DONALSONVILLE HOSPITAL INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- DONALSONVILLE HOSPITAL INC (EIN 58-0973772)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-16
- IRS object ID
- 201121369349306372
- 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 | 2011-05-16T16:18:16-05:00 | 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 | BURKE WORSHAM & HARRELL LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 208 S WOOLFORK AVE | AddressLine1 |
| City | DONALSONVILLE | City |
| State | GA | State |
| ZIP Code | 39845 | 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 | 580973772 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DONALSONVILLE HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | DONA | NameControl |
| Phone | 2295245217 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 102 HOSPITAL CIRCLE | AddressLine1 |
| City | DONALSONVILLE | City |
| State | GA | State |
| ZIP Code | 39845 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | HERMAN BROOKINS | Name |
| Title | PRESIDENT | Title |
| Phone | 2295245217 | Phone |
| Date Signed | 2011-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JUJUAN B BOWEN | Name |
| Phone | 2295242137 | Phone |
| Date Prepared | 2011-05-16 | DatePrepared |
| 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) |
|---|---|---|
| Gross Receipts | 32769480 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1977 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | THE MISSION OF DONALSONVILLE HOSPITAL, INC. IS TO PROVIDE, AT THE DIRECTION OF OUR MEDICAL STAFF, A UNIFORM LEVEL OF HIGH QUALITY SERVICES AS ARE WITHIN OUR SCOPE OF SERVICES TO ALL WHO SEEK OUR AID. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 5 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 398 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 29106441 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 30550984 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 278773 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2060720 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 74878 | OtherRevenuePriorYear |
| Other Revenue Current Year | 64701 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 29460092 | TotalRevenuePriorYear |
| Total Revenue Current Year | 32676405 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12048534 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 16865297 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 22239085 | OtherExpensePriorYear |
| Other Expenses Current Year | 13654961 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 34287619 | TotalExpensesPriorYear |
| Total Expenses Current Year | 30520258 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -4827527 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2156147 | RevenuesLessExpensesCY |
| Total Assets BOY | 41150379 | TotalAssetsBOY |
| Total Assets EOY | 43672283 | TotalAssetsEOY |
| Total Liabilities BOY | 2733417 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3099174 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 38416962 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 40573109 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE MISSION OF DONALSONVILLE HOSPITAL, INC. IS TO PROVIDE, AT THE DIRECTION OF OUR MEDICAL STAFF, A UNIFORM LEVEL OF HIGH QUALITY SERVICES AS ARE WITHIN OUR SCOPE OF SERVICES TO ALL WHO SEEK OUR AID. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 25060 | Expense |
| Description | DONALSONVILLE HOSPITAL COLLABORATES WITH THE SEMINOLE COUNTY HEALTH DEPARTMENT TO HELP PROVIDE ASSISTANCE TO OUR UNINSURED, NON-MEDICAID POPULATION THAT SUFFERS FROM HYPERTENSION AND DIABETES. THE GOAL IS TO ASSURE THE AVAILABILITY OF JOINT MANAGED SERVICES TO THE POPULATION WITH THESE CHRONIC DISEASES IN SEMINOLE COUNTY. THE PROGRAM INCLUDES SCREENING, EDUCATION, ANNUAL LAB TESTS, MONITORING AND TREATMENT FOR PREVENTION AND CONTROL OF HYPERTENSION AND DIABETES FOR THE NEEDY POPULATION OF SEMINOLE COUNTY. THE TARGET POPULATION INCLUDES THOSE SEMINOLE COUNTY RESIDENTS WHO HAVE DIABETES AND/OR HYPERTENSION AND ARE UNINSURED, UNDER INSURED, NON-MEDICAID ELIGIBLE, AND ON FIXED INCOMES. THERE IS A DEFINITE COMMUNITY NEED IN SEMINOLE COUNTY WITH ABOUT 35.8% OF THE DEATHS IN SEMINOLE COUNTY BEING RELATED TO CARDIOVASCULAR DISEASE. THE AMERICAN HEART ASSOCIATION HAS REPORTED THAT FOR EVERY DOLLAR SPEND FOR HYPERTENSION/DIABETES MANAGEMENT THAT THERE IS A NET SAVINGS OF NINE DOLLARS PER DIRECT AND INDIRECT HEALTH REALTED COSTS. THERE WERE ABOUT 103 ACTIVE PATIENTS ENROLLED IN THE SEMINOLE COUNTY PROGRAM. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 4091157 | Expense |
