CLAYTON GENERAL INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- CLAYTON GENERAL INC (EIN 58-1955423)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-11
- IRS object ID
- 201711319349302826
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule N
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-11T14:37:45-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 560747981 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1Txt |
| City | ASHEVILLE | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 28806 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581955423 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLAYTON GENERAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLAY | BusinessNameControlTxt |
| Phone | 7709918010 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 UPPER RIVERDALE RD SW | AddressLine1Txt |
| City | RIVERDALE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30274 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES ADAMS | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 7709918010 | PhoneNum |
| Signature | 2017-05-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY BIBBY | PreparerPersonNm |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | PhoneNum |
| Preparation | 2017-05-11 | 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 | JAMES ADAMS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 UPPER RIVERDALE RD SW | AddressLine1Txt |
| City | RIVERDALE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30274 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $115,651,113 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SOUTHERNREGIONAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1991 | FormationYr |
| Legal Domicile State | GA | LegalDomicileStateCd |
| Activity Or Mission | CLAYTON GENERAL, INC. EXISTS TO SERVE THE COMMUNITIES OF THE SOUTHERN CRESCENT OF THE METRO ATLANTA AREA BY IMPROVING THE HEALTH STATUS AND QUALIFY OF LIFE OF ITS CITIZENS. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 1 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 1 | VotingMembersIndependentCnt |
| Total Employee | 1545 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $31,589 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$89,156 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,625,059 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,225,800 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $208,567,992 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $110,463,716 | CYProgramServiceRevenueAmt |
| PY Investment Income | $3,271,402 | PYInvestmentIncomeAmt |
| CY Investment Income | $364,666 | CYInvestmentIncomeAmt |
| PY Other Revenue | $9,557,024 | PYOtherRevenueAmt |
| CY Other Revenue | $596,931 | CYOtherRevenueAmt |
| PY Total Revenue | $225,021,477 | PYTotalRevenueAmt |
| CY Total Revenue | $115,651,113 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,507,900 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,780,750 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $87,190,080 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $43,397,663 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $144,384,247 | PYOtherExpensesAmt |
| CY Other Expenses | $145,522,343 | CYOtherExpensesAmt |
| PY Total Expenses | $234,082,227 | PYTotalExpensesAmt |
| CY Total Expenses | $190,700,756 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$9,060,750 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$75,049,643 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $98,561,834 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,851,286 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $109,842,997 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $94,999,896 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$11,281,163 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$92,148,610 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CLAYTON GENERAL, INC. EXISTS TO SERVE THE COMMUNITIES OF THE CLAYTON GENERAL OF THE METRO ATLANTA AREA BY IMPROVING THE HEALTH STATUS AND QUALIFY OF LIFE OF ITS CITIZENS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $179,798,544 | ExpenseAmt |
| Grant | $1,780,750 | GrantAmt |
