2012-08-15T12:52:18-05:00 2011-09-30 CHERRY BEKAERT & HOLLAND LLP 1029 GREENE STREET AUGUSTA GA 30901 990 2010-10-01 586002701 MCDUFFIE COUNTY HOSPITAL AUTHORITY DBA MCDUFFIE REGIONAL MEDICAL CENTER MCDU 7065951411 521 WEST HILL STREET THOMSON GA 30824 BILL DOUPE 7065951411 2012-08-15 1 STEPHEN D FARMER 7067243557 2012-08-15 2010 2016-02-24 21:20:13Z BILL DOUPE 521 WEST HILL STREET THOMSON GA 30824 17237716 0 X WWW.MRMC.ORG X 1948 GA HEALTHCARE 9 9 281 31 0 0 3100 44073 19936057 16530118 77475 117620 549954 544003 20566586 17235814 0 1000 0 0 9893439 9532518 0 0 632 11963055 9785430 21856494 19318948 -1289908 -2083134 17046648 14031000 3200469 2183616 13846179 11847384 X THE MISSION OF MCDUFFIE REGIONAL MEDICAL CENTER IS TO PROVIDE QUALITY HEALTH CARE TO ALL PATIENTS WITH THE ASSISTANCE OF OUR ASSOCIATES AND PHYSICIANS.THE VISION OF MCDUFFIE REGIONAL MEDICAL CENTER IS TO BE UTILIZED AS OUR COMMUNITIES' HEALTHCARE PARTNER OF CHOICE.THE VALUES STATEMENT REFLECTS OUR COMMITMENT AND PRIORITIES TO PEOPLE FIRST,PATIENT CARE THAT EMBODIES COMPASSION, RESPECT, AND PRIVACY,EXCEEDING THE NEED AND EXPECTATIONS OF OUR CUSTOMERS, OPPORTUNITIES TO SERVE OUR COMMUNITIES AND LISTEN TO THEIR NEEDSPHYSICIANS WHO ARE HIGHLY QUALIFIED AND PROVIDE SELECTED MEDICAL SERVICESLEADERSHIP DEDICATED TO PRESERVING THE FUTURE OF HEALTHCARE EXCELLENCE IN HEALTHCARE DELIVERY AND CUSTOMER SERVICEFISCAL STABILITY THAT ENABLES EXPANDED, ADVANCED SERVICESINITIATIVE DEMONSTRATING OUR DEDICATION TO CONTINOUS QUALITY IMPROVEMENTRELATIONSHIPS THAT FOSTER CONTINUED GROWTH AS PROVIDER OF CHOICESERVICE AVAILABLE AND ACCESSIBLE TO ALL 0 0 13943543 17118194 THE HOSPITAL CARRIED OUT MEDICAL-RELATED SERVICES TO THE COMMUNITY AND CONDUCTED HEALTH EDUCATION COURSES AND HEALTH FAIRS, PROVIDED EDUCATIONAL LITERATURE AND SPONSORED ILLNESS SUPPORT GROUPS. A STAFF MEMBER SERVES THE EAST GEORGIA CANCER COALITION BOARD WHO PROMOTES CANCER AWARENESS AND SCREENINGS. OTHER STAFF MEMBERS SERVE ON A VARIETY OF BOARDS AND ARE INVOLVED IN CIVIC ENDEAVORS THAT PROMOTE HEALTH AND WELLNESS. THE HOSPITAL PROVIDED DRUGS AND TRANSPORTATION FROM THE HOSPITAL TO THOSE UNABLE TO PAY. UNCOMPENSATED CARE WAS PROVIDED AS WELL AS INDIGENT AND CHARITY CARE. A HOSPITAL-BASED PROGRAM ASSISTANCE COUNSELOR IS PROVIDED AT THE HOSPITAL'S EXPENSE IN ORDER TO ASSIST PATIENTS WITH QUALIFYING FOR MEDICARE DISABILITY, MEDICAID, SSI OR OTHER GOVERNMENTAL FINANCIAL ASSISTANCE PROGRAMS. THE HOSPITAL TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND SERVES AS A HEALTHCARE SAFETY