2011-08-15T12:07:10-05:00 2010-09-30 DRAFFIN & TUCKER LLP PO BOX 6 ALBANY GA 317020006 990 2009-10-01 581559677 ARCHBOLD FOUNDATION INC ARCH 2292282200 PO BOX 620 THOMASVILLE GA 317990620 FRANCES M PARKER 2292282200 2011-08-15 true JACQUELINE G ATKINS 2298837878 2011-08-12 2009 2016-02-24 21:20:13Z FRANCES M PARKER 910 SOUTH BROAD ST THOMASVILLE GA 31792 38603990 false X X 1983 GA SUPPORT ORGANIZATION 21 15 0 0 2714901 2489725 0 -157565 4440128 76799 8412 2634135 6938265 530738 4380553 0 237888 263445 107000 232587 232587 302513 336516 1178139 5213101 1455996 1725164 71312138 72798041 91878 44239 71220260 72753802 SUPPORT ORGANIZATION false false 4699961 4100000 50817 PAYMENT TO JOHN D. ARCHBOLD MEMORIAL HOSPITAL TO BE USED FOR NURSING SCHOLARSHIPS AND THE CONSTRUCTION AND EQUIPPING OF FACILITIES. 60553 60553 PAYMENT TO ARCHBOLD HEALTH SERVICES FOR CONTRIBUTIONS MADE TO THE HOSPICE PROGRAM. 15000 15000 PAYMENT TO JOHN D. ARCHBOLD MEMORIAL HOSPITAL FOR PHARMACY FOR INDIGENT CANCER PATIENTS. 205000 205000 PAYMENT TO AREA DENTIST FOR INDIGENT CARE CANCER PATIENTS. 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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 X X true COMMUNITY COUNSELING SVC CO LLP CAMPAIGN true 2603256 232587 2370669 2603256 232587 2370669 GA GOLF TOURNAMENT 217150 103732 113418 20100 8689 6028 16374 7961 TREE OF LIGHTS 16883 16773 110 420 3139 234033 120505 113528 20100 8689 6028 16794 11100 62711 50817 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 60553 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 175000 CAPITAL CONTRIBUTION JOHN D ARCHBOLD MEM HOSP P O BOX 1018 THOMASVILLE GA 317991018 580566121 3 3800000 CAPITAL CONTRIBUTION 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 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 FRANCES PARKER 149390 29006 1242 11677 4680 195995 CHARLES D HIGHTOWER 253826 61288 7144 16360 4680 343298 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 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 SEE 6A NARRATIVE ABOVE. 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 CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 ARCHBOLD MEDICAL CENTER IS THE SOLE MEMBER OF THE ORGANIZATION WITH RIGHTS TO ELECT MEMBERS OF THE GOVERNING BODY, APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY AND RECEIVE A SHARE OF THE ORGANIZATION'S NET ASSETS UPON THE ORGANIZATION'S DISSOLUTION. 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 11 EACH TRUSTEE WHO ATTENDED EITHER OF TWO EDUCATIONAL SESSIONS, CONDUCTED BY THE ORGANIZATION'S CFO AND GENERAL COUNSEL PRIOR TO FILING THE FORM 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 ARCHBOLD MEDICAL CENTER COMPENSATION COMMITTEE MAKES RECOMMENDATIONS TO THE EXECUTIVE COMMITTEE WHO IN TURN REPORTS 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. 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 AVAILABLE TO THE PUBLIC. CUSTODY OR CONTROL ARRANGEMENT SCHEDULE G, PAGE 1, PART I, LINE 2B, COLUMN (III) COMMUNITY COUNSELING SVC CO., LLP FOUNDATION DOES ALL FUNDRAISING AND RECEIPT OF PLEDGED GIFTS AND FUNDS FUNDRAISING VS. REIMBURSEMENT EXPLANATION SCHEDULE G, PAGE 1, PART I, LINE 2B, COLUMN (V) COMMUNITY COUNSELING SVC CO., LLP ONGOING CAMPAIGN - RAISE 16M FUNDS FOR ONCOLOGY CENTER AND NEW NORTH TOWER 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 CHARLES HIGHTOWER 48 J. PERRY MUSTIAN 49 FRANCES PARKER 1 ARCHBOLD HEALTH SERVICES INC PO BOX 620 THOMASVILLE GA 317990620 581376434 MGMT GA 501 9 NA JOHN D ARCHBOLD MEMORIAL HOSPITAL PO BOX 1018 THOMASVILLE GA 317991018 580566121 ACUTE CARE GA 501 3 NA ARCHBOLD MEDICAL CENTER INC PO BOX 1018 THOMASVILLE GA 317991018 581552650 HEALTHCARE GA 501 11A NA false true true false false false false false false false true false true true false false true false