2012-05-10T15:50:46-05:00 2011-06-30 WARREN AVERETT LLC 2500 ACTON ROAD BIRMINGHAM AL 35243 990 2010-07-01 581966795 DEKALB MEDICAL CENTER INC DEKA 4045011000 2701 NORTH DECATUR ROAD DECATUR GA 30033 JOHN SHELTON 4045011000 2012-05-03 1 2059794100 2010 2016-02-24 21:20:13Z JOHN SHELTON 2701 NORTH DECATUR ROAD DECATUR GA 30033 422869996 0 X WWW.DEKALBMEDICAL.ORG X 1991 GA AT DEKALB MEDICAL, OUR MISSION IS TO IMPROVE LIVES THROUGH THE DELIVERY OF EXCELLENT HEALTH AND WELLNESS SERVICES IN PARTNERSHIP WITH OUR PHYSICIANS. 7 6 2870 240 120993 59104 1620773 1192414 397818422 413438521 -3859566 6038682 1553633 2195151 397133262 422864768 0 0 0 0 188069534 194620044 0 0 0 224083058 227304366 412152592 421924410 -15019330 940358 397952138 404221357 266531359 245325559 131420779 158895798 AT DEKALB MEDICAL, OUR MISSION IS TO IMPROVE LIVES THROUGH THE DELIVERY OF EXCELLENT HEALTH AND WELLNESS SERVICES IN PARTNERSHIP WITH OUR PHYSICIANS. 0 0 244037154 315897214 DEKALB MEDICAL NORTH DECATUR - 22,261 PATIENTS DISCHARGED FROM THE HOSPITAL FOR A TOTAL OF 112,424 PATIENT DAYS. THERE WERE 180,682 OUTPATIENT VISITS TO THE HOSPITAL DURING THE FISCAL YEAR. 58031895 77832387 DEKALB MEDICAL AT HILLANDALE - 4,738 PATIENTS WERE DISCHARGED FROM THE HOSPITAL FOR A TOTAL OF 20,121 PATIENT DAYS. THERE WERE 85,730 OUTPATIENT VISITS TO THE HOSPITAL DURING THE FISCAL YEAR. 28305552 19708920 DEKALB MEDICAL PHYSICIAN NETWORK - 103,759 PATIENTS WERE TREATED IN THE PHYSICIAN OFFICES DURING THE FISCAL YEAR. 4896079 2159290 4896079 2159290 335270680 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 1 496 0 1 2870 1 1 1 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 GA X DIANE HARDEN 4045015025 2701 NORTH DECATUR ROAD DECATUR GA 30033 ERIC NORWOOD 40.00 X X 1060770 0 41979 OLIVER LEE 5.00 X 0 0 0 TERRY DUIS 5.00 X 0 0 0 ROBERT WILSON 5.00 X 0 0 0 DAVID JOLLAY 5.00 X 0 0 0 ROBIN DRETLER MD 5.00 X 0 0 0 DOMINIQUE SMITH MD 5.00 X 0 0 0 JOHN SHELTON 40.00 X 741752 0 53598 DIANE HARDEN 40.00 X 630657 0 48792 DUANE BARCLAY DO 40.00 X 508471 0 38760 TOM CRAWFORD 40.00 X 394927 0 42927 CATHLEEN WHEATLEY 40.00 X 278267 0 77045 CLAY FOWLER 40.00 X 307418 0 39294 RUTH ANDERSON 40.00 X 365619 0 34066 JAN GANNON 40.00 X 197700 0 63537 CHERYL IVERSON 40.00 X 326282 0 46772 DAVID HOLLADAY MD 40.00 X 935240 0 19246 RAYMOND LAWHEAD MD 40.00 X 601353 0 16847 SHAINUL BHATIA MD 40.00 X 455574 0 26316 AUGSTINE CONDUAH MD 40.00 X 491244 0 16833 RODERICK STEVENSON MD 40.00 X 365665 0 12345 7660939 0 578357 109 0 1 0 DEKALB ANESTHESIA ASSOCIATES PA 21717 WEST PARK COURT SUITE A STONE MOUNTAIN GA 300870000 ANESTHESIOLOGY SERVICES 3216448 COGENT HEALTHCARE PO BOX 