CLAYTON GENERAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CLAYTON GENERAL INC (EIN 58-1955423)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-14
- IRS object ID
- 201421349349304467
- Schema version
- 2012v2.1
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-14T13:10:18-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581955423 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHERN REGIONAL HEALTH SYSTEM INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SOUT | NameControl |
| Phone | 7709918010 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 UPPER RIVERDALE RD SW | AddressLine1 |
| City | RIVERDALE | City |
| State | GA | State |
| ZIP Code | 30274 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAY HOFFMAN | Name |
| Title | CFO | Title |
| Phone | 7709918010 | Phone |
| Date Signed | 2014-05-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JAMES CRISSEY | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 UPPER RIVERDALE RD SW | AddressLine1 |
| City | RIVERDALE | City |
| State | GA | State |
| ZIP Code | 30274 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 239907580 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.SOUTHERNREGIONAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1991 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | SOUTHERN REGIONAL HEALTH SYSTEM, 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 14 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1830 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 350033 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 50779 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 246691743 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 236677977 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2947630 | InvestmentIncomePriorYear |
| Investment Income Current Year | 149986 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 3029048 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2305106 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 252719200 | TotalRevenuePriorYear |
| Total Revenue Current Year | 239133069 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1637628 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 1648361 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 93583341 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 94567498 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 167297185 | OtherExpensePriorYear |
| Other Expenses Current Year | 163635242 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 262518154 | TotalExpensesPriorYear |
| Total Expenses Current Year | 259851101 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -9798954 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -20718032 | RevenuesLessExpensesCY |
| Total Assets BOY | 161542499 | TotalAssetsBOY |
| Total Assets EOY | 157983096 | TotalAssetsEOY |
| Total Liabilities BOY | 133132516 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 140973630 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 28409983 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 17009466 | NetAssetsOrFundBalancesEOY |
| Mission Description | SOUTHERN REGIONAL HEALTH SYSTEM, 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 245111576 | Expense |
| Grants | 1648361 | Grants |
| Revenue | 237063756 | Revenue |
| Description | SOUTHERN REGIONAL HEALTH SYSTEM, INC. PROVIDED 65,298 DAYS OF ACUTE AND INTENSIVE CARE, TREATED MORE THAN 132,000 OUTPATIENTS, AND PROVIDED EMERGENCY CARE TO MORE THAN 80,057 PATIENTS IN THE EMERGENCY ROOM. SRHS ALSO PROVIDED 5,575 DAYS OF CARE TO THE MORE THAN 3,348 BABIES BORN AT SRHS. | Description |
| Total Program Service Expense | 245111576 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 88 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1830 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 14 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JAY HOFFMAN CFO | NamePerson |
| Telephone Number | 7709918010 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 UPPER RIVERDALE RD SW | AddressLine1 |
| City | RIVERDALE | City |
| State | GA | State |
| ZIP Code | 30274 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (28 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|---|
| RONALD M DODSON | ||||||||||
| CHAIRMAN | 1.00 | 3.00 | X | X | 4000 | 0 | 0 | |||
| BENNY WHITMORE | ||||||||||
| VICE CHAIRMAN | 1.00 | 3.00 | X | X | 3520 | 0 | 0 | |||
| RICHARD C PROKESCH | ||||||||||
| SECRETARY | 1.00 | X | X | 11700 | 0 | 0 | ||||
| JAY R PRAKASH | ||||||||||
| TREASURER | 1.00 | X | X | 5000 | 0 | 0 | ||||
| JAMES G ADAMS | ||||||||||
| BOARD MEMBER | 1.00 | 1.00 | X | 8200 | 0 | 0 | ||||
| REV ED J BEST JR | ||||||||||
| BOARD MEMBER | 1.00 | 1.00 | X | 4050 | 0 | 0 | ||||
| ANDREA CALLAWAY | ||||||||||
| BOARD MEMBER | 1.00 | 1.00 | X | 8370 | 0 | 0 | ||||
| SHERRY K HANCOCK | ||||||||||
| BOARD MEMBER | 1.00 | X | 4225 | 0 | 0 | |||||
| GLYNDA B KING | ||||||||||
| BOARD MEMBER | 1.00 | 1.00 | X | 3800 | 0 | 0 | ||||
| GARY J LAGGIS | ||||||||||
| BOARD MEMBER | 1.00 | X | 2200 | 0 | 0 | |||||
| DANIEL T MCDEVITT MD | ||||||||||
| BOARD MEMBER | 1.00 | X | 40476 | 0 | 0 | |||||
| PRAVEEN RASTOGI MD | ||||||||||
| BOARD MEMBER | 1.00 | X | 2631 | 0 | 0 | |||||
| RAJU M VANAPALLI | ||||||||||
| BOARD MEMBER | 1.00 | 3.00 | X | 5600 | 0 | 0 | ||||
| JAMES O WATKINS | ||||||||||
| BOARD MEMBER | 1.00 | 1.00 | X | 5500 | 0 | 0 | ||||
| BARRY ZISHOLTZ | ||||||||||
| BOARD MEMBER | 1.00 | X | 3400 | 0 | 0 | |||||
| JAMES E CRISSEY | ||||||||||
| CEO | 34.00 | 6.00 | X | 329595 | 0 | 28690 | ||||
| JAY HOFFMAN | ||||||||||
| CFO (BEGIN APRIL 2013) | 34.00 | 6.00 | X | 0 | 0 | 0 | ||||
| S LEE BOLES | ||||||||||
| CFO (THRU MARCH 2013) | 34.00 | 6.00 | X | 299403 | 0 | 27331 | ||||
| JOHN R MCLAIN | ||||||||||
| COO | 40.00 | X | 294267 | 0 | 23522 | |||||
| WILLIE COCHRAN | ||||||||||
| CMO | 40.00 | X | 263311 | 0 | 26214 | |||||
| JANIS M DARNABY | ||||||||||
| CNO (THRU APRIL 2013) | 40.00 | X | 231586 | 0 | 12987 | |||||
| JOE E BARKER | ||||||||||
| KEY EMPLOYEE | 40.00 | 155574 | 0 | 9784 | X | |||||
| STACEY J HANCOCK | ||||||||||
| HIGHEST COMPENSATED EMPLOYEE | 40.00 | 154698 | 0 | 20661 | X | |||||
| CLAUDIA E HALL | ||||||||||
| HIGHEST COMPENSATED EMPLOYEE | 40.00 | 144029 | 0 | 20237 | X | |||||
| WELLINGTON ROLLIE | ||||||||||
| HIGHEST COMPENSATED EMPLOYEE | 55.50 | 142839 | 0 | 20190 | X | |||||
| YVELINE SAMUEL-HERARD | ||||||||||
| HIGHEST COMPENSATED EMPLOYEE | 50.40 | 138978 | 0 | 23100 | X | |||||
| SHARON W SIMMONS | ||||||||||
| HIGHEST COMPENSATED EMPLOYEE | 40.00 | 135791 | 0 | 18521 | X | |||||
| STEPHEN W MAHAN | ||||||||||
| FORMER CEO | 40.00 | 134713 | 0 | 11292 | X | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2537456 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 242529 | TotalOtherCompensation |
| Number Individuals GT100 K | 65 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| COMPLETERX | |||||
| 3100 S GESSNER STE 640 | HOUSTON | TX | 77063 | PHARMACY MANAGEMENT | 15603821 |
| MORRISONS MANAGEMENT SERVICES | |||||
| PO BOX 102289 | ATLANTA | GA | 30368 | CAFETERIA MANAGEMENT | 4550347 |
| GREENBERG TRAURIG LLP | |||||
| 3290 NORTHSIDE PARKWAY | ATLANTA | GA | 30368 | LEGAL SERVICES | 1354779 |
| SOUND PHYSICIANS | |||||
| PO BOX 742936 | LOS ANGELES | CA | 90074 | PHYSICIAN SERVICES | 1065067 |
| NELSON MULLINS RILEY & SCARBOROUGH LLP | |||||
| PO BOX 11070 | COLUMBIA | SC | 29211 | LEGAL SERVICES | 890628 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 117 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICE | 623000 | 236327944 | 236327944 | |
| LAB OUTREACH | 621500 | 350033 | 350033 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 236677977 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 923149 | TotalRevenueColumn |
| Exclusion | $923,149 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1348 | TotalRevenueColumn |
| Exclusion | $1,348 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 660183 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 660183 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 660183 | TotalRevenueColumn |
| Exclusion | $660,183 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 774511 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -774511 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -774511 | TotalRevenueColumn |
| Exclusion | -$774,511 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| EAGLE PHYSICIANS | 900099 | 735812 | 735812 | |
| PAID PARKING REVENUE | 621990 | 520067 | $520,067 | |
| MISCELLANEOUS | 900099 | 199613 | $199,613 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 189431 | TotalRevenueColumn |
| Exclusion | $189,431 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1644923 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 239133069 | TotalRevenueColumn |
| Related Or Exempt Function Income | 237063756 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 350033 | UnrelatedBusinessRevenue |
| Exclusion | $1,719,280 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1558195 | Total |
| Program Services | 1558195 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 90166 | Total |
| Program Services | 90166 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1781562 | Total |
| Management And General | 1781562 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74706302 | Total |
| Program Services | 70792945 | ProgramServices |
| Management And General | 3913357 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3455605 | Total |
| Program Services | 3198317 | ProgramServices |
| Management And General | 257288 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9028466 | Total |
| Program Services | 8356250 | ProgramServices |
| Management And General | 672216 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5595563 | Total |
| Program Services | 5178944 | ProgramServices |
| Management And General | 416619 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104163 | Total |
| Management And General | 104163 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 549742 | Total |
| Management And General | 549742 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156702 | Total |
| Management And General | 156702 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24688 | Total |
| Management And General | 24688 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29881614 | Total |
| Program Services | 27690654 | ProgramServices |
| Management And General | 2190960 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 715774 | Total |
| Management And General | 715774 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2889232 | Total |
| Program Services | 2395981 | ProgramServices |
| Management And General | 493251 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3048066 | Total |
| Program Services | 3048066 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5411242 | Total |
| Program Services | 5407982 | ProgramServices |
| Management And General | 3260 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 162534 | Total |
| Program Services | 95965 | ProgramServices |
| Management And General | 66569 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 414820 | Total |
| Program Services | 236559 | ProgramServices |
| Management And General | 178261 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2948905 | Total |
| Program Services | 2948905 | ProgramServices |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14921 | Total |
| Management And General | 14921 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8354047 | Total |
| Program Services | 8354047 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2851653 | Total |
| Management And General | 2851653 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| BAD DEBT | 52085258 | 52085258 |
| MEDICAL SUPPLIES | 36246075 | 36246075 |
| PATIENT RELATED EXPENSE | 10331786 | 10331786 |
| PROVIDER TAX | 3249575 | 3249575 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4194445 | Total |
| Program Services | 3845906 | ProgramServices |
| Management And General | 348539 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 259851101 | Total |
| Program Services | 245111576 | ProgramServices |
| Management And General | 14739525 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7450 | BOY |
| EOY | 5449 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2594989 | BOY |
| EOY | 3168505 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 46011842 | BOY |
| EOY | 43615917 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 436621 | BOY |
| EOY | 584479 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2823171 | BOY |
| EOY | 2942239 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1168656 | BOY |
| EOY | 1071543 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 288543802 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 220691212 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61112949 | BOY |
| EOY | 67852590 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41460146 | BOY |
| EOY | 34000447 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2754765 | BOY |
| EOY | 2592304 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 250570 | BOY |
| EOY | 250570 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2921340 | BOY |
| EOY | 1899053 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 161542499 | BOY |
| EOY | 157983096 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31959913 | BOY |
| EOY | 51319054 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42775922 | BOY |
| EOY | 41632850 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13144263 | BOY |
| EOY | 13161490 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45252418 | BOY |
| EOY | 34860236 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 133132516 | BOY |
| EOY | 140973630 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28153018 | BOY |
| EOY | 16726219 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 256965 | BOY |
| EOY | 283247 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28409983 | BOY |
| EOY | 17009466 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 161542499 | BOY |
| EOY | 157983096 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -20718032 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 1398987 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 7918528 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $17,709 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 17709 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE HOSPITAL IS A MEMBER OF THE GEORGIA HOSPITAL ASSOCIATION (GHA). THIS ORGANIZATIONS 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 $17,709 FOR GHA. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1068402 | OtherCostOrOtherBasis |
| Book Value | 1068402 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 127899191 | OtherCostOrOtherBasis |
| Depreciation | 90501621 | Depreciation |
| Book Value | 37397570 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6386071 | OtherCostOrOtherBasis |
| Depreciation | 4561391 | Depreciation |
| Book Value | 1824680 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 140782811 | OtherCostOrOtherBasis |
| Depreciation | 125628200 | Depreciation |
| Book Value | 15154611 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12407327 | OtherCostOrOtherBasis |
| Book Value | 12407327 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 67852590 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (6 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| INSURANCE RESERVE | $13,124,851 |
| ACCRUED BOND INTEREST | $819,347 |
| PHYSICIAN DINING | $138,164 |
| UNFUNDED PENSION LIABILITY | $20,352,786 |
| PROFESSIONAL FEES PAYABLE | $33,170 |
| MORRISON'S DEBT FORGIVENESS | $391,918 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 34860236 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 125.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8451669 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 8451669 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04070 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 53425267 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 48542012 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4883255 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02350 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 61876936 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 48542012 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 13334924 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06420 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22451737 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13982193 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8469544 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04080 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22451737 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13982193 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8469544 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04080 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 84328673 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 62524205 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 21804468 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10500 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $13,453,622 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 47821872 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 46141294 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1680578 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 SPIVEY STATION ASC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | REAL ESTATE MANAGEMENT | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.45410 | OrganizationProfitOrOwnership |
