2013-11-13T07:18:04-06:00 2012-12-31 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2012-01-01 650543088 COFFEE REGIONAL MEDICAL CENTER INC COFF 9123841900 1101 OCILLA ROAD/PO BOX 1287 DOUGLAS GA 31533 DON LEWIS 9123841900 2013-11-15 true JACQUELINE G ATKINS 2298837878 2013-11-12 2012 2016-02-24 21:20:13Z DON LEWIS 1101 OCILLA ROAD / PO BOX 1287 DOUGLAS GA 31533 92997358 false X WWW.COFFEEREGIONAL.ORG X 1995 GA HOSPITAL SERVICES FOR COFFEE COUNTY & SURROUNDING AREAS 11 9 830 76 0 284969 362288 89470431 78922916 649630 1955991 1837315 4127832 92242345 85369027 0 0 42678559 45293264 0 0 50599458 41726494 93278017 87019758 -1035672 -1650731 93216600 92381186 52185149 52624243 41031451 39756943 HOSPITAL SERVICES FOR COFFEE COUNTY & SURROUNDING AREAS false false 74116036 78927323 HOSPITAL SERVICES - SHORT TERM CARE FOR INPATIENT AND OUTPATIENT SERVICES FOR DOUGLAS AND COFFEE COUNTY. COFFEE REGIONAL MEDICAL CENTER SERVED 5,884 PATIENTS FOR A TOTAL OF 20,899 DAYS IN 2012. NURSERY DAYS WERE 928 IN 2012. COFFEE REGIONAL MEDICAL CENTER PROVIDED APPROXIMATELY 9,540,000 OF INDIGENT AND CHARITY SERVICES IN 2012. 74116036 true true false true false false false false false false true false false true true true false true false false true false false false false false true true false false true true false false false false false false false false false false false false false false true true false false false true 26 0 830 true false true CJ false false false false false false false false X 11 9 false false false false true true true true true false false false true true true true true true true false GA X DONALD C LEWIS 9123841900 1101 OCILLA RD DOUGLAS GA 31533 JAIME DAVIS MD 1.00 X 195103 0 31629 COLIN TOOGOOD 1.00 1.00 X 0 0 0 GABE EVANS 1.00 1.00 X 0 0 0 MATT GREER 1.00 X X 0 0 0 BRANDY WILKES 1.00 1.00 X 0 0 0 ARTHUR JOHNSON 1.00 X 0 0 0 GREG GOGGANS 1.00 X 0 0 0 MIKE WILLS 1.00 X 0 0 0 GUY MOORMAN 1.00 1.00 X 0 0 0 THAD CARTER 1.00 X 0 0 0 ANNIE FARRAR 1.00 X 0 0 0 JUSTIN HARRELL MD 1.00 X 0 0 0 GEORGE HECK 40.00 2.00 X 406294 0 65210 DONALD C LEWIS 40.00 2.00 X 264329 0 64406 BARRY BLOOM 40.00 2.00 X 139089 0 26461 SHERRY THOMAS 40.00 X 213842 0 25020 EDDY N DUNCAN MD 40.00 X 483097 0 62999 THOMAS C HENRIS MD 40.00 X 463117 0 62870 GEORGE EGOLF 40.00 X 219358 0 30736 PATRICIA COLLINS 40.00 X 218396 0 30753 STUART O'STEEN 40.00 X 215660 0 30154 2818285 430238 19 false true false REHABILITATION SPECIALISTS 169 MEADOWLARK LANE FITZGERALD GA 31750 PHYSICAL THERAP 341567 DARRELL COLLINS MD P O BOX 2109 DOUGLAS GA 31534 CARDIOLOGIST 229532 DRAFFIN & TUCKER LLP P O BOX 6 ALBANY GA 31702 ACCOUNTING 115510 3M COMPANY 2807 PAYSPHERE CIRCLE CHICAGO IL 60674 IT SUPPORT 104588 STAN SINCLAIR MD 306 WESTSIDE DRIVE DOUGLAS GA 31533 PROFESSIONAL 102981 6 275000 87288 362288 PATIENT SERVICE REVENUE 621990 78922916 78922916 78922916 820354 820354 149617 149617 149617 149617 8763868 100 7628251 80 1135617 20 1135637 1135637 EHR PAYMENT 621990 2416954 2416954 PHARMACY REVENUE 621990 919300 919300 CAFETERIA 722514 336128 336128 305833 4407 301426 3978215 85369027 78927323 6079416 X 1431383 226732 1204651 33691771 30453520 3238251 1002162 916717 85445 6852300 6135014 717286 2315648 2032958 282690 144853 144853 115510 115510 11825 11825 90916 90916 10875210 9416578 1458632 582340 48212 534128 5282418 4606230 676188 10200 10200 1516981 1358886 158095 335785 262179 73606 255339 255339 1822840 1822840 6252588 5600443 652145 1606754 383711 1223043 MEDICAL SUPPLIES 8364937 8364937 REPAIRS AND MAINT 3120611 1997178 1123433 PROVIDER TAXES 867928 867928 DUES & SUBSCRIPTIONS 177630 109333 68297 291829 125229 166600 87019758 74116036 12903722 0 3394014 1794942 8211976 8914030 240 319 741718 850522 920654 2155220 96570344 64865835 33123649 31704509 36554150 34371873 10270199 12589771 93216600 92381186 14468214 16916761 33048769 31972347 3785228 3287834 882938 447301 52185149 52624243 X 41031451 39756943 41031451 39756943 93216600 92381186 -1650731 376223 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 11825 11825 false SCHEDULE C, PART II-B, LINE 1 THE ORGANIZATION BELONGS TO GEORGIA HOSPITAL ASSOCIATION AND TO AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE ANNUAL DUES PAID ARE ALLOCATED TO THE LOBBYING ACTIVITIES OF THESE ASSOCIATIONS. 441214 441214 51373416 26639249 24734167 135514 108313 27201 44518918 38118273 6400645 101282 101282 31704509 DUE FROM RELATED PARTIES 12215423 DEFERRED FINANCING COST 374348 12589771 COST REPORT SETTLEMENTS 447301 447301 X LIABILITY UNDER FIN 48 FOOTNOTE SCHEDULE D, PAGE 3, PART X CRH HEALTH CARE, INC., EXCLUDING CRH VENTURES, INC. AND SOUTHEASTERN MANAGED CARE, INC. IS A NOT-FOR-PROFIT CORPORATION 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 CORPORATION APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE CORPORATION ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF DECEMBER 31, 2012 AND 2011 OR FOR THE YEARS THEN ENDED. 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1101 OCILLA ROAD P O BOX 1287 DOUGLAS GA 31533

X X X PHYS OFCS, RURAL HLTH CLINIC COFFEE REGIONAL MEDICAL CENTER INC 1 true true 125.0 true 200.0 true X X true true X X X X X X true false X X X X true X false false 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 COMMUNITY BUILDING ACTIVITIES PART II 5K RUN NOVEMBER 3 2012 COFFEE REGIONALS ANNUAL FALL FITNESS 5K RUNFUN WALK WAS HELD NOVEMBER 3 2012 WITH OVER 140 PARTICIPANTS IN ADDITION TO THE 5K EVENT A ONE MILE FUN RUN WAS HELD FOR THE YOUTH IN OUR COMMUNITY A CHECK FOR 1898 PROCEEDS FROM THE EVENT WAS DONATED TO THE CARDIAC REHAB AWARENESS PROGRAM APPROXIMATELY 40 MAN HOURS AT A COST OF 1000 HEALTH FAIR OCTOBER 6 2012 THE ANNUAL HEALTH SAFETY FESTIVAL HELD THE FIRST SATURDAY IN OCTOBER 2012 ATTRACTED NEARLY 1095 VISITORS WITH OVER 80 EXHIBITORS DEMONSTRATIONS AND HEALTH SCREENS THE FESTIVAL OFFERED WONDERFUL INTERACTIVE WAYS TO PROMOTE A HEALTHY LIFESTYLE 421 VISITORS TOOK ADVANTAGE OF THE COMPLETE BIOCHEMICAL BLOOD PROFILES OFFERED AT A REDUCED FEE OF 30 ACTUAL CHARGE OF 535 RESULTING IN A COMMUNITY SAVINGS OF 219885 APPROXIMATELY 100 MAN HOURS AT A COST OF 2000 SPORTS PHYSICALS APRI1 20 2012 ATHLETIC PHYSICALS ARE REQUIRED BY BOTH THE GEORGIA HIGH SCHOOL AND GEORGIA INDEPENDENT SCHOOL ASSOCIATION FOR STUDENTS PLANNING ON PARTICIPATING IN SCHOOL ATHLETIC PROGRAMS EACH YEAR COFFEE REGIONAL PROVIDES OVER 600 SPORTS PHYSICALS TO STUDENTS PARTICIPATING IN INTERSCHOLASTIC SPORTS DURING THE SUMMER AND THROUGHOUT THE FOLLOWING YEAR THIS EVENT RESULTED IN A TOTAL COST SAVINGS TO THE COMMUNITY OF OVER 15000 APPROXIMATELY 40 PHYSICIAN HOURS AND 32 STAFF HOURS AT A COST OF 6640 PROJECT SEARCH PROJECT SEARCH IS A ONEYEAR EDUCATIONAL PROGRAM FOR STUDENTS WITH DISABILITIES IN THEIR LAST YEAR OF HIGH SCHOOL IT IS TARGETED FOR STUDENTS WHOSE MAIN GOAL IS COMPETITIVE EMPLOYMENT COFFEE REGIONAL MEDICAL CENTER PROVIDES THE SETTING FOR TWELVE PROJECT SEARCH STUDENTS THUS ALLOWING TOTAL IMMERSION IN THE WORKPLACE TO FACILITATE THE TEACHING AND LEARNING PROCESS THROUGH CONTINUOUS FEEDBACK AND APPLICATION OF NEW SKILLS INDIVIDUALIZED JOB DEVELOPMENT AND PLACEMENT BEGINS AFTER ROTATIONS AT ONE OR MORE WORKSTATIONS ARE COMPLETED STUDENTS RECEIVE SUPPORT THROUGH ON THEJOB COACHING AND WORKSITE ACCOMMODATIONS PROVIDED BY COFFEE REGIONAL THE PROGRAM IS DEDICATED TO WORKFORCE DEVELOPMENT THAT BENEFITS THE INDIVIDUAL COMMUNITY AND WORKPLACE CLASSROOM SPACE AT 300MONTH TOTAL OF 2700 AND APPROXIMATELY 60 STAFF HOURS OF TRAINING MENTORING AND EDUCATION OF 12 STUDENTSYEAR AT A COST OF 1200 BREAST CANCER SUPPORT GROUP MONTHLY 2012 IN 2012 COFFEE REGIONAL OFFERED A FREE MONTHLY BREAST CANCER SUPPORT GROUP FOR WOMEN IN THE COMMUNITY RECENTLY DIAGNOSED WITH BREAST CANCER THOSE UNDERGOING TREATMENT AND THOSE WHO HAVE COMPLETED TREATMENT CRMCS CLINICAL EDUCATION DEPARTMENT LEADS AND ORGANIZES EACH MEETING PROVIDING SUPPORT EDUCATION RESOURCES AND EXPERT SPEAKERS AT EACH MEETING APPROXIMATELY 1015 PEOPLE ATTEND EACH MONTHLY MEETING 144 MAN HOURS PER YEAR AT A COST OF 2800 DIABETES