STRATEGY STUDIO / PUBLIC DATA EXPLORER

SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY (EIN 32-0090450)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-13
IRS object ID
201301339349302660
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-13T15:03:51-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN560747981EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DIXON HUGHES GOODMAN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1500 RIDGEFIELD COURTAddressLine1
CityASHEVILLECity
StateNCState
ZIP Code28806ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN320090450EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SOUTHERN CRESCENT HOSPITAL FOR SPECIALTYBusinessNameLine1
Business Name Line2CARE INCBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlSOUTNameControl
Phone7708977600Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line111 UPPER RIVERDALE ROADAddressLine1
CityRIVERDALECity
StateGAState
ZIP Code30274ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBENNY WHITMOREName
TitleCHAIRMAN/PRESIDENTTitle
Phone7708977600Phone
Date Signed2013-05-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAMY BIBBYName
PTINP00445891PTIN
Phone8282542254Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonBENNY WHITMORENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line111 UPPER RIVERDALE ROADAddressLine1
CityRIVERDALECity
StateGAState
ZIP Code30274ZIPCode
FieldValueIRS element (for citing)
Gross Receipts10886755GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2002YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE IS TO PROVIDE HIGH-QUALITY, LONG-TERM ACUTE CARE TO THE COMMUNITIES WE SERVE.ActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees80TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11938014ProgramServiceRevenuePriorYear
Program Service Revenue CY10882370ProgramServiceRevenueCY
Investment Income Prior Year10450InvestmentIncomePriorYear
Investment Income Current Year2366InvestmentIncomeCurrentYear
Other Revenue Prior Year2486OtherRevenuePriorYear
Other Revenue Current Year2019OtherRevenueCurrentYear
Total Revenue Prior Year11950950TotalRevenuePriorYear
Total Revenue Current Year10886755TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year218286GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY261584GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5541310SalariesEtcPriorYear
Salaries Etc Current Year4690359SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5530981OtherExpensePriorYear
Other Expenses Current Year5379513OtherExpensesCurrentYear
Total Expenses Prior Year11290577TotalExpensesPriorYear
Total Expenses Current Year10331456TotalExpensesCurrentYear
Revenues Less Expenses Prior Year660373RevenuesLessExpensesPriorYear
Revenues Less Expenses CY555299RevenuesLessExpensesCY
Total Assets BOY10487074TotalAssetsBOY
Total Assets EOY10759632TotalAssetsEOY
Total Liabilities BOY9913566TotalLiabilitiesBOY
Total Liabilities EOY9630824TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY573508NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1128808NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MISSION OF SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE IS TO PROVIDE HIGH-QUALITY, LONG-TERM ACUTE CARE TO THE COMMUNITIES WE SERVE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8731909Expense
Grants261584Grants
Revenue10882370Revenue
DescriptionTHE GOSPEL VALUES UNDERLYING THE MISSION STATEMENT CHALLENGES SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE TO MAKE CHOICES WHICH RESPOND TO THE PATIENT'S NEEDS IN PROVIDING THE NECESSARY SETTING FOR THE APPROPRIATE CONTINUUM OF CARE. SPECIAL CONSIDERATION IS GIVEN TO THOSE WHO ARE ECONOMICALLY DISADVANTAGED AND UNDERSERVED. THE HOSPITAL CARES FOR PATIENTS WHO ARE MEDICALLY COMPLEX AND MAY REQUIRE DAILY MONITORING: VENTILATOR DEPENDENT PATIENTS, OXYGEN DEPENDENT PATIENTS NEEDING RESPIRATORY REHABILITATION, PATIENTS WITH SLOW HEALING WOUNDS, PATIENTS BENEFITING FROM PHYSICAL, OCCUPATIONAL OR SPEECH THERAPY, AND FOR PATIENTS REQUIRING PALLIATIVE AND END OF LIFE CARE. THE MEDICAL AND THERAPEUTIC NEEDS OF THE PATIENTS ARE MET USING AN INTERDISCIPLINARY, HOLISTIC TEAM APPROACH INCORPORATING MEDICAL MANAGEMENT, PHYSICAL, RESPIRATORY, OCCUPATIONAL AND SPEECH THERAPIES IN AN EFFORT TO RESTORE INDIVIDUAL QUALITY OF LIFE TO AS HIGH A DEGREE AS POSSIBLE AND TO PROMOTE SELF-HELP AND INDEPENDENCE TO THE EXTENT FEASIBLE. THE SPIRITUAL NEEDS OF THE PATIENTS, FAMILIES, AND SIGNIFICANT OTHERS ARE PROVIDED FOR AS WELL. THE GROWTH AND DEVELOPMENT OF SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE IS DETERMINED BY THE HEALTH CARE NEEDS OF THE COMMUNITIES THAT IT SERVES, AVAILABLE RESOURCES, AND THE INTERRELATIONSHIP OF THOSE SERVING AND THOSE BEING SERVED. RESPONSIBLE STEWARDSHIP MANDATES THAT SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE SEARCH OUT NEW, EFFECTIVE MEANS TO DELIVER QUALITY HEALTH CARE AND TO PROMOTE WHOLENESS IN THE HUMAN PERSON FOR THOSE WHO REQUIRE THIS LONG-TERM ACUTE CONTINUUM OF CARE.THE VISION OF SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE IS TO PROVIDE HEALTH CARE THAT IS SPIRITUALLY ROOTED, FULLY INTEGRATED IN THE CONTINUUM OF CARE, SUPPORTIVE OF HEALTHIER COMMUNITIES, INNOVATIVE AND INTERDISCIPLINARY IN A HOLISTIC APPROACH TO CARE, AND COMPASSIONATE IN RESPONSE TO THE NEEDS OF PATIENTS IN THEIR LIFE JOURNEY. SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE'S APPROACH TO STRENGTHEN CURRENT MINISTRIES: TO IMPLEMENT INNOVATIVE APPROACHES TO CARING FOR THE WHOLE PERSON; TO INCREASE ACCESS TO HEALTH CARE FOR THE POOR AND UNDERSERVED THROUGH ADVOCACY AND OTHER INITIATIVES; TO MAKE A CONTRIBUTION TO CREATING HEALTHY COMMUNITIES; AND TO CREATE A WORK ENVIRONMENT FILLED WITH HOPE, DIGNITY, AND MUTUAL RESPECT.COMMUNITY BENEFITSIN SUPPORT OF ITS MISSION AND PHILOSOPHY REGARDING SOCIAL ACCOUNTABILITY, SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PROVIDES CARE TO PATIENTS WHO BEAR A SIGNIFICANT HEALTH-CARE FINANCIAL BURDEN RELATIVE TO THEIR FINANCIAL RESOURCES. SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE CLASSIFIES THE RESOURCES UTILIZED FOR THE CARE OF PATIENTS BEARING A SIGNIFICANT HEALTH CARE FINANCIAL BURDEN AS COMPARED TO THEIR RESOURCES AS CHARITY CARE. CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF THE FINANCIAL BURDEN OF THE HEALTH CARE SERVICES AND/OR WHO ARE UNINSURED OR UNDERINSURED. CHARITY CARE IS PROVIDED WITHOUT CHARGE OR AT A CHARGE THAT IS LESS THAN THE USUAL CHARGE FOR SUCH SERVICES. THE DETERMINATION AS TO THE AMOUNT TO BE CHARGED, IF ANY, IS MADE ACCORDING TO A PATIENT'S ABILITY TO PAY, CONSIDERATION OF THE PATIENT'S ASSETS AND LIABILITIES, AND DETERMINED BY THE ESTABLISHED ELIGIBILITY CRITERIA BASED ON THE MOST CURRENT FEDERAL POVERTY GUIDELINES. A FINANCIALLY INDIGENT PATIENT IS ONE WHO IS UNINSURED OR UNDERINSURED AND WHOSE ECONOMIC CIRCUMSTANCES PLACE THEM AT OR UNDER 200% OF THE FEDERAL POVERTY GUIDELINES. A MEDICALLY INDIGENT PATIENT IS A PERSON WHOSE MEDICAL OR HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEEDS 25% OF THEIR ANNUAL GROSS INCOME. NO PATIENT IS REFUSED NECESSARY MEDICAL CARE ON THE BASIS OF THEIR INABILITY TO PAY.IN ADDITION TO UNCOMPENSATED COSTS, SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE SUPPORTS AND PARTICIPATES IN COMMUNITY BENEFIT PROGRAMS DESIGNED TO POSITIVELY IMPACT THE HEALTH STATUS OF THE COMMUNITIES SERVED.REIMBURSED GOVERNMENT SPONSORED PROGRAMSIN ADDITION TO THE PROVISION OF CARE WITHOUT EXPECTATION OF PAYMENT (CHARITY CARE), SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PROVIDES SERVICES TO PERSONS COVERED UNDER GOVERNMENT SPONSORED PROGRAMS, INCLUDING MEDICARE, TRICARE (FORMERLY CHAMPUS WHICH PROVIDES CIVILIAN HEALTH CARE BENEFITS TO MILITARY PERSONNEL, MILITARY RETIREES AND THEIR DEPENDENTS, AND SOME MEMBERS OF THE RESERVE COMPONENT) AND TRICARE FOR LIFE (A MEDICARE SUPPLEMENT INSURANCE PROGRAM AVAILABLE TO INDIVIDUALS WHO HAD BEEN ELIGIBLE FOR TRICARE). AS ALREADY CITED, SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PROVIDED MEDICAL SERVICES TO PERSONS COVERED UNDER THE FEDERAL MEDICARE PROGRAM WHICH, IN FACT, COMPRISED THE LARGEST SINGLE PAYER CLASSIFICATION OF PATIENTS SERVED BY THIS HEALTH SYSTEM. THE PAYMENT RATE FOR INPATIENT SERVICES IS ON A PER DISCHARGE RATE, CALCULATED BASED ON THE DIAGNOSTIC-RELATED GROUP INTO WHICH THE PATIENT IS CATEGORIZED. NUMBER OF PATIENTS SERVED BY THE LTACH: 294NUMBER OF PATIENT DAYS OF CARE PROVIDED BY THE LTACH: 7,294NUMBER OF PATIENT DAYS OF CHARITY CARE PROVIDED BY THE LTACH: 164CHARITY CARE COST: $ 168,252TOTAL PROGRAM SERVICE EXPENSES (GRANTS $261,584) $ 8,683,519Description
Total Program Service Expense8731909TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109630NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees80NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MIKE MURRAYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7132772300TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11700 WEST LOOP SOUTH STE 1100AAddressLine1
CityHOUSTONCity
StateTXState
ZIP Code77027ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (6 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
BENNY R WHITMORE
CHAIRMAN/PRESIDENT2.00XX381200
WILLIAM E CASEY
BOARD MEMBER1.00X553900
RONALD M DODSON
BOARD MEMBER1.00X267900
MARGARET L MANOS
BOARD MEMBER1.00X436500
MITCH JOHNSON
BOARD MEMBER1.00X606000
JAN HAMILTON-CRAWFORD
HOSPITAL ADMINISTRATOR/CEO40.00X196223026063
FieldValueIRS element (for citing)
Total Reportable Comp From Org218678TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation26063TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources1CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SOUTHERN REGIONAL MEDICAL CENTER
1100 UPPER RIVERDALE ROAD SWRIVERDALEGA30274ANCILLIARY HOSPITAL SERVICES1212809
CHRISTUS CONTINUING CARE DBA CDHS
919 HIDDEN RIDGEIRVINGTX75038MANAGEMENT SERVICES642936
PRECISE HEALTHCARE SOLUTIONS LLC
