2023-08-08T10:21:45-04:00 2022-09-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2021-10-01 580566121 JOHN D ARCHBOLD MEMORIAL HOSPITAL INC JOHN 2292282853 P O BOX 1018 THOMASVILLE GA 317991018 DARCY M CRAVEN PRESIDENT/CEO 2292282737 2023-07-31 true DARCY CRAVEN 999009999 WILLIAM EDWARD PHILLIPS P00451499 2298837878 2023-08-03 2021 2023-04-26 12:10:37Z DARCY M CRAVEN P O BOX 1018 THOMASVILLE GA 317991018 393372072 false X WWW.ARCHBOLD.ORG X 1923 GA HEALTHCARE SERVICES 13 8 0 53 715627 51872256 18460657 353338607 362554073 30593277 8658376 2398727 2778919 438202867 392452025 438050 383288 0 152916057 159790683 0 0 192952770 204614426 346306877 364788397 91895990 27663628 974216793 925267221 185777374 178386471 788439419 746880750 X HEALTHCARE SERVICES false false 261765078 383288 285005929 JOHN 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. 21739242 34887269 MITCHELL 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. 9882749 31411007 GRADY 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. 29194011 11462910 BROOKS 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. 29194011 11462910 322581080 true true false true false false false false false true true false false true false true false true false false false false false false false false true true true true true true false false false false false false false true true true false false false false false true false false false true 173 0 0 true true false false false false false false false false false false false X 13 8 true false false false true true true true true false false true true true true true true true true false GA X GREG HEMBREE 2292282853 PO BOX 1018 THOMASVILLE GA 317991018 J PERRY MUSTIAN PAST PRES/CE 40.00 X 0 3319631 16194 DARCY M CRAVEN PRESIDENT/CE 1.00 51.00 X X 0 984304 158848 COY IRVIN MD VP MEDICAL A 40.00 X 599708 0 29908 GREG HEMBREE ASST SEC/SR 1.00 51.00 X 0 545305 77528 JIM CARTER COO 40.00 1.00 X 427829 0 69308 AMY GRIFFIN VP PATIENT C 40.00 X 360984 0 63490 DINESH B PATEL MD PHYSICIAN 40.00 X 391828 0 23947 EUGENE SUN MD PHYSICIAN 40.00 X 353997 0 21148 JASON NESMITH MD TRUSTEE 1.00 X 322677 0 18660 MARK L CATTERSON PHYSICIAN 40.00 X 316330 0 24048 CHRIS NEWMAN VP ANCILLARY 40.00 X 268622 0 30138 SHANE HERRIN MD PHYSICIAN 40.00 X 267454 0 22981 LISSA MURPHY MD PHYSICIAN 40.00 X 268051 0 16332 JAMIE WOMACK VP CRITICAL 20.00 20.00 X 0 244279 35920 JAMES BUE VP FACILITY 40.00 X 229419 0 25660 MARK LOWE VP MARKETING 40.00 X 157801 0 1499 DAVID I MEDEROS DO TRUSTEE 1.00 1.00 X 0 9400 0 DARYL CRENSHAW MD TRUSTEE 1.00 1.00 X 0 8515 0 BRIAN SZWARC MD TRUSTEE 1.00 X 0 744 0 JOE BROWN TRUSTEE 1.00 X 0 0 0 CRAIG R WENTWORTH EDD CHAIRMAN 1.00 1.00 X X 0 0 0 DEBORAH GASKINS TRUSTEE 1.00 X 0 0 0 SINA GRIFFITH VICE CHAIRMA 1.00 X X 0 0 0 W GREGORY HAMIL TRUSTEE 1.00 1.00 X 0 0 0 HENRY A STONE III TRUSTEE 1.00 1.00 X 0 0 0 NATHANIEL H ABRAMS JR TREASURER 1.00 1.00 X X 0 0 0 CHARLES R SANDERS JR MD TRUSTEE 1.00 X 0 0 0 JAMES TREY W FALCONER III MD TRUSTEE 1.00 X 0 0 0 HAILE MCCOLLUM SECRETARY 1.00 X X 0 0 0 SUE STEPHENSON TRUSTEE 1.00 X 0 0 0 3964700 5112178 635609 140 false true false QUALIVIS LLC 5930 CONERSTONE CT W300 SAN DIEGO CA 92121 NURSING 7961810 RED HILLS RADIOLOGY 714 N DAWSON STREET THOMASVILLE GA 317924451 RADIOLOGY SVC 6739484 MORRISON MANAGEMENT SPECIALISTS 5801 PEACHTREE DUNWOODY RD ATLANTA GA 303421503 DIETARY SVCS 6267458 SOUTHLAND HOSPITALIST GROUP PO BOX 1276 THOMASVILLE GA 317991276 HOSPITALIST SVC 4032138 SOUTHLAND EMERGENCY MEDICAL PO BOX 