POLK MEDICAL CENTER INC

Address
420 E SECOND AVENUE SUITE 102
ROME, GA 301613210
Contact
Website: http://www.polkhospital.org
Phone: +1 (706) 509-6074
Nonprofit
NTEE: E20 - Hospitals and Related Primary Medical Care Facilities
EIN: 45-3957368

Mission

POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY.
 2016201520142013
Basic features of the organization
Year of formation2011
Form of organization
CorporationTrue
Human resources, including compensation
Summary compensation info
Total compensation of current key personnel$20,500.00$18,250.00  
Sum of reportable (W2/1099) compensation$683,498.00$652,832.00  
Number of employees0000
Number of people compensated >$100k1010  
Number of volunteers2220  
Number of highly compensated contractors44  
Personnel
Bosworth, George
TitleMEMBERMEMBER  
Name of key/compensated personGEORGE A BOSWORTH MDGEORGE A BOSWORTH MD  
Position of compensated person
Current individual trustee or directorTrueTrue  
Average hours per week working for org1.001.00  
Reportable compensation from org$2,750.00$500.00  
Other comp, non-reportable, from org and related orgs$0.00$0.00  
Corresponding comp from related orgs
Reportable compensation from related orgs $5,356.00$5,225.00  
Average hours per week working for related orgs1.001.00  
Casey, Bruce
TitleMEMBERMEMBERMEMBERMEMBER
Name of key/compensated personBRUCE CASEYBRUCE CASEYBRUCE CASEYBRUCE CASEY
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue
Average hours per week working for org1.001.001.001.00
Reportable compensation from org$2,750.00$2,750.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$0.00$0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00$0.00$2,750.00$2,750.00
Average hours per week working for related orgs 0.00  
Cummings, Lee
TitleMEMBERMEMBERMEMBERMEMBER
Name of key/compensated personLEE CUMMINGSLEE CUMMINGSLEE CUMMINGSLEE CUMMINGS
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue
Average hours per week working for org1.001.001.001.00
Reportable compensation from org$2,750.00$2,500.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$0.00$0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00$0.00$3,000.00$3,000.00
Average hours per week working for related orgs 0.00  
Freeman, Darroll
TitleMEMBERMEMBERMEMBERMEMBER
Name of key/compensated personDARROLL FREEMANDARROLL FREEMANDARROLL FREEMANDARROLL FREEMAN
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue
Average hours per week working for org1.001.001.001.00
Reportable compensation from org$2,750.00$2,750.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$0.00$0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00$0.00$3,000.00$3,000.00
Average hours per week working for related orgs 0.00  
Freeman, J
TitleMEMBERMEMBERMEMBERMEMBER
Name of key/compensated personJ SAM FREEMANJ SAM FREEMANJ SAM FREEMANJ SAM FREEMAN
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue
Average hours per week working for org1.001.001.001.00
Reportable compensation from org$2,000.00$2,750.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$0.00$0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs $3,500.00$4,375.00$7,625.00$6,875.00
Average hours per week working for related orgs1.001.002.002.00
Fulmer, Lovejoy
TitlePHARMACIST   
Name of key/compensated personLOVEJOY FULMER   
Position of compensated person
Average hours per week working for org40.00   
Reportable compensation from org$120,780.00   
Other comp, non-reportable, from org and related orgs$12,635.00   
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00   
Gorman, Matthew
TitlePOLK ADMINISPOLK ADMINIS  
Name of key/compensated personMATTHEW GORMANMATTHEW GORMAN  
Position of compensated person
Average hours per week working for org40.0040.00  
Reportable compensation from org$0.00$0.00  
Other comp, non-reportable, from org and related orgs$22,499.00$15,695.00  
Corresponding comp from related orgs
Reportable compensation from related orgs $273,024.00$229,953.00  
Kinard, Tifani
TitleDIRECTOR CLI   
Name of key/compensated personTIFANI KINARD   
Position of compensated person
Average hours per week working for org40.00   
Reportable compensation from org$138,586.00   
Other comp, non-reportable, from org and related orgs$13,206.00   
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00   
Kuglar, Larry
TitleMEMBERVICE CHAIRMAMEMBERMEMBER
Name of key/compensated personLARRY KUGLARLARRY KUGLARLARRY KUGLARLARRY KUGLAR
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue
Average hours per week working for org1.001.001.001.00
Reportable compensation from org$2,500.00$2,250.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$0.00$0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs $4,750.00$2,875.00$3,000.00$5,625.00
Average hours per week working for related orgs1.001.002.002.00
Lindsey, Christy
TitlePHARMACISTPHARMACIST  
Name of key/compensated personCHRISTY LINDSEYCHRISTY LINDSEY  
Position of compensated person
Average hours per week working for org40.0040.00  
Reportable compensation from org$126,034.00$119,965.00  
Other comp, non-reportable, from org and related orgs$5,209.00$11,991.00  
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00$0.00  
Norman, Jerry
Title  MEMBERMEMBER
Name of key/compensated person  JERRY F NORMANJERRY F NORMAN
Position of compensated person
Current individual trustee or director  TrueTrue
Average hours per week working for org  1.001.00
Reportable compensation from org  $0.00$0.00
Other comp, non-reportable, from org and related orgs  $0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs   $10,898.00$8,950.00
Average hours per week working for related orgs  3.003.00
Owen, Deana
TitlePHARMACY DIRPHARMACY DIR  
Name of key/compensated personDEANA OWENDEANA OWEN  
Position of compensated person
Average hours per week working for org40.0040.00  
Reportable compensation from org$166,103.00$157,641.00  
Other comp, non-reportable, from org and related orgs$10,515.00$10,489.00  
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00$0.00  
Poy, Lovejoy
Title PHARMACIST  
Name of key/compensated person LOVEJOY POY  
Position of compensated person
Average hours per week working for org 40.00  
Reportable compensation from org $115,527.00  
Other comp, non-reportable, from org and related orgs $21,897.00  
Corresponding comp from related orgs
Reportable compensation from related orgs  $0.00  
Sheerin, Richard
TitleCFOCFOCFOCFO
Name of key/compensated personRICHARD T SHEERINRICHARD T SHEERINRICHARD T SHEERINRICHARD T SHEERIN
Position of compensated person
Average hours per week working for org1.001.001.001.00
Reportable compensation from org$0.00$0.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$22,438.00$37,085.00$48,033.00$50,779.00
Corresponding comp from related orgs
Reportable compensation from related orgs $523,404.00$475,853.00$338,538.00$431,630.00
Average hours per week working for related orgs51.0051.0052.0042.00
Shelley, Frank
TitleMEMBERMEMBERMEMBERMEMBER
Name of key/compensated personFRANK SHELLEYFRANK SHELLEYFRANK SHELLEYFRANK SHELLEY
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue
Average hours per week working for org1.001.001.001.00
Reportable compensation from org$2,500.00$2,500.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$0.00$0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs $3,375.00$2,625.00$6,500.00$5,625.00
Average hours per week working for related orgs1.001.002.002.00
Smith, Sandra
Title RN  
Name of key/compensated person SANDRA SMITH  
Position of compensated person
Average hours per week working for org 40.00  
Reportable compensation from org $123,709.00  
Other comp, non-reportable, from org and related orgs $6,860.00  
Corresponding comp from related orgs
Reportable compensation from related orgs  $0.00  
Stuenkel, Kurt
TitlePRESIDENT/SEPRESIDENT/SEPRESIDENTPRESIDENT
Name of key/compensated personKURT STUENKELKURT STUENKELKURT STUENKELKURT STUENKEL
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue
Average hours per week working for org1.001.001.001.00
Reportable compensation from org$0.00$0.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$20,850.00$49,041.00$65,222.00$70,505.00
Corresponding comp from related orgs
Reportable compensation from related orgs $1,657,756.00$1,559,023.00$1,027,247.00$1,402,161.00
Average hours per week working for related orgs51.0051.0052.0042.00
Waldrep, Carol
TitleER RNER RN  
Name of key/compensated personCAROL WALDREPCAROL WALDREP  
Position of compensated person
Average hours per week working for org40.0040.00  
Reportable compensation from org$111,495.00$117,740.00  
Other comp, non-reportable, from org and related orgs$21,659.00$20,697.00  
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00$0.00  
Wyatt, Harold
TitleCHAIRMANCHAIRMANMEMBERMEMBER
Name of key/compensated personHAROLD W WYATT JRHAROLD W WYATT JRHAROLD W WYATT JRHAROLD W WYATT JR
Position of compensated person
Current individual trustee or directorTrueTrueTrueTrue
Average hours per week working for org1.001.001.001.00
Reportable compensation from org$2,500.00$2,250.00$0.00$0.00
Other comp, non-reportable, from org and related orgs$0.00$0.00$0.00$0.00
Corresponding comp from related orgs
Reportable compensation from related orgs $0.00$0.00$2,375.00$2,375.00
Average hours per week working for related orgs 0.00  
Purpose: mission, activities, & accomplishments
Mission or significant activitiesPOLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY.PRIMARY INITIAL ACTIVITY OF THE CORPORATION WAS TO PROVIDE MANAGEMENT SERVICES AND MANAGEMENT DIRECTION TO AND FOR THE BENEFIT OF THE LICENSED OPERATOR OF THE HOSPITAL COMMENCING APRIL 1, 2012. EFFECTIVE NOVEMBER 6, 2014, THE CORPORATION BECAME THE LICENSED OPERATOR OF POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA. PMC IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY.PRIMARY INITIAL ACTIVITY OF THE CORPORATION SHALL BE TO PROVIDE MANAGEMENT SERVICES AND MANAGEMENT DIRECTION TO AND FOR THE BENEFIT OF THE LICENSED OPERATOR OF THE HOSPITAL COMMENCING APRIL 1, 2012. IT IS ANTICIPATED THAT EVENTUALLY THE CORPORATION WILL BECOME THE LICENSED OPERATOR OF POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA. PMC IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY.PRIMARY INITIAL ACTIVITY OF THE CORPORATION SHALL BE TO PROVIDE MANAGEMENT SERVICES AND MANAGEMENT DIRECTION TO AND FOR THE BENEFIT OF THE LICENSED OPERATOR OF THE HOSPITAL COMMENCING APRIL 1, 2012. IT IS ANTICIPATED THAT EVENTUALLY THE CORPORATION WILL BECOME THE LICENSED OPERATOR OF POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA. PMC IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY.
Program service expenses, total$18,736,854.00$11,127,460.00  
Programs, including revenue & expenses
POLK MEDICAL CENTER IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING GENERAL ACUTE CARE SERVICES TO THE POLK COUNTY AND NORTHERN HARALSON COUNTY COMMUNITIES. DURING FISCAL YEAR 2016, PATIENT DAYS AT POLK MEDICAL CENTER TOTALED 6,936 AND DISCHARGES TOTALED 112. EMERGENCY ROOM VISITS TOTALED 28,159.
Program expenses$18,736,854.00   
Grants and allocations made$323,700.00   
Program revenue$27,616,270.00   
Program descriptionPOLK MEDICAL CENTER IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING GENERAL ACUTE CARE SERVICES TO THE POLK COUNTY AND NORTHERN HARALSON COUNTY COMMUNITIES. DURING FISCAL YEAR 2016, PATIENT DAYS AT POLK MEDICAL CENTER TOTALED 6,936 AND DISCHARGES TOTALED 112. EMERGENCY ROOM VISITS TOTALED 28,159.   
PROVIDER OF MANAGEMENT SERVICES TO THE OPERATOR OF POLK MEDICAL CENTER (PMC), A 501(C)(3) HOSPITAL LOCATED IN CEDARTOWN, GA, LEASED AND OPERATED BY THE HOSPITAL AUTHORITY OF FLOYD COUNTY, A RELATED ORGANIZATION, UNTIL NOVEMBER 5, 2014. EFFECTIVE NOVEMBER 6, 2014, THE CORPORATION BECAME THE LICENSED OPERATOR OF PMC.
Program expenses $11,127,460.00  
Grants and allocations made $168,750.00  
Program revenue $17,632,166.00  
Program description PROVIDER OF MANAGEMENT SERVICES TO THE OPERATOR OF POLK MEDICAL CENTER (PMC), A 501(C)(3) HOSPITAL LOCATED IN CEDARTOWN, GA, LEASED AND OPERATED BY THE HOSPITAL AUTHORITY OF FLOYD COUNTY, A RELATED ORGANIZATION, UNTIL NOVEMBER 5, 2014. EFFECTIVE NOVEMBER 6, 2014, THE CORPORATION BECAME THE LICENSED OPERATOR OF PMC.PROVIDES MANAGEMENT SERVICES TO THE OPERATOR OF POLK MEDICAL CENTER, A 501 (C)(3) HOSPITAL LOCATED IN CEDARTOWN, GA, CURRENTLY LEASED AND OPERATED BY THE HOSPITAL AUTHORITY OF FLOYD COUNTY, A RELATED ORGANIZATION.PROVIDES MANAGEMENT SERVICES TO THE OPERATOR OF POLK MEDICAL CENTER, A 501 (C)(3) HOSPITAL LOCATED IN CEDARTOWN, GA, CURRENTLY LEASED AND OPERATED BY THE HOSPITAL AUTHORITY OF FLOYD COUNTY, A RELATED ORGANIZATION.
Financial data
Revenue
Total revenue$27,621,404.00$18,708,933.00$0.00$0.00
Revenue from contributions (total) $0.00$0.00$0.00
Investment income, current yr$5,623.00$1,076,767.00$0.00$0.00
Total revenue from grants, etc., current yr$0.00$0.00$0.00$0.00
Total unrelated business revenue$0.00$0.00$0.00$0.00
Other revenue, current yr-$385.00$37.00$0.00$0.00
Program service revenue (total)$27,616,166.00$17,632,129.00$0.00$0.00
Gross receipts$27,722,739.00$59,066,309.00$0.00$0.00
Other types of revenue
Miscellaneous revenue (total)$104.00$37.00  
Income from dividends, interest, and similar investments$5,623.00$32,530.00  
Net rental income-$489.00$0.00$0.00$0.00
Expense categories (totals)
Total functional expenses: sum of all$22,174,687.00$14,029,022.00$24,000.00$34,500.00
Total functional expenses: program service $18,736,854.00$11,127,460.00$0.00$0.00
Total functional expenses: management and general$3,437,833.00$2,901,562.00$24,000.00$34,500.00
Total functional expenses: fundraising$0.00$0.00$0.00$0.00
Fees for services
Lobbying fees (total) $2,775.00  
Legal fees (total)$2,526.00$402,994.00  
Fundraising service fees (total)$0.00$0.00$0.00$0.00
Assets and liabilities
Total assets$54,952,190.00$46,442,977.00$22,747,433.00$3,491,343.00
Total assets, beginning of year$46,442,977.00$22,747,433.00$3,491,343.00 
Total liabilities$44,884,062.00$41,821,566.00$22,805,933.00$3,525,843.00
Total liabilities, beginning of year$41,821,566.00$22,805,933.00$3,525,843.00 
Unrestricted net assets, end of yr$10,068,128.00$4,621,411.00-$58,500.00-$34,500.00
Net assets$10,068,128.00$4,621,411.00-$58,500.00-$34,500.00
Net assets, beginning of year$4,621,411.00-$58,500.00-$34,500.00 
Other liabilities$7,997,264.00$6,462,959.00$1,244,655.00$3,525,843.00
Bond liabilities$34,809,050.00   
Other assets$379,130.00$7,293.00  
Investments: publicly traded securities$392,184.00   
Cash: non-interest bearing$1,266,138.00$560,032.00  
Cash: non-interest bearing, beginning of year$560,032.00   
Inventories for sale or use$260,429.00$211,422.00  
Other financial variables
Revenue less expenses$5,446,717.00$4,679,911.00-$24,000.00-$34,500.00
Advertising (total)$54,006.00$95,434.00  
Savings & temp cash investment$13,268,011.00$2,141,261.00  
Accounts receivable, net$5,908,303.00$5,036,428.00  
Prepaid expenses & deferred charges$395,982.00$418,275.00$282,660.00 
Accounts payable & accrued expenses$2,077,748.00$1,185,451.00$1,750.00 
Secured mortgages and notes payable $34,173,156.00$21,559,528.00 
Total net assets or fund balances$10,068,128.00$4,621,411.00-$58,500.00-$34,500.00
Depreciation, depletion, amortization$3,360,467.00$3,467,488.00  
Governance and accountability
Number of voting members9999
Number of independent voting members8888
Financial sheets auditedTrueTrueTrueTrue
Audit on consolidated basis  TrueTrue
Audited on both consolidated and separate basisTrueTrue  
Discontinued or disposed >25% of net assets True  
Accrual accountingTrueTrueTrueTrue
Tax year start date2015-07-012014-07-012013-07-012012-07-01
Tax year end date2016-06-012015-06-012014-06-012013-06-01
Indicators for schedules (selected)
Attached copy of audited financialsTrueTrue  
LobbiedTrueTrue  
Operate hospital facilitiesTrueTrue  
Grants to domestic org/gov't >$5kTrueTrue  
Hospital data
Facility count11  
Hospital facilities
POLK MEDICAL CENTER
Facility namePOLK MEDICAL CENTERPOLK MEDICAL CENTER  
Facility line number11  
Facility's websiteWWW.POLKHOSPITAL.ORGWWW.POLKHOSPITAL.ORG  
Address 2360 ROCKMART HIGHWAY2360 ROCKMART HIGHWAY  
StateGAGA  
Zip code3012530125  
State license number115-705115-705  
Type(s) of facility
Licensed facilityTrueTrue  
General medical and surgicalTrueTrue  
Critical access hospitalTrueTrue  
ER - 24 hoursTrueTrue  
Other facility typeSWING BED SNFSWING BED SNF  
Community benefits and community building
Has financial assistance policyTrueTrue  
Provide discounts to medically indigentTrueTrue  
Financial assistance at cost, net community benefit $1,021,920.00$677,243.00  
Financial assistance at cost, percent of total $0.05$0.05  
Medicaid, net community benefit expense$340,714.00$163,259.00  
Medicaid, percent of total expense$0.02$0.01  
Community health improvement, net community benefit expense$16,669.00$5,426.00  
Community health improvement, percent of total expense$0.00$0.00  
Total benefits, net community benefit expense$1,380,151.00$846,961.00  
Total community benefits as percent of total expense$0.06$0.06  
Bad debt expense$12,645,020.00$7,340,131.00  
Bad debt due to charity$6,701,860.00$4,293,977.00  
Revenue from Medicare$9,458,730.00$5,410,597.00  
Medicare allowable costs$9,507,281.00$5,442,996.00  
Medicare surplus or shortfall-$48,551.00-$32,399.00  
Metadata about the filing
E-return type: 990, 990EZ, or 990PF990990990990
Reason for form submission
First filing   True
Date e-filing submitted2017-09-272016-08-052015-07-172014-06-27
IRS schema version2015v3.02014v6.02013v4.02012v2.3
Filing identifier201721329349301967201611349349301116201531339349301498201401359349300715
Use these data in your project Benchmark this organization against its peers