| Physicans Profit Or Ownership | 0.48000 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHERN REGIONAL HEALTH SYSTEM | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 11 UPPER RIVERDALE RD SW | AddressLine1 |
| City | RIVERDALE | City |
| State | GA | State |
| ZIP Code | 30274 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SOUTHERN REGIONAL HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 125.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 6A: THE ORGANIZATION PREPARED A REPORT TO THE COMMUNITY FOR FY 2012, AND IT IS POSTED ON THE SOUTHERN REGIONAL MEDICAL CENTER WEB SITE IN AN ADOBE PDF FORMAT. | ||
| 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 I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 52085258. | ||
| 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 2012 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 HTE 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 V, SECTION B, LINE 3: 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. | SOUTHERN REGIONAL HEALTH SYSTEM | |
| PART V, SECTION B, LINE 4: 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 | SOUTHERN REGIONAL HEALTH SYSTEM | |
| PART V, SECTION B, LINE 20D: 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. | SOUTHERN REGIONAL HEALTH SYSTEM | |
| 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. | ||
| GA | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| SOUTHERN CRESCENT PHYSICIANS GROUP | |||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 581955425 | 501(C)(3) | 1124970 | OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE |
| SOUTHERN CRESCENT REAL ESTATE | |||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 581955424 | 501(C)(3) | 310000 | OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE |
| ARTS CLAYTON | |||||||
| 1365 S MAIN ST | JONESBORO | GA | 30236 | 581727604 | 501(C)(3) | 6000 | OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE |
| UNIVERSITY OF GEORGIA FOUNDATION | |||||||
| 394 SOUTH MILLEDGE AVE | ATHENS | GA | 30602 | 586033837 | 501(C)(3) | 30000 | OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE |
| SOUTHLAKE AMBULATORY SURGERY CENTER LP | |||||||
| 7813 SPIVEY STATION BLVD | JONESBORO | GA | 30236 | 582272588 | 65000 | OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE | |
| GOOD SHEPARD CLINIC | |||||||
| 6392 MURPHY DR | MORROW | GA | 30260 | 582578581 | 501(C)(3) | 5000 | OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE |
| AMERICAN HEART ASSOCIATION | |||||||
| 7272 GREENVILLE AVE | DALLAS | TX | 75231 | 135613797 | 501(C)(3) | 5000 | OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 6 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 1 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | TUITION ASSISTANCE | TypeOfGrant |
| Number Of Recipients | 42 | NumberOfRecipients |
| Amount Of Cash Grant | 88005 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | X | TravelForCompanions |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES E CRISSEY | ||||||||||||||
| CEO | 323926 | 0 | 0 | 0 | 5669 | 0 | 9233 | 0 | 19457 | 0 | 358285 | 0 | 0 | 0 |
| S LEE BOLES | ||||||||||||||
| CFO (THRU MARCH 2013) | 290321 | 0 | 0 | 0 | 9082 | 0 | 8961 | 0 | 18370 | 0 | 326734 | 0 | 0 | 0 |
| JOHN R MCLAIN | ||||||||||||||
| COO | 288618 | 0 | 0 | 0 | 5649 | 0 | 9041 | 0 | 14481 | 0 | 317789 | 0 | 0 | 0 |
| WILLIE COCHRAN | ||||||||||||||
| CMO | 258152 | 0 | 0 | 0 | 5159 | 0 | 7844 | 0 | 18370 | 0 | 289525 | 0 | 0 | 0 |
| JANIS M DARNABY | ||||||||||||||
| CNO (THRU APRIL 2013) | 229236 | 0 | 0 | 0 | 2350 | 0 | 7407 | 0 | 5580 | 0 | 244573 | 0 | 0 | 0 |
| JOE E BARKER | ||||||||||||||
| KEY EMPLOYEE | 153626 | 0 | 0 | 0 | 1948 | 0 | 5412 | 0 | 4372 | 0 | 165358 | 0 | 0 | 0 |
| STACEY J HANCOCK | ||||||||||||||
| HIGHEST COMPENSATED EMPLOYEE | 150589 | 0 | 0 | 0 | 4109 | 0 | 6180 | 0 | 14481 | 0 | 175359 | 0 | 0 | 0 |
| CLAUDIA E HALL | ||||||||||||||
| HIGHEST COMPENSATED EMPLOYEE | 119891 | 0 | 20000 | 0 | 4138 | 0 | 5756 | 0 | 14481 | 0 | 164266 | 0 | 0 | 0 |
| WELLINGTON ROLLIE | ||||||||||||||
| HIGHEST COMPENSATED EMPLOYEE | 135071 | 0 | 2475 | 0 | 5293 | 0 | 5709 | 0 | 14481 | 0 | 163029 | 0 | 0 | 0 |
| YVELINE SAMUEL-HERARD | ||||||||||||||
| HIGHEST COMPENSATED EMPLOYEE | 134345 | 0 | 250 | 0 | 4383 | 0 | 4864 | 0 | 18236 | 0 | 162078 | 0 | 0 | 0 |
| SHARON W SIMMONS | ||||||||||||||
| HIGHEST COMPENSATED EMPLOYEE | 131465 | 0 | 0 | 0 | 4326 | 0 | 4040 | 0 | 14481 | 0 | 154312 | 0 | 0 | 0 |
| STEPHEN W MAHAN | ||||||||||||||
| FORMER CEO | 132867 | 0 | 0 | 0 | 1846 | 0 | 5124 | 0 | 6168 | 0 | 146005 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| 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. ADDITIONALLY, SOUTHERN REGIONAL HEALTH SYSTEM, INC. HAS A CORPORATE MEMBERSHIP TO A LOCAL COUNTRY CLUB FOR WHICH SELECTED OFFICERS AND KEY EMPLOYEES PARTICIPATE IN SOCIAL CLUB MEMBERSHIP. THE ORGANIZATION INTENDS FOR THESE PRIVILGES TO BE BUSINESS USE ONLY AND CONSEQUENTLY, THESE BENEFITS ARE NOT INCLUDED IN THEIR TAXABLE WAGES. |
| 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 K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| CLAYTON COUNTY HOSPITAL AUTHORITY SERIES 2010A | ||||||||
| A | 582016041 | 184153EE0 | 2010-12-15 | 35205000 | REFINANCE 2009 BONDS | 0 | 1 | 0 |
| CLAYTON COUNTY HOSPITAL AUTHORITY SERIES 2010B | ||||||||
| B | 582016041 | 184153EQ3 | 2010-12-15 | 7500000 | REFINANCE 1998A BONDS | 0 | 1 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|
| A | 3000 | 35280659 | 34693200 | 587459 | 1 | 0 | 1 | 1 |
| B | 1140000 | 7500000 | 7374841 | 125159 | 1 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)
| Bond ReferenceBondReferenceCd | Proc To Undertk Corrective ActionProcToUndertkCorrectiveAction |
|---|---|
| A | 0 |
| B | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE TAX RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT. THE COMPLETED IRS FORM 990 TAX RETURN, ALONG WITH ALL SUPPORTING SCHEDULES, WAS POSTED TO THE SRHS EXTRANET FOR BOARD MEMBER ACCESS AND REVIEW NOTIFICATION OF THE POSTING WAS SENT VIA EMAIL. 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 IX, LINE 11G | CONSULTING : PROGRAM SERVICE EXPENSES 113,158. MANAGEMENT AND GENERAL EXPENSES 503,896. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 617,054. PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 27,577,496. MANAGEMENT AND GENERAL EXPENSES 1,687,064. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,264,560. | OTHER FEES |
| FORM 990, PART XI, LINE 9: | ACCRUED PENSION ADJUSTMENT 8,540,000. CHANGES IN NET ASSETS 982,000. TRANSFER OF CAPITAL -1,631,030. ROUNDING ADJUSTMENT 27,558. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| SOUTHERN CRESCENT PHYSICIANS GROUP | ||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 581955425 | HEALTHCARE | GA | 501(C)(3) | 3 | SOUTHERN REGIONAL HEALTH SYSTEM INC | 1 |
| SOUTHERN REGIONAL MEDICAL CENTER FOUNDATION | ||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 581983516 | FUNDRAISING | GA | 501(C)(3) | LINE 11, TYPE II | SOUTHERN REGIONAL HEALTH SYSTEM INC | 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 | SOUTHERN REGIONAL HEALTH SYSTEM INC | 1 |
| SOUTHERN REGIONAL AMBULATORY SURGERY INC | ||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 582541044 | HEALTHCARE | GA | 501(C)(3) | LINE 11, TYPE II | SOUTHERN REGIONAL HEALTH SYSTEM INC | 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 | SOUTHERN REGIONAL HEALTH SYSTEM INC | 1 |
| SOUTHERN CRESCENT REAL ESTATE INC | ||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 581955424 | REAL ESTATE MANAGEMENT | GA | 501(C)(3) | LINE 11, TYPE II | SOUTHERN REGIONAL HEALTH SYSTEM INC | 1 |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPIVEY STATION ASC BUILDING LP | ||||||||||||||
| TWO SUN COURT STE 350 | NORCROSS | GA | 30092 | 263323060 | RENTAL | GA | SOUTHERN REGIONAL HEALTH SYSTEM INC | RELATED | 76692 | 5125004 | 0 | 0 | 0.45410 | |
| SOUTHLAKE AMBULATORY SURGERY CENTER | ||||||||||||||
| 4000 CORPORATE CENTER DR | MORROW | GA | 30260 | 582272588 | SURGICAL | GA | N/A | |||||||
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SOUTHERN REGIONAL MEDICAL SERVICES INC | ||||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 208774854 | EQUIPMENT LEASE | GA | SOUTH REGIONAL HEALTH SYSTEM INC | C | 46641 | 485459 | 1.00000 | 1 |
| SOUTHERN CRESCENT HEALTH NETWORK INC | ||||||||||||
| 11 UPPER RIVERDALE RD SW | RIVERDALE | GA | 30274 | 582220817 | PHYSICIAN NETWORK | GA | SOUTH REGIONAL HEALTH SYSTEM INC | C | -583 | 82579 | 1.00000 | 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 | 1 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| SOUTHERN REGIONAL AMBULATORY SURGERY | |
| B | 65000 |
| SOUTHERN CRESCENT PHYSICIANS GROUP | |
| B | 1124970 |
| SOUTHERN CRESCENT REAL ESTATE | |
| B | 310000 |