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JOHN D ARCHBOLD MEMORIAL HOSPITAL INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
JOHN D ARCHBOLD MEMORIAL HOSPITAL INC (EIN 58-0566121)
Tax period
2021-10-01 to 2022-09-30
Filed
2023-08-08
IRS object ID
202322209349300907
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

FieldValueIRS element (for citing)
Return2023-08-08T10:21:45-04:00ReturnTs
Tax Period End2022-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN580914992PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DRAFFIN & TUCKER LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 71309AddressLine1Txt
CityALBANYCityNm
State AbbreviationGAStateAbbreviationCd
ZIP317081309ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN580566121EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JOHN D ARCHBOLD MEMORIALBusinessNameLine1Txt
Business Name Line2HOSPITAL INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlJOHNBusinessNameControlTxt
Phone2292282853PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1P O BOX 1018AddressLine1Txt
CityTHOMASVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP317991018ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDARCY M CRAVENPersonNm
Person TitlePRESIDENT/CEOPersonTitleTxt
Phone2292282737PhoneNum
Signature2023-07-31SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDARCYPersonFirstNm
Person LastCRAVENPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonWILLIAM EDWARD PHILLIPSPreparerPersonNm
PTINP00451499PTIN
Phone2298837878PhoneNum
Preparation2023-08-03PreparationDt
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDARCY M CRAVENPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1P O BOX 1018AddressLine1Txt
CityTHOMASVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP317991018ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$393,372,072GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.ARCHBOLD.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1923FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionHEALTHCARE SERVICESActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers53TotalVolunteersCnt
Total Gross UBI$715,627TotalGrossUBIAmt
PY Contributions Grants$51,872,256PYContributionsGrantsAmt
CY Contributions Grants$18,460,657CYContributionsGrantsAmt
PY Program Service Revenue$353,338,607PYProgramServiceRevenueAmt
CY Program Service Revenue$362,554,073CYProgramServiceRevenueAmt
PY Investment Income$30,593,277PYInvestmentIncomeAmt
CY Investment Income$8,658,376CYInvestmentIncomeAmt
PY Other Revenue$2,398,727PYOtherRevenueAmt
CY Other Revenue$2,778,919CYOtherRevenueAmt
PY Total Revenue$438,202,867PYTotalRevenueAmt
CY Total Revenue$392,452,025CYTotalRevenueAmt
PY Grants And Similar Paid$438,050PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$383,288CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$152,916,057PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$159,790,683CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$192,952,770PYOtherExpensesAmt
CY Other Expenses$204,614,426CYOtherExpensesAmt
PY Total Expenses$346,306,877PYTotalExpensesAmt
CY Total Expenses$364,788,397CYTotalExpensesAmt
PY Revenues Less Expenses$91,895,990PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$27,663,628CYRevenuesLessExpensesAmt
Total Assets BOY$974,216,793TotalAssetsBOYAmt
Total Assets EOY$925,267,221TotalAssetsEOYAmt
Total Liabilities BOY$185,777,374TotalLiabilitiesBOYAmt
Total Liabilities EOY$178,386,471TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$788,439,419NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$746,880,750NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionHEALTHCARE SERVICESMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$261,765,078ExpenseAmt
Grant$383,288GrantAmt
Revenue$285,005,929RevenueAmt
DescJOHN D. ARCHBOLD MEMORIAL HOSPITAL (JDAMH) IN THOMASVILLE GEORGIA OPERATES WITH 264 LICENSED BEDS; OF WHICH 226 ARE MED/SURG, 18 BEDS ARE DESIGNATED TO A PSYCH UNIT, 20 BEDS ARE REHAB. IN ADDITION, THEY OPERATE A 64 BED SKILLED NURSING FACILITY. JDAMH IS A RURAL REFERRAL CENTER COVERING THOMAS COUNTY AND SURROUNDING COUNTIES IN SOUTHERN GEORGIA AND NORTHERN FLORIDA. 68% OF PATIENTS WERE COVERED BY MEDICARE AND MEDICAID, AND 3.0% OF PATIENT REVENUE WAS PROVIDED AS INDIGENT CARE. IN 2022, JDAMH PROVIDED AN ESTIMATED 38.9 MILLION IN INDIGENT CARE CHARGES. JDAMH TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION JDAMH PROVIDED APPROXIMATELY 27.1 MILLION IN ADDITIONAL UNCOMPENSATED CARE. THROUGHOUT THE YEAR, JDAMH PRODUCES OR SPONSORS MANY SPECIAL PROGRAMS FOR THE COMMUNITY TO EDUCATE THEM ON IMPORTANT HEALTH NEEDS. JDAMH, INC. ALSO MAINTAINS HOSPITALS IN GRADY COUNTY, BROOKS COUNTY, AND MITCHELL COUNTY, FILING UNDER EIN 58-0566121.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$21,739,242ExpenseAmt
Revenue$34,887,269RevenueAmt
DescMITCHELL COUNTY HOSPITAL AND NURSING HOMES OPERATE IN CAMILLA, GEORGIA AS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE CARE BEDS AND 156 NURSING HOME BEDS. IT SERVES MITCHELL COUNTY AND 61% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2022, APPROXIMATELY 5.2 MILLION OF INDIGENT CARE WAS PROVIDED TO THE COMMUNITY. IN ADDITION, MITCHELL COUNTY HOSPITAL PROVIDED AN ESTIMATED 5.4 MILLION IN ADDITIONAL UNCOMPENSATED CARE. HOSPITAL AUTHORITY OF MITCHELL COUNTY (EIN 58-6001307) FILED UNDER EIN 58-0566121.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$9,882,749ExpenseAmt
Revenue$31,411,007RevenueAmt
DescGRADY GENERAL HOSPITAL (GGH) IN CAIRO, GEORGIA OPERATES A 60 LICENSED BED ACUTE CARE FACILITY. TEN BEDS CAN BE USED AS SWING BEDS. IT SERVES GRADY COUNTY AND 59% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2022, GGH PROVIDED APPROXIMATELY 5.1 MILLION IN INDIGENT CARE. IN ADDITION, GRADY GENERAL HOSPITAL PROVIDED AN ESTIMATED 4.4 MILLION IN ADDITIONAL UNCOMPENSATED CARE. EIN 58-1646537 FILED UNDER EIN 58-0566121.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$29,194,011ExpenseAmt
Revenue$11,462,910RevenueAmt
DescBROOKS COUNTY HOSPITAL OPERATES IN QUITMAN, GEORGIA AS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE CARE BEDS. IT SERVES BROOKS COUNTY AND 60% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2022, AN ESTIMATED 2.6 MILLION OF INDIGENT CARE WAS PROVIDED TO THE COMMUNITY. IN ADDITION, BROOKS COUNTY HOSPITAL PROVIDED APPROXIMATELY 2.5 MILLION IN ADDITIONAL UNCOMPENSATED CARE. EIN 58-6002830 FILED UNDER EIN 58-0566121.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$29,194,011TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue$11,462,910TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$322,581,080TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (true)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemYes (true)BusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntYes (true)BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document173IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnYes (true)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonGREG HEMBREEPersonNm
Phone2292282853PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1018AddressLine1Txt
CityTHOMASVILLECityNm
State AbbreviationGAStateAbbreviationCd
ZIP317991018ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (30 entries)

TitleTitleTxtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
J PERRY MUSTIAN
PAST PRES/CE40.00Yes (X)$0$3,319,631$16,194
DARCY M CRAVEN
PRESIDENT/CE51.00Yes (X)$0$984,304$158,8481.00Yes (X)
COY IRVIN MD
VP MEDICAL A$599,708$0$29,90840.00Yes (X)
GREG HEMBREE
ASST SEC/SR51.00Yes (X)$0$545,305$77,5281.00
JIM CARTER
COO1.00Yes (X)$427,829$0$69,30840.00
AMY GRIFFIN
VP PATIENT C$360,984$0$63,49040.00Yes (X)
DINESH B PATEL MD
PHYSICIAN$391,828$0$23,94740.00Yes (X)
EUGENE SUN MD
PHYSICIAN$353,997$0$21,14840.00Yes (X)
JASON NESMITH MD
TRUSTEE$322,677$0$18,6601.00Yes (X)
MARK L CATTERSON
PHYSICIAN$316,330$0$24,04840.00Yes (X)
CHRIS NEWMAN
VP ANCILLARY$268,622$0$30,13840.00Yes (X)
SHANE HERRIN MD
PHYSICIAN$267,454$0$22,98140.00Yes (X)
LISSA MURPHY MD
PHYSICIAN$268,051$0$16,33240.00Yes (X)
JAMIE WOMACK
VP CRITICAL20.00$0$244,279$35,92020.00Yes (X)
JAMES BUE
VP FACILITY$229,419$0$25,66040.00Yes (X)
MARK LOWE
VP MARKETING$157,801$0$1,49940.00Yes (X)
DAVID I MEDEROS DO
TRUSTEE1.00$0$9,400$01.00Yes (X)
DARYL CRENSHAW MD
TRUSTEE1.00$0$8,515$01.00Yes (X)
BRIAN SZWARC MD
TRUSTEE$0$744$01.00Yes (X)
JOE BROWN
TRUSTEE$0$0$01.00Yes (X)
CRAIG R WENTWORTH EDD
CHAIRMAN1.00Yes (X)$0$0$01.00Yes (X)
DEBORAH GASKINS
TRUSTEE$0$0$01.00Yes (X)
SINA GRIFFITH
VICE CHAIRMAYes (X)$0$0$01.00Yes (X)
W GREGORY HAMIL
TRUSTEE1.00$0$0$01.00Yes (X)
HENRY A STONE III
TRUSTEE1.00$0$0$01.00Yes (X)
NATHANIEL H ABRAMS JR
TREASURER1.00Yes (X)$0$0$01.00Yes (X)
CHARLES R SANDERS JR MD
TRUSTEE$0$0$01.00Yes (X)
JAMES TREY W FALCONER III MD
TRUSTEE$0$0$01.00Yes (X)
HAILE MCCOLLUM
SECRETARYYes (X)$0$0$01.00Yes (X)
SUE STEPHENSON
TRUSTEE$0$0$01.00Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$3,964,700TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,112,178TotReportableCompRltdOrgAmt
Total Other Compensation$635,609TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K140IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
QUALIVIS LLC
5930 CONERSTONE CT W300SAN DIEGOCA92121NURSING$7,961,810
RED HILLS RADIOLOGY
714 N DAWSON STREETTHOMASVILLEGA317924451RADIOLOGY SVC$6,739,484
MORRISON MANAGEMENT SPECIALISTS
5801 PEACHTREE DUNWOODY RDATLANTAGA303421503DIETARY SVCS$6,267,458
SOUTHLAND HOSPITALIST GROUP
PO BOX 1276THOMASVILLEGA317991276HOSPITALIST SVC$4,032,138
SOUTHLAND EMERGENCY MEDICAL
PO BOX 1276THOMASVILLEGA317991279ER PHYSICIAN$2,618,767
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K74CntrctRcvdGreaterThan100KCnt
Related Organizations$4,195,850RelatedOrganizationsAmt
Government Grants$13,062,370GovernmentGrantsAmt
All Other Contributions$1,202,437AllOtherContributionsAmt
Total Contributions$18,460,657TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT SERVICE REVENUE623000$355,615,372$355,615,372
DSH MEDICAID623000$6,223,074$6,223,074
LAB SERVICES621500$715,627$715,627
FieldValueIRS element (for citing)
Total Program Service Revenue$362,554,073TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,003,870TotalRevenueColumnAmt
Exclusion$9,003,870ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$2,268,456RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$523,322RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$1,745,134RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,745,134TotalRevenueColumnAmt
Exclusion$1,745,134ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$51,231OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$396,725OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$345,494OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$345,494TotalRevenueColumnAmt
Exclusion-$345,494ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MISCELLANOUS REVENUE621990$325,610$325,610
MEDICAL RECORD TRANSCRIPT FEE621990$219,904$219,904
RESEARCH STUDIES623000$196,005$196,005

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$292,266TotalRevenueColumnAmt
Related Or Exempt Func Income$187,150RelatedOrExemptFuncIncomeAmt
Exclusion$105,116ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,033,785OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$392,452,025TotalRevenueColumnAmt
Related Or Exempt Func Income$362,767,115RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$715,627UnrelatedBusinessRevenueAmt
Exclusion$10,508,626ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$96,000TotalAmt
Program Services$96,000ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$287,288TotalAmt
Program Services$287,288ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$7,987,662TotalAmt
Program Services$341,336ProgramServicesAmt
Management And General$7,646,326ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$120,560,744TotalAmt
Program Services$105,347,382ProgramServicesAmt
Management And General$15,213,362ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,859,440TotalAmt
Program Services$1,464,415ProgramServicesAmt
Management And General$395,025ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$17,319,972TotalAmt
Program Services$14,292,890ProgramServicesAmt
Management And General$3,027,082ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$12,062,865TotalAmt
Program Services$9,956,689ProgramServicesAmt
Management And General$2,106,176ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$318,642TotalAmt
Management And General$318,642ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$18,803TotalAmt
Management And General$18,803ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$93,113TotalAmt
Management And General$93,113ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$1,078,875TotalAmt
Management And General$1,078,875ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$81,343,902TotalAmt
Program Services$77,026,516ProgramServicesAmt
Management And General$4,317,386ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$225,805TotalAmt
Program Services$67,984ProgramServicesAmt
Management And General$157,821ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$9,271,398TotalAmt
Program Services$7,309,398ProgramServicesAmt
Management And General$1,962,000ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$1,097,693TotalAmt
Program Services$847,166ProgramServicesAmt
Management And General$250,527ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$6,922,807TotalAmt
Program Services$5,936,195ProgramServicesAmt
Management And General$986,612ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$894,183TotalAmt
Program Services$632,709ProgramServicesAmt
Management And General$261,474ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$37,534TotalAmt
Program Services$37,534ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$771,393TotalAmt
Program Services$771,393ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$24,928,783TotalAmt
Program Services$21,625,719ProgramServicesAmt
Management And General$3,303,064ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$3,128,968TotalAmt
Program Services$3,128,968ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES JDAMH$58,671,189$58,670,987$202
PROVIDER FEES$5,038,738$5,038,738
R&M JDAM$3,608,437$3,202,365$406,072
MEDICAL SUPPLIES GRADY$2,183,396$2,183,396

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$4,980,767TotalAmt
Program Services$4,316,012ProgramServicesAmt
Management And General$664,755ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$364,788,397TotalAmt
Program Services$322,581,080ProgramServicesAmt
Management And General$42,207,317ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$55,058,932BOYAmt
EOY$36,608,568EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$102,856BOYAmt
EOY$102,989EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$52,008,632BOYAmt
EOY$45,565,775EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,738,150BOYAmt
EOY$3,886,515EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$5,069,254BOYAmt
EOY$5,758,346EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$604,838,207LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$389,052,117LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$208,363,387BOYAmt
EOY$215,786,090EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$447,989,506BOYAmt
EOY$383,166,127EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,229,669BOYAmt
EOY$1,229,669EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$200,656,407BOYAmt
EOY$233,163,142EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$974,216,793BOYAmt
EOY$925,267,221EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$37,130,400BOYAmt
EOY$36,439,456EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$2,151,974BOYAmt
EOY$1,552,015EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$96,495,000BOYAmt
EOY$90,395,000EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$50,000,000BOYAmt
EOY$50,000,000EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$185,777,374BOYAmt
EOY$178,386,471EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$785,768,285BOYAmt
EOY$744,557,902EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,671,134BOYAmt
EOY$2,322,848EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$788,439,419BOYAmt
EOY$746,880,750EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$974,216,793BOYAmt
EOY$925,267,221EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$27,663,628ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$69,222,297NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (true)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

Total Direct Lobbying TotalDirectLobbyingGrp

FieldValueIRS element (for citing)
Filing Organizations Total$10,821FilingOrganizationsTotalAmt

Total Lobbying Expend TotalLobbyingExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$10,821FilingOrganizationsTotalAmt

Other Exempt Purpose Expend OtherExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$322,581,080FilingOrganizationsTotalAmt

Total Exempt Purpose Expend TotalExemptPurposeExpendGrp

FieldValueIRS element (for citing)
Filing Organizations Total$322,591,901FilingOrganizationsTotalAmt