| Revenue | $110,432,127 | RevenueAmt |
| Desc | CLAYTON GENERAL, INC. PROVIDED 26,743 DAYS OF ACUTE AND INTENSIVE CARE, TREATED MORE THAN 61,000 OUTPATIENTS, AND PROVIDED EMERGENCY CARE TO 30,057 PATIENTS IN THE EMERGENCY ROOM. CLAYTON GENERAL, INC. ALSO PROVIDED 2,644 DAYS OF CARE TO THE 1,587 BABIES BORN AT CLAYTON GENERAL, INC. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OPERATIONAL ASSETS WERE ACQUIRED BY PRIME HEALTHCARE ON FEBRUARY 2, 2016. THE ORGANIZATION CEASED ACTIVITIES ON THIS DATE. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $179,798,544 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | Yes (1) | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 56 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1545 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 1 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 1 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | GA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7709918010 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 UPPER RIVERDALE RD SW | AddressLine1Txt |
| City | RIVERDALE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30274 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 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 |
|---|---|---|---|---|---|---|---|---|
| JAMES G ADAMS | ||||||||
| CHAIRMAN, PRESIDENT | 1.00 | 4.00 | Yes (X) | Yes (X) | $1,500 | $0 | $0 | |
| FELICIA FRANKLIN-WARNER | ||||||||
| BOARD MEMBER (UNTIL FEB 2016) | 1.00 | Yes (X) | $600 | $0 | $0 | |||
| DANIEL T MCDEVITT MD | ||||||||
| BOARD MEMBER (UNTIL FEB 2016) | 1.00 | Yes (X) | $1,000 | $0 | $0 | |||
| ANDREA S CALLAWAY | ||||||||
| BOARD MEMBER (UNTIL FEB 2016) | 1.00 | Yes (X) | $1,400 | $0 | $0 | |||
| REV DR ED J BEST JR | ||||||||
| BOARD MEMBER (UNTIL FEB 2016) | 1.00 | Yes (X) | $400 | $0 | $0 | |||
| DON MCMILLIAN MD | ||||||||
| BOARD MEMBER (UNTIL FEB 2016) | 1.00 | Yes (X) | $800 | $0 | $0 | |||
| LANDRY MERKISON | ||||||||
| BOARD MEMBER (UNTIL FEB 2016) | 1.00 | Yes (X) | $400 | $0 | $0 | |||
| SHERRY K HANCOCK | ||||||||
| BOARD MEMBER (UNTIL FEB 2016) | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| GLYNDA B KING | ||||||||
| BOARD MEMBER (UNTIL FEB 2016) | 1.00 | Yes (X) | $1,200 | $0 | $0 | |||
| RAMONA THURMAN BIVINS | ||||||||
| BOARD MEMBER (UNTIL FEB 2016) | 1.00 | Yes (X) | $600 | $0 | $0 | |||
| BARRY ZISCHOLTZ MD | ||||||||
| BOARD MEMBER (UNTIL FEB 2016) | 1.00 | Yes (X) | $1,000 | $0 | $0 | |||
| RAJU M VANAPALLI MD | ||||||||
| BOARD MEMBER (UNTIL FEB 2016) | 1.00 | Yes (X) | $1,000 | $0 | $0 | |||
| JOHN MCLAIN | ||||||||
| VP OF OPERATIONS | 40.00 | Yes (X) | $320,919 | $0 | $18,096 | |||
| WILLIE COCHRAN | ||||||||
| VP MEDICAL AFFAIRS | 40.00 | Yes (X) | $161,718 | $0 | $16,497 | |||
| JOE E BAKER | ||||||||
| VP OF FACILITIES | 40.00 | Yes (X) | $158,898 | $0 | $9,329 | |||
| STACY J HANCOCK | ||||||||
| VP OF HUMAN RESOURCES | 40.00 | Yes (X) | $173,831 | $0 | $17,592 | |||
| JIM JUNE | ||||||||
| DIRECTOR OF REVENUE CYCLES | 40.00 | Yes (X) | $186,908 | $0 | $15,697 | |||
| RICHARD K ALLEN | ||||||||
| VP OF INFORMATION TECH | 40.00 | Yes (X) | $157,144 | $0 | $21,690 | |||
| KIM RYAN | ||||||||
| CEO (UNTIL FEB 2016) | 40.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| GEORGE E HOFFMAN JR | ||||||||
| CFO (UNTIL FEB 2016) | 40.00 | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMILA KINCHLOE | ||||||||
| HIGHEST COMPENSATION EMPLOYEE | 40.00 | $111,683 | $0 | $17,636 | Yes (X) | |||
| JANIE HINTON | ||||||||
| HIGHEST COMPENSATION EMPLOYEE | 40.00 | $144,062 | $0 | $17,620 | Yes (X) | |||
| VIRGINIA DICKSON | ||||||||
| HIGHEST COMPENSATION EMPLOYEE | 40.00 | $139,560 | $0 | $11,302 | Yes (X) | |||
| SCOTT BLACKLEY | ||||||||
| HIGHEST COMPENSATION EMPLOYEE | 40.00 | $136,558 | $0 | $84 | Yes (X) | |||
| ERNEST BEDSAUL | ||||||||
| HIGHEST COMPENSATION EMPLOYEE | 40.00 | $136,070 | $0 | $18,689 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,837,251 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $164,232 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 52 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| COMPLETERX | |||||
| 3100 S GESSNER STE 640 | HOUSTON | TX | 77063 | PHARMACY MANAGEMENT | $6,400,000 |
| SOUND PHYSICIANS | |||||
| PO BOX 742936 | LOS ANGELES | CA | 900742936 | HOSPITALISTS | $3,194,640 |
| DISTRIBUTION COOPERATIVE | |||||
| 5356 EAST PONCE DE LEON AVE 100 | STONE MOUNTAIN | GA | 30083 | MEDICAL SUPPLIES | $2,461,627 |
| GEORGIA POWER | |||||
| 96 ANNEX | ATLANTA | GA | 30396 | ELECTRICITY | $2,293,473 |
| HEWLETT PACKARD FINANCIAL | |||||
| PO BOX 402582 | ATLANTA | GA | 303842582 | EQUIPMENT LEASES | $2,076,798 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 118 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $4,225,800 | RelatedOrganizationsAmt |
| Total Contributions | $4,225,800 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICE | 623000 | $110,106,353 | $110,106,353 | |
| MEDICAID EHR PAYMENT | 623000 | $325,774 | $325,774 | |
| LAB OUTREACH | 621500 | $31,589 | $31,589 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $110,463,716 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,784 | TotalRevenueColumnAmt |
| Exclusion | $14,784 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $754 | TotalRevenueColumnAmt |
| Exclusion | $754 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $395,486 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $395,486 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $395,486 | TotalRevenueColumnAmt |
| Exclusion | $395,486 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $349,128 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $349,128 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $349,128 | TotalRevenueColumnAmt |
| Exclusion | $349,128 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MISCELLANEOUSE INCOME | 900099 | $99,143 | $99,143 |
| PAID PARKING REVENUE | 621990 | $52,911 | $52,911 |
| CAFETERIA REVENUE | 624200 | $49,391 | $49,391 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $201,445 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $115,651,113 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $110,432,127 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $31,589 | UnrelatedBusinessRevenueAmt |
| Exclusion | $961,597 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,780,750 | TotalAmt |
| Program Services | $1,780,750 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,099,992 | TotalAmt |
| Management And General | $1,099,992 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,133,626 | TotalAmt |
| Program Services | $30,766,302 | ProgramServicesAmt |
| Management And General | $1,367,324 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,706,533 | TotalAmt |
| Program Services | $1,579,837 | ProgramServicesAmt |
| Management And General | $126,696 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,983,392 | TotalAmt |
| Program Services | $5,539,176 | ProgramServicesAmt |
| Management And General | $444,216 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,474,120 | TotalAmt |
| Program Services | $2,290,437 | ProgramServicesAmt |
| Management And General | $183,683 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,438 | TotalAmt |
| Management And General | $100,438 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,546,413 | TotalAmt |
| Management And General | $2,546,413 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,500 | TotalAmt |
| Management And General | $41,500 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,541 | TotalAmt |
| Management And General | $13,541 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,364,950 | TotalAmt |
| Program Services | $13,473,077 | ProgramServicesAmt |
| Management And General | $1,891,873 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,947 | TotalAmt |
| Management And General | $118,947 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,143,098 | TotalAmt |
| Program Services | $1,933,351 | ProgramServicesAmt |
| Management And General | $209,747 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $969,646 | TotalAmt |
| Program Services | $969,496 | ProgramServicesAmt |
| Management And General | $150 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,761,374 | TotalAmt |
| Program Services | $2,761,106 | ProgramServicesAmt |
| Management And General | $268 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,075 | TotalAmt |
| Program Services | $4,851 | ProgramServicesAmt |
| Management And General | $12,224 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,706 | TotalAmt |
| Program Services | -$4,883 | ProgramServicesAmt |
| Management And General | $40,589 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $357,341 | TotalAmt |
| Program Services | $357,341 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,959,629 | TotalAmt |
| Program Services | $5,317,511 | ProgramServicesAmt |
| Management And General | $2,642,118 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| BANKRUPTCY LOSS | $53,983,919 | $53,983,919 |
| BAD DEBT | $33,994,028 | $33,994,028 |
| MEDICAL SUPPLIES | $16,964,324 | $16,964,324 |
| PATIENT RELATED EXPENSE | $3,991,925 | $3,991,925 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,158,489 | TotalAmt |
| Program Services | $4,095,996 | ProgramServicesAmt |
| Management And General | $62,493 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,700,756 | TotalAmt |
| Program Services | $179,798,544 | ProgramServicesAmt |
| Management And General | $10,902,212 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,450 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,841,214 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,602,517 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $724,254 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,972,033 | BOYAmt |
| EOY | $46,555 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,556,982 | BOYAmt |
| EOY | $634,874 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $201,961 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $199,000 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,678,746 | BOYAmt |
| EOY | $2,961 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,541,772 | BOYAmt |
| EOY | $1,048,323 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $335,719 | BOYAmt |
| EOY | $126,530 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $250,570 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,052,577 | BOYAmt |
| EOY | $992,043 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,561,834 | BOYAmt |
| EOY | $2,851,286 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,860,502 | BOYAmt |
| EOY | $40,657,760 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,175,175 | BOYAmt |
| EOY | $2,720,362 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,807,320 | BOYAmt |
| EOY | $51,621,774 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $109,842,997 | BOYAmt |
| EOY | $94,999,896 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$13,141,512 | BOYAmt |
| EOY | -$94,008,959 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,860,349 | BOYAmt |
| EOY | $1,860,349 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$11,281,163 | BOYAmt |
| EOY | -$92,148,610 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $98,561,834 | BOYAmt |
| EOY | $2,851,286 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$75,049,643 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$352,881 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$5,464,921 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $16,292 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $16,292 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL IS A MEMBER OF THE GEORGIA HOSPITAL ASSOCIATION (GHA). THIS ORGANIZATION ENGAGES IN LOBBYING FOR THE BENEFIT OF THEIR MEMBERSHIP BODIES, AND A PORTION OF THE MEMBERSHIP DUES PAID TO THE ORGANIZATION IS ATTRIBUTABLE TO LOBBYING EXPENDITURES. FOR THE YEAR, THE PORTION OF DUES ATTRIBUTABLE TO LOBBYING EXPENDITURES WAS $16,292 FOR GHA. | ExplanationTxt |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $201,961 | OtherCostOrOtherBasisAmt |
| Depreciation | $199,000 | DepreciationAmt |
| Book Value | $2,961 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,961 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| OTHER RECEIVABLES | $990,603 |
| DEFAULTS | $1,440 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $992,043 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| INSURANCE RESERVE | $15,940,143 |
| PHYSICIAN DINING | $7,236 |
| UNFUNDED PENSION LIABILITY | $35,614,696 |
| PROFESSIONAL FEES PAYABLE | -$47,130 |
| MORRISON'S DEBT FORGIVENESS | $31,829 |
| DUE TO AFFILIATES | $75,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $51,621,774 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,504,126 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,504,126 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01840 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,763,143 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,099,313 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,663,830 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01920 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,267,269 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $21,099,313 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $7,167,956 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03760 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,014,700 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,182,081 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,832,619 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04630 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,014,700 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,182,081 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,832,619 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04630 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $43,281,969 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $27,281,394 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $16,000,575 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08390 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $33,994,028 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $19,330,686 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $19,137,902 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $192,784 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 SPIVEY STATION ASC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | REAL ESTATE MANAGEMENT | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.45410 | OrgProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.48000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLAYTON GENERAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 UPPER RIVERDALE RD SW | AddressLine1Txt |
| City | RIVERDALE | CityNm |
| State Abbreviation | GA | StateAbbreviationCd |
| ZIP | 30274 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLAYTON GENERAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SOUTHERNREGIONAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SOUTHERNREGIONAL.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CLAYTON GENERAL, INC. | PART V, SECTION B, LINE 5: SEVENTEEN INDIVIDUAL COMMUNITY STAKEHOLDERS WERE INTERVIEWED AND ONE FOCUS GROUP OF NINE PATIENTS AND FAMILY ADVISORS (PFA) WAS CONDUCTED BY THE STRATEGIC PLANNING OFFICE. THESE STAKEHOLDERS INCLUDED A MIX OF INTERNAL AND EXTERNAL REPRESENTATIVES TO SRMC, PASTORS, PUBLIC HEALTH OFFICIALS, HEALTH CARE PROVIDERS, SOCIAL AGENCY REPRESENTATIVES, GOVERNMENT LEADERS, AND BOARD MEMBERS. SEE APPENDIX B OF THE CHNA FOR INDIVIDUAL STAKEHOLDER NAMES. |
| CLAYTON GENERAL, INC. | PART V, SECTION B, LINE 6A: EMORY UNIVERSITY HOSPITAL, EMORY UNIVERSITY HOSPITAL MIDTOWN, EMORY JOHNS CREEK HOSPITAL, SAINT JOSEPH'S HOSPITAL, WESLEY WOODS GERIATRIC HOSPITAL, WESLEY WOODS LONG-TERM ACUTE CARE HOSPITAL, EMORY ADVENTIST HOSPITAL |
| CLAYTON GENERAL, INC. | PART V, SECTION B, LINE 11: THE HOSPITAL IS TAKING THE FOLLOWING ACTIONS TO ADDRESS SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA:INCREASE DIABETES AWARES OUTREACHEXPAND EFFORTS TO REDUCE SMOKING AND TOBACCO USEINCREASE ACCESS TO WEIGHT LOSS MANAGEMENT PROGRAMSEXPAND AND ENHANCE CARDIOVASCULAR DISEASE & STROKE AWARENESS AND EDUCATIONEXPAND CANCER PREVENTION PROGRAMS AND ACCESS TO CAREADDRESS FETAL MORTALITY WITH COMMUNITY PARTNERSHIPS AND ACCESSINCREASE AWARENESS OF PREVENTABLE INFECTIOUS DISEASES |
| CLAYTON GENERAL, INC. | PART V, SECTION B, LINE 22D: THE HOSPITAL'S FAP PROVIDES A DISCOUNT FOR INDIVIDUALS THAT QUALIFY UNDER THE POLICY'S PROVISIONS. THE HOSPITAL HAS MADE PLANS TO IMPLEMENT A METHOD OF DETERMINING AMOUNTS GENERALLY BILLED (AGB) PER THE RECENTLY RELEASED PROPOSED REGULATIONS UNDER SECTION 1.501(R), HOWEVER GIVEN THE HIGH LEVEL OF DISCOUNT AVAILABLE UNDER THE CURRENT POLICY, THE ORGANIZATION IS CONFIDENT THAT ITS POLICIES ARE WELL WITHIN GUIDELINES. |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE ORGANIZATION UTILIZED THE RATIO OF COST TO CHARGE INFORMATION FROM WORKSHEET 2 OF SCHEDULE H, FORM 990. |
| PART I, LINE 7G: | THE SUBSIDIZED HEALTH SERVICES LISTED ON LINE 7G ARE RELATED TO EMERGENCY ROOM SERVICES AND WOMEN'S COMMUNITY CARE SERVICES PROVIDED TO THE RESIDENTS OF THE SOUTHERN CRESCENT. |
| PART III, LINE 4: | THE ORGANIZATION FOLLOWS THE METHOD DESCRIBED IN HFMA STATEMENT 15. THE COSTING METHODOLOGY WAS BASED ON THE WORKSHEET C FROM THE FY 2014 COST REPORT, AND THE COST TO CHARGE RATIO WAS APPLIED TO BAD DEBT EXPENSE TO CALCULATE BAD DEBT EXPENSE AT COST. |
| PART III, LINE 8: | THE METHODOLOGY USED FOR THIS SECTION WAS WORKSHEET 2, SCHEDULE H OF THE FORM 990. |
| PART III, LINE 9B: | PATIENTS ARE SCREENED BASED ON COUNTY OF RESIDENCE, INCOME LEVELS, AND WHETHER THE MEDICAL CARE IS CONSIDERED CATASTROPHIC IN NATURE. DEPENDING ON THE CRITERIA, PATIENT'S BILLS ARE REDUCED BY ADJUSTMENTS TO CHARITY OR INDIGENT CARE USING THE SPECIFIC GUIDELINES IN THE POLICY. INCOME CRITERIA ARE BASED ON VARIOUS PERCENTAGES OF FEDERAL POVERTY GUIDELINES (FPG). THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES WHEN THEY QUALIFY FOR INDIGENT CARE / CHARITY CARE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS. |
| PART VI, LINE 2: | HEALTH NEEDS ARE GENERALLY ASSESSED THROUGH A STRATEGIC PLANNING PROCESS THAT LOOKS AT THE PRIMARY AND SECONDARY SERVICE AREAS FOR TRENDS IN AGE, INCOME, AND USE RATES FOR VARIOUS SERVICES OR ILLNESSES. COMMUNITY NEEDS ARE ALSO BASED ON A NEEDS ASSESSMENT RELATED TO VARIOUS PHYSICIAN SPECIALTIES, FOR EXAMPLE, THE SERVICE AREA HAS NEEDS FOR PRIMARY CARE PHYSICIANS. THE ORGANIZATION WORKS WITH LOCAL PHYSICIAN PRACTICES TO SHAPE THIS INFORMATION AND ENCOURAGE VARIOUS PHYSICIAN RECRUITMENT ACTIVITIES. HEALTH NEEDS ARE ALSO INDIRECTLY ASSESSED BY ANALYZING TRENDS FOR SERVICES OFFERED AT THE ORGANIZATION AND THE HEALTH STATUS OF THOSE PATIENTS. |
| PART VI, LINE 3: | THE ORGANIZATION INFORMS AND EDUCATES PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE BY POSTED SIGNS, FORMS, AND EMAILS. |
| PART VI, LINE 4: | THE ORGANIZATION SERVES THE PATIENTS IN THE SOUTHERN CRESCENT OF THE METRO ATLANTA AREA. OUR PRIMARY SERVICE AREA INCLUDES CLAYTON COUNTY, FAYETTE COUNTY, HENRY COUNTY, AND PORTIONS OF SOUTH FULTON COUNTY. THE SOUTHERN CRESCENT IS A LARGE DIVERSE COMMUNITY, AND THE ORGANIZATION OFFERS SERVICES TO MEET THESE VARIED NEEDS. THE MAJOR SERVICES THE ORGANIZATION OFFERS IN THE SOUTHERN CRESCENT ARE OB SERVICES, NEONATOLOGY, GYNECOLOGICAL, ONCOLOGY & HEMATOLOGY, NEUROLOGY, NEUROSURGERY, ORTHOPEDICS, VASCULAR CARE, CARDIOLOGY AND INTERVENTIONAL CARDIOLOGY, ACUTE REHABILITATION, OP IMAGING, OP SURGERY & GASTROENTEROLOGY, EMERGENCY CARE, AND WOMEN'S COMMUNITY CARE. |
| PART VI, LINE 5: | THE ORGANIZATION PROMOTES HEALTH IN THE COMMUNITY THROUGH 90 SECOND HEALTH BREAK COMMERCIALS, SPRING INTO HEALTHY LIVING CONFERENCE, HEALTH SCREENINGS AND SPONSORSHIPS. THE ORGANIZATION HAS A COMMUNITY BASED BOARD OF DIRECTORS AND IS ALSO LINKED TO THE COMMUNITY THROUGH THE CLAYTON COUNTY HOSPITAL AUTHORITY (CCHA), WHICH IS A GOVERNMENT ENTITY.EXCESS FUNDS FROM THE OPERATION OF THE ORGANIZATION ARE REDIRECTED BACK TO THE MISSION OF THE ORGANIZATION THROUGH THE PURCHASE OF EQUIPMENT, MAINTAINING / UPGRADING THE FACILITIES, DEVELOPING NEW SERVICES TO BENEFIT THE COMMUNITY, OR FUNDING OPERATIONS. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | GA |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| CLAYTON COUNTY CHAMBER OF COMMERCE | |||||||
| 2270 MT ZION ROAD | JONESBORO | GA | 30236 | 580801495 | 501(C)(6) | $8,250 | OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE |
| CLAYTON GENERAL GROUP | |||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 581955425 | 501(C)(3) | $1,542,500 | OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE |
| CLAYTON GENERAL REAL ESTATE | |||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 581955424 | 501(C)(3) | $230,000 | OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | APPROVED EDUCATION PROGRAMS DURING PERIODS OF SIGNIFICANT LABOR SHORTAGES ARE ELIGIBLE FOR TUITION REIMBURSEMENT. EMPLOYEES MUST APPLY PRIOR TO THE START OF THE COURSE. WITHIN 30 DAYS OF SUCCESSFUL COMPLETION OF THE COURSE, THE EMPLOYEE MUST SUBMIT A COPY OF THEIR GRADE, AND THE ORIGINAL TUITION RECEIPT FROM THE INSTITUTION TO THE HUMAN RESOURCES DEPARTMENT FOR PROCESSING. EMPLOYEES MUST COMPLETE THE COURSE WHILE EMPLOYED AT THE HOSPITAL. THE FILING ORGANIZATION MONITORS TAX EXEMPT PURPOSE COMPLIANCE FOR THE USE OF FUNDS GRANTED TO ITS SUPPORTING ORGANIZATIONS THROUGH A SHARED MANAGEMENT TEAM. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN MCLAIN | ||||||||||||||
| VP OF OPERATIONS | $320,919 | $0 | $0 | $0 | $0 | $0 | $722 | $0 | $17,374 | $0 | $339,015 | $0 | $0 | $0 |
| WILLIE COCHRAN | ||||||||||||||
| VP MEDICAL AFFAIRS | $161,718 | $0 | $0 | $0 | $0 | $0 | $1,769 | $0 | $14,728 | $0 | $178,215 | $0 | $0 | $0 |
| JOE E BAKER | ||||||||||||||
| VP OF FACILITIES | $158,898 | $0 | $0 | $0 | $0 | $0 | $1,215 | $0 | $8,114 | $0 | $168,227 | $0 | $0 | $0 |
| STACY J HANCOCK | ||||||||||||||
| VP OF HUMAN RESOURCES | $173,831 | $0 | $0 | $0 | $0 | $0 | $218 | $0 | $17,374 | $0 | $191,423 | $0 | $0 | $0 |
| JIM JUNE | ||||||||||||||
| DIRECTOR OF REVENUE CYCLES | $186,908 | $0 | $0 | $0 | $0 | $0 | $3,341 | $0 | $12,356 | $0 | $202,605 | $0 | $0 | $0 |
| RICHARD K ALLEN | ||||||||||||||
| VP OF INFORMATION TECH | $157,144 | $0 | $0 | $0 | $0 | $0 | $519 | $0 | $21,171 | $0 | $178,834 | $0 | $0 | $0 |
| JANIE HINTON | ||||||||||||||
| HIGHEST COMPENSATION EMPLOYEE | $144,062 | $0 | $0 | $0 | $0 | $0 | $236 | $0 | $17,384 | $0 | $161,682 | $0 | $0 | $0 |
| VIRGINIA DICKSON | ||||||||||||||
| HIGHEST COMPENSATION EMPLOYEE | $139,560 | $0 | $0 | $0 | $0 | $0 | $198 | $0 | $11,104 | $0 | $150,862 | $0 | $0 | $0 |
| ERNEST BEDSAUL | ||||||||||||||
| HIGHEST COMPENSATION EMPLOYEE | $136,070 | $0 | $0 | $0 | $0 | $0 | $1,983 | $0 | $16,706 | $0 | $154,759 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | SPOUSE TRAVEL EXPENSES ARE REIMBURSED WHEN HIS/HER ATTENDANCE IS NECESSARY AND ESSENTIAL. SPOUSAL TRAVEL EXPENSES REQUIRE PRIOR APPROVAL. REIMBURSEMENT SHALL BE LIMITED TO TRANSPORTATION EXPENSE NOT TO EXCEED THE AIR TRAVEL RATE IN COACH CLASS AND OUT-OF-POCKET EXPENSES WITH RESPECT LODGING AND FOOD. REIMBURSEMENT SHALL BE LIMITED TO LODGING BASED ON DOUBLE ACCOMODATION. THE POLICY RECOGNIZES THAT GOVERNING BOARD MEMBERS ARE OFTEN PLACED IN SOCIAL SITUATIONS AT SUCH MEETINGS AND WOULD REPRESENT THE HOSPITAL OPTIMALLY WITH THE ASSISTANCE OF THEIR SPOUSES. |
| PART I, LINE 1B | A FORMAL POLICY EXISTS, AND RECEIPTS AND APPROVAL ARE REQUIRED BEFORE REIMBUSREMENT FORMS ARE PROCESSED THROUGH THE ACCOUNTING DEPARTMENT FOR PAYMENT. |
Schedule N IRS990ScheduleN
Disposition Of Assets Detail DispositionOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | OPERATING ASSETS | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2016-02-01 | DistributionDt |
| Fair Market Value Of Asset | $80,867,447 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | COST | MethodOfFMVDeterminationTxt |
| EIN | 208065139 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRIME HEALTHCARE FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 16850 BEAR VALLEY RD STE 200 | AddressLine1Txt |
| City | VICTORVILLE | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 92395 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(C)(3) | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | 0 | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | 0 | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2Ind |
| Receive Compensation2 | 0 | ReceiveCompensation2Ind |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 3 | CLAYTON GENERAL OPERATIONAL ASSETS WERE ACQUIRED BY PRIME HEALTHCARE ON FEBRUARY 2, 2016. THE ORGANIZATION CEASED ACTIVITIES ON THIS DATE. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION HIRED AND DELEGATED MANAGEMENT DUTIES TO EMORY HEALTHCARE. EMORY HEALTHCARE PROVIDED THE CEO, KIM RYAN, AND CFO, GEORGE HOFFMAN. THE CEO WAS COMPENSATED $225,282 AND THE CFO WAS COMPENSATED $203,428. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE TAX RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT. THE COMPLETED IRS FORM 990 TAX RETURN WAS PROVIDED TO THE BOARD. BOARD MEMBERS REVIEWED THE TAX RETURN BEFORE IT WAS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS AND SENIOR MANAGEMENT. ANY POTENTIAL CONFLICT IS DISCUSSED WITH THE BOARD OF DIRECTORS (ABSENT THE MEMBER WITH THE POTENTIAL CONFLICT). IF IT IS DETERMINED THAT CONFLICT EXISTS, THEN THE BOARD MAY HAVE THE MEMBER EITHER RESIGN OR REMOVE THE CONFLICT, OR THEY MOVE FORWARD WITH THE TRANSACTION IF SPECIFIC FACTS ARE PRESENT. IF THE LATER SITUATION TAKES PLACE, THEN THE MEMBER IS EXCLUDED FROM DISCUSSIONS AND THE VOTE FOR THAT TRANSACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS AUTHORIZES THE COMPENSATION PACKAGE OF EXECUTIVIES UTILIZING THE VHA GEORGIA SURVEY OF EXECUTIVE COMPENSATION AND OTHER APPROPRIATE SURVEYS. THE SURVEY IS REVIEWED TO ENSURE COMPETITIVE WAGES AND BENEFITS FOR THE CEO, CFO, OTHER OFFICERS, AND KEY EMPLOYEES OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION COMPLIES WITH THE OPEN RECORDS LAW. UPON WRITTEN REQUEST, GOVERNING DOCUMENTS DEEMED ACCESSIBLE TO THE PUBLIC UNDER THE LAW CAN BE VIEWED IN THE OFFICE OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. |
| FORM 990, PART XI, LINE 9: | BANKRUPTCY -3,011,621. CONTRIBUTIONS FROM RELATED ORGANIZATIONS -4,225,800. TRANSFERS OF CAPITAL - BANKRUPTCY 1,772,500. |
| PART XII, LINE 2C | THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 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 | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| CLAYTON GENERAL GROUP INC | ||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 581955425 | HEALTHCARE | GA | 501(C)(3) | 3 | CLAYTON GENERAL INC | Yes (1) |
| CLAYTON GENERAL FOUNDATION INC | ||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 581983516 | FUNDRAISING | GA | 501(C)(3) | LINE 11, TYPE II | CLAYTON GENERAL INC | Yes (1) |
| SOUTHERN REGIONAL MEDICAL CENTER AUXILIARY | ||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 582027384 | GIFT SHOP AND VOLUNTEER | GA | 501(C)(3) | LINE 11, TYPE II | CLAYTON GENERAL INC | Yes (1) |
| CLAYTON GENERAL ASC INC | ||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 582541044 | HEALTHCARE | GA | 501(C)(3) | LINE 11, TYPE II | CLAYTON GENERAL INC | Yes (1) |
| CLAYTON COUNTY HOSPITAL AUTHORITY TRUST COMPANY LIABILITY TRUST | ||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 582016041 | LIABILITY INSURANCE | GA | 501(C)(3) | LINE 11, TYPE II | CLAYTON GENERAL INC | Yes (1) |
| CLAYTON GENERAL REAL ESTATE INC | ||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 581955424 | REAL ESTATE MANAGEMENT | GA | 501(C)(3) | LINE 11, TYPE II | CLAYTON GENERAL INC | Yes (1) |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPIVEY STATION ASC BUILDING LP | ||||||||||||||
| TWO SUN COURT STE 350 | NORCROSS | GA | 30092 | 263323060 | RENTAL | GA | CLAYTON GENERAL INC | RELATED | $38,837 | $698,549 | 0 | 0 | 0.45410 | |
| SOUTHLAKE ASC LLP | ||||||||||||||
| 4000 CORPORATE CENTER DR | MORROW | GA | 30260 | 582272588 | SURGICAL | GA | N/A | |||||||
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CLAYTON GENERAL SERVICES INC | ||||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 208774854 | EQUIPMENT LEASE | GA | SOUTH REGIONAL HEALTH SYSTEM INC | C | $411 | $42,972 | 1.00000 | Yes (1) |
| SOUTHERN CRESCENT HEALTH NETWORK INC | ||||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 582220817 | PHYSICIAN NETWORK | GA | SOUTH REGIONAL HEALTH SYSTEM INC | C | $5,922 | 1.00000 | Yes (1) | |
| SPIVEY STATION MANAGEMENT ASSOCIATION INC | ||||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 260629861 | HEALTHCARE | GA | SOUTH REGIONAL HEALTH SYSTEM INC | C | 1.00000 | Yes (1) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt |
|---|---|
| SOUTHLAKE ASC LLP | |
| B | $500,000 |
| CLAYTON COUNTY HOSPITAL AUTHORITY TRUST | |
| B | $3,470,800 |
| CLAYTON GENERAL REAL ESTATE INC | |
| B | $100,000 |
| CLAYTON GENERAL SERVICES INC | |
| B | $155,000 |