CULLMAN REGIONAL MEDICAL CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CULLMAN REGIONAL MEDICAL CENTER INC (EIN 63-1058174)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-02-04
IRS object ID
201330359349300538
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

FieldValueIRS element (for citing)
Timestamp2013-02-04T14:30:05-06:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DRAFFIN & TUCKER LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 6AddressLine1
CityALBANYCity
StateGAState
ZIP Code317020006ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN631058174EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CULLMAN REGIONAL MEDICAL CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCULLNameControl
Phone2567372595Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HIGHWAY 157AddressLine1
CityCULLMANCity
StateALState
ZIP Code35058ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameNESHA DONALDSONName
TitleCFOTitle
Phone2567372595Phone
Date Signed2013-02-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJACQUELINE G ATKINSName
Phone2298837878Phone
Date Prepared2013-02-04DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJIM WEIDNER CEONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HIGHWAY 157AddressLine1
CityCULLMANCity
StateALState
ZIP Code35058ZIPCode
FieldValueIRS element (for citing)
Gross Receipts95187352GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteCRMCHOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1939YearFormation
State Legal DomicileALStateLegalDomicile
Activity Or Mission DescriptionCULLMAN REGIONAL MEDICAL CENTER, LICENSED FOR 145 BEDS, OPERATES A 115-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF CULLMAN, ALABAMA AND SURROUNDING AREAS REGARDLESS OF A PATIENT'S ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees1215TotalNbrEmployees
Total Nbr Volunteers53TotalNbrVolunteers
Total Gross UBI1195875TotalGrossUBI
Net Unrelated Business Txbl Income66767NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year579857ContributionsGrantsPriorYear
Contributions Grants Current Year899159ContributionsGrantsCurrentYear
Program Service Revenue Prior Year89626904ProgramServiceRevenuePriorYear
Program Service Revenue CY86348609ProgramServiceRevenueCY
Investment Income Prior Year1442951InvestmentIncomePriorYear
Investment Income Current Year1430535InvestmentIncomeCurrentYear
Other Revenue Prior Year5161858OtherRevenuePriorYear
Other Revenue Current Year5599750OtherRevenueCurrentYear
Total Revenue Prior Year96811570TotalRevenuePriorYear
Total Revenue Current Year94278053TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year133680GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY75004GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year50063985SalariesEtcPriorYear
Salaries Etc Current Year47975187SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year48818232OtherExpensePriorYear
Other Expenses Current Year48051373OtherExpensesCurrentYear
Total Expenses Prior Year99015897TotalExpensesPriorYear
Total Expenses Current Year96101564TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-2204327RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1823511RevenuesLessExpensesCY
Total Assets BOY103646122TotalAssetsBOY
Total Assets EOY98326482TotalAssetsEOY
Total Liabilities BOY96478225TotalLiabilitiesBOY
Total Liabilities EOY97809827TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7167897NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY516655NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCULLMAN REGIONAL MEDICAL CENTER, LICENSED FOR 145 BEDS, OPERATES A 115-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF CULLMAN, ALABAMA AND SURROUNDING AREAS REGARDLESS OF A PATIENT'S ABILITY TO PAY.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense84405107Expense
Grants75004Grants
Revenue89346058Revenue
DescriptionCRMC PROVIDES ACUTE CARE PATIENT SERVICES WHICH ARE RENDERED TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. CRMC USES CHARITY APPLICATIONS BASED UPON FEDERAL POVERTY GUIDELINES AND FAMILY SIZE TO DETERMINE ELIGIBILITY FOLLOWING SERVICES PROVIDED. CRMC PROVIDES CARE 24 HOURS PER DAY, SEVEN DAYS A WEEK AND HAS PROVIDED 25,121 INPATIENT DAYS CARE, 7% WERE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN; 45,341 EMERGENCY ROOM VISITS, 26% WERE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN; AND 98,728 OUTPATIENT VISITS, 19% NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN. THE TOTAL UNREIMBUSED COST OF MEDICAL SERVICES PROVIDED TO THOSE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN IS REPORTED ON SCHEDULE H. CRMC ALSO PROVIDES COMMUNITY EDUCATION AND WELLNESS ACTIVITIES TO THE COMMUNITY AND IS A MAJOR CONTRIBUTOR TO A LOCAL INDIGENT CLINIC SERVICING CULLMAN COUNTY.Description
Total Program Service Expense84405107TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096199NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees1215NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturetrueInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonNESHA DONALDSONNamePerson
Telephone Number2567372598TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HWY 157AddressLine1
CityCULLMANCity
StateALState
ZIP Code35058ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
JIM WEIDNER
CEO40.00XX289952021440
DAVID MCKOY
CHAIRMAN2.00XX000
TODD MCLEROY
VICE-CHAIRMA2.00XX000
HOYT BROWNIE PRICE MD
SECRETARY2.00XX000
ALAN WOOD
TREASURER2.00XX000
R CLYNE ADAMS DMD
MEMBER2.00X000
CLINT FREY
MEMBER2.00X000
DEL BROCK
MEMBER2.00X000
ROBIN HALL MD
MEMBER2.00X000
STEPHEN DONALDSON
MEMBER2.00X000
JUDY BUTLER
MEMBER2.00X000
ROGER HUMPHREY
MEMBER2.00X000
VINCE BERGQUIST MD
MEMBER2.00X000
JETE EDMISSON
CFO & COO40.00X199932014586
NESHA DONALDSON
CFO40.00X8524003493
CHERYL BAILEY
VP-PAT. SVC.40.0012856805169X
STACEY HILL
PHARMACY DIR40.00115443014653X
TERESA AARON
PHARMACIST40.00114838012500X
JERIMAH DAVIS
DIV DIRECTOR40.00113588012485X
SUSAN COPELAND
VP-AMB.40.0011319608705X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1160757TotalReportableCompFromOrg
Total Other Compensation93031TotalOtherCompensation
Number Individuals GT100 K10NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MEDASSETS
P O BOX 405652ATLANTAGA303845652BUS OFC SVCS1905988
CULLMAN ANESTHESIOLOGY
PO BOX 1005CULLMANAL350561005CRNA SVCS1672162
NORTHWEST ALABAMA LITHOTRIPSY
237 OXMOOR CIRCLE SUITE 108BIRMINGHAMAL35209LITHOTRIPSY SVC520300
UAHSF
UAB HOSPITAL 619 19TH ST SBIRMINGHAMAL35249CARDIOLOGY SVCS410023
PROXSYS LLC
75 REMITTANCE DRIVECHICAGOIL606756636OUTSOURCING SVC394233
FieldValueIRS element (for citing)
Number Of Contractors GT100 K25NumberOfContractorsGT100K
Related Organizations746983RelatedOrganizations
Government Grants101313GovernmentGrants
All Other Contributions50863AllOtherContributions
Total Contributions899159TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICE REVENUES6230008515273485152734
OUTREACH LAB SERVICES621500696673696673
CPAP MEDICAL EQUIPMENT621990413161413161
CONFERENCE CENTER5320006020760207
SPORTS FIRST7139402583425834
FieldValueIRS element (for citing)
Total Program Service Revenue86348609TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1239804TotalRevenueColumn
Exclusion$1,239,804ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real280215Real
Personal426011Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real280215Real
Personal426011Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column706226TotalRevenueColumn
Related Or Exempt Function Income426011RelatedOrExemptFunctionIncome
Exclusion$280,215ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other1100030Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other909299Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other190731Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column190731TotalRevenueColumn
Exclusion$190,731ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
EMS MANAGEMENT FEES62191029799442979944
CAFETERIA/CATERING561000643074$643,074
FITNESS CENTER713940483137$483,137

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column787369TotalRevenueColumn
Related Or Exempt Function Income787369RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue4893524TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column94278053TotalRevenueColumn
Related Or Exempt Function Income89346058RelatedOrExemptFunctionIncome
Unrelated Business Revenue1195875UnrelatedBusinessRevenue
Exclusion$2,836,961ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total75004Total
Program Services75004ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total634043Total
Management And General634043ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total36701978Total
Program Services33198390ProgramServices
Management And General3503588ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1677557Total
Program Services1522026ProgramServices
Management And General155531ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6247101Total
Program Services5567407ProgramServices
Management And General679694ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2714508Total
Program Services2416184ProgramServices
Management And General298324ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total2426350Total
Program Services1990626ProgramServices
Management And General435724ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total326695Total
Program Services112710ProgramServices
Management And General213985ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total115439Total
Management And General115439ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total110476Total
Management And General110476ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total9631323Total
Program Services8637637ProgramServices
Management And General993686ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total185481Total
Program Services8664ProgramServices
Management And General176817ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total10905828Total
Program Services9223609ProgramServices
Management And General1682219ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total52685Total
Management And General52685ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total6605273Total
Program Services6336438ProgramServices
Management And General268835ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total473998Total
Program Services460618ProgramServices
Management And General13380ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total49159Total
Program Services17622ProgramServices
Management And General31537ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total12793Total
Management And General12793ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total4686805Total
Program Services4496052ProgramServices
Management And General190753ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1021973Total
Program Services1021973ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES89864888986488
REPAIRS AND MAINT20250843117351713349
MISCELLANEOUS157681212157469
TAXES AND LICENSE142516142516

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total135326Total
Program Services21712ProgramServices
Management And General113614ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total96101564Total
Program Services84405107ProgramServices
Management And General11696457ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1233718BOY
EOY3877620EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY18022762BOY
EOY13849345EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY808482BOY
EOY928471EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY543000BOY
EOY626132EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis102109613LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec64620742LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY39950223BOY
EOY37488871EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY34853873BOY
EOY34195337EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3001810BOY
EOY2207757EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY5232254BOY
EOY5152949EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY103646122BOY
EOY98326482EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY10527411BOY
EOY10628658EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY35040BOY
EOY25950EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY69052936BOY
EOY68167633EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY279183BOY
EOY233184EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY16583655BOY
EOY18754402EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY96478225BOY
EOY97809827EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4793013BOY
EOY516655EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2374884BOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7167897BOY
EOY516655EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY103646122BOY
EOY98326482EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1823511ReconcilationRevenueExpenses
Reconcilation Other Changes-4827731ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1997443OtherCostOrOtherBasis
Book Value1997443BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis43431954OtherCostOrOtherBasis
Depreciation19476610Depreciation
Book Value23955344BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis7027876OtherCostOrOtherBasis
Depreciation5606971Depreciation
Book Value1420905BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis48183180OtherCostOrOtherBasis
Depreciation39537161Depreciation
Book Value8646019BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1469160OtherCostOrOtherBasis
Book Value1469160BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings37488871TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
OTHER RECEIVABLES2440138
COST REPORT SETTLEMENT1451046
UNAMORTIZED BOND ISSUE COSTS1207495
OTHER CURRENT ASSETS48559
ACCRUED INTEREST5711
FieldValueIRS element (for citing)
Total Book Value Other Assets5152949TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
MINIMUM PENSION LIABILITY$15,393,099
ACCRUED INTEREST$1,810,451
INTERCOMPANY LIABILITY$1,550,852
FieldValueIRS element (for citing)
Total Of Amounts18754402TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierLIABILITY UNDER FIN 48 FOOTNOTEIdentifier
Return ReferenceSCHEDULE D, PAGE 3, PART XReturnReference
ExplanationINCOME TAXES THE HOSPITAL 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 HOSPITAL 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 HOSPITAL 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 JUNE 30, 2012 AND 2011 OR FOR THE YEARS THEN ENDED. THE HOSPITAL'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2009-2011.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served2222PersonsServed
Total Community Benefit Expense2413250TotalCommunityBenefitExpense
Net Community Benefit Expense2413250NetCommunityBenefitExpense
Percent Of Total Expense0.02510PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served17349PersonsServed
Total Community Benefit Expense8620227TotalCommunityBenefitExpense
Direct Offsetting Revenue4750340DirectOffsettingRevenue
Net Community Benefit Expense3869887NetCommunityBenefitExpense
Percent Of Total Expense0.04030PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served19571PersonsServed
Total Community Benefit Expense11033477TotalCommunityBenefitExpense
Direct Offsetting Revenue4750340DirectOffsettingRevenue
Net Community Benefit Expense6283137NetCommunityBenefitExpense
Percent Of Total Expense0.06540PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs17NumberOfActivitiesOrPrograms
Persons Served6164PersonsServed
Total Community Benefit Expense294112TotalCommunityBenefitExpense
Direct Offsetting Revenue11328DirectOffsettingRevenue
Net Community Benefit Expense282784NetCommunityBenefitExpense
Percent Of Total Expense0.00290PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Benefit Expense622TotalCommunityBenefitExpense
Net Community Benefit Expense622NetCommunityBenefitExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Benefit Expense1575TotalCommunityBenefitExpense
Net Community Benefit Expense1575NetCommunityBenefitExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served12PersonsServed
Total Community Benefit Expense9469TotalCommunityBenefitExpense
Net Community Benefit Expense9469NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs23NumberOfActivitiesOrPrograms
Persons Served6176PersonsServed
Total Community Benefit Expense305778TotalCommunityBenefitExpense
Direct Offsetting Revenue11328DirectOffsettingRevenue
Net Community Benefit Expense294450NetCommunityBenefitExpense
Percent Of Total Expense0.00300PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs23NumberOfActivitiesOrPrograms
Persons Served25747PersonsServed
Total Community Benefit Expense11339255TotalCommunityBenefitExpense
Direct Offsetting Revenue4761668DirectOffsettingRevenue
Net Community Benefit Expense6577587NetCommunityBenefitExpense
Percent Of Total Expense0.06840PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Persons Served461PersonsServed
Total Community Building Expense18503TotalCommunityBuildingExpense
Direct Offsetting Revenue3330DirectOffsettingRevenue
Net Community Building Expense15173NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Persons Served461PersonsServed
Total Community Building Expense18503TotalCommunityBuildingExpense
Direct Offsetting Revenue3330DirectOffsettingRevenue
Net Community Building Expense15173NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$22,866,122BadDebtExpenseAmount
Amount Reimbursed By Medicare36432842AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare40814134CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-4381292MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line1HERITAGE DIAGNOSTICSBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityIMAGING SERVICESDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.21000OrganizationProfitOrOwnership
Physicans Profit Or Ownership0.79000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1CULLMAN REGIONAL MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HIGHWAY 157AddressLine1
CityCULLMANCity
StateALState
ZIP Code35058ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherHOSPICE, CLINICS & HOME HEALTHOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1CULLMAN REGIONAL MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent150.0FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent300.0FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Medical IndigencyXMedicalIndigency
Medicaid MedicareXMedicaidMedicare
Other FactorsXOtherFactors
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On NonpaymentfalseActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Medicare RateXMedicareRate
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF CULLMAN COUNTYBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HIGHWAY 157AddressLine1
CityCULLMANCity
StateALState
ZIP Code35058ZIPCode
FieldValueIRS element (for citing)
Facility TypeHOSPICEFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
OTHER TESTING METHODS FOR FREE OR DISCOUNTED CAREPART I LINE 3CFEDERAL POVERTY GUIDELINES 150 ARE USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE DISCOUNTED CARE WILL BE BASED ON MEDICARE REIMBURSEMENT
COSTING METHODOLOGY EXPLANATIONPART I LINE 7THE 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 EXPLANATIONPART III LINE 4LINE 2 IS TAKEN DIRECTLY FROM THE INCOME STATEMENT AND REPRESENTS TOTAL BAD DEBT EXPENSED DURING THE FISCAL YEAR THE FOLLOWING IS AN EXCERPT FROM THE AUDITED FINANCIAL STATEMENTS THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE
MEDICARE EXPLANATIONPART III LINE 8THE HOSPITAL UTILIZES LYONS SOFTWARE FOR COST ACCOUNTING PURPOSES THE MEDICARE COST REPORT WAS USED TO GATHER INFORMATION RELATED TO MEDICARE CHARGES AND REIMBURSEMENT MEDICARE COST WAS CALCULATED BY ADDING DIRECT COSTS TO INDIRECT COSTS WHICH ARE ALLOCATIONS OF OVERHEAD DEPARTMENTS USING A REASONABLE STATISTICAL BASIS
COLLECTION PRACTICES EXPLANATIONPART III LINE 9BTHE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL AID POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS FINANCIAL AID THEY ARE NOT REPORTED AS REVENUE
NEEDS ASSESSMENTPART VITHE HOSPITAL PARTICIPATES IN THE CULLMAN COUNTY HEALTH COALITION THIS ORGANIZATION COMPRISED OF VARIOUS HEALTH CARE PROVIDERS AND COMMUNITY LEADERS ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY AND STRIVES TO PROVIDE RESOURCES THAT BEST MEET THOSE NEEDS
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPART VITHE HOSPITAL HAS CLEARLY WRITTEN FINANCIAL AID POLICIES THAT ARE AVAILABLE ON THE ORGANIZATION WEB SITE AND THROUGHOUT THE BUSINESS OFFICE SIGNS ARE PROMINENTLY POSTED IN THE ER ABOUT THE AVAILABILITY OF FINANCIAL AID A REPRESENTATIVE IS ALSO AVAILABLE TO DISCUSS ELIGIBILITY TO GOVERNMENT PROGRAMS THERE IS ALSO A MEDICAID KIOSK LOCATED IN THE ER WAITING ROOM
COMMUNITY INFORMATIONPART VITHE HOSPITAL DRAWS PATIENTS PRINCIPALLY FROM CULLMAN COUNTY AND THE NEIGHBORING COUNTIES OF WALKER WINSTON MARSHALL MORGAN AND BLOUNT CRMC IS THE ONLY HOSPITAL IN ITS PRIMARY SERVICE AREA THE PRIMARY SERVICE AREA INCLUDES THE CITY OF CULLMAN POPULATION 15000 AND CULLMAN COUNTY POPULATION 81000 PER CAPITA INCOME FOR THIS AREA IS SLIGHTLY BELOW THE PER CAPITA INCOME FOR THE STATE OF ALABAMA CULLMAN IS SERVED BY I65 AND IS LOCATED BETWEEN HUNTSVILLE AND BIRMINGHAM
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSEPART VITHE ORGANIZATION AND ITS VOLUNTEER BOARDS ARE COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS AS WELL AS PHYSICIAN MEMBERS THE EMERGENCY DEPARTMENT IS OPEN 24 HOURS PER DAY 7 DAYS PER WEEK AND IS OPEN TO ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY HOSPITAL EMPLOYEES IN CONJUNCTION WITH OUR LOCAL JUDGES HAVE DEVELOPED A TRAUMA PREVENTION PROGRAM THIS PROGRAM IS PROVIDED BY CRMC EMPLOYEES ON A VOLUNTARY BASIS OUR LOCAL JUDGES REFER TEENAGE DRIVING OFFENDERS TO THE PROGRAM TO TEACH THEM THE IMPORTANCE OF VEHICLE SAFETY WHILE THEY ARE HERE THEY ACTUALLY GET TO WITNESS THE VARIOUS STAGES OF A TRAUMA ACCIDENT FROM THE TIME THEY ARRIVE AT THE ER UNTIL THEY LEAVE THE HOSPITAL COMMUNITY BUILDING ACTIVITIES ALSO INCLUDE PROVIDING AMBULANCE SUPPORT FOR VARIOUS COMMUNITY ACTIVITIES AND PROVIDING COMMUNITY SUPPORT GROUPS THESE SUPPORT GROUPS ALZHEIMERS BREAST CANCER ETC PROMOTE THE PHYSICAL AND MENTAL HEALTH OF THE COMMUNITY THAT WE SERVE CRMC PROVIDES WOMENS FIRST AND SENIOR CHOICE PROGRAMS THE WOMENS FIRST PROGRAM OFFERS SEMINARS AND EDUCATION ON HEALTH AND LIFESTYLE ISSUES SUCH AS STRESS MANAGEMENT PMS MENOPAUSE AND HEART DISEASE IT ALSO GIVES DISCOUNT ADMISSION TO WORKSHOPS AND HEALTH SCREENINGS SENIOR CHOICE PROVIDES SERVICES TO PROMOTE EMOTIONAL SOCIAL AND PHYSICAL WELL BEING FOR COMMUNITY MEMBERS WHO ARE 50 AND OVER THESE PROGRAMS CURRENTLY HAVE 8465 MEMBERS CRMC ALSO PROVIDES A COMMUNITY EDUCATION CENTER WHICH OFFERS MEETING ROOMS AND CATERING SERVICES FOR LOCAL BUSINESSES CHURCHES CIVIC ORGANIZATIONS AND EDUCATIONAL GROUPS ALL OF OUR AMBULANCES ARE EQUIPPED WITH 12 LEAD EKG TECHNOLOGY WHICH TRANSMITS THE INFORMATION DIRECTLY TO THE EMERGENCY ROOM PHYSICIAN ALLOWING THEM TO GET THE INFORMATION WHILE THE PATIENT IS IN TRANSIT THIS PROGRAM HAS REDUCED THE TIME FROM DOOR TO ANGIOPLASTY BY GETTING THE CARDIOLOGY TEAM IN PLACE BEFORE THE PATIENT ARRIVES
LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILEDPART VIALABAMA
CULLMAN REGIONAL MEDICAL CENTER LINE NUMBER 1 PART V LINE 11HPART V LINE 11HTHE HOSPITAL HAS CLEARLY WRITTEN FINANCIAL AID POLICIES THAT ARE AVAILABLE ON THE ORGANIZATION WEB SITE AND THROUGH THE BUSINESS OFFICE SIGNS ARE PROMINENTLY POSTED IN THE ER ABOUT THE AVAILABILITY OF FINANCIAL AID A REPRESENTATIVE IS ALSO AVAILABLE TO DISCUSS ELIGIBILITY TO GOVERNMENT PROGRAMS

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1GOOD SAMARITAN CLINICBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1401 ARNOLD ST NEAddressLine1
CityCULLMANCity
StateALState
ZIP Code35055ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient200149215EINOfRecipient
IRC Section3IRCSection
Amount Of Cash Grant75004AmountOfCashGrant
Purpose Of GrantCURRENT OPERATIONSPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATESIdentifier
Return ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2ReturnReference
ExplanationTHE HOSPITAL CONTINUOUSLY EVALUATES COMMUNITY ORGANIZATIONS (AS IDENTIFIED IN PART II ABOVE) PROVIDING HEALTHCARE NEEDS TO THE MEDICALLY UNDERSERVED WHO ALSO ARE MOST LIKELY UNABLE TO PAY. THE HOSPITAL EVALUATES THE NEEDS ON AN INDIVIDUAL BASIS BASED ON DOCUMENTED REQEUSTS FOR SERVICES PROVIDED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
JIM WEIDNER
289281671159015539311392
JETE EDMISSON
1460545387814298288214518

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FRINGE OR EXPENSE EXPLANATIONSCHEDULE J, PAGE 1, PART I, LINE 1AA MEMBERSHIP TO THE LOCAL COUNTRY CLUB IS PROVIDED BY MEANS OF CONTRACTUAL AGREEMENT TO CERTAIN OFFICERS. AS THE MEMBERSHIP IS CONSIDERED TO PROMOTE AND FURTHER THE ORGANIZATION'S TAX EXEMPT MISSION AND IS INTENDED TO BE USED FOR BUSINESS PURPOSES ONLY, THE AMOUNT IS NOT INCLUDED IN TAXABLE WAGES.
SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTSSCHEDULE J, PAGE 1, PART I, LINE 4JETE EDMISSON 24,091 0 0
OTHER ADDITIONAL INFORMATIONSCHEDULE J, PART IIIJETE EDMISSION RECEIVED A SEVERANCE PACKAGE UPON TERMINATION IN ACCORDANCE WITH HIS CONTRACTUAL AGREEMENT.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1HEALTH CARE AUTHORITY OF CULLMAN CTBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN631149220IssuerEIN
CUSIP Number230186AMOCUSIPNumber
Date Issued2009-12-03DateIssued
Issue Price68624416IssuePrice
Description Of PurposeDEFEASE 1993/2007 BONDS.DescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuertrueOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired2290977AmountRetired
Total Proceeds68624416TotalProceeds
Refunding Escrow61819381RefundingEscrow
Issuance Costs From Proceeds1352854IssuanceCostsFromProceeds
Working Capital Expenditures5452182WorkingCapitalExpenditures
Year Of Subst Completion2009YearOfSubstCompletion
Current RefundingtrueCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtyfalseMngmentCntrctBondFinancdPrprty
Engage Bond Counsel ContractsfalseEngageBondCounselContracts
Any Research AgreementsfalseAnyResearchAgreements
Engage Bond Counsel ResearchtrueEngageBondCounselResearch
Post Issuance Compliance ProcdrstruePostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T FiledfalseForm8038TFiled
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdstrueHedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1MERRILL LYNCHBusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge26.0TermOfHedge
Superintegrated HedgefalseSuperintegratedHedge
Hedge TerminatedfalseHedgeTerminated
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Gross Proceeds InvestedfalseGrossProceedsInvested
Exception To RebatefalseExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FIRST ACCOMPLISHMENT DESCRIPTIONFORM 990, PAGE 2, PART III, LINE 4ACOMMUNITY EDUCATION AND WELLNESS ACTIVITIES TO THE COMMUNITY AND IS A MAJOR CONTRIBUTOR TO A LOCAL INDIGENT CLINIC SERVICING CULLMAN COUNTY.
ELECTION OF MEMBERS AND THEIR RIGHTSFORM 990, PAGE 6, PART VI, LINE 7ATHE HEALTH CARE AUTHORITY OF CULLMAN COUNTY APPOINTS THE VOTING MAJORITY OF THE ORGANIZATION'S BOARD AND CONTROLS THE OPERATIONS AS WELL.
DECISIONS SUBJECT TO APPROVAL OF MEMBERSFORM 990, PAGE 6, PART VI, LINE 7BTHE HEALTH CARE AUTHORITY OF CULLMAN COUNTY APPOINTS THE VOTING MAJORITY OF THE ORGANIZATION'S BOARD AND CONTROLS THE OPERATIONS OF THE ORGANIZATION.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BMANAGEMENT ASSISTS IN PREPARING SCHEDULES, REVIEWS THE ENTIRE DRAFT OF THE FORM 990 FOR CONTENT, AND RECOMMENDS CHANGES, IF ANY. PRIOR TO FILING, THE FINANCE COMMITTEE, CFO, ATTORNEY AND ACCOUNTING DEPARTMENT REVIEW THE FORM. THE FINAL FORM, AS IT IS ULTIMATELY FILED WITH ALL SCHEDULES AND ATTACHMENTS, IS POSTED TO THE BOARD WEBSITE PRIOR TO FILING AND AN E-MAIL ALERTS EACH VOTING MEMBER OF ITS AVAILABILITY.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CANNUALLY, BOARD MEMBERS, OFFICERS, AND DEPARTMENTAL DIRECTORS MUST IDENTIFY ANY CONFLICT, MANAGEMENT MONITORS AND MAY SUGGEST ANY AREAS OF CONFLICT. THE BOARD CHAIRMAN OR ADMINISTRATION REVIEWS ACTUAL AND PERCEIVED CONFLICTS OF INTEREST. IN THE EVENT OF A CONFLICT, THE MEMBER OR OFFICER WITH THE CONFLICT WILL DISMISS THEMSELVES FROM THE DISCUSSION AND ANY VOTES ON THE ISSUE.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15AANNUALLY THE BOARD (OR A COMMITTEE CHARGED WITH THE RESPONSIBILITY AND AUTHORITY TO DO SO ON BEHALF OF THE BOARD) REVIEWS THE COMPENSATION PACKAGE AND PROPOSED CONTRACT OF THE CEO. THE REVIEW IS CONDUCTED BY INDEPENDENT BOARD MEMBERS, IS BASED UPON REVIEW OF COMPARABILITY DATA PROVIDED BY OUTSIDE CONSULTANTS, AND IS DOCUMENTED IN THE RECORDS OF THE BOARD REFLECTING THE BASIS OF THE DETERMINATION BY THE THE BOARD (OR AUTHORIZED COMMITTEE).
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BANNUALLY THE BOARD (OR A COMMITTEE CHARGED WITH THE RESPONSIBILITY AND AUTHORITY TO DO SO ON BEHALF OF THE BOARD) REVIEWS THE COMPENSATION PACKAGE OF THE CFO AND OTHER OFFICERS. THE REVIEW IS CONDUCTED BY THE HUMAN RESOURCES DEPARTMENT, IS BASED ON THE SALARY SCALE AND MATRIX THAT WAS SET IN 2008. COMPENSATION IS BAED ON YEARS OF EXPERIENCE IN THAT POSITION AND BY USING PROMOTIONAL GUIDELINES FOR INHOUSE PROMOTIONS. THE RESULT IS DOCUMENTED IN THE RECORDS OF THE BOARD REFLECTING THE BASIS OF THE DETERMINATION BY THE THE BOARD (OR AUTHORIZED COMMITTEE).
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO ANY MEMBER OF THE PUBLIC WHO MAKES THEIR REQUEST AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION.
RELATED ORGANIZATIONSFORM 990, PAGE 7, PART VIIAVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS: JIM WEIDNER 2 HOURS CLINT FREY 2 HOURS DEL BROCK 2 HOURS JETE EDMISSION 2 HOURS NESHA DONALDSON 2 HOURS TODD MCLEROY 2 HOURS
OTHER CHANGES IN NET ASSETS EXPLANATIONFORM 990, PART XI, LINE 5DECREASES: CHANGE IN PLAN ASSETS & PBO 2,336,397 CHANGE IN TEMP REST NET ASSETS OF AFFILIATE 747,518 UNREALIZED LOSSES ON INVESTMENTS 1,399,133 CHANGE IN VALUE OF INTEREST RATE SWAP 298,149 CHANGE IN UNRESTRICTED ASSETS OF AFFILIATE 46,534 TOTAL DECREASE IN NET ASSETS 4,827,731

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CULLMAN REGIONAL MEDICAL CTR FNDN
1912 ALABAMA HIGHWAY 157CULLMANAL35056630727880FOUNDATIONAL501C311CNAfalse
HEALTH CARE AUTHORITY OF CULLMAN CO
1912 ALABAMA HIGHWAY 157CULLMANAL35058631149220AUTHORITYAL501C16NAfalse
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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