2011-03-15T05:59:56-05:00 2010-04-30 DIXON HUGHES PLLC 500 Ridgefield Court Asheville NC 28806 990 2009-05-01 582513901 CHATUGE REGIONAL HOSPITAL INC CHAT 7068962222 110 SOUTH MAIN ST HIAWASSEE GA 30546 Tim Henry 7064396493 2011-03-15 1 Amy Bibby 8282542254 2009 2016-02-24 21:20:13Z Tim Henry 110 South Main St Hiawassee GA 30546 17947217 0 X N/A X 1955 GA To provide high quality, cost effective health care and to promote wellness in our community. 6 4 345 42 0 0 10570 95081 18391436 17589144 61196 19607 201484 243385 18664686 17947217 0 0 9219072 9232292 0 0 9223240 8194739 18442312 17427031 222374 520186 8843402 9374160 1997870 2008442 6845532 7365718 To provide high quality, cost effective health care and to promote wellness throughout our community. 0 0 16431084 17660290 THE COMMUNITY BENEFIT CONTRIBUTION OF CHATUGE REGIONAL HOSPITAL AND NURSING HOME IS PRIMARILY ATTRIBUTABLE TO THE PROVISION OF GENERAL HOSPITAL AND SKILLED NURSING CARE SUPPORTING THE COMMUNITY'S GENERAL PRACTICE, AND FAMILY PRACTICE PHYSICIANS. THESE SERVICES PROVIDE PRIMARY ACCESS TO HEALTH CARE SERVICES AND IMPROVE HEALTH IN OUR RURAL COMMUNITY.IN ORDER TO PORTRAY THE FULL BREADTH OF OUR CONTRIBUTION, OUR COMMUNITY BENEFIT INFORMATION IS DESCRIBED BELOW: SECTION 1: QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT - DESCRIBES THE HOSPITAL'S COMMUNITY BENEFIT MISSION, HOW THE MISSION IS TRANSLATED INTO A PROACTIVE APPROACH DESIGNED TO MEET COMMUNITY HEALTH NEEDS, HOW THE HOSPITAL MEETS TAX-EXEMPT REQUIREMENTS, AND A DESCRIPTION OF COMMUNITY BENEFIT PROGRAMS AND SERVICES THAT HIGHLIGHT THE HOSPITAL'S IMPACT ON COMMUNITY HEALTH. SECTION 2: QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT - DESCRIBES THE HOSPITAL'S COMMUNITY BENEFIT CONTRIBUTION IN FINANCIAL TERMS PRESENTING THE AMOUNT OF CHARITY CARE AND BAD DEBTS, AND THE NET EXPENSE OF COMMUNITY BENEFIT SERVICES. SECTION 1 - QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT ORGANIZATIONAL COMMITMENT TO PROVIDING COMMUNITY BENEFIT:A. THE MISSION OF CHATUGE REGIONAL HOSPITAL AND NURSING HOME IS TO PROVIDE HIGH QUALITY, COST EFFECTIVE HEALTH CARE AND TO PROMOTE WELLNESS THROUGHOUT OUR COMMUNITY. OUR VISION IS TO BE THE "FIRST CHOICE" PROVIDER OF COMPREHENSIVE MEDICAL SERVICES IN OUR AREA. WE VALUE OUR PATIENTS AND RESIDENTS AND BELIEVE THEY ARE OUR MOST IMPORTANT RESPONSIBILITY. WE SHALL ALWAYS SEEK TO MEET THE PHYSICAL, EMOTIONAL, EDUCATIONAL AND SPIRITUAL NEEDS OF OUR PATIENTS AND THEIR FAMILIES. WE VALUE OUR MEDICAL STAFF AND WILL SEEK WAYS TO HELP THEM IMPROVE PROFESSIONALLY AND FACILITATE THE PRACTICE OF MEDICINE. WE VALUE OUR EMPLOYEES AND SHALL TREAT EACH OTHER WITH COURTESY, FAIRNESS, RESPECT AND INTEGRITY. WE SHALL WORK AS A TEAM TO DO OUR BEST TO PROMOTE OUR MISSION AND FULFILL OUR VISION. WE VALUE OUR COMMUNITY. WE ARE COMMITTED TO THE TREATMENT AND CARE OF OUR PATIENTS AND THE PROMOTION OF HEALTH AND WELLNESS IN OUR COMMUNITY. WE WILL CONFRONT ALL ETHICAL AND MORAL HEALTH-RELATED ISSUES NECESSARY TO ENHANCE THE QUALITY OF LIFE IN OUR COMMUNITY. WE VALUE QUALITY CARE AND WILL SEEK TO DELIVER CUSTOMER-FOCUSED, COST EFFICIENT