NET FOR THOSE WHO ARE NOT ABLE TO RECIEVE SERVICE ELSEWHERE BECAUSE OF THEIR FINANCIAL INABILITY TO PAY. 13943543 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 38 0 281 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X PAT PARRIS 7065975205 521 HILL STREETWEST THOMSON GA 30824 JERRY HARRISON 1.00 X 0 0 0 ANITA CUMMINGS 1.00 X 0 0 0 ROBIN DUDLEY 1.00 X 0 0 0 BILL DOUPE' 1.00 X 0 0 0 JOE WILLS MD 1.00 X 0 0 0 JOHN SEAY 1.00 X 0 0 0 MICHELLE COLLINS 1.00 X 0 0 0 JACKIE DUPREE 1.00 X 0 0 0 DARYL WILEY 1.00 X 0 0 0 RENEE WRIGHT 1.00 X 0 0 0 RUSTY LOVELACE 1.00 X 0 0 0 DOUGLAS C KEIRCONTEMPTHRU AGENCY 40.00 X 7260 0 20300 PATRICIA W PARRIS 40.00 X 99212 0 992 BELINDA CAMPBELL 40.00 X 73370 0 734 LISA TUCKER 40.00 X 77976 0 780 APRIL KEENE 40.00 X 50122 0 501 PEGGY BARMORE 40.00 X 94251 0 943 JESSIE LYNN RYAN 40.00 X 170560 0 1545 DAWN SWAW 1.00 X 49882 0 499 ROBERTO BORJA 1.00 X 127484 0 0 CYNTHIA HARRIS WARE 40.00 X 124135 0 1241 ROBERTO BARJA 16.00 X 0 0 0 874252 0 27535 3 0 1 0 CARDINAL PO BOX 905867 CHARLOTTE NC 28290 DRUGS & MEDICAL SUPPLIES 431810 BIOMET 75 REMITTANCE DR 3283 CHICAGO IL 60675 ORTHO IMPLANTS/SUPPLIES 412025 QUORUM HEALTH RESOURCES 105 CENTINENTIAL PLACE BRENTWOOD TN 37027 HOSPITAL MANAGEMENT 396525 CROTHALL CLINICAL EQU 13028 COLLECTIONS CENTER DRIVE CHICAGO IL 60675 BIO-MED SERVICE 390024 HOLOGIC 35 COSBY DR BEDFORD MA 01730 EQUIPMENT & REPAIRS 273628 19 17856 26217 44073 PATIENT SERVICE REVENU 621990 16530118 16530118 16530118 117620 117620 3803 1902 1901 1901 1901 EMS MANAGEMENT 621990 463685 463685 MISCELLANEOUS 621990 41947 41947 CAFETERIA/VENDING INCO 621990 36470 36470 542102 17235814 17035750 0 155991 1000 1000 645917 46543 599374 6441951 5124657 1317294 77595 45779 31802 14 1813969 1337621 476348 553086 402900 150083 103 918815 730012 188803 290387 290387 35750 35750 22660 22660 1751110 1064705 686405 11134 10659 475 2489501 2229949 259467 85 400849 271512 129337 1176558 683883 492675 29627 1583 27900 144 9380 1601 7779 73680 43345 30285 50 889924 326408 563280 236 281121 216452 64669 BAD DEBT 1404934 1404934 19318948 13943543 5374773 632 3040 72009 1014275 2164274 1787355 530539 503441 278588 201611 24146009 16558660 8188034 7587349 4609135 3519701 258763 359534 17046648 14031000 1312741 1907526 64738 65737 1822990 210353 3200469 2183616 X 13720940 11722397 125239 124987 13846179 11847384 17046648 14031000 X -2083134 84339 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 125239 0 749 1000 0 0 124988 124733 0 506 0 0 0 125239 121781 1962 990 0 0 0 124733 1.00000 0 0 1006611 1006611 10438818 5905779 4533039 214625 207984 6641 11873191 9902552 1970639 612764 542345 70419 7587349 OTHER SECURITIES 3519701 F 3519701 OTHER CURRENT LIABILITIES 210353 210353 17235814 19318948 -2083134 -22573 106912 84339 -1998795 15810209 1902 1902 15808307 1427507 1427507 17235814 17915916 1902 1902 17914014 1404934 1404934 19318948 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: RESTRICTED, EXPENDABLE NET ASSETS ARE AVAILABLE FOR SCHOLARSHIPS DESIGNED TO ASSIST EMPLOYEES OF THE HOSPITAL AND CITIZENS OF MCDUFFIE COUNTY AND SURROUNDING AREAS IN THEIR PURSUIT OF HEALTH CARE RELATED CAREERS THROUGH THE USRY SCHOLARSHIP FUND. UPON GRADUATION, RECIPIENTS OF A SCHOLARSHIP MUST REPAY THE LOAN THROUGH EITHER THREE YEARS OF SERVICE AT THE HOSPITAL OR MAKING EQUAL MONTHLY INSTALLMENTS OVER A PERIOD NOT TO EXCEED TWENTY-FOUR MONTHS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: MANAGEMENT HAS EVALUATED THE EFFECT OF THE GUIDANCE PROVIDED BY U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES THAT BECAME EFFECTIVE THIS YEAR. MANAGEMENT HAS EVALUATED ALL THE TAX POSITIONS THAT COULD HAVE A SIGNIFICANT EFFECT ON THE FINANCIAL STATEMENTS AND DETERMINED THE HOSPITAL HAD NO UNCERTAIN INCOME TAX POSITIONS AT SEPTEMBER 30,2011. PART XI, LINE 8 - OTHER ADJUSTMENTS: CAPITAL CONTRIBUTIONS RENT EXPENSE NETTED AGAINST RENTAL INCOME PART XII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSE NETTED AGAINST RENTAL INCOME 1,902. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED AGAINST PATIENT REVENUE 1,404,934. UNREALIZED LOSS ON INVESTMENT 22,573. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENT EXPENSE NETTED AGAINST RENTAL INCOME 1,902. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE NETTED AGAINST PATIENT REVENUE 1,404,934. 1 1 1 X 125.000000000000 1 X 1 1 1 0 1 X 1 1 4 1 MCDUFFIE COUNTY HOSPITAL AUTHORITY DBA

MCDUFFIE REGIONAL MED CENTER521 HILL ST THOMSON GA 30824

X X X 2 MCDUFFIE BONE & JOINT

510 MT PLEASANT ROAD THOMSON GA 30824

OP ORTHOPEDIC PHYSICIAN'S OFFICE 3 MRMC HOSPITALISTS

521 WEST HILL ST THOMSON GA 30824

IP PHYSICIANS' HOSPITALISTS PRACTICE 4 MRMC PHYSICAL & OCCUPATIONAL THERAPY CLI

WARE STREET THOMSON GA 30824

OP PHYSICAL & OCCUPATIONAL THERAPY CLINIC MCDUFFIE COUNTY HOSPITAL AUTHORITY 1 0 0 0 0 0 0 0 0 0 0 0 PART III, LINE 8: BAD DEBT REPORTED ON FORM 990, PART IX, LINE 24A AND INCLUDED IN LINE 25 IS $1,404,934.PART I, LINE 7A: SUBSIDIES FOR PHYSICIAN CLINICS; SUBSIDIZED SERVICES FOR COLONOSCOPIES PERFORMED AT MCDUFFIE COUNTY HEALTH DEPARTMENT; SUBSIDIZED PRESCRIPTION MEDICATIONS AND TRANSPORTATION; WELLNESS WORKS PROGRAM FOR COMMUNITY THAT PROVIDES HEALTH FAIRS, PHYSICALS AND SCHEDULING FOR HEALTH CARE ACCESS.PART I, LINE 7F: TUITION FOR MEDICAL STUDENT EDUCATION FOR UNDERSERVED POPULATION OF MCDUFFIE COUNTY.PART III, LINE 4: BAD DEBT: INCOME STATEMENT IS CHARGED WITH ACTUAL BAD DEBT EXPENSE BASED UPON EXHAUSTED COLLECTION EFFORTS PER HOSPITAL POLICY. A PROVISION FOR CURRENT AR UNCOLLECTIBLE ACCOUNTS IS CHARGED BASED UPON EXPERIENCE AND CIRCUMSTANCES WHICH AFFECT THE COLLECTIBILITY OF RECEIVABLES. AMOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED AGAINST THE ALLOWANCE. IN THE OPINION OF MANAGEMENT, ADEQUATE PROVISIONS HAVE BEEN MADE FOR UNCOLLECTIBLE ACCOUNTS. COSTING METHODOLOGY USED ON LINES 2 AND 3 IS THE RCC CALCULATED ON WORKSHEET 2. USED THE BAD DEBT EXPENSE FROM THE AUDITED FINANCIALS MULTIPLIED BY THE RCC.PART III, LINE 8: HOSPITALS HAVE NO CHOICE BUT TO TREAT PATIENTS THAT PRESENT FOR EMERGENCY SERVICES AND MUST TREAT WITHOUT REGARD TO ABILITY TO PAY EVEN THOUGH THE PATIENT MAY HAVE NUMEROUS BAD DEBTS. NO OTHER INDUSTRY WOULD CONTINUE TO PROVIDE SERVICES IF THE BILLS REMAINED UNPAID, I.E. ELECTRIC, TELEPHONE. THEREFORE BAD DEBT SHOULD BE ALLOWED AS COMMUITY BENEFIT SINCE THERE IS NO BENEFIT TO THE HOSPITAL. BAD DEBT COMPROMISES A HOSPITAL'S OPERATIONS SO THE BENEFIT PROVIDED ENURES TO THE COMMUNITY.PART III, LINE 9B: THE HOSPITAL DOES NOT PURSUE COLLECTIONS ON PATIENTS IDENTIFIED AND QUALIFIED FOR INDIGENT CARE.PART V: DESCRIPTION PROVIDED IN THIS SECTION.3. PATIENTS ARE INFORMED AT THE TIME OF REGISTRATION THAT AN INDIGENT/CHARITY PROGRAM IS AVAILABLE. SIGNS ARE POSTED IN EACH REGISTRATION AREA, THE EMERGENCY DEPARTMENT, LOBBY AND MAIN CORRIDOR TO INPATIENT WING. EACH PATIENT ACCOUNT REPRESENTATIVE INFORMS THEIR PATIENTS OF THE INDIGENT/CHARITY PROGRAM AND ASSISTS THE PATIENT WITH COMPLETION OF THE APPLICATION. WE EMPLOY RESOURCE CORP. OF AMERICA REPRESENTATIVES THAT NOT ONLY TAKE INDIGENT APPLICATIONS, BUT ASSIST PATIENTS IN APPLYING FOR OTHER GOVERNMENTAL PROGRAMS SUCH AS SSI, MEDICAID, MEDICARE DISABILITY, ETC.4. MCDUFFIE REGIONAL RESIDES IN MCDUFFIE COUNTY. MCDUFFIE COUNTY IS 60% AFRICAN AMERICAN, 4% LATINO, 36% CAUCASION, 10% BELOW FPG, 21% WITH NO INSURANCE, AND 8% UNEMPLOYED. MRMC SERVES LINCOLN, WARREN AND GLASCOCK COUNTIES IN ITS SERVICE AREA.5. PART II, LINE 8: MRMC PROVIDES CLINICAL EDUCATION, TRAINING, AND MENTORSHIP FOR STUDENTS OF AUGUSTA TECH, VIRGINIA COLLEGE, MEDICAL COLLEGE OF GEORGIA, AUGUSTA STATE UNIVERSITY, AND THOMSON HIGH SCHOOL. STUDENTS MEET THEIR CLINICAL AND ON JOB EDUCATIONAL CRITERIA THROUGH SERVICE AT MRMC.6. MRMC'S BOARD IS MADE UP OF A CROSS SECTION OF NONEMPLOYEE COMMUNITY LEADERS AND ETHNIC GROUPS. OUR MEDICAL STAFF IS OPEN. SURPLUS FUNDS ARE USED TO PROVIDE FOR NEW SERVICES, FUTURE GROWTH, AND DEVELOPMENT OF THE FACILITY IN ORDER TO CONTINUE TO PROVIDE SERVICES TO THE COMMUNITIES WE SERVE. X 1 1 X X 0 0 0 0 0 0 0 0 0 JESSIE LYNN RYAN 170560 0 0 0 0 0 1545 0 0 0 172105 0 0 0 SUPPLEMENTAL INFORMATION PART III DOUG KEIR IS CEO OF MCDUFFIE REGIONAL MEDICAL CENTER. HE IS EMPLOYED BY QUORUM HEALTH RESOURCES BUT REPORTS TO MCDUFFIE HOSPITAL AUTHORITY. HE ASSUMES RESPONSIBILITY FOR DAY-TO-DAY OPERATIONS. FORM 990, PART VI, SECTION B, LINE 11 AN ELECTRONIC COPY OF THE FORM 990 IS PROVIDED TO THE GOVERNING BODY PRIOR TO FILING FOR THEIR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C POLICY AND PROCEDURE WERE EXPLAINED DURING HOSPITALWIDE ORIENTATION. CODE OF BUSINESS PRACTICE PROVIDED TO EACH ASSOCIATE. FORM 990, PART VI, SECTION B, LINE 15 CEO'S SALARY IS PROVIDED BY HOSPITAL AUTHORITY AS A PORTION OF THE MANAGEMENT CONTRACT THROUGH QUORUM. MCDUFFIE REGIONAL MEDICAL CENTER RECEIVES COPIES OF THE GEORGIA HOSPITAL ASSOC. SALARY SURVEY ANNUALLY TO ENSURE COMPARABILITY WITH OTHER HOSPITALS. MARKET ADJUSTMENTS ARE ADMINISTERED WHEN REQUIRED AND BUDGETED APPROPRIATELY. QUORUM CONSULTANT COMPLETES PERIODIC SALARY REVIEWS AND UPDATES THE WAGE AND SALARY ADMININSTRATION PLAN AS PART OF THE MANGEMENT CONTRACT. FORM 990, PART VI, SECTION C, LINE 18 MCDUFFIE COUNTY HOSPITAL'S FORMS 990 AND 1023 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 MCDUFFIE COUNTY HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -22,573. PRIOR PERIOD ADJUSTMENTS: 106,912. CAPITAL CONTRIBUTIONS RENT EXPENSE NETTED AGAINST RENTAL INCOME TOTAL TO FORM 990, PART XI, LINE 5: 84,339. EXECUTIVE COMMITTEE FORM 990, PART XI, 2A AND 2C THE MCDUFFIE HOSPITAL AUTHORITY ASSUMES THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANTS. FORM 8899 AND 1098-C FORM 990, PART V, 7G, & 7H THE ORGANIZATION DID NOT RECEIVE CONTRIBUTIONS OF QUALIFIED INTELLECTUAL PROPERTY AND WAS THEREFORE NOT REQUIRED TO FILE FORM 8899. THE ORGANIZATION DID NOT HAVE ANY REPORTABLE GAMING (GAMBLING) WINNINGS TO PRIZE WINNERS AND THEREFORE THE BACKUP WITHHOLDING RULES DID NOT APPLY. THE ORGANIZATION DID NOT RECIVE CONTRIBUTIONS OF VEHICLES IN THE CURRENT YEAR AND WAS THEREFORE NOT REQUIRED TO FILE FORM 1098-C.