DONALSONVILLE HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: DONALSONVILLE HOSPITAL INC (EIN 58-0973772)
Tax period: 2010-07-01 to 2011-06-30
Filed: 2012-05-15
IRS object ID: 201211369349304411
Schema version: 2010v3.7
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 D
Schedule H
Schedule J
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-05-15T12:58:49-05:00	Timestamp
Tax Period End Date	2011-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BURKE WORSHAM & HARRELL LLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	230 CHERRY STREET	AddressLine1
City	DONALSONVILLE	City
State	GA	State
ZIP Code	39845	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2010-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	580973772	EIN

Name Name

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

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

US Address USAddress

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

Officer Officer

Field	Value	IRS element (for citing)
Name	HERMAN BROOKINS	Name
Title	PRESIDENT	Title
Phone	2295245217	Phone
Date Signed	2012-05-14	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	JUJUAN B BOWEN	Name
Phone	2295242137	Phone
Date Prepared	2012-05-15	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Gross Receipts	39004717	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1977	YearFormation
State Legal Domicile	GA	StateLegalDomicile
Activity Or Mission Description	THE MISSION OF DONALSONVILLE HOSPITAL, INC. IS TO PROVIDE, AT THE DIRECTION OF OUR MEDICAL STAFF, A UNIFORM LEVEL OF HIGH QUALITY SERVICES AS ARE WITHIN OUR SCOPE OF SERVICES TO ALL WHO SEEK OUR AID.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	5	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	5	NbrIndependentVotingMembers
Total Nbr Employees	416	TotalNbrEmployees
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Current Year	0	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	30550984	ProgramServiceRevenuePriorYear
Program Service Revenue CY	32825575	ProgramServiceRevenueCY
Investment Income Prior Year	2060720	InvestmentIncomePriorYear
Investment Income Current Year	5992867	InvestmentIncomeCurrentYear
Other Revenue Prior Year	64701	OtherRevenuePriorYear
Other Revenue Current Year	85780	OtherRevenueCurrentYear
Total Revenue Prior Year	32676405	TotalRevenuePriorYear
Total Revenue Current Year	38904222	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	16865297	SalariesEtcPriorYear
Salaries Etc Current Year	16490151	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	13654961	OtherExpensePriorYear
Other Expenses Current Year	14009589	OtherExpensesCurrentYear
Total Expenses Prior Year	30520258	TotalExpensesPriorYear
Total Expenses Current Year	30499740	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	2156147	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	8404482	RevenuesLessExpensesCY
Total Assets BOY	43672283	TotalAssetsBOY
Total Assets EOY	51653155	TotalAssetsEOY
Total Liabilities BOY	3099174	TotalLiabilitiesBOY
Total Liabilities EOY	2675564	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	40573109	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	48977591	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	THE MISSION OF DONALSONVILLE HOSPITAL, INC. IS TO PROVIDE, AT THE DIRECTION OF OUR MEDICAL STAFF, A UNIFORM LEVEL OF HIGH QUALITY SERVICES AS ARE WITHIN OUR SCOPE OF SERVICES TO ALL WHO SEEK OUR AID.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	25060	Expense
Description	DONALSONVILLE HOSPITAL COLLABORATES WITH THE SEMINOLE COUNTY HEALTH DEPARTMENT TO HELP PROVIDE ASSISTANCE TO OUR UNINSURED, NON-MEDICAID POPULATION THAT SUFFERS FROM HYPERTENSION AND DIABETES. THE GOAL IS TO ASSURE THE AVAILABILITY OF JOINT MANAGED SERVICES TO THE POPULATION WITH THESE CHRONIC DISEASES IN SEMINOLE COUNTY. THE PROGRAM INCLUDES SCREENING, EDUCATION, ANNUAL LAB TESTS, MONITORING AND TREATMENT FOR PREVENTION AND CONTROL OF HYPERTENSION AND DIABETES FOR THE NEEDY POPULATION OF SEMINOLE COUNTY. THE TARGET POPULATION INCLUDES THOSE SEMINOLE COUNTY RESIDENTS WHO HAVE DIABETES AND/OR HYPERTENSION AND ARE UNINSURED, UNDER INSURED, NON-MEDICAID ELIGIBLE, AND ON FIXED INCOMES. THERE IS A DEFINITE COMMUNITY NEED IN SEMINOLE COUNTY WITH ABOUT 35.8% OF THE DEATHS IN SEMINOLE COUNTY BEING RELATED TO CARDIOVASCULAR DISEASE. THE AMERICAN HEART ASSOCIATION HAS REPORTED THAT FOR EVERY DOLLAR SPEND FOR HYPERTENSION/DIABETES MANAGEMENT THAT THERE IS A NET SAVINGS OF NINE DOLLARS PER DIRECT AND INDIRECT HEALTH REALTED COSTS. THERE WERE ABOUT 103 ACTIVE PATIENTS ENROLLED IN THE SEMINOLE COUNTY PROGRAM.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	4140560	Expense
Description	PROVIDED PRIMARY HEALTHCARE TO RESIDENTS OF SEMINOLE AND SURROUNDING COUNTIES. SERVICES ARE PROVIDED WITHOUT REFERENCES TO RACE, RELIGION OR THEIR ABILITY TO PAY. INDIGENT PATIENTS WERE CLASSIFIED AS ANY PATIENT WITHOUT THIRD PARTY COVERAGE THAT HAD AN INCOME LEVEL BELOW 125% OF FEDERAL POVERTY GUIDELINES. CHARITY PATIENTS WERE CLASSIFIED AS ANY PATIENT WITHOUT THIRD PARTY COVERAGE THAT HAD AN INCOME LEVEL BETWEEN 125% AND 200% OF THE FEDERAL POVERTY GUIDELINES.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	212964	Expense
Description	PROVIDE ASSISTANCE TO LOCAL STUDENTS IN OBTAINING HEALTHCARE DEGREES AND CERTIFICATIONS. LOCAL STUDENTS ARE GIVEN FINANCIAL ASSISTANCE THAT PAYS FOR BOOKS, TUITION AND LODGING FOR DEGREES AND CERTIFICATIONS IN THE HEALTHCARE INDUSTRY.	Description

Activity Other ActivityOther

Field	Value	IRS element (for citing)
Expense	51245	Expense
Description	DONALSONVILLE HOSPITAL PROVIDES SEVERAL MISCELLANEOUS PROGRAMS TO THE GENERAL PUBLIC.	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	51245	TotalOfOtherProgramServiceExp
Total Program Service Expense	4429829	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	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	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	true	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	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	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	21	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	416	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	5	NbrVotingGoverningBodyMembers
Number Independent Voting Members	5	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	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	false	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	GA	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	JAMES MOODY	NamePerson
Telephone Number	2295245217	TelephoneNumber

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Highest Compensated EmployeeHighestCompensatedEmployee
HERMAN BROOKINS
DIRECTOR/CHR	40.00	X	X	404150	0	0
CHARLES H ORRICK
DIRECTOR/ADM	40.00	X	X	227977	0	0
BROADDUS SIMPSON
DIRECTOR/SEC	1.00	X		8419	0	0
MITCH BLANKS
DIRECTOR	1.00	X		8419	0	0
BILL BURKE
DIRECTOR	1.00	X		8419	0	0
MURDOC M HENDERSON
PHYSICIAN	40.00			327554	0	0	X
HOWARD SOHNEN MD
	40.00			285000	0	0	X
JOSEPH WALKER JR
PHYSICIAN	40.00			275000	0	0	X
ANDREA ALEXANDER
PHYSICIAN	40.00			244231	0	0	X
JESSICA NUNEZ MD
	40.00			221660	0	0	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2010829	TotalReportableCompFromOrg
Number Individuals GT100 K	8	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
NATIONAL EMERGENCY SERVICE
PO BOX 65810	CHARLOTTE	NC	28265	PHYSICIANS	521994
CPSI
PO BOX 850309	MOBILE	AL	366850309	COMPUTER SUPPOR	199219
DRAFFIN & TUCKER
2617 GILLIONVILLE ROAD	ALBANY	GA	31703	AUDIT/COST REP	139860
FRANKLIN SERLEMANN
PO BOX 674293	DETROIT	MI	482674293	RADIOLOGIST	130941

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

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	REVENUE FROM OPERATIONS	Description
Total Revenue Column	32825575	TotalRevenueColumn
Exclusion	$32,825,575	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	32825575	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	5992867	TotalRevenueColumn
Exclusion	$5,992,867	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	186275	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	100495	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	85780	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	85780	TotalRevenueColumn
Exclusion	$85,780	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	38904222	TotalRevenueColumn
Exclusion	$38,904,222	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	632127	Total
Management And General	632127	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	12261458	Total
Program Services	4429829	ProgramServices
Management And General	7831629	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	2834462	Total
Management And General	2834462	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	762104	Total
Management And General	762104	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	892722	Total
Management And General	892722	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1156866	Total
Management And General	1156866	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Management And GeneralManagementAndGeneral
SUPPLIES & DRUGS	5190053	5190053
OTHER FEES	3326680	3326680
BAD DEBT EXPENSE	2578211	2578211
CONTRACT SERVICES	665805	665805
INSURANCE	199252	199252

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	30499740	Total
Program Services	4429829	ProgramServices
Management And General	26069911	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	1502135	BOY
EOY	2003018	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	7373657	BOY
EOY	7526075	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	1792465	BOY
EOY	2022750	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	839005	BOY
EOY	904696	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	67388	BOY
EOY	113857	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	25065860	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	12693398	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	12668696	BOY
EOY	12372462	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	19428937	BOY
EOY	26710297	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	43672283	BOY
EOY	51653155	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	3099164	BOY
EOY	2675556	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	10	BOY
EOY	8	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	3099174	BOY
EOY	2675564	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	40573109	BOY
EOY	48977591	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	40573109	BOY
EOY	48977591	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	43672283	BOY
EOY	51653155	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	8404482	ReconcilationRevenueExpenses
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	true	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 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	25065860	OtherCostOrOtherBasis
Depreciation	12693398	Depreciation
Book Value	12372462	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	12372462	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	CREDIT LINES	Description
Amount	$8	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	8	TotalOfAmounts
Total Revenue	38904222	TotalRevenue
Total Expenses	30499740	TotalExpenses
Excess Or Deficit For Year	8404482	ExcessOrDeficitForYear
Excess Or Deficit Per FS	8404482	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	38904222	TotRevenueEtcAuditedFinclStmt
Revenue Subtotal	38904222	RevenueSubtotal
Total Revenue Per Form990	38904222	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	30499740	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	30499740	ExpensesSubtotal
Total Expenses Per Form990	30499740	TotalExpensesPerForm990

Schedule H IRS990ScheduleH

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

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1345682	TotalCommunityBenefitExpense
Net Community Benefit Expense	1345682	NetCommunityBenefitExpense
Percent Of Total Expense	0.04410	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1345682	TotalCommunityBenefitExpense
Net Community Benefit Expense	1345682	NetCommunityBenefitExpense
Percent Of Total Expense	0.04410	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	76305	TotalCommunityBenefitExpense
Net Community Benefit Expense	76305	NetCommunityBenefitExpense
Percent Of Total Expense	0.00250	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	76305	TotalCommunityBenefitExpense
Net Community Benefit Expense	76305	NetCommunityBenefitExpense
Percent Of Total Expense	0.00250	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1421987	TotalCommunityBenefitExpense
Net Community Benefit Expense	1421987	NetCommunityBenefitExpense
Percent Of Total Expense	0.04660	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$2,668,073	BadDebtExpenseAmount
Amount Attributable To	2134458	AmountAttributableTo
Amount Reimbursed By Medicare	3804406	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	4062460	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-258054	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

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

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

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

Name Name

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

Address Address

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

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

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

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

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	200.0	FPGFreePercent
Uses FPG Discounted	false	UsesFPGDiscounted
Explains Basis	true	ExplainsBasis
Uninsured Discount	X	UninsuredDiscount
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	true	IncludesPublicityMeasures
Posted In Emergency Room	X	PostedInEmergencyRoom
Posted In Admission Office	X	PostedInAdmissionOffice
Available On Request	X	AvailableOnRequest
Actions On Nonpayment	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 (6 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SUBSIDIZED HEALTH SERVICES EXPLANATION	PART I LINE 7G	PART I 7A TOTAL COMMUNITY BENEFIT EXPENSE FINANCIAL ASSISTANCE COST REPORTED FROM CHARITY AND INDIGENT CARE IS AS FOLLOWS TOTAL CHARGES XXX-XX-XXXX X 325 TOTAL OVERALL COST TO CHANGE RATIO 1345682 PART I 7G TOTAL COMMUNITY BENEFIT EXPENSE SUBSIDIZED HEALTH SERVICES PAID 25060 TO LOCAL HEALTH DEPARTMENT TO FUND SUPPLIES DRUGS AND STAFF NEEDED TO TREAT PATIENTS WITH HYPERTENSION AND DIABETES PAID 51245 TO NONPROFIT CONSULTING COMPANY THAT ASSISTS LOCAL RESIDENTS WTIH OBTAINING FREE PRESCRIPTION DRUG COVERAGE PART I LINE 3C WE DID NOT USE THE FPG TO OFFER DISCOUNTED CARE UPON ADMISSION WE INTERVIEW ALL PATIENTS WITHOUT 3RD PARTY COVERAGE AND ANY BELOW 200 OF THE FPG QUALIFY FOR FREE CARE ANY OTHERS ARE GIVE A 15 DISCOUNT REGARDLESS OF THEIR INCOME STATUS PART I LINE 6A HOSPITAL DID NOT PREPARE A COMMUNITY BENEFIT REPORT DURING THE FISCAL YEAR PART III LINE 9B HOSPITAL DID APPLY OUR PROVISIONS FOR COLLECTION PRACTICES ON THE PATIENTS THAT HAD NO 3RD PARTY INSURANCE COVERAGE ONLY IF THEY DIDNT QUALIFY FOR FREE CARE BY FALLING UNDER THE 200 OF FPG 1 PART III LINE 4 DID NOT USE AS COMMUNITY BENEFIT 1 PART III LINE 8 DID NOT USE AS COMMUNITY BENEFIT
NEEDS ASSESSMENT	PART VI	BOARD DISCUSSES NEEDS OF COMMUNITY WITH PHYSICIANS AND DEPARTMENT HEADS TO DETERMINE WHAT PROGRAMS SERVICES ARE NEEDY IN THIS COMMUNITY
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	PART VI	SIGNS ARE POSTED THROUGHOUT FACILITY IN THE ADMISSIONS AREA OF GENERAL MED SURGERY OB AND ER AS WELL AS THE WAITING ROOMS IN THOSE DEPARTMENTS
COMMUNITY INFORMATION	PART VI	SMALL RURAL COMMUNITY WITH APPROXIMATELY 9000 RESIDENTS IN THE COUNTY WITH AGRICULTURE BEING THE MAIN SOURCE OF EMPLOYMENT AND INDUSTRY 65 OF THE POPULATION SERVED IN OUR COMMUNITY HAVE 3RD PARTY COVERAGE FROM MEDICARE OR MEDICAID
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE	PART VI	CONDUCTS NUMEROUS FREE HEALTH FAIRS THROUGHOUT THE COMMUNITY
DONALSONVILLE HOSPITAL INC LINE NUMBER 1 PART V LINE 19D	PART V LINE 19D	HOSPITAL DISCOUNTED PATIENTS WITHOUT 3RD PARTY INSURANCE COVERAGE BY 15

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
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 (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Total Compensation Filing OrgTotalCompensationFilingOrg
HERMAN BROOKINS
404150	404150
CHARLES H ORRICK
227977	227977
MURDOC M HENDERSON
327554	327554
HOWARD SOHNEN MD
285000	285000
JOSEPH WALKER JR
275000	275000
ANDREA ALEXANDER
244231	244231
JESSICA NUNEZ MD
221660	221660

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
FIRST ACHIEVEMENT DESCRIPTION	FORM 990, PAGE 2, PART III, LINE 4A	BEING RELATED TO CARDIOVASCULAR DISEASE. THE AMERICAN HEART ASSOCIATION HAS REPORTED THAT FOR EVERY DOLLAR SPEND FOR HYPERTENSION/DIABETES MANAGEMENT THAT THERE IS A NET SAVINGS OF NINE DOLLARS PER DIRECT AND INDIRECT HEALTH REALTED COSTS. THERE WERE ABOUT 103 ACTIVE PATIENTS ENROLLED IN THE SEMINOLE COUNTY PROGRAM.
ALL OTHER ACHIEVEMENTS DESCRIPTION	FORM 990, PAGE 2, PART III, LINE 4D	DONALSONVILLE HOSPITAL PROVIDES SEVERAL MISCELLANEOUS PROGRAMS TO THE GENERAL PUBLIC.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	THE FORM 990 IS REVIEWED BY THE CFO AND THE CHAIRMAN BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	OUR ORGANIZATION REGULARLY MONITORS THE POLICY COMPLIANCE THROUGH MONTHLY BOARD MEETINGS.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	THE BOARD OF DIRECTORS MEET REGULAR ON A MONTHLY BASIS AND THE ORGANIZATIONS SALARY DECISIONS ARE REVIEWED BY THE BOARD.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	HE BOARD OF DIRECTORS MEET REGULAR ON A MONTHLY BASIS AND THE SALARY DECISIONS ARE REVIEWED BY THE BOARD.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	THE HOSPITAL KEEPS A COPY OF THE AUDITED FINANCIAL STATEMENTS AS WELL AS A COPY OF THE FORM 990 FOR EACH FISCAL YEAR WHICH ARE MADE AVAILABLE UPON REQUEST TO THE GENERAL PUBLIC.