COFFEE REGIONAL MEDICAL CENTER INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
COFFEE REGIONAL MEDICAL CENTER INC (EIN 65-0543088)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-10
IRS object ID
201113149349301101
Schema version
2010v3.4
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

FieldValueIRS element (for citing)
Timestamp2011-11-10T07:22:42-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DRAFFIN & TUCKER LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 6AddressLine1
CityALBANYCity
StateGAState
ZIP Code317020006ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN650543088EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COFFEE REGIONAL MEDICAL CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOFFNameControl
Phone9123841900Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11101 OCILLA ROAD/PO BOX 1287AddressLine1
CityDOUGLASCity
StateGAState
ZIP Code31533ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDON LEWISName
TitleCHIEF FINANCIAL OFFICERTitle
Phone9123841900Phone
Date Signed2011-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJACQUELINE G ATKINSName
Phone2298837878Phone
Date Prepared2011-11-09DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDON LEWISNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11101 OCILLA ROAD / PO BOX 1287AddressLine1
CityDOUGLASCity
StateGAState
ZIP Code31533ZIPCode
FieldValueIRS element (for citing)
Gross Receipts95606204GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.COFFEEREGIONAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1995YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionHOSPITAL SERVICES FOR COFFEE COUNTY & SURROUNDING AREASActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees792TotalNbrEmployees
Total Nbr Volunteers60TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year405474ContributionsGrantsPriorYear
Contributions Grants Current Year229367ContributionsGrantsCurrentYear
Program Service Revenue Prior Year82847086ProgramServiceRevenuePriorYear
Program Service Revenue CY86218316ProgramServiceRevenueCY
Investment Income Prior Year2753321InvestmentIncomePriorYear
Investment Income Current Year1091750InvestmentIncomeCurrentYear
Other Revenue Prior Year2028585OtherRevenuePriorYear
Other Revenue Current Year2080693OtherRevenueCurrentYear
Total Revenue Prior Year88034466TotalRevenuePriorYear
Total Revenue Current Year89620126TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year42956971SalariesEtcPriorYear
Salaries Etc Current Year43630186SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year43845381OtherExpensePriorYear
Other Expenses Current Year46271984OtherExpensesCurrentYear
Total Expenses Prior Year86802352TotalExpensesPriorYear
Total Expenses Current Year89902170TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1232114RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-282044RevenuesLessExpensesCY
Total Assets BOY89973342TotalAssetsBOY
Total Assets EOY89941653TotalAssetsEOY
Total Liabilities BOY48564683TotalLiabilitiesBOY
Total Liabilities EOY47414624TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY41408659NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY42527029NetAssetsOrFundBalancesEOY
Mission DescriptionHOSPITAL SERVICES FOR COFFEE COUNTY & SURROUNDING AREASMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense80716674Expense
Revenue86219374Revenue
DescriptionHOSPITAL SERVICES - SHORT TERM CARE FOR INPATIENT AND OUTPATIENT SERVICES FOR DOUGLAS AND COFFEE COUNTY. COFFEE REGIONAL MEDICAL CENTER SERVED 5,765 PATIENTS FOR A TOTAL OF 19,704 DAYS IN 2010. NURSERY DAYS WERE 999 IN 2010. COFFEE REGIONAL MEDICAL CENTER PROVIDED APPROXIMATELY 8,353,000 OF INDIGENT AND CHARITY SERVICES IN 2010.Description
Total Program Service Expense80716674TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109635NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees792NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccounttrueForeignFinancialAccount
Name Of Foreign CountryCJNameOfForeignCountry
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChapterstrueLocalChapters
Policies Reference ChapterstruePoliciesReferenceChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDONALD C LEWISNamePerson
Telephone Number9123841900TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11101 OCILLA RDAddressLine1
CityDOUGLASCity
StateGAState
ZIP Code31533ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
COLIN TOOGOOD
DIRECTOR1.00X000
GABE EVANS
DIRECTOR1.00X000
MATT GREER
DIRECTOR1.00X000
J DAVID ARNETT MD
DIRECTOR1.00X000
ARTHUR JOHNSON
DIRECTOR1.00X000
JON LOTT
DIRECTOR1.00X000
MIKE WILLS
CHAIRMAN1.00X000X
GUY MOORMAN
DIRECTOR1.00X000
THAD CARTER
DIRECTOR1.00X000
CHARLES MILLER MD
DIRECTOR1.00X000
ROB HURST
DIRECTOR1.00X000
GEORGE HECK
CEO40.00360860035814X
DONALD C LEWIS
CFO40.00257374035112X
SHERRY THOMAS
VP PT. CARE40.00214417023187X
THOMAS C HENRIS MD
ANESTHESIOLO40.00484863033619X
EDDY N DUNCAN MD
ANESTHESIOLO40.00473157033619X
JONATHAN GASKINS MD
ER PHYSICIAN40.00383411017087X
CHARLES COWART MD
ER PHYSICIAN40.00363694024515X
JEFFERY T WINGE MD
ER PHYSICIAN40.00270561029795X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2808337TotalReportableCompFromOrg
Total Other Compensation232748TotalOtherCompensation
Number Individuals GT100 K20NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1Address Line2AddressOfContractor/AddressUS/AddressLine2CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HALL BOOTH SMITH & SLOVER
1180 WEST PEACHTREE SUITE 900ATLANTIC CENTER PLAZAATLANTAGA30309LEGAL252365
ALLIANCE RECRUITING
2708 HALIFAX COURTMCKINNEYTX75070RECRUITMENT188179
ROWE CONSTRUCTION
684 COLUMBUS ROADPEARSONGA31642CONSTRUCTION179291
STEVEN JOHNSON MD
1611 CLUB DRIVEDOUGLASGA31533LOCUM TENUM120205
WILLIAM CHARLES MILLER
1611 CLUB DRIVEDOUGLASGA31533SURGICAL ON CAL119819
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Government Grants229167GovernmentGrants
All Other Contributions200AllOtherContributions
Total Contributions229367TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUEDescription
Business Code621990BusinessCode
Total Revenue Column86218316TotalRevenueColumn
Related Or Exempt Function Income86218316RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue86218316TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column865309TotalRevenueColumn
Exclusion$865,309ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real189440Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real189440Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column189440TotalRevenueColumn
Exclusion$189,440ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities6212519Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities5942847Securities
Other43231Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities269672Securities
Other-43231Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column226441TotalRevenueColumn
Exclusion$226,441ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
PHARMACY REVENUE6219901164239$1,164,239
CAFETERIA561000276144$276,144
WELLNESS CENTER561439259862$259,862

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column191008TotalRevenueColumn
Related Or Exempt Function Income1058RelatedOrExemptFunctionIncome
Exclusion$189,950ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1891253TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column89620126TotalRevenueColumn
Related Or Exempt Function Income86219374RelatedOrExemptFunctionIncome
Exclusion$3,171,385ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total926764Total
Management And General926764ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total33301234Total
Program Services30217330ProgramServices
Management And General3083904ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total799459Total
Program Services739086ProgramServices
Management And General60373ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6390672Total
Program Services5709357ProgramServices
Management And General681315ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2212057Total
Program Services1958243ProgramServices
Management And General253814ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total127552Total
Management And General127552ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total109043Total
Management And General109043ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4817936Total
Program Services4524044ProgramServices
Management And General293892ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total11005776Total
Program Services10274675ProgramServices
Management And General731101ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total12989Total
Program Services238ProgramServices
Management And General12751ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1444782Total
Program Services1287850ProgramServices
Management And General156932ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total249515Total
Program Services206955ProgramServices
Management And General42560ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1785200Total
Program Services1785200ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total5313614Total
Program Services4736556ProgramServices
Management And General577058ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total992758Total
Program Services95003ProgramServices
Management And General897755ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBTS1736127017361270
REPAIRS AND MAINT20702381520395549843
TAXES & LICENSES41143037629373801
DUES & SUBSCRIPTIONS225369110593114776
MISCELLANEOUS20268449303153381

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total141828Total
Program Services102947ProgramServices
Management And General38881ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total89902170Total
Program Services80716674ProgramServices
Management And General9185496ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2621589BOY
EOY3845201EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY8930610BOY
EOY8069070EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY3424BOY
EOY76EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY672813BOY
EOY640037EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2583784BOY
EOY2581612EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis85749123LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec53788155LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY34357643BOY
EOY31960968EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY31125919BOY
EOY33603163EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY607634BOY
EOY302953EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY9069926BOY
EOY8938573EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY89973342BOY
EOY89941653EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY13144059BOY
EOY12937858EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
EOY20695EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY35420624BOY
EOY34456071EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY48564683BOY
EOY47414624EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY41408659BOY
EOY42527029EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY41408659BOY
EOY42527029EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY89973342BOY
EOY89941653EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-282044ReconcilationRevenueExpenses
Reconcilation Other Changes1400414ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis257796OtherCostOrOtherBasis
Book Value257796BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis37742508OtherCostOrOtherBasis
Depreciation24293136Depreciation
Book Value13449372BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis133428OtherCostOrOtherBasis
Depreciation82211Depreciation
Book Value51217BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis35053601OtherCostOrOtherBasis
Depreciation29412808Depreciation
Book Value5640793BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis12561790OtherCostOrOtherBasis
Book Value12561790BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings31960968TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM RELATED PARTIES8262132
COST REPORT SETTLEMENT463043
DEFERRED FINANCING COST213398
FieldValueIRS element (for citing)
Total Book Value Other Assets8938573TotalBookValueOtherAssets

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierLIABILITY UNDER FIN 48 FOOTNOTEIdentifier
Return ReferenceSCHEDULE D, PAGE 3, PART XReturnReference
ExplanationCRH HEALTH CARE, INC., EXCLUDING CRH VENTURES, INC. AND SOUTHEASTERN MANAGED CARE, INC. IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage1.25000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense3012000TotalCommunityBenefitExpense
Net Community Benefit Expense3012000NetCommunityBenefitExpense
Percent Of Total Expense0.04100PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense15353904TotalCommunityBenefitExpense
Direct Offsetting Revenue15700243DirectOffsettingRevenue
Net Community Benefit Expense-346339NetCommunityBenefitExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense38869TotalCommunityBenefitExpense
Direct Offsetting Revenue26948DirectOffsettingRevenue
Net Community Benefit Expense11921NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense18404773TotalCommunityBenefitExpense
Direct Offsetting Revenue15727191DirectOffsettingRevenue
Net Community Benefit Expense2677582NetCommunityBenefitExpense
Percent Of Total Expense0.04120PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense241540TotalCommunityBenefitExpense
Net Community Benefit Expense241540NetCommunityBenefitExpense
Percent Of Total Expense0.00330PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense106272TotalCommunityBenefitExpense
Net Community Benefit Expense106272NetCommunityBenefitExpense
Percent Of Total Expense0.00150PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense16688TotalCommunityBenefitExpense
Net Community Benefit Expense16688NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense364500TotalCommunityBenefitExpense
Net Community Benefit Expense364500NetCommunityBenefitExpense
Percent Of Total Expense0.00500PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense18769273TotalCommunityBenefitExpense
Direct Offsetting Revenue15727191DirectOffsettingRevenue
Net Community Benefit Expense3042082NetCommunityBenefitExpense
Percent Of Total Expense0.04620PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$6,260,613BadDebtExpenseAmount
Amount Attributable To4640642AmountAttributableTo
Amount Reimbursed By Medicare17812378AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare18174329CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-361951MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1COFFEE REGIONAL MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11101 OCILLA ROAD P O BOX 1287AddressLine1
CityDOUGLASCity
StateGAState
ZIP Code31533ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherPHYS OFCS, RURAL HLTH CLINICOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COFFEE REGIONAL MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedfalseEligibilityCriteriaExplained
Uses FPG FreefalseUsesFPGFree
Uses FPG DiscountedfalseUsesFPGDiscounted
Explains BasisfalseExplainsBasis
Explains Application MethodfalseExplainsApplicationMethod
Includes Publicity MeasuresfalseIncludesPublicityMeasures
Actions On NonpaymentfalseActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
EXCLUSIONS FROM PERCENT OF TOTAL EXPENSEPART I LINE 7 COLUMN FIN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN F THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990 PART IX LINE 25 FORM 990 PART IX LINE 25 89902170 LESS BAD DEBTS IN PART IX 17361270 DENOMINATOR FOR COLUMN F 72540990
COSTING METHODOLOGY EXPLANATIONPART I LINE 7THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATIONS A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS 2008 SEE ALSO THE DESCRIPTION FOR PART III LINE 4
COMMUNITY BUILDING ACTIVITIESPART II5K RUN NOVEMBER 13 2010 COFFEE REGIONALS ANNUAL FALL FITNESS 5K RUNFUN WALK WAS HELD NOVEMBER 15 2010 WITH OVER 200 PARTICIPANTS IN ADDITION TO THE 5K EVENT A ONE MILE FUN RUN WAS HELD FOR THE YOUTH IN OUR COMMUNITY A CHECK FOR 3200 PROCEEDS FROM THE EVENT WAS DONATED TO THE COFFEE ALLIANCE FOR THE ARTS THE COFFEE ALLIANCE FOR THE ARTS IS A NON PROFIT ORGANIZATION FOCUSED ON PROVIDING ART ENRICHMENT EXPERIENCES FOR THE RESIDENTS OF COFFEE COUNTY APPROXIMATELY 40 MAN HOURS AT A COST OF 800 HEALTH FAIR OCTOBER 2 2010 THE ANNUAL HEALTH SAFETY FESTIVAL HELD OCTOBER 3 2010 ATTRACTED NEARLY 980 VISITORS WITH OVER 80 EXHIBITORS DEMONSTRATIONS AND HEALTH SCREENS THE FESTIVAL OFFERED WONDERFUL INTERACTIVE WAYS TO PROMOTE A HEALTHY LIFESTYLE 436 VISITORS TOOK ADVANTAGE OF THE COMPLETE BIOCHEMICAL BLOOD PROFILES OFFERED AT A REDUCED FEE OF 30 ACTUAL CHARGE OF 535 RESULTING IN A COMMUNITY SAVINGS OF 220180 APPROXIMATELY 100 MAN HOURS AT A COST OF 2000 PROSTATE CANCER SCREENING OCTOBER 15 17 2010 THE EARLIER PROSTATE CANCER IS DISCOVERED THE BETTER THE CHANCES ARE THAT IT CAN BE TREATED EFFECTIVELY WHEN PROSTATE CANCER IS IN ITS EARLIEST STAGES STILL CONFINED TO THE PROSTATE GLAND IT USUALLY CAUSES NO PAIN OR OTHER SYMPTOMS THATS WHY EACH YEAR COFFEE REGIONAL MEDICAL CENTER OFFERS LOW COST PROSTATE CANCER SCREENINGS DRE AND PSA BLOOD TEST TO YOUR COMMUNITY FOR A REDUCED LAB FEE OF ONLY 10 ACTUAL CHARGE 147 RESULTING IN A COMMUNITY SAVINGS OF 17399 IN 2010 127 MEN TOOK ADVANTAGE OF THIS LIFESAVING SCREEN APPROXIMATELY 6 PHYSICIAN HOURS AND 36 STAFF HOURS AT A COST OF 1620 SPORTS PHYSICALS MAY 19 2010 ATHLETIC PHYSICALS ARE REQUIRED BY BOTH THE GEORGIA HIGH SCHOOL AND GEORGIA INDEPENDENT SCHOOL ASSOCIATION FOR STUDENTS PLANNING ON PARTICIPATING IN SCHOOL ATHLETIC PROGRAMS EACH YEAR COFFEE REGIONAL PROVIDES OVER 600 SPORTS PHYSICALS TO STUDENTS PARTICIPATING IN INTERSCHOLASTIC SPORTS DURING THE SUMMER AND THROUGHOUT THE FOLLOWING YEAR THIS EVENT RESULTED IN A TOTAL COST SAVINGS TO THE COMMUNITY OF OVER 15000 APPROXIMATELY 40 PHYSICIAN HOURS AND 32 STAFF HOURS AT A COST OF 6640 PROJECT SEARCH PROJECT SEARCH IS A ONEYEAR EDUCATIONAL PROGRAM FOR STUDENTS WITH DISABILITIES IN THEIR LAST YEAR OF HIGH SCHOOL IT IS TARGETED FOR STUDENTS WHOSE MAIN GOAL IS COMPETITIVE EMPLOYMENT COFFEE REGIONAL MEDICAL CENTER PROVIDES THE SETTING FOR TWELVE PROJECT SEARCH STUDENTS THUS ALLOWING TOTAL IMMERSION IN THE WORKPLACE TO FACILITATE THE TEACHING AND LEARNING PROCESS THROUGH CONTINUOUS FEEDBACK AND APPLICATION OF NEW SKILLS INDIVIDUALIZED JOB DEVELOPMENT AND PLACEMENT BEGINS AFTER ROTATIONS AT ONE OR MORE WORKSTATIONS ARE COMPLETED STUDENTS RECEIVE SUPPORT THROUGH ONTHEJOB COACHING AND WORKSITE ACCOMMODATIONS PROVIDED BY COFFEE REGIONAL THE PROGRAM IS DEDICATED TO WORKFORCE DEVELOPMENT THAT BENEFITS THE INDIVIDUAL COMMUNITY AND WORKPLACE BREAST CANCER SUPPORT GROUP MONTHLY 2010 IN 2010 COFFEE REGIONAL OFFERED A FREE MONTHLY BREAST CANCER SUPPORT GROUP FOR WOMEN IN THE COMMUNITY RECENTLY DIAGNOSED WITH BREAST CANCER THOSE UNDERGOING TREATMENT AND THOSE WHO HAVE COMPLETED TREATMENT CRMCS CLINICAL EDUCATION DEPARTMENT LEADS AND ORGANIZES EACH MEETING PROVIDING SUPPORT EDUCATION RESOURCES AND EXPERT SPEAKERS AT EACH MEETING APPROXIMATELY 1015 PEOPLE ATTEND EACH MONTHLY MEETING 144 MAN HOURS PER YEAR AT A COST OF 2800 DIABETES SUPPORT GROUP MONTHLY 2010 COFFEE REGIONAL OFFERS A FREE MONTHLY DIABETES SUPPORT GROUP FOR THE GENERAL PUBLIC CRMCS CLINICAL EDUCATION DEPARTMENT LEADS AND ORGANIZES EACH MEETING PROVIDING SUPPORT EDUCATION RESOURCES AND EXPERT SPEAKERS AT EACH MEETING EXPERTS SUCH AS DIETICIANS PODIATRISTS AND PHYSICIANS PROVIDE VALUABLE EDUCATION TO OUR COMMUNITY REGARDING DIABETES APPROXIMATELY 30 PEOPLE ATTEND EACH MONTHLY MEETING 144 MAN HOURS PER YEAR AT A COST OF 2800 AMERICAN CANCER SOCIETY RELAY FOR LIFE APRIL 2010 CRMC PROVIDES A CORPORATE SPONSOR OF 1500 ANNUALLY TO THE AMERICAN CANCER SOCIETY FOR CANCER RESEARCH TREATMENT AND RESOURCES EACH YEAR MANY OF COFFEE REGIONAL EMPLOYEES PROVIDE NUMEROUS MAN HOURS FOR THE COMMUNITY WIDE RELAY FOR LIFE EVENT IN EFFORT TO RAISE MONEY AND AWARENESS APPROXIMATELY 180 MAN HOURS AT A COST OF 3600
BAD DEBT EXPENSE EXPLANATIONPART III LINE 4AMOUNTS ON PART III LINES 2 AND 3 WERE CALCULATED USING THE RCC AS DEFINED IN WORKSHEET 2 EXCERPT FROM AUDITED FINANCIAL STATEMENTS ALLOWANCE FOR DOUBTFUL ACCOUNTS THE CORPORATION PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON AN EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE
MEDICARE EXPLANATIONPART III LINE 8THE MEDICARE SHORTFALL OF 361951 SHOULD BE TREATED AS COMMUNITY BENEFIT UNLESS SERVICES WERE PROVIDED BY THIS NOTFORPROFIT ORGANIZATION THESE MEDICARE PATIENTS WOULD BECOME THE OBLIGATION OF GOVERNMENT SINCE THE FEDERAL GOVERNMENT WOULD NEED TO FULFILL THIS RESPONSIBLITY MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS
COLLECTION PRACTICES EXPLANATIONPART III LINE 9BTHE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES FOR PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS
NEEDS ASSESSMENTPART VITHE ORGANIZATION EVALUATES THE NEEDS OF THEIR PATIENT BASE THROUGH THE NUMBER OF PATIENTS REFERRED TO OTHER FACILITIES FOR SERVICES NOT PROVIDED BY THE FACILITY ITSELF AND THROUGH OTHER INDICATORS
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPART VIFINANCIAL COUNSELING DEPARTMENT WILL PROVIDE INFORMATION AND APPLICATIONS TO ALL PATIENTSGUARANTORS SEEKING FINANCIAL ASSISTANCE FOR SERVICES RENDERED AT COFFEE REGIONAL MEDICAL CENTER THAT ARE DEEMED MEDICALLY NECESSARY FINANCIAL COUNSELORS WILL DISCUSS ELIGIBILITY FOR MEDICAL ASSISTANCE PROGRAMS THROUGH THE DEPARTMENT OF FAMILY CHILDREN SERVICES AND SOCIAL SECURITY ADMINISTRATION IF ELIGIBILITY IS NOT MET FOR ANY MEDICAL ASSISTANCE PROGRAM THE FINANCIAL COUNSELING DEPARMTENT WILL SEEK ELIGIBILITY THROUGH COFFEE REGIONAL MEDICAL CENTERS INDIGENT CARE TRUST FUND PROGRAM PATIENTSGUARANTORS REQUESTING FINANCIAL ASSISTANCE ARE REFERRED TO THE FINANCIAL COUNSELORS FC OR BENEFIT SPECIALIST AT THE TIME OF REGISTRATION FOR OUTPATIENT SERVICES AND EMERGENCY DEPARTMENT AFTER MEDICAL SCREENING HAS BEEN COMPLETED SOCIAL SERVICES REQUEST PHYSICIAN OFFICES REQUEST OR FROM THE PATIENT FINANCIAL SERVICES DEPARTMENT PATIENTS ADMITTED FOR INPATIENT OR OBSERVATION SERVICES MAY BE VISITED BY THE FC AFTER THE PATIENT HAS BEEN PLACED IN A ROOM AND STABILIZED FC WILL DISCUSS WITH THE PATIENTGUARANTOR THE INDIGENT CARE TRUST FUND PROGRAM REQUIREMENTS AND APPLICATION PROCESS THE PATIENTGUARANTOR WILL BE REQUIRED TO COMPLETE AN INDIGENT APPLICATION PROVIDE PROOF OF IDENTITY PROVIDE BIRTH CERTIFICATES OR PROOF OF DEPENDENCY FOR CHILDREN WITH NO IDENTITY AND PROVIDE VERIFICATION OF INCOME IE W2S FEDERAL TAX RETURN PAY STUBS ETC IF VERIFICATION IS NOT PROVIDED AT THE TIME OF THE INTERVIEW THE PATIENTGUARANTOR WILL BE REQUIRED TO PROVIDE WITHIN 30 DAYS APPLICATIONS MADE ON BEHALF OF DECEASED PATIENTS MUST HAVE VERIFICATION OF INCOME AND INFORMATION CONCERNING THE VALUE OF THE PATIENTS ESTATE PATIENTS WHO CHOOSE NOT TO UTILIZE CURRENT BENEFITS THEY ARE ELIGIBLE FOR IE VETERANS BENEFITS MEDICARE AND COMMERCIAL INSURANCE WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM UPON RECEIPT OF THE COMPLETED APPLICATION INCLUDING NECESSARY DOCUMENTATION CALCULATION OF THE HOUSEHOLD SIZE AND ANNUAL HOUSEHOLD INCOME IS COMPUTED AND COMPARED TO THE FEDERAL POVERTY GUIDELINES FPG TO DETERMINE THE PERCENTAGE OF ASSISTANCE A PATIENTGUANRANTOR IS ELIGIBLE TO RECEIVE PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW THE GROSS INCOME CEILING FOR POTENTIAL MEDICAID ELIGIBILITY ARE REQUIRED TO APPLY FOR MEDICAID ASSISTANCE IS PROVIDED TO PATIENTS IN FILING FOR OTHER BENEFITS AND COMPLETING MEDICAID APPLICATIONS PATIENTS WHO CHOOSE NOT TO APPLY FOR OTHER BENEFITS TO WHICH THEY MAY BE ENTITLED IE MEDICAID APPLICATIONS WILL NOT BE CONSIDERED FOR THE INDIGENT PROGRAM PATIENTS WHO CHOOSE TO APPLY COFFEE REGIONAL MEDICAL CENTERS ACCOUNTS FOR THE PURPOSE OF MEETING MEDICALLY NEEDY SPEND DOWN TO RECEIVE ONGOING MEDICAID WILL NOT BE ALLOWED TO APPLY FOR THE INDIGENT PROGRAM FOR THAT ACCOUNT PATIENTSGUARANTORS OVER 18 YEARS OF AGE BUT CLASSIFIED AS DEPENDENTS FOR TAX PURPOSES DUE TO STUDENT ELIGIBILITY WILL HAVE A TOTAL HOUSEHOLD SIZE INCLUDING PARENTS AND SUBSEQUENT INCOME PATIENTSGUARANTORS NOT ELIGIBLE FOR OTHER MEDICAL ASSISTANCE PROGRAMS WILL BE PROCESSED UNDER THE INDIGENT CARE TRUST FUND GUIDELINES USING THE FOLLOWING CATEGORIES INDIGENT PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BELOW 125 OF THE FPG THE APPLICABLE ACCOUNTS WILL BE ADJUSTED TO ZERO BALANCES CHARITY PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN OR EQUAL TO 125 BUT NOT GREATER THAN 200 OF THE FPG THE APPLICABLE ACCOUNTS WILL BE ADJUSTED BY THE APPROPRIATE PERCENTAGES AN ADJUSTMENT OF 85 OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 125 AND 150 OF FPG AN ADJUSTMENT OF 70 OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 150 AND 175 OF FPG AN ADJUSTMENT OF 55 OF APPLICABLE CHARGES FOR PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS BETWEEN 175 AND 200 OF FPG CATASTROPHIC PATIENTS WHOSE ANNUAL HOUSEHOLD INCOME IS GREATER THAN 200 FPG MAY QUALIFY FOR CHARITY ADJUSTMENTS ON APPLICABLE ACCOUNTS IF CONSIDERATION OF CRMC PATIENT OBLIGATIONS REDUCES THE ANNUAL HOUSEHOLD INCOME TO THE APPROPRIATE FPG NOTIFICATION OF STATUS OF COMPLETED APPLICATION IS PROVIDED TO THE PATIENTGUARANTOR WITHIN 5 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION APPROVED APPLICATIONS ARE VALID FOR 30 DAYS FROM DATE OF SIGNATURE INCOMPLETE APPLICATIONS ARE HELD FOR 30 DAYS IF NO DOCUMENTATION IS PROVIDED TO COMPLETE THE APPLICATION A DENIAL LETTER IS SENT TO THE PATIENTGUARANTOR THE APPLICATION MAY BE COMPLETED IF THE PATIENTGUARANTOR PROVIDES THE REQUESTED INFORMATION WITHIN 15 WORKING DAYS OF THE DENIAL NOTIFICATION OF STATUS OF COMPLETED APPLICATION WILL BE MAILED WITHIN 15 WORKING DAYS OF RECEIPT OF NEEDED INFORMATION NO CONSIDERATION FOR ELIGIBILITY WILL BE REVIEWED FOR ACCOUNTS REFERRED TO OUTSIDE COLLECTION AGENCIES THE APPLICATION AND DOCUMENTATION WILL BECOME PROPERTY OF COFFEE REGIONAL MEDICAL CENTER AND IS TO BE KEPT CONFIDENTIAL IN THE SAME MANNER AS MEDICAL RECORDS HOWEVER THIS INFORMATION WILL BE USED FOR AGGREGATE REPORTING PURPOSES ONLY
COMMUNITY INFORMATIONPART VICOFFEE REGIONAL MEDICAL CENTERS PRIMARY SERVICE AREA IS COFFEE COUNTY THE COUNTY HAD A POPULATION OF 42356 CITIZENS IN DECEMBER OF 2010 OF WHICH APPROXIMATELY 259 FALL BELOW GOVERNMENTAL DEFINED POVERTY GUIDELINES THE UNINSURED PERCENTAGE OF THE POPULATION WAS 193 COFFEE COUNTYS UNEMPLOYMENT RATE AT YEAREND WAS 147
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSEPART VICOFFEE REGIONAL MEDICAL CENTER IS GOVERNED BY A BOARD OF DIRECTORS CONSISTING OF 11 MEMBERS THE COFFEE COUNTY HOSPITAL AUTHORITY NOMINATES POTENTIAL BOARD MEMBERS AS OPENINGS ARISE THE BOARDS MAKEUP IS NINE COMMUNITY MEMBERS REFLECTING THE DIVERSITY OF THE COMMUNITY THE REMAINING TWO MEMBERS ARE THE CHIEF OF STAFF AND CHIEF OF STAFF ELECT IT IS THE PHILOSOPHY OF COFFEE REGIONAL MEDICAL CENTER TO ASSURE THE CONTINUATION AND ENHANCEMENT OF PATIENT CARE BY REINVESTING EXCESS FUNDS BACK INTO THE OPERATIONS OF THE FACILITY THIS INCLUDES GREATER ACCESSIBILITY OF CARE THROUGH THE CREATION OF A RURAL HEALTH CENTER IMPLEMENTATION OF A TELEMEDICINE PROGRAM AND RECRUITMENT OF PHYSICIANS TO THE UNDERSERVED ENVIRONMENT ENHANCEMENT OF TECHNOLOGY IS ALSO IMPERATIVE TO ASSURE APPROPRIATE DIAGNOSTIC AND THERAPEUTIC OPTIONS FOR THE COMMUNITY UPDATING THE AMBULANCE FLEET IS CONSISTENTLY HIGH ON THE FUNDING PRIORITY LIST TO ASSURE SERVICE TO THE MOST REMOTE AREAS OF THE COUNTY WHICH IN SQUARE MILES IS THE SECOND LARGEST COUNTY IN THE STATE OF GEORGIA
LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILEDPART VIGEORGIA

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredfalseSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
GEORGE HECK
35423266281225023564396674
DONALD C LEWIS
25434830261225022862292486
SHERRY THOMAS
214338791092212265237604
THOMAS C HENRIS MD
484821421225021369518482
EDDY N DUNCAN MD
473130271225021369506776
JONATHAN GASKINS MD
38339912122504837400498
CHARLES COWART MD
363652421225012265388209
JEFFERY T WINGE MD
270546151225017545300356

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierFRINGE OR EXPENSE EXPLANATIONIdentifier
Return ReferenceSCHEDULE J, PAGE 1, PART I, LINE 1AReturnReference
ExplanationEXECUTIVE AND KEY PERSONNEL WERE PROVIDED COUNTRY CLUB MEMBERSHIPS TO AID IN MARKETING AND FOR REWARD AND RECOGNITION.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1COFFEE COUNTY HOSPITAL AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN586003116IssuerEIN
CUSIP Number192137DJ3CUSIPNumber
Date Issued2004-11-16DateIssued
Issue Price39213858IssuePrice
Description Of PurposeDEFEASEMENT OF PREVIOUS BONDSDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Issuance Costs From Proceeds767435IssuanceCostsFromProceeds
Working Capital Expenditures38446423WorkingCapitalExpenditures
Year Of Subst Completion2004YearOfSubstCompletion
Current RefundingfalseCurrentRefunding
Advance RefundingtrueAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtyfalseMngmentCntrctBondFinancdPrprty
Any Research AgreementsfalseAnyResearchAgreements
Bond Counsel Routinely EngagedfalseBondCounselRoutinelyEngaged
Post Issuance Compliance ProcdrstruePostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T FiledfalseForm8038TFiled
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Gross Proceeds InvestedfalseGrossProceedsInvested
Exception To RebatefalseExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FINANCIAL ACCOUNTS IN FOREIGN COUNTRIESFORM 990, PART V, LINE 4BCAYMAN ISLANDS
ELECTION OF MEMBERS AND THEIR RIGHTSFORM 990, PAGE 6, PART VI, LINE 7ABOARD MEMBERS OF THE ORGANIZATION ARE APPOINTED BY CRH HEALTH CARE, INC., THE PARENT ORGANIZATION.
DECISIONS SUBJECT TO APPROVAL OF MEMBERSFORM 990, PAGE 6, PART VI, LINE 7BDECISIONS OF THE BOARD ARE SUBJECT TO APPROVAL BY CRH HEALTH CARE, INC., THE PARENT ORGANIZATION.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BFORM 990 IS PROVIDED TO THE BOARD FOR THEIR REVIEW AFTER FILING WITH THE IRS. MANAGEMENT'S REVIEW OF FORM 990 IS PERFORMED BEFORE THE FILING DATE AND INCLUDES A REVIEW OF FINANCIAL DATA AND OTHER DETAILS.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CBOARD MEMBERS ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS ANNUALLY. THIS IS REVIEWED BY THE CEO AND BOARD CHAIRMAN, IF NEEDED. MEMBERS HAVE EXCUSED THEMSELVES FROM CERTAIN DISCUSSIONS/DECISIONS AS A RESULT OF CONFLICTS.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ABOARD COMPENSATION COMMITTEE REVIEWS COMPENSATION DATA FROM SEVERAL SOURCES. IN 2010, YAFFE AND ASSOCIATES WAS ENGAGED TO PROVIDE THE CEO/VP'S COMPENSATION ANALYSIS.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BSEE RESPONSE FOR LINE 15A ABOVE.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS OF THE ORGANIZATION ARE ALL AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S CORPORATE OFFICE.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1CRH PHYSICIAN PRACTICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11101 OCILLA ROADAddressLine1
CityDOUGLASCity
StateGAState
ZIP Code31533ZIPCode
FieldValueIRS element (for citing)
EIN205778734EIN
Primary ActivitiesPHY OFCPrimaryActivities
Legal Domicile StateGALegalDomicileState
Total Income5808690TotalIncome
EOY Assets1102507EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CRH HEALTH CARE INC
1101 OCILLA ROAD P O BOX 1287DOUGLASGA31533582163724MGMT SVCGA501C311DNAfalse
CRH HEALTH SERVICES INC
1101 OCILLA ROAD P O BOX 1287DOUGLASGA31533582165827FOUNDATIONGA501C311DNAfalse

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
CRH VENTURES INC
1101 OCILLA ROAD P O BOX 1287DOUGLASGA31533582165279OFC RENTALGAN/A
SOUTHEASTERN MANAGED CARE INC
1101 OCILLA ROAD P O BOX 1287DOUGALSGA31533582236627MNGD CAREGAN/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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