2013-03-15T07:44:27-05:00 2012-04-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2011-05-01 582513901 CHATUGE REGIONAL HOSPITAL INC CHAT 7068962222 110 SOUTH MAIN ST HIAWASSEE GA 30546 TIM HENRY 7064396493 2013-03-18 1 AMY BIBBY P00445891 8282542254 2011 2016-02-25 16:41:14Z MICHAEL GOWDER 110 SOUTH MAIN ST HIAWASSEE GA 30546 18568217 0 X N/A X 1955 GA TO PROVIDE HIGH QUALITY, COST EFFECTIVE HEALTH CARE AND TO PROMOTE WELLNESS IN OUR COMMUNITY. 8 6 339 40 0 0 2681 17244 17364875 18292146 19516 22240 228290 236587 17615362 18568217 0 0 0 0 9491810 9753303 0 0 0 8776540 9740703 18268350 19494006 -652988 -925789 9661141 9397816 2948411 3610875 6712730 5786941 X TO PROVIDE HIGH QUALITY, COST EFFECTIVE HEALTH CARE AND TO PROMOTE WELLNESS THROUGHOUT OUR COMMUNITY. 0 0 18360356 18388344 CHATUGE REGIONAL HOSPITAL, A 501(C)(3) HEALTHCARE ORGANIZATION, TAKES A PROACTIVE APPROACH TO MEET COMMUNITY HEALTH NEEDS, THE ORGANIZATION'S TAX-EXEMPT REQUIREMENTS, AND OFFERS COMMUNITY BENEFIT PROGRAMS AND SERVICES WHICH RESULT IN A POSITIVE IMPACT ON COMMUNITY HEALTH. CHATUGE REGIONAL HOSPITAL (CRH) AND CHATUGE REGIONAL NURSING HOME (CRNH) HAVE A VISION TO BE THE "FIRST CHOICE" PROVIDER OF COMPREHENSIVE MEDICAL SERVICES IN OUR AREA. WE VALUE OUR PATIENTS AND RESIDENTS AND BELIEVE THEY ARE OUR MOST IMPORTANT RESPONSIBILITY. WE SHALL ALWAYS SEEK TO MEET THE PHYSICAL, EMOTIONAL, EDUCATIONAL AND SPIRITUAL NEEDS OF OUR PATIENTS AND THEIR FAMILIES. WE VALUE OUR MEDICAL STAFF AND WILL SEEK WAYS TO HELP THEM IMPROVE PROFESSIONALLY AND FACILITATE THE PRACTICE OF MEDICINE. WE VALUE OUR EMPLOYEES AND SHALL TREAT EACH OTHER WITH COURTESY, FAIRNESS, RESPECT AND INTEGRITY. WE SHALL WORK AS A TEAM TO DO OUR BEST TO PROMOTE OUR MISSION AND FUFILL OUR VISION. WE VALUE OUR COMMUNITY. WE ARE COMMITTED TO THE TREATMENT AND CARE OF OUR PATIENTS AND THE PROMOTION OF HEALTH AND WELLNESS IN OUR COMMUNITY. WE WILL CONFRONT ALL ETHICAL AND MORAL HEALTH-RELATED ISSUES NECESSARY TO ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY. WE VALUE QUALITY CARE AND WILL SEEK TO DELIVER CUSTOMER-FOCUSED, COST EFFICIENT SERVICES WITH COMPASSION AND CARING. CHATUGE REGIONAL HOSPITAL WAS DEEMED TO BE A CRITICAL ACCESS HOSPITAL BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS), EFFECTIVE MAY 1, 2002, AND BY THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH (DCH). CRH IS THE ONLY ACUTE CARE HOSPITAL IN TOWNS COUNTY, GEORGIA. CRH IS LIMITED TO 25 ACUTE AND INTENSIVE CARE MEDICAL/SURGICAL BEDS. THESE BEDS ARE ALSO USED FOR SHORT-TERM SKILLED NURSING CARE. OUTPATIENT SERVICES INCLUDE RADIOLOGY, LABORATORY AND OTHER DIAGNOSTIC SERVICES, REHABILITATION SERVICES, AND 24/7 EMERGENCY