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      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
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        <PersonNm>DIANA MULKEY</PersonNm>
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        <PersonNm>JANE MILLER</PersonNm>
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        <EmployeeBenefitProgramAmt>0</EmployeeBenefitProgramAmt>
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        <PersonNm>TERRY GOODGER</PersonNm>
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      <OfficerDirectorTrusteeEmplGrp>
        <PersonNm>CHARLES WHITE</PersonNm>
        <TitleTxt>CHIEF MEDICAL OFFICE DIRECTOR</TitleTxt>
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        <PersonNm>CATHY VILLINES</PersonNm>
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        <ExplanationTxt>Activity GOLF TOURNAMENT Grantee UNITED WAY OF WHITE COUNTY Street PO BOX 1288 City, State, Zip Cleveland, GA 30528Amount 17,750</ExplanationTxt>
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        <ExplanationTxt>Description AmountOFFICE 2,258TRAVEL 155COPIER LEASE 80INSURANCE 4,495CONTRIBUTIONS 675LICENSES, FEE &amp; PERMITS 200TREATMENT EXPENSE MEDICAL 766PHONE/FAX 2,164SUPPLIES 586</ExplanationTxt>
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        <FormAndLineReferenceDesc>Other changes in net assets or fund balances Part I line 20</FormAndLineReferenceDesc>
        <ExplanationTxt>Description AmountSMALL EQUIPMENT 86</ExplanationTxt>
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        <FormAndLineReferenceDesc>Description of other assets Part II line 24</FormAndLineReferenceDesc>
        <ExplanationTxt>Category Beginning of Year End of YearEQUIPMENT 5,677 5,677</ExplanationTxt>
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        <ExplanationTxt>Category Beginning of Year End of YearOTHER LIABILITIES 0 18,407</ExplanationTxt>
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