STEPHENS COUNTY HOSPITAL AUTHORITY: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- STEPHENS COUNTY HOSPITAL AUTHORITY (EIN 58-6001667)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-08-17
- IRS object ID
- 201502299349302750
- Schema version
- 2013v4.0
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-08-17T12:20:34-05:00 | ReturnTs |
| Tax Period End | 2014-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 560747981 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 586001667 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEPHENS COUNTY HOSPITAL AUTHORITY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STEP | BusinessNameControlTxt |
| Phone | 7062824200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 163 HOSPITAL DRIVE | AddressLine1 |
| City | TOCCOA | City |
| State | GA | State |
| ZIP Code | 30577 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SIGNING OFFICER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7062824200 | PhoneNum |
| Signature | 2015-08-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY BIBBY | PreparerPersonNm |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | EDWARD C GAMBRELL JR | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 163 HOSPITAL DRIVE | AddressLine1 |
| City | TOCCOA | City |
| State | GA | State |
| ZIP Code | 30577 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $53,824,531 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STEPHENSCOUNTYHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | PROVIDES INPATIENT, OUTPATIENT, OCCUPATIONAL, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF STEPHENS COUNTY, GEORGIA AND SURROUNDING AREAS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 672 | TotalEmployeeCnt |
| Total Volunteers | 32 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $93,770 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $52,741,083 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $52,878,763 | CYProgramServiceRevenueAmt |
| PY Investment Income | $34,465 | PYInvestmentIncomeAmt |
| CY Investment Income | $26,672 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,006,133 | PYOtherRevenueAmt |
| CY Other Revenue | $919,096 | CYOtherRevenueAmt |
| PY Total Revenue | $53,875,451 | PYTotalRevenueAmt |
| CY Total Revenue | $53,824,531 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $27,577,271 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $25,867,252 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $28,781,377 | PYOtherExpensesAmt |
| CY Other Expenses | $27,872,142 | CYOtherExpensesAmt |
| PY Total Expenses | $56,358,648 | PYTotalExpensesAmt |
| CY Total Expenses | $53,739,394 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,483,197 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $85,137 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $41,294,442 | TotalAssetsBOYAmt |
| Total Assets EOY | $41,866,262 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $16,326,680 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $16,995,872 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $24,967,762 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $24,870,390 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION OF STEPHENS COUNTY HOSPITAL AUTHORITY IS TO PROVIDE HEALTH CARE AND RELATED SERVICES TO ENHANCE INDIVIDUAL HEALTH AND WELL BEING IN A MANNER THAT MEETS THE EXPECTATIONS OF PATIENTS AND OTHER CUSTOMERS; PRESERVES THE RIGHTS OF PATIENTS, EMPLOYEES AND OTHERS TO BE TREATED WITH DIGNITY, RESPECT AND CONCERN; PROVIDES PROFESSIONALLY AND TECHNICALLY PROFICIENT PERSONNEL IN AN EFFECTIVE AND RESOURCE EFFICIENT MANNER; UTILIZES ALL RESOURCES APPROPRIATELY TO CONTAIN COSTS AND TO PROVIDE FOR ADDITIONAL SERVICE OPPORTUNITIES; AND ALL PHASES OF OPERATIONS MUST BE CARRIED OUT IN AN ETHICAL MANNER. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $50,211,711 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $52,878,763 | RevenueAmt |
| Desc | STEPHENS COUNTY HOSPITAL AUTHORITY OPERATES 96 INPATIENT BEDS AND PROVIDES OUTPATIENT SERVICES TO A SERVICE AREA THAT EXTENDS BEYOND STEPHENS COUNTY TO SURROUNDING COUNTIES OF FRANKLIN, HART, HABERSHAM, RABUN, AND BANKS IN GEORGIA AND INTO NEIGHBORING OCONEE COUNTY IN SOUTH CAROLINA. STEPHENS COUNTY HOSPITAL AUTHORITY ALSO OPERATES A 92 BED PERSONAL CARE HOME. THE STEPHENS COUNTY HOSPITAL PARTICIPATES IN SEVERAL EMPLOYER SPONSORED HEALTH FAIRS AND ALSO SUPPORTS THE LOCAL EMPLOYERS IN THE "DRUGS DON'T WORK" PROGRAM. THE STEPHENS COUNTY HOSPITAL DOES NOT TURN ANY INDIVIDUAL DOWN FOR SERVICES BASED ON THE INABILITY TO PAY FOR SUCH SERVICES. | Desc |
| Total Program Service Expenses | $50,211,711 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 11 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 672 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEFFREY B LAIRD CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7062824281 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 163 HOSPITAL DRIVE | AddressLine1 |
| City | TOCCOA | City |
| State | GA | State |
| ZIP Code | 30577 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| MARK G WILKINSON | |||||||
| CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROBERT W SLATE MD | |||||||
| VICE CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| STANLEY W ROBERTS | |||||||
| SECRETARY/TREASURER | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PAULA M DICKERSON | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JON C WEST | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| GEORGE SANDERS | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| MAX BROCK | |||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| EDWARD C GAMBRELL | |||||||
| CEO/ADMINISTRATOR | 50.00 | Yes (X) | $293,206 | $0 | $38,063 | ||
| JEFFREY B LAIRD | |||||||
| CFO/CONTROLLER | 50.00 | Yes (X) | $99,831 | $0 | $32,251 | ||
| ANGELA R KING | |||||||
| REHAB SERVICES MANAGER | 40.00 | $127,524 | $0 | $21,300 | Yes (X) | ||
| RONALD L REESE | |||||||
| STAFF PHARMACIST | 45.00 | $126,162 | $0 | $15,051 | Yes (X) | ||
| KELLY R HART | |||||||
| PHARMACY MANAGER | 40.00 | $125,503 | $0 | $21,265 | Yes (X) | ||
| JAMES W FORDYCE DO | |||||||
| ORTHOPEDIC SURGEON | 40.00 | $479,491 | $0 | $30,137 | Yes (X) | ||
| STEPHEN T SMALL | |||||||
| NURSE PRACTITIONER | 40.00 | $155,449 | $0 | $4,696 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,407,166 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $162,763 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 14 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HD SMITH WHOLESALE DRUGS | |||||
| 6001 GLOBAL DISTRIBUTION WAY | LOUISVILLE | KY | 40228 | WHOLESALE DRUG | $1,567,743 |
| MEDLINE INDUSTRIES | |||||
| DEPT CH 14400 | PALATINE | IL | 600054400 | MEDICAL SUPPLY DISTRIBUTOR | $1,167,390 |
| DEPAY SYNTHES SALES INC | |||||
| PO BOX 406663 | ATLANTA | GA | 303846663 | ORTHOPEDIC SURGICAL SUPPLIES | $636,537 |
| BECKMAN COULTER INC | |||||
| DEPT CH 10164 | PALATINE | IL | 300550164 | LABORATORY EQUIPMENT & SUPPLIES | $545,296 |
| MEDRONIC USA | |||||
| PO BOX 409201 | ATLANTA | GA | 303849201 | ORTHOPEDIC SURGICAL SUPPLIES | $510,273 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 29 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUE | 622000 | $49,745,768 | $49,745,768 |
| RESIDENT REVENUE | 623000 | $2,132,674 | $2,132,674 |
| AMBULANCE SERVICE SUBSIDY BY COUN | 621910 | $651,222 | $651,222 |
| EHR MEANINGFUL USE | 900099 | $349,099 | $349,099 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $52,878,763 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,672 | TotalRevenueColumnAmt |
| Exclusion | $26,672 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA SALES | 900099 | $582,810 | $582,810 |
| PHARMACY - EMPLOYEE COPAYS | 900099 | $175,610 | $175,610 |
| MISCELLANEOUS | 900099 | $160,676 | $160,676 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $919,096 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $53,824,531 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $52,878,763 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $945,768 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $840,294 | TotalAmt |
| Program Services | $111,565 | ProgramServicesAmt |
| Management And General | $728,729 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,472 | TotalAmt |
| Program Services | $81,472 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,319,893 | TotalAmt |
| Program Services | $19,166,037 | ProgramServicesAmt |
| Management And General | $1,153,856 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $534,540 | TotalAmt |
| Program Services | $487,165 | ProgramServicesAmt |
| Management And General | $47,375 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,706,358 | TotalAmt |
| Program Services | $2,466,502 | ProgramServicesAmt |
| Management And General | $239,856 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,384,695 | TotalAmt |
| Program Services | $1,261,974 | ProgramServicesAmt |
| Management And General | $122,721 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,575 | TotalAmt |
| Management And General | $2,575 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,665 | TotalAmt |
| Management And General | $109,665 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,262,719 | TotalAmt |
| Program Services | $5,881,879 | ProgramServicesAmt |
| Management And General | $380,840 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,699 | TotalAmt |
| Management And General | $37,699 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,540,164 | TotalAmt |
| Program Services | $854,628 | ProgramServicesAmt |
| Management And General | $685,536 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,834,214 | TotalAmt |
| Program Services | $1,834,214 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,338 | TotalAmt |
| Program Services | $20,199 | ProgramServicesAmt |
| Management And General | $17,139 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $355,478 | TotalAmt |
| Program Services | $355,478 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,271,154 | TotalAmt |
| Program Services | $2,271,154 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $626,474 | TotalAmt |
| Program Services | $626,474 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL SUPPLIES | $7,567,155 | $7,567,155 |
| BAD DEBT EXPENSE | $5,878,350 | $5,878,350 |
| FOOD | $745,858 | $745,858 |
| MEDICAID PROVIDER FEE T | $601,607 | $601,607 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,692 | TotalAmt |
| Management And General | $1,692 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $53,739,394 | TotalAmt |
| Program Services | $50,211,711 | ProgramServicesAmt |
| Management And General | $3,527,683 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $615,732 | BOYAmt |
| EOY | $566,976 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,553,559 | BOYAmt |
| EOY | $3,066,455 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,799,710 | BOYAmt |
| EOY | $11,338,564 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,845,054 | BOYAmt |
| EOY | $1,686,873 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $320,875 | BOYAmt |
| EOY | $402,743 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $64,317,574 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $42,932,548 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,908,762 | BOYAmt |
| EOY | $21,385,026 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,206 | BOYAmt |
| EOY | $40,358 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,183,544 | BOYAmt |
| EOY | $3,379,267 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,294,442 | BOYAmt |
| EOY | $41,866,262 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,658,999 | BOYAmt |
| EOY | $8,112,175 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,860,537 | BOYAmt |
| EOY | $5,925,854 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,807,144 | BOYAmt |
| EOY | $2,957,843 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,326,680 | BOYAmt |
| EOY | $16,995,872 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,175,796 | BOYAmt |
| EOY | $23,620,149 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,791,966 | BOYAmt |
| EOY | $1,250,241 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,967,762 | BOYAmt |
| EOY | $24,870,390 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,294,442 | BOYAmt |
| EOY | $41,866,262 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $85,137 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$182,509 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $9,496 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $9,496 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THIS AMOUNT REPRESENTS THE APPROXIMATE LOBBYING PORTION OF DUES PAID TO THE THE AMERICAN HOSPTIAL ASSOCIATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $293,388 | OtherCostOrOtherBasisAmt |
| Book Value | $293,388 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,225,441 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,292,570 | DepreciationAmt |
| Book Value | $15,932,871 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,740,884 | OtherCostOrOtherBasisAmt |
| Depreciation | $901,611 | DepreciationAmt |
| Book Value | $839,273 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,054,212 | OtherCostOrOtherBasisAmt |
| Depreciation | $26,738,367 | DepreciationAmt |
