CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY (EIN 63-0288852)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-02-05
- IRS object ID
- 201300369349300610
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-02-05T08:22:16-06:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAFFIN & TUCKER LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 6 | AddressLine1 |
| City | ALBANY | City |
| State | GA | State |
| ZIP Code | 317020006 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 630288852 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATTAHOOCHEE VALLEY HOSPITAL | BusinessNameLine1 |
| Business Name Line2 | SOCIETY | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHAT | NameControl |
| Phone | 3347561050 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4800 48TH STREET | AddressLine1 |
| City | VALLEY | City |
| State | AL | State |
| ZIP Code | 36854 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DOUG DEWBERRY | Name |
| Title | CEO | Title |
| Phone | 3347561050 | Phone |
| Date Signed | 2013-02-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACQUELINE G ATKINS | Name |
| Phone | 2298837878 | Phone |
| Date Prepared | 2013-02-04 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DOUG DEWBERRY | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4800 48TH STREET | AddressLine1 |
| City | VALLEY | City |
| State | AL | State |
| ZIP Code | 36854 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 51706844 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.LANIERHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1942 | YearFormation |
| State Legal Domicile | AL | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE MEDICAL SERVICES TO RESIDENTS OF CHAMBERS COUNTY, ALABAMA AND WEST POINT, GEORGIA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 17 | NbrIndependentVotingMembers |
| Total Nbr Employees | 704 | TotalNbrEmployees |
| Total Nbr Volunteers | 75 | TotalNbrVolunteers |
| Total Gross UBI | 40833 | TotalGrossUBI |
| Contributions Grants Prior Year | 613870 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 90245 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 49022998 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 49479644 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 45438 | InvestmentIncomePriorYear |
| Investment Income Current Year | 26666 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 342111 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2101568 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 50024417 | TotalRevenuePriorYear |
| Total Revenue Current Year | 51698123 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 21737582 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 23339131 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 28320352 | OtherExpensePriorYear |
| Other Expenses Current Year | 29023532 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 50057934 | TotalExpensesPriorYear |
| Total Expenses Current Year | 52362663 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -33517 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -664540 | RevenuesLessExpensesCY |
| Total Assets BOY | 35283275 | TotalAssetsBOY |
| Total Assets EOY | 37243295 | TotalAssetsEOY |
| Total Liabilities BOY | 17553725 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 20178285 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 17729550 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 17065010 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE MEDICAL SERVICES TO RESIDENTS OF CHAMBERS COUNTY, ALABAMA AND WEST POINT, GEORGIA. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 48996320 | Expense |
| Revenue | 51365346 | Revenue |
| Description | THE GEORGE H. LANIER MEMORIAL HOSPITAL PROVIDES EMERGENCY SERVICES, AN ENCOSCOPY UNIT, SURGERY UNIT, CATH LAB, CARDIAC REHAB, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, RADIOLOGY LAB AND SLEEP DISORDERS LAB. THE HOSPITAL IS A LICENSED 115-BED NOT-FOR-PROFIT ACUTE CARE FACILITY PRIMARILY SERVING CHAMBER COUNTY, ALABAMA AND WEST POINT, GEORGIA. SERVICES PROVIDED INCLUDE GENERAL SURGERY, CARDIOLOGY, GENERAL MEDICINE, GASTROENTEROLOGY, PULMONARY, EMERGENCY MEDICINE, IMAGING/RADIOLOGY, DIALYSIS, AMBULATORY SURGERY AND SWING BED. THE GEORGE H. LANIER NURSING HOME IS A 103-BED SKILLED NURSING FACILITY. | Description |
| Total Program Service Expense | 48996320 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | true | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 98 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 704 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 17 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | DAVID WILKERSON | NamePerson |
| Telephone Number | 3347561050 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4800 48TH STREET | AddressLine1 |
| City | VALLEY | City |
| State | AL | State |
| ZIP Code | 36854 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (26 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ARVIND KAMATH MD | |||||||
| TRUSTEE | 3.00 | X | 8115 | 0 | 0 | ||
| DOT ANDERSON | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| LUANNE D BERLIN | |||||||
| VICE PRESIDE | 3.00 | X | 0 | 0 | 0 | X | |
| GLORIA HULL | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| RICHARD SCOTT | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| ARTHUR PERKINS MD | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| KAYE MAXWELL | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| CY WOOD | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| JOSH MOON | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| CURT KOLLAR | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| JAMES BENDELL MD | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| OSCAR CRAWLEY | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| CAM LANIER | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| WILLIAM SCOTT III | |||||||
| PRESIDENT | 3.00 | X | 0 | 0 | 0 | X | |
| GAINES LANIER | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| VALERIE GRAY | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| KRIS REDDY MD | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| TERRY VESTER MD | |||||||
| TRUSTEE | 3.00 | X | 0 | 0 | 0 | ||
| DAVID WILKERSON | |||||||
| SECRETARY/TR | 3.00 | X | 0 | 0 | 0 | X | |
| DOUG DEWBERRY | |||||||
| CEO | 50.00 | 228383 | 0 | 6464 | X | ||
| TOMMY LANE | |||||||
| CFO | 50.00 | 118075 | 0 | 6316 | X | ||
| PHILLIPPE TRANQUI | |||||||
| PHYSICIAN | 50.00 | 345364 | 0 | 6464 | X | ||
| MAX SHIVER MD | |||||||
| PHYSICIAN | 50.00 | 288594 | 0 | 6464 | X | ||
| DAVID FAGAN | |||||||
| PHYSICIAN | 50.00 | 279624 | 0 | 6464 | X | ||
| JOHN DUKE | |||||||
| PHARMACIST | 42.00 | 130580 | 0 | 6341 | X | ||
| MICHAEL HARRIS | |||||||
| LABORATORY M | 42.00 | 108272 | 0 | 6289 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1507007 | TotalReportableCompFromOrg |
| Total Other Compensation | 44802 | TotalOtherCompensation |
| Number Individuals GT100 K | 9 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| LANGFORD CONSTRUCTION | |||||
| 314 GREENVILLE ST | LAGRANGE | GA | 30240 | CONTRACTOR | 2280447 |
| HUMAN PERFORMANCE & REHAB CTRS | |||||
| P O BOX 8068 | COLUMBUS | GA | 319088068 | PHYSICAL THERAP | 1408804 |
| CPSI | |||||
| P O BOX 850309 | MOBILE | AL | 366850309 | IT SYSTEMS | 435418 |
| EMCARE PHYSICIAN SERVICES | |||||
| 7032 COLLECTION CENTER | CHICAGO | IL | 60693 | ER PHYSICIANS | 243306 |
| LABORATORY CORPORATION | |||||
| P O BOX 12140 | BURLINGTON | NC | 27215 | O/S LAB FEES | 226437 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Related Organizations | 5311 | RelatedOrganizations |
| Government Grants | 14400 | GovernmentGrants |
| All Other Contributions | 70534 | AllOtherContributions |
| Total Contributions | 90245 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICE REVENUES | 623000 | 49438811 | 49438811 | |
| REFERENCE LAB | 621500 | 40833 | 40833 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 49479644 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25999 | TotalRevenueColumn |
| Exclusion | $25,999 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 667 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 667 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 667 | TotalRevenueColumn |
| Exclusion | $667 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 23809 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 8721 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15088 | TotalRevenueColumn |
| Exclusion | $15,088 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| MEDICAID EHR INCENTIVES | 624200 | 1860291 | 1860291 | |
| CAFETERIA | 621990 | 159945 | $159,945 | |
| MISCELLANEOUS | 621990 | 23559 | 23559 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 42685 | TotalRevenueColumn |
| Related Or Exempt Function Income | 42685 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2086480 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 51698123 | TotalRevenueColumn |
| Related Or Exempt Function Income | 51365346 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 40833 | UnrelatedBusinessRevenue |
| Exclusion | $201,699 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 426062 | Total |
| Program Services | 15980 | ProgramServices |
| Management And General | 410082 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18999709 | Total |
| Program Services | 17900366 | ProgramServices |
| Management And General | 1099343 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2509352 | Total |
| Program Services | 2314124 | ProgramServices |
| Management And General | 195228 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1404008 | Total |
| Program Services | 1294776 | ProgramServices |
| Management And General | 109232 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 241429 | Total |
| Management And General | 241429 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 82193 | Total |
| Management And General | 82193 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2837598 | Total |
| Program Services | 2534669 | ProgramServices |
| Management And General | 302929 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21404 | Total |
| Management And General | 21404 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2584484 | Total |
| Program Services | 2233295 | ProgramServices |
| Management And General | 351189 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2008038 | Total |
| Program Services | 1828319 | ProgramServices |
| Management And General | 179719 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49341 | Total |
| Program Services | 34332 | ProgramServices |
| Management And General | 15009 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14039 | Total |
| Program Services | 10167 | ProgramServices |
| Management And General | 3872 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2156443 | Total |
| Program Services | 1963441 | ProgramServices |
| Management And General | 193002 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 294485 | Total |
| Program Services | 188948 | ProgramServices |
| Management And General | 105537 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 9643025 | 9643025 | |
| MEDICAL SUPPLIES | 5734958 | 5734958 | |
| PROVIDER TAX | 2235658 | 2235658 | |
| REPAIRS & MAINTENANCE | 786395 | 785803 | 592 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 334042 | Total |
| Program Services | 278459 | ProgramServices |
| Management And General | 55583 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52362663 | Total |
| Program Services | 48996320 | ProgramServices |
| Management And General | 3366343 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1550 | BOY |
| EOY | 1550 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7834529 | BOY |
| EOY | 4471526 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5207905 | BOY |
| EOY | 7458895 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 227171 | BOY |
| EOY | 235146 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 184676 | BOY |
| EOY | 169853 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 63220873 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 42069718 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19300252 | BOY |
| EOY | 21151155 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1819424 | BOY |
| EOY | 1840185 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 372620 | BOY |
| EOY | 372620 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 335148 | BOY |
| EOY | 1542365 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35283275 | BOY |
| EOY | 37243295 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4185067 | BOY |
| EOY | 5535147 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 473695 | BOY |
| EOY | 413483 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10935000 | BOY |
| EOY | 10280000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1700541 | BOY |
| EOY | 3757260 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 259422 | BOY |
| EOY | 192395 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17553725 | BOY |
| EOY | 20178285 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17729550 | BOY |
| EOY | 17065010 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17729550 | BOY |
| EOY | 17065010 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35283275 | BOY |
| EOY | 37243295 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -664540 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 600197 | OtherCostOrOtherBasis |
| Book Value | 600197 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 39695090 | OtherCostOrOtherBasis |
| Depreciation | 22553681 | Depreciation |
| Book Value | 17141409 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1146755 | OtherCostOrOtherBasis |
| Depreciation | 1001256 | Depreciation |
| Book Value | 145499 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 21682203 | OtherCostOrOtherBasis |
| Depreciation | 18514781 | Depreciation |
| Book Value | 3167422 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 96628 | OtherCostOrOtherBasis |
| Book Value | 96628 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 21151155 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| BOND INTEREST PAYABLE | $96,479 |
