Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | 15,218,723 | 17,177,580 | 19,293,433 | 21,446,055 | 25,625,873 | 98,761,664 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | 15,218,723 | 17,177,580 | 19,293,433 | 21,446,055 | 25,625,873 | 98,761,664 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support (Subtract line 7c from line 6.) | 98,761,664 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 15,218,723 | 17,177,580 | 19,293,433 | 21,446,055 | 25,625,873 | 98,761,664 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 8,500 | 8,500 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 8,500 | 8,500 | ||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 68,334 | -23,034 | 45,300 | |||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 1,677 | 1,677 | ||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 15,220,400 | 17,186,080 | 19,361,767 | 21,423,021 | 25,625,873 | 98,817,141 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE OF THE BOARD SHALL CONSIST OF THREE DIRECTORS, WHICH SHALL INCLUDE THE CHAIR OF THE BOARD, THE CEO OF AHC, AND ONE OTHER MEMBER OF THE BOARD, WHO MUST ALSO BE A MEMBER OF THE AHC BOARD AND BE APPROVED BY THE AHC BOARD (THE "AHC BOARD MEMBER"). THE CHAIR OF THE BOARD SHALL ACT AS THE CHAIR OF THE EXECUTIVE COMMITTEE. IN THE EVENT OF A CONFLICT OR UNAVAILABILITY OF THE AHC BOARD MEMBER FOR A PARTICULAR EXECUTIVE COMMITTEE MEETING, THE CHAIR OF THE BOARD MAY APPOINT ANOTHER MEMBER OF THE BOARD TO THE EXECUTIVE COMMITTEE FOR SUCH MEETING, PROVIDED THAT SUCH INDIVIDUAL MUST BE WITHOUT PERSONAL OR FINANCIAL INTEREST IN THE PARTICULAR ISSUES TO BE DISCUSSED IN SUCH EXECUTIVE COMMITTEE MEETING, WHICH WOULD AMOUNT TO A CONFLICT OF INTEREST. THE EXECUTIVE COMMITTEE MAY EXERCISE THE AUTHORITY OF THE BOARD AND SHALL HAVE POWER TO TRANSACT ALL BUSINESS OF THE BOARD AND THE MANAGEMENT OF THE CORPORATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD, SUBJECT TO THE LIMITATIONS SET FORTH IN THESE BYLAWS. |
| FORM 990, PART VI, SECTION A, LINE 6 | AUGUSTA HEALTH CARE, INC. (AHC) IS THE SOLE MEMBER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CORPORATION'S BOARD OF DIRECTORS SHALL BE ELECTED BY THE AHC BOARD OF DIRECTORS TO TERMS OF ONE YEAR EACH MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BOARD OF AHC HAS THE EXCLUSIVE POWER TO APPROVE: (1) OPERATING, RESEARCH AND EDUCATION, BUDGET, AND CAPITAL EXPENDITURES, (2) COMPENSATION OF PHYSICIANS, (3) INCURRENCE OF DEBT, INCLUDING LEASES OR LINES OF CREDIT, (4) THE SALE, LEASE, EXCHANGE, MORTGAGE, ENCUMBRANCE, OR OTHER DISPOSITION OF ASSETS OTHER THAN IN THE ORDINARY COURSE OF BUSINESS, (5) ELECTION OF THE MEMBERS OF THE BOARD OF DIRECTORS, (6) REMOVAL OF THE MEMBERS OF THE BOARD OF DIRECTORS, WITH OR WITHOUT CAUSE, (7) ELECTION OF THE EXECUTIVE DIRECTOR, (8) AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION AND/OR BYLAWS, (9) MERGERS, DISSOLUTIONS, AND MAJOR CORPORATE TRANSACTIONS DEFINED IN THE BYLAWS, (10) THE ESTABLISHMENT OF POLICIES IN CONNECTION WITH MAJOR POLICY ISSUES WHICH THE CORPORATION MUST ADOPT AND FOLLOW, AND (11) SUPPORTING ANY ORGANIZATION DEEMED BY THE PRESIDENT OF AHC TO BE A COMPETITOR OF AHC OR ANY OF ITS OPERATING DIVISIONS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT OF AUGUSTA HEALTH CARE INC. THE CFO AND ACCOUNTING DIRECTOR OF AUGUSTA HEALTH REVIEWED THE 990 DRAFT. REQUESTED CHANGES AND CORRECTIONS WERE ADDRESSED BY THE TAX PREPARER. THE FINAL DRAFT OF THE RETURN WAS POSTED ON THE ORGANIZATION'S INTERNAL WEBSITE WITH ACCESS RESTRICTED TO THE BOARD. ALL QUESTIONS AS A RESULT OF THIS POSTING WERE RESOLVED AND ANSWERED TIMELY. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE GOVERNANCE COMMITTEE OF AUGUSTA HEALTH CARE, INC. IS CHARGED WITH REVIEWING THE CONFLICT OF INTEREST STATEMENTS EACH YEAR. THE REVIEW IS CONDUCTED IN APRIL AFTER THE ANNUAL BOARD MEETING AND IS ADDITIONALLY REVIEWED AS CHANGES OCCUR IN CIRCUMSTANCES AND IS CONSIDERED IN MANAGEMENT'S GOVERNANCE DECISION MAKING. CONFLICTS OF INTEREST ARE REVIEWED AS A MATTER OF BUSINESS AT EVERY BOARD AND COMMITTEE MEETING. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THOSE FOUND TO BE IN A CONFLICT OF INTEREST MUST ABSTAIN FROM VOTING AND MAY BE ASKED TO LEAVE THE MEETING DEPENDING ON THE TOPIC AND THEIR DEGREE OF CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15A | AUGUSTA MEDICAL GROUP WORKS WITH HUMAN RESOURCES PERSONNEL OF AUGUSTA HEALTH CARE, INC. TO ESTABLISH COMPENSATION FOR KEY EMPLOYEES. IN TURN, AUGUSTA HEALTH CARE, INC. UTILIZES THE SERVICES OF INTEGRATED HEALTHCARE STRATEGIES, 901 MARQUETTE AVE S., SUITE 2100, MINNEAPOLIS, MN TO DETERMINE COMPETITIVE WAGE RANGES, VARIABLE COMPENSATION AND PERQUISITES FOR EXECUTIVE POSITIONS. IT IS THE GOAL OF THE AUGUSTA HEALTH BOARD TO SATISFY THE FOLLOWING OBJECTIVES: COMPETITIVENESS, STRATEGIC ALIGNMENT, REGULATORY COMPLIANCE AND PUBLIC TRUST. THE BENCHMARKS USED ARE 50TH AND 60TH PERCENTILE OF SIMILAR POSITIONS IN PEER INSTITUTIONS FOR EXPERIENCED PROFESSIONALS. FINDINGS OF THE CONSULTANT ARE REVIEWED BY THE BOARD OF DIRECTORS OF AUGUSTA HEALTH, INC., THE SOLE MEMBER. |
| FORM 990, PART VI, SECTION C, LINE 18 | PHOTOCOPIES OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ACCOUNTING OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ACCOUNTING OFFICE. PLEASE DIRECT ALL REQUESTS TO: AUGUSTA HEALTH CARE, INC. ATTN: DIRECTOR OF ACCOUNTING P.O. BOX 1000 FISHERSVILLE, VA 22939-1000 |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 99,407. MANAGEMENT AND GENERAL EXPENSES 64,687. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 164,094. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 6,472,418. MANAGEMENT AND GENERAL EXPENSES 104,845. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,577,263. OTHER FEES: PROGRAM SERVICE EXPENSES 87,766. MANAGEMENT AND GENERAL EXPENSES 99,838. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 187,604. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| FORM 990, PART III, LINE 4A | AUGUSTA MEDICAL GROUP ("AMG") IS ORGANIZED AND OPERATED IN MANNER THAT SUPPORTS AUGSUTA HEALTH CARE'S ("AHC") CHARITABLE PURPOSES THROUGH THE OWNERSHIP AND OPERATION OF A COMMUNITY PHYSICIAN DEVELOPMENT SERVICE. THIS SERVICE PROVIDES A MEANS TO ENABLE AHC TO: (I) RECRUIT AND EMPLOY A STABLE BASE OF PHYSICIANS TO SUPPORT THE LEVEL OF MEDICAL CARE PROVIDED THROUGH AHC; (II) RECRUIT AND EMPLOY PHYSICIANS IN A BROAD ARRAY OF SPECIALTIES TO ENHANCE THE OVERALL LEVEL OF SPECIALIZED CARE AVAILABLE WITHIN THE GREATER AUGUSTA COUNTY, VIRGINIA COMMUNITY; (III) CREATE A VEHICLE FOR FUTURE COLLABORATION BETWEEN THE HOSPITAL AND ITS MEDICAL STAFF; AND (IV) STABILIZE THE PROVISION OF PRIMARY CARE THROUGH EXISTING PHYSICIAN PRACTICES IN THE GREATER AUGUSTA COUNTY, VIRGINIA AREA. DEVELOPING THIS PHYSICIAN BASE THROUGH PHYSICIAN RECRUITMENT EFFORTS, PHYSICIAN AFFILIATIONS AND/OR EMPLOYMENT AGREEMENTS, AMG HELPS AHC PROVIDE THE COMMUNITY AN ADEQUATE NUMBER OF QUALIFIED PHYSICIANS PRACTICING IN HOSPITAL-BASED SPECIALTIES. AMG ALSO OWNS AND OPERATES PHYSICIAN PRACTICES AND PROVIDES OTHER HEALTHCARE RELATED OUTPATIENT SERVICES IN THE COMMUNITY SERVED BY AUGUSTA HEALTH. AS WITH AHC, AMG ENSURES THAT PATIENTS ARE TREATED FOR MEDICALLY NECESSARY CONDITIONS REGARDLESS OF RACE, RELIGION, ETHNICITY OR ABILITY TO PAY, IN A MANNER CONSISTENT WITH AHC'S CHARITY CARE PROGRAM. IN RECOGNIZING THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES, AMG DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. |
| FORM 990, PART VI, LINE 1: | THE ORGANIZATION DOES NOT HAVE A MAJORITY INDEPENDENT BOARD PER THE IRS'S DEFINITION OF AN INDEPENDENT BOARD MEMBER DUE TO COMPENSATION FROM RELATED ORGANIZATIONS; HOWEVER, AUGUSTA MEDICAL GROUP WAS FORMED TO SUPPLEMENT THE SERVICES OF ITS SOLE MEMBER, AUGUSTA HEALTH CARE, INC., AND THROUGH A SIGNIFICANT DEGREE OF MANAGEMENT, GOVERNANCE RESERVED POWERS, AND APPOINTMENT RIGHTS, THE SOLE MEMBER HAS EFFECTIVE OVERSIGHT OVER THE ORGANIZATION. THE BOARD OF AUGUSTA HEALTH CARE, INC. HAS AN INDEPENDENT MAJORITY. |
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