2016-11-02T07:21:53-05:00 2015-12-31 621517792 PERSHING YOAKLEY & ASSOCIATES P C 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2015-01-01 650543088 COFFEE REGIONAL MEDICAL CENTER INC COFF 9123841900 1101 OCILLA ROAD/PO BOX 1287 DOUGLAS GA 315332207 VICKI LEWIS PRESIDENT AND CEO 9123841900 2016-11-02 1 DEBORAH O ERNSBERGER P00364912 8656730844 2015 2017-02-10 21:41:12Z VICKI LEWIS 1101 OCILLA ROAD/PO BOX 1287 DOUGLAS GA 315332207 126066607 0 X WWW.COFFEEREGIONAL.ORG X 1995 GA TO BE A LEADING PROVIDER OF A COMPREHENSIVE RANGE OF HIGH-QUALITY, REASONABLY PRICED HEALTH CARE SERVICES IN COFFEE COUNTY, GEORGIA, AND THE SURROUNDING REGION. THESE HEALTH CARE SERVICES ARE PROVIDED TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. 11 10 931 77 53591 -15789 279000 522277 95288956 116292031 2778311 1870700 3485672 3090544 101831939 121775552 0 0 0 0 52517924 51067588 0 0 0 50219338 65351477 102737262 116419065 -905323 5356487 77178672 80243205 51992034 50167522 25186638 30075683 TO BE A LEADING PROVIDER OF A COMPREHENSIVE RANGE OF HIGH-QUALITY, REASONABLY PRICED HEALTH CARE SERVICES IN COFFEE COUNTY, GEORGIA, AND THE SURROUNDING REGION. THESE HEALTH CARE SERVICES ARE PROVIDED TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. 0 0 102530275 118843260 HOSPITAL SERVICES - SHORT TERM CARE FOR INPATIENT AND OUTPATIENT SERVICES FOR DOUGLAS AND COFFEE COUNTY. COFFEE REGIONAL MEDICAL CENTER (CRMC) SERVED 4,596 PATIENTS FOR A TOTAL OF 18,345 DAYS IN 2015. NURSERY DAYS WERE 996 IN 2015. COFFEE REGIONAL MEDICAL CENTER PROVIDED APPROXIMATELY $11,092,818 OF INDIGENT AND CHARITY SERVICES IN 2015. 102530275 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 46 0 1 931 1 1 1 1 CJ 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X LAVONDA CRAVEY 9123841900 1101 OCILLA ROAD DOUGLAS GA 315332207 THAD CARTER SECRETARY 1.00 X X 0 0 0 GARY EVANS DIRECTOR 1.00 X 0 0 0 BRANDY WILKES DIRECTOR 1.00 1.00 X 0 0 0 GREG GOGGANS DIRECTOR 1.00 X 0 0 0 MATT GREER CHAIR 1.00 X X 0 0 0 MIKE WILLS DIRECTOR 1.00 1.00 X 0 0 0 ANNIE FARRAR VICE CHAIR 1.00 X X 0 0 0 RUEBEN SPEIGHT DIRECTOR 1.00 1.00 X 0 0 0 GABE EVANS DIRECTOR 1.00 X 0 0 0 DARREL COLLINS DO DIRECTOR 20.00 X 179617 0 0 JEFFERY DOCKERY MD DIRECTOR 1.00 X 0 0 0 VICKI LEWIS PRESIDENT/CEO 50.00 2.00 X 327085 0 37009 SHERRY THOMAS EXECUTIVE VP/CNE 50.00 2.00 X 241559 0 25133 BARRY BLOOM VP/EXEC. DIRECTOR OF FOUNDATION 50.00 2.00 X 205653 0 19933 BRADLEY GOLDBERG OB/GYN PHYSICIAN 50.00 X 506207 0 29943 STEVEN DIAMOND OB/GYN PHYSICIAN 50.00 X 478448 0 19933 THOMAS HENRIS ANESTHESIOLOGIST 50.00 X 478003 0 42917 KHONDKER ISLAM GASTROENTEROLOGIST 50.00 X 452027 0 42933 THOMAS WEHMANN SURGEON 50.00 X 429207 0 24000 3297806 0 241801 50 0 1 0 REHABILITATION SERVICES OF SOUTH GA 169 MEADOWLARK LANE FITZGERALD GA 31750 CONTRACT PHYSICAL THERAPY 562180 JOSEPH T CHAVLOVICH 7409 CHELTNAM COURT NEW PORT RICHEY FL 34655 CONTRACT SERVICES 153000 PHILIPS FINANCIAL LLC 2425 SETTLERS STREET CHARLESTON SC 34655 MANAGEMENT SERVICES 131358 DRAFFIN & TUCKER PO BOX 71309 ALBANY GA 31708 AUDITING SERVICES 108800 CHARLES WOEPPEL 329 WHITWORTH WAY NASHVILLE TN 37205 CONTRACT SERVICES 108277 5 275000 247277 522277 PATIENT REVENUE 621990 116238440 116238440 REFERENCE LAB 621500 53591 53591 116292031 2193027 2193027 144100 0 144100 144100 144100 3968728 4238423 52632 -269695 -52632 -322327 -322327 PHARMACY REVENUE 621990 1341068 1341068 EHR PAYMENT 621990 595378 595378 CAFETERIA 722514 395215 395215 614783 614783 2946444 121775552 118789669 53591 2410015 X 779497 127405 652092 38974081 34913081 4061000 73924 65917 8007 8613622 7521068 1092554 2626464 2272185 354279 220296 220296 142160 142160 8247 8247 127804 127804 14975235 12611201 2364034 246162 70140 176022 4567813 3986897 580916 2018101 1747272 270829 214628 174883 39745 185748 179306 6442 1593821 1593821 5683167 4920486 762681 1701933 284260 1417673 BAD DEBT 14174537 14174537 SUPPLIES 10478548 10478548 DEVELOPMENT 2888601 2888601 UBTI 6556 6556 6118120 4505864 1612256 116419065 102530275 13888790 0 4595967 4982310 11241391 13320878 213314 898624 1898349 898615 627058 98225611 70013139 27704096 28212472 29886497 30059362 1740168 1142776 77178672 80243205 20875450 18992205 28649148 28274305 2467436 2901012 51992034 50167522 X 25186638 30075683 25186638 30075683 77178672 80243205 X 5356487 -452077 -15365 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8247 8247 0 SCHEDULE C, PART II-B, LINE 1 A PORTION OF THE ANNUAL DUES PAID TO THE GEORGIA HOSPITAL ASSOCIATION IS ALLOCATED TO THE LOBBYING ACTIVITIES OF THESE ASSOCIATIONS. 441214 441214 55353371 32559008 22794363 146203 125490 20713 40903551 37328641 3574910 1381272 1381272 28212472 X PART X, LINE 2: CRH HEALTHCARE, INC., EXCLUDING COFFEE REGIONAL MEDICAL CENTER SEGREGATED PORTFOLIO, CRH VENTURES, INC. AND SOUTHEASTERN MANAGED CARE, INC. IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. COFFEE REGIONAL MEDICAL CENTER SEGREGATED PORTFOLIO IS AN EXEMPTED SEGREGATED PORTFOLIO COMPANY THAT WAS INCORPORATED UNDER THE PROVISIONS OF THE COMPANIES LAW OF THE CAYMAN ISLANDS AND HAS RECEIVED AN UNDERTAKING FROM THE CAYMAN ISLANDS GOVERNMENT EXEMPTING IT FROM ALL LOCAL INCOME, PROFITS AND CAPITAL GAINS TAXES. CRH VENTURES, INC. AND SOUTHEASTERN MANAGED CARE, INC. ARE TAXABLE ENTITIES AND ARE, THEREFORE, SUBJECT TO FEDERAL INCOME TAXES. CRH VENTURES, INC. AND SOUTHEASTERN MANAGED CARE, INC. FILE SEPARATE FEDERAL INCOME TAX RETURNS. THE CORPORATION APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE CORPORATION 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 BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF DECEMBER 31, 2015 AND 2014 OR FOR THE YEARS THEN ENDED. THE CORPORATION'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. CENTRAL AMERICA AND THE CARIBBEAN 1 1 INVESTMENTS 11250044 1 1 0 0 1 1 11250044 0 11250044 0 0 1 0 0 0 1 1 1 X 125.000000000000 1 X 1 1 1 0 1 1 3657971 3657971 0.03140 18444364 13313280 5131084 0.04410 22102335 13313280 8789055 0.07550 23785 23785 0.00020 2400 2400 0.00000 26185 26185 0.00020 22128520 13313280 8815240 0.07570 1500 1500 0.00000 3840 3840 0.00000 3900 3900 0.00000 9240 9240 1 14174537 10630902 21270097 19823168 1446929 X 1 1 1 1 COFFEE REGIONAL MEDICAL CENTER 1101 OCILLA ROAD PO BOX 1287 DOUGLAS GA 31533 034-490 X X X PHYSICIAN OFFICES, RURAL HEALTH CLINIC COFFEE REGIONAL MEDICAL CENTER INC 0 0 1 X X X X X X X X 13 1 0 0 1 X WWW.COFFEEREGIONAL.ORG 1 13 1 WWW.COFFEEREGIONAL.ORG 0 0 1 X 100.000000000000 200.000000000000 1 1 X X X X 1 X WWW.COFFEEREGIONAL.ORG X WWW.COFFEEREGIONAL.ORG X WWW.COFFEEREGIONAL.ORG X X X X X 1 X 0 X X X X 1 X 0 0 COFFEE REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 5: IN 2012, CRMC DEVELOPED A COMMUNITY SURVEY QUESTIONNAIRE TO PROVIDE TO PERSONS WITHIN ITS SERVICE AREA. PAPER COPIES AS WELL AS AN ONLINE SURVEY WERE MADE AVAILABLE IN BOTH ENGLISH AND SPANISH. CRMC PROVIDED THE SURVEY TO ALL PATIENTS WHO PRESENTED TO CRMC THROUGH FRONT ADMISSIONS AND TO ALL PATIENTS WHO PRESENTED TO THE THREE LARGEST PRIMARY CARE CLINICS: COFFEE WOMEN'S CARE CENTER, CRH OB/GYN, AND CRH PEDIATRICS. PATIENTS WERE INCENTIVIZED TO PARTICIPATE.A WRITTEN SURVEY WAS PROVIDED TO PHYSICIANS AND LEADERS WITHIN THE COMMUNITY TO ASSESS THE HEALTH OF THE COMMUNITY, AS WELL AS ITS SPECIFIC NEEDS. THE LEADER BASE WAS DRAWN FROM COUNTY BOARD OF COMMISSIONERS, DFACS TECHNICAL COLLEGE, ENTREPRENEURS, COMMUNITY VOLUNTEERS AND MINISTRY. COFFEE REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 11: COFFEE REGIONAL MEDICAL CENTER IDENTIFIED THE FOUR TOP AREAS TO FOCUS ON OUT OF ALL NEEDS IDENTIFIED BY THE COMMUNITY HEALTH NEEDS ASSESMENT. THESE FOUR ARE CONSIDERED THE MOST SIGNIFICANT HEALTH NEEDS IN THE COMMUNITY AND WILL BE COVERED BY THE IMPACT INITIATIVES. OTHER HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT BUT NOT DEEMED SIGNIFICANT MAY BE INDIRECTLY IMPACTED BY THE INITIATIVES, BUT RESOURCE CONSTRAINTS PREVENT CRMC FROM DIRECTLY ADDRESSING THESE INITIATIVES.GOAL #1: ADDITIONAL PRIMARY CARE SERVICESCRMC HAS IMPLEMENTED A 24 HOUR A DAY, SEVEN DAY A WEEK HOSPITALIST PROGRAM TO AID PRIMARY CARE PHYSICIANS WITH THE TRANSITION OF CLINIC PATIENTS TO INPATIENT CARE. THE HOSPITALIST PROGRAM ALLOWS THE PRIMARY CARE PHYSICIANS THE ABILITY TO STAY IN THE PRACTICE SETTING VERSUS ROUNDING ON PATIENTS IN THE HOSPITAL, CREATING MORE OPEN CLINIC VISIT SLOTS ON THE SCHEDULE WHICH ENHANCES PATIENT ACCESS TO CARE.GOAL #2: ACCESS TO CARE/TRANSPORTATION- CRMC PROVIDED COMMUNITY EDUCATION AND ON-SITE ASSISTANCE FOR THE HEALTHCARE INSURANCE EXCHANGE IN AN EFFORT TO PROVIDE THE UNINSURED GREATER ACCESS TO CARE.- ADDITIONAL TRANSPORTATION SERVICES HAVE BEEN ADDED TO THE AREA TO BETTER SERVICE THE COMMUNITY.- TWO NEW HOME HEALTH CARE AGENCIES HAVE ALSO BEEN ADDED TO THE AREA TO SECURE A GREATER CONTINUUM OF CARE POST-HOSPITALIZATION.- PRIMARY CARE IS PROVIDED TO STUDENTS AT THE LOCAL STATE COLLEGE THROUGH THE CRMC WALK-IN CLINIC.- CRMC CONTINUES TO WORK WITH THE LOCAL RURAL HEALTH CLINIC, TRANSPORT COMPANIES, HOME HEALTH AGENCIES AND OTHER LOCAL WALK-IN CLINICS TO HELP PROVIDE ACCESS TO CARE WHEN POSSIBLE.- CAB VOUCHERS ARE PROVIDED TO PATIENTS POST-HOSPITAL DISCHARGE WHEN NECESSARY.GOAL #3: HEALTH EDUCATION/OBESITY/DIET AND NUTRITION/PREVENTIVE CARE- IN 2015 CRMC PROVIDED ONGOING MONTHLY SUPPORT GROUPS INCLUDING A DIABETIC SUPPORT GROUP AND CHILD BIRTH CLASSES. THESE CLASSES OR SUPPORT GROUPS ARE PROVIDED AT NO COST TO THE COMMUNITY IN AN EFFORT TO EDUCATE THE COMMUNITY ON HEALTHY EATING HABITS, PREVENTIVE CARE AND HEALTHY LIFESTYLES.- THE CRMC WELLNESS CENTER ORGANIZED A NUMBER OF FITNESS EVENTS IN 2015 TO ENCOURAGE A HEALTHY COMMUNITY AND BRING WELLNESS AWARENESS TO THE COMMUNITY THROUGHOUT THE YEAR.- THROUGH THE CRMC WELLNESS CENTER, WELLNESS EDUCATION WAS PROVIDED TO 150 PLUS STUDENTS AT THE BOYS AND GIRLS CLUB OF COFFEE COUNTY.- CRMC ALSO OFFERS A LOW COST, HEALTHY MEAL OPTION IN THE CAFETERIA DAILY AND IS OPEN TO THE PUBLIC.- THE ANNUAL COMMUNITY HEALTH FESTIVAL OFFERS FREE AND REDUCED COST SCREENINGS, INCLUDING BLOOD SUGAR, BMI, BLOOD PRESSURE, AND CBC. THE FESTIVAL ALSO PROVIDES THE COMMUNITY WITH NUMEROUS HEALTH RESOURCES AND EDUCATION. OVER 1000 PARTICIPANTS TOOK PART IN THE FAIR IN 2015.- ONGOING COMMUNITY EDUCATION ON HEALTH AND WELLNESS IS PROVIDED THROUGH COMMUNITY LUNCH AND LEARN EDUCATIONAL SESSIONS, PUBLIC SERVICE ANNOUNCEMENTS AND COMMUNITY EVENTS IN AN EFFORT TO BETTER EDUCATE COFFEE COUNTY.GOAL #4: CANCER TREATMENT OPTIONS- COFFEE COUNTY NOW HAS THE PRESENCE OF TWO PART-TIME ONCOLOGISTS IN THE AREA.- CRMC SUPPORTS EVIDENCE-BASED PROSTATE CANCER SCREENINGS AND EARLY DETECTION THROUGH ANNUAL, REDUCED FEE PROSTATE SCREENING FOR THE MEMBERS OF THE COMMUNITY, AS WELL AS PSA SCREENING THROUGH LOCAL PHYSICIANS.- CRMC CONTINUES TO PROVIDE THE LATEST IN TECHNOLOGY TO AID IN THE EARLY DETECTION OF BREAST CANCER THROUGH ITS RECENT PURCHASE OF THE HOLOGIC 3D MAMMOGRAPHY TECHNOLOGY, KNOWN AS "TOMOSYNTHESIS".- CRMC REACHED OUT TO A REGIONAL FACILITY FOR ADDITIONAL ASSISTANCE IN FURTHER DEVELOPING THE ONCOLOGY SERVICES IN COFFEE COUNTY. COFFEE REGIONAL MEDICAL CENTER INC PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY DISCOUNTS CHARGES BASED ON A SLIDING FEE SCALE WHICH COMPARES THE APPLICANT'S ANNUAL HOUSEHOLD INCOME TO FEDERAL POVERTY GUIDELINES. CHARGES ARE REDUCED AS MUCH AS 55% IN ACCORDANCE WITH THE FACILITY'S FINANCIAL ASSISTANCE POLICY. 1 1 - COFFEE REGIONAL FIRST CARE 1101 OCILLA ROAD DOUGLAS GA 31533 RURAL HEALTH CLINIC PART I, LN 7 COL(F): THERE IS $14,174,537 OF BAD DEBT EXPENSE WHICH IS INCLUDED IN FORM 990, PART IX, LINE 24(B). THIS AMOUNT WAS REMOVED IN THE CALCULATION OF THE PERCENT OF TOTAL EXPENSE ON SCHEDULE H LINE 7F. PART II, COMMUNITY BUILDING ACTIVITIES: HEART TO HEART 5K RUN - FEBRUARY 20, 2015CRMC'S ANNUAL FALL FITNESS 5K RUN/FUN WALK WAS HELD IN FEBRUARY 2015 WITH OVER 231 PARTICIPANTS. IN ADDITION TO THE 5K EVENT, A ONE MILE FUN RUN WAS HELD FOR THE YOUTH IN OUR COMMUNITY. A CHECK FOR $5,148 WAS DONATED TO THE CARDIAC REHAB AWARENESS PROGRAM. (APPROXIMATELY 40 HOURS AT A COST OF $800)HEALTH FAIR - OCTOBER 3, 2015THE ANNUAL HEALTH & SAFETY FESTIVAL HELD OCTOBER 4, 2015 ATTRACTED APPROXIMATELY 1000 VISITORS. WITH OVER 80 EXHIBITORS, DEMONSTRATIONS AND HEALTH SCREENS, THE FESTIVAL OFFERED WONDERFUL, INTERACTIVE WAYS TO PROMOTE A HEALTHY LIFESTYLE. 430 VISITORS TOOK ADVANTAGE OF THE COMPLETE BIOCHEMICAL BLOOD PROFILES OFFERED AT A REDUCED FEE OF $30 (ACTUAL CHARGE OF $535) RESULTING IN A COMMUNITY SAVINGS $217,150. (APPROXIMATELY 100 HOURS AT A COST OF $2,000)PROSTATE CANCER SCREENING - SEPTEMBER 17TH & 19TH, 2015THE EARLIER PROSTATE CANCER IS DISCOVERED, THE BETTER THE CHANCES ARE THAT IT CAN BE TREATED EFFECTIVELY. WHEN PROSTATE CANCER IS IN ITS EARLIEST STAGES (STILL CONFINED TO THE PROSTATE GLAND), IT USUALLY CAUSES NO PAIN OR OTHER SYMPTOMS. THAT IS WHY EACH YEAR COFFEE REGIONAL MEDICAL CENTER OFFERS LOW COST PROSTATE CANCER SCREENINGS (DRE AND PSA BLOOD TESTS) TO OUR COMMUNITY FOR A REDUCED LAB FEE OF ONLY $10 (ACTUAL CHARGE $147) RESULTING IN A COMMUNITY SAVINGS OF $15,481. IN 2015, 113 MEN TOOK ADVANTAGE OF THIS LIFE-SAVING SCREENING. (APPROXIMATELY 13.5 PHYSICIAN HOURS AND 36 STAFF HOURS AT A COST OF $2,745)SPORTS PHYSICALS - APRIL 21, 2015ATHLETIC PHYSICALS ARE REQUIRED BY BOTH THE GEORGIA HIGH SCHOOL AND GEORGIA INDEPENDENT SCHOOL ASSOCIATIONS FOR STUDENTS PLANNING ON PARTICIPATING IN SCHOOL ATHLETIC PROGRAMS. EACH YEAR CRMC PROVIDES OVER 600 SPORTS PHYSICALS TO STUDENTS PARTICIPATING IN INTERSCHOLASTIC SPORTS DURING THE SUMMER AND THROUGHOUT THE FOLLOWING YEAR. THIS EVENT RESULTED IN A TOTAL COST SAVINGS TO THE COMMUNITY OF OVER $15,000. (APPROXIMATELY 40 PHYSICIAN HOURS AND 32 STAFF HOURS AT A COST OF $6,640.)PROJECT SEARCH 2015PROJECT SEARCH IS A ONE-YEAR EDUCATIONAL PROGRAM FOR STUDENTS WITH DISABILITIES IN THEIR LAST YEAR OF HIGH SCHOOL. IT IS TARGETED FOR STUDENTS WHOSE MAIN GOAL IS COMPETITIVE EMPLOYMENT. COFFEE REGIONAL MEDICAL CENTER PROVIDES THE SETTING FOR TWELVE PROJECT SEARCH STUDENTS, THUS ALLOWING TOTAL IMMERSION IN THE WORKPLACE TO FACILITATE THE TEACHING AND LEARNING PROCESS THROUGH CONTINUOUS FEEDBACK AND APPLICATION OF NEW SKILLS. INDIVIDUALIZED JOB DEVELOPMENT AND PLACEMENT BEGINS AFTER ROTATIONS AT ONE OR MORE WORKSTATIONS ARE COMPLETED. STUDENTS RECEIVE SUPPORT THROUGH ON-THE-JOB COACHING AND WORKSITE ACCOMMODATIONS PROVIDED BY CRMC. THE PROGRAM IS DEDICATED TO WORKFORCE DEVELOPMENT THAT BENEFITS THE INDIVIDUAL, COMMUNITY AND WORKPLACE. (CLASSROOM SPACE AT $300/MONTH TOTAL OF $2,700 AND APPROXIMATELY 60 STAFF HOURS OF TRAINING, MENTORING AND EDUCATION OF 12 STUDENTS PER YEAR AT A COST OF $1,200)BREAST CANCER SUPPORT GROUP - MONTHLY 2015IN 2015, CRMC OFFERED A FREE MONTHLY BREAST CANCER SUPPORT GROUP FOR WOMEN IN THE COMMUNITY RECENTLY DIAGNOSED WITH BREAST CANCER, THOSE UNDERGOING TREATMENT, AND THOSE WHO HAVE COMPLETED TREATMENT. CRMC'S CLINICAL EDUCATION DEPARTMENT LEADS AND ORGANIZES EACH MEETING PROVIDING SUPPORT, EDUCATION, RESOURCES AND EXPERT SPEAKERS AT EACH MEETING. APPROXIMATELY 10-15 PEOPLE ATTEND EACH MONTHLY MEETING. (144 HOURS PER YEAR AT A COST OF $2,800)DIABETES SUPPORT GROUP - MONTHLY 2015CRMC OFFERS A FREE MONTHLY DIABETES SUPPORT GROUP FOR THE GENERAL PUBLIC. CRMC'S CLINICAL EDUCATION DEPARTMENT LEADS AND ORGANIZES EACH MEETING PROVIDING SUPPORT, EDUCATION, RESOURCES AND EXPERT SPEAKERS AT EACH MEETING. EXPERTS SUCH AS DIETICIANS, PODIATRISTS AND PHYSICIANS PROVIDE VALUABLE EDUCATION TO OUR COMMUNITY REGARDING DIABETES. APPROXIMATELY 30 PEOPLE ATTEND EACH MONTHLY MEETING. (144 HOURS PER YEAR AT A COST OF $2,800)AMERICAN CANCER SOCIETY (RELAY FOR LIFE) - APRIL 2015CRMC PROVIDES A CORPORATE SPONSOR OF $1,000 ANNUALLY TO THE AMERICAN CANCER SOCIETY FOR CANCER RESEARCH, TREATMENT, AND RESOURCES. EACH YEAR MANY OF COFFEE REGIONAL EMPLOYEES PROVIDE NUMEROUS MAN HOURS FOR THE COMMUNITY WIDE RELAY FOR LIFE EVENT IN EFFORT TO RAISE MONEY AND AWARENESS. (APPROXIMATELY 180 HOURS AT A COST OF $3,600)COMMUNITY CHILDBIRTH CLASSES - BIMONTHLY 2015 CRMC PROVIDES WEEKLY CHILDBIRTH CLASSES EVERY OTHER MONTH FOR THE COMMUNITY. THE WEEKLY SESSIONS ARE FACILITATED BY THE LABOR AND DELIVERY RN STAFF. THE CLASSES PROVIDE EDUCATIONAL LESSONS ABOUT NUTRITIONAL NEEDS OF MOTHER AND FETUS, ANESTHESIA, DELIVERY, BREASTFEEDING AND MANY OTHER INFORMATIVE TOPICS. (2 RN STAFF, 8 HOURS PER MONTH FOR 6 MONTHS AT $25 PER HOUR FOR A TOTAL ANNUAL COST OF $2,400).COFFEE COUNTY CHILDHOOD CANCER SUPPORT GROUP - 2015CRMC PROVIDES SPACE MONTHLY FOR THE COFFEE COUNTY CHILDHOOD CANCER SUPPORT GROUP AT NO COST TO THEM. THE CHILDHOOD CANCER SUPPORT GROUP IS A NON-PROFIT ORGANIZATION THAT PROVIDES FAMILIES AND PATIENTS WITH CHILDHOOD CANCER SUPPORT, EDUCATION, RESOURCES AND EXPERT SPEAKERS AT EACH MONTHLY MEETING. (CLASSROOM SPACE $100 PER MONTH FOR A TOTAL OF $1,200 ANNUALLY)ALZHEIMER'S DISEASE SUPPORT GROUP OF COFFEE COUNTY - 2015CRMC PROVIDES SPACE MONTHLY FOR THE ALZHEIMER'S DISEASE SUPPORT GROUP OF COFFEE COUNTY AT NO COST TO THEM. THE SUPPORT GROUP IS A NON-PROFIT ORGANIZATION THAT PROVIDES FAMILIES SUPPORT, EDUCATION, RESOURCES AND EXPERT SPEAKERS AT EACH MONTHLY MEETING. (CLASSROOM SPACE $100 PER MONTH FOR A TOTAL OF $1,200 ANNUALLY)SIDELINE SERVICE - 2015 CRMC PROVIDES SIDELINE SERVICE FOR EACH HIGH SCHOOL FOOTBALL GAME IN COFFEE COUNTY. A FULLY EQUIPPED AMBULANCE, EMT, AND PARAMEDIC ARE PROVIDED FOR EACH HOME FOOTBALL GAME AS A COURTESY TO THE SCHOOL SYSTEM AND SPECTATORS. (AT A COST OF $250 PER GAME FOR A TOTAL OF $1,500 ANNUALLY)COFFEE COUNTY CHAMBER OF COMMERCE NEW CENTURY LEADERS - 2015 PARTICIPANTS IN NEW CENTURY LEADERS COMMIT TO AN EIGHT MONTH PROJECT THAT ALLOWS THEM TO TAKE A CLOSE LOOK AT GOVERNMENT, EDUCATION, ECONOMIC DEVELOPMENT, AND ALL ISSUES DEALING WITH QUALITY OF LIFE ON A LOCAL AND STATE LEVEL. THE PROGRAM IS DESIGNED TO HELP PARTICIPANTS DEVELOP LEADERSHIP SKILLS FOR THE WORKPLACE AND THE COMMUNITY. CRMC SPONSORED 2 EMPLOYEES IN 2015 FOR THE NEW CENTURY LEADER PROGRAM. STAFF TIME, TRAVEL AND EXPENSES FOR THE PROGRAM IS APPROXIMATELY $3,840. (2 EMPLOYEES, 12 DAYS OF TRAINING AT 8 HOURS PER DAY = 192 STAFF HOURS AT $20 PER HOUR FOR A TOTAL OF $3,840)STUDENTS - 2015IN 2015 THE MEDICAL CENTER SUPPORTED HEALTHCARE EXCELLENCE THROUGHOUT GEORGIA BY TRAINING OVER 250 STUDENTS. - ABAC (TIFTON, GA) - NURSING (RN)- ALBANY STATE UNIVERSITY (ALBANY, GA) - MASTERS IN NURSING - COFFEE HIGH SCHOOL (DOUGLAS, GA) - HEALTH OCCUPATION STUDENTS, PROJECT SEARCH, STEM STUDENTS- GA HEALTH SCIENCE UNIVERSITY (AUGUSTA, GA) - PHYSICIAN ASSISTANT - GA SOUTHERN UNIVERSITY (STATESBORO, GA) - NURSING, NURSE PRACTITIONER, DIETICIAN - MERCER (MACON, GA) - MEDICAL STUDENTS - OKEFENOKEE TECHNICAL COLLEGE (WAYCROSS, GA) - LAB, NURSING (LPN), RADIOLOGY TECHNOLOGY, RESPIRATORY THERAPY- SOUTHEASTERN TECH (VIDALIA, GA) - SURGICAL TECHNOLOGY- SOUTH GEORGIA STATE COLLEGE (DOUGLAS, GA) - NURSING (RN) 1ST YR & 2ND YR - SOUTH UNIVERSITY (SAVANNAH, GA) - PHARMACY, PHYSICIAN ASSISTANT - VALDOSTA STATE UNIVERSITY - NURSING (RN), EXERCISE PHYSIOLOGY - WALDEN UNIVERSITY (ONLINE) - MASTERS IN NURSING - WIREGRASS (DOUGLAS, GA) - CNA, EMT, HIT CODING, LPN, PHLEBOTOMY, RADIOLOGY PART III, LINE 2: AMOUNTS ON PART III, LINES 2 AND 3 REPRESENT CHARGES WRITTEN OFF AS UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT AND WRITTEN OFF TO BAD DEBT EXPENSE. LINE 3 IS ESTIMATED AT 75% OF THE AMOUNT ON LINE 2. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE CORPORATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY FOR THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE CORPORATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE CORPORATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE CORPORATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS APPROXIMATELY 97% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2015 AND 2014. THE CORPORATION DID NOT HAVE A MATERIAL CHANGE IN THE ALLOWANCE PERCENTAGE FOR MEDICARE OR MEDICAID DURING 2015 OR 2014. THE ALLOWANCES DISCLOSED ON THE CONSOLIDATED BALANCE SHEETS REPRESENT THE ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS WITH THIRD-PARTY PAYORS, AS WELL AS THE ESTIMATED ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE CORPORATION'S PROVISION FOR BAD DEBTS INCREASED APPROXIMATELY $2,018,000 FROM APPROXIMATELY $12,157,000 FOR 2014 TO APPROXIMATELY $14,175,000 FOR 2015. THIS WAS THE RESULT OF INCREASED SELF-PAY PATIENT VOLUME. THE CORPORATION HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2015 OR 2014. PART III, LINE 8: 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: THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES FOR PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS. PART VI, LINE 2: COFFEE REGIONAL MEDICAL CENTER EVALUATES THE NEEDS OF ITS PATIENT BASE THROUGH THE NUMBER OF PATIENTS REFERRED TO OTHER FACILITIES FOR SERVICES NOT PROVIDED BY THE FACILITY ITSELF AND THROUGH OTHER INDICATORS. IN 2013, THE HOSPITAL ORGANIZATION COMPLETED ITS COMMUNITY HEALTH NEEDS ASSESSMENT. THE FINAL REPORT CAN BE FOUND AT THE FOLLOWING LINK:HTTP://WWW.COFFEEREGIONAL.ORG/THE IMPLEMENTATION STRATEGY PLAN IS INCLUDED AS A PART OF THE CHNA ON PAGES 25 THROUGH 29. PART VI, LINE 3: THE FINANCIAL COUNSELING DEPARTMENT WILL PROVIDE INFORMATION AND APPLICATIONS TO ALL PATIENT OR GUARANTORS SEEKING FINANCIAL ASSISTANCE FOR SERVICES RENDERED AT COFFEE REGIONAL MEDICAL CENTER THAT ARE DEEMED MEDICALLY NECESSARY.FINANCIAL COUNSELORS WILL DISCUSS ELIGIBILITY FOR MEDICAL ASSISTANCE PROGRAMS THROUGH THE DEPARTMENT OF FAMILY & CHILDREN SERVICES AND THE SOCIAL SECURITY ADMINISTRATION. IF ELIGIBILITY IS NOT MET FOR ANY MEDICALASSISTANCE PROGRAM, THE FINANCIAL COUNSELING DEPARTMENT WILL SEEK ELIGIBILITY THROUGH COFFEE REGIONAL MEDICAL CENTER'S INDIGENT CARE TRUST FUND PROGRAM.PATIENTS OR GUARANTORS REQUESTING FINANCIAL ASSISTANCE ARE REFERRED TO THE FINANCIAL COUNSELORS (FC) OR THE BENEFIT SPECIALIST CONTACT THE PATIENT AT THE TIME OF REGISTRATION FOR OUTPATIENT SERVICES OR IN THE EMERGENCY DEPARTMENT (AFTER MEDICAL SCREENING HAS BEEN COMPLETED). THE FC WILL ALSO CONTACT AN INDIVIDUAL IF THERE IS A REQUEST FROM SOCIAL SERVICES, A PHYSICIAN OFFICE, OR THE PATIENT FINANCIAL SERVICES DEPARTMENT. PATIENTS ADMITTED FOR INPATIENT OR OBSERVATION SERVICES MAY BE VISITED BY THE FC AFTER THE PATIENT HAS BEEN PLACED IN A ROOM AND STABILIZED.THE FC WILL DISCUSS WITH THE PATIENT OR GUARANTOR THE INDIGENT CARE TRUST FUND PROGRAM REQUIREMENTS AND APPLICATION PROCESS. THE PATIENT OR GUARANTOR WILL BE REQUIRED TO COMPLETE AN INDIGENT APPLICATION, PROVIDE PROOF OF IDENTITY, PROVIDE BIRTH CERTIFICATES OR PROOF OF DEPENDENCY FOR CHILDREN WITH NO IDENTITY, AND PROVIDE VERIFICATION OF INCOME (I.E. W-2'S, FEDERAL TAX RETURN, PAY STUBS, ETC.). IF VERIFICATION IS NOT PROVIDED AT THE TIME OF THE INTERVIEW, THE PATIENT OR GUARANTOR WILL BE REQUIRED TO PROVIDE WITHIN 30 DAYS. APPLICATIONS MADE ON BEHALF OF DECEASED PATIENTS MUST HAVE VERIFICATION OF INCOME AND INFORMATION CONCERNING THE VALUE OF THE PATIENT'S ESTATE.PATIENTS WHO CHOOSE NOT TO UTILIZE CURRENT BENEFITS THEY ARE ELIGIBLE FOR (I.E. VETERANS BENEFITS, MEDICARE, AND COMMERCIAL INSURANCE) WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM. UPON RECEIPT OF THE COMPLETED APPLICATION INCLUDING NECESSARY DOCUMENTATION, CALCULATION OF THE HOUSEHOLD SIZE AND ANNUAL HOUSEHOLD INCOME IS COMPUTED AND COMPARED TO THE FEDERAL POVERTY GUIDELINES (FPG) TO DETERMINE THE PERCENTAGE OF ASSISTANCE A PATIENT OR GUARANTOR IS ELIGIBLE TO RECEIVE. PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW THE GROSS INCOME CEILING FOR POTENTIAL MEDICAID ELIGIBILITY ARE REQUIRED TO APPLY FOR MEDICAID. ASSISTANCE IS PROVIDED TO PATIENTS IN FILING FOR OTHER BENEFITS AND COMPLETING MEDICAID APPLICATIONS. PATIENTS WHO CHOOSE NOT TO APPLY FOR OTHER BENEFITS TO WHICH THEY MAY BE ENTITLED (I.E. MEDICAID) WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM. PATIENTS WHO CHOOSE TO APPLY COFFEE REGIONAL MEDICAL CENTER'S ACCOUNTS FOR THE PURPOSE OF MEETING MEDICALLY NEEDY SPEND DOWN TO RECEIVE ONGOING MEDICAID WILL NOT BE ALLOWED TO APPLY FOR THE INDIGENT PROGRAM FOR THAT ACCOUNT.PATIENTS OR GUARANTORS OVER 18 YEARS OF AGE BUT CLASSIFIED AS DEPENDENTS FOR TAX PURPOSES DUE TO STUDENT ELIGIBILITY WILL HAVE A TOTAL HOUSEHOLD SIZE THAT INCLUDES PARENTS AND SUBSEQUENT INCOME. PATIENTS OR GUARANTORS NOT ELIGIBLE FOR OTHER MEDICAL ASSISTANCE PROGRAMS WILL BE PROCESSED UNDER THE INDIGENT CARE TRUST FUND GUIDELINES USING THE FOLLOWING CATEGORIES:- INDIGENT - FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW 125% OF THE FPG, THE APPLICABLE ACCOUNTS WILL BE ADJUSTED TO ZERO BALANCES.- CHARITY - FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN OR EQUAL TO 125% BUT NOT GREATER THAN 200% OF THE FPG, THE APPLICABLE ACCOUNTS WILL BE ADJUSTED BY THE APPROPRIATE PERCENTAGES. - AN ADJUSTMENT OF 85% OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 125% AND 150% OF FPG - AN ADJUSTMENT OF 70% OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 150% AND 175% OF FPG - AN ADJUSTMENT OF 55% OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 175% AND 200% OF FPG- CATASTROPHIC - PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN 200% FPG MAY QUALIFY FOR CHARITY ADJUSTMENTS ON APPLICABLE ACCOUNTS, IF CONSIDERATION OF THE CRMC PATIENT OBLIGATIONS REDUCES THE ANNUAL HOUSEHOLD INCOME TO THE APPROPRIATE FPG.NOTIFICATION OF STATUS OF COMPLETED APPLICATION IS PROVIDED TO THE PATIENT OR GUARANTOR WITHIN 5 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION. APPROVED APPLICATIONS ARE VALID FOR 30 DAYS FROM DATE OF SIGNATURE. INCOMPLETE APPLICATIONS ARE HELD FOR 30 DAYS. IF NO DOCUMENTATION IS PROVIDED TO COMPLETE THE APPLICATION, A DENIAL LETTER IS SENT TO THE PATIENT OR GUARANTOR. THE APPLICATION MAY BE COMPLETED IF THE PATIENT OR GUARANTOR PROVIDES THE REQUESTED INFORMATION WITHIN 15 WORKING DAYS OF THE DENIAL. NOTIFICATION OF STATUS OF COMPLETED APPLICATION WILL BE MAILED WITHIN 15 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION.THE APPLICATION AND DOCUMENTATION WILL BECOME PROPERTY OF COFFEE REGIONAL MEDICAL CENTER AND IS TO BE KEPT CONFIDENTIAL IN THE SAME MANNER AS MEDICAL RECORDS. HOWEVER, THIS INFORMATION WILL BE USED FOR AGGREGATE REPORTING PURPOSES ONLY. PART VI, LINE 4: COFFEE REGIONAL MEDICAL CENTER'S PRIMARY SERVICE AREA IS COFFEE COUNTY, GEORGIA. THE COUNTY HAD A POPULATION OF 43,108 CITIZENS IN 2015, OF WHICH APPROXIMATELY 28.1% FALL BELOW GOVERNMENTAL DEFINED POVERTY GUIDELINES. COFFEE COUNTY'S UNEMPLOYMENT RATE AT YEAR-END WAS 8.1%. PART VI, LINE 5: COFFEE REGIONAL MEDICAL CENTER IS GOVERNED BY A BOARD OF DIRECTORS CONSISTING OF 11 MEMBERS. CRH HEALTHCARE, INC., THE SOLE MEMBER, ELECTS ALL BOARD MEMBERS OF CRMC. THE BOARD IS MADE UP OF NINE COMMUNITY MEMBERS REFLECTING THE DIVERSITY OF THE COMMUNITY. THE REMAINING TWO MEMBERS ARE THE CHIEF OF STAFF OF CRMC AND THE CHIEF OF STAFF ELECT. IT IS THE PHILOSOPHY OF CRMC TO ASSURE THE CONTINUATION AND ENHANCEMENT OF PATIENT CARE BY REINVESTING EXCESS FUNDS BACK INTO THE OPERATIONS OF THE FACILITY.THIS INCLUDES GREATER ACCESSIBILITY OF CARE THROUGH THE CREATION OF A RURAL HEALTH CENTER, IMPLEMENTATION OF A TELEMEDICINE PROGRAM AND RECRUITMENT OF PHYSICIANS TO THE UNDERSERVED ENVIRONMENT. ENHANCEMENT OF TECHNOLOGY IS ALSO IMPERATIVE TO ASSURE APPROPRIATE DIAGNOSTIC AND THERAPEUTIC OPTIONS FOR THE COMMUNITY. UPDATING THE AMBULANCE FLEET IS CONSISTENTLY HIGH ON THE FUNDING PRIORITY LIST TO ASSURE SERVICE TO THE MOST REMOTE AREAS OF THE COUNTY, WHICH IN SQUARE MILES IS THE SECOND LARGEST COUNTY IN THE STATE OF GEORGIA. CRMC HAS AN OPEN MEDICAL STAFF POLICY EXTENDING PRIVILEGES TO PROFESSIONALLY COMPETENT PRACTITIONERS WHO CONTINUOUSLY MEET THE QUALIFICATIONS, STANDARDS AND REQUIREMENTS OF CRMC. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES GA X X X X X 0 0 0 0 0 1 0 0 0 DARREL COLLINS DO DIRECTOR 179617 0 0 0 0 0 0 0 0 0 179617 0 0 0 VICKI LEWIS PRESIDENT/CEO 327006 0 0 0 79 0 0 0 37009 0 364094 0 0 0 SHERRY THOMAS EXECUTIVE VP/CNE 241464 0 0 0 95 0 5200 0 19933 0 266692 0 0 0 BARRY BLOOM VP/EXEC. DIRECTOR OF FOUNDATION 205591 0 0 0 62 0 0 0 19933 0 225586 0 0 0 BRADLEY GOLDBERG OB/GYN PHYSICIAN 425837 0 80348 0 22 0 10010 0 19933 0 536150 0 0 0 STEVEN DIAMOND OB/GYN PHYSICIAN 349286 0 129100 0 62 0 0 0 19933 0 498381 0 0 0 THOMAS HENRIS ANESTHESIOLOGIST 475336 0 2605 0 62 0 22984 0 19933 0 520920 0 0 0 KHONDKER ISLAM GASTROENTEROLOGIST 451999 0 0 0 28 0 23000 0 19933 0 494960 0 0 0 THOMAS WEHMANN SURGEON 421188 0 7940 0 79 0 17500 0 6500 0 453207 0 0 0 PART I, LINE 6 CERTAIN EXECUTIVE OFFICERS AND PHYSICIANS ARE ELIGIBLE FOR BONUS/INCENTIVE PAYMENTS. THESE PAYMENTS ARE RELIANT ON VARIOUS ORGANIZATIONAL AND PERSONAL GOALS ESTABLISHED BY THE GOVERNING BODY. WHETHER A BONUS/INCENTIVE PAYMENT IS AWARDED IS DEPENDENT UPON THE NET PROFIT OF THE ORGANIZATION. A COFFEE COUNTY HOSPITAL AUTHORITY 586003116 192137DJ3 2004-11-16 39213858 DEFEASANCE OF PREVIOUS BONDS 0 0 0 A 10564710 39213858 767435 38446423 2004 0 1 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 6 CRH HEALTHCARE, INC., THE PARENT ORGANIZATION, HAS THE AUTHORITY TO APPOINT OR REMOVE BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A BOARD MEMBERS OF THE ORGANIZATION ARE APPOINTED, AND CAN BE REMOVED, BY CRH HEALTHCARE, INC., THE PARENT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE BOARD ARE SUBJECT TO APPROVAL BY CRH HEALTHCARE, INC., THE PARENT ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PREPARED BY AN INDEPENDENT FIRM AND IS PROVIDED TO THE BOARD PRIOR TO FILING WITH THE IRS. THE MANAGEMENT OF COFFEE REGIONAL MEDICAL CENTER, INC. PERFORMS A REVIEW OF FORM 990 BEFORE THE FILING DATE AND INCLUDES A REVIEW OF FINANCIAL DATA AND OTHER DETAILS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS ANNUALLY. THIS IS REVIEWED BY THE CEO AND BOARD CHAIRMAN, IF NEEDED. MEMBERS RECUSE THEMSELVES FROM CERTAIN DISCUSSIONS/DECISIONS AS A RESULT OF ANY CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS OF CRMC IS DETERMINED BY AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS OF THE ORGANIZATION ARE ALL AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S CORPORATE HEADQUARTERS. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 8,313,092. MANAGEMENT AND GENERAL EXPENSES 146,386. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,459,478. CONSULTING FEES: PROGRAM SERVICE EXPENSES 139,816. MANAGEMENT AND GENERAL EXPENSES 661,280. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 801,096. RECRUITMENT FEES: PROGRAM SERVICE EXPENSES 1,402. MANAGEMENT AND GENERAL EXPENSES 47,706. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,108. PURCHASED SERVICE FEES: PROGRAM SERVICE EXPENSES 4,156,891. MANAGEMENT AND GENERAL EXPENSES 1,476,662. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,633,553. MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 32,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,000. FORM 990, PART XI, LINE 9: PARTNERSHIP INCOME -15,365. CRH PHYSICIAN PRACTICES LLC 1101 OCILLA ROAD DOUGLAS GA 315332207 205778734 PHYSICIANS OFFICES GA -3498391 2297814 CRMC EMERGENCY PHYSICIANS OF COFFEE CO LLC PO BOX 1287 DOUGLAS GA 315341287 451775790 ER PHYSICIANS GA -777780 182938 CRMC ORTHOPEDIC SURGEONS OF GEORGIA LLC PO BOX 1287 DOUGLAS GA 315341287 452786844 PHYSICIANS OFFICES GA -4106905 837255 CRMC COFFEE REGIONAL MEDICAL CENTER SEGREGATED PORTFOLIO 62 FORUM LANE 3RD FLOOR BOX 30600 CAMANA BAY CJ INSURANCE CJ -564218 11268032 CRMC CRH HEALTHCARE INC 1101 OCILLA ROAD DOUGLAS GA 315332207 582163724 MANAGEMENT SERVICES GA 501(C)(3) LINE 11C, III-FI N/A 0 CRH HEALTH SERVICES INC 1101 OCILLA ROAD DOUGLAS GA 315332207 582165827 FOUNDATION GA 501(C)(3) LINE 11B, II N/A 0 CRH VENTURES INC 1101 OCILLA ROAD DOUGLAS GA 315332207 582165279 OFFICE RENTAL GA N/A C 0 SOUTHEASTERN MANAGED CARE INC 1101 OCILLA ROAD DOUGLAS GA 315332207 582236627 MANAGED CARE GA N/A C 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0