Civic Intelligence

Ccsg Inc.

990 • Fiscal year 2016 • EIN 47-3501366

Oct 01, 2015 to Sep 30, 2016 • Filed on Aug 15, 2017

915 Gordon AvenueThomasville, GA 31792-6614

(229) 228-2880

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

99th percentile

3.07x

Higher debt load relative to assets than 99% of similar nonprofits.

2016 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2016

Liabilities / Revenue

84th percentile

0.90x

Higher debt load relative to revenue than 84% of similar nonprofits.

2016 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2016

Net Margin

6th percentile

-60%

Higher net margin than 6% of similar nonprofits.

2016 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2016

Top Officer Pay

Score unavailable

No value available

This filing does not contain officer compensation rows.

Source year 2016

Asset Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2016

Revenue Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2016

Assets

$582,527

No earlier filing loaded for comparison.

Net Assets

-$1,203,924

No earlier filing loaded for comparison.

Liabilities

$1,786,451

No earlier filing loaded for comparison.

Revenue

$1,990,210

No earlier filing loaded for comparison.

Expenses

$3,194,134

No earlier filing loaded for comparison.

Net Income

-$1,203,924

No earlier filing loaded for comparison.

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$50M$0-$50MAssets 2016: $582,527Liabilities 2016: $1,786,451Net Assets 2016: -$1,203,9242016Assets 2017: $360,766Liabilities 2017: $3,356,533Net Assets 2017: -$2,995,7672017Assets 2018: $460,651Liabilities 2018: $5,124,784Net Assets 2018: -$4,664,1332018Assets 2019: $1,016,250Liabilities 2019: $9,683,307Net Assets 2019: -$8,667,0572019Assets 2020: $967,913Liabilities 2020: $13,756,313Net Assets 2020: -$12,788,4002020Assets 2021: $1,050,982Liabilities 2021: $18,998,134Net Assets 2021: -$17,947,1522021Assets 2022: $1,050,904Liabilities 2022: $25,304,684Net Assets 2022: -$24,253,7802022Assets 2023: $1,305,188Liabilities 2023: $32,778,062Net Assets 2023: -$31,472,8742023Assets 2024: $1,282,679Liabilities 2024: $41,328,864Net Assets 2024: -$40,046,1852024

Highlighted filing

2016

Assets$582,527
Liabilities$1,786,451
Net Assets-$1,203,924

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$20M$10M$0-$10MRevenue 2016: $1,990,210Expenses 2016: $3,194,134Net Income 2016: -$1,203,9242016Revenue 2017: $1,661,093Expenses 2017: $3,452,936Net Income 2017: -$1,791,8432017Revenue 2018: $2,130,388Expenses 2018: $3,798,754Net Income 2018: -$1,668,3662018Revenue 2019: $4,396,082Expenses 2019: $8,399,006Net Income 2019: -$4,002,9242019Revenue 2020: $4,815,506Expenses 2020: $8,936,849Net Income 2020: -$4,121,3432020Revenue 2021: $6,124,484Expenses 2021: $11,283,236Net Income 2021: -$5,158,7522021Revenue 2022: $6,833,626Expenses 2022: $13,140,254Net Income 2022: -$6,306,6282022Revenue 2023: $7,433,069Expenses 2023: $14,652,163Net Income 2023: -$7,219,0942023Revenue 2024: $7,924,494Expenses 2024: $16,497,805Net Income 2024: -$8,573,3112024

Highlighted filing

2016

Revenue$1,990,210
Expenses$3,194,134
Net Income-$1,203,924
Jump To
Filing Snapshot
Filing Period
Oct 1, 2015 to Sep 30, 2016
Signed
Aug 15, 2017
Return Version
2015v3.0
Gross Receipts
$1,990,210
Mission and Program Overview

Mission

Ccsg is organized for the purpose of providing medical care, education and research through the operation of a medical clinic.

Balance Sheet Detail
LineBeginningEndChange
Assets
Accounts Receivable-$582,527-
Total Assets$0$582,527▲ $582,527
Liabilities
Other Liabilities-$1,786,451-
Total Liabilities$0$1,786,451▲ $1,786,451
Net Assets / Fund Balance
Unrestricted Net Assets-$-1,203,924-
Total Net Assets Fund Balance$0$-1,203,924▼ $1,203,924
Total Liabilities and Net Assets / Fund Balance$0$582,527▲ $582,527
Compensation and Service Providers

Employees

NameTitleOtherTotal
J Perry MustianPresident/ce$1,720,985$1,720,985
Charles D HightowerSEC/TREAS; C$527,876$527,876
Grady RamseyVice Preside$229,620$229,620
Daniel E Autry JrPast Asst Vi$133,641$133,641

Board Members and Trustees

NameTitle
Daniel E Autry SrChairman
J Perry MustianPresident/CEO
Grady RamseyVice President
Charles D HightowerSEC/TREAS; CFO

Highest Paid Contractors

ContractorServicesLocationCompensation
Cardiology Consultants Of South GaMedical Prof100 MIMOSA DRIVE SUITE 2L, Thomasville, GA 31792$3,076,386
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$1,990,210
Investment Income
$0
Other Revenue
$0
Change in Net Assets
$-1,203,924
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$3,194,134
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Fees for Services Other$3,126,226$2,500-$3,128,726
Occupancy$31,773--$31,773
Fees for Services Management$17,178--$17,178
Office Expenses$10,267--$10,267
Other Expenses$6,190--$6,190
Total Functional Expenses$3,191,634$2,500$0$3,194,134
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Due to Related Parties$1,786,451
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
Yes
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
No

Governance Explanations

Form 990, Page 6, Part VI, Line 2

Daniel autry jr daniel autry sr vp board member family relationship

Form 990, Page 6, Part VI, Line 6

Archbold medical group, inc. (amg) is the sole member of the organization with rights to elect members of the governing body, approve significant decisions of the governing body and receive a share of the organization's net assets upon the organization's dissolution.

Form 990, Page 6, Part VI, Line 7A

Amg, the sole member of ccsg, inc., has power to appoint, elect, replace or remove the trustees of the governing body. Additionally the ceo and cfo of john d. Archbold memorial hospital, a related organization, shall serve as ex-officio members of the board with the power to vote.

Form 990, Page 6, Part VI, Line 7B

The filing organization's governing body must seek approval in writing from the sole member, amg, for operating and capital budgets, expenditures or commitments that exceed 10,000, asset sales and dispositions, plan of dissolution of the organization, etc.

Form 990, Page 6, Part VI, Line 11B

The organization's cfo presented the form 990 to trustees in attendance during the board meeting prior to filing the return with the irs. The trustees had the opportunity to ask questions and make comments. A copy of the return was made available to those board members who were unable to attend the meeting.

Form 990, Page 6, Part VI, Line 12C

On an annual basis, the organization distributes a conflict of interest questionnaire and disclosure statement to each trustee. This questionnaire includes questions related to financial interests, outside interests or activities, and gifts, meals, and entertainment. In addition to disclosing any applicable information on the questionnaire, the trustee acknowledges that (s)he has received a copy of the conflict of interest policy, has read, understands, and agrees to comply with it, and understands that the organization is a charitable organization and that in order to maintain its federal tax exemption it must engage primarily in activities which accomplish one or more of its tax-exempt purposes. Responses are summarized and collectively reviewed by the audit & compliance committee of amc, a related organization. During each board meeting, the chairman inquires if any trustee has an actual or potential conflict of interest related to any agenda item. If the trustee discloses any such interest, the trustee is excused from the meeting while the determination as to whether an actual conflict of interest exists is discussed and voted upon by disinterested members of the board or committee. If invited to do so, the trustee with a potential conflict may respond to questions put forth by fellow disinterested trustees regarding any proposed transaction or arrangement. The minutes of the board and all committees with board-delegated powers will record the name of any interested person/trustee who disclosed or was found to have a financial interest in connection with a transaction or arrangement resulting in an actual or potential conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the board's or committee's decision as to whether a conflict of interest in fact existed; and the names of the persons who were present for discussions and votes related to the transaction or arrangement, the content of the discussions, and a record of any votes taken in connection therewith.

Form 990, Page 6, Part VI, Line 19

No documents are or will be made available to the public.

Form 990, Part VII

Daniel autry jr was employed as the director of finance, assistant vice president, for the filing organization and is the son of board member daniel autry sr. His compensation, however, is paid directly by a related organization and is reimbursed by the sole member, amg.

