2012-05-09T07:00:01-05:00 2011-06-30 DRAFFIN & TUCKER LLP PO BOX 6 ALBANY GA 317020006 990 2010-07-01 630288852 CHATTAHOOCHEE VALLEY HOSPITAL SOCIETY CHAT 3347561050 4800 48TH STREET VALLEY AL 36854 DOUG DEWBERRY 3347561050 2012-05-15 true JACQUELINE G ATKINS 2298837878 2012-05-07 2010 2016-02-24 21:20:13Z DOUG DEWBERRY 4800 48TH STREET VALLEY AL 36854 50031742 false X WWW.LANIERHOSPITAL.COM X 1942 AL TO PROVIDE MEDICAL SERVICES TO RESIDENTS OF CHAMBERS COUNTY, ALABAMA AND WEST POINT, GEORGIA. 20 18 654 75 48744 115935 613870 45079932 49022998 62744 45438 328026 342111 45586637 50024417 0 0 19110079 21737582 0 0 26874459 28320352 45984538 50057934 -397901 -33517 35997124 35283275 18234057 17553725 17763067 17729550 TO PROVIDE MEDICAL SERVICES TO RESIDENTS OF CHAMBERS COUNTY, ALABAMA AND WEST POINT, GEORGIA. false false 46800195 49116549 THE GEORGE H. LANIER MEMORIAL HOSPITAL PROVIDES EMERGENCY SERVICES, AN ENCOSCOPY UNIT, SURGERY UNIT, CATH LAB, CARDIAC REHAB, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, RADIOLOGY LAB AND SLEEP DISORDERS LAB. THE HOSPITAL IS A LICENSED 115-BED NOT-FOR-PROFIT ACUTE CARE FACILITY PRIMARILY SERVING CHAMBER COUNTY, ALABAMA AND WEST POINT, GEORGIA. SERVICES PROVIDED INCLUDE GENERAL SURGERY, CARDIOLOGY, GENERAL MEDICINE, GASTROENTEROLOGY, PULMONARY, EMERGENCY MEDICINE, IMAGING/RADIOLOGY, DIALYSIS, AMBULATORY SURGERY AND SWING BED. THE GEORGE H. LANIER NURSING HOME IS A 103-BED SKILLED NURSING FACILITY. 46800195 true true false false false false false false false false true false false false true true true false false false false false false false true false true true false false true false false false false false true false false false false false false false true true false false false true 80 0 true 654 true true true false false false false false false false false false false false X 20 18 true false false false false false false true true false false true true true true true true true true false X RICHARD SCOTT 3347561050 4800 48TH STREET VALLEY AL 36854 X KRIS REDDY MD 3.00 X 10455 0 0 ARVIND KAMATH MD 3.00 X 5545 0 0 DOT ANDERSON 3.00 X 0 0 0 LUANNE D BERLIN 3.00 X 0 0 0 GLORIA HULL 3.00 X 0 0 0 RICHARD SCOTT 3.00 X X 0 0 0 ARTHUR PERKINS MD 3.00 X 0 0 0 KAYE MAXWELL 3.00 X 0 0 0 CY WOOD 3.00 X X 0 0 0 JOSH MOON 3.00 X 0 0 0 CURT KOLLAR 3.00 X 0 0 0 JAMES BENDELL MD 3.00 X 0 0 0 OSCAR CRAWLEY 3.00 X 0 0 0 BOB JOHNSON 3.00 X X 0 0 0 CAM LANIER 3.00 X 0 0 0 WILLIAM SCOTT III 3.00 X 0 0 0 GAINES LANIER 3.00 X 0 0 0 VALERIE GRAY 3.00 X 0 0 0 TERRY VESTER MD 3.00 X 0 0 0 DAVID WILKERSON 3.00 X 0 0 0 DOUG DEWBERRY 40.00 X 157494 0 3240 TOMMY LANE 40.00 X 118230 0 3240 PHILLIPPE TRANQUI 40.00 X 311079 0 3240 DAVID FAGAN 40.00 X 219863 0 3240 JOHN DUKE 40.00 X 117491 0 3240 EVE WALLACE 40.00 X 100940 0 3240 1041097 19440 6 false true false HUMAN PERFORMANCE & REHAB CTRS P O BOX 8068 COLUMBUS GA 319088068 PHYSICAL THERAP 1328822 MORRISON MANAGEMENT SPECIALIST P O BOX 102289 ATLANTA GA 303682289 DIETARY SVCS 1040030 THE VALENCIA GROUP P O BOX 361545 BIRMINGHAM AL 35236 COLLECTIONS 501982 RIVERVIEW ANESTHESIA INC 106 EMBER WAY LAGRANGE GA 30240 ANESTHESIA 481351 CPSI P O BOX 850309 MOBILE AL 366850309 IT SYSTEMS 305246 9 613870 613870 PATIENT SERVICE REVENUES 623000 48974254 48974254 REFERENCE LAB 621500 48744 48744 49022998 43573 43573 1865 1865 1865 1865 25793 7325 18468 CAFETERIA 624200 181348 181348 PHYSICIAN PRACTICE RECOVERY 621990 86100 86100 MISCELLANEOUS 621990 27348 27348 28847 28847 323643 50024417 49116549 48744 226786 275724 275724 17623658 16550112 1073546 2541611 2349974 191637 1296589 1198826 97763 71656 71656 80152 80152 3606801 3088816 517985 15577 15577 7803861 7488366 315495 1973034 1796447 176587 52083 38919 13164 13272 10717 2555 1997946 1819130 178816 310042 200109 109933 BAD DEBTS 9361809 9361809 PROVIDER TAX 1992753 1992753 REPAIRS & MAINTENANCE 691750 689773 1977 USE TAX 130453 130453 RECRUITING 90592 4436 86156 128571 79555 49016 50057934 46800195 3257739 0 1560 1550 6226182 7834529 5092203 5207905 216603 227171 143743 184676 59226630 39926378 20299391 19300252 1801589 1819424 372620 372620 1843233 335148 35997124 35283275 4027933 4185067 473695 11555000 10935000 2017337 1700541 633787 259422 18234057 17553725 X 17763067 17729550 17763067 17729550 35997124 35283275 -33517 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false false false 600197 600197 36890266 21344581 15545685 1137475 951393 186082 20573727 17630404 2943323 24965 24965 19300252 THIRD PARTY SETTLEMENTS 156994 BOND INTEREST PAYABLE 102428 259422 50024417 50057934 -33517 -41400 -41400 -74917 49926847 7325 7325 49919522 104895 104895 50024417 50001764 7325 7325 49994439 63495 63495 50057934 LIABILITY UNDER FIN 48 FOOTNOTE SCHEDULE D, PAGE 3, PART X THE SOCIETY WAS INCORPORATED FOR THE PURPOSE OF OPERATING A NOT-FOR-PROFIT PUBLIC HOSPITAL, NURSING HOME AND HOME HEALTH SERVICES IN VALLEY, ALABAMA AND HAS RECEIVED A LETTER FROM THE INTERNAL REVENUE SERVICE THAT THE SOCIETY IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)3 OF THE INTERNAL REVENUE CODE. THE SOCIETY APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE SOCIETY ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JUNE 30, 2011 AND 2010 OR FOR THE YEARS THEN ENDED. THE SOCIETY'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2008-2010. RECONCILIATION OF CHANGES - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 8 FUNDRAISING EXPENSES 7,325 CAPITAL CONTRIBUTIONS -41,400 WAIVER EXPENSE -51,306 SCHOLARSHIP/RECRUITING EXPENSE -12,189 FUNDRAISING EXPENSES -7,325 WAIVER EXPENSE 51,306 SCHOLARSHIP/RECRUITING EXPENSE 12,189 REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 2D FUNDRAISING EXPENSES 7,325 REVENUE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 4B CAPITAL CONTRIBUTIONS 41,400 WAIVER EXPENSE 51,306 SCHOLARSHIP/RECRUITING EXPENSE 12,189 EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XIII, LINE 2D FUNDRAISING EXPENSES 7,325 EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XIII, LINE 4B WAIVER EXPENSE 51,306 SCHOLARSHIP/RECRUITING EXPENSE 12,189 GOLF TOURNAMENT 25793 25793 7325 25793 25793 7325 7325 18468 true true true X true X 1.75000 true false false 217256 217256 0.00530 7946268 6174332 1771936 0.04350 125908 125682 226 8289432 6300014 1989418 0.04880 8289432 6300014 1989418 0.04880 75000 75000 0.00180 75000 75000 0.00180 true 4165200 14813434 13448845 1364589 X true true 1 1 CHATTAHOOCHEE VALLEY HOSPITAL SOCIE

4800 48TH STREET VALLEY AL 36854

X X X SNF; HOME HEALTH CARE CHATTAHOOCHEE VALLEY HOSPITAL SOCIE 1 2 LANIER HOME HEALTH SERVICES

4800 48TH STREET VALLEY AL 36854

HOME HEALTH AGENCY GEORGE H LANIER NURSING HOME

4800 48TH STREET VALLEY AL 36854

SKILLED NURSING FACILITY EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I LINE 7 COLUMN F IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN F THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990 PART IX LINE 25 FORM 990 PART IX LINE 25 50057934 LESS BAD DEBTS IN PART IX 9361809 ADD EXPENSES REPORTED IN PART VIII 7325 DENOMINATOR FOR COLUMN F 40703450 COSTING METHODOLOGY EXPLANATION PART I LINE 7 COSTS FOR PART I LINE 7A AND 7B AND PART III SECTION A LINE 2 WERE CALCULATED USING THE RCC CALCULATED IN WORKSHEET 2 OTHER COSTS WERE OBTAINED FROM THE ORGANIZATIONS ACCOUNTING RECORDS BAD DEBT EXPENSE EXPLANATION PART III LINE 4 EXCERPT FROM FOOTNOTE TO AUDITED FINANCIAL STATEMENT ALLOWANCE FOR DOUBTFUL ACCOUNTS THE SOCIETY PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE MEDICARE EXPLANATION PART III LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS COLLECTION PRACTICES EXPLANATION PART III LINE 9B COLLECTION ATTEMPTS ON ALL ACCOUNTS ARE MADE BY THE HOSPITAL WITHIN THE FIRST 90 DAYS AFTER AN ACCOUNT GOES BEYOND 90 DAYS THE ACCOUNT IS SENT TO A COLLECTION AGENCY THE ACCOUNT STAYS WITH THE COLLECTION AGENCY FOR APPROXIMATELY 4 MONTHS AND IF NOT COLLECTED THE ACCOUNT IS SENT BACK TO THE HOSPITAL AND WRITTEN OFF AS A BAD DEBT NEEDS ASSESSMENT PART VI WE USE THE STATE DEPARTMENT OF PUBLIC HEALTHS ANNUAL STATISTICAL REPORT TO LOOK AT THE HEALTHCARE NEEDS OF CHAMBERS COUNTY AND EVALUATE SERVICES NEEDED OR PROVIDED IN RESPONSE TO THAT REPORT OUR BOARD OF TRUSTEES ALSO REVIEWS AND DISCUSSES SERVICES AS PART OF OUR ANNUAL STRATEGIC PLAN UPDATE PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI A SOCIAL WORKER WORKS WITH PATIENTS AND EXPLAINS TO THEM OPTIONS THEY HAVE AVAILABLE AND TRIES TO HELP THEM QUALIFY FOR ANY OUTSIDE AID THAT MIGHT BE AVAILABLE WE ALSO HAVE AN INDIGENTCHARITY CARE POLICY THAT QUALIFYING PATIENTS ARE ELIGIBLE FOR COMMUNITY INFORMATION PART VI THE ORGANIZATION SERVES A PREDOMINATELY RURAL AREA THE PRIMARY SERVICE AREA IS CHAMBERS COUNTY IN ALABAMA AND WEST POINT GEORGIA AND SURROUNDING AREA THE POPULATION OF CHAMBERS COUNTY IS APPROXIMATELY 33939 WITH A PER CAPITA INCOME OF 27504 AND A MEDIAN HOUSEHOLD INCOME OF 30061 APPROXIMATELY 9 OF THE POPULATION HAS A BACHELORS DEGREE OR HIGHER EDUCATION APPROXIMATELY 36 OF THE POPULATION DOESNT HAVE A HIGH SCHOOL DIPLOMA THE UNEMPLOYMENT RATE IN THE COUNTY IS APPROXIMATELY 116 THE POPULATION OF WEST POINT GEORGIA IS APPROXIMATELY 3400 WITH A PER CAPITA INCOME OF 18935 AND A MEDIAN HOUSEHOLD INCOME OF 37021 THE AREAS CITIZENS EXPERIENCE HIGH LEVELS OF HEART DISEASE DIABETES AND CANCER HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI CVHS HAS BEEN INSTRUMENTAL IN PROVIDING HEALTHCARE AWARENESS TO THE COMMUNITY BY HOSTING NUMEROUS EVENTS INCLUDING AN ANNUAL HEALTH FAIR OPEN TO ALL RESIDENTS OF THE COMMUNITY OFFERING SERVICES FOR THE PEDIATRIC TO THE GERIATRIC RESIDENTS OTHER EVENTS INCLUDE BREAST CANCER AWARENESS PRENATAL AND BREAST FEEDING EDUCATION CLASSES HEART HEALTH MONTH SELF MANAGED DIABETES CLASSES DIABETIC EYE DISEASE SEMINAR AND VARIOUS HEALTH RELATED SUPPORT GROUPS CVHS ALSO PARTICIPATES IN LOCAL SCHOOL OUTREACH PROGRAMS PROVIDING EDUCATION IN THE AREAS OF SMOKING CESSATION ALCOHOL HEALTHY EATING HABITS AND THE IMPORTANCE OF EXERCISE AND READING WE ALSO PARTICIPATE IN KID CHECK CAREER DAY EVENTS AND SCHOOL HEALTH FAIRS CVHS PARTICIPATED IN NATIONAL WELLNESS CAMPAIGN SCALEBACK ALABAMA AS WELL AS INVOLVING COMMUNITY PARTICIPATION IN SCALEBACK ALABAMA PHYSICIANS AND MIDLEVEL PRACTITIONERS SPEAK REGULARLY AT LOCAL CIVIC CLUBS TO PROVIDE HEALTHCARE AWARENESS AND PREVENTATIVE MEASURE INFORMATION CVHS PARTNERED WITH THE CHATTAHOOCHEE FULLER CENTER TO BUILD A HOME FOR A CVHS EMPLOYEE AND WITH THE LOCAL LIBRARY TO PROVIDE PHYSICIAN DRIVEN EDUCATION SEMINARS CVHS HOLDS QUARTERLY FORUMS FOR LOCAL EMS DEPARTMENTS X X X X false false false false false true true false false DOUG DEWBERRY 144994 12500 3240 160734 PHILLIPPE TRANQUI 301584 9495 3240 314319 DAVID FAGAN 219863 3240 223103 COMPENSATION CONTINGENT UPON NET EARNINGS OF ORGANIZATION SCHEDULE J, PAGE 1, PART I, LINE 6A THE CEO IS PAID AN ANNUAL PERFORMANCE INCENTIVE ONE-THIRD OF WHICH IS PAID FOR ATTAINMENT OF FINANCIAL PERFORMANCE TARGETS. COMPENSATION CONTINGENT UPON NET EARNINGS OF RELATED ORG SCHEDULE J, PAGE 1, PART I, LINE 6B SEE NARRATIVE FOR LINE 6A. BOB JOHNSON BD MBR/BANK CHR 1700541 BANK LOAN BALANCE false CURT KOLLAR BD MBR/BANK CFO 1700541 BANK LOAN BALANCE false BOB JOHNSON BD MBR/BANK CHR 7814071 BANK CASH BALANCES false CURT KOLLAR BD MBR/BANK CFO 7814071 BANK CASH BALANCES false ADDITIONAL INFORMATION SCHEDULE L PART V CURT KOLLAR CFO OF CHARTER BANK AND BOB JOHNSON BOARD CHAIRMAN FOR CHARTER BANK ARE BOTH BOARD MEMBERS OF THE FILING ORGANIZATION THE ORGANIZATION HAS A LOAN WITH THE BANK IN THE AMOUNT OF 1700541 AS WELL AS CASH ACCOUNTS TOTALING 7814071 AT FISCAL YEAR END RELATED PARTY INFORMATION AMONG OFFICERS FORM 990, PAGE 6, PART VI, LINE 2 CAM LANIER GAINES LANIER TRUSTEE TRUSTEE FAMILY RELATIONSHIP RICHARD SCOTT WILLIAM SCOTT TRUSTEE TRUSTEE FAMILY RELATIONSHIP CURT KOLLAR BOB JOHNSON TRUSTEE TRUSTEE BUSINESS RELATIONSHIP ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 WAS DISTRIBUTED TO TRUSTEES FOR THEIR REVIEW BY POSTING ON LANIER'S WEBSITE UNDER A SECURE FORMAT/PASSWORD PROTECTED. QUESTIONS FROM THE TRUSTEES REGARDING THE TAX RETURN, IF ANY WERE ASKED, WERE ANSWERED AT THE BOARD MEETING BEFORE THE TAX RETURN WAS FILED. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C THE ORGANIZATION REQUIRES ALL BOARD MEMBERS AND MANAGEMENT EMPLOYEES TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY AND MONITORS THE COMPLIANCE WITH THIS POLICY. BOARD MEMBERS RECUSE THEMSELVES DURING DISCUSSIONS AND ANY VOTING IF THEY HAVE A CONFLICT OF INTEREST. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A A COMMITTEE COMPRISED OF INDEPENDENT BOARD MEMBERS REVIEWS THE ANNUAL PERFORMANCE OF THE CEO AND SETS THE COMPENSATION AFTER THE REVIEW. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B PERFORMANCE APPRAISALS ARE PERFORMED ANNUALLY BY THE CEO. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 AS A GENERAL RULE, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. ANY WRITTEN REQUESTS BY THE PUBLIC WOULD BE REVIEWED AND ACTED UPON BY THE BOARD. RELATED ORGANIZATIONS FORM 990, PAGE 7, PART VII AVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS LUANNE BERLIN .10 HOURS ARVIND KAMATH, MD .10 HOURS WILLIAM SCOTT, III .10 HOURS RICHARD SCOTT .10 HOURS DOUG DEWBERRY .10 HOURS CY WOOD .10 HOURS LANIER HEALTH SERVICES FOUNDATION 4800 48TH STREET VALLEY AL 36854 631286859 FOUNDATION AL 501C3 11A CVHS CHATTAHOOCHEE VALLEY HOSPITAL SOCIE true false false true false false false false false false false false true true true false false false false