2013-05-14T07:13:12-05:00 2012-06-30 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2011-07-01 582175978 CRISP REGIONAL HOSPITAL INC CRIS 2292763130 902 7TH STREET NORTH CORDELE GA 31015 STEVEN GAUTNEY 2292763130 2013-05-15 true JACQUELINE G ATKINS 2298837878 2013-05-10 2011 2016-02-24 21:20:13Z STEVEN GAUTNEY 902 7TH STREET NORTH CORDELE GA 31015 66788156 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. 8 6 899 39 -5904 -5904 30761 21055 67448810 64240823 1020943 431161 1735705 1818694 70236219 66511733 171030 155205 0 28830809 28402532 0 0 38534286 33414007 67536125 61971744 2700094 4539989 78987576 81853986 22920795 20610872 56066781 61243114 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 43990303 155205 65050208 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. 43990303 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 182 0 899 true true true false false false false false false false false false X 8 6 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 31015 X WILLIAM PANNELL MD 1.00 X 227243 0 0 STEVE GAUTNEY 40.00 X X 216234 0 7987 SULE SALAMI MD 1.00 X X 4413 0 0 ROE J DAVIS 1.00 X X 0 0 0 BETTYE ROBERSON 1.00 X 0 0 0 RONNEY LEDFORD 1.00 X X 0 0 0 WAYNE MARTIN 1.00 X 0 0 0 MIKE MILLER 1.00 X 0 0 0 JESSICA CARTER 40.00 X 123379 0 13801 MILTON JONES MD 40.00 X 135694 0 14065 MARY ELLEN HANCOCK 40.00 X 119708 0 9531 CHRISTY CLARY 40.00 X 114740 0 9419 RENA DICKERSON 40.00 X 106803 0 0 CHARLOTTE VESTAL 40.00 X 106803 0 3239 LEONARD CARTER 40.00 X 61455 0 7170 1216472 65212 8 true true false 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 27 21055 14198 21055 PROGRAM SERVICE REVENUE 623000 62945326 62945326 EMS OPERATIONS CONTRACT 621910 724720 724720 MEDICAID EHR INCENTIVES 621990 570777 570777 64240823 420201 420201 212556 27525 185031 185031 190935 -5904 259858 248898 10960 10960 10960 12832 12832 12832 DIETARY/VENDING 624200 566525 566525 OTHER REVENUES 621990 330613 330613 DIETARY CATERING 624200 286228 286228 437465 287837 149628 1620831 66511733 65050208 -5904 1446374 155205 155205 593057 221900 371157 178667 178667 22234414 16332135 5902279 520276 489555 30721 2624557 1693635 930922 2251561 1395277 856284 361482 45000 316482 695917 695917 150224 150224 9799 9799 12252070 10264955 1987115 150356 66612 83744 3865990 2999767 866223 455 455 1542429 182208 1360221 604883 440405 164478 57724 37276 20448 3375780 1617461 1758319 819305 356069 463236 MEDICAL SUPPLIES 7401621 7401621 LICENSES AND TAXES 1047713 40038 1007675 OTHER EXPENSES 501956 71557 430399 REPAIRS AND MAINT 262701 116864 145837 313602 62308 251294 61971744 43990303 17981441 0 91098 107800 4995483 7119673 7740815 8496368 1126176 1158778 931460 1029537 71931043 43485723 29369044 28445320 31867979 33085283 402000 402000 380035 311018 2083486 1698209 78987576 81853986 4536618 3677185 17975000 16755000 409177 178687 22920795 20610872 X 56066781 61243114 56066781 61243114 78987576 81853986 X 4539989 636344 X false true true X false X false false false false false false false false false false false false true 9799 9799 false false false false 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. false false false false false false false false false false 1937621 1937621 34814934 16297917 18517017 1067439 923669 143770 33971780 26264137 7707643 139269 139269 28445320 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 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. true true X true X 1.25000 true X true false false 322644 322644 0.00520 13887247 12040415 1846832 0.02980 14209891 12040415 2169476 0.03500 7662074 6125841 1536233 0.02480 7662074 6125841 1536233 0.02480 21871965 18166256 3705709 0.05980 true 14949559 15411964 15195046 216918 X true true CRISP HC ALLIANCE HEALTH SERVICES 0.80000 0.20000 1 1 CRISP REGIONAL HOSPITAL

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X X X SNF, NF, HHA, HOSPICE, RHC, RD CRISP REGIONAL HOSPITAL 1 true true 125.0 true 200.0 true X X X X X true true X X X true false true X false false 6 CRISP REGIONAL NURSING HOME & REHAB

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HOSPICE ARABI HEALTHCARE CENTER

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RHC WARWICK HEALTHCARE CENTER

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RHC CRISP REGIONAL DIALYSIS UNIT

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DIALYSIS 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 true EMPLOYEE EDUCATION LOANS 36 49168 PHYSICIAN EDUCATION LOANS 8 106037 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 WILLIAM PANNELL MD 227243 227243 STEVE GAUTNEY 211502 4732 7987 224221 CHARLOTTE VESTAL 106765 38 3239 110042 LEONARD CARTER 61450 5 3177 3993 68625 SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 CHARLOTTE VESTAL 30,600 0 0 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 540000 7743975 9830000 525885 1772086 2008 true false true true 3000000 157765 2735973 2009 false false true true false false false false false false true false false false false false false true false false false false false false false false false false false false 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 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 CRISP REGIONAL HOSPITAL true HOSPITAL AUTHORITY OF CRISP COUNTY 902 7TH STREET NORTH CORDELE GA 31015 586003098 AUTHORITY GA 501C3 6 NA false CRISP HEALTHCARE ALLIANCE LLC PO BOX 5007 CORDELE GA 31010 582307830 PURCHASING GA CRH CRISP REGIONAL HOSPITAL INC RELATED 29165 549332 false false 0.80000 CRISP MEDICAL SERVICES INC 902 7TH STREET NORTH CORDELE GA 31015 582175987 DORMANT GA N/A false false false false false false false false false false false true true true false true false false CRISP REGIONAL HOSPITAL DEVELOPMENT L 46704 NET FUNDS RAISED