Filing and Contact Details

Filer

Filer Name
Ccsg Inc
EIN
47-3501366
Phone
2292282880
Address
915 GORDON AVENUE, THOMASVILLE, GA 31792-6614

Signing Officer

Name
J Perry Mustian
Title
President/CEO
Phone
2292282880
Signed
2017-08-15
Discuss with paid preparer
Yes

Organization Details

Principal Officer
J Perry Mustian
Formed
2015
Legal Domicile
Ga
Voting Board Members
3
Independent Board Members
0
Employees
0

Preparer

Firm
Draffin & Tucker Llp
Address
PO BOX 71309, ALBANY, GA 31708-1309
Preparer
Jacqueline G Atkins
Phone
2298837878
Supplemental Narrative

Additional Explanations

Form 990, Part IX, Line 11G

Collection fees 0 2,500 0 conttracted services 3,126,226 0 0

Financial Statement Notes

Schedule D, Page 3, Part X

Excerpt from consolidated parent organization audited financial statements. The medical center, with the exception of archbold medical enterprises, inc., 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 medical center applies accounting policies that prescribe when to recognize and how to measure the consolidated 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 medical center 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 consolidated balance sheets for unrecognized income tax positions. Further, no interest or penalties have been accrued or charged to expense as of september 30, 2016 and 2015 or for the years then ended. The medical center's tax returns are subject to possible examination by the taxing authorities. For federal income tax purposes, the tax returns essentially remain open for possible examination for a period of three years after the respective filing deadlines of those returns. (the medical center refers to archbold medical center, inc., the parent corporation.)

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IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0EXCERPT FROM CONSOLIDATED PARENT ORGANIZATION AUDITED FINANCIAL STATEMENTS. THE MEDICAL CENTER, WITH THE EXCEPTION OF ARCHBOLD MEDICAL ENTERPRISES, INC., 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 MEDICAL CENTER APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE CONSOLIDATED 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 MEDICAL CENTER 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 CONSOLIDATED BALANCE SHEETS FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF SEPTEMBER 30, 2016 AND 2015 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTER'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. (THE MEDICAL CENTER REFERS TO ARCHBOLD MEDICAL CENTER, INC., THE PARENT CORPORATION.)
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt229440
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/OtherCompensationRltdOrgsAmt21242
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0J PERRY MUSTIAN
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm1CHARLES D HIGHTOWER
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm2GRADY RAMSEY
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0PRESIDENT/CEO
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt1SEC/TREAS; CFO
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt2VICE PRESIDENT
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt01720985
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt1527876
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TotalCompensationRltdOrgsAmt2229620
IRS990ScheduleJ/SeverancePaymentInd0false
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0THE FILING ORGANIZATION RELIES ON THE METHODS USED BY ARCHBOLD MEDICAL CENTER, INC. (AMC), THE SOLE MEMBER, TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY AMC INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AS WELL AS BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED.
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt1J. PERRY MUSTIAN 0 868,000 0 GRADY RAMSEY 0 12,800 0
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt2THE IRS RULES & REGULATIONS REQUIRE THAT CERTAIN NON-CURRENT, NON-CASH ITEMS ARE REPORTED IN PART II OF FORM 990 REGARDLESS OF THE CURRENT BENEFIT TO THE EMPLOYEE. THESE SAME RULES, IN SOME CASES, REQUIRE THE COMPENSATION AND BENEFITS TO BE REPORTED TWICE IN PART II, ONCE WHEN THE ENTITY ACCRUES FOR A FUTURE PAYMENT AND ONCE WHEN THE PAYMENT IS ACTUALLY MADE TO THE EMPLOYEE. THEREFORE, AN EMPLOYEE'S STATED TOTAL COMPENSATION AND BENEFITS REPORTED ON PART II ARE SUBSTANTIALLY HIGHER THAN THE ACTUAL CASH COMPENSATION RECEIVED IN THE CURRENT YEAR. AMOUNTS REPORTED AS BENEFITS INCLUDE AMOUNTS FOR LIFE INSURANCE, HEALTH INSURANCE, THRIFT PLAN CONTRIBUTIONS, AND PENSION CONTRIBUTIONS. BENEFITS RELATED TO PENSION AND RETIREMENT PLANS REFLECT AMOUNTS ACCUMULATED, BUT NOT PAID, TO THE INDIVIDUAL IN RECOGNITION OF TOTAL YEARS OF EMPLOYMENT, NOT JUST THE CURRENT YEAR. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN A FEW OF AMC'S TOP EXECUTIVES PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS ACCRUED BUT UNFUNDED IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON-QUALIFIED RETIREMENT PLAN. AMC 457(F) RETIREMENT PLAN CERTAIN EXECUTIVES WHO ARE NOT ELIGIBLE FOR THE SERP MAY BE ELIGIBLE TO PARTICIPATE IN A 457(F) PLAN TO HELP THEM ACCUMULATE FUNDS FOR THEIR LONG TERM FINANCIAL NEEDS. THE ORGANIZATION MAY CONTRIBUTE A PERCENTAGE OF BASE SALARY INTO AN INDIVIDUAL EXECUTIVES ACCOUNT IF THE ORGANIZATION MEETS CERTAIN FINANCIAL TARGETS. THE ORGANIZATION OWNS ANY PLAN ASSETS UNTIL THEY ARE PAID TO THE EMPLOYEE AND ALL FUNDS ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. VESTING BEGINS AT AGE 55 WITH FIVE YEARS OF SERVICE AT A RATE OF 90% AND THEN INCREASES TO 100% AT AGE 60. PAYMENTS ARE MADE ANNUALLY UPON VESTING. BONUS AWARDS: OFFICERS AND PHYSICIANS ARE AWARDED BONUSES/INCENTIVES CONTINGENT IN PART ON MEETING MANAGEMENT-BY-OBJECTIVE INCENTIVE PLAN GOALS AND EXCESS OF REVENUE OVER EXPENSES.
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc0SCHEDULE J, PAGE 1, PART I, LINE 3
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc1SCHEDULE J, PAGE 1, PART I, LINE 4
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc2SCHEDULE J, PART III
IRS990ScheduleJ/SupplementalNonqualRtrPlanInd0true
IRS990/ScheduleORequiredInd0true
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0DANIEL AUTRY JR DANIEL AUTRY SR VP BOARD MEMBER FAMILY RELATIONSHIP
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1ARCHBOLD MEDICAL GROUP, INC. (AMG) IS THE SOLE MEMBER OF THE ORGANIZATION WITH RIGHTS TO ELECT MEMBERS OF THE GOVERNING BODY, APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY AND RECEIVE A SHARE OF THE ORGANIZATION'S NET ASSETS UPON THE ORGANIZATION'S DISSOLUTION.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2AMG, THE SOLE MEMBER OF CCSG, INC., HAS POWER TO APPOINT, ELECT, REPLACE OR REMOVE THE TRUSTEES OF THE GOVERNING BODY. ADDITIONALLY THE CEO AND CFO OF JOHN D. ARCHBOLD MEMORIAL HOSPITAL, A RELATED ORGANIZATION, SHALL SERVE AS EX-OFFICIO MEMBERS OF THE BOARD WITH THE POWER TO VOTE.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THE FILING ORGANIZATION'S GOVERNING BODY MUST SEEK APPROVAL IN WRITING FROM THE SOLE MEMBER, AMG, FOR OPERATING AND CAPITAL BUDGETS, EXPENDITURES OR COMMITMENTS THAT EXCEED 10,000, ASSET SALES AND DISPOSITIONS, PLAN OF DISSOLUTION OF THE ORGANIZATION, ETC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4THE ORGANIZATION'S CFO PRESENTED THE FORM 990 TO TRUSTEES IN ATTENDANCE DURING THE BOARD MEETING PRIOR TO FILING THE RETURN WITH THE IRS. THE TRUSTEES HAD THE OPPORTUNITY TO ASK QUESTIONS AND MAKE COMMENTS. A COPY OF THE RETURN WAS MADE AVAILABLE TO THOSE BOARD MEMBERS WHO WERE UNABLE TO ATTEND THE MEETING.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5ON AN ANNUAL BASIS, THE ORGANIZATION DISTRIBUTES A CONFLICT OF INTEREST QUESTIONNAIRE AND DISCLOSURE STATEMENT TO EACH TRUSTEE. THIS QUESTIONNAIRE INCLUDES QUESTIONS RELATED TO FINANCIAL INTERESTS, OUTSIDE INTERESTS OR ACTIVITIES, AND GIFTS, MEALS, AND ENTERTAINMENT. IN ADDITION TO DISCLOSING ANY APPLICABLE INFORMATION ON THE QUESTIONNAIRE, THE TRUSTEE ACKNOWLEDGES THAT (S)HE HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ, UNDERSTANDS, AND AGREES TO COMPLY WITH IT, AND UNDERSTANDS THAT THE ORGANIZATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. RESPONSES ARE SUMMARIZED AND COLLECTIVELY REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE OF AMC, A RELATED ORGANIZATION. DURING EACH BOARD MEETING, THE CHAIRMAN INQUIRES IF ANY TRUSTEE HAS AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST RELATED TO ANY AGENDA ITEM. IF THE TRUSTEE DISCLOSES ANY SUCH INTEREST, THE TRUSTEE IS EXCUSED FROM THE MEETING WHILE THE DETERMINATION AS TO WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS IS DISCUSSED AND VOTED UPON BY DISINTERESTED MEMBERS OF THE BOARD OR COMMITTEE. IF INVITED TO DO SO, THE TRUSTEE WITH A POTENTIAL CONFLICT MAY RESPOND TO QUESTIONS PUT FORTH BY FELLOW DISINTERESTED TRUSTEES REGARDING ANY PROPOSED TRANSACTION OR ARRANGEMENT. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD-DELEGATED POWERS WILL RECORD THE NAME OF ANY INTERESTED PERSON/TRUSTEE WHO DISCLOSED OR WAS FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH A TRANSACTION OR ARRANGEMENT RESULTING IN AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED; AND THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATED TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSIONS, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6NO DOCUMENTS ARE OR WILL BE MADE AVAILABLE TO THE PUBLIC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7DANIEL AUTRY JR WAS EMPLOYED AS THE DIRECTOR OF FINANCE, ASSISTANT VICE PRESIDENT, FOR THE FILING ORGANIZATION AND IS THE SON OF BOARD MEMBER DANIEL AUTRY SR. HIS COMPENSATION, HOWEVER, IS PAID DIRECTLY BY A RELATED ORGANIZATION AND IS REIMBURSED BY THE SOLE MEMBER, AMG.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt8COLLECTION FEES 0 2,500 0 CONTTRACTED SERVICES 3,126,226 0 0
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PAGE 6, PART VI, LINE 2
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PAGE 6, PART VI, LINE 6
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PAGE 6, PART VI, LINE 7A
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PAGE 6, PART VI, LINE 7B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PAGE 6, PART VI, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PAGE 6, PART VI, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6FORM 990, PAGE 6, PART VI, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7FORM 990, PART VII
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc8FORM 990, PART IX, LINE 11G
IRS990ScheduleR/AssetExchangeInd0false
IRS990ScheduleR/AssetPurchaseFromOtherOrgInd0false
IRS990ScheduleR/AssetSaleToOtherOrgInd0false
IRS990ScheduleR/DivRelatedOrganizationInd0false
IRS990ScheduleR/GiftGrntCapContriFromOthOrgInd0false
IRS990ScheduleR/GiftGrntOrCapContriToOthOrgInd0false
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IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN0581494513
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd0GA
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt0HEALTHCARE
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt0ARCHBOLD MEDICAL ENTERPRISES
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt0400 OLD ALBANY ROAD
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm0THOMASVILLE
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd0GA
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ControlledOrganizationInd2false
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingEntityName/BusinessNameLine1Txt1AMC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingEntityName/BusinessNameLine1Txt2AMC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingEntityName/BusinessNameLine1Txt3AMC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingEntityName/BusinessNameLine1Txt4AMC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingEntityName/BusinessNameLine2Txt0ARCHBOLD MEDICAL CENTER INC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingEntityName/BusinessNameLine2Txt1ARCHBOLD MEDICAL CENTER INC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DirectControllingEntityName/BusinessNameLine2Txt2ARCHBOLD MEDICAL CENTER INC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt0ARCHBOLD MEDICAL CENTER INC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt1JOHN D ARCHBOLD MEM HOSPITAL INC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt2ARCHBOLD FOUNDATION INC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt3ARCHBOLD HEALTH SERVICES INC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt4ARCHBOLD MEDICAL GROUP INC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/EIN0581552650
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/EIN1580566121
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt0501C3
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt1501C3
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt2501C3
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt3501C3
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/ExemptCodeSectionTxt4501C3
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd0GA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd1GA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd2GA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd3GA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/LegalDomicileStateCd4GA
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt0H/C MGMT
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt1ACUTE CARE
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt2FOUNDATION
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt3HEALTHCARE
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PrimaryActivitiesTxt4PHYSICIANS
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt011C
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt13
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt211B
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt39
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/PublicCharityStatusTxt43
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt0P O BOX 1018
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt1P O BOX 1018
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt2PO BOX 620
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt3PO BOX 620
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/AddressLine1Txt4P O BOX 620
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/USAddress/ZIPCd4317990620
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IRS990ScheduleR/PaidEmployeesSharingInd0true
IRS990ScheduleR/PerformOfServicesByOtherOrgInd0true
IRS990ScheduleR/PerformOfServicesForOthOrgInd0true
IRS990ScheduleR/ReceiptOfIntAnntsRntsRyltsInd0false
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IRS990ScheduleR/RentalOfFcltsFromOthOrgInd0false
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IRS990ScheduleR/TransferToOtherOrgInd0false
IRS990/SchoolOperatingInd0false
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IRS990/SignificantNewProgramSrvcInd0false
IRS990/StatesWhereCopyOfReturnIsFldCd0GA
IRS990/SubjectToProxyTaxInd0false
IRS990/TaxablePartyNotificationInd0false
IRS990/TaxExemptBondsInd0false
IRS990/TempOrPermanentEndowmentsInd0false
IRS990/TerminateOperationsInd0false
IRS990/TotalAssetsEOYAmt0582527
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IRS990/TotalAssetsGrp/EOYAmt0582527
IRS990/TotalCompGreaterThan150KInd0true
IRS990/TotalEmployeeCnt00
IRS990/TotalFunctionalExpensesGrp/FundraisingAmt00
IRS990/TotalFunctionalExpensesGrp/ManagementAndGeneralAmt02500
IRS990/TotalFunctionalExpensesGrp/ProgramServicesAmt03191634
IRS990/TotalFunctionalExpensesGrp/TotalAmt03194134
IRS990/TotalGrossUBIAmt00
IRS990/TotalLiabilitiesEOYAmt01786451
IRS990/TotalLiabilitiesGrp/BOYAmt00
IRS990/TotalLiabilitiesGrp/EOYAmt01786451
IRS990/TotalNetAssetsFundBalanceGrp/BOYAmt00
IRS990/TotalNetAssetsFundBalanceGrp/EOYAmt0-1203924
IRS990/TotalOtherCompensationAmt0982722
IRS990/TotalProgramServiceExpensesAmt03191634
IRS990/TotalProgramServiceRevenueAmt01990210
IRS990/TotalRevenueGrp/RelatedOrExemptFuncIncomeAmt01990210
IRS990/TotalRevenueGrp/TotalRevenueColumnAmt01990210
IRS990/TotLiabNetAssetsFundBalanceGrp/BOYAmt00
IRS990/TotLiabNetAssetsFundBalanceGrp/EOYAmt0582527
IRS990/TotReportableCompRltdOrgAmt01629400
IRS990/TrnsfrExmptNonChrtblRltdOrgInd0false
IRS990/TypeOfOrganizationCorpInd0X
IRS990/UnrelatedBusIncmOverLimitInd0false
IRS990/UnrestrictedNetAssetsGrp/EOYAmt0-1203924
IRS990/UponRequestInd0X
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ReturnHeader/BuildTS02017-02-10 21:41:12Z
ReturnHeader/BusinessOfficerGrp/DiscussWithPaidPreparerInd0true
ReturnHeader/BusinessOfficerGrp/PersonNm0J PERRY MUSTIAN
ReturnHeader/BusinessOfficerGrp/PersonTitleTxt0PRESIDENT/CEO
ReturnHeader/BusinessOfficerGrp/PhoneNum02292282880
ReturnHeader/BusinessOfficerGrp/SignatureDt02017-08-15
ReturnHeader/Filer/BusinessName/BusinessNameLine1Txt0CCSG INC
ReturnHeader/Filer/BusinessNameControlTxt0CCSG
ReturnHeader/Filer/EIN0473501366
ReturnHeader/Filer/PhoneNum02292282880
ReturnHeader/Filer/USAddress/AddressLine1Txt0915 GORDON AVENUE
ReturnHeader/Filer/USAddress/CityNm0THOMASVILLE

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