2016-08-12T12:41:08-05:00 2015-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2014-10-01 582359398 OCONEE REGIONAL MEDICAL CENTER INC OCON 4784543520 821 NORTH COBB STREET MILLEDGEVILLE GA 31061 MICHAEL VAUGHN INTERIM CFO 4784543520 2016-08-12 1 AMY BIBBY P00445891 8282542254 2014 2016-09-27 15:27:22Z MICHAEL VAUGHN 821 NORTH COBB STREET MILLEDGEVILLE GA 31061 71697867 0 X WWW.OCONEEREGIONAL.COM X 1997 GA TO PROVIDE HEALTHCARE SERVICES TO ALL PATIENTS WITHIN THE ORGANIZATION'S SERVICE AREA. 11 9 722 125 276141 0 635778 392933 70918892 70961310 135510 136837 235295 206787 71925475 71697867 39250 7050 0 0 31599915 28887155 0 0 0 47978605 47354007 79617770 76248212 -7692295 -4550345 48686874 41425174 35442085 33860615 13244789 7564559 X THE MISSION OF OCONEE REGIONAL MEDICAL CENTER IS TO PROVIDE HIGH QUALITY, SAFE, COMPASSIONATE, PATIENT-FOCUSED HEALTHCARE. 0 0 65665047 7050 70821202 OCONEE REGIONAL MEDICAL CENTER IS A 140-BED GENERAL, ACUTE-CARE INSTITUTION, OFFERING A WIDE RANGE OF SPECIALIZED SERVICES AND PROGRAMS. SUCH SERVICES INCLUDE ACUTE MEDICAL/SURGICAL CARE, A BLOOD BANK, CANCER CENTER UNIT, CARDIOVASCULAR LABORATORY, CT & MRI SCANNERS, LITHOTRIPSY, MAMMOGRAPHY, MEDICAL/SURGICAL INTENSIVE CARE UNIT, OB/GYN, ORTHOPEDIC SURGERY, OUTPATIENT SURGERY, PEDIATRIC CARE, PHARMACY DIAGNOSTIC RADIOLOGY, 24-HOUR EMERGENCY SERVICE, LAPAROSCOPIC SURGERY, PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, POST-OPERATIVE RECOVERY ROOM, AND RESPIRATORY CARE SERVICES.IT IS THE POLICY OF OCONEE REGIONAL MEDICAL CENTER TO ADMIT AND TREAT ALL PERSONS WITHOUT REGARD TO RACE, COLOR, SEX, HANDICAP, NATIONAL ORIGIN, OR RELIGIOUS CREED. ADMISSION REQUIREMENTS AND ASSIGNMENTS OF HOSPITAL FACILITIES ARE THE SAME FOR ALL PERSONS. THERE ARE NO DISTINCTIONS IN ELIGIBILITY FOR RECEIVING ANY PATIENT CARE SERVICES. HOSPITAL FACILITIES ARE AVAILABLE TO ALL PATIENTS AND VISITORS. INDIVIDUALS AND ORGANIZATIONS HAVING OCCASION TO REFER PATIENTS FOR ADMISSION OR RECOMMEND OCONEE REGIONAL MEDICAL CENTER ARE ADVISED TO DO SO WITHIN THE HOSPITAL'S POLICY TO PROVIDE QUALITY HEALTHCARE TO ALL PERSONS.FOR THE YEAR ENDED SEPTEMBER 30, 2015, THE CENTER PROVIDED INDIGENT AND CHARITY CARE AT A COST OF APPROXIMATELY $1,521,806. THE CENTER ALSO PROVDES CARE TO PATIENTS COVERED BY MEDICARE/MEDICAID AT A TOTAL SHORTFALL OF $4,265,558 AND A SURPLUS OF $1,087,896 FOR MEDICARE AND MEDICAID, RESPECTIVELY. THE CENTER ALSO PROVIDES A SITE FOR MEDICAL STUDENTS TO COMPLETE CLINICAL ROTATIONS FOR NURSING AND RADIOLOGY. 