2013-02-05T08:22:16-06:00 2012-06-30 DRAFFIN & TUCKER LLP PO BOX 6 ALBANY GA 317020006 990 2011-07-01 630288852 CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY CHAT 3347561050 4800 48TH STREET VALLEY AL 36854 DOUG DEWBERRY 3347561050 2013-02-15 true JACQUELINE G ATKINS 2298837878 2013-02-04 2011 2016-02-25 16:41:14Z DOUG DEWBERRY 4800 48TH STREET VALLEY AL 36854 51706844 false X WWW.LANIERHOSPITAL.COM X 1942 AL TO PROVIDE MEDICAL SERVICES TO RESIDENTS OF CHAMBERS COUNTY, ALABAMA AND WEST POINT, GEORGIA. 17 17 704 75 40833 613870 90245 49022998 49479644 45438 26666 342111 2101568 50024417 51698123 0 0 21737582 23339131 0 0 28320352 29023532 50057934 52362663 -33517 -664540 35283275 37243295 17553725 20178285 17729550 17065010 TO PROVIDE MEDICAL SERVICES TO RESIDENTS OF CHAMBERS COUNTY, ALABAMA AND WEST POINT, GEORGIA. false false 48996320 51365346 THE GEORGE H. LANIER MEMORIAL HOSPITAL PROVIDES EMERGENCY SERVICES, AN ENCOSCOPY UNIT, SURGERY UNIT, CATH LAB, CARDIAC REHAB, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, RADIOLOGY LAB AND SLEEP DISORDERS LAB. THE HOSPITAL IS A LICENSED 115-BED NOT-FOR-PROFIT ACUTE CARE FACILITY PRIMARILY SERVING CHAMBER COUNTY, ALABAMA AND WEST POINT, GEORGIA. SERVICES PROVIDED INCLUDE GENERAL SURGERY, CARDIOLOGY, GENERAL MEDICINE, GASTROENTEROLOGY, PULMONARY, EMERGENCY MEDICINE, IMAGING/RADIOLOGY, DIALYSIS, AMBULATORY SURGERY AND SWING BED. THE GEORGE H. LANIER NURSING HOME IS A 103-BED SKILLED NURSING FACILITY. 48996320 true true false false false false false false false false true false false false true true true false false false false false false false true false true true false false true false false false false false false false true false false false false false true true true false false true 98 0 704 true true true false false false false false false false false false X 17 17 true false false false false false false true true false false true true true true true true true true false X DAVID WILKERSON 3347561050 4800 48TH STREET VALLEY AL 36854 X ARVIND KAMATH MD 3.00 X 8115 0 0 DOT ANDERSON 3.00 X 0 0 0 LUANNE D BERLIN 3.00 X X 0 0 0 GLORIA HULL 3.00 X 0 0 0 RICHARD SCOTT 3.00 X 0 0 0 ARTHUR PERKINS MD 3.00 X 0 0 0 KAYE MAXWELL 3.00 X 0 0 0 CY WOOD 3.00 X 0 0 0 JOSH MOON 3.00 X 0 0 0 CURT KOLLAR 3.00 X 0 0 0 JAMES BENDELL MD 3.00 X 0 0 0 OSCAR CRAWLEY 3.00 X 0 0 0 CAM LANIER 3.00 X 0 0 0 WILLIAM SCOTT III 3.00 X X 0 0 0 GAINES LANIER 3.00 X 0 0 0 VALERIE GRAY 3.00 X 0 0 0 KRIS REDDY MD 3.00 X 0 0 0 TERRY VESTER MD 3.00 X 0 0 0 DAVID WILKERSON 3.00 X X 0 0 0 DOUG DEWBERRY 50.00 X 228383 0 6464 TOMMY LANE 50.00 X 118075 0 6316 PHILLIPPE TRANQUI 50.00 X 345364 0 6464 MAX SHIVER MD 50.00 X 288594 0 6464 DAVID FAGAN 50.00 X 279624 0 6464 JOHN DUKE 42.00 X 130580 0 6341 MICHAEL HARRIS 42.00 X 108272 0 6289 1507007 44802 9 false true false LANGFORD CONSTRUCTION 314 GREENVILLE ST LAGRANGE GA 30240 CONTRACTOR 2280447 HUMAN PERFORMANCE & REHAB CTRS P O BOX 8068 COLUMBUS GA 319088068 PHYSICAL THERAP 1408804 CPSI P O BOX 850309 MOBILE AL 366850309 IT SYSTEMS 435418 EMCARE PHYSICIAN SERVICES 7032 COLLECTION CENTER CHICAGO IL 60693 ER PHYSICIANS 243306 LABORATORY CORPORATION P O BOX 12140 BURLINGTON NC 27215 O/S LAB FEES 226437 7 5311 14400 70534 90245 PATIENT SERVICE REVENUES 623000 49438811 49438811 REFERENCE LAB 621500 40833 40833 49479644 25999 25999 667 667 667 667 23809 8721 15088 15088 MEDICAID EHR INCENTIVES 624200 1860291 1860291 CAFETERIA 621990 159945 159945 MISCELLANEOUS 621990 23559 23559 42685 42685 2086480 51698123 51365346 40833 201699 426062 15980 410082 18999709 17900366 1099343 2509352 2314124 195228 1404008 1294776 109232 241429 241429 82193 82193 2837598 2534669 302929 21404 21404 2584484 2233295 351189 2008038 1828319 179719 49341 34332 15009 14039 10167 3872 2156443 1963441 193002 294485 188948 105537 BAD DEBT EXPENSE 9643025 9643025 MEDICAL SUPPLIES 5734958 5734958 PROVIDER TAX 2235658 2235658 REPAIRS & MAINTENANCE 786395 785803 592 334042 278459 55583 52362663 48996320 3366343 0 1550 1550 7834529 4471526 5207905 7458895 227171 235146 184676 169853 63220873 42069718 19300252 21151155 1819424 1840185 372620 372620 335148 1542365 35283275 37243295 4185067 5535147 473695 413483 10935000 10280000 1700541 3757260 259422 192395 17553725 20178285 X 17729550 17065010 17729550 17065010 35283275 37243295 -664540 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false 600197 600197 39695090 22553681 17141409 1146755 1001256 145499 21682203 18514781 3167422 96628 96628 21151155 BOND INTEREST PAYABLE 96479 THIRD PARTY SETTLEMENTS 95916 192395 51698123 52362663 -664540 -664540 51617147 51617147 80976 80976 51698123 52281687 52281687 80976 80976 52362663 LIABILITY UNDER FIN 48 FOOTNOTE SCHEDULE D, PAGE 3, PART X TAX STATUS THE SOCIETY 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 SOCIETY 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 SYSTEM 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 OR 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 CHARGED TO EXPENSE AS OF JUNE 30, 2012 AND 2011 OR FOR THE YEARS THEN ENDED. THE SOCIETY'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2009-2011. RECONCILIATION OF CHANGES - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 8 WAIVER EXPENSE -55,355 SCHOLARSHIP/RECRUITING EXPENSE -25,621 WAIVER EXPENSE 55,355 SCHOLARSHIP/RECRUITING EXPENSE 25,621 REVENUE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 4B WAIVER EXPENSE 55,355 SCHOLARSHIP/RECRUITING EXPENSE 25,621 EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XIII, LINE 4B WAIVER EXPENSE 55,355 SCHOLARSHIP/RECRUITING EXPENSE 25,621 GOLF TOURNAMENT 23809 23809 3516 4060 1145 23809 23809 3516 4060 1145 8721 15088 true true X true X true X 1.75000 true false false 169775 169775 0.00400 8453074 6661557 1791517 0.04190 140888 126334 14554 0.00030 8763737 6787891 1975846 0.04620 8763737 6787891 1975846 0.04620 100000 100000 0.00230 100000 100000 0.00230 true 9643025 16222179 16762010 -539831 X true true 1 1 CHATTAHOOCHEE VALLEY HOSPITAL SOCIE

4800 48TH STREET VALLEY AL 36854

X X X SNF; HOME HEALTH CARE; CLINICS CHATTAHOOCHEE VALLEY HOSPITAL SOCIE 1 false true true 100.0 true 175.0 true X X X X true true X X X X true false true X false false 2 LANIER HOME HEALTH SERVICES

4800 48TH STREET VALLEY AL 36854

HOME HEALTH AGENCY GEORGE H LANIER NURSING HOME

4800 48TH STREET VALLEY AL 36854

SKILLED NURSING FACILITY 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 52362663 LESS BAD DEBT EXPENSE 9643025 ADD EXPENSES REPORTED IN PART VIII 8721 DENOMINATOR FOR COLUMN F 42728359 COSTING METHODOLOGY EXPLANATION PART I LINE 7 COSTS FOR PART I LINE 7A AND 7B WERE CALCULATED USING THE RCC CALCULATED IN WORKSHEET 2 OTHER COSTS WERE OBTAINED FROM THE ORGANIZATIONS ACCOUNTING RECORDS BAD DEBT EXPENSE EXPLANATION PART III LINE 4 EXCERPT FROM FOOTNOTE TO AUDITED FINANCIAL STATEMENT ALLOWANCE FOR DOUBTFUL ACCOUNTS THE SOCIETY PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE 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 COLLECTION PRACTICES EXPLANATION PART III LINE 9B COLLECTION ATTEMPTS ON ALL ACCOUNTS ARE MADE BY THE HOSPITAL WITHIN THE FIRST 90 DAYS AFTER AN ACCOUNT GOES BEYOND 90 DAYS THE ACCOUNT IS SENT TO A COLLECTION AGENCY THE ACCOUNT STAYS WITH THE COLLECTION AGENCY FOR APPROXIMATELY 4 MONTHS AND IF NOT COLLECTED THE ACCOUNT IS SENT BACK TO THE HOSPITAL AND WRITTEN OFF AS A BAD DEBT NEEDS ASSESSMENT PART VI WE USE THE STATE DEPARTMENT OF PUBLIC HEALTHS ANNUAL STATISTICAL REPORT TO LOOK AT THE HEALTHCARE NEEDS OF CHAMBERS COUNTY AND EVALUATE SERVICES NEEDED OR PROVIDED IN RESPONSE TO THAT REPORT OUR BOARD OF TRUSTEES ALSO REVIEWS AND DISCUSSES SERVICES AS PART OF OUR ANNUAL STRATEGIC PLAN UPDATE PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI A SOCIAL WORKER WORKS WITH PATIENTS AND EXPLAINS TO THEM OPTIONS THEY HAVE AVAILABLE AND TRIES TO HELP THEM QUALIFY FOR ANY OUTSIDE AID THAT MIGHT BE AVAILABLE WE ALSO HAVE AN INDIGENTCHARITY CARE POLICY FOR WHICH QUALIFYING PATIENTS ARE ELIGIBLE COMMUNITY INFORMATION PART VI THE ORGANIZATION SERVES A PREDOMINATELY RURAL AREA THE PRIMARY SERVICE AREA IS CHAMBERS COUNTY IN ALABAMA AND WEST POINT GEORGIA AND SURROUNDING AREA THE POPULATION OF CHAMBERS COUNTY IS APPROXIMATELY 34000 WITH A PER CAPITA INCOME OF 28994 AND A MEDIAN HOUSEHOLD INCOME OF 33500 APPROXIMATELY 105 OF THE POPULATION HAS A BACHELORS DEGREE OR HIGHER EDUCATION APPROXIMATELY 26 OF THE POPULATION DOESNT HAVE A HIGH SCHOOL DIPLOMA THE UNEMPLOYMENT RATE IN THE COUNTY IS APPROXIMATELY 114 THE POPULATION OF WEST POINT GEORGIA IS APPROXIMATELY 3500 WITH A PER CAPITA INCOME OF 18935 AND A MEDIAN HOUSEHOLD INCOME OF 37021 THE AREAS CITIZENS EXPERIENCE HIGH LEVELS OF HEART DISEASE DIABETES AND CANCER HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI CVHS HAS BEEN INSTRUMENTAL IN PROVIDING HEALTHCARE AWARENESS TO THE COMMUNITY BY HOSTING NUMEROUS EVENTS INCLUDING AN ANNUAL HEALTH FAIR OPEN TO ALL RESIDENTS OF THE COMMUNITY OFFERING SERVICES FOR THE PEDIATRIC TO THE GERIATRIC RESIDENTS LANIER PROVIDED MINI HEALTH SCREENS AND FLU SHOTS TO VARIOUS BUSINESSES IN THE COMMUNITY OTHER EVENTS INCLUDE BREAST CANCER AWARENESS PRENATAL AND BREAST FEEDING EDUCATION CLASSES HEART HEALTH MONTH SELFMANAGED DIABETES CLASSES DIABETIC EYE DISEASE SEMINAR AND VARIOUS HEALTH RELATED SUPPORT GROUPS CVHS ALSO PARTICIPATES IN LOCAL SCHOOL OUTREACH PROGRAMS PROVIDING EDUCATION IN THE AREAS OF SMOKING CESSATION ALCOHOL HEALTHY EATING HABITS AND THE IMPORTANCE OF EXERCISE AND READING WE ALSO PARTICIPATE IN KID CHECK CAREER DAY EVENTS AND SCHOOL HEALTH FAIRS CVHS PARTICIPATED IN NATIONAL WELLNESS CAMPAIGN SCALEBACK ALABAMA AS WELL AS INVOLVING COMMUNITY PARTICIPATION IN SCALEBACK ALABAMA PHYSICIANS AND MIDLEVEL PRACTITIONERS SPEAK REGULARLY AT LOCAL CIVIC CLUBS TO PROVIDE HEALTHCARE AWARENESS AND PREVENTATIVE MEASURE INFORMATION CVHS PARTNERED WITH LOCAL LIBRARY TO PROVIDE PHYSICIAN DRIVEN EDUCATION SEMINARS CVHS HOLDS QUARTERLY FORUMS FOR LOCAL EMS DEPARTMENTS CHATTAHOOCHEE VALLEY HOSPITAL SOCIE LINE NUMBER 1 PART V LINE 13G PART V LINE 13G THE HOSPITALS SOCIAL WORKER REVIEWS CRITERIA AND ELIGIBILITY WITH ALL SELF PAY PATIENTS ADMITTED TO THE HOSPITAL CHATTAHOOCHEE VALLEY HOSPITAL SOCIE LINE NUMBER 1 PART V LINE 19D PART V LINE 19D THE ORGANIZATION BILLS SELF PAY PATIENTS BASED ON ESTABLISHED CHARGES AND OFFERS A 50 DISCOUNT IF PAID WITHIN 30 DAYS AFTER 30 DAYS THE DISCOUNT IS CALCULATED AT A SLIDING RATE BASED ON DAYS TO RECEIPT OF PAYMENT ULTIMATELY CHARGES FOR SELF PAY PATIENTS ARE REDUCED TO THE AVERAGE NEGOTIATED CHARGE FOR AN INSURED PATIENT X X X X false false false false false false false false false DOUG DEWBERRY 228383 6464 234847 PHILLIPPE TRANQUI 303364 42000 6464 351828 MAX SHIVER MD 288594 6464 295058 DAVID FAGAN 279624 6464 286088 OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III THE CEO IS PAID AN ANNUAL PERFORMANCE INCENTIVE ONE-THIRD OF WHICH IS PAID FOR ATTAINMENT OF FINANCIAL PERFORMANCE TARGETS. CURT KOLLAR BD MBR/BANK CFO 1377969 BANK LOAN BALANCE false CURT KOLLAR BD MBR/BANK CFO 4727545 BANK CASH BALANCES false TOMMY LANE HOSP CFO/BK BD 1377969 BANK LOAN BALANCE false TOMMY LANE HOSP CFO/BK BD 4727545 BANK CASH BALANCES false ADDITIONAL INFORMATION SCHEDULE L PART V CURT KOLLAR CFO OF CHARTER BANK IS A BOARD MEMBER OF THE FILING ORGANIZATION THE ORGANIZATION HAS A LOAN WITH THE BANK IN THE AMOUNT OF 1377968 AS WELL AS CASH ACCOUNTS TOTALING 4727545 AT FISCAL YEAR END THE CFO OF THE FILING ORGANIZATION TOMMY LANE IS A BOARD MEMBER AT CHARTER BANK RELATED PARTY INFORMATION AMONG OFFICERS FORM 990, PAGE 6, PART VI, LINE 2 CAM LANIER GAINES LANIER TRUSTEE TRUSTEE FAMILY RELATIONSHIP RICHARD SCOTT WILLIAM SCOTT TRUSTEE TRUSTEE FAMILY RELATIONSHIP ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS REVIEWED BY MANAGEMENT IN DETAIL FOR ACCURACY OF FINANCIAL AND OTHER DATA. THE FORM IS THEN DISTRIBUTED TO TRUSTEES BY POSTING ON LANIER'S WEBSITE UNDER A SECURE FORMAT/PASSWORD PROTECTED. IMMEDIATE NOTIFICATION OF ITS AVAILABILITY IS SENT TO THE BOARD'S EXECUTIVE COMMITTEE, WHICH HAS THE AUTHORITY TO ACT FOR THE FULL BOARD, VIA EMAIL FOR THEIR REVIEW AND EVALUATION, PRIOR TO FILING WITH THE IRS. REMAINING BOARD MEMBERS HAVE FULL ACCESS TO THE WEBSITE AND PERIODICALLY VISIT THE WEBSITE FOR ESSENTIAL BOARD MEETING MATERIALS. ANY QUESTIONS FROM THE GENERAL BOARD TRUSTEES ARE RESOLVED AT THE NEXT OFFICIAL BOARD MEETING. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C THE ORGANIZATION REQUIRES ALL BOARD MEMBERS AND MANAGEMENT EMPLOYEES TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY AND MONITORS THE COMPLIANCE WITH THIS POLICY. BOARD MEMBERS RECUSE THEMSELVES DURING DISCUSSIONS AND ANY VOTING IF THEY HAVE A CONFLICT OF INTEREST. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A A COMMITTEE COMPRISED OF INDEPENDENT BOARD MEMBERS REVIEWS THE ANNUAL PERFORMANCE OF THE CEO AND SETS THE COMPENSATION AFTER THE REVIEW. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B PERFORMANCE APPRAISALS ARE PERFORMED ANNUALLY BY THE CEO. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 AS A GENERAL RULE, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. ANY WRITTEN REQUESTS BY THE PUBLIC WOULD BE REVIEWED AND ACTED UPON BY THE BOARD. RELATED ORGANIZATIONS FORM 990, PAGE 7, PART VII AVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS: ARVIND KAMATH, MD .10 HOURS LUANNE BERLIN .10 HOURS DAVID WILKERSON .10 HOURS DOUG DEWBERRY .10 HOURS TOMMY LANE .10 HOURS LANIER HEALTH SERVICES FOUNDATION 4800 48TH STREET VALLEY AL 36854 631286859 FOUNDATION AL 501C3 11A CVHS CHATTAHOOCHEE VALLEY HOSPITAL SOCIE true false false true false false false false false false false false true true true false false false false LANIER HEALTH SERVICES FOUNDATION C 5311 FOUNDATION RECORDS LANIER HEALTH SERVICES FOUNDATION L -895 FOUNDATION NET INCOME LANIER HEALTH SERVICES FOUNDATION M AMOUNT INDETERMINABLE LANIER HEALTH SERVICES FOUNDATION N AMOUNT INDETERMINABLE