Lobbying Nontaxable Amount LobbyingNontaxableAmountGrp

FieldValueIRS element (for citing)
Filing Organizations Total$1,000,000FilingOrganizationsTotalAmt

Grassroots Nontaxable GrassrootsNontaxableGrp

FieldValueIRS element (for citing)
Filing Organizations Total$250,000FilingOrganizationsTotalAmt

Avg Lobbying Nontaxable Amount AvgLobbyingNontaxableAmountGrp

FieldValueIRS element (for citing)
Current Year Minus3$1,000,000CurrentYearMinus3Amt
Current Year Minus2$1,000,000CurrentYearMinus2Amt
Current Year Minus1$1,000,000CurrentYearMinus1Amt
Current Year$1,000,000CurrentYearAmt
Total$4,000,000TotalAmt
FieldValueIRS element (for citing)
Lobbying Ceiling$6,000,000LobbyingCeilingAmt

Avg Total Lobbying Expend AvgTotalLobbyingExpendGrp

FieldValueIRS element (for citing)
Current Year Minus3$12,512CurrentYearMinus3Amt
Current Year Minus2$12,686CurrentYearMinus2Amt
Current Year Minus1$13,029CurrentYearMinus1Amt
Current Year$10,821CurrentYearAmt
Total$49,048TotalAmt

Avg Grassroots Nontaxable AvgGrassrootsNontaxableGrp

FieldValueIRS element (for citing)
Current Year Minus3$250,000CurrentYearMinus3Amt
Current Year Minus2$250,000CurrentYearMinus2Amt
Current Year Minus1$250,000CurrentYearMinus1Amt
Current Year$250,000CurrentYearAmt
Total$1,000,000TotalAmt
FieldValueIRS element (for citing)
Grassroots Ceiling$1,500,000GrassrootsCeilingAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,671,134BeginningYearBalanceAmt
Investment Earnings Or Losses-$348,286InvestmentEarningsOrLossesAmt
End Year Balance$2,322,848EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,190,524BeginningYearBalanceAmt
Investment Earnings Or Losses$480,610InvestmentEarningsOrLossesAmt
End Year Balance$2,671,134EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,997,550BeginningYearBalanceAmt
Investment Earnings Or Losses$192,974InvestmentEarningsOrLossesAmt
End Year Balance$2,190,524EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,973,758BeginningYearBalanceAmt
Investment Earnings Or Losses$23,792InvestmentEarningsOrLossesAmt
End Year Balance$1,997,550EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,335,125BeginningYearBalanceAmt
Investment Earnings Or Losses$251,064InvestmentEarningsOrLossesAmt
Other Expenditures$2,612,431OtherExpendituresAmt
End Year Balance$1,973,758EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$9,647,084OtherCostOrOtherBasisAmt
Book Value$9,647,084BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$177,315,823OtherCostOrOtherBasisAmt
Depreciation$80,962,031DepreciationAmt
Book Value$96,353,792BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$30,237,402OtherCostOrOtherBasisAmt
Depreciation$19,986,905DepreciationAmt
Book Value$10,250,497BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$376,430,067OtherCostOrOtherBasisAmt
Depreciation$288,103,181DepreciationAmt
Book Value$88,326,886BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,207,831OtherCostOrOtherBasisAmt
Book Value$11,207,831BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$215,786,090TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (8 entries)

DescDescBook ValueBookValueAmt
DUE FROM RELATED PARTIES$201,081,805
OTHER RECEIVABLES$17,125,113
EHR RECEIVABLE$4,234,290
DUE FROM SELF INSURANCE TRUST$3,387,831
THIRD PARTY SETTLEMENTS$2,713,955
PHYSICIAN RECEIVABLES$2,629,082
SCHOLARSHIP/TUITION RECEIVABLE$1,422,624
INTEREST RECEIVABLE$568,442
FieldValueIRS element (for citing)
Total Book Value Other Assets$233,163,142TotalBookValueOtherAssetsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PAGE 2, PART V, LINE 4ENDOWMENT FUNDS RESTRICTED BY DONORS ARE HELD IN A PERMANENT HEALTHCARE ENDOWMENT FUND WHICH WAS ESTABLISHED TO SUPPORT HEALTH CARE SERVICES.
SCHEDULE D, PAGE 3, PART XTHE MEDICAL CENTER, WITH THE EXCEPTION OF ARCHBOLD MEDICAL ENTERPRISES, INC., IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX- EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE CONSOLIDATED FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE MEDICAL CENTER ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2022 AND 2021 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTER'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. NOTE, "THE MEDICAL CENTER" REFERS TO ARCHBOLD MEDICAL CENTER, INC. THE PARENT ORGANIZATION OF THE MULTI-ENTITY HEALTHCARE SYSTEM.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
Most Hospitals PolicyYes (X)MostHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other3.250000000000DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportfalseAnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$15,802,867TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$15,802,867NetCommunityBenefitExpnsAmt
Total Expense0.04330TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$42,985,152TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$43,875,237DirectOffsettingRevenueAmt

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$625,168TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$554,604DirectOffsettingRevenueAmt
Net Community Benefit Expns$70,564NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$59,413,187TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$44,429,841DirectOffsettingRevenueAmt
Net Community Benefit Expns$15,873,431NetCommunityBenefitExpnsAmt
Total Expense0.04350TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$195,517TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$195,517NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,471,167TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,471,167NetCommunityBenefitExpnsAmt
Total Expense0.00400TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$30,268,354TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$30,268,354NetCommunityBenefitExpnsAmt
Total Expense0.08300TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$96,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$96,000NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$32,031,038TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$32,031,038NetCommunityBenefitExpnsAmt
Total Expense0.08780TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$91,444,225TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$44,429,841DirectOffsettingRevenueAmt
Net Community Benefit Expns$47,904,469NetCommunityBenefitExpnsAmt
Total Expense0.13130TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$39,461,896BadDebtExpenseAmt
Reimbursed By Medicare$65,121,161ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$70,353,073CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$5,231,912MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities4HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (4 entries)

FacilityFacilityNumAddress Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdWebsite AddressWebsiteAddressTxtState LicenseStateLicenseNumLicensed HospitalLicensedHospitalIndGeneral Medical And SurgicalGeneralMedicalAndSurgicalIndEmergency Room24 HrsEmergencyRoom24HrsIndOtherOtherDescFacility Reporting GroupFacilityReportingGroupCdCritical Access HospitalCriticalAccessHospitalInd
JOHN D ARCHBOLD MEM HOSP
1P O BOX 1018THOMASVILLEGA317991018WWW.ARCHBOLD.ORG136-91Yes (X)Yes (X)Yes (X)PSYCH, REHAB, NURSING HOMEA
GRADY GENERAL HOSPITAL
21155 FIFTH STREET SECAIROGA31728WWW.ARCHBOLD.ORG065-413Yes (X)Yes (X)Yes (X)SWING BED SNFA
BROOKS COUNTY HOSPITAL
3903 N COURT STQUITMANGA31643WWW.ARCHBOLD.ORG014-028Yes (X)Yes (X)RHC, SWING BED SNFAYes (X)
MITCHELL COUNTY HOSPITAL
490 STEPHENS STCAMILLAGA31730WWW.ARCHBOLD.ORG101-120Yes (X)Yes (X)NURSING HOME, RHC, SWING BEDAYes (X)

