ARCHBOLD MEDICAL CENTER INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- ARCHBOLD MEDICAL CENTER INC (EIN 58-1552650)
- Tax period
- 2015-10-01 to 2016-09-30
- Filed
- 2017-08-08
- IRS object ID
- 201702209349300805
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-08-08T10:55:27-04:00 | ReturnTs |
| Tax Period End | 2016-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 580914992 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAFFIN & TUCKER LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 71309 | AddressLine1Txt |
| City | ALBANY | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 317081309 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581552650 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARCHBOLD MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ARCH | BusinessNameControlTxt |
| Phone | 2292282229 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 1018 | AddressLine1Txt |
| City | THOMASVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 317991018 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | J PERRY MUSTIAN | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 2292282200 | PhoneNum |
| Signature | 2017-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JACQUELINE G ATKINS | PreparerPersonNm |
| PTIN | P00861721 | PTIN |
| Phone | 2298837878 | PhoneNum |
| Preparation | 2017-08-02 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | J PERRY MUSTIAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 1018 | AddressLine1Txt |
| City | THOMASVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 317991018 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,756,553 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.ARCHBOLD.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1983 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | HEALTHCARE MANAGEMENT | ActivityOrMissionDesc |
| Voting Members Governing Body | 26 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 3031 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $25,691,764 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $25,756,553 | CYProgramServiceRevenueAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $25,691,764 | PYTotalRevenueAmt |
| CY Total Revenue | $25,756,553 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $11,070,851 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,080,540 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $14,620,913 | PYOtherExpensesAmt |
| CY Other Expenses | $13,676,013 | CYOtherExpensesAmt |
| PY Total Expenses | $25,691,764 | PYTotalExpensesAmt |
| CY Total Expenses | $25,756,553 | CYTotalExpensesAmt |
| CY Revenues Less Expenses | $0 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $33,659,630 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,882,792 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $33,659,630 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $27,882,792 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Mission | HEALTHCARE MANAGEMENT | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $25,756,553 | ExpenseAmt |
| Revenue | $25,756,553 | RevenueAmt |
| Desc | HEALTHCARE MANAGEMENT. | Desc |
| Total Program Service Expenses | $25,756,553 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 3031 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 26 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GREG HEMBREE | PersonNm |
| Phone | 2292282853 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1018 | AddressLine1Txt |
| City | THOMASVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 317991018 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (37 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| J PERRY MUSTIAN | ||||||||
| PRESIDENT/CE | 40.00 | 10.00 | Yes (X) | Yes (X) | $805,868 | $0 | $915,117 | |
| JAMES S KARAS MD | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $9,400 | $0 | $0 | ||
| GINA SHUMAKE | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $1,748 | $0 | $0 | ||
| JOHN B CARICO MD | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $1,000 | $0 | $0 | ||
| VICTOR M MCMILLAN MD | ||||||||
| CHAIRMAN | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RICHARD L SINGLETARY JR | ||||||||
| VICE CHAIRMA | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NATHANIEL H ABRAMS JR | ||||||||
| SECRETARY | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| THOMAS CALLAWAY III | ||||||||
| TREASURER | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DANIEL E AUTRY SR | ||||||||
| TRUSTEE | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| BRYANT BEADLES | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| GATES KIRKHAM | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| IMOGENE CONYERS | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JEAN MORGAN HATHAWAY | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| STEPHANIE TILLMAN | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| WALLACE GOODMAN | ||||||||
| TRUSTEE | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT D MILES JR MD | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHARLES M STAFFORD | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BENJAMIN J WILDS MD | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JANET SCHMIDT | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK PARKER | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| W GREGORY HAMIL | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CORDELL BRAGG MD | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KAREN BRAMBLETT MD | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| MELISSA S BRUHN | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL CROWLEY MD | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| HAILE MCCOLLUM | ||||||||
| TRUSTEE | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| STEPHEN R AVERA | ||||||||
| PAST CHAIRMA | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| GARY BONVILLIAN PHD | ||||||||
| PAST TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| WILLIAM W ELLIS MD | ||||||||
| PAST TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| CALVIN J REAMS MD | ||||||||
| PAST TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| CHARLES D HIGHTOWER | ||||||||
| ASST SEC/CFO | 40.00 | 10.00 | Yes (X) | $499,921 | $0 | $27,955 | ||
| WILLIAM CLAY CAMPBELL | ||||||||
| ASSISTANT SE | 1.00 | 40.00 | Yes (X) | $0 | $253,686 | $45,125 | ||
| ZACH WHEELER | ||||||||
| VP HUMAN RES | 40.00 | 0.00 | $306,456 | $0 | $306,459 | Yes (X) | ||
| TRACY L GRAY | ||||||||
| VP INFORMATI | 40.00 | 0.00 | $286,334 | $0 | $33,441 | Yes (X) | ||
| LYNNE FRITZ BYRD | ||||||||
| VP REV MANAG | 40.00 | 0.00 | $209,257 | $0 | $18,692 | Yes (X) | ||
| RICK IVEY | ||||||||
| VP PUBLIC AF | 40.00 | 0.00 | $191,088 | $0 | $32,714 | Yes (X) | ||
| CARLA PEARCE | ||||||||
| CHIEF ACCT O | 40.00 | 0.00 | $162,903 | $0 | $12,056 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,473,975 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $253,686 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,391,559 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CERNER HEALTH SERVICES INC | |||||
| P O BOX 959167 | ST LOUIS | MO | 631959167 | SOFTWARE MAINT | $2,635,122 |
| STUDOR GROUP | |||||
| 350 WEST CEDAR STREET SUITE 300 | PENSACOLA | FL | 325024911 | MGMT CONS SVCS | $639,856 |
| SOFT COMPUTER CONSULTANTS | |||||
| 5400 TECH DATA DRIVE | CLEARWATER | FL | 337603116 | SOFTWARE MAINT | $522,615 |
| SHARED MEDICAL SYSTEMS | |||||
| 51 VALLEY STREAM PKWY | MALVERN | PA | 193551406 | SOFTWARE MAINT | $494,344 |
| BAKER & HOSTETLER LLP | |||||
| P O BOX 70189 | CLEVELAND | OH | 441900189 | LEGAL SERVICES | $397,627 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | HEALTHCARE MANAGEMENT FEES | Desc |
| Business | 561000 | BusinessCd |
| Total Revenue Column | $25,756,553 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $25,756,553 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $25,756,553 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,756,553 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $25,756,553 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,261,009 | TotalAmt |
| Program Services | $2,261,009 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,940,672 | TotalAmt |
| Program Services | $7,940,672 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $168,069 | TotalAmt |
| Program Services | $168,069 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,069,890 | TotalAmt |
| Program Services | $1,069,890 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $640,900 | TotalAmt |
| Program Services | $640,900 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,320,241 | TotalAmt |
| Program Services | $1,320,241 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,000 | TotalAmt |
| Program Services | $300,000 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $112,438 | TotalAmt |
| Program Services | $112,438 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,196,743 | TotalAmt |
| Program Services | $4,196,743 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,202 | TotalAmt |
| Program Services | $18,202 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $735,840 | TotalAmt |
| Program Services | $735,840 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,817,060 | TotalAmt |
| Program Services | $5,817,060 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $210,802 | TotalAmt |
| Program Services | $210,802 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,796 | TotalAmt |
| Program Services | $10,796 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| DUES & SUBSCRIPTIONS | $607,714 | $607,714 |
| CONTINGENCY | $211,656 | $211,656 |
| MISCELLANEOUS | $68,552 | $68,552 |
| REPAIRS & MAINTENANCE | $42,791 | $42,791 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,178 | TotalAmt |
| Program Services | $23,178 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,756,553 | TotalAmt |
| Program Services | $25,756,553 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,618,534 | BOYAmt |
| EOY | $4,692,712 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,041,096 | BOYAmt |
| EOY | $23,190,080 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,659,630 | BOYAmt |
| EOY | $27,882,792 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,959,692 | BOYAmt |
| EOY | $22,458,629 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,699,938 | BOYAmt |
| EOY | $5,424,163 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,659,630 | BOYAmt |
| EOY | $27,882,792 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,659,630 | BOYAmt |
| EOY | $27,882,792 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $0 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Func Int | Yes (X) | SupportingOrgType3FuncIntInd |
| Supported Organizations | 3 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (3 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| JOHN D ARCHBOLD MEMORIAL HOSPITAL INC | ||||
| 580566121 | 3 | Yes (true) | $24,660,931 | $0 |
| ARCHBOLD HEALTH SERVICES INC | ||||
| 581376434 | 9 | Yes (true) | $552,481 | $0 |
| ARCHBOLD MEDICAL GROUP INC | ||||
| 262988454 | 3 | false | $342,377 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 3 | SupportedOrganizationsTotalCnt |
| Support Sum | $25,555,789 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | false | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | false | TimelyProvidedDocumentsInd |
| Officers Close Relationship | Yes (true) | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | false | SupportedOrgVoiceInvestmentInd |
Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Parent Supported Org | Yes (X) | ParentSupportedOrgInd |
| Appoint Elect Majority Officer | Yes (true) | AppointElectMajorityOfficerInd |
| Exercise Direction Policies | Yes (true) | ExerciseDirectionPoliciesInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, SECTION A, LINE 1 | ARCHBOLD MEDICAL CENTER, INC. (AMC) IS ORGANIZED AS A NONPROFIT CORPORATION TO CARRY OUT CHARITABLE, BENEVOLENT, EDUCATIONAL AND SCIENTIFIC PURPOSES. AMC PROVIDES FINANCIAL AND MANAGEMENT ASSISTANCE TO JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC. (JDAMH), ARCHBOLD HEALTH SERVICES, INC. (AHS), AND OTHER HEALTH CARE RELATED ORGANIZATIONS DESCRIBED IN SECTION 509(A)(1) OR 509(A)(2) OF THE INTERNAL REVENUE CODE OF 1954, WHICH ARE OR MAY BECOME AFFILIATED WITH AMC, JDAMH, OR AHS. ALTHOUGH ARCHBOLD MEDICAL GROUP, INC. (AMG) IS NOT NAMED SPECIFICALLY IN AMC'S ARTICLES OF INCORPORATION, THE FILING ORGANIZATION HAS BEEN SPPORTING THE ORGANIZATION IN THE SAME MANNER AS OTHER SUPPORTED ORGANIZATIONS SINCE AMG'S CRATION IN 2008. THUS AMC AND AMG HAVE AN HISTORIC AND CONTINUING RELATIONSHIP. |
| PART IV, SECTION E, LINE 3A | AS SOLE MEMBER OF EACH SUPPORTED ORGANIZATION, AMC HAS THE POWER TO ELECT OR REPLACE AND TO REMOVE ALL MEMBERS OF THE GOVERNING BODY. |
| PART IV, SECTION E, LINE 3B | AS SOLE MEMBER, AMC HAS THE AUTHORITY TO APPROVE THE DECISIONS OF THE GOVERNING BODY FOR EACH OF ITS SUPPORTED ORGANIZATIONS, INCLUDING BUT NOT LIMITED TO, CAPITAL AND OPERATING BUDGETS, MERGERS OR ACQUISITIONS, CONTRACTS AND TRANSACTIONS OVER A CERTAIN AMOUNT, DISSOLUTION, ETC. |
| SUPPLEMENTAL INFORMATION | ARCHBOLD MEDICAL CENTER, INC., AS THE PARENT CORPORATION, PROVIDES MANAGEMENT SERVICES FOR ITS SUPPORTED ORGANIZATIONS. |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | Yes (true) | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | Yes (true) | DirectContactLegislatorsInd |
| Direct Contact Legislators | $189,870 | DirectContactLegislatorsAmt |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $63,175 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $253,045 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | LOBBYING ACTIVITIES INCLUDE THE MEDICAL CENTER'S MEMBERSHIP IN THE GEORGIA ALLIANCE OF COMMUNITY HOSPITALS; A PORTION OF BOTH THE AMERICAN HOSPITAL ASSOCIATION AND GEORGIA HOSPITAL ASSOCIATION DUES; AND A PORTION OF SALARIES DIRECTLY RELATED TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE FROM RELATED PARTIES | Desc |
| Book Value | $23,190,080 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $23,190,080 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED PARTIES | Desc |
| Amt | $5,424,163 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $5,424,163 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | THE MEDICAL CENTER, WITH THE EXCEPTION OF ARCHBOLD MEDICAL ENTERPRISES, INC., IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX- EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE MEDICAL CENTER APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE CONSOLIDATED 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 MEDICAL CENTER ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2016 AND 2015 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTER'S 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| J PERRY MUSTIAN | ||||||||||||
| PRESIDENT/CEO | $624,570 | $164,733 | $16,565 | $881,100 | $34,017 | $1,720,985 | ||||||
| CHARLES D HIGHTOWER | ||||||||||||
| ASST SEC/CFO/SN VP | $380,938 | $112,125 | $6,858 | $20,900 | $7,055 | $527,876 | ||||||
| WILLIAM CLAY CAMPBELL | ||||||||||||
| ASSISTANT SECRETARY | $215,096 | $32,032 | $6,558 | $12,454 | $32,671 | $298,811 | ||||||
| ZACH WHEELER | ||||||||||||
| VP HUMAN RESOURCES | $233,129 | $70,705 | $2,622 | $299,924 | $6,535 | $612,915 | ||||||
| TRACY L GRAY | ||||||||||||
| VP INFORMATION SVC | $226,638 | $57,374 | $2,322 | $28,726 | $4,715 | $319,775 | ||||||
