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POLK MEDICAL CENTER INC: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
POLK MEDICAL CENTER INC (EIN 45-3957368)
Tax period
2018-07-01 to 2019-06-30
Filed
2020-01-16
IRS object ID
202000169349300005
Schema version
2018v3.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2020-01-16T07:40:36-06:00ReturnTs
Tax Period End2019-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN580914992PreparerFirmEIN

Preparer Firm Name PreparerFirmName

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

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 71309AddressLine1Txt
CityALBANYCityNm
State AbbreviationGAStateAbbreviationCd
ZIP317081309ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2018-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN453957368EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1POLK MEDICAL CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPOLKBusinessNameControlTxt
Phone7065096074PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1420 E SECOND AVENUE SUITE 102AddressLine1Txt
CityROMECityNm
State AbbreviationGAStateAbbreviationCd
ZIP301613210ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCLARICE CABLEPersonNm
Person TitleCONTROLLER/TAX OFCRPersonTitleTxt
Phone7065096074PhoneNum
Signature2020-01-31SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJACQUELINE G ATKINSPreparerPersonNm
PTINP00861721PTIN
Phone2298837878PhoneNum
Preparation2020-01-15PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address208.73.87.26IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-01-16IPDt
IP Tm07:40:36IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id3DB754BF4A86932C7270BAD44D636E9B352C5FABAtSubmissionCreationDeviceId
At Submission Filing Device Id3DB754BF4A86932C7270BAD44D636E9B352C5FABAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2020-09-23 17:36:50ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1FLOYD POLK MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerKURT STUENKELPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1304 TURNER MCCALL BLVDAddressLine1Txt
CityROMECityNm
State AbbreviationGAStateAbbreviationCd
ZIP301620233ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$33,677,186GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.POLKHOSPITAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2011FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionPOLK 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 Body12VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers15TotalVolunteersCnt
Total Gross UBI$27,823TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$21,041NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$253,531PYContributionsGrantsAmt
CY Contributions Grants$831,887CYContributionsGrantsAmt
PY Program Service Revenue$33,149,773PYProgramServiceRevenueAmt
CY Program Service Revenue$32,217,980CYProgramServiceRevenueAmt
PY Investment Income$645,672PYInvestmentIncomeAmt
CY Investment Income$540,366CYInvestmentIncomeAmt
PY Other Revenue$17PYOtherRevenueAmt
CY Other Revenue$86,953CYOtherRevenueAmt
PY Total Revenue$34,048,993PYTotalRevenueAmt
CY Total Revenue$33,677,186CYTotalRevenueAmt
PY Grants And Similar Paid$318,601PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$310,000CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$13,259,267PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$13,514,222CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$11,853,468PYOtherExpensesAmt
CY Other Expenses$10,835,087CYOtherExpensesAmt
PY Total Expenses$25,431,336PYTotalExpensesAmt
CY Total Expenses$24,659,309CYTotalExpensesAmt
PY Revenues Less Expenses$8,617,657PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$9,017,877CYRevenuesLessExpensesAmt
Total Assets BOY$66,780,229TotalAssetsBOYAmt
Total Assets EOY$77,697,143TotalAssetsEOYAmt
Total Liabilities BOY$42,574,853TotalLiabilitiesBOYAmt
Total Liabilities EOY$42,878,580TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$24,205,376NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$34,818,563NetAssetsOrFundBalancesEOYAmt
MissionPOLK 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 SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$20,933,262ExpenseAmt
Grant$310,000GrantAmt
Revenue$32,277,110RevenueAmt
DescPOLK MEDICAL CENTER IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING GENERAL ACUTE CARE SERVICES TO THE POLK COUNTY AND NORTHERN HARALSON COUNTY COMMUNITIES. DURING FISCAL YEAR 2019, PATIENT DAYS AT POLK MEDICAL CENTER TOTALED 7,405 AND DISCHARGES TOTALED 130. EMERGENCY ROOM VISITS TOTALED 27,393.Desc
Total Program Service Expenses$20,933,262TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (true)GrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document22IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Own WebsiteYes (X)OwnWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCLARICE CABLEPersonNm