| THIRD PARTY SETTLEMENTS | $95,916 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 192395 | TotalOfAmounts |
| Total Revenue | 51698123 | TotalRevenue |
| Total Expenses | 52362663 | TotalExpenses |
| Excess Or Deficit For Year | -664540 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | -664540 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 51617147 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 51617147 | RevenueSubtotal |
| Other Revenues Not Included | 80976 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 80976 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 51698123 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 52281687 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 52281687 | ExpensesSubtotal |
| Other Expenses Not Included | 80976 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 80976 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 52362663 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| LIABILITY UNDER FIN 48 FOOTNOTE | SCHEDULE D, PAGE 3, PART X | TAX STATUS THE SOCIETY IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE SOCIETY APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE SYSTEM ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OR AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JUNE 30, 2012 AND 2011 OR FOR THE YEARS THEN ENDED. THE SOCIETY'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2009-2011. |
| RECONCILIATION OF CHANGES - OTHER | SCHEDULE D, PAGE 4, PART XI, LINE 8 | WAIVER EXPENSE -55,355 SCHOLARSHIP/RECRUITING EXPENSE -25,621 WAIVER EXPENSE 55,355 SCHOLARSHIP/RECRUITING EXPENSE 25,621 |
| REVENUE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 4B | WAIVER EXPENSE 55,355 SCHOLARSHIP/RECRUITING EXPENSE 25,621 |
| EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XIII, LINE 4B | WAIVER EXPENSE 55,355 SCHOLARSHIP/RECRUITING EXPENSE 25,621 |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 23809 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 23809 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 3516 | CashPrizesEvent1 |
| Rent Facility Costs Event1 | 4060 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 1145 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 23809 | GrossReceiptsTotal |
| Gross Revenue Total Events | 23809 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 3516 | CashPrizesTotalEvents |
| Rent Facility Costs Total Events | 4060 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 1145 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 8721 | DirectExpenseSummaryEvents |
| Net Income Summary | 15088 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 1.75000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | false | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 169775 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 169775 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00400 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8453074 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6661557 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1791517 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04190 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 140888 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 126334 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 14554 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8763737 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6787891 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1975846 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04620 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8763737 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6787891 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1975846 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04620 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 100000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 100000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00230 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 100000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 100000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00230 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $9,643,025 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 16222179 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 16762010 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -539831 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| 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 | CHATTAHOOCHEE VALLEY HOSPITAL SOCIE | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4800 48TH STREET | AddressLine1 |
| City | VALLEY | City |
| State | AL | State |
| ZIP Code | 36854 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | SNF; HOME HEALTH CARE; CLINICS | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATTAHOOCHEE VALLEY HOSPITAL SOCIE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | false | CHNAConducted |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 100.0 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 175.0 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| LANIER HOME HEALTH SERVICES | ||||
| 4800 48TH STREET | VALLEY | AL | 36854 | HOME HEALTH AGENCY |
| GEORGE H LANIER NURSING HOME | ||||
| 4800 48TH STREET | VALLEY | AL | 36854 | SKILLED NURSING FACILITY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE | PART I LINE 7 COLUMN F | IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN F THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990 PART IX LINE 25 FORM 990 PART IX LINE 25 52362663 LESS BAD DEBT EXPENSE 9643025 ADD EXPENSES REPORTED IN PART VIII 8721 DENOMINATOR FOR COLUMN F 42728359 |
| COSTING METHODOLOGY EXPLANATION | PART I LINE 7 | COSTS FOR PART I LINE 7A AND 7B WERE CALCULATED USING THE RCC CALCULATED IN WORKSHEET 2 OTHER COSTS WERE OBTAINED FROM THE ORGANIZATIONS ACCOUNTING RECORDS |
| BAD DEBT EXPENSE EXPLANATION | PART III LINE 4 | EXCERPT FROM FOOTNOTE TO AUDITED FINANCIAL STATEMENT ALLOWANCE FOR DOUBTFUL ACCOUNTS THE SOCIETY PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE |
| MEDICARE EXPLANATION | PART III LINE 8 | MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS |
| COLLECTION PRACTICES EXPLANATION | PART III LINE 9B | COLLECTION ATTEMPTS ON ALL ACCOUNTS ARE MADE BY THE HOSPITAL WITHIN THE FIRST 90 DAYS AFTER AN ACCOUNT GOES BEYOND 90 DAYS THE ACCOUNT IS SENT TO A COLLECTION AGENCY THE ACCOUNT STAYS WITH THE COLLECTION AGENCY FOR APPROXIMATELY 4 MONTHS AND IF NOT COLLECTED THE ACCOUNT IS SENT BACK TO THE HOSPITAL AND WRITTEN OFF AS A BAD DEBT |
| NEEDS ASSESSMENT | PART VI | WE USE THE STATE DEPARTMENT OF PUBLIC HEALTHS ANNUAL STATISTICAL REPORT TO LOOK AT THE HEALTHCARE NEEDS OF CHAMBERS COUNTY AND EVALUATE SERVICES NEEDED OR PROVIDED IN RESPONSE TO THAT REPORT OUR BOARD OF TRUSTEES ALSO REVIEWS AND DISCUSSES SERVICES AS PART OF OUR ANNUAL STRATEGIC PLAN UPDATE |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI | A SOCIAL WORKER WORKS WITH PATIENTS AND EXPLAINS TO THEM OPTIONS THEY HAVE AVAILABLE AND TRIES TO HELP THEM QUALIFY FOR ANY OUTSIDE AID THAT MIGHT BE AVAILABLE WE ALSO HAVE AN INDIGENTCHARITY CARE POLICY FOR WHICH QUALIFYING PATIENTS ARE ELIGIBLE |
| COMMUNITY INFORMATION | PART VI | THE ORGANIZATION SERVES A PREDOMINATELY RURAL AREA THE PRIMARY SERVICE AREA IS CHAMBERS COUNTY IN ALABAMA AND WEST POINT GEORGIA AND SURROUNDING AREA THE POPULATION OF CHAMBERS COUNTY IS APPROXIMATELY 34000 WITH A PER CAPITA INCOME OF 28994 AND A MEDIAN HOUSEHOLD INCOME OF 33500 APPROXIMATELY 105 OF THE POPULATION HAS A BACHELORS DEGREE OR HIGHER EDUCATION APPROXIMATELY 26 OF THE POPULATION DOESNT HAVE A HIGH SCHOOL DIPLOMA THE UNEMPLOYMENT RATE IN THE COUNTY IS APPROXIMATELY 114 THE POPULATION OF WEST POINT GEORGIA IS APPROXIMATELY 3500 WITH A PER CAPITA INCOME OF 18935 AND A MEDIAN HOUSEHOLD INCOME OF 37021 THE AREAS CITIZENS EXPERIENCE HIGH LEVELS OF HEART DISEASE DIABETES AND CANCER |
| HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE | PART VI | CVHS HAS BEEN INSTRUMENTAL IN PROVIDING HEALTHCARE AWARENESS TO THE COMMUNITY BY HOSTING NUMEROUS EVENTS INCLUDING AN ANNUAL HEALTH FAIR OPEN TO ALL RESIDENTS OF THE COMMUNITY OFFERING SERVICES FOR THE PEDIATRIC TO THE GERIATRIC RESIDENTS LANIER PROVIDED MINI HEALTH SCREENS AND FLU SHOTS TO VARIOUS BUSINESSES IN THE COMMUNITY OTHER EVENTS INCLUDE BREAST CANCER AWARENESS PRENATAL AND BREAST FEEDING EDUCATION CLASSES HEART HEALTH MONTH SELFMANAGED DIABETES CLASSES DIABETIC EYE DISEASE SEMINAR AND VARIOUS HEALTH RELATED SUPPORT GROUPS CVHS ALSO PARTICIPATES IN LOCAL SCHOOL OUTREACH PROGRAMS PROVIDING EDUCATION IN THE AREAS OF SMOKING CESSATION ALCOHOL HEALTHY EATING HABITS AND THE IMPORTANCE OF EXERCISE AND READING WE ALSO PARTICIPATE IN KID CHECK CAREER DAY EVENTS AND SCHOOL HEALTH FAIRS CVHS PARTICIPATED IN NATIONAL WELLNESS CAMPAIGN SCALEBACK ALABAMA AS WELL AS INVOLVING COMMUNITY PARTICIPATION IN SCALEBACK ALABAMA PHYSICIANS AND MIDLEVEL PRACTITIONERS SPEAK REGULARLY AT LOCAL CIVIC CLUBS TO PROVIDE HEALTHCARE AWARENESS AND PREVENTATIVE MEASURE INFORMATION CVHS PARTNERED WITH LOCAL LIBRARY TO PROVIDE PHYSICIAN DRIVEN EDUCATION SEMINARS CVHS HOLDS QUARTERLY FORUMS FOR LOCAL EMS DEPARTMENTS |
| CHATTAHOOCHEE VALLEY HOSPITAL SOCIE LINE NUMBER 1 PART V LINE 13G | PART V LINE 13G | THE HOSPITALS SOCIAL WORKER REVIEWS CRITERIA AND ELIGIBILITY WITH ALL SELF PAY PATIENTS ADMITTED TO THE HOSPITAL |
| CHATTAHOOCHEE VALLEY HOSPITAL SOCIE LINE NUMBER 1 PART V LINE 19D | PART V LINE 19D | THE ORGANIZATION BILLS SELF PAY PATIENTS BASED ON ESTABLISHED CHARGES AND OFFERS A 50 DISCOUNT IF PAID WITHIN 30 DAYS AFTER 30 DAYS THE DISCOUNT IS CALCULATED AT A SLIDING RATE BASED ON DAYS TO RECEIPT OF PAYMENT ULTIMATELY CHARGES FOR SELF PAY PATIENTS ARE REDUCED TO THE AVERAGE NEGOTIATED CHARGE FOR AN INSURED PATIENT |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg |
|---|---|---|---|
| DOUG DEWBERRY | |||
| 228383 | 6464 | 234847 | |
| PHILLIPPE TRANQUI | |||
| 303364 | 6464 | 351828 | 42000 |
| MAX SHIVER MD | |||
| 288594 | 6464 | 295058 | |
| DAVID FAGAN | |||
| 279624 | 6464 | 286088 | |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | OTHER ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE J, PART III | ReturnReference |
| Explanation | THE CEO IS PAID AN ANNUAL PERFORMANCE INCENTIVE ONE-THIRD OF WHICH IS PAID FOR ATTAINMENT OF FINANCIAL PERFORMANCE TARGETS. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| CURT KOLLAR | |||
| BD MBR/BANK CFO | 1377969 | BANK LOAN BALANCE | false |
| CURT KOLLAR | |||
| BD MBR/BANK CFO | 4727545 | BANK CASH BALANCES | false |
| TOMMY LANE | |||
| HOSP CFO/BK BD | 1377969 | BANK LOAN BALANCE | false |
| TOMMY LANE | |||
| HOSP CFO/BK BD | 4727545 | BANK CASH BALANCES | false |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE L PART V | ReturnReference |
| Explanation | CURT KOLLAR CFO OF CHARTER BANK IS A BOARD MEMBER OF THE FILING ORGANIZATION THE ORGANIZATION HAS A LOAN WITH THE BANK IN THE AMOUNT OF 1377968 AS WELL AS CASH ACCOUNTS TOTALING 4727545 AT FISCAL YEAR END THE CFO OF THE FILING ORGANIZATION TOMMY LANE IS A BOARD MEMBER AT CHARTER BANK | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| RELATED PARTY INFORMATION AMONG OFFICERS | FORM 990, PAGE 6, PART VI, LINE 2 | CAM LANIER GAINES LANIER TRUSTEE TRUSTEE FAMILY RELATIONSHIP RICHARD SCOTT WILLIAM SCOTT TRUSTEE TRUSTEE FAMILY RELATIONSHIP |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED BY MANAGEMENT IN DETAIL FOR ACCURACY OF FINANCIAL AND OTHER DATA. THE FORM IS THEN DISTRIBUTED TO TRUSTEES BY POSTING ON LANIER'S WEBSITE UNDER A SECURE FORMAT/PASSWORD PROTECTED. IMMEDIATE NOTIFICATION OF ITS AVAILABILITY IS SENT TO THE BOARD'S EXECUTIVE COMMITTEE, WHICH HAS THE AUTHORITY TO ACT FOR THE FULL BOARD, VIA EMAIL FOR THEIR REVIEW AND EVALUATION, PRIOR TO FILING WITH THE IRS. REMAINING BOARD MEMBERS HAVE FULL ACCESS TO THE WEBSITE AND PERIODICALLY VISIT THE WEBSITE FOR ESSENTIAL BOARD MEETING MATERIALS. ANY QUESTIONS FROM THE GENERAL BOARD TRUSTEES ARE RESOLVED AT THE NEXT OFFICIAL BOARD MEETING. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | THE ORGANIZATION REQUIRES ALL BOARD MEMBERS AND MANAGEMENT EMPLOYEES TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY AND MONITORS THE COMPLIANCE WITH THIS POLICY. BOARD MEMBERS RECUSE THEMSELVES DURING DISCUSSIONS AND ANY VOTING IF THEY HAVE A CONFLICT OF INTEREST. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | A COMMITTEE COMPRISED OF INDEPENDENT BOARD MEMBERS REVIEWS THE ANNUAL PERFORMANCE OF THE CEO AND SETS THE COMPENSATION AFTER THE REVIEW. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | PERFORMANCE APPRAISALS ARE PERFORMED ANNUALLY BY THE CEO. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | AS A GENERAL RULE, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. ANY WRITTEN REQUESTS BY THE PUBLIC WOULD BE REVIEWED AND ACTED UPON BY THE BOARD. |
| RELATED ORGANIZATIONS | FORM 990, PAGE 7, PART VII | AVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS: ARVIND KAMATH, MD .10 HOURS LUANNE BERLIN .10 HOURS DAVID WILKERSON .10 HOURS DOUG DEWBERRY .10 HOURS TOMMY LANE .10 HOURS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LANIER HEALTH SERVICES FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4800 48TH STREET | AddressLine1 |
| City | VALLEY | City |
| State | AL | State |
| ZIP Code | 36854 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 631286859 | EIN |
| Primary Activities | FOUNDATION | PrimaryActivities |
| Legal Domicile State | AL | LegalDomicileState |
| Exempt Code Section | 501C3 | ExemptCodeSection |
| Public Charity Status | 11A | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CVHS | BusinessNameLine1 |
| Business Name Line2 | CHATTAHOOCHEE VALLEY HOSPITAL SOCIE | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | true | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| LANIER HEALTH SERVICES FOUNDATION | ||
| C | 5311 | FOUNDATION RECORDS |
| LANIER HEALTH SERVICES FOUNDATION | ||
| L | -895 | FOUNDATION NET INCOME |
| LANIER HEALTH SERVICES FOUNDATION | ||
| M | AMOUNT INDETERMINABLE | |
| LANIER HEALTH SERVICES FOUNDATION | ||
| N | AMOUNT INDETERMINABLE | |