FURP.ORG / PUBLIC DATA EXPLORER

DONALSONVILLE HOSPITAL INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
DONALSONVILLE HOSPITAL INC (EIN 58-0973772)
Tax period
2014-07-01 to 2015-06-30
Filed
2016-02-25
IRS object ID
201620569349300122
Schema version
2014v6.0
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

FieldValueIRS element (for citing)
Return2016-02-25T13:55:39-06:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN580914992PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DRAFFIN & TUCKER LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 71309AddressLine1Txt
CityALBANYCityNm
State AbbreviationGAStateAbbreviationCd
ZIP31708ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN580973772EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DONALSONVILLE HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlDONABusinessNameControlTxt
Phone2295245217PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1102 HOSPITAL CIRCLEAddressLine1Txt
CityDONALSONVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP398451100ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonHERMAN BROOKINSPersonNm
Person TitleCEOPersonTitleTxt
Phone2295245217PhoneNum
Signature2016-02-25SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJACQUELINE G ATKINSPreparerPersonNm
PTINP00861721PTIN
Phone2298837878PhoneNum
Preparation2016-02-25PreparationDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerHERMAN BROOKINSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1102 HOSPITAL CIRCLEAddressLine1Txt
CityDONALSONVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP398451100ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$27,473,902GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.DONALSONVILLEHOSPITAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1977FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionDONALSONVILLE HOSPITAL OPERATES A 65-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF DONALSONVILLE, GEORGIA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY.ActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent3VotingMembersIndependentCnt
Total Employee338TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$27,053,037PYProgramServiceRevenueAmt
CY Program Service Revenue$25,017,622CYProgramServiceRevenueAmt
PY Investment Income$6,572,059PYInvestmentIncomeAmt
CY Investment Income$251,442CYInvestmentIncomeAmt
PY Other Revenue$1,826,488PYOtherRevenueAmt
CY Other Revenue$1,165,878CYOtherRevenueAmt
PY Total Revenue$35,451,584PYTotalRevenueAmt
CY Total Revenue$26,434,942CYTotalRevenueAmt
PY Grants And Similar Paid$23,403,397PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$926,730CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$15,335,950PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$14,806,461CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$12,222,360PYOtherExpensesAmt
CY Other Expenses$12,178,998CYOtherExpensesAmt
PY Total Expenses$50,961,707PYTotalExpensesAmt
CY Total Expenses$27,912,189CYTotalExpensesAmt
PY Revenues Less Expenses-$15,510,123PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,477,247CYRevenuesLessExpensesAmt
Total Assets BOY$29,266,335TotalAssetsBOYAmt
Total Assets EOY$27,485,020TotalAssetsEOYAmt
Total Liabilities BOY$3,307,593TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,173,263TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$25,958,742NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$24,311,757NetAssetsOrFundBalancesEOYAmt
MissionDONALSONVILLE HOSPITAL OPERATES A 65-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF DONALSONVILLE, GEORGIA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$22,857,050ExpenseAmt
Grant$926,730GrantAmt
Revenue$25,581,755RevenueAmt
DescDONALSONVILLE HOSPITAL PROVIDES PRIMARY HEALTHCARE TO RESIDENTS OF SEMINOLE COUNTY AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY.Desc
Total Program Service Expenses$22,857,050TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document17IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee338EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member3IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesfalseMinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJAMES MOODYPersonNm
Phone2295245217PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1102 HOSPITAL CIRCLEAddressLine1Txt
CityDONALSONVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP398451100ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeInd
HERMAN BROOKINS
CHAIRMAN/CEO40.00Yes (X)Yes (X)$411,223$0$48,000
CHARLES H ORRICK
ADMINISTRATO40.00Yes (X)Yes (X)$229,986$0$52,473
BROADDUS SIMPSON
SECRETARY1.00Yes (X)Yes (X)$13,339$0$0
MITCH BLANKS
DIRECTOR1.00Yes (X)$8,702$0$0
WILLIAM BURKE CPA
DIRECTOR1.00Yes (X)$8,702$0$0
CHARLES STEWART
DIRECTOR1.00Yes (X)$8,702$0$00.00
JAMES MOODY
CFO40.00Yes (X)$191,764$0$26,957
MURDOC HENDERSON MD
PHYSICIAN50.00$364,454$0$29,839Yes (X)
ANDREA ALEXANDER MD
PHYSICIAN50.00$339,980$0$24,311Yes (X)
JOSEPH WALKER SR MD
PHYSICIAN50.00$321,923$0$24,301Yes (X)
JESSICA NUNUZ MD
PHYSICIAN50.00$308,075$0$14,556Yes (X)
ROYCE CANNINGTON JR
CRNA50.00$218,095$0$7,224Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,424,945TotalReportableCompFromOrgAmt
Total Other Compensation$227,661TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K12IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
NES GEORGIA INC
PO BOX 277001ATLANTAGA303847001ER PHYSICIANS$1,148,544
MEDICAL DOCTOR ASSOCIATION
PO BOX 277185ATLANTAGA303847185PHYSICIANS$357,340
CPSI
PO BOX 850309MOBILEAL366850309IT SUPPORT$343,356
FRANKLIN & SEIDELMANN INC
PO BOX 674293DETROITMI482674293RADIOLOGY$222,748
SOUTHERN LINENS
704 OLD JAKIN ROADDONALSONVILLEGA39845BENEFITS$170,715
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K9CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPROGRAM SERVICE REVENUEDesc
Business621990BusinessCd
Total Revenue Column$25,017,622TotalRevenueColumnAmt
Related Or Exempt Func Income$25,017,622RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$25,017,622TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$46,725TotalRevenueColumnAmt
Exclusion$46,725ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$155,576RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$94,492RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$61,084RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$61,084TotalRevenueColumnAmt
Exclusion$61,084ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$1,149,185SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$944,468SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$204,717SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$204,717TotalRevenueColumnAmt
Exclusion$204,717ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
EHR GRANT INCOME621990$543,375$543,375
CAFETERIA722513$540,661$540,661
MISCELLANEOUS REVENUE621990$16,335$16,335

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,423TotalRevenueColumnAmt
Related Or Exempt Func Income$4,423RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,104,794OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$26,434,942TotalRevenueColumnAmt
Related Or Exempt Func Income$25,581,755RelatedOrExemptFuncIncomeAmt
Exclusion$853,187ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$926,730TotalAmt
Program Services$926,730ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$999,848TotalAmt
Management And General$999,848ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$10,562,637TotalAmt
Program Services$9,650,081ProgramServicesAmt
Management And General$912,556ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$371,452TotalAmt
Program Services$313,470ProgramServicesAmt
Management And General$57,982ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,245,992TotalAmt
Program Services$1,912,699ProgramServicesAmt
Management And General$333,293ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$626,532TotalAmt
Program Services$518,379ProgramServicesAmt
Management And General$108,153ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$16,473TotalAmt
Management And General$16,473ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$356,170TotalAmt
Management And General$356,170ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$3,136TotalAmt
Program Services$3,136ProgramServicesAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$5,269TotalAmt
Management And General$5,269ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,953,355TotalAmt
Program Services$2,789,466ProgramServicesAmt
Management And General$163,889ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$66,977TotalAmt
Management And General$66,977ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$2,016,699TotalAmt
Program Services$1,287,912ProgramServicesAmt
Management And General$728,787ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$495,360TotalAmt
Program Services$462,220ProgramServicesAmt
Management And General$33,140ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$42,360TotalAmt
Program Services$27,632ProgramServicesAmt
Management And General$14,728ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$23,650TotalAmt
Program Services$23,510ProgramServicesAmt
Management And General$140ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,096,648TotalAmt
Program Services$1,023,282ProgramServicesAmt
Management And General$73,366ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$172,798TotalAmt
Program Services$110,945ProgramServicesAmt
Management And General$61,853ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$3,416,758$3,416,758
REPAIR AND MAINTENANCE$576,468$70,604$505,864
MISCELLANEOUS EXPENSE$370,072$562$369,510
PROVIDER FEE$312,166$312,166

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$254,639TotalAmt
Program Services$7,498ProgramServicesAmt
Management And General$247,141ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$27,912,189TotalAmt
Program Services$22,857,050ProgramServicesAmt
Management And General$5,055,139ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY-$29,281BOYAmt
EOY$405,028EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$2,743,848BOYAmt
EOY$2,226,355EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$8,678,247BOYAmt
EOY$8,422,212EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$1,765,901BOYAmt
EOY$1,694,172EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,006,712BOYAmt
EOY$841,487EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$216,097BOYAmt
EOY$363,407EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$27,478,021LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$17,137,737LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$10,727,113BOYAmt
EOY$10,340,284EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$2,512,763BOYAmt
EOY$2,737,339EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$964,887BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$680,048BOYAmt
EOY$454,736EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$29,266,335BOYAmt
EOY$27,485,020EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,930,758BOYAmt
EOY$3,156,810EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$376,835BOYAmt
EOY$16,453EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,307,593BOYAmt
EOY$3,173,263EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$25,958,742BOYAmt
EOY$24,311,757EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$25,958,742BOYAmt
EOY$24,311,757EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$29,266,335BOYAmt
EOY$27,485,020EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$1,477,247ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$169,738NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$3,136OtherActivitiesAmt
Total Lobbying Expenditures$3,136TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE C, PART II-B, LINE 1FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION BELONGS TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS. A PORTION OF THE MEMBERSHIP DUES PAID TO THE ASSOCIATIONS ARE DEDICATED TO LOBBYING ACTIVITIES.ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,528,700BeginningYearBalanceAmt
Investment Earnings Or Losses$153,274InvestmentEarningsOrLossesAmt
Grants Or Scholarships$948,672GrantsOrScholarshipsAmt
Administrative Expenses$15,415AdministrativeExpensesAmt
End Year Balance$1,717,887EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$19,475,699BeginningYearBalanceAmt
Investment Earnings Or Losses$3,479,857InvestmentEarningsOrLossesAmt
Grants Or Scholarships$20,346,937GrantsOrScholarshipsAmt
Administrative Expenses$79,919AdministrativeExpensesAmt
End Year Balance$2,528,700EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$19,404,875BeginningYearBalanceAmt
Investment Earnings Or Losses$3,456,495InvestmentEarningsOrLossesAmt
Grants Or Scholarships$3,305,000GrantsOrScholarshipsAmt
Administrative Expenses$80,671AdministrativeExpensesAmt
End Year Balance$19,475,699EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$25,508,972BeginningYearBalanceAmt
Investment Earnings Or Losses-$1,018,580InvestmentEarningsOrLossesAmt
Grants Or Scholarships$5,000,000GrantsOrScholarshipsAmt
Administrative Expenses$85,517AdministrativeExpensesAmt
End Year Balance$19,404,875EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$18,450,580BeginningYearBalanceAmt
Investment Earnings Or Losses$7,152,931InvestmentEarningsOrLossesAmt
Administrative Expenses$94,539AdministrativeExpensesAmt
End Year Balance$25,508,972EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY1.00000BoardDesignatedBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$686,053OtherCostOrOtherBasisAmt
Book Value$686,053BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$3,416,817InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$12,203,164OtherCostOrOtherBasisAmt
Depreciation$8,721,550DepreciationAmt
Book Value$6,898,431BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$343,388OtherCostOrOtherBasisAmt
Depreciation$335,432DepreciationAmt
Book Value$7,956BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$10,810,757OtherCostOrOtherBasisAmt
Depreciation$8,080,755DepreciationAmt
Book Value$2,730,002BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$17,842OtherCostOrOtherBasisAmt
Book Value$17,842BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$10,340,284TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO THIRD PARTY PAYORSDesc
Amt$16,453Amt
FieldValueIRS element (for citing)
Total Liability$16,453TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$24,996,531TotalRevEtcAuditedFinclStmtAmt
Revenue Subtotal$24,996,531RevenueSubtotalAmt
Other Revenues Not Included$1,438,411OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$1,438,411RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$26,434,942TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$26,473,778TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$26,473,778ExpensesSubtotalAmt
Other Expenses Not Included$1,438,411OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$1,438,411ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$27,912,189TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PAGE 2, PART V, LINE 4ENDOWMENT FUNDS CONSIST OF INVESTMENTS FOR THE DEFERRED COMPENSATION PLAN, AND MALPRACTICE INSURANCE. THE COMMUNITY FOUNDATION ACCOUNT WAS CLOSED DURING THE FISCAL YEAR 6/30/15. THE ORGANIZATION HAS ESTABLISHED A FUNDED DEFERRED COMPENSATION PLAN FOR CERTAIN KEY EMPLOYEES. MALPRACTICE INSURANCE IS A TRUST SET UP TO FUND POTENTIAL LIABILITIES UNDER THE HOSPITAL'S SELF INSURANCE PROGRAM. THE TRUSTEE IS SYNOVUS TRUST COMPANY, N.A. IN 2006, THE ORGANIZATION INVESTED FUNDS WITH THE COMMUNITY FOUNDATION OF SOUTH GEORGIA, INC. ("CFSG"), AN UNRELATED 501(C)(3) ORGANIZATION, WHICH ARE TO BE USED EXCLUSIVELY FOR THE CHARITABLE AND HEALTH PURPOSES OF THE COMMUNITY. THESE FUNDS WERE HELD BY CFSG AS DONOR-ADVISED FUNDS SUBJECT TO THE FILING ORGANIZATION'S EXCLUSIVE LEGAL CONTROL. AS OF 6/30/15, ALL FUNDS HELD BY CFSG HAVE BEEN DISTRIBUTED IN ACCORDANCE WITH THE PURPOSE FOR WHICH THE ACCOUNT WAS ESTABLISHED.
SCHEDULE D, PAGE 3, PART XTHE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION 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 ORGANIZATION 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 JUNE 30, 2015 AND 2014 OR FOR THE YEARS THEN ENDED. THE ORGANIZATION'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 THESE RETURNS.
SCHEDULE D, PAGE 4, PART XI, LINE 4BMEALS EXPENSE FOR SNF PATIENTS 506,412 GRANTS/ASSISTANCE 926,730 INVESTMENT MANAGEMENT FEES 5,269
SCHEDULE D, PAGE 4, PART XII, LINE 4BGRANTS/ASSISTANCE 926,730 INVESTMENT MANAGEMENT FEES 5,269 MEALS EXPENSE FOR SNF PATIENTS 506,412

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other1.250000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CarefalseFPGReferenceDiscountedCareInd
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,013,506TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,013,506NetCommunityBenefitExpnsAmt
Total Expense0.03620TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,114,587TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,903,596DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,210,991NetCommunityBenefitExpnsAmt
Total Expense0.04320TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$127,331TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$49,779DirectOffsettingRevenueAmt
Net Community Benefit Expns$77,552NetCommunityBenefitExpnsAmt
Total Expense0.00280TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,255,424TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,953,375DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,302,049NetCommunityBenefitExpnsAmt
Total Expense0.08220TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$369,937TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$369,937NetCommunityBenefitExpnsAmt
Total Expense0.01320TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$926,730TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$926,730NetCommunityBenefitExpnsAmt
Total Expense0.03310TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,296,667TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,296,667NetCommunityBenefitExpnsAmt
Total Expense0.04630TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,552,091TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,953,375DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,598,716NetCommunityBenefitExpnsAmt
Total Expense0.12850TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$3,352,197BadDebtExpenseAmt
Reimbursed By Medicare$3,219,006ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$3,653,479CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$434,473MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DONALSONVILLE HOSPITAL INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1102 HOSPITAL CIRCLEAddressLine1Txt
CityDONALSONVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP398451100ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.DONALSONVILLEHOSPITAL.ORGWebsiteAddressTxt
State License125-318StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherSNFOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1DONALSONVILLE HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.DONALSONVILLEHOSPITAL.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt13ImplementationStrategyAdptYr
Strategy Posted WebsitefalseStrategyPostedWebsiteInd
Strategy AttachedYes (true)StrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care125.000000000000FPGFamilyIncmLmtFreeCarePct
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesYes (true)CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 5DONALSONVILLE HOSPITAL STARTED THE PROCESS OF ASSESSING THE NEEDS OF THE COMMUNITY BY GETTING INPUT FROM THE LOCAL PHYSICIANS. THERE ARE 13 LOCAL PHYSICIANS THAT ARE ACTIVE ON THE MEDICAL STAFF AT DONALSONVILLE HOSPITAL. 4 BOARD CERTIFIED GENERAL SURGEONS, 2 OBGYNS, 3 PEDIATRICIANS, 2 FAMILY PRACTICE AND 1 DERMATOLOGIST. THE MEDICAL STAFF IS MADE UP OF A WIDE VARIETY OF PRIMARY CARE PHYSICIANS. MANAGEMENT OF THE HOSPITAL HAS ALWAYS HAD AN EXTREMELY CLOSE WORKING RELATIONSHIP WITH THE MEDICAL STAFF. ONE KEY COMPONENT OF ASSESSING THE NEEDS OF THE LOCAL COMMUNITY IS TO GET INPUT FROM THE MEDICAL STAFF. ALL PHYSICIANS HAVE BEEN WILLING TO GIVE FEEDBACK AND INPUT ON THE HEALTH NEEDS OF THE COMMUNITY. THE HOSPITAL BOARD OF DIRECTORS HAS A BROAD RANGE OF COMMUNITY INVOLVEMENT AND LEADERSHIP ROLES. THERE ARE 5 MEMBERS OF THE BOARD AND OF THE FIVE 2 ARE INVOLVED WITH LOCAL COUNTY AND CITY GOVERNMENTS AS A COUNTY COMMISSIONER AND CITY COUNCILMAN. ALSO, THE BOARD OF DIRECTORS HAS 2 OTHER MEMBERS INVOLVED WITH OTHER NONPROFITS AND IS ACTIVE COMMUNITY LEADERS. THE OTHER BOARD MEMBER HAS A VAST KNOWLEDGE AND EXPERIENCE IN THE AGRICULTURAL AREA, WHICH MAKES UP A MAJOR PART OF INDUSTRY AND RESIDENTS OF SEMINOLE COUNTY. THE BOARD OF DIRECTORS THOUGHT THAT THERE SHOULD BE 2 ADDITIONAL MEMBERS ADDED TO THE CHNA PANEL THAT WOULD HELP WITH ASSESSING THE NEEDS OF THE COMMUNITY. A LOCAL COUNTY COMMISSIONER, WHO IS ALSO A CO-PASTOR OF VISION FAITH OUTREACH MINISTRIES WAS ADDED. THE COUNTY COMMISSIONER HAS ACCESS AND CONTACT WITH A LARGE PORTION OF INDIVIDUALS THAT ARE MINORITY, UNDERSERVED AND NEEDY. ALSO, THE BOARD OF DIRECTORS WANTED INPUT FROM THE LOCAL HEALTH DEPARTMENT DIRECTOR. THE HOSPITAL HAS WORKED WITH THE DIRECTOR FOR YEARS ADDRESSING THE NEEDS OF THE LOCAL HEALTH DEPARTMENT BY PROVIDING FUNDS FOR SPECIFIC PROGRAMS PRESENTED BY THE DIRECTOR FOR MEDICAL HELP FOR NEEDY LOCAL RESIDENTS. FIRST, STATISTICS WERE GATHERED FROM OUR INTERNAL DATA BASE EXAMINING THE PATIENTS THAT HAVE VISITED DONALSONVILLE HOSPITAL IN THE PAST 2 YEARS. THE DATA GATHERING INCLUDED INFORMATION THAT TRACKED THE TOP DIAGNOSES FOR PATIENTS THAT VISITED THE HOSPITAL. THESE REPORTS WERE EVALUATED AND THE CHNA PANEL UTILIZED THEM ALONG WITH STATISTICS GATHERED FROM GHA, U. S. CENSUS BUREAU, AMERICAN DIABETES ASSOCIATION, THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH, THE GEORGIA DEPARTMENT OF PUBLIC HEALTH, SEMINOLE COUNTY HEALTH DEPARTMENT AND NATIONAL CANCER INSTITUTE. THESE STATS WERE USED TO DETERMINE WHAT THE HEALTH NEEDS OF SEMINOLE COUNTY RESIDENTS ARE AND TO DETERMINE WHICH NEEDS COULD THE HOSPITAL BE SUCCESSFUL AT IMPLEMENTING SOME STRATEGY TO IMPROVE. AFTER LOOKING AT ALL OF THE DATA GATHERED, THE CHNA PANEL DETERMINED THAT THE HEALTH NEEDS THAT COULD BE IMPROVED BY THE HOSPITAL INPUT WERE AS FOLLOWS: 1.DIABETES/HYPERTENSION DISEASE 2.OBESITY IN ADULTS 3.CANCER 4.MENTAL HEALTH.
FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 11DONALSONVILLE HOSPITAL, INC. IS CONTINUING TO WORK WITH AND PROVIDE FUNDING FOR THE LOCAL HEALTH DEPARTMENT IN TREATMENT OF DIABETES & HYPERTENSION. PROVIDING EDUCATION PROGRAMS AND ENCOURAGING WELLNESS PROGRAMS. THE HOSPITAL IS PROVIDING FREE MAMMOGRAMS AND HEALTH SCREENINGS WHILE CONTINUING TO WORK ON OBTAINING A CERTIFICATE OF NEED TO CHANGE HOSPITAL IP BEDS FROM MED/SURG TO MENTAL HEALTH. BOTH 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND THE 2013 CHNA IMPLEMENTATION PLAN ARE WIDELY PUBLICIZED ON THE ORGANIZATION'S WEBSITE AT WWW.DONALSONVILLEHOSPITAL.ORG.
FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 13HALL PATIENTS ARE CHARGED EQUALLY REGARDLESS OF ANY OF THE ABOVE. THOSE INDIVIDUALS WITHOUT THIRD PARTY COVERAGE ARE GIVEN A 15% DISCOUNT IF THEY DO NOT QUALIFY FOR FREE CARE. THEY ARE ALSO GIVEN THE OPPORTUNITY TO RECEIVE A 50% DISCOUNT IF BILL IS PAID WITHIN 1 YEAR OF DISCHARGE. ALSO, FREE CARE IS OFFERED FOR PATIENTS MEETING CHARITY GUIDELINES - RANGING FROM 125% TO 200% OF FEDERAL POVERTY GUIDELINES.
FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 22DTHE HOSPITAL DISCOUNTED GROSS CHARGES FOR PATIENTS WITHOUT THIRD PARTY INSURANCE COVERAGE BY FIFTEEN PERCENT. THIS PERCENTAGE IS THE AVERAGE DISCOUNT GIVEN TO INSURANCE COMPANIES.
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SEMINOLE MANOR NURSING HOMEBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1102 HOSPITAL CIRCLEAddressLine1Txt
CityDONALSONVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP317451100ZIPCd
FieldValueIRS element (for citing)
FacilitySNFFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CAREALL INDIVIDUALS THAT DO NOT HAVE THIRD PARTY COVERAGE ARE GIVEN A 15% DISCOUNT IF THEY DO NOT QUALIFY FOR FREE CARE. BEGINNING 1/21/2014, INDIVIDUALS ARE ABLE TO RECEIVE A 50% DISCOUNT IF THEY AGREE TO PAY WITHIN 1 YEAR OF DISCHARGE.
PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSEIN 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 27,912,186 ADD: EXPENSES REPORTED IN PART VIII 94,492 DENOMINATOR FOR COLUMN (F) 28,006,678
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATIONCOSTS FOR PART I, LINE 7A, 7B AND 7C WERE COMPUTED USING THE RATIO OF PATIENT CARE COST TO CHARGES CALCULATED ON WORKSHEET 2. OTHER COSTS WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGYAMOUNTS 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 STATEMENTSACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION 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 OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLES, 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 (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION 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 ORGANIZATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 88% AND 89% OF SELF-PAY ACCOUNTS RECEIVABLE AT JUNE 30, 2015 AND 2014, RESPECTIVELY. IN ADDITION, THE ORGANIZATION'S SELF-PAY WRITE-OFFS INCREASED 300,000 FROM 3,000,000 FOR FISCAL YEAR 2014 TO 3,300,000 FOR FISCAL YEAR 2015. THE ORGANIZATION HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2015 OR 2014. THE ORGANIZATION DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRD-PARTY PAYORS, NOR DOES IT HAVE SIGNIFICANT WRITE-OFFS FROM THIRD-PARTY PAYORS.
PART III, LINE 8 - MEDICARE EXPLANATIONMEDICARE 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 EXPLANATIONOUR PATIENT FINANCIAL SERVICES DEPARTMENT VISITS PATIENTS WHO HAVE NO INSURANCE TO DISCUSS ASSISTANCE AND REFER THOSE PATIENTS TO OUR LOCAL DFCS OFFICE TO OBTAIN ASSISTANCE WITH APPLYING FOR MEDICAID AND OTHER FINANCIAL ASSISTANCE. OUR PATIENT FINANCIAL SERVICES DEPARTMENT, WHICH DOES SELF-PAY BILLING AND COLLECTION, INFORMS PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND ASSISTS THEM IN MAKING AN APPLICATION. BILLING STATEMENTS PROVIDE A MESSAGE AND TELEPHONE NUMBER TO CALL IF THE PATIENT HAS DIFFICULTY MAKING PAYMENT. FOR PATIENTS WHO QUALIFY AS INDIGENT AND CHARITY PATIENTS, THERE IS NO FINANCIAL OBLIGATION. THOSE PATIENTS WHO DO NOT QUALIFY AS INDIGENT AND CHARITY PATIENTS, AND DON'T HAVE ANY 3RD PARTY COVERAGE ARE SENT STATEMENTS AND LETTERS WHERE THEY ARE PAST DUE 30, 60 AND 90 DAYS. IF PAYMENT ARRANGEMENTS ARE STILL NOT MADE AFTER 90 DAYS, THEN THOSE ACCOUNTS ARE REFERRED TO COLLECTIONS. BEFORE REFERRAL TO A COLLECTION AGENCY, OUR COLLECTION DEPARTMENT EXAMINES THE ACCOUNTS FOR POSSIBLE 3RD PARTY COVERAGE. IF NO 3RD PARTY COVERAGE EXISTS, THEN WE MOVE FORWARD WITH OUR NORMAL IN-HOUSE COLLECTION PROCEDURES.
PART VI, LINE 2 - NEEDS ASSESSMENTA COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN FISCAL YEAR 2013. INFORMATION WAS SOLICITED FROM VARIOUS INDIVIDUALS REPRESENTING THE INTERESTS OF THE COMMUNITY BY MEANS OF FOCUS GROUPS, EXTERNAL STATISTICS, AND INTERNAL DATA. THE ORGANIZATION CONDUCTS VARIOUS TYPES OF ASSESSMENTS TO DETERMINE THE COMMUNITY'S NEEDS FOR HEALTH SERVICES. OUR ORGANIZATION COLLABORATES WITH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TO IDENTIFY THE NEEDS OF THE COMMUNITY. COMMUNITY RESEARCH HAS SHOWN THAT THE SERVICES FOR WHICH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TURN TO THE ORGANIZATION FOR EMERGENCY SERVICES, DIAGNOSTIC TESTS AND X-RAYS, AND ALSO GENERAL MEDICAL CARE. OTHER SERVICES FOR WHICH THEY TURN TO US AS A MAJOR PROVIDER ARE MINOR SURGERY, PEDIATRIC CARE, GENERAL SURGERY, AND OBSTETRICAL CARE. THIS INFORMATION, COMBINED WITH OUR EXTENSIVE COLLABORATIONS AND OUR ROLE AS A LEADER IN THE COMMUNITY, PROVIDES US THE MEANS TO UNDERSTAND AND ADDRESS THE COMMUNITY'S NEEDS AND ENSURES OUR OUTREACH PROGRAMS ARE FOCUSED ON THE POPULATIONS WHO NEED OUR SERVICES THE MOST. OUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS, ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY. PROGRESS ON CHNA IMPLEMENTATION STRATEGIES 2014-2015: DURING THE FISCAL YEAR ENDING 6/30/2015, DONALSONVILLE HOSPITAL WAS INVOLVED IN THE FOLLOWING ACTIVITIES ASSOCIATED WITH OUR COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION. 1.DIABETES/HYPERTENSION - A. FUNDING AND SUPPORT OF THE LOCAL HEALTH DEPARTMENT WAS CONTINUED FOR THIS FISCAL YEAR. THIS CONSISTED OF FUNDING FOR A LOCAL STROKE AND HEART ATTACK PREVENTION PROGRAM. THE PROGRAM SERVICED 56 PATIENTS THAT WERE AGE 18 YEARS OR OLDER WHO WERE DIAGNOSED WITH PRIMARY HYPERTENSION AND OR DIABETES. THE PATIENT SERVICES INCLUDED EDUCATION, SCREENING AND TREATMENT. THE TOTAL AMOUNT CONTRIBUTED TO THE PROGRAM WAS 21,537. THERE WERE 3 LOCALLY HELD HEALTH FAIRS OFFERING FREE SERVICES TO THE PUBLIC. THESE SERVICES INCLUDED BMI, BLOOD PRESSURE CHECKS, CHOLESTEROL, TRIGLYCERIDES, HDL AND LDL. A TOTAL OF 141 PEOPLE ATTENDED THE HEALTH FAIRS AND WERE FOLLOWED UP BY THEIR LOCAL PHYSICIANS. THE TOTAL COST RELATED TO THE HEALTH FAIRS WAS 3,000. 2.OBESITY IN ADULTS - A. FUNDING AND SUPPORT OF A DIETARY CONSULTANT CONTINUES THROUGH THE DIETARY DEPARTMENT AT DONALSONVILLE HOSPITAL. THE TOTAL COST PER QUARTERLY VISIT IS 200. WE ARE FUNDING A REGISTERED DIETICIAN TO COME TWICE PER MONTH TO ADVISE AND MEET WITH PATIENTS REGARDING PROPER DIETS AND DEVELOPMENT OF BETTER EATING HABITS. THE TOTAL COST PER MONTH WAS 416. B. WEIGHT LOSS CONSULTING BY ONE OF OUR EMPLOYED PHYSICIANS CONTINUED THROUGHOUT THE FISCAL YEAR 6/30/2015. A TOTAL OF 151 PATIENT VISITS OCCURRED RELATED SPECIFICALLY TO CONSULTING PATIENTS REGARDING HEALTHY WEIGHT LOSS. THESE VISITS CONSISTED OF COUNSELING THAT INCLUDED BETTER NUTRITION, EXERCISE AND HEALTHY WEIGHT LOSS EDUCATION. THE TOTAL COST FOR THIS SERVICE WAS 310,000. 3.CANCER - A. DONALSONVILLE HOSPITAL CONTINUES TO MAINTAIN A STATE-OF- THE-ART HOLOGIC DIGITAL MAMMOGRAPHY MACHINE AND CAD SYSTEM. THE DIGITAL MAMMOGRAPHY IS PROVEN TO BE MORE EFFECTIVE AT FINDING CANCER IN WOMEN THAN WITH THE FILM TESTING. 1,035 MAMMOGRAMS WERE PERFORMED DURING THE FISCAL YEAR ENDING 6/30/15. OF THE 1,035 MAMMOGRAMS, 21 WOMEN WERE RECOMMENDED FOR BIOPSIES. OF THE 21 BIOPSIES RECOMMENDED, 10 WERE POSITIVE, 5 NEGATIVE AND 6 WERE LISTED AS "NO RESULTS". PERIODIC FREE MAMMOGRAMS AND PSAS ARE OFFERED TO THE PUBLIC. THE TOTAL COST WAS 3,000. 4.MENTAL HEALTH - A. DONALSONVILLE HOSPITAL CONTINUED TO SUPPORT AND FUND A LOCAL PSYCHOTHERAPIST FOR TREATMENT OF MENTAL HEALTH PATIENTS SEEN THROUGH OUR EMERGENCY ROOM. DR. GARY SMITH CONSULTED WITH A TOTAL OF APPROXIMATELY 50 PATIENTS THROUGHOUT THE FISCAL YEAR. THE TOTAL COST WAS 32,400. WE HAVE NOT BEEN ABLE TO OBTAIN A CERTIFICATE OF NEED FOR THE GERIATRIC PSYCHIATRIC UNIT. WE ARE PLANNING AND RESEARCHING WAYS OF UTILIZING OUR CURRENT PLANT AND BEDS TO SUPPLY ADDITIONAL MENTAL HEALTH SERVICES TO OUR COMMUNITY. WE STARTED MEETINGS IN JUNE 2015 WITH ANOTHER CONSULTING GROUP TO DISCUSS THE POSSIBILITIES OF ADDING ADOLESCENT AND ADULT MENTAL HEALTH BEDS. WE ARE MOVING TOWARDS ANOTHER CERTIFICATE OF NEED APPLICATION.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHE BOARD HAS CLEARLY WRITTEN INDIGENT AND FINANCIAL AID POLICIES THAT ARE AVAILABLE THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND FINANCIAL AID. PATIENT EDUCATION ON THE ORGANIZATIONS INDIGENT/CHARITY AND FINANCIAL AID PROGRAMS ARE CONDUCTED DURING PRE-REGISTRATION, THROUGH OUR PATIENT FINANCIAL SERVICES DEPARTMENT FOR PATIENTS THAT DO NOT HAVE ANY 3RD PARTY COVERAGE. BROCHURES ARE PROMINENTLY DISPLAYED AT EACH REGISTRATION BOOTH. THE BUSINESS OFFICE CONTINUOUSLY PROVIDES INFORMATION TO THE BUSINESS OFFICE MANAGERS OF OUR LOCAL PHYSICIAN'S PRACTICES. PHONE CALLS AND LETTERS ARE SENT TO ALL PATIENTS THAT ARE NOT INTERVIEWED AT THE TIME OF ADMISSION EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAMS. OUR EMERGENCY DEPARTMENT IS OPERATED 24/7 AND OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. THE BOARD HAS CLEARLY WRITTEN INDIGENT/CHARITY AND FINANCIAL AID POLICIES THAT ARE AVAILABLE THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE CARE AND FINANCIAL AID.
PART VI, LINE 4 - COMMUNITY INFORMATIONTHE ORGANIZATION SERVES A PREDOMINATELY RURAL AREA IN SEMINOLE COUNTY, IN ITS BROADEST BOUNDARIES. DONALSONVILLE IS THE ECONOMIC AND MEDICAL HUB FOR THE REGION, AND THE ORGANIZATION DRAWS FROM A POPULATION OF APPROXIMATELY 9,000 RESIDENTS FOR MAJOR HEALTH CARE SERVICES. THE REGION IS MARKED BY VAST DICHOTOMIES OF WEALTH, EDUCATION, AND HEALTH STATUS. THE ORGANIZATION SERVES A POPULATION THAT HAS A HIGH PROPORTION OF LOW-INCOME INDIVIDUALS. ABOUT 22.01% OF FAMILIES AND 25.49% OF THE POPULATION WERE BELOW THE POVERTY LINE.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTHOUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS, ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY. WE HAVE PARTICIPATED IN VARIOUS LOCAL HEALTH FAIRS TO PROMOTE GOOD HEALTH AND PROVIDE SCREENING MECHANISMS FOR DETECTING HIGH BLOOD PRESSURE, ABNORMAL BLOOD SUGAR LEVELS AND HIGH CHOLESTEROL. THESE ARE THE MOST PRESSING AND PREVENTABLE DISEASES IN OUR COMMUNITY. WE WORK CLOSELY WITH THE LOCAL HEALTH DEPARTMENT TO ASSIST THEM WITH THE PROGRAMS THAT THEY FACILITATE THROUGHOUT THE YEAR. OUR BOARD HAS HAD IN PLACE FOR 20 YEARS, A SCHOLARSHIP PROGRAM FOR PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS. WE HAVE BEEN FORTUNATE TO HAVE MANY OF OUR LOCAL RESIDENTS FINISH MEDICAL SCHOOL, NURSING SCHOOL AND OTHER PROFESSIONAL CERTIFICATIONS, AND COME BACK TO DONALSONVILLE TO PRACTICE AND WORK IN OUR LOCAL HEALTHCARE COMMUNITY. THE PHYSICIAN SCHOLARSHIP PROGRAM HAS PRODUCED 6 OF OUR CURRENT 12 MEMBER MEDICAL STAFF. WE ALSO HAVE 4 IN THE PROGRAM THAT ARE SCHEDULED TO COME BACK TO OUR COMMUNITY OVER THE NEXT 10 YEARS. THIS TYPE OF PROGRAM HAS HELPED KEEP HEALTHCARE AVAILABLE AND ACCESSIBLE TO OUR RURAL COMMUNITY. IT HAS ENABLED US TO START NEW SERVICES THAT WOULD NOT HAVE EXISTED OTHERWISE. OUR BOARD IS DEDICATED TO PLANNING AND PREPARING FOR THIS RURAL COMMUNITY TO HAVE EASILY ACCESSIBLE HEALTHCARE FOR MANY YEARS TO COME.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1NEW FOUND COMMUNITY FOUNDATION INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line16100 LAKE FORREST DRIVE NWAddressLine1Txt
CityATLANTACityNm
State AbbreviationGAStateAbbreviationCd
ZIP303283822ZIPCd
FieldValueIRS element (for citing)
Recipient EIN451957153RecipientEIN
IRC Section501C3IRCSectionDesc
Cash Grant$926,730CashGrantAmt
Purpose Of GrantCOMMUNITY HEALTHPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2FormAndLineReferenceDesc
ExplanationTHE FUNDS ARE GIVEN TO THE 501(C)(3) ORGANIZATION WITH THE INTENT THAT THE RECIPIENT WILL USE THE FUNDS FOR THEIR TAX EXEMPT PURPOSE. THESE FUNDS ARE DISCUSSED BY THE BOARD OF DIRECTORS AND DECISIONS ARE MADE AS TO WHETHER OR NOT FUNDS ARE NEEDED FOR COMMUNITY BENEFIT PROJECTS.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt
HERMAN BROOKINS
CHAIRMAN/CEO$388,891$13,630$8,702$48,000$459,223
CHARLES H ORRICK
ADMINISTRATOR$203,414$17,870$8,702$42,496$282,459$9,977
JAMES MOODY
CFO$178,134$13,630$16,436$218,721$10,521
MURDOC HENDERSON MD
PHYSICIAN$364,454$22,615$394,293$7,224
ANDREA ALEXANDER MD
PHYSICIAN$339,980$17,077$364,291$7,234
JOSEPH WALKER SR MD
PHYSICIAN$321,923$17,077$346,224$7,224
JESSICA NUNUZ MD
PHYSICIAN$308,075$8,077$322,631$6,479
ROYCE CANNINGTON JR
CRNA$218,095$225,319$7,224

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART IIIFormAndLineReferenceDesc
ExplanationPART I, LINE 4 - DEFERRED COMPENSATION PLAN 457(B) THE ORGANIZATION HAS ESTABLISHED A DEFERRED COMPENSATION PLAN FOR CERTAIN KEY EMPLOYEES. THE 457(B) PLAN IS A NON-QUALIFIED RETIREMENT PLAN THAT ALLOWS A MAXIMUM SALARY DEFERRAL OF THE LESSER OF 18,000 OR ONE-THIRD OF AN EMPLOYEE'S SALARY.ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonBRIAN BROOKINSPersonNm
FieldValueIRS element (for citing)
Relationship DescriptionFAMILY BD MMBRRelationshipDescriptionTxt
Transaction$208,634TransactionAmt
TransactionCOMPENSATIONTransactionDesc
Sharing Of RevenuesfalseSharingOfRevenuesInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART VFormAndLineReferenceDesc
ExplanationBRIAN BROOKINS, AN EMPLOYEE OF THE ORGANIZATION, IS THE SON OF HERMAN BROOKINS, WHO IS THE CHAIRMAN OF THE BOARD AND CEO.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 8BTHE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PAGE 6, PART VI, LINE 11BTHE INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 (BASED UPON INFORMATION PROVIDED BY THE ORGANIZATION) PROVIDES A COPY OF THE RETURN TO BE REVIEWED BY MANAGEMENT. MANAGEMENT PERFORMS A DETAILED REVIEW WHICH CONSISTS OF REVIEWING THE FINANCIAL DATA, THE NARRATIVES DISCLOSED, AND OTHER FACTS PRESENTED ON THE RETURN. UPON REVIEW, THE FORM 990 AND RELATED SCHEDULES ARE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND FEEDBACK. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES, A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 12CTHE ORGANIZATION HAS A WRITTEN POLICY RESPECTING CONFLICTS OF INTEREST AND DISCLOSURE OF SAME. GENERALLY SPEAKING, THE POLICY REQUIRES ANY "COVERED PERSON" WHO BELIEVES HE HAS A CONFLICT OF INTEREST TO: -DISCLOSE THE EXISTENCE AND NATURE OF THE CONFLICT OF INTEREST (INCLUDING ALL FACTS KNOWN RESPECTING THE SUBJECT MATTER) TO THE CHAIRMAN OF THE BOARD; -PLAY NO PART, DIRECTLY OR INDIRECTLY, IN THE DELIBERATION OR VOTE OF THE BOARD OF DIRECTORS WITH RESPECT TO THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS; AND -RECUSE HIMSELF FROM THAT PORTION OF THE MEETING AT WHICH THE CONFLICT OF INTEREST IS DISCUSSED. THE DEFINITION OF A "COVERED PERSON" INCLUDES ALL BOARD MEMBERS, OFFICERS AND MEMBERS OF SENIOR MANAGEMENT OF THE ORGANIZATION. WHEN A COVERED PERSON DISCLOSES A POTENTIAL CONFLICT OF INTEREST TO THE BOARD CHAIRMAN, THE CHAIRMAN IS OBLIGED TO BRING THE MATTER TO THE ATTENTION OF THE FULL BOARD WHO DETERMINES WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. IF A CONFLICT OF INTEREST EXISTS, THE TRANSACTION OR MATTER GIVING RISE TO THE CONFLICT OF INTEREST MAY NOT PROCEED UNLESS THE BOARD DETERMINES, BY A MAJORITY VOTE, THAT, DESPITE THE CONFLICT OF INTEREST, THE TRANSACTION/MATTER IS NEVERTHELESS IN THE ORGANIZATION'S BEST INTEREST AND IS FAIR AND REASONABLE TO THE ORGANIZATION. IN ADDITION TO THE REQUIREMENT TO DISCLOSE A POTENTIAL CONFLICT OF INTEREST AT THE TIME IT ARISES, EACH MUST SUBMIT ANNUALLY A `CONFLICT AND DISCLOSURE OF INTEREST QUESTIONNAIRE'.
FORM 990, PAGE 6, PART VI, LINE 15ATHE BOARD OF DIRECTORS REVIEWS AND APPROVES THE COMPENSATION FOR THE CEO. THE BOARD USES COMPARABLE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS AT SIMILARLY SIZED ORGANIZATIONS AND SALARY SURVEYS TO DETERMINE THE COMPENSATION FOR THE CEO. THE CEO, A VOTING MEMBER OF THE BOARD, IS DISMISSED FROM THE MEETING DURING THE REVIEW OF HIS COMPENSATION. THE LAST DETERMINATION USING COMPARABLE COMPENSATION DATA AND SALARY SURVEYS WAS IN 2006. HOWEVER, COST OF LIVING ADJUSTMENTS ARE GIVEN ANNUALLY AND ARE APPROVED BY THE BOARD.
FORM 990, PAGE 6, PART VI, LINE 15BTHE BOARD OF DIRECTORS MEETS ON A MONTHLY BASIS, AND THE SALARY DECISIONS ARE REVIEWED BY THE BOARD.
FORM 990, PAGE 6, PART VI, LINE 19THE ORGANIZATION WILL MAKE AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO ANY MEMBER OF THE PUBLIC WHO MAKES THEIR REQUEST AT THE ADMINISTRATIVE OFFICE OF THE FILING ENTITY.
FORM 990, PART IX, LINE 11GCONTRACT LABOR 868,197 0 0 PROFESSIONAL FEES 1,615,026 48,459 0 PURCHASED SERVICES 138,956 115,430 0 CONSULTING FEES 167,287 0 0