Civic Intelligence

Ccsg Inc.

990 • Fiscal year 2019 • EIN 47-3501366

Oct 01, 2018 to Sep 30, 2019 • Filed on Aug 07, 2020

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

100th percentile

9.53x

Higher debt load relative to assets than 100% of similar nonprofits.

2019 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2019

Liabilities / Revenue

92nd percentile

2.20x

Higher debt load relative to revenue than 92% of similar nonprofits.

2019 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2019

Net Margin

3rd percentile

-91%

Higher net margin than 3% of similar nonprofits.

2019 filings • 501(c)3 • $1M-$5M nonprofits • Source year 2019

Top Officer Pay

Score unavailable

No value available

This filing does not contain officer compensation rows.

Source year 2019

Asset Growth

96th percentile

121%

Faster asset growth than 96% of similar nonprofits.

2019 filings • 501(c)3 • $1M-$5M nonprofits • Annualized from 2018 to 2019

Revenue Growth

94th percentile

106%

Faster revenue growth than 94% of similar nonprofits.

2019 filings • 501(c)3 • $1M-$5M nonprofits • Annualized from 2018 to 2019

Assets

Up

$1,016,250

Up $555,599 (+121%) from 2018

Net Assets

Down

-$8,667,057

Down $4,002,924 (-86%) from 2018

Liabilities

Up

$9,683,307

Up $4,558,523 (+89%) from 2018

Revenue

Up

$4,396,082

Up $2,265,694 (+106%) from 2018

Expenses

Up

$8,399,006

Up $4,600,252 (+121%) from 2018

Net Income

Down

-$4,002,924

Down $2,334,558 (-140%) from 2018

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

2019

Assets$1,016,250
Liabilities$9,683,307
Net Assets-$8,667,057

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

2019

Revenue$4,396,082
Expenses$8,399,006
Net Income-$4,002,924
Jump To
Filing Snapshot
Filing Period
Oct 1, 2018 to Sep 30, 2019
Signed
Aug 7, 2020
Return Version
2018v3.2
Gross Receipts
$4,396,082
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$460,651$1,016,250▲ $555,599
Total Assets$460,651$1,016,250▲ $555,599
Liabilities
Other Liabilities$5,124,784$9,683,307▲ $4,558,523
Total Liabilities$5,124,784$9,683,307▲ $4,558,523
Net Assets / Fund Balance
Unrestricted Net Assets$-4,664,133$-8,667,057▼ $4,002,924
Total Net Assets Fund Balance$-4,664,133$-8,667,057▼ $4,002,924
Total Liabilities and Net Assets / Fund Balance$460,651$1,016,250▲ $555,599
Compensation and Service Providers

Employees

NameTitleOtherTotal
J Perry MustianPresident/ce$1,451,271$1,451,271
Greg HembreeSEC/TREAS; C$537,470$537,470
Grady RamseyVice Preside$252,924$252,924

Board Members and Trustees

NameTitle
J Perry MustianPresident/CEO/chair
J Mark ParkerVice Chair
Grady RamseyVice President
Marta Jones TurnerTrustee (res
Greg HembreeSEC/TREAS; CFO

Highest Paid Contractors

ContractorServicesLocationCompensation
Cardiology Consultants Of South GaMed Prof100 MIMOSA DRIVE SUITE 2L, Thomasville, GA 31792$8,331,577
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$4,396,082
Investment Income
$0
Other Revenue
$0
Change in Net Assets
$-4,002,924
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$8,399,006
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$8,241,992--$8,241,992
Occupancy$55,317--$55,317
Office Expenses$23,902--$23,902
Depreciation Depletion$1,652--$1,652
Advertising$1,308--$1,308
Travel$44--$44
Other Expenses$22--$22
Total Functional Expenses$8,399,006$0$0$8,399,006
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$9,683,307
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
Yes
Other officer compensation reviewed
Yes
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 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

Management reviews the form 990 as prepared by its external auditor, and then makes a complete copy available electronically to trustees prior to filing the return. If trustees have questions about the return, management is available and accessible to provide applicable explanations to trustees.

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 15A

Archbold medical center's (amc) compensation committee (committee) of the amc board of trustees makes recommendations to the full amc board on the following positions: the president of amc and the president of the archbold foundation. Amc's president presents recommendations for all senior vice presidents, vice presidents, and other key employees of amc and all related archbold entities to the committee. Since amc has reserve powers for archbold related entities, the committee serves as the compensation committee for each applicable archbold entity. The committee considers the amc president's recommendations, but it also considers recommendations and independent market data analysis from an independent compensation consultant. The amc board utilizes an independent compensation consultant to review the executive compensation program and make recommendations regarding plan design and actual compensation including benefits.

Form 990, Page 6, Part VI, Line 15B

SEE 15A ABOVE.

Form 990, Page 6, Part VI, Line 19

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

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/chair
Phone
2292282880
Signed
2020-08-07
Discuss with paid preparer
Yes

Organization Details

Principal Officer
J Perry Mustian
Formed
2015
Legal Domicile
Ga
Voting Board Members
3
Independent Board Members
1
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

Contracted services 8,239,448 0 0 purchased services 2,544 0 0 total 8,241,992 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 managements 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, 2019 and 2018 or for the years then ended. The medical centers 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 MANAGEMENTS 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, 2019 AND 2018 OR FOR THE YEARS THEN ENDED. THE MEDICAL CENTERS 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.)
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0SCHEDULE D, PAGE 3, PART X
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0J PERRY MUSTIAN
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm1GREG HEMBREE
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm2GRADY RAMSEY
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0PRESIDENT/CEO/CHAIR
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt1SEC/TREAS; CFO
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt2VICE PRESIDENT
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IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0SOCIAL CLUB DUES ARE PAID BY THE ORGANIZATION ON BEHALF OF OFFICERS AND EXECUTIVES OF THE FILING ORGANIZATION. THESE AMOUNTS ARE INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME AND REPORTED ON THEIR W-2. THE ORGANIZATION'S POLICY FOR COMPANION TRAVEL INCLUDES THE REIMBURSEMENT OF REGISTRATION, TRAVEL, AND ENTERTAINMENT EXPENSES FOR GUESTS WHO ACCOMPANY BOARD TRUSTEES TO EITHER OF TWO ANNUAL TRUSTEE CONFERENCES. RECEIPTS MUST BE SUBMITTED PRIOR TO REIMBURSEMENT AND THE AMOUNTS ARE NOT INCLUDED IN THE INDIVIDUAL'S TAXABLE INCOME.
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt1J. PERRY MUSTIAN 0 535,000 0 GREG HEMBREE 0 42,228 0 GRADY RAMSEY 0 14,876 0
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt2THE IRS RULES & REGULATIONS REQUIRE THAT CERTAIN NON-CURRENT, NON-CASH ITEMS ARE REPORTED IN PART VII, COMPENSATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, HIGHEST COMPENSATED EMPLOYEES, AND INDEPENDENT CONTRACTORS, OF THE CORE 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 VII, 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 VII 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 1A
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc1SCHEDULE J, PAGE 1, PART I, LINE 4
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc2SCHEDULE J, PART III
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IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0ARCHBOLD 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/ExplanationTxt1AMG, 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/ExplanationTxt2THE 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/ExplanationTxt3MANAGEMENT REVIEWS THE FORM 990 AS PREPARED BY ITS EXTERNAL AUDITOR, AND THEN MAKES A COMPLETE COPY AVAILABLE ELECTRONICALLY TO TRUSTEES PRIOR TO FILING THE RETURN. IF TRUSTEES HAVE QUESTIONS ABOUT THE RETURN, MANAGEMENT IS AVAILABLE AND ACCESSIBLE TO PROVIDE APPLICABLE EXPLANATIONS TO TRUSTEES.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4ON 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/ExplanationTxt5ARCHBOLD MEDICAL CENTER'S (AMC) COMPENSATION COMMITTEE (COMMITTEE) OF THE AMC BOARD OF TRUSTEES MAKES RECOMMENDATIONS TO THE FULL AMC BOARD ON THE FOLLOWING POSITIONS: THE PRESIDENT OF AMC AND THE PRESIDENT OF THE ARCHBOLD FOUNDATION. AMC'S PRESIDENT PRESENTS RECOMMENDATIONS FOR ALL SENIOR VICE PRESIDENTS, VICE PRESIDENTS, AND OTHER KEY EMPLOYEES OF AMC AND ALL RELATED ARCHBOLD ENTITIES TO THE COMMITTEE. SINCE AMC HAS RESERVE POWERS FOR ARCHBOLD RELATED ENTITIES, THE COMMITTEE SERVES AS THE COMPENSATION COMMITTEE FOR EACH APPLICABLE ARCHBOLD ENTITY. THE COMMITTEE CONSIDERS THE AMC PRESIDENT'S RECOMMENDATIONS, BUT IT ALSO CONSIDERS RECOMMENDATIONS AND INDEPENDENT MARKET DATA ANALYSIS FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE AMC BOARD UTILIZES AN INDEPENDENT COMPENSATION CONSULTANT TO REVIEW THE EXECUTIVE COMPENSATION PROGRAM AND MAKE RECOMMENDATIONS REGARDING PLAN DESIGN AND ACTUAL COMPENSATION INCLUDING BENEFITS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6SEE 15A ABOVE.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7NO DOCUMENTS ARE OR WILL BE MADE AVAILABLE TO THE PUBLIC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt8CONTRACTED SERVICES 8,239,448 0 0 PURCHASED SERVICES 2,544 0 0 TOTAL 8,241,992 0 0
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IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PAGE 6, PART VI, LINE 12C
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IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc7FORM 990, PAGE 6, PART VI, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc8FORM 990, PART IX, LINE 11G
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IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt2ROSE CITY INVESTMENTS & RENTALS INC
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IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt1JOHN D ARCHBOLD MEM HOSPITAL INC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt2ARCHBOLD FOUNDATION INC
IRS990ScheduleR/IdRelatedTaxExemptOrgGrp/DisregardedEntityName/BusinessNameLine1Txt3ARCHBOLD HEALTH SERVICES INC
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IRS990ScheduleR/SupplementalInformationDetail/ExplanationTxt0ROSE CITY INVESTMENTS & RENTALS, INC., HAVING BEEN INACTIVE FOR SEVERAL YEARS, WAS OFFICIALLY DISSOLVED AS A CORPORATION ON SEPTEMBER 23, 2019 UNDER THE LAWS OF THE STATE OF GEORGIA.
IRS990ScheduleR/SupplementalInformationDetail/FormAndLineReferenceDesc0SCHEDULE R
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