| LYNNE FRITZ BYRD | ||||||||||||
| VP REV MANAGEMENT | $166,417 | $40,518 | $2,322 | $11,890 | $6,802 | $227,949 | ||||||
| RICK IVEY | ||||||||||||
| VP PUBLIC AFFAIRS | $189,409 | $1,679 | $25,761 | $6,953 | $223,802 | |||||||
| CARLA PEARCE | ||||||||||||
| CHIEF ACCT OFFICER | $144,945 | $17,670 | $288 | $5,807 | $6,249 | $174,959 | ||||||
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PAGE 1, PART I, LINE 1A | SOCIAL CLUB DUES ARE PAID BY THE ORGANIZATION ON BEHALF OF OFFICERS AND EXECUTIVES OF THE FILING ORGANIZATION. THESE AMOUNTS ARE INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME AND REPORTED ON THEIR W-2. THE ORGANIZATION'S POLICY FOR COMPANION TRAVEL INCLUDES THE REIMBURSEMENT OF REGISTRATION, TRAVEL, AND ENTERTAINMENT EXPENSES FOR GUESTS WHO ACCOMPANY BOARD TRUSTEES TO EITHER OF TWO ANNUAL TRUSTEE CONFERENCES. RECEIPTS MUST BE SUBMITTED PRIOR TO REIMBURSEMENT AND THE AMOUNTS ARE NOT INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME. |
| SCHEDULE J, PAGE 1, PART I, LINE 4 | J. PERRY MUSTIAN 0 868,000 0 WILLIAM CLAY CAMPBELL 0 2,365 0 ZACH WHEELER 0 286,000 0 TRACY L. GRAY 0 17,654 0 LYNNE FRITZ BYRD 0 1,219 0 RICK IVEY 0 14,714 0 |
| SCHEDULE J, PART III | THE IRS RULES & REGULATIONS REQUIRE THAT CERTAIN NON-CURRENT, NON-CASH ITEMS ARE REPORTED IN PART II OF FORM 990 REGARDLESS OF THE CURRENT BENEFIT TO THE EMPLOYEE. THESE SAME RULES, IN SOME CASES, REQUIRE THE COMPENSATION AND BENEFITS TO BE REPORTED TWICE IN PART II, ONCE WHEN THE ENTITY ACCRUES FOR A FUTURE PAYMENT AND ONCE WHEN THE PAYMENT IS ACTUALLY MADE TO THE EMPLOYEE. THEREFORE, AN EMPLOYEE'S STATED TOTAL COMPENSATION AND BENEFITS REPORTED ON PART II ARE SUBSTANTIALLY HIGHER THAN THE ACTUAL CASH COMPENSATION RECEIVED IN THE CURRENT YEAR. AMOUNTS REPORTED AS BENEFITS INCLUDE AMOUNTS FOR LIFE INSURANCE, HEALTH INSURANCE, THRIFT PLAN CONTRIBUTIONS, AND PENSION CONTRIBUTIONS. BENEFITS RELATED TO PENSION AND RETIREMENT PLANS REFLECT AMOUNTS ACCUMULATED, BUT NOT PAID, TO THE INDIVIDUAL IN RECOGNITION OF TOTAL YEARS OF EMPLOYMENT, NOT JUST THE CURRENT YEAR. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN TWO OF THE ORGANIZATION'S TOP EXECUTIVES PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS ACCRUED BUT UNFUNDED 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. AMC 457(F) RETIREMENT PLAN CERTAIN EXECUTIVES WHO ARE NOT ELIGIBLE FOR THE SERP MAY BE ELIGIBLE TO PARTICIPATE IN A 457(F) PLAN TO HELP THEM ACCUMULATE FUNDS FOR THEIR LONG TERM FINANCIAL NEEDS. THE ORGANIZATION MAY CONTRIBUTE A PERCENTAGE OF BASE SALARY INTO AN INDIVIDUAL EXECUTIVES ACCOUNT IF THE ORGANIZATION MEETS CERTAIN FINANCIAL TARGETS. THE ORGANIZATION OWNS ANY PLAN ASSETS UNTIL THEY ARE PAID TO THE EMPLOYEE AND ALL FUNDS ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. VESTING BEGINS AT AGE 55 WITH FIVE YEARS OF SERVICE AT A RATE OF 90% AND THEN INCREASES TO 100% AT AGE 60. PAYMENTS ARE MADE ANNUALLY UPON VESTING. BONUS AWARDS OFFICERS AND PHYSICIANS ARE AWARDED BONUSES/INCENTIVES CONTINGENT IN PART ON MEETING MANAGEMENT-BY-OBJECTIVE INCENTIVE PLAN GOALS AND EXCESS OF REVENUE OVER EXPENSES. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (7 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| LAURA KARAS | |||
| FAM MBR/TRUSTEE | $60,068 | EMPLOYEE COMP | false |
| LINDSAY S SLIGER | |||
| FAM MBR/TRUSTEE | $44,772 | EMPLOYEE COMP | false |
| DANIEL E AUTRY JR | |||
| FAM MBR/TRUSTEE | $144,165 | EMPLOYEE COMP | false |
| THOMAS J CALLAWAY III | |||
| TRUSTEE | $7,716,923 | INVESTMENT MANAGER | false |
| RICHARD L SINGLETARY JR | |||
| TRUSTEE | $272,036,954 | BANKING RELATIONSHIP | false |
| W GREGORY HAMIL | |||
| TRUSTEE | $6,721,135 | BANKING RELATIONSHIP | false |
| HAILE MCCOLLUM | |||
| TRUSTEE | $272,036,954 | BANKING RELATIONSHIP | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | LAURA KARAS AND LINDSAY SLIGER, THE WIFE AND STEPDAUGHTER RESPECTIVELY, OF BOARD TRUSTEE JAMES KARAS, M.D. ARE EMPLOYED BY JDAMH, A RELATED ORGANIZATION. DANIEL AUTRY, JR, THE SON OF BOARD TRUSTEE DANIEL E. AUTRY, IS EMPLOYED BY AMG, A RELATED ORGANIZATION, AND IS COMPENSATED BY THE FILING ORGANIZATION. THOMAS J. CALLAWAY, III IS THE INVESTMENT MANAGER FOR A PORTION OF AMC'S SERP ACCOUNT. THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 9/30/16 FOR THE FILING AND ALL RELATED ORGANIZATIONS. HAILE MCCOLLUM IS A BOARD DIRECTOR OF THOMASVILLE NATIONAL BANK (TNB). RICHARD SINGLETARY, JR, IS THE CHAIRMAN OF TNB. THE FILING ORGANIZATION UTILIZES TNB'S BANKING SERVICES AND ON-SITE THRIFT PLAN SERVICE. THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 9/30/16 FOR THE FILING AND ALL RELATED ORGANIZATIONS. W. GREGORY HAMIL IS A BOARD DIRECTOR OF COMMERCIAL BANK. THE FILING ORGANIZATION UTILIZES THE BANKING SERVICES OF COMMERCIAL BANK. THE AMOUNT ABOVE REFLECTS TOTAL FEES AND BALANCES AT 9/30/16 FOR THE FILING AND ALL RELATED ORGANIZATIONS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 2 | WILLIAM W. ELLIS, MD ROBERT D. MILES JR., MD BD MEMBER BD MEMBER BUSINESS RELATIONSHIP WILLIAM W. ELLIS, MD JAMES S. KARAS, MD BD MEMBER BD MEMBER BUSINESS RELATIONSHIP ROBERT D. MILES, JR. MD JAMES S. KARAS, MD BD MEMBER BD MEMBER BUSINESS RELATIONSHIP CORDELL BRAGG, III MD KAREN BRAMBLETT MD BD MEMBER BD MEMBER BUSINESS RELATIONSHIP |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE ORGANIZATION HAS ONE CLASS OF MEMBERS WHICH SHALL BE LIFE MEMBERS. THE RIGHTS OF THE LIFE MEMBERS SHALL BE AS PROVIDED IN THE LAWS OF THE STATE OF GEORGIA, THE ARTICLES OF INCORPORATION AND THE BYLAWS OF ARCHBOLD MEDICAL CENTER, INC. ("AMC"). EACH LIFE MEMBER HAS ONE VOTE WITH RESPECT TO THE ELECTION OF TRUSTEES OF AMC. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE LIFE MEMBERS OF THE FILING ORGANIZATION ANNUALLY ELECT THE TRUSTEES OF THE GOVERNING BODY. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE ORGANIZATION'S CFO PRESENTED THE FORM 990 TO TRUSTEES IN ATTENDANCE DURING THE BOARD MEETING PRIOR TO FILING THE RETURN WITH THE IRS. THE TRUSTEES HAD THE OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. A COPY OF THE RETURN WAS MADE AVAILABLE TO THOSE BOARD MEMBERS WHO WERE UNABLE TO ATTEND THE MEETING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ON AN ANNUAL BASIS, THE ORGANIZATION DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE AND DISCLOSURE STATEMENT TO EACH TRUSTEE. THIS QUESTIONNAIRE INCLUDES QUESTIONS RELATED TO FINANCIAL INTERESTS, OUTSIDE INTERESTS OR ACTIVITIES, AND GIFTS, MEALS, AND ENTERTAINMENT. IN ADDITION TO DISCLOSING ANY APPLICABLE INFORMATION ON THE QUESTIONNAIRE, THE TRUSTEE ACKNOWLEDGES THAT (S)HE HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ, UNDERSTANDS, AND AGREES TO COMPLY WITH IT, AND UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION STATUS IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. RESPONSES ARE SUMMARIZED AND COLLECTIVELY REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE OF ARCHBOLD MEDICAL CENTER, INC. DURING EACH BOARD MEETING, THE CHAIRMAN INQUIRES IF ANY TRUSTEE HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST RELATED TO ANY AGENDA ITEM. IF THE TRUSTEE DISCLOSES ANY SUCH INTEREST, THE TRUSTEE IS EXCUSED FROM THE MEETING WHILE THE DETERMINATION AS TO WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS IS DISCUSSED AND VOTED UPON BY DISINTERESTED MEMBERS OF THE BOARD AND COMMITTEE. IF INVITED TO DO SO, THE TRUSTEE WITH A POTENTIAL CONFLICT MAY RESPOND TO QUESTIONS PUT FORTH BY FELLOW DISINTERESTED TRUSTEES REGARDING ANY PROPOSED TRANSACTION OR ARRANGEMENT. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS DOCUMENTS THE NAME OF ANY INTERESTED PERSON/TRUSTEE WHO DISCLOSED OR WAS FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH A TRANSACTION OR ARRANGEMENT RESULTING IN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; AND THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATED TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSIONS, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH. |
| FORM 990, PAGE 6, PART VI, LINE 15A | ARCHBOLD MEDICAL CENTERS COMPENSATION COMMITTEE MAKES RECOMMENDATIONS TO THE FULL BOARD ON THE FOLLOWING POSITIONS: THE PRESIDENT OF ARCHBOLD MEDICAL CENTER; THE PRESIDENT OF THE ARCHBOLD FOUNDATION; AND THE PRESIDENT OF ARCHBOLD HEALTH SERVICES. ARCHBOLD MEDICAL CENTERS PRESIDENT ALSO PRESENTS RECOMMENDATIONS FOR ALL SENIOR VICE PRESIDENTS AND VICE PRESIDENTS TO THE COMPENSATION COMMITTEE. IN 2008, INTEGRATED HEALTHCARE SOLUTIONS (IHS) WAS ENGAGED BY THE BOARD TO REVIEW THE EXECUTIVE COMPENSATION PROGRAM AND MAKE RECOMMENDATIONS REGARDING PLAN DESIGN AND ACTUAL COMPENSATION INCLUDING BENEFITS. IN 2009, IHS PROVIDED UPDATED RECOMMENDATIONS ON COMPENSATION TO THE COMPENSATION COMMITTEE. FOR YEARS 2010-2016, THE BOARD CONTINUED TO UTILIZE IHS TO PERFORM MARKET ANALYSIS, REVIEW EXECUTIVE COMPENSATION, AND MAKE RECOMMENDATIONS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | SEE RESPONSE TO 15A ABOVE. |
| FORM 990, PAGE 6, PART VI, LINE 19 | NO DOCUMENTS ARE OR WILL BE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | SERVICE CONTRACTS 1,207,482 0 0 PURCHASED SERVICES 2,346,510 0 0 CONSULTING FEES 642,751 0 0 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Business Name Line2DirectControllingEntityName/BusinessNameLine2Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN D ARCHBOLD MEM HOSPITAL INC | |||||||||||
| P O BOX 1018 | THOMASVILLE | GA | 317991018 | 580566121 | ACUTE CARE | GA | 501C3 | 3 | AMC | ARCHBOLD MEDICAL CENTER INC | Yes (true) |
| ARCHBOLD HEALTH SERVICES INC | |||||||||||
| P O BOX 620 | THOMASVILLE | GA | 317990620 | 581376434 | HEALTHCARE | GA | 501C3 | 9 | AMC | ARCHBOLD MEDICAL CENTER INC | Yes (true) |
| ARCHBOLD FOUNDATION INC | |||||||||||
| P O BOX 620 | THOMASVILLE | GA | 317990620 | 581559677 | FOUNDATION | GA | 501C3 | 11B | AMC | ARCHBOLD MEDICAL CENTER INC | Yes (true) |
| ARCHBOLD MEDICAL GROUP INC | |||||||||||
| P O BOX 620 | THOMASVILLE | GA | 317990620 | 262988454 | PHYSICIANS | GA | 501C3 | 3 | AMC | ARCHBOLD MEDICAL CENTER INC | Yes (true) |
| CCSG INC | |||||||||||
| 915 GORDON AVENUE | THOMASVILLE | GA | 317926614 | 473501366 | MED CLINIC | GA | 501C3 | 3 | AMG | false | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARCHBOLD MEDICAL ENTERPRISES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 400 OLD ALBANY RD | AddressLine1Txt |
| City | THOMASVILLE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 31792 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581494513 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivitiesTxt |
| Legal Domicile State | GA | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AMC | BusinessNameLine1Txt |
| Business Name Line2 | ARCHBOLD MEDICAL CENTER INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C CORP | EntityTypeTxt |
| Share Of Total Income | -$563 | ShareOfTotalIncomeAmt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (10 entries)
| Transaction TypeTransactionTypeTxt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt | InvolvedInvolvedAmt |
|---|---|---|
| ALL ENTITIES | ||
| L | UNDETERMINED | |
| ALL ENTITIES | ||
| M | UNDETERMINED | |
| ALL ENTITIES | ||
| N | UNDETERMINED | |
| ALL ENTITIES | ||
| O | UNDETERMINED | |
| ALL ENTITIES | ||
| Q | UNDETERMINED | |
| JOHN D ARCHBOLD MEM HOSP INC | ||
| D | G/L ACCOUNT | $22,495,879 |
| ARCHBOLD HEALTH SERVICES INC | ||
| D | G/L ACCOUNT | $218,159 |
| ARCHBOLD FOUNDATION INC | ||
| D | G/L ACCOUNT | $447,390 |
| ARCHBOLD MEDICAL ENTERPRISES | ||
| D | G/L ACCOUNT | $28,652 |
| VARIOUS ENTITIES | ||
| E | G/L ACCOUNT | $5,424,163 |