2011-05-16T16:18:16-05:00 2010-06-30 BURKE WORSHAM & HARRELL LLC 208 S WOOLFORK AVE DONALSONVILLE GA 39845 990 2009-07-01 580973772 DONALSONVILLE HOSPITAL INC DONA 2295245217 102 HOSPITAL CIRCLE DONALSONVILLE GA 39845 HERMAN BROOKINS 2295245217 2011-05-15 true JUJUAN B BOWEN 2295242137 2011-05-16 2009 2016-02-24 21:20:13Z 32769480 false X X 1977 GA 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. 5 5 398 0 0 29106441 30550984 278773 2060720 74878 64701 29460092 32676405 0 0 12048534 16865297 0 0 22239085 13654961 34287619 30520258 -4827527 2156147 41150379 43672283 2733417 3099174 38416962 40573109 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. false false 25060 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. 4091157 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. 128084 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. 55318 THE MISSION OF DONALSONVILLE HOSPITAL, INC. IS TO PROVIDE, AT THE DIRECTION 55318 4299619 true false false false false false false false false true true true false false false false false false false false true false false true false false false false false false false false false false false false false false false false false true 26 0 true 398 true false false false false false 5 5 false false false false false false false true true false false true true true true false true true true false GA X JAMES MOODY 2295245217 102 HOSPITAL CIRCLE DONALSONVILLE GA 39845 HERMAN BROOKINS 40.00 X X 432282 0 0 CHARLES H ORRICK 40.00 X X 238490 0 0 BROADDUS SIMPSON 1.00 X 8174 0 0 MITCH BLANKS 1.00 X 8174 0 0 BILL BURKE 1.00 X 8174 0 0 JAMES MOODY 40.00 X 206407 0 0 APRIL HARTMAN 40.00 X 422545 0 0 MURDOC M HENDERSON 40.00 X 317308 0 0 JOSEPH WALKER JR 40.00 X 275000 0 0 ANDREA WADDELL 40.00 X 250000 0 0 ROYCE M CANNINGTON 40.00 X 210018 0 0 DAVID KAY 40.00 X 192231 0 0 RICHARD WOLFF 40.00 X 0 0 0 2568803 9 true true false 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 6 REVENUE FROM OPERATIONS 30550984 30550984 30550984 2060720 2060720 157776 93075 64701 64701 64701 32676405 32676405 860831 860831 11432290 4299619 7132671 4572176 4572176 609441 609441 860977 860977 8662 8662 1250553 1250553 SUPPLIES & DRUGS 4955357 4955357 OTHER FEES 2673743 2673743 BAD DEBT EXPENSE 2042823 2042823 CONTRACT SERVICES 1101363 1101363 INSURANCE 152042 152042 30520258 4299619 26220639 0 16335945 1502135 7533601 7373657 2778880 1792465 768959 839005 59219 67388 24681513 12012817 13207299 12668696 466476 19428937 41150379 43672283 2673331 3099164 60086 10 2733417 3099174 X 38416962 40573109 38416962 40573109 41150379 43672283 X true true true X false X false false false false false false false false false false 24681513 12012817 12668696 12668696 CREDIT LINES 10 10 32676405 30520258 2156147 2156147 32676405 32676405 32676405 30520258 30520258 30520258 true true true X true X true true false false 1595551 1595551 0.94000 1595551 1595551 0.94000 1 417 93000 93000 0.06000 1 417 93000 93000 0.06000 1 417 1688551 1688551 1.00000 true 796770 2603888 2603888 X true false DONALSONVILLE HOSPITAL INC

102 HOSPITAL CIRCLE DONALSONVILLE GA 39845

X 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. BOARD DISCUSSES NEEDS OF COMMUNITY WITH PHYSICIANS AND DEPARTMENT HEADS TO DETERMINE WHAT PROGRAMS SERVICES ARE NEEDY IN THIS COMMUNITY. 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. 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. false false false false false false false false false 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 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.