ATHENS REGIONAL SPECIALTY SERVICES INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- ATHENS REGIONAL SPECIALTY SERVICES INC (EIN 27-1975001)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-08-15
- IRS object ID
- 201732279349302803
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-15T13:07:42-05:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 North Greene Street Suite 400 | AddressLine1Txt |
| City | Greensboro | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27401 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 271975001 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ATHENS REGIONAL SPECIALTY SERVICES INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % WENDY COOK | InCareOfNm |
| Business Name Control | ATHE | BusinessNameControlTxt |
| Phone | 7064757000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1199 PRINCE AVENUE | AddressLine1Txt |
| City | ATHENS | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30606 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WENDY COOK | PersonNm |
| Person Title | SR VP & CFO | PersonTitleTxt |
| Phone | 7064757000 | PhoneNum |
| Signature | 2017-08-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ALLISON H FRANKLIN CPA | PreparerPersonNm |
| PTIN | P00448640 | PTIN |
| Phone | 3362753394 | PhoneNum |
| Preparation | 2017-08-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CHARLES PECK PRESIDENT CEO | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1199 PRINCE AVENUE | AddressLine1Txt |
| City | ATHENS | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $33,815,890 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PIEDMONT.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | TO SERVE AND PROMOTE THE PUBLIC HEALTH OF THE GENERAL POPULATION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 253 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,532,442 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,313,664 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,263 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,666 | CYInvestmentIncomeAmt |
| PY Other Revenue | $10,322,875 | PYOtherRevenueAmt |
| CY Other Revenue | $19,497,560 | CYOtherRevenueAmt |
| PY Total Revenue | $24,858,580 | PYTotalRevenueAmt |
| CY Total Revenue | $33,815,890 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $21,388,153 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,918,390 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $4,019,216 | PYOtherExpensesAmt |
| CY Other Expenses | $3,806,086 | CYOtherExpensesAmt |
| PY Total Expenses | $25,407,369 | PYTotalExpensesAmt |
| CY Total Expenses | $24,724,476 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$548,789 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $9,091,414 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,921,045 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,651,475 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,835,715 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,474,731 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$10,914,670 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$1,823,256 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $24,366,744 | ExpenseAmt |
| Revenue | $33,811,224 | RevenueAmt |
