2019-04-01T10:34:01-05:00 2018-06-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2017-07-01 580973772 DONALSONVILLE HOSPITAL INC DONA 2295245217 102 HOSPITAL CIRCLE DONALSONVILLE GA 398451100 HERMAN BROOKINS CHAIRMAN/CEO 2295245217 2019-04-01 true JACQUELINE G ATKINS P00861721 2298837878 2019-03-29 208.73.87.26 2019-04-01 10:34:01 CD P 3DB754BF4A86932C7270BAD44D636E9B352C5FAB 3DB754BF4A86932C7270BAD44D636E9B352C5FAB 2017 2019-02-21 02:37:17Z HERMAN BROOKINS 102 HOSPITAL CIRCLE DONALSONVILLE GA 398451100 37652124 false X WWW.DONALSONVILLEHOSPITAL.ORG X 1977 GA DONALSONVILLE HOSPITAL OPERATES A 65-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF DONALSONVILLE, GEORGIA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. 5 3 437 5445269 -20499 1940 735498 23221255 34459644 35301 66226 625925 2230767 23884421 37492135 918311 1448313 0 13686306 16143242 0 0 11308602 19770641 25913219 37362196 -2028798 129939 25685797 32052631 4858288 11012148 20827509 21040483 X DONALSONVILLE HOSPITAL OPERATES A 65-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF DONALSONVILLE, GEORGIA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. true false 31339741 1448313 30698590 DONALSONVILLE HOSPITAL PROVIDES PRIMARY HEALTHCARE TO RESIDENTS OF SEMINOLE COUNTY AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY. 31339741 true true false true false false false false false true true false false false false true true false false false false false false false false false true true true false true false false false false false false true false false false false false false false false false false true 33 0 437 true true true false false false false false false false false false X 5 3 false false false false false false false true false false false true true true true false true true true false GA X JAMES MOODY 2295245217 102 HOSPITAL CIRCLE DONALSONVILLE GA 398451100 HERMAN BROOKINS CHAIRMAN/CEO 40.00 X X 441173 0 24000 CHARLES H ORRICK ADMINISTRATO 40.00 X X 235415 0 159 BROADDUS SIMPSON SECRETARY 1.00 X X 13721 0 0 MITCH BLANKS DIRECTOR 1.00 X 9083 0 0 WILLIAM BURKE CPA DIRECTOR 1.00 X 9083 0 0 JAMES MOODY CFO 40.00 X 199360 0 18443 JOSEPH WALKER SR MD PHYSICIAN 40.00 X 379970 0 12853 ANDREA ALEXANDER MD PHYSICIAN 40.00 X 351121 0 14462 VINCENT KELLEY CRNA 40.00 X 244911 0 14647 ROYCE CANNINGTON JR CRNA 40.00 X 222018 0 12853 BRIAN BROOKINS PHARMACIST 40.00 X 221392 0 19973 2327247 117390 12 false true false HORIZON HEALTH P O BOX 840839 DALLAS TX 752840839 BEHAVIORAL HLTH 949383 NES GEORGIA INC PO BOX 936451 ATLANTA GA 31193 ER PHYSICIANS 726086 SHERIDAN RADIOLOGY PO BOX 452796 SUNRISE FL 333452796 TELERADIOLOGY 392928 CPSI PO BOX 850309 MOBILE AL 366850309 IT SUPPORT 324600 WEATHERBY LOCUMS INC P O BOX 972633 DALLAS TX 753972633 LOCUM PHYSICIAN 250814 13 735498 735498 NET PATIENT SERVICE REVENUE 621990 29014375 29014375 REFERENCE LAB 621500 5445269 5445269 34459644 37040 37040 183064 159989 23075 23075 23075 29186 29186 29186 29186 MISCELLANEOUS REVENUE 621990 1674658 1674658 CAFETERIA 722513 523477 523477 MEDICAL RECORD FEES 621990 8053 8053 1504 1504 2207692 37492135 30698590 5445269 612778 X 1448313 1448313 950437 950437 12382270 11232234 1150036 494893 418263 76630 1539607 1301211 238396 776035 653772 122263 62056 62056 276530 276530 8537083 8343861 193222 336294 336294 1863958 1345906 518052 324600 324600 485975 453463 32512 63328 32444 30884 54003 53024 979 194938 194938 1037229 967838 69391 182861 93772 89089 MEDICAL SUPPLIES 4518627 4518627 REPAIR AND MAINTENANCE 980395 169542 810853 MISCELLANEOUS EXPENSE 326908 4400 322508 DUES & SUBSCRIPTIONS 271140 48355 222785 254716 254716 37362196 31339741 6022455 0 8902 88292 359745 2694594 7472793 11170032 1815291 1427190 934197 1058703 423697 143867 32302475 20186803 11759796 12115672 2438859 2322082 472517 1032199 25685797 32052631 2858288 5762148 2000000 5250000 4858288 11012148 X 20827509 21040483 20827509 21040483 25685797 32052631 129939 83035 X false true X true false X false false false false false false false false true 3261 3261 false SCHEDULE C, PART II-B, LINE 1 THE ORGANIZATION BELONGS TO NATIONAL AND STATE HOSPITAL ASSOCIATIONS. A PORTION OF THE MEMBERSHIP DUES PAID TO THE ASSOCIATIONS ARE DEDICATED TO LOBBYING ACTIVITIES. 1841565 -188471 13946 1639148 1834489 19902 12826 1841565 1717887 128532 11930 1834489 2528700 153274 948672 15415 1717887 19475699 3479857 20346937 79919 2528700 1.00000 false false 686053 686053 3416817 14842504 9244678 9014643 343389 337865 5524 12943187 10604260 2338927 70525 70525 12115672 X 33986107 33986107 3506028 3506028 37492135 33856168 33856168 3506028 3506028 37362196 SCHEDULE D, PAGE 2, PART V, LINE 4 ENDOWMENT FUNDS CONSIST OF INVESTMENTS FOR THE DEFERRED COMPENSATION PLAN, AND MALPRACTICE INSURANCE. THE ORGANIZATION HAS ESTABLISHED A FUNDED DEFERRED COMPENSATION PLAN FOR CERTAIN KEY EMPLOYEES. MALPRACTICE INSURANCE IS A TRUST SET UP TO FUND POTENTIAL LIABILITIES UNDER THE HOSPITAL'S SELF INSURANCE PROGRAM. THE TRUSTEE IS SYNOVUS TRUST COMPANY, N.A. SCHEDULE D, PAGE 3, PART X THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION 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, THE ORGANIZATION 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, 2018 AND 2017 OR FOR THE YEARS THEN ENDED. THE ORGANIZATIONS 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 THESE RETURNS. SCHEDULE D, PAGE 4, PART XI, LINE 4B MEALS EXPENSE FOR SNF PATIENTS 481,626 GRANTS/ASSISTANCE 3,024,402 SCHEDULE D, PAGE 4, PART XII, LINE 4B GRANTS/ASSISTANCE 3,024,402 MEALS EXPENSE FOR SNF PATIENTS 481,626 true true X true X 1.250000000000 true X true true false true true 1832324 1832324 0.04880 4926203 4539794 386409 0.01030 98106 62675 35431 0.00090 6856633 4602469 2254164 0.06000 35647 35647 0.00100 1448313 1448313 0.03860 1483960 1483960 0.03960 8340593 4602469 3738124 0.09960 true 4249669 4757979 5379788 -621809 X true true 1 1 DONALSONVILLE HOSPITAL INC 102 HOSPITAL CIRCLE DONALSONVILLE GA 398451100 WWW.DONALSONVILLEHOSPITAL.ORG 125-318 X X X SNF, REHAB DONALSONVILLE HOSPITAL INC 1 false false true X X X X X X X X X X 16 true false false true X WWW.DONALSONVILLEHOSPITAL.ORG X true 16 true WWW.DONALSONVILLEHOSPITAL.ORG false false true X 125.000000000000 200.000000000000 X true true X X X X true X WWW.DONALSONVILLEHOSPITAL.ORG X WWW.DONALSONVILLEHOSPITAL.ORG X X X X X true X false X X X X true X false false FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 3E THE PRIORITIZATION OF SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IS IDENTIFIED AND THE METHODOLOGY FOR PRIORITIZING EACH NEED IS DESCRIBED ON PAGES 12-13 OF THE 2016 CHNA. FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 5 THE CHNA PANEL WAS SELECTED, STARTING WITH THE FIVE HOSPITAL BOARD MEMBERS. THE BOARD MEMBERS HAVE A BROAD RANGE OF COMMUNITY INVOLVEMENT AND LEADERSHIP ROLES, INCLUDING TWO WHO ARE INVOLVED WITH LOCAL COUNTY AND CITY GOVERNMENTS; TWO WHO ARE ACTIVE WITH OTHER NONPROFIT ORGANIZATIONS AND ARE COMMUNITY LEADERS; AND ONE WITH A VAST KNOWLEDGE AND EXPERIENCE IN THE AGRICULTURAL AREA, A MAJOR INDUSTRY OF SEMINOLE COUNTY. THE CHNA PANEL INCLUDED ALL FIVE MEMBERS OF THE BOARD PLUS TWO ADDITIONAL MEMBERS - A LOCAL COUNTY COMMISSIONER WHO ALSO SERVES AS CO-PASTOR IN A LOCAL MINISTRY, AND THE LOCAL HEALTH DEPARTMENT DIRECTOR. THE DONALSONVILLE HOSPITAL COMMUNITY HEALTH NEEDS ASSESSMENT PANEL REVIEWED AND DISCUSSED DATA GATHERED FROM OUTSIDE SOURCES, INPUT FROM LOCAL MEDICAL STAFF, EMPLOYEE MEETINGS, INPUT FROM LOCAL GOVERNMENT, INPUT FROM LOCAL BUSINESSES AS WELL AS INTERNAL DATA. IN UTILIZING THESE SOURCES, THE PANEL ESTABLISHED THE SPECIFIC NEEDS OF THE COMMUNITY BASED ON THE FOLLOWING CRITERIA: SEVERITY, OF CASES, IMPACT ON COMMUNITY AND THE ORGANIZATION'S ABILITY TO IMPLEMENT A SOLUTION TO IMPROVE THE NEED. FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 11 THE 2016 COMMUNITY NEEDS ASSESSMENT AND IMPLEMENTATION PLAN IDENTIFY THE FOLLOWING AREAS AS NEEDS IN THE COMMUNITY THAT COULD BE IMPROVED BY THE HOSPITAL INPUT: 1.DIABETES/HYPERTENSION DISEASE - THE HOSPITAL PROVIDES FUNDING AND SUPPORT TO THE LOCAL HEALTH DEPARTMENT'S DIABETES AND HYPERTENSION PROGRAM. THE HOSPITAL HAS IN THE PAST AND WILL CONTINUE TO HOST AND PARTICIPATE IN HEALTH FAIRS FOR LOCAL BUSINESSES AND THE GENERAL POPULATION. 2.OBESITY IN ADULTS - THE HOSPITAL WORKS TO PROMOTE A WELLNESS PROGRAM AMONG THEIR EMPLOYEES AND COMMUNITY RESIDENTS. 3.CANCER - FREE MAMMOGRAPHY SCREENINGS AND PSA LAB TESTS ARE OFFERED TO THE PUBLIC. 4.MENTAL HEALTH - THE HOSPITAL FUNDS A LOCAL PSYCHOTHERAPIST TO OFFER MEDICAL STAFF ADVICE AND ASSISTANCE. A CERTIFICATE OF NEED WAS APPROVED FOR THE ADDITION OF 20 MENTAL HEALTH BEDS. 20 MEDICAL/SURGICAL BEDS WILL BE CONVERTED TO 12 ADULT PSYCHIATRIC AND 8 CHILD/ADOLESCENT PSYCHIATRIC BEDS. THE DONALSONVILLE HOSPITAL BOARD IS PLANNING TO HAVE THE UNIT OPEN AND OPERATIONAL BY JUNE 1, 2017. BOTH 2016 COMMUNITY HEALTH NEEDS ASSESSMENT AND THE 2016 CHNA IMPLEMENTATION PLAN ARE WIDELY PUBLICIZED ON THE ORGANIZATION'S WEBSITE AND CAN BE FOUND AT HTTP://WWW.DONALSONVILLEHOSPITAL.ORG/DONALSONVILLEHOSPITAL_HEALTHNEEDSASSES SMENT.PDF AND HTTP://WWW.DONALSONVILLEHOSPITAL.ORG/DONALSONVILLEHOSPITAL_HEALTHNEEDSIMPLE MENTATION.PDF, RESPECTIVELY. FACILITY 1, DONALSONVILLE HOSPITAL, INC. - PART V, LINE 13H ALL PATIENTS ARE CHARGED EQUALLY REGARDLESS OF ANY OF THE ABOVE. THOSE INDIVIDUALS WITHOUT THIRD PARTY COVERAGE ARE GIVEN A 15% DISCOUNT IF THEY DO NOT QUALIFY FOR FREE CARE. THEY ARE ALSO GIVEN THE OPPORTUNITY TO RECEIVE A 50% DISCOUNT IF BILL IS PAID WITHIN 1 YEAR OF DISCHARGE. ALSO, FREE CARE IS OFFERED FOR PATIENTS MEETING CHARITY GUIDELINES - RANGING FROM 125% TO 200% OF FEDERAL POVERTY GUIDELINES. 2 SEMINOLE MANOR NURSING HOME 102 HOSPITAL CIRCLE DONALSONVILLE GA 317451100 SNF DONALSONVILLE HOSPITAL REHAB UNIT 102 HOSPITAL CIRCLE DONALSONVILLE GA 317451100 REHAB UNIT PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 37,362,196 ADD: EXPENSES REPORTED IN PART VIII 159,989 DENOMINATOR FOR COLUMN (F) 37,522,185 PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION COSTS FOR PART I, LINE 7A, 7B AND 7C WERE COMPUTED USING THE RATIO OF PATIENT CARE COST TO CHARGES CALCULATED ON WORKSHEET 2. OTHER COSTS WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS SEE PAGES 8 AND 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION 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. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION OUR PATIENT FINANCIAL SERVICES DEPARTMENT VISITS PATIENTS WHO HAVE NO INSURANCE TO DISCUSS ASSISTANCE AND REFER THOSE PATIENTS TO OUR LOCAL DFCS OFFICE TO OBTAIN ASSISTANCE WITH APPLYING FOR MEDICAID OR OTHER FINANCIAL ASSISTANCE. OUR PATIENT FINANCIAL SERVICES DEPARTMENT, WHICH DOES SELF-PAY BILLING AND COLLECTION, INFORMS PATIENTS ABOUT OUR FINANCIAL ASSISTANCE PROGRAM AND ASSISTS THEM IN COMPLETING AN APPLICATION. BILLING STATEMENTS PROVIDE A MESSAGE AND TELEPHONE NUMBER TO CALL IF THE PATIENT IS HAVING DIFFICULTIES MAKING PAYMENTS. FOR PATIENTS WHO QUALIFY AS INDIGENT OR CHARITY PATIENTS, THERE IS NO FINANCIAL OBLIGATION. THOSE PATIENTS WHO DO NOT QUALIFY AS INDIGENT OR CHARITY ARE SENT MULTIPLE STATEMENTS FOR 30, 60, AND 90 DAYS PAST DUE. THOSE PATIENTS WILL ALSO BE SENT TWO LETTERS REGARDING PAST DUE ACCOUNTS. ONCE AN ACCOUNT HAS NO ACTIVITY FOR 180 DAYS, IT WILL BE SENT TO AN OUTSIDE COLLECTION AGENCY. PART VI, LINE 2 - NEEDS ASSESSMENT A COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN FISCAL YEAR 2016. INFORMATION WAS SOLICITED FROM VARIOUS INDIVIDUALS REPRESENTING THE INTERESTS OF THE COMMUNITY BY MEANS OF FOCUS GROUPS, EXTERNAL STATISTICS, AND INTERNAL DATA. THE ORGANIZATION CONDUCTS VARIOUS TYPES OF ASSESSMENTS TO DETERMINE THE COMMUNITY'S NEEDS FOR HEALTH SERVICES AND COLLABORATES WITH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TO IDENTIFY THE NEEDS OF THE COMMUNITY. COMMUNITY RESEARCH HAS SHOWN THAT THE SERVICES FOR WHICH THE CITIZENS OF SEMINOLE AND SURROUNDING COUNTIES TURN TO THE ORGANIZATION ARE EMERGENCY SERVICES, DIAGNOSTIC TESTS AND X-RAYS, AND ALSO GENERAL MEDICAL CARE. OTHER SERVICES FOR WHICH THEY TURN TO US AS A MAJOR PROVIDER ARE MINOR SURGERY, PEDIATRIC CARE, GENERAL SURGERY, AND OBSTETRICAL CARE. THIS INFORMATION, COMBINED WITH OUR EXTENSIVE COLLABORATIONS AND OUR ROLE AS A LEADER IN THE COMMUNITY, PROVIDES US THE MEANS TO UNDERSTAND AND ADDRESS THE COMMUNITY'S NEEDS AND ENSURES OUR OUTREACH PROGRAMS ARE FOCUSED ON THE POPULATIONS WHO NEED OUR SERVICES THE MOST. OUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS, ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE BOARD HAS CLEARLY WRITTEN INDIGENT AND FINANCIAL AID POLICIES THAT ARE AVAILABLE THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND FINANCIAL AID. PATIENT EDUCATION ON THE ORGANIZATIONS INDIGENT/CHARITY AND FINANCIAL AID PROGRAMS ARE CONDUCTED DURING PRE-REGISTRATION, THROUGH OUR PATIENT FINANCIAL SERVICES DEPARTMENT FOR PATIENTS THAT DO NOT HAVE ANY 3RD PARTY COVERAGE. BROCHURES ARE PROMINENTLY DISPLAYED AT EACH REGISTRATION BOOTH. THE BUSINESS OFFICE CONTINUOUSLY PROVIDES INFORMATION TO THE BUSINESS OFFICE MANAGERS OF OUR LOCAL PHYSICIAN'S PRACTICES. PHONE CALLS AND LETTERS ARE SENT TO ALL PATIENTS THAT ARE NOT INTERVIEWED AT THE TIME OF ADMISSION EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAMS. OUR EMERGENCY DEPARTMENT IS OPERATED 24/7 AND OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. PART VI, LINE 4 - COMMUNITY INFORMATION THE ORGANIZATION SERVES A PREDOMINATELY RURAL AREA IN SEMINOLE COUNTY, IN ITS BROADEST BOUNDARIES. DONALSONVILLE IS THE ECONOMIC AND MEDICAL HUB FOR THE REGION, AND THE ORGANIZATION DRAWS FROM A POPULATION OF APPROXIMATELY 9,000 RESIDENTS FOR MAJOR HEALTH CARE SERVICES. THE REGION IS MARKED BY VAST DICHOTOMIES OF WEALTH, EDUCATION, AND HEALTH STATUS. THE ORGANIZATION SERVES A POPULATION THAT HAS A HIGH PROPORTION OF LOW-INCOME INDIVIDUALS. ABOUT 22.01% OF FAMILIES AND 25.49% OF THE POPULATION WERE BELOW THE POVERTY LINE. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH OUR BOARD OF DIRECTORS WORKS CLOSELY WITH THE LOCAL CIVIC ORGANIZATIONS, ELECTED OFFICIALS AND COMMUNITY LEADERS TO DETERMINE WHAT THE HEALTHCARE NEEDS ARE OF OUR COMMUNITY. WE HAVE PARTICIPATED IN VARIOUS LOCAL HEALTH FAIRS TO PROMOTE GOOD HEALTH AND PROVIDE SCREENING MECHANISMS FOR DETECTING HIGH BLOOD PRESSURE, ABNORMAL BLOOD SUGAR LEVELS AND HIGH CHOLESTEROL. THESE ARE THE MOST PRESSING AND PREVENTABLE DISEASES IN OUR COMMUNITY. WE WORK CLOSELY WITH THE LOCAL HEALTH DEPARTMENT TO ASSIST THEM WITH THE PROGRAMS THAT THEY FACILITATE THROUGHOUT THE YEAR. OUR BOARD HAS HAD IN PLACE FOR MORE THAN 20 YEARS, A SCHOLARSHIP PROGRAM FOR PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS. WE HAVE BEEN FORTUNATE TO HAVE MANY OF OUR LOCAL RESIDENTS FINISH MEDICAL SCHOOL, NURSING SCHOOL AND OTHER PROFESSIONAL CERTIFICATIONS, AND COME BACK TO DONALSONVILLE TO PRACTICE AND WORK IN OUR LOCAL HEALTHCARE COMMUNITY. THE PHYSICIAN SCHOLARSHIP PROGRAM HAS PRODUCED 7 OF OUR CURRENT 12 MEMBER MEDICAL STAFF. WE ALSO HAVE 3 IN THE PROGRAM THAT ARE SCHEDULED TO COME BACK TO OUR COMMUNITY OVER THE NEXT FEW YEARS. THIS TYPE OF PROGRAM HAS HELPED KEEP HEALTHCARE AVAILABLE AND ACCESSIBLE TO OUR RURAL COMMUNITY. IT HAS ENABLED US TO START NEW SERVICES THAT WOULD NOT HAVE EXISTED OTHERWISE. OUR BOARD IS DEDICATED TO PLANNING AND PREPARING FOR THIS RURAL COMMUNITY TO HAVE EASILY ACCESSIBLE HEALTHCARE FOR MANY YEARS TO COME. true SOUTHWEST GA HEALTHCARE CLINICS INC 205 BRESEE ST DONALSONVILLE GA 398451134 475012525 501C3 1448313 OPERATIONS 1 SCHEDULE I, PAGE 1, PART I, LINE 2 BEGINNING IN 2017, CERTAIN PHYSICIANS PREVIOUSLY OPERATING AS EMPLOYEES OF THE ORGANIZATION BEGAN PRACTICING UNDER A NEW FEDERALLY QUALIFIED HEALTH CENTER (FQHC) AND ARE NO LONGER EMPLOYEES OF THE ORGANIZATION. HOWEVER, THE ORGANIZATION AGREED TO COVER THE LOSSES THE PHYSICIANS INCURRED ON AN ANNUAL BASIS. THE ORGANIZATION REQUIRES MONTHLY FINANCIAL STATEMENTS FROM THE FQHC AND APPROVAL BY THE BOARD PRIOR TO REIMBURSEMENT. X X false false false false false false false false false HERMAN BROOKINS CHAIRMAN/CEO 409590 22500 9083 24000 465173 CHARLES H ORRICK ADMINISTRATOR 221332 5000 9083 159 235574 JAMES MOODY CFO 183770 15590 18443 217803 JOSEPH WALKER SR MD PHYSICIAN 310000 69970 12853 392823 ANDREA ALEXANDER MD PHYSICIAN 244231 106890 14462 365583 VINCENT KELLEY CRNA 198206 46705 14647 259558 ROYCE CANNINGTON JR CRNA 210018 12000 12853 234871 BRIAN BROOKINS PHARMACIST 188317 15590 17485 19973 241365 SCHEDULE J, PART III PART I, LINE 4 - DEFERRED COMPENSATION PLAN 457(B) THE ORGANIZATION HAS ESTABLISHED A DEFERRED COMPENSATION PLAN FOR CERTAIN KEY EMPLOYEES. THE 457(B) PLAN IS A NON-QUALIFIED RETIREMENT PLAN THAT ALLOWS A MAXIMUM SALARY DEFERRAL OF THE LESSER OF 18,000 OR ONE-THIRD OF AN EMPLOYEE'S SALARY. BRIAN BROOKINS FAMILY BD MMBR 241365 COMPENSATION false SCHEDULE L, PART V BRIAN BROOKINS, AN EMPLOYEE OF THE ORGANIZATION, IS THE SON OF HERMAN BROOKINS, WHO IS THE CHAIRMAN OF THE BOARD AND CEO. FORM 990, PAGE 2, PART III, LINE 2 THE ORGANIZATION OPENED A MENTAL HEALTH UNIT FOR ADULTS AND ADOLESCENTS DURING FISCAL YEAR 2018 IN RESPONSE TO THE CLOSING OF MENTAL HOSPITAL FACILITIES IN THE AREA. FOR THE FISCAL YEAR, GROSS PATIENT SERVICE REVENUES WERE APPROXIMATELY 5,343,000 WITH EXPENSES (DIRECT AND INDIRECT) TOTALING APPROXIMATELY 3,600,000. FORM 990, PAGE 6, PART VI, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PAGE 6, PART VI, LINE 11B THE INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 (BASED UPON INFORMATION PROVIDED BY THE ORGANIZATION) PROVIDES A COPY OF THE RETURN TO BE REVIEWED BY MANAGEMENT. MANAGEMENT PERFORMS A DETAILED REVIEW WHICH CONSISTS OF REVIEWING THE FINANCIAL DATA, THE NARRATIVES DISCLOSED, AND OTHER FACTS PRESENTED ON THE RETURN. UPON REVIEW, THE FORM 990 AND RELATED SCHEDULES ARE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND FEEDBACK. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES, A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING. FORM 990, PAGE 6, PART VI, LINE 12C THE ORGANIZATION HAS A WRITTEN POLICY RESPECTING CONFLICTS OF INTEREST AND DISCLOSURE OF SAME. GENERALLY SPEAKING, THE POLICY REQUIRES ANY "COVERED PERSON" WHO BELIEVES HE 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 -RECUSE HIMSELF 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 THE ORGANIZATION. 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 WHO DETERMINES WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. IF A CONFLICT OF INTEREST EXISTS, 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 ORGANIZATION'S BEST INTEREST AND IS FAIR AND REASONABLE TO THE ORGANIZATION. IN ADDITION TO THE REQUIREMENT TO DISCLOSE A POTENTIAL CONFLICT OF INTEREST AT THE TIME IT ARISES, EACH MUST SUBMIT ANNUALLY A `CONFLICT AND DISCLOSURE OF INTEREST QUESTIONNAIRE'. FORM 990, PAGE 6, PART VI, LINE 15A THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE COMPENSATION FOR THE CEO. THE BOARD USES COMPARABLE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS AT SIMILARLY SIZED ORGANIZATIONS AND SALARY SURVEYS TO DETERMINE THE COMPENSATION FOR THE CEO. THE CEO, A VOTING MEMBER OF THE BOARD, IS DISMISSED FROM THE MEETING DURING THE REVIEW OF HIS COMPENSATION. THE LAST DETERMINATION USING COMPARABLE COMPENSATION DATA AND SALARY SURVEYS WAS IN 2006. HOWEVER, COST OF LIVING ADJUSTMENTS ARE GIVEN ANNUALLY AND ARE APPROVED BY THE BOARD. FORM 990, PAGE 6, PART VI, LINE 15B THE BOARD OF DIRECTORS MEETS ON A MONTHLY BASIS, AND THE SALARY DECISIONS ARE REVIEWED BY THE BOARD. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION WILL MAKE AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO ANY MEMBER OF THE PUBLIC WHO MAKES THEIR REQUEST AT THE ADMINISTRATIVE OFFICE OF THE FILING ENTITY. FORM 990, PART IX, LINE 11G CONTRACT LABOR 6,284,795 0 0 PROFESSIONAL FEES 1,793,110 50,567 0 PURCHASED SERVICES 143,956 142,655 0 CONSULTING FEES 122,000 0 0 TOTAL 8,343,861 193,222 0