2012-08-07T13:21:51-05:00 2011-09-30 DRAFFIN & TUCKER LLP PO BOX 6 ALBANY GA 317020006 990 2010-10-01 581559677 ARCHBOLD FOUNDATION INC ARCH 2292282200 PO BOX 620 THOMASVILLE GA 317990620 FRANCES M PARKER 2292282200 2012-08-15 true JACQUELINE G ATKINS 2298837878 2012-07-30 2010 2016-02-24 21:20:13Z FRANCES M PARKER 910 SOUTH BROAD ST THOMASVILLE GA 31792 4557785 false X X 1983 GA SUPPORT ORGANIZATION 22 15 0 0 2489725 2756376 0 4440128 1755860 8412 -83015 6938265 4429221 4380553 3163116 0 263445 318512 232587 10285 10285 336516 344302 5213101 3836215 1725164 593006 72798041 69292782 44239 87261 72753802 69205521 X SUPPORT ORGANIZATION false false 3709504 3046690 PAYMENT TO JOHN D. ARCHBOLD MEMORIAL HOSPITAL TO BE USED FOR NURSING SCHOLARSHIPS AND THE CONSTRUCTION AND EQUIPPING OF FACILITIES. 61426 61426 PAYMENT TO ARCHBOLD HEALTH SERVICES FOR CONTRIBUTIONS MADE TO THE HOSPICE PROGRAM. 30000 30000 PAYMENT TO JOHN D. ARCHBOLD MEMORIAL HOSPITAL FOR PHARMACY FOR INDIGENT CANCER PATIENTS. 25000 25000 PAYMENT TO AREA DENTIST FOR INDIGENT CARE CANCER PATIENTS. PAYMENT TO HEALTHVISIONS FOR ALL EDUCATIONAL HEALTH INFORMATION. 25000 25000 3825930 true true false false false false false false false false true true false false true true false true false false false false false false true false false true false true false false false false false false false false false false false false false true false false false false true 0 0 0 false true CJ false false false true true false false false false false false false false false X 22 15 true false false false false true true true true false false false true true true true true true true false GA X GAIL P ROBERSON 2292282200 400 OLD ALBANY ROAD THOMASVILLE GA 31792 X J PERRY MUSTIAN 1.00 X X 0 643436 815928 FRANCES PARKER 40.00 X X 203872 0 28081 GINA SHUMAKE 1.00 X 0 42328 0 C MARTIN WOOD III 1.00 X 0 0 0 DOUGLAS MCPHERSON 1.00 X 0 0 0 GANNON HUNT 1.00 X 0 0 0 GERALD KADIS MD 1.00 X 0 0 0 JOHN BRINSON 1.00 X 0 0 0 JOHN N DANIEL III 1.00 X 0 0 0 HAILE MCCOLLUM 1.00 X 0 0 0 KIM B JONES 1.00 X 0 0 0 MILES WATKINS 1.00 X 0 0 0 RANKIN SMITH 1.00 X 0 0 0 REDMOND INGALLS 1.00 X 0 0 0 RICHARD G MOONEY III 1.00 X 0 0 0 DANIEL E AUTRY 1.00 X 0 0 0 ROBERT MILES MD 1.00 X 0 0 0 SHARON MAXWELL FERGUSON 1.00 X 0 0 0 THERESA BROWN 1.00 X 0 0 0 TONY CAMPBELL 1.00 X 0 0 0 AL PARK 1.00 X X 0 0 0 CHARLES E HANCOCK MD 1.00 X X 0 0 0 RODNEY G DEESE 1.00 X X 0 0 0 CHARLES D HIGHTOWER JR 1.00 X 0 391364 34713 203872 1077128 878722 1 false true false HIRTLE CALLAGHAN & CO P O BOX 318 CHURCH ROAD STATION NEW YORK NY 100080318 INVEST MGRS 167044 1 136751 1213267 1406358 2756376 1328164 1328164 14507 56430 -41923 -41923 -41923 427696 427696 427696 427696 30216 136751 72134 -41918 -41918 LAUNDRY REVENUE 621990 826 826 826 4429221 1672845 3163116 3163116 231953 231953 79280 79280 7279 7279 35904 35904 4750 4750 10285 10285 204657 204657 10108 10108 10035 10035 3486 3486 31521 31521 9192 9192 REPAIRS & MAINTENANCE 18411 18411 MISCELLANEOUS 14255 14255 DUES & SUBSCRIPTIONS 1983 1983 3836215 3825930 0 10285 488925 877545 1896199 1729312 1341327 423521 942087 917806 69470830 50441892 15326227 72798041 69292782 7640 33451 36599 53810 44239 87261 X 59126865 57538557 13626937 11666964 72753802 69205521 72798041 69292782 X 593006 -4141287 X true false true X false X X X false false false JOHN D ARCHBOLD MEMORIAL HOSPITAL INC 580566121 3 true true true 3101690 2 3163116 PART I, LINE 11H - SERVICES PROVIDED TO SUPPORTED ORGANIZATIONS. THE FILING ENTITY PROVIDES FUNDRAISING SERVICES TO BOTH SUPPORTED ORGANIZATIONS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false 570536 570536 389800 206700 183100 380991 216821 164170 917806 15326227 F 15326227 DUE TO RELATED PARTIES 53810 53810 LIABILITY UNDER FIN 48 FOOTNOTE SCHEDULE D, PAGE 3, PART X THE MEDICAL CENTER, WITH THE EXCEPTION OF ARCHBOLD MEDICAL ENTERPRISES, INC., IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX- EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER 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 MEDICAL CENTER 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 ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2011 AND 2010 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTER'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2008-2010. GOLF TOURNAMENT 149039 118823 30216 23100 16552 500 13125 14233 TREE OF LIGHTS 17928 17928 345 4279 166967 136751 30216 23100 16552 500 13470 18512 72134 -41918 true JOHN D ARCHBOLD MEM HOSP P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 300000 NURSING SCHOLARSHIPS ARCHBOLD HEALTH SERVICES P O BOX 620 THOMASVILLE GA 317990620 581376434 3 61426 HOSPICE SUPPORT JOHN D ARCHBOLD MEMORIAL HOSPITAL P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 15000 DRUG EXP-INDIGENT JOHN D ARCHBOLD MEM HOSP P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 15000 DENTAL - INDIGENT JOHN D ARCHBOLD MEM HOSP P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 15000 CRITICAL CONDITIONS JOHN D ARCHBOLD MEM HOSP P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 17237 CAPITAL CONTRIBUTION JOHN D ARCHBOLD MEM HOSP P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 2729453 CAPITAL CONTRIBUTION JOHN D ARCHBOLD MEM HOSP P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 10000 PATIENT SUPPORT 2 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 ARCHBOLD FOUNDATION IS A SUPPORTING ORGANIZATION FOR JOHN D. ARCHBOLD MEMORIAL HOSPITAL AND ARCHBOLD HEALTH SERVICES. THE FOUNDATION ACCEPTS GRANT REQUESTS FROM ENTITIES WITHIN JDAMH AND AHS. THESE GRANT REQUESTS ARE IN THE FORM OF LETTERS, EACH OF WHICH INCLUDE A SPECIFIC GRANT AMOUNT AND A BUDGET AND/OR DESCRIPTION OF PROPOSED SERVICES OR PURCHASES. THE GRANT REQUESTS ARE REVIEWED ANNUALLY PRIOR TO APPROVAL OF THE ANNUAL BUDGET. DEPARTMENTS REPORT THE USE OF FUNDS TO THE FOUNDATION ADMINISTRATION. X true true X X X X X false true false false false true true false false J PERRY MUSTIAN 471067 163560 8809 802600 13328 1459364 FRANCES PARKER 153247 30723 19902 16387 11694 231953 CHARLES D HIGHTOWER JR 271638 82602 37124 21117 13596 426077 FRINGE OR EXPENSE EXPLANATION SCHEDULE J, PAGE 1, PART I, LINE 1A SOCIAL CLUB DUES ARE PAID BY THE ORGANIZATION ON BEHALF OF OFFICERS AND EXECUTIVES OF THE FILING ORGANIZATION. ADDITIONALLY, THESE OFFICERS AND EXECUTIVES ARE REIMBURSED MILEAGE. THESE AMOUNTS ARE INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME AND REPORTED ON THEIR W-2. SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 J. PERRY MUSTIAN 0 783,000 0 COMPENSATION CONTINGENT UPON NET EARNINGS OF ORGANIZATION SCHEDULE J, PAGE 1, PART I, LINE 6A CONTINGENT IN PART ON MEETING MANAGEMENT BY OBJECTIVE INCENTIVE PLAN GOALS AND EXCESS OF REVENUE OVER EXPENSES. COMPENSATION CONTINGENT UPON NET EARNINGS OF RELATED ORG SCHEDULE J, PAGE 1, PART I, LINE 6B CONTINGENT IN PART ON MEETING MANAGEMENT BY OBJECTIVE INCENTIVE PLAN GOALS AND EXCESS OF REVENUE OVER EXPENSES. OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III THE IRS RULES & REGULATIONS REQUIRE THAT CERTAIN NON-CURRENT, NON-CASH ITEMS ARE REPORTED IN PART II REGARDLESS OF THE CURRENT BENEFIT TO THE EMPLOYEE. THESE SAME RULES, IN SOME CASES, REQUIRE THE COMPENSATION AND BENEFITS TO BE REPORTED TWICE IN PART II, ONCE WHEN THE ENTITY ACCRUES FOR A FUTURE PAYMENT AND ONCE WHEN THE PAYMENT IS ACTUALLY MADE TO THE EMPLOYEE. THEREFORE, AN EMPLOYEE'S STATED TOTAL COMPENSATION AND BENEFITS REPORTED ON PART II ARE SUBSTANTIALLY HIGHER THAN THE ACTUAL CASH COMPENSATION RECEIVED IN THE CURRENT YEAR. AMOUNTS REPORTED AS BENEFITS INCLUDE AMOUNTS FOR LIFE INSURANCE, HEALTH INSURANCE, THRIFT PLAN CONTRIBUTIONS, AND PENSION CONTRIBUTIONS. BENEFITS RELATED TO PENSION AND RETIREMENT PLANS REFLECT AMOUNTS ACCUMULATED, BUT NOT PAID, TO THE INDIVIDUAL IN RECOGNITION OF TOTAL YEARS OF EMPLOYMENT, NOT JUST THE CURRENT YEAR. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN THREE OF THE ORGANIZATION'S TOP EXECUTIVES PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS ACCRUED BUT UNFUNDED IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON-QUALIFIED RETIREMENT PLAN. ALL OTHER ACHIEVEMENTS DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4D PAYMENT TO AREA DENTIST FOR INDIGENT CARE CANCER PATIENTS. PAYMENT TO HEALTHVISIONS FOR ALL EDUCATIONAL HEALTH INFORMATION. FINANCIAL ACCOUNTS IN FOREIGN COUNTRIES FORM 990, PART V, LINE 4B CAYMAN ISLANDS RELATED PARTY INFORMATION AMONG OFFICERS FORM 990, PAGE 6, PART VI, LINE 2 DANIEL AUTRY RANKIN SMITH BD TRUSTEE BD TRUSTEE BUSINESS RELATIONSHIP JOHN N. DANIEL III MILES WATKINS BD TRUSTEE BD TRUSTEE BUSINESS RELATIONSHIP ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD OF TRUSTEES OF THE FILING ENTITY ARE ELECTED ANNUALLY BY THE SOLE MEMBER, ARCHBOLD MEDICAL CENTER, INC. ("AMC"). IN ADDITION, AMC HAS THE POWER TO SELECT OR REPLACE AND TO REMOVE THE TRUSTEES OF THE GOVERNING BODY. AMC'S CHAIRMAN OF THE BOARD OF TRUSTEES SHALL SERVE AS EX-OFFICIO OF THE BOARD OF ARCHBOLD FOUNDATION WITHOUT VOTING RIGHTS. DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B THE SOLE MEMBER, ARCHBOLD MEDICAL CENTER, INC. ("AMC"), HAS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY, INCLUDING BUT NOT LIMITED TO, CAPITAL AND OPERATING BUDGETS, MERGERS OR ACQUISITIONS, CONTRACTS AND TRANSACTIONS OVER A CERTAIN AMOUNT, DISSOLUTION, ETC. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B PRIOR TO FILING THE FORM 990, THE ORGANIZATION PRESENTED ITS FORM 990 TO TRUSTEES ATTENDING THE JULY 2012 REGULARLY SCHEDULED BOARD MEETING. THE ORGANIZATIONS CFO PRESENTED THE INFORMATION, AND TRUSTEES HAD THE OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C ON AN ANNUAL BASIS, THE ORGANIZATION DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE AND DISCLOSURE STATEMENT TO EACH TRUSTEE. THIS QUESTIONNAIRE INCLUDES QUESTIONS RELATED TO FINANCIAL INTERESTS, OUTSIDE INTERESTS OR ACTIVITIES, AND GIFTS, MEALS, AND ENTERTAINMENT. IN ADDITION TO DISCLOSING ANY APPLICABLE INFORMATION ON THE QUESTIONNAIRE, THE TRUSTEE SIGNS AN ACKNOWLEDGMENT STATEMENT THAT (S)HE HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ, UNDERSTANDS, AND AGREES TO COMPLY WITH IT, AND UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION STATUS IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. RESPONSES ARE SUMMARIZED AND COLLECTIVELY REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE OF ARCHBOLD MEDICAL CENTER, INC. DURING EACH BOARD MEETING, THE CHAIRMAN INQUIRES IF ANY TRUSTEE HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST RELATED TO ANY AGENDA ITEM. IF THE TRUSTEE DISCLOSES ANY SUCH INTEREST, THE TRUSTEE IS EXCUSED FROM THE MEETING WHILE THE DETERMINATION AS TO WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS IS DISCUSSED AND VOTED UPON BY DISINTERESTED MEMBERS OF THE BOARD AND COMMITTEE. IF INVITED TO DO SO, THE TRUSTEE WITH A POTENTIAL CONFLICT MAY RESPOND TO QUESTIONS PUT FORTH BY FELLOW DISINTERESTED TRUSTEES REGARDING ANY PROPOSED TRANSACTION OR ARRANGEMENT. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS WILL CONTAIN THE NAME OF ANY INTERESTED PERSON/TRUSTEE WHO DISCLOSED OR WAS FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH A TRANSACTION OR ARRANGEMENT RESULTING IN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; AND THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATED TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSIONS, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A ARCHBOLD MEDICAL CENTERS COMPENSATION COMMITTEE MAKES RECOMMENDATIONS TO THE FULL BOARD ON THE FOLLOWING POSITIONS: THE PRESIDENT OF ARCHBOLD MEDICAL CENTER; THE PRESIDENT OF THE ARCHBOLD FOUNDATION; AND THE PRESIDENT OF ARCHBOLD HEALTH SERVICES. ARCHBOLD MEDICAL CENTERS PRESIDENT ALSO PRESENTS RECOMMENDATIONS FOR ALL SENIOR VICE PRESIDENTS AND HOSPITAL VICE PRESIDENTS TO THE COMPENSATION COMMITTEE. IN 2008, INTEGRATED HEALTHCARE SOLUTIONS (IHS) WAS ENGAGED BY THE BOARD TO REVIEW THE EXECUTIVE COMPENSATION PROGRAM AND MAKE RECOMMENDATIONS REGARDING PLAN DESIGN AND ACTUAL COMPENSATION INCLUDING BENEFITS. IN 2009, IHS PROVIDED UPDATED RECOMMENDATIONS ON COMPENSATION TO THE COMPENSATION COMMITTEE. FOR YEARS 2010 AND 2011, THE BOARD CONTINUED TO UTILIZE IHS TO PERFORM MARKET ANALYSIS, REVIEW EXECUTIVE COMPENSATION, AND MAKE RECOMMENDATIONS. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B SEE RESPONSE TO 15A ABOVE. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. RELATED ORGANIZATIONS FORM 990, PAGE 7, PART VII AVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS: J. PERRY MUSTIAN 49 HOURS CHARLES HIGHTOWER 48 HOURS CHARLES HANCOCK 1 HOUR DANIEL AUTRY 4 HOURS FRANCES PARKER 1 HOUR RICHARD MOONEY 1 HOUR ROBERT MILES 2 HOURS OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 5 CAPITAL CONTRIBUTIONS 1,959,973 NET UNREALIZED LOSS ON INVESTMENTS 2,181,314 TOTAL DECREASES IN NET ASSETS 4,141,287 ARCHBOLD HEALTH SERVICES INC PO BOX 620 THOMASVILLE GA 317990620 581376434 MGMT GA 501C3 9 AMC ARCHBOLD MEDICAL CENTER INC false JOHN D ARCHBOLD MEMORIAL HOSPITAL I PO BOX 1018 THOMASVILLE GA 317991018 580566121 ACUTE CARE GA 501C3 3 AMC ARCHBOLD MEDICAL CENTER INC false ARCHBOLD MEDICAL CENTER INC PO BOX 1018 THOMASVILLE GA 317991018 581552650 HEALTHCARE GA 501C3 11A NA false ARCHBOLD MEDICAL ENTERPRISES 400 OLD ALBANY ROAD THOMASVILLE GA 31792 581494513 HEALTHCARE GA N/A false true true false false false false false false false true false true true false false true false