65665047 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 79 0 1 722 1 1 1 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X X MICHAEL VAUGHN 4784573550 PO BOX 690 MILLEDGEVILLE GA 31059 X DAVID GROSECLOSE ORMC BOARD CHAIR (THRU 9/15) 4.00 6.00 X X 0 0 0 VANESSA WALKER ORMC VICE CHAIR 4.00 4.00 X X 0 0 0 TED ZARKOWSKY ORHS BOARD CHAIR 4.00 6.00 X X 0 0 0 DR PHYLLIS PARKS-VEAL ORHS VICE CHAIR 4.00 4.00 X X 0 0 0 MICHAEL ANDERSON BOARD MEMBER 3.00 3.00 X 0 0 0 ALICE LOPER BOARD MEMBER 3.00 3.00 X 0 0 0 ANDY COWART BOARD MEMBER 2.00 2.00 X 0 0 0 DR PRABDHEEP BRAR BOARD MEMBER 2.00 2.00 X 0 0 0 DR MICHAEL DUKE BOARD MEMBER 2.00 2.00 X 0 0 0 DR MARSHALL IVEY BOARD MEMBER 2.00 2.00 X 0 0 0 DR NINFA SAUNDERS BOARD MEMBER 1.00 1.00 X 0 0 0 RHONDA PERRY BOARD MEMBER 2.00 2.00 X 0 0 0 DON HEACOCK MD BOARD MEMBER (THRU 5/15) 2.00 2.00 X 10250 0 0 GEORGE GRIMES MD BOARD MEMBER (THRU 5/15) 1.00 1.00 X 6142 0 0 RAM PURI MD BOARD MEMBER (THRU 5/15) 2.00 2.00 X 293722 0 0 JEFF CRISP BOARD MEMBER (THRU 5/15) 2.00 2.00 X 0 0 0 JAMES SMITH MD BOARD MEMBER (THRU 7/15) 3.00 3.00 X 0 0 0 REBECCA J AYCOCK PRESIDENT/CEO (THRU 5/15) 40.00 7.00 X 368344 0 18484 BRENDA K QUALLS VP CFO 40.00 5.00 X 199177 0 14615 DEBORAH BLOCK VP CNO 40.00 X 153587 0 23070 LORRAINE DANIEL OVERHOUSE SUPERVISOR RN 40.00 X 120178 0 32055 DEANNE HERRING CLINICAL SUPPORT DIRECTOR 40.00 X 148716 0 13138 BRUCE ALAN WHITEHOUSE CIO 40.00 X 135297 0 27616 SHANNON LOWERY PHARMACIST 40.00 X 121720 0 39 CAROL BABB ASSISTANT DIRECTOR OF PHARMACY 40.00 X 117445 0 32327 1674578 0 161344 19 0 1 0 LOGOS EMERGENCY SPECIALISTS 232 COUNTRY CREEK ROAD MACON GA 31220 EMERGENCY PHYSICIAN SERVICES 4332005 BCAS INC PO BOX 1707 MILLEDGEVILLE GA 31061 ANESTHESIA SERVICES 1437500 ENDURACARE ACUTE CARE SERVICES LLC PO BOX 654072 DALLAS TX 752654072 REHABILITATION SERVICES 1051063 ARAMARK CTS 12483 COLLECTIONS CENTER DR CHICAGO IL 60693 BIOMED SERVICES 983068 HOSPITAL HOUSEKEEPING SYSTEMS LLC PO BOX 826 SAN ANTONIO TX 782930826 HOUSEKEEPING SERVICES 845827 12 30876 332000 30057 392933 NET PATIENT SERVICE REVENUE 621400 69681581 69405440 276141 MEANINGFUL USE REVENUE 900099 1279729 1279729 70961310 5245 5245 129878 129878 136033 0 136033 136033 136033 1714 0 1714 1714 1714 MISCELLANEOUS REVENUE 900099 48445 48445 FITNESS CENTER 713940 21884 21884 CAFETERIA AND VENDING 900099 425 425 70754 71697867 70821202 276141 207591 X 7050 7050 1284677 310114 974563 22650722 19329616 3321106 365980 300298 65682 2894185 2374768 519417 1691591 1388002 303589 798665 8966 789699 775802 775802 96000 96000 26555 26555 15157189 14997795 159394 29147 29147 4567480 1929149 2638331 303988 17996 285992 1263664 1263664 37129 25720 11409 1270026 1270026 3974848 3974848 1267662 895733 371929 MEDICAL SUPPLIES 8512371 8512371 BAD DEBTS 7987575 7987575 PROVIDER TAX 921519 921519 RECRUITMENT 53376 53376 311011 149837 161174 76248212 65665047 10583165 0 1130352 343586 2426221 2450779 9175427 7691213 1940743 1881284 958100 761416 105438506 86435295 22502854 19003211 6949537 4079554 3603640 5214131 48686874 41425174 8873164 9421517 