975075 DALLAS TX 753975075 HOSPITALISTS 2722346 BRASFIELD & GORRIE PO BOX 11407 BIRMINGHAM AL 352460351 GENERAL CONSTRUCTION CONTRACTORS 2374581 SODEXHO INC AND AFFILIATES PO BOX 536922 ATLANTA GA 303536922 FOOD & EVS MANAGEMENT SERVICES 2267844 METRO VASCULAR PC 2675 N DECATUR ROAD SUITE 210 DECATUR GA 300330000 CONTRACT VASCULAR ULTRASOUND SERVICES 1214142 245 568292 624122 1192414 DEKALB MEDICAL AT NORT 900099 315897214 315897214 DEKALB MEDICAL AT HILL 900099 77832387 77832387 PHYSICIAN PRACTICE NET 900099 19708920 19708920 413438521 4630167 4630167 102477 102477 102477 102477 1397343 16400 5228 1397343 11172 1408515 1408515 WELLNESS CENTER 900099 771191 771191 LAB OUTREACH REVENUE 900099 120993 120993 CAFETERIA/VENDING 900099 94980 94980 1105510 1105510 2092674 422864768 415512679 120993 6038682 4811863 4811863 162869996 138209571 24660425 5859714 4829792 1029922 8522761 6622709 1900052 12555710 10337627 2218083 868831 250 868581 302468 302468 26864431 10570016 16294415 1568768 5575 1563193 75378471 71728528 3649943 8001386 713478 7287908 25875807 13193080 12682727 188113 48465 139648 203452 74427 129025 21031342 17741390 3289952 3818259 503737 3314522 PROVISION FOR UNCOLLECT 51757472 51757472 0 REPAIRS AND MAINTENANCE 9467512 8674055 793457 MEMBERSHIPS, DUES & SUB 1139629 215324 924305 OTHER EXPENSES 837981 44740 793241 LOSS ON EXTINGUISHMENT 444 444 0 421924410 335270680 86653730 0 15942468 13485455 7076737 7621947 50602142 62572601 5439927 5860483 1863143 2749509 402388755 264646631 143085471 137742124 168891348 168590597 1029985 1063206 4020917 4535435 397952138 404221357 39260026 43330734 194411884 191970095 32859449 10024730 266531359 245325559 X 130835289 158345967 585490 549831 131420779 158895798 397952138 404221357 X 940358 26534661 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 403305 403305 231403470 128555836 102847634 163034275 133724229 29310046 7547705 2366566 5181139 137742124 ASSET RETIREMENT OBLIGATION 4661599 INTEREST RATE SWAPS 1879226 SELF INSURANCE RESERVES 3483905 10024730 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE SYSTEM APPLIES ASC 740, INCOME TAXES, ASC 740 PROVIDES GUIDANCE ON WHEN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND HOW THE VALUES OF THESE POSITIONS ARE DETERMINED. THERE IS CURRENTLY NO IMPACT ON THE SYSTEM'S CONSOLIDATED FINANCIAL STATEMENTS AS A RESULT OF THE APPLICATION OF ASC 740. 1 1 X 1 X 1 X 1 1 1 0 1 1 16674208 0 16674208 0.04500 51919792 46550258 5369534 0.01450 68594000 46550258 22043742 0.05950 1779 61332 0 61332 0.00020 1779 61332 61332 0.00020 1779 68655332 46550258 22105074 0.05970 1 16246683 3249337 95908755 88196989 7711766 X 1 0 2 1 DEKALB MEDICAL AT NORTH DECATUR

2701 NORTH DECATUR ROAD DECATUR GA 300330000

X X X 2 DEKALB MEDICAL AT HILLANDALE

2801 DEKALB MEDICAL PARKWAY LITHONIA GA 300580000

X X X DEKALB MEDICAL CENTER AT NORTH DECATUR 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 0 1 X X X 1 X X X X X X 1 X 0 1 DEKALB MEDICAL CENTER AT HILLANDALE 2 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 0 1 X X X 1 X X X X X X 1 X 0 1 PART I, LINE 3C: THE ORGANIZATION USES FEDERAL POVERTY GUIDELINES. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS PRODUCED BY DEKALB MEDICAL CENTER, INC. PART I, LINE 7: THE COSTING METHODOLOGY USED WAS BASED ON A RATIO OF COST TO CHARGES. COSTS WERE CALCULATED BY TAKING TOTAL OPERATING EXPENSES AND REDUCING THEM BY BAD DEBT EXPENSE AND ANY NON-PATIENT CARE REVENUE. CHARGES ARE EQUAL TO TOTAL GROSS PATIENT CHARGES. PART I, LINE 7G: N/A PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 51757472. PART II: N/A PART III, LINE 4: THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES, IN THE NORMAL COURSE OF BUSINESS, THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ITS ASSESSMENT OF THESE AND OTHER FACTORS BY PAYOR CATEGORY, AND ADJUSTS THE ALLOWANCE AND REALTED PROVISION ACCORDINGLY. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, MANAGEMENT ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A RELATED PROVISION, IF NECESSARY, FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, MANAGEMENT RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICES ON THE BASIS OF PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION ON THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX, LINE 25 IS RECORDED AT GROSS PATIENT CHARGES LESS ANY PAYMENTS AND DISCOUNTS, INCLUDING CHARITY. THE BAD DEBT COST ON PART III, LINE 2 IS CALCULATED BY MULTIPLYING TOTAL BAD DEBT EXPENSE BY THE RATIO OF TOTAL OPERATING EXPENSE TO TOTAL GROSS PATIENT CHARGES. PART III, LINE 8: MEDICARE ALLOWABLE COST PER THE AS-FILED MEDICARE COST REPORT IS USED TO DETERMINE MEDICARE COSTS. REVENUE RECEIVED FROM MEDICARE INCLUDING CO-PAYS / DEDUCTIBLES COMES FROM THE AS-FILED MEDICARE COST REPORT. PART III, LINE 9B: N/A DEKALB MEDICAL CENTER AT NORTH DECATUR PART V, SECTION B, LINE 15E: GARNISHMENTS AND LIENS ON AUTOMOBILE ACCIDENT SETTLEMENTS ARE USED AS PART OF THE COLLECTION POLICY. DEKALB MEDICAL CENTER AT HILLANDALE PART V, SECTION B, LINE 15E: GARNISHMENTS AND LIENS ON AUTOMOBILE ACCIDENT SETTLEMENTS ARE USED AS PART OF THE COLLECTION POLICY. DEKALB MEDICAL CENTER AT NORTH DECATUR PART V, SECTION B, LINE 19D: ALL PATIENTS ARE BILLED AT GROSS CHARGES. THE HEALTH SYSTEM OFFERS PAYMENT PLANS, PROMPT PAY DISCOUNTS AND CHARITY CARE TO THE UNINSURED, SEVERELY UNDER INSURED AND PATIENT BALANCES REMAINING AFTER INSURANCE. DEKALB MEDICAL CENTER AT HILLANDALE PART V, SECTION B, LINE 19D: ALL PATIENTS ARE BILLED AT GROSS CHARGES. THE HEALTH SYSTEM OFFERS PAYMENT PLANS, PROMPT PAY DISCOUNTS AND CHARITY CARE TO THE UNINSURED, SEVERELY UNDER INSURED AND PATIENT BALANCES REMAINING AFTER INSURANCE. DEKALB MEDICAL CENTER AT NORTH DECATUR PART V, SECTION B, LINE 21: ALL PATIENTS ARE BILLED AT GROSS CHARGES. THE HEALTH SYSTEM OFFERS PAYMENT PLANS, PROMPT PAY DISCOUNTS AND CHARITY CARE TO THE UNINSURED, SEVERELY UNDER-INSURED AND PATIENT BALANCES REMAINING AFTER INSURANCE. DEKALB MEDICAL CENTER AT HILLANDALE PART V, SECTION B, LINE 21: ALL PATIENTS ARE BILLED AT GROSS CHARGES. THE HEALTH SYSTEM OFFERS PAYMENT PLANS, PROMPT PAY DISCOUNTS AND CHARITY CARE TO THE UNINSURED, SEVERELY UNDER-INSURED AND PATIENT BALANCES REMAINING AFTER INSURANCE. PART VI, LINE 2: EVERY FIVE YEARS, WE PARTNER WITH THE DEKALB BOARD OF HEALTH TO ASSESS LOCAL RISK FACTORS AND MEASURE THE SUCCESS OF OUR HEALTHCARE INITIATIVES. THE COMMUNITY "HEALTH REPORT" INCLUDES AN EVALUATION OF DISEASE PREVALENCE AND COMPARISON AGAINST NATIONAL AVERAGES THAT HELPS US ENGINEER SERVICES TO ELIMINATE HEALTH DISPARITIES BASED ON ETHNICITY, INCOME, EDUCATION AND OTHER FACTORS. AMONG THE OPPORTUNITIES IDENTIFIED FOR PREVENTION AND COMMUNITY ACTION IN DEKALB AND SURROUNDING COUNTIES WERE THE FOLLOWING:*80% OF REFUGEES IN GEORGIA LIVE IN DEKALB COUNTY AND SPEAK MORE THAN 64 DIFFERENT LANGUAGES*72% OF ALL HOSPITALIZATIONS ARE CAUSED BY HEART DISEASE *PREGNANCY AND CHILDBIRTH COMPLICATIONS ARE THE 2ND LEADING CAUSE OF HOSPITALIZATION*STROKE, HEART DISEASE AND CANCER WERE THE LEADING CAUSES FOR DEATH IN ADULTS AGED 65 AND OVER PART VI, LINE 3: PATIENTS PROVIDED CARE BY THE HOSPITAL MEET WITH A FINANCIAL COUNSELOR AFTER THEIR CARE IS RENDERED. ELIGIBILITY CRITERIA FOR VARIOUS FINANCIAL ASSISTANCE PROGRAMS IS REVIEWED WITH THE PATIENT INCLUDING CHARITY, MEDICAID, OR OTHER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS. BILLING STATEMENTS RECEIVED BY A PATIENT ADVISES THEM TO CONTACT THE FINANCIAL COUNSELING DEPARTMENT ABOUT THESE PROGRAMS. PART VI, LINE 4: DEKALB REGIONAL HEALTH SYSTEM SERVES THE POPULATION OF DEKALB COUNTY, GA (54% AFRICAN AMERICAN, 35% WHITE, 4% ASIAN) AS WELL AS ROCKDALE AND GWINNETT COUNTIES. PART VI, LINE 6: UNDERSTANDING THAT A HEALTHY COMMUNITY IS ABOUT MORE THAN JUST THE ABSENCE OF DEATH AND DISEASE, WE ALSO CONTRIBUTE TO THE ECONOMIC VITALITY AND CREATION OF QUALITY JOBS RIGHT HERE AT HOME. NAMED THE 2010 CORPORATION OF THE YEAR BY THE DEKALB COUNTY CHAMBER OF COMMERCE FOR OUR ROLE AS AN ACTIVE CORPORATE CITIZEN AND PROPONENT OF DIVERSITY, THE FOLLOWING PROGRAMS HAVE HELPED BUILD THE HEALTH OF OUR COMMUNITY:*WE HELP REDUCE TEEN PREGNANCY AND SEXUALLY TRANSMITTED DISEASE BY PROVIDING FREE PREVENTION EDUCATION THROUGH OUR PUBERTY ROCKS PROGRAM FOR PRE-TEENS.*WE SUPPORT 100 BLACK MEN OF DEKALB IN THE EFFORT TO PROVIDE HIGHER EDUCATION TO AT-RISK YOUTH.*WE PARTNER WITH THE PHYSICIAN'S CARE CLINIC TO PROVIDE NEARLY 2,000 LOW OR NO COST PATIENT VISITS A YEAR INCLUDING LAB WORK AND PRESCRIPTION MEDICATIONS TO AREA LOW-INCOME AND UNINSURED RESIDENTS.*WE SPONSOR A FREE ANNUAL CANCER SCREENING DAY ON TWO OF OUR HOSPITAL CAMPUSES.*RECENT HEALTHY WORKPLACE INITIATIVES INCLUDE SMOKE-FREE BUILDINGS INSIDE AND OUT, A NO-NICOTINE HIRING POLICY AND ADOPTION OF HEALTHY FOOD OPTIONS IN HOSPITAL CAFETERIAS*WE COLLECT AND DONATE SURPLUS MEDICAL SUPPLIES TO MEDSHARE INTERNATIONAL IN SUPPORT OF HEALTH INITIATIVES IN LESS FORTUNATE COUNTRIES.*AN OPEN MEDICAL STAFF THAT ATTRACTS UNLIMITED, HIGHLY TRAINED MEDICAL TALENT TO SERVE THE AREA.*WE ARE A MAJOR SPONSOR OF THE LEADERSHIP DEKALB INITIATIVE TO PROMOTE COMMUNITY CONNECTIVITY AND ACTION PLANS FOR ECONOMIC DEVELOPMENT, SUSTAINABILITY AND IMPROVEMENT OF THE QUALITY OF LIFE IN DEKALB COUNTY.*DEKALB MEDICAL PROVIDES FURTHER ENRICHMENT AND EMPLOYMENT OPPORTUNITIES BY CHAMPIONING WORKPLACE SUCCESS FOR YOUTH AND ADULTS WITH DISABILITIES. PARTNERING WITH THE NATIONALLY RECOGNIZED TOMMY NOBIS CENTER, DEKALB MEDICAL CONTRACTS WITH THE CENTER TO PROVIDE SWITCHBOARD OPERATORS FOR THE HEALTH SYSTEM. *WE PARTNER WITH DEKALB COUNTY HIGH SCHOOLS TO PROVIDE MENTALLY AND PHYSICALLY CHALLENGED STUDENTS WITH VOCATIONAL TRAINING AND REAL-LIFE WORK EXPERIENCE IN THE HEALTHCARE INDUSTRY. THE STUDENTS, WHO RECEIVE SCHOOL CREDIT, SERVE AS VOLUNTEERS IN OUR CAFETERIA, LAUNDRY ROOM AND MOTHER-BABY UNITS. *WE PARTICIPATE IN NUMEROUS CAREER DAYS, ENCOURAGING THE SCIENCE AND MATH EDUCATION THAT'S NEEDED TO PROVIDE COMPETENT HEALTH WORKERS OF THE FUTURE.*WE SUPPORT A DEKALB WORKFORCE DEVELOPMENT PARTNERSHIP THAT PROVIDES TRAINING PROGRAMS, EDUCATION AND A CLINICAL SITE FOR PATIENT CARE TECHNICIAN CERTIFICATION.*WE MAINTAIN A PARTNERSHIP WITH GEORGIA PERIMETER COLLEGE AND MERCER UNIVERSITY TO PROVIDE CLINICAL ROTATIONS, PRECEPTORSHIPS, EDUCATION AND INSTRUCTION TO GEORGIA'S FUTURE NURSES. PART VI, LINE 7: DEKALB REGIONAL HEALTH SYSTEM, INC. IS THE PARENT ENTITY WHICH PROVIDES SUPPORT TO DEKALB MEDICAL CENTER, INC., DECATUR HEALTH RESOURCES, INC. AND DEKALB MEDICAL CENTER FOUNDATION, INC. DEKALB MEDICAL CENTER, INC. OPERATES TWO ACUTE CARE HOSPITALS AND A PHYSICIAN PRACTICE NETWORK TO PROVIDE HEALTHCARE SERVICES TO THE RESIDENTS OF DEKALB COUNTY, GEORGIA AND SURROUNDING COUNTIES. DECATUR HEALTH RESOURCES PROVIDES LONG-TERM ACUTE CARE HOSPITAL SERVICES TO PATIENTS WHO NEED ADDITIONAL TIME TO RECOVER FROM SERIOUS ILLNESS. DEKALB MEDICAL CENTER FOUNDATION'S MISSION IS TO STRENGTHEN THE LINK BETWEEN DEKALB REGIONAL HEALTH SYSTEM AND THE COMMUNITY IT SERVICES THROUGH COMMUNICATION, EDUCATION, SERVICE AND PHILANTHROPY. REPORTS FILED WITH STATES PART VI, LINE 7 GA X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 ERIC NORWOOD 490381 0 524064 0 46325 0 20825 0 30902 0 1112497 0 0 0 JOHN SHELTON 298973 0 417099 0 25680 0 42952 0 12592 0 797296 0 53213 0 DIANE HARDEN 247901 0 342254 0 40502 0 40418 0 10140 0 681215 0 53361 0 DUANE BARCLAY DO 252265 0 225490 0 30716 0 38760 0 1660 0 548891 0 42696 0 TOM CRAWFORD 148399 0 212927 0 33601 0 39927 0 4081 0 438935 0 39851 0 CATHLEEN WHEATLEY 212812 0 42622 0 22833 0 73889 0 4574 0 356730 0 27600 0 CLAY FOWLER 145638 0 145030 0 16750 0 31402 0 8932 0 347752 0 41250 0 RUTH ANDERSON 145697 0 196880 0 23042 0 33730 0 1352 0 400701 0 36383 0 JAN GANNON 153827 0 21258 0 22615 0 55567 0 9073 0 262340 0 21258 0 CHERYL IVERSON 122780 0 186682 0 16820 0 34200 0 13490 0 373972 0 34986 0 DAVID HOLLADAY MD 917468 0 0 0 17772 0 13475 0 7735 0 956450 0 0 0 RAYMOND LAWHEAD MD 496976 0 80000 0 24377 0 13475 0 5336 0 620164 0 0 0 SHAINUL BHATIA MD 233812 0 175662 0 46100 0 18375 0 9896 0 483845 0 0 0 AUGSTINE CONDUAH MD 474589 0 0 0 16655 0 7902 0 9608 0 508754 0 0 0 RODERICK STEVENSON MD 279174 0 75400 0 11091 0 3882 0 8463 0 378010 0 0 0 THE DEKALB COUNTY HOSPITAL AUTHORITY 586011209 24047CCC0 2003-12-10 28325646 REFUND SERIES 1993 A BONDS 09-21-1993 0 0 0 THE DEKALB COUNTY HOSPITAL AUTHORITY 586011209 24047CDH8 2010-05-03 180623920 REFUND BONDS DATED 3/29/2000, 12/10/2003, 5/18/2005 0 0 0 28325646 2691072 233698 1 0 1 1 180623920 14114456 3421900 19992698 1 0 1 1 0 0 0 0 0 0.00840 0.00000 0.00840 1 0 0 0 0 0 0.00840 0.00000 0.00840 1 1 0 0 0 0 0 0 0 0 0 0 0 DEKALB ANESTHESIA ASSOCIATES FORMER BOARD MEMBER 3216447 PROVIDER OF ANESTHESIA SERVICES 0 DR MICHAEL QUINONES PRACTICING PHYSICIAN 73196 PHYSICIAN CALL COVERAGE 0 DEKALB SURGICAL ASSOCIATES FORMER BOARD MEMBER 118754 PHYSICIAN CALL COVERAGE 0 FORM 990, PART VI, SECTION A, LINE 6 DEKALB REGIONAL HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF DEKALB MEDICAL CENTER, INC. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO THE AUDIT COMMITTEE OF THE DEKALB REGIONAL HEALTH SYSTEM, INC. BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ALL MANAGEMENT EMPLOYEES TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY AND MONITORS THE COMPLIANCE WITH THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE DEKALB REGIONAL HEALTH SYSTEM, INC. BOARD OF DIRECTORS. THE COMMITTEE USES AN INDEPENDENT CONSULTANT TO ASSIST IN SETTING COMPENSATION LEVELS. FORM 990, PART VI, SECTION C, LINE 19 AS A GENERAL RULE, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. ANY WRITTEN REQUEST BY THE PUBLIC WOULD BE REVIEWED AND ACTED UPON BY THE BOARD. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: INTEREST RATE SWAP 1,196,741. PENSION FUNDING TRUE UP 13,293,686. INTERCOMPANY TRANSFERS 2,607,699. NET ASSETS RELEASED FROM RESTRICTIONS -708,456. NET UNREALIZED GAINS ON INVESTMENTS 10,145,089. PRIOR PERIOD ADJUSTMENTS -98. TOTAL TO FORM 990, PART XI, LINE 5: 26,534,661. FORM 990, PART XI, LINE 2C: THE ORGANIZATION MADE NO CHANGES TO ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. NETWORK MEDICAL PROVIDERS 2701 NORTH DECATUR ROAD DECATUR GA 300330000 582121470 PHYSICIANS SERVICES GA 0 0 N/A DEKALB MEDICAL SPECIALTY CARE GROUP LLC 2701 NORTH DECATUR ROAD DECATUR GA 300330000 263454941 PHYSICIANS SERVICES GA 0 0 N/A DEKALB MEDICAL PRIMARY CARE GROUP LLC 2701 NORTH DECATUR ROAD DECATUR GA 300330000 263454827 PHYSICIANS SERVICES GA 0 0 N/A DEKALB MEDICAL OCCUPATIONAL MEDICINE GROUP LLC 2701 NORTH DECATUR ROAD DECATUR GA 300330000 263455069 PHYSICIANS SERVICES GA 0 0 N/A DEKALB MEDICAL HOSPITALISTS 2701 NORTH DECATUR ROAD DECATUR GA 300330000 582639633 PHYSICIANS SERVICES GA 0 0 N/A DECATUR NETWORK MEDICAL PROVIDER 2701 NORTH DECATUR ROAD DECATUR GA 300330000 586300825 PHYSICIANS SERVICES GA 0 0 N/A DEKALB REGIONAL HEALTH SYSTEM INC 2701 NORTH DECATUR ROAD DECATUR GA 300330000 582034958 SUPPORT DMC, INC. GA 501(C)(3) TYPE II SUPPORT ORG N/A 0 DECATUR HEALTH RESOURCES INC 450 NORTH CHANDLER STREER DECATUR GA 300300000 582081599 LONG TERM ACUTE CARE GA 501(C)(3) HOSPITAL DEKALB REGIONAL HEALTH SYSTEM INC 0 DEKALB MEDICAL CENTER FOUNDATION INC 2701 NORTH DECATUR ROAD DECATUR GA 300330000 581924605 FUNDRAISING ON BEHALF OF DMC, INC. GA 501(C)(3) TYPE III SUPPORT ORG DEKALB REGIONAL HEALTH SYSTEM INC 0 DRHS VENTURES INC 2701 NORTH DECATUR ROAD DECATUR GA 300330000 201864828 JOINT VENTURES GA DEKALB REGIONAL HEALTH SYSTEM INC C DEKALB PHYSICIAN HOSPITAL ORGANIZATION INC 250 E PONCE DE LEON AVENUE DECATUR GA 300330000 582110792 PHYSICIANS SERVICES GA N/A C 899537 615972 0.50000 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 DEKALB MEDICAL CENTER FOUNDATION INC C 568292 FMV DEKALB REGIONAL HEALTH SYSTEM INC R 597910 FMV DECATUR HEALTH RESOURCES INC R 2009770 FMV DEKALB REGIONAL HEALTH SYSTEM INC J 3420582 FMV