CHATUGE REGIONAL HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CHATUGE REGIONAL HOSPITAL INC (EIN 58-2513901)
- Tax period
- 2011-05-01 to 2012-04-30
- Filed
- 2013-03-15
- IRS object ID
- 201310779349300101
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-03-15T07:44:27-05:00 | Timestamp |
| Tax Period End Date | 2012-04-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 560747981 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIXON HUGHES GOODMAN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 RIDGEFIELD COURT | AddressLine1 |
| City | ASHEVILLE | City |
| State | NC | State |
| ZIP Code | 28806 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-05-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582513901 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATUGE REGIONAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHAT | NameControl |
| Phone | 7068962222 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 SOUTH MAIN ST | AddressLine1 |
| City | HIAWASSEE | City |
| State | GA | State |
| ZIP Code | 30546 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TIM HENRY | Name |
| Title | CEO | Title |
| Phone | 7064396493 | Phone |
| Date Signed | 2013-03-18 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY BIBBY | Name |
| PTIN | P00445891 | PTIN |
| Phone | 8282542254 | Phone |
| 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 | MICHAEL GOWDER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 SOUTH MAIN ST | AddressLine1 |
| City | HIAWASSEE | City |
| State | GA | State |
| ZIP Code | 30546 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 18568217 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1955 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HIGH QUALITY, COST EFFECTIVE HEALTH CARE AND TO PROMOTE WELLNESS IN OUR COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 339 | TotalNbrEmployees |
| Total Nbr Volunteers | 40 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 2681 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 17244 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 17364875 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 18292146 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 19516 | InvestmentIncomePriorYear |
| Investment Income Current Year | 22240 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 228290 | OtherRevenuePriorYear |
| Other Revenue Current Year | 236587 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 17615362 | TotalRevenuePriorYear |
| Total Revenue Current Year | 18568217 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 9491810 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 9753303 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8776540 | OtherExpensePriorYear |
| Other Expenses Current Year | 9740703 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 18268350 | TotalExpensesPriorYear |
| Total Expenses Current Year | 19494006 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -652988 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -925789 | RevenuesLessExpensesCY |
| Total Assets BOY | 9661141 | TotalAssetsBOY |
| Total Assets EOY | 9397816 | TotalAssetsEOY |
| Total Liabilities BOY | 2948411 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3610875 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6712730 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5786941 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE HIGH QUALITY, COST EFFECTIVE HEALTH CARE AND TO PROMOTE WELLNESS THROUGHOUT OUR COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 18360356 | Expense |
| Revenue | 18388344 | Revenue |
| Description | CHATUGE REGIONAL HOSPITAL, A 501(C)(3) HEALTHCARE ORGANIZATION, TAKES A PROACTIVE APPROACH TO MEET COMMUNITY HEALTH NEEDS, THE ORGANIZATION'S TAX-EXEMPT REQUIREMENTS, AND OFFERS COMMUNITY BENEFIT PROGRAMS AND SERVICES WHICH RESULT IN A POSITIVE IMPACT ON COMMUNITY HEALTH. CHATUGE REGIONAL HOSPITAL (CRH) AND CHATUGE REGIONAL NURSING HOME (CRNH) HAVE A VISION TO BE THE "FIRST CHOICE" PROVIDER OF COMPREHENSIVE MEDICAL SERVICES IN OUR AREA. WE VALUE OUR PATIENTS AND RESIDENTS AND BELIEVE THEY ARE OUR MOST IMPORTANT RESPONSIBILITY. WE SHALL ALWAYS SEEK TO MEET THE PHYSICAL, EMOTIONAL, EDUCATIONAL AND SPIRITUAL NEEDS OF OUR PATIENTS AND THEIR FAMILIES. WE VALUE OUR MEDICAL STAFF AND WILL SEEK WAYS TO HELP THEM IMPROVE PROFESSIONALLY AND FACILITATE THE PRACTICE OF MEDICINE. WE VALUE OUR EMPLOYEES AND SHALL TREAT EACH OTHER WITH COURTESY, FAIRNESS, RESPECT AND INTEGRITY. WE SHALL WORK AS A TEAM TO DO OUR BEST TO PROMOTE OUR MISSION AND FUFILL OUR VISION. WE VALUE OUR COMMUNITY. WE ARE COMMITTED TO THE TREATMENT AND CARE OF OUR PATIENTS AND THE PROMOTION OF HEALTH AND WELLNESS IN OUR COMMUNITY. WE WILL CONFRONT ALL ETHICAL AND MORAL HEALTH-RELATED ISSUES NECESSARY TO ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY. WE VALUE QUALITY CARE AND WILL SEEK TO DELIVER CUSTOMER-FOCUSED, COST EFFICIENT SERVICES WITH COMPASSION AND CARING. CHATUGE REGIONAL HOSPITAL WAS DEEMED TO BE A CRITICAL ACCESS HOSPITAL BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS), EFFECTIVE MAY 1, 2002, AND BY THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH (DCH). CRH IS THE ONLY ACUTE CARE HOSPITAL IN TOWNS COUNTY, GEORGIA. CRH IS LIMITED TO 25 ACUTE AND INTENSIVE CARE MEDICAL/SURGICAL BEDS. THESE BEDS ARE ALSO USED FOR SHORT-TERM SKILLED NURSING CARE. OUTPATIENT SERVICES INCLUDE RADIOLOGY, LABORATORY AND OTHER DIAGNOSTIC SERVICES, REHABILITATION SERVICES, AND 24/7 EMERGENCY MEDICAL SERVICES. CRNH IS THE ONLY NURSING FACILTIY IN THE COUNTY PROVIDING SKILLED AND INTERMEDIATE LEVELS OF LONG-TERM CARE. CRNH IS LICENSED FOR 112 BEDS AND CONSISTENTLY HAS A WAITING LIST FOR ADMISSIONS. A MAJORITY OF THE RESIDENTS OF CRNH ARE MEDICARE AND MEDICAID BENEFICIARIES. IT IS A LONG-ESTABLISHED POLICY OF CRH TO PROVIDE QUAITY CARE FOR ITS PATIENTS REGARDLESS OF THEIR FINANCIAL CIRCUMSTANCES. QUALIFICATION FOR HOSPITAL INDEGENT CARE IS SET AT 125% OF THE CURRENT FEDERAL POVERTY GUIDELINES AND IS BASED ON SIZE OF THE FAMILY UNIT. CRH AND CRNH ALSO PROVIDE FREE OR REDUCED COST CARE TO ALL ELIGIBLE PERSONS REQUESTING CHARITY CARE ASSISTANCE. FOR EMERGENCY MEDICAL SERVICES, INCLUDING ACTIVE LABOR, NO PERSON WILL BE DENIED CARE DUE TO AN INABILITY TO PAY FOR SERVICES. CRH AND CRNH PARTICIPATE IN MEDICARE, MEDICAID, PEACHCARE, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS. CRH, IN CONJUNCTION WITH ITS SISTER HOSPITAL, UNION GENERAL HOSPITAL, ARE THE ONLY TAX-EXEMPT, NON-PROFIT HOSPITALS WITHIN THE IMMEDIATE EIGHT-COUNTY AREA OF THE NORTH CENTRAL AND NORTHEAST GEORGIA MOUNTAINS. DUE TO THE MOUNTAINOUS TERRAIN AND BEING BOUNDED BY THE CHATTAHOOCHEE NATIONAL FOREST AND LAKE CHATUGE, TOWNS COUNTY AND ITS NEIGHBORING CLAY COUNTY, NC, HAVE SEVERAL VERY REMOTE COMMUNITIES FROM WHICH ACCESS TO MEDICAL CARE CAN LITERALLY BE MORE THAN AN HOUR AWAY IN SOME CASES. TOWNS COUNTY ATTRACTS MANY VISITORS FOR CAMPING, HIKING, FISHING, AND HUNTING. THE TWISTING MOUNTAIN ROADS ATTRACT BICYCLISTS AND MOTORCYCLISTS THROUGHOUT THE SPRING, SUMMER AND FALL SEASONS. THESE ACTIVITIES MANY TIMES RESULT IN MEDICAL EMERGENCIES, SOME VERY SERIOUS, TO WHICH THE EMERGENCY DEPARTMENT OF CRH MUST BE PREPARED TO MEET. CRH ESTABLISHED A FAMILY MEDICAL PRACTICE IN HAYESVILLE, NC (CLAY COUNTY) TO HELP MEET THE MEDICALLY UNDERSERVED IN THE COMMUNITY. THE MEDICAL OFFICE IS STAFFED WITH FAMILY NURSE PRACTITIONERS (FNPS) AND SUPPORTED BY PHYSICIANS FROM CRH'S EMERGENCY DEPARTMENT. | Description |
| Total Program Service Expense | 18360356 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 34 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 339 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TIMOTHY HENRY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7064396843 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 35 HOSPITAL ROAD | AddressLine1 |
| City | BLAIRSVILLE | City |
| State | GA | State |
| ZIP Code | 30512 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| PATSY EFIRD | |||||||
| CHAIRPERSON | 1.00 | X | X | 0 | 0 | 0 | |
| G DAVID GOWDER MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 49689 | 4255 | ||
| DAVID BREEDLOVE MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 350 | 0 | ||