22492845 21402488 2078901 1837524 1997175 1199086 35442085 33860615 X 13244789 7564559 13244789 7564559 48686874 41425174 X -4550345 -1037375 -92510 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 32686 32686 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO GEORGIA HOSPITAL ASSOCIATION, AN ORGANIZATION THAT LOBBIES ON BEHALF OF ITS MEMBERSHIP BODY. A PORTION OF THE DUES IS SPECIFICALLY RELATED TO LOBBYING. ALSO, THE ORGANIZATION PAID A FIRM TO REPRESENT OCONEE REGIONAL MEDICAL CENTER AND THEIR HEALTHCARE ISSUES AT A STATE GOVERNMENT LEVEL. 2385639 2385639 46814810 36289525 10525285 6968 6968 56227689 50145770 6081919 3400 3400 19003211 UNAMORTIZED BOND ISSUE COSTS 132317 INTERCOMPANY DUE TO/DUE FROM 4825253 OTHER RECEIVABLES 192135 PHYSICIAN RECEIVABLES 64426 5214131 ESTIMATED THIRD-PARTY SETTLEMENTS 1199086 1199086 X 62672917 -1037375 -1037375 63710292 7987575 7987575 71697867 68260637 0 68260637 7987575 7987575 76248212 PART X, LINE 2: INCOME TAXES- THE SYSTEM AND ITS AFFILIATES, EXCEPT FOR ORHV, PCC AND OSWC, HAVE BEEN RECOGNIZED AS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) AND, THEREFORE, RELATED INCOME IS GENERALLY NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES. ORHV, PCC AND OSWC ACCOUNT FOR INCOME TAXES IN ACCORDANCE WITH FOR-PROFIT ACCOUNTING GUIDANCE. THE SYSTEM AND ITS AFFILIATES HAVE EVALUATED THEIR TAX POSITIONS AND HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2015 AND 2014. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2012 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 7,987,575. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 7,987,575. 1 1 1 X 125.000000000000 1 X 1 1 1 0 0 1521806 390162 1131644 0.01480 4650488 2069040 2581448 0.03390 6068797 4384717 1684080 0.02210 12241091 6843919 5397172 0.07080 12241091 6843919 5397172 0.07080 4 2000 2000 0.00000 1 2500 2500 0.00000 5 4500 4500 1 7987575 2117107 16325383 15237487 1087896 X 1 1 1 1 OCONEE REGIONAL MEDICAL CENTER 821 NORTH COBB STREET MILLEDGEVILLE GA 31061 X X X SKILLED NURSING UNIT OCONEE REGIONAL MEDICAL CENTER 1 0 0 1 X X X X X X X 13 1 0 0 1 X SEE DISCLOSURE X 1 12 0 1 0 1 X 125.000000000000 250.000000000000 X X X 1 1 X X X X 1 X SEE DISCLOSURE X SEE DISCLOSURE X X X 1 0 X X X 1 X 0 0 OCONEE REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 5: THE HOSPITAL FACILITY USED FACE TO FACE INTERVIEWS, WRITTEN QUESTIONNAIRES, FOCUS GROUPS INCLUDING THOSE WITH KNOWLEDGE IN PUBLIC HEALTH AND THOSE SERVING OR A MEMBER OF THE UNDERSERVED AND CHRONIC DISEASE POPULATION AS INPUT FROM THE COMMUNITY. OCONEE REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 11: ACCESS TO CARE (TRANSPORTATION) - ORMC DOES NOT HAVE THE RESOURCES TO MEET THIS NEED. BALDWIN TRANSIT IS AVAILABLE TO TRANSPORT PATIENTS TO MEDICAL APPOINTMENTS OR SERVICES FOR A NOMINAL FEE.MENTAL HEALTH - RIVER EDGE BEHAVIORAL HEALTH PROVIDES PATIENTS WITH BOTH OUTPATIENT AND INPATIENT MENTAL HEALTH SUPPORT AND TREATMENT. ALSO, OCONEE CENTER IS LOCATED IN BALDWIN COUNTY AND PROVIDES OUTPATIENT BEHAVIORAL HEALTH SERVICES.SEXUAL HEALTH (STDS) - THIS NEED IS ONE THAT ORMC WANTS TO ADDRESS AND FEELS A POSITIVE IMPACT CAN BE MADE. HOWEVER, IT IS UNCLEAR AT THIS TIME HOW TO ADDRESS THIS ISSUE; THEREFORE, ORMC WOULD LIKE TO EXPLORE RESOURCES AND POTENTIAL PARTNERSHIPS MORE AND COULD POSSIBLY INCORPORATE THIS ISSUE IN THE CURRENT OR A FUTURE IMPLEMENTATION PLAN.INFANT MORTALITY - CROSSROADS PREGNANCY CENTER, BALDWIN FAMILY CONNECTION, AND THE BALDWIN COUNTY HEALTH DEPARTMENT PROVIDE THE RESOURCES AND SERVICES TO MEET THIS NEED.LOCAL ECONOMY - ORMC CONTINUES TO SUPPORT COUNTY-WIDE INITIATIVES TO BRING MORE INDUSTRY TO THE COMMUNITY OCONEE REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 13H: STATE REGULATIONS OCONEE REGIONAL MEDICAL CENTER 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. PART V, SECTION B, LINE 7A: HTTP://WWW.OCONEEREGIONAL.COM/WP-CONTENT/UPLOADS/2015/05/CHNA2013REPORT FINAL.PDF PART V, SECTION B, LINE 16B: HTTP://03C54F6.NETSOLHOST.COM/WP-CONTENT/UPLOADS/2015/05/INDIGENTCHARIT YCAREAPPLICATION.PDF PART V, SECTION B, LINE 16A: HTTP://03C54F6.NETSOLHOST.COM/WP-CONTENT/UPLOADS/2015/05/INDIGENTCARETR USTLETTER.PDF PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY OCONEE REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16A WEBSITE: SEE DISCLOSURE OCONEE REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 16B WEBSITE: SEE DISCLOSURE PART I, LINE 7: WORKSHEET 2 OF THE 2014 SCHEDULE H INSTRUCTIONS WAS USED TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID AT COST. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE OF $7,987,575 INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) IS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES INCLUDED THE FOLLOWING:CONTRIBUTIONS TO UNITED WAY AND AMERICAN CANCER SOCIETY'S RELAY FOR LIFE. SUPPORT FOR A MEMORIAL FUN RUN, AMPUTEE GOLF TOURNAMENT, FIREFIGHTERS BURN FOUNDATION, AND COMMUNITY PROGRAM FOR PARTNERS IN EDUCATION. PART III, LINE 4: THE IRS WORKSHEETS WERE UTILIZED TO DETERMINE THE COST-TO-CHARGE RATIO.BAD DEBT EXPENSE WAS MULTIPLIED BY THE COST-TO-CHARGE RATIO AND THEN THREE-QUARTERS OF THAT AMOUNT WAS ESTIMATED TO BE ATTRIBUTABLE TO ACCOUNTS FOR INDIVIDUALS WHO WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE. PART III, LINE 8: THE TOTAL AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. THERE ARE MEMBERS IN OUR COMMUNITY THAT ARE RESIDENTS OF THE GEORGIA WAR VETERANS HOME AND OF CENTRAL STATE HOSPITAL WHO ARE MEDICARE BENEFICIARIES. ALTHOUGH ORMC IS REIMBURSED BY MEDICARE FOR THESE PARTICULARLY FRAGILE PATIENTS UNDER THE PROSPECTIVE PAYMENT RULES, THESE PATIENTS ARE TYPICALLY MORE SEVERLY ILL, HAVE MULTIPLE COMPLICATIONS AND LONGER LENGTHS OF STAY THAN THE AVERAGE MEDICARE PATIENT. WE TREAT ALL MEDICARE PATIENTS THAT PRESENT TO OUR HOSPITAL (IF WE HAVE THE NEEDED SERVICE AVAILABLE). PROVIDING SERVICES TO COMMUNITY MEMBERS AT LESS THAN COST IS CERTAINLY A BENEFIT TO THOSE MEMBERS.THE COSTING METHODOLOGY IS A COMBINATION OF COST REPORT PLUS COST AND CHARGES FOR PROFESSIONAL FEES AND OUT PATIENT FEE SCHEDULE NOT INCLUDED ON THE COST REPORT. PART III, LINE 9B: ACCOUNTS FOR PATIENTS WHO MEET THE CRITERIA FOR FINANCIAL ASSISTANCE ARE WRITTEN OFF TO INDIGENT /CHARITY ACCOUNTS AND NO ATTEMPTS ARE MADE TO COLLECT FROM THE PATIENT. FOR ALL OTHER ACCOUNTS IF OTHER INFORMATION IS KNOWN TO THE COLLECTOR, SUCH AS PATIENT IS DECEASED AND THERE IS NO RECORD OF ESTATE, OR PATIENT MET CHARITY REQUIREMENTS IN PREVIOIUS YEARS AND IT IS KNOWN THAT HIS OR HER CIRCUMSTANCES HAVE NOT CHANGED, FOR INSTANCE, THE ACCOUNT IS WRITTEN OFF TO CHARITY AND NOT SENT TO COLLECTIONS. WE MAKE EVERY EFFORT TO ASSIST PATIENTS TO PROVIDE DOCUMENTATION TO QUALIFY FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: ONGOING DISCUSSIONS WITH LOCAL MEDICAL STAFF, INTERNAL CASE MANAGEMENT AND DISCHARGE PLANNING PERSONNEL, COMMUNITY BOARD MEMBERS AND LOCAL LEADERS PROVIDE INFORMATION ON THE HEALTH NEEDS OF THE POPULATION WE SERVE. IN ADDITION, IN 2013 ORMC CONDUCTED A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT, INVOLVING MANY LOCAL AGENCIES, PUBLIC HEALTH STAFF, AND REPRESENTATIVES OF THE COMMUNITY WE SERVE. PART VI, LINE 3: NOTICES OF OUR FINANCIAL ASSISTANCE POLICY ARE POSTED IN ALL REGISTRATION AREAS AND INFORMATION IS GIVEN TO THE PATIENT AT THE TIME OF ADMISSION. REPRESENTATIVES ARE ON SITE TO MEET WITH INPATIENTS AND OUTPATIENTS, WHO DO NOT HAVE INSURANCE, AND DETERMINE FIRST IF THEY MEET THE CRITERIA FOR ANY STATE OR FEDERAL ASSISTANCE PROGRAM, OR ALTERNATIVELY IF THEY MEET THE ORMC FINANCIAL ASSISTANCE CRITERIA. FOLLOW UP PHONE CALLS ARE MADE TO THESE PATIENTS TO ASSIST IN COMPLETING THE PAPERWORK. PART VI, LINE 4: THE PRIMARY SERVICE AREA CONSISTS OF BALDWIN COUNTY, GA. WITH A POPULATION OF 42,829 IN 2013 AND IS EXPECTED TO DECLINE OVER THE NEXT 5 YEARS. AVERAGE MEDIAN INCOME IS $33,515 COMPARED TO THE GEORGIA AVERAGE OF $45,069. A SEVERE LOSS OF JOBS IN INDUSTRY AND IN STATE GOVERNMENT IN THE AREA HAS FEDERAL UNEMPLOYMENT MUCH HIGHER THAN THE STATE AND NATIONAL AVERAGES. 52% OF CHILDREN LIVE IN A SINGLE PARENT HOUSEHOLD. AN ESTIMATED 71% OF THE POPULATION LIVE IN A FOOD DESERT WITH LOW ACCESS TO THE STORE. 31.3% OF THE POPULATION OF BALDWIN COUNTY IS OBESE. PART VI, LINE 5: ALL SURPLUS FUNDS ARE RETAINED BY THE ORGANIZATION. THROUGH THE CAPITAL PLANNING AND BUDGETING PROCESS, MILLIONS OF DOLLARS ARE REINVESTED IN PLANT AND EQUIPMENT EACH YEAR TO ENABLE ORMC TO PROVIDE MODERN, QUALITY CARE TO PATIENTS. NEW PROGRAMS ARE CONSIDERED AND EVALUATED BASED ON THE COLLECTIVE KNOWLEDGE OF THE COMMUNITY AND PATIENTS WE SERVE.ORMC IS THE ONLY HOSPITAL IN BALDWIN COUNTY AND MAINTAINS AN OPEN MEDICAL STAFF. BOARD MEMBERS REPRESENT A CROSS SECTION OF OUR COMMUNITY. ORMC ESTABLISHED AN OBSTETRICS CLINIC TO PROVIDE PRENATAL AND OB SERVICES TO PATIENTS WHO DO NOT HAVE ACCESS TO A PRIVATE PHYSICIAN DUE TO PAYOR SOURCE. THE CLINIC WAS CLOSED DECEMBER 2012 AFTER RECRUITING A NEW OB/GYN TO THE AREA. ORMC CONTRIBUTED TO A NEW FEDERALLY QUALIFIED HEALTH CENTER TO ASSIST WITH START UP OPERATING COSTS. PART VI, LINE 6: ORMC'S ROLE IS TO PROVIDE HEALTHCARE TO RESIDENTS OF OUR SERVICE AREA. THE SEVICE AREA INCLUDES 7 COUNTIES. ALL PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT RECEIVE SERVICES OR TREATMENT IN ACCORDANCE WITH EMTALA. ORMC IS THE LARGEST ORGANIZATION WITHIN THE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES GA X 0 1 X X X 0 0 0 0 0 0 0 0 0 RAM PURI MD BOARD MEMBER (THRU 5/15) 0 0 0 0 293722 0 0 0 0 0 293722 0 0 0 REBECCA J AYCOCK PRESIDENT/CEO (THRU 5/15) 360756 0 0 0 7588 0 8397 0 10087 0 386828 0 0 0 BRENDA K QUALLS VP CFO 199177 0 0 0 0 0 4625 0 9990 0 213792 0 0 0 DEBORAH BLOCK VP CNO 153587 0 0 0 0 0 3643 0 19427 0 176657 0 0 0 LORRAINE DANIEL OVERHOUSE SUPERVISOR RN 120178 0 0 0 0 0 2907 0 29148 0 152233 0 0 0 DEANNE HERRING CLINICAL SUPPORT DIRECTOR 148716 0 0 0 0 0 3463 0 9675 0 161854 0 0 0 BRUCE ALAN WHITEHOUSE CIO 135297 0 0 0 0 0 0 0 27616 0 162913 0 0 0 PART I, LINE 1A THE ORGANIZATION PAYS COUNTRY CLUB DUES FOR CERTAIN OFFICERS OF THE ORGANIZATION. ANY PERSONAL USE PORTION IS INCLUDED IN THE EMPLOYEE'S FORM W-2. PART I, LINE 1B BOARD EXECUTIVE COMPENSATION COMMITTEE REVIEWS ALL COMPENSATION FOR SENIOR LEADERS. THIS REVIEW INCLUDES THE COUNTRY CLUB DUES PAID BY THE ORGANIZATION FOR JEAN AYCOCK. FORM 990, PART VI, SECTION A, LINE 7A NOMINEES TO THE BOARD OF DIRECTORS MUST BE RATIFIED BY THE BOARD OF OCONEE REGIONAL HEALTH SYSTEMS, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND WAS SENT TO ALL VOTING BOARD MEMBERS TO REVIEW. SUBSEQUENTLY THE RETURN WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ANNUALLY SIGN A STATEMENT. ALL STATEMENTS HAVE TO BE SIGNED BY A MEMBER OF SENIOR LEADERSIP. ANY CONFLICTS OF INTEREST ARE REPORTED IN THE ANNUAL AUDIT COMPLETED BY EXTERNAL AUDITORS. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS CURRENT COMPENSATION PACKAGES AND AGREEMENTS OF MEMBERS OF SENIOR LEADERSHIP, AND COMPARES THE OFFERS TO A SURVEY OF SALARY RANGES FOR COMPARATIVELY SITUATED HEALTHCARE ORGANIZATIONS. BENCHMARKS STUDIED ARE REPORTED BY THE GEORGIA HOSPITAL ASSOCIATION AND OTHERS BASED ON BED SIZE, VOLUMES, AND GEOGRAPHIC AREA. THE BOARD APPROVES THE COMPENSATION FOR THE CEO, AND APPROVES AN OVERALL PERCENTAGE INCREASE FOR THE VICE PRESIDENTS, FOR WHICH THE CEO DETERMINES ULTIMATE DISTRIBUTION. DURING THE YEAR THE COMMITTEE DID NOT MEET AND THERE WAS NO CHANGE IN COMPENSATION. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE ORGANIZATION'S FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART VII, LINE 1 BOARD MEMBERS GEORGE GRIMES AND RAM PURI RECEIVE COMPENSATION FOR MEDICAL DIRECTOR SERVICES, AS WELL AS PAYMENTS FOR MEDICAL SERVICES, TO THE ORGANIZATION, LISTED IN COLUMN (D) OF PART VII, LINE 1. NO PORTION OF THESE AMOUNTS ARE FOR SERVICES AS A MEMBER OF THE BOARD OF DIRECTORS. FORM 990, PART IX, LINE 11G PURHCASED SERVICES: PROGRAM SERVICE EXPENSES 4,433,035. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,433,035. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,375,582. MANAGEMENT AND GENERAL EXPENSES 149,394. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,524,976. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 9,189,178. MANAGEMENT AND GENERAL EXPENSES 10,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,199,178. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SEGREGATED PORTFOLIO -92,510. FORM 990, PART XI, LINE 2 THE ORGANIZATION RECEIVES AUDITED FINANCIAL STATEMENTS ON A CONSOLIDATED BASIS WITH ITS CORPORATE PARENT, OCONEE REGIONAL HEALTH SYSTEMS, AND OTHER AFFILIATED ENTITIES. FORM 990, PART XII THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. OCONEE REGIONAL HEALTH SYSTEMS INC PO BOX 690 MILLEDGEVILLE GA 31061 582359394 HEALTHCARE GA 501(C)(3) LINE 11B, II N/A 0 OCONEE REGIONAL HEALTH SERVICES INC PO BOX 690 MILLEDGEVILLE GA 31061 582359397 HEALTHCARE GA 501(C)(3) LINE 11A, I OCONEE REGIONAL HEALTH SYSTEMS INC 0 OCONEE REGIONAL EMERGENCY MEDICAL SERVICES INC PO BOX 690 MILLEDGEVILLE GA 31061 582643857 HEALTHCARE GA 501(C)(3) LINE 11A, I OCONEE REGIONAL HEALTH SERVICES INC 0 OCONEE REGIONAL HEALTHCARE FOUNDATION INC 821 NORTH COBB STREET MILLEDGEVILLE GA 31061 582359396 FUNDRAISING AND SUPPORT GA 501(C)(3) LINE 11A, I OCONEE REGIONAL HEALTH SYSTEMS INC 0 OCONEE REGIONAL SENIOR LIVING PO BOX 690 MILLEDGEVILLE GA 31061 582455613 HEALTHCARE GA 501(C)(3) LINE 11A, I OCONEE REGIONAL HEALTH SYSTEMS INC 0 JASPER HEALTH SERVICES INC PO BOX 690 MILLEDGEVILLE GA 31061 582510435 HEALTHCARE GA 501(C)(3) LINE 3 OCONEE REGIONAL HEALTH SYSTEMS INC 0 OCONEE SLEEP AND WELLNESS CENTER LLC 821 NORTH COBB STREET MILLEDGEVILLE GA 31061 264767102 HEALTHCARE GA N/A OCONEE REGIONAL HEALTH VENTURES INC PO BOX 690 MILLEDGEVILLE GA 31061 582528516 ANCILLARY HEALTHCARE GA N/A C 0 OCONEE REGIONAL HEALTH SYSTEM SEGREGATED PORTFOLIO 62 FORUM LANE 3RD FLOOR GRAND CAYMAN CJ INSURANCE CJ N/A C 0 0 0 0 1 1 0 0 0 0 1 0 0 1 0 0 0 1 1 1