LIBERTY REGIONAL MEDICAL CENTER INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- LIBERTY REGIONAL MEDICAL CENTER INC (EIN 58-2413173)
- Tax period
- 2011-12-01 to 2012-11-30
- Filed
- 2013-10-14
- IRS object ID
- 201302879349300220
- 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 I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-10-14T10:24:40-05:00 | Timestamp |
| Tax Period End Date | 2012-11-30 | 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 71309 | AddressLine1 |
| City | ALBANY | City |
| State | GA | State |
| ZIP Code | 317081309 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-12-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582413173 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LIBERTY REGIONAL FOUNDATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LIBE | NameControl |
| Phone | 9123699438 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 919 | AddressLine1 |
| City | HINESVILLE | City |
| State | GA | State |
| ZIP Code | 313100919 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SCOTT KROELL | Name |
| Title | CEO | Title |
| Phone | 9123699438 | Phone |
| Date Signed | 2013-10-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACQUELINE G ATKINS | Name |
| Phone | 2298837878 | Phone |
| Date Prepared | 2013-10-07 | 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 | SCOTT KROELL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 919 | AddressLine1 |
| City | HINESVILLE | City |
| State | GA | State |
| ZIP Code | 313100919 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2074303 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1998 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | SUPPORT OF AN ACUTE-CARE AUTHORITY HOSPITAL BY PROVIDING FUNDRAISING AND AMBULANCE SERVICES FOR RESIDENTS OF THE COUNTY AND SURROUNDING AREAS REGARDLESS OF ABILITY TO PAY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 3 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 122904 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 125583 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1649942 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 1920683 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 165 | InvestmentIncomePriorYear |
| Investment Income Current Year | 25 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 18112 | OtherRevenuePriorYear |
| Other Revenue Current Year | 24104 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1791123 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2070395 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 27733 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 24010 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1540976 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1686294 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 696 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 255156 | OtherExpensePriorYear |
| Other Expenses Current Year | 388037 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1823865 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2098341 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -32742 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -27946 | RevenuesLessExpensesCY |
| Total Assets BOY | 940249 | TotalAssetsBOY |
| Total Assets EOY | 1376113 | TotalAssetsEOY |
| Total Liabilities BOY | 1139618 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1603428 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -199369 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | -227315 | NetAssetsOrFundBalancesEOY |
| Mission Description | SUPPORT OF AN ACUTE-CARE AUTHORITY HOSPITAL BY PROVIDING FUNDRAISING AND AMBULANCE SERVICES FOR RESIDENTS OF THE COUNTY AND SURROUNDING AREAS REGARDLESS OF ABILITY TO PAY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 2003043 | Expense |
| Revenue | 1922813 | Revenue |
| Description | LIBERTY REGIONAL EMS, INC. SUPPORTS LIBERTY REGIONAL MEDICAL CENTER, AN AUTHORITY HOSPITAL, IN ITS PURSUIT TO PROVIDE HEALTHCARE TO THE RESIDENTS OF LIBERTY COUNTY, REGARDLESS OF ABILITY TO PAY FOR SERVICES. THE CURRENT YEAR DISBURSEMENTS FOR LIBERTY REGIONAL EMS, INC. WERE FOR AMBULANCE SERVICES PROVIDED TO THE COMMUNITY AND SURROUNDING AREAS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 37226 | Expense |
| Grants | 24010 | Grants |
| Description | LIBERTY REGIONAL FOUNDATION, INC. SUPPORTS LIBERTY REGIONAL MEDICAL CENTER, AN AUTHORITY HOSPITAL, IN ITS PURSUIT TO PROVIDE HEALTHCARE TO THE RESIDENTS OF LIBERTY COUNTY, REGARDLESS OF ABILITY TO PAY FOR SERVICES. THE CURRENT YEAR DISBURSEMENTS FOR LIBERTY REGIONAL FOUNDATION, INC. WERE FOR FACILITY IMPROVEMENTS AND EQUIPMENT USED TO CARRY OUT THE HOSPITAL'S EXEMPT PURPOSE. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 2040269 | 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 | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | 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 | false | Hospital |
| Grants To Organizations | true | 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 | false | 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 | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| 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 | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | 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 |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SAM JOHNSON CFO | NamePerson |
| Telephone Number | 9123699426 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 919 | AddressLine1 |
| City | HINESVILLE | City |
| State | GA | State |
| ZIP Code | 313100919 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (9 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| JON P LONG | ||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 |
| JAMES E ROGERS | ||||||
| VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 |
| WILLIAM D DARSEY | ||||||
| SEC/TRES. | 1.00 | X | X | 0 | 0 | 0 |
| ALAN N BAROODY | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| REGINALD L PIERCE SR | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| BOBBY HERRINGTON MD | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| JAMES THOMAS JR | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| SCOTT KROELL | ||||||
| HOSPITAL CEO | 1.00 | X | 0 | 221323 | 40926 | |
| SAM JOHNSON | ||||||
| HOSPITAL CFO | 1.00 | X | 0 | 181621 | 6310 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp Frm Rltd Orgs | 402944 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 47236 | TotalOtherCompensation |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Government Grants | 124613 | GovernmentGrants |
| All Other Contributions | 970 | AllOtherContributions |
| Total Contributions | 125583 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT REVENUE | Description |
| Business Code | 621910 | BusinessCode |
| Total Revenue Column | 1920683 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1920683 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 1920683 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 25 | TotalRevenueColumn |
| Exclusion | $25 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 25095 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 3908 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 21187 | TotalRevenueColumn |
| Exclusion | $21,187 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| OTHER INCOME | 621990 | 2130 | 2130 | |
| MEDICAL RECORD SALES | 621990 | 787 | $787 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2917 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2070395 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1922813 | RelatedOrExemptFunctionIncome |
| Exclusion | $21,999 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24010 | Total |
| Program Services | 24010 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1679094 | Total |
| Program Services | 1623402 | ProgramServices |
| Management And General | 55692 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7200 | Total |
| Program Services | 7200 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39156 | Total |
| Program Services | 39156 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 504 | Total |
| Program Services | 504 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 151014 | Total |
| Program Services | 148634 | ProgramServices |
| Management And General | 1684 | ManagementAndGeneral |
| Fundraising | 696 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112702 | Total |
| Program Services | 112702 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| MISCELLANEOUS | 47537 | 47537 |
| LICENSES & TAXES | 15100 | 15100 |
| REPAIRS & MAINTENANCE | 11423 | 11423 |
| MEDICAL SUPPLIES | 8810 | 8810 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1791 | Total |
| Program Services | 1791 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2098341 | Total |
| Program Services | 2040269 | ProgramServices |
| Management And General | 57376 | ManagementAndGeneral |
| Fundraising | 696 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 240 | BOY |
| EOY | 240 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 78813 | BOY |
| EOY | 109693 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 811316 | BOY |
| EOY | 1263978 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 30000 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 30000 | LandBldgEquipmentAccumDeprec |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49880 | BOY |
| EOY | 2202 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 940249 | BOY |
| EOY | 1376113 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1139618 | BOY |
| EOY | 1603428 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1139618 | BOY |
| EOY | 1603428 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -199369 | BOY |
| EOY | -227315 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -199369 | BOY |
| EOY | -227315 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 940249 | BOY |
| EOY | 1376113 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -27946 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type2 | X | SupportingOrg509a3Type2 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSP AUTH OF LIBERTY CO DBA LIBERTY REGIONAL MED CTR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 586025016 | EIN |
| Type Of Organization | 6 | TypeOfOrganization |
| Listed In Governing Doc | true | ListedInGoverningDoc |
| Supported Organization Notified | true | SupportedOrganizationNotified |
| Organized In US | true | OrganizedInUS |
| Amount | $24,010 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 24010 | SumOfAmounts |
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 |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 30000 | OtherCostOrOtherBasis |
| Depreciation | 30000 | Depreciation |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | LIABILITY UNDER FIN 48 FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PAGE 3, PART X | ReturnReference |
| Explanation | THE AUTHORITY IS A GOVERNMENTAL ENTITY AND IS EXEMPT FROM INCOME TAXES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN CONSIDERED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE FOUNDATION 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 FOUNDATION 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 FOUNDATION 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 OF 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 NOVEMBER 30, 2012 AND 2011 OR FOR THE YEARS THEN ENDED. THE FOUNDATION'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2009-2011. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | MUSIC ON THE MA | NameOfEvent1 |
| Gross Receipts Event1 | 25095 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 25095 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 1508 | RentFacilityCostsEvent1 |
| Entertainment Event1 | 2400 | EntertainmentEvent1 |
| Gross Receipts Total | 25095 | GrossReceiptsTotal |
| Gross Revenue Total Events | 25095 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 1508 | RentFacilityCostsTotalEvents |
| Entertainment Total Events | 2400 | EntertainmentTotalEvents |
| Direct Expense Summary Events | 3908 | DirectExpenseSummaryEvents |
| Net Income Summary | 21187 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSPITAL AUTHORITY OF LIBERTY COUNT | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 919 | AddressLine1 |
| City | HINESVILLE | City |
| State | GA | State |
| ZIP Code | 31313 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 586025016 | EINOfRecipient |
| IRC Section | GOV | IRCSection |
| Amount Of Cash Grant | 24010 | AmountOfCashGrant |
| Purpose Of Grant | CAPITAL CONTRIBUTION | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES | Identifier |
| Return Reference | SCHEDULE I, PAGE 1, PART I, LINE 2 | ReturnReference |
| Explanation | THE ORGANIZATION MONITORS THE USE OF CAPITAL CONTRIBUTIONS TO LIBERTY MEDICAL CENTER THROUGH A COMMON MANAGEMENT TEAM. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (2 entries)
| Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Related OrgsTotalCompensationRelatedOrgs |
|---|---|---|---|---|---|
| SCOTT KROELL | |||||
| 191381 | 25000 | 4942 | 22480 | 18446 | 262249 |
| SAM JOHNSON | |||||
| 170178 | 10000 | 1443 | 6310 | 187931 | |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | RELATED ORG METHODS USED FOR COMPENSATION EXPLANATION | Identifier |
| Return Reference | SCHEDULE J, PAGE 1, PART I, LINE 3 | ReturnReference |
| Explanation | NONE OF THE INDIVIDUAL BOARD MEMBERS OR OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION. THE FILING ORGANIZATION, INSTEAD, RELIES ON THE METHODS USED BY THE SUPPORTED ORGANIZATION, HOSPITAL AUTHORITY OF LIBERTY COUNTY DBA LIBERTY REGIONAL MEDICAL CENTER ("HA"), TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY THE HA INCLUDES INDEPENDENT COMPENSATION SURVEYS, WRITTEN EMPLOYMENT CONTRACTS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | FINAL FORM 990 IS PROVIDED TO BOARD DURING ITS REGULARLY SCHEDULED MEETING PRIOR TO FILING TO ALLOW THE BOARD AN OPPORTUNITY FOR REVIEW BEFORE SUBMISSION TO THE INTERNAL REVENUE SERVICE. MANAGEMENT REVIEWS THE RETURN FOR ACCURACY AND COMPLETENESS IN THE FINANCIAL AND NARRATIVE DETAILS. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICT OF INTEREST FORMS ARE SIGNED ANNUALLY BY ALL HOSPITAL AUTHORITY BOARD MEMBERS. ANY DETERMINATION AS TO WHETHER A CONFLICT EXISTS IS THE RESPONSIBIITY OF THE REMAINING BOARD MEMBERS AND THE CONFLICTED INDIVIDUAL IS DISMISSED FROM THE DISCUSSIONS AND VOTES ON THE MATTER. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | THE CEO IS COMPENSATED BY THE HOSPITAL AUTHORITY OF LIBERTY COUNTY DBA LIBERTY REGIONAL MEDICAL CENTER ("HA"), THE SUPPORTED ORGANIZATION. HA'S HUMAN RESOURCES DEPARTMENT PROVIDES SALARY RECOMMENDATIONS FOR ALL LIBERTY REGIONAL MEDICAL CENTER'S EMPLOYEES BASED UPON SALARY SURVEY DATA PROVIDED BY THE GEORGIA HOSPITAL ASSOCIATION. THE CEO'S COMPENSATION IS SET BY HIS EMPLOYMENT CONTRACT AND ANY PAY INCREASE IS SUBJECT TO THE APPROVAL OF HA'S BOARD. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | THE CFO IS COMPENSATED BY THE SUPPORTED ORGANIZATION. HA'S HUMAN RESOURCES DEPARTMENT PROVIDE SALARY RECOMMENDATIONS FOR ALL LIBERTY REGIONAL MEDICAL CENTER EMPLOYEES BASED UPON SALARY SURVEY DATA PROVIDED BY THE GEORGIA HOSPITAL ASSOCIATION. THE CFO'S COMPENSATION AND ANY PAY INCREASE IS SUBJECT TO THE APPROVAL OF HA'S BOARD. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | THE FILING ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO ANY MEMBER OF THE PUBLIC WHO MAKES THEIR REQUEST AT THE ADMINISTRATIVE OFFICE. |
| RELATED ORGANIZATIONS | FORM 990, PAGE 7, PART VII | AVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS: JOHN LONG 1 HOUR JAMES ROGERS 1 HOUR WILLIAM DARSEY 1 HOUR ALAN BAROODY 1 HOUR REGINALD PIERCE SR 1 HOUR BOBBY HERRINGTON MD 1 HOUR JAMES THOMAS JR 1 HOUR SCOTT KROELL 40 HOURS SAM JOHNSON 40 HOURS |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOSP AUTH LIBERTY REGIONAL MED CTR | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 919 | AddressLine1 |
| City | HINESVILLE | City |
| State | GA | State |
| ZIP Code | 31310 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 586025016 | EIN |
| Primary Activities | HEALTHCARE | PrimaryActivities |
| Legal Domicile State | GA | LegalDomicileState |
| Exempt Code Section | 509A1 | ExemptCodeSection |
| Public Charity Status | 6 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | 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 | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |