2014-05-06T15:27:21-05:00 2013-06-30 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2012-07-01 582175978 CRISP REGIONAL HOSPITAL INC CRIS 2292763130 902 7TH STREET NORTH CORDELE GA 310153234 STEVEN GAUTNEY 2292763130 2014-05-15 true JACQUELINE G ATKINS 2298837878 2014-05-05 2012 2015-11-30 17:44:51Z STEVEN GAUTNEY 902 7TH STREET NORTH CORDELE GA 310153234 65798444 false X WWW.CRISPREGIONAL.ORG X 1995 GA TO PROVIDE APPROPRIATE, QUALITY CARE AND ASSISTANCE IN MAINTAINING GOOD HEALTH IN AN EFFICIENT AND CARING MANNER TO ALL WHO NEED OUR SERVICES AND AS NEAR THEIR HOME AS POSSIBLE. 9 8 875 40 -13182 -13182 21055 3573 64240823 63609347 431161 356582 1818694 1739189 66511733 65708691 155205 216370 0 28402532 30323098 0 0 33414007 34340487 61971744 64879955 4539989 828736 81853986 99541315 20610872 37934172 61243114 61607143 TO PROVIDE APPROPRIATE, QUALITY CARE AND ASSISTANCE IN MAINTAINING GOOD HEALTH IN AN EFFICIENT AND CARING MANNER TO ALL WHO NEED OUR SERVICES AND AS NEAR THEIR HOME AS POSSIBLE. false false 45620071 216370 64345862 HOSPITAL, SNF & HHA; SHORT-TERM ACUTE CARE FOR IP & OP SERVICES FOR CRISP COUNTY AND SURROUNDING COUNTIES. TOTAL PATIENT DAYS FOR FYE 6/30/13 WERE 14,392; HHA VISITS FOR WERE 9,253; AND SNF PATIENT DAYS WERE 29,188; HEALTH AND REHABILITATION PATIENT DAYS TOTAL 11,812. 45620071 true false false true false false false false false false true false false false false true false true false false false false false false false false true true false true true true false false false false false false false false false false false false false false false true true true false false true 192 0 875 true true true false false false false false false false false false X 9 8 false false false false false false false true true false false true true true true true true true true true true GA X JESSICA CARTER 2292763130 902 7TH STREET CORDELE GA 310153234 STEVE GAUTNEY 40.00 3.00 X X 230709 0 22632 WILLIAM PANNELL MD 1.00 1.00 X 224590 0 0 SULE SALAMI MD 1.00 1.00 X X 1019 0 0 ROE J DAVIS 1.00 3.00 X X 0 0 0 BETTYE ROBERSON 1.00 1.00 X 0 0 0 RONNEY LEDFORD 1.00 X X 0 0 0 WAYNE MARTIN 1.00 1.00 X 0 0 0 MIKE MILLER RPH 1.00 X 0 0 0 PHIL BERRYMAN 1.00 1.00 X 0 0 0 JESSICA CARTER 40.00 3.00 X 154402 0 29556 SRILATHA NADIPINENI MD 40.00 X 256553 0 22632 VISHAL BURRA MD 40.00 X 182933 0 20101 MILTON JONES MD 40.00 X 159934 0 22783 MARY ELLEN HANCOCK 40.00 X 124446 0 13595 WHITNEY HILL 40.00 X 124317 0 3816 CHARLOTTE VESTAL X 98963 0 249 1557866 135364 13 true true false INNOVATIVE THERAPY CONCEPTS LLC 2 MASHBURN ST SUITE 102 HAWKINSVILLE GA 31036 MEDICAL SERVICE 1103929 FIRST CALL MEDICAL STAFFING INC PO BOX 402 SYLVESTER GA 31791 MED STAFFING 552595 GT YOUNG LLC 79 ABERDEEN CIRCLE CORDELE GA 31015 PHYSICIAN 387415 GR MCNAIR LLC 113 TIMBERLAND DRIVE CORDELE GA 31015 PHYSICIAN 380415 KENNETH BENJAMIN MD 2213 PENDLETON ALBANY GA 31721 PHYSICIAN 329171 27 3573 1906 3573 PROGRAM SERVICE REVENUE 623000 62797813 62797813 EMS OPERATIONS CONTRACT 621910 579284 579284 MEDICAID EHR INCENTIVES 621990 232250 232250 63609347 412843 412843 196776 30862 165914 165914 179096 -13182 2630 58891 -56261 -56261 -56261 23875 23875 23875 DIETARY/VENDING 722513 556735 556735 OTHER REVENUES 621990 359228 359228 DIETARY CATERING 722513 294664 294664 338773 198191 140582 1549400 65708691 64345862 -13182 1372438 X 216370 216370 662908 221400 441508 99212 99212 23360858 17184104 6176754 566858 480561 86297 3333314 2001739 1331575 2299948 1443466 856482 386007 45000 341007 248907 248907 144159 144159 10379 10379 13293315 10780211 2513104 138766 61046 77720 3612492 2718989 893503 2500 2500 1547066 191428 1355638 622384 431426 190958 63638 39312 24326 3616827 1668417 1948410 920871 396724 524147 MEDICAL SUPPLIES 7451170 7451170 LICENSES AND TAXES 1273189 33003 1240186 OTHER EXPENSES 329571 71635 257936 JCAHO/ STATE COMPLIANCE 289118 46743 242375 390128 134827 255301 64879955 45620071 19259884 0 107800 173273 7119673 5907926 8496368 9383619 1158778 1470066 1029537 1181283 85512796 45596151 28445320 39916645 33085283 35965560 402000 402000 311018 1787041 1698209 3353902 81853986 99541315 3677185 5964172 16755000 31970000 178687 20610872 37934172 X 61243114 61607143 61243114 61607143 81853986 99541315 828736 -464707 X false true X true false X false false false false false false false false true 10379 10379 false SCHEDULE C, PART II-B, LINE 1 THE HOSPITAL PAYS MEMBERSHIP DUES TO NATIONAL AND STATE ORGANIZATIONS. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THOSE ORGANIZATIONS PARTICIPATE. 2102411 2102411 39984602 17375349 22609253 1068224 956407 111817 36176472 27264395 8912077 6181087 6181087 39916645 LIABILITY UNDER FIN 48 FOOTNOTE SCHEDULE D, PAGE 3, PART X CRISP REGIONAL HEALTH SERVICES, INC., CRISP REGIONAL HOSPITAL, INC. AND CRISP REGIONAL DEVELOPMENT FOUNDATION, INC. ARE NOT-FOR-PROFIT CORPORATIONS THAT HAVE BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CORPORATIONS APPLY 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, THEY ONLY RECOGNIZE THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGES TO EXPENSE AS OF JUNE 30, 2013 AND 2012 OR FOR THE YEARS THEN ENDED. THE OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2010-2012. true true X true X 1.25000 true X true false false 264458 264458 0.00410 14527944 11920191 2607753 0.04020 14792402 11920191 2872211 0.04430 7943229 5241377 2701852 0.04160 7943229 5241377 2701852 0.04160 22735631 17161568 5574063 0.08590 true 15639755 15280171 15349370 -69199 X true true CRISP HC ALLIANCE HEALTH SERVICES 0.80000 0.20000 1 1 CRISP REGIONAL HOSPITAL

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NURSING FACILITY CRISP REGIONAL CONVENIENT CARE

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RHC BLACKSHEAR RETIREMENT VILLAS

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ASSISTED LIVING SUBSIDIZED HEALTH SERVICES EXPLANATION PART I LINE 7G THIS SECTION INCLUDES NET ACTUAL COSTS FOR SUBSIDIZED PHYSICIAN AND RURAL HEALTH CLINICS OF 1769220 EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I LINE 7 COLUMN F IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN F THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990 PART IX LINE 25 FORM 990 PART IX LINE 25 64879955 ADD EXPENSES ON PART VIII 30862 DENOMINATOR FOR COLUMN F 64910817 COSTING METHODOLOGY EXPLANATION PART I LINE 7 THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATIONS A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS 2008 SEE ALSO THE DESCRIPTION FOR PART III LINE 4 BAD DEBT EXPENSE EXPLANATION PART III LINE 4 AMOUNTS ON PART III LINE 2 REPRESENT THE AMOUNT OF NET CHARGES WRITTEN OFF AS UNCOLLECTIBLE AND RECORDED AS BAD DEBT EXPENSE ON THE AUDITED FINANCIAL STATEMENTS EXCERPT FROM AUDITED FINANCIAL STATEMENTS ALLOWANCE FOR DOUBTFUL ACCOUNTS ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE THE CORPORATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRDPARTY COVERAGE THE CORPORATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IF NECESSARY FOR EXAMPLE FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRDPARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY FOR RECEIVABLES ASSOCIATED WITH SELFPAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL THE CORPORATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE THE DIFFERENCE BETWEEN THE STANDARD RATES OR THE DISCOUNTED RATES IF NEGOTIATED AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS THE CORPORATIONS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELFPAY PATIENTS INCREASED APPROXIMATELY 691000 FROM 2012 TO 2013 AS A RESULT OF NEGATIVE TRENDS EXPERIENCED IN THE COLLECTION OF AMOUNTS FROM SELFPAY PATIENTS IN FISCAL YEAR 2013 THE CORPORATION HAS NOT CHANGED ITS INDIGENT CARE POLICIES DURING FISCAL YEARS 2012 OR 2013 THE CORPORATION DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRDPARTY PAYORS NOR DID IT HAVE SIGNIFICANT WRITEOFFS FROM THIRDPARTY PAYORS MEDICARE EXPLANATION PART III LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS NEEDS ASSESSMENT PART VI CRISP REGIONAL ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY BY EVALUATING DISEASE INCIDENCES IN THE POPULATION AS WELL AS ECONOMIC AND DEMOGRAPHIC CHARACTERISTICS OF THE POPULATION IN COMPARISON TO THE UTILIZATION AND AVAILABILITY OF APPLICABLE SERVICES PRIMARY SOURCE FOR ASSESSMENT INFORMATION IS THE COMMUNITY HEALTH STATUS INDICATORS PUBLISHED BY THE US DEPARTMENT OF HEALTH HUMAN SERVICES AND INTERNAL INFORMATION PRODUCED BY HOSPITAL RECORDS CRISP REGIONAL IS CLASSIFIED AS A HEALTH MANPOWER SHORTAGE AREA DUE TO THE DISPROPORTIONALLY LARGE LOW INCOME POPULATION IN ADDITION CRISPS SERVICE HAS A SIGNIFICANT NUMBER OF MIGRANT AND UNDOCUMENTED FARM WORKS THAT PRESENT EPISODIC COMMUNITY HEALTH NEEDS THE ORGANIZATION COMPLETED ITS FIRST COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY PLAN BOTH DOCUMENTS CAN BE FOUND ON ITS WEBSITE AT HTTPCRISPREGIONALORG ON THE HOME PAGE UNDER 2013 COMMUNITY HEALTH NEEDS ASSESSMENT PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI CRISP REGIONAL HOSPITAL HAS A CLEARLY DEFINED PROCESS FOR ADDRESSING INDIGENT ANDOR SELFPAY PATIENTS PATIENTS THAT PRESENT AT THE REGISTRATION DESK AS SELF PAY PATIENTS RECEIVING OUTPATIENT SERVICES ARE DIRECTED TO OUR PATIENT FINANCIAL COUNSELOR FOR ADVISEMENT AT THIS POINT A FINANCIAL COUNSELOR REVIEWS THE APPLICATION FOR THE INDIGENT CARE TRUST FUND ASSISTANCE IF THIS ASSISTANCE APPLIES THE COUNSELOR WILL ASSIST IN THE APPLICATION PROCESS AND ASSURE COMPLETION OF THE APPLICATION FOR REVIEW IF THIS ASSISTANCE DOES NOT APPLY WE REFER TO A LIST OF SERVICES THAT REQUIRE A CERTAIN AMOUNT TO BE PAID BEFORE THE SERVICE IS RENDERED WE ALSO ASSIST IN SETTING UP A CONTRACT TO INITIATE A MONTHLY PAYMENT PLAN FOR A PATIENT THAT PRESENTS IN CRISP REGIONAL HOSPITAL AS AN INPATIENT AND IS SELF PAY THE PATIENT FINANCIAL COUNSELOR GOES TO THE PATIENTS ROOM TO ASSURE THAT THEY ARE CORRECTLY CLASSIFIED AS A SELF PAY PATIENT SELF PAY PATIENTS ARE THEN REFERRED TO CHAMBERLIN AND EDMONDS TO ASSESS ELIGIBILITY FOR MEDICAID ASSISTANCE IF NOT ELIGIBLE FOR MEDICAID WE ASSIST THEM WITH AN APPLICATION FOR INDIGENT CARE TRUST FUND ASSISTANCE IF NOT ELIGIBLE FOR THE INDIGENT PROGRAM THEN WE ASSIST WITH A CONTRACT TO START MONTHLY PAYMENTS POLICY INDIGENT CARE TRUST FUND POLICY PURPOSE TO PROVIDE GUIDELINES AND CRITERIA FOR USE IN DETERMINING A PATIENTS FINANCIAL STATUS WITH A DISTINCTION MADE BETWEEN A PATIENTS UNWILLINGNESS TO PAY BAD DEBT AND A PATIENTS INABILITY TO PAY INDIGENT CARE INDIGENT CARE IS DEFINED AS A TOTAL OR PARTIAL WRITEOFF OF A PATIENTS ACCOUNT BALANCES FOR A PATIENT WHO IS DETERMINED TO BE MEDICALLY INDIGENT POLICY STATEMENT CLASSIFY AS MEDICALLY INDIGENT THOSE PATIENTS WITH AN INCOME NO GREATER THAN 200 OF THE FEDERAL POVERTY LEVEL GUIDELINES AS PUBLISHED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES PATIENTS WHO ARE CLASSIFIED AS MEDICALLY INDIGENT WHO HAVE MET ALL REQUIREMENTS SET FORTH WILL HAVE THEIR ACCOUNTS WRITTEN OFF ON A SLIDING SCALE FEE 100 OF THE ACCOUNTS AT 125 OF THE FEDERAL POVERTY SCALE TO 7 OF ACCOUNTS WHEN INCOME IS AT 200 OF THE SCALE UP TO THE MAXIMUM ALLOWED AMOUNT PER PATIENT PER YEAR 1 GUIDELINES FOR THE INDIGENT CARE TRUST FUND FINANCIAL ASSISTANCE PROGRAM THE INTENT OF THESE GUIDELINES IS TO PROVIDE ALL AFFECTED PARTIES WITH DEFINITIONS INTERPRETATIONS AND STANDARDS FOR THE UNIFORM ADMINISTRATION OF CRISP REGIONAL HOSPITALS INDIGENT CARE TRUST FUND ICTF DEFINITIONS AINDIGENTCHARITY PATIENT A PATIENT WHO IS A RESIDENT OF GEORGIA WHOSE FAMILY INCOME DOES NOT EXCEED 200 OF THE FEDERAL POVERTY LEVELS AS ESTABLISHED BY THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR THE CURRENT YEAR BRESIDENCY REQUIREMENTS A PATIENT MUST BE A RESIDENT OF THE STATE OF GEORGIA FOR SIX MONTHS TO MEET RESIDENCY REQUIREMENTS EVIDENCE OF RESIDENCY SUCH AS A LIGHT BILL MUST BE PROVIDED PHYSICAL ADDRESSES NO POST OFFICE BOXES ALLOWED CGROSS INCOME THE INDIVIDUAL AND FAMILY FEDERAL ADJUSTED GROSS INCOME AS SHOWN ON THE MOST RECENT FEDERAL OR STATE INCOME TAX RETURN AND THE PATIENTS LAST 3 MONTHS PAY STUBS INCOME INCLUDES SALARIES TIPS WAGES ETC INTEREST AND DIVIDEND INCOME UNEMPLOYMENT COMPENSATION RETIREMENT PAY AND ANY OTHER TAXABLE INCOME DHOUSEHOLD THE NUMBER OF PERSONS CLAIMED ON INCOME TAX FILING OR THE PERSONS THE APPLICANT IS LEGALLY RESPONSIBLE FOR 2 LEVELS OF ASSISTANCE TWO LEVELS OF ASSISTANCE ARE OFFERED AND ARE DEFINED BELOW AINDIGENT FINANCIAL ASSISTANCE PATIENTS WHOSE INCOME IS BELOW 125 OF THE FEDERAL POVERTY LEVELS ARE CLASSIFIED AS MEDICALLY INDIGENT BCHARITABLE FINANCIAL ASSISTANCE PATIENTS WHOSE INCOME LEVEL IS BETWEEN 126200 OF THE FEDERAL POVERTY LEVELS WILL BE CLASSIFIED AS CHARITABLE CASES THESE PATIENTS WILL BE RESPONSIBLE FOR A PERCENTAGE OF HOSPITAL CHARGES AND ARE REQUIRED TO SIGN AND MAINTAIN CURRENT PAYMENTS ON A REPAYMENT CONTRACT WITH THE BUSINESS OFFICE CALL PATIENTS MUST COMPLETE A DETERMINATION OF INDIGENT CARE WORKSHEET PRIOR TO BEING CONSIDERED FOR FINANCIAL ASSISTANCE DISCLOSURE OF ALL CIRCUMSTANCES CONCERNING INSURANCE THIRD PARTY LIABILITY ASSETS LIABILITIES AND ANY OTHER FACTORS ARE REQUIRED REFUSAL TO DISCLOSE ALL REQUIRED INFORMATION WILL RESULT IN AUTOMATIC INELIGIBILITY DALL PATIENTS ARE REQUIRED TO APPLY FOR STATE AND FEDERAL PROGRAMS EG MEDICAID IN CONJUNCTION WITH THE APPLICATION FOR FINANCIAL ASSISTANCE REFUSAL TO APPLY WILL RENDER A PATIENT INELIGIBLE PROOF OF APPROVAL OR DENIAL FROM STATE ANDOR FEDERAL PROGRAMS MUST BE PROVIDED TO DETERMINE FINAL ELIGIBILITY FOR FINANCIAL ASSISTANCE 3 CATEGORY OF PATIENTS INDIGENT CARE TRUST FUNDS HAVE SEEN A SIGNIFICANT DECREASE IN THE RECENT PAST IN AN EFFORT TO PROVIDE AS MUCH ASSISTANCE TO AS MANY PATIENTS AS POSSIBLE TWO CATEGORIES OF ASSISTANCE HAVE BEEN DEVELOPED EACH CATEGORY HAS MONETARY LIMITATIONS ACATEGORY 1 PATIENTS WHO ARE CHRONICALLY ILL OR WHOSE CONDITION IS LIFE THREATENING BCATEGORY 2 PATIENT WHO HAVE SHORT TERM ILLNESSES OR WHOSE CONDITIONS ARE NOT LIFE THREATENING 4 INELIGIBLE PATIENTSNONCOVERED CHARGES CERTAIN TYPES OF CHARGES ANDOR CONDITIONS ARE NOT COVERED THOSE ARE OUTLINED BELOW APREGNANT WOMEN ARE NOT ELIGIBLE FOR INDIGENT TRUST CARE FINANCIAL ASSISTANCE BACCOUNTS COVERED UNDER LIABILITY OR WORKERS COMPENSATION CVICTIMS OF CRIME UNLESS THE PATIENT HAS PURSUED ASSISTANCE FROM THE STATE ANDOR FEDERAL VICTIMS ASSISTANCE PROGRAM AND BEEN DENIED DPATIENTS WHO HAVE INSURANCE COVERAGE INCLUDING COBRA EUNDOCUMENTED IMMIGRANTS ARE NOT ELIGIBLE FCHARGES NOT COVERED ARE AS FOLLOWS PRIVATE ROOM DIFFERENCES ELECTIVE SURGERY PLASTIC SURGERY FEES CHARGED BY YOUR PHYSICIAN RADIOLOGY ANESTHESIOLOGIST AND PATHOLOGIST AMBULANCE PHYSICAL THERAPY SPEECH THERAPY OCCUPATIONAL THERAPY AND WOUND CARE ARE ALSO NOT COVERED 5 CAPS ON ASSISTANCE LIMITATIONS OF ASSISTANCE ARE FOR ONE CONSECUTIVE YEAR ONCE A PATIENT REACHES THEIR CATEGORY CAP NO FURTHER ASSISTANCE WILL BE PROVIDED UNTIL THE NEW CALENDAR YEAR BEGINS ACATEGORY 1 PATIENTS ASSISTANCE IS CAPPED AT 15000 FOR 12 MONTHS BCATEGORY 2 PATIENTS ASSISTANCE IS CAPPED AT 7000 FOR 12 MONTHS COMMUNITY INFORMATION PART VI CRISP REGIONAL HOSPITAL SERVES CRISP DOOLY AND WILCOX COUNTIES AS OUR PRIMARY SERVICE AREAS THESE AREAS ACCOUNT FOR 89 OF PATIENT ACTIVITY THE OTHER FOUR CONTIGUOUS COUNTIES SUMTER WORTH TURNER AND LEE ARE SECONDARY GEOGRAPHIC MARKET AREAS CORDELE IS THE ECONOMIC AND MEDICAL HUB OF THIS AREA AND DRAWS ON A POPULATION APPROACHING 200000 THE TOTAL SCHOOL ENROLLMENT IN CRISP COUNTY WAS 4400 IN 2012 NURSERY SCHOOL AND KINDERGARTEN ENROLLMENT WAS 990 AND ELEMENTARY OR HIGH SCHOOL ENROLLMENT WAS 3600 CHILDREN COLLEGE OR GRADUATE SCHOOL ENROLLMENT WAS 606 INDUSTRIES IN 2012 FOR THE EMPLOYED POPULATION 16 YEARS AND OLDER THE LEADING INDUSTRIES IN CRISP COUNTY WERE HEALTHCARE SOCIAL ASSISTANCE EDUCATIONAL SERVICES MANUFACTURING AND RETAIL TRADE INCOME THE MEDIAN INCOME OF HOUSEHOLDS IN CRISP COUNTY WAS 32320 69 OF THE HOUSEHOLDS RECEIVED EARNINGS AND 15 RECEIVED RETIREMENT INCOME OTHER THAN SOCIAL SECURITY 35 OF THE HOUSEHOLDS RECEIVED SOCIAL SECURITY THE AVERAGE INCOME FROM SOCIAL SECURITY WAS 15297 THESE INCOME SOURCES ARE NOT MUTUALLY EXCLUSIVE THAT IS SOME HOUSEHOLDS RECEIVED INCOME FROM MORE THAN ONE SOURCE POVERTY AND PARTICIPATION IN GOVERNMENT PROGRAMS IN 2012 31 OF PEOPLE WERE IN POVERTY 53 OF RELATED CHILDREN UNDER 18 WERE BELOW THE POVERTY LEVEL COMPARED WITH 14 OF PEOPLE 65 YEARS OLD AND OVER RESIDENTS WITH INCOME BELOW 50 OF THE POVERTY LEVEL IN 2012 WERE 12 23 OF ALL FAMILIES AND 51 OF FAMILIES WITH A FEMALE HOUSEHOLDER AND NO HUSBAND PRESENT HAD INCOMES BELOW THE POVERTY LEVEL FOR PEOPLE REPORTING ONE RACE ALONE 55 WAS WHITE 44 WAS BLACK OR AFRICAN AMERICAN 05 WAS AMERICAN INDIAN AND ALASKA NATIVE 1 WAS ASIAN 1 WAS CLASSIFIED AS OTHER RACE 1 REPORTED TWO OR MORE RACES 3 OF THE PEOPLE IN CRISP COUNTY WERE HISPANIC 52 OF THE PEOPLE IN CRISP COUNTY WERE WHITE NONHISPANIC PEOPLE OF HISPANIC ORIGIN MAY BE OF ANY RACE HOUSING COSTS THE MEDIAN MONTHLY HOUSING COSTS FOR MORTGAGED OWNERS WAS 1023 NONMORTGAGED OWNERS 325 AND RENTERS 576 29 OF OWNERS WITH MORTGAGES 8 OF OWNERS WITHOUT MORTGAGES AND 47 OF RENTERS IN CRISP COUNTY SPENT 35 OR MORE OF HOUSEHOLD INCOME ON HOUSING NATIVITY AND LANGUAGE LESS THAN 12 OF THE PEOPLE LIVING IN CRISP COUNTY IN 20082012 WERE FOREIGN BORN 99 WAS NATIVE INCLUDING 85 WHO WERE BORN IN GEORGIA AMONG PEOPLE AT LEAST 5 YEARS OLD LIVING IN CRISP COUNTY IN 20082012 42 SPOKE A LANGUAGE OTHER THAN ENGLISH AT HOME OF THOSE SPEAKING A LANGUAGE OTHER THAN ENGLISH AT HOME 63 SPOKE SPANISH HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI CRISP REGIONAL IS SERVED BY A VOLUNTEER GOVERNING BOARD COMPOSED OF COMMUNITY MEMBERS FROM CRISP AND DOOLY COUNTIES TWO BOARD MEMBERS ARE MEMBERS OF THE ACTIVE MEDICAL STAFF A PRIMARY FOCUS OF THE BOARD IS TO ADDRESS THE ACCESSIBILITY OF HEALTHCARE SERVICES AND ACCESS TO QUALIFIED HEALTHCARE PROFESSIONALS THE ORGANIZATION OPERATES A 24HR7DAY A WEEK EMERGENCY DEPARTMENT THAT SERVES OVER 18000 PATIENTS ANNUALLY AS A MEANS TO ALLEVIATE ED OVERCROWDING AND CREATE A MORE APPROPRIATE TREATMENT ENVIRONMENT THE BOARD ALSO FUNDS FINANCIALLY OPERATING DEFICITS AT THE CRISP CONVENIENT CARE CLINIC THE ED PATIENT POPULATION INCLUDES 27 THAT ARE CLASSIFIED AS INDIGENT OR NONINSURED THE CONVENIENT CARE CLINIC EXPERIENCES NEARLY 27 INDIGENT OR SELFPAY POPULATION AND REQUIRES 414000 IN NON COMPENSATED FUNDING FROM THE ORGANIZATIONS GENERAL FUNDS CRISP REGIONAL PROMOTES HEALTH AND ADDRESSES HEALTH PROFESSIONAL ACCESS IN SEVERAL COMMUNITY SERVICES THE HOSPITAL PROVIDES HOUSING WITHOUT COST TO MEDICAL RESIDENTS AND STUDENTS ENGAGED IN CLINICAL EXPERIENCE AT CRISP REGIONAL THE BOARD FURNISHES THREE APARTMENTS AS A MEANS TO ASSURE MEDICAL STUDENTS AND MEDICAL RESIDENTS ARE EXPOSED TO THE SPECIAL NEEDS OF RURAL POPULATIONS AND AGRICULTURE ECONOMY IN ADDITION TO THESE SERVICES CRISP REGIONAL PARTNERS WITH COLLEGES TO OFFER PRACTICAL EXPERIENCE IN A VARIETY OF AREAS THROUGHOUT THE HOSPITAL FROM PROVIDING BEDSIDE CARE ON PATIENT FLOORS TO THE INTENSIVE CARE UNIT ICU AND EMERGENCY DEPARTMENT ED DURING THEIR CLINICAL ROTATIONS STUDENTS CAN DIRECTLY APPLY WHAT THEY ARE LEARNING ABOUT THE CAUSES OF CERTAIN HEALTH CONDITIONS AND HOW TO DIAGNOSE AND TREAT THEM THROUGH ITS RURAL HEALTH CLINIC PROGRAM CRISP REGIONAL HEALTH SERVICES OFFERS MEDICAL CARE TO SURROUNDING RURAL COMMUNITIES TWO RURAL HEALTH CARE CLINICS PROVIDE COVERAGE FOR PRIMARY HEALTH CARE CHRONIC AND ACUTE ILLNESS MINOR SUTURING OBGYN SERVICES VARIOUS VACCINATIONS LAB DRAWINGS AND PHYSICALS THE PROGRAM ALLOWS RURAL RESIDENTS TO RECEIVE EXCELLENT HEALTH CARE PROVIDED BY HIGHQUALITY HEALTH CARE PROFESSIONALS CLOSE TO HOME IT ALSO OFFERS AFFORDABLE HEALTH CARE COVERAGE TO THESE RESIDENTS LAST YEAR BOTH CLINICS TREATED A TOTAL OF 3021 PATIENTS CRISP REGIONAL HEALTH SERVICES HOSTS FOUR ANNUAL COMMUNITY HEALTH FAIRS OFFERING INFORMATION EDUCATION AND BASIC TESTS FOR FREE OR AT DEEPLY REDUCED COSTS TESTS INCLUDE BODY MASS INDEX BLOOD PRESSURE SCREENING HEIGHT AND WEIGHT CHECKS BLOOD GLUCOSE AND PULMONARY LUNG FUNCTION ALSO INCLUDED IS DIAGNOSTIC LAB WORK CONSISTING OF LIPID PROFILE THYROID PROSTATE AND IRON PANEL SCREENINGS WE PROVIDE THIS TO OUR COMMUNITY BECAUSE THE IMPORTANCE OF PRESCREENING INCREASED AWARENESS AND EDUCATING THE COMMUNITY CONTRIBUTES TO RESIDENTS BETTER OVERALL HEALTH CRISP REGIONAL HOSPITAL SPONSORED LETS HEAR IT FOR THE GIRLS WITH THE ALBANY CANCER COALITION TO PROMOTE CANCER AWARENESS TO THE LADIES OF THE COMMUNITY ADDITIONAL INFORMATION PART VI PART III LINE 6A COMMUNITY BENEFIT REPORT THE ORGANIZATION DOES NOT HAVE A FORMALIZED WRITTEN COMMUNITY BENEFIT REPORTING PROCESS BUT DOES PUBLICIZE A COMMUNITY BENEFIT REPORT CRISP REGIONAL HOSPITAL LINE NUMBER 1 PART V LINE 3 PART V LINE 3 THE HOSPITALS CHIEF EXECUTIVE OFFICER APPOINTED INDIVIDUALS TO SERVE ON THE CHNA HOSPITAL STEERING COMMITTEE CHSC THE CHSC IDENTIFIED COMMUNITY LEADERS PARTNERS AND REPRESENTATIVES TO INCLUDE IN THE CHNA PROCESS INDIVIDUALS AGENCIES PARTNERS POTENTIAL PARTNERS AND OTHERS WERE REQUESTED TO WORK WITH THE HOSPITAL TO 1 ASSESS THE NEEDS OF THE COMMUNITY 2 REVIEW AVAILABLE COMMUNITY RESOURCES AND 3 PRIORITIZE THE HEALTH NEEDS OF THE COMMUNITY GROUPS OR INDIVIDUALS WHO REPRESENT MEDICALLYUNDERSERVED POPULATIONS LOW INCOME POPULATIONS MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASES WERE INCLUDED THE HOSPITAL IDENTIFIED OVER 120 COMMUNITY MEMBERS TO PARTICIPATE IN THE CHNA PROCESS TWOHOUR COMMUNITY HEALTH INPUT MEETINGS COMMUNITY MEETINGS AND ONEHOUR COMMUNITY STAKEHOLDER INTERVIEWS INTERVIEWS WERE ESSENTIAL PARTS OF THE CHNA PROCESS THREE COMMUNITY MEETINGS AND 10 STAKEHOLDER INTERVIEWS WERE CONDUCTED IN ORDER TO OBTAIN THE COMMUNITYS INPUT INTO THE HEALTH NEEDS OF CRISP COUNTY EACH COMMUNITY MEETING WAS DRIVEN BY AN AGENDA PLANNED IN ADVANCE SIGNIN SHEETS AND EVALUATIONS WERE ALSO USED THE COMMUNITY HEALTH PROFILE WAS SHARED WITH THE PARTICIPANTS AT EACH MEETING PARTICIPANTS WERE ASKED ABOUT THEIR OBSERVATIONS ON THE HEALTH DATA PRESENTED IN THE PROFILE IN ADDITION PARTICIPANTS WERE REQUESTED TO PROVIDE INPUT AS TO NEEDS THAT MAY NOT HAVE BEEN IDENTIFIED IN THE PROFILE QUESTIONS AND DISCUSSION WERE ENCOURAGED WITH THE OBJECTIVE THAT PARTICIPANTS WOULD INCREASE THEIR UNDERSTANDING OF WHAT THE DATA MEANT IN TERMS OF THE BURDEN OF CHRONIC DISEASES THE IMPACT OF THE DEMOGRAPHICS OF THE POPULATION ON HEALTH SERVICES HEALTH STATUS HEALTH BEHAVIORS AND ACCESS TO HEALTH CARE AS THE GROUP DISCUSSED THE HEALTH PROBLEMS OR HEALTH ISSUES THE FACILITATOR MADE A LIST OF THE HEALTH PROBLEMS THE COMMUNITY PARTICIPANTS INDICATED WERE IMPORTANT PRIORITY ISSUES WERE IDENTIFIED AT THE END OF THE DISCUSSION THESE PRIORITIES DID NOT REFLECT PROGRAMS SERVICES OR APPROACHES TO RESOLVING PROBLEMS BUT RATHER HEALTH ISSUES TO BE ADDRESSED COMMUNITY PARTICIPANTS INCLUDED PHYSICIANS AND OTHER MEDICAL PROFESSIONALS EDUCATORS ENTREPRENEURS AND OTHER BUSINESSMEN AND WOMEN PROFESSIONALS REPRESENTATIVES FROM THE DEPARTMENT OF LABOR HOUSING AUTHORITY LAW ENFORCEMENT UNITED WAY AND CHAMBER OF COMMERCE RELIGIOUS LEADERS AS WELL AS JOURNALISTS CRISP REGIONAL HOSPITAL LINE NUMBER 1 PART V LINE 20D PART V LINE 20D WHETHER OR NOT THE BALANCE IS WRITTEN OFF 100 OR LESS IS BASED ON INFORMATION RECEIVED FROM THE PATIENT VIA THE INDIGENT CARE APPLICATION AND WHAT TIERED LEVEL OF ELIGIBILITY WITHIN THE FEDERAL POVERTY GUIDELINES AND ASSOCIATED LEVEL OF DISCOUNTS UNDER WHICH THEY MAY QUALIFY true EMPLOYEE EDUCATION LOANS 24 41333 PHYSICIAN EDUCATION LOANS 9 175037 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 THE ORGANIZATION OFFERS TO PROMOTE HEALTH CARE CAREERS FOR PEOPLE IN CRISP AND SURROUNDING COUNTIES BY PROVIDING SCHOLARSHIPS WITHIN CERTAIN GUIDELINES. EACH APPLICANT MUST PROVIDE A COMPLETED APPLICATION, SCHOOL TRANSCRIPTS, LETTER OF RECOMMENDATION, COMPLETION OF PREREQUISITES AND LETTER OF ACCEPTANCE TO A SPECIFIC PROGRAM, INTENT TO BECOME EMPLOYED BY THE ORGANIZATION, INTERVIEW BY APPROPRIATE VICE PRESIDENT, AND OBTAIN APPROVAL BY THE EDUCATIONAL LOAN REVIEW BOARD. REIMBURSEMENT FOR THE COST OF TUITION, BOOKS, AND REQUIRED COURSE MATERIALS PER SEMESTER WILL BE GIVEN FOR A CURRENT GPA OF 2.0 OR BETTER. A REIMBURSEMENT REQUEST INCLUDING EVIDENCE OF ACTUAL EXPENSES MUST BE SUBMITTED FOR APPROVAL. DEFAULT OF THE TERMS REQUIRES FULL OR PARTIAL PAYBACK OF THE SCHOLARSHIP FUNDS. AMOUNTS REPORTED REFLECT ASSISTANCE FORGIVEN BASED ON YEARS OF EMPLOYMENT PROVIDED. X X true false false false false false false false false STEVE GAUTNEY 225977 4732 22632 253341 WILLIAM PANNELL MD 224590 224590 JESSICA CARTER 154177 225 6924 22632 183958 SRILATHA NADIPINENI MD 256553 22632 279185 VISHAL BURRA MD 182933 20101 203034 MILTON JONES MD 159934 7800 14983 182717 CHARLOTTE VESTAL 98963 249 99212 SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 CHARLOTTE VESTAL 98,963 0 0 A HOSPITAL AUTH OF CRISP COUNTYGA CRH REV CERTIFICATES PAYABLE 2008A 586003098 226688BY4 2008-05-29 10000000 REFUND/CONSTRUCTION false true false B HOSPITAL AUTH OF CRISP COUNTY GA CRH REV CERTIFICATES PAYABLE 2008B 586003098 226688CE7 2008-05-29 3000000 CONSTRUCTION false true false C HOSPITAL AUTH OF CRISP COUNTY GA CRH REV CERTIFICATES PAYABLE 2013 586003098 226688CS6 2013-06-18 16500000 CONSTRUCTION false true false A 735000 7743975 9830000 525885 1772086 2008 true false true true B 3000000 157765 2735973 2009 false false true true C 16500000 847137 16170000 2013 false false true true A false false false false false false false true B false false false false false false false true C false false false false false false false true A false false false false false false false false false B false false false false false false false false false C false false false false false false false false false A false ADDITIONAL INFORMATION SCHEDULE K HOSPITAL AUTH OF CRISP COUNTY GA ALL REVENUE BONDS HAVE BEEN ISSUED WITHIN THE LAST FEW YEARS AND ARBITRAGE CALCULATIONS ARE NOT CURRENTLY DUE ASIDE FROM THE ORIGINAL FORM 8038 FILED UPON ISSUE OF THE REVENUE BONDS NO OTHER FORMS HAVE BEEN REQUIRED ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B ALL BOARD MEMBERS RECEIVE A COPY OF THE FORM 990 BEFORE IT IS FILED. IF ANY MEMBER HAS ANY CONCERNS, THEY MUST INFORM ADMINISTRATION. AN EXTENSIVE REVIEW IS PERFORMED BY MANAGEMENT. THE BOARD MEMBERS PERFORM ONLY A BASIC REVIEW OF THE RETURN PRIOR TO ITS FILING WITH THE IRS. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C THE CONFLICT OF INTEREST POLICY IS DIRECTED NOT ONLY TO DIRECTORS AND OFFICERS, BUT TO ALL EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF CRISP REGIONAL HOSPITAL, INC. A CONFLICTING INTEREST MAY BE DEFINED AS AN INTEREST, DIRECT OR INDIRECT, WITH ANY PERSONS OR FIRMS. IT IS THE POLICY OF THE BOARD THAT THE EXISTENCE OF ANY OF THE INTERESTS SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT SHALL BE THE CONTINUING RESPONSIBILITY OF THE BOARD, OFFICERS, AND MANAGEMENT EMPLOYEES TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND TO IMMEDIATELY MAKE SUCH DISCLOSURES. DISCLOSURES OF CONFLICTS SHOULD BE MADE TO THE BOARD OR A COMMITTEE THEREOF, WHO WILL DETERMINE WHETHER A CONFLICT EXISTS, AND IN THE CASE OF AN EXISTING CONFLICT, DETERMINE APPROPRIATE ACTION. THE INDIVIDUAL WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTIONS. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE COMPENSATION FOR THE CEO. THE BOARD USES COMPARABLE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS AT SIMILARLY SIZED ORGANIZATIONS. THE GHA ANNUAL SALARY SURVEY AND OTHER DATA IS USED TO DETERMINE COMPENSATION FOR MANAGEMENT. THE DECISION IS DOCUMENTED BY THE BOARD. THIS PROCESS WAS LAST UNDERTAKEN FOR THE CEO IN 2012. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B THE CEO REVIEWS AND APPROVES THE COMPENSATION FOR THE CFO AND OTHER TOP OFFICERS. THE CEO USES COMPARABLE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS AT SIMILARLY SIZED ORGANIZATIONS. THE GHA ANNUAL SALARY SURVEY AND OTHER DATA IS ALSO UTILIZED. THIS PROCESS WAS LAST UNDERTAKEN IN 2012. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION WILL MAKE AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO ANY MEMBER OF THE PUBLIC WHO MAKES THEIR REQUEST AT THE ADMINISTRATIVE OFFICE OF THE FILING ENTITY. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G COLLECTION AGENCIES 0 336,121 0 SERVICE CONTRACTS 1,107,755 587,298 0 LAUNDRY/LINEN SERVICES 72,820 227,017 0 OTHER PURCHASED SERVICES 4,307,449 1,362,668 0 PHYSICIAN FEES 5,038,132 0 0 THERAPY CONTRACT FEES 254,055 0 0 CRISP REGIONAL HEALTH SERVICE INC 902 7TH STREET NORTH CORDELE GA 310153234 582175975 HOLDING CO GA 501C3 11A NA false CRISP REGIONAL HOSP DEV FNDN INC 902 7TH STREET NORTH CORDELE GA 310153234 582175978 FOUNDATION GA 501C3 11A CRH CRISP REGIONAL HOSPITAL true HOSPITAL AUTHORITY OF CRISP COUNTY 902 7TH STREET NORTH CORDELE GA 310153234 586003098 AUTHORITY GA 501C3 6 NA false CRISP HEALTHCARE ALLIANCE LLC PO BOX 5007 CORDELE GA 310105007 582307830 PURCHASING GA CRH CRISP REGIONAL HOSPITAL INC RELATED 35856 579160 false false 0.80000 CRISP MEDICAL SERVICES INC 902 7TH STREET NORTH CORDELE GA 310153234 582175987 DORMANT GA N/A false false false false false false false false false false false false false true true true false true false false CRISP REGIONAL HOSPITAL DEVELOPMENT M 31931 NET FUNDS RAISED