DONALSONVILLE HOSPITAL INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: DONALSONVILLE HOSPITAL INC (EIN 58-0973772)
Tax period: 2011-07-01 to 2012-06-30
Filed: 2013-05-15
IRS object ID: 201341359349304654
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
Form 990
Schedule A
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-05-15T11:15:06-05:00	Timestamp
Tax Period End Date	2012-06-30	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	2011-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	580973772	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	DONALSONVILLE HOSPITAL INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	DONA	NameControl
Phone	2295245217	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	102 HOSPITAL CIRCLE	AddressLine1
City	DONALSONVILLE	City
State	GA	State
ZIP Code	39845	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	HERMAN BROOKINS	Name
Title	CEO	Title
Phone	2295245217	Phone
Date Signed	2013-05-15	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	JACQUELINE G ATKINS	Name
Phone	2298837878	Phone
Date Prepared	2013-05-14	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	HERMAN BROOKINS	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	102 HOSPITAL CIRCLE	AddressLine1
City	DONALSONVILLE	City
State	GA	State
ZIP Code	39845	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	36158583	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.DONALSONVILLEHOSPITAL.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1977	YearFormation
State Legal Domicile	GA	StateLegalDomicile
Activity Or Mission Description	DONALSONVILLE HOSPITAL OPERATES A 65-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF DONALSONVILLE, GEORGIA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	5	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	3	NbrIndependentVotingMembers
Total Nbr Employees	401	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Current Year	0	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	32825575	ProgramServiceRevenuePriorYear
Program Service Revenue CY	28346142	ProgramServiceRevenueCY
Investment Income Prior Year	5992867	InvestmentIncomePriorYear
Investment Income Current Year	-161193	InvestmentIncomeCurrentYear
Other Revenue Prior Year	85780	OtherRevenuePriorYear
Other Revenue Current Year	2122656	OtherRevenueCurrentYear
Total Revenue Prior Year	38904222	TotalRevenuePriorYear
Total Revenue Current Year	30307605	TotalRevenueCurrentYear
Grants And Similar Amnts CY	5000000	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	16490151	SalariesEtcPriorYear
Salaries Etc Current Year	15692617	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	14009589	OtherExpensePriorYear
Other Expenses Current Year	11825396	OtherExpensesCurrentYear
Total Expenses Prior Year	30499740	TotalExpensesPriorYear
Total Expenses Current Year	32518013	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	8404482	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-2210408	RevenuesLessExpensesCY
Total Assets BOY	51659929	TotalAssetsBOY
Total Assets EOY	49376758	TotalAssetsEOY
Total Liabilities BOY	2682327	TotalLiabilitiesBOY
Total Liabilities EOY	3301292	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	48977602	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	46075466	NetAssetsOrFundBalancesEOY
Mission Description	DONALSONVILLE HOSPITAL OPERATES A 65-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF DONALSONVILLE, GEORGIA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	27656965	Expense
Grants	5000000	Grants
Revenue	29764099	Revenue
Description	DONALSONVILLE HOSPITAL PROVIDES PRIMARY HEALTHCARE TO RESIDENTS OF SEMINOLE COUNTY AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. INDIGENT PATIENTS ARE CLASSIFIED AS ANY PATIENT WITHOUT THIRD PARTY COVERAGE THAT HAD AN INCOME LEVEL BELOW 125% OF THE FEDERAL POVERTY GUIDELINES. CHARITY PATIENTS ARE CLASSIFIED AS ANY PATIENT WITHOUT THIRD PARTY COVERAGE THAT HAD AN INCOME LEVEL BETWEEN 125% AND 200% OF THE FEDERAL POVERTY GUIDELINES.	Description
Total Program Service Expense	27656965	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	true	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	true	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	true	ReportFin48Footnote
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	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	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	true	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	true	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	false	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	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	29	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	401	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	5	NbrVotingGoverningBodyMembers
Number Independent Voting Members	3	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	false	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	false	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	JAMES MOODY	NamePerson
Telephone Number	2295245217	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	102 HOSPITAL CIRCLE	AddressLine1
City	DONALSONVILLE	City
State	GA	State
ZIP Code	39845	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (11 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
HERMAN BROOKINS
CHAIRMAN/CEO	40.00	X	X	376224	0	0
CHARLES H ORRICK
ADMINISTRATO	40.00	X	X	213712	0	0
BROADDUS SIMPSON
SECRETARY	1.00	X	X	8503	0	0
MITCH BLANKS
DIRECTOR	1.00	X		8503	0	0
WILLIAM BURKE
DIRECTOR	1.00	X		8503	0	0
JAMES MOODY
CFO	40.00		X	190983	0	0
MURDOC HENDERSON MD
PHYSICIAN	50.00			331248	0	0	X
JESSICA NUNUZ MD
PHYSICIAN	50.00			306877	0	0	X
JOSEPH WALKER SR MD
PHYSICIAN	50.00			295277	0	0	X
ANDREA ALEXANDER WADDELL MD
CRNA	50.00			264329	0	0	X
ROYCE CANNINGTON JR
CRNA	50.00			210018	0	0	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2214177	TotalReportableCompFromOrg
Number Individuals GT100 K	15	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
NATIONAL EMERGENCY SERVICE
PO BOX 65810	CHARLOTTE	NC	28265	ER PHYSICIANS	949557
FRANKLIN SEIDLEMAN
PO BOX 67293	DETROIT	MI	482674293	RADIOLIGIST	493170
CPSI
PO BOX 850309	MOBILE	AL	366850309	IT SUPPORT	236979
DRAFFIN & TUCKER LLP
2617 GILLIONVILLE ROAD	ALBANY	GA	31703	ACCOUNTING	185343

