Financial and Organizational Information Regarding Our Hospital
| Transparency Completeness Checklist (HB 321 & HB 186) Prepared by the Georgia Alliance of Community Hospitals (GACH) and Georgia Hospital Association (GHA) |
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| HB 321 Document/List/Report Required: | Special Requirements/Notes: | Date Posted: |
| Consolidated Financial Statements including Hospital Previous: FY21 Statements - 03-31-2021 FY20 Statements - 06-26-2020 FY19 Statements - 10-01-2019 |
Contains HB 321 required note (gross patient revenue, allowances, charity care, and net patient revenue) | 07-01-2022 |
| Combining or Consolidating Schedules/Financial Information break out for Hospital Subsidiaries Previous: 2021 Schedules - 07-07-2021 2020 Schedules - 06-26-2020 2019 Schedules - 10-01-2019 |
Contains GAAS required report: see Independent Auditor's Report in Audited Financials | 07-01-2022 |
| IRS Form 990 Previous: FY20 Form - 07-07-2021 FY19 Form - 06-26-2020 FY18 Form - 10-01-2019 |
Copies of Schedule H and other filed Schedules (except Schedule B) | 07-01-2022 |
| Annual Hospital Questionnaire (AHQ) Previous: 2020 AHQ - 07-07-2021 2019 AHQ - 06-26-2020 2018 AHQ - 10-01-2019 |
248 Annual Hospital Questionnaire Final and Filed | 07-01-2022 |
| Medicaid Disproportionate Share Hospital (DSH) Survey Previous: 2019 DSH Survey - 07-07-2021 2018 DSH Survey - 06-26-2021 2017 DSH Survey: part 1 & part 2 - 10-01-2019 |
Disproportionate Share Hospital (DSH) Examination Parts I & II | 07-01-2022 |
| List of Real Property Holdings Owned by Hospital | 07-01-2022 | |
| List of Hospital Indebtedness GACH/GHA template: see Audited Financial Statements, Note 8 Previous: FY21 Statements - 03-31-2021 FY20 Statements - 06-26-2020 FY19 Statements - 10-01-2019 |
Does not include names of any bond disclosure sites to which hospital submitted info | 07-01-2022 |
| Report of End of Year Net Assets: see Audited Financials, Note 9 Previous: FY21 Statements - 07-07-2021 FY20 Statements - 06-26-2020 FY19 Statements - 10-01-2019 |
Includes assets for hospital, parent, subsidiaries, and foundation controlled or owned by hospital or parent | 07-01-2022 |
| Dated Organizational Chart - 03-01-2022 Previous: Dated Organizational Chart - 10-18-2021 Dated Organizational Chart - 07-12-2021 Dated Organizational Chart - 05-01-2021 Dated Organizational Chart - 11-01-2021 Corporate Chart - 10-01-2019 |
03-01-2022 | |
| Compensation Benefits Report Previous: 2020 Report - 07-07-2021 2019 Report - 06-26-2020 2018 Report - 10-01-2019 |
07-01-2022 | |
| Evidence of Hospital Accreditation (e.g. the Joint Commission or DNV) | 10-13-2021 | |
| Indigent and Charity Care Policy Previous: 2019 Policy - 10-01-2019 |
06-26-2020 | |
| Debt Collection Policy Previous: 2019 Policy - 10-01-2019 |
06-26-2020 | |
| Audited Financial Statements - Hospital | N/A | 06-26-2020 |
| Audited Financial Statements - Hospital Parent Company | N/A | 06-26-2020 |
| Combining or Consolidating Schedules/Financial Information break out for Hospital & Brother/Sister Co. | N/A | 06-26-2020 |
| Audited Financial Statements - Hospital Subsidiaries | N/A | 06-26-2020 |
| Alternative IRS Form 990 (if available) | N/A | 10-01-2019 |
| Community Benefit Report | N/A | 07-01-2022 |
| List of Hospital JVs and Ownership Interests | N/A | 10-01-2019 |
| Statement that there is no going concern disclosure in the hospital's audited financial statements | N/A | 10-01-2019 |
| Copy of any "going concern" note in Hospital Financial Statements | N/A | 10-01-2019 |
| HB 186 Documents Required: | Special Requirements: | Date Posted: |
| Shepherd Center Financial Survey Previous: 2019 Survey - 07-07-2021 2018 Survey - 11-02-2020 |
N/A | 07-01-2022 |
| Any ASC Surveys Filed by Hospital | N/A | 06-26-2020 |
| Any Imaging Center Surveys by Hospital | N/A | 10-01-2019 |