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PIEDMONT REGIONAL HEALTH INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
PIEDMONT REGIONAL HEALTH INC (EIN 43-2007498)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-13
IRS object ID
201441339349300129
Schema version
2012v2.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-05-13T06:51:17-07:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1McNair McLemore MiddlebrooksBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1Post Office Box OneAddressLine1
CityMaconCity
StateGAState
ZIP Code312020001ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN432007498EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Piedmont Regional Health IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPIEDNameControl
Phone4786212100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11005 Boulder DriveAddressLine1
CityGrayCity
StateGAState
ZIP Code31032ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTeresa W MoodyName
TitleSecretaryTitle
Date Signed2014-05-13DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJ RANDOLPH NICHOLSName
PTINP00347246PTIN
Phone4787466277Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts26516032GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web Sitewww.ethicahealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2003YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionThe development, construction, acquisition, ownership, leasing, management and operation of skilled health care facilities.ActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees594TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year22407388ProgramServiceRevenuePriorYear
Program Service Revenue CY26514725ProgramServiceRevenueCY
Investment Income Prior Year3952InvestmentIncomePriorYear
Investment Income Current Year1307InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year22411340TotalRevenuePriorYear
Total Revenue Current Year26516032TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9807204SalariesEtcPriorYear
Salaries Etc Current Year10503682SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year11036623OtherExpensePriorYear
Other Expenses Current Year12793615OtherExpensesCurrentYear
Total Expenses Prior Year20843827TotalExpensesPriorYear
Total Expenses Current Year23297297TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1567513RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3218735RevenuesLessExpensesCY
Total Assets BOY11016733TotalAssetsBOY
Total Assets EOY12094938TotalAssetsEOY
Total Liabilities BOY9376627TotalLiabilitiesBOY
Total Liabilities EOY10351818TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1640106NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1743120NetAssetsOrFundBalancesEOY
Mission DescriptionThe development, construction, acquisition, ownership, leasing, management and operation of skilled health care facilities.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense23297297Expense
Revenue26514725Revenue
DescriptionLeased and operated skilled care, intermediate care and other health care related facilities. Consistent with the policies previously adopted by the board of directors of Community Health Systems, Inc., the Section 509(a)(3) supporting organization and parent entity of the integrated health care delivery system of which the Organization is a member, the Organization provides substantial community benefit to the communities it serves pursuant to both community benefit quidelines and a charity care policy. The Organization continues to assess and develop programs to benefit the community.Description
Total Program Service Expense23297297TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109692NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees594NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonPiedmont Regional Health IncNamePerson
Telephone Number4786212100TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11005 Boulder DriveAddressLine1
CityGrayCity
StateGAState
ZIP Code31032ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerFormerFormer
Buddy Ponder
Director4.000.00X0240000
J Olan Jones
Director4.000.00X0240000
Paul A Cable
Director4.000.00X0240000
James B Patton
Director4.000.00X0240000
Joseph A Wall
Chairman4.000.00X0240000
Teresa W Moody
Secretary4.000.00015577016560X
Kay F Gray
President13.330.00015275310227X
T Randolph Coody
Director0.0040.00016311417879X
Ronnie D Rollins
Director0.0040.000124125323167X
FieldValueIRS element (for citing)
Total Reportable Comp Frm Rltd Orgs1832890TotalReportableCompFrmRltdOrgs
Total Other Compensation67833TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Rose Group Inc
PO Box 567Lake ButlerFL32054Medical125979
Pulaski Real Estate Holdings
PO Box 448MetterGA30439Lease102977
MSC Nursing Home LLC
PO Box 448MetterGA30439Lease412425
Linde RSS LLC
104B West Court SquareLivingstonTN38570Medical787532
IWBP LLC
1060 East Hiawatha StreetMetterGA30439Heating & Air415870
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Service Revenues66329196632919
Governmental Programs Rev1988180619881806
FieldValueIRS element (for citing)
Total Program Service Revenue26514725TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1307TotalRevenueColumn
Exclusion$1,307ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column26516032TotalRevenueColumn
Related Or Exempt Function Income26514725RelatedOrExemptFunctionIncome
Exclusion$1,307ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8502274Total
Program Services8502274ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total126432Total
Program Services126432ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1224711Total
Program Services1224711ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total650265Total
Program Services650265ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total902823Total
Program Services902823ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total52337Total
Program Services52337ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total0Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total44880Total
Program Services44880ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total714688Total
Program Services714688ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total492107Total
Program Services492107ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total250431Total
Program Services250431ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
Support Services928476928476
Taxes and Licenses19462651946265
Nursing Services23603852360385
Contracted Services30631473063147

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2038076Total
Program Services2038076ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total23297297Total
Program Services23297297ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY984518BOY
EOY956102EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1838614BOY
EOY3365100EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY42161BOY
EOY41215EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis10298830LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2688364LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY7535998BOY
EOY7610466EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY615442BOY
EOY122055EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11016733BOY
EOY12094938EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1404573BOY
EOY1419010EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY3105000BOY
EOY3004000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY4867054BOY
EOY4722644EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
EOY1206164EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY9376627BOY
EOY10351818EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1640106BOY
EOY1743120EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1640106BOY
EOY1743120EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11016733BOY
EOY12094938EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3218735ReconcilationRevenueExpenses
Reconcilation Other Changes-3115721ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Total0Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years17378588CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years19960791CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20318769CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22407388CurrentTaxYearMinus1Year
Current Tax Year26514725CurrentTaxYear
Total106580261Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years17378588CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years19960791CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20318769CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22407388CurrentTaxYearMinus1Year
Current Tax Year26514725CurrentTaxYear
Total106580261Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509106580261PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8954CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years164CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9349CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3952CurrentTaxYearMinus1Year
Current Tax Year1307CurrentTaxYear
Total23726Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8954CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years164CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9349CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3952CurrentTaxYearMinus1Year
Current Tax Year1307CurrentTaxYear
Total23726Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Total0Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years17387542CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years19960955CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20328118CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22411340CurrentTaxYearMinus1Year
Current Tax Year26516032CurrentTaxYear
Total106603987Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99980PublicSupportPercentage509
Prior Year Support Percentage0.99950PriorYearSupportPercentage
Investment Income Percentage0.00020InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00050PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8900000OtherCostOrOtherBasis
Depreciation2461065Depreciation
Book Value6438935BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1051798OtherCostOrOtherBasis
Depreciation118232Depreciation
Book Value933566BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis347032OtherCostOrOtherBasis
Depreciation109067Depreciation
Book Value237965BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7610466TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDistribution PayableDescription
Amount$1,206,164Amount
FieldValueIRS element (for citing)
Total Of Amounts1206164TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt26516032TotRevenueEtcAuditedFinclStmt
Revenue Subtotal26516032RevenueSubtotal
Total Revenue Per Form99026516032TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt23297297TotExpensesEtcAuditedFinclStmt
Expenses Subtotal23297297ExpensesSubtotal
Total Expenses Per Form99023297297TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleComp Based On Related OrgsCompBasedOnRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgs
Teresa W Moody
Secretary155770623110329172330
T Randolph Coody
Director163114652511354180993
Ronnie D Rollins
Director124125310000131671264420
Kay F Gray
President15275361104117162980

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Middle Coastal Unified Development AuthorityBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN582140014IssuerEIN
Date Issued2007-01-15DateIssued
Issue Price3515000IssuePrice
Description Of PurposeAcquisition of Real EstateDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Total Proceeds3515000TotalProceeds
Current RefundingfalseCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiled
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Regulatory Safe Harbor SatisfiedfalseRegulatorySafeHarborSatisfied
Gross Proceeds InvestedfalseGrossProceedsInvested
Written Proc To Monitor ReqstrueWrittenProcToMonitorReqs

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part XI, Line 9Other Changes In Net Assets Or Fund Balances - Other DecreasesDistributed to a Supporting Organization of the Int H Del Sy = -$3115721
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableThe Organization's governing documents, conflict of interest policy and financial statements are available for public inspection upon request in accordance with the Section 6104(d) disclosure requirements.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThe Organization regularly and consistently complies with the compensation approval process which is part of its conflicts of interest policy. Every two to three years, on average, the Organization participates in a comprehensive process conducted on its behalf by the compensation committee of the board of directors of Community Health Systems, Inc., its sole member and parent of the integrated health care delivery system in which the Organization is a member. This process involves review of comparability data compiled by an independent third-party compensation consultant. Comparability data is gathered for the Organization's senior management, and on occasion, key or highly compensated employees, and, based on the same, the consultant issues a written report reflecting the consultant's opinion concerning whether the proposed compensation arrangements constitute reasonable compensation under Section 4958 of the Code. This process is conducted by the compensation committee, which then makes recommendations to the board of directors. The board of directors is also provided with materials regarding the compensation review, including copies of the consultant's report. The board then votes as to the reasonableness of each of the individual compensation arrangements (if any disqualified or otherwise conflicted individuals are present at the meeting, they do not participate in the deliberations and are excused from the room during the vote). The process is designed and carried out by the board of directors in a manner designed to satisfy all three of the requirements necessary to establish the rebuttable presumption of reasonableness with respect to compensation arrangements for disqualified persons under Section 53.4958-6 of the Regulations. As part of this process, outside counsel is retained to further advise the board on the rebuttable presumption process and to provide the board with a legal opinion regarding the same. As a final step, each part of the process required to establish the rebuttable presumption is documented using the Rebuttable Presumption Checklist released by the IRS.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsThe organization regularly and consistently monitors and enforces compliance with its conflicts of interest policy. Such compliance is effectuated through the Organization's board of directors' review of annual conflict disclosure statements from the directors as well as receipt and review of conflict disclosure statements with respect to certain proposed transactions or arrangements the Organization is considering prior to any board action with respect to such matters. The conflicts policy outlines the specific procedure to be followed to determine whether interested persons have actual conflicts of interest. If it is determined that a board member has an actual conflict of interest, then such board member is not allowed to participate in the board deliberations on the specific matter and is excused from, and is not allowed to participate in any board vote on the matter.
Form 990, Part VI, Line 11bForm 990, Part VI, Line 11b: Form 990 Review ProcessThis process involves the electronic posting of the draft Form 990 with all its schedules for the Organization's board of directors to review followed, after a sufficient review period, by a meeting of the board at which board members will have the opportunity to ask questions of management and the outside tax advisors involved in the preparation of the Form 990.
Form 990, Part VI, Line 6Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderThe Organization has a sole member, Community Health Systems, Inc., a nonprofit Georgia corporation.
Form 990, Part VI, Line 2Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, EtEach of the directors of the Organization, Messrs. Wall, Ponder, Patton, Cable and Jones, are also members of the board of directors of Community Health Ventures, Inc., a taxable Georgia corporation which is a related organization. This director overlap creates a business relationship.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Johnson County LTC LLC
1005 Boulder DriveGrayGA31032203644958Health CareGA4317742427151NA
Candler County II LTC LLC
1005 Boulder DriveGrayGA31032203644923Health CareGA5359469661319NA
Bulloch County LTC LLC
1005 Boulder DriveGrayGA31032203644663Health CareGA61093001881569NA
Evans County LTC LLC
1005 Boulder DriveGrayGA31032203645112Health CareGA4554079325620NA
Candler County LTC LLC
1005 Boulder DriveGrayGA31032203644753Health CareGA5435882599092NA

Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Steward Health Services Inc
213 Third StreetMaconGA31201432007486Hospice Services, Home Health ServicesGA501(c)(3)Line 9NAfalse
Community Ancillary Services Inc
213 Third StreetMaconGA31201432007496Pharmaceutical, Med Supply & Home CareGA501(c)(3)Line 9NAfalse
Home & Community Services Inc
PO Box 1803MaconGA31202432007492Transportation & Managed CareGA501(c)(3)Line 9NAfalse
Health Systems Real Estate Inc
1005 Boulder DriveGrayGA31032432007488Real EstateGA501(c)(3)Line 9NAfalse
Health Systems Facilities Inc
1005 Boulder DriveGrayGA31032743083594Operation of HC FacilitiesGA501(c)(3)Line 9NAfalse
Health Scholarships Inc
1005 Boulder DriveGrayGA31032581805305Operation of HC FacilitiesGA501(c)(3)Line 9NAfalse
Community Rehabilitation Services Inc
PO Box 1804MaconGA31202203253779Rehabilitation ServicesGA501(c)(3)Line 9NAfalse
Community Health Systems Inc
PO Box 1037MaconGA31202743083593Support ServicesGA501(c)(3)Ln 11, Type 1NAfalse
Community Health Foundation Inc
PO Box 1833MaconGA31202571157153Financial Support, Scholarship ProgramGA501(c)(3)Line 9NAfalse
Clinical Services Inc
1005 Boulder DriveGrayGA31032571157115Clinical & Healthcare ServicesGA501(c)(3)Line 9NAfalse

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Community Health Ventures IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1213 Third StreetAddressLine1
CityMaconCity
StateGAState
ZIP Code31201ZIPCode
FieldValueIRS element (for citing)
EIN201392241EIN
Primary ActivityRisk Mgmt.PrimaryActivity
Legal Domicile StateGALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CHSIBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC corpTypeOfEntity
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Community Ancillary Services Inc
m1382840
Community Rehabilitation Services Inc
m1710161
Community Health Systems Inc
m928476
Community Health Foundation Inc
r815081
Clinical Services Inc
m902824
Clinical Services Inc
j73625