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GEORGIA HIGHLANDS MEDICAL SERVICES INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
GEORGIA HIGHLANDS MEDICAL SERVICES INC (EIN 58-1338038)
Tax period
2012-06-01 to 2013-05-31
Filed
2013-09-25
IRS object ID
201302689349300405
Schema version
2012v2.0
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-09-25T07:52:30-07:00Timestamp
Tax Period End Date2013-05-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1GRACE & ASSOCIATES PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line129 LENOX POINTE NEAddressLine1
CityATLANTACity
StateGAState
ZIP Code303243172ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-06-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN581338038EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Georgia Highlands Medical Services IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGEORNameControl
Phone7708871668Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1260 Elm Street P O Box 307AddressLine1
CityCummingCity
StateGAState
ZIP Code30028ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameC Alex SmithName
TitleCEOTitle
Date Signed2013-09-25DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJ N GraceName
PTINP00579388PTIN
Phone4043649000Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts5340993GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web Sitewww.georgiahighlandsmedical.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1978YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionTo develop and administer a comprehensive primary health care system for citizens of Forsyth County, Georgia, surrounding communities and their citizens, regardless of the citizen's ability to pay for services.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees74TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year2129962ContributionsGrantsPriorYear
Contributions Grants Current Year2117816ContributionsGrantsCurrentYear
Program Service Revenue Prior Year2638811ProgramServiceRevenuePriorYear
Program Service Revenue CY3207123ProgramServiceRevenueCY
Investment Income Prior Year796InvestmentIncomePriorYear
Investment Income Current Year1054InvestmentIncomeCurrentYear
Other Revenue Prior Year15000OtherRevenuePriorYear
Other Revenue Current Year15000OtherRevenueCurrentYear
Total Revenue Prior Year4784569TotalRevenuePriorYear
Total Revenue Current Year5340993TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3416917SalariesEtcPriorYear
Salaries Etc Current Year3598624SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1329940OtherExpensePriorYear
Other Expenses Current Year1437054OtherExpensesCurrentYear
Total Expenses Prior Year4746857TotalExpensesPriorYear
Total Expenses Current Year5035678TotalExpensesCurrentYear
Revenues Less Expenses Prior Year37712RevenuesLessExpensesPriorYear
Revenues Less Expenses CY305315RevenuesLessExpensesCY
Total Assets BOY2640441TotalAssetsBOY
Total Assets EOY2755336TotalAssetsEOY
Total Liabilities BOY1227279TotalLiabilitiesBOY
Total Liabilities EOY1036859TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1413162NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1718477NetAssetsOrFundBalancesEOY
Mission DescriptionTo develop and administer a comprehensive primary health care system for citizens of Forsyth County, Georgia, surrounding communities and their citizens, regardless of the citizen's ability to pay for services.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense3793523Expense
Revenue2627894Revenue
DescriptionThe program provides health services to low income individuals. Patients are charged for medical services based on their income level. During the year 44,250 patient visits were provided.Description
Total Program Service Expense3793523TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionstrueDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10964NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees74NumberOfEmployees
Employment Tax Returns FiledfalseEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMrs Linda HowellNamePerson
Telephone Number7708871668TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1260 Elm StreetAddressLine1
CityCummingCity
StateGAState
ZIP Code30040ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Diane Wade
Director1.000.00X000
Gina Santos
Director1.000.00X000
Burma Parks
Director1.000.00X000
Jesann Hendrix
President1.000.00X000
George Arguelles
Director1.000.00X000
Elba Montalvo
Director1.000.00X000
Dr Scott Henderson
Director1.000.00X000
Raymond DiPaula
Director1.000.00X000
Ruth Baumann
Secretary1.000.00X000
Scott Hansard
Treasurer1.000.00X000
Linda Howell
CFO40.000.0013204400X
C Alex Smith
CEO40.000.009078600X
Dr Arif Patni DO
Medical Director0.000.0020834800X
Safia Pirani MD
Physician40.000.0015601800X
Brinkley Goodson DO
Physician40.000.0017987700X
Swapna Madhavan MD
Physiciain32.000.0015750300X
Richard F Hamaker
Physician Asst.40.000.009006100X
Magdy Rezk MD
Physician40.000.0015107200X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1165709TotalReportableCompFromOrg
Number Individuals GT100 K6NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Wilmington Trust NA co Lincoln Financial
PO Box 7876Fort WayneIN46801403(b) EE/ER Contrib229639
State Health Benefit Plan
PO Box 931550AtlantaGA311931550Employee health ins.317888
Laboratory Corporation of America
PO Box 12140BurlingtonNC27216Laboratory services122641
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Government Grants1930443GovernmentGrants
All Other Contributions187373AllOtherContributions
Noncash Contributions67373NoncashContributions
Total Contributions2117816TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient fees, net26278932627893
Other support and revenue579230579230
FieldValueIRS element (for citing)
Total Program Service Revenue3207123TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1054TotalRevenueColumn
Exclusion$1,054ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real15000Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real15000Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column15000TotalRevenueColumn
Related Or Exempt Function Income15000RelatedOrExemptFunctionIncome

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

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

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column5340993TotalRevenueColumn
Related Or Exempt Function Income3222123RelatedOrExemptFunctionIncome
Exclusion$1,054ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total438137Total
Program Services165526ProgramServices
Management And General272611ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2524600Total
Program Services2312932ProgramServices
Management And General211668ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total0Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total635887Total
Program Services548856ProgramServices
Management And General87031ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total0Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total103178Total
Program Services90423ProgramServices
Management And General12755ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total19534Total
Program Services5734ProgramServices
Management And General13800ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total37142Total
Management And General37142ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total200898Total
Program Services24122ProgramServices
Management And General176776ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total16862Total
Management And General16862ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Donated pharmaceuticals6737367373
Repairs and Maintenance89347223387114
Contractual317501202959114542
Supplies43754635357083976

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total147673Total
Program Services19795ProgramServices
Management And General127878ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total5035678Total
Program Services3793523ProgramServices
Management And General1242155ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY239368BOY
EOY142898EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY109671BOY
EOY322887EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY316261BOY
EOY358040EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY24241BOY
EOY36831EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY5637BOY
EOY8344EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis4189337LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2329882LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1913902BOY
EOY1859455EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY31361BOY
EOY26881EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY2640441BOY
EOY2755336EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY320750BOY
EOY244759EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY905246BOY
EOY790327EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1283BOY
EOY1773EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1227279BOY
EOY1036859EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1413162BOY
EOY1718477EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1413162BOY
EOY1718477EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2640441BOY
EOY2755336EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses305315ReconcilationRevenueExpenses
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteefalseAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2158369CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2535369CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2580362CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2129962CurrentTaxYearMinus1Year
Current Tax Year2118066CurrentTaxYear
Total11522128Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2158369CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2535369CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2580362CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2129962CurrentTaxYearMinus1Year
Current Tax Year2118066CurrentTaxYear
Total11522128Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total0AmountsSubstContributorsTotal
Public Support Total17011522128PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years32717CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years23590CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years19148CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15796CurrentTaxYearMinus1Year
Current Tax Year16054CurrentTaxYear
Total107305Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years19257CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years49572CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years58649CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year14498CurrentTaxYearMinus1Year
Current Tax Year578979CurrentTaxYear
Total720955Total
FieldValueIRS element (for citing)
Total Support12350388TotalSupport
Gross Receipts From Admissions Etc12614505GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.93290PublicSupportPertcentage170
Public Support Pertcent Prior Year0.97030PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis200000OtherCostOrOtherBasis
Book Value200000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2964971OtherCostOrOtherBasis
Depreciation1522424Depreciation
Book Value1442547BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis120029OtherCostOrOtherBasis
Depreciation54572Depreciation
Book Value65457BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis904337OtherCostOrOtherBasis
Depreciation752886Depreciation
Book Value151451BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1859455TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionAccrued interestDescription
Amount$1,773Amount
FieldValueIRS element (for citing)
Total Of Amounts1773TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt5340993TotRevenueEtcAuditedFinclStmt
Revenue Subtotal5340993RevenueSubtotal
Total Revenue Per Form9905340993TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt5035678TotExpensesEtcAuditedFinclStmt
Expenses Subtotal5035678ExpensesSubtotal
Total Expenses Per Form9905035678TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
Swapna Madhavan MD
Physiciain157503157503
Safia Pirani MD
Physician156018156018
Magdy Rezk MD
Physician151072151072
Dr Arif Patni DO
Medical Director208348208348
Brinkley Goodson DO
Physician179877179877

Schedule M IRS990ScheduleM

Drugs And Medical Supplies DrugsAndMedicalSupplies

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F99067373NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftsfalseReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableThese documents are available on site and can be reviewed upon request.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThe organization utilizes a wage and salary scale for all employees. The scale is periodically revised and approved by the Board of Directors.
Form 990, Part VI, Line 15aForm 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top ManagementThe organization utilizes a wage and salary scale that is approved by the Board of Directors for the CEO.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsThe conflict of interest policy is found in our organization ethics policy and the board member by-laws and is discussed in annual Board retreats each year. Members of the Board of Directors are prohibited from realizing any financial gain from their service as board members. No member of the Board shall be an employee of the Center, or spouse or child, parent, brother or sister by blood or marriage of such an employee. No members of the Board may have an employer-employee relationship. No members of the Board may be relatives such as spouse, brother, sister, son, daughter, cousin or in-laws.
Form 990, Part VI, Line 11bForm 990, Part VI, Line 11b: Form 990 Review ProcessAfter the return is prepared by the outside CPA firm, and before being submitted to the Internal Revenue Service, it is reviewed by the CEO/CFO and forwarded to the Finance Committee and Board of Directors for review.
Client Note 1 - Georgia Highlands Medical Services, Inc. did not have any fundraising expenses during the year ended May 31, 2013.