2016-08-11T15:53:50-05:00 2015-09-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 31708 990 2014-10-01 580566121 JOHN D ARCHBOLD MEMORIAL HOSPITAL INC JOHN 2292282853 P O BOX 1018 THOMASVILLE GA 317991018 J PERRY MUSTIAN PRESIDENT 2292282853 2016-08-15 true JACQUELINE G ATKINS P00861721 2298837878 2016-08-03 2014 2016-09-27 15:27:22Z J PERRY MUSTIAN PRESIDENTCEO P O BOX 1018 THOMASVILLE GA 317991018 323948190 false X WWW.ARCHBOLD.ORG X 1923 GA HEALTHCARE SERVICES 21 9 0 121 998313 -41866 7657280 8951237 292282469 310010448 1660285 1627490 3622002 2801737 305222036 323390912 503862 578106 0 124783721 119343852 0 0 152551358 163590637 277838941 283512595 27383095 39878317 579473377 616656098 158785630 155175929 420687747 461480169 X HEALTHCARE SERVICES false false 192936629 578106 248334684 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 3.0% OF PATIENT REVENUE WAS PROVIDED AS INDIGENT CARE. IN 2015, JDAMH PROVIDED OVER 21.8 MILLION IN INDIGENT CARE CHARGES. JDAMH TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION JDAMH PROVIDED APPROXIMATELY 44.1 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. 14368924 24422205 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 63% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2015, GGH PROVIDED OVER 1.6 MILLION IN INDIGENT CARE. IN ADDITION, GRADY GENERAL HOSPITAL PROVIDED OVER 7.8 MILLION IN ADDITIONAL UNCOMPENSATED CARE. EIN 58-1646537 FILED UNDER EIN 58-0566121. 8712674 9155944 BROOKS COUNTY HOSPITAL OPERATES IN QUITMAN, GEORGIA AS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE CARE BEDS. IT SERVES BROOKS COUNTY AND 73% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2015, 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. 18255254 27461664 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 63% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2015, OVER 5.3 MILLION OF INDIGENT CARE WAS PROVIDED TO THE COMMUNITY. IN ADDITION, MITCHELL COUNTY HOSPITAL PROVIDED OVER 2.7 MILLION ADDITIONAL UNCOMPENSATED CARE. EIN 58-6001207 FILED UNDER EIN 58-0566121. 18255254 27461664 234273481 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 208 0 0 true true false false false false false false false false false X 21 9 false false false false true true true true true false false false true true true true true false true false GA X CHARLES D HIGHTOWER JR 2292282853 PO BOX 1018 THOMASVILLE GA 317991018 J PERRY MUSTIAN PRES/HOSP CE 1.00 48.00 X X 0 823165 18215 GREGORY H PATTERSON MD PAST TRUSTEE 1.00 41.00 X 0 595363 42355 EDWARD L HALL MD PAST TRUSTEE 1.00 40.00 X 0 423274 46597 JASON NESMITH TRUSTEE 1.00 X 0 244998 36553 JAMES S KARAS MD TRUSTEE 1.00 1.00 X 58099 0 0 TIMOTHY GRAYSON MD TRUSTEE 1.00 X 13600 0 0 JOHN B CARICO MD TRUSTEE 1.00 1.00 X 3000 0 0 PAUL L STEINBERG MD PAST TRUSTEE 1.00 X 2232 0 0 BRYANT BEADLES TRUSTEE 1.00 1.00 X 0 0 0 NATHANIEL H ABRAMS JR CHAIRMAN 1.00 1.00 X X 0 0 0 GREG HAMIL TRUSTEE 1.00 1.00 X 0 0 0 BENJAMIN WILDS MD SECRETARY 1.00 1.00 X X 0 0 0 HAILE MCCOLLUM VICE CHAIRMA 1.00 1.00 X X 0 0 0 GARY BONVILLIAN PHD TREASURER 1.00 1.00 X X 0 0 0 IMOGENE CONYERS TRUSTEE 1.00 1.00 X 0 0 0 MARTA TURNER TRUSTEE 1.00 1.00 X 0 0 0 THOMAS J CALLAWAY III TRUSTEE 1.00 1.00 X 0 0 0 WALLACE GOODMAN TRUSTEE 1.00 2.00 X 0 0 0 CHARLES R SANDERS JR MD TRUSTEE 1.00 X 0 0 0 STEPHEN R AVERA 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 JANET SCHMIDT TRUSTEE 1.00 1.00 X 0 0 0 ALSTON WATT TRUSTEE 1.00 X 0 0 0 CHARLES D HIGHTOWER JR ASST SEC/ HO 1.00 48.00 X 0 470193 109944 JIM CARTER COO 40.00 X 189315 0 30844 MEL HARTSFIELD MD VP MEDICAL A 40.00 X 370601 0 48280 KEN BROOKER VP CLINICAL 40.00 X 248207 0 63163 AMY GRIFFIN VP PATIENT C 40.00 X 213961 0 25597 LADON TOOLE VP NETWORK O 40.00 X 200623 0 24001 JOSH MOORE VP OPERATION 40.00 X 155693 0 12712 JULIA WEEKS PHYSICIAN 40.00 X 318974 0 25569 DINESH B PATEL MD PHYSICIAN 40.00 X 312510 0 22647 STEPHEN RUBENDALL MD PHYSICIAN 40.00 X 284810 0 20421 JASON H SMITH PHYSICIAN 40.00 X 263317 0 17930 RAMESAN NAIR MD PHYSICIST 40.00 X 257458 0 49932 JOHN FISCHER FORMER COO X 296574 0 3770 3188974 2556993 598530 82 true true false RED HILLS RADIOLOGY 714 N DAWSON STREET THOMASVILLE GA 317924451 RADIOLOGY SVC 6367318 SOUTHLAND HOSPITALIST GROUP PO BOX 1276 THOMASVILLE GA 317991276 HOSPITALIST SVC 2846046 MORRISON MANAGEMENT SPECIALISTS 5801 PEACHTREE DUNWOODY RD ATLANTA GA 303421503 DIETARY SVCS 2721568 SOUTH GEORGIA EMERGENCY MEDICINE P O BOX 1913 THOMASVILLE GA 317991913 ER PHYSICIAN 2489063 SOUTHLAND EMERGENCY MEDICAL PO BOX 1279 THOMASVILLE GA 317991279 ER PHYSICIAN 2415058 40 3598200 5353037 8951237 PATIENT SERVICE REVENUE 623000 309012135 309012135 LAB SERVICES 621500 998313 998313 310010448 1461437 1461437 1002324 121173 881151 881151 881151 365456 199403 166053 166053 166053 397754 236702 161052 161052 DRUG SALES 621990 1220713 1220713 CAFETERIA SALES 722210 176459 176459 MEDICAL RECORD TRANSCRIPT FEE 623000 146132 146132 216230 216230 1759534 323390912 309374497 998313 4066865 X 96000 96000 482106 482106 1659928 76931 1582997 300344 300344 97398141 82888110 14510031 1203000 1155220 47780 10519908 9020726 1499182 8262531 7046947 1215584 374573 374573 89456 89456 43715857 35653884 8061973 260087 28760 231327 40118250 28222324 11895926 1729959 1712428 17531 9985105 8848800 1136305 1034280 719654 314626 65057 65057 23924721 21202088 2722633 2089448 2089448 MEDICAL SUPPLIES JDAMH 28398197 28398197 PROVIDER FEES 4484481 4484481 REPAIRS & MAINTENANCE JDA 2666125 2421141 244984 MEDICAL SUPPLIES GRADY 1814979 1814979 2840062 2330681 509381 283512595 234273481 49239114 0 5402919 21868418 50849220 51895791 3169225 3758246 2958671 3940001 508155181 256546277 255884312 251608904 192711702 203256539 26572 26572 68470756 80301627 579473377 616656098 34757427 33898485 828203 722444 123200000 120555000 158785630 155175929 X 417171944 458116818 3515803 3363351 420687747 461480169 579473377 616656098 39878317 914105 X true X true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7061 7061 283556122 283563183 1000000 250000 1000000 1000000 1000000 1000000 4000000 6000000 10085 10308 6274 7061 33728 250000 250000 250000 250000 1000000 1500000 3515803 -152452 3363351 3066204 449599 3515803 2817109 249095 3066204 2446192 370917 2817109 2243517 202675 2446192 1.00000 false false 8944638 8944638 151692861 52742547 98950314 23711722 12532283 11179439 318733829 191271447 127462382 5072131 5072131 251608904 DUE FROM RELATED PARTIES 42764610 OTHER RECEIVABLES 14594658 DUE FROM SELF INSURANCE TRUST 11589454 DUE FROM MEDICARE/MEDICAID 4541356 PHYSICIAN RECEIVABLES 2725386 DEFERRED BOND ISSUE COST - 2003 1809529 SCHOLARSHIP/TUITION RECEIVABLE 1752486 INTEREST RECEIVABLE 514839 EHR RECEIVABLE 9309 80301627 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 EXCERPT FROM CONSOLIDATED PARENT ORGANIZATION AUDITED FINANCIAL STATEMENTS. 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, 2015 AND 2014 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. (THE MEDICAL CENTER REFERS TO ARCHBOLD MEDICAL CENTER, INC., THE PARENT CORPORATION.) true true X true X true X 3.250000000000 true true true false false 9477938 9477938 0.03340 30012898 34356923 -4344025 621706 474951 146755 0.00050 40112542 34831874 5280668 0.03390 696905 696905 0.00250 4811043 4811043 0.01690 15739061 15739061 0.05540 20100 20100 0.00010 21267109 21267109 0.07490 61379651 34831874 26547777 0.10880 2000 2000 200484 200484 0.00070 629 629 506 506 203619 203619 0.00070 true 55963097 83542651 87229646 -3686995 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 false false true X X X X X X X X X X 13 true true false true X WWW.ARCHBOLD.ORG X X true 13 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 SURVEYS, IN-PERSON AND TELEPHONE INTERVIEWS, COMMUNITY FORUMS AND FOCUS GROUPS. 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 THE ORGANIZATION PROVIDES MANY COMMUNITY BENEFIT PROGRAMS THAT ADDRESS THE HEALTH AND SOCIAL DETERMINANTS OF HEALTH THROUGHOUT THOMAS, GRADY, BROOKS, AND MITCHELL COUNTIES AND THE SURROUNDING COMMUNITIES. THE COMMUNITY IS FORTUNATE TO HAVE A LARGE NUMBER OF HEALTH AND SOCIAL SERVICE AGENCIES WHO WORK INDIVIDUALLY AND COLLECTIVELY TO PROVIDE SERVICES PROGRAMS AND SUPPORT FOR THE COUNTY RESIDENTS. TO THAT END, THE ORGANIZATION WILL NOT ADDRESS SOME OF THE NEEDS IDENTIFIED IN THE 2013-14 ASSESSMENT BECAUSE: (1) THE ORGANIZATION ADDRESSES THE NEED, BUT CURRENTLY HAS NO PLANS TO EXPAND SERVICES, (2) OTHER PROVIDERS ARE ALREADY ADDRESSING THE NEEDS AND (3) THE NEED IDENTIFIED IS BEYOND THE SCOPE OF THIS ORGANIZATION. 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 25 283,512,597 ADD: EXPENSES REPORTED IN PART VIII 357,875 DENOMINATOR FOR COLUMN (F) 283,870,472 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 AND INPUT FROM GROUPS AND THROUGH SURVEYS. 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 2013-2014 CHNA'S CAN BE FOUND AT THE FOLLOWING WEB ADDRESSES: HTTP://WWW.ARCHBOLD.ORG/UPLOADS/DOCUMENTS/BROOKS-KEYHEALTHISSUES-2013.PDF HTTP://WWW.ARCHBOLD.ORG/UPLOADS/DOCUMENTS/GRADY-KEYHEALTHISSUES-2013.PDF HTTP://WWW.ARCHBOLD.ORG/UPLOADS/DOCUMENTS/MITCHELL-KEYHEALTHISSUES-2013.PDF HTTP:LLWWW.ARCHBOLD.ORG/UPLOADS/DOCUMENTS/THOMAS-KEYHEALTHISSUES-2013.PDF PROGRESS ON CHNA IMPLEMENTATION STRATEGIES 2013-2014: ACCESS TO CARE 2013-2014 IMPLEMENTATION PLAN ODOCUMENT PRIMARY CARE PROVIDER FOR EACH SCREENING PARTICIPANT OPROVIDE CARE OPTIONS FOR PARTICIPANTS WITHOUT PRIMARY CARE PHYSICIAN OATTEMPT TO ENSURE PARTICIPANTS WITH ABNORMAL SCREENS HAVE FOLLOW-UP APPOINTMENTS OPROVIDE INFORMATION ON FINANCIAL ASSISTANCE PROGRESS EACH SCREENING PARTICIPANT WITHOUT PROPER ACCESS TO CARE RECEIVED A PRINTED LIST OF PRIMARY CARE PROVIDERS AND A BROCHURE ON THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. ATTEMPTS TO REACH SCREENING PARTICIPANTS WITH ABNORMAL RESULTS WERE MADE IN WRITING AND BY PHONE. WE ALSO PROVIDED FREE OPPORTUNITIES TO LEARN ABOUT END-OF-LIFE ADVANCE DIRECTIVES, SCREENING RECOMMENDATIONS, AND NON-TRADITIONAL, INTEGRATIVE APPROACHES TO CARE. CANCER, DIABETES, RESPIRATORY DISEASE 2013-2014 IMPLEMENTATION PLAN OFREE SCREENINGS TO DETECT BREAST, CERVICAL, COLON, ORAL PROSTATE AND SKIN CANCER OFREE MONTHLY TOBACCO CESSATION CLASSES OFREE PUBLIC HEALTH TALKS OSUPPORT GROUPS PROGRESS HEALTH TALKS: OPHYSICIAN PANEL ON BREAST CANCER OCERVICAL CANCER OCOLORECTAL CANCER OSKIN CANCER OMAMMOGRAPHY OHOW DIABETES CAN LEAD TO DIGESTIVE DISEASE OCOPD AND ASTHMA SCREENINGS OFFERED INCLUDING SCREEN FOR DISEASE STATE: 2013-14 OCANCER-SPECIFIC, EXCLUDING LUNG CANCER (10) ODIABETES (24) OLUNG-CANCER (48, WEEKLY BASIS) OPULMONARY FUNCTION (2) 2014-15 OCANCER-SPECIFIC, EXCLUDING LUNG CANCER (3) ODIABETES (20) OLUNG-CANCER (48, WEEKLY BASIS) OPULMONARY FUNCTION (1) 2015-16 YTD OCANCER-SPECIFIC, EXCLUDING LUNG CANCER (1) ODIABETES (13) OLUNG-CANCER (36, WEEKLY BASIS) OPULMONARY FUNCTION (1) HEART DISEASE, KIDNEY DISEASE, STROKE 2013-2014 IMPLEMENTATION PLAN OFREE SCREENINGS WITH CARDIOVASCULAR, RENAL AND STROKE RISK FACTOR-SPECIFIC TESTING OFREE PUBLIC HEALTH TALKS PROGRESS HEALTH TALKS: OAPPROACHES TO TREATING KIDNEY DISEASE OCORONARY ARTERY DISEASE OPERIPHERAL ARTERY DISEASE OHEART DISEASE RISK FACTORS, PREVENTION AND OTREATMENT SCREENINGS OFFERED INCLUDING SCREEN FOR DISEASE STATE: 2013-14 OHEART/STROKE (31) OKIDNEY (13) 2014-15 OHEART/STROKE (26) OKIDNEY (2) 2015-16 YTD OHEART/STROKE (20) OKIDNEY (3) TEEN PREGNANCY, SUBSTANCE ABUSE 2013-2014 IMPLEMENTATION PLAN CONTINUE PROVIDING CONSULTATIVE AND EDUCATIONAL SUPPORT TO OUR COMMUNITY PARTNERS AS APPROPRIATE. PROGRESS THE FINANCIAL ASSISTANCE WE'VE TYPICALLY PROVIDED COMMUNITY PARTNERS HAS DECLINED FROM PREVIOUS YEARS, BUT WE'VE PROVIDED ASSISTANCE FINANCIALLY AS WE FELT WAS APPROPRIATE, AND HAVE REMAINED AVAILABLE FOR CONSULTATIVE AND EDUCATIONAL OPPORTUNITIES. OBESITY 2013-2014 IMPLEMENTATION PLAN OEVALUATE A MORE SIGNIFICANT, CONSISTENT AND DIRECT ROLE IN FIGHTING OBESITY OHEALTH TALKS SPECIFICALLY ADDRESSING OBESITY OFREE BREASTFEEDING CLASSES OSTART OVEREATERS ANONYMOUS CLASSES PROGRESS OROLE EVALUATED, FORMS CENTERPIECE OF 2016-2017 CHNA ODECIDED TO HOLD ON OBESITY-SPECIFIC HEALTH TALKS UNTIL WE MOVED FORWARD WITH A MORE COMPREHENSIVE OBESITY-BASED STRATEGY OFREE BREASTFEEDING CLASSES ONGOING OOVEREATERS ANONYMOUS CLASSES LAUNCHED AND STILL AVAILABLE, BUT RARELY USED PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PUBLISHED POLICY, SIGNS AND PAMPHLETS AT ALL REGISTRATION POINTS. 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 15,658; 62.2% WHITE/35.4% BLACK; MEDIAN HOUSEHOLD INCOME 31,686; 28.8% LIVING IN POVERTY; 25.2% UNDER 65 UNINSURED. GRADY COUNTY: ESTIMATED POPULATION 25,205; 67.4% WHITE/29.1% BLACK; MEDIAN HOUSEHOLD INCOME 31,653; 26.2% LIVING IN POVERTY; 27.9% UNDER 65 UNINSURED. MITCHELL COUNTY: ESTIMATED POPULATION 22,574; 49.8% WHITE/48.0% BLACK; MEDIAN HOUSEHOLD INCOME 31,101; 32.6% LIVING IN POVERTY; 21% UNDER 65 UNINSURED. THOMAS COUNTY: ESTIMATED POPULATION 45,063; 60.5% WHITE/36.8% BLACK; MEDIAN HOUSEHOLD INCOME 35,515; 24.5% LIVING IN POVERTY; 20.2% UNDER 65 UNINSURED. INFORMATION OBTAINED FROM WWW.CENSUS.GOV PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH IMPROVE HEALTH OUTCOMES IN COMMUNITIES SERVED, ENSURING ACCESS TO CARE TO ALL. USING THE CHNA AS A ROADMAP, WE'VE HELPED INFLUENCE BETTER HEALTH BEHAVIORS AND ACCESS TO CLINICAL CARE. USING THE UNIVERSITY OF WISCONSIN'S ROBERT WOOD JOHNSON RANKINGS, HEALTH OUTCOMES HAVE IMPROVED IN OUR REGION. 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. 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 135 390834 MED STUDENT HOUSING 75 91272 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 true true false false false false false false false J PERRY MUSTIAN PRES/HOSP CEO 595361 215177 12627 -15100 33315 841380 GREGORY H PATTERSON MD PAST TRUSTEE 442963 110296 42104 35820 6535 637718 EDWARD L HALL MD PAST TRUSTEE 407215 13152 2907 40062 6535 469871 JASON NESMITH TRUSTEE 190154 11809 43035 30032 6521 281551 CHARLES D HIGHTOWER JR ASST SEC/ HOSP CFO 314944 73807 81442 101884 8060 580137 JIM CARTER COO 155915 32860 540 19219 11625 220159 MEL HARTSFIELD MD VP MEDICAL AFFAIRS 311987 52020 6594 40900 7380 418881 KEN BROOKER VP CLINICAL SERVICES 180355 39606 28246 55886 7277 311370 AMY GRIFFIN VP PATIENT CARE 176071 37080 810 16377 9220 239558 LADON TOOLE VP NETWORK OPS 154828 44880 915 13131 10870 224624 JOSH MOORE VP OPERATIONAL SVCS 130561 24700 432 5662 7050 168405 JULIA WEEKS PHYSICIAN 317594 1380 20464 5105 344543 DINESH B PATEL MD PHYSICIAN 174629 137647 234 16200 6447 335157 STEPHEN RUBENDALL MD PHYSICIAN 192440 88711 3659 13899 6522 305231 JASON H SMITH PHYSICIAN 188247 60911 14159 12825 5105 281247 RAMESAN NAIR MD PHYSICIST 256399 1059 42877 7055 307390 JOHN FISCHER FORMER COO 17236 279338 318 3452 300344 SCHEDULE J, PAGE 1, PART I, LINE 1A SOCIAL CLUB DUES ARE PAID BY THE ORGANIZATION ON BEHALF OF SOME 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 -56,000 0 CHARLES D. HIGHTOWER, JR. 0 74,584 0 KEN BROOKER 0 25,924 0 JOHN FISCHER 279,338 0 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 1680000 85000000 7374851 10000000 1437504 65537920 2012 false false true true B 17985000 17985000 145000 17840000 2013 true false true true C 3510000 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 1678856 PROFESSIONAL MED SVC false TIMOTHY GRAYSON MD BOARD TRUSTEE 111316 RENTAL; PATIENT SVCS false THOMAS J CALLAWAY III BOARD TRUSTEE 9262747 INVESTMENT MANAGER false PAUL STEINBERG MD BOARD TRUSTEE 1381778 MEDICAL SERVICES false MARY ANNE BULLARD GRAYSON MD FAMILY MEMBER 7074651 PROF MED CORP false JOHN B CARICO MD BOARD TRUSTEE 7074651 RADIOLOGY SERVICES false GREG HAMIL BOARD TRUSTEE 6792351 DIRECTOR OF BANK false CHARLES R SANDERS JR MD BOARD TRUSTEE 224982 RENTAL; PATIENT SVCS false JAMES S KARAS MD BOARD TRUSTEE 3714455 RENTAL; PATIENT SVCS false LAURA C KARAS FAMILY MEMBER 66166 COMPENSATION false LINDSEY SCANLAN FAMILY MEMBER 40672 COMPENSATION false HAILE MCCOLLUM BOARD TRUSTEE 242173230 DIRECTOR OF BANK false GARY BONVILLIAN BOARD TRUSTEE 282163 TU SCHOLARSHIPS false ALSTON WATT BOARD TRUSTEE 6792351 DIRECTOR OF BANK false SCHEDULE L, PART IV LINDSEY SCANLAN 40,672 FAMILY MEMBER COMPENSATION HAILE MCCOLLUM 242,173,230 BOARD TRUSTEE DIRECTOR OF BANK GARY BONVILLIAN 282,163 BOARD TRUSTEE TU SCHOLARSHIPS ALSTON WATT 6,792,351 BOARD TRUSTEE DIRECTOR OF BANK 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 9/30/15 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. TIMOTHY GRAYSON, MD - RENTAL OF PROFESSIONAL OFFICE SPACE; PAYMENTS TO HIS PRACTICE TO TREAT UNINSURED EMERGENCY PATIENTS; HEALTH PLAN PAYMENTS. GREG HAMIL - DIRECTOR WITH COMMERCIAL BANK. AMOUNT REFLECTS TOTAL FEES AND BALANCES AT 9/30/15 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. PAUL STEINBERG, MD - PAYMENTS TO PROFESSIONAL CORPORATION FOR CONTRACTED EMERGENCY PHYSICIAN SERVICES; PAYMENTS FOR DIAGNOSTIC MEDICAL SERVICES. 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 SCANLAN 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 9/30/15 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 9/30/15 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 63% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2015, OVER 5.3 MILLION OF INDIGENT CARE WAS PROVIDED TO THE COMMUNITY. IN ADDITION, MITCHELL COUNTY HOSPITAL PROVIDED OVER 2.7 MILLION ADDITIONAL UNCOMPENSATED CARE. EIN 58-6001207 FILED UNDER EIN 58-0566121. 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 SIGNS AN ACKNOWLEDGMENT STATEMENT 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 STATUS 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 ARCHBOLD MEDICAL CENTER, INC. 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 HOSPITAL 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 2010-2015, 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 156,321 78,845 0 CONTRACT SERVICES JDAMH 11,506,150 3,874,877 0 CONTRACT SERVICES BROOKS 1,360,004 0 0 CONTRACT SERVICES GRADY 1,440,085 0 0 CONTRACT SERVICES MITCHELL 3,846,702 0 0 OUTSIDE LAB REFERRAL FEES JDA 915,037 0 0 OUTSIDE LAB REFERRAL GRADY 103,075 0 0 OUTSIDE LAB REFERRAL BROOKS 140 0 0 PROFESSIONAL FEES JDAMH 12,519,308 4,108,251 0 PROFESSIONAL FEES GRADY 2,048,454 0 0 PROFESSIONAL FEES BROOKS 766,404 0 0 PROFESSIONAL FEES MITCHELL 992,204 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 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