONS RELATED TO FINANCIAL INTERESTS, OUTSIDE INTERESTS OR ACTIVITIES, AND GIFTS, MEALS, AND ENTERTAINMENT. IN ADDITION TO DISCLOSING ANY APPLICABLE INFORMATION ON THE QUESTIONNAIRE, THE TRUSTEE ACKNOWLEDGES THAT (S)HE HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ, UNDERSTANDS, AND AGREES TO COMPLY WITH IT, AND UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. RESPONSES ARE SUMMARIZED AND COLLECTIVELY REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE OF AMC, THE SOLE MEMBER. DURING EACH BOARD MEETING, THE CHAIRMAN INQUIRES IF ANY TRUSTEE HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST RELATED TO ANY AGENDA ITEM. IF THE TRUSTEE DISCLOSES ANY SUCH INTEREST, THE TRUSTEE IS EXCUSED FROM THE MEETING WHILE THE DETERMINATION AS TO WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS IS DISCUSSED AND VOTED UPON BY DISINTERESTED MEMBERS OF THE BOARD AND COMMITTEE. IF INVITED TO DO SO, THE TRUSTEE WITH A POTENTIAL CONFLICT MAY RESPOND TO QUESTIONS PUT FORTH BY FELLOW DISINTERESTED TRUSTEES REGARDING ANY PROPOSED TRANSACTION OR ARRANGEMENT. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS DOCUMENTS THE NAME OF ANY INTERESTED PERSON/TRUSTEE WHO DISCLOSED OR WAS FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH A TRANSACTION OR ARRANGEMENT RESULTING IN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; AND THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATED TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSIONS, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH. FORM 990, PAGE 6, PART VI, LINE 15B ARCHBOLD MEDICAL CENTER'S PRESIDENT ALSO PRESENTS RECOMMENDATIONS FOR ALL SENIOR VICE PRESIDENTS AND VICE PRESIDENTS AND OTHER KEY EMPLOYEES TO THE COMPENSATION COMMITTEE. IN 2008, INTEGRATED HEALTHCARE SOLUTIONS (IHS) WAS ENGAGED BY THE BOARD TO REVIEW THE EXECUTIVE COMPENSATION PROGRAM AND MAKE RECOMMENDATIONS REGARDING PLAN DESIGN AND ACTUAL COMPENSATION INCLUDING BENEFITS. IN 2009, IHS PROVIDED UPDATED RECOMMENDATIONS ON COMPENSATION TO THE COMPENSATION COMMITTEE. FOR YEARS 2010-2016, THE BOARD CONTINUED TO UTILIZE IHS TO PERFORM MARKET ANALYSIS, REVIEW EXECUTIVE COMPENSATION, AND MAKE RECOMMENDATIONS. FORM 990, PAGE 6, PART VI, LINE 19 NO DOCUMENTS ARE OR WILL BE MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONSULTANT FEES JDAMH 300 75,566 0 CONTRACT SERVICES JDAMH 14,368,514 4,397,508 0 CONTRACT SERVICES BROOKS 1,334,263 0 0 CONTRACT SERVICES GRADY 1,865,360 0 0 CONTRACT SERVICES MITCHELL 3,900,374 0 0 OUTSIDE LAB REFERRAL FEES JDA 883,281 0 0 OUTSIDE LAB REFERRAL GRADY 111,120 0 0 OUTSIDE LAB REFERRAL BROOKS 581 0 0 PROFESSIONAL FEES JDAMH 13,352,812 3,247,768 0 PROFESSIONAL FEES GRADY 2,064,436 0 0 PROFESSIONAL FEES BROOKS 761,826 0 0 PROFESSIONAL FEES MITCHELL 987,668 0 0 ARCHBOLD FOUNDATION INC PO BOX 620 THOMASVILLE GA 317990620 581559677 FOUNDATION GA 501C3 11B AMC ARCHBOLD MEDICAL CENTER INC false ARCHBOLD HEALTH SERVICES INC PO BOX 620 THOMASVILLE GA 317990620 581376434 HEALTHCARE GA 501C3 9 AMC ARCHBOLD MEDICAL CENTER INC false ARCHBOLD MEDICAL CENTER INC PO BOX 1018 THOMASVILLE GA 317991018 581552650 H/C MGMT GA 501C3 11C NA false ARCHBOLD MEDICAL GROUP INC P O BOX 620 THOMASVILLE GA 317990620 262988454 PHYSICIANS GA 501C3 3 AMC ARCHBOLD MEDICAL CENTER INC false CCSG INC 915 GORDON AVENUE THOMASVILLE GA 317926614 473501366 MED CLINIC GA 501C3 3 AMG false ARCHBOLD MEDICAL ENTERPRISES 400 OLD ALBANY ROAD THOMASVILLE GA 317924013 581494513 HEALTHCARE GA N/A false false false true true false false false false false true false true true true true false false true false