Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 | ||||||
| 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 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| 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. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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 | ||||
| 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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990 - ORGANIZATION'S MISSION | GWINNETT MEDICAL GROUP, INC., (GMGI),WAS FORMED FOR THE PURPOSE OF ESTABLISHING AND OPERATING CERTAIN HOSPITAL BASED AND CLINICAL OUTREACH PHYSICIAN SERVICES WITH OUR SERVICE COMMUNITY. GMGI EMPLOYS SPECIALTY PHYSICIANS THAT SERVE PATIENTS WITHIN GWINNETT HOSPITAL SYSTEM, INC. AND PRIMARY CARE AND OTHER PHYSICIANS THAT SERVE PATIENTS IN CLINICAL SETTINGS WITHIN THE COMMUNITY. THESE PHYSICIAN SERVICES ARE AN INTEGRAL PART OF THE HEALTHCARE MISSION OF GWINNETT HOSPITAL SYSTEM, INC. AND GWINNETT HEALTH SYSTEM, INC. |
| FORM 990 | PAGE 1 PRINCIPAL OFFICER AND SIGNING OFFICER - ROBERT T. QUATTROCCHI IS PRESIDENT AND CEO OF NORTHSIDE HOSPITAL, INC. MR. QUATTROCCHI SERVES AS THE PRINCIPAL OFFICER OF GWINNETT MEDICAL GROUP FOR FISCAL YEAR ENDED JUNE 30, 2019 SOLELY IN HIS CAPACITY AS PRESIDENT AND CEO OF NORTHSIDE HOSPITAL, INC., SUCCESSOR-IN-INTEREST BY MERGER TO GWINNETT MEDICAL GROUP, INC. SHANNON A. BANNA IS THE CFO OF NORTHSIDE HOSPITAL, INC. MS. BANNA SERVES AS THE CFO OF GWINNETT MEDICAL GROUP FOR FISCAL YEAR ENDED JUNE 30, 2019 SOLELY IN HER CAPACITY AS CFO, NORTHSIDE HOSPITAL, INC., SUCCESSOR-IN- INTEREST BY MERGER TO GWINNETT MEDICAL GROUP, INC. |
| FORM 990, PAGE 2, PART III, LINE 4A | GMGI OPERATES AN INPATIENT MEDICAL GROUP AT BOTH GWINNETT MEDICAL CENTER LAWRENCEVILLE (GMCL) AND GWINNETT MEDICAL CENTER DULUTH (GMCD), BOTH OF WHICH ARE PARTS OF GWINNETT HOSPITAL SYSTEM, INC. THE INPATIENT MEDICAL GROUP (THE GROUP) PROVIDES CARE TO PATIENTS AT BOTH GMCL AND GMCD. THE SERVICE IS AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK. THE GROUP ACCEPTS REFERRALS FROM PRIMARY CARE PRACTICES; PROVIDES MEDICAL CONSULTS AS REQUESTED; AND COVERS PATIENTS IN NEED OF ADMISSION FROM THE EMERGENCY DEPARTMENT WHO DO NOT HAVE A PRIMARY CARE PHYSICIAN. OUR INPATIENT PHYSICIANS, OR HOSPITALISTS, HAVE COMPLETED TRAINING IN INTERNAL MEDICINE AND MANY HAVE ADDITIONAL SUBSPECIALTY TRAINING. THE HOSPITALISTS ALLOW PRIMARY CARE PHYSICIANS AT GMCL AND GMCD TO FOCUS ON OUTPATIENT OR OFFICE- BASED CARE BY REFERRING HOSPITALIZED PATIENTS' CARE TO THE TEAM OF HOSPITALISTS WORKING AT GMCL AND GMCD. DURING FISCAL YEAR 2019, THE HOSPITALISTS HAD 88,830 PATIENT ENCOUNTERS. |