| MAX COCHRAN | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DINAH PARIS | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JEFF PATTERSON | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| MYRON TURNER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JAMES K WILLIAMS | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| REBECCA T DYER | |||||||
| CEO | 40.00 | X | 0 | 109946 | 28827 | ||
| TIMOTHY N HENRY | |||||||
| CFO | 40.00 | X | 0 | 144017 | 17327 | ||
| J MICHAEL GOWDER | |||||||
| COO | 40.00 | X | 0 | 147636 | 15384 | ||
| ANNETTE STOOKEY | |||||||
| PHYSICAL THERAPY MANAGER | 40.00 | 110553 | 0 | 10827 | X | ||
| KAREN KELLEY | |||||||
| PHARMACIST | 40.00 | 120593 | 0 | 26617 | X | ||
| RICHARD KELLEY | |||||||
| HOSPITAL & NH ADMINISTRATOR | 40.00 | 131878 | 0 | 20540 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 363024 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 451638 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 123777 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 1 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| STERLING EMERGENCY SERVICES | |||||
| PO BOX 758746 | BALTIMORE | MD | 21275 | ER DOCTORS | 2344974 |
| THE ERX GROUP LLC | |||||
| 9724 KINGSTON PIKE STE 406 | KNOXVILLE | TN | 37922 | PROVIDED ER PHYSICIANS | 523928 |
| QUEST DIAGNOSTICS | |||||
| PO BOX 281945 | ATLANTA | GA | 20284 | LAB SUPPLIES | 122186 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
| All Other Contributions | 17244 | AllOtherContributions |
| Total Contributions | 17244 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE RE | Description |
| Business Code | 623000 | BusinessCode |
| Total Revenue Column | 18292146 | TotalRevenueColumn |
| Related Or Exempt Function Income | 18292146 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 18292146 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22240 | TotalRevenueColumn |
| Exclusion | $22,240 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 140389 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 140389 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 140389 | TotalRevenueColumn |
| Exclusion | $140,389 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| CAFETERIA & VENDING | 722210 | 56954 | 56954 |
| SALE OF SUPPLIES/DRUGS | 446110 | 15964 | 15964 |
| MISCELLANEOUS | 900099 | 5744 | 5744 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17536 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17536 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 96198 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18568217 | TotalRevenueColumn |
| Related Or Exempt Function Income | 18388344 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $162,629 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8336060 | Total |
| Program Services | 7792805 | ProgramServices |
| Management And General | 543255 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 89178 | Total |
| Program Services | 83366 | ProgramServices |
| Management And General | 5812 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 738123 | Total |
| Program Services | 690020 | ProgramServices |
| Management And General | 48103 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 589942 | Total |
| Program Services | 551496 | ProgramServices |
| Management And General | 38446 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49272 | Total |
| Management And General | 49272 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2096764 | Total |
| Program Services | 2036818 | ProgramServices |
| Management And General | 59946 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19826 | Total |
| Program Services | 19826 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1834150 | Total |
| Program Services | 1591018 | ProgramServices |
| Management And General | 243132 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9450 | Total |
| Program Services | 9450 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 918812 | Total |
| Program Services | 775683 | ProgramServices |
| Management And General | 143129 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35789 | Total |
| Program Services | 33834 | ProgramServices |
| Management And General | 1955 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2326 | Total |
| Program Services | 2326 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9193 | Total |
| Program Services | 9193 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 607519 | Total |
| Program Services | 607519 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 230218 | Total |
| Program Services | 230218 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 2794986 | 2794986 | |
| MEDICAL SUPPLIES | 1131917 | 1131917 | |
| MISCELLANEOUS | 481 | -119 | 600 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19494006 | Total |
| Program Services | 18360356 | ProgramServices |
| Management And General | 1133650 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1344641 | BOY |
| EOY | 1877338 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 757271 | BOY |
| EOY | 263853 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2721326 | BOY |
| EOY | 2399619 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 332733 | BOY |
| EOY | 344616 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 302473 | BOY |
| EOY | 562282 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 9711318 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5773710 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4202697 | BOY |
| EOY | 3937608 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 12500 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9661141 | BOY |
| EOY | 9397816 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1233351 | BOY |
| EOY | 1515330 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 172976 | BOY |
| EOY | 118106 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1542084 | BOY |
| EOY | 1977439 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2948411 | BOY |
| EOY | 3610875 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6712730 | BOY |
| EOY | 5786941 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6712730 | BOY |
| EOY | 5786941 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9661141 | BOY |
| EOY | 9397816 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -925789 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 415739 | OtherCostOrOtherBasis |
| Book Value | 415739 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3636029 | OtherCostOrOtherBasis |
| Depreciation | 2258426 | Depreciation |
| Book Value | 1377603 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 129722 | OtherCostOrOtherBasis |
| Depreciation | 80573 | Depreciation |
| Book Value | 49149 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5529828 | OtherCostOrOtherBasis |
| Depreciation | 3434711 | Depreciation |
| Book Value | 2095117 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3937608 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CAPITAL LEASE OBLIGATIONS | $54,869 |
| ESTIMATED 3RD PARTY PAYOR SETTLEMENTS | $230,591 |
| INTERCOMPANY PAYABLES | $1,673,331 |
| DEFERRED REVENUE | $18,648 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1977439 | TotalOfAmounts |
| Total Revenue | 18568217 | TotalRevenue |
| Total Expenses | 19494006 | TotalExpenses |
| Excess Or Deficit For Year | -925789 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | -925789 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 18568217 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 18568217 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 18568217 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 19494006 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 19494006 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 19494006 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | INCOME TAXES - CHATUGE REGIONAL HOSPITAL IS A NOT-FOR-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION HAS EVALUATED THEIR TAX POSITION AND HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF APRIL 30, 2012 AND 2011. FISCAL YEARS ENDING ON AND AFTER APRIL 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 125.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 0 | AmountsBudgetedForCharityCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 0 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 88939 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 258490 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -169551 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3959140 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5207463 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1248323 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4048079 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5465953 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1417874 | NetCommunityBenefitExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11909 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 11909 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11909 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 11909 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4059988 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5465953 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1405965 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $2,794,986 | BadDebtExpenseAmount |
| Amount Attributable To | 159910 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 15612431 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 11652329 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 3960102 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATUGE REGIONAL HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 SOUTH MAIN ST | AddressLine1 |
| City | HIAWASSEE | City |
| State | GA | State |
| ZIP Code | 30546 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHATUGE REGIONAL HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 125.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 0 | ExplainsApplicationMethod |
| Includes Publicity Measures | 0 | IncludesPublicityMeasures |
| Actions On Nonpayment | 0 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| CHATUGE REGIONAL NURSING HOME | ||||
| 386 BELAIRE DRIVE | HIAWASSEE | GA | 30546 | SKILLED NURSING |
| HAYESVILLE FAMILY PRACTICE | ||||
| 450 HWY 64 BUSINESS SUITE 4 | HAYNESVILLE | GA | 28904 | FAMILY CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| 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 $ 2794986. | |
| PART III, LINE 4: THERE IS NO FOOTNOTE ADDRESSING BAD DEBT IN THE ORGANIZATION'S FINANCIAL STATEMENTS.BASED ON EXPERIENCE, THE ORGANIZATION HAS FOUND THAT THERE IS A PORTION OF BAD DEBT THAT IS GENERALLY ATTRIBUTABLE TO CHARITY CARE. THE ORGANIZATION MULTIPLIED THE PORTION OF BAD DEBT ATTRIBUTABLE TO CHARITY BY THE COST-TO-CHARGE RATIO CALCULATED USING THE IRS 2011 SCHEDULE H WORKSHEET 2. | |
| PART III, LINE 8: THIS SHORTFALL IS GENERATED PRIMARILY FROM PROVIDING EMERGENCY PHYSICIAN SERVICES AND SHOULD COUNT 100% TOWARD COMMUNITY BENEFIT EXPENSE. | |
| PART III, LINE 9B: ONCE THE PATIENT IS APPROVED FOR INDIGENT CARE (100% WRITE OFF) THE ACCOUNT(S) IS (ARE) RECLASSED TO INDIGENT CARE AND NO FURTHER COLLECTION ACIVITY IS CONDUCTED. FOR PATIENTS APPROVED FOR CHARITY CARE (REDUCED CHARGE), THE ACCOUNT GUARANTOR WILL RECEIVE STATEMENTS AND PHONE CALLS TO COLLECT THE REMAINING BALANCE DUE. | |
| PART V, SECTION B, LINE 10: MONTHLY OR ANNUAL INCOME AT OR BELOW 125% OF THE CURRENT FEDERAL PROVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% INDIGENT/CHARITY CARE. THOSE INCOMES BETWEEN 125% AND 400% OF THE FPG ARE ELIGIBLE FOR A REDUCTION IN CHARGES BASED ON A SLIDING SCALE. | CHATUGE REGIONAL HOSPITAL, INC. |
| PART V, SECTION B, LINE 11H: PATIENTS ARE OFFERED A 20% DISCOUNT IF THEY PAY UP FRONT. | CHATUGE REGIONAL HOSPITAL, INC. |
| PART V, SECTION B, LINE 13G: ANNUAL NEWSPAPER NOTICE INDICATING AVAILABLILITY OF FINANCIAL ASSISTANCE. REGISTRATION AND COLLECTORS PROVIDE INFORMATION AND FINANCIAL ASSISTANCE APPLICATION. SIGNAGE POSTED IN REGISTRATION AND EMERGENCY DEPARTMENT. | CHATUGE REGIONAL HOSPITAL, INC. |
| PART VI, LINE 2: THE ORGANIZATION PRIMARILY SOLICITS FEEDBACK FROM THE MEDICAL STAFF AND CITY AND COUNTY OFFICIALS. | |
| PART VI, LINE 3: NOTICES ARE PUBLISHED IN THE LOCAL COMMUNITY NEWSPAPER REGARDING THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. ACCOUNT COLLECTORS INFORM THE ACCOUNT GUARANTOR OF THE AVAILABILITY OF INDIGENT AND CHARITY CARE ONCE THE COLLECTION PROCESS IS INITIATED. THE ORGANIZATION MAILS OUT APPLICATIONS FOR FINANCIAL AID, BUT RECEIVES A LIMITED NUMBER RETURNED. | |
| PART VI, LINE 4: THE ORGANIZATION SERVES A GENERALLY RURAL, MOUNTAINOUS AREA AND IS THE SOLE HOSPITAL IN TOWNS COUNTY. DUE TO THE MOUNTAINOUS TERRAIN AND BEING BOUNDED BY THE CHATTAHOOCHEE NATIONAL FOREST AND LAKE CHATUGE, TOWNS COUNTY AND ITS NEIGHBORING CLAY COUNTY, NC HAVE VERY REMOTE COMMUNITIES FROM WHICH ACCESS TO MEDICAL CARE CAN LITERALLY BE MORE THAN AN HOUR AWAY IN SOME CASES. TOWNS COUNTY ATTRACTS MANY VISITORS FOR CAMPING, BOATING, HIKING, FISHING AND HUNTING, AS WELL AS BICYCLISTS AND MOTORCYCLISTS, WHICH OFTEN LEAD TO SERIOUS INJURY THAT THE EMERGENCY DEPARTMENT MUST MBE PREPARED TO MEET. FURTHERMORE, CRH IS A CRITICAL ACCESS HOSPITAL FOR THE RESIDENTS OF TOWNS COUNTY, GA, AND CLAY COUNTY, NC. A SIGNIFICANT PORTION OF THE RESIDENT POPULATION ARE MEDICARE AND MEDICAID BENEFICIARIES. TOWNS COUNTY IS DEEMED TO HAVE A MEDICALLY UNDERSERVED POPULATION (MUP) BY THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH. | |
| PART VI, LINE 5: THE ORGANIZATION CONDUCTS HEALTH FAIRS OPEN TO THE COMMUNITY WHEREIN FREE HEALTH SCREENINGS AND LOW-COST BASIC LAB TESTS ARE DONE. OTHER HEALTH INFORMATION IS PROVIDED INCLUDING INFORMATION ON SMOKING CESSATION AND DIABETES. THE ORGANZATION IS ENTIRELY TOBACCO-FREE, THUS PROMOTING A HEALTHY LIFESTYLE.SURPLUS FUNDS ARE USED TO PROVIDE FOR THE ADDITION, IMPROVEMENT, OR REPLACEMENT OF CAPITAL AND EQUIPMENT NEEDS. | |
| PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTHCARE SYSTEM. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TIMOTHY N HENRY | |||||||||||||
| 0 | 143717 | 0 | 300 | 0 | 0 | 0 | 13000 | 0 | 4327 | 0 | 161344 | 0 | 0 |
| J MICHAEL GOWDER | |||||||||||||
| 0 | 147336 | 0 | 300 | 0 | 0 | 0 | 11057 | 0 | 4327 | 0 | 163020 | 0 | 0 |
| RICHARD KELLEY | |||||||||||||
| 131578 | 0 | 300 | 0 | 0 | 0 | 20540 | 0 | 0 | 0 | 152418 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | DIRECTOR G. DAVID GOWDER,MD AND CHEIF OPERATING OFFICER J. MICHAEL GOWDER HAVE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 6 | UNION GENERAL HOSPITAL, INC., A GEORGIA 501(C)(3) NON-PROFIT HEALTHCARE ORGANIZATION, IS THE SOLE MEMBER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. THE CFO PROVIDED A COPY OF THE COMPLETED FORM 990 TO EACH BOARD MEMBER AND REVIEWED IT IN DETAIL AT A BOARD MEETING PRIOR TO FILING THE RETURN. |
| FORM 990, PART VI, SECTION B, LINE 12C | OFFICERS, DIRECTORS, AND TRUSTEES ARE REQUIRED TO ANNUALLY SIGN A STATEMENT REGARDING CONFLICTS OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE ORGANIZATION USES THE GEORGIA ASSOCIATION COMPENSATION STUDY AS A BENCHMARK FOR ALL EXECUTIVE COMPENSATION. THE BOARD OF THE SOLE MEMBER APPROVES THE CEO'S COMPENSATION, WHICH IS PAID THROUGH THE SOLE MEMBER. ALL OTHER EXECUTIVE COMPENSATION IS MANAGED BY THE CEO. |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE ORGANIZATION'S FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE BY REQUEST. |
| FORM 990, PART VII | G. DAVID GOWDER IS COMPENSATED BY A RELATED ORGANIZATION FOR SERVICES PERFORMED AS ER DIRECTOR OF THAT ORGANIZATION. NO PART OF HIS COMPENSATION IS PAID FOR HIS SERVICES AS BOARD MEMBER. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| UNION GENERAL HOSPITAL INC | ||||||||||
| 214 HOSPITAL CIRCLE | BLAIRSVILLE | GA | 30512 | 586025393 | HOSPITAL | GA | 501(C)(3) | LINE 3 | N/A | 0 |
| MOUNTAIN COMMUNITY HEALTHCARE FOUNDATION | ||||||||||
| PO BOX 509 | HIAWASSEE | GA | 30546 | 201376498 | SUPPORT | GA | 501(C)(3) | LINE 11C, III-FI | N/A | 0 |
| UNION GENERAL AMBULANCE SERVICE INC | ||||||||||
| 35 HOSPITAL ROAD | BLAIRSVILLE | GA | 30512 | 452735005 | AMBULANCE SERVICE | GA | 501(C)(3) | LINE 11B, II | N/A | 0 |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNION COUNTY DIALYSIS LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 214 HOSPITAL CIRCLE | AddressLine1 |
| City | BLAIRSVILLE | City |
| State | GA | State |
| ZIP Code | 30512 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582503326 | EIN |
| Primary Activity | DIALYSIS CLINIC | PrimaryActivity |
| Legal Domicile State | GA | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |