2021-08-13T15:18:30-05:00 2020-09-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2019-10-01 453072990 TIFT REGIONAL HEALTH SYSTEM INC TIFT 2293536310 PO BOX 2650 TIFTON GA 317932650 KIM WILLS SVP CFO 2293536310 2021-08-12 true WILLIAM EDWARD PHILLIPS P00451499 2298837878 2021-08-13 2019 2022-09-23 18:48:47Z CHRISTOPHER DORMAN PO BOX 2650 TIFTON GA 317932650 468957093 false X HTTPS://WWW.TIFTREGIONAL.COM/ X 2011 GA OUR MISSION IS TO DELIVER A LIFETIME OF QUALITY AND COMPASSIONATE CARE FOR EACH PATIENT WE SERVE. 8 6 2971 0 1118273 41392381 253173677 389938453 14764121 29732972 3344892 7893287 272400963 468957093 0 0 152220028 229785505 0 0 105228458 204409329 257448486 434194834 14952477 34762259 904950801 948245014 338302114 356282503 566648687 591962511 X OUR MISSION IS TO DELIVER A LIFETIME OF QUALITY AND COMPASSIONATE CARE FOR EACH PATIENT WE SERVE. false false 331794105 392588410 TIFT REGIONAL HEALTH SYSTEM (TRHS) IS A GROWING, NOT-FOR-PROFIT HOSPITAL SYSTEM. ITS MAIN CAMPUS SERVES 12 COUNTIES IN SOUTH CENTRAL GEORGIA. TRHS OFFERS MORE THAN 135 PHYSICIANS WITH EXPERTISE IN OVER 30 SPECIALTIES. TRHS PROVIDES A WIDE RANGE OF CARE, INCLUDING SIGNATURE SERVICES IN SURGERY, ONCOLOGY, CARDIOVASCULAR CARE, WOMEN'S HEALTH, NEURODIAGNOSTICS, GERIATRIC PSYCHIATRIC CARE, RADIOLOGY AND MORE. THE MAIN CAMPUS IS TIFT REGIONAL MEDICAL CENTER (TRMC), A 181-BED REGIONAL REFERRAL HOSPITAL LOCATED IN TIFTON AT 901 EAST 18TH STREET. TRMC'S WEST CAMPUS, LOCATED IN TIFTON AT 2225 HIGHWAY 41 NORTH, IS AN OUTPATIENT FACILITY WHICH HOUSES VARIOUS DIAGNOSTIC SERVICES AND THE REGION'S LARGEST MULTI-SPECIALTY PRACTICE. A 3RD CAMPUS OF TRMC IS IN ADEL, GA. SOUTHWELL MEDICAL IS A 60-BED HOSPITAL (THAT IS NOT SEPARATELY LICENSED) INCLUDING A 12-BED GERIATRIC PSYCHIATRIC UNIT. A 95-BED SKILLED NURSING FACILITY, SOUTHWELL HEALTH & REHABILITATION, ALSO IS LOCATED ON THE SOUTHWELL MEDICAL CAMPUS. 331794105 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true true false false false false false false false false true false true false false false true true false false false true 269 0 2971 true false false false false false false false false false false false false X 8 6 false false false true true true true true true false false true true true true true true true true false GA X KIM WILLS 2293533397 PO BOX 2650 TIFTON GA 31793 ANTHONY BURKE MD PHYSICIAN 40.00 X 1336194 0 37000 EDWARD HELLMAN MD PHYSICIAN 40.00 X 1241834 0 37000 WILLIAM KAISER MD PHYSICIAN 40.00 X 1154574 0 37000 JEFFRY PETERS MD PHYSICIAN 40.00 X 1102072 0 37000 GEORGE YARED MD PHYSICIAN 40.00 X 1079603 0 37000 FORTE MCEACHIN MD EXEC. MEDICA 40.00 X 969106 0 37000 JESSICA BEIER MD TRUSTEE/PHYS 41.00 1.00 X 806062 0 37000 CHRISTOPHER DORMAN CEO & PRESID 40.00 1.00 X 711187 0 91028 JAMES SCOTT MD TRUSTEE/PHYS 41.00 X 771628 0 26000 KAREN D SUMMERLIN SVP GENERAL 40.00 X 537044 0 65275 WILLIAM RICHARDSON CEO (FORMER) 40.00 X 540445 0 28041 CAMERON NIXON MD CHIEF TRANSF 40.00 X 530845 0 37000 KIM WILLS SVP CFO 40.00 2.00 X 401705 0 50475 CAROL SMITH SVP CNO 40.00 X 337531 0 45476 CLAIRE BYRNES SVP AMBULATO 40.00 X 234670 0 35433 LINDA WILSON VP REVENUE C 40.00 X 218973 0 22475 JUSTIN BECK CHIEF STRATE 40.00 X 213526 0 22645 MARIE ROOF VP CIP 40.00 X 201123 0 21538 MICHAEL PURVIS VP COO (SW M 40.00 X 200428 0 21300 TAMARA BRANCH VP LEGAL COU 40.00 X 188485 0 21393 TONIA GARRETT AVP SURGICAL 40.00 X 187841 0 16735 ALEX LE COO 40.00 X 173452 0 18490 INDERA RAMPAL-HARROD VP HR (FORME 40.00 X 158289 0 12532 JOHN BROWNLEE CHAIRMAN 1.00 1.00 X X 0 0 0 SCOTT FULP DMD TRUSTEE 1.00 X 0 0 0 CHASE DAUGHTREY TRUSTEE 1.00 X 0 0 0 GEORGE M D HUNT IV VICE CHAIRMA 1.00 2.00 X X 0 0 0 WILLIAM BOWEN JR TRUSTEE 1.00 1.00 X 0 0 0 JOYCE MIMS SECRETARY 1.00 1.00 X X 0 0 0 13296617 794836 262 true true false ASPIRION HEALTH RESOURCES LLC 1506 6TH AVENUE SUITE 3 COLUMBUS GA 31902 BILLING 837428 DIAGNOSTIC PET LLC 1670 ROSCOE ROAD NEWNAN GA 30263 MEDICAL 834250 GOLDFISH LOCUMS LLC 6865 WINDCREST DRIVE SUITE 300 PLANO TX 75024 LOCUM TENENS 704407 MEADOWS & OHLY 275 SCIENTIFIC DRIVE PEACHTREE CORNERS GA 30092 PROJECT MANAGER 566913 HEALTHFUSE LLC 414 NORTH MAIN STREET THIENSVILLE WI 53092 CONSULTING 507354 44 41392381 786960 41392381 NET PATIENT SERVICE REVENUE 623000 388929096 388929096 CLINIC AND OTHER PATIENT REV. 623000 884137 884137 MOB & DATA CENTER 531120 125220 125220 389938453 9695854 9695854 20017149 19969 20017149 19969 20037118 20037118 EMPLOYEE PHARMACY 623000 5243330 5243330 REBATES AND DISCOUNTS 623000 1367151 1367151 CAFETERIA & VENDING 722514 1184691 1184691 98115 98115 7893287 468957093 392588410 34976302 6505301 2112306 4392995 14841 14841 174874016 136291437 38582579 7246708 5529238 1717470 29249807 22317603 6932204 11894832 9075757 2819075 212755 212755 326206 326206 38856502 27209333 11647169 653457 180158 473299 3697182 2059243 1637939 17490559 4822147 12668412 5959662 1643079 4316583 267421 73728 193693 384784 106085 278699 4761710 4761710 38052992 34824919 3228073 3459193 953700 2505493 MEDICAL & SURGICAL SUPP. 38396496 35520598 2875898 PHARMACY & DRUGS 37576196 34761739 2814457 PROVIDER TAXES 5065326 5065326 FRAUD LOSS 2691296 2691296 6557592 4485999 2071593 434194834 331794105 102400729 0 61187178 93759446 5258571 5320712 56667200 56770135 1771228 3371364 2912332 3447728 6753866 8446368 697344077 375624087 269695978 321719990 493974158 445593759 1047186 1047186 4490886 2305376 1192218 6462950 904950801 948245014 52375273 65231402 5400000 149034015 104709229 132063887 150786764 4828939 30155108 338302114 356282503 X 566648687 591962511 566648687 591962511 904950801 948245014 X 34762259 -865206 -8583229 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 84951 84951 false SCHEDULE C, PART II-B, LINE 1 TIFT REGIONAL HEALTH SYSTEM IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION, THE GEORGIA HOSPITAL ASSOCIATION AND OTHER MEMBERSHIP ORGANIZATIONS. THE LOBBYING EXPENSE REFLECTED REPRESENTS THE ESTIMATED PORTION OF DUES PAID TO THESE ORGANIZATIONS SPENT ON LOBBYING ACTIVITIES AT FEDERAL, STATE OR LOCAL LEVELS OF GOVERNMENT. 11015460 11015460 328855756 98726700 230129056 357472861 276897387 80575474 321719990 MEDICARE ACCELERATED PAYMENTS 25325348 ACCRUED PROFESSIONAL LIABILITY 3008926 ESTIMATED THIRD PARTY SETTLEMENTS 1018373 DEFERRED COMPENSATION 802461 30155108 X SCHEDULE D, PAGE 3, PART X SOUTHWELL, SYSTEM, AND AMBULATORY ARE NOT-FOR-PROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACO IS CONSIDERED A DISREGARDED ENTITY OF THE SYSTEM. ENTERPRISES IS A FOR-PROFIT CORPORATION. SOUTHWELL APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE 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, SOUTHWELL 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 BALANCE SHEETS FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2020 AND 2019 OR FOR THE YEARS THEN ENDED. 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 FOR THOSE RETURNS. true true X true X 2.250000000000 false true true false true true 23008099 23008099 0.05300 35259955 26214753 9045202 0.02080 375451 212969 162482 0.00040 58643505 26427722 32215783 0.07420 7650610 112468 7538142 0.01740 7650610 112468 7538142 0.01740 66294115 26540190 39753925 0.09160 false 54093940 59318322 68979682 -9661360 X true true 1 1 TIFT REGIONAL MEDICAL CENTER 901 E 18TH STREET TIFTON GA 31793 137-180 X X X TIFT REGIONAL MEDICAL CENTER 1 false true false false true X 225.000000000000 X true true X X X true X WWW.TIFTREGIONAL.COM/FINANCIALASSISTAN X WWW.TIFTREGIONAL.COM/FINANCIALASSISTAN X WWW.TIFTREGIONAL.COM/FINANCIALASSISTAN X X X X X X true X false X X X X true X false false FACILITY 1, TIFT REGIONAL MEDICAL CENTER - PART V, LINE 2 EFFECTIVE MARCH 1, 2019, THE TIFT COUNTY HOSPITAL AUTHORITY (THE "AUTHORITY") TRANSFERRED VIA A 40-YEAR LEASE SUBSTANTIALLY ALL OF ITS OPERATIONS, ASSETS AND LIABILITIES TO TIFT REGIONAL HEALTH SYSTEM, INC. THE AUTHORITY IS A GOVERNMENTAL HOSPITAL AUTHORITY ORGANIZED PURSUANT TO THE OFFICIAL CODE OF GEORGIA, AND IS CONSIDERED A GOVERNMENTAL INSTRUMENTALITY UNDER THE INTERNAL REVENUE CODE. TIFT REGIONAL HEALTH SYSTEM, INC. IS A TAX-EXEMPT ORGANIZATION PUSUANT TO INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTIONS 501(C)(3), 509(A) (1) AND 170(B)(1)(III). 33 TIFT REGIONAL DIALYSIS CENTER 1010 EDGEFIELD DRIVE TIFTON GA 31794 END STAGE RENAL DIALYSIS AFFINITY CLINIC 2225 US HIGHWAY 41N TIFTON GA 31794 MULTI-SPEICALTY CLINIC GEORGIA SPORTS MEDICINE 2227 US HIGHWAY 41N TIFTON GA 31794 ORTHOPAEDIC SURGERY TIFT REGIONAL ANESTHESIA 2227 US HIGHWAY 41N TIFTON GA 31794 ANESTHESIOLOGY SOUTHWELL HEALTH & REHABLITATION 260 MJ TAYLOR ROAD ADEL GA 31620 SKILLED NURSING SOUTH GEORGIA SURGICAL 1007 GREENFIELD DRIVE TIFTON GA 31794 GENERAL SURGERY TIFT REGIONAL UROLOGY 1815 OLD OCILLA ROAD TIFTON GA 31794 UROLOGY AFFINITY PEDIATRICS 39 KENT ROAD SUITE 5 TIFTON GA 31794 PEDIATRICS HOSPICE OF TIFT AREA 618 N CENTRAL AVENUE TIFTON GA 31794 HOSPICE TIFT REGIONAL WOUND CARE 907 E 18TH STREET SUITE 140 TIFTON GA 31794 OUTPATIENT WOUND CARE TIFT REGIONAL OUTPATIENT THERAPY 2227 US HIGHWAY 41N TIFTON GA 31794 OUTPATIENT THERAPY PT/OT/SPEECH AFFINITY PHYSICIANS FOR WOMEN 1493 KENNEDY ROAD SUITE C TIFTON GA 31794 OBSTETRICS & GYNECOLOGY SOUTHWELL MEDICAL ADEL PRIMARY CARE 172 MJ TAYLOR ROAD ADEL GA 31620 FAMILY MEDICINE ALLURE PLASTIC & RECONSTRUCTIVE 907 E 18TH STREET SUITE 340 TIFTON GA 31794 PLASTIC SURGERY TIFT REGIONAL VASCULAR 1641 MADISON AVENUE TIFTON GA 31794 VASCULAR SURGERY SOUTHWELL NEPHROLOGY 39 KENT ROAD SUITE 1 TIFTON GA 31794 NEPHROLOGY TIFT REGIONAL OPTHALMOLOGY 1803 OLD OCILLA ROAD TIFTON GA 31794 OPTHALMOLOGY/OPTICAL TIFT FAMILY MEDICINE 907 E 18TH STREET SUITE 130 TIFTON GA 31794 FAMILY MEDICINE ARTHRITIS & OSTEOPOROSIS CENTER 2227 US HIGHWAY 41N TIFTON GA 31794 RHEUMATOLOGY AFFINNITY CLINICNEUROLOGY 2227 US HIGHWAY 41N TIFTON GA 31794 NEUROLOGY OCILLA PEDIATRICS 813 IRWIN AVENUE TIFTON GA 31794 PEDIATRICS AFFINTIY PEDIATRICS 3007 2ND STREET NE MOULTRIE GA 31768 PEDIATRICS NASHVILLE PRIMARY CARE 416A E MCPHERSON AVENUE NASHVILLE GA 31639 FAMILY MEDICINE ASHBURN PRIMARY CARE 611 E WASHINGTON AVENUE ASHBURN GA 31714 FAMILY MEDICINE TRMC ONCOLOGY PROFESSIONALS 1623 MADISON AVENUE TIFTON GA 31794 ONCOLOGY AFFINITY CLINIC MOULTRIE 2 HOSPITAL PARK MOULTRIE GA 31768 MULTI-SPECIALTY CLINIC AFFINITY PHYSICIANS FOR WOMEN MOUTL 2 HOSPTIAL PARK MOULTRIE GA 31768 OBSTETRICS & GYNECOLOGY SOUTHWELL CENTER FOR HEARING & WELL 39 KENT ROAD SUITE 2 TIFTON GA 31794 FAMILY MEDICINE SOUTHWELL SCHOOL CLINIC 1464 CARPENTER ROAD S TIFTON GA 31794 SCHOOL BASED CLINIC SOUTHWELL SCHOOL CLINIC 700 8TH STREET W TIFTON GA 31794 SCHOOL BASED CLINIC SYLVESTER FAMILY PRACTICE 1010 W FRANKLIN STREET SYLVESTER GA 31791 FAMILY MEDICINE TIFT COMMUNITY HEALTH CENTER 2735 S CENTRAL AVENUE TIFTON GA 31794 FAMILY MEDICINE WORKSMART OCCUPATION HEALTH 4468 UNION ROAD TIFTON GA 31794 OCCUPATIONAL HEALTH SCHEDULE H, PART I, LINE 7 A COST-TO-CHARGE RATIO IS CALCULATED USING WORKSHEET 2 INCLUDED IN THE FORM 990, SCHEDULE H INSTRUCTIONS. SCHEDULE H, PART III, LINE 2 CHANGES IN CREDIT ISSUES THAT ARE NOT ADDRESSED AT THE DATE OF SERVICE ARE RECOGNIZED AS BAD DEBT EXPENSE AND ARE INCLUDED AS A COMPONENT OF OPERATING EXPENSES. CREDIT ISSUES THAT ARE ADDRESSED AT THE DATE OF SERVICE ARE TREATED AS PRICE CONCESSIONS THAT REDUCE THE TRANSACTION PRICE, WHICH ARE REPORTED AS A REDUCTION OF NET PATIENT SERVICE REVENUE. THERE WERE NO BAD DEBTS RECORDED IN OPERATING EXPENSES DURING THE FISCAL YEAR. BASED ON MANAGEMENT'S JUDGEMENT AND EXPERIENCE, 100% OF SELF-PAY ACCOUNT BALANCES ARE RECORDED AS PRICE CONCESSIONS. SCHEDULE H, PART III, LINE 4 SOUTHWELL HAS ARRANGEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO SOUTHWELL AT AMOUNTS DIFFERENT FROM ESTABLISHED RATES. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, SOUTHWELL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES, SUBJECT TO CERTAIN DISCOUNTS AND IMPLICIT PRICE CONCESSIONS AS DETERMINED BY SOUTHWELL. SOUTHWELL DETERMINES THE TRANSACTION PRICE BASED ON STANDARD CHARGES FOR SERVICES PROVIDED, REDUCED BY CONTRACTUAL ADJUSTMENTS PROVIDED TO THIRD- PARTY PAYORS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH SOUTHWELL'S POLICY, AND IMPLICIT PRICE CONCESSIONS PROVIDED TO UNINSURED PATIENTS. IMPLICIT PRICE CONCESSIONS REPRESENT THE DIFFERENCE BETWEEN AMOUNTS BILLED AND THE ESTIMATED CONSIDERATION SOUTHWELL EXPECTS TO RECEIVE FROM PATIENTS, WHICH ARE DETERMINED BASED ON HISTORICAL COLLECTION EXPERIENCE, CURRENT MARKET CONDITIONS, AND OTHER FACTORS. SOUTHWELL DETERMINES ITS ESTIMATES OF CONTRACTUAL ADJUSTMENTS AND DISCOUNTS BASED ON CONTRACTUAL AGREEMENTS, DISCOUNT POLICIES, AND HISTORICAL EXPERIENCE. SEE FOOTNOTES 2 AND 3 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR ADDITIONAL INFORMATION REGARDING UNCOMPENSATED CARE. 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. THE FULL AMOUNT OF THE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. MEDICARE IS A FEDERAL PROGRAM WHICH DICTATES PAYMENT RATES AND CONDITIONS OF PARTICIPATION FOR SERVING CERTAIN ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. SERVING THE NEEDS OF OUR RESIDENTS AT BELOW MEDICARE'S COMPUTATION OF COSTS PROVIDES NECESSARY LOCAL CARE FOR A SEGMENT OF THE POPULATION THAT CONSTITUTES A CHARITABLE CLASS. SCHEDULE H, PART III, LINE 9B PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY ("FAP") RECIEVE A 100% DISCOUNT. THERE ARE NO COLLECTION ACTIVITIES FOR QUALIFYING FAP-ELIGIBLE PATIENTS. SCHEDULE H, PART VI, LINE 2 AS A GOVERNMENTAL ORGANIZATION OPERATED PURSUANT TO GEORGIA HOSPITAL AUTHORITIES LAW PRIOR TO MARCH 1, 2019, THE HOSPITAL WAS NOT SUBJECT TO THE PROVISIONS OF INTERNAL REVENUE CODE SECTION 501(R). NEVERTHELESS, THE HOSPITAL AUTHORITY CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2014 AN 2017 FOR ITS TIFTON CAMPUS. IN ADDITION, AS PART OF THE STRATEGIC PLANNING PROCESS FOR EACH CAMPUS, COMMUNITY INPUT RELATED TO HEALTH NEEDS IS RECEIVED FROM A VARIETY OF SOURCES, INCLUDING PHYSICIANS, NURING STAFF AND COMMUNITY MEMBERS. SCHEDULE H, PART VI, LINE 3 THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY ("FAP"), PLAIN LANGUAGE SUMMARY AND FINANCIAL ASSISTANCE APPLICATION ARE AVAILABLE ONLINE AND UPON REQUEST AT THE 2 HOSPITAL CAMPUSES (TRMC AND SOUTHWELL MEDICAL). A PLAIN LANGUAGE SUMMARY OF THE FAP IS OFFERED TO EACH PATIENT UPON ADMISSION AND SIGNAGE IS POSTED THROUGHOUT BOTH CAMPUSES REGARDING THE FAP. SCHEDULE H, PART VI, LINE 4 TIFT REGIONAL HEALTH SYSTEM, INC. SERVES A 12-COUNTY AREA OF SOUTHWEST GEORGIA WHICH HAS A TOAL POPULATION IN EXCESS OF A QUARTER OF A MILLION RESIDENTS. THE POPULATION FOR THE COUNTIES IN THE PRIMARY SERVICE AREA ACCORDING TO THE 2010 CENSUS ARE - TIFT COUNTY (40,787), TURNER COUNTY (8,338) AND COOK COUNTY (17,033). THE 9 COUNTIES IN THE SECONDARY SERVICE AREA INCLUDE ATKINSON, BENHILL, BERRIEN, COFFEE, COLQUITT, CRISP, IRWIN, WILCOX, AND WORTH COUNTIES WHICH HAVE A TOTAL POPULATION OF 196,667. THIS AREA OF GEORGIA HAS MEDIAN AGE SIMILAR TO THE STATE AVERAGE, BUT LOWER MEDIAN HOUSEHOLD INCOMES, LOWER EDUCATIONAL ATTAINEMENT LEVELS AND HIGHER DISABILITY RATES. IN THE PRIMARY SERVICE AREA, OVER 50% OF THE POPULATION LIVES BELOW 200% OF THE FEDERAL POVERTY LINE. MORE THAN A THIRD OF THE POPULATION OF TIFT COUNTY AND COOK COUNTY ARE OBESE, AND THE OBESITY RATE IN TURNER COUNTY IS 31.1%. HEART DISEASE IS THE LEADING CAUSE OF DEATH IN THE PRIMARY SERVICE AREA AND IS OVER 30% HIGHER THAN THE AVERAGE FOR THE STATE. SCHEDULE H, PART VI, LINE 5 TIFT REGIONAL HEALTH SYSTEM, INC. IS GOVERNED BY AN INDEPENDENT BOARD OF DIRECTORS COMPRISED OF COMMUNITY REPRESENTATIVES. THE ORGANIZATION IS A NOT-FOR-PROFIT ORGANIZATION UNDER GEORGIA LAW AND A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ANY EXCESS REVENUES OVER EXPENSES ARE REINVESTED INTO SERVING THE HEALTHCARE NEEDS OF THE COMMUNITY. TIFT REGIONAL MEDICAL CENTER ("TRMC") IS 181-BED REGIONAL REFERRAL HOSPITAL THAT OPERATES AN EMERGENCY ROOM 24/7/365. SOUTHWELL MEDICAL IS A NON-SEPARATELY LICENSED 60-BED HOSPITAL CAMPUS OF TRMC. THIS FACILITY INCLUDES 12 GERIATRIC PSYCHIATRIC BEDS. A 95-BED SKILLED NURSING FACILITY (SOUTHWELL HEALTH & REHABILITATION) IS ALSO LOCATED ON THIS CAMPUS. TRMC, SOUTHWELL MEDICAL AND SOUTHWELL HEALTH & REHABILITATION PARTICIPATE IN THE MEDICARE AND MEDICAID PROGRAMS. TIFT REGIONAL HEALTH SYSTEM TREATS ALL PATIENTS IN A NONDISCRIMINATORY MANNER WITHOUT REGARD TO THEIR ABILITY TO PAY FOR ANY EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THE MEDICAL STAFF OF THE HOSPITAL IS OPEN TO ALL PROPERLY CREDENTIALED QUALIFIED PHYSICIANS. SCHEDULE H, PART VI, LINE 6 TIFT REGIONAL HEALTH SYSTEM, INC. OPERATES TIFT REGIONAL MEDICAL CENTER, A 181-BED REGIONAL REFERRAL HOSPITAL LOCATED IN TIFTON, GEORGIA, AND SOUTHWELL MEDICAL (FORMERLY COOK MEDICAL CENTER), A 60-BED NONSEPARATELY LICENSED HOSPITAL CAMPUS OF TRMC (INCLUDING 12 GERIATRIC PSYCHIATRIC BEDS) AND A 95-BED SKILLED NURSING FACILITY. TIFT REGIONAL MEDICAL CENTER FOUNDATION, INC. IS A TAX-EXEMPT ORGANIZATION RESPONSIBLE FOR FUNDRAISING EFFORTS BENEFITTING TIFT REGIONAL HEALTH SYSTEM, INC. SOUTHWELL AMBULATORY, INC. IS A NONPROFIT ORGANIZATION THAT PROVIDES SPECIALTY PHYSICIAN AND OTHER MEDICAL SERVICES. ITS EXEMPTION APPLICATION IS PENDING IRS APPROVAL. SOUTHWELL, INC. SERVES AS THE PARENT ORGANIZATION. IT IS A TAX-EXEMPT ORGANIZATION RESPONSIBLE FOR STRATEGIC AND FINANCIAL PLANNING FOR THE VARIOUS MEMBERS OF THE MULTI-ENTITY HEALTHCARE PROVIDER SYSTEM. TIFT ENTERPRISES, INC. IS A FOR-PROFIT SUBSIDIARY OF SOUTHWELL, INC. IT SERVES AS A HOLDING COMPANY FOR CERTAIN INVESTMENTS AND PROVIDES LIMITED MANAGEMENT SERVICES. SCHEDULE H, PART VI, LINE 7 GEORGIA X X X X X true true false false false false false false false ANTHONY BURKE MD PHYSICIAN 794727 513797 27670 25000 12000 1373194 EDWARD HELLMAN MD PHYSICIAN 1039328 201540 966 25000 12000 1278834 WILLIAM KAISER MD PHYSICIAN 1064142 88626 1806 25000 12000 1191574 JEFFRY PETERS MD PHYSICIAN 789071 311195 1806 25000 12000 1139072 GEORGE YARED MD PHYSICIAN 962601 115336 1666 25000 12000 1116603 FORTE MCEACHIN MD EXEC. MEDICAL DIR. 908124 60016 966 25000 12000 1006106 JESSICA BEIER MD TRUSTEE/PHYSICIAN 695578 92438 18046 25000 12000 843062 CHRISTOPHER DORMAN CEO & PRESIDENT 554798 114274 42115 77901 13127 802215 JAMES SCOTT MD TRUSTEE/PHYSICIAN 755868 7108 8652 14000 12000 797628 KAREN D SUMMERLIN SVP GENERAL COUNSEL 466003 64075 6966 51504 13771 602319 WILLIAM RICHARDSON CEO (FORMER) 44524 90639 405282 16041 12000 568486 CAMERON NIXON MD CHIEF TRANSFORMATION 474267 28428 28150 25000 12000 567845 KIM WILLS SVP CFO 324002 60750 16953 38475 12000 452180 CAROL SMITH SVP CNO 281715 38736 17080 33476 12000 383007 CLAIRE BYRNES SVP AMBULATORY SERV. 208123 26211 336 23433 12000 270103 LINDA WILSON VP REVENUE CYCLE 197704 14828 6441 10475 12000 241448 JUSTIN BECK CHIEF STRATEGY & INN 200845 12051 630 10645 12000 236171 MARIE ROOF VP CIP 185411 13906 1806 9538 12000 222661 MICHAEL PURVIS VP COO (SW MEDICAL) 159117 41311 9300 12000 221728 TAMARA BRANCH VP LEGAL COUNSEL 173810 14339 336 9393 12000 209878 TONIA GARRETT AVP SURGICAL SERVICE 155319 9091 23431 4735 12000 204576 ALEX LE COO 158660 11757 3035 6490 12000 191942 INDERA RAMPAL-HARROD VP HR (FORMER) 28929 129360 6532 6000 170821 SCHEDULE J, PAGE 1, PART I, LINE 4 ANTHONY BURKE, MD 0 11,000 0 EDWARD HELLMAN, MD 0 11,000 0 WILLIAM KAISER, MD 0 11,000 0 JEFFRY PETERS, MD 0 11,000 0 GEORGE YARED, MD 0 11,000 0 FORTE MCEACHIN, MD 0 11,000 0 JESSICA BEIER, MD 0 11,000 0 CHRISTOPHER DORMAN 0 63,901 0 KAREN D. SUMMERLIN 0 37,504 0 CAMERON NIXON, MD 0 11,000 0 KIM WILLS 0 24,475 0 CAROL SMITH 0 21,299 0 CLAIRE BYRNES 0 12,331 0 MICHAEL PURVIS 29,789 0 0 INDERA RAMPAL-HARROD 105,452 0 0 A 2013 BONDS 586001719 886640HS3 2019-03-01 81326130 FINANCE/REFINANCE ADDITIONS AND IMPROVEMENTS TO HOSPITAL FACILITY; REFUND OUTSTANDING 2002 BONDS; RE false false false B BANK OF AMERICA 586001719 NONENONEN 2019-03-01 31862844 ACQUISITION, INSTALLATION AND IMPLEMENTATION OF EMR SYSTEM. false false false A 2029779 79296351 2017 true false false true B 6449966 25412878 2017 true false false true A false false false false false false true B false false false false false false true A false true false false false false false false true B false true false false false false false false true A true B true PURPOSE OF ISSUE DESCRIPTION 2013 BONDS FINANCE/REFINANCE ADDITIONS AND IMPROVEMENTS TO HOSPITAL FACILITY; REFUND OUTSTANDING 2002 BONDS; REPAY A BANK LOAN; AND PAY ISSUANCE COST OF 2013 BONDS. PURPOSE OF ISSUE DESCRIPTION BANK OF AMERICA ACQUISITION, INSTALLATION AND IMPLEMENTATION OF EMR SYSTEM. ADDITIONAL INFORMATION 2013 BONDS EFFECTIVE MARCH 1, 2019 THE OPERATIONS, ASSETS AND LIABILITIES OF THE TIFT COUNTY HOSPITAL AUTHORITY AN INSTRUMENTALITY OF THE STATE OF GEORGIA, WERE TRANSFERRED TO TIFT REGIONAL HEALTH SYSTEM, INC., AN ORGANIZATION EXEMPT FROM INCOME TAXES PURSUANT TO IRC SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3). AS A RESULT, THE EXISTING TAX-EXEMPT DEBT OF THE HOSPITAL AUTHORITY WAS REISSUED AS QUALIFIED 501(C)(3) DEBT. AS A RESULT OF THE REISSUANCE, THE NEW OBLIGATIONS ARE TREATED AS CURRENTLY REFUNDING THE AUTHORITY'S DEBT AT THE DATE OF THE TRANSFER. JAMES HUNTER GARRETT FAMILY MEMBER 47443 COMPENSATION false RYAN BYRNES MD FAMILY MEMBER 146379 COMPENSATION false MARGARET RICHARDSON-NIXON MD FAMILY MEMBER 345543 COMPENSATION false SCHEDULE L, PART V THE 3 INDIVIDUALS IDENTIFIED ABOVE ARE RELATIVES OF KEY EMPLOYEES OF TIFT REGIONAL HEALTH SYSTEM. ALL ARE COMPENSATED AT FAIR MARKET VALUE FOR SERVICES PERFORMED. X 1 786960 false false false FORM 990, PAGE 2, PART III, LINE 4A TIFT REGIONAL HEALTH SYSTEM (TRHS) IS A GROWING, NOT-FOR-PROFIT HOSPITAL SYSTEM. ITS MAIN CAMPUS SERVES 12 COUNTIES IN SOUTH CENTRAL GEORGIA. TRHS OFFERS MORE THAN 135 PHYSICIANS WITH EXPERTISE IN OVER 30 SPECIALTIES. TRHS PROVIDES A WIDE RANGE OF CARE, INCLUDING SIGNATURE SERVICES IN SURGERY, ONCOLOGY, CARDIOVASCULAR CARE, WOMEN'S HEALTH, NEURODIAGNOSTICS, GERIATRIC PSYCHIATRIC CARE, RADIOLOGY AND MORE. THE MAIN CAMPUS IS TIFT REGIONAL MEDICAL CENTER (TRMC), A 181-BED REGIONAL REFERRAL HOSPITAL LOCATED IN TIFTON AT 901 EAST 18TH STREET. TRMC'S WEST CAMPUS, LOCATED IN TIFTON AT 2225 HIGHWAY 41 NORTH, IS AN OUTPATIENT FACILITY WHICH HOUSES VARIOUS DIAGNOSTIC SERVICES AND THE REGION'S LARGEST MULTI-SPECIALTY PRACTICE. A 3RD CAMPUS OF TRMC IS IN ADEL, GA. SOUTHWELL MEDICAL IS A 60-BED HOSPITAL (THAT IS NOT SEPARATELY LICENSED) INCLUDING A 12-BED GERIATRIC PSYCHIATRIC UNIT. A 95-BED SKILLED NURSING FACILITY, SOUTHWELL HEALTH & REHABILITATION, ALSO IS LOCATED ON THE SOUTHWELL MEDICAL CAMPUS. FORM 990, PAGE 6, PART VI, LINE 5 THE ORGANIZATION FELL VICTIM TO A SOCIAL ENGINEERING SCHEME THAT RESULTED IN A THEFT OF 2,691,296. TWO WIRE TRANSFERS WERE MADE TO AN ACCOUNT SETUP TO APPEAR AS IF THEY BELONGED TO THE ACTUAL CONTRACTOR ON THE EMERGENCY ROOM/BED TOWER CONSTRUCTION PROJECT. CONTACT WAS MADE VIA EMAIL AND TELEPHONE TO SET UP THE ACH TRANSFERS. AS A RESULT OF THE FRAUD, NEW POLICIES HAVE BEEN IMPLEMENTED TO REDUCE THE LIKLIHOOD OF SIMILAR FUTURE ATTEMPTS AND EMPLOYEES HAVE RECEIVED ADDITIONAL EDUCATION ON THE POLICIES AND ON SECURITY. THE FBI CYBER CRIMES UNIT IS INVESTIGATING THIS CRIME. FORM 990, PAGE 6, PART VI, LINE 6 SOUTHWELL, INC. IS THE SOLE MEMBER OF TIFT REGIONAL HEALTH SYSTEM, INC. SOUTHWELL IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN INTERNAL REVENUE CODE SECTION 501(C)(3). FORM 990, PAGE 6, PART VI, LINE 7A ALL APPOINTMENTS TO THE BOARD OF DIRECTORS ARE FILLED BY THE REMAINING MEMBERS OF THE BOARD SUBJECT TO THE APPROVAL OF SOUTHWELL, INC. IN ADDITION, A DIRECTOR MAY BE REMOVED AT ANY TIME, WITH OR WITHOUT CAUSE, SUBJECT TO THE APPROVAL OF SOUTHWELL, INC. FORM 990, PAGE 6, PART VI, LINE 7B SOUTHWELL, INC. IS THE SOLE MEMBER OF TIFT REGIONAL HEALTH SYSTEM, INC. ("TRHS"). THE FOLLOWING ACTIONS CANNOT BE TAKEN WITHOUT THE APPROVAL OF THE MEMBER: 1) FILL VACANCIES IN, NOMINATE AND APPROVE THE ELECTION OF AND APPROVE OR DIRECT THE REMOVAL OF DIRECTORS OF TRHS; 2) APPROVE ALL AMENDMENTS, MODIFICATIONS, RESTATEMENTS AND ALTERATIONS OF TRHS'S ARTICLES OF INCORPORATION OR BYLAWS; 3) APPROVE MERGERS, CONSOLIDATIONS, ACQUISITIONS, JOINT VENTURES, AFFILIATIONS OR ANY OTHER REORGANIZATION OF TRHS; 4) APPROVE THE SALE, TRANSFER, LONG-TERM LEASE, LONG-TERM ENCUMBRANCE, MORTGAGE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL ASSETS OF TRHS AND OF ANY REAL PROPERTY OWNED BY TRHS; 5) APPROVE ANY PLAN OF DISSOLUTION; 6) APPROVE AND DETERMINE THE DISTRIBUTION OF ASSETS OF THE CORPORATION UPON DISSOLUTION OF TRHS SUBJECT TO ARTICLE V OF THE TRHS'S ARTICLES OF INCORPORATION; 7) ADD OR REMOVE MEMBERS OF TRHS; 8) APPROVE ANY MATERIAL INCURRENCE OF DEBT THAT REQUIRES AN ADDENDUM TO THE MASTER TRUST INDENTURE, EXCLUDING CAPITAL LEASES OF LESS THAN 1,000,001; 9) APPOINT OR REMOVE THE CHAIR OF THE BOARD OF DIRECTORS OF TRHS; 10) APPROVE THE ANNUAL BUDGET OF TRHS; 11) SELECT THE AUDITOR FIRM FOR TRHS AND APPROVE THE ANNUAL AUDIT PERFORMED BY SUCH FIRM; 12) APPROVE CAPITAL EXPENDITURES BY TRHS OF 1,000,001 OR GREATER; 13) APPROVE SCOPE OF SERVICES PROVIDED BY TRHS; 14) APPOINT OR REMOVE THE PRESIDENT/CEO OF TRHS; AND 15) APPROVE ANY AMENDMENT TO THE LEASE BETWEEN THE HOSPITAL AUTHORITY OF TIFT COUNTY AND TRHS. FORM 990, PAGE 6, PART VI, LINE 11B FORM 990 IS PREPARED BY AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTANT FROM INFORMATION PROVIDED BY MANAGEMENT AND FROM AUDITED FINANCIAL STATEMENTS. AFTER THE RETURN IS PREPARED AND PRIOR TO FILING WITH THE IRS, THE RETURN IS REVIEWED IN DETAIL BY SENIOR FINANCIAL MANAGEMENT. A COPY OF THE RETURN IS THEN MADE AVAILABLE TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PAGE 6, PART VI, LINE 12C TRHS ANNUALLY DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE TO EACH MEMBER OF THE BOARD OF DIRECTORS. BOARD MEMBERS MUST DISCLOSE ANY POTENTIAL CONFLICTS. ANY BOARD MEMBER WITH A POTENTIAL CONFLICT MUST RECUSE THEMSELVES FROM THE MEETING AT WHICH THE POTENTIAL CONFLICT IS DISCUSSED. ONLY NON-CONFLICTED MEMBERS MAY DECIDE TO PURSUE A TRANSACTION INVOLVING A CONFLICT IF A MAJORITY OF THE REMAINING MEMBERS DETERMINE THE TRANSACTION IS IN THE ORGANIZATION'S BEST INTEREST. VIOLATION OF THE COI POLICY IS SUBJECT TO CORRECTIVE ACTION. FORM 990, PAGE 6, PART VI, LINE 15A THE TIFT REGIONAL HEALTH SYSTEM, INC.("TRHS") BOARD OF DIRECTORS HAS APPOINTED A COMMITTEE OF INDEPENDENT, CONFLICT-FREE BOARD MEMBERS TO DEVOTE THEIR TIME AND ATTENTION TO THE OVERSIGHT OF TRHS'S EXECUTIVE COMPENSATION PROGRAMS. THE COMMITTEE ANNUALLY RETAINS INDEPENDENT ADVISORS (INCLUDING HEALTH CARE COMPENSATION CONSULTANTS) TO PROVIDE THIRD-PARTY INFORMATION AND ADVICE, TO ENSURE EXECUTIVE COMPENSATION IS REASONABLE WHEN COMPARED TO THE PRACTICES OF OTHER SIMILARLY SITUATED ORGANIZATIONS, AND THAT THE PROGRAM HAS SIGNIFICANT AND APPROPRIATE COMPENSATION THAT IS SUBJECT TO MEETING ORGANIZATIONAL AND INDIVIDUAL GOALS (TO ENSURE THE ALIGNMENT OF PAY AND PERFORMANCE). COMPENSATION IS APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD, WHO ARE INDEPENDENT WITH NO FINANCIAL INTEREST IN THE COMPENSATION THEY REVIEW AND APPROVE. INCENTIVE BASED COMPENSATION IS CALCULATED BASED ON ACHIEVEMENTS AGAINST GOALS AND METRICS THAT WERE PRE-APPROVED BY THE BOARD. THE GOALS AND METRICS SPAN TRHS'S FIVE PILLARS OF SERVICE: QUALITY, FINANCE, PEOPLE, GROWTH AND COMMUNITY. THE PERFORMANCE PAY PLAN IS INTENDED TO REWARD EXECUTIVES FOR EXEMPLARY PERFORMANCE AND TO BE PART OF A COMPETITIVE TOTAL COMPENSATION PACKAGE. TOTAL COMPENSATION (INCLUDING THE PERFORMANCE PAY PLAN) IS DETERMINED TO BE REASONABLE AND STRICTLY COMPLIANT WITH ALL RULES AND REGULATIONS THAT GOVERN EXECUTIVE PAY AT A TAX-EXEMPT ORGANIZATION LIKE TRHS. FORM 990, PAGE 6, PART VI, LINE 15B SEE THE RESPONSE TO QUESTION 15A ABOVE. FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS ARE FILED WITH AND AVAILABLE ON THE GEORGIA SECRETARY OF STATE WEBSITE OR THROUGH THAT OFFICE. GOVERNING DOCUMENTS CAN ALSO BE OBTAINED BY CONTACTING TRHS. TRHS IS UNDER OBLIGATION TO DISCLOSE TO BOND HOLDERS PERTINENT FINANCIAL INFORMATION. A PUBLIC INSPECTION COPY OF FORM 990 IS AVAILABLE UPON REQUEST AND UPON THE TRHS WEBSITE. FORM 990, PART XI, LINE 9 FUND BAL. TRANSFER TO SOUTHWELL AMBUL. -8,633,229 INTERCOMPANY ADJUSTMENT TIFT ENTERPRISES 50,000 TOTAL -8,583,229 OTHER CHANGES IN FUND BALANCE RESULT FROM TRANSFERS WITH AFFILIATED ENTITIES CARE ALLIANCE PO BOX 2650 TIFTON GA 31793 474357229 ACO GA 10000 TIFT REG SOUTHWELL INC PO BOX 2650 TIFTON GA 31793 581772605 PARENT GA 501C3 12C NA false SOUTHWELL AMBULATORY INC PO BOX 2650 TIFTON GA 31793 843430446 MED. SVCS. GA 501C3 3 SOUTHWELL false TIFT REGIONAL MEDICAL CENTER FND PO BOX 747 TIFTON GA 31793 581705285 FUNDRAISIN GA 501C3 12D NA false TIFT ENTERPRISES INC PO BOX 747 TIFTON GA 31793 581986064 HOLDING CO GA N/A false false true false false false false false false false false false false false true true false false false false