SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
Medium right arrow Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow Attach to Form 990.
Medium right arrow Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
Name of the organization
JOHN D ARCHBOLD MEMORIAL
HOSPITAL INC
Employer identification number

58-0566121
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    15,984,641   15,984,641 3.990 %
b Medicaid (from Worksheet 3, column a) . . . . .     42,322,864 42,300,590 22,274 0.010 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     644,661 617,796 26,865 0.010 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     58,952,166 42,918,386 16,033,780 4.000 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     5,941,400   5,941,400 1.480 %
f Health professions education (from Worksheet 5) . . .     1,761,066   1,761,066 0.440 %
g Subsidized health services (from Worksheet 6) . . . .     35,414,064   35,414,064 8.840 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     96,000   96,000 0.020 %
j Total. Other Benefits . .     43,212,530   43,212,530 10.790 %
k Total. Add lines 7d and 7j .     102,164,696 42,918,386 59,246,310 14.800 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and
training for community members
           
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
37,846,529
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
60,788,408
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
61,098,186
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-309,778
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?4Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General Medical and Surgical Children's Hospital Teaching Hospital Critical Access Hospital Research Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 JOHN D ARCHBOLD MEM HOSP
DBA ARCHBOLD MEMORIAL
P O BOX 1018
THOMASVILLE,GA317991018
WWW.ARCHBOLD.ORG
136-91
X X         X   PSYCH, REHAB, NURSING HOME A
2 GRADY GENERAL HOSPITAL
DBA ARCHBOLD GRADY
1155 FIFTH STREET SE
CAIRO,GA31728
WWW.ARCHBOLD.ORG
065-413
X X         X   SWING BED SNF A
3 BROOKS COUNTY HOSPITAL
DBA ARCHBOLD BROOKS
903 N COURT ST
QUITMAN,GA31643
WWW.ARCHBOLD.ORG
014-028
X       X   X   RHC, SWING BED SNF A
4 MITCHELL COUNTY HOSPITAL
DBA ARCHBOLD MITCHELL
90 STEPHENS ST
CAMILLA,GA31730
WWW.ARCHBOLD.ORG
101-120
X       X   X   NURSING HOME, RHC, SWING BED A
Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
A
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1234
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 22
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): WWW.ARCHBOLD.ORG
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
A
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
WWW.ARCHBOLD.ORG
b
WWW.ARCHBOLD.ORG
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
Page 6
Part VFacility Information (continued)

Billing and Collections
A
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
A
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 3E THE COMMUNITY HEALTH NEEDS ASSESSMENT FOR 2022 WAS CONDUCTED FOR EACH COUNTY IN THE SERVICE AREA. THE TOP 3 SIGNIFICANT HEALTH NEEDS FOR BROOKS, GRADY, MITCHELL AND THOMAS COUNTIES WERE - DIABETES, OBESITY AND HIGH BLOOD PRESSURE. OTHER SIGNIFICANT HEALTH NEEDS IDENTIFIED BY THE COMMUNITY INCLUDE HEART DISEASE, MENTAL HEALTH, CANCER, DRUG ADDICTION, BACK OR JOINT PAIN, COVID-19, ALCOHOL ABUSE, AND ACCESS TO VACCINES. A COMPLETE DISCUSSION OF THE HEALTH NEEDS FOR EACH COUNTY MAY BE FOUND AT - HTTPS://WWW.ARCHBOLD.ORG/ABOUT/COMMUNITY-HEALTH-NEEDSASSESSMENTS/.
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 5 INPUT FROM COMMUNITY MEMBERS REPRESENTING THE BROADER INTERESTS OF THE COUNTY WAS GATHERED THROUGH A COMBINATION OF ONLINE AND WRITTEN SURVEYS. THESE EFFORTS YIELDED INFORMATION THAT WILL BE USED IN ADDRESSING BARRIERS, ALLOCATING RESOURCES AND ASSETS AND DETERMINING OPPORTUNITIES TO SUPPORT. INPUT WAS CONSIDERED IN DETERMINING GAPS IN SERVICES AND TO IDENTIFY WHETHER DEVELOPING NEW RELATIONSHIPS AND PARTNERSHIPS WAS NECESSARY TO MEET THE NEEDS OF THE COMMUNITY. THIS YEAR WE ENHANCED OUR APPROACH TO OBTAINING THIS INFORMATION FROM OUR COMMUNITIES. AN ONLINE SURVEY WAS ACCESSIBLE THROUGH OUR WEBSITE (ARCHBOLD.ORG), ARCHBOLD SOCIAL MEDIA CHANNELS INCLUDING FACEBOOK, INSTAGRAM AND TWITTER. A PRESS RELEASE WAS SENT TO THE THOMASVILLE TIMES-ENTERPRISE ASKING FOR THE COMMUNITY'S PARTICIPATION. A WEBSITE LINK AND/OR PAPER COPIES OF THE SURVEY WERE SENT TO THE FOLLOWING ENTITIES: O DOUGLASS HIGH SCHOOL ALUMNI ASSOCIATION- SURVEY LINK O MAGNOLIA HIGH SCHOOL ALUMNI-SURVEY LINK O SOUTHWEST GEORGIA TECHNICAL COLLEGE-SURVEY LINK O THOMAS COUNTY FAMILY CONNECTION-SURVEY LINK O THOMAS/GRADY UGA EXTENSION-SURVEY LINK O THOMAS COUNTY HEALTH DEPARTMENT-PAPER COPIES AND SURVEY LINK O PRIMARY CARE OF SOUTHWEST GEORGIA-PAPER COPIES AND SURVEY LINK O ARCHBOLD EMPLOYEES-SURVEY LINK O THOMAS COUNTY EMPLOYEES-SURVEY LINK O CITY OF THOMASVILLE EMPLOYEES-SURVEY LINK O THOMASVILLE-THOMAS COUNTY CHAMBER OF COMMERCE-SURVEY LINK O COMMUNITY OUTREACH TRAINING CENTER-SURVEY LINK O JACK HADLEY BLACK HISTORY MUSEUM-SURVEY LINK
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 6A THE NEEDS ASSESSMENT WAS CONDUCTED FOR JOHN D. ARCHBOLD MEMORIAL HOSPITAL ALONG WITH GRADY GENERAL HOSPITAL, BROOKS COUNTY HOSPITAL AND MITCHELL COUNTY HOSPITAL. (DURING FY 2023, JOHN D. ARCHBOLD MEMORIAL HOSPITAL, GRADY GENERAL HOSPITAL, BROOKS COUNTY HOSPITAL, AND MITCHELL COUNTY HOSPITAL BEGAN DOING BUSINESS AS ARCHBOLD MEMORIAL, ARCHBOLD GRADY, ARCHBOLD BROOKS, AND ARCHBOLD MITCHELL, RESPECTIVELY.)
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 7D DISTRIBUTED COPIES TO THE COMMUNITY; AVAILABLE ONLINE
GROUP A, FACILITY 1, JOHN D. ARCHBOLD MEM HOSP - PART V, LINE 11 QUALITATIVELY, THE GREATEST MEDICAL NEEDS ACCORDING TO COMMUNITY PERCEPTION INCLUDED: 1. DIABETES 2. OBESITY 3. HIGH BLOOD PRESSURE 4. HEART DISEASE 5. MENTAL HEALTH ISSUES 6. CANCER 7. DRUG ADDICTION 8. BACK/JOINT PAIN 9. COVID-19 10. ALCOHOL ABUSE 11. LUNG DISEASE 12. ACCESS TO VACCINES NEEDS NOT ADDRESSED NOT ALL HEALTH NEEDS ARE EASILY ADDRESSED BY ARCHBOLD. FURTHER, KEEPING TOO BROAD OF A FOCUS WILL DILUTE THE IMPACT WE CAN HAVE ON EACH HEALTH NEED. THESE ARE SOME OF THE PRIMARY REASONS WE AREN'T ADDRESSING SOME HEALTH NEEDS IN OUR IMPLEMENTATION PLAN. OUR BIGGEST OPPORTUNITY IS TO HELP WITH IMPROVING DISEASE STATES BY ADDRESSING OBESITY AND REMAINING AVAILABLE FOR ASSISTANCE WITH OTHER HEALTH NEEDS AS REQUESTED AND AS TIME AND FINANCES PERMIT.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2022
Page 9
Schedule H (Form 990) 2022
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?8
Name and address Type of Facility (describe)
1 GLENN-MOR NURSING HOME
DBA ARCHBOLD LIVING THOMASVILLE
10629 U S HIGHWAY 19 S
THOMASVILLE,GA31792
SKILLED NURSING HOME
2 JDA PSYCHIATRIC UNIT
DBA ARCHBOLD NORTHSIDE
P O BOX 1018
THOMASVILLE,GA31792
PSYCHIATRIC UNIT
3 JDA REHABILITATION UNIT
DBA ARCHBOLD MEMORIAL REHAB
P O BOX 1018
THOMASVILLE,GA31792
REHABILITATION UNIT
4 MITCHELL CO CONVALESCENT CENTER
DBA ARCHBOLD LIVING CAMILLA
90 STEPHENS STREET
CAMILLA,GA31728
SKILLED NURSING HOME
5 CAMILLA PEDIATRICS CENTER
DBA ARCHBOLD PEDIATRICS CAMILLA
P O BOX 360
CAMILLA,GA31728
RURAL HEALTH CLINIC
6 MEDICAL GROUP OF MITCHELL COUNTY
DBA ARCHBOLD PRIMARY CARE CAMILLA
P O BOX 360
CAMILLA,GA31728
RURAL HEALTH CLINIC
7 ARCHBOLD PELHAM PRIMARY CARE CLINIC
DBA ARCHBOLD PRIMARY CARE PELHAM
P O BOX 360
CAMILLA,GA31728
RURAL HEALTH CLINIC
8 PELHAM PARKWAY NURSING HOME
DBA ARCHBOLD LIVING PELHAM
608 DOGWOOD DRIVE NE
PELHAM,GA31797
SKILLED NURSING HOME
9
10
Schedule H (Form 990) 2022
Page 10
Schedule H (Form 990) 2022
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
SCHEDULE H, PART I, LINE 7 THE ORGANIZATION USES THE COST TO CHARGE RATIO USING THE IRS' RECOMMENDED FORMAT IN WORKSHEET 2. OTHER COSTS IN PART I LINES 7E THROUGH 7I WERE OBTAINED FROM THE ORGANIZATION'S ACCOUNTING RECORDS.
SCHEDULE H, PART III, LINE 2 AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AND INCLUDES IMPLICIT PRICE CONCESSIONS. SEE THE DISCUSSION OF IMPLICIT PRICE CONCESSIONS IN FOOTNOTE 2 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, LINE 4 SEE THE DISCUSSION OF PRICE CONCESSIONS AND NET PATIENT SERVICE REVENUE IN FOOTNOTE 2 IN THE ATTACHED AUDITED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS.
SCHEDULE H, PART III, LINE 9B PATIENTS THAT ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE ARE APPROVED FOR A PERIOD OF 6 MONTHS. THE PATIENTS ARE REQUIRED TO CONTACT THE FINANCIAL ASSISTANCE OFFICE DURING THIS POINT IF THEY INCUR ADDITIONAL CHARGES THAT QUALIFY FOR FINANCIAL ASSISTANCE DURING THIS TIME PERIOD. THE SAME PROCESS IS IN EFFECT FOR THE PATIENTS WHO QUALIFY FOR THE SLIDING FEE DISCOUNT. THIS DISCOUNT WILL LIMIT THE PATIENTS TO AN OUT OF POCKET MAXIMUM AMOUNT IN THE GIVEN TIME PERIOD. WE DO NOT HAVE ANY AUTOMATIC ADJUSTMENTS OR AN AUTOMATED SYSTEM TO TRACK THE PREVIOUSLY APPROVED PATIENTS.
SCHEDULE H, PART VI, LINE 2 REVIEW OF ASSESSMENTS OF OTHER ORGANIZATIONS THAT IDENTIFY NEEDS AND HAVE ON-GOING PARTICIPATION WITH THOSE ORGANIZATIONS. COLLECT, REVIEW AND USE PRIMARY, SECONDARY AND QUALITATIVE DATA IN DETERMINING NEEDS. UPDATE COMMUNITY HEALTH STATUS AS LOCAL, STATE AND FEDERAL DATA IS REPORTED. REVIEW INTERNAL DATA SUCH AS SCREENING OUTCOMES AND PATIENT VOLUMES FOR SERVICES. RESPONSE TO REQUESTS FROM COMMUNITY, INPUT FROM A GROUP MEETING OF THE DOUGLASS HIGH SCHOOL ALUMNI ASSOCIATION, SEVERAL WRITTEN SURVEYS AND A TELEPHONE INTERVIEW. THE ORGANIZATION ANALYZES QUANTITATIVE FEDERAL, STATE AND LOCAL DATA AS WELL AS SEEKS QUALITATIVE INPUT FROM MEMBERS OF THE COMMUNITY, ESPECIALLY THE UNDERSERVED. THE ORGANIZATION ALSO ASSESSES THE NEEDS OF THE COMMUNITY THROUGH UTILIZING ASSESSMENTS CONDUCTED BY OTHER COMMUNITY ORGANIZATIONS, REVIEWING INTERNAL DATA ON PATIENT VOLUMES AND SCREENING OUTCOMES, PARTICIPATING IN COMMUNITY ORGANIZATIONS THAT IDENTIFY NEEDS, SPONSORING COMMUNITY EDUCATION TASK FORCES THAT PROVIDE INPUT AND RESPONDING TO SPECIFIC REQUESTS FROM COMMUNITY MEMBERS. COPIES OF THE 2022-2023 CHNA'S AND THE RELATED IMPLEMENTATION PLAN CAN BE FOUND AT THE FOLLOWING WEB ADDRESSES: HTTPS://WWW.ARCHBOLD.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/
SCHEDULE H, PART VI, LINE 3 ANNUAL NOTICES ARE PLACED IN THE NEWSPAPERS FOR THE COUNTIES WE SERVE WITH HEALTHCARE. NOTICE OF THE FAP PROGRAM IS CONTAINED IN THE PATIENT HANDBOOK, SIGNS AND BROCHURES OUTLINING THE AVAILABILITY OF THE FAP PROGRAM ARE AVAILABLE AT POINTS OF ACCESS FOR PATIENTS, PAPER APPLICATIONS ARE AVAILABLE AT ALL ADMISSION AREAS AND BUSINESS OFFICES, ELECTRONIC VERSION OF THE APPLICATION CAN BE DOWNLOADED FREE OF CHARGE VIA WEBSITE AND THE ASSISTANCE PROGRAM IS DISCUSSED IN DETAIL DURING COLLECTION CALLS WITH PATIENTS.
SCHEDULE H, PART VI, LINE 4 COUNTIES SERVED IN GEORGIA INCLUDE BROOKS, GRADY, MITCHELL, THOMAS. DISPROPORTIONATE HEALTHCARE NEEDS, FEDERALLY DESIGNATED AS MEDICALLY UNDERSERVED AREAS (MUA) OR HEALTH PROFESSIONAL SHORTAGE AREAS (HSPA), LOW INCOME, PUBLIC HOUSING RESIDENTS, SENIORS, MIGRANT WORKERS, UNINSURED, UNDERINSURED, MIXTURE OF ETHNICITIES, ALL AGES, MIXTURE OF EDUCATIONAL LEVELS. BROOKS COUNTY: ESTIMATED POPULATION 16,253, 60.8% WHITE/34% BLACK, MEDIAN HH INCOME 42,263, 25.5% LIVING IN POVERTY, 17.3% UNDER 65 UNINSURED GRADY COUNTY: ESTIMATED POPULATION 26,008, 66.2% WHITE/29.7% BLACK, MEDIAN HH INCOME 51,929, 21.6% LIVING IN POVERTY, 19.5% UNDER 65 UNINSURED MITCHELL COUNTY: ESTIMATED POPULATION 21,116, 50.2% WHITE/46% BLACK, MEDIAN HH INCOME 45,966, 22.7% LIVING IN POVERTY, 17.4% UNDER 65 UNINSURED THOMAS COUNTY: ESTIMATED POPULATION 45,561, 60.6% WHITE/36% BLACK, MEDIAN HH INCOME 55,958, 19.8% LIVING IN POVERTY, 15.4% UNDER 65 UNINSURED INFORMATION OBTAINED FROM WWW.CENSUS.GOV - QUICK FACTS UPDATED 12/14/23
SCHEDULE H, PART VI, LINE 5 LIVE BETTER IS THE ARCHBOLD-LED INITIATIVE FOCUSED ON IMPROVING THE HEALTH OF THE CITIZENS OF THOMAS COUNTY. LIVE BETTER WORKS PRIMARILY WITH LOCAL SCHOOL SYSTEMS IN PROVIDING MONTHLY HEALTH EDUCATION MATERIAL TO ALL K-5 STUDENTS IN THOMAS COUNTY. LIVE BETTER ALSO PROVIDES OPPORTUNITIES FOR BOTH KIDS AND ADULTS TO STAY ACTIVE THROUGH ANNUAL 5K AND ONE-MILE FUN RUNS. OUTSIDE OF THE LIVE BETTER INITIATIVE, ARCHBOLD PROVIDES FREE HEALTH SCREENS AND EDUCATIONAL HEALTH TALKS TO THE COMMUNITY THROUGHOUT THE YEAR. OBESITY IS A PREVENTABLE CONDITION, YET THE COMMON RISK FACTOR WITH THE MOST PROMINENT HEALTH ISSUES IN THOMAS COUNTY: HEART DISEASE, HYPERTENSION, STROKE, COPD, VASCULAR DISEASE, DIABETES AND CANCER.
SCHEDULE H, PART VI, LINE 6 ARCHBOLD MEDICAL CENTER, INC. AS THE PARENT CORPORATION HAS SOLE CONTROL OVER ITS NONPROFIT SUBSIDIARIES, JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC., ARCHBOLD FOUNDATION, INC., AND ARCHBOLD MEDICAL GROUP, INC. (EFFECTIVE 1/1/2023, ARCHBOLD HEALTH SERVICES, INC., WHICH PROVIDES AMBULATORY HEALTH CARE SERVICES, MERGED WITH AND INTO JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC.) JOHN D. ARCHBOLD MEMORIAL HOSPITAL, INC. OPERATES HOSPITALS (ARCHBOLD MEMORIAL, ARCHBOLD GRADY, ARCHBOLD BROOKS, AND ARCHBOLD MITCHELL) AND LONG-TERM CARE FACILITIES ARCHBOLD LIVING THOMASVILLE, ARCHBOLD LIVING CAMILLA, ARCHBOLD LIVING PELHAM, AND ARCHBOLD LIVING CAIRO. ARCHBOLD FOUNDATION, INC. IS A SUPPORT FOUNDATION WITH THE SOLE PURPOSE OF BUILDING AND SUSTAINING A FINANCIAL LEGACY THAT SUPPORTS JOHN D. ARCHBOLD MEMORIAL HOSPITAL AND ITS AFFILIATED ENTITIES. ARCHBOLD MEDICAL GROUP, INC. EMPLOYS PHYSICIANS AND OTHER SUPPORT PERSONNEL TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES ESSENTIAL TO THE PREVENTION AND TREATMENT OF DISEASE FOR THE BENEFIT OF ALL INDIVIDUALS IN THE SERVICE AREA. ARCHBOLD MEDICAL GROUP, INC. ALSO SERVES AS THE SOLE MEMBER OF CCSG, INC. AND AMGIR, INC., BOTH 501(C)(3) ORGANIZATIONS WHICH OPERATE MEDICAL CLINICS.
Schedule H (Form 990) 2022
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