1276 THOMASVILLE GA 317991279 ER PHYSICIAN 2618767 74 4195850 13062370 1202437 18460657 PATIENT SERVICE REVENUE 623000 355615372 355615372 DSH MEDICAID 623000 6223074 6223074 LAB SERVICES 621500 715627 715627 362554073 9003870 9003870 2268456 523322 1745134 1745134 1745134 51231 396725 -345494 -345494 -345494 MISCELLANOUS REVENUE 621990 325610 325610 MEDICAL RECORD TRANSCRIPT FEE 621990 219904 219904 RESEARCH STUDIES 623000 196005 196005 292266 187150 105116 1033785 392452025 362767115 715627 10508626 X 96000 96000 287288 287288 7987662 341336 7646326 120560744 105347382 15213362 1859440 1464415 395025 17319972 14292890 3027082 12062865 9956689 2106176 318642 318642 18803 18803 93113 93113 1078875 1078875 81343902 77026516 4317386 225805 67984 157821 9271398 7309398 1962000 1097693 847166 250527 6922807 5936195 986612 894183 632709 261474 37534 37534 771393 771393 24928783 21625719 3303064 3128968 3128968 MEDICAL SUPPLIES JDAMH 58671189 58670987 202 PROVIDER FEES 5038738 5038738 R&M JDAM 3608437 3202365 406072 MEDICAL SUPPLIES GRADY 2183396 2183396 4980767 4316012 664755 364788397 322581080 42207317 0 55058932 36608568 102856 102989 52008632 45565775 3738150 3886515 5069254 5758346 604838207 389052117 208363387 215786090 447989506 383166127 1229669 1229669 200656407 233163142 974216793 925267221 37130400 36439456 2151974 1552015 96495000 90395000 50000000 50000000 185777374 178386471 X 785768285 744557902 2671134 2322848 788439419 746880750 974216793 925267221 27663628 -69222297 X true X true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10821 10821 322581080 322591901 1000000 250000 1000000 1000000 1000000 1000000 4000000 6000000 12512 12686 13029 10821 49048 250000 250000 250000 250000 1000000 1500000 2671134 -348286 2322848 2190524 480610 2671134 1997550 192974 2190524 1973758 23792 1997550 4335125 251064 2612431 1973758 1.00000 false false 9647084 9647084 177315823 80962031 96353792 30237402 19986905 10250497 376430067 288103181 88326886 11207831 11207831 215786090 DUE FROM RELATED PARTIES 201081805 OTHER RECEIVABLES 17125113 EHR RECEIVABLE 4234290 DUE FROM SELF INSURANCE TRUST 3387831 THIRD PARTY SETTLEMENTS 2713955 PHYSICIAN RECEIVABLES 2629082 SCHOLARSHIP/TUITION RECEIVABLE 1422624 INTEREST RECEIVABLE 568442 233163142 X SCHEDULE D, PAGE 2, PART V, LINE 4 ENDOWMENT 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 X THE 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. true true X true X true X 3.250000000000 true true false false 15802867 15802867 0.04330 42985152 43875237 625168 554604 70564 0.00020 59413187 44429841 15873431 0.04350 195517 195517 0.00050 1471167 1471167 0.00400 30268354 30268354 0.08300 96000 96000 0.00030 32031038 32031038 0.08780 91444225 44429841 47904469 0.13130 true 39461896 65121161 70353073 -5231912 X true true 4 1 JOHN D ARCHBOLD MEM HOSP P O BOX 1018 THOMASVILLE GA 317991018 WWW.ARCHBOLD.ORG 136-91 X X X PSYCH, REHAB, NURSING HOME A 2 GRADY GENERAL HOSPITAL 1155 FIFTH STREET SE CAIRO GA 31728 WWW.ARCHBOLD.ORG 065-413 X X X SWING BED SNF A 3 BROOKS COUNTY HOSPITAL 903 N COURT ST QUITMAN GA 31643 WWW.ARCHBOLD.ORG 014-028 X X X RHC, SWING BED SNF A 4 MITCHELL COUNTY HOSPITAL 90 STEPHENS ST CAMILLA GA 31730 WWW.ARCHBOLD.ORG 101-120 X X X NURSING HOME, RHC, SWING BED A A 1234 false false true X X X X X X X X X X 22 true true false true X WWW.ARCHBOLD.ORG X X true 22 true WWW.ARCHBOLD.ORG false false true X 200.000000000000 325.000000000000 X true true X X X true X WWW.ARCHBOLD.ORG X WWW.ARCHBOLD.ORG X WWW.ARCHBOLD.ORG X X X X X X true X false X X X X true X false false GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 3E THE 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 5 INPUT 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 6A THE 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 7D DISTRIBUTED COPIES TO THE COMMUNITY; AVAILABLE ONLINE GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 11 QUALITATIVELY, 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. 8 GLENN-MOR NURSING HOME 10629 U S HIGHWAY 19 S THOMASVILLE GA 31792 SKILLED NURSING HOME JDA PSYCHIATRIC UNIT P O BOX 1018 THOMASVILLE GA 31792 PSYCHIATRIC UNIT JDA REHABILITATION UNIT P O BOX 1018 THOMASVILLE GA 31792 REHABILITATION UNIT MITCHELL CO CONVALESCENT CENTER 90 STEPHENS STREET CAMILLA GA 31728 SKILLED NURSING HOME CAMILLA PEDIATRICS CENTER P O BOX 360 CAMILLA GA 31728 RURAL HEALTH CLINIC MEDICAL GROUP OF MITCHELL COUNTY P O BOX 360 CAMILLA GA 31728 RURAL HEALTH CLINIC ARCHBOLD PELHAM PRIMARY CARE CLINIC P O BOX 360 CAMILLA GA 31728 RURAL HEALTH CLINIC PELHAM PARKWAY NURSING HOME 608 DOGWOOD DRIVE NE PELHAM GA 31797 SKILLED NURSING HOME SCHEDULE H, PART I, LINE 7 THE 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 2 AMOUNTS 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 4 SEE THE DISCUSSION OF PRICE CONCESSIONS AND NET PATIENT SERVICE REVENUE IN FOOTNOTE 2 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. SCHEDULE H, PART III, LINE 9B PATIENTS 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 2 REVIEW 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 3 ANNUAL 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 4 COUNTIES 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 5 LIVE 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 6 ARCHBOLD 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. true THOMAS UNIVERSITY 1501 MILLPOND ROAD THOMASVILLE GA 31792 580644897 501C3 11000 MEDICAL LAB PROG THOMAS UNIVERSITY 1501 MILLPOND ROAD THOMASVILLE GA 31792 580644897 501C3 85000 NURSG PROGRAM 1 SCHOLARSHP/TUITION PROG 140593 MED STUDENT HOUSING 209 146695 FMV HOUSING/UTIL. SCHEDULE I, PAGE 1, PART I, LINE 2 THE 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. X X true true X X X X X true true false false false false false false false J PERRY MUSTIAN PAST PRES/CEO (8/20) 192272 3127359 16194 3335825 DARCY M CRAVEN PRESIDENT/CEO 745869 236250 2185 149300 9548 1143152 COY IRVIN MD VP MEDICAL AFFAIRS 349321 243529 6858 17400 12508 629616 GREG HEMBREE ASST SEC/SR VP/CFO 388587 153154 3564 65020 12508 622833 JIM CARTER COO 337943 88644 1242 59760 9548 497137 AMY GRIFFIN VP PATIENT CARE 285843 73899 1242 56822 6668 424474 DINESH B PATEL MD PHYSICIAN 233360 157944 524 14399 9548 415775 EUGENE SUN MD PHYSICIAN 285517 68037 443 11600 9548 375145 JASON NESMITH MD TRUSTEE 220210 102253 214 9112 9548 341337 MARK L CATTERSON PHYSICIAN 291602 22751 1977 14500 9548 340378 CHRIS NEWMAN VP ANCILLARY SVCS 221882 46200 540 29460 678 298760 SHANE HERRIN MD PHYSICIAN 261072 6000 382 13433 9548 290435 LISSA MURPHY MD PHYSICIAN 260904 5500 1647 15654 678 284383 JAMIE WOMACK VP CRITICAL ACCESS 191659 52080 540 26427 9493 280199 JAMES BUE VP FACILITY SERVICES 175213 50642 3564 25660 255079 MARK LOWE VP MARKETING 36717 121084 1499 159300 SCHEDULE J, PAGE 1, PART I, LINE 4 DARCY 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 III THE 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. A HOSP AUTH OF THE CITY OF THOMASVILL 2017C REVENUE BONDS 581719301 NONENONEN 2017-07-12 82750000 CONSTRUCTION BLDG AND EQUIPMENT false true false B HOSP AUTH OF THE CITY OF THOMASVILL 2017A REVENUE BONDS 581719301 NONENONEN 2017-07-12 17985000 CONSTRUCTION PROJECT DEPOSIT false true false C HOSP AUTH OF THE CITY OF THOMASVILL 2017B REVENUE BONDS 581719301 NONENONEN 2017-07-12 15435000 CONSTRUCTION PROJECT DEPOSIT false true false A 15190000 82850000 82522324 327676 false true false true B 17985000 17985000 2017 false false true true C 10585000 15435000 15435000 2017 false false true true A false false false false false false true B false false false false false false true C false false false false false false true A false false true false false false false false true B false false true false true false false false true C false false true false true false false false true A false B false C false PURPOSE OF ISSUE DESCRIPTION HOSP AUTH OF THE CITY OF THOMASVILLE CONSTRUCTION BLDG AND EQUIPMENT PURPOSE OF ISSUE DESCRIPTION HOSP AUTH OF THE CITY OF THOMASVILLE CONSTRUCTION PROJECT DEPOSIT PURPOSE OF ISSUE DESCRIPTION HOSP AUTH OF THE CITY OF THOMASVILLE CONSTRUCTION PROJECT DEPOSIT JAMES W FALCONER III MD BOARD TRUSTEE 567449 RENTAL, PATIENT SVCS false JAMI STEPHENSON FAMILY MEMBER 129525 COMPENSATION false DAVID MEDEROS DO BOARD TRUSTEE 4678074 PROFESSIONAL MED SVC false HAILE P MCCOLLUM BOARD TRUSTEE 76000 SERVICE AGREEMENT false SINA E GRIFFITH FAMILY MEMBER 13917337 SERVICE AGREEMENT false WILLIAM W ELLIS MD BOARD TRUSTEE 13917337 SERVICE AGREEMENT false TIMOTHY B DANIEL MD BOARD TRUSTEE 4941340 SERVICE AGREEMENT false SCHEDULE L, PART V JAMES 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. FORM 990, PAGE 2, PART III, LINE 4A JOHN 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 4D BROOKS 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 2 NATHANIEL 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 6 THE 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 7A THE 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 7B THE 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 11B MANAGEMENT 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 12C ON 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 15A ARCHBOLD 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 15B SEE 15A ABOVE. FORM 990, PAGE 6, PART VI, LINE 19 NO DOCUMENTS ARE OR WILL BE MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONSULTANT 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 ARCHBOLD FOUNDATION INC PO BOX 620 THOMASVILLE GA 317990620 581559677 FOUNDATION GA 501C3 12B AMC ARCHBOLD MEDICAL CENTER INC false ARCHBOLD HEALTH SERVICES INC PO BOX 620 THOMASVILLE GA 317990620 581376434 HEALTHCARE GA 501C3 10 AMC ARCHBOLD MEDICAL CENTER INC false ARCHBOLD MEDICAL CENTER INC PO BOX 1018 THOMASVILLE GA 317991018 581552650 H/C MGMT GA 501C3 12C NA false ARCHBOLD MEDICAL GROUP INC P O BOX 620 THOMASVILLE GA 317990620 262988454 PHYSICIANS GA 501C3 3 AMC ARCHBOLD MEDICAL CENTER INC false CCSG INC 915 GORDON AVENUE THOMASVILLE GA 317926614 473501366 MED CLINIC GA 501C3 3 AMG false AMGIR INC 915 GORDON AVENUE THOMASVILLE GA 317926614 821188691 MED CLINIC GA 501C3 3 AMG false ARCHBOLD MEDICAL ENTERPRISES 400 OLD ALBANY ROAD THOMASVILLE GA 317924013 581494513 HEALTHCARE GA N/A false GEORGIA-FLORIDA PREFERRED INC 915 GORDON AVE THOMASVILLE GA 31792 581744334 HEALTHCARE GA JDAMH C CORP 4614 178364 1.00000 true false false true true false false false false false true false true true true true false false true false