UPSON COUNTY HOSPITAL INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- UPSON COUNTY HOSPITAL INC (EIN 58-1734026)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-10-25
- IRS object ID
- 201242999349300004
- 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 H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-10-25T07:45:45-05:00 | 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 | 581734026 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPSON COUNTY HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | UPSO | NameControl |
| Phone | 7066478111 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 WEST GORDON STREET | AddressLine1 |
| City | THOMASTON | City |
| State | GA | State |
| ZIP Code | 30286 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN WILLIAMS | Name |
| Title | CFO | Title |
| Phone | 7066478111 | Phone |
| Date Signed | 2012-10-31 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACQUELINE G ATKINS | Name |
| Phone | 2298837878 | Phone |
| Date Prepared | 2012-10-19 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPSON REGIONAL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID CASTLEBERRY CEO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 WEST GORDON STREET | AddressLine1 |
| City | THOMASTON | City |
| State | GA | State |
| ZIP Code | 30286 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 109902523 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.URMC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1951 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | UPSON REGIONAL MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY HEALTH CARE SERVICES TO THE SURROUNDING AREA, REGARDLESS OF THE ABILITY TO PAY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 719 | TotalNbrEmployees |
| Total Nbr Volunteers | 57 | TotalNbrVolunteers |
| Total Gross UBI | 729089 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -594706 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 648995 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 715610 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 91631490 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 92347876 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2171135 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1864406 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1998831 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2515875 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 96450451 | TotalRevenuePriorYear |
| Total Revenue Current Year | 97443767 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 23676 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 63112 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 36408646 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 37588078 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 48933509 | OtherExpensePriorYear |
| Other Expenses Current Year | 50201078 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 85365831 | TotalExpensesPriorYear |
| Total Expenses Current Year | 87852268 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 11084620 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 9591499 | RevenuesLessExpensesCY |
| Total Assets BOY | 129992214 | TotalAssetsBOY |
| Total Assets EOY | 136992212 | TotalAssetsEOY |
| Total Liabilities BOY | 20391713 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 20099130 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 109600501 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 116893082 | NetAssetsOrFundBalancesEOY |
| Mission Description | UPSON REGIONAL MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY HEALTH CARE SERVICES TO THE SURROUNDING AREA, REGARDLESS OF THE ABILITY TO PAY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 74074861 | Expense |
| Grants | 63112 | Grants |
| Revenue | 92347876 | Revenue |
| Description | UPSON REGIONAL MEDICAL CENTER OFFERS A COMPLETE LINE OF MEDICAL SERVICES INCLUDING 24-HOUR EMERGENCY CENTER, MEDICAL-SURGICAL CARE, OBSTETRICS, PEDIATRICS, WOMEN'S HEALTH SERVICES, AND MORE. PATIENT DAYS FOR THE YEAR TOTALED 15,705 IN 2011. | Description |
| Total Program Service Expense | 74074861 | 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 | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | 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 | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | 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 | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | 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 | true | 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 | 155 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 719 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | true | ForeignFinancialAccount |
| Name Of Foreign Country | CJ | NameOfForeignCountry |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | 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 | true | 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 | JOHN WILLIAMS CFO | NamePerson |
| Telephone Number | 7066478111 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 WEST GORDON ST | AddressLine1 |
| City | THOMASTON | City |
| State | GA | State |
| ZIP Code | 30286 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| NORMAN MORRIS | ||||||||
| PRESIDENT | 0.75 | X | X | 0 | 0 | 0 | ||
| JAMES J EDWARDS JR | ||||||||
| VICE PRESIDE | 0.75 | X | X | 0 | 0 | 0 | ||
| DORIS GRACE | ||||||||
| SECRETARY | 0.75 | X | X | 0 | 0 | 0 | ||
| BARNEY HANCOCK | ||||||||
| ASST SECRETA | 0.75 | X | X | 0 | 0 | 0 | ||
| WILLIAM H HIGHTOWER IV | ||||||||
| MEMBER | 0.75 | X | 0 | 0 | 0 | |||
| KAY ROBINSON | ||||||||
| MEMBER | 0.75 | X | 0 | 0 | 0 | |||
| STEVE KEADLE | ||||||||
| MEMBER | 0.75 | X | 0 | 0 | 0 | |||
| RALPH P WARNOCK MD | ||||||||
| MEMBER | 0.75 | X | 0 | 0 | 0 | |||
| JOHN WILLIAMS | ||||||||
| CFO | 40.00 | X | 191708 | 0 | 3886 | |||
| DAVID CASTLEBERRY | ||||||||
| CEO/ADMINIST | 40.00 | X | 0 | 0 | 0 | |||
| JOSEE GILL | ||||||||
| CHIEF CLINIC | 40.00 | 156329 | 0 | 2819 | X | |||
| SANDEEP DATTA | ||||||||
| ANESTHESIOLO | 40.00 | 553243 | 0 | 4900 | X | |||
| DAVID A PETERSON | ||||||||
| ANESTHESIOLO | 40.00 | 529446 | 0 | 4900 | X | |||
| STEVENS YANG | ||||||||
| ANESTHESIOLO | 40.00 | 495594 | 0 | 4554 | X | |||
| LOUIS MAMELI MD | ||||||||
| PHYSICIAN | 40.00 | 266050 | 0 | 4866 | X | |||
| HUGH D SMITHII MD | ||||||||
| PHYSICIAN | 40.00 | 247781 | 0 | 4650 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2440151 | TotalReportableCompFromOrg |
| Total Other Compensation | 30575 | TotalOtherCompensation |
| Number Individuals GT100 K | 23 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | true | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| BRASFIELD & GORRIE LLC | |||||
| 3021 7TH AVENUE SOUTH | BIRMINGHAM | AL | 35233 | BLDG CONTRACTOR | 3082467 |
| INNOVATIVE THERAPY CONCEPTS LLC | |||||
| 2 MASHBURN STREET SUITE 102 | HAWKINSVILLE | GA | 31036 | PHYSICAL THER | 1600000 |
| PRODIGY HEALTHCARE INC | |||||
| 200 ARIZONA AVE SUITE 200 | ATLANTA | GA | 30307 | RADIOLOGY | 1071137 |
| SODEXO INC & AFFILIATES | |||||
| PO BOX 536922 | ATLANTA | GA | 303536922 | CAFETERIA MGMT | 1001974 |
| HEALTHTECH MANAGEMENT SERVICES INC | |||||
| 105 WESTWOOD PLACE SUITE 300 | BRENTWOOD | TN | 37027 | HOSPITAL MNGT | 639712 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 23 | NumberOfContractorsGT100K |
| Government Grants | 668461 | GovernmentGrants |
| All Other Contributions | 47149 | AllOtherContributions |
| Total Contributions | 715610 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 92347876 | TotalRevenueColumn |
| Related Or Exempt Function Income | 92347876 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 92347876 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1813034 | TotalRevenueColumn |
| Exclusion | $1,813,034 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 401205 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 191740 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 209465 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 209465 | TotalRevenueColumn |
| Exclusion | $209,465 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 12310338 | Securities |
| Other | 8050 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 12179184 | Securities |
| Other | 87832 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 131154 | Securities |
| Other | -79782 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 51372 | TotalRevenueColumn |
| Exclusion | $51,372 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| WELLNESS CENTER | 713940 | 729089 | 729089 | |
| MISCELLANEOUS | 722210 | 727182 | $727,182 | |
| CAFETERIA | 561499 | 476521 | $476,521 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 373618 | TotalRevenueColumn |
| Exclusion | $373,618 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2306410 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 97443767 | TotalRevenueColumn |
| Related Or Exempt Function Income | 92347876 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 729089 | UnrelatedBusinessRevenue |
| Exclusion | $3,651,192 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41410 | Total |
| Program Services | 41410 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21702 | Total |
| Program Services | 21702 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 696582 | Total |
| Management And General | 696582 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28789175 | Total |
| Program Services | 24487978 | ProgramServices |
| Management And General | 4301197 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 507242 | Total |
| Program Services | 431940 | ProgramServices |
| Management And General | 75302 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5557684 | Total |
| Program Services | 4670881 | ProgramServices |
| Management And General | 886803 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2037395 | Total |
| Program Services | 1712302 | ProgramServices |
| Management And General | 325093 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 387311 | Total |
| Program Services | 74185 | ProgramServices |
| Management And General | 313126 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 439642 | Total |
| Management And General | 439642 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 124435 | Total |
| Management And General | 124435 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10762 | Total |
| Management And General | 10762 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28228 | Total |
| Management And General | 28228 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8232634 | Total |
| Program Services | 6133938 | ProgramServices |
| Management And General | 2098696 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 190933 | Total |
| Program Services | 33310 | ProgramServices |
| Management And General | 157623 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3622864 | Total |
| Program Services | 2236862 | ProgramServices |
| Management And General | 1386002 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 575322 | Total |
| Program Services | 301523 | ProgramServices |
| Management And General | 273799 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3072048 | Total |
| Program Services | 2880138 | ProgramServices |
| Management And General | 191910 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 355578 | Total |
| Program Services | 237098 | ProgramServices |
| Management And General | 118480 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16046 | Total |
| Management And General | 16046 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5068138 | Total |
| Program Services | 4703232 | ProgramServices |
| Management And General | 364906 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 499684 | Total |
| Program Services | 456805 | ProgramServices |
| Management And General | 42879 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBTS | 16733573 | 16733573 | |
| MEDICAL SUPPLIES | 7592429 | 7592429 | |
| REPAIRS & MAINTENANCE | 2312534 | 1090411 | 1222123 |
| MISCELLANEOUS | 537773 | 87902 | 449871 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 401144 | Total |
| Program Services | 147242 | ProgramServices |
| Management And General | 253902 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 87852268 | Total |
| Program Services | 74074861 | ProgramServices |
| Management And General | 13777407 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3413 | BOY |
| EOY | 4182 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20567608 | BOY |
| EOY | 18265287 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6604419 | BOY |
| EOY | 7867549 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 125000 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1766683 | BOY |
| EOY | 1752973 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 946527 | BOY |
| EOY | 1128521 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 95521071 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 44505737 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48401679 | BOY |
| EOY | 51015334 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51341976 | BOY |
| EOY | 56248316 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 359909 | BOY |
| EOY | 585050 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129992214 | BOY |
| EOY | 136992212 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6105577 | BOY |
| EOY | 6876877 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13035000 | BOY |
| EOY | 11790000 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1251136 | BOY |
| EOY | 1432253 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20391713 | BOY |
| EOY | 20099130 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 109600501 | BOY |
| EOY | 116893082 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 109600501 | BOY |
| EOY | 116893082 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 129992214 | BOY |
| EOY | 136992212 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 9591499 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -2298918 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| 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 | $10,762 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 10762 | 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 ORGANIZATION PAYS ANNUAL DUES TO NATIONAL AND STATE INDUSTRY ORGANIZATIONS. A PORTION OF THOSE DUES ARE ATTRIBUTABLE TO THE LOBBYING ACTIVITIES OF THESE ORGANIZATIONS FOR THE BENEFIT OF THEIR MEMBERS. | 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 | 1371229 | OtherCostOrOtherBasis |
| Book Value | 1371229 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 50060728 | OtherCostOrOtherBasis |
| Depreciation | 19468143 | Depreciation |
| Book Value | 30592585 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 753581 | OtherCostOrOtherBasis |
| Depreciation | 431619 | Depreciation |
| Book Value | 321962 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 38195601 | OtherCostOrOtherBasis |
| Depreciation | 24605975 | Depreciation |
| Book Value | 13589626 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5139932 | OtherCostOrOtherBasis |
| Book Value | 5139932 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 51015334 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | EST. THIRD PARTY PAYOR SETTLEMENTS | Description |
| Amount | $1,432,253 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1432253 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | LIABILITY UNDER FIN 48 FOOTNOTE | Identifier |
| Return Reference | SCHEDULE D, PAGE 3, PART X | ReturnReference |
| Explanation | THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AND ARE TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE REMAINING WHOLLY OWNED SUBSIDIARIES ARE CONSIDERED DISREGARDED ENTITIES AND ARE INCLUDED IN THE HOSPITAL'S TAX FILINGS. THEREFORE, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL AND FOUNDATION APPLY 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 AND FOUNDATION ONLY RECOGNIZE 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 DECEMBER 31, 2011 AND 2010 OR FOR THE YEARS THEN ENDED. THE HOSPITAL AND FOUNDATION'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2008-2010. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 1.25000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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) |
|---|---|---|
| Persons Served | 5023 | PersonsServed |
| Total Community Benefit Expense | 3229836 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3229836 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04530 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 17042 | PersonsServed |
| Total Community Benefit Expense | 12523917 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9380328 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3143589 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04410 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 22065 | PersonsServed |
| Total Community Benefit Expense | 15753753 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9380328 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6373425 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08940 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 7508 | PersonsServed |
| Total Community Benefit Expense | 103101 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 103101 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 460 | PersonsServed |
| Total Community Benefit Expense | 8194 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 8194 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9864289 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6819814 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3044475 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04270 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 47398 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 47398 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 7968 | PersonsServed |
| Total Community Benefit Expense | 10022982 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6819814 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3203168 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04490 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 30033 | PersonsServed |
| Total Community Benefit Expense | 25776735 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 16200142 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9576593 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13430 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 212 | PersonsServed |
| Total Community Building Expense | 267652 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 267652 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00380 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 7202 | PersonsServed |
| Total Community Building Expense | 74204 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 74204 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 7414 | PersonsServed |
| Total Community Building Expense | 341856 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 341856 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00480 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $16,733,573 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 17136224 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 16435813 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 700411 | 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 | UPSON COUNTY HOSPITAL INC | BusinessNameLine1 |
| Business Name Line2 | DBA UPSON REGIONAL MEDICAL CENTER | BusinessNameLine2 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 WEST GORDON STREET | AddressLine1 |
| City | THOMASTON | City |
| State | GA | State |
| ZIP Code | 30286 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | O/P PHYS OFC; WELLNS CTR; AMB | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UPSON COUNTY HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 125.0 | 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 |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | true | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Other Actions | X | OtherActions |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Other Actions Taken | X | OtherActionsTaken |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| 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 | 7 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (7 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| UPSON MEDICAL ASSOCIATES LLC | ||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | PHYSICIANS OFFICE |
| UPSON CO HOSPITAL WELLNESS CENTER | ||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | WELLNESS CENTER |
| UPSON AMBULANCE CO LLC | ||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | AMBULANCE SERVICE |
| UPSON WOMEN'S SERVICES LLC | ||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | PHYSICIANS OFFICE |
| UPSON FAMILY PHYSICIANS LLC | ||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | PHYSICIANS OFFICE |
| UPSON SURGICAL ASSOCIATES LLC | ||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | PHYSICIANS OFFICE |
| UPSON ORTHOPEDIC ASSOCIATES LLC | ||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | PHYSICIANS OFFICE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SUBSIDIZED HEALTH SERVICES EXPLANATION | PART I LINE 7G | SUBSIDIZED HEALTH SERVICES COSTS INCLUDE THOSE ATTRIBUTABLE TO UPSON MEDICAL ASSOCIATES 1344196 UPSON WOMENS SERVICES 948267 AND UPSON FAMILY PHYSICIANS 305072 THESE CLINICS PROMOTE HEALTH CARE FOR UNDERSERVED POPULATIONS IN THE AREA |
| 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 87852265 LESS BAD DEBTS IN PART IX 16733573 ADD EXPENSES ON PART VIII 191740 DENOMINATOR FOR COLUMN F 71310432 |
| 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 FOR LINE 7A COSTS WERE CALCULATED USING THE COSTTOCHARGE RATIO DERIVED FROM WORKSHEET 2 AS PROVIDED IN THE IRS INSTRUCTIONS SUBSIDIZED HEALTH SERVICES PRESENTED ON LINE 7G WERE BASED ON ACTUAL COSTS PER THE AUDITED FINANCIAL STATEMENTS NET OF ASSOCIATED BAD DEBT EXPENSE ALL OTHER COSTS PRESENTED IN THE TABLE WERE CALCULATED THROUGH THE COST ACCOUNTING SOFTWARE CBISA |
| COMMUNITY BUILDING ACTIVITIES | PART II | AS ONE OF THE REGIONS LARGEST EMPLOYERS UPSON REGIONAL MEDICAL CENTER INVESTS IN ITS SERVICE AREA TO DEVELOP WORKFORCE AND LEADERSHIP CAPACITY NEEDED TO STRENGTHEN THE REGION THESE ACTIVITIES PROVIDE OPPORTUNITIES TO ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS THESE ACTIVITIES SUPPORT COMMUNITY ASSETS BY OFFERING THE EXPERTISE AND RESOURCES OF HEALTHCARE ORGANIZATIONS THESE INCLUDE INVOLVEMENT WITH THE LOCAL AND STATE CHAMBERS OF COMMERCE PROVIDING LEADERSHIP TRAINING AND PARTICIPATION IN YOUTH LEADERSHIP PROGRAMS PART OF THE COMMUNITY HEALTH IMPROVEMENT ADVOCACY INCLUDES OUR PHYSICIAN RECRUITMENT ACTIVITIES TO MEET THE HEALTH NEEDS OF THE UNDERSERVED AND PHYSICIAN STUDENT LOAN REPAYMENT FOR 2 PRIMARY CARE PHYSICIANS AND 1 OBSTETRICIANGYNECOLOGIST WHO HAVE COME TO SERVE OUR COMMUNITIES |
| BAD DEBT EXPENSE EXPLANATION | PART III LINE 4 | AUDITED FINANCIAL STATEMENTS FOOTNOTE ON ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS THE HOSPITAL PROVIDES AN ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS BASED ON EVALUATION OF THE OVERALL COLLECTABILITY OF THE ACCOUNTS RECEIVABLE AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE COST OF BAD DEBTS FOLLOWS THE METHODOLOGY PRESCRIBED ON WORKSHEET 2 USING THE COSTTOCHARGE RATIO BASED ON AUDITED FINANCIAL STATEMENTS |
| MEDICARE EXPLANATION | PART III LINE 8 | MEDICARE COSTS REFLECT ALLOWABLE COSTS PER THE MEDICARE COST REPORT USING ACCEPTABLE ALLOCATIONS OF INDIRECT COSTS BASED ON STATISTICAL BASIS |
| COLLECTION PRACTICES EXPLANATION | PART III LINE 9B | ACCOUNTS KNOWN TO HAVE QUALIFIED FOR FINANCIAL ASSISTANCE ARE WRITTEN OFF WITH AN ADJUSTMENT INDICATING INDIGENT WRITEOFF |
| NEEDS ASSESSMENT | PART VI | UPSON REVIEWED ITS SERVICE AREAS POPULATION HEALTH STATISTICS PER THE GEORGIA DIVISION OF PUBLIC HEALTH THE GEORGIA DEPARTMENT OF COMMUNITY HEALTHS MINORITY HEALTH AND HEALTH DISPARITIES REPORT KIDS COUNT BY COUNTY REPORT OF THE ANNIE E CASEY FOUNDATIONFAMILY CONNECTIONS PARTNERSHIP THE FIVEYEAR NEEDS ASSESSMENT COMPILED BY A LOCAL CONSORTIUM FAMILY YOUTH AND CHILDREN ALLIANCE AS WELL AS EMERGENCY ROOM DISCHARGE DATA FOR THE TOP FIVE DIAGNOSIS RELATED GROUPS AMONG INDIGENT AND UNDERSERVED PATIENTS |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI | UPSON REGIONAL MEDICAL CENTER INFORMS AND EDUCATES THE PATIENTS USING THE FOLLOWING PROCESSES THE CHARITY CARE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION IS POSTED IN THE ADMISSION AREAS EMERGENCY DEPARTMENTS AND OTHER AREAS OF THE FACILITY IN WHICH ELIGIBLE PATIENTS ARE PRESENT WE PROVIDE A COPY OF THE POLICY AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO THE PATIENTS AS PART OF THE ADMISSION PROCESS A SUMMARY OF THE POLICY IS ALSO INCLUDED IN THE PATIENT BILLING WE DISCUSS WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS SUCH AS QUALIFYING FOR MEDICAID OR STATE PROGRAMS AND ASSIST THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS WHERE APPLICABLE WE PROVIDE TRAINING TO THE STAFF ON FINANCIAL ASSISTANCE AND HOW TO QUALIFY PATIENTS FOR MEDICAID SCHIP AND OTHER GOVERNMENT PROGRAMS WE ALSO PROVIDE BROCHURES IN THE ADMISSIONS PACKAGE EXPLAINING THE AVAILABILITY CRITERIA AND THE PROCESS FOR APPLYING FOR FINANCIAL ASSISTANCE OUR EFFORTS TO INFORM NONENGLISH SPEAKING PATIENTS ABOUT THE FINANCIAL ASSISTANCE POLICY IS PROVIDED BY AN INTERPRETER THROUGH THE USE OF LANGUAGE LINE A TELEPHONE INTERPRETATION SERVICE |
| COMMUNITY INFORMATION | PART VI | UPSON SERVES A SEVENCOUNTY AREA IN MIDDLE GEORGIA INCLUDING PIKE LAMAR UPSON CRAWFORD MONROE MERIWETHER AND TALBOT COUNTIES AS A WHOLE THE SERVICE AREA WHICH USED TO BE A BOOMING TEXTILE AREA HAS RATES OF UNEMPLOYMENT UNINSURED AND POVERTY THAT ARE HIGHER THAN THE STATE AVERAGE THE POPULATION AGE MIMICS A BOWTIE WITH LARGE NUMBERS OF ELDERLY AND LARGE NUMBERS OF CHILDREN UNDER THE AGE OF 18 AND A SHRINKING NUMBER OF MIDDLEAGED CITIZENS |
| HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE | PART VI | UPSON MADE 7414 CONTACTS WITH COMMUNITY HEALTH EDUCATION PROGRAMS HEALTH SCREENINGS HEALTH CARE SUPPORT VALUED AT 74000 TO SUPPORT BETTER HEALTH THROUGH SPONSORSHIPS AND DONATIONS UPSON CONTRIBUTED MORE THAN 47000 TO LOCAL CHARITIES LIKE THE AMERICAN CANCER SOCIETY UPSON REGIONAL MEDICAL CENTER CONTINUES TO WORK COLLABORATIVELY WITH THE LOCAL HEALTH DEPARTMENTS COUNTY EXTENSION SERVICES CIVIC CLUBS AND CHURCHES TO PROVIDE ANNUAL HEALTH FAIRS SCREENINGS AND EDUCATIONAL PROGRAMS DUE TO THE CONTINUAL DECLINE OF INDUSTRY IN THIS AREA BEGINNING WITH THE TEXTILE INDUSTRY SHUTDOWN MANY PEOPLE DEPEND ON THESE ANNUAL HEALTH FAIRS FOR THEIR PREVENTATIVE HEALTH CARE THE NUMBER OF UNDERINSURED AND UNINSURED PEOPLE INCREASES EACH YEAR UPSON REGIONAL OFFERS MANY FREE AND DISCOUNTED DIAGNOSTIC SCREENINGS AND TESTS THIS HAS PROVIDED EARLY DETECTION FOR MANY DISEASES AS WELL AS PROMOTED HEALTH AND WELLNESS THROUGH ANNUAL CHECKUPS SINCE THAT TIME THESE ANNUAL HEALTH FAIRS ARE A COOPERATIVE EFFORT AMONG MANY GROUPS IN OUR COMMUNITY IN 2011 WE PROVIDED FREE OR DISCOUNTED TESTS AT HEALTH FAIRS CANCER SCREENINGS DIABETES SCREENINGS CARDIAC SCREENINGS AND EDUCATIONAL OFFERINGS WE PROVIDED FREE FLU IMMUNIZATIONS UPSON ALSO CONTRIBUTED 10000 EACH TO THE HEALTH DEPARTMENTS OF LAMAR PIKE UPSON AND MERIWETHER COUNTIES TO SUPPORT IMMUNIZATIONS PRENATAL CLINICS FAMILY PLANNING AND MEDICATION ASSISTANCE PROGRAMS |
| LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED | PART VI | GEORGIA |
| UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 13G | PART V LINE 13G | NOTICE EXPLAINING POLICY POSTED IN THE LOCAL NEWSPAPER QUARTERLY |
| UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 15E | PART V LINE 15E | IF PAYMENT IS NOT RECEIVED AFTER OUR INHOUSE COLLECTION PROCESSES ARE EXHAUSTED ACCOUNTS ARE PLACED WITH ONE OF THE TWO AGENCIES WE CONTRACT WITH FOR COLLECTIONS THE COLLECTION AGENCY IS PERMITTED TO FILE SUIT FOR GARNISHMENT OF WAGES ONLY AGAINST A PATIENT WHO HAS THE RESOURCES TO PAY A SECONDARY AGENCY IS USED IF THE PRIMARY AGENCY HAS BEEN UNSUCCESSFUL |
| UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 16E | PART V LINE 16E | STATEMENTS ARE MAILED AND COLLECTION CALLS ARE MADE IF THE PATIENT HAS THE RESOURCES TO PAY SUIT MAY BE APPROVED BY THE PFS DIRECTOR OF THE HOSPITAL FOR THE PURPOSE OF GARNISHMENT OF WAGES TO COLLECT THE ACCOUNT |
| UPSON COUNTY HOSPITAL INC LINE NUMBER 1 PART V LINE 17E | PART V LINE 17E | PATIENTS ARE SENT STATEMENTS BEGINNING ON THE DATE THE ACCOUNT IS FINAL BILLED USUALLY ABOUT FIVE DAYS FROM THE DATE OF SERVICE STATEMENTS ARE GENERATED EVERY 30 DAYS EACH STATEMENT INDICATES THE FINANCIAL POLICY AND WHO TO CONTACT TO APPLY FOR FINANCIAL ASSISTANCE ON THE LAST STATEMENT ON OR AROUND 120 DAYS THE PATIENT IS ADVISED THE ACCOUNT MAY BE PLACED WITH AN OUTSIDE AGENCY WHICH MAY ALSO INVOLVE APPROPRIATE LEGAL PROCEDURES |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| LAMAR COUNTY HEALTH DEPT | |||||||
| 118 ACADEMY DRIVE 8 | BARNESVILLE | GA | 30204 | 586000365 | GOV | 10000 | HEALTHCARE PROGRAMS |
| MERIWETHER COUNTY HEALTH DEPT | |||||||
| 51 GAY CONNECTOR | GREENVILLE | GA | 30222 | 581379373 | GOV | 10000 | HEALTHCARE PROGRAMS |
| PIKE COUNTY HEALTH DEPT | |||||||
| 541 GRIFFIN ST | ZEBULON | GA | 30295 | 586002843 | GOV | 10000 | HEALTHCARE PROGRAMS |
| UPSON COUNTY HEALTH DEPT | |||||||
| 314 E LEE ST | THOMASTON | GA | 30286 | 586002312 | GOV | 10000 | HEALTHCARE PROGRAMS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 4 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | TUITION REIMBURSEMENT | TypeOfGrant |
| Number Of Recipients | 11 | NumberOfRecipients |
| Amount Of Cash Grant | 21702 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE I, PAGE 4, PART IV | ReturnReference |
| Explanation | SCHEDULE I, PART III - GRANTS AND OTHER ASSISTANCE TO INDIVIDUALS IN THE UNITED STATES SCHOLARSHIP ASSISTANCE IS OFFERED TO UPSON COUNTY RESIDENTS AND FULL TIME, PART TIME AND PRN EMPLOYEES PURSUING A HEALTHCARE CAREER. EACH APPLICANT MUST COMPLETE AN APPLICATION; BE ACCEPTED BY AN ACCREDITED SCHOOL IN A HEALTHCARE PROGRAM OF THEIR CHOICE; SUBMIT TWO LETTERS OF RECOMMENDATION, A CERTIFIED COPY OF PREVIOUS EDUCATIONAL TRANSCRIPTS, AND A LETTER OF ACCEPTANCE IN THE HEALTHCARE CAREER PROGRAM; OBTAIN APPROVAL FROM THE DEPARTMENT DIRECTOR OR SENIOR MANAGEMENT; BE INTERVIEWED BY CHIEF NURSING OFFICER; MAINTAIN A 3.0 CUMULATIVE AVERAGE; SUBMIT TRANSCRIPTS OF GRADES EVERY SCHOOL TERM; AND SERVE AS AN EMPLOYEE A MINIMUM OF ONE YEAR FOR EACH SCHOOL YEAR FOR WHICH SCHOLARSHIP MONIES WERE GRANTED. TRANSCRIPTS OF GRADES MUST BE RECEIVES BEFORE REIMBURSEMENT. SHOULD THE STUDENT NOT SEEK AND MAINTAIN EMPLOYMENT WITH URMC AFTER GRADUATION, FUNDS WILL BECOME DUE AND PAYABLE IN A PRORATA FASHION BASED ON EMPLOYMENT TERM. TUITION REIMBURSEMENT IS AWARDED FULL TIME AND REGULARLY SCHEDULED PART TIME EMPLOYEES. MONIES ARE GRANTED TO COVER TUITION, BOOKS AND LABORATORY FEES. EACH APPLICANT MUST BE ENROLLED IN AN ACCREDITED COLLEGE/UNIVERSITY WITHIN A PROGRAM DIRECTLY RELATED TO THE EMPLOYEE'S PRESENT POSITION OR A FIELD THAT WILL BE OF BENEFIT TO THE MEDICAL CENTER; SEEK APPROVAL FROM MANAGEMENT; FURNISH A TRANSCRIPT OF GRADES; MAINTAIN A "C" OR HIGHER GRADE AVERAGE. TO BE REIMBURSED, AN EMPLOYEE MUST PRESENT A CERTIFIED COPY OF THE GRADE REPORT WITH AN AVERAGE OF "C" OR HIGHER. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | 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 | Deferred Comp Filing OrgDeferredCompFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg |
|---|---|---|---|---|
| JOHN WILLIAMS | ||||
| 191708 | 3886 | 195594 | ||
| DAVID CASTLEBERRY | ||||
| JOSEE GILL | ||||
| 156329 | 2819 | 159148 | ||
| SANDEEP DATTA | ||||
| 492884 | 4900 | 558143 | 18759 | 41600 |
| DAVID A PETERSON | ||||
| 502073 | 4900 | 534346 | 9835 | 17538 |
| STEVENS YANG | ||||
| 432492 | 4554 | 500148 | 7102 | 56000 |
| LOUIS MAMELI MD | ||||
| 266050 | 4866 | 270916 | ||
| HUGH D SMITHII MD | ||||
| 247781 | 4650 | 252431 | ||
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | OTHER ADDITIONAL INFORMATION | Identifier |
| Return Reference | SCHEDULE J, PART III | ReturnReference |
| Explanation | CEO AND MANAGEMENT COMPANY AN UNRELATED ORGANIZATION, HEALTHTECH MANAGEMENT SERVICES, PROVIDES THE CEO FOR THE FILING ORGANIZATION. THE FILING ORGANIZATION COMPENSATES THE MANAGEMENT COMPANY APPROXIMATELY 342,000 FOR THE SERVICES OF CEO, DAVID CASTLEBERRY. OTHER SERVICES PROVIDED BY HEALTHTECH INCLUDE CONSULTING, REVENUE CYCLE, LICENSURE, INFORMATION SYSTEMS, AND PRODUCTIVITY REPORTING. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| HOSPITAL AUTHORITY OF UPSON COUNTY | |||||||
| 586002427 | NONENONEN | 2004-12-30 | 10000000 | RENOVATION & EXPANSION OF HOSPITAL | false | false | false |
| HOSPITAL AUTHORITY OF UPSON COUNTY | |||||||
| 586002427 | NONENONEN | 2005-01-20 | 6000000 | RENOVATION & EXPANSION OF HOSPITAL | false | false | false |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|
| 2635000 | 10000000 | 124175 | 9875825 | 2007 | false | false | true | true |
| 1575000 | 6000000 | 79846 | 5920154 | 2007 | false | false | true | true |
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 | false | true |
| false | false | false | false | false | false | 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 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FINANCIAL ACCOUNTS IN FOREIGN COUNTRIES | FORM 990, PART V, LINE 4B | CAYMAN ISLANDS |
| MANAGEMENT DELEGATED | FORM 990, PAGE 6, PART VI, LINE 3 | THE ORGANIZATION ENGAGES THE MANAGEMENT SERVICES OF HEALTHTECH MANAGEMENT SERVICES TO PROVIDE THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION. SUCH CEO BEARS THE FULL DUTIES AND RESPONSIBILITIES OF THE SAME POSITION THROUGHOUT THE HOSPITAL INDUSTRY. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 WAS EMAILED TO EACH BOARD OF TRUSTEE MEMBER PRIOR TO THE IRS FILING DUE DATE FOR THEIR REVIEW. FORM 990 REVIEW WAS PLACED ON THE BOARD AGENDA FOR DISCUSSION SHOULD ANY QUESTIONS OCCUR. THE 990 IS REVIEWED BY THE CFO IN DETAIL PRIOR TO FILING WITH THE IRS. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | THE POLICY COVERS ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. SHOULD A MATTER COME BEFORE THE BOARD OF DIRECTORS WHICH CONSTITUTES A CONFLICT OF INTEREST, THE INDIVIDUAL INVOLVED WILL MAKE KNOWN THE POTENTIAL CONFLICT AND WITHDRAW FROM THE MEETING SO LONG AS THE MATTER SHALL CONTINUE UNDER DISCUSSION AND SHALL NOT EITHER VOTE ON THE MATTER UNDER DISCUSSION OR ATTEMPT TO INFLUENCE A DECISION OF THE GOVERNING AUTHORITY WITH RESPECT TO SUCH MATTERS, UPON WHICH THERE COULD POSSIBLY BE A CONFLICT OF INTEREST. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | HEALTHTECH MANAGEMENT SERVICES, THE MANAGEMENT COMPANY ENGAGED TO PROVIDE THE CEO, OBTAINS COMPARABLE SALARY DATA FOR CEOS AND PRESENTS IT TO THE BOARD OF DIRECTORS WHO MAKE A FINAL DECISION. THE CEO IS NOT PRESENT DURING THE DISCUSSION AND DECISION-MAKING PROCESS. DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN THE MINUTES OF THE MEETING. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | IN DETERMINING COMPENSATION FOR THE CFO, THE ORGANIZATION'S HUMAN RESOURCES DEPARTMENT OBTAINS COMPARABLE SALARY DATA AND PRESENTS IT TO THE GOVERNING BODY WHO MAKES THE FINAL DECISION. THE CFO IS NOT PRESENT DURING THE DISCUSSION AND DECISION-MAKING PROCESS. DELIBERATIONS AND DECISIONS ARE DOCUMENTED IN THE MINUTES OF THE MEETING. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | ALL DOCUMENTS ARE AVAILABLE FOR INSPECTION, WITH NOTICE, IN THE OFFICE OF THE ORGANIZATION. |
| RELATED ORGANIZATIONS | FORM 990, PAGE 7, PART VII | AVERAGE HOURS SPENT AT OTHER RELATED ORGANIZATIONS: DAVID CASTLEBERRY 1 HOUR JOHN WILLIAMS 1 HOUR |
| OTHER CHANGES IN NET ASSETS EXPLANATION | FORM 990, PART XI, LINE 5 | UPSON COUNTY HOSPITAL, INC. HAD 2,298,918 IN UNREALIZED LOSSES ON INVESTMENTS FOR FY11. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Business Name Line2DirectControllingEntityName/BusinessNameLine2 |
|---|---|---|---|---|---|---|---|---|---|---|
| UPSON MEDICAL ASSOCIATES LLC | ||||||||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | 550840991 | PHYS OFC | GA | 2442726 | 834854 | UCH | UPSON COUNTY HOSPITAL INC |
| UPSON CO HOSPITAL WELLNESS CENTER | ||||||||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | 205095610 | WELLNESS C | GA | 729090 | 410056 | UCH | UPSON COUNTY HOSPITAL INC |
| UPSON AMBULANCE CO LLC | ||||||||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | 205095675 | AMBULANCE | GA | 2708352 | 1369721 | UCH | UPSON COUNTY HOSPITAL INC |
| UPSON WOMEN'S SERVICES LLC | ||||||||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | 263227893 | PHYS OFC | GA | 1990574 | 523500 | UCH | UPSON COUNTY HOSPITAL INC |
| UPSON FAMILY PHYSICIANS LLC | ||||||||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | 270192553 | PHYS OFC | GA | 642889 | 248781 | UCH | UPSON COUNTY HOSPITAL INC |
| UPSON SURGICAL ASSOCIATES LLC | ||||||||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | 275252545 | PHYS OFC | GA | 486192 | 320284 | UCH | UPSON COUNTY HOSPITAL INC |
| UPSON ORTHOPEDIC ASSOCIATES LLC | ||||||||||
| 801 WEST GORDON STREET | THOMASTON | GA | 30286 | 272123255 | PHYS OFC | GA | 200 | UCH | UPSON COUNTY HOSPITAL INC | |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | URMC HEALTH FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 1089 | AddressLine1 |
| City | THOMASTON | City |
| State | GA | State |
| ZIP Code | 30286 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 830411781 | EIN |
| Primary Activities | FOUNDATION | PrimaryActivities |
| Legal Domicile State | GA | LegalDomicileState |
| Exempt Code Section | 501C3 | ExemptCodeSection |
| Public Charity Status | 11D | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UCH | BusinessNameLine1 |
| Business Name Line2 | UPSON COUNTY HOSPITAL | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | true | 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 | false | 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 | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | true | 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 |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| URMC HEALTH FOUNDATION | ||
| L | 215438 | NET REVENUES |
| URMC HEALTH FOUNDATION | ||
| N | 26200 | ESTIMATE TIME SPENT |