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POLK MEDICAL CENTER INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
POLK MEDICAL CENTER INC (EIN 45-3957368)
Tax period
2017-07-01 to 2018-06-30
Filed
2019-05-15
IRS object ID
201911359349301601
Schema version
2017v2.3
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)
Return2019-05-15T07:37:48-05:00ReturnTs
Tax Period End2018-06-30TaxPeriodEndDt

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 Begin2017-07-01TaxPeriodBeginDt

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)
PersonRICHARD T SHEERINPersonNm
Person TitleCFOPersonTitleTxt
Phone7065096074PhoneNum
Signature2019-05-14SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJACQUELINE G ATKINSPreparerPersonNm
PTINP00861721PTIN
Phone2298837878PhoneNum
Preparation2019-05-13PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address208.73.87.26IPv4AddressTxt
FieldValueIRS element (for citing)
IP2019-05-15IPDt
IP Tm07:37:48IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id3DB754BF4A86932C7270BAD44D636E9B352C5FABAtSubmissionCreationDeviceId
At Submission Filing Device Id3DB754BF4A86932C7270BAD44D636E9B352C5FABAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

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$34,065,970GrossReceiptsAmt
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$24,582TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$15,084NetUnrelatedBusTxblIncmAmt
CY Contributions Grants$253,531CYContributionsGrantsAmt
PY Program Service Revenue$30,538,769PYProgramServiceRevenueAmt
CY Program Service Revenue$33,149,773CYProgramServiceRevenueAmt
PY Investment Income$87,750PYInvestmentIncomeAmt
CY Investment Income$645,672CYInvestmentIncomeAmt
PY Other Revenue$88PYOtherRevenueAmt
CY Other Revenue$17CYOtherRevenueAmt
PY Total Revenue$30,626,607PYTotalRevenueAmt
CY Total Revenue$34,048,993CYTotalRevenueAmt
PY Grants And Similar Paid$326,068PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$318,601CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$13,920,623PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$13,259,267CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$10,670,394PYOtherExpensesAmt
CY Other Expenses$11,853,468CYOtherExpensesAmt
PY Total Expenses$24,917,085PYTotalExpensesAmt
CY Total Expenses$25,431,336CYTotalExpensesAmt
PY Revenues Less Expenses$5,709,522PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$8,617,657CYRevenuesLessExpensesAmt
Total Assets BOY$57,480,058TotalAssetsBOYAmt
Total Assets EOY$66,780,229TotalAssetsEOYAmt
Total Liabilities BOY$41,754,821TotalLiabilitiesBOYAmt
Total Liabilities EOY$42,574,853TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$15,725,237NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$24,205,376NetAssetsOrFundBalancesEOYAmt
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$20,156,913ExpenseAmt
Grant$318,601GrantAmt
Revenue$33,125,208RevenueAmt
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 2018, PATIENT DAYS AT POLK MEDICAL CENTER TOTALED 7,564 AND DISCHARGES TOTALED 102. EMERGENCY ROOM VISITS TOTALED 28,645.Desc
Total Program Service Expenses$20,156,913TotalProgramServiceExpensesAmt
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 Document17IRPDocumentCnt
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
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 DocumentsYes (true)ChangeToOrgDocumentsInd
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
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonRICHARD T SHEERINPersonNm
Phone7065096074PhoneNum

US Address USAddress

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

Form990 Part VII Section A Form990PartVIISectionAGrp (19 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/SE1.0051.00Yes (X)Yes (X)$0$2,860,734$23,258
GEORGE A BOSWORTH MD
MEMBER1.001.00Yes (X)$2,750$7,000$0
LARRY KUGLAR
MEMBER1.001.00Yes (X)$2,500$4,500$0
FRANK SHELLEY
MEMBER1.001.00Yes (X)$2,750$3,500$0
BRAD WARD MD
MEMBER1.001.00Yes (X)$2,500$3,000$0
BRUCE CASEY
MEMBER1.00Yes (X)$2,750$0$0
LEE CUMMINGS
MEMBER1.00Yes (X)$2,750$0$0
HAROLD W WYATT JR
CHAIRMAN1.00Yes (X)Yes (X)$2,250$0$0
DARROLL FREEMAN
MEMBER1.00Yes (X)$2,250$0$0
TODD BUSSEY
MEMBER1.00Yes (X)$0$0$0
NEIL E GORDON MD
MEMBER1.00Yes (X)$0$0$0
SONDI SMITH VEST
MEMBER1.00Yes (X)$0$0$0
RICHARD T SHEERIN
CFO1.0051.00Yes (X)$0$515,595$19,536
MATTHEW GORMAN
POLK ADMINIS40.00$0$313,621$25,986Yes (X)
DEANA OWEN
PHARMACY DIR40.00$165,399$0$20,741Yes (X)
TIFANI KINARD
CHIEF NURSIN40.00$159,893$0$13,740Yes (X)
CHRISTY LINDSEY
PHARMACIST40.00$132,801$0$7,104Yes (X)
LOVEJOY LEIGH
PHARMACIST40.00$128,680$0$18,223Yes (X)
PHILLIP ROBERTS
REGISTERED N40.00$121,880$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$729,153TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$3,707,950TotReportableCompRltdOrgAmt
Total Other Compensation$128,588TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K19IndivRcvdGreaterThan100KCnt
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
ARAMARK MANAGEMENT SERVICE
P O BOX 233ROMEGA301610233HOUSEKEEPING$499,860
MORRISON MANAGEMENT SPECIALISTS
P O BOX 102289ATLANTAGA303682289FOOD SERVICES$480,157
CERNER CORPORATION
P O BOX 412702KANSAS CITYMO641412702IT SERVICES$276,994
G4S SECURE SOLUTIONS(USA) INC
PO BOX 277469ATLANTAGA303847469SECURITY$266,120
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
All Other Contributions$253,531AllOtherContributionsAmt
Total Contributions$253,531TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT SERVICE REVENUE623000$33,032,872$33,032,872
EHR REVENUE623000$92,319$92,319
REFERENCE LAB621500$24,582$24,582
FieldValueIRS element (for citing)
Total Program Service Revenue$33,149,773TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$662,649TotalRevenueColumnAmt
Exclusion$662,649ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$16,977OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$16,977OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$16,977TotalRevenueColumnAmt
Exclusion-$16,977ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescPURCHASE DISCOUNTSDesc
Business623000BusinessCd
Total Revenue Column$17TotalRevenueColumnAmt
Related Or Exempt Func Income$17RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$17OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$34,048,993TotalRevenueColumnAmt
Related Or Exempt Func Income$33,125,208RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$24,582UnrelatedBusinessRevenueAmt
Exclusion$645,672ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$318,601TotalAmt
Program Services$318,601ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$20,500TotalAmt
Management And General$20,500ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$10,015,408TotalAmt
Program Services$9,074,452ProgramServicesAmt
Management And General$940,956ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,492,900TotalAmt
Program Services$2,258,567ProgramServicesAmt
Management And General$234,333ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$730,459TotalAmt
Program Services$669,591ProgramServicesAmt
Management And General$60,868ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$1,112,282TotalAmt
Management And General$1,112,282ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$68,199TotalAmt
Management And General$68,199ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$44,595TotalAmt
Management And General$44,595ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,008,388TotalAmt
Program Services$239,230ProgramServicesAmt
Management And General$769,158ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$56,678TotalAmt
Program Services$4,478ProgramServicesAmt
Management And General$52,200ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$231,923TotalAmt
Program Services$134,653ProgramServicesAmt
Management And General$97,270ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$502,991TotalAmt
Program Services$62,700ProgramServicesAmt
Management And General$440,291ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,829,583TotalAmt
Program Services$1,676,630ProgramServicesAmt
Management And General$152,953ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,361,997TotalAmt
Program Services$1,228,161ProgramServicesAmt
Management And General$133,836ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$20,511TotalAmt
Program Services$9,601ProgramServicesAmt
Management And General$10,910ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$117,428TotalAmt
Program Services$117,428ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,642,712TotalAmt
Program Services$2,421,781ProgramServicesAmt
Management And General$220,931ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$733,968TotalAmt
Management And General$733,968ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$1,354,945$1,340,977$13,968
REPAIRS & MAINTENANCE$667,054$558,622$108,432
DUES & SUBSCRIPTIONS$43,968$20,379$23,589
LICENSES & TAXES$21,569$21,012$557

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$34,677TotalAmt
Program Services$50ProgramServicesAmt
Management And General$34,627ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$25,431,336TotalAmt
Program Services$20,156,913ProgramServicesAmt
Management And General$5,274,423ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$920,153BOYAmt
EOY$251,090EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$6,716,641BOYAmt
EOY$6,129,123EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$5,836,762BOYAmt
EOY$9,646,009EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$237,145BOYAmt
EOY$298,049EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$377,259BOYAmt
EOY$411,481EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$43,965,420LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$16,576,366LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$30,210,194BOYAmt
EOY$27,389,054EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$12,851,977BOYAmt
EOY$22,351,190EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$329,927BOYAmt
EOY$304,233EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$57,480,058BOYAmt
EOY$66,780,229EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,279,215BOYAmt
EOY$3,025,952EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$34,458,933BOYAmt
EOY$34,146,264EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$5,016,673BOYAmt
EOY$5,402,637EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$41,754,821BOYAmt
EOY$42,574,853EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$15,725,237BOYAmt
EOY$24,205,376EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,725,237BOYAmt
EOY$24,205,376EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$57,480,058BOYAmt
EOY$66,780,229EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$8,617,657ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$137,518NetUnrlzdGainsLossesInvstAmt
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

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$2,543OtherActivitiesAmt
Total Lobbying Expenditures$2,543TotalLobbyingExpendituresAmt
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$6,858,600DepreciationAmt
Book Value$21,540,891BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$50,508OtherCostOrOtherBasisAmt
Depreciation$6,852DepreciationAmt
Book Value$43,656BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,676,786OtherCostOrOtherBasisAmt
Depreciation$9,710,914DepreciationAmt
Book Value$4,965,872BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$27,389,054TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
MOB CAPITAL LEASE$2,907,597
DUE TO RELATED ORGANIZATIONS$1,360,209
THIRD PARTY PAYMENTS$1,134,831
FieldValueIRS element (for citing)
Total Liability$5,402,637TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$33,858,279TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$137,518NetUnrealizedGainsInvstAmt
Other Revenue-$53,196OtherRevenueAmt
Revenue Not Reported-$190,714RevenueNotReportedAmt
Revenue Subtotal$34,048,993RevenueSubtotalAmt
Total Revenue Per Form990$34,048,993TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$25,378,140TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$25,378,140ExpensesSubtotalAmt
Other Expenses Not Included$53,196OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$53,196ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$25,431,336TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 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, 2018 AND 2017 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 2DCHARITABLE DONATIONS EXPENSE -8,601 INVESTMENT FEES -44,595
SCHEDULE D, PAGE 4, PART XII, LINE 4BCHARITABLE DONATIONS EXPENSE 8,601 INVESTMENT FEES 44,595

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$1,155,811TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,155,811NetCommunityBenefitExpnsAmt
Total Expense0.04540TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,834,065TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,723,228DirectOffsettingRevenueAmt
Net Community Benefit Expns$110,837NetCommunityBenefitExpnsAmt
Total Expense0.00440TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,033TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$757DirectOffsettingRevenueAmt
Net Community Benefit Expns$276NetCommunityBenefitExpnsAmt

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,990,909TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,723,985DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,266,924NetCommunityBenefitExpnsAmt
Total Expense0.04980TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$138,133TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$138,133NetCommunityBenefitExpnsAmt
Total Expense0.00540TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,114TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,114NetCommunityBenefitExpnsAmt

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$310,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$310,000NetCommunityBenefitExpnsAmt
Total Expense0.01220TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$449,247TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$449,247NetCommunityBenefitExpnsAmt
Total Expense0.01770TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$7,440,156TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,723,985DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,716,171NetCommunityBenefitExpnsAmt
Total Expense0.06750TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$21,877,298BadDebtExpenseAmt
Bad Debt Expense Attributable$11,594,968BadDebtExpenseAttributableAmt
Reimbursed By Medicare$10,270,441ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$10,336,077CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$65,636MedicareSurplusOrShortfallAmt

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
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
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 Adpt16ImplementationStrategyAdptYr
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 (4 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 17 THROUGH 24 OF THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH IS AVAILABLE ON THE ORGANIZATION'S WEBSITE.
FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 5THE CHNA UTILIZED A PARTICIPATORY, COLLABORATIVE APPROACH AND EXAMINED HEALTH IN ITS BROADEST CONTEXT. THE ASSESSMENT PROCESS INCLUDED THE FOLLOWING: O REVIEW OF PREVIOUS CHNA O SYNTHESIZING EXISTING DATA ON SOCIAL, ECONOMIC, AND HEALTH INDICATORS IN POLK, FLOYD AND CHATTOOGA COUNTIES O INDIVIDUAL COMMUNITY SURVEYS O FOCUS GROUPS WITH A RANGE OF DIVERSE INDIVIDUALS - INCLUDING PROVIDERS, ELECTED OFFICIALS, COMMUNITY-BASED ORGANIZATIONAL STAFF AND COMMUNITY RESIDENTS
FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 7DTHE 2016 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 HEALTHY NUTRITION DISEASE WERE DETERMINED IN THE 2016 CHNA TO BE 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 SERVICE AND COMMUNITY LEADERSHIP, WE CAN LEVERAGE COMMUNITY ASSETS TO IMPROVE THE HEALTH OF RESIDENTS IN POLK, FLOYD AND CHATTOOGA 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 53%) 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 ALLOWANCE FOR DOUBTFUL ACCOUNTS ON PAGES 7 AND 8 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 2016. THIS INCLUDED INTERVIEWS WITH COMMUNITY LEADERS AND HEALTH CARE PROFESSIONALS AND FOCUS GROUPS. IN ADDITION, THE AUTHORITY 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 THREE-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 POPULATION BASE IS APPROXIMATELY 72.3% CAUCASIAN, 13.0% AFRICAN AMERICAN, 12.8% HISPANIC OR LATINO AND 3.4% OTHER RACES. NORTHWEST GEORGIA IS A MEDICAL AND EDUCATION HUB. MANUFACTURING IS THE COUNTY'S LARGEST INDUSTRY. THE TOP 10 EMPLOYERS ARE: -MEGGITT POLYMERS AND COMPOSITES -POLK COUNTY SCHOOL DISTRICT -HON COMPANY -TIP TOP POULTRY -AT&T COMMUNICATIONS -POLK COUNTY GOVERNMENT -ANGELICA TEXTILE SERVICES -JEFFERSON SOUTHERN CORPORATION -WAL-MART -EBY-BROWN THE MEDIAN PER HOUSEHOLD INCOME IS 39,356. AN ESTIMATED 18.6% OF THE POLK COUNTY POPULATION IS BELOW THE POVERTY LEVEL AND ABOUT 67.2 PERCENT OF POLK RESIDENTS OWN THEIR OWN HOMES.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTHPOLK MEDICAL CENTER GENERATES MORE THAN 45 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 CARDIAC REHABILITATION CARDIOLOGY DIAGNOSTIC RADIOLOGY EMERGENCY ROOM EMERGENCY MEDICAL SERVICES FAMILY MEDICINE HOSPICE OUTPATIENT REHAB AND SPORTS MEDICINE SENIOR ENRICHMENT PROGRAM SUB-ACUTE REHABILITATION PROGRAM SURGERY WOUND CARE URGENT CARE POLK MEDICAL CENTER IS COMMITTED TO PROVIDING HEALTH CARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. IN FY 2018, POLK MEDICAL CENTER PROVIDED 3.5 MILLION IN UNREIMBURSED CARE TO INDIVIDUALS. THE 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 1,874 DURING FY 2018. POLK MEDICAL CENTER CO-WORKERS AND VOLUNTEERS REACHED APPROXIMATELY 30,500 POLK COUNTY RESIDENTS THROUGH COMMUNITY ENDEAVORS AT AN EXPENSE OF 138,133 IN FY 2018: 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 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 2018 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 SYSTEMTHE CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY IS A HOSPITAL AUTHORITY CREATED AND ORGANIZED UNDER THE GEORGIA HOSPITAL AUTHORITIES LAW. IT IS THE OWNER OF POLK MEDICAL CENTER A 25-BED, CRITICAL ACCESS HOSPITAL LOCATED IN CEDARTOWN, GA. THE POLK AUTHORITY CONSISTS OF A SELF-PERPETUATING SIX- PERSON BOARD, ALL OF WHOM ARE POLK COUNTY RESIDENTS. IN 2011 THE POLK AUTHORITY SOLICITED PROPOSALS RESPECTING THE LEASE AND OPERATION OF POLK MEDICAL CENTER. FLOYD HEALTHCARE MANAGEMENT INC. (FHMI) AND THE HOSPITAL AUTHORITY OF FLOYD COUNTY (HAFC) JOINTLY RESPONDED TO THE REQUEST FOR PROPOSALS BY SUBMITTING A PROPOSAL UNDER WHICH THE FOLLOWING TRANSACTIONS AND UNDERTAKINGS WOULD OCCUR: (1) HAFC WOULD LEASE POLK MEDICAL CENTER FROM THE POLK AUTHORITY AND OPERATE IT FOR A PERIOD OF UP TO FIVE YEARS; (2) FHMI WOULD CREATE A NON-PROFIT CORPORATION TO BE CALLED POLK MEDICAL CENTER INC. (PMCI), WHICH WOULD HAVE A BOARD OF DIRECTORS COMPRISED OF NINE PERSONS APPOINTED BY FHMI, THREE OF WHOM WOULD BE RESIDENTS OF FLOYD COUNTY AND SIX OF WHOM WOULD BE RESIDENTS OF POLK COUNTY; (3) PMCI WOULD BE ENGAGED BY HAFC TO MANAGE THE DAY-TO-DAY OPERATION OF POLK MEDICAL CENTER DURING THE TERM OF THE AFORESAID FIVE-YEAR LEASE; (4) PMCI AND FHMI WOULD UNDERTAKE TO CONSTRUCT A NEW, 25-BED REPLACEMENT HOSPITAL ON LAND ALREADY OWNED BY THE POLK AUTHORITY ON THE OUTSKIRTS OF CEDARTOWN, WITH CONSTRUCTION TO BE COMPLETED WITHIN FIVE YEARS; AND (5) UPON COMPLETION OF CONSTRUCTION, THE FIVE-YEAR LEASE WOULD TERMINATE, AND OWNERSHIP OF THE NEW HOSPITAL WOULD RESIDE IN THE POLK AUTHORITY, WHICH WOULD IN TURN LEASE IT TO PMCI FOR A PERIOD OF 35 YEARS. THE FOREGOING PROPOSAL WAS ACCEPTED BY THE POLK AUTHORITY, AND IN LATE 2011, AGREEMENTS BY AND AMONG FHMI, PMCI, HAFC AND THE POLK AUTHORITY WERE EXECUTED, INCLUDING THE FIVE-YEAR LEASE AGREEMENT AND A HOSPITAL CONSTRUCTION AGREEMENT. ON APRIL 1, 2012 THE FIVE-YEAR LEASE AGREEMENT COMMENCED AT WHICH TIME HAFC BECAME THE LICENSED OPERATOR OF POLK MEDICAL CENTER, WITH THE NEWLY CREATED PMCI ENGAGED TO PROVIDE DAY-TO-DAY MANAGEMENT OF THE HOSPITAL'S OPERATION. EFFECTIVE NOVEMBER 5, 2014, THE AUTHORITY'S LEASE FOR POLK MEDICAL CENTER FROM THE CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY ENDED. ACCORDINGLY, THE OPERATIONS, ASSETS AND LIABILITIES OF POLK MEDICAL CENTER TRANSFERRED TO CEDARTOWN-POLK AUTHORITY. 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$677,895$1,162,596$1,020,243$23,258$2,883,992
RICHARD T SHEERIN
CFO$410,980$95,851$8,764$19,536$535,131
MATTHEW GORMAN
POLK ADMINISTRATOR$241,845$69,751$2,025$25,986$339,607
DEANA OWEN
PHARMACY DIRECTOR$147,177$17,777$445$20,741$186,140
TIFANI KINARD
CHIEF NURSING OFFICE$144,007$15,591$295$13,740$173,633

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 1,004,542 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 2,860,734 LISTED AS COMPENSATION FOR MR. KURT STUENKEL IN FORM 990 PART VII SECTION A, 180,879 REPRESENTS A PERFORMANCE BASED PAYMENT ARISING FROM THE 2017 PERFORMANCE PERIOD, 981,717 REPRESENTS A RETENTION BONUS, AND 1,004,542 REPRESENTS THE NONQUALIFIED SERP PLAN. ACCORDINGLY, MR. STUENKEL'S SALARY FOR 2017 WOULD HAVE BEEN 693,596 EXCLUDING THE 2017 PORTION OF THE INCENTIVE BASED PAYMENT AND THE SERP 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$90,000RetiredAmt
Total Proceeds$34,834,415TotalProceedsAmt
Issuance Costs From Proceeds$338,636IssuanceCostsFromProceedsAmt
Capital Expenditures$34,495,779CapitalExpendituresAmt
Substantial Completion2014SubstantialCompletionYr
Current RefundingfalseCurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
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 (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 4EFFECTIVE JULY 2017, THE BYLAWS WERE AMENDED TO INCREASE THE NUMBER OF VOTING BOARD MEMBERS FROM NINE TO TWELVE, THE THREE ADDITIONAL MEMBERS SHALL IN SOME WAY BE SIGNIFICANTLY CONNECTED TO POLK COUNTY AT THE TIME OF APPOINTMENT.
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