Financial and organizational information regarding our hospital

Below is the Transparency Completeness Checklist (HB 321 & HB 186), which has been prepared by the Georgia Alliance of Community Hospitals (GACH) and Georgia Hospital Association (GHA).

Consolidated financial statements including hospital

Special requirements and notes

  • Contains HB 321 required note (gross patient revenue, allowances, charity care, and net patient revenue)

Combining or consolidating schedules/financial information breakout for hospital subsidiaries

Special Requirements/Notes

  • Contains GAAS required report.

IRS Form 990

Special Requirements/Notes

  • Copies of Schedule H and other filed Schedules (except Schedule B)

Annual Hospital Questionnaire (AHQ)

Special Requirements/Notes

  • 248 Annual Hospital Questionnaire Final and Filed

Medicaid Disproportionate Share Hospital (DSH) Survey

Special Requirements/Notes

  • Disproportionate Share Hospital (DSH) Examination Parts I & II

List of Real Property Holdings Owned by Hospital

Hospital Indebtedness

Special Requirements/Notes

  • Does not include names of any bond disclosure sites to which hospital submitted info
  • See Consolidated Statements of Financial Position in the audited financial statements attached

Report of End of Year Net Assets

Special Requirements/Notes

  • Includes assets for hospital, parent, subsidiaries, and foundation controlled or owned by hospital or parent
  • See Consolidated Statements of Financial Position in the audited financial statements attached

Dated Organizational Chart

Compensation Benefits Report

Evidence of Hospital Accreditation (e.g., The Joint Commission of DNV)

Indigent and Charity Care Policy

Debt Collection Policy

Audited Financial Statements – Hospital

  • Posted 6-26-2020

Special Requirements/Notes

  • N/A

Audited Financial Statements – Hospital Parent Company

  • Posted 6-26-2020

Special Requirements/Notes

  • N/A

Combining or Consolidating Schedules/Financial Information break out for Hospital & Brother/Sister Co.

  • Posted 6-26-2020

Special Requirements/Notes

  • N/A

Audited Financial Statements – Hospital Subsidiaries

  • Posted 6-26-2020

Special Requirements/Notes

  • N/A

Alternative IRS Form 990 (if available)

  • Posted 10-01-2019

Special Requirements/Notes

  • N/A

Community Benefit Report

Special Requirements/Notes

  • N/A

List of Hospital JVs and Ownership Interests


  • Posted 10-01-2019

Special Requirements/Notes

  • N/A

Statement that there is no going concern disclosure in the hospital’s audited financial statements

  • Posted 10-01-2019

Special Requirements/Notes

  • There is no going concern disclosure in the hospital’s audited financial statements.

Copy of any “going concern” note in Hospital Financial Statements

  • Posted 10-01-2019

Special Requirements/Notes

  • N/A

Shepherd Center Financial Survey

Special Requirements/Notes:

  • N/A

Any ASC Surveys Filed by Hospital

  • Posted 06-26-2020

Special Requirements/Notes:

  • N/A

Any Imaging Center Surveys by Hospital

  • Posted 10-01-2019

Special Requirements/Notes:

  • N/A