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	4	NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	PROGRAM SERVICE REVENUE	Description
Business Code	621990	BusinessCode
Total Revenue Column	28346142	TotalRevenueColumn
Related Or Exempt Function Income	28346142	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	28346142	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	546574	TotalRevenueColumn
Exclusion	$546,574	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	174628	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	84996	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	89632	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	89632	TotalRevenueColumn
Exclusion	$89,632	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	5058215	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	5765982	Securities

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	-707767	Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-707767	TotalRevenueColumn
Exclusion	-$707,767	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	ExclusionExclusionAmount
EHR GRANT INCOME	621990	1361897	1361897
CAFETERIA	621990	615067		$615,067
MISCELLANEOUS REVENUE	624200	51480	51480

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	4580	TotalRevenueColumn
Related Or Exempt Function Income	4580	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	2033024	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	30307605	TotalRevenueColumn
Related Or Exempt Function Income	29764099	RelatedOrExemptFunctionIncome
Exclusion	$543,506	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	5000000	Total
Program Services	5000000	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	806428	Total
Management And General	806428	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	11630560	Total
Program Services	10396096	ProgramServices
Management And General	1234464	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	625051	Total
Program Services	522481	ProgramServices
Management And General	102570	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	1878760	Total
Program Services	1570458	ProgramServices
Management And General	308302	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	751818	Total
Program Services	595309	ProgramServices
Management And General	156509	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	100168	Total
Management And General	100168	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	166267	Total
Management And General	166267	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	2686	Total
Management And General	2686	ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	76331	Total
Management And General	76331	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	2446444	Total
Program Services	2255527	ProgramServices
Management And General	190917	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	60990	Total
Management And General	60990	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	2267449	Total
Program Services	1609325	ProgramServices
Management And General	658124	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	471186	Total
Program Services	430843	ProgramServices
Management And General	40343	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	57728	Total
Program Services	25711	ProgramServices
Management And General	32017	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	46640	Total
Program Services	42550	ProgramServices
Management And General	4090	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	3318	Total
Management And General	3318	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1120609	Total
Program Services	1024685	ProgramServices
Management And General	95924	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	184425	Total
Program Services	118279	ProgramServices
Management And General	66146	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
MEDICAL SUPPLIES	3661968	3661968
REPAIR AND MAINTENANCE	434162	97855	336307
PROVIDER FEE	285950	285950
MISCELLANEOUS EXPENSE	270930	5300	265630

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	168145	Total
Program Services	14628	ProgramServices
Management And General	153517	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	32518013	Total
Program Services	27656965	ProgramServices
Management And General	4861048	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	17513	BOY
EOY	19050	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	1985506	BOY
EOY	3579115	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	7526074	BOY
EOY	8495662	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	82500	BOY
EOY	162111	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	1243683	BOY
EOY	1328812	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	904696	BOY
EOY	1000148	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	113857	BOY
EOY	124864	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	25990678	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	13814008	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	12372462	BOY
EOY	12176670	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	2876767	BOY
EOY	2968754	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	24372659	BOY
EOY	18221241	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	164212	BOY
EOY	1300331	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	51659929	BOY
EOY	49376758	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	2682327	BOY
EOY	3286826	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
EOY	14466	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	2682327	BOY
EOY	3301292	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	48977602	BOY
EOY	46075466	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	48977602	BOY
EOY	46075466	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	51659929	BOY
EOY	49376758	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	-2210408	ReconcilationRevenueExpenses
Reconcilation Other Changes	-691728	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

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	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$2,686	OtherActivitiesAmount
Total Lobbying Expenditures IIB	2686	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	THE ORGANIZATION BELONGS TO A STATE HOSPITAL ASSOCIATION. A PORTION OF THE MEMBERSHIP DUES PAID TO THE ASSOCIATION ARE DEDICATED TO LOBBYING ACTIVITIES.	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

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	25508972	BeginningOfYearBalance
Investment Earnings Or Losses	-1018580	InvestmentEarningsOrLosses
Grants Or Scholarships	5000000	GrantsOrScholarships
Administrative Expenses	85517	AdministrativeExpenses
End Of Year Balance	19404875	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	18450580	BeginningOfYearBalance
Investment Earnings Or Losses	7152931	InvestmentEarningsOrLosses
Administrative Expenses	94539	AdministrativeExpenses
End Of Year Balance	25508972	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	13861471	BeginningOfYearBalance
Investment Earnings Or Losses	4660648	InvestmentEarningsOrLosses
Administrative Expenses	71539	AdministrativeExpenses
End Of Year Balance	18450580	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	18843153	BeginningOfYearBalance
Investment Earnings Or Losses	-4920716	InvestmentEarningsOrLosses
Administrative Expenses	60966	AdministrativeExpenses
End Of Year Balance	13861471	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	1.00000	BoardDesignatedEOYBalance
Endowments Held By Unrelated Orgs	true	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	false	EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R	false	AreRelatedOrgsListedScheduleR

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	686053	OtherCostOrOtherBasis
Book Value	686053	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	3416817	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	11900526	OtherCostOrOtherBasis
Depreciation	6055261	Depreciation
Book Value	9262082	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	343388	OtherCostOrOtherBasis
Depreciation	318769	Depreciation
Book Value	24619	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	9643894	OtherCostOrOtherBasis
Depreciation	7439978	Depreciation
Book Value	2203916	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	12176670	TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
Description	COMMUNITY FOUNDATION INVESTMENTS	Description
Book Value	18221241	BookValue
Method Of Valuation	F	MethodOfValuation

Field	Value	IRS element (for citing)
Total Of Book Value Program Related	18221241	TotalOfBookValueProgramRelated

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	DUE TO THIRD PARTY PAYORS	Description
Amount	$14,466	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	14466	TotalOfAmounts
Total Revenue	30307605	TotalRevenue
Total Expenses	32518013	TotalExpenses
Excess Or Deficit For Year	-2210408	ExcessOrDeficitForYear
Excess Or Deficit Per FS	-2210408	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	24653550	TotRevenueEtcAuditedFinclStmt
Revenue Subtotal	24653550	RevenueSubtotal
Other Revenues Not Included	5654055	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	5654055	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	30307605	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	26863958	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	26863958	ExpensesSubtotal
Other Expenses Not Included	5654055	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	5654055	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	32518013	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
INTENDED USES FOR ENDOWMENT FUNDS	SCHEDULE D, PAGE 2, PART V, LINE 4	ENDOWMENT FUNDS CONSIST OF INVESTMENTS FOR THE DEFERRED COMPENSATION PLAN, MALPRACTICE INSURANCE AND COMMUNITY FOUNDATION. THE ORGANIZATION HAS ESTABLISHED A FUNDED DEFERRED COMPENSATION PLAN FOR CERTAIN KEY EMPLOYEES. MALPRACTICE INSURANCE IS A TRUST SET UP TO FUND POTENTIAL LIABILITIES UNDER THE HOSPITAL'S SELF INSURANCE PROGRAM. THE TRUSTEE IS SYNOVUS TRUST COMPANY, N.A. IN 2006, THE ORGANIZATION INVESTED FUNDS WITH THE COMMUNITY FOUNDATION OF SOUTH GEORGIA, INC., WHICH ARE TO BE USED EXCLUSIVELY FOR THE CHARITABLE AND HEALTH PURPOSES OF THE COMMUNITY.
LIABILITY UNDER FIN 48 FOOTNOTE	SCHEDULE D, PAGE 3, PART X	THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION 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 ORGANIZATION 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 ORGANIZATION'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2009-2011.
RECONCILIATION OF CHANGES - OTHER	SCHEDULE D, PAGE 4, PART XI, LINE 8	MEALS EXPENSE FOR SNF PATIENTS -577,722 CHARITABLE CONTRIBUTIONS -5,000,000 INVESTMENT MANAGEMENT FEES -76,333 CHARITABLE CONTRIBUTIONS 5,000,000 INVESTMENT MANAGEMENT FEES 76,333 MEALS EXPENSE FOR SNF PATIENTS 577,722
REVENUE AMOUNTS INCLUDED ON RETURN - OTHER	SCHEDULE D, PAGE 4, PART XII, LINE 4B	MEALS EXPENSE FOR SNF PATIENTS 577,722 CHARITABLE CONTRIBUTIONS 5,000,000 INVESTMENT MANAGEMENT FEES 76,333
EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER	SCHEDULE D, PAGE 4, PART XIII, LINE 4B	CHARITABLE CONTRIBUTIONS 5,000,000 INVESTMENT MANAGEMENT FEES 76,333 MEALS EXPENSE FOR SNF PATIENTS 577,722

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	true	FPGReferenceFreeCare

Other Percentage OtherPercentage

Field	Value	IRS element (for citing)
Other	X	Other
Free Other Percentage	1.25000	FreeOtherPercentage

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent200 D	X	Pcent200D
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	false	ExpensesExceededBudget
Annual Community Benefit Report	false	AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	696458	TotalCommunityBenefitExpense
Net Community Benefit Expense	696458	NetCommunityBenefitExpense
Percent Of Total Expense	0.02140	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1764031	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2924885	DirectOffsettingRevenue
Net Community Benefit Expense	-1160854	NetCommunityBenefitExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Total Community Benefit Expense	15571	TotalCommunityBenefitExpense
Direct Offsetting Revenue	10256	DirectOffsettingRevenue
Net Community Benefit Expense	5315	NetCommunityBenefitExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2476060	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2935141	DirectOffsettingRevenue
Net Community Benefit Expense	-459081	NetCommunityBenefitExpense
Percent Of Total Expense	0.02160	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	60745	TotalCommunityBenefitExpense
Net Community Benefit Expense	60745	NetCommunityBenefitExpense
Percent Of Total Expense	0.00190	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Total Community Benefit Expense	5000000	TotalCommunityBenefitExpense
Net Community Benefit Expense	5000000	NetCommunityBenefitExpense
Percent Of Total Expense	0.15380	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	5060745	TotalCommunityBenefitExpense
Net Community Benefit Expense	5060745	NetCommunityBenefitExpense
Percent Of Total Expense	0.15560	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	7536805	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2935141	DirectOffsettingRevenue
Net Community Benefit Expense	4601664	NetCommunityBenefitExpense
Percent Of Total Expense	0.17720	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$2,893,964	BadDebtExpenseAmount
Amount Reimbursed By Medicare	3975068	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	4199015	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-223947	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	DONALSONVILLE HOSPITAL INC	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	102 HOSPITAL CIRCLE	AddressLine1
City	DONALSONVILLE	City
State	GA	State
ZIP Code	39845	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Er24 Hours	X	Er24Hours
Other	SNF	Other

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	DONALSONVILLE HOSPITAL INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	false	CHNAConducted
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	125.0	FPGFreePercent
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	200.0	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	true	IncludesPublicityMeasures
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Available On Request	X	AvailableOnRequest
Actions On Nonpayment	false	ActionsOnNonpayment
Collection Activities	false	CollectionActivities
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	1	NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	SEMINOLE MANOR NURSING HOME	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	102 HOSPITAL CIRCLE	AddressLine1
City	DONALSONVILLE	City
State	GA	State
ZIP Code	31745	ZIPCode

Field	Value	IRS element (for citing)
Facility Type	SNF	FacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
COSTING METHODOLOGY EXPLANATION	PART I LINE 7	THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATIONS A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS 2008 SEE ALSO THE DESCRIPTION FOR PART III LINE 4
BAD DEBT EXPENSE EXPLANATION	PART III LINE 4	AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT AND WRITTEN OFF TO BAD DEBT EXPENSE AUDITED FINANCIAL STATEMENT FOOTNOTE ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRDPARTY COVERAGE THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IF NECESSARY FOR EXAMPLE FOR EXPECTED UNCOLLECTIBLES DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRDPARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY FOR RECEIVABLES ASSOCIATED WITH SELFPAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE THE DIFFERENCE BETWEEN THE STANDARD RATES OR THE DISCOUNTED RATES IF NEGOTIATED AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS THE ORGANIZATIONS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELFPAY PATIENTS REMAINED AT 85 OF SELFPAY ACCOUNTS RECEIVABLE AT JUNE 30 2011 AND AT JUNE 30 2012 IN ADDITION THE ORGANIZATIONS SELFPAY WRITEOFFS INCREASED 300000 FROM 2700000 FOR FISCAL YEAR 2011 TO 3000000 FOR FISCAL YEAR 2012 THE ORGANIZATION HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEARS 2012 OR 2011 THE ORGANIZATION DOES NOT MAINTAIN A MATERIAL ALLOWANCE FOR DOUBTFUL ACCOUNTS FROM THIRDPARTY PAYORS NOR DOES IT HAVE SIGNIFICANT WRITEOFFS FROM THIRDPARTY PAYORS
MEDICARE EXPLANATION	PART III LINE 8	MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS
COLLECTION PRACTICES EXPLANATION	PART III LINE 9B	OUR PATIENT FINANCIAL SERVICES DEPARTMENT VISITS PATIENTS WHO HAVE NO INSURANCE TO DISCUSS ASSISTANCE AND REFER THOSE PATIENTS TO OUR LOCAL DFCS OFFICE TO OBTAIN ASSISTANCE WITH APPLYING FOR MEDICAID AND OTHER FINANCIAL ASSISTANCE OUR PATIENT FINANCIAL SERVICES DEPARTMENT WHICH DOES SELFPAY BILLING AND COLLECTION INFORMS PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND ASSISTS THEM IN MAKING AN APPLICATION BILLING STATEMENTS PROVIDE A MESSAGE AND TELEPHONE NUMBER TO CALL IF THE PATIENT HAS DIFFICULTY MAKING PAYMENT FOR PATIENTS WHO QUALIFY AS INDIGENT AND CHARITY PATIENTS THERE IS NO FINANCIAL OBLIGATION THOSE PATIENTS WHO DO NOT QUALIFY AS INDIGENT AND CHARITY PATIENTS AND DONT HAVE ANY 3RD PARTY COVERAGE ARE SENT STATEMENTS AND LETTERS WHERE THEY ARE PAST DUE 30 60 AND 90 DAYS IF PAYMENT ARRANGEMENTS ARE STILL NOT MADE AFTER 90 DAYS THEN THOSE ACCOUNTS ARE REFERRED TO COLLECTIONS BEFORE REFERRAL TO A COLLECTION AGENCY OUR COLLECTION DEPARTMENT EXAMINES THE ACCOUNTS FOR POSSIBLE 3RD PARTY COVERAGE IF NO 3RD PARTY COVERAGE EXISTS THEN WE MOVE FORWARD WITH OUR NORMAL INHOUSE COLLECTION PROCEDURES
NEEDS ASSESSMENT	PART VI	THE ORGANIZATION CONDUCTS VARIOUS TYPES OF ASSESSMENTS TO DETERMINE THE COMMUNITYS NEEDS FOR HEALTH SERVICES OUR ORGANIZATION COLLABORATES WITH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TO IDENTIFY THE NEEDS OF THE COMMUNITY COMMUNITY RESEARCH HAS SHOWN THAT THE SERVICES FOR WHICH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TURN TO THE ORGANIZATION FOR ARE EMERGENCY SERVICES DIAGNOSTIC TESTS AND XRAYS AND ALSO GENERAL MEDICAL CARE OTHER SERVICES FOR WHICH THEY TURN TO US AS A MAJOR PROVIDER ARE MINOR SURGERY PEDIATRIC CARE GENERAL SURGERY AND OBSTETRICAL CARE THIS INFORMATION COMBINED WITH OUR EXTENSIVE COLLABORATIONS AND OUR ROLE AS A LEADER IN THE COMMUNITY PROVIDES US THE MEANS TO UNDERSTAND AND ADDRESS THE COMMUNITYS NEEDS AND ENSURES OUR OUTREACH PROGRAMS ARE FOCUSED ON THE POPULATIONS WHO NEED OUR SERVICES THE MOST OUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	PART VI	THE BOARD HAS CLEARLY WRITTEN INDIGENT AND FINANCIAL AID POLICIES THAT ARE AVAILABLE THROUGH THE BUSINESS OFFICE SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND FINANCIAL AID PATIENT EDUCATION ON THE ORGANIZATIONS INDIGENTCHARITY AND FINANCIAL AID PROGRAMS ARE CONDUCTED DURING PREREGISTRATION THROUGH OUR PATIENT FINANCIAL SERVICES DEPARTMENT FOR PATIENTS THAT DO NOT HAVE ANY 3RD PARTY COVERAGE BROCHURES ARE PROMINENTLY DISPLAYED AT EACH REGISTRATION BOOTH THE BUSINESS OFFICE CONTINUOUSLY PROVIDES INFORMATION TO THE BUSINESS OFFICE MANAGERS OF OUR LOCAL PHYSICIANS PRACTICES PHONE CALLS AND LETTERS ARE SENT TO ALL PATIENTS THAT ARE NOT INTERVIEWED AT THE TIME OF ADMISSION EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAMS OUR EMERGENCY DEPARTMENT IS OPERATED 247 AND OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY THE BOARD HAS CLEARLY WRITTEN INDIGENTCHARITY AND FINANCIAL AID POLICIES THAT ARE AVAILABLE THROUGH THE BUSINESS OFFICE SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE CARE AND FINANCIAL AID
COMMUNITY INFORMATION	PART VI	THE ORGANIZATION SERVES A PREDOMINATELY RURAL AREA IN SEMINOLE COUNTY IN ITS BROADEST BOUNDARIES DONALSONVILLE IS THE ECONOMIC AND MEDICAL HUB FOR THE REGION AND THE ORGANIZATION DRAWS FROM A POPULATION OF 9000 TO 10000 RESIDENTS FOR MAJOR HEALTH CARE SERVICES THE REGION IS MARKED BY VAST DICHOTOMIES OF WEALTH EDUCATION AND HEALTH STATUS THE ORGANIZATION SERVES A POPULATION THAT HAS A HIGH PROPORTION OF LOW INCOME INDIVIDUALS ABOUT 158 OF FAMILIES AND 232 OF THE POPULATION WERE BELOW THE POVERTY LINE
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE	PART VI	OUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY WE HAVE PARTICIPATED IN VARIOUS LOCAL HEALTH FAIRS TO PROMOTE GOOD HEALTH AND PROVIDE SCREENING MECHANISMS FOR DETECTING HIGH BLOOD PRESSURE ABNORMAL BLOOD SUGAR LEVELS AND HIGH CHOLESTEROL THESE ARE THE MOST PRESSING AND PREVENTABLE DISEASES IN OUR COMMUNITY WE WORK CLOSELY WITH THE LOCAL HEALTH DEPARTMENT TO ASSIST THEM WITH THE PROGRAMS THAT THEY FACILITATE THROUGHOUT THE YEAR OUR BOARD HAS HAD IN PLACE FOR 20 YEARS A SCHOLARSHIP PROGRAM FOR PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS WE HAVE BEEN FORTUNATE TO HAVE MANY OF OUR LOCAL RESIDENTS FINISH MEDICAL SCHOOL NURSING SCHOOL AND OTHER PROFESSIONAL CERTIFICATIONS AND COME BACK TO DONALSONVILLE TO PRACTICE AND WORK IN OUR LOCAL HEALTHCARE COMMUNITY THE PHYSICIAN SCHOLARSHIP PROGRAM HAS PRODUCED 4 OF OUR CURRENT 12 MEMBER MEDICAL STAFF WE ALSO HAVE 5 IN THE PROGRAM THAT ARE SCHEDULED TO COME BACK TO OUR COMMUNITY OVER THE NEXT 10 YEARS THIS TYPE OF PROGRAM HAS HELPED KEEP HEALTHCARE AVAILABLE AND ACCESSIBLE TO OUR RURAL COMMUNITY IT HAS ENABLED US TO START NEW SERVICES THAT WOULD NOT HAVE EXISTED OTHERWISE OUR BOARD IS DEDICATED TO PLANNING AND PREPARING FOR THIS RURAL COMMUNITY TO HAVE EASILY ACCESSIBLE HEALTHCARE FOR MANY YEARS TO COME
DONALSONVILLE HOSPITAL INC LINE NUMBER 1 PART V LINE 19D	PART V LINE 19D	THE HOSPITAL DISCOUNTED GROSS CHARGES FOR PATIENTS WITHOUT THIRD PARTY INSURANCE COVERAGE BY FIFTEEN PERCENT

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY FOUNDATION OF SOUTH GA IN	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	135 N BROAD STREET	AddressLine1
City	THOMASVILLE	City
State	GA	State
ZIP Code	31792	ZIPCode

Field	Value	IRS element (for citing)
EIN Of Recipient	582210876	EINOfRecipient
IRC Section	3	IRCSection
Amount Of Cash Grant	5000000	AmountOfCashGrant
Purpose Of Grant	COMMUNITY HEALTH	PurposeOfGrant

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	1	TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES	Identifier
Return Reference	SCHEDULE I, PAGE 1, PART I, LINE 2	ReturnReference
Explanation	THE FUNDS ARE GIVEN TO THE 501(C)(3) ORGANIZATION WITH THE INTENT THAT THE RECIPIENT WILL USE THE FUNDS FOR THEIR TAX EXEMPT PURPOSE.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	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	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Bonus Filing OrgBonusFilingOrg	Total Compensation Filing OrgTotalCompensationFilingOrg
HERMAN BROOKINS
359334	16890	376224
CHARLES H ORRICK
201302	12410	213712
JAMES MOODY
178313	12670	190983
MURDOC HENDERSON MD
331248		331248
JESSICA NUNUZ MD
306877		306877
JOSEPH WALKER SR MD
295277		295277
ANDREA ALEXANDER WADDELL MD
247920	16409	264329
ROYCE CANNINGTON JR
210018		210018

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Identifier	OTHER ADDITIONAL INFORMATION	Identifier
Return Reference	SCHEDULE J, PART III	ReturnReference
Explanation	PART I, LINE 4 - DEFERRED COMPENSATION PLAN 457(B) THE ORGANIZATION HAS ESTABLISHED A DEFERRED COMPENSATION PLAN FOR CERTAIN KEY EMPLOYEES. THE 457(B) PLAN IS A NON-QUALIFIED RETIREMENT PLAN THAT ALLOWS A MAXIMUM SALARY DEFERRAL OF THE LESSER OF 16,500 OR ONE-THIRD OF AN EMPLOYEE'S SALARY.	Explanation

Schedule L IRS990ScheduleL

Loan Table LoanTable

Field	Value	IRS element (for citing)
Name Person	BEAU CANNINGTON	NamePerson
Purpose Of Loan	SCHOLARSHIP LOAN	PurposeOfLoan
Loan From Organization	X	LoanFromOrganization
Original Principal	$100,000	OriginalPrincipalAmount
Balance Due	162111	BalanceDue
Default	false	Default
Approved By Board	true	ApprovedByBoard
Written Agreement	true	WrittenAgreement

Field	Value	IRS element (for citing)
Total Balance Due	162111	TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Field	Value	IRS element (for citing)
Name Person	BRIAN BROOKINS	NamePerson

Field	Value	IRS element (for citing)
Relationship	FAM BD MEMBER	Relationship
Amount Of Transaction	188522	AmountOfTransaction
Description Of Transaction	COMPENSATION	DescriptionOfTransaction
Sharing Of Revenues	false	SharingOfRevenues

Form990 Schedule L Part V Form990ScheduleLPartV

Field	Value	IRS element (for citing)
Identifier	ADDITIONAL INFORMATION	Identifier
Return Reference	SCHEDULE L PART V	ReturnReference
Explanation	BRIAN BROOKINS AN EMPLOYEE OF THE ORGANIZATION IS THE SON OF HERMAN BROOKINS WHO IS THE CHAIRMAN OF THE BOARD AND CEO	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
DOCUMENTATION BY COMMITTEE	FORM 990, PAGE 6, PART VI, LINE 8B	THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	THE INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 (BASED UPON INFORMATION PROVIDED BY THE ORGANIZATION) PROVIDES A COPY OF THE RETURN TO BE REVIEWED BY MANAGEMENT. UPON REVIEW, THE FORM 990 AND RELATED SCHEDULES ARE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND FEEDBACK. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES, A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	THE ORGANIZATION HAS A WRITTEN POLICY RESPECTING CONFLICTS OF INTEREST AND DISCLOSURE OF SAME. GENERALLY SPEAKING, THE POLICY REQUIRES ANY "COVERED PERSON" WHO BELIEVES HE HAS A CONFLICT OF INTEREST TO: -DISCLOSE THE EXISTENCE AND NATURE OF THE CONFLICT OF INTEREST (INCLUDING ALL FACTS KNOWN RESPECTING THE SUBJECT MATTER) TO THE CHAIRMAN OF THE BOARD; -PLAY NO PART, DIRECTLY OR INDIRECTLY, IN THE DELIBERATION OR VOTE OF THE BOARD OF DIRECTORS WITH RESPECT TO THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS; AND -RECUSE HIMSELF FROM THAT PORTION OF THE MEETING AT WHICH THE CONFLICT OF INTEREST IS DISCUSSED. THE DEFINITION OF A "COVERED PERSON" INCLUDES ALL BOARD MEMBERS, OFFICERS AND MEMBERS OF SENIOR MANAGEMENT OF THE ORGANIZATION. WHEN A COVERED PERSON DISCLOSES A POTENTIAL CONFLICT OF INTEREST TO THE BOARD CHAIRMAN, THE CHAIRMAN IS OBLIGED TO BRING THE MATTER TO THE ATTENTION OF THE FULL BOARD WHO DETERMINES WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. IF A CONFLICT OF INTEREST EXISTS, THE TRANSACTION OR MATTER GIVING RISE TO THE CONFLICT OF INTEREST MAY NOT PROCEED UNLESS THE BOARD DETERMINES, BY A MAJORITY VOTE, THAT, DESPITE THE CONFLICT OF INTEREST, THE TRANSACTION/MATTER IS NEVERTHELESS IN THE ORGANIZATION'S BEST INTEREST AND IS FAIR AND REASONABLE TO THE ORGANIZATION. IN ADDITION TO THE REQUIREMENT TO DISCLOSE A POTENTIAL CONFLICT OF INTEREST AT THE TIME IT ARISES, EACH MUST SUBMIT ANNUALLY A `CONFLICT AND DISCLOSURE OF INTEREST QUESTIONNAIRE'.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	THE BOARD OF DIRECTORS MEET REGULAR ON A MONTHLY BASIS AND THE ORGANIZATIONS SALARY DECISIONS ARE REVIEWED THE BOARD.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	THE BOARD OF DIRECTORS MEET REGULAR ON A MONTHLY BASIS AND THE SALARY DECISIONS ARE REVIEWED BY THE BOARD.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	THE ORGANIZATION KEEPS A COPY OF THE AUDITED FINANCIAL STATEMENTS AS WELL AS A COPY OF THE FORM 990 FOR EACH FISCAL YEAR WHICH ARE MADE AVAILABLE UP REQUEST TO THE GENERAL PUBLIC.
OTHER CHANGES IN NET ASSETS EXPLANATION	FORM 990, PART XI, LINE 5	UNREALIZED LOSS ON INVESTMENTS 691,051 PRIOR YEAR NET ASSET ADJUSTMENT 677 TOTAL DECREASE IN NET ASSETS 691,728