2015-05-13T15:48:01-05:00 2014-06-30 560747981 DIXON HUGHES GOODMAN LLP PO BOX 1747 CHARLESTON WV 253261747 990 2013-07-01 581719867 COLUMBUS AMBULATORY HEALTHCARE SERVICES INC COLU 7066606103 707 CENTER STREET COLUMBUS GA 31901 ALLEN BUTCHER CFO 7066606303 2015-04-30 1 SUSAN S DULL P00233523 3043430168 2013 2016-02-25 16:41:14Z M SCOTT HILL 707 CENTER STREET COLUMBUS GA 31901 14952780 0 X COLUMBUSREGIONAL.COM X 1986 GA TO PROMOTE THE HEALTH AND HEALING OF OUR PATIENTS THROUGH THE PROVISION OF PHYSICIAN SERVICES. 16 11 285 14 0 0 170000 89250 16697607 14863530 0 0 0 0 16867607 14952780 400 400 0 0 21605338 14157106 0 0 0 8370012 6501174 29975750 20658680 -13108143 -5705900 -4928323 -17457361 9146654 1574138 -14074977 -19031499 X THE MISSION OF COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC. IS TO PROMOTE THE HEALTH AND HEALING OF OUR PATIENTS THROUGH THE PROVISION OF PHYSICIAN SERVICES. 0 0 17494579 400 14863530 COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC., IS A NOT-FOR-PROFIT COMPANY SERVING COLUMBUS AND SURROUNDING COUNTIES. IN KEEPING WITH ITS TAX-EXEMPT MISSION, COLUMBUS AMBULATORY HEALTHCARE SERVICES PROVIDES A WIDE VARIETY OF PRIMARY AND SPECIALTY PHYSICIAN SERVICES TO ALL PATIENTS REQUESTING SUCH SERVICES, REGARDLESS OF ABILITY TO PAY. MANY OF THESE PATIENTS ARE CLASSIFIED AS INDIGENT RESIDENTS OF MUSCOGEE COUNTY, AND AS SUCH ARE COVERED THROUGH A CONTRACTUAL AGREEMENT THE MEDICAL CENTER, INC. (A TAX-EXEMPT AFFILIATE) HAS WITH THE COLUMBUS CONSOLIDATED GOVERNMENT.SEVERAL OBJECTIVES ARE ACCOMPLISHED THROUGH THE PROVISION BY COLUMBUS AMBULATORY HEALTHCARE SERVICES OF THESE NON-CRITICAL SERVICES:- THE BURDEN ON THE MEDICAL CENTER'S EMERGENCY DEPARTMENT IS RELIEVED AS THAT SERVICE IS USED LESS OFTEN AS A PRIMARY SOURCE OF CARE. THIS ENABLES EMERGENCY SERVICE PERSONNEL TO CONCENTRATE ON TRUE EMERGENCIES.- THE OVERALL HEALTH CARE COST OF THE COMMUNITY IS REDUCED, SINCE IT IS LESS COSTLY TO TREAT A NON-CRITICAL PATIENT THROUGH AMBULATORY SERVICES THAN AN EMERGENCY SERVICE, WHICH IS STAFFED AND MAINTAINED TO RESPOND TO LIFE-THREATENING CONDITIONS.- INDIGENT PATIENTS RECEIVED WHAT COULD BE THEIR ONLY SOURCE OF AFFORDABLE, AVAILABLE CARE THROUGH MULTIPLE SPECIALTY CLINICS AND THE SERVICES OF VISITING SPECIALISTS.- ACCESS TO A MULTITUDE OF SERVICES IS INCREASED FOR INDIGENT AND LOW-INCOME PATIENTS AS CLINIC STAFF NETWORK WITH SUPPORT GROUPS, CHARITABLE ORGANIZATIONS AND SOCIAL SERVICE AGENCIES IN THE AREA.INDIGENT CARE PROGRAMCOLUMBUS AMBULATORY HEALTHCARE SERVICES, INC. AND THE MEDICAL CENTER, INC. - ALSO AN AFFILIATE OF THE COLUMBUS REGIONAL HEALTHCARE SYSTEM - PROVIDE OUTPATIENT AND INPATIENT SERVICES TO THE CITY'S INDIGENT