2014-08-05T14:35:53-05:00 2013-09-30 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2012-10-01 581559677 ARCHBOLD FOUNDATION INC ARCH 2292282200 PO BOX 620 THOMASVILLE GA 317990620 E VANN MIDDLETON 2292282200 2014-08-15 true JACQUELINE G ATKINS 2298837878 2014-07-29 2012 2015-11-30 17:44:51Z E VANN MIDDLETON P O BOX 1018 THOMASVILLE GA 317991018 5540550 false X WWW.ARCHBOLD.ORG/FOUNDATION X 1983 GA SUPPORT ORGANIZATION 17 9 0 0 2695592 1811493 0 2932616 3680705 -28388 -10387 5599820 5481811 3214675 496509 0 336368 348391 1456 954 417987 328254 363706 3880753 1209560 1719067 4272251 77351034 84730591 1393472 1310758 75957562 83419833 X SUPPORT ORGANIZATION false false 343815 338909 SUPPORT TO JOHN D. ARCHBOLD MEMORIAL HOSPITAL TO BE USED FOR NURSING SCHOLARSHIPS AND THE CONSTRUCTION AND EQUIPPING OF FACILITIES. SUPPORT TO ARCHBOLD HEALTH SERVICES FOR CONTRIBUTIONS MADE TO THE HOSPICE PROGRAM. 65000 65000 SUPPORT TO JOHN D. ARCHBOLD MEMORIAL HOSPITAL FOR PHARMACEUTICALS FOR INDIGENT CANCER PATIENTS. 92600 92600 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 10598777 967278 9631499 11666964 1068187 10598777 13626937 1959973 11666964 14346827 719890 13626937 15195018 848191 14346827 1.00000 false false 313370 205811 107559 107559 DUE TO RELATED PARTIES 1300433 1300433 X INTENDED USES FOR ENDOWMENT FUNDS 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. LIABILITY UNDER FIN 48 FOOTNOTE 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 CONSOLIDATED FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE MEDICAL CENTER ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2013 AND 2012 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTER'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2010-2012. GOLF TOURNAMENT 169354 129807 39547 15670 12060 2337 14210 1000 10830 PINK AFFAIR 29855 21050 8805 1 17011 17011 2632 216220 167868 48352 15670 12060 2337 14210 1000 13462 58739 -10387 true JOHN D ARCHBOLD MEMORIAL HOSPITAL P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 50000 DRUG EXP-INDIGENT JOHN D ARCHBOLD MEM HOSP INC P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 300000 NURSING SCHOLARSHIPS JOHN D ARCHBOLD MEM HOSP INC P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 35000 DENTAL - INDIGENT JOHN D ARCHBOLD MEM HOSP INC P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 15000 CRITICAL CONDITIONS JOHN D ARCHBOLD MEM HOSP INC P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 38909 CAPITAL CONTRIBUTION JOHN D ARCHBOLD MEM HOSP INC P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 55000 PATIENT SUPPORT 1 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 ARCHBOLD FOUNDATION IS A SUPPORTING ORGANIZATION FOR JOHN D. 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. false true false false false false false false false J PERRY MUSTIAN 572180 270394 10311 -290799 9454 571540 FRANCES PARKER 158415 33820 19875 17187 7454 236751 CHARLES D HIGHTOWER JR 297105 99400 45837 25876 8294 476512 RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION 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. SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 J. PERRY MUSTIAN 0 -330,000 0 OTHER ADDITIONAL INFORMATION 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. THE CURRENT YEAR'S VALUE OF THE SERP DECREASED DUE TO A CHANGE IN THE FACTORS USED IN CALCULATING THE ESTIMATED NET PROJECTED PAYMENT. VANN MIDDLETON, FOUNDATION PRESIDENT, BEGAN SERVING AS PRESIDENT FOR THE FILING ORGANIZATION ON JUNE 10, 2013. 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. CHARLES E HANCOCK MD TRUSTEE 215531680 BANKING RELATIONSHIP false KIM JONES TRUSTEE 6748055 BANKING RELATIONSHIP false RICHARD G MOONEY III TRUSTEE 9634872 INVESTMENT MANAGER false MILES WATKINS TRUSTEE 215531680 BANKING RELATIONSHIP false LEE TY TURNER TRUSTEE 6748055 BANKING RELATIONSHIP false ADDITIONAL INFORMATION SCHEDULE L PART V CHARLES E HANCOCK MD AND MILES WATKINS ARE DIRECTORS OF THOMASVILLE NATIONAL BANK THE ORGANIZATION UTILIZES BANKING SERVICES AND ONSITE THRIFT PLAN SERVICES FROM THOMASVILLE NATIONAL BANK THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 93013 FOR THE FILING AND ALL RELATED ORGANIZATIONS KIM JONES AND LEE TY TURNER ARE DIRECTORS OF COMMERCIAL BANK THE ORGANIZATION UTILIZES BANKING SERVICES FROM COMMERCIAL BANK THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 93013 FOR THE FILING AND ALL RELATED ORGANIZATIONS RICHARD G MOONEY III IS THE INVESTMENT MANAGER FOR AMCS SERP ACCOUNT THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 93013 FOR THE FILING AND ALL RELATED ORGANIZATIONS ALL OTHER ACCOMPLISHMENT DESCRIPTION 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. RELATED PARTY INFORMATION AMONG OFFICERS FORM 990, PAGE 6, PART VI, LINE 2 JOHN N. DANIEL III MILES WATKINS TRUSTEE TRUSTEE BUSINESS RELATIONSHIP TONY CAMPBELL RICHARD G. MOONEY III TRUSTEE TRUSTEE BUSINESS RELATIONSHIP TONY CAMPBELL CHARLES E. HANCOCK, M.D. TRUSTEE TRUSTEE BUSINESS RELATIONSHIP CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 THE ORGANIZATION HAS A SOLE MEMBER, ARCHBOLD MEDICAL CENTER, INC. (AMC) WITH THE POWER TO SELECT OR REPLACE AND TO REMOVE THE TRUSTEES OF THE GOVERNING BODY, AS WELL AS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY. ELECTION OF MEMBERS AND THEIR RIGHTS 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 SELECT 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. DECISIONS SUBJECT TO APPROVAL OF MEMBERS 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. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 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 2014 REGULARLY SCHEDULED BOARD MEETING. THE ORGANIZATIONS CFO PRESENTED THE INFORMATION, AND TRUSTEES HAD THE OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. ENFORCEMENT OF CONFLICTS POLICY 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. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 NO DOCUMENTS ARE OR WILL BE MADE AVAILABLE TO THE PUBLIC. OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 9 TEMPORARILY RESTRICTED FUNDS RELEASED -967,279 TOTAL DECREASE IN NET ASSETS -967,279 ARCHBOLD HEALTH SERVICES INC PO BOX 620 THOMASVILLE GA 317990620 581376434 MGMT GA 501C3 9 AMC ARCHBOLD MEDICAL CENTER INC false JOHN D ARCHBOLD MEMORIAL HOSP INC PO BOX 1018 THOMASVILLE GA 317991018 580566121 ACUTE CARE GA 501C3 3 AMC ARCHBOLD MEDICAL CENTER INC false ARCHBOLD MEDICAL CENTER INC PO BOX 1018 THOMASVILLE GA 317991018 581552650 HEALTHCARE GA 501C3 11A NA false ARCHBOLD MEDICAL ENTERPRISES 400 OLD ALBANY ROAD THOMASVILLE GA 31792 581494513 HEALTHCARE GA N/A false false true true false false false false false false false false true false true true false false true false