| FORM 990, PAGE 2, PART III, LINE 4B | GMGI OPERATES THREE UNIQUE SURGICAL PRACTICES: NEUROSURGERY & SPINE ASSOCIATES, GWINNETT TRAUMA SERVICES, AND CARDIOVASCULAR & THORACIC SURGEONS. GMCL IS A LEVEL II TRAUMA CENTER AND THE ONLY DESIGNATED TRAUMA CENTER IN GWINNETT COUNTY. THIS DESIGNATION MEANS GMCL HAS MET THE CRITERIA SET FORTH BY THE GEORGIA OFFICE OF EMERGENCY MEDICAL SERVICE AND TRAUMA TO CARE FOR CRITICALLY INJURED PATIENTS. THE GMGI TRAUMA PROGRAM IS STAFFED BY BOARD-CERTIFIED TRAUMA SURGEONS AND EMERGENCY MEDICINE PHYSICIANS. GMCL HAS ORTHOPEDIC, NEUROSURGERY AND COMPLEX FACIAL TRAUMA SPECIALISTS AVAILABLE. THIS GROUP, WHICH OPERATES IN THE STATE-OF-THE-ART STRICKLAND HEART CENTER AT GMCL, LAUNCHED IN JANUARY 2012, WITH TWO OF THE MOST EXPERIENCED AND RECOGNIZABLE SURGEONS IN THE AREA. GMGI'S TWO CARDIOTHORACIC SURGEONS POSSESS MORE THAN 45 YEARS OF CARDIAC SURGICAL EXPERIENCE. THE GOAL OF THESE PHYSICIANS IS TO PROVIDE WORLD CLASS CARDIAC CARE AND CLINICAL EXCELLENCE. BOTH SPECIALIZE IN VARIOUS OPEN HEART SURGERIES INCLUDING: AORTIC ANEURYSM SURGERY; AORTIC VALVE SURGERY; CORONARY BYPASS; MINIMALLY INVASIVE HEART SURGERY; MITRAL VALVE REPAIR AND REPLACEMENT; OPEN HEART SURGERY; AND VALVE REPAIR AND REPLACEMENT SURGERY. AT NEUROSURGERY & SPINE, PATIENTS RECEIVE COMPREHENSIVE NEUROSURGICAL CARE FROM SOME OF THE REGIONS MOST RESPECTED NEUROSURGEONS. GMGI OFFERS DISTINCT ADVANTAGES FOR THE EXPERT DIAGNOSIS AND TREATMENT OF A COMPREHENSIVE RANGE OF CEREBRAL AND SPINAL ISSUES AND CONDITIONS. WITH SPECIALIZED FELLOWSHIP TRAINING IN CEREBROVASCULAR AND SKULL BASE NEUROSURGERY, COMPLEX AND MINIMALLY INVASIVE SPINE SURGERY AND RESEARCH IN SPINAL CORD THERAPEUTICS DELIVERY, GMGI'S SURGICAL SPECIALISTS HAVE THE EXPERIENCE AND EXPERTISE FOR A RANGE OF SERVICES AND TREATMENTS. |
| FORM 990, PAGE 2, PART III, LINE 4D | OTHER PATIENT CARE PROGRAMS INCLUDE: EXPENSES CRITICAL CARE 5,130,101 OB CLINIC 4,413,869 MILES MASON KIDS CLINIC 2,295,065 NEUROLOGY 881,361 ENT 878,183 PALLIATIVE CARE 388,510 WOUND CARE 238,756 CONCUSSION 189,709 BARIATRICS 71,813 OTHER 195,875 TOTAL EXPENSES 14,683,242 TOTAL REVENUES 11,002,220 |
| FORM 990, PART V | THE SECTION 4960 EXCISE TAX DOES NOT APPLY TO THIS ORGANIZATION. ALL EMPLOYEES RECEIVING REMUNERATION IN EXCESS OF SECTION 4960(A) THRESHOLD ARE PHYSICIANS PAID FOR PROVIDING MEDICAL SERVICES. IN ADDITION, NO EMPLOYEE RECEIVED AN EXCESS PARACHUTE PAYMENT. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE SOLE MEMBER OF GWINNETT MEDICAL GROUP, INC. IS GWINNETT HEALTH SYSTEM, INC., A RELATED SECTION 501(C)(3) ORGANIZATION. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE BOARD OF DIRECTORS OF GWINNETT MEDICAL GROUP, INC. IS APPOINTED BY THE CHAIRMAN OF THE BOARD OF DIRECTORS OF GWINNETT HEALTH SYSTEM, INC. |
| FORM 990, PAGE 6, PART VI, LINE 7B | UNDER THE ORGANIZATION'S GOVERNING DOCUMENTS, CERTAIN DECISIONS MADE BY THE GOVERNING BODY MUST BE APPROVED BY THE BOARD OF DIRECTORS OF GWINNETT HEALTH SYSTEM, INC. (A RELATED SECTION 501(C)(3) PARENT ORGANIZATION AND THE SOLE MEMBER OF THE ORGANIZATION). |
| FORM 990, PAGE 6, PART VI, LINE 11B | EFFECTIVE 12:01 A.M. ON AUGUST 28, 2019, GWINNETT MEDICAL GROUP, INC. MERGED WITH AND INTO NORTHSIDE HOSPITAL, INC., AN UNRELATED GEORGIA NONPROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS EXEMPT UNDER SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE OF 1986 (THE SUCCESSOR ORGANIZATION), WITH THE SUCCESSOR ORGANIZATION SURVIVING THE MERGER. THE MERGER OCCURRED PRIOR TO THE FILING OF THIS RETURN. AFTER THE RETURN WAS PREPARED AND PRIOR TO FILING, IT WAS REVIEWED IN DETAIL BY SENIOR FINANCIAL MANAGEMENT OF THE SUCCESSOR ORGANIZATION. A SHORT PERIOD FINAL RETURN FOR GWINNETT MEDICAL GROUP, INC. WILL BE FILED SUBSEQUENT TO THE FILING OF THIS RETURN. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ANNUALLY, A CONFLICTS OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO AND DISCUSSED WITH EACH MEMBER OF THE BOARD OF DIRECTORS. THE HOSPITAL'S LEGAL DEPARTMENT IS RESPONSIBLE FOR ENSURING THESE QUESTIONNAIRES ARE SIGNED AND RETURNED. LEGAL MONITORS ALL TRANSACTIONS INVOLVING CONFLICTS OF INTEREST WITH BOARD MEMBERS. BOARD MEMBERS MUST DISCLOSE POTENTIAL CONFLICTS USING A REASONABLE BELIEF STANDARD; PLAY NO DIRECT OR INDIRECT PART IN DELIBERATIONS; AND ABSENT THEMSELVES FROM ANY MEETING AT WHICH A CONFLICT IS DISCUSSED. ONLY NONCONFLICTED MEMBERS MAY DECIDE TO PURSUE A TRANSACTION OR ARRANGEMENT INVOLVING A CONFLICT IF A MAJORITY DETERMINES THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST. VIOLATION OF THE COI POLICY IS SUBJECT TO CORRECTIVE ACTION, INCLUDING EXONERATION, CENSURE AND/OR REQUESTING RESIGNATION OF THE MEMBER. APPROVAL FOR ANY LOANS, PAYMENTS, HONORARIUMS, TRIP OR TRAVEL REIMBURSEMENTS, SERVICES, PRODUCTS, ENTERTAINMENT, PRIZES OR AWARDS PROVIDED TO ANY BOARD MEMBER MUST BE APPROVED BY AN ADMINISTRATIVE OFFICER OR HIS OR HER DESIGNEE. THE CEO MUST OBTAIN APPROVAL OF THE CHAIRMAN OF THE BOARD (AND PAYMENTS TO THE CEO ARE APPROVED BY ANOTHER ADMINISTRATIVE OFFICER). IN ADDITION, HUMAN RESOURCES SENDS OUT A CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM TO OFFICERS AND KEY EMPLOYEES EVERY 3 - 5 YEARS. THESE OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICT THAT ARISE DURING THE FISCAL YEAR. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE FILED WITH AND AVAILABLE ON THE GEORGIA SECRETARY OF STATE WEBSITE OR THROUGH THAT OFFICE. THESE DOCUMENTS CAN ALSO BE OBTAINED BY CONTACTING GWINNETT HOSPITAL SYSTEM. THE CONFLICT OF INTEREST POLICY CAN BE OBTAINED BY CONTACTING THE HOSPITAL. CERTAIN DOCUMENTS ARE AVAILABLE UPON REQUEST AT THE HOSPITAL. FOR MORE INFORMATION VISIT - HTTPS://WWW.GWINNETTMEDICALCENTER.ORG/FACILITIES/NORTHSIDE-HOSPITAL- GWINNETT. |
| FORM 990, PART VII | BOARD MEMBERS OF GWINNETT ENTITIES ARE PROVIDED A SMALL STIPEND FOR THEIR SERVICES. |
| Software ID: | |
| Software Version: |