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CULLMAN REGIONAL MEDICAL CENTER INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CULLMAN REGIONAL MEDICAL CENTER INC (EIN 63-1058174)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-11
IRS object ID
201241329349301989
Schema version
2010v3.7
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)
Timestamp2012-05-11T12:39:51-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DRAFFIN & TUCKER LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 6AddressLine1
CityALBANYCity
StateGAState
ZIP Code317020006ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN631058174EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CULLMAN REGIONAL MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCULLNameControl
Phone2567372595Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HIGHWAY 157AddressLine1
CityCULLMANCity
StateALState
ZIP Code35058ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameNESHA DONALDSONName
TitleCFOTitle
Phone2567372595Phone
Date Signed2012-05-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJACQUELINE G ATKINSName
Phone2298837878Phone
Date Prepared2012-05-11DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJIM WEIDNER CEONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HIGHWAY 157AddressLine1
CityCULLMANCity
StateALState
ZIP Code35058ZIPCode
FieldValueIRS element (for citing)
Gross Receipts97680620GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteCRMCHOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1939YearFormation
State Legal DomicileALStateLegalDomicile
Activity Or Mission DescriptionCULLMAN REGIONAL MEDICAL CENTER, LICENSED FOR 145 BEDS, OPERATES A 115-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF CULLMAN, ALABAMA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees1211TotalNbrEmployees
Total Nbr Volunteers48TotalNbrVolunteers
Total Gross UBI1186552TotalGrossUBI
Net Unrelated Business Txbl Income130673NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year203610ContributionsGrantsPriorYear
Contributions Grants Current Year579857ContributionsGrantsCurrentYear
Program Service Revenue Prior Year112596381ProgramServiceRevenuePriorYear
Program Service Revenue CY89626904ProgramServiceRevenueCY
Investment Income Prior Year6866090InvestmentIncomePriorYear
Investment Income Current Year1442951InvestmentIncomeCurrentYear
Other Revenue Prior Year4753706OtherRevenuePriorYear
Other Revenue Current Year5161858OtherRevenueCurrentYear
Total Revenue Prior Year124419787TotalRevenuePriorYear
Total Revenue Current Year96811570TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year38263GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY133680GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year49319562SalariesEtcPriorYear
Salaries Etc Current Year50063985SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year69114619OtherExpensePriorYear
Other Expenses Current Year48818232OtherExpensesCurrentYear
Total Expenses Prior Year118472444TotalExpensesPriorYear
Total Expenses Current Year99015897TotalExpensesCurrentYear
Revenues Less Expenses Prior Year5947343RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-2204327RevenuesLessExpensesCY
Total Assets BOY107982569TotalAssetsBOY
Total Assets EOY103646122TotalAssetsEOY
Total Liabilities BOY98817923TotalLiabilitiesBOY
Total Liabilities EOY96478225TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY9164646NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7167897NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionCULLMAN REGIONAL MEDICAL CENTER, LICENSED FOR 145 BEDS, OPERATES A 115-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF CULLMAN, ALABAMA AND SURROUNDING AREAS REGARDLESS OF THEIR ABILITY TO PAY.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense83457420Expense
Grants133680Grants
Revenue92308800Revenue
DescriptionCRMC PROVIDES ACUTE CARE PATIENT SERVICES WHICH ARE RENDERED TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. CRMC USES CHARITY APPLICATIONS BASED UPON FEDERAL POVERTY GUIDELINES AND FAMILY SIZE TO DETERMINE ELIGIBILITY FOLLOWING SERVICES PROVIDED. CRMC PROVIDES CARE 24 HOURS PER DAY, SEVEN DAYS A WEEK AND HAS PROVIDED 28,739 INPATIENT DAYS CARE, 5% WERE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN; 42,619 EMERGENCY ROOM VISITS, 19% WERE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN; AND 105,543 OUTPATIENT VISITS, 30% NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN. THE TOTAL UNREIMBUSED COST OF MEDICAL SERVICES PROVIDED TO THOSE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN IS REPORTED ON SCHEDULE H. CRMC ALSO PROVIDES COMMUNITY EDUCATION AND WELLNESS ACTIVITIES TO THE COMMUNITY AND IS A MAJOR CONTRIBUTOR TO A LOCAL INDIGENT CLINIC SERVICING CULLMAN COUNTY.Description
Total Program Service Expense83457420TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
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 AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
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 EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096196NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees1211NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
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
States Where Copy Of Return Is FiledALStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonNESHA DONALDSONNamePerson
Telephone Number2567372598TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HWY 157AddressLine1
CityCULLMANCity
StateALState
ZIP Code35058ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
JIM WEIDNER
CEO40.00XX87535013600
DAVID MCKOY
CHAIRMAN2.00XX000
TODD MCLEROY
VICE-CHAIRMA2.00XX000
HOYT BROWNIE PRICE MD
SECRETARY2.00XX000
ALAN WOOD
TREASURER2.00XX000
R CLYNE ADAMS DMD
MEMBER2.00X000
STEVE GLASSCOCK
MEMBER2.00X000
JAY MULLINS
MEMBER2.00X000
DOUG DOGGETT
MEMBER2.00X000
CLINT FREY
MEMBER2.00X000
DEL BROCK
MEMBER2.00X000
ROBIN HALL MD
MEMBER2.00X000
STEPHEN DONALDSON
MEMBER2.00X000
JOHN MORRIS MD
MEMBER/PRES2.00X000
JETE EDMISSON
CFO & COO40.00X167200016632
CHERYL BAILEY
VP-PAT. SVC.40.00X12395905157
SUSAN COPELAND
VP-AMB.40.00X10735008563
CHARNA BROWN
VP-QUALITY40.00X98686014073
WILLIAM GUNTER
CRNA40.00178589016858X
NORMAN BURKETT
CRNA40.00176722017169X
LINDA LOVELADY
CRNA40.00174789016175X
JEFFREY SMITH
CRNA40.00168630016850X
THOMAS WOOSLEY
CRNA40.00160977014509X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1444437TotalReportableCompFromOrg
Total Other Compensation139586TotalOtherCompensation
Number Individuals GT100 K19NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcestrueCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MEDASSETS
P O BOX 405652ATLANTAGA303845652BUS OFC SVCS930377
CPSI
6600 WALL STREETMOBILEAL36695COMPUTER SVCS617750
MAYO COLLABORATIVE SERVICES
PO BOX 9146MINNEAPOLISMN55480LAB SVCS403486
NORTHWEST ALABAMA LITHOTRIPSY
237 OXMOOR CIRCLE SUITE 108BIRMINGHAMAL35209LITHOTRIPSY SVC390225
MEDASSIST INC
6455 RELIABLE PARKWAYCHICAGOIL60686OUTSOURCING SVC382599
FieldValueIRS element (for citing)
Number Of Contractors GT100 K20NumberOfContractorsGT100K
Related Organizations421755RelatedOrganizations
Government Grants101447GovernmentGrants
All Other Contributions56655AllOtherContributions
Total Contributions579857TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICE REVENUES6230008844035288440352
OUTREACH LAB SERVICES621500746855746855
CPAP MEDICAL EQUIPMENT621990373707373707
CONFERENCE CENTER5320005264952649
SPORTS FIRST7139401334113341
FieldValueIRS element (for citing)
Total Program Service Revenue89626904TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column886350TotalRevenueColumn
Exclusion$886,350ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real201286Real
Personal360641Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real201286Real
Personal360641Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column561927TotalRevenueColumn
Related Or Exempt Function Income360641RelatedOrExemptFunctionIncome
Exclusion$201,286ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other1259632Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other703031Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other556601Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column556601TotalRevenueColumn
Exclusion$556,601ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory286778GrossSalesOfInventory
Cost Of Goods Sold166019CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column120759TotalRevenueColumn
Related Or Exempt Function Income120759RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
MANAGEMENT FEES72221027822922782292
CAFETERIA/CATERING561000632842$632,842
FITNESS CENTER713940459282$459,282

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column604756TotalRevenueColumn
Related Or Exempt Function Income604756RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue4479172TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column96811570TotalRevenueColumn
Related Or Exempt Function Income92308800RelatedOrExemptFunctionIncome
Unrelated Business Revenue1186552UnrelatedBusinessRevenue
Exclusion$2,736,361ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total133680Total
Program Services133680ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total805126Total
Program Services367230ProgramServices
Management And General437896ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total38644832Total
Program Services34754836ProgramServices
Management And General3889996ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1586407Total
Program Services1453006ProgramServices
Management And General133401ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6187810Total
Program Services5577073ProgramServices
Management And General610737ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2839810Total
Program Services2559521ProgramServices
Management And General280289ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total3122767Total
Program Services2525710ProgramServices
Management And General597057ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total535841Total
Program Services35348ProgramServices
Management And General500493ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total112780Total
Management And General112780ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total93290Total
Management And General93290ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total7164238Total
Program Services6596367ProgramServices
Management And General567871ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total227801Total
Program Services5134ProgramServices
Management And General222667ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total22973231Total
Program Services20892058ProgramServices
Management And General2081173ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total23042Total
Program Services23042ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total6485716Total
Program Services4288355ProgramServices
Management And General2197361ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total403591Total
Program Services379003ProgramServices
Management And General24588ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total73671Total
Program Services26418ProgramServices
Management And General47253ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total33769Total
Management And General33769ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total4714670Total
Program Services3117340ProgramServices
Management And General1597330ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total377311Total
Program Services377311ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
REPAIRS AND MAINT21227533309041791849
DUES AND SUBSCRIPTIONS131474131474
TAXES AND LICENSE130372130372
MISCELLANEOUS750404274998
SPECIAL EVENTS16875150421833

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total99015897Total
Program Services83457420ProgramServices
Management And General15558477ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY93532BOY
EOY1233718EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY21017321BOY
EOY18022762EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY721807BOY
EOY808482EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY607151BOY
EOY543000EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis101579874LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec61629651LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY41954262BOY
EOY39950223EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY31782354BOY
EOY34853873EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY5900260BOY
EOY3001810EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY5905882BOY
EOY5232254EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY107982569BOY
EOY103646122EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY11428499BOY
EOY10527411EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY41849BOY
EOY35040EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY70756525BOY
EOY69052936EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY335870BOY
EOY279183EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY16255180BOY
EOY16583655EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY98817923BOY
EOY96478225EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3552787BOY
EOY4793013EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY5611859BOY
EOY2374884EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9164646BOY
EOY7167897EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY107982569BOY
EOY103646122EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-2204327ReconcilationRevenueExpenses
Reconcilation Other Changes207578ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis2194053OtherCostOrOtherBasis
Book Value2194053BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis44010046OtherCostOrOtherBasis
Depreciation18237191Depreciation
Book Value25772855BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis3730084OtherCostOrOtherBasis
Depreciation3290434Depreciation
Book Value439650BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis46897715OtherCostOrOtherBasis
Depreciation38121664Depreciation
Book Value8776051BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4747976OtherCostOrOtherBasis
Depreciation1980362Depreciation
Book Value2767614BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings39950223TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
OTHER RECEIVABLES3720217
UNAMORTIZED BOND ISSUE COSTS1258878
OTHER CURRENT ASSETS128254
COST REPORT SETTLEMENT123086
ACCRUED INTEREST1819
FieldValueIRS element (for citing)
Total Book Value Other Assets5232254TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
MINIMUM PENSION LIABILITY$13,349,020
ACCRUED INTEREST$1,836,388
INTERCOMPANY RECEIVABLE$1,398,247
FieldValueIRS element (for citing)
Total Of Amounts16583655TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierLIABILITY UNDER FIN 48 FOOTNOTEIdentifier
Return ReferenceSCHEDULE D, PAGE 3, PART XReturnReference
ExplanationTHE HOSPITAL 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 HOSPITAL 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 HOSPITAL ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JUNE 30, 2011 AND 2010 OR FOR THE YEARS THEN ENDED. THE HOSPITAL'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2008-2010.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted CarefalseFPGReferenceDiscountedCare
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served2192PersonsServed
Total Community Benefit Expense2249088TotalCommunityBenefitExpense
Net Community Benefit Expense2249088NetCommunityBenefitExpense
Percent Of Total Expense0.02270PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served17084PersonsServed
Total Community Benefit Expense8987874TotalCommunityBenefitExpense
Direct Offsetting Revenue5482774DirectOffsettingRevenue
Net Community Benefit Expense3505100NetCommunityBenefitExpense
Percent Of Total Expense0.03530PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served19276PersonsServed
Total Community Benefit Expense11236962TotalCommunityBenefitExpense
Direct Offsetting Revenue5482774DirectOffsettingRevenue
Net Community Benefit Expense5754188NetCommunityBenefitExpense
Percent Of Total Expense0.05800PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs21NumberOfActivitiesOrPrograms
Persons Served50928PersonsServed
Total Community Benefit Expense372592TotalCommunityBenefitExpense
Direct Offsetting Revenue2000DirectOffsettingRevenue
Net Community Benefit Expense370592NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served3500PersonsServed
Total Community Benefit Expense1275TotalCommunityBenefitExpense
Net Community Benefit Expense1275NetCommunityBenefitExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served65PersonsServed
Total Community Benefit Expense11398TotalCommunityBenefitExpense
Net Community Benefit Expense11398NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs25NumberOfActivitiesOrPrograms
Persons Served54493PersonsServed
Total Community Benefit Expense385265TotalCommunityBenefitExpense
Direct Offsetting Revenue2000DirectOffsettingRevenue
Net Community Benefit Expense383265NetCommunityBenefitExpense
Percent Of Total Expense0.00390PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs25NumberOfActivitiesOrPrograms
Persons Served73769PersonsServed
Total Community Benefit Expense11622227TotalCommunityBenefitExpense
Direct Offsetting Revenue5484774DirectOffsettingRevenue
Net Community Benefit Expense6137453NetCommunityBenefitExpense
Percent Of Total Expense0.06190PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served1PersonsServed
Total Community Building Expense2470TotalCommunityBuildingExpense
Net Community Building Expense2470NetCommunityBuildingExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs13NumberOfActivitiesOrPrograms
Persons Served6443PersonsServed
Total Community Building Expense74106TotalCommunityBuildingExpense
Net Community Building Expense74106NetCommunityBuildingExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served875PersonsServed
Total Community Building Expense425TotalCommunityBuildingExpense
Net Community Building Expense425NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs15NumberOfActivitiesOrPrograms
Persons Served7319PersonsServed
Total Community Building Expense77001TotalCommunityBuildingExpense
Net Community Building Expense77001NetCommunityBuildingExpense
Percent Of Total Expense0.00080PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$5,757,736BadDebtExpenseAmount
Amount Reimbursed By Medicare36698247AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare35574541CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall1123706MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost Accounting SystemXCostAccountingSystem
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line1HERITAGE DIAGNOSTICSBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityIMAGING SERVICESDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.21000OrganizationProfitOrOwnership
Physicans Profit Or Ownership0.79000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1CULLMAN REGIONAL MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11912 ALABAMA HIGHWAY 157AddressLine1
CityCULLMANCity
StateALState
ZIP Code35058ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherHOSPICE, CLINICS & HOME HEALTHOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1CULLMAN REGIONAL MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOSPICE OF CULLMAN COUNTYBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1402 4TH AVENUE NEAddressLine1
CityCULLMANCity
StateALState
ZIP Code35055ZIPCode
FieldValueIRS element (for citing)
Facility TypeHOSPICEFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
OTHER TESTING METHODS FOR FREE OR DISCOUNTED CAREPART I LINE 3CFEDERAL POVERTY GUIDELINES 150 ARE USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE DISCOUNTED CARE WILL BE BASED ON MEDICARE REIMBURSEMENT
EXCLUSIONS FROM PERCENT OF TOTAL EXPENSEPART I LINE 7 COLUMN FIN 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 99015897 ADD EXPENSES REPORTED IN PART VIII 166019 DENOMINATOR FOR COLUMN F 99181916
COSTING METHODOLOGY EXPLANATIONPART I LINE 7THE 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 EXPLANATIONPART III LINE 4COST IS DETERMINED USING THE HOSPITALS INTERNAL COST ACCOUNTING SYSTEM THIS SYSTEM ALLOCATES COSTS USING A STEP DOWN METHOD SIMILAR TO BUT MORE DETAILED THAN MEDICARES COST REPORTING METHODOLOGY OVERALL COST IS DEVELOPED AT THE CHARGE LEVEL BY PATIENT ACCOUNT AND THEN AGGREGATED TO CALCULATE COSTTOCHARGE RATIOS BY PAYOR CATEGORY THE RATIOS ARE APPLIED TO THE CHARGES TO ARRIVE AT COST PAYMENTS ARE THEN SUBTRACTED FROM THESE COSTS TO DETERMINE LOSSES ON PARTICULAR PAYOR GROUPS THE COSTING METHODOLOGY USED FOR THE SYSTEMS COMMUNITY BENEFIT IS CONSISTENT FOR ANY PAYOR GROUPINGS CHARITY BAD DEBT MEDICAID THE FOLLOWING IS AN EXCERPT FROM THE AUDITED FINANCIAL STATEMENTS THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE
MEDICARE EXPLANATIONPART III LINE 8THE HOSPITAL UTILIZES LYONS SOFTWARE FOR COST ACCOUNTING PURPOSES ALTHOUGH THE MEDICARE COST REPORT WAS USED TO GATHER INFORMATION RELATED TO MEDICARE CHARGES AND REIMBURSMENT MEDICARE COST WAS CALCULATED USING THE LYONS SOFTWARE
COLLECTION PRACTICES EXPLANATIONPART III LINE 9BTHE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE THEY ARE NOT REPORTED AS REVENUE
NEEDS ASSESSMENTPART VITHE HOSPITAL PARTICIPATES IN THE CULLMAN COUNTY HEALTH COALITION THIS ORGANIZATION COMPRISED OF VARIOUS HEALTH CARE PROVIDERS AND COMMUNITY LEADERS ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY AND STRIVES TO PROVIDE RESOURCES THAT BEST MEET THOSE NEEDS
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEPART VITHE HOSPITAL HAS CLEARLY WRITTEN FINANCIAL AID POLICIES THAT ARE AVAILABLE ON THE ORGANIZATION WEB SITE AND THROUGH THE BUSINESS OFFICE SIGNS ARE PROMINENTLY POSTED IN THE ER ABOUT THE AVAILABILITY OF FINANCIAL AID A REPRESENTATIVE IS ALSO AVAILABLE TO DISCUSS ELIGIBILITY TO GOVERNMENT PROGRAMS
COMMUNITY INFORMATIONPART VITHE HOSPITAL DRAWS PATIENTS PRINCIPALLY FROM CULLMAN COUNTY AND THE NEIGHBORING COUNTIES OF WALKER WINSTON MARSHALL MORGAN AND BLOUNT CRMC IS THE ONLY HOSPITAL IN ITS PRIMARY SERVICE AREA THE PRIMARY SERVICE AREA INCLUDES THE CITY OF CULLMAN POPULATION 15000 AND CULLMAN COUNTY POPULATION 81000 PER CAPITA INCOME FOR THIS AREA IS SLIGHTLY BELOW THE PER CAPITA INCOME FOR THE STATE OF ALABAMA CULLMAN IS SERVED BY I65 AND IS LOCATED BETWEEN HUNTSVILLE AND BIRMINGHAM
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSEPART VITHE ORGANIZATION AND ITS VOLUNTEER BOARDS ARE COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS AS WELL AS PHYSICIAN MEMBERS THE EMERGENCY DEPARTMENT IS OPEN 24 HOURS PER DAY 7 DAYS PER WEEK AND IS OPEN TO ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY HOSPITAL EMPLOYEES IN CONJUNCTION WITH OUR LOCAL JUDGES HAVE DEVELOPED A TRAUMA PREVENTION PROGRAM THIS PROGRAM IS PROVIDED BY CRMC EMPLOYEES ON A VOLUNTARY BASIS OUR LOCAL JUDGES REFER TEENAGE DRIVING OFFENDERS TO THE PROGRAM TO TEACH THEM THE IMPORTANCE OF VEHICLE SAFETY WHILE THEY ARE HERE THEY ACTUALLY GET TO WITNESS THE VARIOUS STAGES OF A TRAUMA ACCIDENT FROM THE TIME THEY ARRIVE AT THE ER UNTIL THEY LEAVE THE HOSPITAL COMMUNITY BUILDING ACTIVITIES ALSO INCLUDE PROVIDING AMBULANCE SUPPORT FOR VARIOUS COMMUNITY ACTIVITIES AND PROVIDING COMMUNITY SUPPORT GROUPS THESE SUPPORT GROUPS ALZHEIMERS BREAST CANCER ETC PROMOTE THE PHYSICAL AND MENTAL HEALTH OF THE COMMUNITY THAT WE SERVE CRMC PROVIDES WOMENS FIRST AND SENIOR CHOICE PROGRAMS THE WOMENS FIRST PROGRAM OFFERS SEMINARS AND EDUCATION ON HEALTH AND LIFESTYLE ISSUES SUCH AS STRESS MANAGEMENT PMS MENOPAUSE AND HEART DISEASE IT ALSO GIVES DISCOUNT ADMISSION TO WORKSHOPS AND HEALTH SCREENINGS SENIOR CHOICE PROVIDES SERVICES TO PROMOTE EMOTIONAL SOCIAL AND PHYSICAL WELL BEING FOR COMMUNITY MEMBERS WHO ARE 50 AND OVER THESE PROGRAMS CURRENTLY HAVE 8459 MEMBERS CRMC ALSO PROVIDES A COMMUNITY EDUCATION CENTER WHICH OFFERS MEETING ROOMS AND CATERING SERVICES FOR LOCAL BUSINESSES CHURCHES CIVIC ORGANIZATIONS AND EDUCATIONAL GROUPS ALL OF OUR AMBULANCES ARE EQUIPPED WITH 12 LEAD EKG TECHNOLOGY WHICH TRANSMITS THE INFORMATION DIRECTLY TO THE EMERGENCY ROOM PHYSICIAN ALLOWING THEM TO GET THE INFORMATION WHILE THE PATIENT IS IN TRANSIT THIS PROGRAM HAS REDUCED THE TIME FROM DOOR TO ANGIOPLASTY BY GETTING THE CARDIOLOGY TEAM IN PLACE BEFORE THE PATIENT ARRIVES

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1GOOD SAMARITAN CLINICBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1401 ARNOLD ST NEAddressLine1
CityCULLMANCity
StateALState
ZIP Code35055ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient200149215EINOfRecipient
IRC Section3IRCSection
Amount Of Cash Grant133680AmountOfCashGrant
Purpose Of GrantCURRENT OPERATIONSPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATESIdentifier
Return ReferenceSCHEDULE I, PAGE 1, PART I, LINE 2ReturnReference
ExplanationTHE HOSPITAL CONTINOUSLY EVALUATES COMMUNITY ORGANIZATIONS (AS IDENTIFIED IN PART II ABOVE) PROVIDING HEALTHCARE NEEDS TO THE MEDICALLY UNDERSERVED WHO ALSO ARE MOST LIKELY UNABLE TO PAY. THE HOSPITAL EVALUATES THE NEEDS ON AN INDIVIDUAL BASIS BASED ON DOCUMENTED REQEUSTS FOR SERVICES PROVIDED.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
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

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
JIM WEIDNER
8735617913600101135
JETE EDMISSON
16686633416632183832
WILLIAM GUNTER
17802656316858195447
NORMAN BURKETT
17654417817169193891
LINDA LOVELADY
17427351616175190964
JEFFREY SMITH
16845717316850185480
THOMAS WOOSLEY
16015382414509175486

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FRINGE OR EXPENSE EXPLANATIONSCHEDULE J, PAGE 1, PART I, LINE 1ASOCIAL CLUB DUES A MEMBERSHIP TO THE LOCAL COUNTRY CLUB IS PROVIDED BY MEANS OF CONTRACTUAL AGREEMENT TO CERTAIN OFFICERS. AS THE MEMBERSHIP IS CONSIDERED TO PROMOTE AND FURTHER THE ORGANIZATION'S TAX EXEMPT MISSION AND IS INTENDED TO BE USED FOR BUSINESS PURPOSES ONLY, THE AMOUNT IS NOT INCLUDED IN TAXABLE WAGES.
OTHER ADDITIONAL INFORMATIONSCHEDULE J, PART IIIAN UNRELATED ORGANIZATION, PITTS MANAGEMENT, PROVIDES THE FILING ORGANIZATION'S CEO, JIM WEIDNER, UNDER A MANAGEMENT CONTRACT, UNTIL AUGUST 31, 2010. EFFECTIVE SEPTEMBER 1, 2010, MR. WEIDNER BECAME AN EMPLOYEE OF THE ORGANIZATION. FEES CHARGED BY THE MANAGEMENT ENTITY FOR ADMINISTRATIVE MANAGEMENT SERVICES TOTALED APPROXIMATELY 170,000.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1HEALTHCARE AUTHORITY OF CULLMAN CTYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN631149220IssuerEIN
CUSIP Number230186AMOCUSIPNumber
Date Issued2009-12-03DateIssued
Issue Price68624416IssuePrice
Description Of PurposeDEFEASE 1993/2007 BONDS.DescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuertrueOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired1703589AmountRetired
Total Proceeds68624416TotalProceeds
Refunding Escrow61819381RefundingEscrow
Issuance Costs From Proceeds1352854IssuanceCostsFromProceeds
Working Capital Expenditures5452182WorkingCapitalExpenditures
Year Of Subst Completion2009YearOfSubstCompletion
Current RefundingtrueCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtyfalseMngmentCntrctBondFinancdPrprty
Any Research AgreementsfalseAnyResearchAgreements
Bond Counsel Routinely EngagedtrueBondCounselRoutinelyEngaged
Post Issuance Compliance ProcdrstruePostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T FiledfalseForm8038TFiled
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdstrueHedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1MERRILL LYNCHBusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge26.0TermOfHedge
Superintegrated HedgefalseSuperintegratedHedge
Hedge TerminatedfalseHedgeTerminated
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Gross Proceeds InvestedfalseGrossProceedsInvested
Exception To RebatefalseExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FIRST ACHIEVEMENT DESCRIPTIONFORM 990, PAGE 2, PART III, LINE 4ACOMMUNITY EDUCATION AND WELLNESS ACTIVITIES TO THE COMMUNITY AND IS A MAJOR CONTRIBUTOR TO A LOCAL INDIGENT CLINIC SERVICING CULLMAN COUNTY.
MANAGEMENT DELEGATEDFORM 990, PAGE 6, PART VI, LINE 3THE ORGANIZATION CONTRACTED WITH PITTS MANAGEMENT WHICH PROVIDES THE CEO FOR THE ENTITY UNTIL AUGUST 31, 2010. BEGINNING SEPTEMBER 1, 2010, THE CEO BECAME THE EMPLOYEE OF THE ORGANIZATION.
ELECTION OF MEMBERS AND THEIR RIGHTSFORM 990, PAGE 6, PART VI, LINE 7ATHE HEALTH CARE AUTHORITY OF CULLMAN COUNTY APPOINTS THE VOTING MAJORITY OF THE ORGANIZATION'S BOARD AND CONTROLS THE OPERATIONS AS WELL.
DECISIONS SUBJECT TO APPROVAL OF MEMBERSFORM 990, PAGE 6, PART VI, LINE 7BTHE HEALTH CARE AUTHORITY OF CULLMAN COUNTY APPOINTS THE VOTING MAJORITY OF THE ORGANIZATION'S BOARD AND CONTROLS THE OPERATIONS OF THE ORGANIZATION.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BMANAGEMENT ASSISTS IN PREPARING SCHEDULES, REVIEWS THE ENTIRE DRAFT OF THE FORM 990 FOR CONTENT, AND RECOMMENDS CHANGES, IF ANY. PRIOR TO FILING, THE FINANCE COMMITTEE REVIEWS THE FORM. THE FINAL FORM, AS IT IS ULTIMATELY FILED WITH ALL SCHEDULES AND ATTACHMENTS, IS POSTED TO THE BOARD WEBSITE PRIOR TO FILING AND AN E-MAIL ALERTS EACH VOTING MEMBER OF ITS AVAILABILITY.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CANNUALLY, BOARD MEMBERS MUST IDENTIFY ANY CONFLICT, MANAGEMENT MONITORS AND MAY SUGGEST ANY AREAS OF CONFLICT. THE BOARD CHAIRMAN REVIEWS ACTUAL AND PERCEIVED CONFLICTS OF INTEREST. IN THE EVENT OF A CONFLICT, THE MEMBER OR OFFICER WITH THE CONFLICT WILL DISMISS THEMSELVES FROM THE DISCUSSION AND ANY VOTES ON THE ISSUE.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15AANNUALLY THE BOARD (OR A COMMITTEE CHARGED WITH THE RESPONSIBILITY AND AUTHORITY TO DO SO ON BEHALF OF THE BOARD) REVIEWS THE COMPENSATION PACKAGE AND PROPOSED CONTRACT OF THE CEO. THE REVIEW IS CONDUCTED BY INDEPENDENT BOARD MEMBERS, IS BASED UPON REVIEW OF COMPARABILITY DATA PROVIDED BY OUTSIDE CONSULTANTS, AND IS DOCUMENTED IN THE RECORDS OF THE BOARD REFLECTING THE BASIS OF THE DETERMINATION BY THE THE BOARD (OR AUTHORIZED COMMITTEE).
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BANNUALLY THE BOARD (OR A COMMITTEE CHARGED WITH THE RESPONSIBILITY AND AUTHORITY TO DO SO ON BEHALF OF THE BOARD) REVIEWS THE COMPENSATION PACKAGE OF THE CFO AND OTHER OFFICERS. THE REVIEW IS CONDUCTED BY INDEPENDENT BOARD MEMBERS, IS BASED UPON REVIEW OF COMPARABILITY DATA PROVIDED BY OUTSIDE CONSULTANTS, AND IS DOCUMENTED IN THE RECORDS OF THE BOARD REFLECTING THE BASIS OF THE DETERMINATION BY THE THE BOARD (OR AUTHORIZED COMMITTEE).
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO ANY MEMBER OF THE PUBLIC WHO MAKES THEIR REQUEST AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION.
RELATED ORGANIZATIONSFORM 990, PAGE 7, PART VIIAVERAGE WEEKLY HOURS DEVOTED TO RELATED ORGANIZATIONS CLINT FREY - 1 HOUR DEL BROCK - 1 HOUR JIM WEIDNER - 2 HOURS JETE EDMISSION - 2 HOURS
OTHER CHANGES IN NET ASSETS EXPLANATIONFORM 990, PART XI, LINE 5INCREASES: FOUNDATION IN UNRESTRICTED ASSETS OF AFFILIATE 253,556 UNREALIZED GAINS ON INVESTMENTS 2,743,079 CHANGE IN VALUE OF INTEREST RATE SWAP 590,151 DECREASES: CHANGE IN PLAN ASSETS AND PBO 227,202 CHANGE IN TEMPORARILY RESTRICTED NET ASSETS OF AFFILIATE 3,152,006 NET INCREASE 207,578

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CULLMAN REGIONAL MEDICAL CTR FNDN
1912 ALABAMA HIGHWAY 157CULLMANAL35056630727880FOUNDATIONAL501C311CNAfalse
HEALTHCARE AUTHORITY OF CULLMAN CO
1912 ALABAMA HIGHWAY 157CULLMANAL35056631149220AUTHORITYAL501C36NAfalse
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 OrgtrueGiftGrantOrCapContrFrOtherOrg
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 OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg