PIEDMONT REGIONAL HEALTH INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- PIEDMONT REGIONAL HEALTH INC (EIN 43-2007498)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-10
- IRS object ID
- 202321309349301012
- Schema version
- 2021v4.0
- 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) |
|---|---|---|
| Return | 2023-05-10T08:44:42-04:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 581094351 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCNAIR MCLEMORE MIDDLEBROOKS & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | POST OFFICE BOX ONE | AddressLine1Txt |
| City | MACON | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 312020001 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 432007498 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PIEDMONT REGIONAL HEALTH INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PIED | BusinessNameControlTxt |
| Phone | 4786212100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1005 BOULDER DRIVE | AddressLine1Txt |
| City | GRAY | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 31032 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TERESA W MOODY | PersonNm |
| Person Title | SECRETARY | PersonTitleTxt |
| Phone | 4786212100 | PhoneNum |
| Signature | 2023-05-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | TERESA | PersonFirstNm |
| Person Last | MOODY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WILLIAM R ROUNTREE | PreparerPersonNm |
| PTIN | P01231836 | PTIN |
| Phone | 4787466277 | PhoneNum |
| Preparation | 2023-05-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TERESA W MOODY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1005 BOULDER DRIVE | AddressLine1Txt |
| City | GRAY | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 31032 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $23,594,337 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ETHICAHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | THE DEVELOPMENT, CONSTRUCTION, ACQUISITION, OWNERSHIP, LEASING, MANAGEMENT, AND OPERATION OF SKILLED HEALTH CARE FACILITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 501 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $2,579,690 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,742,505 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $21,032,668 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $21,626,216 | CYProgramServiceRevenueAmt |
| PY Investment Income | $283 | PYInvestmentIncomeAmt |
| CY Investment Income | $168 | CYInvestmentIncomeAmt |
| CY Other Revenue | $225,448 | CYOtherRevenueAmt |
| PY Total Revenue | $23,612,641 | PYTotalRevenueAmt |
| CY Total Revenue | $23,594,337 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,951,614 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,554,670 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,796,464 | PYOtherExpensesAmt |
| CY Other Expenses | $12,038,083 | CYOtherExpensesAmt |
| PY Total Expenses | $23,748,078 | PYTotalExpensesAmt |
| CY Total Expenses | $24,592,753 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$135,437 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$998,416 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,165,812 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,936,950 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,844,199 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,540,921 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$678,387 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $396,029 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE DEVELOPMENT, CONSTRUCTION, ACQUISITION, OWNERSHIP, LEASING, MANAGEMENT, AND OPERATION OF SKILLED HEALTH CARE FACILITIES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $24,592,753 | ExpenseAmt |
| Desc | LEASED AND OWNED SKILLED CARE, INTERMEDIATE CARE, AND OTHER HEALTH CARE RELATED FACILITIES. CONSISTENT WITH THE POLICIES PREVIOUSLY ADOPTED BY THE BOARD OF DIRECTORS OF COMMUNITY HEATLH SYSTEMS, INC., THE SECTION 509(A)(3) SUPPORTING ORGANIZATION AND PARENT ENTITY OF THE INTEGRATED HEALTH CARE DELIVERY SYSTEM OF WHICH THE ORGANIZATION IS A MEMBER, THE ORGANIZATION PROVIDES SUBSTANTIAL COMMUNITY BENEFIT TO THE COMMUNITIES IT SERVES PURSUANT TO BOTH COMMUNITY BENEFIT GUIDELINES AND A CHARITY CARE POLICY. THE ORGANIZATION CONTINUES TO ASSESS AND DEVELOP PROGRAMS TO BENEFIT THE COMMUNITY. | Desc |
| Total Program Service Expenses | $24,592,753 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | Yes (true) | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 101 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 501 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PIEDMONT REGIONAL HEALTH INC | PersonNm |
| Phone | 4786212100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1005 BOULDER DRIVE | AddressLine1Txt |
| City | GRAY | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 31032 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| ANGELA HAMMACK | |||||||||
| CORPORATE SE | 0.00 | 40.00 | Yes (X) | $0 | $278,269 | $17,676 | |||
| RALPH WARNOCK | |||||||||
| DIRECTOR | 4.00 | 40.00 | $0 | $255,478 | $17,245 | Yes (X) | |||
| TERESA W MOODY | |||||||||
| SECRETARY | 4.00 | 40.00 | $0 | $209,153 | $19,186 | Yes (X) | |||
| ANN MORGAN | |||||||||
| RN | 40.00 | 0.00 | $151,329 | $0 | $15,306 | Yes (X) | |||
| KAY GRAY | |||||||||
| FORMER PRESI | 0.00 | 40.00 | Yes (X) | $0 | $131,348 | $7,652 | |||
| VICKIE NIX | |||||||||
| RN | 40.00 | 0.00 | $119,860 | $0 | $12,894 | Yes (X) | |||
| LUCY ROGERS | |||||||||
| DIRECTOR | 0.00 | 30.00 | Yes (X) | $0 | $51,090 | $2,072 | |||
| KATHRYN DENNIS | |||||||||
| CHAIRMAN | 4.00 | 1.00 | $0 | $24,000 | $0 | Yes (X) | |||
| PAUL A CABLE | |||||||||
| DIRECTOR | 0.00 | 4.00 | Yes (X) | $0 | $24,000 | $0 | |||
| HERBERT M PONDER JR | |||||||||
| DIRECTOR | 0.00 | 4.00 | Yes (X) | $0 | $24,000 | $0 | |||
| JOSEPH A WALL | |||||||||
| CHAIRMAN | 0.00 | 4.00 | Yes (X) | $0 | $24,000 | $0 | |||
| BEN GRIFFIN | |||||||||
| DIRECTOR | 4.00 | 40.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $271,189 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,021,338 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $92,031 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| INTEGRA REHABILITATION | |||||
| 1013 RIVERBURCH PKWY SUITE 2 | DALTON | GA | 30721 | REHAB SERVICES | $845,273 |
| MSC NURSING HOME LLC | |||||
| PO BOX 448 | METTER | GA | 30439 | HEALTHCARE | $437,518 |
| MEDICAL SOLUTIONS LLC | |||||
| PO BO X 850737 | MINNEAPLOIS | MN | 554850737 | AGENCY | $278,635 |
| CLINICAL RESOURCES LLC | |||||
| 3338 PEACHTREE RD NE SUITE 102 | ATLANTA | GA | 30326 | HEALTHCARE | $167,725 |
| PULASKI REAL ESTATE HOLDINGS | |||||
| PO BOX 448 | METTER | GA | 30439 | REAL ESTATE | $111,099 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Info In Schedule O Part VIII | Yes (X) | InfoInScheduleOPartVIIIInd |
| Government Grants | $1,742,505 | GovernmentGrantsAmt |
| Total Contributions | $1,742,505 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| GOVERNMENTAL PROGRAMS REV | $18,718,696 | $18,718,696 |
| SERVICE REVENUES | $2,907,520 | $2,907,520 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $21,626,216 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $168 | TotalRevenueColumnAmt |
| Exclusion | $168 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER | Desc |
| Total Revenue Column | $225,448 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $225,448 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $225,448 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,594,337 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $21,851,664 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $168 | ExclusionAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,431,567 | TotalAmt |
| Program Services | $10,431,567 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $200,472 | TotalAmt |
| Program Services | $200,472 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,155,066 | TotalAmt |
| Program Services | $1,155,066 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $767,565 | TotalAmt |
| Program Services | $767,565 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,359,128 | TotalAmt |
| Program Services | $2,359,128 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $836 | TotalAmt |
| Program Services | $836 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,000 | TotalAmt |
| Program Services | $35,000 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,547 | TotalAmt |
| Program Services | $83,547 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $359,601 | TotalAmt |
| Program Services | $359,601 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $609,817 | TotalAmt |
| Program Services | $609,817 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $480,533 | TotalAmt |
| Program Services | $480,533 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| NURSING SERVICES | $3,109,516 | $3,109,516 |
| TAXES | $1,553,300 | $1,553,300 |
| OTHER SERVICES | $1,414,571 | $1,414,571 |
| PLANT SUPPLIES / REPAIRS | $653,997 | $653,997 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,378,237 | TotalAmt |
| Program Services | $1,378,237 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,592,753 | TotalAmt |
| Program Services | $24,592,753 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $9,141 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,714,574 | BOYAmt |
| EOY | $1,947,389 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $52,262 | BOYAmt |
| EOY | $51,494 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,577,096 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,685,776 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,394,093 | BOYAmt |
| EOY | $3,891,320 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,883 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $37,606 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,165,812 | BOYAmt |
| EOY | $5,936,950 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,831,236 | BOYAmt |
| EOY | $1,684,063 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,708,000 | BOYAmt |
| EOY | $1,555,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,628,975 | BOYAmt |
| EOY | $2,228,899 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $675,988 | BOYAmt |
| EOY | $72,959 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,844,199 | BOYAmt |
| EOY | $5,540,921 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$678,387 | BOYAmt |
| EOY | $396,029 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$678,387 | BOYAmt |
| EOY | $396,029 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,165,812 | BOYAmt |
| EOY | $5,936,950 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$998,416 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $2,072,832 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | $2,579,690 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,742,505 | CurrentTaxYearAmt |
| Total | $4,322,195 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $26,925,912 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $27,050,207 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $26,855,377 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $21,032,668 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $21,851,664 | CurrentTaxYearAmt |
| Total | $123,715,828 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $26,925,912 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $27,050,207 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $26,855,377 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $23,612,358 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $23,594,169 | CurrentTaxYearAmt |
| Total | $128,038,023 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $128,038,023 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $257 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $166 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $22 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $283 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $168 | CurrentTaxYearAmt |
| Total | $896 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $257 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $166 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $22 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $283 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $168 | CurrentTaxYearAmt |
| Total | $896 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $26,926,169 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $27,050,373 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $26,855,399 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $23,612,641 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $23,594,337 | CurrentTaxYearAmt |
| Total | $128,038,919 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 1.00000 | PublicSupportCY509Pct |
| Public Support PY509 | 1.00000 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,900,000 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,115,575 | DepreciationAmt |
| Book Value | $2,784,425 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,564,937 | OtherCostOrOtherBasisAmt |
| Depreciation | $801,164 | DepreciationAmt |
| Book Value | $763,773 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,112,159 | OtherCostOrOtherBasisAmt |
| Depreciation | $769,037 | DepreciationAmt |
| Book Value | $343,122 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,891,320 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ADVANCE PAYMENTS UNAPPLIED | Desc |
| Amt | $72,959 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $72,959 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $23,594,337 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $23,594,337 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $23,594,337 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $24,592,753 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $24,592,753 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $24,592,753 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|---|
| ANGELA HAMMACK | ||||||||
| CORPORATE SECRETARY | $267,514 | $10,755 | $17,676 | $295,945 | ||||
| RALPH WARNOCK | ||||||||
| DIRECTOR | $237,784 | $17,694 | $17,245 | $272,723 | ||||
| TERESA W MOODY | ||||||||
| SECRETARY | $197,708 | $11,445 | $19,186 | $228,339 | ||||
| ANN MORGAN | ||||||||
| RN | $145,410 | $5,919 | $15,306 | $166,635 | ||||
| KAY GRAY | ||||||||
| FORMER PRESIDENT | $100,092 | $31,256 | $7,652 | $139,000 | ||||
| LUCY ROGERS | ||||||||
| DIRECTOR | $51,090 | $2,072 | $53,162 | |||||
| PAUL A CABLE | ||||||||
| DIRECTOR | $24,000 | $24,000 | ||||||
| HERBERT M PONDER JR | ||||||||
| DIRECTOR | $24,000 | $24,000 | ||||||
| JOSEPH A WALL | ||||||||
| CHAIRMAN | $24,000 | $24,000 | ||||||
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MIDDLE COASTAL UNITED DA | BusinessNameLine1Txt |
| Business Name Line2 | BANK OF OKLAHOMA | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 582140014 | BondIssuerEIN |
| Bond Issued | 2007-01-15 | BondIssuedDt |
| Issue Price | $3,515,000 | IssuePriceAmt |
| Purpose | ACQUISITION OF RE | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Refunding Tax Exempt Bonds | false | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | false | RefundingTaxableBondsInd |
| Final Allocation Made | false | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | false | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | false | RebateNotDueYetInd |
| Exception To Rebate | false | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | false | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PURPOSE OF ISSUE DESCRIPTION | FormAndLineReferenceDesc |
| Explanation | MIDDLE COASTAL UNITED DA ACQUISITION OF RE | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 6 | THE ORGANIZATION HAS A SOLE MEMBER, COMMUNITY HEALTH SYSTEMS, INC., A NONPROFIT GEORGIA CORPORATION. |
| FORM 990, PAGE 6, PART VI, LINE 7A | UNDER THE ORGANIZATION'S BYLAWS, WHILE IT IS THE SOLE MEMBER OF THE ORGANIZATION, COMMUNITY HEALTH SYSTEMS, INC., AS A TYPE I SECTION 509(A)(3) AND SECTION 501(C)(3) SUPPORTING ORGANIZATION, HAS THE SOLE RIGHT TO ELECT, REPLACE AND TO REMOVE THE MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS AND SHALL ENSURE THAT AT ALL TIMES, A MAJORITY OF THE MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS SHALL BE COMPOSED OF PERSONS WHO ARE CONCURRENTLY SERVING AS MEMBERS OF THE BOARD OF DIRECTORS OF COMMUNITY HEALTH SYSTEMS, INC. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 FOR PIEDMONT REGIONAL HEALTH, INC. IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. UPON COMPLETION, THE INDEPENDENT ACCOUNTING FIRM PROVIDES A DRAFT OF THE FORM 990 TO THE AUDIT COMMITTEE OF THE ORGANIZATION FOR ITS REVIEW. ALLOWING ADEQUATE TIME FOR REVIEW, THE INDEPENDENT ACCOUNTING FIRM SUBSEQUENTLY MEETS WITH THE AUDIT COMMITTEE OF THE ORGANIZATION TO REVIEW AND DISCUSS THE DRAFT FORM 990. FOLLOWING THE AUDIT COMMITTEE'S REVIEW, DISCUSSION AND APPROVAL OF THE DRAFT FORM 990, THE AUDIT COMMITTEE THEN PROVIDES THE DRAFT FORM 990 TO THE ORGANIZATION'S BOARD OF DIRECTORS WITH A RECOMMENDATION TO REVIEW AND APPROVE THE FORM 990. SUBSEQUENT TO RECEIPT OF THE DRAFT FORM 990, A MEETING OF THE ORGANIZATION'S BOARD OF DIRECTORS IS HELD TO DISCUSS THE RECOMMENDATION FROM ITS AUDIT COMMITTEE AND TO ASK QUESTIONS OF THE INDEPENDENT ACCOUNTING FIRM AND THE ORGANIZATION'S MANAGEMENT. FOLLOWING REVIEW AND DISCUSSION, THE BOARD THEN APPROVES THE FORM 990 TO BE FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | COMPLIANCE WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY IS EFFECTUATED BY, AT A MINIMUM, THE BOARD OF DIRECTOR'S ANNUAL REVIEW OF CONFLICT DISCLOSURE STATEMENTS PROVIDED BY THE ORGANIZATION'S DIRECTORS AND OFFICERS. ALSO, THE ORGANIZATION'S BOARD OF DIRECTORS REVIEW CONFLICT DISCLOSURE STATEMENTS PRIOR TO TAKING ACTION ON PROPOSED TRANSACTIONS AND CONTRACTUAL ARRANGEMENTS. THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY PROVIDES THE PROCEDURE FOR WHICH INTERESTED PERSONS ARE EVALUATED TO DETERMINE IF A CONFLICT EXISTS. IF IT IS DETERMINED THAT A BOARD MEMBER HAS A CONFLICT OF INTEREST, THEN SUCH BOARD MEMBERS ARE NOT ALLOWED TO PARTICIPATE IN DELIBERATIONS ON THE SPECIFIC MATTER AND IS EXCUSED FROM, AND NOT ALLOWED TO PARTICIPATE IN, ANY BOARD VOTE ON THE MATTER. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE ORGANIZATION REGULARLY AND CONSISTENTLY COMPLIES WITH THE COMPENSATION APPROVAL PROCESS, AS DEFINED BY ITS CONFLICTS OF INTEREST POLICY, THROUGH A COMPREHENSIVE ENGAGEMENT CONDUCTED BY ITS COMPENSATION COMMITTEE. A THIRD-PARTY COMPENSATION CONSULTANT IS ENGAGED TO GATHER COMPARABILITY DATA FOR THE ORGANIZATION'S SENIOR MANAGEMENT AND ITS KEY OR HIGHLY COMPENSATED EMPLOYEES. FOLLOWING COMPLETION OF THE ENGAGEMENT, THE THIRD-PARTY CONSULTANT ISSUES A WRITTEN REPORT REFLECTING ITS OPINION CONCERNING WHETHER THE ORGANIZATION'S PROPOSED COMPENSATION ARRANGEMENTS CONSTITUTE REASONABLE COMPENSATION UNDER SECTION 4958 OF THE INTERNAL REVENUE CODE. UPON RECEIPT AND REVIEW OF THE CONSULTANT'S WRITTEN REPORT AND SUPPORTING MATERIALS, THE ORGANIZATION'S COMPENSATION COMMITTEE THEN PROVIDES ALL SUCH MATERIALS ALONG WITH RECOMMENDATIONS TO ITS BOARD OF DIRECTORS FOR CONSIDERATION. SUBSEQUENTLY, THE BOARD OF DIRECTORS HOLDS A MEETING TO REVIEW THE MATERIALS AND RECOMMENDATIONS FROM ITS COMPENSATION COMMITTEE AT WHICH TIME THE BOARD WILL VOTE ON THE REASONABLENESS OF COMPENSATION FOR EACH INDIVIDUAL INCLUDED IN THE COMPENSATION ENGAGEMENT. IF ANY DISQUALIFIED OR OTHERWISE CONFLICTED BOARD MEMBERS ARE PRESENT AT THE MEETING, THEY DO NOT PARTICIPATE IN THE DELIBERATIONS AND ARE EXCUSED FROM VOTING ON SUCH MATTERS. THE COMPENSATION APPROVAL PROCESS IS CARRIED OUT BY THE ORGANIZATION'S BOARD OF DIRECTORS IN A MANNER DESIGNED TO SATISFY ALL THREE OF THE REQUIREMENTS NECESSARY TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS WITH RESPECT TO COMPENSATION ARRANGEMENTS FOR DISQUALIFIED PERSONS UNDER SECTION 53.4958-6 OF THE INTERNAL REVENUE CODE. AS PART OF THE PROCESS, THE ORGANIZATION'S BOARD OF DIRECTORS RETAINS THIRD-PARTY LEGAL COUNSEL TO FURTHER ADVISE THE BOARD ON THE REBUTTABLE PRESUMPTION PROCESS AND TO PROVIDE THE BOARD WITH A LEGAL OPINION REGARDING THE SAME. THE FINAL STEP IN THE PROCESS IS PREPARATION OF DOCUMENTATION REQUIRED TO ESTABLISH THE REBUTTABLE PRESUMPTION UTILIZING THE REBUTTABLE PRESUMPTION CHECKLIST ISSUED BY THE INTERNAL REVENUE SERVICE. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE ORGANIZATION REGULARLY AND CONSISTENTLY COMPLIES WITH THE COMPENSATION APPROVAL PROCESS, AS DEFINED BY ITS CONFLICTS OF INTEREST POLICY, THROUGH A COMPREHENSIVE ENGAGEMENT CONDUCTED BY ITS COMPENSATION COMMITTEE. A THIRD-PARTY COMPENSATION CONSULTANT IS ENGAGED TO GATHER COMPARABILITY DATA FOR THE ORGANIZATION'S SENIOR MANAGEMENT AND ITS KEY OR HIGHLY COMPENSATED EMPLOYEES. FOLLOWING COMPLETION OF THE ENGAGEMENT, THE THIRD-PARTY CONSULTANT ISSUES A WRITTEN REPORT REFLECTING ITS OPINION CONCERNING WHETHER THE ORGANIZATION'S PROPOSED COMPENSATION ARRANGEMENTS CONSTITUTE REASONABLE COMPENSATION UNDER SECTION 4958 OF THE INTERNAL REVENUE CODE. UPON RECEIPT AND REVIEW OF THE CONSULTANT'S WRITTEN REPORT AND SUPPORTING MATERIALS, THE ORGANIZATION'S COMPENSATION COMMITTEE THEN PROVIDES ALL SUCH MATERIALS ALONG WITH RECOMMENDATIONS TO ITS BOARD OF DIRECTORS FOR CONSIDERATION. SUBSEQUENTLY, THE BOARD OF DIRECTORS HOLDS A MEETING TO REVIEW THE MATERIALS AND RECOMMENDATIONS FROM ITS COMPENSATION COMMITTEE AT WHICH TIME THE BOARD WILL VOTE ON THE REASONABLENESS OF COMPENSATION FOR EACH INDIVIDUAL INCLUDED IN THE COMPENSATION ENGAGEMENT. IF ANY DISQUALIFIED OR OTHERWISE CONFLICTED BOARD MEMBERS ARE PRESENT AT THE MEETING, THEY DO NOT PARTICIPATE IN THE DELIBERATIONS AND ARE EXCUSED FROM VOTING ON SUCH MATTERS. THE COMPENSATION APPROVAL PROCESS IS CARRIED OUT BY THE ORGANIZATION'S BOARD OF DIRECTORS IN A MANNER DESIGNED TO SATISFY ALL THREE OF THE REQUIREMENTS NECESSARY TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS WITH RESPECT TO COMPENSATION ARRANGEMENTS FOR DISQUALIFIED PERSONS UNDER SECTION 53.4958-6 OF THE INTERNAL REVENUE CODE. AS PART OF THE PROCESS, THE ORGANIZATION'S BOARD OF DIRECTORS RETAINS THIRD-PARTY LEGAL COUNSEL TO FURTHER ADVISE THE BOARD ON THE REBUTTABLE PRESUMPTION PROCESS AND TO PROVIDE THE BOARD WITH A LEGAL OPINION REGARDING THE SAME. THE FINAL STEP IN THE PROCESS IS PREPARATION OF DOCUMENTATION REQUIRED TO ESTABLISH THE REBUTTABLE PRESUMPTION UTILIZING THE REBUTTABLE PRESUMPTION CHECKLIST ISSUED BY THE INTERNAL REVENUE SERVICE. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST IN ACCORDANCE WITH THE SECTION 6104(D) DISCLOSURE REQUIREMENTS. |
| FORM 990, PART VIII | PART VIII, LINE 1E -- THE PROVIDER RELIEF FUND WAS ESTABLISHED THROUGH THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY ACT (CARES ACT)AND THE PAYCHECK PROTECTION PROGRAM AND HEALTHCARE ENHANCEMENT ACT (PPCHE). THIS LEGISLATION AUTHORIZED THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES TO MAKE GENERAL AND TARGETED DISTRIBUTIONS TO QUALIFYING HEALTHCARE PROVIDERS BASED ON THE VARIOUS FORMULAS AND CRITERIA DESIGNATED IN THE LEGISLATION. THE CORPORATION UTILIZED FUNDS TOTALING 2,579,690 DURING THE YEAR ENDED JUNE 30, 2021. THIS AMOUNT IS INCLUDED ON LINE 1E ON THE FORM 990 STATEMENT OF REVENUE. |
| FORM 990, PART XI, LINE 9 | CONTRIBUTION OF NET ASSETS 2,072,832 |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Total IncomeTotalIncomeAmt | End Of Year AssetsEndOfYearAssetsAmt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|
| CANDLER COUNTY LTC LLC | |||||||||
| 110 STONE BROOKE DRIVE | GRAY | GA | 31032 | 203644753 | HEALTH CAR | GA | $4,883,048 | $650,806 | NA |
| EVANS COUNTY LTC LLC | |||||||||
| 110 STONE BROOKE DRIVE | GRAY | GA | 31032 | 203645112 | HEALTH CAR | GA | $4,280,414 | $1,374,733 | NA |
| BULLOCH COUNTY LTC LLC | |||||||||
| 110 STONE BROOKE DRIVE | GRAY | GA | 31032 | 203644663 | HEALTH CAR | GA | $4,261,950 | $2,247,031 | NA |
| CANDLER COUNTY II LTC LLC | |||||||||
| 110 STONE BROOKE DRIVE | GRAY | GA | 31032 | 203644923 | HEALTH CAR | GA | $5,985,228 | $918,608 | NA |
| JOHNSON COUNTY LTC LLC | |||||||||
| 110 STONE BROOKE DRIVE | GRAY | GA | 31032 | 203644958 | HEALTH CAR | GA | $4,167,401 | $487,320 | NA |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| CLINICAL SERVICES INC | ||||||||||
| 1005 BOULDER DRIVE | GRAY | GA | 31032 | 571157115 | CLINICAL & | GA | 501C | 10 | CHSI | false |
| COMMUNITY HEALTH FOUNDATION INC | ||||||||||
| 110 STONE BROOKE DRIVE | GRAY | GA | 31032 | 571157153 | FINANCIAL | GA | 501C | 10 | CHSI | false |
| COMMUNITY HEALTH SYSTEMS INC | ||||||||||
| PO BOX 1037 | MACON | GA | 31202 | 743083593 | SUPPORT SE | GA | 501C | 12A | NA | false |
| COMMUNITY REHABILITATION SERVICES | ||||||||||
| 110 STONE BROOKE DRIVE | GRAY | GA | 31032 | 203253779 | REHABILITA | GA | 501C | 10 | CHSI | false |
| HEALTH SCHOLARSHIPS INC | ||||||||||
| 1005 BOULDER DRIVE | GRAY | GA | 31032 | 581805305 | OPERATION | GA | 501C | 10 | CHSI | false |
| HEALTH SYSTEMS FACILITIES INC | ||||||||||
| 1005 BOULDER DRIVE | GRAY | GA | 31032 | 743083594 | OPERATION | GA | 501C | 10 | CHSI | false |
| HEALTH SYSTEMS REAL ESTATE INC | ||||||||||
| 110 STONE BROOKE DRIVE | GRAY | GA | 31032 | 432007488 | RE | GA | 501C | 10 | CHSI | false |
| HOME & COMMUNITY SERVICES INC | ||||||||||
| 110 STONE BROOKE DRIVE | GRAY | GA | 31032 | 432007492 | TRANS | GA | 501C | 10 | CHSI | false |
| COMMUNITY ANCILLARY SERVICES INC | ||||||||||
| 110 STONE BROOKE DRIVE | GRAY | GA | 31032 | 432007496 | PHAR | GA | 501C | 10 | CHSI | false |
| STEWARD HEALTH SERVICES INC | ||||||||||
| 110 STONE BROOKE DRIVE | GRAY | GA | 31032 | 432007486 | HOSPICE | GA | 501C | 10 | CHSI | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTH VENTURES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4875 RIVERSIDE DRIVE SUITE 105 | AddressLine1Txt |
| City | MACON | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 31210 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 201392241 | EIN |
| Primary Activities | RISK MGMT. | PrimaryActivitiesTxt |
| Legal Domicile State | GA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHSI | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C CORP | EntityTypeTxt |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (5 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt |
|---|---|
| CLINICAL SERVICES INC | |
| M | $3,181,961 |
| COMMUNITY REHABILITATION SERV INC | |
| M | $822,833 |
| COMMUNITY ANCILLARY SERV INC | |
| M | $1,616,956 |
| COMMUNITY HEALTH FOUNDATION INC | |
| R | $300 |
| HOME & COMMUNITY SERVICES INC | |
| J | $566,000 |