2012-05-15T12:58:49-05:00 2011-06-30 BURKE WORSHAM & HARRELL LLC 230 CHERRY STREET DONALSONVILLE GA 39845 990 2010-07-01 580973772 DONALSONVILLE HOSPITAL INC DONA 2295245217 102 HOSPITAL CIRCLE DONALSONVILLE GA 39845 HERMAN BROOKINS 2295245217 2012-05-14 true JUJUAN B BOWEN 2295242137 2012-05-15 2010 2016-02-24 21:20:13Z 39004717 false X X 1977 GA 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. 5 5 416 0 0 30550984 32825575 2060720 5992867 64701 85780 32676405 38904222 0 0 16865297 16490151 0 0 13654961 14009589 30520258 30499740 2156147 8404482 43672283 51653155 3099174 2675564 40573109 48977591 X 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. false false 25060 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. 4140560 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. 212964 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. 51245 DONALSONVILLE HOSPITAL PROVIDES SEVERAL MISCELLANEOUS PROGRAMS TO THE GENERAL PUBLIC. 51245 4429829 true false false false false false false false false false true false false false true false true true false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false false true 21 0 true 416 true false false false false false false X 5 5 false false false false false false false true true false false true true true true false true true true false GA X JAMES MOODY 2295245217 102 HOSPITAL CIRCLE DONALSONVILLE GA 39845 HERMAN BROOKINS 40.00 X X 404150 0 0 CHARLES H ORRICK 40.00 X X 227977 0 0 BROADDUS SIMPSON 1.00 X 8419 0 0 MITCH BLANKS 1.00 X 8419 0 0 BILL BURKE 1.00 X 8419 0 0 MURDOC M HENDERSON 40.00 X 327554 0 0 HOWARD SOHNEN MD 40.00 X 285000 0 0 JOSEPH WALKER JR 40.00 X 275000 0 0 ANDREA ALEXANDER 40.00 X 244231 0 0 JESSICA NUNEZ MD 40.00 X 221660 0 0 2010829 8 false true false 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 4 REVENUE FROM OPERATIONS 32825575 32825575 32825575 5992867 5992867 186275 100495 85780 85780 85780 38904222 38904222 632127 632127 12261458 4429829 7831629 2834462 2834462 762104 762104 892722 892722 1156866 1156866 SUPPLIES & DRUGS 5190053 5190053 OTHER FEES 3326680 3326680 BAD DEBT EXPENSE 2578211 2578211 CONTRACT SERVICES 665805 665805 INSURANCE 199252 199252 30499740 4429829 26069911 0 1502135 2003018 7373657 7526075 1792465 2022750 839005 904696 67388 113857 25065860 12693398 12668696 12372462 19428937 26710297 43672283 51653155 3099164 2675556 10 8 3099174 2675564 X 40573109 48977591 40573109 48977591 43672283 51653155 8404482 X true true true X false X false false false false false false false false false false 25065860 12693398 12372462 12372462 CREDIT LINES 8 8 38904222 30499740 8404482 8404482 38904222 38904222 38904222 30499740 30499740 30499740 true true true X false true true false false 1345682 1345682 0.04410 1345682 1345682 0.04410 76305 76305 0.00250 76305 76305 0.00250 1421987 1421987 0.04660 true 2668073 2134458 3804406 4062460 -258054 X true true 1 1 DONALSONVILLE HOSPITAL INC

102 HOSPITAL CIRCLE DONALSONVILLE GA 39845

X X X DONALSONVILLE HOSPITAL INC 1 true true 200.0 false true X true true X X X true false true X false false 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 false false false false false false false false false 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 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.