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ABusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1234FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
OtherYes (X)OtherInd
CHNA Conducted22CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.ARCHBOLD.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt22ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLWWW.ARCHBOLD.ORGStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care325.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.ARCHBOLD.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.ARCHBOLD.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.ARCHBOLD.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 3ETHE COMMUNITY HEALTH NEEDS ASSESSMENT FOR 2022 WAS CONDUCTED FOR EACH COUNTY IN THE SERVICE AREA. THE TOP 3 SIGNIFICANT HEALTH NEEDS FOR BROOKS, GRADY, MITCHELL AND THOMAS COUNTIES WERE - DIABETES, OBESITY AND HIGH BLOOD PRESSURE. OTHER SIGNIFICANT HEALTH NEEDS IDENTIFIED BY THE COMMUNITY INCLUDE HEART DISEASE, MENTAL HEALTH, CANCER, DRUG ADDICTION, BACK OR JOINT PAIN, COVID-19, ALCOHOL ABUSE, AND ACCESS TO VACCINES. A COMPLETE DISCUSSION OF THE HEALTH NEEDS FOR EACH COUNTY MAY BE FOUND AT - HTTPS://WWW.ARCHBOLD.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/.
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 5INPUT FROM COMMUNITY MEMBERS REPRESENTING THE BROADER INTERESTS OF THE COUNTY WAS GATHERED THROUGH A COMBINATION OF ONLINE AND WRITTEN SURVEYS. THESE EFFORTS YIELDED INFORMATION THAT WILL BE USED IN ADDRESSING BARRIERS, ALLOCATING RESOURCES AND ASSETS AND DETERMINING OPPORTUNITIES TO SUPPORT. INPUT WAS CONSIDERED IN DETERMINING GAPS IN SERVICES AND TO IDENTIFY WHETHER DEVELOPING NEW RELATIONSHIPS AND PARTNERSHIPS WAS NECESSARY TO MEET THE NEEDS OF THE COMMUNITY. THIS YEAR WE ENHANCED OUR APPROACH TO OBTAINING THIS INFORMATION FROM OUR COMMUNITIES. AN ONLINE SURVEY WAS ACCESSIBLE THROUGH OUR WEBSITE (ARCHBOLD.ORG), ARCHBOLD SOCIAL MEDIA CHANNELS INCLUDING FACEBOOK, INSTAGRAM AND TWITTER. A PRESS RELEASE WAS SENT TO THE THOMASVILLE TIMES-ENTERPRISE ASKING FOR THE COMMUNITYS PARTICIPATION. A WEBSITE LINK AND/OR PAPER COPIES OF THE SURVEY WERE SENT TO THE FOLLOWING ENTITIES: DOUGLASS HIGH SCHOOL ALUMNI ASSOCIATION SURVEY LINK MAGNOLIA HIGH SCHOOL ALUMNISURVEY LINK SOUTHWEST GEORGIA TECHNICAL COLLEGESURVEY LINK THOMAS COUNTY FAMILY CONNECTIONSURVEY LINK THOMAS/GRADY UGA EXTENSIONSURVEY LINK THOMAS COUNTY HEALTH DEPARTMENTPAPER COPIES AND SURVEY LINK PRIMARY CARE OF SOUTHWEST GEORGIAPAPER COPIES AND SURVEY LINK ARCHBOLD EMPLOYEESSURVEY LINK THOMAS COUNTY EMPLOYEESSURVEY LINK CITY OF THOMASVILLE EMPLOYEESSURVEY LINK THOMASVILLE-THOMAS COUNTY CHAMBER OF COMMERCESURVEY LINK COMMUNITY OUTREACH TRAINING CENTERSURVEY LINK JACK HADLEY BLACK HISTORY MUSEUMSURVEY LINK
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 6ATHE NEEDS ASSESSMENT WAS CONDUCTED FOR JOHN D. ARCHBOLD MEMORIAL HOSPITAL ALONG WITH GRADY GENERAL HOSPITAL, BROOKS COUNTY HOSPITAL AND MITCHELL COUNTY HOSPITAL.
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 7DDISTRIBUTED COPIES TO THE COMMUNITY; AVAILABLE ONLINE
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 11QUALITATIVELY, THE GREATEST MEDICAL NEEDS ACCORDING TO COMMUNITY PERCEPTION INCLUDED: 1. DIABETES 2. OBESITY 3. HIGH BLOOD PRESSURE 4. HEART DISEASE 5. MENTAL HEALTH ISSUES 6. CANCER 7. DRUG ADDICTION 8. BACK/JOINT PAIN 9. COVID-19 10. ALCOHOL ABUSE 11. LUNG DISEASE 12. ACCESS TO VACCINES NEEDS NOT ADDRESSED NOT ALL HEALTH NEEDS ARE EASILY ADDRESSED BY ARCHBOLD. FURTHER, KEEPING TOO BROAD OF A FOCUS WILL DILUTE THE IMPACT WE CAN HAVE ON EACH HEALTH NEED. THESE ARE SOME OF THE PRIMARY REASONS WE ARENT ADDRESSING SOME HEALTH NEEDS IN OUR IMPLEMENTATION PLAN. OUR BIGGEST OPPORTUNITY IS TO HELP WITH IMPROVING DISEASE STATES BY ADDRESSING OBESITY AND REMAINING AVAILABLE FOR ASSISTANCE WITH OTHER HEALTH NEEDS AS REQUESTED AND AS TIME AND FINANCES PERMIT.
FieldValueIRS element (for citing)
Facility8FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
GLENN-MOR NURSING HOME
10629 U S HIGHWAY 19 STHOMASVILLEGA31792SKILLED NURSING HOME
JDA PSYCHIATRIC UNIT
P O BOX 1018THOMASVILLEGA31792PSYCHIATRIC UNIT
JDA REHABILITATION UNIT
P O BOX 1018THOMASVILLEGA31792REHABILITATION UNIT
MITCHELL CO CONVALESCENT CENTER
90 STEPHENS STREETCAMILLAGA31728SKILLED NURSING HOME
CAMILLA PEDIATRICS CENTER
P O BOX 360CAMILLAGA31728RURAL HEALTH CLINIC
MEDICAL GROUP OF MITCHELL COUNTY
P O BOX 360CAMILLAGA31728RURAL HEALTH CLINIC
ARCHBOLD PELHAM PRIMARY CARE CLINIC
P O BOX 360CAMILLAGA31728RURAL HEALTH CLINIC
PELHAM PARKWAY NURSING HOME
608 DOGWOOD DRIVE NEPELHAMGA31797SKILLED NURSING HOME

