2012-11-13T10:12:48-06:00 2011-12-31 DRAFFIN & TUCKER LLP PO BOX 6 ALBANY GA 317020006 990 2011-01-01 650543088 COFFEE REGIONAL MEDICAL CENTER INC COFF 9123841900 1101 OCILLA ROAD/PO BOX 1287 DOUGLAS GA 31533 DON LEWIS 9123841900 2012-11-15 true JACQUELINE G ATKINS 2298837878 2012-11-13 2011 2016-02-24 21:20:13Z DON LEWIS 1101 OCILLA ROAD / PO BOX 1287 DOUGLAS GA 31533 92973154 false X WWW.COFFEEREGIONAL.ORG X 1995 GA HOSPITAL SERVICES FOR COFFEE COUNTY & SURROUNDING AREAS 10 9 786 77 0 229367 284969 86218316 89470431 1091750 649630 2080693 1837315 89620126 92242345 0 0 43630186 42678559 0 0 46271984 50599458 89902170 93278017 -282044 -1035672 89941653 92333662 47414624 51302211 42527029 41031451 HOSPITAL SERVICES FOR COFFEE COUNTY & SURROUNDING AREAS false false 82388544 89472991 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. 82388544 true true false true false false false false false false true false false true false true false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false true true false false false false true 31 0 786 true false true CJ false false false false false false false false X 10 9 false false false false false true true true true false false false true true true true true true true false GA X DONALD C LEWIS 9123841900 1101 OCILLA RD DOUGLAS GA 31533 X DREW BAGWELL MD 1.00 X 350948 0 13033 COLIN TOOGOOD 1.00 X 0 0 0 GABE EVANS 1.00 X X 0 0 0 MATT GREER 1.00 X 0 0 0 J DAVID ARNETT MD 1.00 X 0 0 0 ARTHUR JOHNSON 1.00 X 0 0 0 JON LOTT 1.00 X 0 0 0 MIKE WILLS 1.00 X 0 0 0 GUY MOORMAN 1.00 X 0 0 0 THAD CARTER 1.00 X 0 0 0 GEORGE HECK 40.00 X 370229 0 32620 DONALD C LEWIS 40.00 X 256265 0 22755 SHERRY THOMAS 40.00 X 214258 0 11747 EDDY N DUNCAN MD 40.00 X 496531 0 13048 THOMAS C HENRIS MD 40.00 X 480538 0 13048 GEORGE EGOLF 40.00 X 223930 0 12053 PATRICIA COLLINS 40.00 X 217332 0 11993 STUART O'STEEN 40.00 X 215625 0 11822 2825656 142119 22 false true false 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 7 275000 9969 284969 PATIENT SERVICE REVENUE 621990 89470431 89470431 89470431 575262 575262 176258 176258 176258 176258 457735 347442 403143 327666 54592 19776 74368 74368 PHARMACY REVENUE 621990 946779 946779 CAFETERIA 561000 294747 294747 WELLNESS CENTER 561439 223039 223039 196492 2560 193932 1661057 92242345 89472991 2484385 1271855 363981 907874 31868714 28711816 3156898 927504 845032 82472 6339762 5600909 738853 2270724 1996149 274575 147767 147767 120470 120470 11726 11726 86136 86136 5733049 5537325 195724 11837533 10733328 1104205 11050 11050 1457667 1457074 593 265975 226990 38985 1722681 1722681 5435441 4845152 590289 1370395 75919 1294476 BAD DEBTS 18208960 18208960 REPAIRS AND MAINT 2615963 1675499 940464 TAXES & LICENSES 863410 31881 831529 MISCELLANEOUS 332216 124524 207692 379019 231324 147695 93278017 82388544 10889473 0 3845201 3394014 8069070 8211976 76 240 640037 741718 2581612 920654 91753445 58629796 31960968 33123649 33603163 36554150 302953 8938573 9387261 89941653 92333662 12937858 14468214 20695 33771282 33048769 684789 3785228 47414624 51302211 X 42527029 41031451 42527029 41031451 89941653 92333662 X -1035672 -459906 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false false false true 11726 11726 false false false false false SCHEDULE C, PART II-B, LINE 1 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. false false false false false false false false false false 257796 257796 37821039 25551679 12269360 134846 95261 39585 40812717 32982856 7829861 12727047 12727047 33123649 DUE FROM RELATED PARTIES 9853057 DEFERRED FINANCING COST 417142 COST REPORT SETTLEMENT -882938 9387261 LIABILITY UNDER FIN 48 FOOTNOTE SCHEDULE D, PAGE 3, PART X 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. true true true X 1.25000 true X true true true false true true 2651223 2651223 0.03530 15164720 14734127 430593 0.00570 17815943 14734127 3081816 0.04100 19385 19385 0.00030 4400 4400 0.00010 23785 23785 0.00040 17839728 14734127 3105601 0.04140 1500 1500 2 3840 3840 0.00010 12 1200 1200 14 6540 6540 0.00010 true 18208960 13656720 18594668 20966599 -2371931 X true true 1 1 COFFEE REGIONAL MEDICAL CENTER

1101 OCILLA ROAD P O BOX 1287 DOUGLAS GA 31533

X X X PHYS OFCS, RURAL HLTH CLINIC COFFEE REGIONAL MEDICAL CENTER 1 true true 125.0 true 200.0 true X X true true X X X X X X true false true X false false 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 X true false X X X X X false false false false false false false false false DREW BAGWELL MD 298124 52824 12250 783 363981 GEORGE HECK 364405 5824 12250 20370 402849 DONALD C LEWIS 253606 2659 12250 10505 279020 SHERRY THOMAS 214189 69 10949 798 226005 EDDY N DUNCAN MD 496507 24 12250 798 509579 THOMAS C HENRIS MD 480501 37 12250 798 493586 GEORGE EGOLF 223842 88 11405 648 235983 PATRICIA COLLINS 217263 69 11195 798 229325 STUART O'STEEN 215611 14 11024 798 227447 FRINGE OR EXPENSE EXPLANATION SCHEDULE J, PAGE 1, PART I, LINE 1A EXECUTIVE AND KEY PERSONNEL WERE PROVIDED COUNTRY CLUB MEMBERSHIPS TO AID IN MARKETING AND FOR REWARD AND RECOGNITION. COFFEE COUNTY HOSPITAL AUTHORITY 586003116 192137DJ3 2004-11-16 39213858 DEFEASEMENT OF PREVIOUS BONDS false false false 6165089 39213858 767435 38446423 2004 false true true true false false false false false false true false false false false false false 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) CRH PHYSICIAN PRACTICES 1101 OCILLA ROAD DOUGLAS GA 31533 205778734 PHY OFC GA 7714208 2728650 CRMC COFFEE REGIONAL MEDICAL CENTER 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 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 false false false false false false false false true false true false true true false false false false