| Desc | SPECIALTY PHYSICIAN PRACTICES: THE 59 SPECIALIST PHYSICIANS OF ATHENS REGIONAL SPECIALTY SERVICES, INC. (ARSS) DELIVERED HEALTH CARE TO THE GENERAL PUBLIC BY PROVIDING SERVICES AND RESOURCES DURING THE COURSE OF 112,876 BILLABLE PATIENT ENCOUNTERS IN THE 17 COUNTY NORTHEAST GEORGIA AREA SERVED BY ATHENS REGIONAL HEALTH SERVICES, INC. IN 2016. DURING THE SAME PERIOD, ARSS INC. PROVIDED $180,902 IN LOW INCOME ASSISTANCE. | Desc |
| Total Program Service Expenses | $24,366,744 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 29 | IRPDocumentCnt |
| IRP Document W2 G | 1 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 253 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WENDY COOK | PersonNm |
| Phone | 7064753462 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1199 PRINCE AVENUE | AddressLine1Txt |
| City | ATHENS | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30606 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| CHARLES PECK | |||||||||
| PRESIDENT & CEO | 3.0 | 52.0 | Yes (X) | Yes (X) | $0 | $1,190,913 | $41,202 | ||
| Philip A Sheffield MD | |||||||||
| Trustee | 3.0 | 6.0 | Yes (X) | $0 | $0 | $0 | |||
| Richard B Russell JR | |||||||||
| Trustee, CHAIR | 3.0 | 9.0 | Yes (X) | $0 | $0 | $0 | |||
| G Michael Smith | |||||||||
| Trustee | 3.0 | 12.0 | Yes (X) | $0 | $0 | $0 | |||
| ROBERT Heath | |||||||||
| Trustee | 3.0 | 12.0 | Yes (X) | $0 | $0 | $0 | |||
| Asa Boynton | |||||||||
| Trustee | 3.0 | 6.0 | Yes (X) | $0 | $0 | $0 | |||
| WENDY J COOK | |||||||||
| SR. VP & CFO | 3.0 | 52.0 | Yes (X) | $0 | $603,691 | $59,930 | |||
| BENJAMIN HOLLAND | |||||||||
| Physician | 40.0 | 0.0 | $885,810 | $0 | $53,318 | Yes (X) | |||
| KENT NILLSON | |||||||||
| Physician | 40.0 | 0.0 | $876,513 | $0 | $55,519 | Yes (X) | |||
| KHAN PHOLEL | |||||||||
| Physician | 40.0 | 0.0 | $864,461 | $0 | $45,368 | Yes (X) | |||
| JARED GRIFFIS | |||||||||
| Physician | 40.0 | 0.0 | $867,639 | $0 | $42,373 | Yes (X) | |||
| PARKER GROW | |||||||||
| Physician | 40.0 | 0.0 | $870,016 | $0 | $40,394 | Yes (X) | |||
| JAMES G THAW | |||||||||
| FORMER TRUSTEE | 0.0 | 0.0 | $0 | $405,745 | $60,861 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,364,439 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,200,349 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $398,965 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 73 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SYNERGY SURGICALISTS INC | |||||
| 280 W KAGY BLVD STE D 320 | BOXEMAN | MT | 59715 | SURGICALIST COVERAGE | $938,869 |
| JACKSON COKER | |||||
| 300 OLD ALABAMA ROAD SUITE 119-608 | ALPHARETTA | GA | 30022 | OB HOSPITALISTS COVE | $592,708 |
| HARRIS MEDICAL HOSPITALISTS | |||||
| 1180 SATELITTE BLVD SUITE 200 | SUWANEE | GA | 30024 | HOSPITALIST COVERAGE | $396,413 |
| MAXIM PHYSICIAN RESOURCES | |||||
| 12558 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | HOSPITALIST COVERAGE | $246,361 |
| HEALTH MOUNT LLC | |||||
| 1326 MONTGOMERY LANE | SOUTHLAKE | TX | 76092 | HOSPITALIST COVERAGE | $147,635 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Total Contributions | $0 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $14,313,664 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,313,664 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,313,664 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,666 | TotalRevenueColumnAmt |
| Exclusion | $4,666 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| INTERCOMPANY TRANSFERS | 900099 | $18,920,387 | $18,920,387 |
| MISCELLANEOUS NON-PATIENT INCOME | 900099 | $577,173 | $577,173 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $19,497,560 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,815,890 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $33,811,224 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $4,666 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,364,439 | TotalAmt |
| Program Services | $4,364,439 | ProgramServicesAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,235,751 | TotalAmt |
| Program Services | $13,092,944 | ProgramServicesAmt |
| Management And General | $142,807 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,431,729 | TotalAmt |
| Program Services | $1,416,281 | ProgramServicesAmt |
| Management And General | $15,448 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,093,674 | TotalAmt |
| Program Services | $1,081,874 | ProgramServicesAmt |
| Management And General | $11,800 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $792,797 | TotalAmt |
| Program Services | $784,243 | ProgramServicesAmt |
| Management And General | $8,554 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $610,849 | TotalAmt |
| Program Services | $558,902 | ProgramServicesAmt |
| Management And General | $51,947 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,737 | TotalAmt |
| Management And General | $39,737 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,149 | TotalAmt |
| Program Services | $6,809 | ProgramServicesAmt |
| Management And General | $340 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,039 | TotalAmt |
| Program Services | $2,039 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $158,155 | TotalAmt |
| Program Services | $152,405 | ProgramServicesAmt |
| Management And General | $5,750 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,555,898 | TotalAmt |
| Program Services | $1,497,367 | ProgramServicesAmt |
| Management And General | $58,531 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,383 | TotalAmt |
| Program Services | $57,383 | ProgramServicesAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,180 | TotalAmt |
| Program Services | $74,180 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,568 | TotalAmt |
| Program Services | $171,266 | ProgramServicesAmt |
| Management And General | $15,302 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $352,568 | TotalAmt |
| Program Services | $352,568 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| EQUIPMENT RENTAL | $14,980 | $14,980 | |
| MEDICAL SUPPLIES | $462,213 | $462,213 | |
| DRUGS | $245,137 | $245,137 | |
| RECRUITING | $25,092 | $17,576 | $7,516 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,138 | TotalAmt |
| Program Services | $14,138 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,724,476 | TotalAmt |
| Program Services | $24,366,744 | ProgramServicesAmt |
| Management And General | $357,732 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $537,699 | BOYAmt |
| EOY | $363,525 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,871,153 | BOYAmt |
| EOY | $1,895,408 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,879 | BOYAmt |
| EOY | $87,871 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $1,928,379 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $1,623,708 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $450,314 | BOYAmt |
| EOY | $304,671 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,921,045 | BOYAmt |
| EOY | $2,651,475 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,835,715 | BOYAmt |
| EOY | $4,474,731 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,835,715 | BOYAmt |
| EOY | $4,474,731 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$10,914,670 | BOYAmt |
| EOY | -$1,823,256 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$10,914,670 | BOYAmt |
| EOY | -$1,823,256 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,921,045 | BOYAmt |
| EOY | $2,651,475 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $9,091,414 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp | |
| Land | LandGrp |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $0 | OtherCostOrOtherBasisAmt |
| Depreciation | $0 | DepreciationAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,454 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,454 | DepreciationAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,912,925 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,614,254 | DepreciationAmt |
| Book Value | $298,671 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,000 | OtherCostOrOtherBasisAmt |
| Book Value | $6,000 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $304,671 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
| Total Liability | $0 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Form Sch D Part X Line 2 | FormAndLineReferenceDesc |
| Explanation | ASC 740-10 DISCLOSURE THE HEALTH SYSTEM APPLIES FASB ACCOUNTING STANDARD CODIFICATION (ASC) 740-10, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, WHICH ADDRESSES ACCOUNTING FOR UNCERTAINTY IN INCOME TAX POSITIONS. IT ALSO PROVIDES GUIDANCE AS TO WHEN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND HOW THE VALUES OF THESE POSITIONS ARE DETERMINED. THERE IS NO IMPACT ON THE HEALTH SYSTEM'S CONSOLIDATED FINANCIAL STATEMENTS AS A RESULT OF THE APPLICATION OF ASC 740-10. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (true) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (true) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (true) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES G THAW | ||||||||||||||
| FORMER TRUSTEE | $0 | $0 | $0 | $0 | $0 | $405,745 | $0 | $59,595 | $0 | $1,266 | $0 | $466,606 | $0 | $0 |
| WENDY J COOK | ||||||||||||||
| SR. VP & CFO | $0 | $383,184 | $0 | $117,067 | $0 | $103,440 | $0 | $50,342 | $0 | $9,588 | $0 | $663,621 | $0 | $0 |
| CHARLES PECK | ||||||||||||||
| PRESIDENT & CEO | $0 | $777,816 | $0 | $318,500 | $0 | $94,597 | $0 | $36,918 | $0 | $4,284 | $0 | $1,232,115 | $0 | $0 |
| BENJAMIN HOLLAND | ||||||||||||||
| Physician | $524,242 | $0 | $289,225 | $0 | $72,343 | $0 | $46,525 | $0 | $6,793 | $0 | $939,128 | $0 | $0 | $0 |
| KENT NILLSON | ||||||||||||||
| Physician | $558,942 | $0 | $254,525 | $0 | $63,046 | $0 | $46,525 | $0 | $8,994 | $0 | $932,032 | $0 | $0 | $0 |
| KHAN PHOLEL | ||||||||||||||
| Physician | $520,042 | $0 | $293,425 | $0 | $50,994 | $0 | $38,575 | $0 | $6,793 | $0 | $909,829 | $0 | $0 | $0 |
| JARED GRIFFIS | ||||||||||||||
| Physician | $519,642 | $0 | $293,825 | $0 | $54,172 | $0 | $38,575 | $0 | $3,798 | $0 | $910,012 | $0 | $0 | $0 |
| PARKER GROW | ||||||||||||||
| Physician | $519,242 | $0 | $294,225 | $0 | $56,549 | $0 | $38,575 | $0 | $1,819 | $0 | $910,410 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form Sch J Part I Line 5a & 6a | CONTINGENT COMPENSATION EXECUTIVE AND LEADERSHIP POSITIONS ARE ELIGIBLE TO PARTICIPATE IN A VARIABLE PAY PLAN. GROSS REVENUES AND NET EARNINGS ARE VARIABLE PAY PLAN FACTORS. THIS PLAN PROVIDES INCENTIVES BASED ON SYSTEMP ERFORMANCE. THE RESULTS ARE BASED ON THE ACCOMPLISHMENT OF SPECIFIC STRATEGIC OBJECTIVES INVOLVING (1) SUSTAINED AND IMPROVED FINANCIAL PERFORMANCE AND EFFICIENCY (2) employee satisfaction and retention (3) IMPROVED CUSTOMER SATISFACTION INCLUDING MEMBERS, PHYSICIANS, PATIENTS, AND EMPLOYEES (4) MAINTENANCE AND IMPROVEMENT IN QUALITY AND CLINICAL OUTCOMES. THE PERFORMANCE SCORECARD IS DETERMINED ANNUALLY AND APPROVED BY THE BENEFITS AND COMPENSATION COMMITTEE OF THE BOARD. THE PLAN WILL BE DISALLOWED BASED ON LOSS OF THE JOINT COMMISSION ACCREDITATION OR A VIOLATION OF THE BOND COVENANTS. PHYSICIANS RECEIVE A BASE SALARY PLUS AN INCENTIVE WHICH IS CALCULATED AS A PERCENTAGE OF NET PRODUCTION. NET PRODUCTION IS BASED ON WORK RVU PRODUCTION AND AN ESTABLISHED COMPENSATION PER WORK RVU RATE BASED ON FAIR MARKET VALUE. THE CALCULATION OF NET PRODUCTION IS SUBJECT ALWAYS TO COMPLIANCE WITH ALL APPLICABLE FEDERAL AND STATE LAWS. |
| FORM SCH J PART I LINE 4A | SEVERANCE PAYMENT CERTAIN OFFICERS HAVE WRITTEN SEVERANCE AGREEMENTS WITH THE EMPLOYER. THIS SEVERANCE AGREEMENT TYPICALLY PROVIDES THAT IN THE EVENT OF INVOLUNTARY TERMINATION THE OFFICER WILL CONTINUE TO RECEIVE THE OFFICER'S BASE COMPENSATION FOR A PERIOD OF 24 MONTHS FOLLOWING THE OFFICER'S DATE OF TERMINATION. THE OFFICER IS ALSO ENTITLED AS ADDITIONAL SEVERANCE ANY OTHER BENEFITS TO WHICH HE WOULD HAVE BEEN ENTITLED HAD THE EXECUTIVE REMAINED AN EMPLOYEE. THE VALUE OF THE OTHER BENEFITS ARE MADE AVAILABLE TO THE OFFICER IN ACTUAL BENEFITS OR EQUIVALENT VALUE TO THE EXTENT PERMITTED IN LAW AND BY UNDERLYING CONTRACTS THAT MAY SUPPORT SUCH BENEFITS. JAMES THAW RECEIVED SEVERANCE PAYMENTS TOTALING $466,606. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990 Part III Line 1 | MISSION STATEMENT EXPLANATION ATHENS REGIONAL SPECIALTY SERVICES, INC. (ARSS) WAS INCORPORATED ON FEBRUARY 18, 2010. ARSS WAS FORMED TO SUPPORT THE EFFORTS OF ATHENS REGIONAL MEDICAL CENTER BY STRIVING TO IMPROVE THE HEALTH OF THE GENERAL POPULATION OF THE AREA SERVED BY ENSURING THE AVAILABILITY OF QUALITY SPECIALTY MEDICAL SERVICES. ARSS CURRENTLY EMPLOYS 41 SPECIALIZED PHYSICIANS WITH EXPERTISE IN CARDIOLOGY, OBSTETRICS, PSYCHIATRY, PHYSICAL MEDICINE AND REHABILITATION, PEDIATRICS, HYPERBARIC MEDICINE AND GENERAL AND COLORECTAL SURGERY. ARSS PROVIDES SPECIALTY MEDICAL SERVICES TO THE GENERAL PUBLIC THROUGH ITS EMPLOYEE PHYSICIANS, REGARDLESS OF EACH PATIENT'S ABILITY TO PAY. |
| Form 990 Part VI Line 11b | REVIEWING FORM 990 THE COMPLETED 990 IS REVIEWED BY THE ATHENS REGIONAL SPECIALTY SERVICES, INC. FINANCE COMMITTEE AND THE BOARD OF DIRECTORS PRIOR TO FILING. |
| Form 990 Part VI Line 12c | MONITORING CONFLICTS OF INTEREST ATHENS REGIONAL SPECIALTY SERVICES, INC. HAS ESTABLISHED A CONFLICT OF INTEREST POLICY WHICH HAS BEEN REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. ATHENS REGIONAL SPECIALTY SERVICES, INC. IS COMMITTED TO THE BELIEF THAT SOUND BUSINESS PRACTICES START WITH AN ABSOLUTE COMMITMENT FROM EACH EMPLOYEE TO ACT ETHICALLY IN CARRYING OUT ATHENS REGIONAL SPECIALTY SERVICES, INC.'S BUSINESS, AND TO COMPLY WITH THE LAWS AND REGULATIONS THAT IMPACT ITS BUSINESS, THUS ATHENS REGIONAL SPECIALTY SERVICES, INC.'S EMPLOYEES MUST AVOID PARTICIPATING IN ACTIVITIES THAT CREATE OR APPEAR TO CREATE A CONFLICT OF INTEREST. DECLARED CONFLICTS ARE REVIEWED WITH THE INDIVIDUAL. IT REMAINS THE DECLARERS RESPONSIBILITY TO NOTIFY OF A CONFLICT AS DISCUSSIONS ARISE AND TO RECUSE THEMSELVES DURING THE DECISION MAKING PROCESS. |
| Form 990 Part VI Line 15a | DETERMINING COMPENSATION THIS ENTITY DOES NOT DETERMINE COMPENSATION ON A STAND ALONE BASIS. ATHENS REGIONAL HEALTH SERVICES, INC.'S (ARHS) BOARD OF DIRECTORS HAS DESIGNATED THE COMPENSATION COMMITTEE TO BE RESPONSIBLE FOR ESTABLISHING COMPENSATION PRACTICES WHICH ARE REASONABLE AND DO NOT VIOLATE THE PRIVATE INUREMENT PROHIBITION. THE COMPENSATION COMMITTEE IS COMPRISED OF THE BOARD CHAIRPERSON OF ATHENS REGIONAL HEALTH SERVICES, INC. (ARHS), ATHENS REGIONAL MEDICAL CENTER, INC. (ARMC), ATHENS REGIONAL PHYSICIAN SERVICES, INC. (ARPS), AND VICE-CHAIRPERSON OF ATHENS REGIONAL MEDICAL CENTER, INC. (ARMC). THE PRACTICES AND PROCESSES ARE DESIGNED TO AVOID ANY CLAIM FOR INTERMEDIATE SANCTIONS AND TO SATISFY THE REQUIREMENTS TO OBTAIN THE REBUTTABLE PRESUMPTION OF REASONABLENESS. THE COMPENSATION COMMITTEE ANNUALLY REVIEWS OUTSIDE, INDEPENDENT DATA TO ESTABLISH THE COMPENSATION OF OUR OFFICERS AND KEY EMPLOYEES. THE BOARD OF DIRECTORS REVIEW AND SET FORTH THE COMPENSATION FOR THE SYSTEM CEO USING THE SAME PROCESS AS THE COMPENSATION COMMITTEE. THE COMMITTEE ENGAGES AND UTILIZES AN INDEPENDENT CONSULTING FIRM, TO PROVIDE EXPERT INFORMATION REGARDING INDUSTRY-WIDE COMPENSATION NORMS. THE COMPENSATION COMMITTEE MEETS WITH A REPRESENTATIVE FROM THE CONSULTING FIRM AND THE HUMAN RESOURCES DEPARTMENT WHEN REVIEWING COMPENSATION FOR THE SENIOR LEADERSHIP GROUP ON A YEARLY BASIS. THE COMPANY PHILOSOPHY IS TO MATCH THE MARKET ON AVERAGE PAY, IDENTIFYING THE MEDIAN. TOTAL CASH COMPENSATION IS GENERALLY TARGETED BY TO BE AT THE MEDIAN OF ARHS'S PEERS. |
| Form 990 Part VI Line 19 | GOVERNING DOCUMENTS ATHENS REGIONAL SPECIALTY SERVICES, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS OR ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| ATHENS REGIONAL PHYSICIAN SERVICES INC | ||||||||||
| 1199 PRINCE AVENUE | ATHENS | GA | 30606 | 582332921 | PRIMARY CARE | GA | 501(C)(3) | 11.B | NA | false |
| ATHENS REGIONAL MEDICAL CENTER INC | ||||||||||
| 1200 PRINCE AVENUE | ATHENS | GA | 30606 | 582179989 | HOSPITAL | GA | 501(C)(3) | 3 | NA | false |
| HOSPITAL AUTHORITY OF CLARKE COUNTY GA | ||||||||||
| 1201 PRINCE AVENUE | ATHENS | GA | 30606 | 586003375 | HOSPITAL | GA | 501(C)(3) | 3 | NA | false |
| ATHENS REGIONAL FOUNDATION INC | ||||||||||
| 1202 PRINCE AVENUE | ATHENS | GA | 30606 | 581978389 | FUNDRAISING | GA | 501(C)(3) | 11.B | NA | false |
| ATHENS REGIONAL HEALTH RESOURCES INC | ||||||||||
| 1203 PRINCE AVENUE | ATHENS | GA | 30606 | 581930580 | HEALTHCARE | GA | 501(C)(3) | 11.B | NA | false |
| REGIONAL FIRSTCARE INC | ||||||||||
| 1204 PRINCE AVENUE | ATHENS | GA | 30606 | 582362733 | MANAGEMENT | GA | 501(C)(3) | 11.B | NA | false |
| ATHENS REGIONAL HEALTH SERCIVES INC | ||||||||||
| 1205 PRINCE AVENUE | ATHENS | GA | 30606 | 581930582 | MANAGEMENT | GA | 501(C)(3) | 11.B | NA | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ATHENS AREA HEALTH PLAN SELECT INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 255 WEST CLAYTON STREET | AddressLine1Txt |
| City | ATHENS | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 306013711 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582257670 | EIN |
| Primary Activities | HEALTH MAINT. | PrimaryActivitiesTxt |
| Legal Domicile State | GA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARHS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C Corp | EntityTypeTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Comments