SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY (EIN 32-0090450)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-12
- IRS object ID
- 201101329349303655
- Schema version
- 2009v1.7
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-12T16:00:58-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 Ridgefield Court | AddressLine1 |
| City | Asheville | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320090450 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY | BusinessNameLine1 |
| Business Name Line2 | CARE INC | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SOUT | NameControl |
| Phone | 7708977600 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 UPPER RIVERDALE ROAD | AddressLine1 |
| City | RIVERDALE | City |
| State | GA | State |
| ZIP Code | 30274 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | WILLIAM E CASEY | Name |
| Title | CHAIRMAN | Title |
| Phone | 7708977600 | Phone |
| Date Signed | 2011-05-12 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Amy Bibby | Name |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | WILLIAM E CASEY | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 UPPER RIVERDALE ROAD | AddressLine1 |
| City | RIVERDALE | City |
| State | GA | State |
| ZIP Code | 30274 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 12937468 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HIGH-QUALITY, LONG-TERM ACUTE CARE TO THE COMMUNITIES WE SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 1 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 11893572 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 12926964 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 91997 | InvestmentIncomePriorYear |
| Investment Income Current Year | 8182 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 2375 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2322 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 11987944 | TotalRevenuePriorYear |
| Total Revenue Current Year | 12937468 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 127784 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 465522 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4108208 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4590503 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 5533479 | OtherExpensePriorYear |
| Other Expenses Current Year | 14592074 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 9769471 | TotalExpensesPriorYear |
| Total Expenses Current Year | 19648099 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2218473 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -6710631 | RevenuesLessExpensesCY |
| Total Assets BOY | 7793564 | TotalAssetsBOY |
| Total Assets EOY | 9620489 | TotalAssetsEOY |
| Total Liabilities BOY | 1169798 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9707354 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6623766 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -86865 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE MISSION OF SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE IS TO PROVIDE HIGH-QUALITY, LONG-TERM ACUTE CARE TO THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 9118267 | Expense |
| Grants | 465522 | Grants |
| Revenue | 12926964 | Revenue |
| Description | TO FULFILL ITS MISSION, THE SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PROVIDES LONG TERM ACUTE INPATIENT CARE TO INDIVIDUALS WHOSE CONDITION IS SO SIGNIFICANT THAT A HOSPITAL STAY OF ONE MONTH OR MORE IS ANTICIPATED. THE HOSPITAL CARES FOR PATIENTS WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING; VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. THE MEDICAL AND THERAPEUTIC NEEDS OF THE PATIENTS ARE MET USING AN INTERDISCIPLINARY, HOLISTIC TEAM APPROACH INCORPORATING MEDICAL MANAGEMENT, PHYSICAL, RESPIRATORY, OCCUPATIONAL AND SPEECH THERAPIES IN AN EFFORT TO RESTORE INDIVIDUAL QUALITY OF LIFE TO AS HIGH A DEGREE AS POSSIBLE AND TO PROMOTE SELF-HELP AND INDEPENDENCE TO THE EXTENT FEASIBLE. THE SPIRITUAL NEEDS OF THE PATIENTS, FAMILIES AND SIGNIFICANT OTHERS ARE PROVIDED FOR AS WELL. PATIENT CARE PROGRAM SERVICESTO THE LIMITS OF ITS RESOURCES, SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE IS AN INSTITUTION OF PUBLIC CHARITY; THUS, THE MOST TANGIBLE EXPRESSION OF CHARITABLE PURPOSE IS THE PROVISION OF HEALTHCARE SERVICES TO THOSE PERSONS WHO ARE UNABLE TO PAY (CHARITY CARE). INPATIENT CHARITY CARE - UNREIMBURSED COSTS OF PROVIDING CARE FOR THE FINANCIALLY AND MEDICALLY INDIGENT.IN KEEPING WITH MISSION, VALUES, AND VISION, SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PROVIDES CHARITY CARE SERVICES IN A MANNER THAT RESPECTS THE DIGNITY OF THE PATIENTS AND THEIR FAMILIES. CHARITY CARE IS PROVIDED WITHOUT CHARGE OR AT A CHARGE THAT IS LESS THAN THE USUAL CHARGE FOR SUCH SERVICES. THE DETERMINATION AS TO THE AMOUNT TO BE CHARGED, IF ANY, IS MADE ACCORDING TO A PATIENT'S ABILITY TO PAY, CONSIDERATION OF THE PATIENT'S ASSETS AND LIABILITIES, AND DETERMINED BY THE ESTABLISHED ELIGIBILITY CRITERIA BASED ON THE MOST CURRENT FEDERAL POVERTY GUIDELINES. A FINANCIALLY INDIGENT PATIENT IS ONE WHO IS UNINSURED OR UNDERINSURED AND WHOSE ECONOMIC CIRCUMSTANCES PLACE THEM AT OR UNDER 200% OF THE FEDERAL POVERTY GUIDELINES. A MEDICALLY INDIGENT PATIENT IS A PERSON WHOSE MEDICAL OR HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEEDS 25% OF THEIR ANNUAL GROSS INCOME. NO PATIENT IS REFUSED NECESSARY MEDICAL CARE ON THE BASIS OF THEIR INABILITY TO PAY.OTHER COMMUNITY BENEFITSUNREIMBURSED GOVERNMENT SPONSORED PROGRAMSIN ADDITION TO THE PROVISION OF CARE WITHOUT EXPECTATION OF PAYMENT (CHARITY CARE), SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PROVIDES SERVICES TO PERSONS COVERED UNDER GOVERNMENT SPONSORED PROGRAMS, INCLUDING MEDICARE, DOD, CHAMPUS, TRICARE, AND TRICARE FOR LIFE. SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PROVIDES SERVICES TO PERSONS COVERED UNDER THE FEDERAL MEDICARE PROGRAM AND, IN FACT, THIS IS THE LARGEST SINGLE PAYER CLASSIFICATION OF PATIENTS SERVED BY THIS HEALTH SYSTEM. THE PAYMENT RATE FOR INPATIENT SERVICES IS ON A PER DISCHARGE RATE, CALCULATED BASED ON THE DIAGNOSTIC-RELATED GROUP INTO WHICH THE PATIENT IS CATEGORIZED. TOTAL PATIENTS SERVED: 293TOTAL PATIENT DAYS OF CARE PROVIDED: 8,214CHARITY CARE PATIENT DAYS PROVIDED: 339CHARITY CARE COST: $ 291,905 | Description |
| Total Program Service Expense | 9118267 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 28 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAUL VEILLON CFO OF CHRISTUS DUBUIS HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7132772300 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1700 WEST LOOP SOUTH STE 1100A | AddressLine1 |
| City | HOUSTON | City |
| State | TX | State |
| ZIP Code | 77027 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (8 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| MITCH JOHNSON | ||||||
| CHAIRMAN/PRESIDENT | 2.00 | X | X | 1100 | 0 | 0 |
| WILLIAM E CASEY | ||||||
| BOARD MEMBER | 1.00 | X | 1700 | 0 | 0 | |
| RONALD M DODSON | ||||||
| BOARD MEMBER | 1.00 | X | 600 | 0 | 0 | |
| WILLIAM B LEWIS JR | ||||||
| BOARD MEMBER | 1.00 | X | 600 | 0 | 0 | |
| MARGARET L MANOS | ||||||
| BOARD MEMBER | 1.00 | X | 1242 | 0 | 0 | |
| BENNY R WHITMORE | ||||||
| BOARD MEMBER | 1.00 | X | 1068 | 0 | 0 | |
| DR CLAIRE WILLIE | ||||||
| BOARD MEMBER | 1.00 | X | 600 | 0 | 0 | |
| JAN HAMILTON-CRAWFORD | ||||||
| HOSPITAL ADMINISTRATOR | 40.00 | X | 171032 | 0 | 4034 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 177942 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 4034 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| SOUTHERN REGIONAL MEDICAL CENTER | |||||
| 11 UPPER RIVERDALE ROAD SW | RIVERDALE | GA | 30274 | ANCILLIARY HOSPITAL SERVICES | 1243465 |
| CHRISTUS DUBUIS HEALTH SYSTEM | |||||
| 1700 WEST LOOP SOUTH STE 1100A | HOUSTON | TX | 77027 | MANAGEMENT SERVICES | 871128 |
| MEDTEMPS INC | |||||
| 6560 HIGHWAY 5 | RIVERDALE | GA | 30274 | CONTRACT LABOR | 280574 |
| PRECISE HEALTHCARE SOLUTIONS LLC | |||||
| 5300 MEMORIAL DR STE 134 | STONE MOUNTAIN | GA | 30083 | CONTRACT LABOR | 251587 |
| WESLEY MEDICAL STAFFING | |||||
| 5901B PEACHTREE DUNWOODY | ATLANTA | GA | 30328 | CONTRACT LABOR | 113354 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENU | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 12926964 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12926964 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 12926964 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8182 | TotalRevenueColumn |
| Exclusion | $8,182 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MEDICAL RECORDS TRANSC | Description |
| Business Code | 561499 | BusinessCode |
| Total Revenue Column | 2322 | TotalRevenueColumn |
| Exclusion | $2,322 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2322 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12937468 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12926964 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $10,504 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 465522 | Total |
| Program Services | 465522 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 181976 | Total |
| Management And General | 181976 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3736778 | Total |
| Program Services | 3479575 | ProgramServices |
| Management And General | 257203 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129983 | Total |
| Program Services | 115366 | ProgramServices |
| Management And General | 14617 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 261965 | Total |
| Program Services | 231017 | ProgramServices |
| Management And General | 30948 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 279801 | Total |
| Program Services | 248337 | ProgramServices |
| Management And General | 31464 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 871128 | Total |
| Management And General | 871128 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 318618 | Total |
| Management And General | 318618 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2066 | Total |
| Management And General | 2066 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2587830 | Total |
| Program Services | 2440553 | ProgramServices |
| Management And General | 147277 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15508 | Total |
| Management And General | 15508 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1412184 | Total |
| Program Services | 1312508 | ProgramServices |
| Management And General | 99676 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 575294 | Total |
| Program Services | 575294 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39894 | Total |
| Program Services | 10962 | ProgramServices |
| Management And General | 28932 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 105818 | Total |
| Program Services | 8583 | ProgramServices |
| Management And General | 97235 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99197 | Total |
| Program Services | 99197 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96161 | Total |
| Program Services | 72121 | ProgramServices |
| Management And General | 24040 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | Program ServicesProgramServices |
|---|---|---|---|
| LITIGATION EXPENSE | 8409144 | 8409144 | |
| BAD DEBT EXPENSE | 59232 | 59232 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19648099 | Total |
| Program Services | 9118267 | ProgramServices |
| Management And General | 10529832 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5781618 | BOY |
| EOY | 7045916 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1416923 | BOY |
| EOY | 1780874 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49812 | BOY |
| EOY | 54732 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74123 | BOY |
| EOY | 60505 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1541533 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 863071 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 471088 | BOY |
| EOY | 678462 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7793564 | BOY |
| EOY | 9620489 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 648402 | BOY |
| EOY | 804128 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 521396 | BOY |
| EOY | 8903226 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1169798 | BOY |
| EOY | 9707354 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6623766 | BOY |
| EOY | -86865 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6623766 | BOY |
| EOY | -86865 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7793564 | BOY |
| EOY | 9620489 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 0 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $2,066 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 2066 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II-B, Line 1i: | Identifier |
| Return Reference | Explanation of Other Lobbying Activities: | ReturnReference |
| Explanation | THE HOSPITAL IS A MEMBER OF THE NATIONAL ASSOCIATION OF LONG TERM HOSPITALS AND THE GEORGIA HOSPITAL ASSOCIATION. THESE ORGANIZATIONS ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBERSHIP BODIES, AND EACH YEAR, A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING EXPENDITURES. FOR THE CURRENT YEAR, DUES ALLOCATED TO LOBBYING WAS APPROXIMATELY $2,066. | Explanation |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 21250 | OtherCostOrOtherBasis |
| Depreciation | 6375 | Depreciation |
| Book Value | 14875 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1520283 | OtherCostOrOtherBasis |
| Depreciation | 856696 | Depreciation |
| Book Value | 663587 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 678462 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| THIRD PARTY SETTLEMENTS PAYABLE | $134,498 |
| DUE TO SOUTHERN REGIONAL | $134,019 |
| DUE TO CHRISTUS DUBUIS HEALTH SYSTEM | $225,565 |
| LITIGATION ACCRUAL | $8,409,144 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 8903226 | TotalOfAmounts |
| Total Revenue | 12937468 | TotalRevenue |
| Total Expenses | 19648099 | TotalExpenses |
| Excess Or Deficit For Year | -6710631 | ExcessOrDeficitForYear |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | -6710631 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 12937468 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 12937468 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 12937468 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 19648099 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 19648099 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 19648099 | TotalExpensesPerForm990 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 282460 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 282460 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01440 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 282460 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 282460 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01440 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 349509 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 349509 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01780 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 349509 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 349509 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01780 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 631969 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 631969 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03220 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $20,109 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9470028 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 7978258 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1491770 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHERN CRESCENT HOSP FOR SPEC CARE | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 UPPER RIVERDALE ROAD | AddressLine1 |
| City | RIVERDALE | City |
| State | GA | State |
| ZIP Code | 30274 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Other | LONG-TERM ACUTE CARE HOSPITAL | Other |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Income Based Criteria | Part I, Line 3c: IN ADDITION TO PROVIDING CHARITY CARE BASED ON THE FEDERAL POVERTY GUIDELINES, THE HOSPITAL PROVIDES CARE TO MEDICALLY INDIGENT PATIENTS WHOSE MEDICAL OR HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEED 25% OF THE PATIENT'S ANNUAL GROSS INCOME AND THE PATIENT IS UNABLE TO PAY THE REMAINING BILL. | IncomeBasedCriteria |
| Costing Method Used | Part I, Line 7: WORKSHEET 2 OF THE 2009 SCHEDULE H INSTRUCTIONS WAS USED TO DERIVE A COST-TO-CHARGES RATIO USED TO CALCULATE AMOUNTS OF COMMUNITY BENEFIT EXPENSE AT COST FOR PART I, LINE 7. | CostingMethodUsed |
| Percent Of Total Expense Expln | Part I, Line 7f: THE AMOUNT OF TOTAL EXPENSE ON FORM 990, PART IX, LINE 25 INCLUDES $59,232 OF BAD DEBT THAT HAS BEEN REMOVED FOR PURPOSES OF CALCULATING COMMUNITY BENEFIT EXPENSE PERCENTAGE REPORTED ON LINE 7, COLUMN (F). | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE FOR BAD DEBT. THE ORGANIZATION USED AN INTERNAL COST-TO-CHARGE RATIO TO COMPUTE BAD DEBT AT COST. | BadDebtFootnote |
| Shortfall As Community Benefit | Part III, Line 8: THE ORGANIZATION USED THE MEDICARE COST REPORT TO DETERMINE COSTS OF CARE RELATING TO MEDICARE PAYMENTS. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | Part III, Line 9b: SOUTHERN CRESCENT HOSPITAL DOES NOT OUTSOURCE PATIENT BALANCES TO A THIRD PARTY DEBT COLLECTION AGENCY. ALL COLLECTIONS ARE DONE BY IN-HOUSE COLLECTORS USING COLLECTION LETTERS. PATIENTS ARE NOT SUBJECT TO HARASSMENT OR LEGAL ACTION DUE TO THEIR INCAPACITY TO PAY. PATIENTS THAT ARE UNABLE TO PAY ARE SENT CHARITY CARE INFORMATION.PATIENTS RECEIVE PRIVATE LETTERS/BILLS EACH MONTH INDICATING BALANCE DUE. PATIENTS WHO HAVE NOT MADE PAYMENTS FOR A 30-DAY PERIOD WILL RECEIVE A LETTER REQUESTING PAYMENT. PATIENTS WHO ARE UNABLE TO PAY THEIR BALANCE WILL BE CONSIDERED FOR CHARITY CARE IF APPROPRIATE. COLLECTION EFFORTS WILL CONTINUE FOR 120 DAYS DURING WHICH AT LEAST 3 COLLECTION ATTEMPTS ARE MADE. AFTER THIS PERIOD THE BALANCE IS WRITTEN OFF EITHER AS BAD DEBT OR CHARITY CARE. MEDICAID PATIENTS OR MEDICARE PATIENTS WHO HAVE MEDICAID WILL BE CONSIDERED INDIGENT. MEDICAID DENIALS OF PAYMENT FOR VALID REGULATIONS, SUCH AS CODE 238 "MEDICAID PAID EQUAL TO OR GREATER THAN MEDICAID PAID, NO FURTHER PAYMENT", WILL RESULT IN THE DEDUCTIBLE AND COINSURANCE TO BE CONSIDERED BAD DEBT AND ANY OTHER BALANCE WILL BE CONSIDERED CHARITY CARE. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: SOUTHERN CRESCENT HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITY THROUGH A STRATEGIC PLANNING PROCESS. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: ALL PATIENTS ARE ASSESSED DURING THE REGISTRATION PROCESS. PATIENTS IDENTIFIED AS POSSIBLE CHARITY CASES WILL BE ASKED TO COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE. PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM BUT ARE NOT CURRENTLY ENROLLED ARE REFERRED TO THE APPROPRIATE PROGRAM. PATIENTS WHO CAN PROVE ELIGIBILITY FOR MEDICAID BUT ARE NOT PATIENTS IN A MEDICAID APPROVED HOSPITAL WILL BE DEEMED AS INDIGENT AND AUTOMATICALLY QUALIFY FOR CHARITY CARE. PATIENTS ADMITTED TO THE HOSPITAL WITH MEDICARE AS THE ONLY INSURANCE WILL BE MONITORED AS MEDICARE DAYS NEAR DEPLETION. THIRTY DAYS PRIOR TO THE END OF THE MEDICARE COVERAGE, AN INTERVIEW AND AN APPLICATION FOR FINANCIAL ASSISTANCE WILL BE REQUESTED AS APPROPRIATE. THESE PATIENTS ARE ASSESSED AS TO MEETING THE GUIDELINES FOR RECEIVING CHARITY CARE IF THE STAY SHOULD EXCEED MEDICARE COVERAGE LIMITS. AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENT'S FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENT ASSISTANCE, A DETERMINATION IS MADE CONCERNING THE PATIENT'S ELIGIBILITY FOR CHARITY. NO COLLECTION EFFORT IS PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATIONS ARE MADE. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE (SCHSC), PART OF THE NATION'S LEADING NONPROFIT, FAITH-BASED LONG-TERM ACUTE CARE SYSTEMS, IS DEDICATED TO PROVIDING EXCEPTIONAL INTERDISCIPLINARY HEALTH CARE TO PATIENTS WHO REQUIRE EXTENDED HOSPITAL STAYS. SOUTHERN CRESCENT HOSPITAL SERVES A POPULATION BASE OF 600,000 IN OUR PRIMARY SERVICE AREA. THERE ARE FOUR ACUTE CARE HOSPITALS AND ONE ADDITIONAL LONG-TERM ACUTE HOSPITAL SERVING THESE ZIP CODES. THERE ARE NO FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS OR POPULATIONS PRESENT IN THE COMMUNITY. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE ORGANIZATION NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. THE ORGANIZATION MAKES DONATIONS TO VARIOUS FOUNDATIONS AND ORGANIZATIONS THAT PROVIDE HEALTH CARE TO THE COMMUNITY. IN ADDITION TO THE PROVISION OF CARE WITHOUT EXPECTATION OF PAYMENT (CHARITY CARE), SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PROVIDES SERVICES TO PERSONS COVERED UNDER GOVERNMENT SPONSORED PROGRAM, INCLUDING MEDICARE, DOD, CHAMPUS, TRICARE AND TRICARE FOR LIFE. | OtherInformation |
| Reports Filed With States | GA | ReportsFiledWithStates |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| SOUTHSIDE MEDICAL CENTER INC | |||||||
| 1046 RIDGE AVENUE SW | ATLANTA | GA | 30315 | 581131002 | 501(C)(3) | 173146 | OPERATIONAL SUPPORT TO PROMOTE EXEMPT PURPOSE |
| SOUTHERN REGIONAL MEDICAL CENTER FOUNDATION | |||||||
| 11 UPPER RIVERDALE ROAD | RIVERDALE | GA | 30274 | 581983516 | 501(C)(3) | 266365 | FUND WIRELESS SYSTEMS TO 7 EMS PROGRAMS, SPONSOR CRESCENT BALL, AND SPONSOR WOMEN CONNECTING WOMEN EVENT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 2 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: THE GRANT TO SOUTHSIDE MEDICAL CENTER, INC., A TAX EXEMPT ENTITY, WAS APPROVED BY THE BOARD AND DOCUMENTED IN THE BOARD MINUTES AND IS MADE ACCORDING TO AN AGREEMENT EFFECTIVE 11/14/2008 BETWEEN SOUTHSIDE MEDICAL CENTER, INC. AND SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE. THE AGREEMENT STATES THAT SOUTHERN CRESCENT HOSPITAL WILL PROVIDE IN TOTAL FINANCIAL ASSISTANCE UP TO $400,000 DURING THE THREE YEAR TERM OF THE AGREEMENT TO COVER OPERATION SHORTFALLS AND A ONE-TIME START UP COST REIMBURSEMENT. THE AGREEMENT WAS ENTERED INTO SO THAT SOUTHSIDE MEDICAL CENTER WOULD BE ABLE TO SERVE THE UNDERSERVED PATIENT COMMUNITY WITHIN THE SERVICE AREAS OF SOUTHERN CRESCENT HOSPITAL REGARDLESS OF THE PATIENT'S ABILITY TO PAY. SOUTHSIDE MEDICAL CENTER IS REQUIRED TO SUBMIT AN ITEMIZATION OF COSTS TO BE APPROVED BY SOUTHERN CRESCENT PRIOR TO EACH PAYMENT. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAN HAMILTON-CRAWFORD | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Base Compensation Filing Org | 140837 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 18255 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 11940 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 0 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 4034 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 175066 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 6 | THE ORGANIZATION MAINTAINS AN INCENTIVE COMPENSATION PLAN. IT IS CONTINGENT UPON THE ACHIEVEMENT OF TWO INDEPENDENT TRIGGERS: (1) AT LEAST 100% OF THE BUDGETED OVERALL SYSTEM NET PROFIT TARGET AND (2) 100% OF COMMUNITY BENEFIT INDICATOR MUST BE MET SYSTEM WIDE. IF THESE TRIGGERS ARE NOT MET,EITHER AN AMOUNT UP TO 5% OF BASE PAY MAY BE AWARDED FOR OUTSTANDING PERFORMANCE AS EVIDENCED BY MEETING INDIVIDUAL INCENTIVE COMPENSATION GOALS OR AN AMOUNT APPROVED BY THE BOARD OF DIRECTORS. JAN HAMILTON-CRAWFORD WAS PAID $18,255 BY REACHING GOALS RELATED TO THIS INCENTIVE COMPENSATION PLAN. | |
| Part III | COMPENSATION FROM UNRELATED ORGANIZATIONS: JAN HAMILTON-CRAWFORD RECEIVED COMPENSATION FROM CHRISTUS CONTINUING CARE (D/B/A "CHRISTUS DUBUIS HEALTH SYSTEM"), AN UNRELATED ORGANIZATION THAT MANAGES SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE AND WHO LEASES THEIR EMPLOYEES TO PERFORM SERVICES FOR SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE. IN ADDITION, SHE RECEIVED NO DIRECT COMPENSATION FROM SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE. COMPENSATION REPORTED ON PART II REFLECTS AN AMOUNT OF TOTAL COMPENSATION ALLOCATED TO SERVICES PERFORMED SPECIFICALLY FOR SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE. | Supplemental Information |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 3 | SOUTHERN CRESCENT HOSPITAL IS MANAGED BY CHRISTUS CONTINUING CARE D/B/A "CHRISTUS DUBUIS HEALTH SYSTEM"). THE EMPLOYEES OF DUBUIS HEALTH SYSTEM, INC. ARE LEASED TO SOUTHERN CRESCENT HOSPITAL TO PERFORM SERVICES. ALL EMPLOYEE POLICIES OF DUBUIS HEALTH SYSTEM, INC. APPLY TO EMPLOYEES WORKING WITHIN CHRISTUS DUBUIS HEALTH SYSTEM AND EMPLOYEES LEASED TO SOUTHERN CRESCENT HOSPITAL. | |
| Form 990, Part VI, Section A, line 7a | THE ORGANIZATION HAS NO OFFICIAL MEMBERS; HOWEVER, SOUTHERN REGIONAL HEALTH SYSTEM, A GEORGIA NONPROFIT CORPORATION, APPOINTED THE INITIAL BOARD, AND RETAINS THE RIGHT TO APPOINT UP TO TWO MEMBERS. | |
| Form 990, Part VI, Section A, line 8b | THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. | |
| Form 990, Part VI, Section B, line 11 | THE RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE ORGANIZATION REVIEWS THE PREPARED RETURN FOR ACCURACY. UPON COMPLETION OF THE FINAL FORM 990 BY THE INDEPENDENT ACCOUNTING FIRM, THE 990 IS SUBMITTED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE. | |
| Form 990, Part VI, Section B, line 12c | THE ORGANIZATION MAINTAINS SEPARATE CONFLICT OF INTEREST POLICIES FOR EMPLOYEES OF THE ORGANIZATION AND FOR THE MEMBERS OF THE BOARD OF DIRECTORS. BOTH POLICIES REQUIRE ANNUAL DISCLOSURE OF ANY CONFLICTS OF INTEREST. THE EMPLOYEE POLICY INCLUDES OFFICERS, MEDICAL DIRECTORS AND OTHER DIRECTORS, AND ALL OTHER ASSOCIATES. THE EMPLOYEE DISCLOSURE IS REVIEWED BY THE EMPLOYEE'S IMMEDIATE SUPERVISOR. IN ADDITION, KEY LEADERS MUST CERTIFY ANNUALLY THEIR RECEIPT AND UNDERSTANDING OF THE CONFLICT OF INTEREST POLICY. IF ANY CONFLICTS ARE PRESENT, THE EMPLOYEE AND THE ORGANIZATION'S ADMINISTRATION WILL IMPLEMENT A MUTUALLY AGREED UPON PLAN TO RESOLVE THE CONFLICT. IN ADDITION, THE ORGANIZATION IMPLEMENTS AN INTEGRITY PROGRAM TO SUPPORT AND MAINTAIN THE CORPORATE INTEGRITY OF THE ORGANIZATION. THE POLICY FOR THE MEMBERS OF THE BOARD OF DIRECTORS REQUIRES ANY BOARD MEMBER, UPON DETERMINATION OF A CONFLICT OF INTEREST, TO ABSENT HIMSELF OR HERSELF WITHOUT COMMENT FROM NOT ONLY THE VOTE BUT ALSO FROM THE DELIBERATION. BOARD MEMBERS ARE NOT ALLOWED TO BE EMPLOYED BY THE ORGANIZATION UNLESS THEY HAVE FIRST RESIGNED FROM THE BOARD. IN ADDITION, AT THE BEGINNING OF EACH BOARD MEETING, THE BOARD CHAIR ASKS THE BOARD MEMBERS TO REVIEW THE AGENDA AND SHARE ANY POTENTIAL CONFLICTS OF INTEREST PRIOR TO THE BEGINNING OF BUSINESS. | |
| Form 990, Part VI, Section B, line 15a | THE SALARY FOR THE PRESIDENT/CHAIRMAN OF THE BOARD OF DIRECTORS WAS BASED ON COMPARATIVE SALARIES FROM OTHER BOARDS. IN DETERMINING THE SALARY FOR THE TOP MANAGMENT OFFICER, THE ORGANIZATION USES THE SAME PROCEDURE AS USED FOR ALL OTHER EMPLOYEES. THE HUMAN RESOURCES DEPARTMENT USES CITY AND STATE SALARY SURVEYS AVAILABLE TO THE PUBLIC. THE SALARY RATES ARE REVIEWED BY THE HUMAN RESOURCES DEPARTMENT PERIODICALLY BASED ON CHANGES IN THE MARKET PLACE. THE BOARD OF DIRECTORS HAS FINAL APPROVAL OVER THE COMPENSATION LEVELS SET. | |
| Form 990, Part VI, Section C, line 18 | PHOTOCOPIES OF THE FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. | |
| Form 990, Part VI, Section C, line 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE THROUGH THE STATE OF GEORGIA'S SECRETARY OF STATE, OR UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FINANCIAL STATEMENTS AND THE CONFLICT OF INTEREST POLICY ARE ALSO AVAILABLE UPON REQUEST OR ONLINE AT WWW.DUBUIS.ORG. | |
| FORM 990, PART V, LINE 2 | SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE ENTERED INTO A MANAGEMENT AGREEMENT WITH CHRISTUS DUBUIS HEALTH SYSTEM, AN UNRELATED ORGANIZATION. AS PROVIDED BY THE MANAGEMENT AGREEMENT, CHRISTUS DUBUIS HEALTH SYSTEM AGREES TO PROVIDE TO THE HOSPITAL AN ADMINISTRATOR AND ALL OTHER EMPLOYEES REQUIRED TO STAFF THE HOSPITAL. SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PAYS DIRECTLY FROM THEIR BANK ACCOUNT THE SALARIES OF ALL EMPLOYEES OTHER THAN THE ADMINISTRATOR AND REIMBURSES CHRISTUS DUBUIS HEALTH SYSTEM FOR THE SALARY EXPENSE OF THE ADMINISTRATOR AND THE PAYROLL TAXES AND EMPLOYEE BENEFITS ASSOCIATED WITH THE ADMINISTRATOR AND ALL OTHER EMPLOYEES. UNDER THIS ARRANGEMENT THERE ARE NO EMPLOYEES OF SOUTHERN CRESCENT HOSPITAL AND THUS NO FORMS W-2 ISSUED BY SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE. HOWEVER, THE EXPENSES RELATED TO THESE EMPLOYEES ARE SHOWN AS SALARY, PAYROLL TAX AND EMPLOYEE BENEFIT EXPENSES ON FORM 990 PART IX. | |
| FORM 990, PART IX, LINE 24A: | The Hospital is currently undergoing an investigation by the U.S Department of Justice. The Hospital has received correspondence from the U.S. Department of Justice stating that the Hospital has been overpaid for Medicare claims in the amount of $8.4 million. | LITIGATION EXPENSE: |
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