2015-08-06T07:41:30-05:00 2014-09-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2013-10-01 581559677 ARCHBOLD FOUNDATION INC ARCH 2292282200 PO BOX 620 THOMASVILLE GA 317990620 E VANN MIDDLETON PRESIDENT 2292282200 2015-08-17 true JACQUELINE G ATKINS P00861721 2298837878 2015-08-04 2013 2016-04-25 22:37:26Z E VANN MIDDLETON P O BOX 1018 THOMASVILLE GA 317991018 5843952 false X WWW.ARCHBOLD.ORG/FOUNDATION X 1983 GA BUILDING ON A TRADITION OF GIVING BACK, THE ARCHBOLD FOUNDATION WAS CREATED IN 1983 AS AN INDEPENDENT, 501(C)(3) SUPPORT FOUNDATION WHOSE SOLE PURPOSE IS TO BUILD AND SUSTAIN A FINANCIAL LEGACY OF SUPPORT OF JOHN D. ARCHBOLD MEMORIAL HOSPITAL AND ARCHBOLD HEALTH SERVICES. THE FOUNDATION HELPS SERVE THE NEEDS OF SEVERAL CRITICAL PROGRAMS WITHIN THE ARCHBOLD MEDICAL CENTER SYSTEM. THE FOUNDATION IS AN INDEPENDENT, NOT FOR PROFIT CORPORATION GOVERNED BY A VOLUNTEER BOARD OF TRUSTEES. OUR PRIMARY GOAL IS TO MAINTAIN THE DELIVERY OF HIGH QUALITY AND COST EFFECTIVE HEALTHCARE FOR THE CITIZENS OF THE REGION WE SERVE. PRIVATE GIFTS TO THE FOUNDATION HELP FUND INNOVATIVE NEW PROGRAMS, FUTURE CAPITAL IMPROVEMENTS, NEW EQUIPMENT AND TECHNOLOGIES AND OTHER CRITICAL SERVICES THAT ALLOW ARCHBOLD TO REMAIN A LEADING CENTER OF EXCELLENCE FOR HEALTHCARE IN OUR REGION. 17 8 0 0 1811493 687779 0 3680705 5116555 -10387 -20751 5481811 5783583 496509 4014846 0 348391 419215 954 10804 304306 363706 384129 1209560 4828994 4272251 954589 84730591 89813369 1310758 4694233 83419833 85119136 X BUILDING ON A TRADITION OF GIVING BACK, THE ARCHBOLD FOUNDATION WAS CREATED IN 1983 AS AN INDEPENDENT, 501(C)(3) SUPPORT FOUNDATION WHOSE SOLE PURPOSE IS TO BUILD AND SUSTAIN A FINANCIAL LEGACY OF SUPPORT OF JOHN D. ARCHBOLD MEMORIAL HOSPITAL AND ARCHBOLD HEALTH SERVICES. THE FOUNDATION HELPS SERVE THE NEEDS OF SEVERAL CRITICAL PROGRAMS WITHIN THE ARCHBOLD MEDICAL CENTER SYSTEM. THE FOUNDATION IS AN INDEPENDENT, NOT FOR PROFIT CORPORATION GOVERNED BY A VOLUNTEER BOARD OF TRUSTEES. OUR PRIMARY GOAL IS TO MAINTAIN THE DELIVERY OF HIGH QUALITY AND COST EFFECTIVE HEALTHCARE FOR THE CITIZENS OF THE REGION WE SERVE. PRIVATE GIFTS TO THE FOUNDATION HELP FUND INNOVATIVE NEW PROGRAMS, FUTURE CAPITAL IMPROVEMENTS, NEW EQUIPMENT AND TECHNOLOGIES AND OTHER CRITICAL SERVICES THAT ALLOW ARCHBOLD TO REMAIN A LEADING CENTER OF EXCELLENCE FOR HEALTHCARE IN OUR REGION. false false 3636312 3632876 SUPPORT TO JOHN D. ARCHBOLD MEMORIAL HOSPITAL TO BE USED FOR NURSING SCHOLARSHIPS AND THE CONSTRUCTION AND EQUIPPING OF FACILITIES. 128977 128977 SUPPORT TO ARCHBOLD HEALTH SERVICES FOR CONTRIBUTIONS MADE TO THE HOSPICE PROGRAM. 82000 82000 SUPPORT TO JOHN D. ARCHBOLD MEMORIAL HOSPITAL FOR PHARMACEUTICALS FOR INDIGENT CANCER PATIENTS. 170993 170993 GRANTS TO AREA DENTISTS FOR TREATMENT OF ELIGIBLE INDIGENT CARE CANCER PATIENTS. 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THE FILING ENTITY PROVIDES FUNDRAISING SERVICES TO BOTH SUPPORTED ORGANIZATIONS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9631499 9631499 10598777 967278 9631499 11666964 1068187 10598777 13626937 1959973 11666964 14346827 719890 13626937 false false 313370 218994 94376 94376 DUE TO RELATED PARTIES 4677376 4677376 X SCHEDULE D, PAGE 2, PART V, LINE 4 ARCHBOLD FOUNDATION, INC. RECEIVED A CONTRIBUTION OF APPROXIMATELY 16,000,000 DURING FISCAL YEAR 2008. THIS CONTRIBUTION IS TO BE RELEASED FROM RESTRICTION TO BE USED FOR CONSTRUCTION PROJECTS AS MATCHING CONTRIBUTIONS ARE RECEIVED. DURING FISCAL YEAR 2014, THE CONSTRUCTION PROJECT WAS COMPLETED AND THE REMAINING RESTRICTED FUNDS WERE RELEASED. SCHEDULE D, PAGE 3, PART X THE MEDICAL CENTER, WITH THE EXCEPTION OF ARCHBOLD MEDICAL ENTERPRISES, INC., IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX- EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE MEDICAL CENTER ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2014 AND 2013 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTER'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. 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ARCHBOLD MEMORIAL HOSPITAL AND ARCHBOLD HEALTH SERVICES. THE FOUNDATION ACCEPTS GRANT REQUESTS FROM DEPARTMENTS WITHIN JDAMH AND AHS. THESE GRANT REQUESTS ARE IN THE FORM OF LETTERS, EACH OF WHICH INCLUDE A SPECIFIC GRANT AMOUNT AND A BUDGET AND/OR DESCRIPTION OF PROPOSED SERVICES OR PURCHASES. THE GRANT REQUESTS ARE REVIEWED ANNUALLY PRIOR TO APPROVAL OF THE ANNUAL BUDGET. DEPARTMENTS REPORT THE USE OF FUNDS TO THE FOUNDATION ADMINISTRATION. true true false false false false false false false J PERRY MUSTIAN TRUSTEE/HOSPITAL CEO 552014 263990 16687 765477 33640 1631808 GERALD KADIS MD TRUSTEE 224400 224400 CHARLES D HIGHTOWER JR ASST SEC/TREAS/CFO 290700 94395 43802 26400 7380 462677 FRANCES PARKER FORMER PRESIDENT 6104 187005 12624 205733 SCHEDULE J, PAGE 1, PART I, LINE 3 THE FILING ORGANIZATION RELIES ON THE METHODS USED BY ARCHBOLD MEDICAL CENTER, INC.(AMC), A RELATED ORGANIZATION, TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY AMC INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. SCHEDULE J, PAGE 1, PART I, LINE 4 J. PERRY MUSTIAN 0 726,000 0 FRANCES PARKER 169,100 0 0 SCHEDULE J, PART III THE IRS RULES & REGULATIONS REQUIRE THAT CERTAIN NON-CURRENT, NON-CASH ITEMS ARE REPORTED IN PART VII OF FORM 990 REGARDLESS OF THE CURRENT BENEFIT TO THE EMPLOYEE. THESE SAME RULES, IN SOME CASES, REQUIRE THE COMPENSATION AND BENEFITS TO BE REPORTED TWICE IN PART VII, ONCE WHEN THE ENTITY ACCRUES FOR A FUTURE PAYMENT AND ONCE WHEN THE PAYMENT IS ACTUALLY MADE TO THE EMPLOYEE. THEREFORE, AN EMPLOYEE'S STATED TOTAL COMPENSATION AND BENEFITS REPORTED ON PART VII ARE SUBSTANTIALLY HIGHER THAN THE ACTUAL CASH COMPENSATION RECEIVED IN THE CURRENT YEAR. AMOUNTS REPORTED AS BENEFITS INCLUDE AMOUNTS FOR LIFE INSURANCE, HEALTH INSURANCE, THRIFT PLAN CONTRIBUTIONS, AND PENSION CONTRIBUTIONS. BENEFITS RELATED TO PENSION AND RETIREMENT PLANS REFLECT AMOUNTS ACCUMULATED, BUT NOT PAID, TO THE INDIVIDUAL IN RECOGNITION OF TOTAL YEARS OF EMPLOYMENT, NOT JUST THE CURRENT YEAR. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN AMC'S TOP EXECUTIVES PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS ACCRUED BUT UNFUNDED IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON-QUALIFIED RETIREMENT PLAN. BONUS AWARDS: OFFICERS AND PHYSICIANS ARE AWARDED BONUSES/INCENTIVES CONTINGENT IN PART ON MEETING MANAGEMENT-BY-OBJECTIVE INCENTIVE PLAN GOALS AND EXCESS OF REVENUE OVER EXPENSES. SEVERANCE PAYMENTS FRANCES PARKER, THE FORMER FOUNDATION PRESIDENT OF THE FILING ORGANIZATION, TERMINATED EMPLOYMENT DURING CALENDAR YEAR 2013. SEVERANCE COMPENSATION WAS PAID IN ACCORDANCE WITH HIS CONTRACT AND WITH ORGANIZATION POLICIES. CHARLES E HANCOCK MD TRUSTEE 226839450 BANKING RELATIONSHIP false RICHARD G MOONEY III TRUSTEE 10746473 INVESTMENT MANAGER false LEE TY TURNER TRUSTEE 6772318 BANKING RELATIONSHIP false HAILE MCCOLLUM TRUSTEE 226839450 BANKING RELATIONSHIP false SCHEDULE L, PART V CHARLES E. HANCOCK, M.D. AND HAILE MCCOLLUM ARE DIRECTORS OF THOMASVILLE NATIONAL BANK. THE ORGANIZATION UTILIZES BANKING SERVICES AND ON-SITE THRIFT PLAN SERVICES FROM THOMASVILLE NATIONAL BANK. THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 9/30/14 FOR THE FILING AND ALL RELATED ORGANIZATIONS. LEE TY TURNER IS A DIRECTOR OF COMMERCIAL BANK. THE ORGANIZATION UTILIZES BANKING SERVICES FROM COMMERCIAL BANK. THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 9/30/14 FOR THE FILING AND ALL RELATED ORGANIZATIONS. RICHARD G. MOONEY, III IS THE INVESTMENT MANAGER FOR AMC'S SERP ACCOUNT. THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 9/30/14 FOR THE FILING AND ALL RELATED ORGANIZATIONS. FORM 990 - ORGANIZATION'S MISSION BUILDING ON A TRADITION OF GIVING BACK, THE ARCHBOLD FOUNDATION WAS CREATED IN 1983 AS AN INDEPENDENT, 501(C)(3) SUPPORT FOUNDATION WHOSE SOLE PURPOSE IS TO BUILD AND SUSTAIN A FINANCIAL LEGACY OF SUPPORT OF JOHN D. ARCHBOLD MEMORIAL HOSPITAL AND ARCHBOLD HEALTH SERVICES. THE FOUNDATION HELPS SERVE THE NEEDS OF SEVERAL CRITICAL PROGRAMS WITHIN THE ARCHBOLD MEDICAL CENTER SYSTEM. THE FOUNDATION IS AN INDEPENDENT, NOT FOR PROFIT CORPORATION GOVERNED BY A VOLUNTEER BOARD OF TRUSTEES. OUR PRIMARY GOAL IS TO MAINTAIN THE DELIVERY OF HIGH QUALITY AND COST EFFECTIVE HEALTHCARE FOR THE CITIZENS OF THE REGION WE SERVE. PRIVATE GIFTS TO THE FOUNDATION HELP FUND INNOVATIVE NEW PROGRAMS, FUTURE CAPITAL IMPROVEMENTS, NEW EQUIPMENT AND TECHNOLOGIES AND OTHER CRITICAL SERVICES THAT ALLOW ARCHBOLD TO REMAIN A LEADING CENTER OF EXCELLENCE FOR HEALTHCARE IN OUR REGION. FORM 990, PAGE 2, PART III, LINE 4D GRANTS TO AREA DENTISTS FOR TREATMENT OF ELIGIBLE INDIGENT CARE CANCER PATIENTS. AMOUNTS GRANTED TO HEALTHVISIONS FOR ALL EDUCATIONAL HEALTH INFORMATION. FORM 990, PAGE 6, PART VI, LINE 2 CHARLES E. HANCOCK, MD HAILE MCCOLLUM BD TRUSTEE BD TRUSTEE BUSINESS RELATIONSHIP FORM 990, PAGE 6, PART VI, LINE 6 THE ORGANIZATION HAS A SOLE MEMBER, ARCHBOLD MEDICAL CENTER, INC. (AMC) WITH THE POWER TO ELECT OR REPLACE AND TO REMOVE THE TRUSTEES OF THE GOVERNING BODY, AS WELL AS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY. FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD OF TRUSTEES OF THE FILING ENTITY ARE ELECTED ANNUALLY BY THE SOLE MEMBER, ARCHBOLD MEDICAL CENTER, INC. ("AMC"). IN ADDITION, AMC HAS THE POWER TO ELECT OR REPLACE AND TO REMOVE THE TRUSTEES OF THE GOVERNING BODY. AMC'S CHAIRMAN OF THE BOARD OF TRUSTEES SHALL SERVE AS EX-OFFICIO OF THE BOARD OF ARCHBOLD FOUNDATION WITHOUT VOTING RIGHTS. FORM 990, PAGE 6, PART VI, LINE 7B THE SOLE MEMBER, ARCHBOLD MEDICAL CENTER, INC. ("AMC"), HAS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY, INCLUDING BUT NOT LIMITED TO, CAPITAL AND OPERATING BUDGETS, MERGERS OR ACQUISITIONS, CONTRACTS AND TRANSACTIONS OVER A CERTAIN AMOUNT, DISSOLUTION, ETC. FORM 990, PAGE 6, PART VI, LINE 11B PRIOR TO FILING THE FORM 990, THE ORGANIZATION PRESENTED ITS FORM 990 TO TRUSTEES ATTENDING THE JULY 2015 REGULARLY SCHEDULED BOARD MEETING. THE ORGANIZATIONS CFO PRESENTED THE INFORMATION, AND TRUSTEES HAD THE OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. FORM 990, PAGE 6, PART VI, LINE 12C ON AN ANNUAL BASIS, THE ORGANIZATION DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE AND DISCLOSURE STATEMENT TO EACH TRUSTEE. THIS QUESTIONNAIRE INCLUDES QUESTIONS RELATED TO FINANCIAL INTERESTS, OUTSIDE INTERESTS OR ACTIVITIES, AND GIFTS, MEALS, AND ENTERTAINMENT. IN ADDITION TO DISCLOSING ANY APPLICABLE INFORMATION ON THE QUESTIONNAIRE, THE TRUSTEE SIGNS AN ACKNOWLEDGMENT STATEMENT THAT (S)HE HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ, UNDERSTANDS, AND AGREES TO COMPLY WITH IT, AND UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION STATUS IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. RESPONSES ARE SUMMARIZED AND COLLECTIVELY REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE OF ARCHBOLD MEDICAL CENTER, INC. DURING EACH BOARD MEETING, THE CHAIRMAN INQUIRES IF ANY TRUSTEE HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST RELATED TO ANY AGENDA ITEM. IF THE TRUSTEE DISCLOSES ANY SUCH INTEREST, THE TRUSTEE IS EXCUSED FROM THE MEETING WHILE THE DETERMINATION AS TO WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS IS DISCUSSED AND VOTED UPON BY DISINTERESTED MEMBERS OF THE BOARD AND COMMITTEE. IF INVITED TO DO SO, THE TRUSTEE WITH A POTENTIAL CONFLICT MAY RESPOND TO QUESTIONS PUT FORTH BY FELLOW DISINTERESTED TRUSTEES REGARDING ANY PROPOSED TRANSACTION OR ARRANGEMENT. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS DOCUMENT THE NAME OF ANY INTERESTED PERSON/TRUSTEE WHO DISCLOSED OR WAS FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH A TRANSACTION OR ARRANGEMENT RESULTING IN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; AND THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATED TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSIONS, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH. FORM 990, PAGE 6, PART VI, LINE 19 NO DOCUMENTS ARE OR WILL BE MADE AVAILABLE TO THE PUBLIC. 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