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PIEDMONT REGIONAL HEALTH INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
PIEDMONT REGIONAL HEALTH INC (EIN 43-2007498)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-07
IRS object ID
201221289349300107
Schema version
2010v3.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-07T06:23:10-07:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1McNair McLemore MiddlebrooksBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1Post Office Box OneAddressLine1
CityMaconCity
StateGAState
ZIP Code312020001ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN432007498EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Piedmont Regional Health IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPIEDNameControl
Phone4786212100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11005 Boulder DriveAddressLine1
CityGrayCity
StateGAState
ZIP Code31032ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTeresa W MoodyName
TitleCorporate SecretaryTitle
Date Signed2012-05-07DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameJ RANDOLPH NICHOLSName
Phone4787466277Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKay F GrayNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11005 Boulder DriveAddressLine1
CityGrayCity
StateGAState
ZIP Code31032ZIPCode
FieldValueIRS element (for citing)
Gross Receipts20328118GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Organization501c3XOrganization501c3
Web Sitewww.ethicahealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2003YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionThe development, construction, acquisition, ownership, leasing, management and operation of skilled health care facilities.ActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees431TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year19960761ProgramServiceRevenuePriorYear
Program Service Revenue CY20318769ProgramServiceRevenueCY
Investment Income Prior Year164InvestmentIncomePriorYear
Investment Income Current Year9349InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year19960925TotalRevenuePriorYear
Total Revenue Current Year20328118TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8444974SalariesEtcPriorYear
Salaries Etc Current Year8202939SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year9074481OtherExpensePriorYear
Other Expenses Current Year11049910OtherExpensesCurrentYear
Total Expenses Prior Year17519455TotalExpensesPriorYear
Total Expenses Current Year19252849TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2441470RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1075269RevenuesLessExpensesCY
Total Assets BOY12670771TotalAssetsBOY
Total Assets EOY12164655TotalAssetsEOY
Total Liabilities BOY9558413TotalLiabilitiesBOY
Total Liabilities EOY9477028TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3112358NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2687627NetAssetsOrFundBalancesEOY
Mission DescriptionThe development, construction, acquisition, ownership, leasing, management and operation of skilled health care facilities.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense19252849Expense
Revenue20318769Revenue
DescriptionLeased and operated skilled care, intermediate care and other health care related facilities. Consistent with the policies previously adopted by the board of directors of Community Health Systems, Inc., the Section 509(a)(3) supporting organization and parent entity of the integrated health care delivery system of which the Organization is a member, the Organization provides substantial community benefit to the communities it serves pursuant to both community benefit quidelines and a charity care policy. The Organization continues to assess and develop programs to benefit the community.Description
Total Program Service Expense19252849TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntitytrueDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109673NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees431NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledtrueForm8899Filed
Form1098 C FiledtrueForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonPiedmont Regional Health IncNamePerson
Telephone Number4786212100TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11005 Boulder DriveAddressLine1
CityGrayCity
StateGAState
ZIP Code31032ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationFormerFormerIndividual Trustee Or DirectorIndividualTrusteeOrDirector
Teresa W Moody
Corporate Sec.4.00X012086016753
T Randolph Coody
Director0.00015400820547X
Ronnie D Rollins
Director0.00094388826395X
Paul A Cable
Director4.000240000X
Pamela S O'Rourke
Chief Operating Officer0.00014543216844X
Mark A Waldrop
Chief Operating Officer, Director0.00071988524692X
Lucy M Rogers
President0.00014110817209X
Lorraine T Taylor
Vice-President & Secretary0.00045158923050X
Kay F Gray
President13.33X014657618399
Joseph A Wall
Chairman4.000240000X
James B Patton
Director4.000240000X
J Olan Jones
Director4.000240000X
Herbert M Ponder
Director4.000240000X
FieldValueIRS element (for citing)
Total Reportable Comp Frm Rltd Orgs2943346TotalReportableCompFrmRltdOrgs
Total Other Compensation163889TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Pulaski Real Estate Holdings
PO Box 448MetterGA30439Professional Servs.102977
MSC Nursing Homes LLC
PO Box 448MetterGA30439Lease412425
Lighthouse Nursing Agency
PO Box 823473PhiladelphiaPA191823473Professional Servs.139980
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Service Revenues62435916243591
Governmental Programs Rev1407517814075178
FieldValueIRS element (for citing)
Total Program Service Revenue20318769TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column9349TotalRevenueColumn
Exclusion$9,349ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column20328118TotalRevenueColumn
Related Or Exempt Function Income20318769RelatedOrExemptFunctionIncome
Exclusion$9,349ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7211663Total
Program Services7211663ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total103495Total
Program Services103495ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total348036Total
Program Services348036ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total539745Total
Program Services539745ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total753174Total
Program Services753174ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total24700Total
Program Services24700ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total0Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total37237Total
Program Services37237ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total764127Total
Program Services764127ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total457826Total
Program Services457826ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1203254Total
Program Services1203254ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
UTILITES491307491307
Taxes and Licenses13215891321589
Support Services565092565092
Nursing Services38548173854817
Community Benefit970411970411

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total606376Total
Program Services606376ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total19252849Total
Program Services19252849ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2849627BOY
EOY2852705EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1440332BOY
EOY1210600EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY20943BOY
EOY40189EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis9614422LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1753062LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8193875BOY
EOY7861360EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY165994BOY
EOY199801EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12670771BOY
EOY12164655EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1154458BOY
EOY1278241EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY3285000BOY
EOY3200000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY5118955BOY
EOY4998787EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY9558413BOY
EOY9477028EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3112358BOY
EOY2687627EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3112358BOY
EOY2687627EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12670771BOY
EOY12164655EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1075269ReconcilationRevenueExpenses
Reconcilation Other Changes-1500000ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Total0Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9138884CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20331400CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years17378588CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19960791CurrentTaxYearMinus1Year
Current Tax Year20318769CurrentTaxYear
Total87128432Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9138884CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20331400CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years17378588CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19960791CurrentTaxYearMinus1Year
Current Tax Year20318769CurrentTaxYear
Total87128432Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50987128432PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years27283CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8954CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year164CurrentTaxYearMinus1Year
Current Tax Year9349CurrentTaxYear
Total45750Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years27283CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8954CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year164CurrentTaxYearMinus1Year
Current Tax Year9349CurrentTaxYear
Total45750Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Total0Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9138884CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20358683CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years17387542CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19960955CurrentTaxYearMinus1Year
Current Tax Year20328118CurrentTaxYear
Total87174182Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99950PublicSupportPercentage509
Prior Year Support Percentage0.99950PriorYearSupportPercentage
Investment Income Percentage0.00050InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00050PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8900000OtherCostOrOtherBasis
Depreciation1648954Depreciation
Book Value7251046BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis536177OtherCostOrOtherBasis
Depreciation50345Depreciation
Book Value485832BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis178245OtherCostOrOtherBasis
Depreciation53763Depreciation
Book Value124482BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7861360TotalOfBookValueLandBuildings
Total Revenue20328118TotalRevenue
Total Expenses19252849TotalExpenses
Excess Or Deficit For Year1075269ExcessOrDeficitForYear
Other-$1,500,000OtherAmount
Total Adjustments-1500000TotalAdjustments
Excess Or Deficit Per FS-424731ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt20328118TotRevenueEtcAuditedFinclStmt
Revenue Subtotal20328118RevenueSubtotal
Total Revenue Per Form99020328118TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt19252849TotExpensesEtcAuditedFinclStmt
Expenses Subtotal19252849ExpensesSubtotal
Total Expenses Per Form99019252849TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart XI, Line 8Identifier
Return ReferencePart XI, Line 8: Other Changes in Net Assets or Fund BalancesReturnReference
ExplanationDistribution to Supporting Organization of the System $ -1500000Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgs
T Randolph Coody
154008616014387174555
Ronnie D Rollins
943888980016595970283
Pamela S O'Rourke
145432581711027162276
Mark A Waldrop
719885980014892744577
Lucy M Rogers
141108564411565158317
Lorraine T Taylor
451589980013250474639
Kay F Gray
146576586312536164975

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Middle Coastal Unified Development AuthorityBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN582140014IssuerEIN
Date Issued2007-01-15DateIssued
Issue Price3515000IssuePrice
Description Of PurposeAcquisition of Real EstateDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds3515000TotalProceeds
Current RefundingfalseCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T FiledfalseForm8038TFiled
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Regulatory Safe Harbor SatisfiedfalseRegulatorySafeHarborSatisfied
Gross Proceeds InvestedfalseGrossProceedsInvested
Exception To RebatetrueExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableThe Organization's governing documents, conflict of interest policy and financial statements are available for public inspection upon request in accordance with the Section 6104(d) disclosure requirements.
Form 990, Part VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesThe Organization regularly and consistently complies with the compensation approval process which is part of its conflicts of interest policy. Every two to three years, on average, the Organization participates in a comprehensive process conducted on its behalf by the compensation committee of the board of directors of Community Health Systems, Inc., its sole member and parent of the integrated health care delivery system in which the Organization is a member. This process involves review of comparability data compiled by an independent third-party compensation consultant. Comparability data is gathered for the Organization's senior management, and on occasion, key or highly compensated employees, and, based on the same, the consultant issues a written report reflecting the consultant's opinion concerning whether the proposed compensation arrangements constitute reasonable compensation under Section 4958 of the Code. This process is conducted by the compensation committee, which then makes recommendations to the board of directors. The board of directors is also provided with materials regarding the compensation review, including copies of the consultant's report. The board then votes as to the reasonableness of each of the individual compensation arrangements (if any disqualified or otherwise conflicted individuals are present at the meeting, they do not participate in the deliberations and are excused from the room during the vote). The process is designed and carried out by the board of directors in a manner designed to satisfy all three of the requirements necessary to establish the rebuttable presumption of reasonableness with respect to compensation arrangements for disqualified persons under Section 53.4958-6 of the Regulations. As part of this process, outside counsel is retained to further advise the board on the rebuttable presumption process and to provide the board with a legal opinion regarding the same. As a final step, each part of the process required to establish the rebuttable presumption is documented using the Rebuttable Presumption Checklist released by the IRS.
Form 990, Part VI, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsThe organization regularly and consistently monitors and enforces compliance with its conflicts of interest policy. Such compliance is effectuated through the Organization's board of directors' review of annual conflict disclosure statements from the directors as well as receipt and review of conflict disclosure statements with respect to certain proposed transactions or arrangements the Organization is considering prior to any board action with respect to such matters. The conflicts policy outlines the specific procedure to be followed to determine whether interested persons have actual conflicts of interest. If it is determined that a board member has an actual conflict of interest, then such board member is not allowed to participate in the board deliberations on the specific matter and is excused from, and is not allowed to participate in any board vote on the matter.
Form 990, Part VI, Line 11Form 990, Part VI, Line 11: Form 990 Review ProcessThis process involves the electronic posting of the draft Form 990 with all its schedules for the Organization's board of directors to review followed, after a sufficient review period, by a meeting of the board at which board members will have the opportunity to ask questions of management and the outside tax advisors involved in the preparation of the Form 990.
Form 990, Part VI, Line 6Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderThe Organization has a sole member, Community Health Systems, Inc., a nonprofit Georgia corporation.
Form 990, Part VI, Line 2Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, EtEach of the directors of the Organization, Messrs. Wall, Patton, Cable, Jones and Ponder are also members of the board of directors of Community Health Ventures, Inc., a taxable Georgia corporation which is a related organization. This director overlap creates a business relationship.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Johnson County LTC LLC
1005 Boulder DriveGrayGA31032203644958Health CareGA3547417329274NA
Candler County II LTC LLC
1005 Boulder DriveGrayGA31032203644923Health CareGA4322699632306NA
Bulloch County LTC LLC
1005 Boulder DriveGrayGA31032203644663Health CareGA3990287470431NA
Evans County LTC LLC
1005 Boulder DriveGrayGA31032203645112Health CareGA4365865393417NA
Candler County LTC LLC
1005 Boulder DriveGrayGA31032203644753Health CareGA3960780493377NA

Form990 Schedule R Part II Form990ScheduleRPartII (10 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Steward Health Services Inc
213 Third StreetMaconGA31201432007486Hospice Services, Home Health ServicesGA501(c)(3)Line 9CHSItrue
Pharmacy Services Inc
213 Third StreetMaconGA31201432007496Pharmaceutical & Medical SuppliesGA501(c)(3)Line 9CHSItrue
Home & Community Services Inc
PO Box 1803MaconGA31202432007492Home Care & Related ServicesGA501(c)(3)Line 9CHSItrue
Health Systems Real Estate Inc
1005 Boulder DriveGrayGA31032432007488Real EstateGA501(c)(3)Line 9CHSItrue
Health Systems Facilities Inc
1005 Boulder DriveGrayGA31032743083594Operation of HC FacilitiesGA501(c)(3)Line 9CHSItrue
Health Scholarships Inc
1005 Boulder DriveGrayGA31032581805305Operation of HC FacilitiesGA501(c)(3)Line 9CHSItrue
Community Rehabilitation Services Inc
PO Box 1804MaconGA31202203253779Rehabilitation ServicesGA501(c)(3)Line 9CHSItrue
Community Health Systems Inc
PO Box 1037MaconGA31202743083593Support ServicesGA501(c)(3)Ln 11, Type 1NAfalse
Community Health Foundation Inc
PO Box 1833MaconGA31202571157153Financial Support, Scholarship ProgramGA501(c)(3)Line 9CHSItrue
Clinical Services Inc
1005 Boulder DriveGrayGA31032571157115Clinical & Healthcare ServicesGA501(c)(3)Line 9CHSItrue

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Community Health Ventures IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1213 Third StreetAddressLine1
CityMaconCity
StateGAState
ZIP Code31201ZIPCode
FieldValueIRS element (for citing)
EIN201392241EIN
Primary ActivityRisk Mgmt.PrimaryActivity
Legal Domicile StateGALegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CHSIBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityC corpTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Pharmacy Services Inc
l944706
Community Rehabilitation Services Inc
l1153835
Community Health Systems Inc
l565092
Community Health Foundation Inc
q963085
Clinical Services Inc
l753174
Clinical Services Inc
i141024