COFFEE REGIONAL MEDICAL CENTER INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- COFFEE REGIONAL MEDICAL CENTER INC (EIN 65-0543088)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-13
- IRS object ID
- 201203189349302015
- Schema version
- 2011v1.2
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-13T10:12:48-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | 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 6 | AddressLine1 |
| City | ALBANY | City |
| State | GA | State |
| ZIP Code | 317020006 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 650543088 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COFFEE REGIONAL MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COFF | NameControl |
| Phone | 9123841900 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 OCILLA ROAD/PO BOX 1287 | AddressLine1 |
| City | DOUGLAS | City |
| State | GA | State |
| ZIP Code | 31533 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DON LEWIS | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 9123841900 | Phone |
| Date Signed | 2012-11-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACQUELINE G ATKINS | Name |
| Phone | 2298837878 | Phone |
| Date Prepared | 2012-11-13 | 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 | DON LEWIS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 OCILLA ROAD / PO BOX 1287 | AddressLine1 |
| City | DOUGLAS | City |
| State | GA | State |
| ZIP Code | 31533 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 92973154 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.COFFEEREGIONAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1995 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | HOSPITAL SERVICES FOR COFFEE COUNTY & SURROUNDING AREAS | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 786 | TotalNbrEmployees |
| Total Nbr Volunteers | 77 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 229367 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 284969 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 86218316 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 89470431 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1091750 | InvestmentIncomePriorYear |
| Investment Income Current Year | 649630 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 2080693 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1837315 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 89620126 | TotalRevenuePriorYear |
| Total Revenue Current Year | 92242345 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 43630186 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 42678559 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 46271984 | OtherExpensePriorYear |
| Other Expenses Current Year | 50599458 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 89902170 | TotalExpensesPriorYear |
| Total Expenses Current Year | 93278017 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -282044 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1035672 | RevenuesLessExpensesCY |
| Total Assets BOY | 89941653 | TotalAssetsBOY |
| Total Assets EOY | 92333662 | TotalAssetsEOY |
| Total Liabilities BOY | 47414624 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 51302211 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 42527029 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 41031451 | NetAssetsOrFundBalancesEOY |
| Mission Description | HOSPITAL SERVICES FOR COFFEE COUNTY & SURROUNDING AREAS | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 82388544 | Expense |
| Revenue | 89472991 | Revenue |
| Description | HOSPITAL SERVICES - SHORT TERM CARE FOR INPATIENT AND OUTPATIENT SERVICES FOR DOUGLAS AND COFFEE COUNTY. COFFEE REGIONAL MEDICAL CENTER SERVED 5,846 PATIENTS FOR A TOTAL OF 19,733 DAYS IN 2011. NURSERY DAYS WERE 975 IN 2011. COFFEE REGIONAL MEDICAL CENTER PROVIDED APPROXIMATELY 6,942,000 OF INDIGENT AND CHARITY SERVICES IN 2011. | Description |
| Total Program Service Expense | 82388544 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| 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 | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | true | 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 | 31 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 786 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | true | ForeignFinancialAccount |
| Name Of Foreign Country | CJ | NameOfForeignCountry |
| 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 | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | 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 | 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 | false | 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 | DONALD C LEWIS | NamePerson |
| Telephone Number | 9123841900 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 OCILLA RD | AddressLine1 |
| City | DOUGLAS | City |
| State | GA | State |
| ZIP Code | 31533 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| DREW BAGWELL MD | ||||||||
| DIRECTOR | 1.00 | X | 350948 | 0 | 13033 | |||
| COLIN TOOGOOD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| GABE EVANS | ||||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X | ||
| MATT GREER | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| J DAVID ARNETT MD | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| ARTHUR JOHNSON | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| JON LOTT | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| MIKE WILLS | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| GUY MOORMAN | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| THAD CARTER | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| GEORGE HECK | ||||||||
| CEO | 40.00 | 370229 | 0 | 32620 | X | |||
| DONALD C LEWIS | ||||||||
| CFO | 40.00 | 256265 | 0 | 22755 | X | |||
| SHERRY THOMAS | ||||||||
| VP PT. CARE | 40.00 | 214258 | 0 | 11747 | X | |||
| EDDY N DUNCAN MD | ||||||||
| ANESTHESIOLO | 40.00 | 496531 | 0 | 13048 | X | |||
| THOMAS C HENRIS MD | ||||||||
| ANESTHESIOLO | 40.00 | 480538 | 0 | 13048 | X | |||
| GEORGE EGOLF | ||||||||
| CRNA | 40.00 | 223930 | 0 | 12053 | X | |||
| PATRICIA COLLINS | ||||||||
| CRNA | 40.00 | 217332 | 0 | 11993 | X | |||
| STUART O'STEEN | ||||||||
| CRNA | 40.00 | 215625 | 0 | 11822 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2825656 | TotalReportableCompFromOrg |
| Total Other Compensation | 142119 | TotalOtherCompensation |
| Number Individuals GT100 K | 22 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| REHABILITATION SPECIALISTS | |||||
| 169 MEADOWLARK LANE | FITZGERALD | GA | 31750 | PHYSICAL THERAP | 305400 |
| STEVEN JOHNSON MD | |||||
| P O BOX 30256 | SEA ISLAND | GA | 31561 | E.R. PHYSICIAN | 160500 |
| ROWE CONSTRUCTION | |||||
| 684 COLUMBUS ROAD | PEARSON | GA | 31642 | CONSTRUCTION | 132281 |
| DARRELL COLLINS MD | |||||
| P O BOX 2109 | DOUGLAS | GA | 31534 | CARDIOLOGIST | 126412 |
| DRAFFIN & TUCKER LLP | |||||
| P O BOX 6 | ALBANY | GA | 31702 | ACCOUNTING | 120470 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Government Grants | 275000 | GovernmentGrants |
| All Other Contributions | 9969 | AllOtherContributions |
| Total Contributions | 284969 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 89470431 | TotalRevenueColumn |
| Related Or Exempt Function Income | 89470431 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 89470431 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 575262 | TotalRevenueColumn |
| Exclusion | $575,262 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 176258 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 176258 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 176258 | TotalRevenueColumn |
| Exclusion | $176,258 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 457735 | Securities |
| Other | 347442 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 403143 | Securities |
| Other | 327666 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 54592 | Securities |
| Other | 19776 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 74368 | TotalRevenueColumn |
| Exclusion | $74,368 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| PHARMACY REVENUE | 621990 | 946779 | $946,779 |
| CAFETERIA | 561000 | 294747 | $294,747 |
| WELLNESS CENTER | 561439 | 223039 | $223,039 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 196492 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2560 | RelatedOrExemptFunctionIncome |
| Exclusion | $193,932 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1661057 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 92242345 | TotalRevenueColumn |
| Related Or Exempt Function Income | 89472991 | RelatedOrExemptFunctionIncome |
| Exclusion | $2,484,385 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1271855 | Total |
| Program Services | 363981 | ProgramServices |
| Management And General | 907874 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31868714 | Total |
| Program Services | 28711816 | ProgramServices |
| Management And General | 3156898 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 927504 | Total |
| Program Services | 845032 | ProgramServices |
| Management And General | 82472 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6339762 | Total |
| Program Services | 5600909 | ProgramServices |
| Management And General | 738853 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2270724 | Total |
| Program Services | 1996149 | ProgramServices |
| Management And General | 274575 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 147767 | Total |
| Management And General | 147767 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 120470 | Total |
| Management And General | 120470 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11726 | Total |
| Management And General | 11726 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86136 | Total |
| Management And General | 86136 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5733049 | Total |
| Program Services | 5537325 | ProgramServices |
| Management And General | 195724 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11837533 | Total |
| Program Services | 10733328 | ProgramServices |
| Management And General | 1104205 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11050 | Total |
| Management And General | 11050 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1457667 | Total |
| Program Services | 1457074 | ProgramServices |
| Management And General | 593 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 265975 | Total |
| Program Services | 226990 | ProgramServices |
| Management And General | 38985 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1722681 | Total |
| Program Services | 1722681 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5435441 | Total |
| Program Services | 4845152 | ProgramServices |
| Management And General | 590289 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1370395 | Total |
| Program Services | 75919 | ProgramServices |
| Management And General | 1294476 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBTS | 18208960 | 18208960 | |
| REPAIRS AND MAINT | 2615963 | 1675499 | 940464 |
| TAXES & LICENSES | 863410 | 31881 | 831529 |
| MISCELLANEOUS | 332216 | 124524 | 207692 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 379019 | Total |
| Program Services | 231324 | ProgramServices |
| Management And General | 147695 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93278017 | Total |
| Program Services | 82388544 | ProgramServices |
| Management And General | 10889473 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3845201 | BOY |
| EOY | 3394014 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8069070 | BOY |
| EOY | 8211976 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76 | BOY |
| EOY | 240 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 640037 | BOY |
| EOY | 741718 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2581612 | BOY |
| EOY | 920654 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 91753445 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 58629796 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31960968 | BOY |
| EOY | 33123649 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33603163 | BOY |
| EOY | 36554150 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 302953 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8938573 | BOY |
| EOY | 9387261 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89941653 | BOY |
| EOY | 92333662 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12937858 | BOY |
| EOY | 14468214 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20695 | BOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33771282 | BOY |
| EOY | 33048769 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 684789 | BOY |
| EOY | 3785228 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47414624 | BOY |
| EOY | 51302211 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42527029 | BOY |
| EOY | 41031451 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42527029 | BOY |
| EOY | 41031451 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89941653 | BOY |
| EOY | 92333662 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -1035672 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -459906 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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 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 | $11,726 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 11726 | 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 GEORGIA HOSPITAL ASSOCIATION AND TO AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE ANNUAL DUES PAID ARE ALLOCATED TO THE LOBBYING ACTIVITIES OF THESE ASSOCIATIONS. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 257796 | OtherCostOrOtherBasis |
| Book Value | 257796 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 37821039 | OtherCostOrOtherBasis |
| Depreciation | 25551679 | Depreciation |
| Book Value | 12269360 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 134846 | OtherCostOrOtherBasis |
| Depreciation | 95261 | Depreciation |
| Book Value | 39585 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 40812717 | OtherCostOrOtherBasis |
| Depreciation | 32982856 | Depreciation |
| Book Value | 7829861 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12727047 | OtherCostOrOtherBasis |
| Book Value | 12727047 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 33123649 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM RELATED PARTIES | 9853057 |
| DEFERRED FINANCING COST | 417142 |
| COST REPORT SETTLEMENT | -882938 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 9387261 | TotalBookValueOtherAssets |
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 | CRH HEALTH CARE, INC., EXCLUDING CRH VENTURES, INC. AND SOUTHEASTERN MANAGED CARE, INC. IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| 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 | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2651223 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2651223 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03530 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15164720 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14734127 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 430593 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00570 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17815943 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14734127 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3081816 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04100 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19385 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 19385 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4400 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4400 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 23785 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 23785 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17839728 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14734127 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3105601 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04140 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1500 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1500 | NetCommunityBuildingExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2 | PersonsServed |
| Total Community Building Expense | 3840 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3840 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 12 | PersonsServed |
| Total Community Building Expense | 1200 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1200 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 14 | PersonsServed |
| Total Community Building Expense | 6540 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 6540 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $18,208,960 | BadDebtExpenseAmount |
| Amount Attributable To | 13656720 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 18594668 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 20966599 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2371931 | 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 | COFFEE REGIONAL MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 OCILLA ROAD P O BOX 1287 | AddressLine1 |
| City | DOUGLAS | City |
| State | GA | State |
| ZIP Code | 31533 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | PHYS OFCS, RURAL HLTH CLINIC | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COFFEE REGIONAL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| 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 |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | 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 VI Form990ScheduleHPartVI (12 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE | PART I LINE 7 COLUMN F | IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN F THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990 PART IX LINE 25 FORM 990 PART IX LINE 25 93278017 LESS BAD DEBTS IN PART IX 18208960 DENOMINATOR FOR COLUMN F 75069057 |
| COSTING METHODOLOGY EXPLANATION | PART I LINE 7 | THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATIONS A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS 2008 SEE ALSO THE DESCRIPTION FOR PART III LINE 4 |
| COMMUNITY BUILDING ACTIVITIES | PART II | 5K RUN NOVEMBER 5 2011 COFFEE REGIONALS ANNUAL FALL FITNESS 5K RUNFUN WALK WAS HELD NOVEMBER 5 2011 WITH OVER 115 PARTICIPANTS IN ADDITION TO THE 5K EVENT A ONE MILE FUN RUN WAS HELD FOR THE YOUTH IN OUR COMMUNITY A CHECK FOR 1725 PROCEEDS FROM THE EVENT WAS DONATED TO THE CARDIAC REHAB AWARENESS PROGRAM APPROXIMATELY 40 MAN HOURS AT A COST OF800 HEALTH FAIR OCTOBER 2 2011 THE ANNUAL HEALTH SAFETY FESTIVAL HELD OCTOBER 2 2011 ATTRACTED NEARLY 1008 VISITORS WITH OVER 80 EXHIBITORS DEMONSTRATIONS AND HEALTH SCREENS THE FESTIVAL OFFERED WONDERFUL INTERACTIVE WAYS TO PROMOTE A HEALTHY LIFESTYLE 466 VISITORS TOOK ADVANTAGE OF THE COMPLETE BIOCHEMICAL BLOOD PROFILES OFFERED AT A REDUCED FEE OF 30 ACTUAL CHARGE OF 535 RESULTING IN A COMMUNITY SAVINGS OF 238610 APPROXIMATELY 100 MAN HOURS AT A COST OF 2000 PROSTATE CANCER SCREENING OCTOBER 13 15 2011 THE EARLIER PROSTATE CANCER IS DISCOVERED THE BETTER THE CHANCES ARE THAT IT CAN BE TREATED EFFECTIVELY WHEN PROSTATE CANCER IS IN ITS EARLIEST STAGES STILL CONFINED TO THE PROSTATE GLAND IT USUALLY CAUSES NO PAIN OR OTHER SYMPTOMS THATS WHY EACH YEAR COFFEE REGIONAL MEDICAL CENTER OFFERS LOW COST PROSTATE CANCER SCREENINGS ORE AND PSA BLOOD TEST TO OUR COMMUNITY FOR A REDUCED LAB FEE OF ONLY 10 ACTUAL CHARGE 147 RESULTING IN A COMMUNITY SAVINGS OF 17116 IN 2011 128 MEN TOOK ADVANTAGE OF THIS LIFESAVING SCREEN APPROXIMATELY 135 PHYSICIAN HOURS AND 36 STAFF HOURS AT A COST OF 2745 SPORTS PHYSICALS APRI1 24 2011 ATHLETIC PHYSICALS ARE REQUIRED BY BOTH THE GEORGIA HIGH SCHOOL AND GEORGIA INDEPENDENT SCHOOL ASSOCIATION FOR STUDENTS PLANNING ON PARTICIPATING IN SCHOOL ATHLETIC PROGRAMS EACH YEAR COFFEE REGIONAL PROVIDES OVER 600 SPORTS PHYSICALS TO STUDENTS PARTICIPATING IN INTERSCHOLASTIC SPORTS DURING THE SUMMER AND THROUGHOUT THE FOLLOWING YEAR THIS EVENT RESULTED IN A TOTAL COST SAVINGS TO THE COMMUNITY OF OVER 15000 APPROXIMATELY 40 PHYSICIAN HOURS AND 32 STAFF HOURS AT A COST OF 6640 PROJECT SEARCH PROJECT SEARCH IS A ONEYEAR EDUCATIONAL PROGRAM FOR STUDENTS WITH DISABILITIES IN THEIR LAST YEAR OF HIGH SCHOOL IT IS TARGETED FOR STUDENTS WHOSE MAIN GOAL IS COMPETITIVE EMPLOYMENT COFFEE REGIONAL MEDICAL CENTER PROVIDES THE SETTING FOR TWELVE PROJECT SEARCH STUDENTS THUS ALLOWING TOTAL IMMERSION IN THE WORKPLACE TO FACILITATE THE TEACHING AND LEARNING PROCESS THROUGH CONTINUOUS FEEDBACK AND APPLICATION OF NEW SKILLS INDIVIDUALIZED JOB DEVELOPMENT AND PLACEMENT BEGINS AFTER ROTATIONS AT ONE OR MORE WORKSTATIONS ARE COMPLETED STUDENTS RECEIVE SUPPORT THROUGH ON THEJOB COACHING AND WORKSITE ACCOMMODATIONS PROVIDED BY COFFEE REGIONAL THE PROGRAM IS DEDICATED TO WORKFORCE DEVELOPMENT THAT BENEFITS THE INDIVIDUAL COMMUNITY AND WORKPLACE CLASSROOM SPACE AT 300MONTH TOTAL OF 2700 AND APPROXIMATELY 60 STAFF HOURS OF TRAINING MENTORING AND EDUCATION OF 12 STUDENTSYEAR AT A COST OF 1200 BREAST CANCER SUPPORT GROUP MONTHLY 2011 IN 2011 COFFEE REGIONAL OFFERED A FREE MONTHLY BREAST CANCER SUPPORT GROUP FOR WOMEN IN THE COMMUNITY RECENTLY DIAGNOSED WITH BREAST CANCER THOSE UNDERGOING TREATMENT AND THOSE WHO HAVE COMPLETED TREATMENT CRMCS CLINICAL EDUCATION DEPARTMENT LEADS AND ORGANIZES EACH MEETING PROVIDING SUPPORT EDUCATION RESOURCES AND EXPERT SPEAKERS AT EACH MEETING APPROXIMATELY 1015 PEOPLE ATTEND EACH MONTHLY MEETING 144 MAN HOURS PER YEAR AT A COST OF 2800 DIABETES SUPPORT GROUP MONTHLY 2011 COFFEE REGIONAL OFFERS A FREE MONTHLY DIABETES SUPPORT GROUP FOR THE GENERAL PUBLIC CRMCS CLINICAL EDUCATION DEPARTMENT LEADS AND ORGANIZES EACH MEETING PROVIDING SUPPORT EDUCATION RESOURCES AND EXPERT SPEAKERS AT EACH MEETING EXPERTS SUCH AS DIETICIANS PODIATRISTS AND PHYSICIANS PROVIDE VALUABLE EDUCATION TO OUR COMMUNITY REGARDING DIABETES APPROXIMATELY 30 PEOPLE ATTEND EACH MONTHLY MEETING 144 MAN HOURS PER YEAR AT A COST OF 2800 AMERICAN CANCER SOCIETY RELAY FOR LIFE APRI1 2011 CRMC PROVIDES A CORPORATE SPONSOR OF 1000 ANNUALLY TO THE AMERICAN CANCER SOCIETY FOR CANCER RESEARCH TREATMENT AND RESOURCES EACH YEAR MANY OF COFFEE REGIONAL EMPLOYEES PROVIDE NUMEROUS MAN HOURS FOR THE COMMUNITY WIDE RELAY FOR LIFE EVENT IN EFFORT TO RAISE MONEY AND AWARENESS APPROXIMATELY 180 MAN HOURS AT A COST OF 3600 COFFEE COUNTY CHILDHOOD CANCER SUPPORT GROUP 2011 CRMC PROVIDES SPACE MONTHLY FOR THE COFFEE COUNTY CHILDHOOD CANCER SUPPORT GROUP AT NO COST TO THEM THE CHILDHOOD CANCER SUPPORT GROUP IS A NON PROFIT ORGANIZATION THAT PROVIDES FAMILIES AND PATIENTS WITH CHILDHOOD CANCER SUPPORT EDUCATION RESOURCES AND EXPERT SPEAKERS AT EACH MONTHLY MEETING CLASSROOM SPACE 100 PER MONTH FOR A TOTAL OF 1200 ANNUALLY AUTISM SUPPORT GROUP OF COFFEE COUNTY 2011 CRMC PROVIDES SPACE MONTHLY FOR THE AUTISM SUPPORT GROUP OF COFFEE COUNTY AT NO COST TO THEM THE AUTISM SUPPORT GROUP IS NONPROFIT ORGANIZATION THAT PROVIDES FAMILIES AND CHILDREN SUPPORT EDUCATION RESOURCES AND EXPERT SPEAKERS AT EACH MONTHLY MEETING CLASSROOM SPACE 100 PER MONTH FOR A TOTAL OF 1200 ANNUALLY SIDELINE SERVICE 2011 CRMC PROVIDES SIDELINE SERVICE FOR EACH HIGH SCHOOL FOOTBALL GAME IN COFFEE COUNTY A FULLY EQUIPPED AMBULANCE EMT AND PARAMEDIC ARE PROVIDED FOR EACH HOME FOOTBALL GAME AS A COURTESY TO THE SCHOOL SYSTEM AND SPECTATORS AT A COST OF 250 PER GAME AND 1500YEAR COFFEE COUNTY CHAMBER OF COMMERCE NEW CENTURY LEADERS 2011 PARTICIPANTS IN NEW CENTURY LEADERS COMMIT TO AN EIGHTMONTH PROJECT THAT ALLOWS THEM TO TAKE A CLOSE LOOK AT GOVERNMENT EDUCATION ECONOMIC DEVELOPMENT AND ALL ISSUES DEALING WITH QUALITY OF LIFE ON A LOCAL AND STATE LEVEL THE PROGRAM IS DESIGNED TO HELP PARTICIPANTS DEVELOP LEADERSHIP SKILLS FOR THE WORKPLACE AND THE COMMUNITY CRMC SPONSORED 2 EMPLOYEES IN 2011 FOR THE NEW CENTURY LEADER PROGRAM STAFF TIME TRAVEL AND EXPENSES FOR THE PROGRAM IS APPROXIMATELY 3840 2 EMPLOYEES 12 DAYS OF TRAINING AT 8 HOURS PER DAY 192 STAFF HOURS203840 |
| BAD DEBT EXPENSE EXPLANATION | PART III LINE 4 | AMOUNTS ON PART III LINES 2 AND 3 REPRESENT CHARGES WRITTEN OFF AS UNCOLLECTIBLE LINE 3 IS ESTIMATED AT 75 OF THE AMOUNT ON LINE 2 EXCERPT FROM AUDITED FINANCIAL STATEMENTS ALLOWANCE FOR DOUBTFUL ACCOUNTS THE CORPORATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON AN EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE |
| MEDICARE EXPLANATION | PART III LINE 8 | MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS |
| COLLECTION PRACTICES EXPLANATION | PART III LINE 9B | THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES FOR PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS |
| NEEDS ASSESSMENT | PART VI | THE ORGANIZATION EVALUATES THE NEEDS OF THEIR PATIENT BASE THROUGH THE NUMBER OF PATIENTS REFERRED TO OTHER FACILITIES FOR SERVICES NOT PROVIDED BY THE FACILITY ITSELF AND THROUGH OTHER INDICATORS |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI | FINANCIAL COUNSELING DEPARTMENT WILL PROVIDE INFORMATION AND APPLICATIONS TO ALL PATIENTSGUARANTORS SEEKING FINANCIAL ASSISTANCE FOR SERVICES RENDERED AT COFFEE REGIONAL MEDICAL CENTER THAT ARE DEEMED MEDICALLY NECESSARY FINANCIAL COUNSELORS WILL DISCUSS ELIGIBILITY FOR MEDICAL ASSISTANCE PROGRAMS THROUGH THE DEPARTMENT OF FAMILY CHILDREN SERVICES AND SOCIAL SECURITY ADMINISTRATION IF ELIGIBILITY IS NOT MET FOR ANY MEDICAL ASSISTANCE PROGRAM THE FINANCIAL COUNSELING DEPARTMENT WILL SEEK ELIGIBILITY THROUGH COFFEE REGIONAL MEDICAL CENTERS INDIGENT CARE TRUST FUND PROGRAM PATIENTSGUARANTORS REQUESTING FINANCIAL ASSISTANCE ARE REFERRED TO THE FINANCIAL COUNSELORS FC OR BENEFIT SPECIALIST AT THE TIME OF REGISTRATION FOR OUTPATIENT SERVICES AND EMERGENCY DEPARTMENT AFTER MEDICAL SCREENING HAS BEEN COMPLETED SOCIAL SERVICES REQUEST PHYSICIAN OFFICES REQUEST OR FROM THE PATIENT FINANCIAL SERVICES DEPARTMENT PATIENTS ADMITTED FOR INPATIENT OR OBSERVATION SERVICES MAY BE VISITED BY THE FC AFTER THE PATIENT HAS BEEN PLACED IN A ROOM AND STABILIZED FC WILL DISCUSS WITH THE PATIENTGUARANTOR THE INDIGENT CARE TRUST FUND PROGRAM REQUIREMENTS AND APPLICATION PROCESS THE PATIENTGUARANTOR WILL BE REQUIRED TO COMPLETE AN INDIGENT APPLICATION PROVIDE PROOF OF IDENTITY PROVIDE BIRTH CERTIFICATES OR PROOF OF DEPENDENCY FOR CHILDREN WITH NO IDENTITY AND PROVIDE VERIFICATION OF INCOME IE W2S FEDERAL TAX RETURN PAY STUBS ETC IF VERIFICATION IS NOT PROVIDED AT THE TIME OF THE INTERVIEW THE PATIENTGUARANTOR WILL BE REQUIRED TO PROVIDE WITHIN 30 DAYS APPLICATIONS MADE ON BEHALF OF DECEASED PATIENTS MUST HAVE VERIFICATION OF INCOME AND INFORMATION CONCERNING THE VALUE OF THE PATIENTS ESTATE PATIENTS WHO CHOOSE NOT TO UTILIZE CURRENT BENEFITS THEY ARE ELIGIBLE FOR IE VETERANS BENEFITS MEDICARE AND COMMERCIAL INSURANCE WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM UPON RECEIPT OF THE COMPLETED APPLICATION INCLUDING NECESSARY DOCUMENTATION CALCULATION OF THE HOUSEHOLD SIZE AND ANNUAL HOUSEHOLD INCOME IS COMPUTED AND COMPARED TO THE FEDERAL POVERTY GUIDELINES FPG TO DETERMINE THE PERCENTAGE OF ASSISTANCE A PATIENTGUARANTOR IS ELIGIBLE TO RECEIVE PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW THE GROSS INCOME CEILING FOR POTENTIAL MEDICAID ELIGIBILITY ARE REQUIRED TO APPLY FOR MEDICAID ASSISTANCE IS PROVIDED TO PATIENTS IN FILING FOR OTHER BENEFITS AND COMPLETING MEDICAID APPLICATIONS PATIENTS WHO CHOOSE NOT TO APPLY FOR OTHER BENEFITS TO WHICH THEY MAY BE ENTITLED IE MEDICAID APPLICATIONS WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM PATIENTS WHO CHOOSE TO APPLY COFFEE REGIONAL MEDICAL CENTERS ACCOUNTS FOR THE PURPOSE OF MEETING MEDICALLY NEEDY SPEND DOWN TO RECEIVE ONGOING MEDICAID WILL NOT BE ALLOWED TO APPLY FOR THE INDIGENT PROGRAM FOR THAT ACCOUNT PATIENTSGUARANTORS OVER 18 YEARS OF AGE BUT CLASSIFIED AS DEPENDENTS FOR TAX PURPOSES DUE TO STUDENT ELIGIBILITY WILL HAVE A TOTAL HOUSEHOLD SIZE INCLUDING PARENTS AND SUBSEQUENT INCOME PATIENTSGUARANTORS NOT ELIGIBLE FOR OTHER MEDICAL ASSISTANCE PROGRAMS WILL BE PROCESSED UNDER THE INDIGENT CARE TRUST FUND GUIDELINES USING THE FOLLOWING CATEGORIES INDIGENT PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW 125 OF THE FPG THE APPLICABLE ACCOUNTS WILL BE ADJUSTED TO ZERO BALANCES CHARITY PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN OR EQUAL TO 125 BUT NOT GREATER THAN 200 OF THE FPG THE APPLICABLE ACCOUNTS WILL BE ADJUSTED BY THE APPROPRIATE PERCENTAGES AN ADJUSTMENT OF 85 OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 125 AND 150 OF FPG AN ADJUSTMENT OF 70 OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 150 AND 175 OF FPG AN ADJUSTMENT OF 55 OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 175 AND 200 OF FPG CATASTROPHIC PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN 200 FPG MAY QUALIFY FOR CHARITY ADJUSTMENTS ON APPLICABLE ACCOUNTS IF CONSIDERATION OF CRMC PATIENT OBLIGATIONS REDUCES THE ANNUAL HOUSEHOLD INCOME TO THE APPROPRIATE FPG NOTIFICATION OF STATUS OF COMPLETED APPLICATION IS PROVIDED TO THE PATIENTGUARANTOR WITHIN 5 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION APPROVED APPLICATIONS ARE VALID FOR 30 DAYS FROM DATE OF SIGNATURE INCOMPLETE APPLICATIONS ARE HELD FOR 30 DAYS IF NO DOCUMENTATION IS PROVIDED TO COMPLETE THE APPLICATION A DENIAL LETTER IS SENT TO THE PATIENTGUARANTOR THE APPLICATION MAY BE COMPLETED IF THE PATIENTGUARANTOR PROVIDES THE REQUESTED INFORMATION WITHIN 15 WORKING DAYS OF THE DENIAL NOTIFICATION OF STATUS OF COMPLETED APPLICATION WILL BE MAILED WITHIN 15 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION NO CONSIDERATION FOR ELIGIBILITY WILL BE REVIEWED FOR ACCOUNTS REFERRED TO OUTSIDE COLLECTION AGENCIES THE APPLICATION AND DOCUMENTATION WILL BECOME PROPERTY OF COFFEE REGIONAL MEDICAL CENTER AND IS TO BE KEPT CONFIDENTIAL IN THE SAME MANNER AS MEDICAL RECORDS HOWEVER THIS INFORMATION WILL BE USED FOR AGGREGATE REPORTING PURPOSES ONLY |
| COMMUNITY INFORMATION | PART VI | COFFEE REGIONAL MEDICAL CENTERS PRIMARY SERVICE AREA IS COFFEE COUNTY THE COUNTY HAD A POPULATION OF 42864 CITIZENS IN DECEMBER OF 2011 OF WHICH APPROXIMATELY 213 FALL BELOW GOVERNMENTAL DEFINED POVERTY GUIDELINES COFFEE COUNTYS UNEMPLOYMENT RATE AT YEAREND WAS 131 |
| HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE | PART VI | COFFEE REGIONAL MEDICAL CENTER IS GOVERNED BY A BOARD OF DIRECTORS CONSISTING OF 11 MEMBERS THE COFFEE COUNTY HOSPITAL AUTHORITY NOMINATES POTENTIAL BOARD MEMBERS AS OPENINGS ARISE THE BOARDS MAKEUP IS NINE COMMUNITY MEMBERS REFLECTING THE DIVERSITY OF THE COMMUNITY THE REMAINING TWO MEMBERS ARE THE CHIEF OF STAFF AND CHIEF OF STAFF ELECT IT IS THE PHILOSOPHY OF COFFEE REGIONAL MEDICAL CENTER TO ASSURE THE CONTINUATION AND ENHANCEMENT OF PATIENT CARE BY REINVESTING EXCESS FUNDS BACK INTO THE OPERATIONS OF THE FACILITY THIS INCLUDES GREATER ACCESSIBILITY OF CARE THROUGH THE CREATION OF A RURAL HEALTH CENTER IMPLEMENTATION OF A TELEMEDICINE PROGRAM AND RECRUITMENT OF PHYSICIANS TO THE UNDERSERVED ENVIRONMENT ENHANCEMENT OF TECHNOLOGY IS ALSO IMPERATIVE TO ASSURE APPROPRIATE DIAGNOSTIC AND THERAPEUTIC OPTIONS FOR THE COMMUNITY UPDATING THE AMBULANCE FLEET IS CONSISTENTLY HIGH ON THE FUNDING PRIORITY LIST TO ASSURE SERVICE TO THE MOST REMOTE AREAS OF THE COUNTY WHICH IN SQUARE MILES IS THE SECOND LARGEST COUNTY IN THE STATE OF GEORGIA |
| LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED | PART VI | GEORGIA |
| COFFEE REGIONAL MEDICAL CENTER LINE NUMBER 1 PART V LINE 19D | PART V LINE 19D | THE HOSPITAL FACILITY DISCOUNTS CHARGES BASED ON A SLIDING FEE SCALE WHICH COMPARES THE APPLICANTS ANNUAL HOUSEHOLD INCOME TO FEDERAL POVERTY GUIDELINES CHARGES ARE REDUCED AS MUCH AS 55 IN ACCORDANCE WITH THE FACILITYS FINANCIAL ASSISTANCE POLICY |
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 | false | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | 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 (9 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg |
|---|---|---|---|---|---|
| DREW BAGWELL MD | |||||
| 298124 | 52824 | 12250 | 783 | 363981 | |
| GEORGE HECK | |||||
| 364405 | 12250 | 20370 | 402849 | 5824 | |
| DONALD C LEWIS | |||||
| 253606 | 12250 | 10505 | 279020 | 2659 | |
| SHERRY THOMAS | |||||
| 214189 | 10949 | 798 | 226005 | 69 | |
| EDDY N DUNCAN MD | |||||
| 496507 | 12250 | 798 | 509579 | 24 | |
| THOMAS C HENRIS MD | |||||
| 480501 | 12250 | 798 | 493586 | 37 | |
| GEORGE EGOLF | |||||
| 223842 | 11405 | 648 | 235983 | 88 | |
| PATRICIA COLLINS | |||||
| 217263 | 11195 | 798 | 229325 | 69 | |
| STUART O'STEEN | |||||
| 215611 | 11024 | 798 | 227447 | 14 | |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | FRINGE OR EXPENSE EXPLANATION | Identifier |
| Return Reference | SCHEDULE J, PAGE 1, PART I, LINE 1A | ReturnReference |
| Explanation | EXECUTIVE AND KEY PERSONNEL WERE PROVIDED COUNTRY CLUB MEMBERSHIPS TO AID IN MARKETING AND FOR REWARD AND RECOGNITION. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COFFEE COUNTY HOSPITAL AUTHORITY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 586003116 | IssuerEIN |
| CUSIP Number | 192137DJ3 | CUSIPNumber |
| Date Issued | 2004-11-16 | DateIssued |
| Issue Price | 39213858 | IssuePrice |
| Description Of Purpose | DEFEASEMENT OF PREVIOUS BONDS | DescriptionOfPurpose |
| Defeased | false | Defeased |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Pool Financing | false | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 6165089 | AmountRetired |
| Total Proceeds | 39213858 | TotalProceeds |
| Issuance Costs From Proceeds | 767435 | IssuanceCostsFromProceeds |
| Other Spent Proceeds | 38446423 | OtherSpentProceeds |
| Year Of Subst Completion | 2004 | YearOfSubstCompletion |
| Current Refunding | false | CurrentRefunding |
| Advance Refunding | true | AdvanceRefunding |
| Final Allocation Made | true | FinalAllocationMade |
| Adequate Books And Recds Maintaind | true | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | false | OwningBondFinancedProperty |
| Any Lease Arrangements | false | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | false | MngmentCntrctBondFinancdPrprty |
| Engage Bond Counsel Contracts | false | EngageBondCounselContracts |
| Any Research Agreements | false | AnyResearchAgreements |
| Engage Bond Counsel Research | false | EngageBondCounselResearch |
| Post Issuance Compliance Procdrs | true | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | false | Form8038TFiled |
| Variable Rate Issue | false | VariableRateIssue |
| Hedge Identified In Books And Recds | false | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | false | GrossProceedsInvested |
| Exception To Rebate | false | ExceptionToRebate |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FINANCIAL ACCOUNTS IN FOREIGN COUNTRIES | FORM 990, PART V, LINE 4B | CAYMAN ISLANDS |
| ELECTION OF MEMBERS AND THEIR RIGHTS | FORM 990, PAGE 6, PART VI, LINE 7A | BOARD MEMBERS OF THE ORGANIZATION ARE APPOINTED, AND CAN BE REMOVED, BY CRH HEALTH CARE, INC., THE PARENT ORGANIZATION. |
| DECISIONS SUBJECT TO APPROVAL OF MEMBERS | FORM 990, PAGE 6, PART VI, LINE 7B | DECISIONS OF THE BOARD ARE SUBJECT TO APPROVAL BY CRH HEALTH CARE, INC., THE PARENT ORGANIZATION. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 IS PROVIDED TO THE BOARD FOR THEIR REVIEW AFTER FILING WITH THE IRS. MANAGEMENT'S REVIEW OF FORM 990 IS PERFORMED BEFORE THE FILING DATE AND INCLUDES A REVIEW OF FINANCIAL DATA AND OTHER DETAILS. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | BOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS ANNUALLY. THIS IS REVIEWED BY THE CEO AND BOARD CHAIRMAN, IF NEEDED. MEMBERS HAVE EXCUSED THEMSELVES FROM CERTAIN DISCUSSIONS/DECISIONS AS A RESULT OF CONFLICTS. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD'S COMPENSATION COMMITTEE REVIEWS COMPENSATION DATA FROM SEVERAL SOURCES. IN 2011, YAFFE AND ASSOCIATES WAS ENGAGED TO PROVIDE THE CEO/VP'S COMPENSATION ANALYSIS. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | SEE RESPONSE FOR LINE 15A ABOVE. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS OF THE ORGANIZATION ARE ALL AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S CORPORATE OFFICE. |
| RELATED ORGANIZATIONS | FORM 990, PAGE 7, PART VII | AVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS: GEORGE HECK 2 HOURS DON LEWIS 2 HOURS COLIN TOOGOOD 1 HOUR DAVID ARNETT MD 1 HOUR GUY MOORMAN 1 HOUR GABE EVANS 1 HOUR |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 5 | UNREALIZED LOSS ON INVESTMENTS (459,906) |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRH PHYSICIAN PRACTICES | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1101 OCILLA ROAD | AddressLine1 |
| City | DOUGLAS | City |
| State | GA | State |
| ZIP Code | 31533 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 205778734 | EIN |
| Primary Activities | PHY OFC | PrimaryActivities |
| Legal Domicile State | GA | LegalDomicileState |
| Total Income | 7714208 | TotalIncome |
| EOY Assets | 2728650 | EOYAssets |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CRMC | BusinessNameLine1 |
| Business Name Line2 | COFFEE REGIONAL MEDICAL CENTER | BusinessNameLine2 |
Form990 Schedule R Part II Form990ScheduleRPartII (2 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 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| CRH HEALTH CARE INC | ||||||||||
| 1101 OCILLA ROAD P O BOX 1287 | DOUGLAS | GA | 31533 | 582163724 | MGMT SVC | GA | 501C3 | 11D | NA | false |
| CRH HEALTH SERVICES INC | ||||||||||
| 1101 OCILLA ROAD P O BOX 1287 | DOUGLAS | GA | 31533 | 582165827 | FOUNDATION | GA | 501C3 | 11D | NA | false |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| CRH VENTURES INC | |||||||
| 1101 OCILLA ROAD P O BOX 1287 | DOUGLAS | GA | 31533 | 582165279 | OFC RENTAL | GA | N/A |
| SOUTHEASTERN MANAGED CARE INC | |||||||
| 1101 OCILLA ROAD P O BOX 1287 | DOUGALS | GA | 31533 | 582236627 | MNGD CARE | GA | N/A |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | 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 | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
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