SUPPORT GROUP MONTHLY 2012 COFFEE REGIONAL OFFERS A FREE MONTHLY DIABETES SUPPORT GROUP FOR THE GENERAL PUBLIC CRMCS CLINICAL EDUCATION DEPARTMENT LEADS AND ORGANIZES EACH MEETING PROVIDING SUPPORT EDUCATION RESOURCES AND EXPERT SPEAKERS AT EACH MEETING EXPERTS SUCH AS DIETICIANS PODIATRISTS AND PHYSICIANS PROVIDE VALUABLE EDUCATION TO OUR COMMUNITY REGARDING DIABETES APPROXIMATELY 30 PEOPLE ATTEND EACH MONTHLY MEETING 144 MAN HOURS PER YEAR AT A COST OF 2800 AMERICAN CANCER SOCIETY RELAY FOR LIFE APRI1 2012 CRMC PROVIDES A CORPORATE SPONSOR OF 1000 ANNUALLY TO THE AMERICAN CANCER SOCIETY FOR CANCER RESEARCH TREATMENT AND RESOURCES EACH YEAR MANY OF COFFEE REGIONAL EMPLOYEES PROVIDE NUMEROUS MAN HOURS FOR THE COMMUNITY WIDE RELAY FOR LIFE EVENT IN EFFORT TO RAISE MONEY AND AWARENESS APPROXIMATELY 180 MAN HOURS AT A COST OF 3600 COFFEE COUNTY CHILDHOOD CANCER SUPPORT GROUP 2012 CRMC PROVIDES SPACE MONTHLY FOR THE COFFEE COUNTY CHILDHOOD CANCER SUPPORT GROUP AT NO COST TO THEM THE CHILDHOOD CANCER SUPPORT GROUP IS A NON PROFIT ORGANIZATION THAT PROVIDES FAMILIES AND PATIENTS WITH CHILDHOOD CANCER SUPPORT EDUCATION RESOURCES AND EXPERT SPEAKERS AT EACH MONTHLY MEETING CLASSROOM SPACE 100 PER MONTH FOR A TOTAL OF 1200 ANNUALLY AUTISM SUPPORT GROUP OF COFFEE COUNTY 2012 CRMC PROVIDES SPACE MONTHLY FOR THE AUTISM SUPPORT GROUP OF COFFEE COUNTY AT NO COST TO THEM THE AUTISM SUPPORT GROUP IS NONPROFIT ORGANIZATION THAT PROVIDES FAMILIES AND CHILDREN SUPPORT EDUCATION RESOURCES AND EXPERT SPEAKERS AT EACH MONTHLY MEETING CLASSROOM SPACE 100 PER MONTH FOR A TOTAL OF 1200 ANNUALLY SIDELINE SERVICE 2012 CRMC PROVIDES SIDELINE SERVICE FOR EACH HIGH SCHOOL FOOTBALL GAME IN COFFEE COUNTY A FULLY EQUIPPED AMBULANCE EMT AND PARAMEDIC ARE PROVIDED FOR EACH HOME FOOTBALL GAME AS A COURTESY TO THE SCHOOL SYSTEM AND SPECTATORS AT A COST OF 250 PER GAME AND 1500YEAR COFFEE COUNTY CHAMBER OF COMMERCE NEW CENTURY LEADERS 2012 PARTICIPANTS IN NEW CENTURY LEADERS COMMIT TO AN EIGHTMONTH PROJECT THAT ALLOWS THEM TO TAKE A CLOSE LOOK AT GOVERNMENT EDUCATION ECONOMIC DEVELOPMENT AND ALL ISSUES DEALING WITH QUALITY OF LIFE ON A LOCAL AND STATE LEVEL THE PROGRAM IS DESIGNED TO HELP PARTICIPANTS DEVELOP LEADERSHIP SKILLS FOR THE WORKPLACE AND THE COMMUNITY CRMC SPONSORED 2 EMPLOYEES IN 2011 FOR THE NEW CENTURY LEADER PROGRAM STAFF TIME TRAVEL AND EXPENSES FOR THE PROGRAM IS APPROXIMATELY 3840 2 EMPLOYEES 12 DAYS OF TRAINING AT 8 HOURS PER DAY 192 STAFF HOURS203840 BAD DEBT EXPENSE EXPLANATION PART III LINE 4 AMOUNTS ON PART III LINES 2 AND 3 REPRESENT CHARGES WRITTEN OFF AS UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT AND WRITTEN OFF TO BAD DEBT EXPENSE LINE 3 IS ESTIMATED AT 75 OF THE AMOUNT ON LINE 2 EXCERPT FROM AUDITED FINANCIAL STATEMENTS ALLOWANCE FOR DOUBTFUL ACCOUNTS THE CORPORATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON AN EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE MEDICARE EXPLANATION PART III LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS COLLECTION PRACTICES EXPLANATION PART III LINE 9B THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES FOR PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS NEEDS ASSESSMENT PART VI THE ORGANIZATION EVALUATES THE NEEDS OF THEIR PATIENT BASE THROUGH THE NUMBER OF PATIENTS REFERRED TO OTHER FACILITIES FOR SERVICES NOT PROVIDED BY THE FACILITY ITSELF AND THROUGH OTHER INDICATORS PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI FINANCIAL COUNSELING DEPARTMENT WILL PROVIDE INFORMATION AND APPLICATIONS TO ALL PATIENTSGUARANTORS SEEKING FINANCIAL ASSISTANCE FOR SERVICES RENDERED AT COFFEE REGIONAL MEDICAL CENTER THAT ARE DEEMED MEDICALLY NECESSARY FINANCIAL COUNSELORS WILL DISCUSS ELIGIBILITY FOR MEDICAL ASSISTANCE PROGRAMS THROUGH THE DEPARTMENT OF FAMILY CHILDREN SERVICES AND SOCIAL SECURITY ADMINISTRATION IF ELIGIBILITY IS NOT MET FOR ANY MEDICAL ASSISTANCE PROGRAM THE FINANCIAL COUNSELING DEPARTMENT WILL SEEK ELIGIBILITY THROUGH COFFEE REGIONAL MEDICAL CENTERS INDIGENT CARE TRUST FUND PROGRAM PATIENTSGUARANTORS REQUESTING FINANCIAL ASSISTANCE ARE REFERRED TO THE FINANCIAL COUNSELORS FC OR BENEFIT SPECIALIST AT THE TIME OF REGISTRATION FOR OUTPATIENT SERVICES AND EMERGENCY DEPARTMENT AFTER MEDICAL SCREENING HAS BEEN COMPLETED SOCIAL SERVICES REQUEST PHYSICIAN OFFICES REQUEST OR FROM THE PATIENT FINANCIAL SERVICES DEPARTMENT PATIENTS ADMITTED FOR INPATIENT OR OBSERVATION SERVICES MAY BE VISITED BY THE FC AFTER THE PATIENT HAS BEEN PLACED IN A ROOM AND STABILIZED FC WILL DISCUSS WITH THE PATIENTGUARANTOR THE INDIGENT CARE TRUST FUND PROGRAM REQUIREMENTS AND APPLICATION PROCESS THE PATIENTGUARANTOR WILL BE REQUIRED TO COMPLETE AN INDIGENT APPLICATION PROVIDE PROOF OF IDENTITY PROVIDE BIRTH CERTIFICATES OR PROOF OF DEPENDENCY FOR CHILDREN WITH NO IDENTITY AND PROVIDE VERIFICATION OF INCOME IE W2S FEDERAL TAX RETURN PAY STUBS ETC IF VERIFICATION IS NOT PROVIDED AT THE TIME OF THE INTERVIEW THE PATIENTGUARANTOR WILL BE REQUIRED TO PROVIDE WITHIN 30 DAYS APPLICATIONS MADE ON BEHALF OF DECEASED PATIENTS MUST HAVE VERIFICATION OF INCOME AND INFORMATION CONCERNING THE VALUE OF THE PATIENTS ESTATE PATIENTS WHO CHOOSE NOT TO UTILIZE CURRENT BENEFITS THEY ARE ELIGIBLE FOR IE VETERANS BENEFITS MEDICARE AND COMMERCIAL INSURANCE WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM UPON RECEIPT OF THE COMPLETED APPLICATION INCLUDING NECESSARY DOCUMENTATION CALCULATION OF THE HOUSEHOLD SIZE AND ANNUAL HOUSEHOLD INCOME IS COMPUTED AND COMPARED TO THE FEDERAL POVERTY GUIDELINES FPG TO DETERMINE THE PERCENTAGE OF ASSISTANCE A PATIENTGUARANTOR IS ELIGIBLE TO RECEIVE PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW THE GROSS INCOME CEILING FOR POTENTIAL MEDICAID ELIGIBILITY ARE REQUIRED TO APPLY FOR MEDICAID ASSISTANCE IS PROVIDED TO PATIENTS IN FILING FOR OTHER BENEFITS AND COMPLETING MEDICAID APPLICATIONS PATIENTS WHO CHOOSE NOT TO APPLY FOR OTHER BENEFITS TO WHICH THEY MAY BE ENTITLED IE MEDICAID APPLICATIONS WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM PATIENTS WHO CHOOSE TO APPLY COFFEE REGIONAL MEDICAL CENTERS ACCOUNTS FOR THE PURPOSE OF MEETING MEDICALLY NEEDY SPEND DOWN TO RECEIVE ONGOING MEDICAID WILL NOT BE ALLOWED TO APPLY FOR THE INDIGENT PROGRAM FOR THAT ACCOUNT PATIENTSGUARANTORS OVER 18 YEARS OF AGE BUT CLASSIFIED AS DEPENDENTS FOR TAX PURPOSES DUE TO STUDENT ELIGIBILITY WILL HAVE A TOTAL HOUSEHOLD SIZE INCLUDING PARENTS AND SUBSEQUENT INCOME PATIENTSGUARANTORS NOT ELIGIBLE FOR OTHER MEDICAL ASSISTANCE PROGRAMS WILL BE PROCESSED UNDER THE INDIGENT CARE TRUST FUND GUIDELINES USING THE FOLLOWING CATEGORIES INDIGENT PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW 125 OF THE FPG THE APPLICABLE ACCOUNTS WILL BE ADJUSTED TO ZERO BALANCES CHARITY PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN OR EQUAL TO 125 BUT NOT GREATER THAN 200 OF THE FPG THE APPLICABLE ACCOUNTS WILL BE ADJUSTED BY THE APPROPRIATE PERCENTAGES AN ADJUSTMENT OF 85 OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 125 AND 150 OF FPG AN ADJUSTMENT OF 70 OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 150 AND 175 OF FPG AN ADJUSTMENT OF 55 OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 175 AND 200 OF FPG CATASTROPHIC PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN 200 FPG MAY QUALIFY FOR CHARITY ADJUSTMENTS ON APPLICABLE ACCOUNTS IF CONSIDERATION OF CRMC PATIENT OBLIGATIONS REDUCES THE ANNUAL HOUSEHOLD INCOME TO THE APPROPRIATE FPG NOTIFICATION OF STATUS OF COMPLETED APPLICATION IS PROVIDED TO THE PATIENTGUARANTOR WITHIN 5 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION APPROVED APPLICATIONS ARE VALID FOR 30 DAYS FROM DATE OF SIGNATURE INCOMPLETE APPLICATIONS ARE HELD FOR 30 DAYS IF NO DOCUMENTATION IS PROVIDED TO COMPLETE THE APPLICATION A DENIAL LETTER IS SENT TO THE PATIENTGUARANTOR THE APPLICATION MAY BE COMPLETED IF THE PATIENTGUARANTOR PROVIDES THE REQUESTED INFORMATION WITHIN 15 WORKING DAYS OF THE DENIAL NOTIFICATION OF STATUS OF COMPLETED APPLICATION WILL BE MAILED WITHIN 15 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION NO CONSIDERATION FOR ELIGIBILITY WILL BE REVIEWED FOR ACCOUNTS REFERRED TO OUTSIDE COLLECTION AGENCIES THE APPLICATION AND DOCUMENTATION WILL BECOME PROPERTY OF COFFEE REGIONAL MEDICAL CENTER AND IS TO BE KEPT CONFIDENTIAL IN THE SAME MANNER AS MEDICAL RECORDS HOWEVER THIS INFORMATION WILL BE USED FOR AGGREGATE REPORTING PURPOSES ONLY COMMUNITY INFORMATION PART VI COFFEE REGIONAL MEDICAL CENTERS PRIMARY SERVICE AREA IS COFFEE COUNTY THE COUNTY HAD A POPULATION OF 44257 CITIZENS IN DECEMBER OF 2012 OF WHICH APPROXIMATELY 2029 FALL BELOW GOVERNMENTAL DEFINED POVERTY GUIDELINES COFFEE COUNTYS UNEMPLOYMENT RATE AT YEAREND WAS 131 HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI COFFEE REGIONAL MEDICAL CENTER IS GOVERNED BY A BOARD OF DIRECTORS CONSISTING OF 11 MEMBERS THE COFFEE COUNTY HOSPITAL AUTHORITY NOMINATES POTENTIAL BOARD MEMBERS AS OPENINGS ARISE THE BOARDS MAKEUP IS NINE COMMUNITY MEMBERS REFLECTING THE DIVERSITY OF THE COMMUNITY THE REMAINING TWO MEMBERS ARE THE CHIEF OF STAFF AND CHIEF OF STAFF ELECT IT IS THE PHILOSOPHY OF COFFEE REGIONAL MEDICAL CENTER TO ASSURE THE CONTINUATION AND ENHANCEMENT OF PATIENT CARE BY REINVESTING EXCESS FUNDS BACK INTO THE OPERATIONS OF THE FACILITY THIS INCLUDES GREATER ACCESSIBILITY OF CARE THROUGH THE CREATION OF A RURAL HEALTH CENTER IMPLEMENTATION OF A TELEMEDICINE PROGRAM AND RECRUITMENT OF PHYSICIANS TO THE UNDERSERVED ENVIRONMENT ENHANCEMENT OF TECHNOLOGY IS ALSO IMPERATIVE TO ASSURE APPROPRIATE DIAGNOSTIC AND THERAPEUTIC OPTIONS FOR THE COMMUNITY UPDATING THE AMBULANCE FLEET IS CONSISTENTLY HIGH ON THE FUNDING PRIORITY LIST TO ASSURE SERVICE TO THE MOST REMOTE AREAS OF THE COUNTY WHICH IN SQUARE MILES IS THE SECOND LARGEST COUNTY IN THE STATE OF GEORGIA LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED PART VI GEORGIA COFFEE REGIONAL MEDICAL CENTER INC LINE NUMBER 1 PART V LINE 20D PART V LINE 20D THE HOSPITAL FACILITY DISCOUNTS CHARGES BASED ON A SLIDING FEE SCALE WHICH COMPARES THE APPLICANTS ANNUAL HOUSEHOLD INCOME TO FEDERAL POVERTY GUIDELINES CHARGES ARE REDUCED AS MUCH AS 55 IN ACCORDANCE WITH THE FACILITYS FINANCIAL ASSISTANCE POLICY X X X X X false false false false false false false false false JAIME DAVIS MD 172157 22932 14 9897 21732 226732 GEORGE HECK 397046 9248 12500 52710 471504 DONALD C LEWIS 261578 2751 12500 51906 328735 BARRY BLOOM 139051 38 7292 19169 165550 SHERRY THOMAS 213732 110 11112 13908 238862 EDDY N DUNCAN MD 483072 25 12500 50499 546096 THOMAS C HENRIS MD 463079 38 12500 50370 525987 GEORGE EGOLF 219182 176 11192 19544 250094 PATRICIA COLLINS 218325 71 11192 19561 249149 STUART O'STEEN 215645 15 11097 19057 245814 A COFFEE COUNTY HOSPITAL AUTHORITY 586003116 192137DJ3 2004-11-16 39213858 DEFEASEMENT OF PREVIOUS BONDS false false false A 7241511 39213858 767435 38446423 2004 false true true true A false false false false false false false true A false false false false false false false false false A false FINANCIAL ACCOUNTS IN FOREIGN COUNTRIES FORM 990, PART V, LINE 4B CAYMAN ISLANDS CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 CRH HEALTHCARE CAN APPOINT BOARD MEMBERS. ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A BOARD MEMBERS OF THE ORGANIZATION ARE APPOINTED, AND CAN BE REMOVED, BY CRH HEALTH CARE, INC., THE PARENT ORGANIZATION. DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B DECISIONS OF THE BOARD ARE SUBJECT TO APPROVAL BY CRH HEALTH CARE, INC., THE PARENT ORGANIZATION. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B A COPY OF FORM 990 IS PROVIDED TO THE BOARD FOR THEIR REVIEW UPON REQUEST. MANAGEMENT'S REVIEW OF FORM 990 IS PERFORMED BEFORE THE FILING DATE AND INCLUDES A DETAILED REVIEW OF FINANCIAL DATA AND RESPONSES/NARRATIVES. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS ANNUALLY. THIS IS REVIEWED BY THE CEO AND BOARD CHAIRMAN, IF NEEDED. MEMBERS ARE REQUIRED TO RECUSE THEMSELVES FROM CERTAIN DISCUSSIONS/DECISIONS AS A RESULT OF CONFLICTS. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A THE BOARD'S COMPENSATION COMMITTEE REVIEWS COMPENSATION DATA FROM SEVERAL SOURCES. IN 2011, YAFFE AND ASSOCIATES WAS ENGAGED TO PROVIDE THE CEO/VP'S COMPENSATION ANALYSIS. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B SEE RESPONSE FOR LINE 15A ABOVE. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS OF THE ORGANIZATION ARE ALL AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S CORPORATE OFFICE. OTHER FEES FOR SERVICES FORM 990, PART IX, LINE 11G PROFESSIONAL FEES 3,806,084 80,398 0 PURCHASED SERVICES 5,240,040 529,276 0 COLLECTION AGENCY 220,452 0 0 MONITORING FEES 16,267 0 0 CONSULTING 92,826 531,567 0 RECRUITING 40,909 317,391 0 CRH PHYSICIAN PRACTICES 1101 OCILLA ROAD DOUGLAS GA 31533 205778734 PHY OFC GA 7712668 1680717 CRMC COFFEE REGIONAL MEDICAL CENTER CRH HEALTH CARE INC 1101 OCILLA ROAD P O BOX 1287 DOUGLAS GA 31533 582163724 MGMT SVC GA 501C3 11C NA false CRH HEALTH SERVICES INC 1101 OCILLA ROAD P O BOX 1287 DOUGLAS GA 31533 582165827 FOUNDATION GA 501C3 11B NA false CRH VENTURES INC 1101 OCILLA ROAD P O BOX 1287 DOUGLAS GA 31533 582165279 OFC RENTAL GA N/A false SOUTHEASTERN MANAGED CARE INC 1101 OCILLA ROAD P O BOX 1287 DOUGALS GA 31533 582236627 MNGD CARE GA N/A false false false false false false false false false false true false true false true true false false false false