GEORGIA MOUNTAINS HOSPICE INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- GEORGIA MOUNTAINS HOSPICE INC (EIN 58-2051326)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-07-03
- IRS object ID
- 201321849349300412
- Schema version
- 2011v1.2
- 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 | 2013-07-03T13:27:43-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 581729751 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Metcalf Davis CPAs | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3340 Peachtree Road NE Suite 2600 | AddressLine1 |
| City | Atlanta | City |
| State | GA | State |
| ZIP Code | 303261089 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582051326 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Georgia Mountains Hospice Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GEOR | NameControl |
| Phone | 8006927199 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 70 Caring Way | AddressLine1 |
| City | Jasper | City |
| State | GA | State |
| ZIP Code | 30143 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Mary Anne Bramlett | Name |
| Title | Financial Coordinator | Title |
| Phone | 7062534100 | Phone |
| Date Signed | 2013-07-03 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Susan Hill | Name |
| PTIN | P00846200 | PTIN |
| Phone | 4042641700 | Phone |
| Date Prepared | 2013-05-24 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Gina Pendley | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 70 Caring Way | AddressLine1 |
| City | Jasper | City |
| State | GA | State |
| ZIP Code | 30143 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2135193 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.georgiamountainhospice.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1993 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | Georgia Mountains Hospice's mission is to provide excellent hospice care utilizing the interdisciplinary team model. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 36 | TotalNbrEmployees |
| Total Nbr Volunteers | 40 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 51244 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 82206 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 1868680 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 1963377 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 7751 | InvestmentIncomePriorYear |
| Investment Income Current Year | 7254 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 23188 | OtherRevenuePriorYear |
| Other Revenue Current Year | -3838 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1950863 | TotalRevenuePriorYear |
| Total Revenue Current Year | 2048999 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 5643 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 1286575 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 1315265 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 30426 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 756966 | OtherExpensePriorYear |
| Other Expenses Current Year | 669805 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2043541 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1990713 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -92678 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 58286 | RevenuesLessExpensesCY |
| Total Assets BOY | 1699751 | TotalAssetsBOY |
| Total Assets EOY | 1778766 | TotalAssetsEOY |
| Total Liabilities BOY | 466193 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 478869 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1233558 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1299897 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | To offer hope to a patient for whom all hope for cure has been exhausted; hope for maximum alertness,hope for independence and control over one's life. To offer support to families by allowing terminal patients to live at home pain free and with dignity. To offer the opportunity to tie up loose ends, make reconciliations, to know "good" goodbyes. To offer spiritual guidance and answers to one's search for meaning in one's life and death. To offer relief from financial strain. To offer care and support to family members and significant others through the bereavment period. To offer support to the community through education on death and dying. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 1393210 | Expense |
| Revenue | 1963529 | Revenue |
| Description | Hospice Program: See schedule OWe provide access to the highest quality hospice program for the people of North Georgia we care for through comprehensive approaches to palliative care, pain management, and compassionate customer services while developing exceptional professional skills regarding hospice care for a rural community.Our goals are 1: To provide service excellence in nursing care, emotional support, spiritual guidance, and bereavement services to terminally ill patients and their families. 2: To provide a spirit of acceptance and mutual respect, quality and compassionate care to all patients requesting services. 3: To promote independence, comfort, and dignity surrounding death in one's chosen environment. 4: To serve as a facilitator of education and community resources for patients with limited life expectancy, their families, and community physicians. | Description |
| Total Program Service Expense | 1393210 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | 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 | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 0 | 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 | 1 | 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 | 0 | 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 | 4 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 36 | 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 | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| 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 | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | 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 | 0 | 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 | The Organization | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8006927199 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 70 Caring Way | AddressLine1 |
| City | Jasper | City |
| State | GA | State |
| ZIP Code | 30143 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (12 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| Mark Atkins | ||||||
| Chairman | 1.00 | X | 0 | 0 | 0 | |
| Jerry Tyson | ||||||
| Vice Chairman | 0.50 | X | 0 | 0 | 0 | |
| Betty Francis | ||||||
| Director | 0.50 | X | 0 | 0 | 0 | |
| Paul Nealey | ||||||
| Treasurer | 0.50 | X | 0 | 0 | 0 | |
| Steve Purvis | ||||||
| Director | 0.00 | X | 0 | 0 | 0 | |
| Marie Lindsey | ||||||
| Director | 0.00 | X | 0 | 0 | 0 | |
| Caroline Carder | ||||||
| Director | 0.00 | X | 0 | 0 | 0 | |
| Samantha Callihan | ||||||
| Director | 0.00 | X | 0 | 0 | 0 | |
| Patricia Roberts | ||||||
| Director | 0.00 | X | 0 | 0 | 0 | |
| Honorable Brenda Weaver | ||||||
| Director | 0.00 | X | 0 | 0 | 0 | |
| Kimberly Conine | ||||||
| Immediate Former Exec. Dir. | 40.00 | 57585 | 0 | 0 | X | |
| Gina Pendley | ||||||
| Executive Director | 40.00 | 0 | 0 | 0 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 57585 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Blue Cross Blue Shield | |||||
| PO Box 100376 | Atlanta | GA | 303840376 | Health insurance | 194637 |
| HospiScript Services LLC | |||||
| PO Box 933273 | Atlanta | GA | 311933273 | Medications | 132193 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Fundraising Events | 45808 | FundraisingEvents |
| All Other Contributions | 36398 | AllOtherContributions |
| Total Contributions | 82206 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Medicare revenue | 621610 | 1730340 | 1730340 |
| Commercial benefits re | 621610 | 124948 | 124948 |
| Medicaid revenue | 621610 | 108089 | 108089 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 1963377 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6461 | TotalRevenueColumn |
| Exclusion | $6,461 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 30555 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 29762 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 793 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 793 | TotalRevenueColumn |
| Exclusion | $793 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 52442 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 45808 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 56432 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -3990 | TotalRevenueColumn |
| Exclusion | -$3,990 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Other revenue | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 152 | TotalRevenueColumn |
| Related Or Exempt Function Income | 152 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 152 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2048999 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1963529 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $3,264 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5643 | Total |
| Program Services | 5643 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88923 | Total |
| Program Services | 12330 | ProgramServices |
| Management And General | 64273 | ManagementAndGeneral |
| Fundraising | 12320 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 992903 | Total |
| Program Services | 680132 | ProgramServices |
| Management And General | 298826 | ManagementAndGeneral |
| Fundraising | 13945 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 153518 | Total |
| Program Services | 149071 | ProgramServices |
| Management And General | 4447 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79921 | Total |
| Program Services | 62113 | ProgramServices |
| Management And General | 17808 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34280 | Total |
| Management And General | 34280 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7438 | Total |
| Management And General | 7438 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24924 | Total |
| Program Services | 2667 | ProgramServices |
| Management And General | 21960 | ManagementAndGeneral |
| Fundraising | 297 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20584 | Total |
| Program Services | 9190 | ProgramServices |
| Management And General | 10635 | ManagementAndGeneral |
| Fundraising | 759 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27922 | Total |
| Program Services | 7527 | ProgramServices |
| Management And General | 19710 | ManagementAndGeneral |
| Fundraising | 685 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26624 | Total |
| Program Services | 7987 | ProgramServices |
| Management And General | 17306 | ManagementAndGeneral |
| Fundraising | 1331 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13747 | Total |
| Program Services | 6764 | ProgramServices |
| Management And General | 6448 | ManagementAndGeneral |
| Fundraising | 535 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Direct medical expense | 317162 | 317162 | ||
| Mileage reimbursements | 131968 | 125627 | 5927 | 414 |
| Bad debt expense | 21800 | 21800 | ||
| Communication | 19080 | 708 | 18372 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24276 | Total |
| Program Services | 6289 | ProgramServices |
| Management And General | 17847 | ManagementAndGeneral |
| Fundraising | 140 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1990713 | Total |
| Program Services | 1393210 | ProgramServices |
| Management And General | 567077 | ManagementAndGeneral |
| Fundraising | 30426 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 540826 | BOY |
| EOY | 769593 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 313068 | BOY |
| EOY | 354634 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 347785 | BOY |
| EOY | 189375 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11321 | BOY |
| EOY | 10517 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 756367 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 352391 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 416194 | BOY |
| EOY | 403976 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 70557 | BOY |
| EOY | 50671 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1699751 | BOY |
| EOY | 1778766 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 125475 | BOY |
| EOY | 138151 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 340718 | BOY |
| EOY | 340718 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 466193 | BOY |
| EOY | 478869 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1174618 | BOY |
| EOY | 1247973 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 58940 | BOY |
| EOY | 51924 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1233558 | BOY |
| EOY | 1299897 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1699751 | BOY |
| EOY | 1778766 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 58286 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 8053 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 75862 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 57110 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 58919 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 51244 | CurrentTaxYearMinus1Year |
| Current Tax Year | 80057 | CurrentTaxYear |
| Total | 323192 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 75862 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 57110 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 58919 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 51244 | CurrentTaxYearMinus1Year |
| Current Tax Year | 80057 | CurrentTaxYear |
| Total | 323192 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 95202 | AmountsSubstContributorsTotal |
| Public Support Total170 | 227990 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 15595 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5541 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 8782 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 6357 | CurrentTaxYearMinus1Year |
| Current Tax Year | 6461 | CurrentTaxYear |
| Total | 42736 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 444 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 987 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 618 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1275 | CurrentTaxYearMinus1Year |
| Current Tax Year | 17347 | CurrentTaxYear |
| Total | 20671 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 386599 | TotalSupport |
| Gross Receipts From Admissions Etc | 11538905 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.58970 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.47080 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
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
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 125233 | OtherCostOrOtherBasis |
| Book Value | 125233 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 432357 | OtherCostOrOtherBasis |
| Depreciation | 190703 | Depreciation |
| Book Value | 241654 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20271 | OtherCostOrOtherBasis |
| Depreciation | 3804 | Depreciation |
| Book Value | 16467 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 178506 | OtherCostOrOtherBasis |
| Depreciation | 157884 | Depreciation |
| Book Value | 20622 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 403976 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Medicaid overpayment liability | Description |
| Amount | $340,718 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 340718 | TotalOfAmounts |
| Total Revenue | 2048999 | TotalRevenue |
| Total Expenses | 1990713 | TotalExpenses |
| Excess Or Deficit For Year | 58286 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 8053 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 8053 | TotalAdjustments |
| Excess Or Deficit Per FS | 66339 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 2064068 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 8053 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 8053 | RevenueNotRptdF990 |
| Revenue Subtotal | 2056015 | RevenueSubtotal |
| Other Revenues Not Included | -7016 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -7016 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 2048999 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 1990713 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 1990713 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 1990713 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Uncertain Tax Positions Under FIN 48: | Part X: | The Organization's policy is to record a liability for any tax position taken that is beneficial to the Organization, including any related interest and penalties, when it is more likely than not the position taken by management with respect to a transaction or class of transactions will be overturned by a taxing authority upon examination. Management believes there are no such positions as of September 30, 2012 and 2011, and, accordingly, no liability has been accrued. Accordingly, the Organization is not required to pay federal taxes on income. Generally the Internal Revenue Service (the "IRS") may examine a tax return for three years from the date it is filed. At September 30, 2012, tax years ended September 30, 2009, 2010 and 2011 remain open for possible examination by the IRS. |
| Part XII, Line 4b - Other Adjustments: | Contributions to temporarily restricted net assets 16,480. Temporarily restricted net assets released from restriction -23,496. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agreement Ref Fundraising | 0 | AgreementRefFundraising |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Golf Tournament | NameOfEvent1 |
| Gross Receipts Event1 | 37875 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 16900 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 20975 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 4424 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 8541 | OtherDirectExpensesEvent1 |
| Name Of Event2 | Mardi Gras Gala | NameOfEvent2 |
| Gross Receipts Event2 | 57976 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 26509 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 31467 | GrossRevenueEvent2 |
| Rent Facility Costs Event2 | 1900 | RentFacilityCostsEvent2 |
| Other Direct Expenses Event2 | 41567 | OtherDirectExpensesEvent2 |
| Gross Receipts Total | 95851 | GrossReceiptsTotal |
| Charitable Contributions Total | 43409 | CharitableContributionsTotal |
| Gross Revenue Total Events | 52442 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 6324 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 50108 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 56432 | DirectExpenseSummaryEvents |
| Net Income Summary | -3990 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Wishes and Dreams | TypeOfGrant |
| Amount Of Cash Grant | 5643 | AmountOfCashGrant |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Steve Purvis | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Current Director | Relationship |
| Description Of Transaction | Mr. Purvis owns Huff Drugs and is a partner with Blue Ridge Pharmacy where the organization purchases pharmaceuticals for patients. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 8b | During the year, minutes of the Executive Committee Meetings were not maintained due to the fact that any decisions arrived at during the Executive Committe Meetings were still subject to full board approval. As such, these motions were documented in the minutes of the full Board meetings. | |
| Form 990, Part VI, Section B, line 11 | Prior to the filing of the Form 990 the Organization's management performed a formal review of a draft copy of the Form 990 as provided by the CPA firm that prepared the return. Management directed any questions and concerns that arose during their review to the CPA firm for further understanding and/or corrections. Once Management was comfortable with the contents of the Form 990, an updated draft of the Form 990 was presented to the Executive Committee of the Board of Directors for their review and approval and then to the full Board. Once the draft was approved by the Board, a final copy of Form 990 was filed with the IRS. | |
| Form 990, Part VI, Section B, line 12c | All members of the Board of Directors, contractors, and agency employees must disclose actual and potential conflicts of interest to the Organization via a "Potential Conflict of Interest Declaration." This declaration must be completed prior to the individual serving the Organization and and must be updated when changes occur. The Executive Director reviews all declarations and reports a summary of declarations to the Board of Directors as requested. | |
| The Board of Directors conducts an annual review of performance for the Executive Director utilizing the position's job description as a guide for evaluating performance. Additionally, the Board uses historical compensation data of the Organization's Executive Director in order to determine an appropriate compensation for this position. The Executive Director conducts performance reviews for other members of management on an annual basis. | ||
| Form 990, Part VI, Section C, line 18 | Any information related to the tax exempt status is available upon request from the Organization and via www.guidestar.org. | |
| Form 990, Part VI, Section C, line 19 | Governing documents are available via the Georgia Secretary of State website at https://sos.georgia.gov. All other governing documents, the Organization's conflict of interest policy and latest financial statements are available upon request during business hours. | |
| Form 990, Part XI, line 5: | Net unrealized gains on investments: 8,053. | Changes in Net Assets or Fund Balances: |
| Schedule D, Part X Other Liabilities | The Organization has received overpayments over a period of time from Medicaid on the patient liability portion of room and board claims for patients residing in nursing homes. The Organization has made many attempts to resolve this problem with Medicaid to no avail. Therfore, the Organization maintains these overpayments in a separate board designated non-interest bearing bank account. The corresponding liability is recorded as Medicaid Overpayments and the balance as of September 30, 2012 was $340,718. | Medicaid Overpayment Liability |
| Part VI, Section A Line 1a | The Organization is governed by a Board of Directors, which is elected in a manner consistent with the state corporate law. The Board of Directors has chosen to delegate certain authority to an Executive Committee consisting of a chairperson, vice chair, treasurer, and secretary. Authority delegated to the Executive Committee includes but is not limited to oversight and involvement in the design and implementation of the Organization' internal control procedures, monitoring of mangement's activity, financial oversight, and committee appointment. However, powers of the Executive Committee are not such as to materially impact the Board's governance responsibilites. | Executive Committee |