SERVICES WITH COMPASSION AND CARING.CHATUGE REGIONAL HOSPITAL WAS DEEMED TO BE A CRITICAL ACCESS HOSPITAL IN EFFECTIVE MAY 1, 2002, BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) AND THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH (DCH).B. CHATUGE REGIONAL HOSPITAL (CRH) IS THE ONLY ACUTE CARE HOSPITAL IN TOWNS COUNTY, GEORGIA. CRH IS LIMITED TO 25 ACUTE AND INTENSIVE CARE MEDICAL/SURGICAL BEDS FOR SHORT-TERM INPATIENT CARE. THE BEDS ALSO QUALIFY FOR "SWING BED" STATUS FOR SHORT-TERM SKILLED NURSING CARE. OUTPATIENT SERVICES INCLUDE RADIOLOGY, LABORATORY AND OTHER DIAGNOSTIC SERVICES, REHABILITATION SERVICES, AND 24/7 EMERGENCY MEDICAL SERVICES. THE CHATUGE REGIONAL NURSING HOME (CRNH) IS THE ONLY NURSING FACILITY IN THE COUNTY PROVIDING SKILLED AND INTERMEDIATE LEVELS OF LONG-TERM CARE. UCNH IS LICENSED FOR 112 BEDS AND CONSISTENTLY HAS A WAITING LIST FOR ADMISSIONS. A MAJORITY OF THE RESIDENTS OF CRNH ARE MEDICARE AND MEDICAID BENEFICIARIES. C. IT IS A LONG ESTABLISHED POLICY OF CRH TO PROVIDE QUALITY CARE FOR ITS PATIENTS REGARDLESS OF FINANCIAL CIRCUMSTANCES. QUALIFICATION FOR HOSPITAL INDIGENT CARE IS SET AT 125% OF THE CURRENT FEDERAL POVERTY GUIDELINES AND IS BASED ON SIZE OF THE FAMILY UNIT. CRH AND CRNH ALSO PROVIDE FREE OR REDUCED COST CARE TO ALL ELIGIBLE PERSONS REQUESTING CHARITY CARE ASSISTANCE. CRH AND CRNH BUDGETS AVAILABLE INDIGENT AND CHARITY CARE AT 3% OF OPERATING EXPENSES. PATIENTS REQUESTING INDIGENT OR CHARITY CARE ASSISTANCE MUST PROVIDE REASONABLE DOCUMENTATION INCLUDING PLACE OF EMPLOYMENT, GROSS INCOME, LIVING EXPENSE AND FAMILY SIZE. FOR EMERGENCY MEDICAL SERVICES, INCLUDING ACTIVE LABOR, NO PERSON WILL BE DENIED CARE DUE TO AN INABILITY TO PAY FOR SERVICES.SECTION 2 - ORGANIZATIONAL DESCRIPTION FOR TAX EXEMPTIONA. CRH OPERATES AN EMERGENCY DEPARTMENT 24 HOURS/DAY, 7 DAYS/WEEK THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY.B. CRH HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. C. CRH AND CRNH IS OWNED BY THE HOSPITAL AUTHORITY OF UNION COUNTY, ITS GOVERNING BODY COMPRISED OF INDEPENDENT PERSONS REPRESENTATIVE OF THE COMMUNITY AND ARE APPOINTED BY UNION COUNTY SOLE COMMISSIONER.D. CRNH CONDUCTS CERTIFIED NURSING ASSISTANT (CNA) TRAINING COURSES TWICE ANNUALLY.E. CRH AND CRNH PARTICIPATES IN MEDICARE, MEDICAID, PEACHCARE, TRICARE, AND/OR OTHER GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS.SECTION 3 - DESCRIPTION OF COMMUNITY BENEFIT PROGRAMSA. CRH IN CONJUNCTION WITH ITS SISTER HOSPITAL, UNION GENERAL HOSPITAL, ARE THE ONLY TAX-EXEMPT, NON-PROFIT HOSPITALS WITHIN THE IMMEDIATE EIGHT COUNTY AREA OF THE NORTH CENTRAL AND NORTHEAST GEORGIA MOUNTAINS. DUE TO THE MOUNTAINOUS TERRAIN AND BEING BOUNDED BY THE CHATTAHOOCHEE NATIONAL FOREST AND LAKE CHATUGE, TOWNS COUNTY AND ITS NEIGHBORING CLAY COUNTY, NC HAS SOME VERY REMOTE COMMUNITIES FROM WHICH ACCESS TO MEDICAL CARE CAN LITERALLY BE MORE THAN HOUR AWAY IN SOME CASES. B. CRH IS A CRITICAL ACCESS HOSPITAL FOR THE RESIDENTS OF TOWNS COUNTY, GA. IN ADDITION, CRH SERVES THE MEDICAL NEEDS FOR CLAY COUNTY, NC, WHICH DOES NOT HAVE A COMMUNITY HOSPITAL.C. DUE TO THE MOUNTAINS ENCOMPASSING THE NATIONAL FOREST AND LAKE CHATUGE, TOWNS COUNTY ATTRACTS MANY VISITORS FOR CAMPING, HIKING, FISHING, AND HUNTING. THE TWISTING MOUNTAIN ROADS ATTRACT BICYCLISTS AND MOTORCYCLISTS THROUGHOUT THE SPRING, SUMMER AND FALL SEASONS. THESE ACTIVITIES MANY TIMES RESULT IN MEDICAL EMERGENCIES, SOME VERY SERIOUS, TO WHICH THE EMERGENCY DEPARTMENT OF CRH MUST BE PREPARED TO MEET.D. IN SEPTEMBER 2005, CRH ESTABLISHED A FAMILY MEDICAL PRACTICE IN HAYESVILLE, NC (CLAY COUNTY) TO HELP MEET THE MEDICALLY UNDERSERVED IN THE COMMUNITY. THE MEDICAL OFFICE IS STAFF WITH FAMILY NURSE PRACTITIONERS (FNPS) WITH PHYSICIAN SUPPORT FROM CRH'S EMERGENCY DEPARTMENT. 16431084 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 34 0 345 1 0 0 0 0 0 0 0 0 0 6 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 GA X X RICHARD L KELLEY 7068962222 110 SOUTH MAIN STREET Hiawasee GA 30546 JOE GRAY 1.00 X 0 0 0 DAVID BREEDLOVE MD 1.00 X 0 0 0 ERNIE PRUITT 1.00 X 0 0 0 JEFF PATTERSON 1.00 X 0 0 0 MAX COCHRAN 1.00 X 0 0 0 PATSY EFIRD 1.00 X 0 0 0 REBECCA T DYER 40.00 X 0 123018 53327 J MICHAEL GOWDER DDS 40.00 X 0 121585 19457 TIMOTHY N HENRY 40.00 X 0 119135 10677 R LEWIS KELLEY 40.00 X 125940 0 102 125940 363738 83563 1 0 1 0 STERLING EMERGENCY SERVICES PO BOX 758746 BALTIMORE MD 21275 ER DOCTORS 986201 MEDICAL ARTS HEALTH CARE PO BOX 102213 ATLANTA GA 30368 PHARMACY SERVICES 170413 QUEST DIAGNOSTICS PO BOX 740736 ATLANTA GA 30374 LABS 156685 ATLANTIC IMAGING PO BOX 54803 ATLANTA GA 30308 X-RAY IMAGING 149825 4 93000 2081 95081 NET PATIENT SERVICE RE 623000 17589144 17589144 17589144 19607 19607 172239 172239 172239 172239 CAFETERIA & VENDING 722210 42763 42763 SALE OF SUPPLIES/DRUGS 446110 13934 13934 MISCELLANEOUS 900099 12431 12431 2018 2018 71146 17947217 17660290 0 191846 126042 63021 63021 7579143 7223371 355772 28445 27110 1335 913172 870307 42865 585490 558007 27483 66487 66487 2220409 2210471 9938 19947 19947 2622003 2343797 278206 843489 703089 140400 40412 30930 9482 14437 14437 521837 521837 196941 196941 BAD DEBT 1617056 1617056 MISCELLANEOUS 31721 30763 958 17427031 16431084 995947 0 1479438 2519601 264133 234133 3196181 2316666 315316 316780 336592 331598 8121086 4670469 3251742 3450617 204765 8843402 9374160 1086643 1120418 91725 225232 819502 662792 1997870 2008442 X 6845532 7365718 6845532 7365718 8843402 9374160 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 415739 415739 3547254 1505684 2041570 109814 66985 42829 3971226 3097800 873426 77053 77053 3450617 CAPITAL LEASE OBLIGATIONS 69680 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 170200 INTERCOMPANY PAYABLES 245305 PHYSICIANS RECRUITMENT 177607 662792 17947217 17427031 520186 0 520186 17947217 0 17947217 0 17947217 17427031 0 17427031 0 17427031 1 1 X 1 X 125.000000000000 1 X 1 0 0 1 0 26511 2467 24044 0.00150 3700516 5501430 -1800914 0.00000 3727027 5503897 -1776870 0.00150 10000 6117 3883 0.00020 5000 5000 0.00030 15000 6117 8883 0.00050 3742027 5510014 -1767987 0.00200 0 1424489 387525 4758776 5196659 -437883 X 1 1 CHATUGE REGIONAL HOSPITAL INC

110 SOUTH MAIN ST HIAWASSEE GA 30546

X X X CHATUGE REGIONAL NURSING HOME

110 SOUTH MAIN ST HIAWASSEE GA 30546

NURSING HOME HAYESVILLE FAMILY PRACTICE

450 HWY 64 BUSINESS SUITE 4 HAYESVILLE NC 28904

FAMILY CLINIC Part III, Line 4: THERE IS NO FOOTNOTE ADDRESSING BAD DEBT IN THE ORGANIZATION'S FINANCIAL STATEMENTS.BASED ON EXPERIENCE, WE HAVE FOUND THAT THERE IS A POTION OF BAD DEBT THAT IS GENERALLY ATTRIBUTABLE TO CHARITY CARE. THE ORGANIZATION MULTIPLIED THE PORTION OF BAD DEBT ATTRIBUTABLE TO CHARITY BY THE COST TO CHARGE RATIO CALCULATED USING THE IRS SCHEDULE H WORKSHEETS. Part III, Line 8: THIS SHORTFALL IS GENERATED PRIMARILY FROM PROVIDING EMERGENCY PHYSICIAN SERVICES AND SHOULD COUNT 100% TOWARD COMMUNITY BENEFIT EXPENSE. Part III, Line 9b: ONCE THE PATIENT IS APPROVED FOR INDIGENT CARE (100% WRITE OFF) THE ACCOUNT(S) IS (ARE) RECLASSED TO INDIGENT CARE AND NO FURTHER COLLECTION ACIVITY IS CONDUCTED. FOR PATIENTS APPROVED FOR CHARITY CARE (REDUCED CHARGE), THE ACCOUNT GUARANTOR WILL RECEIVE STATEMENTS AND PHONE CALLS TO COLLECT THE REMAINING BALANCE DUE. Part VI, Line 2: THE ORGANIZATION PRIMARILY SOLICITS FEEDBACK FROM THE MEDICAL STAFF AND CITY AND COUNTY OFFICIALS Part VI, Line 3: NOTICES ARE PUBLISHED IN THE LOCAL COMMUNITY NEWSPAPER. ACCOUNT COLLECTORS INFORM THE ACCOUNT GUARANTOR OF THE AVAILABILITY OF INDIGENT AND CHARITY CARE. THE ORGANIZATION MAILS OUT APPLICATIONS FOR FINANCIAL AIDE BUT RECEIVES A LIMITED NUMBER RETURNED. Part VI, Line 4: THE ORGANIZATION SERVES A GENERALLY RURAL MOUNTAINOUS AREA AND IS THE SOLE HOSPITAL IN THE COUNTY. TOWNS COUNTY IS DEEMED TO HAVE A MEDICALLY UNDERSERVED POPULATION (MUP) BY THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH. Part VI, Line 6: THE ORGANIZATION CONDUCTS HEALTH FAIRS OPEN TO THE COMMUNITY WHEREIN FREE HEALTH SCREENINGS AND LOW-COST BASIC LAB TESTS ARE DONE. OTHER HEALTH INFORMATION IS PROVIDED INCLUDING INFORMATION ON SMOKING CESSATION AND DIABETES. THE ORGANZATION IS ENTIRELY TOBACCO-FREE, THUS PROMOTING A HEALTHY LIFESTYLE.SURPLUS FUNDS ARE USED TO PROVIDE FOR THE ADDITION, IMPROVEMENT, OR REPLACEMENT OF CAPITAL AND EQUIPMENT NEEDS. X X 0 0 0 0 0 0 0 0 0 REBECCA T DYER 0 123018 0 0 0 0 0 49000 0 4327 0 176345 0 0 Form 990, Part VI, Section B, line 11 The CFO provided a copy of the 990 to each board member and reviewed it in detail at a Board meeting prior to filing the return. Form 990, Part VI, Section B, line 12c OFFICERS, DIRECTORS, AND TRUSTEES ARE REQUIRED TO SIGN A STATEMENT REGARDING CONFLICT OF INTEREST ANNUALLY. Form 990, Part VI, Section B, line 15a The organization uses The Georgia Association compensation study as a benchmark for all executive compensation. The Board approves the CEO's compensation. All other executive compensation is managed by the CEO. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are made available by request. UNION GENERAL HOSPITAL INC 214 HOSPITAL CIRCLE BLAIRSVILLE GA 30512 586025393 HOSPITAL GA 501(C)(3) Line 3 N/A MOUNTAIN COMMUNITY HEALTHCARE FOUNDATION PO BOX 509 HIAWASSEE GA 30546 201376498 SUPPORT GA 501(C)(3) Line 11b, II N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1