| Book Value | $4,315,845 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,649 | OtherCostOrOtherBasisAmt |
| Book Value | $3,649 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $21,385,026 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| THIRD PARTY PAYOR SETTLEMENTS | $2,864,618 |
| OTHER RECEIVABLES | $514,649 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,379,267 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $46,907,726 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $46,907,726 | RevenueSubtotalAmt |
| Other Revenues Not Included | $6,916,805 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $6,916,805 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $53,824,531 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $46,822,589 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $46,822,589 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $6,916,805 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $6,916,805 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $53,739,394 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | INCOME TAXES- THE HOSPITAL AND SCEP ARE NOT-FOR-PROFIT ORGANIZATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR STATE OR FEDERAL INCOME TAXES HAS BEEN PRESENTED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL AND SCEP HAVE EVALUATED THEIR TAX POSITIONS AND HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OBLIGATIONS AS OF SEPTEMBER 30, 2014. NOTHING IS CURRENTLY UNDER REVIEW. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | EXPENSES NET WITH REVENUE 1,038,455. BAD DEBT EXPENSE NET WITH REVENUE 5,878,350. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | EXPENSES NET WITH REVENUE 1,038,455. BAD DEBT EXPENSE NET WITH REVENUE 5,878,350. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 175.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,117,472 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,383,342 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $734,130 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01530 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,663,887 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,127,994 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $535,893 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,047,982 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,171,866 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $876,116 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01830 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,829,341 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,683,202 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,146,139 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04480 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,900 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,900 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,900 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,900 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,832,241 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,683,202 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,149,039 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04490 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,878,350 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $2,525,833 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $13,307,879 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,178,437 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$870,558 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEPHENS COUNTY HOSPITAL | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 163 HOSPITAL DRIVE | AddressLine1 |
| City | TOCCOA | City |
| State | GA | State |
| ZIP Code | 30577 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | DISPROPORTIONATE SHARE HOSPITAL | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEPHENS COUNTY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE DISCLOSURE | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | Yes (1) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 175.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| STEPHENS COUNTY HOSPITAL | PART V, SECTION B, LINE 3: THE HOSPITAL FACILITY USED COMMUNITY-BASED SURVEYS AND FOCUS GROUPS TO GATHER INPUT. |
| PART V, SECTION B, LINE 5A: | HTTP://STEPHENSCOUNTYHOSPITAL.COM/COMMUNITY-HEALTH-NEEDS-A SSESSMENT/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| THE CLARY CARE CENTER | ||||
| 249 HOSPITAL DRIVE | TOCCOA | GA | 30577 | ADVANCED PERSONAL CARE FACILITY |
| THE WILKINSON CENTER | ||||
| 269 HOSPITAL DRIVE | TOCCOA | GA | 30577 | PERSONAL CARE FACILITY |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7G: | THE HOSPITAL OPERATES A COUNTY AMBULANCE. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5,878,350. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE ORGANIZATION PARTICIPATES IN THE FOLLOWING COMMUNITY BUILDING ACTIVITIES:1. PARTICIPATION ON LEADERSHIP TOCCOA-STEPHENS COUNTY PROGRAM CHAIRED BY THE CHAMBER OF COMMERCE.2. COPD COMMUNITY WORKSHOPS, DIABETES COMMUNITY WORKSHOPS, VARIOUS HEALTHFAIRS BY COMMUNITY ORGANIZATIONS AND AREA BUSINESS. |
| PART III, LINE 4: | THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE OF BAD DEBT EXPENSE. THE BAD DEBT EXPENSE AT COST ON PART III, LINE 2 WAS COMPUTED BY USING THE PERCENTAGE OF THE AUDITED FINANCIAL STATEMENT EXPENSES DIVIDED BY TOAL GROSS PATIENT REVENUE. THE ORGANIZATION ESTIMATED THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY CARE BASED ON PRIOR EXPERIENCE. |
| PART III, LINE 8: | A VERY HIGH PERCENTAGE OF THOSE PATIENTS COVERED BY MEDICARE DUE TO AGE OR DISABILITY ARE ALSO MEDICALLY INDIGENT AS EVIDENCED BY A LARGE PERCENTAGE OF THAT POPULATION WITH MEDICAID AS THE SECONDARY COVERAGE. |
| PART III, LINE 9B: | THOSE PATIENTS KNOWN TO QUALIFY OR TO HAVE QUALIFIED FOR FINANCIAL ASSISTANCE ARE CONTACTED TO ASSERTAIN THEIR ABILITY OF PAY AND PLACEMENT ON THE INDIGENT/CHARITY CARE POLICY GUIDELINES OR TO CONFIRM WHETHER OR NOT THERE HAS BEEN A CHANGE IN THEIR FINANCIAL SITUATION. IF THE PREVIOUS QUALIFICATION WAS WITHIN THE LAST THREE MONTHS OR THERE IS A HISTORICAL LONG-TERM QUALIFICATION PATTERN, A PATIENT CAN BE 'ASSUMED' INDIGENT OR IN NEED OF CHARITY. |
| PART VI, LINE 2: | THE ORGANIZATION HAS COMPLETED A FORMALIZED COMMUNITY HEALTH NEEDS ASSESSMENT IN 2013. PREVIOUSLY THE NEEDS WERE DETERMINED BY MANAGEMENT BY OUTSIDE REQUESTS, INTERNAL IDEAS, STATISTICAL DATA GENERATED FROM THE ORGANIZATION'S HIS. |
| PART VI, LINE 3: | EVERYONE RECEIVES NOTIFICATION AT REGISTRATION THAT THERE ARE ASSISTANCE PROGRAMS AVAILABLE AND THAT THE HOSPITAL STAFF IS AVAILABLE TO ASSIST IN THE EXPLORATION OF THEIR ELIGIBILITY. ALL UNINSURED PATIENTS ARE CHECKED AGAINST THE MEDICAID DATABASE FOR ELIGIBILITY AND ENCOURAGED TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. |
| PART VI, LINE 4: | STEPHENS COUNTY HOSPITAL SERVES A RURAL POPULATION OF GEORGIA. ACCORDING TO THE LATEST DATA AVAILABLE FOR 2010, OF THE STEPHENS COUNTY RESIDENTS THAT REQUIRED THE SERVICES OF A HOSPITAL DURING THE YEAR, 26.9% HAD PRIMARY COVERAGE FROM MEDICARE, 27.2% HAD PRIMARY COVERAGE FROM A MEDICAID PROGRAM AND OVER 8% HAD NO 3RD PARTY COVERAGE AT ALL. THE MAJOR ILLNESSES TREATED WERE CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNCONTROLLED DIABETES AND CONGESTIVE HEART FAILURE. |
| PART VI, LINE 5: | STEPHENS COUNTY HOSPITAL AUTHORITY APPLIES ALL FUNDS AVAILABLE TO THE PROVISION OF PATIENT CARE, PATIENT AND COMMUNITY HEALTH EDUCATION, RETIREMENT OF DEBT RELATED TO THE PURCHASE OF FIXED ASSETS UTILIZED IN THE PROVISION OF PATIENT CARE AND THE OUTRIGHT PURCHASE OF EQUIPMENT FOR THE EXPRESSED PURPOSE OF HEALTH CARE FOR OUR COMMUNITY AND SUUROUNDING SERVICE AREA. THE STEPHENS COUNTY HOSPITAL AUTHORITY'S GOVERNING BODY INCLUDES INDIVIDUALS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE ORGANIZATION NOR FAMILY MEMBERS THEREOF. THE STEPHENS COUNTY HOSPITAL AUTHORITY EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. THE STEPHENS COUNTY HOSPITAL AUTHORITY PROVIDES CARE AND EDUCATION TO ANY INDIVIDUAL IN THE COMMUNITY AND SURROUNDING SERVICE AREA THAT SEEKS IT WITHOUT REGARD TO THAT PERSON'S ABILITY TO PAY FOR SUCH SERVICES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EDWARD C GAMBRELL | ||||||||||||||
| CEO/ADMINISTRATOR | $284,509 | $0 | $7,386 | $0 | $1,311 | $0 | $9,006 | $0 | $29,057 | $0 | $331,269 | $0 | $0 | $0 |
| JAMES W FORDYCE DO | ||||||||||||||
| ORTHOPEDIC SURGEON | $479,491 | $0 | $0 | $0 | $0 | $0 | $14,505 | $0 | $15,632 | $0 | $509,628 | $0 | $0 | $0 |
| STEPHEN T SMALL | ||||||||||||||
| NURSE PRACTITIONER | $155,449 | $0 | $0 | $0 | $0 | $0 | $4,696 | $0 | $0 | $0 | $160,145 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 6 | FormAndLineReferenceDesc |
| Explanation | PER CONTRACTUAL EMPLOYMENT AGREEMENT, THE CEO RECEIVES A YEAR-END BONUS OF 1% OF NET EARNINGS AS SHOWN ON THE STEPHENS COUNTY HOSPITAL AUTHORITY'S AUDITED CONSOLIDATED STATEMENTS OF REVENUES, EXPENSES, AND CHANGES IN NET ASSETS. DURING THE FISCAL YEAR 2014, BONUS PAYMENT WAS CALCULATED BASED ON FISCAL YEAR 2012 AUDITED STATEMENTS, WHICH SHOWED A NET INCOME OF $-2,483,197 RESULTING IN $0 IN BONUS PAYMENT. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| HOSPITAL AUTHORITY OF STEPHENS COUNTY GEORGIA SERIES 2006 | ||||||||
| A | 586001667 | 858753DE3 | 2006-10-10 | $4,000,000 | CONSTRUCTION & RENOVATION OF PATIENT ROOMS | 0 | 0 | 0 |
| HOSPITAL AUTHORITY OF STEPHENS COUNTY GEORGIA SERIES 2010 | ||||||||
| B | 586001667 | 2010-12-16 | $4,740,000 | CURRENT REFUNDING | 0 | 0 | 0 | |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | RetiredRetiredAmt | Other Spent ProceedsOtherSpentProceedsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $4,000,000 | $858,233 | $168,861 | $3,831,139 | 2007 | 0 | 0 | Yes (1) | Yes (1) | ||
| B | $4,740,000 | $814,586 | $135,318 | 2001 | Yes (1) | 0 | Yes (1) | Yes (1) | $2,795,000 | $4,604,682 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II, LINE 11, OTHER SPENT PROCEEDS | FormAndLineReferenceDesc |
| Explanation | THE AMOUNTS PRESENTED ON PART II, LINE 11 REPRESENT PROCEEDS SPENT TO REFUND SERIES 2001A AND 2001B ISSUES. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CONSTANCE RICE | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | SISTER OF GEORGE SANDERS (BOARD MEMBER) | RelationshipDescriptionTxt |
| Transaction | $81,472 | TransactionAmt |
| Transaction | COMPENSATION FOR DUTIES AS SURGICAL SERVICES MANAGER | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 7A | SERVICE ON THE BOARD OF TRUSTEES FOR THE HOSPITAL AUTHORITY IS A NON-COMPENSATED POSITION. EVERY POSITION ON THE AUTHORITY IS APPOINTED/ELECTED FOR A SIX YEAR TERM. EACH POSITION IS ELECTED BY THE CURRENT TRUSTEES FROM A SLATE OF THREE NOMINATIONS MADE FROM THE COUNTY COMMISSION. THE SAME PROCESS IS UTILIZED IF A POSITION BECOMES VACANT AT ANYTIME PRIOR TO THE COMPLETION OF A SIX YEAR TERM AND IS FOR THE REMAINDER OF SAID TERM. |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE FORM 990 WAS REVIEWED BY EACH VOTING BOARD MEMBER. AT A REGULAR SCHEDULED BOARD MEETING, THE GOVERNING BOARD FULLY DISCUSSED THE FORM 990. THE ENTIRE BOARD VOTED AND APPROVED THE FORM 990 AS PRESENTED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION CONDUCTS PERIODIC REVIEWS OF EXISTING BUSINESS RELATIONSHIPS AND INITIAL REVIEWS OF ANY NEW BUSINESS RELATIONSHIPS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE AUTHORITY SETS AND REVIEWS THE COMPENSATION PACKAGE OF THE CEO USING COMPARABLE DATA PROVIDED BY THE GEORGIA HOSPITAL ASSOCIATION ON CEO COMPENSATION AT SIMILAR SIZED HOSPITALS IN GEORGIA. CONSIDERATION IS ALSO GIVEN TO THE LEVEL OF EXPERIENCE AND OVER ALL PERFORMANCE OF THE HOSPITAL. THIS SAME PROCESS IS USED THROUGHOUT THE ORGANIZATION IN SETTING AND REVIEWING PAY SCALES FOR ALL JOBS INCLUDING THAT OF ANY "KEY EMPLOYEES." COMPARISON DATA IS USED TO SET A PAY SCALE AND THE LEVEL OF EXPERTISE AND EXPERIENCE IN THE JOB DUTIES DETERMINE THE POINT WITHIN THAT SCALE COMPENSATION IS SET. |
| FORM 990, PART VI, SECTION C, LINE 18 | RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE STEPHENS COUNTY HOSPITAL AUTHORITY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,902,255. MANAGEMENT AND GENERAL EXPENSES 7,171. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,909,426. CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 11,513. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,513. MAINTENANCE CONTRACT: PROGRAM SERVICE EXPENSES 979,624. MANAGEMENT AND GENERAL EXPENSES 362,156. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,341,780. |
| FORM 990, PART XI, LINE 9: | RESTATEMENT ADJUSTMENT DUE TO GASB 65 -182,509. |
| FORM 990, PART XII, LINE 2C | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| STEPHENS COUNTY EMERGENCY PHYSICIANS INC | ||||||||||
| 163 HOSPITAL DRIVE | TOCCOA | GA | 30577 | 020692996 | PROVIDE EMERGENCY ROOM PHYSICIANS TO STEPHENS COUNTY HOSPITAL | GA | 501(C)(3) | 7 | STEPHENS COUNTY HOSPITAL AUTHORITY | Yes (1) |
| STEPHENS COUNTY HOSPITAL FOUNDATION INC | ||||||||||
| 163 HOSPITAL DRIVE | TOCCOA | GA | 30577 | 208089919 | FUNDRAISING ACTIVITIES FOR STEPHENS COUNTY HOSPITAL | GA | 501(C)(3) | 11 | STEPHENS COUNTY HOSPITAL AUTHORITY | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEPHENS COUNTY EMERGENCY PHYSICIANS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | M | TransactionTypeTxt |
| Involved | $1,316,471 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |
Comments