ARCHBOLD MEDICAL CENTER INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- ARCHBOLD MEDICAL CENTER INC (EIN 58-1552650)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-01
- IRS object ID
- 201322139349300032
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-01T12:59:20-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | 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 | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581552650 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARCHBOLD MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ARCH | NameControl |
| Phone | 2292282229 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 1018 | AddressLine1 |
| City | THOMASVILLE | City |
| State | GA | State |
| ZIP Code | 317991018 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | J PERRY MUSTIAN | Name |
| Title | PRESIDENT | Title |
| Phone | 2292282229 | Phone |
| Date Signed | 2013-08-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACQUELINE G ATKINS | Name |
| Phone | 2298837878 | Phone |
| Date Prepared | 2013-08-01 | 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 | J PERRY MUSTIAN PRESIDENTCEO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 1018 | AddressLine1 |
| City | THOMASVILLE | City |
| State | GA | State |
| ZIP Code | 317991018 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 23316644 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.ARCHBOLD.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | HEALTHCARE MANAGEMENT | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 26 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 3092 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 21246944 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 23316644 | ProgramServiceRevenueCY |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 21246944 | TotalRevenuePriorYear |
| Total Revenue Current Year | 23316644 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 11172559 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12358312 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 10074385 | OtherExpensePriorYear |
| Other Expenses Current Year | 10958332 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 21246944 | TotalExpensesPriorYear |
| Total Expenses Current Year | 23316644 | TotalExpensesCurrentYear |
| Revenues Less Expenses CY | 0 | RevenuesLessExpensesCY |
| Total Assets BOY | 29303850 | TotalAssetsBOY |
| Total Assets EOY | 29021396 | TotalAssetsEOY |
| Total Liabilities BOY | 29303850 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 29021396 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances EOY | 0 | NetAssetsOrFundBalancesEOY |
| Mission Description | HEALTHCARE MANAGEMENT | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 23316644 | Expense |
| Revenue | 23316644 | Revenue |
| Description | HEALTHCARE MANAGEMENT. | Description |
| Total Program Service Expense | 23316644 | 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 | false | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | 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 | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| 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 | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | 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 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 3092 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| 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 | 26 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | 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 | false | InvestmentInJointVenture |
| 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 | CHARLES D HIGHTOWERJR | NamePerson |
| Telephone Number | 2292282737 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1018 | AddressLine1 |
| City | THOMASVILLE | City |
| State | GA | State |
| ZIP Code | 317991018 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (40 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| J PERRY MUSTIAN | ||||||||
| PRESIDENT | 40.00 | X | X | 758554 | 0 | 1261563 | ||
| WILLIAM W ELLIS MD | ||||||||
| TRUSTEE | 1.00 | X | 52620 | 0 | 0 | |||
| MERRILL HICKS JR MD | ||||||||
| TRUSTEE | 1.00 | X | 3000 | 0 | 0 | |||
| DANIEL E AUTRY | ||||||||
| TRUSTEE/CHAI | 1.00 | X | X | 0 | 0 | 0 | ||
| NATHANIEL H ABRAMS JR | ||||||||
| TRUSTEE/SECR | 1.00 | X | X | 0 | 0 | 0 | ||
| POWELL JONES | ||||||||
| CHARIMAN/VIC | 1.00 | X | X | 0 | 0 | 0 | ||
| TOM CALLAWAY | ||||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | ||
| BRYANT BEADLES | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| CALVIN J REAMS MD | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| CHARLES HANCOCK MD | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| JOHN B CARICO MD | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| GARY BONVILLIAN PHD | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| GATES KIRKHAM | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| IMOGENE CONYERS | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| JEAN MORGAN HATHAWAY | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| VICTOR M MCMILLIAN MD | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| RODNEY DEESE | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| RICHARD L SINGLETARY JR | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| ROBERT THOMAS III | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| STEPHANIE TILLMAN | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| STEPHEN H CHENEY | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| STEPHEN R AVERA | ||||||||
| VICE CHAIR/T | 1.00 | X | X | 0 | 0 | 0 | ||
| PAT VOSS | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| TIMOTHY A JONES MD | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| PAUL STEINBERG MD | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| WALLACE GOODMAN | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| RUSSELL P CHUBB | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| ROBERT D MILES JR MD | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| KAREN BRAMBLETT MD | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| RICHARD MOONEY III | ||||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |||
| DAVID ROBBINS | ||||||||
| ASST SEC/VP | 40.00 | X | 628209 | 0 | 96968 | |||
| CHARLES HIGHTOWER | ||||||||
| ASST SEC/CFO | 40.00 | X | 410660 | 0 | 44636 | |||
| W CLAY CAMPBELL | ||||||||
| VICE PRESIDE | 1.00 | X | 0 | 228878 | 26541 | |||
| FRANCES PARKER | ||||||||
| VICE PRESIDE | 1.00 | X | 0 | 208026 | 38120 | |||
| ZACH WHEELER | ||||||||
| VP HUMAN RES | 40.00 | 286369 | 0 | 280405 | X | |||
| RICK IVEY | ||||||||
| VP PUBLIC AF | 40.00 | 173902 | 0 | 22994 | X | |||
| LYNNE FRITZ BYRD | ||||||||
| VP REV MGMT | 40.00 | 170213 | 0 | 34041 | X | |||
| ALMEDA SIMPSON | ||||||||
| VP CLINICAL | 40.00 | 161710 | 0 | 24135 | X | |||
| CARLA PEARCE | ||||||||
| CONTROLLER | 40.00 | 139083 | 0 | 19159 | X | |||
| WILLIAM ZIMMERMANN | ||||||||
| SR VP/CIO | 40.00 | 111653 | 0 | 17293 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2895973 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 436904 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1865855 | TotalOtherCompensation |
| Number Individuals GT100 K | 12 | 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 |
|---|---|---|---|---|---|
| SHARED MEDICAL SYSTEMS | |||||
| 51 VALLEY STREAM PKWY | MALVERN | PA | 19355 | SOFTWARE MAINT | 2822319 |
| CASH RETRIEVER | |||||
| 2 CHASE CORPORATE DRIVE SUITE 240 | BIRMINGHAM | AL | 35244 | COLLECTION SVC | 284536 |
| SCC SOFT COMPUTER | |||||
| 5400 TECH DATA DRIVE | CLEARWATER | FL | 33760 | SOFTWARE MAINT | 254939 |
| LAWSON SOFTWARE AMERICAS INC | |||||
| 641 AVENUE OF THE AMERICAS | NEW YORK | NY | 10011 | SOFTWARE MAINT | 249327 |
| ALEXANDER & VANN LLP | |||||
| 411 GORDON AVENUE | THOMASVILLE | GA | 31792 | LEGAL SVCS | 225149 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | HEALTHCARE MANAGEMENT FEES | Description |
| Business Code | 561000 | BusinessCode |
| Total Revenue Column | 23316644 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23316644 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 23316644 | TotalProgramServiceRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 23316644 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23316644 | RelatedOrExemptFunctionIncome |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1928590 | Total |
| Program Services | 1928590 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7500839 | Total |
| Program Services | 7500839 | ProgramServices |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 204098 | Total |
| Program Services | 204098 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2117414 | Total |
| Program Services | 2117414 | ProgramServices |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 607371 | Total |
| Program Services | 607371 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 605762 | Total |
| Program Services | 605762 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 270286 | Total |
| Program Services | 270286 | ProgramServices |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 243463 | Total |
| Program Services | 243463 | ProgramServices |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 195082 | Total |
| Program Services | 195082 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2927844 | Total |
| Program Services | 2927844 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12365 | Total |
| Program Services | 12365 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 940584 | Total |
| Program Services | 940584 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4415767 | Total |
| Program Services | 4415767 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 234982 | Total |
| Program Services | 234982 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9465 | Total |
| Program Services | 9465 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| CONTINGENCY | 941481 | 941481 |
| RECRUITMENT | 87178 | 87178 |
| MISCELLANEOUS | 47323 | 47323 |
| REPAIRS & MAINTENANCE | 25147 | 25147 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1603 | Total |
| Program Services | 1603 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23316644 | Total |
| Program Services | 23316644 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2943941 | BOY |
| EOY | 4498308 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26359909 | BOY |
| EOY | 24523088 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29303850 | BOY |
| EOY | 29021396 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22048331 | BOY |
| EOY | 24477046 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7255519 | BOY |
| EOY | 4544350 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29303850 | BOY |
| EOY | 29021396 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29303850 | BOY |
| EOY | 29021396 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 0 | ReconcilationRevenueExpenses |
| 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) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN D ARCHBOLD MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 580566121 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | true | ListedInGoverningDoc |
| Supported Organization Notified | true | SupportedOrganizationNotified |
| Organized In US | true | OrganizedInUS |
| Amount | $23,608,512 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 4 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 24922299 | SumOfAmounts |
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 | true | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | true | DirectContactLegislators |
| Direct Contact Legislators | $175,691 | DirectContactLegislatorsAmount |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $67,774 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 243465 | 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 | LOBBYING ACTIVITIES INCLUDE THE MEDICAL CENTER'S MEMBERSHIP IN THE GEORGIA ALLIANCE OF COMMUNITY HOSPITALS, A PORTION OF THE AMERICAN HOSPITAL ASSOCIATION AND GEORGIA HOSPITAL ASSOCIATION DUES AND A PORTION OF SALARIES DIRECTLY RELATED TO LOBBYING. | 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 |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE FROM JDAMH, INC. | Description |
| Book Value | 24523088 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 24523088 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO RELATED PARTIES | Description |
| Amount | $4,544,350 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 4544350 | TotalOfAmounts |
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 | THE MEDICAL CENTER, WITH THE EXCEPTION OF ARCHBOLD MEDICAL ENTERPRISES, INC., IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX- EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER 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 MEDICAL CENTER 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 SEPTEMBER 30, 2012 AND 2011 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTER'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2009-2011. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | 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 | true | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | true | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|
| J PERRY MUSTIAN | |||||||||||
| 528111 | 220500 | 9943 | 1239049 | 22514 | 2020117 | ||||||
| DAVID ROBBINS | |||||||||||
| 343056 | 83399 | 201754 | 75750 | 21218 | 725177 | ||||||
| CHARLES HIGHTOWER | |||||||||||
| 286769 | 88092 | 35799 | 21852 | 22784 | 455296 | ||||||
| W CLAY CAMPBELL | |||||||||||
| 179780 | 40633 | 8465 | 13283 | 13258 | 255419 | ||||||
| FRANCES PARKER | |||||||||||
| 156073 | 32506 | 19447 | 17237 | 20883 | 246146 | ||||||
| ZACH WHEELER | |||||||||||
| 211648 | 73011 | 1710 | 263673 | 16732 | 566774 | ||||||
| RICK IVEY | |||||||||||
| 172321 | 1581 | 15747 | 7247 | 196896 | |||||||
| LYNNE FRITZ BYRD | |||||||||||
| 131966 | 37005 | 1242 | 13981 | 20060 | 204254 | ||||||
| ALMEDA SIMPSON | |||||||||||
| 140588 | 19075 | 2047 | 18665 | 5470 | 185845 | ||||||
| CARLA PEARCE | |||||||||||
| 121846 | 17032 | 205 | 8498 | 10661 | 158242 | ||||||
| WILLIAM ZIMMERMANN | |||||||||||
| 61977 | 49676 | 16223 | 1070 | 128946 | |||||||
Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FRINGE OR EXPENSE EXPLANATION | SCHEDULE J, PAGE 1, PART I, LINE 1A | SOCIAL CLUB DUES ARE PAID BY THE ORGANIZATION ON BEHALF OF OFFICERS AND EXECUTIVES OF THE FILING ORGANIZATION. ADDITIONALLY, THESE OFFICERS AND EXECUTIVES ARE REIMBURSED MILEAGE. THESE AMOUNTS ARE INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME AND REPORTED ON THEIR W-2. THE ORGANIZATION'S POLICY FOR COMPANION TRAVEL INCLUDES THE REIMBURSEMENT OF REGISTRATION, TRAVEL AND ENTERTAINMENT EXPENSES FOR GUESTS WHO ACCOMPANY BOARD TRUSTEES TO EITHER OF TWO ANNUAL TRUSTEE CONFERENCES. RECEIPTS MUST BE SUBMITTED PRIOR TO REIMBURSEMENT AND THE AMOUNTS ARE NOT INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME. |
| SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS | SCHEDULE J, PAGE 1, PART I, LINE 4 | J. PERRY MUSTIAN 0 1,217,000 0 DAVID ROBBINS 0 55,000 0 ZACH WHEELER 0 244,000 0 |
| COMPENSATION CONTINGENT UPON NET EARNINGS OF ORGANIZATION | SCHEDULE J, PAGE 1, PART I, LINE 6A | CONTINGENT IN PART ON MEETING MANAGEMENT BY OBJECTIVE INCENTIVE PLAN GOALS AND EXCESS OF REVENUE OVER EXPENSES. |
| COMPENSATION CONTINGENT UPON NET EARNINGS OF RELATED ORG | SCHEDULE J, PAGE 1, PART I, LINE 6B | SEE RESPONSE FOR 6A ABOVE. |
| OTHER ADDITIONAL INFORMATION | SCHEDULE J, PART III | THE IRS RULES & REGULATIONS REQUIRE THAT CERTAIN NON-CURRENT, NON-CASH ITEMS ARE REPORTED IN PART II OF FORM 990 REGARDLESS OF THE CURRENT BENEFIT TO THE EMPLOYEE. THESE SAME RULES, IN SOME CASES, REQUIRE THE COMPENSATION AND BENEFITS TO BE REPORTED TWICE IN PART II, ONCE WHEN THE ENTITY ACCRUES FOR A FUTURE PAYMENT AND ONCE WHEN THE PAYMENT IS ACTUALLY MADE TO THE EMPLOYEE. THEREFORE, AN EMPLOYEE'S STATED TOTAL COMPENSATION AND BENEFITS REPORTED ON PART II ARE SUBSTANTIALLY HIGHER THAN THE ACTUAL CASH COMPENSATION RECEIVED IN THE CURRENT YEAR. AMOUNTS REPORTED AS BENEFITS INCLUDE AMOUNTS FOR LIFE INSURANCE, HEALTH INSURANCE, THRIFT PLAN CONTRIBUTIONS, AND PENSION CONTRIBUTIONS. BENEFITS RELATED TO PENSION AND RETIREMENT PLANS REFLECT AMOUNTS ACCUMULATED, BUT NOT PAID, TO THE INDIVIDUAL IN RECOGNITION OF TOTAL YEARS OF EMPLOYMENT, NOT JUST THE CURRENT YEAR. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN THREE OF THE ORGANIZATION'S TOP EXECUTIVES PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS ACCRUED BUT UNFUNDED IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON-QUALIFIED RETIREMENT PLAN. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (7 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| JOSHUA REAMS MD | |||
| FAM MBR/TRUSTEE | 200904 | EMPLOYEE COMP | false |
| DANIEL E AUTRY JR | |||
| FAM MBR/TRUSTEE | 79877 | EMPLOYEE COMP | false |
| THOMAS J CALLAWAY III | |||
| TRUSTEE | 8084708 | INVESTMENT MANAGER | false |
| STEPHEN CHENEY | |||
| TRUSTEE | 199733013 | BANKING RELATIONSHIP | false |
| POWELL JONES | |||
| TRUSTEE | 6619019 | BANKING RELATIONSHIP | false |
| RICHARD L SINGLETARY JR | |||
| TRUSTEE | 199733013 | BANKING RELATIONSHIP | false |
| RUSSELL CHUBB | |||
| TRUSTEE | 6619019 | BANKING RELATIONSHIP | false |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE L PART V | ReturnReference |
| Explanation | JOSHUA REAMS MD THE SON OF BOARD TRUSTEE CALVIN REAMS MD IS EMPLOYED BY JDAMH A RELATED ORGANIZATION AND IS COMPENSATED BY THE FILING ORGANIZATION DANIEL AUTRY JR THE SON OF BOARD TRUSTEE DANIEL E AUTRY IS EMPLOYED BY AMG A RELATED ORGANIZATION AND IS COMPENSATED BY THE FILING ORGANIZATION THOMAS J CALLAWAY III IS THE INVESTMENT MANAGER FOR AMCS SERP ACCOUNT THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 93012 FOR THE FILING AND ALL RELATED ORGANIZATIONS STEPHEN CHENEY IS THE PRESIDENT OF THOMASVILLE NATIONAL BANK TNB THE FILING ORGANIZATION UTILIZES TNBS BANKING SERVICES AND ONSITE THRIFT PLAN SERVICE THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 93012 FOR THE FILING AND ALL RELATED ORGANIZATIONS POWELL JONES AND RUSSELL CHUBB ARE BOARD DIRECTORS OF COMMERCIAL BANK THE FILING ORGANIZATION UTILIZES THE BANKING SERVICES OF COMMERCIAL BANK THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 93012 FOR THE FILING AND ALL RELATED ORGANIZATIONS RICHARD L SINGLETARY JR IS THE CHAIRMAN OF THOMASVILLE NATIONAL BANK THE FILING ORGANIZATION UTILIZES TNBS BANKING SERVICES AND ONSITE THRIFT PLAN SERVICE THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 93012 FOR THE FILING AND ALL RELATED ORGANIZATIONS | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| RELATED PARTY INFORMATION AMONG OFFICERS | FORM 990, PAGE 6, PART VI, LINE 2 | DANIEL E. AUTRY ROBERT THOMAS III BD MEMBER BD MEMBER BUSINESS RELATIONSHIP STEPHEN CHENEY RICHARD L. SINGLETARY, JR BD MEMBER BD MEMBER BUSINESS RELATIONSHIP WILLIAM W. ELLIS, MD ROBERT D. MILES JR., MD BD MEMBER BD MEMBER BUSINESS RELATIONSHIP VICTOR M. MCMILLAN, MD ROBERT THOMAS III BD MEMBER BD MEMBER BUSINESS RELATIONSHIP |
| CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PAGE 6, PART VI, LINE 6 | THE ORGANIZATION HAS ONE CLASS OF MEMBERS WHICH SHALL BE LIFE MEMBERS. THE RIGHTS OF THE LIFE MEMBERS SHALL BE AS PROVIDED IN THE LAWS OF THE STATE OF GEORGIA, THE ARTICLES OF INCORPORATION AND THE BYLAWS OF ARCHBOLD MEDICAL CENTER, INC. ("AMC"). EACH LIFE MEMBER HAS ONE VOTE WITH RESPECT TO THE ELECTION OF TRUSTEES OF AMC. |
| ELECTION OF MEMBERS AND THEIR RIGHTS | FORM 990, PAGE 6, PART VI, LINE 7A | THE LIFE MEMBERS OF THE FILING ORGANIZATION ANNUALLY ELECT THE TRUSTEES OF THE GOVERNING BODY. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | PRIOR TO FILING THE FORM 990, THE ORGANIZATION PRESENTED ITS FORM 990 TO TRUSTEES ATTENDING THE JULY 2013 REGULARLY SCHEDULED BOARD MEETING. THE ORGANIZATION'S CFO PRESENTED THE INFORMATION, AND TRUSTEES HAD THE OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | ON AN ANNUAL BASIS, THE ORGANIZATION DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE AND DISCLOSURE STATEMENT TO EACH TRUSTEE. THIS QUESTIONNAIRE INCLUDES QUESTIONS RELATED TO FINANCIAL INTERESTS, OUTSIDE INTERESTS OR ACTIVITIES, AND GIFTS, MEALS, AND ENTERTAINMENT. IN ADDITION TO DISCLOSING ANY APPLICABLE INFORMATION ON THE QUESTIONNAIRE, THE TRUSTEE SIGNS AN ACKNOWLEDGMENT STATEMENT THAT (S)HE HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ, UNDERSTANDS, AND AGREES TO COMPLY WITH IT, AND UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION STATUS IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. RESPONSES ARE SUMMARIZED AND COLLECTIVELY REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE OF ARCHBOLD MEDICAL CENTER, INC. DURING EACH BOARD MEETING, THE CHAIRMAN INQUIRES IF ANY TRUSTEE HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST RELATED TO ANY AGENDA ITEM. IF THE TRUSTEE DISCLOSES ANY SUCH INTEREST, THE TRUSTEE IS EXCUSED FROM THE MEETING WHILE THE DETERMINATION AS TO WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS IS DISCUSSED AND VOTED UPON BY DISINTERESTED MEMBERS OF THE BOARD AND COMMITTEE. IF INVITED TO DO SO, THE TRUSTEE WITH A POTENTIAL CONFLICT MAY RESPOND TO QUESTIONS PUT FORTH BY FELLOW DISINTERESTED TRUSTEES REGARDING ANY PROPOSED TRANSACTION OR ARRANGEMENT. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS WILL CONTAIN THE NAME OF ANY INTERESTED PERSON/TRUSTEE WHO DISCLOSED OR WAS FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH A TRANSACTION OR ARRANGEMENT RESULTING IN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; AND THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATED TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSIONS, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | ARCHBOLD MEDICAL CENTERS COMPENSATION COMMITTEE MAKES RECOMMENDATIONS TO THE FULL BOARD ON THE FOLLOWING POSITIONS: THE PRESIDENT OF ARCHBOLD MEDICAL CENTER; THE PRESIDENT OF THE ARCHBOLD FOUNDATION; AND THE PRESIDENT OF ARCHBOLD HEALTH SERVICES. ARCHBOLD MEDICAL CENTERS PRESIDENT ALSO PRESENTS RECOMMENDATIONS FOR ALL SENIOR VICE PRESIDENTS AND HOSPITAL VICE PRESIDENTS TO THE COMPENSATION COMMITTEE. IN 2008, INTEGRATED HEALTHCARE SOLUTIONS (IHS) WAS ENGAGED BY THE BOARD TO REVIEW THE EXECUTIVE COMPENSATION PROGRAM AND MAKE RECOMMENDATIONS REGARDING PLAN DESIGN AND ACTUAL COMPENSATION INCLUDING BENEFITS. IN 2009, IHS PROVIDED UPDATED RECOMMENDATIONS ON COMPENSATION TO THE COMPENSATION COMMITTEE. FOR YEARS 2010-2012, THE BOARD CONTINUED TO UTILIZE IHS TO PERFORM MARKET ANALYSIS, REVIEW EXECUTIVE COMPENSATION, AND MAKE RECOMMENDATIONS. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | SEE RESPONSE TO 15A ABOVE. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | NO DOCUMENTS ARE OR WILL BE AVAILABLE TO THE PUBLIC. |
| RELATED ORGANIZATIONS | FORM 990, PAGE 7, PART VII | AVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS: J. PERRY MUSTIAN 9 HOURS CHARLES HIGHTOWER 9 HOURS WILLIAM CAMPBELL 40 HOURS BRYANT BEADLES 1 HOUR CHARLES HANCOCK 1 HOUR DANIEL AUTRY 2 HOURS FRANCES PARKER 40 HOURS GARY BONVILLIAN 1 HOUR GATES KIRKHAM 1 HOUR IMOGENE CONYERS 1 HOUR JEAN HATHAWAY 1 HOUR NATHANIEL ABRAMS 1 HOUR RICHARD MOONEY 1 HOUR RICHARD SINGLETARY 1 HOUR ROBERT MILES 1 HOUR TIMOTHY JONES 1 HOUR TOM CALLAWAY 1 HOUR W. MERRILL HICKS 1 HOUR WALLACE GOODMAN 2 HOURS JOHN CARICO 1 HOUR KAREN BRAMBLETT 1 HOUR PAT VOSS 1 HOUR POWELL JONES 1 HOUR VICTOR MCMILLAN 1 HOUR RODNEY DEESE 2 HOURS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (5 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 | Business Name Line2DirectControllingEntityName/BusinessNameLine2 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN D ARCHBOLD MEM HOSPITAL INC | |||||||||||
| P O BOX 1018 | THOMASVILLE | GA | 317991018 | 580566121 | ACUTE CARE | GA | 501C3 | 3 | AMC | ARCHBOLD MEDICAL CENTER INC | false |
| ARCHBOLD HEALTH SERVICES INC | |||||||||||
| P O BOX 1018 | THOMASVILLE | GA | 317991018 | 581376434 | HEALTHCARE | GA | 501C3 | 9 | AMC | ARCHBOLD MEDICAL CENTER INC | false |
| ARCHBOLD FOUNDATION INC | |||||||||||
| P O BOX 620 | THOMASVILLE | GA | 317990620 | 581559677 | FOUNDATION | GA | 501C3 | 11B | AMC | ARCHBOLD MEDICAL CENTER INC | false |
| ARCHBOLD MEDICAL GROUP | |||||||||||
| P O BOX 620 | THOMASVILLE | GA | 317990620 | 262988454 | PHYSICIANS | GA | 501C3 | 3 | AMC | ARCHBOLD MEDICAL CENTER INC | false |
| VNA OF SOUTHWEST GEORGIA INC | |||||||||||
| 1323 EAST SHOTWELL STREET | BAINBRIDGE | GA | 398184239 | 581320820 | HOME HLTH | GA | 501C3 | 9 | AHS | ARCHBOLD HEALTH SERVICES INC | false |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARCHBOLD MEDICAL ENTERPRISES | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 OLD ALBANY RD | AddressLine1 |
| City | THOMASVILLE | City |
| State | GA | State |
| ZIP Code | 31792 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581494513 | EIN |
| Primary Activity | HEALTHCARE | PrimaryActivity |
| Legal Domicile State | GA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMC | BusinessNameLine1 |
| Business Name Line2 | ARCHBOLD MEDICAL CENTER INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C CORP | TypeOfEntity |
| Share Of EOY Assets | 1000 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| 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 | true | 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 (5 entries)
| Transaction TypeTransactionType | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|
| ALL ENTITIES | |
| K | UNDETERMINED |
| ALL ENTITIES | |
| L | UNDETERMINED |
| ALL ENTITIES | |
| M | UNDETERMINED |
| ALL ENTITIES | |
| N | UNDETERMINED |
| ALL ENTITIES | |
| P | UNDETERMINED |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE R | ReturnReference |
| Explanation | VNA OF SOUTHWEST GEORGIA INC MERGED ITS OPERATIONS WITH ARCHBOLD HEALTH SERVICES INC ANOTHER RELATED ORGANIZATION EFFECTIVE DECEMBER 31 2011 | Explanation |
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