2015-08-17T08:00:03-05:00 2014-09-30 580914992 DRAFFIN & TUCKER LLP FIVE CONCOURSE PARKWAY SUITE 1250 ATLANTA GA 30328 990 2013-10-01 582149127 CENTRAL GEORGIA HEALTH SYSTEMS INC CENT 4786331407 691 CHERRY STREET MACON GA 31201 RHONDA S PERRY EXECUTIVE VICE PRESIDENT/CFO 2015-08-13 true W Edward Phillips P00451499 4042208494 2013 2016-04-25 22:37:26Z NAVICENT HEALTH INC NINFA M SAUNDERS 691 CHERRY STREET MACON GA 31201 56599364 false X WWW.NAVICENTHEATLH.ORG X 1994 GA CENTRAL GEORGIA HEALTH SYSTEMS, INC. IS A NONPROFIT CORPORATION WHOSE PRIMARY PURPOSE IS TO SERVE AS A PARENT CORPORATION PROVIDING STRATEGIC DIRECTION TO THE MEDICAL CENTER OF CENTRAL GEORGIA, INC. AND OTHER AFFILIATES IN SUPPORT OF THEIR MISSION OF PROVIDING A COMPREHENSIVE RANGE OF HIGH-QUALITY, REASONABLY PRICED HEALTH CARE SERVICES TO THE CENTRAL GEORGIA COMMUNITY. 8 6 492 18122 0 0 0 36690120 46494113 10001189 10001312 154675 103939 46845984 56599364 3488687 3246860 0 0 34746058 32141388 0 0 0 8275576 14944538 46510321 50332786 335663 6266578 54876334 64327272 11675001 14859362 43201333 49467910 CENTRAL GEORGIA HEALTH SYSTEMS, INC. (CGHS) PRIMARY PURPOSE IS TO SERVE AS A CONTROLLING BODY FOR THE MEDICAL CENTER OF CENTRAL GEORGIA, INC., HEALTH SERVICES OF CENTRAL GEORGIA, INC., CENTRAL GEORGIA SENIOR HEALTH, INC., MEDCEN COMMUNITY HEALTH FOUNDATION AND THE MEDICAL CENTER OF PEACH COUNTY, INC. IN SUPPORT OF THEIR MISSION TO PROVIDE HEALTHCARE SERVICES IN CENTRAL GEORGIA BY PROVIDING STRATEGIC DIRECTION, FINANCIAL OVERSIGHT AND FINANCIAL PLANNING. false false 24347138 3246860 37537932 CENTRAL GEORGIA HEALTH SYSTEMS, INC. ("CGHS") PRIMARY PURPOSE IS TO SERVE AS A CONTROLLING BODY FOR THE MEDICAL CENTER OF CENTRAL GEORGIA, INC., HEALTH SERVICES OF CENTRAL GEORGIA, INC., CENTRAL GEORGIA SENIOR HEALTH, INC. AND MEDCEN COMMUNITY HEALTH FOUNDATION, INC. AND OTHER AFFILIATED ENTITIES AND TO PROVIDE STRATEGIC DIRECTION, FINANCIAL MANAGEMENT, RESOURCE ALLOCATION AND OTHER SUPPORT TO ITS AFFILIATES IN THE PROVISION OF HEALTHCARE SERVICES TO THE CENTRAL GEORGIA COMMUNITY. 14925283 19041998 CENTRAL GEORGIA HEALTH SYSTEMS, INC. OPERATES CENTRAL GEORGIA REHABILITATION HOSPITAL, LLC, THE FIRST REHABILITATION FACILITY ESTABLISHED IN CENTRAL GEORGIA AND ONE OF TWO FREE-STANDING REHABILITATION HOSPITALS IN THE STATE. THE REHABILITATION HOSPITAL PROVIDES COMPREHENSIVE PHYSICAL REHABILITATION SERVICES ON AN INPATIENT AND OUTPATIENT BASIS. IT IS LICENSED FOR 58 BEDS. 39272421 true false false true false false false false false true false true true true true false true false false true false false false false false true true true false true false false false false false false false false false false false false true true true true false false true 0 0 492 true true true true CJ false false false false false false false false X 8 6 false false false false false false false true true false false true true true true true true true true true false GA X RHONDA S PERRY 4786331452 777 HEMLOCK STREET MACON GA 31201 CONNIE CATER DIRECTOR 1.00 1.00 X 0 0 0 HELEN RHEA STUMBO DIRECTOR 1.00 2.00 X 0 0 0 HENRY KOPLIN DIRECTOR 1.00 1.00 X 0 0 0 JOAN WALTON DIRECTOR 1.00 1.00 X 0 0 0 MICK ANDERSON MD DIRECTOR 1.00 X 0 0 0 RUTH KNOX DIRECTOR 1.00 X 0 0 0 STARR PURDUE CHAIRMAN 1.00 1.00 X 0 0 0 TIMOTHY JACKSON VICE CHAIRMAN 1.00 3.00 X 0 0 0 KENNETH B BANKS CORPORATE SECRETARY 45.00 5.00 X 585748 0 179232 NINFA M SAUNDERS PRESIDENT/CHIEF EXECUTIVE OFFICER 47.00 3.00 X 768125 0 638299 RHONDA S PERRY CHIEF FINANCIAL OFFICER 45.00 5.00 X 1285717 0 88437 ELBERT T MCQUEEN VP POST ACUTE SERVICES AND REGIONAL DEVELOPMENT 48.00 2.00 X 233257 0 26263 JANE P GRAY AVP PATIENT BUSINESS SERVICES 50.00 X 169264 0 24429 JUDY K WARE CHIEF COMPLIANCE OFFICER 50.00 X 168956 0 22334 KAREN M FARR AVP FINANCIAL SERVICES 50.00 X 170311 0 3929 KATHERINE L BOWEN AVP FIN PLANNING, BUDGET AND INSURANCE 50.00 X 163441 0 15820 TIQUELLA S KING-WHITBY PHYSICIAN 50.00 X 176756 0 25079 A DONALD FAULK JR CEO (TRANSITION) 2.00 X 171300 0 0 3892875 0 1023822 46 true true false HEWITT ASSOCIATES P O BOX 95135 CHICAGO IL 606945135 BENEFITS ADMINSTRATIVE SERVICES 873626 KAUFMAN HALL 5202 OLD ORCHARD RD ST N700 SKOKIE IL 600774409 CONSULTING SERVICES 709635 MACON OCCUPATIONAL MEDICINE 124 3RD STREET MACON GA 312013404 CONTRACT SERV-NURSES, NP, CLERICAL 530352 AON CONSULTING P O BOX 905188 CHARLOTTE NC 282905188 RETIREMENT BENEFIT ADMIN SERVICES 377413 DIXON HUGHES GOODMAN PLLC P O BOX 602828 CHARLOTTE NC 282602828 AUDIT SERVICES 373315 18 0 MEDICARE.MEDICAID REVENUE 621990 16410628 16410628 PATIENT REVENUE 621990 2327129 2327129 REBATE REVENUE 621990 503600 503600 CAFETERIA SALES 621990 38063 38063 SUPPORT REVENUE 541200 27176340 27166506 9834 38353 30065 8288 0 46494113 10000811 10000000 811 0 0 0 0 0 501 0 501 501 501 0 0 0 PARTNERSHIP INVESTMENTS 103939 103939 0 0 0 0 0 0 103939 56599364 56579930 18122 1312 3246860 3246860 0 0 0 2364427 2364427 0 24602036 21063856 3538180 -41927 -67295 25368 3328809 2804446 524363 1888043 1549267 338776 0 786680 265233 521447 505231 505231 54668 54668 0 899482 899482 3196122 1833923 1362199 0 861372 280982 580390 919227 861356 57871 764662 467371 297291 0 520467 454062 66405 183442 95532 87910 0 168353 142195 26158 0 0 1592685 1549717 42968 630187 604306 25881 MEDICAL SUPPLIES 930904 930169 735 MINOR EQ, EQ RENTAL & MAINT 1980219 1963560 16659 TAXES & LICENSES 416111 306736 109375 DUES & SUBSCRIPTIONS 492836 6812 486024 41890 13851 28039 0 50332786 39272421 11060365 0 0 2746760 2026395 2959437 7248386 0 0 98775 101578 677996 722404 22859513 15629974 4294059 7229539 0 22404478 22475917 21694829 24523053 54876334 64327272 2082296 3340970 0 9592705 11518392 11675001 14859362 X 43201333 49467910 43201333 49467910 54876334 64327272 X 6266578 -1 X false true X true false X X X false false false MEDICAL CENTER OF CENTRAL GEORGIA 582149128 3 true true true 3246860 1 3246860 SCHEDULE A, PART I, LINE 11H(VII), AMOUNT OF SUPPORT THE MEDICAL CENTER OF CENTRAL GEORGIA: CENTRAL GEORGIA HEALTH SYSTEMS, INC. IS THE FUNCTIONALLY INTERGRATED PARENT OF A MULTI-ENTITY HEALTHCARE SYSTEM WHICH INCLUDES ITS SUPPORTED ORGANIZATION, THE MEDICAL CENTER OF CENTRAL GEORGIA, INC. CGHS IS RESPONSIBLE FOR STRATEGIC PLANNING, FINANCIAL MANAGEMENT AND RESOURCE ALLOCATION FOR THE MULTI-ENTITY SYSTEM. false false false false false false false false true 54668 54668 false Schedule C, Part II-B, Line 1, Description of the activities reported on Lines 1a through 1i LOBBYING EXPENSES INCLUDE A PORTION OF DUES PAID TO VARIOUS ORGANIZATION (I.E., GEORGIA HOSPITAL ASSOCIATION) ALSO, CONTRACTED INDIVIDUAL TO LOBBY ON THE ORGANIZATIONS BEHALF. 65192 65192 1799944 517818 1282126 0 20994377 15112156 5882221 0 7229539 INVESTMENTS IN AFFILIATES 19018784 C INVESTMENTS IN SUBSIDARY 3457133 C 22475917 WORKERS COMP ESCROW 275000 MISCELLANEOUS RECEIVABLE 686466 PUTNAM COUNTY RECEIVABLE 300000 DUE FROM AFFILIATES 14102334 457B DEFERRED COMPENSATION 9159253 24523053 0 457B DEFERRED COMPENSATION 9159253 SERP LIABILITY 1521683 DC SEBP LIABILITY 837456 11518392 X Schedule D, Part X, Line 2, FIN 48 (ASC 740) footnote NAVICENT HEALTH, INC., THE MEDICAL CENTER, HSNH, CARLYLE PLACE, AND MEDCEN ARE ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX, PURSUANT TO SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. CPI IS A FOREIGN CORPORATION NOT SUBJECT TO TAX IN THE UNITED STATES. PET, RHNH AND SHPG ARE ORGANIZED UNDER GEORGIA LAW AND THE INTERNAL REVENUE CODE AS LIMITED LIABILITY COMPANIES ("LLC"). THE MEMBERS OF AN LLC REPORT TAXABLE INCOME OR LOSS ON THEIR CORPORATE OR INDIVIDUAL TAX RETURNS. NAVICENT HEALTH'S SHARE OF INCOME FROM PET, RHNH AND SHPG OPERATIONS IS NOT CONSIDERED UNRELATED BUSINESS INCOME ("UBI") AND IS THEREFORE NOT SUBJECT TO TAX. HVNH IS SUBJECT TO INCOME TAX. WITH RESPECT TO ITS FOR-PROFIT SUBSIDIARIES, NAVICENT HEALTH ACCOUNTS FOR INCOME TAXES IN ACCORDANCE WITH THE LIABILITY METHOD UNDER WHICH DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL ACCOUNTING AND TAX BASES OF ASSETS AND LIABILITIES. DEFERRED TAX ASSETS OR LIABILITIES AT THE END OF EACH PERIOD ARE DETERMINED USING THE CURRENTLY ENACTED TAX RATE EXPECTED TO APPLY TO TAXABLE INCOME IN THE PERIODS THAT THE DEFERRED TAX ASSET OR LIABILITY IS EXPECTED TO BE REALIZED OR SETTLED. NAVICENT HEALTH AND ITS AFFILIATES HAVE EVALUATED THEIR TAX POSITIONS AND HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2014. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. CENTRAL AMERICA AND THE CARIBBEAN 0 INVESTMENTS 184151000 0 184151000 true false true true true false SCHEDULE F, PART I, LINE 3(F), INVESTMENT CENTRAL GEORGIA HEALTH SYSTEMS IS THE OWNER OF VARIOUS FOREIGN INVESTMENTS WHICH ARE HELD FOR THE BENEFIT OF THE MEDICAL CENTER OF CENTRAL GEORGIA, INC., AN AFFILIATED CONTROLLED TAX EXEMPT ORGANIZATION. FOR ACCOUNTING PURPOSES, THESE INVESTMENTS ARE REFLECTED ON THE BALANCE SHEET OF THE MEDICAL CENTER OF CENTRAL GEORGIA. SCHEDULE F, PART IV, LINE 4, QUALIFIED ELECTING FUND BLACKSTONE PARK AVENUE NON-TAXABLE FUND, L.P. HAS MADE A TIMELY IRC SEC. 1295 ELECTION WITH RESPECT TO VARIOUS INVESTMENTS IN PASSIVE FOREIGN INVESTMENT COMPANIES AND HAS FILED FORM 8621 ON BEHALF OF THE PARTNERSHIP. NO UNRELATED BUSINESS TAXABLE INCOME IS EARNED OR REPORTED AS A RESULT OF THIS INVESTMENT. Schedule F, Part I, Line 3, Method to account for expenditures on org.'s financial statements CENTRAL AMERICA AND THE CARIBBEAN: ACCRUAL Schedule F, Part I, Line 3, Method to account for expenditures on org.'s financial statements CENTRAL AMERICA AND THE CARIBBEAN: ACCRUAL true true X true X 1.25 true X 2.7 true true false true true 978544 0 978544 0.01940 233548 0 233548 0.00460 0 0 0 0.00000 0 0 1212092 0 1212092 0.02400 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0 0 0.00000 0 0 1212092 0 1212092 0.02400 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0 0 0 0 0.00000 false 150873 0 12415359 8156648 4258711 X true true 1 1 CENTRAL GA REHABILITATION HOSPITAL INC 3351 NORTHSIDE DRIVE MACON GA 31210 WWW.NAVICENTHEALTH.ORG 011-627 X REHABILITATION CENTRAL GA REHABILITATION HOSPITAL INC 1 true X X X X X X X X X 12 true true true X WWW.MCCG.ORG X WWW.NAVICENTHEALTH.ORG X X X X X X X X X X false false true true 125 true 270 true X X X X X X true true X X X X X X true false X X X X true X false false Schedule H, Part V Sec B, Line 3, Community Served by Needs Assessment (1) - CENTRAL GEORGIA REHABILITATION HOSPITAL, LLC.: A STRATIFIED RANDOM TELEPHONE SURVEY OF 1,000 INDIVIDUALS AGE 18 OR OLDER WAS CONDUCTED ACROSS BIBB, HOUSTON, PEACH, JONES, TWIGGS, MONROE AND CRAWFORD COUNTIES. AS PART OF THE ASSESSMENT, FIVE FOCUS GROUPS WERE HELD THROUGHOUT THE REGION. PARTICIPANTS INCLUDED 34 KEY INFORMANTS INCLUDING SOCIAL SERVICE PROVIDERS, PHYSICIANS, BUSINESS LEADERS AND OTHERS. PARTICIPANTS ALSO INCLUDED A PUBLIC HEALTH REPRESENTATIVE AND SEVERAL INDIVIDUALS WHO WORK WITH LOW INCOME, MINORITY AND OTHER MEDICALLY UNDERSERVED POPULATIONS. A VARIETY OF SECONDARY DATA SOURCES WAS CONSULTED TO COMPLEMENT THE ASSESSMENT INCLUDING THE CENTERS FOR DISEASE CONTROL AND PREVENTION, GEOLYTICS DEMOGRAPHIC ESTIMATES AND PROJECTIONS, NATIONAL CENTER FOR HEALTH STATISTICS, GEORGIA BUREAU OF INVESTIGATION, US CENSUS DATA, US DEPARTMENT OF HEALTH AND HUMAN SERVICES, THE FBI AND THE US DEPARTMENT OF JUSTICE. PROFESSIONAL RESEARCH CONSULTANTS, INC. CONDUCTED THE COMMUNITY NEEDS ASSESSMENT ON BEHALF OF THE ORGANIZATION.; Schedule H, Part V Sec B, Line 4, Other Hospital Facilities included in Needs Assessment (1) - CENTRAL GEORGIA REHABILITATION HOSPITAL, LLC.: THE MEDICAL CENTER OF CENTRAL GEORGIA; Schedule H, Part V Sec B, Line 5d, Availability of Needs Assessment (1) - CENTRAL GEORIGA REHABILITATION HOSPITAL, LLC.: A COPY OF THE ASSESSMENT WAS PROVIDED TO MANY COMMUNITY LEADERS AND ORGANIZATIONS.; Schedule H, Part V Sec B, Line 7, Needs not addressed in Needs Assessment (1) - CENTRAL GEORGIA REHABILITATION HOSPITAL, LLC.: CENTRAL GEORGIA REHABILITATION HOSPITAL IS A LIMITED PURPOSE FACILITY. THE ORGANIZATION AND THE MEDICAL CENTER OF CENTRAL GEORGIA, A RELATED 501(C)(3) ORGANIZATION IDENTIFIED THE FOLLOWING NEEDS THAT WERE NOT TO BE ADDRESSED IN FISCAL YEAR 2014: 1) MENTAL HEALTH-LACK OF EXPERTISE, RESOURCES AND EXISTENCE OF OTHER PROVIDERS BETTER SUITED TO ADDRESS THIS NEED. 2) ORAL HEALTH-OTHER COMMUNITY ORGANIZATIONS ARE CURRENTLY BETTER SUITED TO ADDRESS THIS NEED. 3) SEXUALLY TRANSMITTED DISEASES-LIMITED RESOURCES AND EXPERTISE. ADDITIONALLY, WE DETERMINED THIS NEED IS BETTER ADDRESSED BY OTHER COMMUNITY ORGANIZATIONS INCLUDING THE PUBLIC HEALTH DEPARTMENT, A VOLUNTEER CLINIC AND LOCAL SCHOOL SYSTEMS. 4) CANCER-MCCG IS BUILDING A CANCER CENTER. TREATMENT OF PATIENTS TO BEGIN DECEMBER, 2014.; Schedule H, Part V Sec B, Line 14g, Other ways hospital publicized Financial Assistance Policy (1) - CENTRAL GEORGIA REHABILITATION HOSPITAL: A STATEMENT RELATED TO THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS ON EACH PATIENT'S BILLING STATEMENT. THERE IS REFERENCE MADE TO THE POLICY IN TWO PLACES. BOTH LOCAL AND TOLL FREE PHONE NUMBERS ARE LISTED FOR STAFF TO PROVIDE ASSISTANCE WITH THE POLICY AND THE ORGANIZATION'S WEBSITE IS LISTED STATING THE FINANCIAL ASSISTANCE POLICIES ARE LOCATED THERE. THERE IS ALSO STATEMENT THAT THE POLICIES ARE AVAILABLE IN BOTH ENGLISH AND SPANISH.; Schedule H, Part V Sec B, Line 20d, How amounts charged to FAP-eligible patients were determined (1) - CENTRAL GEORGIA REHABILITATION HOSPITAL: THE HOSPITAL FACILITY USED AN ESTIMATE OF THE AVERAGE OF THE THREE LOWEST COMMERCIALLY INSURED RATES.; , BAD DEBT BAD DEBT EXPENSE IN THE AMOUNT OF $150,873 HAS BEEN REMOVED FROM TOTAL EXPENSE AND RECLASSIFED AS A REVENUE OFFSET IN THE AUDITED FINANCIAL STATEMENTS. THEREFORE, IT IS UNNECESSARY TO REDUCE THE EXPENSES REFLECTED IN FORM 990 PART IX, LINE 29 FOR PURPOSES OF CALCULATING THE SCHEDULE H, LINE 7, COLUMN (F) PERCENT OF TOTAL EXPENSES SINCE THE PRESENTATION IN PART IX FOLLOWS THE ORGANIZATION'S FINANCIAL ACCOUNTING RECORDS. Schedule H, Part I, Line 6a, Community benefit report prepared by related organization MEDICAL CENTER OF CENTRAL GEORGIA Schedule H, Part I, Line 7, Costing Methodology used to calculate financial assistance COST TO CHARGE RATIO FROM WORKSHEET 2. LOSS ON MEDICAID IS ACTUAL HOSPITAL TAXES PAID FROM GENERAL LEDGER. HOSPITAL NOT ELIGIBLE TO PARTICIPATE IN GEORGIA MEDICAID PROGRAM DUE TO CURRENT RULES RELATED TO REHABILITATION HOSPITAL PARTICIPATION. Schedule H, Part I, Line 7, col(f), Bad Debt Expense excluded from financial assistance calculation 0 Schedule H, Part III, Line 2, Bad debt expense - methodology used to estimate amount PATIENT CHARGES WRITTEN OFF TO BAD DEBT NOT OTHERWISE PAID BY THIRD-PARTY INSURANCE, GOVERNMENT PROGRAMS, PATIENT PAYMENTS OR OTHERWISE QUALIFIED UNDER HOSPITAL'S CHARITY AND INDIGENT POLICIES. Schedule H, Part III, Line 3, Bad Debt Expense Methodology N/A Schedule H, Part III, Line 4, Bad debt expense - financial statement footnote THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. CGHS'S S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 98% OF SELF-PAY ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2014 AND 2013. Schedule H, Part III, Line 8, Community benefit & methodology for determining medicare costs THE COSTING METHODOLOGY IS TO USE THE ACTUAL COSTS INCLUDED IN THE COST REPORT WHICH ARE CALCULATED USING A DEPARTMENTAL SPECIFIC COST TO CHARGE RATIO AS COMPARED TO ACTUAL MEDICARE PAYMENTS. Schedule H, Part III, Line 9b, Collection practices for patients eligible for financial assistance ONCE A PATIENT IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE, IT IS NOTED IN THE PATIENT'S FINANCIAL RECORD AND ANY COLLECTION EFFORTS CEASE. ANY PREVIOUS AMOUNTS BILLED ARE WRITTEN OFF AS PROVIDED IN THE FINANCIAL ASSISTANCE POLICY. THE ASSISTANT VICE PRESIDENT OF REVENUE CYCLE OF THE ORGANIZATION REVIEWS THE FINANCIAL ACTIVITY ON OTHER ACCOUNTS TO DETERMINE IF AN ACCOUNT SHOULD BE TURNED OVER TO OUTSIDE COLLECTIONS. IF A PATIENT ACCOUNT TURNED OVER TO COLLECTIONS IS LATER DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE, THE ACCOUNT IS BROUGHT BACK FROM COLLECTIONS AND THE ACCOUNT WRITTEN OFF. Schedule H, Part VI, Line 2, Needs assessment. A COMMUNITY NEEDS ASSESSMENT WAS PERFORMED IN 2012 ON BEHALF OF THE HOSPITALS OF CENTRAL GEORGIA HEALTH SYSTEM (CGHS) BY PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC). PRC IS A NATIONALLY RECOGNIZED HEALTHCARE CONSULTING FIRM WHICH HAS CONDUCTED HUNDREDS OF COMMUNITY NEEDS ASSESSMENTS SINCE 1994. THE SURVEY AREA INCLUDED THE PRIMARY SERVICE AREA FOR CGHS HOSPITALS INCLUDING BIBB, CRAWFORD, HOUSTON, JONES, MONROE, PEACH AND TWIGGS COUNTIES. THE SURVEY INCLUDED 1,000 LAND LINE AND CELL PHONE SURVEYS AND FIVE KEY INFORMANT FOCUS GROUPS WHICH INCLUDED HEALTHCARE PROVIDERS AND OTHER COMMUNITY LEADERS. ADDITIONALLY, PUBLIC HEALTH, VITAL STATISTICS AND BENCHMARK DATA INCLUDING GEORGIA AND NATIONWIDE RISK FACTOR DATA AND HEALTHLY PEOPLE 2020 WERE USED. Schedule H, Part VI, Line 3, Patient education of eligibility for assistance. PATIENTS ARE INFORMED OF AVAILABLE ASSISTANCE BY THE FOLLOWING METHODS: THE PATIENT IS NOTIFIED UPON ADMISSION OF THE FINANCIAL ASSISTANCE POLICY; SIGNAGE IN ADMISSION AREAS NOTIFIES HOSPITAL PATIENTS AND GUESTS OF THE POLICY; AND THE CGRH BUSINESS OFFICE LIAISON OR DESIGNATED PATIENT ACCOUNT REPRESENTATIVE (PAR) WILL INTERVIEW PATIENTS WHO HAVE LITTLE OR NO THIRD PARTY COVERAGE AND WILL REQUEST DOCUMENTS TO SUPPORT THEIR NEED VIA A FINANCIAL DISCLOSURE FORM. THE FINANCIAL DISCLOSURE FORM WILL ASCERTAIN MONTHLY BILLS AND ASSETS IN THE DETERMINATION OF PATIENT ABILITY TO PAY. Schedule H, Part VI, Line 4, Community information. THE PRIMARY SERVICE AREA IS BIBB, CRAWFORD, HOUSTON, JONES, MONROE, PEACH AND TWIGGS COUNTIES. THERE ARE TWENTY-ONE COUNTIES IN THE SECONDARY SERVICE AREA. A RECENT ESTIMATE OF POPULATION IN THE PRIMARY SERVICE AREA IS 406,725 AND THE SECONDARY SERVICE AREA HAS A POPULATION OF 389,460. Schedule H, Part VI, Line 5, Promotion of community health THE ORGANIZATION IS PART OF A MULTI ENTITY HOSPITAL SYSTEM THAT PROVIDES MEDICAL SERVICES TO THE COMMUNITY. THE ORGANIZATION HAS A BOARD COMPRISED OF MEMBERS OF THE COMMUNITY. THE MEDICAL STAFF OF THE HOSPTIAL IS OPEN TO ALL QUALIFIED PHYSICIAN APPLICANTS. ANY SURPLUS FUNDS ARE REINVESTED IN THE ORGANIZATION AND USED FOR PROGRAM SERVICES. AN EMERGENCY ROOM OPEN 24/7/365 IS AVAILABLE AT OUR SISTER ORGANIZATION, THE MEDICAL CENTER OF CENTRAL GEORGIA, A GENERAL SHORT TERM ACUTE CARE FACILITY AND ONE OF FIVE LEVEL 1 TRAUMA CENTER'S IN THE STATE OF GEORGIA. Schedule H, Part VI, Line 6, Affiliated health care system PART VI, LINE 7: THE ORGANIZATION IS PART OF CENTRAL GEORGIA HEALTH SYSTEMS, INC., A MULTI-ENTITY HEALTHCARE SYSTEM. OTHER ORGANIZATIONS IN THE SYSTEM INCLUDE: MEDICAL CENTER OF CENTRAL GEORGIA, INC. - A 637 BED GENERAL SHORT TERM ACUTE CARE HOSPITAL FACILITY THAT IS DESIGNATED AS A LEVEL 1 TRAUMA CENTER AND MAGNET HOSPITAL FOR NURSING. HEALTH SERVICES OF CENTRAL GEORGIA, INC. - PROVIDES FACULTY PHYSICIANS TO THE RESIDENCY TRAINING PROGRAMS OF THE MEDICAL CENTER OF CENTRAL GEORGIA AS WELL AS OTHER PHYSICIANS, NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS. CENTRAL GEORGIA SENIOR HEALTH, INC. - IS A CONTINUING CARE RETIREMENT COMMUNITY (CCRC) OFFERING INDEPENDENT LIVING, ASSISTED LIVING, MEMORY SUPPORT AND SKILLED NURSING. MEDCEN FOUNDATION, INC. -PROVIDES FUNDRAISING AND SUPPORT FOR CENTRAL GEORGIA HEALTH SYSTEMS, INC. AND ITS AFFILIATES. THE MEDICAL CENTER OF PEACH COUNTY, INC. IS A 25 BED CRITICAL ACCESS HOSPITAL SERVING THE RESIDENTS OF PEACH COUNTY AND SURROUNDING AREAS. Schedule H, Part VI, Line 7, State filing of community benefit report GA true THE MEDICAL CENTER OF CENTRAL GEORGIA INC 691 CHERRY STREET SUITE 400 MACON GA 31201 582149128 501(C)(3) 3246860 SUPPORT 1 0 Schedule I, Part I, Line 2, Procedures for monitoring use of grant funds CGHS REQUIRES ALL ORGANIZATIONS THAT RECEIVE SPONSORSHIPS TO PROVIDE PROOF OF THEIR NON PROFIT STATUS. X false true X X X X X false true false false false false false false false KAREN M FARR AVP FINANCIAL SERVICES 162028 0 0 0 8283 0 2127 0 1802 0 174240 0 0 0 KENNETH B BANKS CORPORATE SECRETARY 282868 0 0 0 302880 0 157183 0 22049 0 764980 0 278853 0 KATHERINE L BOWEN AVP FIN PLANNING, BUDGET AND INSURANCE 162956 0 0 0 485 0 2065 0 13755 0 179261 0 0 0 A DONALD FAULK JR CEO (TRANSITION) 44656 0 0 0 126644 0 0 0 0 0 171300 0 0 0 JANE P GRAY AVP PATIENT BUSINESS SERVICES 168725 0 0 0 539 0 2191 0 22238 0 193693 0 0 0 RHONDA S PERRY CHIEF FINANCIAL OFFICER 415192 0 0 0 870525 0 79515 0 8922 0 1374154 0 870111 0 ELBERT T MCQUEEN VP POST ACUTE SERVICES AND REGIONAL DEVELOPMENT 227376 0 0 0 5881 0 13576 0 12687 0 259520 0 0 0 JUDY K WARE CHIEF COMPLIANCE OFFICER 151051 0 0 0 17905 0 4344 0 17990 0 191290 0 0 0 NINFA M SAUNDERS PRESIDENT/CHIEF EXECUTIVE OFFICER 732091 0 0 0 36034 0 615986 0 22313 0 1406424 0 0 0 TIQUELLA S KING-WHITBY PHYSICIAN 176675 0 0 0 81 0 4627 0 20452 0 201835 0 0 0 Schedule J, Part I, Line 1a, First-class or charter travel FIRST CLASS TRAVEL IS AUTHORIZED BY THE CHAIRMAN OF THE BOARD FOR THE CEO IN SPECIFIC SITUATIONS. Schedule J, Part I, Line 1b, Written policy regarding payment or reimbursement of expenses THE POLICY HAS BEEN AUTHORIZED BY THE CHAIRMAN OF THE BOARD AND IS BEING WRITTEN BY GENERAL COUNSEL. Schedule J, Part I, Line 4b, Supplemental nonqualified retirement plan MCCG HAD A SUPPLEMENTAL EXECUTIVE BENEFIT PROGRAM ("SEBP") FOR CERTAIN EXECUTIVES THAT WAS DESIGNED AS A LOAN REGIME SPLIT DOLLAR LIFE INSURANCE PROGRAM. THIS PROGRAM WAS EXPECTED TO PROVIDE DEATH AND OTHER BENEFITS TO EXECUTIVES AND TO PROVIDE REPAYMENT OF LIFE INSURANCE PREMIUMS TO THE ORGANIZATION. AS A RESULT OF ECONOMIC CONDITIONS, THE LIFE INSURANCE POLICIES DID NOT PERFORM AS ANTICIPATED. DURING 2009 MCCG SUSPENDED ALL PREMIUM PAYMENTS AND REEVALUATED THE EFFECTIVENESS OF THE PROGRAM FOR ALL CURRENT PARTICIPANTS. DURING CALENDAR YEAR 2009 THE MCCG BOARD OF DIRECTORS, AFTER CONSULTATION WITH COMPENSATION AND LEGAL ADVISERS, ADOPTED A RESOLUTION TO MAKE PAYMENTS TO THE RETIRED PARTICIPANTS IN THE SEBP. IN CONSIDERATION FOR THE RECEIPT OF SUCH PAYMENT, THE RETIRED EXECUTIVES SURRENDERED SUBSTANTIALLY ALL RIGHTS AND BENEFITS (OTHER THAN A SMALL DEATH BENEFIT) UNDER THE SEBP TO THE ORGANIZATION. SUBSEQUENTLY, A SIMILAR DECISION WAS MADE DURING FISCAL YEAR ENDED SEPTEMBER 30, 2011 FOR THE REMAINING (EMPLOYED) PARTICIPANTS WITH ANY PAYMENTS TO BE MADE DEPENDENT ON THE INDIVIDUAL CONTINUING TO PROVIDE SUBSTANTIAL SERVICES TO A SPECIFIED FUTURE DATE. IN ADDITION, MCCG AND ITS AFFILIATED ORGANIZATIONS ADOPTED A SERP PROGRAM FOR CERTAIN EXECUTIVES EFFECTIVE FOR SERVICES RENDERED ON OR AFTER JANUARY 1, 2010. THIS PROGRAM PROVIDES FOR ANNUAL ACCOUNT VESTING IF THE PARTICIPANT IS EMPLOYED ON DECEMBER 31 OF THE THIRD YEAR AFTER THE ACCOUNT IS CREATED. THE BENEFIT EQUALS THE ANNUAL INCREASE IN THE PRESENT VALUE OF A LIFETIME ANNUITY PAYABLE COMMENCING AT A SPECIFIED TARGETED FUTURE DATE. THE ANNUTIY IS EQUAL TO A SPECIFIC PERCENTAGE OF FINAL AVERAGE EARNINGS (GENERALLY 60%) LESS (1) THE EXPECTED ANNUAL SEBP PAYMENT USED IN CALCULATING THE SEBP LUMP SUM PAYMENT, (2) THE ANNUAL BENEFIT PROVIDED UNDER THE DEFINED BENEFIT PLAN, AND (3) 100% OF THE PARTICIPANT'S SOCIAL SECURITY BENEFIT. DURING THE YEAR, THE FOLLOWING BENEFITS WERE ACCRUED: RHONDA PERRY $ 46,523 KEN BANKS $137,154 IN ADDITION, CGHS ADOPTED A RETENTION PAYMENT PLAN EFFECTIVE OCTOBER 1, 2011 DESIGNED TO ENCOURAGE DESIGNATED EMPLOYEES TO CONTINUE THEIR EMPLOYMENT. UNDER THE PLAN, CGHS MAY SELECT A RETENTION CREDIT EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE SALARY. THE CREDIT IS REDUCED BY THE VALUE OF LIFE INSURANCE COVERAGE PROVIDED TO THE EXECUTIVE. IN GENERAL, THE PLAN IS SUBJECT TO VESTING AT THE END OF THE THIRD PLAN YEAR AFTER THE ACCOUNT WAS CREATED OR AGE 65 IF EARLIER, AND IS SUBJECT TO FORFEITURE IF THE EXECUTIVE VOLUNTARILY SEPARATES FROM SERVICE. DURING THE YEAR THE FOLLOWING BENEFITS ACCRUED UNDER THIS PLAN: RHONDA PERRY $31,986 KEN BANKS $18,083 ELBERT MCQUEEN $10,638 IN ADDITION, CGHS ADOPTED A NONQUALIFIED, UNFUNDED DEFERRED COMPENSATION PLAN DESIGNED TO ATTRACT AND RETAIN QUALIFIED MANAGEMENT PESONNEL. DURING THE YEAR THE FOLLOWING BENEFITS ACCRUED UNDER THIS PLAN: NINFA M. SAUNDERS $613,556 THE FOLLOWING NONQUALIFIED RETIREMENT PLAN BENEFITS WERE REPORTED AS TAXABLE INCOME TO VESTED INDIVIDUALS: RHONDA PERRY $870,111 KEN BANKS $278,853 A DONALD FAULK $126,644 Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body THE FORM 990 WAS PREPARED BY HOSPITAL PERSONNEL FROM INFORMATION PROVIDED BY MANAGEMENT AND FROM CONSOLIDATED FINANCIAL STATEMENTS (AUDITED BY AN INDEPENDENT CPA FIRM). IT IS REVIEWED IN DETAIL BOTH BY OUR OUTSIDE TAX ADVISOR (ANOTHER INDEPENDENT CPA) AND BY FINANCIAL MANAGEMENT OF CENTRAL GEORGIA HEALTH SYSTEMS. A COPY OF THE FORM 990 WAS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy THE DEPARTMENT OF AUDIT AND COMPLIANCE ISSUES COI DISCLOSURE FORMS ANNUALLY TO OUR BOARD MEMBERS, ADMINISTRATION AND DIRECTORS. AUDIT AND COMPLIANCE RECEIVES, REVIEWS AND DOCUMENTS ALL POTENTIAL CONFLICTS (PERCEIVED AND REAL.) THE RESULTS ARE TAKEN TO THE COMPLIANCE COMMITTEE WHERE THE REAL CONFLICTS OF INTEREST ARE DISCUSSED AND A PLAN FOR CORRECTIVE ACTION IS DEVELOPED. THE CORRECTIVE ACTION RECOMMENDATIONS ARE TAKEN TO THE VARIOUS BOARDS AND ADMINISTRATION FOR IMPLEMENTATION. ANY TIME A CHANGE IN A RELATIONSHIP OR NEW POTENTIAL CONFLICT EVOLVES, THE INDIVIDUALS MUST AMEND THEIR COI DISCLOSURE FORM. CONFLICTED INDIVIDUALS ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND DECISIONS REGARDING SUCH TRANSACTIONS, BUT MAY PROVIDE INFORMATION IF REQUESTED BY THE COMPLIANCE COMMITTEE. Form 990, Part VI, Sec B, Line 15a, Process to establish compensation of top management official THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS ENGAGES AN EXECUTIVE CONSULTING FIRM EVERY 2-3 YEARS TO REVIEW AND PROVIDE RECOMMENDATIONS REGARDING TOTAL COMPENSATION AND BENEFITS FOR THE EXECUTIVE LEADERSHIP TEAM. BASE COMPENSATION, INCENTIVE COMPENSATION, AND BENEFITS ARE INCLUDED IN THE REVIEW. THE EXECUTIVE CONSULTANTS REVIEW ORGANIZATION STRUCTURE, INDIVIDUAL JOB DESCRIPTIONS, AND DISCUSS SCOPE OF LEADERSHIP AND SPAN OF CONTROL WITH HR, THE COO, AND THE CEO AS A PART OF THE PROCESS TO DETERMINE PROPER PLACEMENT OF THE PAY GRADE AND LEVEL OF PARTICIPATION IN INCENTIVE AND BENEFITS PROGRAMS. THE COMPENSATION COMMITTEE PERIODICALLY REAFFIRMS THE TOTAL COMPENSATION PHILOSOPHY WHICH CURRENTLY TARGETS THE 75TH PERCENTILE OF TOTAL COMPENSATION FOR OUR LEADERSHIP TEAM. THE PEER GROUP USED IS NATIONAL HOSPITALS AND HEALTH SYSTEMS OF SIMILAR SIZE AND SCOPE. KEY EMPLOYEES AND OTHERS OUTSIDE OF THE EXECUTIVE LEADERSHIP TEAM HAVE COMPENSATION SET BY HR GUIDELINES AND/OR MARKET COMPENSATION STUDIES. Form 990, Part VI, Sec B, Line 15b, Process to establish compensation of other employees THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS ENGAGES AN EXECUTIVE CONSULTING FIRM EVERY 2-3 YEARS TO REVIEW AND PROVIDE RECOMMENDATIONS REGARDING TOTAL COMPENSATION AND BENEFITS FOR THE EXECUTIVE LEADERSHIP TEAM. BASE COMPENSATION, INCENTIVE COMPENSATION, AND BENEFITS ARE INCLUDED IN THE REVIEW. THE EXECUTIVE CONSULTANTS REVIEW ORGANIZATION STRUCTURE, INDIVIDUAL JOB DESCRIPTIONS, AND DISCUSS SCOPE OF LEADERSHIP AND SPAN OF CONTROL WITH HR, THE COO, AND THE CEO AS A PART OF THE PROCESS TO DETERMINE PROPER PLACEMENT OF THE PAY GRADE AND LEVEL OF PARTICIPATION IN INCENTIVE AND BENEFITS PROGRAMS. THE COMPENSATION COMMITTEE PERIODICALLY REAFFIRMS THE TOTAL COMPENSATION PHILOSOPHY WHICH CURRENTLY TARGETS THE 75TH PERCENTILE OF TOTAL COMPENSATION FOR OUR LEADERSHIP TEAM. THE PEER GROUP USED IS NATIONAL HOSPITALS AND HEALTH SYSTEMS OF SIMILAR SIZE AND SCOPE. KEY EMPLOYEES AND OTHERS OUTSIDE OF THE EXECUTIVE LEADERSHIP TEAM HAVE COMPENSATION SET BY HR GUIDELINES AND/OR MARKET COMPENSATION STUDIES Form 990, Part VI, Sec C, Line 19, Required documents available to the public CGHS PROVIDES COPIES OF ITS GOVERNING AND OTHER CORPORATE DOCUMENTS UPON REQUEST. 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