Phone7065096074PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1304 TURNER MCCALL BLVDAddressLine1Txt
CityROMECityNm
State AbbreviationGAStateAbbreviationCd
ZIP301610233ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
KURT STUENKEL
PRESIDENT/SE1.0052.00Yes (X)Yes (X)$0$1,033,596$25,293
GEORGE A BOSWORTH MD
MEMBER1.001.00Yes (X)$2,750$8,250$0
LARRY KUGLAR
MEMBER1.001.00Yes (X)$2,250$5,000$0
BRAD WARD MD
MEMBER1.001.00Yes (X)$2,500$4,000$0
FRANK SHELLEY
CHAIRMAN1.001.00Yes (X)Yes (X)$2,250$2,500$0
LEE CUMMINGS
MEMBER1.00Yes (X)$2,750$0$0
NEIL E GORDON MD
MEMBER1.00Yes (X)$2,750$0$0
TODD BUSSEY
MEMBER1.00Yes (X)$2,500$0$0
BRUCE CASEY
MEMBER1.00Yes (X)$2,500$0$0
DARROLL FREEMAN
MEMBER1.00Yes (X)$2,500$0$0
SONDI SMITH VEST
MEMBER1.00Yes (X)$2,500$0$0
HAROLD W WYATT JR
PAST MEMBER1.00Yes (X)$2,250$0$0
OTHEL DOYLE TREY KELLEY
MEMBER1.00Yes (X)$0$0$0
RICHARD T SHEERIN
CFO (RETIRED1.0053.00Yes (X)$0$501,138$19,096
CLARICE CABLE
CONTROLLER/T1.0043.00Yes (X)$0$0$0
MATTHEW GORMAN
POLK ADMINIS40.00$0$375,239$28,814Yes (X)
TIFANI KINARD
CHIEF NURSIN40.00$177,879$0$15,288Yes (X)
DEANA OWEN
PHARMACY DIR40.00$170,977$0$21,774Yes (X)
CHRISTY LINDSEY
PHARMACIST40.00$129,722$0$7,923Yes (X)
LOVEJOY LEIGH
PHARMACIST40.00$127,291$0$20,745Yes (X)
PHILLIP ROBERTS
REGISTERED N40.00$126,770$0$7,378Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$760,139TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,929,723TotReportableCompRltdOrgAmt
Total Other Compensation$146,311TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K14IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MORRISON MANAGEMENT SPECIALISTS
P O BOX 102289ATLANTAGA303682289FOOD SERVICES$539,439
ARAMARK MANAGEMENT SERVICE
P O BOX 233ROMEGA301610233HOUSEKEEPING$359,545
CERNER CORPORATION
P O BOX 412702KANSAS CITYMO641412702IT SERVICES$277,700
G4S SECURE SOLUTIONS(USA) INC
PO BOX 277469ATLANTAGA303847469SECURITY$241,804
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
All Other Contributions$831,887AllOtherContributionsAmt
Total Contributions$831,887TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SERVICE REVENUE623000$32,190,157$32,190,157
REFERENCE LAB621500$27,823$27,823
FieldValueIRS element (for citing)
Total Program Service Revenue$32,217,980TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$540,366TotalRevenueColumnAmt
Exclusion$540,366ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PURCHASE DISCOUNTS623000$91,148$91,148
STATE INCOME TAX REFUND UBI623000-$4,195-$4,195
FieldValueIRS element (for citing)
Other Revenue Total$86,953OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$33,677,186TotalRevenueColumnAmt
Related Or Exempt Func Income$32,277,110RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$27,823UnrelatedBusinessRevenueAmt
Exclusion$540,366ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$310,000TotalAmt
Program Services$310,000ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$27,500TotalAmt
Management And General$27,500ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$10,299,436TotalAmt
Program Services$9,324,301ProgramServicesAmt
Management And General$975,135ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,441,447TotalAmt
Program Services$2,210,242ProgramServicesAmt
Management And General$231,205ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$745,839TotalAmt
Program Services$684,192ProgramServicesAmt
Management And General$61,647ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$230,645TotalAmt
Management And General$230,645ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$83,055TotalAmt
Management And General$83,055ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$79,118TotalAmt
Management And General$79,118ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$785,856TotalAmt
Program Services$343,780ProgramServicesAmt
Management And General$442,076ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$70,386TotalAmt
Program Services$3,305ProgramServicesAmt
Management And General$67,081ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$218,207TotalAmt
Program Services$106,230ProgramServicesAmt
Management And General$111,977ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$555,049TotalAmt
Program Services$50,993ProgramServicesAmt
Management And General$504,056ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,823,480TotalAmt
Program Services$1,673,225ProgramServicesAmt
Management And General$150,255ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,286,527TotalAmt
Program Services$1,240,468ProgramServicesAmt
Management And General$46,059ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$20,099TotalAmt
Program Services$6,336ProgramServicesAmt
Management And General$13,763ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$114,721TotalAmt
Program Services$114,721ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,638,020TotalAmt
Program Services$2,420,647ProgramServicesAmt
Management And General$217,373ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$375,976TotalAmt
Management And General$375,976ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$1,759,268$1,743,538$15,730
REPAIRS & MAINTENANCE$549,181$525,413$23,768
LICENSES & TAXES$162,951$162,269$682
DUES & SUBSCRIPTIONS$35,001$13,602$21,399

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$47,547TotalAmt
Management And General$47,547ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$24,659,309TotalAmt
Program Services$20,933,262ProgramServicesAmt
Management And General$3,726,047ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$251,090BOYAmt
EOY$1,531,094EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$6,129,123BOYAmt
EOY$3,346,102EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$9,646,009BOYAmt
EOY$6,279,828EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$298,049BOYAmt
EOY$311,879EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$411,481BOYAmt
EOY$444,291EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$44,212,418LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$19,582,444LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$27,389,054BOYAmt
EOY$24,629,974EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$22,351,190BOYAmt
EOY$39,465,726EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$304,233BOYAmt
EOY$1,688,249EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$66,780,229BOYAmt
EOY$77,697,143EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$3,025,952BOYAmt
EOY$3,001,163EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$34,146,264BOYAmt
EOY$33,844,184EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,402,637BOYAmt
EOY$6,033,233EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$42,574,853BOYAmt
EOY$42,878,580EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$24,205,376BOYAmt
EOY$34,818,563EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$24,205,376BOYAmt
EOY$34,818,563EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$66,780,229BOYAmt
EOY$77,697,143EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$9,017,877ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$1,595,310NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$2,591OtherActivitiesAmt
Total Lobbying Expenditures$2,591TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE C, PART II-B, LINE 1FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION PAYS MEMBERSHIP DUES TO NATIONAL AND STATE ORGANIZATIONS. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THOSE ORGANIZATIONS PARTICIPATE.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$838,635OtherCostOrOtherBasisAmt
Book Value$838,635BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$28,399,491OtherCostOrOtherBasisAmt
Depreciation$8,583,715DepreciationAmt
Book Value$19,815,776BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$50,508OtherCostOrOtherBasisAmt
Depreciation$9,135DepreciationAmt
Book Value$41,373BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,923,784OtherCostOrOtherBasisAmt
Depreciation$10,989,594DepreciationAmt
Book Value$3,934,190BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$24,629,974TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
MOB CAPITAL LEASE$2,835,297
DUE TO RELATED ORGANIZATIONS$1,672,120
THIRD PARTY PAYMENTS$1,525,816
FieldValueIRS element (for citing)
Total Liability$6,033,233TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$35,075,756TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$1,595,310NetUnrealizedGainsInvstAmt
Other Revenue-$170,255OtherRevenueAmt
Revenue Not Reported$1,425,055RevenueNotReportedAmt
Revenue Subtotal$33,650,701RevenueSubtotalAmt
Other Revenues Not Included$26,485OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$26,485RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$33,677,186TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$24,489,495TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$24,489,495ExpensesSubtotalAmt
Other Expenses Not Included$169,814OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$169,814ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$24,659,309TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PAGE 3, PART XPMCI IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PMCI 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, PMCI 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 MANAGEMENTS EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JUNE 30, 2019 AND 2018 OR FOR THE YEARS THEN ENDED. PMCIS TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS.
SCHEDULE D, PAGE 4, PART XI, LINE 2DINVESTMENT FEES NETTED IN REVENUES -79,118 REVENUE ACCOUNTS NETTED TO EXPENSE -91,137
SCHEDULE D, PAGE 4, PART XI, LINE 4BCAPITAL CONTRIBUTIONS 26,485
SCHEDULE D, PAGE 4, PART XII, LINE 4BREVENUES NETTED IN EXPENSES 91,137 INVESTMENT FEES 79,118 MISCELLANEOUS EXPENSE -441

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other1.250000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other3.250000000000DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,018,566TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,018,566NetCommunityBenefitExpnsAmt
Total Expense0.04130TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,605,917TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,678,092DirectOffsettingRevenueAmt

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$13,589TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$11,270DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,319NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,638,072TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,689,362DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,020,885NetCommunityBenefitExpnsAmt
Total Expense0.04140TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$27,831TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$27,831NetCommunityBenefitExpnsAmt
Total Expense0.00110TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$310,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$310,000NetCommunityBenefitExpnsAmt
Total Expense0.01260TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$337,831TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$337,831NetCommunityBenefitExpnsAmt
Total Expense0.01370TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,975,903TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,689,362DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,358,716NetCommunityBenefitExpnsAmt
Total Expense0.05510TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$25,349,462BadDebtExpenseAmt
Bad Debt Expense Attributable$12,674,731BadDebtExpenseAttributableAmt
Reimbursed By Medicare$10,733,982ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$10,791,622CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$57,640MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1POLK MEDICAL CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12360 ROCKMART HIGHWAYAddressLine1Txt
CityCEDARTOWNCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30125ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.POLKHOSPITAL.ORGWebsiteAddressTxt
State License115-705StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherSWING BED SNFOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1POLK MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
OtherYes (X)OtherInd
CHNA Conducted19CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (true)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.POLKHOSPITAL.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt19ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLWWW.POLKHOSPITAL.ORGStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care125.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care325.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.POLKHOSPITAL.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.POLKHOSPITAL.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.POLKHOSPITAL.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 3ETHE PROCESS OF PRIORITIZING THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IS DISCUSSED ON PAGES 14 THROUGH 18 OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH IS AVAILABLE ON THE ORGANIZATION'S WEBSITE.
FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 5POLK MEDICAL CENTER 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. PARTICIPANTS IN THE SURVEY INCLUDED POLK COUNTY HEALTH CARE AND COMMUNITY LEADERS, AND INCLUDED REPRESENTATIVES FROM HEALTH CARE, LAW ENFORCEMENT, CHAMBERS OF COMMERCE, BUSINESS, INDUSTRY, EDUCATION, VOLUNTEERS AND ELECTED OFFICIALS. PARTICIPANTS DEMONSTRATED A COMMUNITY-WIDE KNOWLEDGE AND AN UNDERSTANDING OF COMMUNITY CHALLENGES AND NEEDS. PARTICIPANTS WERE ASKED TO RATE THEIR PERSONAL HEALTH, PROVIDE INFORMATION ABOUT THEIR OWN ACCESS TO HEALTH CARE SERVICES, AS WELL AS TO RATE THE HEALTH OF THE COMMUNITY AND ASSESS THE ISSUES AND BARRIERS TO HEALTH WITHIN THE COMMUNITY.
FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 6ATHE 2019 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 7DTHE 2019 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 11ACCESS TO CARE, CARDIOVASCULAR DISEASE, MENTAL HEALTH SERVICES AND NUTRITION WERE SEEN AS SIGNIFICANT CONCERNS THAT AFFECT MANY RESIDENTS. THE DISTRIBUTION OF BEHAVIORS AND HEALTH OUTCOMES CONSISTENTLY FOLLOW SOCIAL AND ECONOMIC PATTERNS. 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 HEALTH CARE, SOCIAL SERVICES AND COMMUNITY LEADERSHIP, WE CAN LEVERAGE COMMUNITY ASSETS TO IMPROVE THE HEALTH OF RESIDENTS IN FLOYD, POLK, CHATTOOGA AND CHEROKEE COUNTIES.

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATIONTHE 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.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGYAMOUNTS 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.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCETHE 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.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTSSEE THE DISCUSSION OF BAD DEBT EXPENSE ON PAGE 17 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8 - MEDICARE EXPLANATIONMEDICARE 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.
PART III, LINE 9B - COLLECTION PRACTICES EXPLANATIONFOR 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.
PART VI, LINE 2 - NEEDS ASSESSMENTPOLK MEDICAL CENTER (PMC) COMPLETED A HEALTH CARE NEEDS ASSESSMENT IN POLK COUNTY IN FISCAL YEAR 2019. THIS INCLUDED INTERVIEWS WITH COMMUNITY LEADERS AND HEALTH CARE PROFESSIONALS AND FOCUS GROUPS. IN ADDITION, FHMI, THE SOLE MEMBER, DEVELOPS A STRATEGIC PLAN THAT IS UPDATED ANNUALLY. THE STRATEGIC PLAN TAKES INTO CONSIDERATION HEALTH NEEDS FOR OUR SERVICE AREA IN ADDITION TO UTILIZATION OF SERVICES, COMMUNITY PARTICIPATION, AND QUALITY OF SERVICES PROVIDED.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPOLK COMMUNICATES THIS INFORMATION THROUGH 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 ON-SITE REGISTRATION THE ACCESS/REGISTRATION STAFF DISCUSSES 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.
PART VI, LINE 4 - COMMUNITY INFORMATIONPOLK COUNTY HAS AN ESTIMATED 41,000 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, HCA-OWNED HOSPITAL. THE LAND AREA OF POLK COUNTY COVERS 301.34 SQUARE MILES, AND THE POPULATION DENSITY IS 132.96 PEOPLE PER SQUARE MILE. NINETEEN PERCENT (19%) OF THESE INDIVIDUALS LIVE IN POVERTY, AND 30% OF THE CHILDREN LIVING IN POLK COUNTY LIVE IN POVERTY. EIGHTY-THREE PERCENT (83%) OF POLK COUNTY STUDENTS ARE ELIGIBLE FOR THE FEDERAL FREE LUNCH PROGRAM. EIGHT-TWO PERCENT (82%) OF POLK COUNTY RESIDENTS HAVE A HIGH SCHOOL DIPLOMA OR GENERAL EDUCATION DEVELOPMENT (GED) CERTIFICATE, AND 12% HAVE A BACHELOR'S DEGREE OR HIGHER. ACCESS TO HEALTH CARE PROVIDERS IS LOW. THERE ARE 13 PRIMARY CARE PHYSICIANS IN POLK COUNTY AND 28 MENTAL HEALTH PROVIDERS. ACCESS TO CARE ALSO IS HAMPERED BY HEALTH CARE COVERAGE. SIXTEEN PERCENT (16%) OF THE COUNTY'S RESIDENTS (6,605 INDIVIDUALS) ARE WITHOUT HEALTH CARE INSURANCE. THE MEDIAN PER HOUSEHOLD INCOME IS 48,090. AN ESTIMATED 19.0% OF THE POLK COUNTY POPULATION IS BELOW THE POVERTY LEVEL.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTHFLOYD POLK MEDICAL CENTER GENERATES MORE THAN 51 MILLION IN ECONOMIC ACTIVITY IN THE STATE. POLK HAS ABOUT 201 FULL AND PART-TIME EMPLOYEES. POLK MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL PROVIDING THE FOLLOWING SERVICES TO THE POLK COUNTY AND NORTHERN HARALSON COUNTY COMMUNITIES. "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 "SENIOR ENRICHMENT CENTER "SUBACUTE REHABILITATION "SURGICAL SERVICES "URGENT CARE "WOUND CARE POLK MEDICAL CENTER IS COMMITTED TO PROVIDING HEALTH CARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. IN FY 2019, POLK MEDICAL CENTER PROVIDED 5.5 MILLION IN UNREIMBURSED CARE TO INDIVIDUALS. THE FLOYD POLK MEDICAL CENTER PHARMACY PROVIDED PRESCRIPTION DRUGS AT NO OR MINIMAL COST TO INDIGENT PATIENTS BEING DISCHARGED FROM INPATIENT CARE OR THE EMERGENCY ROOM AT A COST OF 4,030 DURING FY 2019. IN FY 2019, FLOYD POLK MEDICAL CENTER'S OUTREACH IN THE COMMUNITY RESULTED IN 22,557 TOUCH POINTS THROUGH EDUCATIONAL PROGRAMS, SUPPORT GROUPS, AND MEDICAL SUPPORT AT COMMUNITY EVENTS. FLOYD CO-WORKERS CONTRIBUTED 168.5 HOURS TO COMMUNITY ENDEAVORS AT A COST TO THE ORGANIZATION OF 22,557, WHICH INCLUDED: CONDUCTING HEALTH FAIRS PROVIDING SCHOOL-BASED EDUCATION PROGRAMS TO STUDENTS ABOUT AUTOMOBILE SAFETY, BICYCLE SAFETY, SAFE PLAY AND CAREERS PROVIDING DIABETES EDUCATION PROVIDING HEART DISEASE EDUCATION PROVIDING MEDICAL SUPPORT AT SPORTS AND COMMUNITY EVENTS THESE STATISTICS DO NOT TAKE INTO ACCOUNT THE ATHLETIC TRAINERS PROVIDED TO POLK COUNTY SCHOOLS, THE POLK COUNTY PATIENTS SEEN AT THE FLOYD MEDICAL CENTER TRAUMA CENTER OR THE INDIGENT CARE PROVIDED AT FLOYD MEDICAL CENTER TO POLK COUNTY RESIDENTS. AS A COMMUNITY HOSPITAL, POLK 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 THE SERVICE AREA. MEMBERS OF THE POLK TEAM ARE COMMITTED TO THE COMMUNITY IN MANY WAYS. IN FY 2019 POLK CO- WORKERS LOANED THEIR TALENTS AND LEADERSHIP SKILLS TO SCHOOL, CIVIC AND PROFESSIONAL ORGANIZATIONS. INDIGENT OUTPATIENT PHARMACY PROGRAM POLK PROVIDES MAINTENANCE PRESCRIPTION PHARMACEUTICALS TO LOW INCOME UNINSURED OUTPATIENTS AT NO COST TO THE PATIENT THROUGH ITS HOSPITAL PHARMACY. ANY QUALIFIED, LOW INCOME PATIENT DISCHARGED FROM POLK MEDICAL CENTER MAY BE ELIGIBLE TO RECEIVE THE PRESCRIBED MEDICATIONS.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEMPOLK 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, WILLOWBROOKE AT FLOYD, 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. FLOYD EMERGENCY PHYSICIANS LLC IS A WHOLLY OWNED SUBSIDIARY OF FHMI WHOSE SOLE PURPOSE IS TO PROVIDE A PHYSICIAN AND MID-LEVEL STAFFING SOLUTION IN THE FLOYD MEDICAL CENTER EMERGENCY CARE CENTER AND THE POLK MEDICAL CENTER EMERGENCY DEPARTMENT. 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 I IRS990ScheduleI

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

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1CEDARTOWN-POLK COUNTY HOSPITAL AUTHBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1424 NORTH MAIN STREETAddressLine1Txt
CityCEDARTOWNCityNm
State AbbreviationGAStateAbbreviationCd
ZIP301252644ZIPCd
FieldValueIRS element (for citing)
Recipient EIN580603152RecipientEIN
IRC SectionGOVIRCSectionDesc
Cash Grant$310,000CashGrantAmt
Valuation Method UsedCASHValuationMethodUsedDesc
Purpose Of GrantCONSTRUCT H2O/SEWERPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2FormAndLineReferenceDesc
ExplanationPOLK MEDICAL CENTER, INC. ENTERED INTO A CONTRACT WITH THE CITY OF CEDARTOWN TO MAKE ANNUAL CONTRIBUTIONS TO THE CITY FOR THE CONSTRUCTION OF NEW WATER AND SEWAGE INFRASTRUCTURE FOR THE NEW HOSPITAL. PURSUANT TO THE AGREEMENT, PMC WILL MAKE PAYMENTS FOR 20 YEARS. ON AN ANNUAL BASIS, MANAGEMENT REVIEWS AND RECONCILES THE ACTIVITY.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
KURT STUENKEL
PRESIDENT/SECRETARY$695,444$150,869$187,283$25,293$1,058,889
RICHARD T SHEERIN
CFO (RETIRED 2019)$417,875$76,951$6,312$19,096$520,234
MATTHEW GORMAN
POLK ADMINISTRATOR$291,801$82,851$587$28,814$404,053
TIFANI KINARD
CHIEF NURSING OFFICE$161,230$16,320$329$15,288$193,167
DEANA OWEN
PHARMACY DIRECTOR$155,823$14,690$464$21,774$192,751

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PAGE 1, PART I, LINE 3NONE OF THE INDIVIDUAL BOARD MEMBERS OR OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION AND THE ORGANIZATION MUST RELY ON THE METHODS EMPLOYED BY THE RELATED ORGANIZATION, FHMI, 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 4KURT STUENKEL 0 176,053 0
SCHEDULE J, PART IIIMR. STUENKEL AND MR. SHEERIN ARE COMPENSATED BY FLOYD HEALTHCARE MANAGEMENT, INC. (EIN: 58-1973570) FOR SERVICES AS THE CEO AND 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. ADDITIONALLY, OF THE 1,033,596 LISTED AS COMPENSATION FOR MR. KURT STUENKEL IN FORM 990 PART VII SECTION A, 150,869 REPRESENTS A PERFORMANCE-BASED PAYMENT ARISING FROM THE 2018 PERFORMANCE PERIOD AND 176,053 REPRESENTS THE NONQUALIFIED 457(F) PLAN. ACCORDINGLY, MR. STUENKEL'S SALARY FOR 2018 WOULD HAVE BEEN 706,674 EXCLUDING THE 2018 PORTION OF THE INCENTIVE-BASED PAYMENT AND THE 457(F)PLAN AMOUNT. 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 K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CEDARTOWN POLK COUNTY HOSP AUTHBusinessNameLine1Txt
Business Name Line2REVENUE BONDS 2016 SERIESBusinessNameLine2Txt
FieldValueIRS element (for citing)
Bond Issuer EIN580603152BondIssuerEIN
CUSIP150759AR9CUSIPNum
Bond Issued2016-04-13BondIssuedDt
Issue Price$30,415,000IssuePriceAmt
PurposeRETIRE BANK LOAN FOR CONSTRUCTION, ACQUISITION, RENOVATION, EXPANSION,PurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$170,000RetiredAmt
Total Proceeds$34,834,415TotalProceedsAmt
Issuance Costs From Proceeds$338,636IssuanceCostsFromProceedsAmt
Capital Expenditures$34,495,779CapitalExpendituresAmt
Substantial Completion2014SubstantialCompletionYr
Refunding Tax Exempt BondsfalseRefundingTaxExemptBondsInd
Refunding Taxable BondsfalseRefundingTaxableBondsInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsfalseAnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropfalseMgmtContractBondFincdPropInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebatefalseExceptionToRebateInd
No Rebate DuefalseNoRebateDueInd
Variable Rate IssuefalseVariableRateIssueInd
Hedge Identified In Bks And RecfalseHedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsfalseWrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionfalseProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE K - DIFFERENCES IN ISSUE PRICE EXPLANATIONCEDARTOWN POLK COUNTY HOSP AUTH THE 2016 SERIES REVENUE BOND PROCEEDS INCLUDES A PREMIUM IN THE AMOUNT OF 4,419,415.
SCHEDULE K - PURPOSE OF ISSUE DESCRIPTIONCEDARTOWN POLK COUNTY HOSP AUTH INSTALLATION AND EQUIPPING OF THE POLK MEDICAL CENTER.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 6FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI) IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PAGE 6, PART VI, LINE 7AFLOYD 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 7BPRIOR 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 11BTHE ORGANIZATION'S CEO, CFO, CONTROLLER, LEGAL COUNSEL AND EMPLOYEES OF FHMI REVIEW THE FORM 990 FOR FINANCIAL AND DISCLOSURE ACCURACY. PRIOR TO ITS FILING, A COPY OF THE ORGANIZATION'S 990 RETURN IS POSTED ON THE BOARD OF DIRECTORS' SECURE WEBSITE FOR THEIR REVIEW. MANAGEMENT WILL SEND AN EMAIL NOTIFYING MEMBERS OF ITS POSTING.
FORM 990, PAGE 6, PART VI, LINE 12CPOLK 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 19THE 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
FLOYD HEALTHCARE MANAGEMENT INC
304 TURNER MCCALL BLVDROMEGA301620233581973570ACUTE CAREGA501C33NAfalse
HOSPITAL AUTHORITY OF FLOYD COUNTY
304 TURNER MCCALL BLVDROMEGA301620233586001173HEALTHCAREGA501C33NAfalse
FLOYD HEALTH CARE FOUNDATION INC
304 TURNER MCCALL BLVDROMEGA30161581375074FOUNDATIONGA501C312AFHMIfalse
CANCER NAVIGATORS INC
255 W 5TH STREET SUITE 300ROMEGA301652817030397867HEALTHCAREGA501C37FHMIfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd