PIEDMONT NEWTON HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- PIEDMONT NEWTON HOSPITAL INC (EIN 58-2155150)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-14
- IRS object ID
- 201213199349303206
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-14T12:30:14-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DRAFFIN & TUCKER LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 6 | AddressLine1 |
| City | ALBANY | City |
| State | GA | State |
| ZIP Code | 317020006 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582155150 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NEWTON HEALTH SYSTEM INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NEWT | NameControl |
| Phone | 7707867053 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5126 HOSPITAL DRIVE | AddressLine1 |
| City | COVINGTON | City |
| State | GA | State |
| ZIP Code | 30014 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TROY B BROOKS | Name |
| Title | CFO | Title |
| Phone | 7707867053 | Phone |
| Date Signed | 2012-11-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACQUELINE G ATKINS | Name |
| Phone | 2298837878 | Phone |
| Date Prepared | 2012-11-14 | 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 | JAMES F WEADICK CEO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5126 HOSPITAL DRIVE NE | AddressLine1 |
| City | COVINGTON | City |
| State | GA | State |
| ZIP Code | 30014 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 75179723 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.NEWTONMEDICAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1995 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE STATE-OF-ART MEDICAL FACILITIES AND HEALTHCARE TO COVINGTON AND OTHER SURROUNDING AREAS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 949 | TotalNbrEmployees |
| Total Nbr Volunteers | 232 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 4633948 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 4369113 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 68748168 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 68630909 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 85864 | InvestmentIncomePriorYear |
| Investment Income Current Year | 212976 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 804678 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1045565 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 74272658 | TotalRevenuePriorYear |
| Total Revenue Current Year | 74258563 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 9000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 6000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 37404836 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 39728265 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 37631275 | OtherExpensePriorYear |
| Other Expenses Current Year | 37017525 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 75045111 | TotalExpensesPriorYear |
| Total Expenses Current Year | 76751790 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -772453 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2493227 | RevenuesLessExpensesCY |
| Total Assets BOY | 74658532 | TotalAssetsBOY |
| Total Assets EOY | 72802936 | TotalAssetsEOY |
| Total Liabilities BOY | 34664789 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 35597537 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 39993743 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 37205399 | NetAssetsOrFundBalancesEOY |
| Mission Description | PROVIDE STATE-OF-ART MEDICAL FACILITIES AND HEALTHCARE TO COVINGTON AND OTHER SURROUNDING AREAS. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 67020699 | Expense |
| Grants | 6000 | Grants |
| Revenue | 68913535 | Revenue |
| Description | NEWTON HEALTH SYSTEM, INC. (THE SYSTEM) LOCATED IN COVINGTON, GEORGIA, OPERATES NEWTON MEDICAL CENTER, A NOT-FOR-PROFIT ACUTE CARE HOSPITAL. THE SYSTEM PROVIDES INPATIENT, OUTPATIENT, EMERGENCY CARE AND HOME HEALTH SERVICES FOR RESIDENTS OF NEWTON COUNTY AND THE SURROUNDING AREA. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. SERVICES ARE PROVIDED REGARDLESS OF THE PATIENT'S ABILITY TO PAY. | Description |
| Total Program Service Expense | 67020699 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | true | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | true | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 115 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 949 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | TROY BROOKS | NamePerson |
| Telephone Number | 7703854426 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5126 HOSPITAL DRIVE NE | AddressLine1 |
| City | COVINGTON | City |
| State | GA | State |
| ZIP Code | 30014 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| MARK HANSON MD | ||||||||
| MEMBER | 1.00 | X | 144031 | 0 | 0 | |||
| TIM PARK MD | ||||||||
| MEMBER | 1.00 | X | 6000 | 0 | 0 | |||
| DL KNOX | ||||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X | ||
| MELVIN BAKER DMD | ||||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | X | ||
| WILLIAM D FORTSON JR | ||||||||
| VICE CHAIR | 1.00 | X | 0 | 0 | 0 | X | ||
| BOB RICHARDSON | ||||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| ESTHER WILLIAMS | ||||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| RICHARD BROWN | ||||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| GEORGE HART | ||||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| RANDALL MEADOWS | ||||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| J VINCENT EAGAN | ||||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| SAMUEL HAY III | ||||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| JAMES WEADICK | ||||||||
| CEO | 40.00 | 400790 | 0 | 51877 | X | |||
| TROY B BROOKS | ||||||||
| CFO | 40.00 | 187871 | 0 | 34814 | X | |||
| BARBARA VALENTINE | ||||||||
| ASST ADMINIS | 40.00 | 150532 | 0 | 26172 | X | |||
| BRYAN PARRY MD | ||||||||
| PHYSICIAN | 40.00 | 330662 | 0 | 15996 | X | |||
| CARTER ROGERS MD | ||||||||
| SURGEON | 40.00 | 318533 | 0 | 18433 | X | |||
| SONAL HAZARIWALA | ||||||||
| NEUROLOGIST | 40.00 | 233598 | 0 | 11134 | X | |||
| ERINNE GRAHAM MD | ||||||||
| PHYSICIAN | 40.00 | 220621 | 0 | 10223 | X | |||
| KARUNA SHAH DO | ||||||||
| NEUROLOGIST | 40.00 | 213065 | 0 | 13782 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2205703 | TotalReportableCompFromOrg |
| Total Other Compensation | 182431 | TotalOtherCompensation |
| Number Individuals GT100 K | 19 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PHYSICAL THERAPY CLINICS OF GA PC | |||||
| PO BOX 767068 | ROSWELL | GA | 30076 | PT SERVICES | 707012 |
| RIVERDALE ANESTHESIA ASSOC PC | |||||
| 405 ARROWHEAD BLVD SUITE C | JONESBORO | GA | 30236 | ANESTHESIA SVCS | 640483 |
| COVENANT ADMINISTRATORS | |||||
| 1745 N BROWN ROAD | LAWRENCEVILLE | GA | 30043 | HEALTH PLAN ADM | 502920 |
| WOUNDCARE ADVANTAGE | |||||
| 304 SIERRA MADRE BLVD | SIERRA MADRE | CA | 91024 | WOUND CARE SVC | 468779 |
| ALCOVY HOSPITALIST PC | |||||
| P O BOX 2779 | COVINGTON | GA | 30015 | HOSPITALISTS | 319352 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 17 | NumberOfContractorsGT100K |
| Government Grants | 4008000 | GovernmentGrants |
| All Other Contributions | 361113 | AllOtherContributions |
| Total Contributions | 4369113 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PROG. SERV. REV. - RELATED | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 68630909 | TotalRevenueColumn |
| Related Or Exempt Function Income | 68630909 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 68630909 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 83329 | TotalRevenueColumn |
| Exclusion | $83,329 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 512988 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 514627 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -1639 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -1639 | TotalRevenueColumn |
| Exclusion | -$1,639 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 199676 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 70029 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 129647 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 129647 | TotalRevenueColumn |
| Exclusion | $129,647 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 326468 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 192298 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 134170 | TotalRevenueColumn |
| Exclusion | $134,170 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 154050 | GrossSalesOfInventory |
| Cost Of Goods Sold | 144206 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9844 | TotalRevenueColumn |
| Exclusion | $9,844 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA SALES | 722210 | 376321 | $376,321 | |
| CASH DISCOUNTS ON PURCHASES | 561000 | 282626 | 282626 | |
| DRUG SALES TO EMPLOYEES | 561000 | 108951 | $108,951 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 135292 | TotalRevenueColumn |
| Exclusion | $135,292 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 903190 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 74258563 | TotalRevenueColumn |
| Related Or Exempt Function Income | 68913535 | RelatedOrExemptFunctionIncome |
| Exclusion | $975,915 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6000 | Total |
| Program Services | 6000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1002087 | Total |
| Program Services | 150031 | ProgramServices |
| Management And General | 852056 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32648486 | Total |
| Program Services | 28884583 | ProgramServices |
| Management And General | 3763903 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 759523 | Total |
| Program Services | 738785 | ProgramServices |
| Management And General | 20738 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2871111 | Total |
| Program Services | 2498127 | ProgramServices |
| Management And General | 372984 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2447058 | Total |
| Program Services | 2116216 | ProgramServices |
| Management And General | 330842 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8135 | Total |
| Management And General | 8135 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 209969 | Total |
| Management And General | 209969 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 198000 | Total |
| Management And General | 198000 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11630 | Total |
| Management And General | 11630 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7348156 | Total |
| Program Services | 6208520 | ProgramServices |
| Management And General | 1139636 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 504184 | Total |
| Program Services | 147465 | ProgramServices |
| Management And General | 356719 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2397164 | Total |
| Program Services | 1759646 | ProgramServices |
| Management And General | 637518 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2761230 | Total |
| Program Services | 2548317 | ProgramServices |