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 7THE ORGANIZATION USES THE COST TO CHARGE RATIO USING THE IRS' RECOMMENDED FORMAT IN WORKSHEET 2. OTHER COSTS IN PART I LINES 7E THROUGH 7I WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS.
SCHEDULE H, PART III, LINE 2AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AND INCLUDES IMPLICIT PRICE CONCESSIONS . SEE THE DISCUSSION OF IMPLICIT PRICE CONCESSIONS IN FOOTNOTE 2 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, LINE 4SEE THE DISCUSSION OF PRICE CONCESSIONS AND NET PATIENT SERVICE REVENUE IN FOOTNOTE 2 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, LINE 8MEDICARE 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.
SCHEDULE H, PART III, LINE 9BPATIENTS THAT ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE APPROVED FOR A PERIOD OF 6 MONTHS. THE PATIENTS ARE REQUIRED TO CONTACT THE FINANCIAL ASSISTANCE OFFICE DURING THIS POINT IF THEY INCUR ADDITIONAL CHARGES THAT QUALIFY FOR FINANCIAL ASSISTANCE DURING THIS TIME PERIOD. THE SAME PROCESS IS IN EFFECT FOR THE PATIENTS WHO QUALIFY FOR THE SLIDING FEE DISCOUNT. THIS DISCOUNT WILL LIMIT THE PATIENTS TO AN OUT OF POCKET MAXIMUM AMOUNT IN THE GIVEN TIME PERIOD. WE DO NOT HAVE ANY AUTOMATIC ADJUSTMENTS OR AN AUTOMATED SYSTEM TO TRACK THE PREVIOUSLY APPROVED PATIENTS.
SCHEDULE H, PART VI, LINE 2REVIEW OF ASSESSMENTS OF OTHER ORGANIZATIONS THAT IDENTIFY NEEDS AND HAVE ON-GOING PARTICIPATION WITH THOSE ORGANIZATIONS. COLLECT, REVIEW AND USE PRIMARY,SECONDARY AND QUALITATIVE DATA IN DETERMINING NEEDS. UPDATE COMMUNITY HEALTH STATUS AS LOCAL, STATE AND FEDERAL DATA IS REPORTED. REVIEW INTERNAL DATA SUCH AS SCREENING OUTCOMES AND PATIENT VOLUMES FOR SERVICES. RESPONSE TO REQUESTS FROM COMMUNITY, INPUT FROM A GROUP MEETING OF THE DOUGLASS HIGH SCHOOL ALUMNI ASSOCIATION, SEVERAL WRITTEN SURVEYS AND A TELEPHONE INTERVIEW. THE ORGANIZATION ANALYZES QUANTITATIVE FEDERAL, STATE AND LOCAL DATA AS WELL AS SEEKS QUALITATIVE INPUT FROM MEMBERS OF THE COMMUNITY, ESPECIALLY THE UNDERSERVED. THE ORGANIZATION ALSO ASSESSES THE NEEDS OF THE COMMUNITY THROUGH UTILIZING ASSESSMENTS CONDUCTED BY OTHER COMMUNITY ORGANIZATIONS, REVIEWING INTERNAL DATA ON PATIENT VOLUMES AND SCREENING OUTCOMES, PARTICIPATING IN COMMUNITY ORGANIZATIONS THAT IDENTIFY NEEDS, SPONSORING COMMUNITY EDUCATION TASK FORCES THAT PROVIDE INPUT AND RESPONDING TO SPECIFIC REQUESTS FROM COMMUNITY MEMBERS. COPIES OF THE 2022-2023 CHNA'S AND THE RELATED IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING WEB ADDRESSES: HTTPS://WWW.ARCHBOLD.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/
SCHEDULE H, PART VI, LINE 3ANNUAL NOTICES ARE PLACED IN THE NEWSPAPERS FOR THE COUNTIES WE SERVE WITH HEALTHCARE. NOTICE OF THE FAP PROGRAM IS CONTAINED IN THE PATIENT HANDBOOK, SIGNS AND BROCHURES OUTLINING THE AVAILABILITY OF THE FAP PROGRAM ARE AVAILABLE AT POINTS OF ACCESS FOR PATIENTS, PAPER APPLICATIONS ARE AVAILABLE AT ALL ADMISSION AREAS AND BUSINESS OFFICES, ELECTRONIC VERSION OF THE APPLICATION CAN BE DOWNLOADED FREE OF CHARGE VIA WEBSITE AND THE ASSISTANCE PROGRAM IS DISCUSSED IN DETAIL DURING COLLECTION CALLS WITH PATIENTS.
SCHEDULE H, PART VI, LINE 4COUNTIES SERVED IN GEORGIA INCLUDE BROOKS, GRADY, MITCHELL, THOMAS. DISPROPORTIONATE HEALTHCARE NEEDS, FEDERALLY DESIGNATED AS MEDICALLY UNDERSERVED AREAS(MUA) OR HEALTH PROFESSIONAL SHORTAGE AREAS(HSPA), LOW- INCOME, PUBLIC HOUSING RESIDENTS, SENIORS, MIGRANT WORKERS, UNINSURED, UNDERINSURED, MIXTURE OF ETHNICITIES, ALL AGES, MIXTURE OF EDUCATIONAL LEVELS. BROOKS COUNTY: ESTIMATED POPULATION 15,457; 61.4% WHITE/35.2% BLACK, MEDIAN HOUSEHOLD INCOME 38,285; 21.9% LIVING IN POVERTY; 20% UNDER 65 UNINSURED. GRADY COUNTY: ESTIMATED POPULATION 24,748; MEDIAN HOUSEHOLD INCOME 43,531; 21.7% LIVING IN POVERTY, 20.8% UNDER 65 UNINSURED. MITCHELL COUNTY: ESTIMATED POPULATION 21,863; 49.3% WHITE/48.0% BLACK; MEDIAN HOUSEHOLD INCOME 38,116; 30.7% LIVING IN POVERTY, 17.7% UNDER 65 UNINSURED. THOMAS COUNTY: ESTIMATED POPULATION 44,451; 60.6% WHITE/36.2% BLACK; MEDIAN HOUSEHOLD INCOME 43,740; 18% LIVING IN POVERTY, 17% UNDER 65 UNINSURED. INFORMATION OBTAINED FROM WWW.CENSUS.GOV 2019 ESTIMATES
SCHEDULE H, PART VI, LINE 5LIVE BETTER IS THE NAME THAT REPRESENTS AN ARCHBOLD-LED EFFORT OF KEY COMMUNITY LEADERS AND COMMUNITY FOCUSED ON IMPROVING THE HEALTH OF THE CITIZENS OF THOMAS COUNTY. LIVE BETTER IS STEERED BY LEADERS OF MAJOR SECTORS OF THE COMMUNITY (GOVERNMENT, EDUCATION, MEDIA, BUSINESS) THAT ARE WORKING TOGETHER WITH ARCHBOLD TO LEVERAGE THE STRENGTHS OF THEIR ORGANIZATIONS TO ACHIEVE MEASURED HEALTH GOALS. THE GROUP HAS MEASURABLE GOALS TO REDUCE THE OBESITY RATE IN THOMAS COUNTY, THE BIGGEST COMMON DENOMINATOR OF POOR HEALTH. OBESITY IS A PREVENTABLE CONDITION, YET THE COMMON RISK FACTOR WITH THE MOST PROMINENT HEALTH ISSUES IN THOMAS COUNTY: HEART DISEASE, HYPERTENSION, STROKE, COPD, VASCULAR DISEASE, DIABETES AND CANCER. THE GOVERNING BODIES OF ALL JDAMH'S HOSPITAL FACILITIES ARE PRIMARILY COMPRISED OF PERSONS WHO ARE NOT EMPLOYEES OR CONTRACTORS (NOR FAMILY MEMBERS THEREOF) AND WHO REPRESENT A BROAD SPECTRUM OF THE COMMUNITY. THE HOSPITALS' MEDICAL STAFFS ARE OPEN TO ALL QUALIFIED PHYSICIANS IN THE REGION. SURPLUS FUNDS ARE REINVESTED IN THE FACILITIES AND OPERATIONS.
SCHEDULE H, PART VI, LINE 6ARCHBOLD MEDICAL CENTER, INC. (MEDICAL CENTER) AS THE PARENT CORPORATION HAS SOLE CONTROL OVER ITS NONPROFIT SUBSIDIARIES, JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC., ARCHBOLD HEALTH SERVICES, INC., ARCHBOLD FOUNDATION, INC., ARCHBOLD MEDICAL GROUP, INC. AND SOLE OWNERSHIP OF ITS FOR-PROFIT SUBSIDIARY, ARCHBOLD MEDICAL ENTERPRISES, INC. JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC. OPERATES JOHN D. ARCHBOLD MEMORIAL HOSPITAL, GRADY GENERAL HOSPITAL, BROOKS COUNTY HOSPITAL, AND MITCHELL COUNTY HOSPITAL AND NURSING HOMES. ARCHBOLD HEALTH SERVICES, INC. PROVIDES FACILITIES AND SUPPORT FOR HOME HEALTH CARE AND AMBULATORY HEALTH CARE SERVICES. ARCHBOLD FOUNDATION, INC. SOLICITS CONTRIBUTIONS AND MANAGES FUNDS FOR THE BENEFIT OF JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC. AND ARCHBOLD HEALTH SERVICES, INC. ARCHBOLD MEDICAL GROUP, INC. EMPLOYS PHYSICIANS AND OTHER SUPPORT PERSONNEL TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES ESSENTIAL TO THE PREVENTION AND TREATMENT OF DISEASE FOR THE BENEFIT OF ALL INDIVIDUALS IN THE SERVICE AREA. ARCHBOLD MEDICAL GROUP, INC. ALSO SERVES AS THE SOLE MEMBER OF CCSG, INC. AND AMGIR, INC., BOTH 501(C)(3) ORGANIZATIONS WHICH OPERATE MEDICAL CLINICS.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
THOMAS UNIVERSITY
1501 MILLPOND ROADTHOMASVILLEGA31792580644897501C3$11,000MEDICAL LAB PROG
THOMAS UNIVERSITY
1501 MILLPOND ROADTHOMASVILLEGA31792580644897501C3$85,000NURSG PROGRAM
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtCash GrantCashGrantAmtRecipientRecipientCntValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDesc
SCHOLARSHP/TUITION PROG$140,593
MED STUDENT HOUSING$146,695209FMVHOUSING/UTIL.

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION OFFERS A TUITION/SCHOLARSHIP REIMBURSEMENT PROGRAM FOR QUALIFIED EMPLOYEES ON SATISFACTORY COMPLETION OF APPROVED COURSES. THE PURPOSE IS TO ENCOURAGE AND ENABLE EMPLOYEES TO ACQUIRE ADDITIONAL EDUCATION IN A HEALTH CARE OR JOB RELATED FIELD WHICH WILL PROMOTE CAREER ADVANCEMENT AND/OR PROVIDE ADVANCED CREDENTIALING OF EMPLOYEES IN AREAS OF NEED. CONDITIONS OF ELIGIBILITY: FULL-TIME EMPLOYMENT OF AT LEAST SIX MONTHS WITH SATISFACTORY WORK RECORD AND PERFORMANCE EVALUATION. COMPLETION OF THE RELEVANT EDUCATION PROGRAM REQUIRES THE APPLICANT TO COMMIT TO OBTAIN STATUS AS A FULL-TIME EMPLOYEE EQUAL TO THE AMOUNT OF TIME SPENT IN EDUCATION. FAILURE TO COMPLY WITH THE REQUIREMENTS OF ELIGIBILITY WOULD SUBJECT THE EMPLOYEE TO FULL OR PARTIAL REIMBURSEMENT OF THE FUNDS RECEIVED TO THE ORGANIZATION. FOR REIMBURSEMENT THE EMPLOYEE MUST PROVIDE A COPY OF A RECEIPT SHOWING ACTUAL PAYMENT OF TUITION FEES. APPLICANT MUST MAINTAIN A C OR HIGHER GRADE AND AN OFFICIAL RECORD OF GRADES AND HOURS CREDIT MAILED DIRECTLY TO THE ORGANIZATION. THE ORGANIZATION SUPPORTS CERTAIN MEDICAL EDUCATION PROGRAMS WITH GRANTS TO THOMAS UNIVERSITY. THIS SUPPORT IS REVIEWED ANNUALLY.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Travel For CompanionsYes (X)TravelForCompanionsInd
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentYes (true)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
J PERRY MUSTIAN
PAST PRES/CEO (8/20)$192,272$3,127,359$16,194$3,335,825
DARCY M CRAVEN
PRESIDENT/CEO$745,869$2,185$149,300$1,143,152$236,250$9,548
COY IRVIN MD
VP MEDICAL AFFAIRS$349,321$243,529$6,858$17,400$12,508$629,616
GREG HEMBREE
ASST SEC/SR VP/CFO$388,587$3,564$65,020$622,833$153,154$12,508
JIM CARTER
COO$337,943$88,644$1,242$59,760$9,548$497,137
AMY GRIFFIN
VP PATIENT CARE$285,843$73,899$1,242$56,822$6,668$424,474
DINESH B PATEL MD
PHYSICIAN$233,360$157,944$524$14,399$9,548$415,775
EUGENE SUN MD
PHYSICIAN$285,517$68,037$443$11,600$9,548$375,145
JASON NESMITH MD
TRUSTEE$220,210$102,253$214$9,112$9,548$341,337
MARK L CATTERSON
PHYSICIAN$291,602$22,751$1,977$14,500$9,548$340,378
CHRIS NEWMAN
VP ANCILLARY SVCS$221,882$46,200$540$29,460$678$298,760
SHANE HERRIN MD
PHYSICIAN$261,072$6,000$382$13,433$9,548$290,435
LISSA MURPHY MD
PHYSICIAN$260,904$5,500$1,647$15,654$678$284,383
JAMIE WOMACK
VP CRITICAL ACCESS$191,659$540$26,427$280,199$52,080$9,493
JAMES BUE
VP FACILITY SERVICES$175,213$50,642$3,564$25,660$255,079
MARK LOWE
VP MARKETING$36,717$121,084$1,499$159,300

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PAGE 1, PART I, LINE 4DARCY M. CRAVEN 0 137,700 0 GREG HEMBREE 0 50,520 0 JIM CARTER 0 42,360 0 AMY GRIFFIN 0 36,720 0 CHRIS NEWMAN 0 18,352 0 JAMIE WOMACK 0 17,707 0 JAMES BUE 0 14,758 0 MARK LOWE 110,100 0 0
SCHEDULE J, PART IIITHE IRS RULES & REGULATIONS REQUIRE THAT CERTAIN NON-CURRENT, NON-CASH ITEMS ARE REPORTED IN PART VII, COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND INDEPENDENT CONTRACTORS, OF THE CORE FORM 990 REGARDLESS OF THE CURRENT BENEFIT TO THE EMPLOYEE. THESE SAME RULES, IN SOME CASES, REQUIRE THE COMPENSATION AND BENEFITS TO BE REPORTED TWICE IN PART VII, ONCE WHEN THE ENTITY ACCRUES FOR A FUTURE PAYMENT AND ONCE WHEN THE PAYMENT IS ACTUALLY MADE TO THE EMPLOYEE. THEREFORE, AN EMPLOYEE'S STATED TOTAL COMPENSATION AND BENEFITS REPORTED ON PART VII ARE SUBSTANTIALLY HIGHER THAN THE ACTUAL CASH COMPENSATION RECEIVED IN THE CURRENT YEAR. AMOUNTS REPORTED AS BENEFITS INCLUDE AMOUNTS FOR LIFE INSURANCE, HEALTH INSURANCE, THRIFT PLAN CONTRIBUTIONS, AND PENSION CONTRIBUTIONS. BENEFITS RELATED TO PENSION AND RETIREMENT PLANS REFLECT AMOUNTS ACCUMULATED, BUT NOT PAID, TO THE INDIVIDUAL IN RECOGNITION OF TOTAL YEARS OF EMPLOYMENT, NOT JUST THE CURRENT YEAR. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ONE EXECUTIVE PARTICIPATES IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS ACCRUED BUT UNFUNDED IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON- QUALIFIED RETIREMENT PLAN. AMC 457(F) RETIREMENT PLAN CERTAIN EXECUTIVES WHO ARE NOT ELIGIBLE FOR THE SERP MAY BE ELIGIBLE TO PARTICIPATE IN A 457(F) PLAN TO HELP THEM ACCUMULATE FUNDS FOR THEIR LONG TERM FINANCIAL NEEDS. THE ORGANIZATION MAY CONTRIBUTE A PERCENTAGE OF BASE SALARY INTO AN INDIVIDUAL EXECUTIVES ACCOUNT IF THE ORGANIZATION MEETS CERTAIN FINANCIAL TARGETS. THE ORGANIZATION OWNS ANY PLAN ASSETS UNTIL THEY ARE PAID TO THE EMPLOYEE AND ALL FUNDS ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. VESTING BEGINS AT AGE 55 WITH FIVE YEARS OF SERVICE AT A RATE OF 90% AND THEN INCREASES TO 100% AT AGE 60. PAYMENTS ARE MADE ANNUALLY UPON VESTING. BONUS AWARDS: OFFICERS AND PHYSICIANS ARE AWARDED BONUSES/INCENTIVES CONTINGENT IN PART ON MEETING MANAGEMENT-BY-OBJECTIVE INCENTIVE PLAN GOALS AND EXCESS OF REVENUE OVER EXPENSES.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)

Bond ReferenceBondReferenceCdBusiness Name Line2IssuerName/BusinessNameLine2TxtBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
HOSP AUTH OF THE CITY OF THOMASVILL
A2017C REVENUE BONDS581719301NONENONEN2017-07-12$82,750,000CONSTRUCTION BLDG AND EQUIPMENTfalseYes (true)false
HOSP AUTH OF THE CITY OF THOMASVILL
B2017A REVENUE BONDS581719301NONENONEN2017-07-12$17,985,000CONSTRUCTION PROJECT DEPOSITfalseYes (true)false
HOSP AUTH OF THE CITY OF THOMASVILL
C2017B REVENUE BONDS581719301NONENONEN2017-07-12$15,435,000CONSTRUCTION PROJECT DEPOSITfalseYes (true)false

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtRefunding EscrowRefundingEscrowAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtRefunding Tax Exempt BondsRefundingTaxExemptBondsIndRefunding Taxable BondsRefundingTaxableBondsIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintIndOther Spent ProceedsOtherSpentProceedsAmtSubstantial CompletionSubstantialCompletionYr
A$15,190,000$82,850,000$82,522,324$327,676falseYes (true)falseYes (true)
B$17,985,000falsefalseYes (true)Yes (true)$17,985,0002017
C$10,585,000$15,435,000falsefalseYes (true)Yes (true)$15,435,0002017

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
AfalsefalsefalsefalsefalsefalseYes (true)
BfalsefalsefalsefalsefalsefalseYes (true)
CfalsefalsefalsefalsefalsefalseYes (true)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
AfalsefalseYes (true)falsefalsefalsefalsefalseYes (true)
BfalsefalseYes (true)falseYes (true)falsefalsefalseYes (true)
CfalsefalseYes (true)falseYes (true)falsefalsefalseYes (true)

Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
Afalse
Bfalse
Cfalse

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PURPOSE OF ISSUE DESCRIPTIONHOSP AUTH OF THE CITY OF THOMASVILLE CONSTRUCTION BLDG AND EQUIPMENT
PURPOSE OF ISSUE DESCRIPTIONHOSP AUTH OF THE CITY OF THOMASVILLE CONSTRUCTION PROJECT DEPOSIT
PURPOSE OF ISSUE DESCRIPTIONHOSP AUTH OF THE CITY OF THOMASVILLE CONSTRUCTION PROJECT DEPOSIT

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (7 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
JAMES W FALCONER III MD
BOARD TRUSTEE$567,449RENTAL, PATIENT SVCSfalse
JAMI STEPHENSON
FAMILY MEMBER$129,525COMPENSATIONfalse
DAVID MEDEROS DO
BOARD TRUSTEE$4,678,074PROFESSIONAL MED SVCfalse
HAILE P MCCOLLUM
BOARD TRUSTEE$76,000SERVICE AGREEMENTfalse
SINA E GRIFFITH
FAMILY MEMBER$13,917,337SERVICE AGREEMENTfalse
WILLIAM W ELLIS MD
BOARD TRUSTEE$13,917,337SERVICE AGREEMENTfalse
TIMOTHY B DANIEL MD
BOARD TRUSTEE$4,941,340SERVICE AGREEMENTfalse

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART VFormAndLineReferenceDesc
ExplanationJAMES W. FALCONER, III, MD - RENT OF PROPERTY; MEDICAL SERVICES TO PRACTICE; PAYMENTS TO TREAT UNINSURED EMERGENCY PATIENTS. JAMI STEPHENSON IS THE SON OF SUE STEPHENSON, BOARD TRUSTEE, AND IS EMPLOYED AND COMPENSATED BY JDAMH. DAVID MEDEROS, D.O., BOARD TRUSTEE, PROVIDES HOSPITALIST COVERAGE FOR HOSPITAL, INPATIENT REHAB AND IS A MEMBER OF THE MEDICAL STAFF LEADERSHIP COMMITTEE. HAILE P. MCCOLLUM PROVIDES PROFESSIONAL BRANDING AND MARKETING SERVICES. SINA GRIFFITH IS THE DAUGHTER OF WILLIAM W. ELLIS, M.D., WHO WAS A FORMER TRUSTEE (WHO SERVED ON THE HOSPITAL BOARD DURING THE PAST 5 YEARS) AND WHOSE CARDIOLOGY PRACTICE HAS A PROFESSIONAL SERVICES AGREEMENT WITH THE HOSPITAL. AMOUNT REFLECTS PAYMENTS ASSOCIATED WITH FAMILY MEMBERS CARDIOLOGY SERVICES PERFORMED UNDER THE PROFESSIONAL SERVICES AGREEMENT, A CARDIOVASCULAR SERVICE LINE CO-MANAGEMENT AND PERFORMANCE IMPROVEMENT AGREEMENT, PHYSICIAN RECRUITMENT INCOME GUARANTEE FOR A CARDIOLOGY PRACTICE PARTNER, AND ATTENDANCE AT MEDICAL STAFF LEADERSHIP MEETINGS. WILLIAM W. ELLIS, M.D. WAS A FORMER TRUSTEE WHO SERVED ON THE BOARD DURING THE PAST 5 YEARS, AND HE WAS A PRACTICE PARTNER IN A CARDIOLOGY PRACTICE WHICH HAS A PROFESSIONAL SERVICES AGREEMENT WITH THE HOSPITAL. AMOUNT REFLECTS PAYMENTS ASSOCIATED WITH CARDIOLOGY SERVICES PERFORMED UNDER THE PROFESSIONAL SERVICES AGREEMENT, A CARDIOVASCULAR SERVICE LINE CO-MANAGEMENT AND PERFORMANCE IMPROVEMENT AGREEMENT, PHYSICIAN RECRUITMENT INCOME GUARANTEE FOR A CARDIOLOGY PRACTICE PARTNER, AND ATTENDANCE AT MEDICAL STAFF LEADERSHIP MEETINGS. TIMOTHY B. DANIEL, M.D. SERVED ON THE BOARD AS A TRUSTEE DURING FY 2022, AND HE WAS A PRACTICE PARTNER IN AN INTERVENTIONAL RADIOLOGY PRACTICE WHICH HAS A PROFESSIONAL SERVICES AGREEMENT WITH THE HOSPITAL. AMOUNT REFLECTS PAYMENTS ASSOCIATED WITH INTERVENTIONAL RADIOLOGY SERVICES PERFORMED UNDER THE PROFESSIONAL SERVICES AGREEMENT AND A MEDICAL SERVICES AGREEMENT, ALLOCATED PAYMENTS FROM STATE OF GEORGIA TRAUMA FUNDING, PHYSICIAN RECRUITMENT INCOME GUARANTEE FOR AN INTERVENTIONAL PRACTICE PARTNER,AND ATTENDANCE AT MEDICAL STAFF LEADERSHIP MEETINGS.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 2, PART III, LINE 4AJOHN D. ARCHBOLD MEMORIAL HOSPITAL (JDAMH) IN THOMASVILLE GEORGIA OPERATES WITH 264 LICENSED BEDS; OF WHICH 226 ARE MED/SURG, 18 BEDS ARE DESIGNATED TO A PSYCH UNIT, 20 BEDS ARE REHAB. IN ADDITION, THEY OPERATE A 64 BED SKILLED NURSING FACILITY. JDAMH IS A RURAL REFERRAL CENTER COVERING THOMAS COUNTY AND SURROUNDING COUNTIES IN SOUTHERN GEORGIA AND NORTHERN FLORIDA. 68% OF PATIENTS WERE COVERED BY MEDICARE AND MEDICAID, AND 3.0% OF PATIENT REVENUE WAS PROVIDED AS INDIGENT CARE. IN 2022, JDAMH PROVIDED AN ESTIMATED 38.9 MILLION IN INDIGENT CARE CHARGES. JDAMH TREATS ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. IN ADDITION JDAMH PROVIDED APPROXIMATELY 27.1 MILLION IN ADDITIONAL UNCOMPENSATED CARE. THROUGHOUT THE YEAR, JDAMH PRODUCES OR SPONSORS MANY SPECIAL PROGRAMS FOR THE COMMUNITY TO EDUCATE THEM ON IMPORTANT HEALTH NEEDS. JDAMH, INC. ALSO MAINTAINS HOSPITALS IN GRADY COUNTY, BROOKS COUNTY, AND MITCHELL COUNTY, FILING UNDER EIN 58-0566121.
FORM 990, PAGE 2, PART III, LINE 4DBROOKS COUNTY HOSPITAL OPERATES IN QUITMAN, GEORGIA AS A CRITICAL ACCESS HOSPITAL WITH 25 ACUTE CARE BEDS. IT SERVES BROOKS COUNTY AND 60% OF ITS PATIENTS WERE MEDICARE/MEDICAID. IN 2022, AN ESTIMATED 2.6 MILLION OF INDIGENT CARE WAS PROVIDED TO THE COMMUNITY. IN ADDITION, BROOKS COUNTY HOSPITAL PROVIDED APPROXIMATELY 2.5 MILLION IN ADDITIONAL UNCOMPENSATED CARE. EIN 58-6002830 FILED UNDER EIN 58-0566121.
FORM 990, PAGE 6, PART VI, LINE 2NATHANIEL ABRAMS, JR HAILE MCCOLLUM TRUSTEE TRUSTEE BUSINESS RELATIONSHIP NATHANIEL ABRAMS, JR HENRY A. STONE, III TRUSTEE TRUSTEE BUSINESS RELATIONSHIP HAILE MCCOLLUM HENRY A. STONE, III TRUSTEE TRUSTEE BUSINESS RELATIONSHIP
FORM 990, PAGE 6, PART VI, LINE 6THE ORGANIZATION HAS A SOLE MEMBER, ARCHBOLD MEDICAL CENTER, INC. (AMC) WITH THE POWER TO ELECT OR REPLACE AND TO REMOVE THE TRUSTEES OF THE GOVERNING BODY, AS WELL AS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY.
FORM 990, PAGE 6, PART VI, LINE 7ATHE BOARD OF TRUSTEES OF THE FILING ENTITY ARE ELECTED ANNUALLY BY THE SOLE MEMBER, AMC. IN ADDITION, AMC HAS THE POWER TO ELECT OR REPLACE AND TO REMOVE THE TRUSTEES OF THE GOVERNING BODY. THE CEO OF AMC SHALL BE A MEMBER OF THE BOARD WITH THE POWER TO VOTE.
FORM 990, PAGE 6, PART VI, LINE 7BTHE SOLE MEMBER, AMC HAS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY, INCLUDING BUT NOT LIMITED TO, CAPITAL AND OPERATING BUDGETS, MERGERS OR ACQUISITIONS, CONTRACTS AND TRANSACTIONS OVER A CERTAIN AMOUNT, DISSOLUTION, ETC.
FORM 990, PAGE 6, PART VI, LINE 11BMANAGEMENT REVIEWS THE FORM 990 AS PREPARED BY ITS EXTERNAL AUDITOR, AND THEN MAKES A COMPLETE COPY AVAILABLE ELECTRONICALLY TO TRUSTEES PRIOR TO FILING THE RETURN. IF TRUSTEES HAVE QUESTIONS ABOUT THE RETURN, MANAGEMENT IS AVAILABLE AND ACCESSIBLE TO PROVIDE APPLICABLE EXPLANATIONS TO TRUSTEES.
FORM 990, PAGE 6, PART VI, LINE 12CON AN ANNUAL BASIS, THE ORGANIZATION DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE AND DISCLOSURE STATEMENT TO EACH TRUSTEE. THIS QUESTIONNAIRE INCLUDES QUESTIONS RELATED TO FINANCIAL INTERESTS, OUTSIDE INTERESTS OR ACTIVITIES, AND GIFTS, MEALS, AND ENTERTAINMENT. IN ADDITION TO DISCLOSING ANY APPLICABLE INFORMATION ON THE QUESTIONNAIRE, THE TRUSTEE ACKNOWLEDGES THAT (S)HE HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ, UNDERSTANDS, AND AGREES TO COMPLY WITH IT, AND UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. RESPONSES ARE SUMMARIZED AND COLLECTIVELY REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE OF AMC, THE SOLE MEMBER. DURING EACH BOARD MEETING, THE CHAIRMAN INQUIRES IF ANY TRUSTEE HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST RELATED TO ANY AGENDA ITEM. IF THE TRUSTEE DISCLOSES ANY SUCH INTEREST, THE TRUSTEE IS EXCUSED FROM THE MEETING WHILE THE DETERMINATION AS TO WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS IS DISCUSSED AND VOTED UPON BY DISINTERESTED MEMBERS OF THE BOARD AND COMMITTEE. IF INVITED TO DO SO, THE TRUSTEE WITH A POTENTIAL CONFLICT MAY RESPOND TO QUESTIONS PUT FORTH BY FELLOW DISINTERESTED TRUSTEES REGARDING ANY PROPOSED TRANSACTION OR ARRANGEMENT. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS DOCUMENTS THE NAME OF ANY INTERESTED PERSON/TRUSTEE WHO DISCLOSED OR WAS FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH A TRANSACTION OR ARRANGEMENT RESULTING IN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; AND THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATED TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSIONS, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH.
FORM 990, PAGE 6, PART VI, LINE 15AARCHBOLD MEDICAL CENTER'S (AMC) COMPENSATION COMMITTEE (COMMITTEE) OF THE AMC BOARD OF TRUSTEES MAKES RECOMMENDATIONS TO THE FULL AMC BOARD ON THE FOLLOWING POSITIONS: THE PRESIDENT OF AMC AND THE PRESIDENT OF THE ARCHBOLD FOUNDATION. AMC'S PRESIDENT PRESENTS RECOMMENDATIONS FOR ALL SENIOR VICE PRESIDENTS, VICE PRESIDENTS, AND OTHER KEY EMPLOYEES OF AMC AND ALL RELATED ARCHBOLD ENTITIES TO THE COMMITTEE. SINCE AMC HAS RESERVE POWERS FOR ARCHBOLD RELATED ENTITIES, THE COMMITTEE SERVES AS THE COMPENSATION COMMITTEE FOR EACH APPLICABLE ARCHBOLD ENTITY. THE COMMITTEE CONSIDERS THE AMC PRESIDENT'S RECOMMENDATIONS, BUT IT ALSO CONSIDERS RECOMMENDATIONS AND INDEPENDENT MARKET DATA ANALYSIS FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE AMC BOARD UTILIZES AN INDEPENDENT COMPENSATION CONSULTANT TO REVIEW THE EXECUTIVE COMPENSATION PROGRAM AND MAKE RECOMMENDATIONS REGARDING PLAN DESIGN AND ACTUAL COMPENSATION INCLUDING BENEFITS.
FORM 990, PAGE 6, PART VI, LINE 15BSEE 15A ABOVE.
FORM 990, PAGE 6, PART VI, LINE 19NO DOCUMENTS ARE OR WILL BE MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART IX, LINE 11GCONSULTANT FEES JDAMH 0 87,611 0 CONTRACT SERVICES JDAMH 41,108,937 1,541,803 0 CONTRACT SERVICES BROOKS 1,232,970 0 0 CONTRACT SERVICES GRADY 4,652,658 143,132 0 CONTRACT SERVICES MITCHELL 6,486,224 3,341 0 OUTSIDE LAB REFERRAL FEES JDA 1,302,342 0 0 OUTSIDE LAB REFERRAL GRADY 20,594 0 0 OUTSIDE LAB REFERRAL BROOKS 1,799 0 0 PROFESSIONAL FEES JDAMH 16,841,325 2,009,944 0 PROFESSIONAL FEES GRADY 2,329,883 264,334 0 PROFESSIONAL FEES BROOKS 1,157,841 79,137 0 PROFESSIONAL FEES MITCHELL 1,891,943 187,076 0 CONSULTANT GRADY 0 1,008 0 TOTAL 77,026,516 4,317,386 0

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtBusiness Name Line2DirectControllingEntityName/BusinessNameLine2TxtControlled OrganizationControlledOrganizationInd
ARCHBOLD FOUNDATION INC
PO BOX 620THOMASVILLEGA317990620581559677FOUNDATIONGA501C312BAMCARCHBOLD MEDICAL CENTER INCfalse
ARCHBOLD HEALTH SERVICES INC
PO BOX 620THOMASVILLEGA317990620581376434HEALTHCAREGA501C310AMCARCHBOLD MEDICAL CENTER INCfalse
ARCHBOLD MEDICAL CENTER INC
PO BOX 1018THOMASVILLEGA317991018581552650H/C MGMTGA501C312CNAfalse
ARCHBOLD MEDICAL GROUP INC
P O BOX 620THOMASVILLEGA317990620262988454PHYSICIANSGA501C33AMCARCHBOLD MEDICAL CENTER INCfalse
CCSG INC
915 GORDON AVENUETHOMASVILLEGA317926614473501366MED CLINICGA501C33AMGfalse
AMGIR INC
915 GORDON AVENUETHOMASVILLEGA317926614821188691MED CLINICGA501C33AMGfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPct
ARCHBOLD MEDICAL ENTERPRISES
400 OLD ALBANY ROADTHOMASVILLEGA317924013581494513HEALTHCAREGAN/Afalse
GEORGIA-FLORIDA PREFERRED INC
915 GORDON AVETHOMASVILLEGA31792581744334HEALTHCAREGAYes (true)JDAMHC CORP$4,614$178,3641.00000
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (true)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd