STEPHENS COUNTY HOSPITAL AUTHORITY: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- STEPHENS COUNTY HOSPITAL AUTHORITY (EIN 58-6001667)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-07-31
- IRS object ID
- 201342129349300244
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-07-31T12:53:59-05:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | 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 | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 586001667 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEPHENS COUNTY HOSPITAL AUTHORITY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | STEP | NameControl |
| Phone | 7062824200 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 163 HOSPITAL DRIVE | AddressLine1 |
| City | TOCCOA | City |
| State | GA | State |
| ZIP Code | 30577 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JEFFREY LAIRD | Name |
| Title | CFO | Title |
| Phone | 7062824200 | Phone |
| Date Signed | 2013-07-31 | 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 | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | EDWARD C GAMBRELL JR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 163 HOSPITAL DRIVE | AddressLine1 |
| City | TOCCOA | City |
| State | GA | State |
| ZIP Code | 30577 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 56641131 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.STEPHENSCOUNTYHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1945 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | PROVIDES INPATIENT, OUTPATIENT, OCCUPATIONAL, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF STEPHENS COUNTY, GEORGIA AND SURROUNDING AREAS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 699 | TotalNbrEmployees |
| Total Nbr Volunteers | 35 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 103533 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 10366 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 50404539 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 55537338 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 123786 | InvestmentIncomePriorYear |
| Investment Income Current Year | 158547 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 888770 | OtherRevenuePriorYear |
| Other Revenue Current Year | 934880 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 51520628 | TotalRevenuePriorYear |
| Total Revenue Current Year | 56641131 | 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 | 29860784 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 28160964 | 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 | 22098400 | OtherExpensePriorYear |
| Other Expenses Current Year | 27741544 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 51959184 | TotalExpensesPriorYear |
| Total Expenses Current Year | 55902508 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -438556 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 738623 | RevenuesLessExpensesCY |
| Total Assets BOY | 43260957 | TotalAssetsBOY |
| Total Assets EOY | 42275649 | TotalAssetsEOY |
| Total Liabilities BOY | 16548621 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 14824690 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 26712336 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 27450959 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF STEPHENS COUNTY HOSPITAL AUTHORITY IS TO PROVIDE HEALTH CARE AND RELATED SERVICES TO ENHANCE INDIVIDUAL HEALTH AND WELL BEING IN A MANNER THAT MEETS THE EXPECTATIONS OF PATIENTS AND OTHER CUSTOMERS; PRESERVES THE RIGHTS OF PATIENTS, EMPLOYEES AND OTHERS TO BE TREATED WITH DIGNITY, RESPECT AND CONCERN; PROVIDES PROFESSIONALLY AND TECHNICALLY PROFICIENT PERSONNEL IN AN EFFECTIVE AND RESOURCE EFFICIENT MANNER; UTILIZES ALL RESOURCES APPROPRIATELY TO CONTAIN COSTS AND TO PROVIDE FOR ADDITIONAL SERVICE OPPORTUNITIES; AND ALL PHASES OF OPERATIONS MUST BE CARRIED OUT IN AN ETHICAL MANNER. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 51910340 | Expense |
| Revenue | 55537338 | Revenue |
| Description | STEPHENS COUNTY HOSPITAL AUTHORITY OPERATES 96 INPATIENT BEDS AND PROVIDES OUTPATIENT SERVICES TO A SERVICE AREA THAT EXTENDS BEYOND STEPHENS COUNTY TO SURROUNDING COUNTIES OF FRANKLIN, HART, HABERSHAM, RABUN, AND BANKS IN GEORGIA AND INTO NEIGHBORING OCONEE COUNTY IN SOUTH CAROLINA. STEPHENS COUNTY HOSPITAL AUTHORITY ALSO OPERATES A 92 BED PERSONAL CARE HOME. THE STEPHENS COUNTY HOSPITAL PARTICIPATES IN SEVERAL EMPLOYER SPONSORED HEALTH FAIRS AND ALSO SUPPORTS THE LOCAL EMPLOYERS IN THE "DRUGS DON'T WORK" PROGRAM. THE STEPHENS COUNTY HOSPITAL DOES NOT TURN ANY INDIVIDUAL DOWN FOR SERVICES BASED ON THE INABILITY TO PAY FOR SUCH SERVICES. | Description |
| Total Program Service Expense | 51910340 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | 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 | 0 | 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 | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 1 | 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 | 1 | 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 | 14 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 699 | 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 | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | 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 | 1 | 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 | 1 | 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 | JEFFREY B LAIRD CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7062824281 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 163 HOSPITAL DRIVE | AddressLine1 |
| City | TOCCOA | City |
| State | GA | State |
| ZIP Code | 30577 | ZIPCode |
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 |
|---|---|---|---|---|---|---|---|
| MARK G WILKINSON | |||||||
| CHAIRMAN | 2.00 | X | X | 0 | 0 | 0 | |
| ROBERT W SLATE MD | |||||||
| VICE CHAIRMAN | 2.00 | X | X | 0 | 0 | 0 | |
| STANLEY W ROBERTS | |||||||
| SECRETARY/TREASURER | 2.00 | X | X | 0 | 0 | 0 | |
| PAULA M DICKERSON | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| JON C WEST | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| GEORGE SANDERS | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| MAX BROCK | |||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | ||
| EDWARD C GAMBRELL | |||||||
| CEO/ADMINISTRATOR | 50.00 | X | 293788 | 0 | 34201 | ||
| JEFFREY B LAIRD | |||||||
| CFO/CONTROLLER | 50.00 | X | 98921 | 0 | 28299 | ||
| FAYE M TAYLOR | |||||||
| CNO/DIRECTOR OF NURSING | 50.00 | 106435 | 0 | 18448 | X | ||
| TINA DEBORD | |||||||
| QUALITY IMPROVEMENT DIRECTOR | 50.00 | 108244 | 0 | 21516 | X | ||
| ANGELA R KING | |||||||
| REHAB SERVICES MANAGER | 40.00 | 131425 | 0 | 19025 | X | ||
| RONALD L REESE | |||||||
| STAFF PHARMACIST | 45.00 | 125211 | 0 | 13573 | X | ||
| KELLY R HART | |||||||
| PHARMACY MANAGER | 40.00 | 113363 | 0 | 18874 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 977387 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 153936 | TotalOtherCompensation |
| Number Individuals GT100 K | 13 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| MORRIS AND DICKSON LLC | |||||
| PO BOX 51367 | SHREVEPORT | LA | 71135 | LEGAL SERVICES | 709276 |
| US FOODSERVICE INC | |||||
| PO BOX 281945 | ATLANTA | GA | 30384 | FOODSERVICE | 586326 |
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | IT SERVICES | 453215 |
| GE HEALTHCARE | |||||
| PO BOX 402076 | ATLANTA | GA | 30384 | MEDICAL SERVICES | 285903 |
| FMD LITHOTRIPSY SERVICES LLC | |||||
| 1850 LEE ROAD | WINTER PARK | FL | 32789 | MEDICAL SERVICES | 262200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 32 | NumberOfContractorsGT100K |
| All Other Contributions | 10366 | AllOtherContributions |
| Total Contributions | 10366 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUE | 622000 | 50849021 | 50849021 |
| RESIDENT REVENUE | 623000 | 2117041 | 2117041 |
| MEANINGFUL USE MONIES | 900099 | 1902127 | 1902127 |
| AMBULANCE SERVICE SUBS | 621910 | 621490 | 621490 |
| PHYSICIAN BILLING FEES | 622000 | 47659 | 47659 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 55537338 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 34281 | TotalRevenueColumn |
| Exclusion | $34,281 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 124266 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 124266 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 124266 | TotalRevenueColumn |
| Exclusion | $124,266 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA SALES | 900099 | 528099 | $528,099 |
| PHARMACY - EMPLOYEE CO | 900099 | 214954 | $214,954 |
| MISCELLANEOUS | 900099 | 191827 | $191,827 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 934880 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 56641131 | TotalRevenueColumn |
| Related Or Exempt Function Income | 55537338 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,093,427 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 455245 | Total |
| Program Services | 22760 | ProgramServices |
| Management And General | 432485 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22239649 | Total |
| Program Services | 20644546 | ProgramServices |
| Management And General | 1595103 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 587259 | Total |
| Program Services | 534793 | ProgramServices |
| Management And General | 52466 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3342912 | Total |
| Program Services | 3044252 | ProgramServices |
| Management And General | 298660 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1535899 | Total |
| Program Services | 1398680 | ProgramServices |
| Management And General | 137219 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8887 | Total |
| Management And General | 8887 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 92000 | Total |
| Management And General | 92000 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5001501 | Total |
| Program Services | 4457589 | ProgramServices |
| Management And General | 543912 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35903 | Total |
| Program Services | 35903 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6405106 | Total |
| Program Services | 5574846 | ProgramServices |
| Management And General | 830260 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1639353 | Total |
| Program Services | 1639353 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 200 | Total |
| Program Services | 200 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 318862 | Total |
| Program Services | 318862 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2369356 | Total |
| Program Services | 2369356 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 901526 | Total |
| Program Services | 901526 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT | 6994042 | 6994042 | |
| MEDICAL SUPPLIES | 3319909 | 3319909 | |
| MEDICAID PROVIDER FEE T | 653723 | 653723 | |
| MISCELLANEOUS | 1176 | 1176 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55902508 | Total |
| Program Services | 51910340 | ProgramServices |
| Management And General | 3992168 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 221366 | BOY |
| EOY | 1013533 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4663840 | BOY |
| EOY | 4577315 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9552509 | BOY |
| EOY | 9286172 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1884179 | BOY |
| EOY | 1781992 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1771530 | BOY |
| EOY | 1771476 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 382685 | BOY |
| EOY | 264430 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 62240562 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 40135841 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23445235 | BOY |
| EOY | 22104721 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1339613 | BOY |
| EOY | 1476010 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43260957 | BOY |
| EOY | 42275649 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5756382 | BOY |
| EOY | 5575970 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8674903 | BOY |
| EOY | 7775220 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2117336 | BOY |
| EOY | 1473500 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16548621 | BOY |
| EOY | 14824690 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24531770 | BOY |
| EOY | 25466324 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2180566 | BOY |
| EOY | 1984635 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26712336 | BOY |
| EOY | 27450959 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43260957 | BOY |
| EOY | 42275649 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 738623 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $4,100 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 4100 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THIS AMOUNT REPRESENTS THE APPROXIMATE LOBBYING PORTION OF DUES PAID TO THE THE AMERICAN HOSPTIAL ASSOCIATION. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 242888 | OtherCostOrOtherBasis |
| Book Value | 242888 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 30410667 | OtherCostOrOtherBasis |
| Depreciation | 13913661 | Depreciation |
| Book Value | 16497006 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1175648 | OtherCostOrOtherBasis |
| Depreciation | 790812 | Depreciation |
| Book Value | 384836 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 29554173 | OtherCostOrOtherBasis |
| Depreciation | 24963182 | Depreciation |
| Book Value | 4590991 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 857186 | OtherCostOrOtherBasis |
| Depreciation | 468186 | Depreciation |
| Book Value | 389000 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 22104721 | TotalOfBookValueLandBuildings |
| Total Revenue | 56641131 | TotalRevenue |
| Total Expenses | 55902508 | TotalExpenses |
| Excess Or Deficit For Year | 738623 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 738623 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 48993366 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 48993366 | RevenueSubtotal |
| Other Revenues Not Included | 7647765 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 7647765 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 56641131 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 48254743 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 48254743 | ExpensesSubtotal |
| Other Expenses Not Included | 7647765 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 7647765 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 55902508 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | INCOME TAXES- THE HOSPITAL AND SCEP ARE NOT-FOR-PROFIT ORGANIZATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR STATE OR FEDERAL INCOME TAXES HAS BEEN PRESENTED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL AND SCEP HAVE EVALUATED THEIR TAX POSITIONS AND HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OBLIGATIONS AS OF SEPTEMBER 30, 2012. NOTHING IS CURRENTLY UNDER REVIEW. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | MEDICARE PROVIDER FEES NETTED WITH REVENUE 653,723. BAD DEBT EXPENSE NETTED WITH REVENUE 6,994,042. | |
| PART XIII, LINE 4B - OTHER ADJUSTMENTS: | MEDICARE PROVIDER FEES NETTED WITH REVENUE 653,723. BAD DEBT EXPENSE NETTED WITH REVENUE 6,994,042. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| 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 |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2869749 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2253751 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 615998 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01260 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2985799 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2270723 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 715076 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01460 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4887374 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3762695 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1124679 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02300 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10742922 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8287169 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2455753 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05020 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1480690 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1284429 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 196261 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00400 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1480690 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1284429 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 196261 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00400 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12223612 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9571598 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2652014 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05420 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,253,480 | BadDebtExpenseAmount |
| Amount Attributable To | 500000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 10757764 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14852986 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -4095222 | 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 | STEPHENS COUNTY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 163 HOSPITAL DRIVE | AddressLine1 |
| City | TOCCOA | City |
| State | GA | State |
| ZIP Code | 30577 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | DISPROPORTIONATE SHARE HOSPITAL | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEPHENS COUNTY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 125.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| 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 |
|---|---|---|---|---|
| THE CLARY CARE CENTER | ||||
| 249 HOSPITAL DRIVE | TOCCOA | GA | 30577 | ADVANCED PERSONAL CARE FACILITY |
| THE WILKINSON CENTER | ||||
| 269 HOSPITAL DRIVE | TOCCOA | GA | 30577 | PERSONAL CARE FACILITY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 7G: THE HOSPITAL OPERATES A COUNTY AMBULANCE. |
| 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 $ 6994042. |
| PART III, LINE 4: THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE OF BAD DEBT EXPENSE. THE BAD DEBT EXPENSE AT COST ON PART III, LINE 2 WAS COMPUTED BY USING THE PERCENTAGE OF THE AUDITED FINANCIAL STATEMENT EXPENSES DIVIDED BY TOAL GROSS PATIENT REVENUE. THE ORGANIZATION ESTIMATED THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO CHARITY CARE BASED ON PRIOR EXPERIENCE. |
| PART III, LINE 8: A VERY HIGH PERCENTAGE OF THOSE PATIENTS COVERED BY MEDICARE DUE TO AGE OR DISABILITY ARE ALSO MEDICALLY INDIGENT AS EVIDENCED BY A LARGE PERCENTAGE OF THAT POPULATION WITH MEDICAID AS THE SECONDARY COVERAGE. |
| PART III, LINE 9B: PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE, FREE CARE, OR ANOTHER FORM OF FINANCIAL ASSISTANCE ARE NOT CONTACTED UNLESS ADDITIONAL INFORMATION IS NEEDED FOR QUALIFICATION OR THE CONTINUOUS OF QUALIFICATION FOR SAID PROGRAM. |
| PART VI, LINE 2: THE ORGANIZATION UTILIZED MANY OUTSIDE COMPILATIONS OF DATA TO ASSESS THE HEALTH NEEDS OF THE POPULATION WE SERVE. THERE ARE MANY SOURCES AVAILABLE ON THE INTERNET THAT DEPICT THE ILLNESSES HISTORICALLY TREATED IN THE COMMUNITY. WE ALSO UTILIZE INTERNAL DATA AS TO WHAT HEALTH ISSUES ARE BEING TREATED BY OUR HOSPITAL. GEORGIA HOSPITAL ASSOCIATION COMMUNITY COMPLETED A PROFILE AND NEEDS ASSESSMENT FOR OUR SERVICE AREA WITHIN THE PAST TWO YEARS AND PROVIDED THAT TO OUR ORGANIZATION. |
| PART VI, LINE 3: THERE ARE SIGNS AT EVERY CHECK-IN POINT WITHIN THE HOSPITAL AS WELL AS PAMPHLETS GIVEN OUT TO EVERY PATIENT REGISTERED WHO HAS NO THIRD PARTY COVERAGE. ALSO, DURING COLLECTION EFFORTS BY IN-HOUSE STAFF, PATIENTS ARE INFORMED OF AND ENCOURAGED TO FILL OUT APPLICATIONS FOR FINANCIAL ASSISTANCE FOR THOSE WITHOUT 3RD PARTY COVERAGE. |
| PART VI, LINE 4: STEPHENS COUNTY HOSPITAL SERVES A RURAL POPULATION OF GEORGIA. ACCORDING TO THE LATEST DATA AVAILABLE FOR 2010, OF THE STEPHENS COUNTY RESIDENTS THAT REQUIRED THE SERVICES OF A HOSPITAL DURING THE YEAR, 26.9% HAD PRIMARY COVERAGE FROM MEDICARE, 27.2% HAD PRIMARY COVERAGE FROM A MEDICAID PROGRAM AND OVER 8% HAD NO 3RD PARTY COVERAGE AT ALL. THE MAJOR ILLNESSES TREATED WERE CHRONIC OBSTRUCTIVE PULMONARY DISEASE, UNCONTROLLED DIABETES AND CONGESTIVE HEART FAILURE. |
| PART VI, LINE 5: STEPHENS COUNTY HOSPITAL AUTHORITY APPLIES ALL FUNDS AVAILABLE TO THE PROVISION OF PATIENT CARE, PATIENT AND COMMUNITY HEALTH EDUCATION, RETIREMENT OF DEBT RELATED TO THE PURCHASE OF FIXED ASSETS UTILIZED IN THE PROVISION OF PATIENT CARE AND THE OUTRIGHT PURCHASE OF EQUIPMENT FOR THE EXPRESSED PURPOSE OF HEALTH CARE FOR OUR COMMUNITY AND SUUROUNDING SERVICE AREA. THE STEPHENS COUNTY HOSPITAL AUTHORITY'S GOVERNING BODY INCLUDES INDIVIDUALS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA AND WHO ARE NEITHER EMPLOYEES OR INDEPENDENT CONTRACTORS OF THE ORGANIZATION NOR FAMILY MEMBERS THEREOF. THE STEPHENS COUNTY HOSPITAL AUTHORITY EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. THE STEPHENS COUNTY HOSPITAL AUTHORITY PROVIDES CARE AND EDUCATION TO ANY INDIVIDUAL IN THE COMMUNITY AND SURROUNDING SERVICE AREA THAT SEEKS IT WITHOUT REGARD TO THAT PERSON'S ABILITY TO PAY FOR SUCH SERVICES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 | 1 | 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 (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EDWARD C GAMBRELL | |||||||||||||
| 278178 | 0 | 8410 | 0 | 7200 | 0 | 8909 | 0 | 25292 | 0 | 327989 | 0 | 0 | 0 |
| ANGELA R KING | |||||||||||||
| 131425 | 0 | 0 | 0 | 0 | 0 | 3915 | 0 | 15110 | 0 | 150450 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 6 | ReturnReference |
| Explanation | PER CONTRACTUAL EMPLOYMENT AGREEMENT, THE CEO RECEIVES A YEAR-END BONUS OF 1% OF NET EARNINGS AS SHOWN ON THE STEPHENS COUNTY HOSPITAL AUTHORITY'S AUDITED CONSOLIDATED STATEMENTS OF REVENUES, EXPENSES, AND CHANGES IN NET ASSETS. DURING THE FISCAL YEAR 2011, BONUS PAYMENT WAS CALCULATED BASED ON FISCAL YEAR 2010 AUDITED STATEMENTS, WHICH SHOWED A NET INCOME OF $841,038 RESULTING IN $8,410 IN BONUS PAYMENT. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| HOSPITAL AUTHORITY OF STEPHENS COUNTY GEORGIA SERIES 2006 | |||||||
| 586001667 | 858753DE3 | 2006-10-10 | 4000000 | CONSTRUCTION & RENOVATION OF PATIENT ROOMS | 0 | 0 | 0 |
| HOSPITAL AUTHORITY OF STEPHENS COUNTY GEORGIA SERIES 2010 | |||||||
| 586001667 | 2010-12-16 | 4740000 | CURRENT REFUNDING | 0 | 0 | 0 | |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Amount RetiredAmountRetired | Other Spent ProceedsOtherSpentProceeds |
|---|---|---|---|---|---|---|---|---|---|---|
| 4000000 | 858233 | 168861 | 3831139 | 2007 | 0 | 0 | 1 | 1 | ||
| 4740000 | 814586 | 135318 | 2001 | 1 | 0 | 1 | 1 | 915000 | 4604682 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART II, LINE 11, OTHER SPENT PROCEEDS | Identifier |
| Explanation | THE AMOUNTS PRESENTED ON PART II, LINE 11 REPRESENT PROCEEDS SPENT TO REFUND SERIES 2001A AND 2001B ISSUES. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CONSTANCE RICE | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | SISTER OF GEORGE SANDERS (BOARD MEMBER) | Relationship |
| Amount Of Transaction | 78744 | AmountOfTransaction |
| Description Of Transaction | COMPENSATION FOR DUTIES AS SURGICAL SERVICES MANAGER | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 7A | SERVICE ON THE BOARD OF TRUSTEES FOR THE HOSPITAL AUTHORITY IS A NON-COMPENSATED POSITION. EVERY POSITION ON THE AUTHORITY IS APPOINTED/ELECTED FOR A SIX YEAR TERM. EACH POSITION IS ELECTED BY THE CURRENT TRUSTEES FROM A SLATE OF THREE NOMINATIONS MADE FROM THE COUNTY COMMISSION. THE SAME PROCESS IS UTILIZED IF A POSITION BECOMES VACANT AT ANYTIME PRIOR TO THE COMPLETION OF A SIX YEAR TERM AND IS FOR THE REMAINDER OF SAID TERM. |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE FORM 990 WAS REVIEWED BY EACH VOTING BOARD MEMBER. AT A REGULAR SCHEDULED BOARD MEETING, THE GOVERNING BOARD FULLY DISCUSSED THE FORM 990. THE ENTIRE BOARD VOTED AND APPROVED THE FORM 990 AS PRESENTED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION CONDUCTS PERIODIC REVIEWS OF EXISTING BUSINESS RELATIONSHIPS AND INITIAL REVIEWS OF ANY NEW BUSINESS RELATIONSHIPS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE AUTHORITY SETS AND REVIEWS THE COMPENSATION PACKAGE OF THE CEO USING COMPARABLE DATA PROVIDED BY THE GEORGIA HOSPITAL ASSOCIATION ON CEO COMPENSATION AT SIMILAR SIZED HOSPITALS IN GEORGIA. CONSIDERATION IS ALSO GIVEN TO THE LEVEL OF EXPERIENCE AND OVER ALL PERFORMANCE OF THE HOSPITAL. THIS SAME PROCESS IS USED THROUGHOUT THE ORGANIZATION IN SETTING AND REVIEWING PAY SCALES FOR ALL JOBS INCLUDING THAT OF ANY "KEY EMPLOYEES." COMPARISON DATA IS USED TO SET A PAY SCALE AND THE LEVEL OF EXPERTISE AND EXPERIENCE IN THE JOB DUTIES DETERMINE THE POINT WITHIN THAT SCALE COMPENSATION IS SET. |
| FORM 990, PART VI, SECTION C, LINE 18 | RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE STEPHENS COUNTY HOSPITAL AUTHORITY MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| STEPHENS COUNTY EMERGENCY PHYSICIANS INC | ||||||||||
| 163 HOSPITAL DRIVE | TOCCOA | GA | 30577 | 020692996 | PROVIDE EMERGENCY ROOM PHYSICIANS TO STEPHENS COUNTY HOSPITAL | GA | 501(C)(3) | 7 | N/A | 1 |
| STEPHENS COUNTY HOSPITAL FOUNDATION INC | ||||||||||
| 163 HOSPITAL DRIVE | TOCCOA | GA | 30577 | 208089919 | FUNDRAISING ACTIVITIES FOR STEPHENS COUNTY HOSPITAL | GA | 501(C)(3) | 11 | N/A | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | 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 | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEPHENS COUNTY EMERGENCY PHYSICIANS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | L | TransactionType |
| Amount Involved | 1315875 | AmountInvolved |
| Method Of Amt Determination | CASH | MethodOfAmtDetermination |