2015-07-08T12:40:03-05:00 2014-08-31 621517792 PERSHING YOAKLEY & ASSOCIATES PC ONE CHEROKEE MILLS 2220 SUTHERLAND AVE KNOXVILLE TN 379192363 990 2013-09-01 582077522 RIDGEVIEW INSTITUTE INC RIDG 7704344567 3995 SOUTH COBB DRIVE SMYRNA GA 300806397 FRANK SARTOR PRESIDENT & CEO 7704344567 2015-07-08 1 DEBORAH O ERNSBERGER P00364912 8656730844 2013 2016-02-25 16:41:14Z FRANK SARTOR 3995 SOUTH COBB DRIVE SMYRNA GA 300806397 33879906 0 X WWW.RIDGEVIEWINSTITUTE.COM X 1994 GA TO PROVIDE A CONTINUUM OF MENTAL HEALTH AND ADDICTION TREATMENT SERVICES TO THE COMMUNITY. 6 3 562 0 0 0 6089 6789 31882416 33405194 59016 40844 -599358 -348622 31348163 33104205 0 0 0 0 19955452 21398860 0 0 0 11351795 11510107 31307247 32908967 40916 195238 27197636 26444501 12655181 11706808 14542455 14737693 X OUR MISSION IS TO PROVIDE A COMPREHENSIVE CONTINUUM OF MENTAL HEALTH AND ADDICTION TREATMENT SERVICES BASED UPON A COMMITMENT TO EXCELLENCE AND QUALITY CARE TO PATIENTS AND FAMILIES. WE WILL CONTINUALLY STRIVE TO ASSESS AND IMPROVE OUR PERFORMANCE AS A NONPROFIT HEALTHCARE PROVIDER. 0 0 20359522 33048765 RIDGEVIEW INSTITUTE, INC. PROVIDES MENTAL HEALTH AND ADDICTION TREATMENT SERVICES. 101457 RIDGEVIEW INSTITUTE, INC. IS THE SPONSOR OF THE GEORGIA COMMUNITY TRUST AND PROVIDES ADMINISTRATION FOR THE TRUST. THE GEORGIA COMMUNITY TRUST IS A NONPROFIT POOLED INCOME TRUST FOR INDIVIDUALS WITH A DISABILITY. BY UTILIZING THE TRUST, THE INDIVIDUALS WITH THE DISABILITY PRESERVE THEIR RIGHT TO PUBLIC ASSISTANCE, INCLUDING MEDICAID AND SUPPLEMENTAL SECURITY INCOME (SSI). A NOMINAL ANNUAL FEE IS CHARGED BY THE TRUST($100 - $500). THE GEORGIA COMMUNITY TRUST IS THE ONLY SUCH TRUST IN THE STATE OF GEORGIA AND ONE OF A FEW IN THE COUNTRY. 1127228 RIDGEVIEW INSTITUTE, INC. OFFERS FREE ASSESSMENTS TO ANYONE IN THE COMMUNITY WHO REQUESTS ONE. A TOTAL OF 9,809 FREE ASSESSMENTS WERE PROVIDED DURING FISCAL YEAR 2014. RIDGEVIEW WORKS WITH PEOPLE WHO ARE STRUGGLING WITH MENTAL HEALTH, ADDICTION, EATING DISORDERS AND OTHER ISSUES AND RECOMMENDS TREATMENT OPTIONS. 17042 FREE COMMUNITY EDUCATION IS PRESENTED AT LOCAL SCHOOLS AND UNIVERSITIES FOR BOTH STUDENTS AND PARENTS. COMMUNITY EDUCATION ALSO INCLUDES LOCAL URGENT CARE CLINIC TO EDUCATE ABOUT BEHAVIORAL HEALTH ISSUES AND VERBAL DE-ESCALATION. THE HOSPITAL ALSO PARTICIPATES IN LOCAL AND REGIONAL AWARENESS EVENTS AS A COMMUNITY SPONSOR. 500 HOURS OF FREE COMMUNITY EDUCATION WAS PROVIDED DURING FISCAL YEAR 2014. 17042 21605249 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 74 0 1 562 1 0 0 0 0 0 0 0 0 0 0 X 6 3 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 1 1 0 0 GA X DIANA REDMOND 7704344568 3995 SOUTH COBB DRIVE SMYRNA GA 300806397 ROBERT FINK CHAIRMAN 40.00 X 72901 0 15548 THOMAS B JOHNS MD BOARD MEMBER & MEDICAL DIR 40.00 X X 225225 0 0 JOHN RAY JR BOARD MEMBER 2.00 X 0 0 0 ROBERT J TAYLOR BOARD MEMBER 2.00 X 0 0 0 LEROY BROCK BOARD MEMBER 2.00 X 0 0 0 TED SMITH BOARD MEMBER 2.00 X 0 0 0 PAUL HACKMAN PRESIDENT & CEO 40.00 X 319461 0 28224 BARBARA LINDENBAUM DIRECTOR OF CLINICAL SERVI 40.00 X 153296 0 19055 WILLIAM F SARTOR DIR OF ADMIN SV 40.00 X 138940 0 25133 RUTH JENKINS CFO 40.00 X 115750 0 12558 DEBORAH BAKER RN 40.00 X 130892 0 1802 BRENDA MCCRAY RNII 40.00 X 120013 0 2383 LINDA LEGER DIRECTOR OF INFORMATION SY 40.00 X 109049 0 7314 LISA TYLINSKI RN 40.00 X 102729 0 1862 KATHRYN S BREWER RN 40.00 X 100711 0 15548 1588967 0 129427 11 0 1 0 SOUTHERN FOOD SERVICE PO BOX 11407 BIRMINGHAM AL 35246 FOOD SERVICES 527235 EMORY ADVENTIST HOSPITAL PO BOX 932089 ATLANTA GA 31193 LAB SERVICES 437950 PERKINS WILL 1315 PEACHTREE STREET NE ATLANTA GA 30309 ATTORNEYS 307966 NURSEFINDERS PO BOX 910738 DALLAS TX 75391 TEMP NURSING LABOR 294531 CARTERS PHARMACY 4015 SOUTH COBB DRIVE SMYRNA GA 30080 PHARMACY 252041 10 6789 6789 PATIENT REVENUES 623990 33319440 33319440 CAFETERIA 624200 60465 60465 FAMILY WORKSHOPS 621990 21513 21513 MEDICAL STAFF APPLICATION 621990 2100 2100 MEDICAL RECORDS 621990 1676 1676 33405194 40844 40844 419272 775701 -356429 -356429 -356429 MISCELLANEOUS 900099 7807 7807 7807 33104205 32988300 0 109116 X 1141788 1141788 16420213 10180532 6239681 391924 242993 148931 2158717 1338405 820312 1286218 797455 488763 91884 91884 91088 56475 34613 3613054 2240092 1372962 602599 373611 228988 76777 47602 29175 142928 88615 54313 249068 154422 94646 1000468 620290 380178 641590 397786 243804 BAD DEBT 2170473 2170473 SUPPLIES 1286636 797714 488922 TRAINING 302290 187420 114870 ANCILLARY 221404 137270 84134 1019848 632306 387542 32908967 21605249 11303718 0 3528411 3249785 1756860 1768742 4915054 5220025 70631 69445 507149 462978 28846659 13905061 14807837 14941598 1611694 731928 27197636 26444501 2133429 2067152 8856876 8065891 1664876 1573765 12655181 11706808 X 14542455 14737693 14542455 14737693 27197636 26444501 195238 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 9387 9387 0 PART II-B, LINE 1: RIDGEVIEW INSTITUTE PAYS MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION, GEORGIA HOSPITAL ASSOCIATION, NATIONAL ASSOCIATION OF ADDICTION TREATMENT PROVIDERS, AND NATIONAL ASSOCIATION OF PSYCHIATRIC HEALTH SYSTEMS. A PORTION OF THESE DUES IS DESIGNATED FOR LOBBYING ACTIVITIES BY THESE ORGANIZATIONS. 3126885 3126885 19215249 8558794 10656455 306681 249757 56924 6197844 5096510 1101334 14941598 ACCRUED PAYROLL 1551718 ACCRUED INTEREST 22047 1573765 X 33879906 775701 775701 33104205 0 33104205 33684669 775701 775701 32908968 0 32908968 PART X, LINE 2: RIDGEVIEW INSTITUTE, INC. (RVI) IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A), AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC), AS AMENDED. RIDGEVIEW REAL ESTATE LLC ("LLC") IS WHOLLY OWNED BY RVI AND IS ORGANIZED UNDER GEORGIA LAW AND THE IRC AS A LIMITED LIABILITY COMPANY. THE INCOME FROM THE LLC'S OPERATIONS IS NOT CONSIDERED UNRELATED BUSINESS INCOME TO RVI AND IS, THEREFORE, NOT SUBJECT TO TAX. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. AT AUGUST 31, 2014, MANAGEMENT DOES NOT BELIEVE THAT RVI OR THE LLC HOLD ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 775,701. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 775,701. 1 1 1 X 1 X 1 1 0 0 394748 0 394748 0.01280 202154 0 202154 0.00660 596902 596902 0.01940 1225685 1225685 0.03990 4328 4328 0.00010 1144271 1144271 0.03720 2374284 2374284 0.07720 2971186 2971186 0.09660 78525 78525 0.00260 10000 10000 0.00030 7043 7043 0.00020 95568 95568 0.00310 1 1332615 4016977 4254058 -237081 X 1 1 1 1 RIDGEVIEW INSTITUTE INC 3995 SOUTH COBB DRIVE SMYRNA GA 30080 WWW.RIDGEVIEWINSTITUTE.COM X PSYCHIATRIC RIDGEVIEW INSTITUTE INC 1 1 X X X X X X X X X 12 1 0 1 X WWW.RIDGEVIEWINSTITUTE.COM X X X X X X X 0 0 1 1 100.000000000000 1 200.000000000000 1 X X X X 1 1 X X X X 1 X 0 0 X X 0 0 RIDGEVIEW INSTITUTE, INC. PART V, SECTION B, LINE 3: RIDGEVIEW INSTITUTE INVOLVED THE SOCIAL SERVICES DEPARTMENTS OF COBB COUNTY SCHOOLS INCLUDING DIRECTORS OF COUNSELING/SOCIAL WORK AND PREVENTION INTERVENTION DEPARTMENTS. RIDGEVIEW INSTITUTE SURVEYED THERAPEUTIC PROVIDERS IN COBB COUNTY TO IDENTIFY AREAS OF NEED. RIDGEVIEW INSTITUTE, INC. PART V, SECTION B, LINE 7: SEVERAL NEEDS OUTLINED IN THE CHNA PROCESSES HAVE NOT BEEN ADDRESSED IN THIS PLAN. IN INITIAL DISCUSSION AND SUBSEQUENT PRIORITIZATION, THE COMMUNITY NEEDS ASSESSMENT TEAM CONSIDERED THE LEVELS TO WHICH SOME NEEDS WERE ALREADY BEING ADDRESSED IN THE SERVICE AREA. ADDITIONALLY, SOME COMMUNITY NEEDS FALL OUT OF THE SCOPE OF EXPERTISE AND RESOURCES OF THE HOSPITAL. RIDGEVIEW INSTITUTE, INC. PART V, SECTION B, LINE 16E: SEND TO 3RD PARTY COLLECTION AGENCY FOR FURTHER COLLECTION ACTIVITY. RIDGEVIEW INSTITUTE, INC. PART V, SECTION B, LINE 19D: RIDGEVIEW INSTITUTE IS A BEHAVIORAL HEALTHCARE FACILITY. MEDICAL EMERGENCY PATIENTS ARE REFERRED TO AND/OR TRANSFERRED TO A MEDICAL HOSPITAL. RIDGEVIEW INSTITUTE, INC. PART V, SECTION B, LINE 20D: SELF PAY RATE WITH POSSIBILITY OF DISCOUNT OR CHARITY DEPENDANT ON FINANCIAL DISCLOSURE INFORMATION PROVIDED BY PATIENT. PART I, LINE 7: A COST-TO-CHARGE RATIO, DERIVED FROM THE SCHEDULE H APPLICABLE WORKSHEETS, INCLUDING WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, WAS USED TO DETERMINE CHARITY CARE. THE TOTAL OPERATING EXPENSE WAS DIVIDED BY PATIENT REVENUES TO CALCULATE AN OVERALL RATIO THAT WAS THEN APPLIED TO INDIGENT AND CHARITY CARE CHARGES TO ARRIVE AT COST. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDE: (1) ADMINISTRATION OF THE GEORGIA COMMUNITY TRUST (A NONPROFIT POOLED INCOME TRUST FOR INDIVIDUALS WITH A DISABILITY) AND (2) FREE MENTAL HEALTH ASSESSMENTS OFFERED TO THE COMMUNITY. NO COSTS WERE ATTRIBUTABLE TO A PHYSICIAN CLINIC. 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 $ 2,170,473. PART II, COMMUNITY BUILDING ACTIVITIES: RIDGEVIEW INSTITUTE PROVIDES FREE LEVEL OF CARE EVALUTIONS/ASSESSMENTS TO ANYONE IN THE COMMUNITY. RIDGEVIEW INSTITUE PROVIDES FREE ASSESSMENTS 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR TO ANY INDIVIDUAL IN CRISIS. RIDGEVIEW INSTITUE HOSTS 35+ INDEPENDENT SUPPORT GROUPS EACH WEEK ON CAMPUS FREE OF CHARGE EACH YEAR. RIDGEVIEW INSTITUTE HAS AN OPEN MEDICAL STAFF, HOLDS 15+ EDUCATIONAL SEMINARS AND PROVIDES SPACE FOR EVENTS OF LOCAL SCHOOL SYSTEMS, LOCAL COUNSELING AGENCIES, LOCAL ADDICTION CERTIFICATION BOARDS AND PROFESSIONAL STATE LICENSING ORGANIZATIONS FREE OF CHARGE. RIDGEVIEW USES SURPLUS FUNDS TO INCREASE PROGRAMMING AND STAFFING IN ORDER TO BETTER PROVIDE FOR THE COMMUNITY. RIDGEVIEW HAS A COMMUNITY BOARD CONSISTING OF A LOCAL HEALTHCARE ATTORNEY, A RETIRED BANKER, A PROFESSOR AT MOREHOUSE COLLEGE AND A LOCAL FINANCIAL PROFESSIONAL. RIDGEVIEW PARTICIPATES IN A JOINT VENTURE WITH EMORY UNIVERSITY TO PROVIDE FELLOWSHIP OPPORTUNITIES FOR CHILD/ADOLESCENT PSYCHIATRIC PHYSICIANS. RIDGEVIEW INSTITUTE PROVIDES FREE EDUCATION TO BEHAVIORAL HEALTH PROFESSIONALS IN THE COMMUNITY, LOCAL SCHOOLS AND UNIVERSITIES, ER'S AND HOSPITALS IN GEORGIA AND LOCAL BUSINESSES IN THE COMMUNITY. PART III, LINE 4: A COST-TO-CHARGE RATIO WAS ALSO USED TO DETERMINE BAD DEBT COST. THE TOTAL OPERATING EXPENSE WAS DIVIDED BY PATIENT REVENUES TO CALCULATE AN OVERALL RATIO THAT WAS THEN APPLIED TO THE BAD DEBT EXPENSE TO ARRIVE AT COST.THE AUDITED FINANCIAL STATEMENTS READ AS FOLLOWS: "PATIENT ACCOUNTS RECEIVABLE ARE REPORTED NET OF AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS. THE CONTRACTUAL ALLOWANCE REPRESENTS THE DIFFERENCE BETWEEN ESTABLISHED BILLING RATES AND ESTIMATED REIMBURSEMENT FROM MEDICARE AND OTHER THIRD-PARTY PAYMENT PROGRAMS. CURRENT OPERATIONS INCLUDE A PROVISION FOR BAD DEBTS ESTIMATED BASED UPON THE AGE OF THE ACCOUNTS AND ANY UNUSUAL CIRCUMSTANCES WHICH AFFECT THE COLLECTION OF PATIENT ACCOUNTS RECEIVABLE. MANAGEMENT REVIEWS ALL ESSENTIAL ACCOUNTS FOR COLLECTIBILITY PRIOR TO RECORDING REVENUE." PART III, LINE 8: THE COST OF MEDICARE WAS DETERMINED FROM THE MEDICARE COST REPORT. PART III, LINE 9B: RIDGEVIEW INSTITUTE HAS THE POLICY FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKES INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR CHARITY, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR CHARITY FROM RIDGEVIEW INSTITUTE, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS/HER PAYMENT AGREEMENTS WITH RIDGEVIEW INSTITUTE. FOR PATIENTS WHO QUALIFY FOR CHARITY AND FOR PATIENTS WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR HOSPITAL BILLS, RIDGEVIEW INSTITUTE MAY OFFER EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS; WILL NOT IMPOSE WAGE GARNISHMENTS OR LIENS ON PRIMARY RESIDENCES; WILL NOT SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES; AND WILL CEASE ALL COLLECTION EFFORTS. PART VI, LINE 2: RIDGEVIEW INSTITUTE IDENTIFIED COMMUNITY HEALTH NEEDS BY UNDERGOING AN ASSESSMENT PROCESS. THIS PROCESS INCORPORATED A COMPREHENSIVE REVIEW BY THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT TEAM ALONG WITH SECONDARY AND PRIMARY DATA INPUT USING THE EXPERTISE OF DIXON HUGHES GOODMAN, LLP. THE TEAM USED SEVERAL SOURCES OF QUANTITATIVE HEALTH, SOCIAL AND DEMOGRAPHIC DATA SPECIFIC TO THE HOME COUNTY OF THE FACILITY PROVIDED BY LOCAL PUBLIC HEALTH AGENCIES, HEALTH CARE ASSOCIATIONS AND OTHER DATA SOURCES. RIDGEVIEW INSTITUTE TOOK ADVANTAGE OF THIS OPPORTUNITY TO COLLABORATE WITH ITS ADMINISTRATORS, PHYSICIANS, STATE AGENCIES, AND LOCAL ORGANIZATIONS. PART VI, LINE 3: RIDGEVIEW INSTITUTE MAKES AVAILABLE FINANCIAL ASSISTANCE TO PERSONS WHO HAVE HEALTHCARE NEEDS AND ARE UNINSURED, OR UNDERINSURED, AND WHOSE HOUSEHOLD INCOME IS LESS THAN OR EQUAL TO 200% OF THE FEDERAL INCOME POVERTY GUIDELINES. THE AMOUNT THAT A PATIENT IS EXPECTED TO PAY AND THE AMOUNT OF FINANCIAL ASSISTANCE OFFERED DEPENDS ON THE PATIENT'S INSURANCE COVERAGE, INCOME, AND ASSETS AS SET FORTH IN THE ELIGIBILITY SECTION OF THIS POLICY. THE FEDERAL INCOME POVERTY GUIDELINES WILL BE USED IN DETERMINING THE AMOUNT OF CHARITY CARE AND THE AMOUNT CHARGED TO PATIENTS, IF ANY, AFTER AN ADJUSTMENT. AMOUNTS CHARGED FOR EMERGENCY AND MEDICALLY NECESSARY MEDICAL SERVICES TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE WILL NOT BE MORE THAN THE AMOUNT GENERALLY BILLED TO INDIVIDUALS WITH INSURANCE COVERING SUCH CARE. PART VI, LINE 4: RIDGEVIEW INSTITUTE SPECIALIZES IN TREATING PEOPLE WITH ADDICTION OR MENTAL HEALTH PROBLEMS IN THE COBB COUNTY AREA. MANY OF RIDGEVIEW'S PATIENTS ARE ENCOMPASSED IN THIS GEOGRAPHIC AREA. USING A COUNTY DEFINITION AS A SERVICE AREA IS CRUCIAL FOR OUR ANALYSIS AS MANY SECONDARY DATA SOURCES ARE COUNTY SPECIFIC AND SERVE AS A COMPARISON TOOL TO OTHER COUNTIES, THE STATE OF GEORGIA, AND THE UNITED STATES. ALSO, MANY OF OUR COMMUNITY INPUT SOURCES CONSIDER COBB COUNTY THEIR PRIMARY SERVICE AREA. THESE INCLUDE MEMBERS OF DIFFERENT AGENCIES OF COBB COUNTY, AS WELL AS MANY DIFFERENT COMMUNITY ADVOCACY GROUPS WITH WHOM RIDGEVIEW INSTITUTE HAS RELATIONSHIPS.RIDGEVIEW MOST DIRECTLY SERVES COBB COUNTY (POPULATION APPROXIMATELY 690,000 BASED ON 2010 CENSUS) AND ADJOINING COUNTIES IN THE METRO ATLANTA AREA. APPROXIMATELY 65% OF THE PATIENTS AT RIDGEVIEW INSTITUTE COME FROM GEORGIA, WITH THE GREATEST NUMBER COMING FROM THE METRO ATLANTA AREA. THE REMAINDER COMES MOSTLY FROM ADJACENT STATES IN THE SOUTHEAST, THOUGH A FEW COME FROM OTHER PLACES IN THE UNITED STATES.THERE ARE SIX OTHER FREE-STANDING BEHAVIORAL HEALTH FACILITIES IN THE GREATER METRO ATLANTA AREA. THERE ARE THREE OTHER TREATMENT CENTERS THAT PROVIDE AN OUTPATIENT AND/OR RESIDENTIAL LEVEL OF CARE FOR ADDICTION PATIENTS ONLY. PART VI, LINE 5: RIDGEVIEW INSTITUTE HAS AN OPEN MEDICAL STAFF, HOLDS 15+ EDUCATIONAL SEMINARS AND PROVIDES SPACE AND SERVICES FOR MANY COMMUNITY EVENTS FREE OF CHARGE EACH YEAR. RIDGEVIEW USES SURPLUS FUNDS TO INCREASE PROGRAMMING AND STAFFING IN ORDER TO BETTER PROVIDE FOR THE COMMUNITY. SOME SURPLUS FUNDS WERE USED IN CALENDAR YEAR 2013 TO ADD FOUR BEDS TO OLDER ADULT SERVICES. RIDGEVIEW HAS A COMMUNITY BOARD CONSISTING OF A LOCAL HEALTHCARE ATTORNEY, A RETIRED BANKER, A PROFESSOR AT MOREHOUSE SCHOOL OF MEDICINE AND A LOCAL FINANCIAL PROFESSIONAL. RIDGEVIEW PARTICIPATES IN A JOINT VENTURE WITH EMORY UNIVERSITY TO PROVIDE FELLOWSHIP OPPORTUNITIES FOR CHILD/ADOLESCENT PSYCHIATRIC PHYSICIANS. RIDGEVIEW PROVIDES FREE EDUCATION TO COMMUNITY PARTNERS, I.E. SCHOOLS, PHYSICIAN PRACTICES. PART VI, LINE 6: N/A PART VI, LINE 7, REPORTS FILED WITH STATES GA X X X X 0 0 0 0 0 0 0 0 0 THOMAS B JOHNS MD BOARD MEMBER & MEDICAL DIR 225225 0 0 0 0 0 0 0 0 0 225225 0 0 0 PAUL HACKMAN PRESIDENT & CEO 298961 0 20500 0 0 0 6013 0 22211 0 347685 0 0 0 BARBARA LINDENBAUM DIRECTOR OF CLINICAL SERVI 140796 0 12500 0 0 0 2819 0 16236 0 172351 0 0 0 WILLIAM F SARTOR DIR OF ADMIN SV 126940 0 12000 0 0 0 2432 0 22701 0 164073 0 0 0 A HOSPITAL AUTHORITY OF THE CITY OF SMYRNA GEORGIA 582401110 NONEAVAIL 2005-06-16 3672000 2005 BONDS - EXPANSION 0 0 0 B HOSPITAL AUTHORITY OF THE CITY OF SMYRNA GEORGIA 582401110 NONEAVAIL 2013-02-20 6247000 REVENUE ANTICIPATION CERTIFICATES 0 0 0 A 3672000 73440 3598560 2005 0 0 1 1 B 6247000 5476718 121645 648637 2013 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 PART III, LINE 9, PART IV, LINE 7, AND PART V PROVISIONS EXIST IN THE BOND DOCUMENTS FOR MONITORING THE REQUIREMENTS OF IRC SECTION 141 AND 148. IN ADDITION, RIDGEVIEW INSTITUTE HAS QUARTERLY REPORTING AND COVENANT CALCULATIONS DUE TO ITS BANKS. RAY & SHERMAN LLC JOHN RAY, JR., BOARD MEMBER, IS A RAY & SHERMAN MANAGING PARTNER. 47417 RAY & SHERMAN, LLC PROVIDES LEGAL SERVICES TO RIDGEVIEW INSTITUTE, INC. JOHN RAY, JR., RIDGEVIEW INSTITUTE, INC. BOARD MEMBER, IS A MANAGING PARTNER OF RAY & SHERMAN, LLC. ALL TRANSACTIONS ARE CONDUCTED AT ARM'S LENGTH. 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PREPARED BY AN UNRELATED AND INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY THE ORGANIZATION'S MANAGEMENT. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12 THE ORGANIZATION'S BY-LAWS CONTAIN A SECTION DEDICATED TO CONFLICTS OF INTEREST. BOARD MEMBERS ARE REQUIRED TO COMPLETE ANNUALLY, A RELATIONSHIP DECLARATION TO IDENTIFY ANY POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD USES THE FOLLOWING TOOLS TO ESTABLISH THE COMPENSATION FOR THE CEO: A COMPENSATION COMMITTEE (COMPRISED OF INDEPENDENT BOARD MEMBERS), A WRITTEN CONTRACT FOR THE CEO, COMPENSATION SURVEYS, AND BOARD LEVEL APPROVAL. THE CEO USES BENCHMARK SURVEYS AND RECRUITERS TO ESTABLISH THE COMPENSATION FOR THE OTHER OFFICERS AND KEY EMPLOYEES OF THE HOSPITAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THESE DOCUMENTS AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 954,192. MANAGEMENT AND GENERAL EXPENSES 584,828. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,539,020. PROGRAM MANAGEMENT FEES: PROGRAM SERVICE EXPENSES 345,119. MANAGEMENT AND GENERAL EXPENSES 211,525. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 556,644. PURCHASED COUNSELING: PROGRAM SERVICE EXPENSES 20,877. MANAGEMENT AND GENERAL EXPENSES 12,796. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,673. PURCHASED ANCILLARY: PROGRAM SERVICE EXPENSES 707,698. MANAGEMENT AND GENERAL EXPENSES 433,750. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,141,448. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 163,913. MANAGEMENT AND GENERAL EXPENSES 100,463. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 264,376. CONSULTING FEE: PROGRAM SERVICE EXPENSES -248. MANAGEMENT AND GENERAL EXPENSES -152. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -400. COLLECTION FEES: PROGRAM SERVICE EXPENSES 45,858. MANAGEMENT AND GENERAL EXPENSES 28,107. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,965. RESIDENTS FEE: PROGRAM SERVICE EXPENSES 2,683. MANAGEMENT AND GENERAL EXPENSES 1,645. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,328. RIDGEVIEW REAL ESTATE LLC 3995 SOUTH COBB DRIVE SMYRNA GA 30080 582077522 RENTAL PROPERTY GA 441321 2231692 RIDGEVIEW INSTITUTE INC