MEDICAL SERVICES. CRNH IS THE ONLY NURSING FACILTIY IN THE COUNTY PROVIDING SKILLED AND INTERMEDIATE LEVELS OF LONG-TERM CARE. CRNH IS LICENSED FOR 112 BEDS AND CONSISTENTLY HAS A WAITING LIST FOR ADMISSIONS. A MAJORITY OF THE RESIDENTS OF CRNH ARE MEDICARE AND MEDICAID BENEFICIARIES. IT IS A LONG-ESTABLISHED POLICY OF CRH TO PROVIDE QUAITY CARE FOR ITS PATIENTS REGARDLESS OF THEIR FINANCIAL CIRCUMSTANCES. QUALIFICATION FOR HOSPITAL INDEGENT CARE IS SET AT 125% OF THE CURRENT FEDERAL POVERTY GUIDELINES AND IS BASED ON SIZE OF THE FAMILY UNIT. CRH AND CRNH ALSO PROVIDE FREE OR REDUCED COST CARE TO ALL ELIGIBLE PERSONS REQUESTING CHARITY CARE ASSISTANCE. FOR EMERGENCY MEDICAL SERVICES, INCLUDING ACTIVE LABOR, NO PERSON WILL BE DENIED CARE DUE TO AN INABILITY TO PAY FOR SERVICES. CRH AND CRNH PARTICIPATE IN MEDICARE, MEDICAID, PEACHCARE, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. CRH, IN CONJUNCTION WITH ITS SISTER HOSPITAL, UNION GENERAL HOSPITAL, ARE THE ONLY TAX-EXEMPT, NON-PROFIT HOSPITALS WITHIN THE IMMEDIATE EIGHT-COUNTY AREA OF THE NORTH CENTRAL AND NORTHEAST GEORGIA MOUNTAINS. DUE TO THE MOUNTAINOUS TERRAIN AND BEING BOUNDED BY THE CHATTAHOOCHEE NATIONAL FOREST AND LAKE CHATUGE, TOWNS COUNTY AND ITS NEIGHBORING CLAY COUNTY, NC, HAVE SEVERAL VERY REMOTE COMMUNITIES FROM WHICH ACCESS TO MEDICAL CARE CAN LITERALLY BE MORE THAN AN HOUR AWAY IN SOME CASES. TOWNS COUNTY ATTRACTS MANY VISITORS FOR CAMPING, HIKING, FISHING, AND HUNTING. THE TWISTING MOUNTAIN ROADS ATTRACT BICYCLISTS AND MOTORCYCLISTS THROUGHOUT THE SPRING, SUMMER AND FALL SEASONS. THESE ACTIVITIES MANY TIMES RESULT IN MEDICAL EMERGENCIES, SOME VERY SERIOUS, TO WHICH THE EMERGENCY DEPARTMENT OF CRH MUST BE PREPARED TO MEET. CRH ESTABLISHED A FAMILY MEDICAL PRACTICE IN HAYESVILLE, NC (CLAY COUNTY) TO HELP MEET THE MEDICALLY UNDERSERVED IN THE COMMUNITY. THE MEDICAL OFFICE IS STAFFED WITH FAMILY NURSE PRACTITIONERS (FNPS) AND SUPPORTED BY PHYSICIANS FROM CRH'S EMERGENCY DEPARTMENT. 18360356 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 34 0 1 339 1 0 0 0 0 0 0 0 0 0 0 X 8 6 1 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 GA X TIMOTHY HENRY 7064396843 35 HOSPITAL ROAD BLAIRSVILLE GA 30512 X PATSY EFIRD 1.00 X X 0 0 0 G DAVID GOWDER MD 1.00 X 0 49689 4255 DAVID BREEDLOVE MD 1.00 X 0 350 0 MAX COCHRAN 1.00 X 0 0 0 DINAH PARIS 1.00 X 0 0 0 JEFF PATTERSON 1.00 X 0 0 0 MYRON TURNER 1.00 X 0 0 0 JAMES K WILLIAMS 1.00 X 0 0 0 REBECCA T DYER 40.00 X 0 109946 28827 TIMOTHY N HENRY 40.00 X 0 144017 17327 J MICHAEL GOWDER 40.00 X 0 147636 15384 ANNETTE STOOKEY 40.00 X 110553 0 10827 KAREN KELLEY 40.00 X 120593 0 26617 RICHARD KELLEY 40.00 X 131878 0 20540 363024 451638 123777 3 0 1 1 STERLING EMERGENCY SERVICES PO BOX 758746 BALTIMORE MD 21275 ER DOCTORS 2344974 THE ERX GROUP LLC 9724 KINGSTON PIKE STE 406 KNOXVILLE TN 37922 PROVIDED ER PHYSICIANS 523928 QUEST DIAGNOSTICS PO BOX 281945 ATLANTA GA 20284 LAB SUPPLIES 122186 3 17244 17244 NET PATIENT SERVICE RE 623000 18292146 18292146 18292146 22240 22240 140389 0 140389 140389 140389 CAFETERIA & VENDING 722210 56954 56954 SALE OF SUPPLIES/DRUGS 446110 15964 15964 MISCELLANEOUS 900099 5744 5744 17536 17536 96198 18568217 18388344 0 162629 8336060 7792805 543255 89178 83366 5812 738123 690020 48103 589942 551496 38446 49272 49272 2096764 2036818 59946 19826 19826 1834150 1591018 243132 9450 9450 918812 775683 143129 35789 33834 1955 2326 2326 9193 9193 607519 607519 230218 230218 BAD DEBT 2794986 2794986 MEDICAL SUPPLIES 1131917 1131917 MISCELLANEOUS 481 -119 600 19494006 18360356 1133650 0 1344641 1877338 757271 263853 2721326 2399619 332733 344616 302473 562282 9711318 5773710 4202697 3937608 0 12500 9661141 9397816 1233351 1515330 172976 118106 1542084 1977439 2948411 3610875 X 6712730 5786941 6712730 5786941 9661141 9397816 -925789 0 X X 0 1 1 X 0 X 415739 415739 3636029 2258426 1377603 129722 80573 49149 5529828 3434711 2095117 3937608 CAPITAL LEASE OBLIGATIONS 54869 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 230591 INTERCOMPANY PAYABLES 1673331 DEFERRED REVENUE 18648 1977439 18568217 19494006 -925789 -925789 18568217 0 18568217 0 18568217 19494006 0 19494006 0 19494006 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: INCOME TAXES - CHATUGE REGIONAL HOSPITAL IS A NOT-FOR-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION HAS EVALUATED THEIR TAX POSITION AND HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF APRIL 30, 2012 AND 2011. FISCAL YEARS ENDING ON AND AFTER APRIL 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. 1 1 X 1 X 125.000000000000 1 X 1 0 1 0 88939 258490 -169551 0.00000 3959140 5207463 -1248323 0.00000 4048079 5465953 -1417874 11909 11909 0.00070 11909 11909 0.00070 4059988 5465953 -1405965 0.00070 0 2794986 159910 15612431 11652329 3960102 X 1 1 1 1 CHATUGE REGIONAL HOSPITAL INC

110 SOUTH MAIN ST HIAWASSEE GA 30546

X X X CHATUGE REGIONAL HOSPITAL INC 1 1 1 125.000000000000 1 400.000000000000 0 0 0 0 0 1 X 0 0 2 CHATUGE REGIONAL NURSING HOME

386 BELAIRE DRIVE HIAWASSEE GA 30546

SKILLED NURSING HAYESVILLE FAMILY PRACTICE

450 HWY 64 BUSINESS SUITE 4 HAYNESVILLE GA 28904

FAMILY CLINIC PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2794986. PART III, LINE 4: THERE IS NO FOOTNOTE ADDRESSING BAD DEBT IN THE ORGANIZATION'S FINANCIAL STATEMENTS.BASED ON EXPERIENCE, THE ORGANIZATION HAS FOUND THAT THERE IS A PORTION OF BAD DEBT THAT IS GENERALLY ATTRIBUTABLE TO CHARITY CARE. THE ORGANIZATION MULTIPLIED THE PORTION OF BAD DEBT ATTRIBUTABLE TO CHARITY BY THE COST-TO-CHARGE RATIO CALCULATED USING THE IRS 2011 SCHEDULE H WORKSHEET 2. PART III, LINE 8: THIS SHORTFALL IS GENERATED PRIMARILY FROM PROVIDING EMERGENCY PHYSICIAN SERVICES AND SHOULD COUNT 100% TOWARD COMMUNITY BENEFIT EXPENSE. PART III, LINE 9B: ONCE THE PATIENT IS APPROVED FOR INDIGENT CARE (100% WRITE OFF) THE ACCOUNT(S) IS (ARE) RECLASSED TO INDIGENT CARE AND NO FURTHER COLLECTION ACIVITY IS CONDUCTED. FOR PATIENTS APPROVED FOR CHARITY CARE (REDUCED CHARGE), THE ACCOUNT GUARANTOR WILL RECEIVE STATEMENTS AND PHONE CALLS TO COLLECT THE REMAINING BALANCE DUE. CHATUGE REGIONAL HOSPITAL, INC. PART V, SECTION B, LINE 10: MONTHLY OR ANNUAL INCOME AT OR BELOW 125% OF THE CURRENT FEDERAL PROVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% INDIGENT/CHARITY CARE. THOSE INCOMES BETWEEN 125% AND 400% OF THE FPG ARE ELIGIBLE FOR A REDUCTION IN CHARGES BASED ON A SLIDING SCALE. CHATUGE REGIONAL HOSPITAL, INC. PART V, SECTION B, LINE 11H: PATIENTS ARE OFFERED A 20% DISCOUNT IF THEY PAY UP FRONT. CHATUGE REGIONAL HOSPITAL, INC. PART V, SECTION B, LINE 13G: ANNUAL NEWSPAPER NOTICE INDICATING AVAILABLILITY OF FINANCIAL ASSISTANCE. REGISTRATION AND COLLECTORS PROVIDE INFORMATION AND FINANCIAL ASSISTANCE APPLICATION. SIGNAGE POSTED IN REGISTRATION AND EMERGENCY DEPARTMENT. PART VI, LINE 2: THE ORGANIZATION PRIMARILY SOLICITS FEEDBACK FROM THE MEDICAL STAFF AND CITY AND COUNTY OFFICIALS. PART VI, LINE 3: NOTICES ARE PUBLISHED IN THE LOCAL COMMUNITY NEWSPAPER REGARDING THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. ACCOUNT COLLECTORS INFORM THE ACCOUNT GUARANTOR OF THE AVAILABILITY OF INDIGENT AND CHARITY CARE ONCE THE COLLECTION PROCESS IS INITIATED. THE ORGANIZATION MAILS OUT APPLICATIONS FOR FINANCIAL AID, BUT RECEIVES A LIMITED NUMBER RETURNED. PART VI, LINE 4: THE ORGANIZATION SERVES A GENERALLY RURAL, MOUNTAINOUS AREA AND IS THE SOLE HOSPITAL IN TOWNS COUNTY. DUE TO THE MOUNTAINOUS TERRAIN AND BEING BOUNDED BY THE CHATTAHOOCHEE NATIONAL FOREST AND LAKE CHATUGE, TOWNS COUNTY AND ITS NEIGHBORING CLAY COUNTY, NC HAVE VERY REMOTE COMMUNITIES FROM WHICH ACCESS TO MEDICAL CARE CAN LITERALLY BE MORE THAN AN HOUR AWAY IN SOME CASES. TOWNS COUNTY ATTRACTS MANY VISITORS FOR CAMPING, BOATING, HIKING, FISHING AND HUNTING, AS WELL AS BICYCLISTS AND MOTORCYCLISTS, WHICH OFTEN LEAD TO SERIOUS INJURY THAT THE EMERGENCY DEPARTMENT MUST MBE PREPARED TO MEET. FURTHERMORE, CRH IS A CRITICAL ACCESS HOSPITAL FOR THE RESIDENTS OF TOWNS COUNTY, GA, AND CLAY COUNTY, NC. A SIGNIFICANT PORTION OF THE RESIDENT POPULATION ARE MEDICARE AND MEDICAID BENEFICIARIES. TOWNS COUNTY IS DEEMED TO HAVE A MEDICALLY UNDERSERVED POPULATION (MUP) BY THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH. PART VI, LINE 5: THE ORGANIZATION CONDUCTS HEALTH FAIRS OPEN TO THE COMMUNITY WHEREIN FREE HEALTH SCREENINGS AND LOW-COST BASIC LAB TESTS ARE DONE. OTHER HEALTH INFORMATION IS PROVIDED INCLUDING INFORMATION ON SMOKING CESSATION AND DIABETES. THE ORGANZATION IS ENTIRELY TOBACCO-FREE, THUS PROMOTING A HEALTHY LIFESTYLE.SURPLUS FUNDS ARE USED TO PROVIDE FOR THE ADDITION, IMPROVEMENT, OR REPLACEMENT OF CAPITAL AND EQUIPMENT NEEDS. PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTHCARE SYSTEM. 0 0 0 0 0 0 0 0 0 TIMOTHY N HENRY 0 143717 0 300 0 0 0 13000 0 4327 0 161344 0 0 J MICHAEL GOWDER 0 147336 0 300 0 0 0 11057 0 4327 0 163020 0 0 RICHARD KELLEY 131578 0 300 0 0 0 20540 0 0 0 152418 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 DIRECTOR G. DAVID GOWDER,MD AND CHEIF OPERATING OFFICER J. MICHAEL GOWDER HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 UNION GENERAL HOSPITAL, INC., A GEORGIA 501(C)(3) NON-PROFIT HEALTHCARE ORGANIZATION, IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. THE CFO PROVIDED A COPY OF THE COMPLETED FORM 990 TO EACH BOARD MEMBER AND REVIEWED IT IN DETAIL AT A BOARD MEETING PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, AND TRUSTEES ARE REQUIRED TO ANNUALLY SIGN A STATEMENT REGARDING CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION USES THE GEORGIA ASSOCIATION COMPENSATION STUDY AS A BENCHMARK FOR ALL EXECUTIVE COMPENSATION. THE BOARD OF THE SOLE MEMBER APPROVES THE CEO'S COMPENSATION, WHICH IS PAID THROUGH THE SOLE MEMBER. ALL OTHER EXECUTIVE COMPENSATION IS MANAGED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE ORGANIZATION'S FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE BY REQUEST. FORM 990, PART VII G. DAVID GOWDER IS COMPENSATED BY A RELATED ORGANIZATION FOR SERVICES PERFORMED AS ER DIRECTOR OF THAT ORGANIZATION. NO PART OF HIS COMPENSATION IS PAID FOR HIS SERVICES AS BOARD MEMBER. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. UNION GENERAL HOSPITAL INC 214 HOSPITAL CIRCLE BLAIRSVILLE GA 30512 586025393 HOSPITAL GA 501(C)(3) LINE 3 N/A 0 MOUNTAIN COMMUNITY HEALTHCARE FOUNDATION PO BOX 509 HIAWASSEE GA 30546 201376498 SUPPORT GA 501(C)(3) LINE 11C, III-FI N/A 0 UNION GENERAL AMBULANCE SERVICE INC 35 HOSPITAL ROAD BLAIRSVILLE GA 30512 452735005 AMBULANCE SERVICE GA 501(C)(3) LINE 11B, II N/A 0 UNION COUNTY DIALYSIS LLC 214 HOSPITAL CIRCLE BLAIRSVILLE GA 30512 582503326 DIALYSIS CLINIC GA N/A 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0