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)
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