FURP.ORG / PUBLIC DATA EXPLORER

THE COBB FOUNDATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
THE COBB FOUNDATION INC (EIN 58-1634125)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-14
IRS object ID
201213199349304991
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-14T14:28:56-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DRAFFIN & TUCKER LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 6AddressLine1
CityALBANYCity
StateGAState
ZIP Code317020006ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN581634125EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1THE COBB FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOBBNameControl
Phone7068566100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 280AddressLine1
CityHARTWELLCity
StateGAState
ZIP Code30643ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJ STEVEN BARBERName
TitleCFOTitle
Phone7068566100Phone
Date Signed2012-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameWILLIAM EDWARD PHILLIPSName
Phone2298837878Phone
Date Prepared2012-11-12DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1HART CO HOSP & HARTWELL HEALTHCAREBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonCHARLES ADAMSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO BOX 589AddressLine1
CityROYSTONCity
StateGAState
ZIP Code30662ZIPCode
FieldValueIRS element (for citing)
Gross Receipts19310422GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteHARTCOUNTYHOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1986YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionTO CONTINUOUSLY IMPROVE THE QUALITY OF PRIMARY, LONG-TERM AND HOME CARE WITHIN OUR RESOURCE CAPABILITIES AND TO PROMOTE HEALTHIER LIFESTYLES THROUGH EDUCATION CONSISTENT WITH INDIVIDUAL AND COMMUNITY NEEDS.ActivityOrMissionDescription
Nbr Voting Members Governing Body3NbrVotingMembersGoverningBody
Nbr Independent Voting Members3NbrIndependentVotingMembers
Total Nbr Employees300TotalNbrEmployees
Total Nbr Volunteers28TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year492ContributionsGrantsPriorYear
Contributions Grants Current Year17972ContributionsGrantsCurrentYear
Program Service Revenue Prior Year18261903ProgramServiceRevenuePriorYear
Program Service Revenue CY18784439ProgramServiceRevenueCY
Investment Income Prior Year114090InvestmentIncomePriorYear
Investment Income Current Year95816InvestmentIncomeCurrentYear
Other Revenue Prior Year180244OtherRevenuePriorYear
Other Revenue Current Year217503OtherRevenueCurrentYear
Total Revenue Prior Year18556729TotalRevenuePriorYear
Total Revenue Current Year19115730TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year10768947SalariesEtcPriorYear
Salaries Etc Current Year9839977SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year11290974OtherExpensePriorYear
Other Expenses Current Year11944353OtherExpensesCurrentYear
Total Expenses Prior Year22059921TotalExpensesPriorYear
Total Expenses Current Year21784330TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-3503192RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-2668600RevenuesLessExpensesCY
Total Assets BOY12633788TotalAssetsBOY
Total Assets EOY11587421TotalAssetsEOY
Total Liabilities BOY18088044TotalLiabilitiesBOY
Total Liabilities EOY19850622TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-5454256NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-8263201NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO CONTINUOUSLY IMPROVE THE QUALITY OF PRIMARY, LONG-TERM AND HOME CARE WITHIN OUR RESOURCE CAPABILITIES AND TO PROMOTE HEALTHIER LIFESTYLES THROUGH EDUCATION CONSISTENT WITH INDIVIDUAL AND COMMUNITY NEEDS.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense19722691Expense
Revenue18773895Revenue
DescriptionTHE COBB FOUNDATION, INC.(THE FOUNDATION) OPERATES HART COUNTY HOSPITAL, AN 82-BED ACUTE CARE HOSPITAL, AND HARTWELL HEALTHCARE CENTER, A 92-BED LONG-TERM CARE FACILITY. HART COUNTY HOSPITAL (THE HOSPITAL) PROVIDES INPATIENT, SWINGBED, OUTPATIENT AND EMERGENCY CARE SERVICES TO RESIDENTS OF HART, FRANKLIN AND ELBERT COUNTIES AND THE SURROUNDING AREAS. THE HOSPITAL HAD 2,488 INPATIENT DAYS, AND 8,535 EMERGENCY ROOM VISITS DURING 2011. THE HOSPITAL PARTICIPATES IN THE MEDICARE AND MEDICAID GOVERNMENT INSURANCE PROGRAMS. UNDER THESE PROGRAMS, THE HOSPITAL PROVIDES CARE TO PATIENTS AT PAYMENT RATES WHICH ARE DETERMINED BY THE FEDERAL AND STATE GOVERNMENTS, REGARDLESS OF THE HOSPITAL'S ACTUAL CHARGES. IN SOME CASES, THESE PROGRAMS PAY THE HOSPITAL AT AMOUNTS WHICH ARE LESS THAN THE COST OF PROVIDING THE SERVICES. THE HOSPITAL ALSO PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS INDIGENT AND CHARITY POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. CHARGES FOREGONE, AT ESTABLISHED RATES, UNDER THE INDIGENT AND CHARITY CARE POLICY APPROXIMATED 1,370,000. IN ADDITION, THE HOSPITAL HAD BAD DEBT EXPENSE (PATIENT BILLS THAT WERE NOT COLLECTED)OF APPROXIMATELY 2,347,000. HARTWELL HEALTHCARE CENTER PROVIDED OVER 32,000 RESIDENT DAYS DURING 2011. OF THESE DAYS, APPROXIMATELY 84% WERE COVERED BY THE MEDICAID AND MEDICARE INSURANCE PROGRAMS.Description
Total Program Service Expense19722691TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109654NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees300NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members3NbrVotingGoverningBodyMembers
Number Independent Voting Members3NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonsfalseAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKIM DRAFTSNamePerson
Telephone Number7068566159TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 280AddressLine1
CityHARTWELLCity
StateGAState
ZIP Code30643ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
JACK EDMUNDS
VICE CHAIR1.00XX1200172000
FORT OGLESBY
BOARD CHAIR1.00XX1950112000
GREGORY HEARN
SECRETARY1.00XX1200112000
CHARLES T ADAMS
CEO20.00X031654053844
STEVE BARBER
CFO20.00X016049923109
DAVID SEAGRAVES
ADMINISTRATO20.0010700010700015888X
JERRY WISE
ADMINISTRATO20.00717317173119398X
DONNA TONEY
PHARMACIST20.00613936139316177X
JENNIFER DICKERSON
PHARMACIST13.0034432731682629X
ANGELA HARPOLD
PHARMACIST15.00404996607715100X
SANDRA SHUGART
PHARMACIST16.00412096445412604X
FieldValueIRS element (for citing)
Total Reportable Comp From Org360614TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs960462TotalReportableCompFrmRltdOrgs
Total Other Compensation158749TotalOtherCompensation
Number Individuals GT100 K10NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
GEORGIA ANESTHESIA SERVICES
1179 MELODY LANEHARTWELLGA30643CRNA/ANESTHESIA499998
CPSI
660 WALL STREETMOBILEAL36695BUSINESS OFFICE497456
THE LONGSTREET CLINIC
725 JESSE JEWELL PKWYGAINSVILLEGA30501HOSPITALIST371875
PRODIGY HEALTHCARE
200 ARIZONA AVE NE SUITE 200ATLANTAGA30307RADIOLOGY SVCS347289
HARTWELL EMERGENCY PHYSICIANS
300 S PARK RD SUITE 400HOLLYWOODFL33021ER PHYSICIAN326000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
All Other Contributions17972AllOtherContributions
Noncash Contributions748NoncashContributions
Total Contributions17972TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUE, NETDescription
Total Revenue Column18784439TotalRevenueColumn
Related Or Exempt Function Income18784439RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue18784439TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column106360TotalRevenueColumn
Exclusion$106,360ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities184148Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities194692Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-10544Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-10544TotalRevenueColumn
Related Or Exempt Function Income-10544RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CAFETERIA & VENDING136138$136,138
VENDOR DISCOUNTS73369$73,369
MISCELLANEOUS7996$7,996
FieldValueIRS element (for citing)
Total Other Revenue217503TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column19115730TotalRevenueColumn
Related Or Exempt Function Income18773895RelatedOrExemptFunctionIncome
Exclusion$323,863ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total111350Total
Management And General111350ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7892497Total
Program Services7613893ProgramServices
Management And General278604ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total84943Total
Program Services81945ProgramServices
Management And General2998ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1168162Total
Program Services1126926ProgramServices
Management And General41236ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total583025Total
Program Services561947ProgramServices
Management And General21078ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total65862Total
Management And General65862ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total87110Total
Management And General87110ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total5273Total
Management And General5273ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3832198Total
Program Services2692441ProgramServices
Management And General1139757ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2373830Total
Program Services2347979ProgramServices
Management And General25851ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total761926Total
Program Services670495ProgramServices
Management And General91431ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total60890Total
Program Services31524ProgramServices
Management And General29366ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total885736Total
Program Services779448ProgramServices
Management And General106288ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total200314Total
Program Services200314ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBTS23468412346841
MEDICAID PROVIDER FEE565164565164
REPAIRS & MAINTENANCE5215145136707844
PHYSICIAN RECRUITMENT105361105361

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total132334Total
Program Services84743ProgramServices
Management And General47591ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total21784330Total
Program Services19722691ProgramServices
Management And General2061639ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY162198BOY
EOY103504EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1503759BOY
EOY1578499EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY118377BOY
EOY7167EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY483633BOY
EOY490375EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY44022BOY
EOY31889EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis18642626LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10659278LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8813601BOY
EOY7983348EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1055187BOY
EOY1031508EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY114406BOY
EOY119910EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY338605BOY
EOY241221EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12633788BOY
EOY11587421EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1590898BOY
EOY1255807EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY16497146BOY
EOY18594815EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY18088044BOY
EOY19850622EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-5454256BOY
EOY-8263201EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-5454256BOY
EOY-8263201EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12633788BOY
EOY11587421EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-2668600ReconcilationRevenueExpenses
Reconcilation Other Changes-140345ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Form4720 Filed4955 TaxfalseForm4720Filed4955Tax
Correction MadefalseCorrectionMade
Form1120 Pol FiledfalseForm1120PolFiled
Form4720 FiledfalseForm4720Filed
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$2,903OtherActivitiesAmount
Total Lobbying Expenditures IIB2903TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3
Form4720 Filed4912 TaxfalseForm4720Filed4912Tax
Substantially All Dues NondeductfalseSubstantiallyAllDuesNondeduct
Only In House LobbyingfalseOnlyInHouseLobbying
Agree To Carryover Prior YearfalseAgreeToCarryoverPriorYear

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
Return ReferenceSCHEDULE C, PART II-B, LINE 1ReturnReference
ExplanationCOBB FOUNDATION PARTICIPATED IN LOBBYING ACTIVITIES THROUGH MEMBERSHIP IN THE GEORGIA HOSPITAL ASSOCIATION. A PORTION OF THE FOUNDATION'S YEARLY DUES IS ALLOCATED TO LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis303881OtherCostOrOtherBasis
Book Value303881BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis7703176OtherCostOrOtherBasis
Depreciation2450744Depreciation
Book Value5252432BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis10383939OtherCostOrOtherBasis
Depreciation8005319Depreciation
Book Value2378620BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis251630OtherCostOrOtherBasis
Depreciation203215Depreciation
Book Value48415BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7983348TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
TY COBB HEALTHCARE SYSTEM$15,730,821
HART COUNTY HOSPITAL AUTHORITY$2,141,413
ACCRUED PENSION BENEFITS$463,665
MEDICARE/MEDICAID COST REPORT SETTLE$258,916
FieldValueIRS element (for citing)
Total Of Amounts18594815TotalOfAmounts
Total Revenue19115730TotalRevenue
Total Expenses21784330TotalExpenses
Excess Or Deficit For Year-2668600ExcessOrDeficitForYear
Net Unrealized GL On Investments-1722780NetUnrealizedGLOnInvestments
Other-$959,964OtherAmount
Total Adjustments-2682744TotalAdjustments
Excess Or Deficit Per FS-5351344ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt55913904TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-1722780NetUnrealizedGainsInvestments
Other Revenues38526227OtherRevenues
Revenue Not Rptd F99036803447RevenueNotRptdF990
Revenue Subtotal19110457RevenueSubtotal
Investment Expenses Not Included5273InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt5273RevenueNotRptdOnFinStmt
Total Revenue Per Form99019115730TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt61265248TotExpensesEtcAuditedFinclStmt
Other Expenses Included39486191OtherExpensesIncluded
Expenses Not Rptd F99039486191ExpensesNotRptdF990
Expenses Subtotal21779057ExpensesSubtotal
Investment Expenses Not Included25273InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt5273ExpensesNotRptdOnFinStmt
Total Expenses Per Form99021784330TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
LIABILITY UNDER FIN 48 FOOTNOTESCHEDULE D, PAGE 3, PART XEXCERPT FROM AUDITED FINANCIAL STATEMENTS - INCOME TAXES. THE SYSTEM AND THE FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE SEGREGATED PORFOLIO INTENDS TO CONDUCT ITS AFFAIRS IN A MANNER IN WHICH IT WILL NOT BE SUBJECT TO U.S. FEDERAL INCOME TAX OR GEORGIA INCOME TAX. REGIONAL IS CONSIDERED A DISREGARDED ENTITY OF THE SYSTEM. THE SYSTEM APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE SYSTEM ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCCRUED OR CHARGED TO EXPENSE AS OF DECEMBER 31, 2011 OR 2010 OR FOR THE YEARS THEN ENDED. THE SYSTEM'S OPEN AUDIT PERIODS ARE FOR THE TAX YEARS ENDED 2008-2010.
RECONCILIATION OF CHANGES - OTHERSCHEDULE D, PAGE 4, PART XI, LINE 8TY COBB HEALTHCARE SYSTEM 39,638,771 TY COBB HEALTHCARE SEGREGATED PORTFOLIO 471,458 INTERCOMPANY ELIMINATIONS -1,584,002 TY COBB HEALTHCARE SYSTEM -40,659,904 TY COBB HEALTHCARE SEGREGATED PORTFOLIO -552,954 INTERCOMPANY ELIMINATIONS 1,726,667
REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHERSCHEDULE D, PAGE 4, PART XII, LINE 2DTY COBB HEALTHCARE SYSTEM 39,638,771 TY COBB HEALTHCARE SEGREGATED PORTFOLIO 471,458 INTERCOMPANY ELIMINATIONS -1,584,002
EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHERSCHEDULE D, PAGE 4, PART XIII, LINE 2DTY COBB HEALTHCARE SYSTEM 40,659,904 TY COBB HEALTHCARE SEGREGATED PORTFOLIO 552,954 INTERCOMPANY ELIMINATIONS -1,726,667

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage1.25000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense564740TotalCommunityBenefitExpense
Net Community Benefit Expense564740NetCommunityBenefitExpense
Percent Of Total Expense0.02910PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense1557018TotalCommunityBenefitExpense
Direct Offsetting Revenue1764030DirectOffsettingRevenue
Net Community Benefit Expense-207012NetCommunityBenefitExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense73141TotalCommunityBenefitExpense
Direct Offsetting Revenue59720DirectOffsettingRevenue
Net Community Benefit Expense13421NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense2194899TotalCommunityBenefitExpense
Direct Offsetting Revenue1823750DirectOffsettingRevenue
Net Community Benefit Expense371149NetCommunityBenefitExpense
Percent Of Total Expense0.02980PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense2194899TotalCommunityBenefitExpense
Direct Offsetting Revenue1823750DirectOffsettingRevenue
Net Community Benefit Expense371149NetCommunityBenefitExpense
Percent Of Total Expense0.02980PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense11229TotalCommunityBuildingExpense
Direct Offsetting Revenue300DirectOffsettingRevenue
Net Community Building Expense10929NetCommunityBuildingExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense11229TotalCommunityBuildingExpense
Direct Offsetting Revenue300DirectOffsettingRevenue
Net Community Building Expense10929NetCommunityBuildingExpense
Percent Of Total Expense0.00060PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,346,841BadDebtExpenseAmount
Amount Reimbursed By Medicare4449640AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare5494310CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1044670MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1HART COUNTY HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1PO BOX 280AddressLine1
CityHARTWELLCity
StateGAState
ZIP Code30643ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1HART COUNTY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent125.0FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent200.0FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notified All PatientsXNotifiedAllPatients
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1HARTWELL HEALTHCARE CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1PO BOX 280AddressLine1
CityHARTWELLCity
StateGAState
ZIP Code30643ZIPCode
FieldValueIRS element (for citing)
Facility TypeSKILLED NURSING FACILITYFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
EXCLUSIONS FROM PERCENT OF TOTAL EXPENSEPART I LINE 7 COLUMN FIN 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 21784330 LESS BAD DEBTS IN PART IX 2346841 DENOMINATOR FOR COLUMN F 19437489
COSTING METHODOLOGY EXPLANATIONPART I LINE 7THE COBB FOUNDATION INC USED THE WORKSHEETS 1 2 AND 3 LOCATED IN THE INSTRUCTIONS TO SCHEDULE H OF FORM 990 TO CALCULATE THE COMMUNITY BENEFIT EXPENSE REPORTED IN THE TABLE ON LINE 7
COMMUNITY BUILDING ACTIVITIESPART IITHE COBB FOUNDATION INC PROVIDES FREE MONTHLY HEALTH EDUCATION PROGRAMS TO THE PUBLIC TO PROMOTE WELLNESS AND HEALTHIER LIFESTYLES THE OCCUPATIONAL MEDICINE AND WELLNESS DEPARTMENT ALSO PARTICIPATES IN LUNCH AND LEARN AND HEALTH FAIRS THROUGHOUT THE YEAR THAT PROVIDE HEALTH EDUCATION AND SCREENING OPPORTUNITIES FOR EMPLOYEES OF LOCAL BUSINESSES AS WELL AS THE PUBLIC AT LARGE FOUNDATION EMPLOYEES ARE ACTIVE IN AND PROMOTE WELLNESS TO LOCAL CIVIC GROUPS INCLUDING BUT NOT LIMITED TO THE TRICOUNTY DIABETES TASK FORCE CHAMBER OF COMMERCE ROTARY CLUB KIWANIS CLUB AND SERVICE LEAGUES
BAD DEBT EXPENSE EXPLANATIONPART III LINE 4THE FOLLOWING IS FROM THE FOOTNOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS ALLOWANCE FOR DOUBTFUL ACCOUNTS THE SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE EVALUATION OF THE OVERALL COLLECTIBILITY OF ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE
MEDICARE EXPLANATIONPART III LINE 8MEDICARE SHORTFALL THE FULL AMOUNT OF MEDICARE SHORTFALL 1053828 REPORTED ON LINE 7 SHOULD BE CONSIDERED AS COMMUNITY BENEFIT HART COUNTY HOSPITAL HAS RECEIVED MEDICARE DEPENDENT HOSPITAL STATUS FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES MEDICARE DEPENDENT HOSPITAL STATUS MEANS THAT THE MAJORITY OF THE HOSPITALS INPATIENTS ARE INSURED BY THE MEDICARE PROGRAM THEREFORE THE HOSPITAL IS THE PRIMARY AND A VITAL SOURCE OF HEALTHCARE SERVICES TO MEDICARE PATIENTS IN ITS SERVICE AREA MEDICARE ALLOWABLE COSTS MEDICARE ALLOWABLE COSTS OF CARE REPORTED ON LINE 6 WAS DETERMINED FROM THE MEDICARE COST REPORT FOR HART COUNTY HOSPITAL
COLLECTION PRACTICES EXPLANATIONPART III LINE 9BTHE HOSPITAL NOTIFIES PATIENTS OF THE FINANCIAL ASSISTANCE POLICY IN COMMUNICATIONS WITH THE PATIENT REGARDING THE PATIENTS BILLS NORMAL COLLECTION PRACTICES BASED ON THE PATIENTS RESPONSE WOULD CEASE ONCE IT IS DETERMINED THE PATIENT QUALIFIES FOR CHARITY CARE OR FINANCIAL ASSISTANCE
NEEDS ASSESSMENTPART VITHE COBB FOUNDATION INC USES DISCHARGE DATA MARKET ANALYSES AND INFORMATION FROM INDIVIDUALS IN THE COMMUNITY TO ASSESS THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES RECENTLY THE FOUNDATION CONDUCTED A THOROUGH AND ACCURATE MARKET AND NEEDS ASSESSMENT USING BOTH INTERNAL RESOURCES AND PERSONNEL AS WELL AS A QUALIFIED EXTERNAL ORGANIZATION CONSULTANT EXPERIENCED IN COLLECTING ORGANIZING AND ANALYZING THE APPROPRIATE MARKET DEMOGRAPHIC AND HEALTH RELATED INFORMATION NECESSARY TO HELP MAKE THE CORRECT DECISIONS ABOUT THE HEALTHCARE SERVICES NEEDED IN OUR MARKET THE FOLLOWING DATA ELEMENTS WERE OBTAINED DEMOGRAPHIC INFORMATION ECONOMIC DATA HEALTHCARE UTILIZATION DATA HOUSING DATA AND ECONOMIC AND INDUSTRIAL DEVELOPMENT DATA AND TRENDS THE FOUNDATIONS BOARD INCLUDES COMMUNITY REPRESENTATIVES WHO VOICE THE NEEDS OF THE COMMUNITY SUGGESTION BOXES ARE ALSO AVAILABLE TO PATIENTS VISITORS AND EMPLOYEES TO SUBMIT THOUGHTS OR IDEAS
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPART VISELF PAY PATIENTS ARE REFERRED TO A PATIENT FINANCIAL COUNSELOR THE PATIENT FINANCIAL COUNSELOR WILL ASSIST THE PATIENT OR GUARANTOR IN APPLYING FOR FINANCIAL ASSISTANCE IF NO SOURCE OF FINANCIAL ASSISTANCE IS AVAILABLE THE HOSPITAL WILL REVIEW THE ACCOUNT FOR AN INDIGENT OR CHARITY ALLOWANCE
COMMUNITY INFORMATIONPART VITHE FOUNDATION OPERATES FACILITIES LOCATED IN HART COUNTY GEORGIA A RURAL AREA WITH A POPULATION OF APPROXIMATLY 25000 PEOPLE THE COUNTY IS LOCATED IN THE NORTHEAST PART OF GEORGIA ALONG THE INTERSTATE 85 CORRIDOR HALFWAY BETWEEN ATLANTA GA AND GREENVILLE SC THE FOUNDATION OPERATES THE ONLY ACUTE CARE HOSPITAL IN HART COUNTY HART COUNTY IS CHARACTERIZED AS HAVING A HIGHER THAN STATE AVERAGE MEDIAN AGE LOWER THAN STATE AVERAGE EDUCATION LEVEL AND HIGHER RATES OF CHRONIC DISEASE THE COUNTY HAS EXPERIENCED MINIMAL GROWTH IN POPULATION JOB CREATION AND INDUSTRIAL DEVELOPMENT FORECASTERS ARE PREDICTING THE COUNTY WILL GROW AT A FASTER RATE IN ALL THESE AREAS IN THE FUTURE AS DEVELOPMENT ALONG THE I85 CORRIDOR CONTINUES AND NEW GROWTH WILL OCURR AS HIGHWAY 17 IS WIDENED TO FOUR LANES
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSEPART VITHE COBB FOUNDATION INC HAS AN OPEN MEDICAL STAFF AND THE BOARD OF DIRECTORS CONSIST OF COMMUNITY LEADERS
LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILEDPART VIGEORGIA
HART COUNTY HOSPITAL LINE NUMBER 1 PART V LINE 19DPART V LINE 19DPATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE ARE CHARGED A DISCOUNTED RATE BASED UPON HOSPITAL POLICY

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Discretionary Spending AccountXDiscretionarySpendingAccount
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg
CHARLES T ADAMS
2470406250070003750016344370384
STEVE BARBER
145848105004151676516344183608
DAVID SEAGRAVES
9875170001249158881228889875170001249107000
JERRY WISE
6830234297173168302342991129351015888

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FRINGE OR EXPENSE EXPLANATIONSCHEDULE J, PAGE 1, PART I, LINE 1ACEO IS PROVIDED WITH A DISCRETIONARY SPENDING ACCOUNT OF 600 EACH MONTH.
SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTSSCHEDULE J, PAGE 1, PART I, LINE 4CHARLES T ADAMS 0 30,000 0
OTHER ADDITIONAL INFORMATIONSCHEDULE J, PART IIICOBB FOUNDATION, INC. AND ITS RELATED PARTY, TY COBB HEALTHCARE SYSTEM, INC., EACH OPERATE AN ACUTE CARE HOSPITAL. TCHS IS IN THE PROCESS OF BUILDING A NEW ACUTE CARE HOSPITAL. THE TWO HOSPITALS OPERATED BY TCHS AND COBB FOUNDATION WILL CLOSE WHEN THE NEW HOSPITAL OPENS. THE CONVERSION FROM TWO HOSPITALS TO ONE WILL CAUSE OVERLAP IN SOME POSITIONS. TOP MANAGEMENT OFFICERS OF THE COBB FOUNDATION WERE OFFERED RETENTION INCENTIVES TO STAY FOR TWO YEARS DURING THE CONVERSION PROCESS.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FIRST ACCOMPLISHMENT DESCRIPTIONFORM 990, PAGE 2, PART III, LINE 4APROVIDES CARE TO PATIENTS AT PAYMENT RATES WHICH ARE DETERMINED BY THE FEDERAL AND STATE GOVERNMENTS, REGARDLESS OF THE HOSPITAL'S ACTUAL CHARGES. IN SOME CASES, THESE PROGRAMS PAY THE HOSPITAL AT AMOUNTS WHICH ARE LESS THAN THE COST OF PROVIDING THE SERVICES. THE HOSPITAL ALSO PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS INDIGENT AND CHARITY POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. CHARGES FOREGONE, AT ESTABLISHED RATES, UNDER THE INDIGENT AND CHARITY CARE POLICY APPROXIMATED 1,370,000. IN ADDITION, THE HOSPITAL HAD BAD DEBT EXPENSE (PATIENT BILLS THAT WERE NOT COLLECTED)OF APPROXIMATELY 2,347,000. HARTWELL HEALTHCARE CENTER PROVIDED OVER 32,000 RESIDENT DAYS DURING 2011. OF THESE DAYS, APPROXIMATELY 84% WERE COVERED BY THE MEDICAID AND MEDICARE INSURANCE PROGRAMS.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BAFTER REVIEW AND APPROVAL BY MANAGEMENT, AN ELECTRONIC COPY OF THE FORM 990 WAS EMAILED TO ALL MEMBERS OF THE COBB FOUNDATION, INC.'S BOARD OF DIRECTORS FOR APPROVAL.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CTHE BOARD OF DIRECTORS AND CEO MONITOR AND ENFORCE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ATHE COMPENSATION OF THE COBB FOUNDATION, INC.'S CEO IS REVIEWED AND APPROVED BY THE INDEPENDENT BOARD OF DIRECTORS. EXTERNAL COMPARABILITY REPORTING WAS USED IN THE DETERMINATION OF THE COMPENSATION OF THE CEO.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BTHE COMPENSATION OF THE COBB FOUNDATION, INC.'S CFO IS REVIEWED AND APPROVED BY THE INDEPENDENT BOARD OF DIRECTORS. EXTERNAL COMPARABILITY REPORTING WAS USED IN THE DETERMINATION OF THE COMPENSATION OF THE CFO.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19THE COBB FOUNDATION, INC.'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR THE PUBLIC TO REVIEW AT THE FOUNDATION'S CORPORATE OFFICE UPON REQUEST.
ADDITIONAL INFORMATIONFORM 990, PART VIIHOURS SPENT AT RELATED ORGANIZATIONS BY LISTED INDIVIDUALS INCLUDE DAVID SEAGRAVES 20 HOURS DONNA TONEY 33 HOURS WILLIAM ROGERS 7 HOURS CHARLES ADAMS 20 HOURS STEVE BARBER 20 HOURS
OTHER CHANGES IN NET ASSETS EXPLANATIONFORM 990, PART XI, LINE 5CHANGES IN NET UNREALIZED GAINS AND LOSSES ON OTHER THAN TRADING SECURITIES AND PENSION-RELATED CHANGES OTHER THAN PERIODIC BENEFIT COST.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1TY COBB HEALTHCARE SYSTEM INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 589AddressLine1
CityROYSTONCity
StateGAState
ZIP Code30662ZIPCode
FieldValueIRS element (for citing)
EIN580633978EIN
Primary ActivitiesHEALTHCAREPrimaryActivities
Legal Domicile StateGALegalDomicileState
Exempt Code Section501C3ExemptCodeSection
Public Charity Status3PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg