2011-08-15T12:07:10-05:00 2010-09-30 DRAFFIN & TUCKER LLP PO BOX 6 ALBANY GA 317020006 990 2009-10-01 581552650 ARCHBOLD MEDICAL CENTER INC ARCH 2292282229 PO BOX 1018 THOMASVILLE GA 317991018 J PERRY MUSTIAN 2292282229 2011-08-15 true JACQUELINE G ATKINS 2298837878 2011-08-12 2009 2016-02-24 21:20:13Z J PERRY MUSTIAN PRESIDENTCEO P O BOX 1018 THOMASVILLE GA 317991018 21360272 false X WWW.ARCHBOLD.ORG X 1983 GA HEALTHCARE MANAGEMENT 26 12 3063 0 0 18749359 21360272 0 0 18749359 21360272 0 0 9848884 10698375 0 0 8900475 10661897 18749359 21360272 0 33059955 29859672 33059955 29859672 0 HEALTHCARE MANAGEMENT false false 21360272 21360272 HEALTHCARE MANAGEMENT. 21360272 true false false true false false false false false true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 true 3063 true false false false false false false false false false false false false false false 26 12 false false false false true true false true true false false false true true true true true true true false GA X MR CHARLES D HIGHTOWERJR 2292282737 PO BOX 1018 THOMASVILLE GA 317991018 J PERRY MUSTIAN 40.00 X X 601574 0 558930 EDWARD HALL MD 1.00 X 0 418966 12030 CALVIN J REAMS MD 1.00 X 0 199769 14378 DANIEL E AUTRY 1.00 X X 0 0 0 NATHANIEL H ABRAMS JR 1.00 X X 0 0 0 POWELL JONES 1.00 X X 0 0 0 TOM CALLAWAY 1.00 X X 0 0 0 BRYANT BEADLES 1.00 X 0 0 0 CHARLES HANCOCK MD 1.00 X 0 0 0 GARY BONVILLIAN PHD 1.00 X 0 0 0 GATES KIRKHAM 1.00 X 0 0 0 IMOGENE CONYERS 1.00 X 0 0 0 JEAN MORGAN 1.00 X 0 0 0 JOHN A BLACKMON MD 1.00 X 0 0 0 RICHARD G MOONEY III 1.00 X 0 0 0 RICHARD L SINGLETARY JR 1.00 X 0 0 0 ROBERT H JEFFERSON JR 1.00 X 0 0 0 ROBERT THOMAS III 1.00 X 0 0 0 ROBERT W BALFOUR 1.00 X 0 0 0 STEPHANIE TILLMAN 1.00 X 0 0 0 STEPHEN H CHENEY 1.00 X 0 0 0 STEPHEN R AVERA 1.00 X 0 0 0 SUE GARFIELD 1.00 X 0 0 0 TIMOTHY A JONES MD 1.00 X 0 0 0 VICTOR MCMILLAN MD 1.00 X 0 0 0 W MERRILL HICKS MD 1.00 X 0 0 0 WALLACE GOODMAN 1.00 X 0 0 0 WILLIAM W ELLIS MD 1.00 X 0 0 0 DAVID ROBBINS 40.00 X 407990 0 184760 CHARLES HIGHTOWER 40.00 X 322258 0 21040 ZACH WHEELER 40.00 X 267474 0 104633 WILLIAM ZIMMERMANN 40.00 X 253895 0 23394 W CLAY CAMPBELL 1.00 X 0 226961 19572 FRANCES PARKER 1.00 X 0 179638 16357 LYNNE FRITZ BYRD 40.00 X 169965 0 16331 RICK IVEY 40.00 X 165083 0 16616 JILL W JONES 40.00 X 127453 0 14649 ANTOINE POYTHRESS 40.00 X 113631 0 9374 FIELDS W VARNER 40.00 X 110271 0 7104 GAIL BRADLEY 40.00 X 103739 0 4680 CARLA PEARCE 40.00 X 100063 0 11365 2743396 1025334 1035213 12 false true false CASH RETRIEVER TWO CHASE CORP DRIVE SUITE 240 BIRMINGHAM AL 35244 COLLECTIONS 679970 ALLSTATE WORKPLACE DIVISION PO BOX 190 VALDOSTA GA 31603 INSURANCE 487461 CODING COMPLIANCE SOLUTIONS 1000 S WOODWARD AVE SUITE 105 BIRMINGHAM AL 48009 CPT CODE REVIEW 372817 SIEMENS HEALTH SERVICES PO BOX 828556 PHILADELPHIA PA 19182 TECHNOLOGY 236134 SCC SOFT COMPUTER 5400 TECH DATA DRIVE CLEARWATER FL 33760 TECHNOLOGY 164301 10 PATIENT SERVICE REVENUE 21360272 21360272 21360272 21360272 21360272 2331944 2331944 6047214 6047214 74095 74095 1649509 1649509 595613 595613 1643573 1643573 225000 225000 265339 265339 119171 119171 4159652 4159652 24906 24906 717268 717268 1503309 1503309 228185 228185 12710 12710 CONTINGENCY 1299369 1299369 DUES & SUBSCRIPTIONS 266326 266326 RECRUITMENT 95097 95097 MISCELLANEOUS 65407 65407 REPAIRS & MAINTENANCE 36430 36430 155 155 21360272 21360272 0 0 2063163 2430894 30996792 27428778 33059955 29859672 20733731 20714854 12326224 9144818 33059955 29859672 X 0 0 33059955 29859672 X false true true X false X X X false false false JOHN D ARCHBOLD MEMORIAL HOSPITAL INC 580566121 3 true true true 0 4 false false false false false true false false false false true 166169 false true 99170 265339 false false false false false SCHEDULE C, PART II-B, LINE 1I LOBBYING ACTIVITIES INCLUDE THE MEDICAL CENTER'S MEMBERSHIP IN THE GEORGIA ALLIANCE OF COMMUNITY HOSPITALS, A PORTION OF THE AMERICAN HOSPITAL ASSOCIATION AND GEORGIA HOSPITAL ASSOCIATION DUES AND A PORTION OF SALARIES DIRECTLY RELATED TO LOBBYING. false false false false false false false false false false DUE FROM JDAMH, INC. 27428778 27428778 DUE TO RELATED PARTIES 9144818 9144818 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, 2010 AND 2009 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTER'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2007-2009. X X true true X X X X X false true false false false true true false false J PERRY MUSTIAN 426490 165750 9334 554250 4680 1160504 EDWARD HALL MD 417311 1655 7350 4680 430996 CALVIN J REAMS MD 191359 8282 128 9698 4680 214147 DAVID ROBBINS 326955 77726 3309 180080 4680 592750 CHARLES HIGHTOWER 253826 61288 7144 16360 4680 343298 ZACH WHEELER 200775 64989 1710 99953 4680 372107 WILLIAM ZIMMERMANN 199871 49833 4191 18714 4680 277289 W CLAY CAMPBELL 173103 45305 8553 14892 4680 246533 FRANCES PARKER 149390 29006 1242 11677 4680 195995 LYNNE FRITZ BYRD 131197 37526 1242 11651 4680 186296 RICK IVEY 163769 1314 11936 4680 181699 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 0 536,000 0 DAVID ROBBINS 0 164,000 0 ZACH WHEELER 0 82,000 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 OF FORM 990 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. CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 THE ORGANIZATION HAS ONE CLASS OF MEMBERS WHICH SHALL BE LIFE MEMBERS. THE RIGHTS OF THE LIFE MEMBERS SHALL BE AS PROVIDED IN THE LAWS OF THE STATE OF GEORGIA, THE ARTICLES OF INCORPORATION AND THE BYLAWS OF ARCHBOLD MEDICAL CENTER, INC. ("AMC"). EACH LIFE MEMBER HAS ONE VOTE WITH RESPECT TO THE ELECTION OF TRUSTEES OF AMC. ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A THE LIFE MEMBERS OF THE FILING ORGANIZATION ANNUALLY ELECT THE TRUSTEES OF THE GOVERNING BODY. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11 EACH TRUSTEE WHO ATTENDED EITHER OF TWO EDUCATIONAL SESSIONS, CONDUCTED BY THE ORGANIZATION'S CFO AND GENERAL COUNSEL PRIOR TO FILING THE FORM ELECTRONICALLY WITH THE IRS, RECEIVED A COPY AND HAD AN OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. TRUSTEES WHO DID NOT ATTEND WERE INVITED TO REVIEW THE FORM AT THEIR CONVENIENCE ALTHOUGH ALL DID NOT DO SO PRIOR TO FILING. 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 THE AMC COMPENSATION COMMITTEE MAKES RECOMMENDATIONS TO THE EXECUTIVE COMMITTEE WHO IN TURN REPORTS TO THE FULL BOARD ON THE FOLLOWING POSITIONS: AMC'S PRESIDENT; THE PRESIDENT OF THE ARCHBOLD FOUNDATION; AND THE PRESIDENT OF ARCHBOLD HEALTH SERVICES. THE PRESIDENT OF ARCHBOLD MEDICAL CENTER 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 TO INCLUDE BENEFITS. IN 2009, IHS PROVIDED UPDATED RECOMMENDATIONS ON COMPENSATION TO THE COMPENSATION COMMITTEE. IN 2010, THE COMPENSATION COMMITTEE ENGAGED IHS TO PROVIDE A COMPLETE REPORT AND 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 ARE OR WILL BE AVAILABLE TO THE PUBLIC. ADDITIONAL INFORMATION SCHEDULE O CORE FORM, PART VII SECTION A - AVERAGE HOURS SPENT IN RELATED ORGANIZATION ACTIVITIES THE FOLLOWING INDIVIDUALS SPEND ADDITIONAL TIME IN RELATED ENTITY MANAGEMENT FUNCTIONS. NAME AVERAGE HOURS WILLIAM CAMPBELL 41 CHARLES HIGHTOWER 9 J. 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