| Description | PROVIDED PRIMARY HEALTHCARE TO RESIDENTS OF SEMINOLE AND SURROUNDING COUNTIES. SERVICES ARE PROVIDED WITHOUT REFERENCES TO RACE, RELIGION OR THEIR ABILITY TO PAY. INDIGENT PATIENTS WERE CLASSIFIED AS ANY PATIENT WITHOUT THIRD PARTY COVERAGE THAT HAD AN INCOME LEVEL BELOW 125% OF FEDERAL POVERTY GUIDELINES. CHARITY PATIENTS WERE CLASSIFIED AS ANY PATIENT WITHOUT THIRD PARTY COVERAGE THAT HAD AN INCOME LEVEL BETWEEN 125% AND 200% OF THE FEDERAL POVERTY GUIDELINES. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 128084 | Expense |
| Description | PROVIDE ASSISTANCE TO LOCAL STUDENTS IN OBTAINING HEALTHCARE DEGREES AND CERTIFICATIONS. LOCAL STUDENTS ARE GIVEN FINANCIAL ASSISTANCE THAT PAYS FOR BOOKS, TUITION AND LODGING FOR DEGREES AND CERTIFICATIONS IN THE HEALTHCARE INDUSTRY. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 55318 | Expense |
| Description | THE MISSION OF DONALSONVILLE HOSPITAL, INC. IS TO PROVIDE, AT THE DIRECTION | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 55318 | TotalOfOtherProgramServiceExp |
| Total Program Service Expense | 4299619 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 26 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 398 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Nbr Voting Governing Body Members | 5 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | false | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JAMES MOODY | NamePerson |
| Telephone Number | 2295245217 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 102 HOSPITAL CIRCLE | AddressLine1 |
| City | DONALSONVILLE | City |
| State | GA | State |
| ZIP Code | 39845 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| HERMAN BROOKINS | ||||||||
| DIRECTOR/CHR | 40.00 | X | X | 432282 | 0 | 0 | ||
| CHARLES H ORRICK | ||||||||
| DIRECTOR/ADM | 40.00 | X | X | 238490 | 0 | 0 | ||
| BROADDUS SIMPSON | ||||||||
| DIRECTOR/SEC | 1.00 | X | 8174 | 0 | 0 | |||
| MITCH BLANKS | ||||||||
| DIRECTOR | 1.00 | X | 8174 | 0 | 0 | |||
| BILL BURKE | ||||||||
| DIRECTOR | 1.00 | X | 8174 | 0 | 0 | |||
| JAMES MOODY | ||||||||
| CFO | 40.00 | X | 206407 | 0 | 0 | |||
| APRIL HARTMAN | ||||||||
| PHYSICIAN | 40.00 | 422545 | 0 | 0 | X | |||
| MURDOC M HENDERSON | ||||||||
| PHYSICIAN | 40.00 | 317308 | 0 | 0 | X | |||
| JOSEPH WALKER JR | ||||||||
| PHYSICIAN | 40.00 | 275000 | 0 | 0 | X | |||
| ANDREA WADDELL | ||||||||
| PHYSICIAN | 40.00 | 250000 | 0 | 0 | X | |||
| ROYCE M CANNINGTON | ||||||||
| CRNA | 40.00 | 210018 | 0 | 0 | X | |||
| DAVID KAY | ||||||||
| PHYSICIAN | 40.00 | 192231 | 0 | 0 | X | |||
| RICHARD WOLFF | ||||||||
| PHYSICIAN | 40.00 | 0 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2568803 | TotalReportableCompFromOrg |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| NATIONAL EMERGENCY SERVICE | |||||
| PO BOX 65810 | CHARLOTTE | NC | 28265 | PHYSICIANS | 656408 |
| RSI | |||||
| 200 AREZONA AVE SUITE 200 | ATLANTA | GA | 30307 | RADIOLOGY SERV | 496574 |
| MEDICAL DOCTOR ASSOC | |||||
| PO BOX 277185 | ATLANTA | GA | 30384 | LOCUMTENEN SERV | 455551 |
| LABCORP | |||||
| PO BOX 2240 | BURLINGTON | NC | 27216 | PROF LAB SERV | 146460 |
| DRAFFIN & TUCKER | |||||
| 2617 GILLIONVILLE ROAD | ALBANY | GA | 31703 | AUDIT/COST REP | 135025 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | REVENUE FROM OPERATIONS | Description |
| Total Revenue Column | 30550984 | TotalRevenueColumn |
| Exclusion | $30,550,984 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 30550984 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2060720 | TotalRevenueColumn |
| Exclusion | $2,060,720 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 157776 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 93075 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 64701 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 64701 | TotalRevenueColumn |
| Exclusion | $64,701 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 32676405 | TotalRevenueColumn |
| Exclusion | $32,676,405 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 860831 | Total |
| Management And General | 860831 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11432290 | Total |
| Program Services | 4299619 | ProgramServices |
| Management And General | 7132671 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4572176 | Total |
| Management And General | 4572176 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 609441 | Total |
| Management And General | 609441 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 860977 | Total |
| Management And General | 860977 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8662 | Total |
| Management And General | 8662 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1250553 | Total |
| Management And General | 1250553 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral |
|---|---|---|
| SUPPLIES & DRUGS | 4955357 | 4955357 |
| OTHER FEES | 2673743 | 2673743 |
| BAD DEBT EXPENSE | 2042823 | 2042823 |
| CONTRACT SERVICES | 1101363 | 1101363 |
| INSURANCE | 152042 | 152042 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30520258 | Total |
| Program Services | 4299619 | ProgramServices |
| Management And General | 26220639 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16335945 | BOY |
| EOY | 1502135 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7533601 | BOY |
| EOY | 7373657 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2778880 | BOY |
| EOY | 1792465 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 768959 | BOY |
| EOY | 839005 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59219 | BOY |
| EOY | 67388 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 24681513 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 12012817 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13207299 | BOY |
| EOY | 12668696 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 466476 | BOY |
| EOY | 19428937 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41150379 | BOY |
| EOY | 43672283 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2673331 | BOY |
| EOY | 3099164 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60086 | BOY |
| EOY | 10 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2733417 | BOY |
| EOY | 3099174 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38416962 | BOY |
| EOY | 40573109 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38416962 | BOY |
| EOY | 40573109 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41150379 | BOY |
| EOY | 43672283 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | true | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 24681513 | OtherCostOrOtherBasis |
| Depreciation | 12012817 | Depreciation |
| Book Value | 12668696 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 12668696 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CREDIT LINES | Description |
| Amount | $10 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 10 | TotalOfAmounts |
| Total Revenue | 32676405 | TotalRevenue |
| Total Expenses | 30520258 | TotalExpenses |
| Excess Or Deficit For Year | 2156147 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 2156147 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 32676405 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 32676405 | RevenueSubtotal |
| Total Revenue Per Form990 | 32676405 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 30520258 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 30520258 | ExpensesSubtotal |
| Total Expenses Per Form990 | 30520258 | TotalExpensesPerForm990 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1595551 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1595551 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.94000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1595551 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1595551 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.94000 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 417 | PersonsServed |
| Total Community Benefit Expense | 93000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 93000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 417 | PersonsServed |
| Total Community Benefit Expense | 93000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 93000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06000 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 417 | PersonsServed |
| Total Community Benefit Expense | 1688551 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1688551 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 1.00000 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $796,770 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 2603888 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2603888 | CostOfCareReimbursedByMedicare |
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 | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | false | ProvisionForCharityCare |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DONALSONVILLE HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 102 HOSPITAL CIRCLE | AddressLine1 |
| City | DONALSONVILLE | City |
| State | GA | State |
| ZIP Code | 39845 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Critical Access Hospital | X | CriticalAccessHospital |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subsidized Health Services Expln | 1 PART I 7A TOTAL COMMUNITY BENEFIT REPORTED FROM CHARITY AND INDIGENT CARE GIVEN AT COST. TOTAL CHANGES = 4,091,157 X 39% (TOTAL OVERALL COST TO CHANGE RATIO) = 1,595,551 1 PART I 7G TOTAL AMOUNTS PAID TO LOCAL HEALTH DEPARTMENT FOR TREATMENT OF HYPERTENSION AND DIABETIC PATIENTS IN THE COMMUNITY. TOTAL AMOUNTS PAID TO CONSULTING COMPANY THAT ASSISTS LOCAL RESIDENTS WITH OBTAINING FREE PRESCRIPTION DRUG COVERAGE. 1 PART III LINE 4 DID NOT USE AS COMMUNITY BENEFIT. 1 PART III LINE 8 DID NOT USE AS COMMUNITY BENEFIT. | SubsidizedHealthServicesExpln |
| Needs Assessment | BOARD DISCUSSES NEEDS OF COMMUNITY WITH PHYSICIANS AND DEPARTMENT HEADS TO DETERMINE WHAT PROGRAMS SERVICES ARE NEEDY IN THIS COMMUNITY. | NeedsAssessment |
| Patient Education Assistance | SIGNS ARE POSTED THROUGHOUT FACILITY IN THE ADMISSIONS AREA OF GENERAL MED SURGERY, OB AND ER AS WELL AS THE WAITING ROOMS IN THOSE DEPARTMENTS. | PatientEducationAssistance |
| Community Information | SMALL RURAL COMMUNITY WITH APPROXIMATELY 9000 RESIDENTS IN THE COUNTY WITH AGRICULTURE BEING THE MAIN SOURCE OF EMPLOYMENT AND INDUSTRY. 65% OF THE POPULATION SERVED IN OUR COMMUNITY HAVE 3RD PARTY COVERAGE FROM MEDICARE OR MEDICAID. | CommunityInformation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|
| HERMAN BROOKINS | ||
| 424108 | 8174 | 432282 |
| CHARLES H ORRICK | ||
| 230316 | 8174 | 238490 |
| JAMES MOODY | ||
| 206407 | 206407 | |
| APRIL HARTMAN | ||
| 422545 | 422545 | |
| MURDOC M HENDERSON | ||
| 317308 | 317308 | |
| JOSEPH WALKER JR | ||
| 275000 | 275000 | |
| ANDREA WADDELL | ||
| 250000 | 250000 | |
| ROYCE M CANNINGTON | ||
| 210018 | 210018 | |
| DAVID KAY | ||
| 192231 | 192231 | |
| RICHARD WOLFF | ||
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FIRST ACHIEVEMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4A | BEING RELATED TO CARDIOVASCULAR DISEASE. THE AMERICAN HEART ASSOCIATION HAS REPORTED THAT FOR EVERY DOLLAR SPEND FOR HYPERTENSION/DIABETES MANAGEMENT THAT THERE IS A NET SAVINGS OF NINE DOLLARS PER DIRECT AND INDIRECT HEALTH REALTED COSTS. THERE WERE ABOUT 103 ACTIVE PATIENTS ENROLLED IN THE SEMINOLE COUNTY PROGRAM. |
| ALL OTHER ACHIEVEMENTS DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4D | THE MISSION OF DONALSONVILLE HOSPITAL, INC. IS TO PROVIDE, AT THE DIRECTION |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11 | NO REVIEW WAS OR WILL BE CONDUCTED. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | OUR ORGANIZATION REGULARLY MONITORS THE POLICY COMPLIANCE THROUGH MONTHLY BOARD MEETINGS. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD OF DIRECTORS MEET REGULAR ON A MONTHLY BASIS AND THE ORGANIZATIONS SALARY DECISIONS ARE REVIEWED BY THE BOARD. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | HE BOARD OF DIRECTORS MEET REGULAR ON A MONTHLY BASIS AND THE SALARY DECISIONS ARE REVIEWED BY THE BOARD. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC |
| ADDITIONAL INFORMATION | SCHEDULE O | SEMINOLE COUNTY PRIMARY CARE PROGRAM DONALSONVILLE HOSPITAL VENDOR : SPRING CREEK HEALTH COOPERATIVE JULY 2009 - JUNE 2010 ACHIEVEMENTS OF THE PROGRAM PHARMACEUTICAL ASSISTANCE PROGRAM YEARLY SUMMARY - SEMINOLE CO PHARMACEUTICAL COORDINATOR (PC) HAS SERVED A TOTAL OF 314 PATIENTS AT THE DONALSONVILLE HOSPITAL. A TOTAL OF 113 NEW PATIENTS WERE ENROLLED THIS YEAR. PC HAD A TOTAL OF 1,139 MEDICATION CONTACTS WITH PATIENT PROVIDING 7,695 PRESCRIPTIONS VALUED AT 1,134,551 FOR THE FISCAL YEAR; A MONTHLY AVERAGE OF 94,546; AND A 20:1 RETURN ON INVESTMENT. AVERAGE COST PER DRUG WAS VALUED AT 147.44 PER KAISER FAMILY FOUNDATION. CASE MANAGEMENT PROGRAM CASE MANAGER (CM) PROVIDED DISEASE AND BEHAVIORAL CASE MANAGEMENT TO 48 PATIENTS DURING THE FIRST QUARTER OF THIS FISCAL YEAR. DUE TO STAFFING ISSUES, THE CASE MANAGEMENT PROGRAM WAS NOT CONTINUED FROM OCT 09 THROUGH JUNE 10. ER REFERRALS PROGRAM HOSPITAL STAFF CONTINUES TO REFER UNINSURED PATIENT IN NEED OF MEDICATIONS TO THE PHARMACEUTICAL COORDINATOR FOR ENROLLMENT IN THE FREE AND/OR REDUCED MEDICATION PROGRAM. |