THROUGH A CONTRACTUAL AGREEMENT WITH THE COLUMBUS CONSOLIDATED GOVERNMENT. THE OBJECTIVE OF THIS INDIGENT CARE PROGRAM IS TO PROVIDE COMPREHENSIVE HEALTH CARE FOR COLUMBUS RESIDENTS WHO ARE NOT COVERED UNDER A PRIVATE OR GOVERNMENTAL INSURANCE PLAN. INDIVIDUALS MEETING RESIDENCY AND INCOME REQUIREMENTS HAVE ACCESS TO A PRIMARY CARE CLINIC AND VARIOUS SPECIALTY CLINICS STAFFED BY QUALIFIED PHYSICIANS AND OTHER HEALTH CARE PERSONNEL. THE CLINICS PROVIDE DIAGNOSIS AND TREATMENT AND HEALTH EDUCATION.IF INPATIENT ADMISSION IS REQUIRED, PATIENTS RECEIVE CARE AT THE MEDICAL CENTER, WHERE THEY HAVE ACCESS TO A FULL RANGE OF DIAGNOSTIC AND TREATMENT SERVICES. IN ADDITION TO ENSURING CARE FOR THE CITY'S INDIGENT POPULATION, THE AGREEMENT WITH THE COLUMBUS CONSOLIDATED GOVERNMENT ALSO PROVIDES FOR ACUTE INPATIENT CARE AND CERTAIN OUTPATIENT CARE FOR THE COMMUNITY'S PRISON POPULATION.DURING FISCAL YEAR 2014, 2,941 FAMILIES, OR 3,025 INDIVIDUALS, WERE ENROLLED IN THE INDIGENT CARE PROGRAM. DURING THE SAME PERIOD, THERE WERE 29,189 OUTPATIENT VISITS AND 232 INPATIENT ADMISSIONS FOR QUALIFIED RESIDENTS AND PRISONERS. ADDITIONALLY 117,775 PRESCRIPTIONS FOR INDIGENT CARE PROGRAM ENROLLEES WERE FILLED IN THE AMBULATORY CARE PHARMACY.IN FISCAL YEAR 2014, TOTAL CHARGES TO PROVIDE INPATIENT AND OUTPATIENT SERVICES THROUGH THE INDIGENT CARE PROGRAM WERE $27,419,440. TOTAL PAYMENTS FROM THE CONSOLIDATED GOVERNMENT TO THE MEDICAL CENTER, INC. FOR INDIGENT HEALTH CARE SERVICES PROVIDED BY ALL AFFILIATES WERE $13,389,689, LEAVING A DEFICIT OF $14,029,751.OUTPATIENT CLINICSTHE MAJORITY OF SERVICES PROVIDED UNDER THE INDIGENT CARE PROGRAM ARE THROUGH THE OUTPATIENT CLINIC OF COLUMBUS AMBULATORY HEALTHCARE SERVICES. INDIGENT PATIENTS ALSO ARE ELIGIBLE FOR OUTPATIENT, DIAGNOSTIC AND THERAPEUTIC SERVICES OFFERED THROUGH THE MEDICAL CENTER.THE MEDICINE CLINIC OF COLUMBUS AMBULATORY HEALTHCARE SERVICES IS THE PRIMARY CONTACT POINT FOR PATIENTS AND THE "GATE-KEEPER" FOR REFERRAL TO THE SPECIALTY CLINICS. HERE, PATIENTS RECEIVE INITIAL ASSESSMENTS, TREATMENT AND REFERRAL AS APPROPRIATE. PATIENT EDUCATION AND REFERRALS TO SOCIAL SERVICE AGENCIES AND SUPPORT GROUPS AS NEEDED ALSO ARE PROVIDED THROUGH THIS CLINIC.OUTPATIENT CLINIC UTILIZATION FOR QUALIFIED RESIDENTS DURING FISCAL YEAR 2014 IS SUMMARIZED IN THE TABLE BELOW: CLINIC VOLUME EYE 1,034 CARDIOLOGY 203 COLOSCOPE/TUMOR/GYNECOLOGY 23 GYNECOLOGY 834 MEDICINE 12,064 NEUROLOGY 105 PODIATRY 152 SURGERY 402 NEPHROLOGY 163 GASTROENTEROLOGY ADULT 220 PULMONARY 58 COUMADIN 393 LABORATORY AND INJECTIONS 5,282 PHARMACOTHERAPY 1,235 TOTAL CLINIC VISITS 22,168FAMILY PRACTICE CENTERTHE FAMILY PRACTICE CENTER, ALSO OFFERED THROUGH COLUMBUS AMBULATORY HEALTHCARE SERVICES AND THE MEDICAL CENTER, INC. PROVIDES A VARIETY OF HEALTH AND MEDICAL SERVICES TO FAMILIES OF THE REGION, REGARDLESS OF THEIR ABILITY TO PAY. SERVICES OFFERED THROUGH THE FAMILY PRACTICE CENTER INCLUDE FAMILY MEDICINE, OCCUPATIONAL MEDICINE, GERIATRIC SERVICES, PRENATAL AND PEDIATRIC SERVICES, OBSTETRICS, X-RAY AND LABORATORY SERVICES, COUNSELING AND TRAVEL IMMUNIZATIONS.THE FAMILY PRACTICE CENTER IS OPERATED BY THE FACULTY OF THE FAMILY PRACTICE RESIDENCY PROGRAM, WHICH WAS ESTABLISHED BY THE MEDICAL CENTER IN 1972 TO TRAIN PRIMARY CARE PHYSICIANS TO SERVE PRIMARILY IN RURAL AND OTHER MEDICALLY UNDERSERVED AREAS. THE CENTER SERVES AS A TRAINING SITE FOR PROGRAM RESIDENTS. 17494579 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 61 0 1 285 1 0 0 0 0 0 0 0 0 0 0 X 16 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X ALLEN BUTCHER CFO 7066606303 707 CENTER STREET COLUMBUS GA 31901 EUGENE DEMONET CHAIRMAN DIRECTOR 2.00 X 0 0 0 MAX BRABSON JR DIRECTOR 2.00 X 0 0 0 KATHRYN CHEEK MD DIRECTOR 2.00 X 0 0 0 CECIL CHEVES DIRECTOR 2.00 X 0 0 0 MICHAEL W GORUM MD DIRECTOR 2.00 X 0 0 0 R SCOTT HANNAY MD DIRECTOR 2.00 X 0 0 0 JULIUS H HUNTER JR DIRECTOR 2.00 X 0 0 0 TODD JARRELL MD DIRECTOR 2.00 X 0 0 0 JOEY LOUDERMILK DIRECTOR 2.00 X 0 0 0 LILIANA MCDANIEL DIRECTOR 2.00 X 0 0 0 WILIAM ROUNDTREE MD DIRECTOR 2.00 X 0 0 0 CAROLE RUTLAND PHD DIRECTOR 2.00 X 0 0 0 WARREN STEELE II DIRECTOR 2.00 X 0 0 0 HENRY W SWIFT JR DIRECTOR 2.00 X 0 0 0 CHARLES A STARK PRESIDENT & CEO; RSGND 6/12/14 2.00 40.00 X 0 785221 212481 M SCOTT HILL PRESIDENT & CEO; APPTD 6/12/14 2.00 40.00 X 0 503116 87012 ROLAND L THACKER SR. VP & CFO; TRMD 10/31/13 2.00 40.00 X 0 599420 130567 ALLEN R BUTCHER SR. VP & CFO; HIRED 3/12/14 2.00 40.00 X 0 0 0 KAREN SMITH CORPORATE SECRETARY 2.00 40.00 X 0 70597 17883 WILLIAM BROUWER PRESIDENT/CEO CRHS PHYSICIAN GROUP 40.00 X 215565 0 18859 ANDREW PIPPAS MEDICAL DIRECTOR & PHYSICIAN - ONCOLOGIST 40.00 X 1523829 0 133428 PETER JIANG PHYSICIAN - ONCOLOGIST 40.00 X 1108880 0 31075 ROBERT JACOBSON PHYSICIAN 40.00 X 501544 0 17871 SURESH NUKALA PHYSICIAN - ONCOLOGIST 40.00 X 472704 0 22825 DEMETRICE HILL PHYSICIAN 40.00 X 467864 0 26724 KENDALL HANDY CHIEF OF SERVICE 1.00 39.00 X 1469 322155 31071 LANCE B DUKE EXEC VP & COO; TRMD 4/9/12 2.00 40.00 X 0 459891 125696 DONALD ELDER SR. VP; TRMD 1/1/13 2.00 40.00 X 0 262491 122223 4291855 3002891 977715 42 1 1 0 INPHYNET CONTRACTING SERVICES PO BOX 634850 CINCINNATI OH 452634850 ER PHYSICIANS 471350 HEALTH MANAGEMENT RESOURCES 9211 FOREST HILL AVE SUITE 101 RICHMOND VA 23235 WEIGHT MGMT PROGRAM PROVIDER 330760 VINCENT NICOLAIS MD 5110 MIDLAND TRACE MIDLAND GA 31820 PHYSICIAN 267108 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 PHYSICIAN STAFFING 217856 PAUL CARTWRIGHT MD 7201 STANDING BOY ROAD COLUMBUS GA 31904 PHYSICIAN 150200 6 89250 89250 PATIENT REVENUE 621990 14113642 14113642 ADMINISTRATIVE FEES REIMBURSEMENT 561000 429692 429692 MISCELLANEOUS 621990 320196 320196 14863530 14952780 14863530 0 0 400 400 4291855 4291855 7829683 7111307 718376 1407543 1280200 127343 628025 579462 48563 811857 811857 33420 33420 1008544 986375 22169 247906 247499 407 402958 396820 6138 96 96 1073431 1073431 90658 75379 15279 16094 10894 5200 23740 23740 290141 290141 789070 789070 BAD DEBT 691372 691372 SUPPLIES 475843 475843 RECRUITMENT 255004 255004 NON-CAPITALIZED EQUIPME 168624 165220 3404 122416 108522 13894 20658680 17494579 3164101 0 -21290074 -19857172 3764383 387274 38607 59039 166619 3632801 1803898 1907410 1828903 10500000 0 92312 17015 -4928323 -17457361 2015427 1540504 7131227 0 0 33634 9146654 1574138 X -14074977 -19031499 -14074977 -19031499 -4928323 -17457361 X -5705900 749378 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 14315 14315 531698600 531712915 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 27379 32330 32191 14315 106215 250000 250000 250000 250000 1000000 1500000 127885 84237 43648 298485 11863 286622 3118955 1707798 1411157 87476 87476 1828903 DUE FROM AFFILIATES 17015 17015 DUE TO RELATED PARTIES 33634 33634 X PART X, LINE 2: THE COLUMBUS REGIONAL HEALTH SYSTEM AND AFFILIATES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. AT JUNE 30, 2014, MANAGEMENT DOES NOT BELIEVE THE COLUMBUS REGIONAL HEALTH SYSTEM HOLDS ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE UNDER ASC 740. X X X X X 0 1 0 0 0 0 0 0 0 CHARLES A STARK PRESIDENT & CEO; RSGND 6/12/14 0 676805 0 102000 0 6416 0 191573 0 20908 0 997702 0 0 M SCOTT HILL PRESIDENT & CEO; APPTD 6/12/14 0 460727 0 37500 0 4889 0 67069 0 19943 0 590128 0 0 ROLAND L THACKER SR. VP & CFO; TRMD 10/31/13 0 350110 0 35200 0 214110 0 113778 0 16789 0 729987 0 141218 WILLIAM BROUWER PRESIDENT/CEO CRHS PHYSICIAN GROUP 199076 0 10000 0 6489 0 3341 0 15518 0 234424 0 0 0 ANDREW PIPPAS MEDICAL DIRECTOR & PHYSICIAN - ONCOL 1412033 0 109777 0 2019 0 115446 0 17982 0 1657257 0 0 0 PETER JIANG PHYSICIAN - ONCOLOGIST 862985 0 244359 0 1536 0 15714 0 15361 0 1139955 0 0 0 ROBERT JACOBSON PHYSICIAN 496108 0 0 0 5436 0 4407 0 13464 0 519415 0 0 0 SURESH NUKALA PHYSICIAN - ONCOLOGIST 445814 0 0 0 26890 0 7766 0 15059 0 495529 0 0 0 DEMETRICE HILL PHYSICIAN 466454 0 0 0 1410 0 8327 0 18397 0 494588 0 0 0 KENDALL HANDY CHIEF OF SERVICE 1469 319875 0 0 0 2280 0 12420 77 18574 1546 353149 0 0 LANCE B DUKE EXEC VP & COO; TRMD 4/9/12 0 184262 0 0 0 275629 0 118731 0 6965 0 585587 0 191268 DONALD ELDER SR. VP; TRMD 1/1/13 0 210055 0 0 0 52436 0 108987 0 13236 0 384714 0 50000 PART I, LINE 4B EMPLOYER CONTRIBUTION TO 457(F) EXECUTIVE RETIREMENT BENEFIT PLAN: CHARLES STARK $182,200 LANCE DUKE $ 92,400 ROLAND THACKER $ 79,800 SCOTT HILL $ 62,100 DONALD ELDER $ 50,000 PAYOUT FROM 457(F) EXECUTIVE RETIREMENT BENEFIT PLAN (INCLUDED IN REPORTABLE COMPENSATION): DONALD ELDER $ 50,000 ROLAND THACKER $141,218 LANCE DUKE $191,268 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. - A RELATED 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC. IS APPOINTED BY THE BOARD OF COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. - A RELATED 501 (C) (3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF COLUMBUS AMBULATORY HEALTHCARE SERVICES, INC. DETERMINES THE ISSUES THAT ARE BROUGHT UP FOR DISCUSSION AND MOST ITEMS CAN BE APPROVED ALONG WITH THE EXECUTIVE TEAM OF COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. - A RELATED 501(C)(3) ORGANIZATION. CAPITAL EXPENDITURES IN EXCESS OF $500,000 MUST BE APPROVED BY THE COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 11 INFORMATION FOR FORM 990 WAS PROVIDED TO AN INDEPENDENT CPA FIRM FOR PREPARATION OF THE RETURN. AFTER THE RETURN WAS PREPARED IT WAS REVIEWED BY THE CFO OF THE ORGANIZATION. THE BOARD IS PROVIDED WITH A THOROUGH AND CONDENSED OVERVIEW OF INFORMATION ON THE FORM 990 AT THE BOARD MEETING BY THE CFO OF THE ORGANIZATION ASSISTED BY THE INDEPENDENT CPA PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. AND ITS AFFILIATES ARE ACCOUNTABLE TO GOVERNMENTAL AUTHORITIES AS WELL AS TO MEMBERS OF THE PUBLIC FOR BOTH THE INTEGRITY OF ITS ACTIONS AS WELL AS PERCEPTIONS AS RELATED TO THOSE ACTIONS. CONSEQUENTLY, THERE EXISTS BETWEEN COLUMBUS REGIONAL AND THE PUBLIC THE FIDUCIARY RESPONSIBILITY WHICH CARRIES WITH IT A BROAD AND UNBENDING DUTY OF LOYALTY AND FIDELITY. COLUMBUS REGIONAL AGENTS (I.E., BOARD MEMBERS, MANAGEMENT, EMPLOYEES, CONTRACTED PARTIES AND CREDENTIALED STAFF) HAVE THE RESPONSIBILITY OF ADMINISTERING THE AFFAIRS OF THE ORGANIZATION HONESTLY AND PRUDENTLY, AND OF EXERCISING THE BEST CARE, SKILL AND JUDGMENT FOR THE SOLE BENEFIT OF COLUMBUS REGIONAL. THOSE AGENTS SHALL EXERCISE THE UTMOST GOOD FAITH IN ALL TRANSACTIONS INVOLVED IN THEIR DUTIES AND SHALL NOT USE THEIR POSITIONS WITH COLUMBUS REGIONAL OR KNOWLEDGE GAINED FOR THEIR PERSONAL BENEFIT IN ANY MANNER. THE INTEREST OF THE ORGANIZATION MUST BE THE FIRST PRIORITY IN ALL RELATED DECISIONS AND ACTIONS. THIS POLICY IS ALSO DIRECTED TOWARD ANYONE WHO HAS PROPRIETARY INFORMATION CONCERNING COLUMBUS REGIONAL. IT IS THE POLICY OF COLUMBUS REGIONAL HEALTHCARE SYSTEM AND ITS AFFILIATES, IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, ASSOCIATED AGENTS MUST ANNUALLY DISCLOSE THE EXISTENCE OF A FINANCIAL OR OTHERWISE BENEFICIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE CHIEF COMPLIANCE OFFICER ASSOCIATED WITH THE PROPOSED CONFLICTING TRANSACTION OR ARRANGEMENT. A CONFLICT OF INTEREST MAY ARISE IN THE RELATIONSHIPS WITH COLUMBUS REGIONAL AGENTS WITH PERSONS AND FIRMS SUPPLYING GOODS AND SERVICES TO THE ORGANIZATION; PERSONS AND FIRMS FROM WHOM THE COMPANY LEASES PROPERTY AND EQUIPMENT; PERSONS AND FIRMS WITH WHOM COLUMBUS REGIONAL IS DEALING OR PLANNING TO DEAL IN CONNECTION WITH THE GIFT, PURCHASE OR SALE OF REAL ESTATE, SECURITIES OR OTHER PROPERTY; COMPETING OR AFFINITY ORGANIZATIONS; DONORS, MEMBERS OR OTHERS SUPPORTING THE ORGANIZATION; AGENCIES, ORGANIZATIONS AND ASSOCIATIONS WHICH AFFECT THE OPERATIONS OF THE COMPANY; AND FAMILY MEMBERS, FRIENDS AND OTHER EMPLOYEES. CONFLICTS OF INTEREST MAY ARISE IN A NUMBER OF DIFFERENT CIRCUMSTANCES AND TRANSACTIONS. IT IS ASSUMED THAT COLUMBUS REGIONAL AGENTS WILL RECOGNIZE SUCH AREAS AND RELATION BY ANALOGY. TRANSACTIONS WITH PARTIES WITH WHOM A CONFLICTING INTEREST EXISTS MAY BE UNDERTAKEN ONLY IF ALL OF THE FOLLOWING ARE OBSERVED: THE CONFLICT OF INTEREST IS FULLY DISCLOSED; THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION; A COMPETITIVE BID OR COMPARABLE VALUATION EXISTS FOR PURCHASING OR RELATED DECISIONS; AND THE CHIEF COMPLIANCE OFFICER IN CONSULTATION WITH OTHERS AS APPROPRIATE, HAS DETERMINED THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. ALL DISCLOSURES MUST BE MADE TO THE CHIEF COMPLIANCE OFFICER (OR IF SHE/HE IS THE ONE WITH THE CONFLICT, THEN THE BOARD CHAIR), WHO WILL BRING THE MATTER TO THE ATTENTION OF THE BOARD AS NECESSARY. THE CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH OTHERS AS APPROPRIATE, SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR AND REASONABLE TO THE ORGANIZATION. THE DECISION OF THE CHIEF COMPLIANCE OFFICER AND/OR BOARD ON THESE MATTERS WILL REST IN THEIR SOLE DISCRETION AND THEIR CONCERN MUST BE FOR THE WELFARE OF THE ORGANIZATION IN THE ADVANCEMENT OF ITS PURPOSE. EACH MEMBER OF MANAGEMENT AND EMPLOYEES WITH DELEGATED POWERS WHO CAN INFLUENCE THE ACTIONS OF COLUMBUS REGIONAL SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY AND COMPLETED THE DISCLOSURE STATEMENT; HAS READ AND UNDERSTANDS THE POLICY; AND HAS AGREED TO COMPLY WITH THE POLICY. IN ADDITION, SHOULD A POTENTIAL CONFLICT OCCUR DURING THE YEAR BUT PRIOR TO THE ANNUAL DISCLOSURE, THE INDIVIDUAL IS OBLIGATED TO CONTACT THE COMPLIANCE OFFICER AND UPDATE THEIR DISCLOSURE STATEMENT IN A TIMELY MANNER. IF THE CHIEF COMPLIANCE OFFICER HAS REASONABLE CAUSE TO BELIEVE A COLUMBUS REGIONAL AGENT HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, HE/SHE SHALL INFORM THAT INDIVIDUAL OF THE BASIS OF SUCH BELIEF AND AFFORD HIM/HER THE OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE INDIVIDUAL'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE CHIEF COMPLIANCE OFFICER DETERMINES THE INDIVIDUAL HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, HE/SHE SHALL FORWARD THE INFORMATION TO THE HUMAN RESOURCES DEPARTMENT AND/OR THE BOARD OF DIRECTORS TO TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 COLUMBUS REGIONAL TAKES VERY SERIOUSLY THE RESPONSIBILITY TO APPROPRIATELY AND EFFECTIVELY MANAGE THE EXECUTIVE COMPENSATION AND BENEFITS PROGRAM FOR ITS KEY EXECUTIVES. SETTING THE COMPENSATION OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, APPROVING THE COMPENSATION OF OTHER SENIOR EXECUTIVES, AND OVERSEEING THE EXECUTIVE COMPENSATION PROGRAM AS A WHOLE, ARE THE RESPONSIBILITIES OF THE COMPENSATION COMMITTEE OF THE BOARD. TO ASSIST THE COMMITTEE, THE BOARD HAS ENGAGED THE SERVICES OF A NATIONALLY RECOGNIZED EXECUTIVE COMPENSATION CONSULTING FIRM. COLUMBUS REGIONAL'S EXECUTIVE COMPENSATION PROGRAM IS DESIGNED TO ATTRACT AND RETAIN HIGHLY QUALIFIED EXECUTIVES TO FULFILL COLUMBUS REGIONAL'S MISSION OF PROMOTING THE HEALTH AND HEALING OF PATIENTS. COLUMBUS REGIONALS PEER GROUP CONSISTS OF NON-PROFIT HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE AND COMPLEXITY FROM ACROSS THE NATION. BASE SALARIES OF EXECUTIVES ARE POSITIONED AT SPECIFIC PERCENTILE TARGETS OF COLUMBUS REGIONAL'S PEER GROUP. CURRENT STUDIES INDICATE THAT OUR BASE SALARIES ARE AT TARGETED LEVELS. COLUMBUS REGIONAL STRIVES TO PROVIDE ALL EXECUTIVES WITH RETIREMENT BENEFITS THAT ARE EQUIVALENT FOR ALL EMPLOYEES. RETIREMENT CONTRIBUTIONS ARE BASED ON A CLEARLY STATED INCOME REPLACEMENT TARGET AS DETERMINED BY RETIREMENT PLAN CONSULTANTS. THE GOAL OF COLUMBUS REGIONAL IS TO PROVIDE MARKET COMPETITIVE COMPENSATION AND BENEFITS PROGRAMS FOR ALL EMPLOYEES AT ALL LEVELS OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY, AS WELL AS FINANCIAL STATEMENTS AND OTHER CORPORATE AND GOVERNING DOCUMENTS, ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: TRANSFER TO AFFILIATES 749,378. COLUMBUS RADIATION ONCOLOGY TREATMENT LLC 707 CENTER STREET COLUMBUS GA 31901 273019214 ONCOLOGY GA 14772 5590999 COLUMBUS AMBULATORY HEALTHCARE SERVICES INC MAC LUMPKIN-SOUTH COLUMBUS URGENT CARE 707 CENTER STREET COLUMBUS GA 31901 273464725 URGENT CARE GA 632141 0 COLUMBUS AMBULATORY HEALTHCARE SERVICES INC COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 707 CENTER STREET COLUMBUS GA 31901 581719994 HEALTH SYSTEM MANAGEMENT GA 501(C)(3) LINE 11B, II N/A 0 COLUMBUS REGIONAL MEDICAL FOUNDATION INC 707 CENTER STREET COLUMBUS GA 31901 581501642 FUNDRAISING GA 501(C)(3) LINE 7 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 1 DOCTOR'S HOSPITAL INC 707 CENTER STREET COLUMBUS GA 31901 261739383 ACUTE CARE HOSPITAL GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 1 HUGHSTON HOSPITAL INC 707 CENTER STREET COLUMBUS GA 31901 331216751 ORTHOPEDIC HOSPITAL GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 1 COLUMBUS REGIONAL AUXILIARY (FRA MEDICAL CENTER AUXILIARY) 707 CENTER STREET COLUMBUS GA 31901 580917974 HOSPITAL AUXILIARY GA 501(C)(3) LINE 11C, III-FI N/A 0 CRHS LONG TERM AND HOME CARE INC 707 CENTER STREET COLUMBUS GA 31901 581719867 NURSING HOME GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 1 COLUMBUS REGIONAL SENIOR LIVING INC 707 CENTER STREET COLUMBUS GA 31901 582628502 CONTINUING CARE RETIREMENT COMMUNITY GA 501(C)(3) LINE 11C, III-FI COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 1 THE MEDICAL CENTER INC 707 CENTER STREET COLUMBUS GA 31901 581685139 ACUTE CARE HOSPITAL GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 1 COLUMBUS DIAGNOSTIC IMAGING CTR LLC 116 INTRACOASTAL POINTE DR 300 JUPITER FL 33477 262291768 DIAGNOSTIC IMAGING FL N/A COLUMBUS HEALTH SERVICES INC 707 CENTER STREET COLUMBUS GA 31901 581640939 RETAIL PHARMACIES GA N/A C 0 COLUMBUS HEALTHCARE RESOURCES INC 707 CENTER STREET COLUMBUS GA 31901 581717754 PROPERTY MANAGEMENT GA N/A C 0 WOMEN'S MEDICAL SERVICES INC 707 CENTER STREET COLUMBUS GA 31901 581695456 MANAGEMENT SERVICES GA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 707 CENTER STREET COLUMBUS GA 31901 581719994 X 0 14315 14315 39976479 39990794 1000000 250000 0 0 0 THE MEDICAL CENTER INC 707 CENTER STREET COLUMBUS GA 31901 581685139 0 0 0 354626607 354626607 1000000 250000 0 0 0 CRHS LONG TERM & HOME CARE INC 707 CENTER STREET COLUMBUS GA 31901 581778572 0 0 0 359871 359871 71974 17994 0 0 0 COLUMBUS AMBULATORY HEALTHCARE SERVICES 707 CENTER STREET COLUMBUS GA 31901 581719867 0 0 0 18559752 18559752 1000000 250000 0 0 0 COLUMBUS REGIONAL MEDICAL FOUNDATION INC 707 CENTER STREET COLUMBUS GA 31901 581501642 0 0 0 1307972 1307972 205797 51449 0 0 0 COLUMBUS REGIONAL SENIOR LIVING 707 CENTER STREET COLUMBUS GA 31901 582628502 0 0 0 5688354 5688354 434418 108605 0 0 0 DOCTOR'S HOSPITAL INC 707 CENTER STREET COLUMBUS GA 31901 261739383 0 0 0 46125202 46125202 1000000 250000 0 0 0 HUGHSTON HOSPITAL INC 707 CENTER STREET COLUMBUS GA 31901 331216751 0 0 0 64290590 64290590 1000000 250000 0 0 0 COLUMBUS REGIONAL AUXILIARY 707 CENTER STREET COLUMBUS GA 31901 580917974 0 0 0 723773 723773 133566 33392 0 0 0