POLK MEDICAL CENTER INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- POLK MEDICAL CENTER INC (EIN 45-3957368)
- Tax period
- 2021-07-01 to 2021-12-31
- Filed
- 2022-11-15
- IRS object ID
- 202233199349308453
- Schema version
- 2021v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-15T11:32:52-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 580914992 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAFFIN & TUCKER LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 71309 | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 317081309 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 453957368 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POLK MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | POLK | BusinessNameControlTxt |
| Phone | 7065096074 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 420 E SECOND AVENUE SUITE 102 | AddressLine1Txt |
| City | ROME | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 301613210 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PHILIP WHEELER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7065096074 | PhoneNum |
| Signature | 2022-11-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | PHILIP | PersonFirstNm |
| Person Last | WHEELER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WILLIAM EDWARD PHILLIPS | PreparerPersonNm |
| PTIN | P00451499 | PTIN |
| Phone | 2298837878 | PhoneNum |
| Preparation | 2022-11-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FLOYD POLK MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KURT STUENKEL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 304 TURNER MCCALL BLVD | AddressLine1Txt |
| City | ROME | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 301620233 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $21,458,525 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FLOYD.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2011 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 76 | TotalVolunteersCnt |
| Total Gross UBI | $5,113 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $2,900 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $4,286,072 | PYContributionsGrantsAmt |
| CY Contributions Grants | $822,938 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $33,267,176 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $20,086,946 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,514,705 | PYInvestmentIncomeAmt |
| CY Investment Income | $451,815 | CYInvestmentIncomeAmt |
| PY Other Revenue | $41,311 | PYOtherRevenueAmt |
| CY Other Revenue | $96,826 | CYOtherRevenueAmt |
| PY Total Revenue | $39,109,264 | PYTotalRevenueAmt |
| CY Total Revenue | $21,458,525 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $313,884 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,348,091 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,067,057 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,548,691 | PYOtherExpensesAmt |
| CY Other Expenses | $5,472,933 | CYOtherExpensesAmt |
| PY Total Expenses | $25,210,666 | PYTotalExpensesAmt |
| CY Total Expenses | $13,539,990 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $13,898,598 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,918,535 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $101,830,364 | TotalAssetsBOYAmt |
| Total Assets EOY | $97,824,042 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $45,057,988 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $32,592,566 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $56,772,376 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $65,231,476 | NetAssetsOrFundBalancesEOYAmt |
| Mission | POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $12,045,167 | ExpenseAmt |
| Revenue | $20,086,946 | RevenueAmt |
| Desc | POLK MEDICAL CENTER IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING GENERAL ACUTE CARE SERVICES TO THE POLK COUNTY AND NORTHERN HARALSON COUNTY COMMUNITIES. DURING THE SIX MONTH SHORT PERIOD ENDING DECEMBER 31, 2021, PATIENT DAYS AT POLK MEDICAL CENTER TOTALED 4,010. EMERGENCY ROOM VISITS TOTALED 14,378. | Desc |
| Total Program Service Expenses | $12,045,167 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 17 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PHILIP WHEELER | PersonNm |
| Phone | 7065093012 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 304 TURNER MCCALL BLVD | AddressLine1Txt |
| City | ROME | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 301610233 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| KURT STUENKEL | |||||||||
| PRESIDENT/SE | 1.00 | 53.00 | Yes (X) | Yes (X) | $0 | $2,971,233 | $24,408 | ||
| WARREN SONNY RIGAS | |||||||||
| COO-FLOYD SY | 15.00 | 35.00 | $0 | $673,362 | $73,944 | Yes (X) | |||
| MATTHEW GORMAN | |||||||||
| POLK ADMINIS | 50.00 | $0 | $531,294 | $59,726 | Yes (X) | ||||
| CLARICE CABLE | |||||||||
| INTERIM CFO | 1.00 | 49.00 | Yes (X) | $0 | $432,294 | $48,127 | |||
| TIFANI KINARD | |||||||||
| ADMINISTRATO | 50.00 | Yes (X) | $217,620 | $0 | $18,922 | ||||
| DEANA OWEN | |||||||||
| PHARMACY DIR | 50.00 | $189,610 | $0 | $16,133 | Yes (X) | ||||
| LEAH S ASHMORE | |||||||||
| THERAPIST | 50.00 | $173,300 | $0 | $32,263 | Yes (X) | ||||
| LOVEJOY LEIGH | |||||||||
| PHARMACIST | 50.00 | $141,279 | $0 | $27,079 | Yes (X) | ||||
| ANITA J JACKSON | |||||||||
| DIRECTOR OF | 50.00 | $138,826 | $0 | $20,966 | Yes (X) | ||||
| ROBERT WADE | |||||||||
| NURSE | $141,829 | $0 | $8,004 | Yes (X) | |||||
| GEORGE A BOSWORTH MD | |||||||||
| MEMBER | 1.00 | 1.00 | Yes (X) | $2,000 | $9,000 | $0 | |||
| KAY CHUMBLER | |||||||||
| MEMBER | 1.00 | 2.00 | Yes (X) | $2,750 | $7,750 | $0 | |||
| FRANK SHELLEY | |||||||||
| CHAIRMAN | 1.00 | 2.00 | Yes (X) | Yes (X) | $2,750 | $3,875 | $0 | ||
| TODD BUSSEY | |||||||||
| MEMBER | 1.00 | 1.00 | Yes (X) | $2,750 | $2,000 | $0 | |||
| BRITT MADDEN JR | |||||||||
| MEMBER | 1.00 | Yes (X) | $2,750 | $0 | $0 | ||||
| NEIL E GORDON MD | |||||||||
| MEMBER | 1.00 | 1.00 | Yes (X) | $2,750 | $0 | $0 | |||
| SONDI SMITH VEST | |||||||||
| MEMBER | 1.00 | Yes (X) | $2,750 | $0 | $0 | ||||
| LEE CUMMINGS | |||||||||
| MEMBER | 1.00 | Yes (X) | $2,500 | $0 | $0 | ||||
| DARROLL FREEMAN | |||||||||
| MEMBER | 1.00 | Yes (X) | $2,500 | $0 | $0 | ||||
| OTHEL DOYLE TREY KELLEY | |||||||||
| MEMBER (TO 9 | 1.00 | Yes (X) | $1,250 | $0 | $0 | ||||
| PHILIP WHEELER | |||||||||
| CFO | Yes (X) | $0 | $0 | $0 | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,027,214 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,630,808 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $329,572 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 21 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MORRISON MANAGEMENT SPECIALISTS | |||||
| P O BOX 102289 | ATLANTA | GA | 303682289 | FOOD SERVICES | $330,677 |
| ARAMARK MANAGEMENT SERVICE | |||||
| P O BOX 233 | ROME | GA | 301610233 | HOUSEKEEPING | $213,578 |
| HEALTHCARE WORKFORCE LOGISTICS | |||||
| PO BOX 860573 | MINNEAPOLIS | MN | 55486 | NURSING | $127,608 |
| CERNER CORPORATION | |||||
| P O BOX 412702 | KANSAS CITY | MO | 641412702 | IT SERVICES | $122,392 |
| WHITE COAT SCIENCES | |||||
| 315 BANKHEAD HIGHWAY | CARROLLTON | GA | 30117 | LAB | $101,900 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $162,169 | GovernmentGrantsAmt |
| All Other Contributions | $660,769 | AllOtherContributionsAmt |
| Total Contributions | $822,938 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 623000 | $20,081,833 | $20,081,833 | |
| REFERENCE LAB | 621500 | $5,113 | $5,113 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $20,086,946 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $451,815 | TotalRevenueColumnAmt |
| Exclusion | $451,815 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA REVENUE | 722210 | $86,789 | $86,789 | |
| PURCHASE DISCOUNTS | 623000 | $10,037 | $10,037 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $96,826 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,458,525 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,091,870 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $5,113 | UnrelatedBusinessRevenueAmt |
| Exclusion | $538,604 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,750 | TotalAmt |
| Management And General | $24,750 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,947,821 | TotalAmt |
| Program Services | $5,551,211 | ProgramServicesAmt |
| Management And General | $396,610 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,658,501 | TotalAmt |
| Program Services | $1,547,879 | ProgramServicesAmt |
| Management And General | $110,622 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $435,985 | TotalAmt |
| Program Services | $408,352 | ProgramServicesAmt |
| Management And General | $27,633 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,689 | TotalAmt |
| Management And General | $35,689 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,036 | TotalAmt |
| Management And General | $5,036 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $895,678 | TotalAmt |
| Program Services | $546,390 | ProgramServicesAmt |
| Management And General | $349,288 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $874 | TotalAmt |
| Program Services | $506 | ProgramServicesAmt |
| Management And General | $368 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,027 | TotalAmt |
| Program Services | $152,450 | ProgramServicesAmt |
| Management And General | $20,577 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $167,324 | TotalAmt |
| Program Services | $6,198 | ProgramServicesAmt |
| Management And General | $161,126 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $343,858 | TotalAmt |
| Program Services | $311,914 | ProgramServicesAmt |
| Management And General | $31,944 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $558,292 | TotalAmt |
| Program Services | $544,074 | ProgramServicesAmt |
| Management And General | $14,218 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,854 | TotalAmt |
| Program Services | $5,585 | ProgramServicesAmt |
| Management And General | $3,269 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,841 | TotalAmt |
| Program Services | $52,841 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,433,818 | TotalAmt |
| Program Services | $1,300,616 | ProgramServicesAmt |
| Management And General | $133,202 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,090 | TotalAmt |
| Management And General | $122,090 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,297,817 | $1,292,584 | $5,233 |
| REPAIRS & MAINTENANCE | $324,035 | $280,182 | $43,853 |
| LICENSES & TAXES | $44,651 | $42,833 | $1,818 |
| DUES & SUBSCRIPTIONS | $8,522 | $1,552 | $6,970 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $527 | TotalAmt |
| Management And General | $527 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,539,990 | TotalAmt |
| Program Services | $12,045,167 | ProgramServicesAmt |
| Management And General | $1,494,823 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,902,954 | BOYAmt |
| EOY | $5,106,578 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,709,047 | BOYAmt |
| EOY | $18,023,413 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,847,820 | BOYAmt |
| EOY | $5,718,470 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $281,047 | BOYAmt |
| EOY | $282,120 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $321,958 | BOYAmt |
| EOY | $585,975 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $57,349,615 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $24,488,473 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,600,915 | BOYAmt |
| EOY | $32,861,142 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,701,519 | BOYAmt |
| EOY | $30,190,041 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,465,104 | BOYAmt |
| EOY | $5,056,303 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,830,364 | BOYAmt |
| EOY | $97,824,042 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,189,493 | BOYAmt |
| EOY | $2,485,342 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,657,523 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,251,126 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,778,185 | BOYAmt |
| EOY | $2,687,881 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,839,184 | BOYAmt |
| EOY | $25,761,820 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $45,057,988 | BOYAmt |
| EOY | $32,592,566 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,772,376 | BOYAmt |
| EOY | $65,231,476 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,772,376 | BOYAmt |
| EOY | $65,231,476 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,830,364 | BOYAmt |
| EOY | $97,824,042 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $7,918,535 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$88,999 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $629,564 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $838,635 | OtherCostOrOtherBasisAmt |
| Book Value | $838,635 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $28,399,491 | OtherCostOrOtherBasisAmt |
| Depreciation | $12,673,241 | DepreciationAmt |
| Book Value | $15,726,250 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $283,152 | OtherCostOrOtherBasisAmt |
| Depreciation | $73,912 | DepreciationAmt |
| Book Value | $209,240 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,828,337 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,741,320 | DepreciationAmt |
| Book Value | $16,087,017 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $32,861,142 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| LEASED ASSETS | $2,265,128 |
| DUE FROM RELATED PARTIES | $1,704,241 |
| DSH RECEIVABLE | $944,495 |
| OTHER RECEIVABLES | $142,439 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,056,303 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| POLK FOUNDATION LIABILITY | $20,000,000 |
| MEDICARE ADVANCE PAYMENTS | $4,238,820 |
| THIRD PARTY SETTLEMENTS | $1,523,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $25,761,820 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 3, PART X | ATRIUM HEALTH INC., ATRIUM HEALTH NAVICENT, ATRIUM HEALTH FLOYD, NCBH, WFUHS, AND VARIOUS AFFILIATES ARE TAX EXEMPT AS DESCRIBED IN SECTION (C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE GENERALLY EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AS A NORTH CAROLINA HOSPITAL AUTHORITY, ATRIUM HEALTH CMHA IS ALSO EXEMPT FROM FEDERAL AND STATE INCOME TAXES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS MADE IN THE COMBINED FINANCIAL STATEMENTS. IF APPLICABLE, UNRELATED BUSINESS INCOME IS REPORTED BY ALL MEMBERS AND SUBSIDIARY ORGANIZATIONS ON IRS FORM 990-T. FISCAL YEARS ENDING ON OR AFTER JUNE 30, 2018 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. THE ENTERPRISE AND ITS SUBSIDIARIES HAVE EVALUATED UNCERTAIN TAX POSITIONS FOR THE FISCAL YEAR ENDED DECEMBER 31, 2021, INCLUDING A QUANTIFICATION OF TAX RISKS IN AREAS SUCH AS UNRELATED BUSINESS INCOME AND TAXATION OF FOR- PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ENTERPRISE'S COMBINED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2021. |
| SCHEDULE D, PAGE 4, PART XIII | THE ATRIUM HEALTH ENTERPRISE AND ITS AFFILIATES, INCLUDING THE FILING ORGANIZATION, HAVE EVALUATED UNCERTAIN TAX POSITIONS FOR THE FISCAL YEAR ENDED DECEMBER 31, 2021, INCLUDING A QUANTIFICATION OF TAX RISKS IN AREAS SUCH AS UNRELATED BUSINESS INCOME AND TAXATION OF ITS FOR-PROFIT SUBSIDIARIES. THE EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ATRIUM HEALTH ENTERPRISE'S COMBINED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2021. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 1.250000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $998,019 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $998,019 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07370 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,487,785 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,221,567 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $266,218 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01970 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,485,804 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,221,567 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,264,237 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09340 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,485,804 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,221,567 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,264,237 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09340 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,835,374 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $917,687 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,861,678 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,823,444 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $38,234 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POLK MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2360 ROCKMART HIGHWAY | AddressLine1Txt |
| City | CEDARTOWN | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30125 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTPS://WWW.FLOYD.ORG | WebsiteAddressTxt |
| State License | 115-705 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | SWING BED SNF | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | POLK MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.FLOYD.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.FLOYD.ORG/ABOUT-FLOYD/PAGE | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.FLOYD.ORG/PATIENTS-VISITOR | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.FLOYD.ORG/PATIENTS-VISITOR | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.FLOYD.ORG/PATIENTS-VISITOR | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 3E | POLK MEDICAL CENTER, INC. AND FLOYD HEALTHCARE MANAGEMENT, INC. BECAME PART OF ATRIUM HEATLH DURING 2021. ATRIUM HEALTH FLOYD CONDUCTED A COMMUNITY SURVEY TO VALIDATE DATA, GIVE MEMBERS OF THE COMMUNITY AN OPPORTUNITY TO COMMENT ON THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT AND TO PROVIDE COMMUNITY-LEVEL INSIGHT INTO THE HEALTH NEEDS FOR EACH OF THE COUNTIES IN OUR PRIMARY SERVICE AREA. RESPONDENTS IDENTIFIED ACCESS TO CARE, CARDIOVASCULAR HEALTH, MENTAL HEALTH ISSUES AND OBESITY AS THE MOST IMPORTANT ISSUES FACING THE FOUR-COUNTY PRIMARY SERVICE AREA. OTHER RESPONSES INCLUDE: 1) ALCOHOL ABUSE 2) ALZHEIMER'S DISEASE 3) CANCER 4) COMMUNITY SAFETY 5) COVID-19 6) DRUG ABUSE 7) ELDER CARE 8) EMERGENCY CARE FOR FISHING AND LAKE COMMUNITIES 9) HEALTH EDUCATION 10)NUTRITION 11)PARENTAL SUPPORT FOR CHILDREN AND TEENS 12)PRESCRIPTION PRICES AN ANALYSIS OF THE HEALTH DATA STATISTICS AND SURVEY RESULTS PROVIDES CLEAR GUIDANCE IN ESTABLISHING THE HEALTH NEEDS OF THE FOUR PRIMARY COUNTIES SERVED BY ATRIUM HEALTH FLOYD: ACCESS TO CARE CARDIOVASCULAR DISEASE MENTAL AND BEHAVIORAL HEALTH NUTRITION AND WELLNESS THE SIGNIFICANT HEALTH NEEDS ARE SUMMARIZED ON PAGES 19 - 21 OF THE CHNA WHICH IS AVAILABLE AT - HTTPS://WWW.FLOYD.ORG/ABOUT-FLOYD/DOCUMENTS/2021-CHNA-POLK-FINAL.PDF. |
| FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 5 | ATRIUM HEALTH FLOYD CONDUCTED A COMMUNITY SURVEY TO VALIDATE DATA, GIVE MEMBERS OF THE COMMUNITY AN OPPORTUNITY TO COMMENT ON THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT AND TO PROVIDE COMMUNITY-LEVEL INSIGHT INTO THE HEALTH NEEDS FOR EACH OF THE COUNTIES IN OUR PRIMARY SERVICE AREA. COMMUNITY SURVEY FINDINGS ARE DISCUSSED BEGINNING ON PAGE 14 OF THE CHNA. |
| FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 6A | THE 2021 CHNA WAS CONDUCTED IN ASSOCIATION WITH FLOYD MEDICAL CENTER, A 300+ BED ACUTE CARE HOSPITAL LOCATED IN ROME, GA, AND CHEROKEE MEDICAL CENTER, A 60-BED LICENSED ALABAMA HOSPITAL LOCATED IN CENTRE, AL. |
| FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 7D | THE 2021 CHNA HAS BEEN DISTRIBUTED UPON REQUEST TO OTHER NON-PROFIT AGENCIES IN THE AREA TO ASSIST WITH GRANTS. COPIES HAVE ALSO BEEN MADE AVAILABLE TO ELECTED OFFICIALS, CHAMBERS OF COMMERCE, AND EDUCATIONAL INSTITUTIONS IN THE AREA. |
| FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 11 | ACCESS TO CARE, CARDIOVASCULAR DISEASE, MENTAL HEALTH SERVICES AND NUTRITION WERE SEEN AS SIGNIFICANT CONCERNS THAT AFFECT MANY RESIDENTS. FURTHERMORE, SOME BARRIERS TO ACCESSING CARE CONTINUE TO PREVENT CURRENT PROGRAMS AND INITIATIVES FROM REACHING THE POPULATIONS IN NEED. THESE CHALLENGES PRESENT IMPORTANT OPPORTUNITIES FOR THE FUTURE. AS WE MOVE FORWARD AS AN INTEGRATED COMMUNITY OF HEALTHCARE, SOCIAL SERVICES AND COMMUNITY LEADERSHIP, WE CAN LEVERAGE COMMUNITY ASSETS TO IMPROVE THE HEALTH OF RESIDENTS IN FLOYD, POLK, CHATTOOGA AND CHEROKEE COUNTIES. THE SUMMARY OF COMMUNITY HEALTH NEEDS BEGINS ON PAGE 17 OF THE CHNA. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7 | THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". SEE ALSO THE DESCRIPTION FOR PART III, LINE 2. |
| SCHEDULE H, PART III, LINE 2 | AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. |
| SCHEDULE H, PART III, LINE 3 | THE FIGURE ON PART III LINE 3 REPRESENTS MANAGEMENT'S ESTIMATE (APPROXIMATELY 50%) BASED ON AN ANALYSIS OF SELF-PAY PATIENTS' ABILITY TO PAY THEIR OUTSTANDING ACCOUNT. THIS ANALYSIS INCLUDES REVIEWING THE PATIENT'S CREDIT HISTORY, INCOME LEVELS AND OVERALL COLLECTIBILITY OF THE ACCOUNT. |
| SCHEDULE H, PART III, LINE 4 | SEE THE DISCUSSION OF PRICE CONCESSIONS AND BAD DEBTS WITHIN THE FOOTNOTE ON NET PATIENT SERVICE REVENUE ON PAGES 14-19 OF 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 | FOR PATIENTS RECEIVING ONLY A PORTION OF THEIR BILL AS CHARITY, THE REMAINING PORTION OF THE BILL IS TREATED THE SAME AS ALL OTHER PATIENTS IN REGARDS TO COLLECTIONS. |
| SCHEDULE H, PART VI, LINE 2 | ATRIUM HEALTH FLOYD WHICH INCLUDES POLK MEDICAL CENTER, INC. COMPLETED A HEALTH CARE NEEDS ASSESSMENT IN FISCAL YEAR 2021. IN ADDITION, FHMI, THE SOLE MEMBER, DEVELOPS A STRATEGIC PLAN THAT IS UPDATED ANNUALLY. THE STRATEGIC PLAN TAKES INTO CONSIDERATION HEALTH NEEDS FOR POLK MEDICAL CENTER'S SERVICE AREA IN ADDITION TO UTILIZATION OF SERVICES, COMMUNITY PARTICIPATION, AND QUALITY OF SERVICES PROVIDED. |
| SCHEDULE H, PART VI, LINE 3 | POLK COMMUNICATES INFORMATION REGARDING A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH THE USE OF SIGNAGE IN THE EMERGENCY CARE CENTER, PATIENT REGISTRATION AREAS, IN THE BUSINESS/PATIENT FINANCIAL SERVICES OFFICES, AND IN THE OFFICES OF OUR FINANCIAL COUNSELORS. DURING TIMES OF PREADMISSION, AS WELL AS DURING ON-SITE REGISTRATION, THE ACCESS/REGISTRATION STAFF DISCUSSES FINANCIAL ASSISTANCE POLICIES WITH THE PATIENT/PATIENT'S FAMILY IF APPROPRIATE. AFTER DISCHARGE AND DURING THE "COLLECTION" PERIOD OUR STAFF ONCE AGAIN DISCUSSES OUR FINANCIAL ASSISTANCE POLICIES. IN ADDITION THERE IS A DEMONSTRATED WORD-OF-MOUTH COMMUNICATION OF THESE POLICIES THROUGH OUR PATIENT POPULATION. |
| SCHEDULE H, PART VI, LINE 4 | POLK COUNTY HAS AN ESTIMATED 42,600 RESIDENTS AND IS PART OF A FOUR-COUNTY AREA SERVED BY FLOYD POLK MEDICAL CENTER, A 25-BED CRITICAL ACCESS HOSPITAL WITH EMERGENCY MEDICINE, SURGERY AND DIAGNOSTIC IMAGING CAPABILITIES, FLOYD MEDICAL CENTER, A 304-BED ACUTE CARE SAFETY NET HOSPITAL, AND A THIRD, ADVENT HEALTH-OWNED HOSPITAL. THE 2021 CHNA COMMUNITY HEALTH PROFILE DISCUSSION BEGINS ON PAGE 7 OF THE CHNA. |
| SCHEDULE H, PART VI, LINE 5 | PATIENT SERVICES: MEETING THE NEEDS OF OUR COMMUNITY 24/7/365 AS A NOT-FOR-PROFIT COMMUNITY HOSPITAL, POLK MEDICAL CENTER PROVIDES THE MEDICAL SERVICES CRITICALLY NECESSARY TO SUPPORT HEALTHY LIVING IN POLK COUNTY. THOSE SERVICES INCLUDE THE FOLLOWING: -BREAST HEALTH -CARDIOLOGY -CORPORATE HEALTH -DIABETES CARE -EMERGENCY CARE -EMERGENCY MEDICAL SERVICES (EMS) -FAMILY MEDICINE -HOSPICE -IMAGING SERVICES -INFUSION THERAPY -LABORATORY SERVICES -OUTPATIENT REHABILITATION -PEDIATRICS -PULMONARY REHABILITATION -SUBACUTE REHABILITATION -URGENT CARE -WOUND CARE CHARITY CARE AND COMMUNITY BENEFITS PERHAPS THE MOST SIGNIFICANT FACTOR IN MEETING COMMUNITY HEALTH NEEDS IS THE CONTINUING COMMITMENT OF POLK MEDICAL CENTER TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. COMMUNITY SERVICE INDIVIDUALLY AND CORPORATELY, POLK MEDICAL CENTER CONTINUES TO BE ACTIVELY INVOLVED IN THE COMMUNITIES WHERE WE HAVE A PRESENCE, LENDING LEADERSHIP, TIME AND OTHER VALUABLE RESOURCES TO EFFORTS TO IMPROVE THE QUALITY OF LIFE FOR FAMILIES IN THE AREA. FOR EXAMPLE: -CARDIOPULMONARY RESUSCITATION, STOP THE BLEED AND FIRST AID EDUCATORS PROVIDE CPR AND FIRST AID TRAINING TO FLOYD EMPLOYEES, EMPLOYEES OF OTHER COMPANIES AND TO MEMBERS OF THE PUBLIC. IN ADDITION, FLOYD'S CHEST PAIN PROGRAM PROVIDES HANDS-ONLY CPR TRAINING IN THE COMMUNITY. -FLOYD EMERGENCY MEDICAL SERVICES, SUPPLEMENTED BY OTHER FLOYD DEPARTMENTS, IS A FIXTURE AT COMMUNITY EVENTS THROUGHOUT THE YEAR, PROVIDING ONSITE AMBULANCE BACK-UP, FIRST AID STATIONS AND MEDICAL SUPPORT WHEN IT IS NEEDED. -POLK MEDICAL CENTER EMPLOYEES MADE THE COVID-19 VACCINE AVAILABLE TO THE PUBLIC THROUGH THE ON-SITE CLINIC. -FLOYD IS HEAVILY INVESTED IN LOCAL SCHOOLS. IN ADDITION TO THE APPROXIAMATELY 8,000 STUDENTS AND 530 EMPLOYEES WHO ARE COVERED BY THE SCHOOL NURSES PROVIDED IN POLK COUNTY SCHOOLS, FLOYD PROVIDES HEALTH AND SAFETY TRAINING PROGRAMS AND CAREER DAY SPEAKERS TO STUDENTS THROUGHOUT THE AREA. AS PART OF THOSE EFFORTS, FLOYD, OF WHICH POLK MEDICAL CENTER IS A PART, SUPPLIES CERTIFIED ATHLETIC TRAINERS TO BOTH HIGH SCHOOLS IN POLK COUNTY. -FLOYD PROVIDES MAINTENANCE PRESCRIPTION PHARMACEUTICALS TO LOW-INCOME UNINSURED OUTPATIENTS AT NO COST TO THE PATIENT THROUGH ITS HOSPITAL PHARMACY. ANY QUALIFIED, LOW-INCOME PATIENT BEING DISCHARGED FROM POLK MEDICAL CENTER MAY BE ELIGIBLE TO RECEIVE THE PRESCRIBED MEDICATIONS. -THE FLOYD HEALTH SYSTEM'S MOBILE MAMMOGRAPHY COACH, OPERATED BY THE BREAST CENTER AT FLOYD, IS EQUIPPED WITH STATE-OF-THE-ART, DIGITAL MAMMOGRAPHY EQUIPMENT AND IS USED TO REACH OUT TO THE MOSTLY RURAL AND UNDERSERVED AREAS IN AND AROUND THE FOUR-COUNTY SERVICE AREA. THE GOAL OF THIS PROGRAM IS TO REACH WOMEN WHO HAVE NEVER HAD A MAMMOGRAM, IN HOPE OF REDUCING THE BREAST CANCER MORTALITY RATE IN OUR REGION, WHICH IS AMONG THE HIGHEST IN THE NATION. -AS A NOT-FOR-PROFIT COMMUNITY HOSPITAL, POLK MEDICAL CENTER IS CONTINUOUSLY LOOKING FOR OPPORTUNITIES TO REACH FARTHER INTO OUR COMMUNITY TO MEET THE NEEDS OF THE FULL SPECTRUM OF INDIVIDUALS WHO SEEK MEDICAL CARE IN NORTHWEST GEORGIA AND NORTHEAST ALABAMA. WE CURRENTLY HAVE SEVERAL OUTREACH PROGRAMS AIMED AT IMPROVING ACCESS TO HEALTH CARE IN OUR COMMUNITY. -MEMBERS OF THE POLK AND FLOYD HEALTH SYSTEM TEAM ARE COMMITTED TO THE COMMUNITY IN MANY WAYS. A PARTIAL LIST OF RECENT LEADERSHIP ROLES POLK EMPLOYEES HELD INCLUDES: -MEMBER, KIWANIS CLUB OF POLK COUNTY BOARD OF DIRECTORS -CHAIR, POLK COUNTY CHAMBER OF COMMERCE BOARD OF DIRECTORS -MEDICAL REPRESENTATIVE, POLK COUNTY COLLEGE AND CAREER ACADEMY -MEMBER, POLK COUNTY WATER AUTHORITY BOARD OF DIRECTORS -CHAIR, ROCKMART FARMERS MARKET BOARD OF DIRECTORS PMCI'S GOVERNING BODY IS PRIMARILY COMPRISED OF PERSONS WHO ARE NOT EMPLOYEES, CONTRACTORS (NOR FAMILY MEMBERS THEREOF), AND RESIDE IN THE PRIMARY SERVICE AREA. THE HOSPITAL'S MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS IN THE REGION. FUNDS RECEIVED FROM OPERATIONS, AFTER OPERATING EXPENSES, ARE USED TO SUPPORT VARIOUS OUTREACH EFFORTS DESCRIBED IN SCHEDULE H AND THE COMMUNITY BENEFIT REPORT; TO FURTHER IMPROVEMENT IN PATIENT CARE. |
| SCHEDULE H, PART VI, LINE 6 | POLK MEDICAL CENTER, INC. (PMCI) IS A GEORGIA NOT-FOR-PROFIT CORPORATION. ON NOVEMBER 6, 2014, PMCI ENTERED INTO A LEASE AGREEMENT WITH CEDARTOWN- POLK COUNTY HOSPITAL AUTHORITY (CEDARTOWN-POLK AUTHORITY) TO LEASE ALL OF THE ASSETS ASSOCIATED WITH POLK MEDICAL CENTER, A CRITICAL ACCESS HOSPITAL PROVIDING INPATIENT AND OUTPATIENT SERVICES. THIS LEASE HAS AN ORIGINAL 35-YEAR TERM. FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI) IS THE SOLE MEMBER OF PMCI. PURSUANT TO THE LEASE, TRANSFER AND REVERSION AGREEMENT BETWEEN THE HOSPITAL AUTHORITY OF FLOYD COUNTY (HAFC) AND FLOYD HEALTHCARE MANAGEMENT, INC. (LEASE), HAFC LEASED THE OPERATIONS OF FLOYD MEDICAL CENTER, FLOYD BEHAVIORAL HEALTH, AND HEYMAN HOSPICECARE AT FLOYD AND SUBSTANTIALLY ALL OF ITS NET ASSETS TO FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI), EFFECTIVE JANUARY 1, 1998. THE CONSIDERATION TO BE PAID BY FHMI CONSISTS PRIMARILY OF: PAYMENT OF PRINCIPAL AND INTEREST ON THE HOSPITAL AUTHORITY OF FLOYD COUNTY REVENUE ANTICIPATION CERTIFICATES; PAYMENT EQUAL TO THE CONTRIBUTION HAFC IS REQUIRED TO MAKE TO SATISFY MINIMUM FUNDING OBLIGATIONS UNDER HAFC'S PENSION PLAN WITH RESPECT TO BENEFITS WHICH HAD ACCRUED UNDER SUCH PLAN PRIOR TO THE LEASE; AND THE PROVISION OF HEALTHCARE SERVICES TO INDIGENT, CHARITY AND OTHER NEEDY PATIENTS EQUAL BUT NOT LIMITED TO A MINIMUM DOLLAR AMOUNT ANNUALLY AS SET FORTH IN THE LEASE. FHMI IS A NOT-FOR-PROFIT CORPORATION CREATED IN 1991 BY THE HAFC. FROM NOVEMBER 26, 1991, THROUGH DECEMBER 31, 1997, FHMI MANAGED AND SUPERVISED FLOYD MEDICAL CENTER AND ALL OTHER FACILITIES, PROJECTS AND PROGRAMS OF THE HAFC PURSUANT TO A MANAGEMENT AGREEMENT. EFFECTIVE JANUARY 1, 1998, THE AFORESAID MANAGEMENT AGREEMENT WAS CONVERTED TO A LEASE AGREEMENT UNDER WHICH ALL FACILITIES, PROJECTS AND PROGRAMS OF HAFC WERE LEASED TO FHMI. AT THAT TIME, FHMI BECAME THE LICENSED OPERATOR OF ALL SUCH FACILITIES, PROJECTS AND PROGRAMS. FHMI IS GOVERNED BY AN EIGHTEEN MEMBER BOARD OF DIRECTORS, THREE OF WHOM MUST BE MEMBERS OF THE HAFC. ADDITIONALLY, FHMI HAS CONTRACTUALLY COMMITTED THAT AT LEAST TWO OF ITS DIRECTORS WILL BE FLOYD COUNTY COMMISSIONERS AND TWO OF ITS DIRECTORS WILL BE CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY MEMBERS. THE FLOYD HEALTHCARE FOUNDATION IS A 501(C)(3) NOT-FOR-PROFIT ORGANIZATION THAT WORKS TO IMPROVE THE HEALTH OF THE COMMUNITIES SERVED BY FLOYD MEDICAL CENTER AND POLK MEDICAL CENTER BY DEVELOPING RELATIONSHIPS AND RAISING FUNDS TO BUILD AND SUPPORT PROGRAMS AND SERVICES THAT MEET IDENTIFIED NEEDS AND FURTHER OUR MISSION. GOVERNED BY ITS OWN VOLUNTEER BOARD OF DIRECTORS AND MANAGED BY A PROFESSIONAL STAFF, THE FOUNDATION RAISES SUPPORT THROUGH VOLUNTEER-LED INITIATIVES THAT PROVIDE FUNDING NOT ONLY FOR FLOYD MEDICAL CENTER BUT ALSO FOR PROGRAMS THAT SEEK TO IMPROVE THE HEALTH OF OUR COMMUNITY. CANCER NAVIGATORS, INC. IS A 501(C)(3) NOT-FOR-PROFIT ORGANIZATION THAT PROVIDES EDUCATION, COUNSELING, AND ACCESS TO RESOURCES FOR CANCER PATIENTS TO HELP THEM EASE DIFFICULT EMOTIONS AND MAINTAIN A SENSE OF CONTROL OVER THEIR DIAGNOSIS AND TREATMENT. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| KURT STUENKEL | |||||||||||
| PRESIDENT/SECRETARY | $440,188 | $2,006,600 | $524,445 | $14,500 | $9,908 | $2,995,641 | |||||
| WARREN SONNY RIGAS | |||||||||||
| COO-FLOYD SYSTEM | $464,823 | $164,600 | $43,939 | $36,915 | $37,029 | $747,306 | |||||
| MATTHEW GORMAN | |||||||||||
| POLK ADMINISTRATOR | $356,151 | $149,800 | $25,343 | $24,546 | $35,180 | $591,020 | |||||
| CLARICE CABLE | |||||||||||
| INTERIM CFO | $302,684 | $115,100 | $14,510 | $13,048 | $35,079 | $480,421 | |||||
| TIFANI KINARD | |||||||||||
| ADMINISTRATOR | $191,746 | $25,277 | $597 | $18,922 | $236,542 | ||||||
| DEANA OWEN | |||||||||||
| PHARMACY DIRECTOR | $168,200 | $20,635 | $775 | $16,133 | $205,743 | ||||||
| LEAH S ASHMORE | |||||||||||
| THERAPIST | $172,662 | $500 | $138 | $32,263 | $205,563 | ||||||
| LOVEJOY LEIGH | |||||||||||
| PHARMACIST | $140,362 | $500 | $417 | $27,079 | $168,358 | ||||||
| ANITA J JACKSON | |||||||||||
| DIRECTOR OF NURSING | $121,069 | $16,701 | $1,056 | $20,966 | $159,792 | ||||||
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PAGE 1, PART I, LINE 3 | NO OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION AND BOARD MEMBERS ARE PAID ONLY A SMALL STIPEND. THE ORGANIZATION RELIES UPON THE METHODS EMPLOYED BY FHMI, A RELATED ORGANIZATION TO PROVIDE OVERSIGHT TO DETERMINE REASONABLE COMPENSATION FOR THE INDIVIDUALS. COMPENSATION DETERMINATION BY FHMI INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. |
| SCHEDULE J, PAGE 1, PART I, LINE 4 | WARREN "SONNY" RIGAS 0 36,915 0 MATTHEW GORMAN 0 24,546 0 CLARICE CABLE 0 13,048 0 |
| SCHEDULE J, PART III | MR. STUENKEL AND MS. CABLE ARE COMPENSATED BY FLOYD HEALTHCARE MANAGEMENT, INC. (EIN: 58-1973570) FOR SERVICES AS THE CEO AND INTERIM CFO, RESPECTIVELY, OF FLOYD HEALTHCARE MANAGEMENT, INC. THEY RECEIVE NO COMPENSATION FROM THE FILING ORGANIZATION. THE CEO PARTICIPATES IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS FUNDED ANNUALLY 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, AND AS SUCH THE ANNUAL FUNDING PAYMENTS PAID INTO IT ARE TAXABLE TO THE PARTICIPANT IN THE YEAR IN WHICH MADE. EFFECTIVE WITH CALENDAR YEAR 2009, MR. STUENKEL'S SERP IS A CASH-BASED PROGRAM. BONUS/INCENTIVE PAY ALL MEMBERS OF THE EXECUTIVE TEAM FOR FHMI PARTICIPATE IN AN INCENTIVE COMPENSATION PLAN UNDER WHICH ANNUAL YEAR-END BONUSES ARE PAID BASED ON INDIVIDUAL AND CORPORATE-WIDE ACHIEVEMENT OF SPECIFIC GOALS AND OBJECTIVES. ONE OF THE GOALS RELATES TO THE RELATED ORGANIZATION'S NET INCOME. THE BONUSES ARE AWARDED ON A CASH-BASED SYSTEM. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 4 | THE FILING ORGANIZATION'S BYLAWS WERE AMENDED EFFECTIVE JULY 1, 2021 TO CHANGE THE FILING ORGANIZATION'S FISCAL YEAR FROM ONE ENDING JUNE 30 TO ONE ENDING DECEMBER 31. |
| FORM 990, PAGE 6, PART VI, LINE 6 | FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI) IS THE SOLE MEMBER OF THE ORGANIZATION. |
| FORM 990, PAGE 6, PART VI, LINE 7A | FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI), A RELATED ORGANIZATION, HAS THE POWER TO APPOINT ELEVEN OF THE TWELVE MEMBER GOVERNING BODY WHILE THE PRESIDENT/CEO OF FHMI IS THE FINAL MEMBER OF THE BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 7B | PRIOR APPROVAL OF FHMI IS REQUIRED FOR ANY OF THE FOLLOWING ACTIONS: DISSOLUTION; SALE, MERGER OR DISPOSITION; ADOPTION OF CAPITAL OR OPERATING BUDGETS; SELECT OR REMOVE THE ADMINISTRATOR; INCUR INDEBTEDNESS IN EXCESS OF 1,000,000; TAKE ANY ACTION ON THE LEASE OR CONTRACT BETWEEN THE CORPORATION AND CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY; AMEND THE CORPORATE ARTICLES OF INCORPORATION OR BYLAWS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE ORGANIZATIONS EXECUTIVE TEAM AND INTERNAL LEGAL COUNSEL REVIEW THE FORM 990 PRIOR TO FILING. THE ORGANIZATIONS BOARD OF MEMBERS RECEIVES A COPY OF THE FORM 990 FOR REVIEW PRIOR TO ITS FILING VIA POSTING ON THE BOARD OF MEMBERS SECURE WEBSITE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | POLK MEDICAL CENTER, INC. (PMCI) HAS A WRITTEN POLICY RESPECTING CONFLICTS OF INTEREST AND DISCLOSURE OF SAME. GENERALLY SPEAKING, THE POLICY REQUIRES ANY "COVERED PERSON" WHO BELIEVES HE/SHE HAS A CONFLICT OF INTEREST TO: -DISCLOSE THE EXISTENCE AND NATURE OF THE CONFLICT OF INTEREST (INCLUDING ALL FACTS KNOWN RESPECTING THE SUBJECT MATTER) TO THE CHAIRMAN OF THE BOARD; -PLAY NO PART, DIRECTLY OR INDIRECTLY, IN THE DELIBERATION OR VOTE OF THE BOARD OF DIRECTORS WITH RESPECT TO THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS; AND -ABSENT HIMSELF/HERSELF FROM THAT PORTION OF THE MEETING AT WHICH THE CONFLICT OF INTEREST IS DISCUSSED. THE DEFINITION OF A "COVERED PERSON" INCLUDES ALL BOARD MEMBERS, OFFICERS AND MEMBERS OF SENIOR MANAGEMENT OF PMCI. WHEN A COVERED PERSON DISCLOSES A POTENTIAL CONFLICT OF INTEREST TO THE BOARD CHAIRMAN, THE CHAIRMAN IS OBLIGED TO BRING THE MATTER TO THE ATTENTION OF THE FULL BOARD. THE BOARD DETERMINES WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. IF THE BOARD DETERMINES THAT THERE IS A CONFLICT OF INTEREST, THE TRANSACTION OR MATTER GIVING RISE TO THE CONFLICT OF INTEREST MAY NOT PROCEED UNLESS THE BOARD DETERMINES, BY A MAJORITY VOTE, THAT, DESPITE THE CONFLICT OF INTEREST, THE TRANSACTION/MATTER IS NEVERTHELESS IN THE CORPORATION'S BEST INTEREST AND IS FAIR AND REASONABLE TO THE CORPORATION. IN ADDITION TO THE REQUIREMENT THAT A COVERED PERSON DISCLOSE A POTENTIAL CONFLICT OF INTEREST AT THE TIME IT ARISES, EACH COVERED PERSON IS ALSO REQUIRED TO SUBMIT, ON AN ANNUAL BASIS, A `CONFLICT AND DISCLOSURE OF INTEREST QUESTIONNAIRE'. THIS MULTI-QUESTION DOCUMENT SERVES AS A REMINDER AND PROMPTS EACH COVERED PERSON TO PONDER THOSE AREAS AND SITUATIONS WHERE A POTENTIAL CONFLICT MIGHT EXIST. ADDITIONALLY, ANY PROPOSED TRANSACTION AT PMCI WHICH INVOLVES AN "INSIDER" (I.E., A BOARD MEMBER, OFFICER, MANAGER, ETC.) IS SCRUTINIZED, WITH THE ASSISTANCE OF CORPORATE LEGAL COUNSEL, FROM THE STANDPOINT OF WHETHER THE TRANSACTION WILL RESULT IN ANY EXCESS BENEFIT TO THE INSIDER. TYPICALLY THIS INVOLVES OBTAINING APPROPRIATE DATA REGARDING COMPARABILITY WHICH IS PROVIDED TO THE BOARD FOR ITS USE IN DETERMINING THAT THE CONSIDERATION BEING PAID TO THE INSIDER AS A PART OF THE TRANSACTION IS REASONABLE AND DOES NOT EXCEED THE VALUE OF THE BENEFIT RECEIVED BY PMCI. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC WHEN THE REQUEST IS MADE AT THE ADMINISTRATIVE OFFICE OF THE FILING CORPORATION. |
| FORM 990, PART XI, LINE 9 | ASSET VALUATION ADJUSTMENT 15,600,628 EQUITY TRANSFER ATRIUM 35,165,742 LOSS ON BOND DEFEASEMENT -2,272,791 EQUITY TRANSFER ESCROW -47,864,015 TOTAL 629,564 ON JULY 14, 2022, FLOYD HEALTHCARE MANAGEMENT, INC. ENTERED INTO A MEMBER SUBSTITUTION AGREEMENT WITH THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY ("CMHA") AND AH GEORGIA, INC., A NORTH CAROLINA NONPROFIT CORPORATION AND WHOLLY-OWNED SUBSIDIARY OF CMHA WHEREBY AH GEORGIA, INC. BECAME THE SOLE MEMBER OF FHMI. FHMI IS THE SOLE MEMBER OF POLK MEDICAL CENTER, INC. ("PMCI"). IN CONSIDERATION FOR BECOMING A PART OF THE CMHA HEALTHCARE SYSTEM, FUNDS WERE TRANSFERRED TO PMCI. PMCI IN TURN AGREED TO TRANSFER SUBSTANTIAL FUNDS TO A NEWLY FORMED FOUNDATION, THE FLOYD-POLK HEALTHCARE FOUNDATION, INC. ONCE THAT ORGANIZATION OBTAINED ITS DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE. THE FUNDS WERE TRANSFERRED TO AN ESCROW ACCOUNT PENDING FINAL APPROVAL BY THE IRS (WHICH WAS OBTAINED AFTER YEAR END). |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Business Name Line2DisregardedEntityName/BusinessNameLine2Txt | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FLOYD HEALTHCARE MANAGEMENT INC | ||||||||||||
| 304 TURNER MCCALL BLVD | ROME | GA | 301620233 | 581973570 | HEALTHCARE | GA | 501C3 | 3 | AH GEORGIA | false | ||
| HOSPITAL AUTHORITY OF FLOYD COUNTY | ||||||||||||
| 304 TURNER MCCALL BLVD | ROME | GA | 301620233 | 586001173 | HEALTHCARE | GA | 501C3 | 3 | NA | false | ||
| FLOYD HEALTH CARE FOUNDATION INC | ||||||||||||
| 304 TURNER MCCALL BLVD | ROME | GA | 30161 | 581375074 | FUNDRAISIN | GA | 501C3 | 12A | FHMI | false | ||
| CANCER NAVIGATORS INC | ||||||||||||
| 255 W 5TH STREET SUITE 300 | ROME | GA | 301652817 | 030397867 | HEALTHCARE | GA | 501C3 | 7 | FHMI | false | ||
| AH GEORGIA INC | ||||||||||||
| PO BOX 32862 | CHARLOTTE | NC | 282322861 | 831707383 | HEALTHCARE | NC | 501C3 | 10 | CMHA | false | ||
| THE CHARLOTTE-MECKLENBURG HOSPITAL | ||||||||||||
| 1000 BLYTHE BLVD | CHARLOTTE | NC | 28203 | 560529945 | HEALTHCARE | NC | false | AUTHORITY | N/A | |||
| FLOYD-POLK HEALTHCARE FOUNDATION | ||||||||||||
| 304 TURNER MCCALL BLVD | ROME | GA | 30165 | 872546864 | FUNDRAISIN | GA | 501C3 | 12A | NA | false | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (true) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |