ARCHBOLD FOUNDATION INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- ARCHBOLD FOUNDATION INC (EIN 58-1559677)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-01
- IRS object ID
- 201342139349300629
- 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 B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-01T12:59:20-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAFFIN & TUCKER LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 71309 | AddressLine1 |
| City | ALBANY | City |
| State | GA | State |
| ZIP Code | 317081309 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581559677 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARCHBOLD FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ARCH | NameControl |
| Phone | 2292282200 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 620 | AddressLine1 |
| City | THOMASVILLE | City |
| State | GA | State |
| ZIP Code | 317990620 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | E VANN MIDDLETON | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 2292282200 | Phone |
| Date Signed | 2013-08-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACQUELINE G ATKINS | Name |
| Phone | 2298837878 | Phone |
| Date Prepared | 2013-08-01 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | E VANN MIDDLETON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 1018 | AddressLine1 |
| City | THOMASVILLE | City |
| State | GA | State |
| ZIP Code | 317991018 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 5657437 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1983 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | SUPPORT ORGANIZATION | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 20 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 2756376 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2695592 | ContributionsGrantsCurrentYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1755860 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2932616 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -83015 | OtherRevenuePriorYear |
| Other Revenue Current Year | -28388 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 4429221 | TotalRevenuePriorYear |
| Total Revenue Current Year | 5599820 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 3163116 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 3214675 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 318512 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 336368 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 10285 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 1456 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 1456 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 344302 | OtherExpensePriorYear |
| Other Expenses Current Year | 328254 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 3836215 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3880753 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 593006 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1719067 | RevenuesLessExpensesCY |
| Total Assets BOY | 69292782 | TotalAssetsBOY |
| Total Assets EOY | 77351034 | TotalAssetsEOY |
| Total Liabilities BOY | 87261 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1393472 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 69205521 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 75957562 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SUPPORT ORGANIZATION | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 3414690 | Expense |
| Grants | 2996214 | Grants |
| Description | PAYMENT TO JOHN D. ARCHBOLD MEMORIAL HOSPITAL TO BE USED FOR NURSING SCHOLARSHIPS AND THE CONSTRUCTION AND EQUIPPING OF FACILITIES. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 75911 | Expense |
| Grants | 75911 | Grants |
| Description | PAYMENT TO ARCHBOLD HEALTH SERVICES FOR CONTRIBUTIONS MADE TO THE HOSPICE PROGRAM. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 47000 | Expense |
| Grants | 47000 | Grants |
| Description | PAYMENT TO JOHN D. ARCHBOLD MEMORIAL HOSPITAL FOR PHARMACY FOR INDIGENT CANCER PATIENTS. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 341696 | Expense |
| Grants | 95550 | Grants |
| Description | PAYMENT TO AREA DENTIST FOR INDIGENT CARE CANCER PATIENTS. PAYMENT TO HEALTHVISIONS FOR ALL EDUCATIONAL HEALTH INFORMATION. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 341696 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 95550 | TotalOfOtherProgramServiceGrnt |
| Total Program Service Expense | 3879297 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | true | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| 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 | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | 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 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| 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 | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 20 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | GAIL P ROBERSON | NamePerson |
| Telephone Number | 2292282200 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 OLD ALBANY ROAD | AddressLine1 |
| City | THOMASVILLE | City |
| State | GA | State |
| ZIP Code | 31792 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| J PERRY MUSTIAN | ||||||
| TRUSTEE/CEO | 1.00 | X | X | 0 | 758554 | 1261563 |
| FRANCES PARKER | ||||||
| PRESIDENT | 40.00 | X | X | 208026 | 0 | 38120 |
| GINA SHUMAKE | ||||||
| SEC & TREAS/ | 1.00 | X | X | 0 | 44170 | 0 |
| THERESA BROWN | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| DOUGLAS MCPHERSON MD | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| GANNON HUNT | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| GERALD KADIS MD | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JOHN BRINSON | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JOHN N DANIEL III | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| HAILE MCCOLLUM | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| KIM B JONES | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| MILES WATKINS | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| RANKIN SMITH | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| REDMOND INGALLS | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| RICHARD G MOONEY III | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| MARTIN C WOOD III | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| ROBERT MILES MD | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| SHARON MAXWELL FERGUSON | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| TONY CAMPBELL | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| AL PARK | ||||||
| VICE CHAIR/S | 1.00 | X | X | 0 | 0 | 0 |
| CHARLES E HANCOCK MD | ||||||
| TRUSTEE/CHAI | 1.00 | X | X | 0 | 0 | 0 |
| RODNEY G DEESE | ||||||
| CHAIRMAN/VIC | 1.00 | X | X | 0 | 0 | 0 |
| CHARLES D HIGHTOWER JR | ||||||
| ASST SEC/HO | 1.00 | X | 0 | 410660 | 44636 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 208026 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1213384 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1344319 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIRTLE CALLAGHAN & CO | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 318 | AddressLine1 |
| Address Line2 | CHURCH ROAD STATION | AddressLine2 |
| City | NEW YORK | City |
| State | NY | State |
| ZIP Code | 100080318 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | INVEST MGRS | DescriptionOfServices |
| Compensation | 163788 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Fundraising Events | 121282 | FundraisingEvents |
| All Other Contributions | 2574310 | AllOtherContributions |
| Total Contributions | 2695592 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1313053 | TotalRevenueColumn |
| Exclusion | $1,313,053 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1619563 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1619563 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1619563 | TotalRevenueColumn |
| Exclusion | $1,619,563 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 29229 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 121282 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 57617 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -28388 | TotalRevenueColumn |
| Exclusion | -$28,388 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5599820 | TotalRevenueColumn |
| Exclusion | $2,904,228 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3214675 | Total |
| Program Services | 3214675 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 246146 | Total |
| Program Services | 246146 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64704 | Total |
| Program Services | 64704 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25518 | Total |
| Program Services | 25518 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26809 | Total |
| Program Services | 26809 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8858 | Total |
| Program Services | 8858 | ProgramServices |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1456 | Total |
| Fundraising | 1456 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 205981 | Total |
| Program Services | 205981 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63 | Total |
| Program Services | 63 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16549 | Total |
| Program Services | 16549 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 363 | Total |
| Program Services | 363 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6565 | Total |
| Program Services | 6565 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21879 | Total |
| Program Services | 21879 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| MISCELLANEOUS | 27874 | 27874 |
| REPAIRS & MAINTENANCE | 11081 | 11081 |
| DUES & SUBSCRIPTIONS | 2232 | 2232 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3880753 | Total |
| Program Services | 3879297 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 1456 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 877545 | BOY |
| EOY | 1280640 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1729312 | BOY |
| EOY | 2000102 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 313370 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 191815 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 917806 | BOY |
| EOY | 121555 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50441892 | BOY |
| EOY | 56523644 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15326227 | BOY |
| EOY | 17425093 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69292782 | BOY |
| EOY | 77351034 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33451 | BOY |
| EOY | 31523 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53810 | BOY |
| EOY | 1361949 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 87261 | BOY |
| EOY | 1393472 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57538557 | BOY |
| EOY | 65358785 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11666964 | BOY |
| EOY | 10598777 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69205521 | BOY |
| EOY | 75957562 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 69292782 | BOY |
| EOY | 77351034 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1719067 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 5032974 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | true | AccountantCompileOrReview |
| FS Audited | false | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type2 | X | SupportingOrg509a3Type2 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN D ARCHBOLD MEMORIAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 580566121 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | true | ListedInGoverningDoc |
| Supported Organization Notified | true | SupportedOrganizationNotified |
| Organized In US | true | OrganizedInUS |
| Amount | $3,138,214 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 2 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 3214125 | SumOfAmounts |
| General Explanation | PART I, LINE 11H - SERVICES PROVIDED TO SUPPORTED ORGANIZATIONS. THE FILING ENTITY PROVIDES FUNDRAISING SERVICES TO BOTH SUPPORTED ORGANIZATIONS. | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 313370 | OtherCostOrOtherBasis |
| Depreciation | 191815 | Depreciation |
| Book Value | 121555 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 121555 | TotalOfBookValueLandBuildings |
Closely Held Equity Interests CloselyHeldEquityInterests
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 17425093 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 17425093 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO RELATED PARTIES | Description |
| Amount | $1,361,949 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1361949 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | LIABILITY UNDER FIN 48 FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PAGE 3, PART X | ReturnReference |
| Explanation | THE MEDICAL CENTER, WITH THE EXCEPTION OF ARCHBOLD MEDICAL ENTERPRISES, INC., IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX- EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE MEDICAL CENTER ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2012 AND 2011 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTER'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2009-2011. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 132400 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 103171 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 29229 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 21000 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 10571 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 7273 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 11091 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 6395 | OtherDirectExpensesEvent1 |
| Name Of Event2 | TREE OF LIGHTS | NameOfEvent2 |
| Gross Receipts Event2 | 18111 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 18111 | CharitableContributionsEvent2 |
| Food And Beverage Event2 | 400 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 887 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 150511 | GrossReceiptsTotal |
| Charitable Contributions Total | 121282 | CharitableContributionsTotal |
| Gross Revenue Total Events | 29229 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 21000 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 10571 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 7273 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 11491 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 7282 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 57617 | DirectExpenseSummaryEvents |
| Net Income Summary | -28388 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| JOHN D ARCHBOLD MEM HOSP INC | |||||||
| P O BOX 1018 | THOMASVILLE | GA | 317991018 | 580566121 | 3 | 300000 | NURSING SCHOLARSHIPS |
| ARCHBOLD HEALTH SERVICES INC | |||||||
| P O BOX 620 | THOMASVILLE | GA | 317990620 | 581376434 | 3 | 75911 | HOSPICE SUPPORT |
| JOHN D ARCHBOLD MEMORIAL HOSPITAL | |||||||
| P O BOX 1018 | THOMASVILLE | GA | 317991018 | 580566121 | 3 | 32000 | DRUG EXP-INDIGENT |
| JOHN D ARCHBOLD MEM HOSP INC | |||||||
| P O BOX 1018 | THOMASVILLE | GA | 317991018 | 580566121 | 3 | 35000 | DENTAL - INDIGENT |
| JOHN D ARCHBOLD MEM HOSP INC | |||||||
| P O BOX 1018 | THOMASVILLE | GA | 317991018 | 580566121 | 3 | 15000 | CRITICAL CONDITIONS |
| JOHN D ARCHBOLD MEM HOSP INC | |||||||
| P O BOX 1018 | THOMASVILLE | GA | 317991018 | 580566121 | 3 | 769372 | CAPITAL CONTRIBUTION |
| JOHN D ARCHBOLD MEM HOSP INC | |||||||
| P O BOX 1018 | THOMASVILLE | GA | 317991018 | 580566121 | 3 | 1926842 | CAPITAL CONTRIBUTION |
| JOHN D ARCHBOLD MEM HOSP INC | |||||||
| P O BOX 1018 | THOMASVILLE | GA | 317991018 | 580566121 | 3 | 60000 | PATIENT SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | 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 | ARCHBOLD FOUNDATION IS A SUPPORTING ORGANIZATION FOR JOHN D. ARCHBOLD MEMORIAL HOSPITAL AND ARCHBOLD HEALTH SERVICES. THE FOUNDATION ACCEPTS GRANT REQUESTS FROM ENTITIES WITHIN JDAMH AND AHS. THESE GRANT REQUESTS ARE IN THE FORM OF LETTERS, EACH OF WHICH INCLUDE A SPECIFIC GRANT AMOUNT AND A BUDGET AND/OR DESCRIPTION OF PROPOSED SERVICES OR PURCHASES. THE GRANT REQUESTS ARE REVIEWED ANNUALLY PRIOR TO APPROVAL OF THE ANNUAL BUDGET. DEPARTMENTS REPORT THE USE OF FUNDS TO THE FOUNDATION ADMINISTRATION. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | true | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | true | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|
| J PERRY MUSTIAN | |||||||||||
| 528111 | 220500 | 9943 | 1239049 | 22514 | 2020117 | ||||||
| FRANCES PARKER | |||||||||||
| 156073 | 32506 | 19447 | 17237 | 20883 | 246146 | ||||||
| CHARLES D HIGHTOWER JR | |||||||||||
| 286769 | 88092 | 35799 | 21852 | 22784 | 455296 | ||||||
Form990 Schedule J Part III Form990ScheduleJPartIII (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FRINGE OR EXPENSE EXPLANATION | SCHEDULE J, PAGE 1, PART I, LINE 1A | SOCIAL CLUB DUES ARE PAID BY THE ORGANIZATION ON BEHALF OF OFFICERS AND EXECUTIVES OF THE FILING ORGANIZATION. ADDITIONALLY, THESE OFFICERS AND EXECUTIVES ARE REIMBURSED MILEAGE. THESE AMOUNTS ARE INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME AND REPORTED ON THEIR W-2. |
| RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION | SCHEDULE J, PAGE 1, PART I, LINE 3 | THE FILING ORGANIZATION RELIES ON THE METHODS USED BY ARCHBOLD MEDICAL CENTER, INC.(AMC), A RELATED ORGANIZATION, TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY AMC INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. |
| SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS | SCHEDULE J, PAGE 1, PART I, LINE 4 | J. PERRY MUSTIAN 0 1,217,000 0 |
| COMPENSATION CONTINGENT UPON NET EARNINGS OF ORGANIZATION | SCHEDULE J, PAGE 1, PART I, LINE 6A | CONTINGENT IN PART ON MEETING MANAGEMENT BY OBJECTIVE INCENTIVE PLAN GOALS AND EXCESS OF REVENUE OVER EXPENSES. |
| COMPENSATION CONTINGENT UPON NET EARNINGS OF RELATED ORG | SCHEDULE J, PAGE 1, PART I, LINE 6B | CONTINGENT IN PART ON MEETING MANAGEMENT BY OBJECTIVE INCENTIVE PLAN GOALS AND EXCESS OF REVENUE OVER EXPENSES. |
| OTHER ADDITIONAL INFORMATION | SCHEDULE J, PART III | THE IRS RULES & REGULATIONS REQUIRE THAT CERTAIN NON-CURRENT, NON-CASH ITEMS ARE REPORTED IN PART II REGARDLESS OF THE CURRENT BENEFIT TO THE EMPLOYEE. THESE SAME RULES, IN SOME CASES, REQUIRE THE COMPENSATION AND BENEFITS TO BE REPORTED TWICE IN PART II, ONCE WHEN THE ENTITY ACCRUES FOR A FUTURE PAYMENT AND ONCE WHEN THE PAYMENT IS ACTUALLY MADE TO THE EMPLOYEE. THEREFORE, AN EMPLOYEE'S STATED TOTAL COMPENSATION AND BENEFITS REPORTED ON PART II ARE SUBSTANTIALLY HIGHER THAN THE ACTUAL CASH COMPENSATION RECEIVED IN THE CURRENT YEAR. AMOUNTS REPORTED AS BENEFITS INCLUDE AMOUNTS FOR LIFE INSURANCE, HEALTH INSURANCE, THRIFT PLAN CONTRIBUTIONS, AND PENSION CONTRIBUTIONS. BENEFITS RELATED TO PENSION AND RETIREMENT PLANS REFLECT AMOUNTS ACCUMULATED, BUT NOT PAID, TO THE INDIVIDUAL IN RECOGNITION OF TOTAL YEARS OF EMPLOYMENT, NOT JUST THE CURRENT YEAR. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN THREE OF AMC'S TOP EXECUTIVES PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS ACCRUED BUT UNFUNDED IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON-QUALIFIED RETIREMENT PLAN. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| CHARLES E HANCOCK MD | |||
| TRUSTEE | 199733013 | BANKING RELATIONSHIP | false |
| KIM JONES | |||
| TRUSTEE | 6619019 | BANKING RELATIONSHIP | false |
| RICHARD G MOONEY III | |||
| TRUSTEE | 8084708 | INVESTMENT MANAGER | false |
| MILES WATKINS | |||
| TRUSTEE | 199733013 | BANKING RELATIONSHIP | false |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE L PART V | ReturnReference |
| Explanation | CHARLES E HANCOCK MD AND MILES WATKINS ARE DIRECTORS OF THOMASVILLE NATIONAL BANK THE ORGANIZATION UTILIZES BANKING SERVICES AND ONSITE THRIFT PLAN SERVICES FROM THOMASVILLE NATIONAL BANK THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 93012 FOR THE FILING AND ALL RELATED ORGANIZATIONS KIM JONES IS A DIRECTOR OF COMMERCIAL BANK THE ORGANIZATION UTILIZES BANKING SERVICES FROM COMMERCIAL BANK THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 93012 FOR THE FILING AND ALL RELATED ORGANIZATIONS RICHARD G MOONEY III IS THE INVESTMENT MANAGER FOR AMCS SERP ACCOUNT THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 93012 FOR THE FILING AND ALL RELATED ORGANIZATIONS | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ALL OTHER ACCOMPLISHMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4D | PAYMENT TO AREA DENTIST FOR INDIGENT CARE CANCER PATIENTS. PAYMENT TO HEALTHVISIONS FOR ALL EDUCATIONAL HEALTH INFORMATION. |
| RELATED PARTY INFORMATION AMONG OFFICERS | FORM 990, PAGE 6, PART VI, LINE 2 | JOHN N. DANIEL III MILES WATKINS TRUSTEE TRUSTEE BUSINESS RELATIONSHIP TONY CAMPBELL RICHARD G. MOONEY III TRUSTEE TRUSTEE BUSINESS RELATIONSHIP TONY CAMPBELL CHARLES E. HANCOCK, M.D. TRUSTEE TRUSTEE BUSINESS RELATIONSHIP |
| ELECTION OF MEMBERS AND THEIR RIGHTS | FORM 990, PAGE 6, PART VI, LINE 7A | THE BOARD OF TRUSTEES OF THE FILING ENTITY ARE ELECTED ANNUALLY BY THE SOLE MEMBER, ARCHBOLD MEDICAL CENTER, INC. ("AMC"). IN ADDITION, AMC HAS THE POWER TO SELECT OR REPLACE AND TO REMOVE THE TRUSTEES OF THE GOVERNING BODY. AMC'S CHAIRMAN OF THE BOARD OF TRUSTEES SHALL SERVE AS EX-OFFICIO OF THE BOARD OF ARCHBOLD FOUNDATION WITHOUT VOTING RIGHTS. |
| DECISIONS SUBJECT TO APPROVAL OF MEMBERS | FORM 990, PAGE 6, PART VI, LINE 7B | THE SOLE MEMBER, ARCHBOLD MEDICAL CENTER, INC. ("AMC"), HAS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY, INCLUDING BUT NOT LIMITED TO, CAPITAL AND OPERATING BUDGETS, MERGERS OR ACQUISITIONS, CONTRACTS AND TRANSACTIONS OVER A CERTAIN AMOUNT, DISSOLUTION, ETC. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | PRIOR TO FILING THE FORM 990, THE ORGANIZATION PRESENTED ITS FORM 990 TO TRUSTEES ATTENDING THE JULY 2013 REGULARLY SCHEDULED BOARD MEETING. THE ORGANIZATIONS CFO PRESENTED THE INFORMATION, AND TRUSTEES HAD THE OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | ON AN ANNUAL BASIS, THE ORGANIZATION DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE AND DISCLOSURE STATEMENT TO EACH TRUSTEE. THIS QUESTIONNAIRE INCLUDES QUESTIONS RELATED TO FINANCIAL INTERESTS, OUTSIDE INTERESTS OR ACTIVITIES, AND GIFTS, MEALS, AND ENTERTAINMENT. IN ADDITION TO DISCLOSING ANY APPLICABLE INFORMATION ON THE QUESTIONNAIRE, THE TRUSTEE SIGNS AN ACKNOWLEDGMENT STATEMENT THAT (S)HE HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ, UNDERSTANDS, AND AGREES TO COMPLY WITH IT, AND UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION STATUS IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. RESPONSES ARE SUMMARIZED AND COLLECTIVELY REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE OF ARCHBOLD MEDICAL CENTER, INC. DURING EACH BOARD MEETING, THE CHAIRMAN INQUIRES IF ANY TRUSTEE HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST RELATED TO ANY AGENDA ITEM. IF THE TRUSTEE DISCLOSES ANY SUCH INTEREST, THE TRUSTEE IS EXCUSED FROM THE MEETING WHILE THE DETERMINATION AS TO WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS IS DISCUSSED AND VOTED UPON BY DISINTERESTED MEMBERS OF THE BOARD AND COMMITTEE. IF INVITED TO DO SO, THE TRUSTEE WITH A POTENTIAL CONFLICT MAY RESPOND TO QUESTIONS PUT FORTH BY FELLOW DISINTERESTED TRUSTEES REGARDING ANY PROPOSED TRANSACTION OR ARRANGEMENT. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS WILL CONTAIN THE NAME OF ANY INTERESTED PERSON/TRUSTEE WHO DISCLOSED OR WAS FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH A TRANSACTION OR ARRANGEMENT RESULTING IN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; AND THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATED TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSIONS, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | AMCS COMPENSATION COMMITTEE MAKES RECOMMENDATIONS TO THE FULL BOARD ON THE FOLLOWING POSITIONS: THE PRESIDENT OF ARCHBOLD MEDICAL CENTER; THE PRESIDENT OF THE ARCHBOLD FOUNDATION; AND THE PRESIDENT OF ARCHBOLD HEALTH SERVICES. AMCS PRESIDENT ALSO PRESENTS RECOMMENDATIONS FOR ALL SENIOR VICE PRESIDENTS AND HOSPITAL VICE PRESIDENTS TO THE COMPENSATION COMMITTEE. IN 2008, INTEGRATED HEALTHCARE SOLUTIONS (IHS) WAS ENGAGED BY THE BOARD TO REVIEW THE EXECUTIVE COMPENSATION PROGRAM AND MAKE RECOMMENDATIONS REGARDING PLAN DESIGN AND ACTUAL COMPENSATION INCLUDING BENEFITS. IN 2009, IHS PROVIDED UPDATED RECOMMENDATIONS ON COMPENSATION TO THE COMPENSATION COMMITTEE. FOR YEARS 2010-2012, THE BOARD CONTINUED TO UTILIZE IHS TO PERFORM MARKET ANALYSIS, REVIEW EXECUTIVE COMPENSATION, AND MAKE RECOMMENDATIONS. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | SEE RESPONSE TO 15A ABOVE. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | NO DOCUMENTS ARE OR WILL BE MADE AVAILABLE TO THE PUBLIC. |
| RELATED ORGANIZATIONS | FORM 990, PAGE 7, PART VII | AVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS: J. PERRY MUSTIAN 48 HOURS CHARLES HIGHTOWER 48 HOURS CHARLES HANCOCK 1 HOUR RODNEY DEESE 1 HOUR FRANCES PARKER 1 HOUR RICHARD MOONEY 1 HOUR ROBERT MILES 1 HOUR |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 5 | INCREASES IN NET ASSETS: UNREALIZED GAIN ON INVESTMENTS 6,101,161 DECREASES IN NET ASSETS: TEMPORARILY RESTRICTED FUNDS RELEASED HAVING MET MATCHING REQUIREMENTS (1,068,187) TOTAL CHANGES IN NET ASSETS: 5,032,974 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Business Name Line2DirectControllingEntityName/BusinessNameLine2 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ARCHBOLD HEALTH SERVICES INC | |||||||||||
| PO BOX 620 | THOMASVILLE | GA | 317990620 | 581376434 | MGMT | GA | 501C3 | 9 | AMC | ARCHBOLD MEDICAL CENTER INC | false |
| JOHN D ARCHBOLD MEMORIAL HOSPITAL I | |||||||||||
| PO BOX 1018 | THOMASVILLE | GA | 317991018 | 580566121 | ACUTE CARE | GA | 501C3 | 3 | AMC | ARCHBOLD MEDICAL CENTER INC | false |
| ARCHBOLD MEDICAL CENTER INC | |||||||||||
| PO BOX 1018 | THOMASVILLE | GA | 317991018 | 581552650 | HEALTHCARE | GA | 501C3 | 11A | NA | false | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARCHBOLD MEDICAL ENTERPRISES | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 OLD ALBANY ROAD | AddressLine1 |
| City | THOMASVILLE | City |
| State | GA | State |
| ZIP Code | 31792 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581494513 | EIN |
| Primary Activity | HEALTHCARE | PrimaryActivity |
| Legal Domicile State | GA | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
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