2020-06-10T13:39:35-05:00 2019-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2018-07-01 581955423 CLAYTON GENERAL INC CLAY 7709918010 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 KEVIN VAN DE GRIFT LIQUIDATING TRUSTEE 7709918010 2020-06-10 1 AMY BIBBY P00445891 8282542254 97.95.251.5 2020-06-10 12:16:41 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A22AE24AEF09E58E11297D5713887849BDE471CE 2018 2020-09-23 17:36:50Z KEVIN VAN DE GRIFT 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 4924682 0 X WWW.SOUTHERNREGIONAL.ORG X 1991 GA CLAYTON GENERAL, INC. EXISTS TO SERVE THE COMMUNITIES OF THE SOUTHERN CRESCENT OF THE METRO ATLANTA AREA BY IMPROVING THE HEALTH STATUS AND QUALITY OF LIFE OF ITS CITIZENS. 1 0 0 0 0 0 0 0 0 0 157 374 1421081 4924308 1421238 4924682 0 0 0 0 62689 0 0 0 0 846898 2326667 909587 2326667 511651 2598015 621342 3214357 5000 0 616342 3214357 CLAYTON GENERAL, INC. EXISTS TO SERVE THE COMMUNITIES OF THE CLAYTON GENERAL OF THE METRO ATLANTA AREA BY IMPROVING THE HEALTH STATUS AND QUALIFY OF LIFE OF ITS CITIZENS. 0 0 2302410 OPERATIONAL ASSETS WERE ACQUIRED BY PRIME HEALTHCARE ON FEBRUARY 2, 2016. THE ORGANIZATION CEASED ACTIVITIES ON THIS DATE AND IS CURRENTLY ENGAGED IN BANKRUPTCY PROCEEDINGS. 2302410 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 GA X THE ORGANIZATION 7709918010 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 JAMES G ADAMS CHAIRMAN, PRESIDENT 1.00 4.00 X X 14576 0 0 14576 0 0 0 0 0 0 PEPPER HAMILTON LLP 1313 MARKET STREET STE 5100 WILMINGTON DE 19899 LEGAL SERVICES 877099 SCROGGINS & WILLIAMSON PC 4401 NORTHSIDE PARKWAY STE 450 ATLANTA GA 30327 LEGAL SERVICES 439851 KURTZMAN CARSON CONSULTANTS LLC 250 ROYALL STREET CANTON MA 02021 PROFESSIONAL SERVICES 136559 LAMBERTH CIFELLI ELLIS & NASON PA 1117 PERIMETER CENTER WEST SUITE W2 ATLANTA GA 30338 LEGAL SERVICES 134344 PRICEWATERHOUSECOOPERS LLP 4040 W BOY SCOUT BOULEVARD TAMPA FL 33607 ACCOUNTING/CONSULTING SERVICES 124957 5 374 374 MISC/REFUNDS/REBATES 900099 4924308 4924308 4924308 4924682 0 0 4924682 X 1850262 1850262 1436 1436 222 222 PLAN PAYMENTS 450430 450430 U.S. TRUSTEE FEE 24257 24257 GA STATE TAX 60 60 2326667 2302410 24257 0 621342 3214357 621342 3214357 5000 0 5000 0 X 616342 3214357 616342 3214357 621342 3214357 2598015 0 X X 0 0 0 X FORM 990, PART VI, SECTION B, LINE 11B THE TAX RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT. THE COMPLETED IRS FORM 990 TAX RETURN WAS PROVIDED TO THE BOARD. BOARD MEMBERS REVIEWED THE TAX RETURN BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS AND SENIOR MANAGEMENT. ANY POTENTIAL CONFLICT IS DISCUSSED WITH THE BOARD OF DIRECTORS (ABSENT THE MEMBER WITH THE POTENTIAL CONFLICT). IF IT IS DETERMINED THAT CONFLICT EXISTS, THEN THE BOARD MAY HAVE THE MEMBER EITHER RESIGN OR REMOVE THE CONFLICT, OR THEY MOVE FORWARD WITH THE TRANSACTION IF SPECIFIC FACTS ARE PRESENT. IF THE LATER SITUATION TAKES PLACE, THEN THE MEMBER IS EXCLUDED FROM DISCUSSIONS AND THE VOTE FOR THAT TRANSACTION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION COMPLIES WITH THE OPEN RECORDS LAW. UPON WRITTEN REQUEST, GOVERNING DOCUMENTS DEEMED ACCESSIBLE TO THE PUBLIC UNDER THE LAW CAN BE VIEWED IN THE OFFICE OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,830,766. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,830,766. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 19,496. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,496. PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. CLAYTON GENERAL GROUP INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 581955425 HEALTHCARE GA 501(C)(3) 3 CLAYTON GENERAL INC 1 CLAYTON GENERAL FOUNDATION INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 581983516 FUNDRAISING GA 501(C)(3) LINE 11, TYPE II CLAYTON GENERAL INC 1 SOUTHERN REGIONAL MEDICAL CENTER AUXILIARY 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 582027384 GIFT SHOP AND VOLUNTEER GA 501(C)(3) LINE 11, TYPE II CLAYTON GENERAL INC 1 CLAYTON GENERAL ASC INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 582541044 HEALTHCARE GA 501(C)(3) LINE 11, TYPE II CLAYTON GENERAL INC 1 CLAYTON GENERAL REAL ESTATE INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 581955424 REAL ESTATE MANAGEMENT GA 501(C)(3) LINE 11, TYPE II CLAYTON GENERAL INC 1 CLAYTON GENERAL SERVICES INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 208774854 EQUIPMENT LEASE GA SOUTH REGIONAL HEALTH SYSTEM INC C 1.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0