Financial and Organizational Information Regarding Our Hospital
| Transparency Completeness Checklist (HB 321 & HB 186) Prepared by the Georgia Alliance of Community Hospitals and Georgia Hospital Association |
||
| HB 321 Document/List/Report Required: | Special Requirements/Notes: | Date Posted: |
| Consolidated Financial Statements including Hospital | Contains HB 321 required note (gross patient revenue, allowances, charity care, and net patient revenue) | 10/01/19 |
| Combining or Consolidating Schedules/Financial Information break out for Hospital Subsidiaries | Contains GAAS required report: see Independent Auditor's Report in Audited Financials | 10/01/19 |
| IRS Form 990 | Copies of Schedule H and other filed Schedules (except Schedule B) | 10/01/19 |
| AHQ | 248 Annual Hospital Questionnaire Final and Filed | 10/01/19 |
| Medicaid DSH Survey | DSH Survey Part I DSH Survey Part II |
10/01/19 |
| List of Real Property Holdings Owned by Hospital | 10/01/19 | |
| List of Hospital Indebtedness GACH/GHA template: see Audited Financial Statements, Note 7 |
Does not include names of any bond disclosure sites to which hospital submitted info | 10/01/19 |
| Report of End of Year Net Assets (see Audited Financials, Note 8) | Includes assets for hospital, parent, subsidiaries, and foundation controlled or owned by hospital or parent | 10/01/19 |
| Dated Organizational Chart | 10/01/19 | |
| Compensation Benefits Report | 10/01/19 | |
| Evidence of Hospital Accreditation (e.g. the Joint Commission or DNV) | 10/01/19 | |
| Indigent and Charity Care Policy | 10/01/19 | |
| Debt Collection Policy | 10/01/19 | |
| Audited Financial Statements - Hospital | N/A | 10/01/19 |
| Audited Financial Statements - Hospital Parent Company | N/A | 10/01/19 |
| Combining or Consolidating Schedules/Financial Information break out for Hospital & Brother/Sister Co. | N/A | 10/01/19 |
| Audited Financial Statements - Hospital Subsidiaries | N/A | 10/01/19 |
| Alternative IRS Form 990 (if available) | N/A | 10/01/19 |
| Community Benefit Report | N/A | 10/01/19 |
| List of Hospital JVs and Ownership Interests | N/A | 10/01/19 |
| Statement that there is no going concern disclosure in the hospital's audited financial statements | N/A | 10/01/19 |
| Copy of any "going concern" note in Hospital Financial Statements | N/A | 10/01/19 |
| HB 186 Documents Required: | Special Requirements: | Date Posted: |
| Any ASC Surveys Filed by Hospital | N/A | 10/01/19 |
| Any Imaging Center Surveys by Hospital | N/A | 10/01/19 |