CRISP REGIONAL HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CRISP REGIONAL HOSPITAL INC (EIN 58-2175978)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-14
- IRS object ID
- 201301349349300220
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-14T07:13:12-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAFFIN & TUCKER LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 71309 | AddressLine1 |
| City | ALBANY | City |
| State | GA | State |
| ZIP Code | 317081309 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582175978 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRISP REGIONAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CRIS | NameControl |
| Phone | 2292763130 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 902 7TH STREET NORTH | AddressLine1 |
| City | CORDELE | City |
| State | GA | State |
| ZIP Code | 31015 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | STEVEN GAUTNEY | Name |
| Title | CEO | Title |
| Phone | 2292763130 | Phone |
| Date Signed | 2013-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACQUELINE G ATKINS | Name |
| Phone | 2298837878 | Phone |
| Date Prepared | 2013-05-10 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | STEVEN GAUTNEY | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 902 7TH STREET NORTH | AddressLine1 |
| City | CORDELE | City |
| State | GA | State |
| ZIP Code | 31015 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 66788156 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CRISPREGIONAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1995 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 899 | TotalNbrEmployees |
| Total Nbr Volunteers | 39 | TotalNbrVolunteers |
| Total Gross UBI | -5904 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -5904 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 30761 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 21055 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 67448810 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 64240823 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1020943 | InvestmentIncomePriorYear |
| Investment Income Current Year | 431161 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1735705 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1818694 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 70236219 | TotalRevenuePriorYear |
| Total Revenue Current Year | 66511733 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 171030 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 155205 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 28830809 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 28402532 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 38534286 | OtherExpensePriorYear |
| Other Expenses Current Year | 33414007 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 67536125 | TotalExpensesPriorYear |
| Total Expenses Current Year | 61971744 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2700094 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 4539989 | RevenuesLessExpensesCY |
| Total Assets BOY | 78987576 | TotalAssetsBOY |
| Total Assets EOY | 81853986 | TotalAssetsEOY |
| Total Liabilities BOY | 22920795 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 20610872 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 56066781 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 61243114 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 43990303 | Expense |
| Grants | 155205 | Grants |
| Revenue | 65050208 | Revenue |
| Description | HOSPITAL, SNF & HHA; SHORT-TERM ACUTE CARE FOR IP & OP SERVICES FOR CRISP COUNTY AND SURROUNDING COUNTIES. TOTAL PATIENT DAYS FOR FYE 6/30/12 WERE 15,237; HHA VISITS FOR WERE 8,346; AND SNF PATIENT DAYS WERE 34,794. | Description |
| Total Program Service Expense | 43990303 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 182 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 899 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | true | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JESSICA CARTER | NamePerson |
| Telephone Number | 2292763130 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 902 7TH STREET | AddressLine1 |
| City | CORDELE | City |
| State | GA | State |
| ZIP Code | 31015 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| WILLIAM PANNELL MD | ||||||||
| BOARD MEMBER | 1.00 | X | 227243 | 0 | 0 | |||
| STEVE GAUTNEY | ||||||||
| PRES/CEO | 40.00 | X | 216234 | 0 | 7987 | X | ||
| SULE SALAMI MD | ||||||||
| ASST SEC/TRE | 1.00 | X | 4413 | 0 | 0 | X | ||
| ROE J DAVIS | ||||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X | ||
| BETTYE ROBERSON | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| RONNEY LEDFORD | ||||||||
| SECRETARY/TR | 1.00 | X | 0 | 0 | 0 | X | ||
| WAYNE MARTIN | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| MIKE MILLER | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| JESSICA CARTER | ||||||||
| CFO | 40.00 | 123379 | 0 | 13801 | X | |||
| MILTON JONES MD | ||||||||
| PHYSICIAN | 40.00 | 135694 | 0 | 14065 | X | |||
| MARY ELLEN HANCOCK | ||||||||
| PHARMACIST | 40.00 | 119708 | 0 | 9531 | X | |||
| CHRISTY CLARY | ||||||||
| PHARMACIST | 40.00 | 114740 | 0 | 9419 | X | |||
| RENA DICKERSON | ||||||||
| NURSING HOME | 40.00 | 106803 | 0 | 0 | X | |||
| CHARLOTTE VESTAL | ||||||||
| CFO | 40.00 | 106803 | 0 | 3239 | X | |||
| LEONARD CARTER | ||||||||
| VP CLINICAL | 40.00 | 61455 | 0 | 7170 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1216472 | TotalReportableCompFromOrg |
| Total Other Compensation | 65212 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| FIRST CALL MEDICAL STAFFING INC | |||||
| PO BOX 402 | SYLVESTER | GA | 31791 | MED STAFFING | 576289 |
| SONOCARE INC | |||||
| 155 OVERLOOK ROAD | AMERICUS | GA | 31709 | MEDICAL SERVICE | 413925 |
| GR MCNAIR LLC | |||||
| 113 TIMBERLAND DRIVE | CORDELE | GA | 31015 | MEDICAL SERVICE | 300600 |
| KENNETH BENJAMIN MD | |||||
| 2213 PENDLETON | ALBANY | GA | 31721 | PHYSICIAN | 280413 |
| INNOVATIVE THERAPY CONCEPTS LLC | |||||
| 2 MASHBURN ST SUITE 102 | HAWKINSVILLE | GA | 31036 | MEDICAL SERVICE | 259382 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 27 | NumberOfContractorsGT100K |
| All Other Contributions | 21055 | AllOtherContributions |
| Noncash Contributions | 14198 | NoncashContributions |
| Total Contributions | 21055 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PROGRAM SERVICE REVENUE | 623000 | 62945326 | 62945326 |
| EMS OPERATIONS CONTRACT | 621910 | 724720 | 724720 |
| MEDICAID EHR INCENTIVES | 621990 | 570777 | 570777 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 64240823 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 420201 | TotalRevenueColumn |
| Exclusion | $420,201 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 212556 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 27525 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 185031 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 185031 | TotalRevenueColumn |
| Related Or Exempt Function Income | 190935 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -5904 | UnrelatedBusinessRevenue |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 259858 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 248898 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 10960 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10960 | TotalRevenueColumn |
| Exclusion | $10,960 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 12832 | GrossSalesOfInventory |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12832 | TotalRevenueColumn |
| Exclusion | $12,832 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| DIETARY/VENDING | 624200 | 566525 | $566,525 | |
| OTHER REVENUES | 621990 | 330613 | 330613 | |
| DIETARY CATERING | 624200 | 286228 | $286,228 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 437465 | TotalRevenueColumn |
| Related Or Exempt Function Income | 287837 | RelatedOrExemptFunctionIncome |
| Exclusion | $149,628 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1620831 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 66511733 | TotalRevenueColumn |
| Related Or Exempt Function Income | 65050208 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -5904 | UnrelatedBusinessRevenue |
| Exclusion | $1,446,374 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 155205 | Total |
| Program Services | 155205 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 593057 | Total |
| Program Services | 221900 | ProgramServices |
| Management And General | 371157 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 178667 | Total |
| Management And General | 178667 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22234414 | Total |
| Program Services | 16332135 | ProgramServices |
| Management And General | 5902279 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 520276 | Total |
| Program Services | 489555 | ProgramServices |
| Management And General | 30721 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2624557 | Total |
| Program Services | 1693635 | ProgramServices |
| Management And General | 930922 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2251561 | Total |
| Program Services | 1395277 | ProgramServices |
| Management And General | 856284 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 361482 | Total |
| Program Services | 45000 | ProgramServices |
| Management And General | 316482 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 695917 | Total |
| Management And General | 695917 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 150224 | Total |
| Management And General | 150224 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9799 | Total |
| Management And General | 9799 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12252070 | Total |
| Program Services | 10264955 | ProgramServices |
| Management And General | 1987115 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 150356 | Total |
| Program Services | 66612 | ProgramServices |
| Management And General | 83744 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3865990 | Total |
| Program Services | 2999767 | ProgramServices |
| Management And General | 866223 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 455 | Total |
| Program Services | 455 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1542429 | Total |
| Program Services | 182208 | ProgramServices |
| Management And General | 1360221 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 604883 | Total |
| Program Services | 440405 | ProgramServices |
| Management And General | 164478 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57724 | Total |
| Program Services | 37276 | ProgramServices |
| Management And General | 20448 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3375780 | Total |
| Program Services | 1617461 | ProgramServices |
| Management And General | 1758319 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 819305 | Total |
| Program Services | 356069 | ProgramServices |
| Management And General | 463236 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 7401621 | 7401621 | |
| LICENSES AND TAXES | 1047713 | 40038 | 1007675 |
| OTHER EXPENSES | 501956 | 71557 | 430399 |
| REPAIRS AND MAINT | 262701 | 116864 | 145837 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 313602 | Total |
| Program Services | 62308 | ProgramServices |
| Management And General | 251294 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61971744 | Total |
| Program Services | 43990303 | ProgramServices |
| Management And General | 17981441 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 91098 | BOY |
| EOY | 107800 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4995483 | BOY |
| EOY | 7119673 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7740815 | BOY |
| EOY | 8496368 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1126176 | BOY |
| EOY | 1158778 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 931460 | BOY |
| EOY | 1029537 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 71931043 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 43485723 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29369044 | BOY |
| EOY | 28445320 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31867979 | BOY |
| EOY | 33085283 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 402000 | BOY |
| EOY | 402000 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 380035 | BOY |
| EOY | 311018 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2083486 | BOY |
| EOY | 1698209 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78987576 | BOY |
| EOY | 81853986 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4536618 | BOY |
| EOY | 3677185 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17975000 | BOY |
| EOY | 16755000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 409177 | BOY |
| EOY | 178687 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22920795 | BOY |
| EOY | 20610872 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56066781 | BOY |
| EOY | 61243114 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 56066781 | BOY |
| EOY | 61243114 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78987576 | BOY |
| EOY | 81853986 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 4539989 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 636344 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed4955 Tax | false | Form4720Filed4955Tax |
| Correction Made | false | CorrectionMade |
| Form1120 Pol Filed | false | Form1120PolFiled |
| Form4720 Filed | false | Form4720Filed |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $9,799 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 9799 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
| Substantially All Dues Nondeduct | false | SubstantiallyAllDuesNondeduct |
| Only In House Lobbying | false | OnlyInHouseLobbying |
| Agree To Carryover Prior Year | false | AgreeToCarryoverPriorYear |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | SCHEDULE C, PART II-B, LINE 1 | ReturnReference |
| Explanation | 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. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1937621 | OtherCostOrOtherBasis |
| Book Value | 1937621 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 34814934 | OtherCostOrOtherBasis |
| Depreciation | 16297917 | Depreciation |
| Book Value | 18517017 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1067439 | OtherCostOrOtherBasis |
| Depreciation | 923669 | Depreciation |
| Book Value | 143770 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 33971780 | OtherCostOrOtherBasis |
| Depreciation | 26264137 | Depreciation |
| Book Value | 7707643 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 139269 | OtherCostOrOtherBasis |
| Book Value | 139269 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 28445320 | TotalOfBookValueLandBuildings |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | LIABILITY UNDER FIN 48 FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PAGE 3, PART X | ReturnReference |
| Explanation | 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 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 OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2009-2011. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 1.25000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | false | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 322644 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 322644 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00520 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13887247 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12040415 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1846832 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02980 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14209891 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12040415 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2169476 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03500 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7662074 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6125841 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1536233 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02480 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7662074 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6125841 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1536233 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02480 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 21871965 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 18166256 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3705709 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05980 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $14,949,559 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 15411964 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 15195046 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 216918 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRISP HC ALLIANCE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | HEALTH SERVICES | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.80000 | OrganizationProfitOrOwnership |
| Physicans Profit Or Ownership | 0.20000 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRISP REGIONAL HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 902 7TH STREET NORTH | AddressLine1 |
| City | CORDELE | City |
| State | GA | State |
| ZIP Code | 310105007 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | SNF, NF, HHA, HOSPICE, RHC, RD | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRISP REGIONAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 125.0 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 200.0 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 6 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (6 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| CRISP REGIONAL NURSING HOME & REHAB | ||||
| 902 BLACKSHEAR ROAD | CORDELE | GA | 31015 | NURSING FACILITY |
| CARESOUTH OF CRISP REGIONAL | ||||
| 906 5TH STREET NORTH | CORDELE | GA | 31015 | HOME HEALTH |
| CRISP REGIONAL HOSPICE | ||||
| 910 5TH STREET NORTH | CORDELE | GA | 31015 | HOSPICE |
| ARABI HEALTHCARE CENTER | ||||
| 4110 BEDGOOD AVENUE | ARABI | GA | 31712 | RHC |
| WARWICK HEALTHCARE CENTER | ||||
| 135 DOGWOOD STREET | WARWICK | GA | 31796 | RHC |
| CRISP REGIONAL DIALYSIS UNIT | ||||
| 1302 5TH STREET NORTH | CORDELE | GA | 31015 | DIALYSIS |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SUBSIDIZED HEALTH SERVICES EXPLANATION | PART I LINE 7G | THIS SECTION INCLUDES NET ACTUAL COSTS FOR SUBSIDIZED PHYSICIAN AND RURAL HEALTH CLINICS OF 2284498 |
| 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 61971744 ADD EXPENSES ON PART VIII 27525 DENOMINATOR FOR COLUMN F 61999269 |
| 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 | EXCERPT FROM AUDITED FINANCIAL STATEMENTS ALLOWANCE FOR DOUBTFUL ACCOUNTS THE CORPORATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE OVERALL COLLECTABILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE 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 |
| 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 |
| 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 88 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 4292 IN 2011 NURSERY SCHOOL AND KINDERGARTEN ENROLLMENT WAS 893 AND ELEMENTARY OR HIGH SCHOOL ENROLLMENT WAS 3399 CHILDREN COLLEGE OR GRADUATE SCHOOL ENROLLMENT WAS 606 INDUSTRIES IN 2011 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 32616 72 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 14204 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 2011 28 OF PEOPLE WERE IN POVERTY 45 OF RELATED CHILDREN UNDER 18 WERE BELOW THE POVERTY LEVEL COMPARED WITH 13 OF PEOPLE 65 YEARS OLD AND OVER RESIDENTS WITH INCOME BELOW 50 OF THE POVERTY LEVEL IN 2011 WERE 12 22 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 54 WAS WHITE 44 WAS BLACK OR AFRICAN AMERICAN 02 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 965 NONMORTGAGED OWNERS 303 AND RENTERS 577 25 OF OWNERS WITH MORTGAGES 8 OF OWNERS WITHOUT MORTGAGES AND 44 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 20072011 WERE FOREIGN BORN 99 WAS NATIVE INCLUDING 84 WHO WERE BORN IN GEORGIA AMONG PEOPLE AT LEAST 5 YEARS OLD LIVING IN CRISP COUNTY IN 20072011 31 SPOKE A LANGUAGE OTHER THAN ENGLISH AT HOME OF THOSE SPEAKING A LANGUAGE OTHER THAN ENGLISH AT HOME 861 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 17000 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 500000 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 THREAT 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 3107 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 HAS INTENTIONS TO PUBLICIZE A COMMUNITY BENEFIT REPORT IN THE NEAR FUTURE |
| CRISP REGIONAL HOSPITAL LINE NUMBER 1 PART V LINE 19D | PART V LINE 19D | 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 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|
| EMPLOYEE EDUCATION LOANS | 36 | 49168 |
| PHYSICIAN EDUCATION LOANS | 8 | 106037 |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES | Identifier |
| Return Reference | SCHEDULE I, PAGE 1, PART I, LINE 2 | ReturnReference |
| Explanation | 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg |
|---|---|---|---|---|
| WILLIAM PANNELL MD | ||||
| 227243 | 227243 | |||
| STEVE GAUTNEY | ||||
| 211502 | 224221 | 4732 | 7987 | |
| CHARLOTTE VESTAL | ||||
| 106765 | 110042 | 38 | 3239 | |
| LEONARD CARTER | ||||
| 61450 | 68625 | 5 | 3993 | 3177 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS | Identifier |
| Return Reference | SCHEDULE J, PAGE 1, PART I, LINE 4 | ReturnReference |
| Explanation | CHARLOTTE VESTAL 30,600 0 0 | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Business Name Line2IssuerName/BusinessNameLine2 | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| HOSPITAL AUTH OF CRISP COUNTYGA | ||||||||
| CRH REV CERTIFICATES PAYABLE 2008A | 586003098 | 226688BY4 | 2008-05-29 | 10000000 | REFUND/CONSTRUCTION | false | true | false |
| HOSPITAL AUTH OF CRISP COUNTY GA | ||||||||
| CRH REV CERTIFICATES PAYABLE 2008B | 586003098 | 226688CE7 | 2008-05-29 | 3000000 | CONSTRUCTION | false | true | false |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Amount Bond DefeasedAmountBondDefeased | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|
| 540000 | 7743975 | 9830000 | 525885 | 1772086 | 2008 | true | false | true | true |
| 3000000 | 157765 | 2735973 | 2009 | false | false | true | true |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Engage Bond Counsel ContractsEngageBondCounselContracts | Any Research AgreementsAnyResearchAgreements | Engage Bond Counsel ResearchEngageBondCounselResearch | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|
| false | false | false | false | false | false | true |
| false | false | false | false | false | false | true |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| false | false | false | false | false | false |
| false | false | false | false | false | false |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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. COPIES GIVEN TO BOARD MEMBERS FOR A BASIC REVIEW. |
| 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 2010. |
| 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 2010. |
| 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. |
| RELATED ORGANIZATIONS | FORM 990, PAGE 7, PART VII | AVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS STEVE GAUTNEY 2 HOURS ROY DAVIS 2 HOURS SULE SALAMI 2 HOURS RANN FOLSOM 2 HOURS CHARLOTTE VESTAL 2 HOURS BETTYE ROBERSON 2 HOURS |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 5 | CHANGE IN UNREALIZED GAIN ON INVESTMENTS 636,344 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Business Name Line2DirectControllingEntityName/BusinessNameLine2 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| CRISP REGIONAL HEALTH SERVICE INC | |||||||||||
| 902 7TH STREET NORTH | CORDELE | GA | 31015 | 582175975 | HOLDING CO | GA | 501C3 | 11A | NA | false | |
| CRISP REGIONAL HOSP DEV FNDN INC | |||||||||||
| 902 7TH STREET NORTH | CORDELE | GA | 31015 | 582175978 | FOUNDATION | GA | 501C3 | 11A | CRH | true | CRISP REGIONAL HOSPITAL |
| HOSPITAL AUTHORITY OF CRISP COUNTY | |||||||||||
| 902 7TH STREET NORTH | CORDELE | GA | 31015 | 586003098 | AUTHORITY | GA | 501C3 | 6 | NA | false | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRISP HEALTHCARE ALLIANCE LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 5007 | AddressLine1 |
| City | CORDELE | City |
| State | GA | State |
| ZIP Code | 31010 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582307830 | EIN |
| Primary Activity | PURCHASING | PrimaryActivity |
| Legal Domicile State | GA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRH | BusinessNameLine1 |
| Business Name Line2 | CRISP REGIONAL HOSPITAL INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | 29165 | ShareOfTotalIncome |
| Share Of EOY Assets | 549332 | ShareOfEOYAssets |
| Disproportionate Allocations | false | DisproportionateAllocations |
| General Or Managing Partner | false | GeneralOrManagingPartner |
| Percentage Ownership | 0.80000 | PercentageOwnership |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRISP MEDICAL SERVICES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 902 7TH STREET NORTH | AddressLine1 |
| City | CORDELE | City |
| State | GA | State |
| ZIP Code | 31015 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582175987 | EIN |
| Primary Activity | DORMANT | PrimaryActivity |
| Legal Domicile State | GA | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRISP REGIONAL HOSPITAL DEVELOPMENT | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | L | TransactionType |
| Amount Involved | 46704 | AmountInvolved |
| Method Of Amt Determination | NET FUNDS RAISED | MethodOfAmtDetermination |