5300 MEMORIAL DR STE 134STONE MOUNTAINGA30083CONTRACT LABOR254737
NELSON MULLINS RILEY & SCARBOROUGH LLP
1320 MAIN STREET COLUMBIACOLUMBIASC29201LEGAL FEES233048
ALLIANCE NURSE CORE INC
240 SMITHSTONE PATHFAYETTEVILLEGA30214CONTRACT LABOR172437
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SERVICEDescription
Business Code623000BusinessCode
Total Revenue Column10882370TotalRevenueColumn
Related Or Exempt Function Income10882370RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue10882370TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2366TotalRevenueColumn
Exclusion$2,366ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionTRANSCRIPTION FEESDescription
Business Code561499BusinessCode
Total Revenue Column2019TotalRevenueColumn
Exclusion$2,019ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue2019TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column10886755TotalRevenueColumn
Related Or Exempt Function Income10882370RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$4,385ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total261584Total
Program Services261584ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total244741Total
Management And General244741ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3778052Total
Program Services3577111ProgramServices
Management And General200941ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total116300Total
Program Services103344ProgramServices
Management And General12956ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total263133Total
Program Services233820ProgramServices
Management And General29313ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total288133Total
Program Services256035ProgramServices
Management And General32098ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total666871Total
Management And General666871ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total99463Total
Management And General99463ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total2361Total
Management And General2361ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2098212Total
Program Services2037648ProgramServices
Management And General60564ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total12903Total
Management And General12903ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total406669Total
Program Services362103ProgramServices
Management And General44566ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total601744Total
Program Services601744ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total76500Total
Program Services16335ProgramServices
Management And General60165ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total84817Total
Program Services2372ProgramServices
Management And General82445ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total145670Total
Program Services145670ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total119048Total
Program Services89286ProgramServices
Management And General29762ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES1022721100232320398
BAD DEBT4253442534

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10331456Total
Program Services8731909ProgramServices
Management And General1599547ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY7555589BOY
EOY8256181EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1944726BOY
EOY1523664EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY47899BOY
EOY59263EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY68868BOY
EOY74883EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1977646LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1138750LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY869992BOY
EOY838896EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY0BOY
EOY6745EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY10487074BOY
EOY10759632EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY935853BOY
EOY885864EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
EOY7457EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY8977713BOY
EOY8737503EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY9913566BOY
EOY9630824EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY573508BOY
EOY1128808EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY573508BOY
EOY1128808EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10487074BOY
EOY10759632EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses555299ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited0FSAudited
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$2,361OtherActivitiesAmount
Total Lobbying Expenditures IIB2361TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHE HOSPITAL IS A MEMBER OF THE NATIONAL ASSOCIATION OF LONG TERM HOSPITALS AND THE GEORGIA HOSPITAL ASSOCIATION. THESE ORGANIZATIONS ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBERSHIP BODIES, AND EACH YEAR, A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS IS ALLOCATED TO LOBBYING EXPENDITURES. FOR THE CURRENT YEAR, DUES ALLOCATED TO LOBBYING WAS APPROXIMATELY $2,361.Explanation

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis21250OtherCostOrOtherBasis
Depreciation14875Depreciation
Book Value6375BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1956396OtherCostOrOtherBasis
Depreciation1123875Depreciation
Book Value832521BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings838896TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DUE TO SOUTHERN REGIONAL$77,770
DUE TO CHRISTUS DUBUIS HEALTH SYSTEM$250,589
LITIGATION ACCRUAL$8,409,144
FieldValueIRS element (for citing)
Total Of Amounts8737503TotalOfAmounts
Total Revenue10886755TotalRevenue
Total Expenses10331456TotalExpenses
Excess Or Deficit For Year555299ExcessOrDeficitForYear
Excess Or Deficit Per FS555299ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt10886755TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal10886755RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99010886755TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt10331456TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal10331456ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99010331456TotalExpensesPerForm990

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense324823TotalCommunityBenefitExpense
Net Community Benefit Expense324823NetCommunityBenefitExpense
Percent Of Total Expense0.03160PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense324823TotalCommunityBenefitExpense
Net Community Benefit Expense324823NetCommunityBenefitExpense
Percent Of Total Expense0.03160PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense9684TotalCommunityBenefitExpense
Net Community Benefit Expense9684NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense245000TotalCommunityBenefitExpense
Net Community Benefit Expense245000NetCommunityBenefitExpense
Percent Of Total Expense0.02380PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense254684TotalCommunityBenefitExpense
Net Community Benefit Expense254684NetCommunityBenefitExpense
Percent Of Total Expense0.02470PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense579507TotalCommunityBenefitExpense
Net Community Benefit Expense579507NetCommunityBenefitExpense
Percent Of Total Expense0.05630PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$14,304BadDebtExpenseAmount

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1SOUTHERN CRESCENT HOSP FOR SPEC CAREBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line111 UPPER RIVERDALE ROADAddressLine1
CityRIVERDALECity
StateGAState
ZIP Code30274ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
OtherLONG-TERM ACUTE CARE HOSPITALOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1SOUTHERN CRESCENT HOSP FOR SPEC CAREBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent400.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy0NondiscrimEmergencyCarePolicy
No Emergency CareXNoEmergencyCare
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 3C: IN ADDITION TO PROVIDING CHARITY CARE BASED ON THE FEDERAL POVERTY GUIDELINES, THE HOSPITAL PROVIDES CARE TO MEDICALLY INDIGENT PATIENTS WHOSE MEDICAL OR HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYERS EXCEED 25% OF THE PATIENT'S ANNUAL GROSS INCOME AND THE PATIENT IS UNABLE TO PAY THE REMAINING BILL.
PART I, LINE 7: WORKSHEET 2 OF THE 2011 SCHEDULE H INSTRUCTIONS WAS USED TO DERIVE A COST-TO-CHARGES RATIO USED TO CALCULATE AMOUNTS OF COMMUNITY BENEFIT EXPENSE AT COST FOR PART I, LINE 7.
PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 42534.
PART III, LINE 4: SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE FOLLOWS IN PRINCIPLE HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT NO. 15. THE SYSTEM HAS ADOPTED AN UNCOMPENSATED CARE POLICY WHERE REVENUE FROM SERVICES PROVIDED TO THE UNINSURED IS RECOGNIZED AT THE TIME OF SERVICE, AND AN OFFSETTING ALLOWANCE FOR VOLUNTARY FREE CARE IS RECORDED. ACCORDINGLY, ALL ACCOUNTS RECEIVABLE FROM THE UNINSURED HAVE BEEN FULLY RESERVED IN THE ALLOWANCE FOR VOLUNTARY FREE CARE. THE ORGANIZATION DOES NOT ISSUE AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION USES SCHEDULE H, WORKSHEET A TO DETERMINE THE BAD DEBT EXPENSE AT COST REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2 USING THE COST-TO-CHARGE RATIO CALCULATED ON FORM 990, SCHEDULE H, WORKSHEET 2, LINE 11. THE ORGANIZATION'S TOTAL BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENT CHARGES (TOTAL OF ALL HOSPITAL FACILITIES) IS IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL STATEMENTS. BAD DEBT EXPENSE IS NET OF: (1) CONTRACTUAL ALLOWANCES, (2) PAYMENTS RECEIVED AND (3) RECOVERIES OF BAD DEBT PREVIOUSLY WRITTEN OFF.ALL UNPAID PATIENT BALANCES ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY OR PATIENTS FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE A DETERMINATION OF THEIR ELIGIBILITY ARE WRITTEN OFF AS CHARITY CARE AND NOT TO BAD DEBT EXPENSE.
PART III, LINE 8: THE ORGANIZATION USED AN INTERNAL EVALUATION PROCESS TO DETERMINE COSTS OF CARE RELATING TO MEDICARE PAYMENTS.
PART III, LINE 9B: SOUTHERN CRESCENT HOSPITAL DOES NOT OUTSOURCE PATIENT BALANCES TO A THIRD PARTY DEBT COLLECTION AGENCY. ALL COLLECTIONS ARE DONE BY IN-HOUSE COLLECTORS USING COLLECTION LETTERS. PATIENTS ARE NOT SUBJECT TO HARASSMENT OR LEGAL ACTION DUE TO THEIR INCAPACITY TO PAY. PATIENTS THAT ARE UNABLE TO PAY ARE SENT CHARITY CARE INFORMATION.UPON ADMISSION, PATIENTS WHO HAVE NO INSURANCE COVERAGE AND NO ABILITY TO PAY WILL BE GIVEN CONSIDERATION FOR CHARITY CARE. EVERY EFFORT WILL BE MADE TO OBTAIN THE APPROPRIATE FINANCIAL DOCUMENTATION TO DETERMINE THE ABILITY TO PAY FOR SERVICES. PATIENTS RECEIVE PRIVATE LETTERS/BILLS EACH MONTH INDICATING THEIR BALANCE DUE. PATIENTS WHO HAVE NOT MADE PAYMENTS FOR A 30-DAY PERIOD WILL RECEIVE A LETTER REQUESTING PAYMENT. PATIENTS WHO ARE UNABLE TO PAY THEIR BALANCE WILL BE CONSIDERED FOR CHARITY CARE IF APPROPRIATE. COLLECTION EFFORTS WILL CONTINUE FOR 120 DAYS WITH THE PATIENT/GUARANTOR RECEIVING AT LEAST THREE LETTERS REQUESTING PAYMENT WITHIN SAID 120 DAY PERIOD. ACCOUNTS THAT ARE NOT DEEMED ELIGIBLE FOR CHARITY CARE OR MEDICAL INDIGENCE WILL BE WRITTEN OFF AS BAD DEBT FOLLOWING THE 120 DAY COLLECTION PERIOD.
PART V, SECTION B, LINE 11H: IN ADDITION TO PROVIDING CHARITY CARE BASED ON THE FEDERAL POVERTY GUIDELINES, THE HOSPITAL PROVIDES CARE TO MEDICALLY INDIGENT PATIENTS WHOSE MEDICAL OR HOSPITAL BILLS, AFTER PAYMENT BY THIRD-PARTY, PAYERS EXCEED 25% OF THE PATIENT'S ANNUAL GROSS INCOME AND THE PATIENT IS UNABLE TO PAY THE REMAINING BILL.SOUTHERN CRESCENT HOSP. FOR SPEC. CARE
PART V, SECTION B, LINE 13G: PROVIDE THE GRANT APPLICATION FOR ASSISTANCE AFTER EVALUATING THE PATIENT'S FINANCIAL STATUS PRIOR TO ADMISSION.SOUTHERN CRESCENT HOSP. FOR SPEC. CARE
PART VI, LINE 2: SOUTHERN CRESCENT HOSPITAL OF SPECIALTY CARE HAS DEVELOPED THE 2012 COMMUNITY BENEFIT PLAN BASED UPON PRIORITIZATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND STRIVES TO ENSURE BEST PRACTICES AND STANDARDS OF CARE ARE MET. HEALTHCARE PRIORITIES INCLUDE: 1) PRIMARY CARE ACCESS, 2) GEOGRAPHIC DISPARITIES, 3) UNDER/UNINSURED/WORKING POOR, 4) ACCESS TO INFORMATION/REFERRALS, 5) CARDIOVASCULAR DISEASE, DIABETES, RESPIRATORY CANCER AND OTHER CHRONIC DISEASES, 6) SENIOR POPULATION, AND 7) 45-64 YEAR OLD POPULATION GROUPAN ADDITIONAL AREA OF FOCUS OVERLAPPING MANY OF THESE PRIORITIES IS THE ALREADY HIGH AND INCREASING PERCENTAGE OF CONSOLIDATED METROPOLITAN STATISTICAL AREA (CMSA) RESIDENTS OF HISPANIC DESCENT. BARRIERS TO ACCESS HEALTHCARE INCLUDE: 1) LIMITED ACCESS, 2) INABILITY TO PAY FOR SERVICES, 3) LACK OF TRANSPORTATION, AND 4) LANGUAGE BARRIERS AND CULTURAL DIFFERENCES SOCIOECONOMIC FACTORS IMPACTING ACCESS TO HEALTHCARE INCLUDE: 1) LACK OF EMPLOYMENT OPPORTUNITIES, 2) INCREASED NUMBER OF RESIDENTS WITH MEDIAN INCOME OF < $25,000, 3) OVER-UTILIZATION OF EMERGENCY DEPARTMENT (ED) FOR PRIMARY CARE SERVICES, AND 4) DIMINISHED HEALTH COVERAGE
PART VI, LINE 3: ALL PATIENTS ARE ASSESSED DURING THE REGISTRATION PROCESS. PATIENTS IDENTIFIED AS POSSIBLE CHARITY CASES WILL BE ASKED TO COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE. PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM BUT ARE NOT CURRENTLY ENROLLED ARE REFERRED TO THE APPROPRIATE PROGRAM. PATIENTS WHO CAN PROVE ELIGIBILITY FOR MEDICAID BUT ARE NOT PATIENTS IN A MEDICAID-APPROVED HOSPITAL WILL BE DEEMED AS INDIGENT AND AUTOMATICALLY QUALIFY FOR CHARITY CARE. PATIENTS ADMITTED TO THE HOSPITAL WITH MEDICARE AS THE ONLY INSURANCE WILL BE MONITORED AS MEDICARE DAYS NEAR DEPLETION. THIRTY DAYS PRIOR TO THE END OF THE MEDICARE COVERAGE, AN INTERVIEW AND AN APPLICATION FOR FINANCIAL ASSISTANCE WILL BE REQUESTED AS APPROPRIATE. THESE PATIENTS ARE ASSESSED AS TO MEETING THE GUIDELINES FOR RECEIVING CHARITY CARE IF THE STAY SHOULD EXCEED MEDICARE COVERAGE LIMITS. AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENT'S FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENT ASSISTANCE, A DETERMINATION IS MADE CONCERNING THE PATIENT'S ELIGIBILITY FOR CHARITY. NO COLLECTION EFFORT IS PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATIONS ARE MADE.
PART VI, LINE 4: THE ORGANIZATION SERVES THE PATIENTS IN THE SOUTHERN CRESCENT OF THE METRO ATLANTA AREA. OUR PRIMARY SERVICE AREA INCLUDES CLAYTON COUNTY, FAYETTE COUNTY, HENRY COUNTY, AND PORTIONS OF SOUTH FULTON COUNTY. THE SOUTHERN CRESCENT IS A LARGE DIVERSE COMMUNITY AND THE ORGANIZATION OFFERS SERVICES TO MEET THESE VARIED NEEDS. THE STATE OF GEORGIA HAS 11% PERSONS 65 YEARS AND OVER AND 16.5% PERSONS BELOW POVERTY LEVEL. CLAYTON COUNTY HAS 6.9% PERSONS 65 YEARS AND OVER AND 18.4% PERSONS BELOW POVERTY LEVEL. FAYETTE COUNTY HAS 13.9% PERSONS 65 YEARS AND OVER AND 5.9% PERSONS BELOW POVERTY LEVEL. HENRY COUNTY HAS 8.8% PERSONS 65 YEARS AND OVER AND 9.5% PERSONS BELOW POVERTY LEVEL. FULTON COUNTY HAS 9.2% PERSONS 65 YEARS AND OVER AND 15.9% PERSONS BELOW POVERTY LEVEL.
PART VI, LINE 5: SURPLUS FUNDS ARE APPLIED EITHER TO COMMUNITY CHARITY CARE NEEDS OR TO OTHER EXEMPT ORGANIZATIONS IN THEIR MISSION TO SUPPORT COMMUNITY NEEDS. ADDITIONALLY, A MAJORITY OF THE GOVERNING BOARD OF THE HOSPITAL IS COMPRISED OF LOCAL PEOPLE FROM THE COMMUNITY TO ENSURE THAT RESIDENTS ARE REPRESENTED. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY.
PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTHCARE SYSTEM.
GAREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
SOUTHSIDE MEDICAL CENTER INC
1046 RIDGE AVENUE SWATLANTAGA30315581131002501(C)(3)200000OPERATIONAL SUPPORT TO PROMOTE EXEMPT PURPOSE
SOUTHERN REGIONAL MEDICAL CENTER FOUNDATION
11 UPPER RIVERDALE ROADRIVERDALEGA30274581983516501(C)(3)45000SPONSOR EVENT PROVIDING SCREENINGS TO COMMUNITY AND HELP PURCHASE MRI FOR SOUTHERN REGIONAL MEDICAL CENTER
ARTS CLAYTON GALLERY
136 MAIN STREETJONESBOROGA30236581727604501(C)(3)6900SUPPORT CHILDREN'S LOCAL ART PROGRAM
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: THE GRANT TO SOUTHSIDE MEDICAL CENTER, INC., A TAX EXEMPT ENTITY, WAS APPROVED BY THE BOARD AND DOCUMENTED IN THE BOARD MINUTES AND IS MADE ACCORDING TO AN AGREEMENT EFFECTIVE 11/14/2008 BETWEEN SOUTHSIDE MEDICAL CENTER, INC. AND SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE. THE AGREEMENT STATES THAT SOUTHERN CRESCENT HOSPITAL WILL PROVIDE IN TOTAL FINANCIAL ASSISTANCE UP TO $400,000 DURING THE THREE YEAR TERM OF THE AGREEMENT TO COVER OPERATION SHORTFALLS AND A ONE-TIME START UP COST REIMBURSEMENT. THE AGREEMENT WAS ENTERED INTO SO THAT SOUTHSIDE MEDICAL CENTER WOULD BE ABLE TO SERVE THE UNDERSERVED PATIENT COMMUNITY WITHIN THE SERVICE AREAS OF SOUTHERN CRESCENT HOSPITAL REGARDLESS OF THE PATIENT'S ABILITY TO PAY. SOUTHSIDE MEDICAL CENTER IS REQUIRED TO SUBMIT AN ITEMIZATION OF COSTS TO BE APPROVED BY SOUTHERN CRESCENT PRIOR TO EACH PAYMENT.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation SurveyXCompensationSurvey
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonJAN HAMILTON-CRAWFORDNamePerson
Base Compensation Filing Org163842BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org32381BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org19337DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org6726NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org222286TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 6CHRISTUS CONTINUING CARE (CCC), THE MANAGEMENT ORGANIZATION, MAINTAINS A PAY FOR PERFORMANCE PLAN APPLICABLE TO EMPLOYEES OF CCC. AWARDS ARE DETERMINED AT THE END OF EACH FISCAL YEAR. TO BE ELIGIBLE TO RECEIVE AN AWARD, A PARTICIPANT MUST: 1) HAVE BEEN A PLAN PARTICIPANT DURING THE FISCAL YEAR ON WHICH THE AWARDS ARE BASED; 2) HAVE MET BASIC BEHAVORIAL EXPECTATIONS OF MANAGEMENT PERSONNEL; 3) HAVE RECEIVED A "PERFORMING WELL" OVERALL RATING ON HIS/HER ANNUAL PERFORMANCE FEEDBACK/REVIEW FOR THAT FISCAL YEAR; AND 4)EITHER BE EMPLOYED IN A MANAGERIAL POSITION ON THE LAST DAY OF THE FISCAL YEAR OR HAVE TERMINATED EMPLOYMENT WITH CCC DURING THE FISCAL YEAR DUE TO DEATH, DISABILITY, RETIREMENT ON OR AFTER AGE 55, INVOLUNTARY TERMINATION AS A RESULT OF ELIMINATION OF SUCH PARTICIPANT'S EMPLOYMENT POSITION, OR THE ACCEPTANCE OF AN INVOLUNTARY TRANSFER TO AN INELIGIBLE POSITION. FINALLY, ANY PREREQUISITE TARGET (I.E. REGIONAL TRIGGERS) ESTABLISHED MUST BE ACHIEVED BEFORE AWARDS ARE GRANTED. PLAN PARTICIPANTS IN ANY OTHER LUMP-SUM INCENTIVE AWARD, BONUS OR SUCCESS SHARING PLAN SPONSORED BY THE ORGANIZATION AT THE SAME TIME THEY PARTICIPATE IN THE PLAN UNLESS APPROVED BY ADMINISTRATION. THE BOARD FOR SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE DOES NOT SPECIFICALLY APPROVE THE COMPENSATION OF THE CEO BUT INSTEAD APPROVES THE PROCESS FOR DETERMINING THE COMPENSATION USED BY CCC.
PART IIICOMPENSATION FROM UNRELATED ORGANIZATIONS: JAN HAMILTON-CRAWFORD RECEIVED COMPENSATION FROM CHRISTUS DUBUIS HEALTH SYSTEM, AN UNRELATED ORGANIZATION, THAT MANAGES SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE AND WHO LEASES THEIR EMPLOYEES TO PERFORM SERVICES FOR THE FILING ORGANIZATION. SHE RECEIVED NO DIRECT COMPENSATION FROM SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE. COMPENSATION REPORTED ON PART II REFLECTS AN AMOUNT OF TOTAL COMPENSATION ALLOCATED TO SERVICES PERFORMED SPECIFICALLY FOR THE FILING ORGANIZATION.SUPPLEMENTAL INFORMATION

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 3SOUTHERN CRESCENT HOSPITAL IS MANAGED BY CHRISTUS CONTINUING CARE (D/B/A "CHRISTUS DUBUIS HEALTH SYSTEM"). THE EMPLOYEES OF CHRISTUS DUBUIS HEALTH SYSTEM ARE LEASED TO SOUTHERN CRESCENT HOSPITAL TO PERFORM SERVICES. ALL EMPLOYEE POLICIES OF CHRISTUS DUBUIS HEALTH SYSTEM APPLY TO EMPLOYEES WORKING WITHIN CHRISTUS DUBUIS HEALTH SYSTEM AND EMPLOYEES LEASED TO SOUTHERN CRESCENT HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7ATHE ORGANIZATION HAS NO OFFICIAL MEMBERS; HOWEVER, SOUTHERN REGIONAL HEALTH SYSTEM, A GEORGIA NONPROFIT CORPORATION, APPOINTED THE INITIAL BOARD, AND RETAINS THE RIGHT TO APPOINT UP TO TWO MEMBERS.
FORM 990, PART VI, SECTION A, LINE 8BTHERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11THE RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE ORGANIZATION REVIEWS THE PREPARED RETURN FOR ACCURACY. UPON COMPLETION OF THE FINAL FORM 990 BY THE INDEPENDENT ACCOUNTING FIRM, THE 990 IS SUBMITTED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION MAINTAINS SEPARATE CONFLICT OF INTEREST POLICIES FOR EMPLOYEES OF THE ORGANIZATION AND FOR THE MEMBERS OF THE BOARD OF DIRECTORS. BOTH POLICIES REQUIRE ANNUAL DISCLOSURE OF ANY CONFLICTS OF INTEREST. THE EMPLOYEE POLICY INCLUDES OFFICERS, MEDICAL DIRECTORS AND OTHER DIRECTORS, AND ALL OTHER ASSOCIATES. THE EMPLOYEE DISCLOSURE IS REVIEWED BY THE EMPLOYEE'S IMMEDIATE SUPERVISOR. IN ADDITION, KEY LEADERS MUST CERTIFY ANNUALLY THEIR RECEIPT AND UNDERSTANDING OF THE CONFLICT OF INTEREST POLICY. IF ANY CONFLICTS ARE PRESENT, THE EMPLOYEE AND THE ORGANIZATION'S ADMINISTRATION WILL IMPLEMENT A MUTUALLY AGREED UPON PLAN TO RESOLVE THE CONFLICT. IN ADDITION, THE ORGANIZATION IMPLEMENTS AN INTEGRITY PROGRAM TO SUPPORT AND MAINTAIN THE CORPORATE INTEGRITY OF THE ORGANIZATION. THE POLICY FOR THE MEMBERS OF THE BOARD OF DIRECTORS REQUIRES ANY BOARD MEMBER, UPON DETERMINATION OF A CONFLICT OF INTEREST, TO ABSENT HIMSELF OR HERSELF WITHOUT COMMENT FROM NOT ONLY THE VOTE BUT ALSO FROM THE DELIBERATION. BOARD MEMBERS ARE NOT ALLOWED TO BE EMPLOYED BY THE ORGANIZATION UNLESS THEY HAVE FIRST RESIGNED FROM THE BOARD. IN ADDITION, AT THE BEGINNING OF EACH BOARD MEETING, THE BOARD CHAIR ASKS THE BOARD MEMBERS TO REVIEW THE AGENDA AND SHARE ANY POTENTIAL CONFLICTS OF INTEREST PRIOR TO THE BEGINNING OF BUSINESS.
FORM 990, PART VI, SECTION B, LINE 15ATHE SALARY FOR THE PRESIDENT/CHAIRMAN OF THE BOARD OF DIRECTORS WAS DETERMINED WHEN THE ORGANIZATION WAS INCORPORATED AND WAS BASED ON COMPARATIVE SALARIES FROM PREVIOUS BOARD ASSIGNMENTS. IN DETERMINING THE SALARY FOR THE CEO, THE BOARD APPROVED PROCEDURES USED BY THE MANAGEMENT ORGANIZATION, CHRISTUS CONTINUING CARE (CCC). CCC USES THE SAME PROCEDURE FOR THE CEO AS IS USED FOR ALL OTHER EMPLOYEES. THE HUMAN RESOURCES DEPARTMENT USES CITY AND STATE SALARY SURVEYS AVAILABLE TO THE PUBLIC AND COMPARATIVE SALARY RATES USED IN THE VARIOUS HOST HOSPITALS. THE SALARY RATES ARE PERIODICALLY REVIEWED BY THE HUMAN RESOURCES DEPARTMENT AND REVISED BASED ON CHANGES IN THE MARKET PLACE. A SURVEY WAS CONDUCTED BY SULLIVAN COTTER IN 2010 CONFIRMING CURRENT SALARY LEVELS ARE COMPARABLE TO OTHER ORGANIZATIONS AND REASONABLE.
FORM 990, PART VI, SECTION C, LINE 18PHOTOCOPIES OF THE FORM 1023 AND RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.
FORM 990, PART VI, SECTION C, LINE 19FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PART V, LINE 2:SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE ENTERED INTO A MANAGEMENT AGREEMENT WITH CHRISTUS DUBUIS HEALTH SYSTEM, AN UNRELATED ORGANIZATION. AS PROVIDED BY THE MANAGEMENT AGREEMENT, CHRISTUS DUBUIS HEALTH SYSTEM AGREES TO PROVIDE TO THE HOSPITAL AN ADMINISTRATOR AND ALL OTHER EMPLOYEES REQUIRED TO STAFF THE HOSPITAL. SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE PAYS DIRECTLY FROM THEIR BANK ACCOUNT THE SALARIES OF ALL EMPLOYEES OTHER THAN THE ADMINISTRATOR AND REIMBURSES CHRISTUS DUBUIS HEALTH SYSTEM FOR THE SALARY EXPENSE OF THE ADMINISTRATOR AND THE PAYROLL TAXES AND EMPLOYEE BENEFITS ASSOCIATED WITH THE ADMINISTRATOR AND ALL OTHER EMPLOYEES. UNDER THIS ARRANGEMENT THERE ARE NO EMPLOYEES OF SOUTHERN CRESCENT HOSPITAL AND THUS NO FORMS W-2 ISSUED BY SOUTHERN CRESCENT HOSPITAL FOR SPECIALTY CARE; HOWEVER, THE EXPENSES RELATED TO THESE EMPLOYEES ARE SHOWN AS SALARY, PAYROLL TAX AND EMPLOYEE BENEFIT EXPENSES ON FORM 990 PART IX.