| Management And General | 212913 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 147986 | Total |
| Program Services | 105601 | ProgramServices |
| Management And General | 42385 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38314 | Total |
| Program Services | 38314 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46604 | Total |
| Management And General | 46604 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5551183 | Total |
| Program Services | 5117080 | ProgramServices |
| Management And General | 434103 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 724366 | Total |
| Program Services | 677129 | ProgramServices |
| Management And General | 47237 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 12916756 | 12916756 | |
| REPAIRS & MAINTENANCE | 2846208 | 2045802 | 800406 |
| TAXES & LICENSES | 900938 | 900938 | |
| DUES & SUBSCRIPTIONS | 237307 | 96880 | 140427 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 169395 | Total |
| Program Services | 64509 | ProgramServices |
| Management And General | 104886 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76751790 | Total |
| Program Services | 67020699 | ProgramServices |
| Management And General | 9731091 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3684887 | BOY |
| EOY | 2925099 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9558858 | BOY |
| EOY | 10012938 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11272270 | BOY |
| EOY | 10699293 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 613380 | BOY |
| EOY | 656149 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 80237 | BOY |
| EOY | 80213 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 115662065 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 69185066 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47452548 | BOY |
| EOY | 46476999 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1996352 | BOY |
| EOY | 1952245 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74658532 | BOY |
| EOY | 72802936 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9418449 | BOY |
| EOY | 9951153 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24575002 | BOY |
| EOY | 23260002 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 671338 | BOY |
| EOY | 2386382 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34664789 | BOY |
| EOY | 35597537 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39993743 | BOY |
| EOY | 37205399 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39993743 | BOY |
| EOY | 37205399 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74658532 | BOY |
| EOY | 72802936 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -2493227 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -295117 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form4720 Filed4955 Tax | false | Form4720Filed4955Tax |
| Correction Made | false | CorrectionMade |
| Form1120 Pol Filed | false | Form1120PolFiled |
| Form4720 Filed | false | Form4720Filed |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $11,630 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 11630 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
| Form4720 Filed4912 Tax | false | Form4720Filed4912Tax |
| Substantially All Dues Nondeduct | false | SubstantiallyAllDuesNondeduct |
| Only In House Lobbying | false | OnlyInHouseLobbying |
| Agree To Carryover Prior Year | false | AgreeToCarryoverPriorYear |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | SCHEDULE C, PART II-B, LINE 1 | ReturnReference |
| Explanation | THE HOSPITAL PAYS AHA DUES ANNUALLY. A PORTION OF THE FEES PAID IS USED BY AHA TO COVER LOBBYING EXPENSES. FOR FISCAL YEAR 2011, 24% OF THE TOTAL PAID WAS ASSOCIATED WITH LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1615489 | OtherCostOrOtherBasis |
| Book Value | 1615489 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 66323280 | OtherCostOrOtherBasis |
| Depreciation | 33698801 | Depreciation |
| Book Value | 32624479 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 629186 | OtherCostOrOtherBasis |
| Depreciation | 487202 | Depreciation |
| Book Value | 141984 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 44929814 | OtherCostOrOtherBasis |
| Depreciation | 34999063 | Depreciation |
| Book Value | 9930751 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2164296 | OtherCostOrOtherBasis |
| Book Value | 2164296 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 46476999 | TotalOfBookValueLandBuildings |
| Total Revenue | 74258563 | TotalRevenue |
| Total Expenses | 76751790 | TotalExpenses |
| Excess Or Deficit For Year | -2493227 | ExcessOrDeficitForYear |
| Other | -$504,749 | OtherAmount |
| Total Adjustments | -504749 | TotalAdjustments |
| Excess Or Deficit Per FS | -2997976 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 74138794 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 514627 | OtherRevenues |
| Revenue Not Rptd F990 | 514627 | RevenueNotRptdF990 |
| Revenue Subtotal | 73624167 | RevenueSubtotal |
| Other Revenues Not Included | 634396 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 634396 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 74258563 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 77136770 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 514627 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 514627 | ExpensesNotRptdF990 |
| Expenses Subtotal | 76622143 | ExpensesSubtotal |
| Other Expenses Not Included | 129647 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 129647 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 76751790 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| LIABILITY UNDER FIN 48 FOOTNOTE | SCHEDULE D, PAGE 3, PART X | THE SYSTEM IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE SYSTEM 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 SYSTEM 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 OR 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 DECEMBER 31, 2011 AND 2010 OR FOR THE YEARS THEN ENDED. THE SYSTEM'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2008-2010. |
| RECONCILIATION OF CHANGES - OTHER | SCHEDULE D, PAGE 4, PART XI, LINE 8 | RENTAL EXPENSES 514,627 AUXILIARY FUNDRAISING AND INVENTORY CURRENT NET REVENUES -144,014 CAPITAL CONTRIBUTIONS -360,735 GAIN ON SALE OF EQUIPMENT -129,647 RENTAL EXPENSES -514,627 GAIN ON SALE OF EQUIPMENT 129,647 |
| REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 2D | RENTAL EXPENSES 514,627 |
| REVENUE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XII, LINE 4B | AUXILIARY FUNDRAISING AND INVENTORY CURRENT NET REVENUES 144,014 CAPITAL CONTRIBUTIONS 360,735 GAIN ON SALE OF EQUIPMENT 129,647 |
| EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER | SCHEDULE D, PAGE 4, PART XIII, LINE 2D | RENTAL EXPENSES 514,627 |
| EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XIII, LINE 4B | GAIN ON SALE OF EQUIPMENT 129,647 |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | AUXILIARY SPECI | NameOfEvent1 |
| Gross Receipts Event1 | 135097 | GrossReceiptsEvent1 |
| Gross Revenue Event1 | 135097 | GrossRevenueEvent1 |
| Other Direct Expenses Event1 | 144603 | OtherDirectExpensesEvent1 |
| Name Of Event2 | GALA SPECIAL EV | NameOfEvent2 |
| Gross Receipts Event2 | 127176 | GrossReceiptsEvent2 |
| Gross Revenue Event2 | 127176 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 37436 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 2 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 64195 | GrossReceiptsOtherEvents |
| Gross Revenue Other Events | 64195 | GrossRevenueOtherEvents |
| Other Direct Expenses Other Events | 10259 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 326468 | GrossReceiptsTotal |
| Gross Revenue Total Events | 326468 | GrossRevenueTotalEvents |
| Other Direct Expenses Total Events | 192298 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 192298 | DirectExpenseSummaryEvents |
| Net Income Summary | 134170 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4555764 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4555764 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05890 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12822590 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12990472 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -167882 | NetCommunityBenefitExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17378354 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12990472 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4387882 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05890 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 714073 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 714073 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00920 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20861550 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 15328929 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5532621 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07150 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 106568 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 106568 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 21682191 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 15328929 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6353262 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08210 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 39060545 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 28319401 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10741144 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.14100 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $2,255,247 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 24741134 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 20393095 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 4348039 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | 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 | NEWTON MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5126 HOSPITAL DRIVE | AddressLine1 |
| City | COVINGTON | City |
| State | GA | State |
| ZIP Code | 30014 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | PHYSICIAN CLINICS | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NEWTON MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | false | CHNAConducted |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 100.0 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 300.0 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NEWTON MEDICAL CENTER HOME HEALTH | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5126 HOSPITAL DRIVE | AddressLine1 |
| City | COVINGTON | City |
| State | GA | State |
| ZIP Code | 30209 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | HOME HEALTH AGENCY | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SUBSIDIZED HEALTH SERVICES EXPLANATION | PART I LINE 7G | THIS SECTION INCLUDES 2381007 COSTS FOR PHYSICIAN CLINICS WHICH PROVIDE ACCESS TO PHYSICIAN SERVICES IN THE COMMUNITY REGARDLESS OF ABILITY TO PAY |
| 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 76751790 ADD EXPENSES REPORTED IN PART VIII 658833 DENOMINATOR FOR COLUMN F 77410623 |
| COSTING METHODOLOGY EXPLANATION | PART I LINE 7 | THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATIONS A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS 2008 SEE ALSO THE DESCRIPTION FOR PART III LINE 4 |
| BAD DEBT EXPENSE EXPLANATION | PART III LINE 4 | AMOUNTS ON PART III LINES 2 AND 3 REPRESENT CHARGES WRITTEN OFF UNDER THE ORGANIZATIONS BAD DEBT POLICY NEWTON MEDICAL CENTER IS THE SOLE PROVIDER OF 24 HOUR 7 DAY A WEEK EMERGENT CARE IN NEWTON COUNTY GEORGIA IN ADDITION MANY CITIZENS OF NEWTON COUNTY HAVE NO ACCESS TO PRIMARY CARE AS A RESULT OF THEIR INABILITY OR UNWILLINGNESS TO PAY FOR SERVICES OTHERS HAVE NO ACCESS TO PRIMARY CARE PHYSICIANS DUE TO THEIR PARTICULAR INSURANCE PLAN THIS IS ESPECIALLY TRUE OF MEDICAID RECIPIENTS MANY OF THESE COMMUNITY MEMBERS SEEK CARE IN THE EMERGENCY ROOM AT NEWTON MEDICAL CENTER FOR BOTH EMERGENT AND NONEMERGENT HEALTH CARE NEEDS SOME OF THESE PATIENTS REQUIRE EXTENDED CARE AS INPATIENTS OR EXTENSIVE OBSERVATION OUR EMERGENCY ROOM ALSO SERVES AS A HOLDING AREA FOR THE MENTALLY ILL OFTEN KEEPING THESE CITIZENS FOR SEVERAL DAYS BEFORE THEY ARE PLACED IN A MORE APPROPRIATE SETTING MANY OF THESE PATIENTS DO NOT MEET CRITERIA OR ARE NONCOMPLIANT IN COMPLETING THE PROCESS NEEDED TO SHOW ELIGIBILITY FOR CHARITY CARE OTHERS ARE UNWILLING TO PAY EVEN THOUGH THEY MAY HAVE THE MEANS TO DO SO MANY INSURED PATIENTS HAVE HIGH DEDUCTIBLES AND ALSO FAIL TO PAY FOR THEIR CARE IN ADDITION NEWTON MEDICAL CENTER PROVIDES SERVICES TO PATIENTS ON AN ELECTIVE BASIS THAT ARE UNABLE TO MEET THEIR OUT OF POCKET EXPENSES UNDER THEIR INSURANCE PROGRAM MEDICARE OR OTHER THIRD PARTY PROVIDER IN THESE CASES THE HOSPITAL DOES WORK WITH THE PATIENTS TO MAKE PAYMENT ARRANGEMENTS HOWEVER MANY PATIENTS FAIL TO FOLLOW THROUGH OR ARE FINANCIALLY UNABLE TO COMPLETE THOSE ARRANGEMENTS CARE IS PROVIDED DESPITE THE RISK THAT MANY PATIENTS WILL NOT MAKE AGREED UPON PAYMENTS IN ALL OF THE CASES DESCRIBED ABOVE THE RESULT IS THE HOSPITAL INCURRING BAD DEBT EXPENSE BY PROVIDING HEALTH CARE SERVICES THAT ARE NEEDED BY COMMUNITY MEMBERS ACCORDINGLY IT IS CLEAR THAT THE COMMUNITY BENEFITS FROM THE HOSPITAL INCURRING BAD DEBT EXPENSE FOR CARE PROVIDED EXCERPT FROM AUDITED FINANCIAL STATEMENTS ALLOWANCE FOR DOUBTFUL ACCOUNTS THE SYSTEM PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE EVALUATION OF THE OVERALL COLLECTABILITY 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 COSTS ARE BASED ON THE COST REPORT USING APPROPRIATE ALLOCATION METHODOLOGIES AND ACCEPTABLE STATISTICAL BASES MEDICARE RECEIPTS WERE COMPILED FROM THE PSR DATA MEDICARE COST REPORT |
| COLLECTION PRACTICES EXPLANATION | PART III LINE 9B | THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES FOR PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS |
| NEEDS ASSESSMENT | PART VI | LOCAL AND STATE DEMOGRAPHICS FROM THE NEWTON COUNTY CHAMBER OF COMMERCE FINANCIAL RECORDS OF PATIENTS FEEDBACK FROM HOSPITAL SPONSORED SCREENINGS AND SUPPORT GROUPS |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI | INFORMATION IS AVAILABLE VIA OUR WEBSITE AT HTTPWWWNEWTONMEDICALCOMPATIENTFINANCIALHTML AS WELL AS A BROCHURE AND INFORMATION WITHIN OUR PATIENT GUIDE SIGNS ADVISING PATIENTS OF THE CHARITY CARE POLICY ARE POSTED AND SUMMARIES ARE AVAILABLE IN ADMISSIONS AND IN THE EMERGENCY ROOM PATIENTS THAT ARE POTENTIALLY ELIGIBLE FOR THE PROGRAMS ARE DIRECTED TO OUR FINANACIAL COUNSELORS FOR FURTHER SCREENING AND TO COMPLETE APPLICATION TO DETERMINE ELIGIBILITY INPATIENTS WHO MAY BE ELIGIBLE FOR CHARITY CARE ARE INFORMED OF THE CHARITY CARE PROGRAMS AS PART OF THE INPATIENT DISCHARGE PROCESS SOME OF THE STAFF ARE BILINGUAL AND ARE USED WITH NONENGLISH SPEAKING PATIENTS WHEN NEEDED THE HOSPITAL USES MEDASSIST TO WORK WITH UNINSURED PATIENTS TO ASSIST THEM IN DETERMINING IF THEY ARE ELIGIBLE FOR PROGRAMS SUCH AS DISABILITY MEDICAID AS WELL THE HOSPITALS CHARITY CARE PROGRAM ALL PATIENTS ACCOUNTS REGISTRATION AND SCHEDULING STAFF ARE TRAINED TO UNDERSTAND THE HOSPITALS CHARITY CARE POLICY AND TO REFER PATIENTS WHO MAY BE ELIGIBLE TO OUR PATIENT COUNSELORS FOR FURTHER ASSISTANCE ALL THIRD PARTIES THAT COLLECT PAYMENT ON BEHALF OF THE HOSPITAL HAVE BEEN MADE AWARE AND RECEIVED TRAINING TO IDENTIFY AND REFER PATIENTS FOR CHARITY CARE THEY ARE REQUIRED TO FOLLOW HOSPITAL POLICIES IN THESE MATTERS |
| COMMUNITY INFORMATION | PART VI | NEWTON COUNTY HAS A HIGHER UNEMPLOYMENT RATE THAN THAT OF THE STATE OR NATION AT 122 UNINSURED PATIENTS MAKE UP 21 OF NEWTON COUNTY THE POPULATION OF THE COUNTY IS AT 99958 AS OF 2012 WITH 54 BEING WHITE 41 BLACK WITH 5 HISPANIC OR OTHER THE HISPANIC POPULATION HAS QUADRUPLED SINCE 2000 THE POPULATION IS AGING IN PLACE |
| HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE | PART VI | THE HOSPITAL SPONSORS A FREE PHYSICIAN REFERRAL SERVICE AS WELL AS SEVERAL AVENUES IN WHICH THE PUBLIC CAN ASK QUESTIONS ABOUT HEALTH SERVICES THIS INCLUDES FACEBOOK TWITTER AND NUMEROUS FORMS LOCATED ON THE NEWTON MEDICAL CENTER WEBSITE THE HOSPITAL RUNS SEVERAL ADS YEARLY TO PROMOTE SERVICES TO THE COMMUNITY THE ORGANIZATION OFFERS SEVERAL FREE HEALTH SCREENINGS AS WELL AS DISCOUNT PROGRAMS TO THE RESIDENTS OF THE COUNTY NEWTON MEDICAL CENTER IS A PARTICIPANT IN MANY PUBLIC ACTIVITIES THROUGH PUBLIC AND PRIVATE ORGANIZATIONS SUCH AS THE POLICE DEPARTMENT PUBLIC SCHOOLS BUSINESS HEALTH FAIRS AND HOSPITAL HEALTH FAIRS OPEN TO THE PUBLIC |
| LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED | PART VI | GEORGIA |
| ADDITIONAL INFORMATION | PART VI | NEWTON MEDICAL CENTER DOES PROVIDE AN ANNUAL COMMUNITY BENEFIT REPORT THIS REPORT INCLUDES FINANCIALS AND DATA ON HOSPITAL OPERATIONS A LETTER FROM THE ADMINISTRATOR DISCUSSING ANY NEW ADDITIONS TO NEWTON MEDICAL CENTER AS WELL AS STATISTICS ON EMPLOYEES AND VOLUNTEERS THIS DOCUMENT ALSO PROVIDES A GLIMPSE INTO ANY NEW PHYSICIAN INITATIVES AND QUALITY INPROVEMENT FOR THE HOSPITAL AND AFFILIATED OFFICES THIS REPORT INCLUDES A DETAILED LISTING OF ALL ORGANIZATIONS THAT NEWTON MEDICAL CENTER PROVIDED CASH DONATIONS OR VOLUNTEERED SERVICES AT IN THE COMMUNITY NEWTON MEDICAL CENTER ALSO PROVIDED NUMEROUS FREE EDUCATIONAL FORUMS AND SUPPORT GROUPS TO THE COMMUNITY ON AN ANNUAL BASIS LASTLY NEWTON MEDICAL CENTER PROVIDES A SIGNIFICANT SERVICE TO THE COMMUNITY IN THE FORM OF CHARITY CARE THIS INFORMATION IS ALSO INCLUDED IN THE ANNUAL COMMUNITY BENEFIT REPORT |
| NEWTON MEDICAL CENTER LINE NUMBER 1 PART V LINE 13G | PART V LINE 13G | INFORMATION IS AVAILABLE VIA OUR WEBSITE AT HTTPWWWNEWTONMEDICALCOMPATIENTFINANCIALHTML AS WELL AS A BROCHURE AND INFORMATION WITHIN OUR PATIENT GUIDE |
| NEWTON MEDICAL CENTER LINE NUMBER 1 PART V LINE 17E | PART V LINE 17E | FINANCIAL COUNSELOR PROCEDURE IF A PATIENT IS UNINSURED THE HOSPITAL FINANCIAL COUNSELOR WILL ATTEMPT TO IDENTIFY IF THE PATIENT IS INDIGENT AT THE TIME OF ADMISSION OR WHILE THE PATIENT IS INHOUSE ONCE IDENTIFIED THE FINANCIAL COUNSELOR SHOULD REFER THE PATIENT FOR ASSISTANCE IN DETERMINING WHETHER THEY ARE ELIGIBLE FOR MEDICAL ASSISTANCE THE MEDICAID ELIGIBILITY VENDOR WILL WORK WITH THE PATIENT TO DETERMINE IF THEY ARE ELIGIBLE FOR THE MEDICAID PROGRAM AND ASSIST THEM IN FILING THE NECESSARY DOCUMENTS IF THE PATIENT IS FOUND TO BE INELIGIBLE FOR MEDICAID PATIENTS WHO HAVE NO THIRDPARTY COVERAGE ANDOR BENEFITS AVAILABLE WILL BE OFFERED THE FACILITY FLAT RATE IF THE PATIENT STATES THAT THEY ARE UNABLE TO AFFORD THE FACILITY ESTABLISHED SELFPAY RATE THEY WILL BE ASSESSED FOR FINANCIAL ASSISTANCE UNDER THE GUIDELINES SET FORTH BY THE FINANCIAL ASSISTANCE POLICY MEDICAID ELIGIBILITY VENDOR PROCEDURE PATIENTS WITHOUT INSURANCE COVERAGE WILL BE SCREENED FOR POTENTIAL LINKAGE TO GOVERNMENT PROGRAMS BEFORE ANY FINANCIAL ASSISTANCE APPLICATION IS PROCESSED DURING THE SCREENING PROCESS THE REPRESENTATIVE SHOULD SECURE A CONFIDENTIAL FINANCIAL APPLICATION THE APPLICATION IS TO BE USED FOR POTENTIAL FINANCIAL ASSISTANCE DETERMINATION ONLY IN THE EVENT THE REPRESENTATIVE IS UNABLE TO OBTAIN ELIGIBILITY FOR THE PATIENT FOR GOVERNMENT PROGRAMS REIMBURSEMENT IF DURING THE INITIAL INTERVIEW WITH THE PATIENT IT IS REVEALED THAT THERE IS NO VIABLE SOURCE OF PAYMENT AND THE PATIENT WILL NOT QUALIFY FOR ANY GOVERNMENTAL PROGRAMS THE MEDICAID ELIGIBILITY SPECIALIST REPRESENTATIVE WILL 1OFFER THE PATIENT A CONFIDENTIAL FINANCIAL APPLICATION FORM 2ASSIST THE PATIENT IN COMPLETING A CONFIDENTIAL FINANCIAL APPLICATION WHICH WILL DOCUMENT THE PATIENTS FINANCIAL NEED 3OBTAIN THE PATIENTS SIGNATURE ON THE CONFIDENTIAL FINANCIAL APPLICATION AND FORWARD THE APPLICATION TO THE FINANCIAL COUNSELOR AS DEEMED APPROPRIATE IN THE EVENT THAT IT IS DETERMINED THAT THE PATIENT HAS SOME ABILITY TO PAY PAYMENT ARRANGEMENTS WILL BE MADE ACCORDING TO THE PATIENTS MEANS ANY DISCOUNT GIVEN TO THE PATIENT WILL BE PRESENTED TO THE PFS DIRECTOR FINAL DETERMINATION WILL BE BASED NOT ONLY ON INCOME BUT A REVIEW OF THE APPLICANTS PERSONAL AND BUSINESS ASSETS AND LIABILITIES FOR THOSE ACCOUNTS THAT REMAIN IN THE DETERMINATION PHASE FOR MEDICAID ELIGIBILITY PAST 30 DAYS FROM ASSIGNMENT WITH NO GOVERNMENT PROGRAM LINKAGE AND THAT MEET THE FINANCIAL CRITERIA FOR FINANCIAL ASSISTANCE MEDICAID ELIGIBILITY SPECIALIST SHOULD HAVE GATHERED ALL SUBSTANTIAL INFORMATION TO ENABLE THE HOSPITAL TO UTILIZE THE FINANCIAL ASSISTANCE POLICY INCLUDED IN THE FINANCIAL ASSISTANCE PACKET IS A CONFIDENTIAL FINANCIAL APPLICATION IF THE MEDICAID ELIGIBILITY SPECIALIST REPRESENTATIVE HAS EXHAUSTED ALL EFFORTS TO SECURE ALL NECESSARY VERIFICATIONS THE APPLICATION FOR FINANCIAL ASSISTANCE SHOULD BE SUBMITTED TO PFS FOR REVIEW AND FINALIZATION WITHOUT THE VERIFICATIONS EARLY OUT PROCEDURE THERE WILL BE CASES WHERE A PATIENTS ABILITY TO PAY MAY CHANGE AFTER THEY LEAVE THE HOSPITAL IN ORDER TO RECOGNIZE THIS THE EARLY OUT AGENCY MUST FOLLOW THESE STEPS TO DO AN INITIAL SCREENING FOR FINANCIAL ASSISTANCE IF IT IS DETERMINED BY THE ANSWERS OF THE PATIENT THAT THEY MAY QUALIFY FOR FINANCIAL ASSISTANCE THE ACCOUNT IS THEN RETURNED BACK TO THE FACILITY BY CHANGING THE PAYOR ID TO FINANCIAL ASSISTANCE A CONFIDENTIAL FINANCIAL APPLICATION WILL BE SENT TO THE PATIENT AND DETERMINATION WILL BE MADE BY NMC UNDER THE NONDISCRETIONARY SEGMENT OF THIS POLICY THE PATIENT WILL BE REQUIRED TO COMPLETE THE APPLICATION AND PROVIDE THE NECESSARY DOCUMENTATION TO PROCESS THE APPLICATION IF THE APPLICATION IS NOT RETURNED OR THE REQUIRED DOCUMENTATION IS INCOMPLETE TO THE BUSINESS OFFICE WITHIN 30 DAYS THE ACCOUNT WILL BE ASSIGNED BACK TO EARLY OUT TO RESUME COLLECTION EFFORTS ACCOUNTS GREATER THAN 6 MONTHS FROM THE SERVICE DATE MAY NOT BE ELIGIBLE FOR THE FINANCIAL ASSISTANCE PROGRAM IF THE ACCOUNT EXCEEDS 6 MONTHS IT WILL BE DETERMINED BY THE PFS DIRECTOR IF THE PATIENT WILL BE ALLOWED TO APPLY AT THE TIME OF BAD DEBT REVIEW EO WILL MAKE A DETERMINATION FOR A FINANCIAL ASSISTANCE RECOMMENDATION UNDER THE DISCRETIONARY PORTION OF THIS POLICY THE ACCOUNTS ONCE DETERMINED FOR RECOMMENDATION WILL THEN BE RETURNED TO THE FACILITY FOR REVIEW AND APPROVAL BY THE PFS DIRECTOR CONTROLLER ANDOR ASSISTANT ADMINISTRATOR FOR FISCAL SERVICES IF THE ACCOUNT IS APPROVED BY TWO OF THE THREE ABOVE STATED MANAGERS FOR NON DISCRETIONARY FINANCIAL ASSISTANCE AN ADJUSTMENT WILL BE MADE TO THE ACCOUNT WITH THE DESIGNATED WRITEOFF CODE ALL OTHER ACCOUNTS WILL BE RETURNED TO EO TO RESUME COLLECTION EFFORTS DOCUMENT REQUIREMENTS WHEN A PATIENT IS IDENTIFIED AS UNINSURED OR REQUESTS A CONFIDENTIAL FINANCIAL APPLICATION NMC PERSONNEL OR A REPRESENTATIVE OF NMC SHALL PROVIDE THE PATIENT WITH THE CONFIDENTIAL FINANCIAL APPLICATION THE PATIENT MUST COMPLETE AND SIGN THE CONFIDENTIAL FINANCIAL APPLICATION SOME OR ALL OF THE FOLLOWING DOCUMENTATION WILL BE REQUIRED AT THE TIME OF THE APPLICATION 1MEDICAL ASSISTANCE ELIGIBILITY SCREENINGDENIAL NOTICE THE MEDICAID ELIGIBILITY VENDOR MUST HAVE SCREENED PATIENT PRIOR TO APPLICATION SCREENING RESULTS SHOULD BE SHOWN BY DOCUMENTATION IN THE MEDITECH SYSTEM 2INCOME TAX RETURNS FOR THE MOST RECENTLY FILED YEAR 3PROOF OF INCOME AND ADJUSTED GROSS INCOME SUCH AS THE PATIENTS YEAR END PAY STUBS W2 OR THEIR ANNUAL MOST RECENT TAX RETURN 4BANK STATEMENTS CHECKING AND SAVINGS PAST 60 DAYS 5ANY OTHER DOCUMENTATION THAT MAY SERVE AS PROOF OF ELIGIBILITY FOR FINANCIAL ASSISTANCE 6A CREDIT BUREAU REPORT MAY BE NEEDED IN DETERMINING ELIGIBILITY THE FINANCIAL RESOURCES OF A PARENT OR GUARDIAN MAY BE CONSIDERED IN DETERMINING THE ELIGIBILITY OF A PATIENT WHO IS DEPENDENT ON THE PARENT OR GUARDIAN FOR FINANCIAL SUPPORT THE FINANCIAL COUNSELOR WILL APPLY FPG GUIDELINES BY USING THE FPG TABLE WHICH IS UPDATED ANNUALLY THE PATIENTS FAMILY SIZE IS USED TO DETERMINE WHETHER ANNUAL INCOME FALLS AT BELOW OR EXCEEDS 300 OF THE FPG |
| NEWTON MEDICAL CENTER LINE NUMBER 1 PART V LINE 19D | PART V LINE 19D | THE HOSPITAL USED THE AVERAGE MANAGED CARE DISCOUNT |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | TUITION/SCHOLA ASSISTANCE | TypeOfGrant |
| Number Of Recipients | 9 | NumberOfRecipients |
| Amount Of Cash Grant | 6000 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES | Identifier |
| Return Reference | SCHEDULE I, PAGE 1, PART I, LINE 2 | ReturnReference |
| Explanation | TUITION ASSISTANCE PROGRAM FULL-TIME AND PART-TIME EMPLOYEES WHO HAVE COMPLETED AT LEAST SIX MONTHS OF UNINTERRUPTED SERVICE ARE ELIGIBLE TO PARTICIPATE IN THE TUITION ASSISTANCE PROGRAM. PRN EMPLOYEES MAY BE ELIGIBLE FOR REIMBURSEMENT FOR NURSING PROGRAMS. COURSES OF STUDY MUST BE RELATED TO A POSITION IN THE MEDICAL CENTER. REIMBURSEMENT UNDER THIS PROGRAM IS LIMITED TO 100% OF TUITION FEES FOR COURSE COMPLETED. THE PROGRAM WILL NOT REIMBURSE EMPLOYEES FOR BOOKS, PARKING, TRAVEL, REGISTRATION, STUDENT ACTIVITIES FEES, MISCELLANEOUS SUPPLIES AND FEES, OR OTHER EXPENSES OF A PERSONAL NATURE. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg |
|---|---|---|---|---|---|
| JAMES WEADICK | |||||
| 395552 | 5238 | 43499 | 8378 | 452667 | |
| TROY B BROOKS | |||||
| 187476 | 395 | 28645 | 6169 | 222685 | |
| BARBARA VALENTINE | |||||
| 149724 | 808 | 22617 | 3555 | 176704 | |
| BRYAN PARRY MD | |||||
| 330232 | 430 | 9800 | 6196 | 346658 | |
| CARTER ROGERS MD | |||||
| 318137 | 396 | 12250 | 6183 | 336966 | |
| SONAL HAZARIWALA | |||||
| 194907 | 162 | 4369 | 6765 | 244732 | 38529 |
| ERINNE GRAHAM MD | |||||
| 220434 | 187 | 3351 | 6872 | 230844 | |
| KARUNA SHAH DO | |||||
| 212601 | 464 | 7608 | 6174 | 226847 | |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS | SCHEDULE J, PAGE 1, PART I, LINE 4 | JAMES WEADICK 0 31,250 0 TROY B. BROOKS 0 19,000 0 BARBARA VALENTINE 0 15,000 0 |
| OTHER ADDITIONAL INFORMATION | SCHEDULE J, PART III | THE ORGANIZATION PROVIDES A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. IT IS ADMINISTERED BY VANGUARD AND IS CONSTRUCTED AS A 457(F)PLAN. THE PARTICIPANTS INCLUDE CERTAIN MEMBERS OF THE HOSPITAL'S EXECUTIVE STAFF. PART II, COLUMN (B)(II) BONUS & INCENTIVE COMPENSATION - EMPLOYEE INCENTIVE PLAN THE EMPLOYEE INCENTIVE PLAN IS BASED ON MULTIPLE GOALS, ONE OF WHICH IS NET OPERATING MARGIN FOR THE HOSPITAL. INCENTIVE PLAN FOR DOCTORS THE PHYSICIAN INCENTIVE PLANS ARE ALL BASED ON NET COLLECTIONS INTO THE PRACTICE, NOT NET INCOME. THEY ARE NOT PREDICATED ON ANY VOLUME GENERATED INTO THE HOSPITAL, NOR FOR THAT MATTER ARE THEY TIED TO PURE VOLUME OF VISITS/SURGERIES/DELIVERIES EITHER. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Business Name Line2IssuerName/BusinessNameLine2 | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| NEWTON COUNTY HOSPITAL AUTHORITY | ||||||||
| 2006 REVENUE BONDS | 586004174 | NONENONEN | 2006-04-27 | 8930000 | 4TH FLOOR ADDN HOSP | false | false | false |
| NEWTON COUNTY HOSPITAL AUTHORITY | ||||||||
| 2007 BOND ISSUE | 586004174 | NONENONEN | 2007-05-30 | 17225000 | ADVC REFUND 1999 BONDS | false | false | false |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | 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 | Refunding EscrowRefundingEscrow |
|---|---|---|---|---|---|---|---|---|---|---|
| 1725000 | 9010590 | 1349661 | 178600 | 8751400 | 2007 | false | false | true | true | |
| 1169998 | 1126717 | 235999 | 2002 | false | true | true | true | 16989001 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Engage Bond Counsel ContractsEngageBondCounselContracts | Any Research AgreementsAnyResearchAgreements | Engage Bond Counsel ResearchEngageBondCounselResearch | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|
| false | false | false | false | false | true | true |
| false | false | false | false | false | true | true |
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 |
|---|---|---|---|---|---|
| false | false | false | false | false | false |
| false | false | false | false | false | false |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DIFFERENCES IN ISSUE PRICE EXPLANATION | Identifier |
| Return Reference | SCHEDULE K | ReturnReference |
| Explanation | NEWTON COUNTY HOSPITAL AUTHORITY TOTAL PROCEEDS INCLUDES TOTAL INVESTMENT EARNINGS FROM SINKING FUND OF APPROXIMATELY 80600 NEWTON COUNTY HOSPITAL AUTHORITY TOTAL PROCEEDS INCLUDES TOTAL INVESTMENT EARNINGS FROM SINKING FUND OF APPROXIMATELY 10100 | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | WILLIAM D FORTSON | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | BOARD MEMBER | Relationship |
| Amount Of Transaction | 48000 | AmountOfTransaction |
| Description Of Transaction | RENT | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE L PART V | ReturnReference |
| Explanation | WILLIAM D FORTSON ALONG WITH HIS SPOUSE OWN AND OPERATE GINN MOTOR COMPANY THE FILING ORGANIZATION COMPENSATED GINN MOTOR COMPANY 48000 DURING THE CALENDAR YEAR 2011 TO LEASE OFFICE SPACE | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS | FORM 990, PAGE 1, PART I, LINE 6 | ESTIMATED VOLUNTEER HOURS FOR FISCAL YEAR 2011 IS 35,646. THE VOLUNTEERS GREET PEOPLE AS THEY ENTER THE HOSPITAL AND WORK AT THE INFORMATION DESK. THEY WORK IN THE HOSPITAL'S GIFT SHOPS. THEY ACT AS GUIDES FOR ANYONE NEEDING ASSISTANCE GETTING AROUND THE HOSPITAL. |
| RELATED PARTY INFORMATION AMONG OFFICERS | FORM 990, PAGE 6, PART VI, LINE 2 | TROY BROOKS W.D. FORTSON CFO BOARD MEMBER BUSINESS RELATIONSHIP TROY BROOKS BOB RICHARDSON CFO BOARD MEMBER BUSINESS RELATIONSHIP D.L. KNOX RANDALL MEADOWS BOARD MEMBER BOARD MEMBER BUSINESS RELATIONSHIP |
| ELECTION OF MEMBERS AND THEIR RIGHTS | FORM 990, PAGE 6, PART VI, LINE 7A | THE CHIEF OF MEDICAL STAFF IS A VOTING MEMBER OF THE BOARD OF DIRECTORS. HE/SHE IS ELECTED FOR A TWO YEAR TERM AS CHIEF OF MEDICAL STAFF BY THE MEDICAL STAFF MEMBERS AND HAS A POSITION ON THE FILING ORGANIZATION'S BOARD BY VIRTUE OF THAT POSITION. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE COMPLETED 990 WILL BE REVIEWED IN A MEETING OF THE AUDIT COMMITTEE PRIOR TO FILING THE FORM WITH THE IRS. THERE WILL BE DISCUSSION AND MINUTES WILL RECORD THIS OCCURRENCE. THERE WILL BE A DETAILED REVIEW. KEY ELEMENTS OF THE FORM 990 FILING WERE COVERED WITH THE ENTIRE BOARD AT THE NOVEMBER 13, 2012 MEETING AND THE MEMBERS WERE INFORMED THAT A REVIEW THE ENTIRE DOCUMENT WAS AVAILABLE TO THEM IF THEY SO DESIRED. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | BOARD MEMBERS ARE SUBJECT TO ANNUAL CONFLICT OF INTEREST INQUIRIES AND ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT. AN EXAMPLE OF A CONFLICT OF INTEREST OCCURRING AND HOW IT WOULD BE DEALT WITH IS DESCRIBED HERE. CAPITAL BUDGETS AND CAPITAL CONSTRUCTION ARE APPROVED BY THE ENTIRE BOARD OF DIRECTORS. IF A CONFLICT OF INTEREST WAS PRESENT, IT WOULD BE IDENTIFIED AT THAT TIME OR SHORTLY THEREAFTER AND CERTAINLY BEFORE ANY AGREEMENTS WERE SIGNED. IF A CONFLICT OF INTEREST WAS IDENTIFIED IT WOULD BE BROUGHT TO THE APPROPRIATE PERSON'S ATTENTION. THIS PERSON WOULD REMOVE HIMSELF FROM ANY POSITION OF KNOWLEDGE OR INFLUENCE ON THE ISSUE AT QUESTION. COMPETITIVE QUOTES WOULD BE SOLICITED FROM SIMILAR TYPES OF VENDORS. THEN THE BEST AND LOW COST VENDOR WOULD BE SELECTED. EACH YEAR BOARD MEMBERS AND MEMBERS OF MANAGEMENT REVIEW THE CONFLICT OF INTEREST POLICY. THEY THEN COMPLETE A FORM WHICH IDENTIFIES WHETHER OR NOT THEY HAVE OR HAVE HAD A CONFLICT OF INTEREST IN THEIR DEALINGS WITH THE HOSPITAL. THIS FORM IS SIGNED AND RETAINED IN THE ADMINISTRATOR'S OFFICE. AN EXISTING CONFLICT IS FIRST REVIEWED BY ONE OR MORE EXECUTIVE MANAGEMENT MEMBERS. IF THE MATTER CANNOT BE RESOLVED AT THAT LEVEL IT WOULD BE REFERRED TO THE CORPORATE COMPLIANCE COMMITTEE OR TO THE BOARD OF DIRECTORS FOR CLARIFICATION AND RESOLUTION. RESTRICTIONS PLACED ON THE APPROPRIATE PERSON WOULD RANGE FROM NOT HAVING ACCESS TO COST INFORMATION OF OTHER VENDORS, NOT BEING INVOLVED IN NEGOTIATIONS, NOT BEING INVOLVED IN SELECTING VENDORS TO SELL TO THE HOSPITAL. WHEN DISCUSSIONS OCCUR THAT PERTAIN TO THIS SUBJECT THIS PERSON WOULD HAVE TO PHYSICALLY REMOVE HIMSELF FROM THAT FORUM. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | OFFICERS OF THE BOARD OF DIRECTORS ARE NOT COMPENSATED IN THEIR POSITION AS BOARD MEMBERS. THE AUDIT COMMITTEE REVIEWS AND DISCUSSES COMPENSATION OF THE MEMBERS OF MANAGEMENT. THEIR RECOMMENDATIONS ARE MADE TO THE FULL BOARD WHERE THEY ARE ACTED UPON. IN SOME INSTANCES THE FULL BOARD RATHER THAN THE COMMITTEE WILL DELIBERATE AND ACT. IN SETTING ANNUAL COMPENSATION FOR MANAGEMENT, A COMPENSATION SURVEY IS USED. APPROVAL BY THE BOARD IS REQUIRED. PROCESS LAST CONDUCTED IN 2008 FOR BOTH CEO AND CFO. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | SEE LINE 15A ABOVE. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE AT THE ORGANIZATION'S ADMINISTRATIVE OFFICES UPON REQUEST. |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 5 | AUXILIARY NET LOSS 295,117 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NEWTON COUNTY HOSPITAL AUTHORITY | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5126 HOSPITAL DRIVE NE | AddressLine1 |
| City | COVINGTON | City |
| State | GA | State |
| ZIP Code | 30014 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 586004714 | EIN |
| Primary Activities | AUTHORITY | PrimaryActivities |
| Legal Domicile State | GA | LegalDomicileState |
| Public Charity Status | 6 | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | false | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | true | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | true | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |