2013-08-14T11:00:22-05:00 2012-09-30 580914992 DRAFFIN & TUCKER LLP FIVE CONCOURSE PARKWAY SUITE 1250 ATLANTA GA 30328 990 2011-10-01 582149128 MEDICAL CENTER OF CENTRAL GEORGIA INC MEDI 4786331407 691 CHERRY STREET MACON GA 31201 RHONDA S PERRY 2013-08-14 true W Edward Phillips P00451499 4042208494 2011 2016-02-24 21:20:13Z NINFA M SAUNDERS 691 CHERRY STREET SUITE 400 MACON GA 31201 1179420097 false X WWW.MCCG.ORG X 1994 GA THE MEDICAL CENTER OF CENTRAL GEORGIA, INC. (MCCG) IS A NON-PROFIT MEDICAL CENTER WHOSE PRIMARY PURPOSE IS TO PROVIDE HIGH QUALITY HEALTHCARE SERVICE FOR INPATIENT, OUTPATIENT , PHYSICIAN CARE, EMERGENCY SERVICES AND OTHER HEALTH CARE RELATED SERVICES TO MACON/BIBB COUNTY, GEORGIA AND SURROUNDING AREAS. 9 8 5561 271 7645391 634071 9684857 8204196 658253425 689704529 31069582 20651650 3078807 3149639 702086671 721710014 20782231 30444174 0 0 291899274 306826018 0 0 0 336409400 359040239 649090905 696310431 52995766 25399583 1104694416 1168004656 378400458 417686148 726293958 750318508 X TO ENHANCE THE HEALTH STATUS OF THOSE WE SERVE IN PARTNERSHIP WITH MEDICAL STAFF AND OTHER COMMUNITY ORGANIZATIONS BY PROVIDING WELLNESS SERVICES, HEALTH EDUCATION, TRAINING, AND ACCESS TO SAFE HIGH QUALITY HEALTH CARE SERVICES. true false 630326652 30444174 684228373 THE MEDICAL CENTER OF CENTRAL GEORGIA (MCCG) IS AN ACADEMIC MEDICAL CENTER, DESIGNATED LEVEL 1 TRAUMA CENTER AND MAGNET HOSPITAL FOR NURSING AND SERVES THE RESIDENTS OF CENTRAL AND SOUTH GEORGIA WITH A PRIMARY AND SECONDARY SERVICE AREA OF 30 COUNTIES AND A POPULATION OF NEARLY 750,000 PERSONS. MCCG HAS OVER 4,600 EMPLOYEES AND A MEDICAL STAFF OF OVER 590 PHYSICIANS, AS THE SECOND LARGEST HOSPITAL IN GEORGIA, IT IS LICENSED FOR 637 BEDS, INCLUDING MEDICAL-SURGICAL, OBSTETRIC, CARDIAC AND CARDIAC SURGERY. THE EMERGENCY CENTER, WITH THE HELIPAD CAPABILITY AND THREE URGENT CARE CENTERS, TREATS OVER 120,000 VISITORS PER YEAR. MCCG PROVIDES A BROAD RANGE OF COMMUNITY-BASED OUTPATIENT DIAGNOSTIC, PRIMARY CARE, AND COMPREHENSIVE REHABILITATION SERVICES. IT IS THE PRIMARY ACADEMIC HOSPITAL FOR MERCER UNIVERSITY SCHOOL OF MEDICINE, PROVIDING RESIDENCY AND FELLOWSHIP PROGRAMS FOR OVER 100 RESIDENTS AND IS AFFILIATED WITH MULTIPLE UNIVERSITIES AS A CLINICAL EDUCATION SITE. MCCG OPERATES THE DOCTORS OFFICE BUILDING, HOSPICE OF CENTRAL GEORGIA AND CENTRAL GEORGIA HOME CARE SERVICES. 630326652 true true false true false false false false false true true false false true true false true false false false false false false false false true true true false true true false false false false false true false false false false false false false false true true true true false false true 540 0 5561 true true true false false false false false false false false false X 9 8 false false false false true true true 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 X A KENNETH HARPER MD 1.00 X 0 0 0 DAN SLAGLE 1.00 X 0 0 0 DAVID DANZIE 1.00 X 0 0 0 JOAN WALTON 1.00 X 0 0 0 KIM JOHNSTON MD 1.00 X 0 0 0 LEE MURPHEY 1.00 X 0 0 0 NANCY ANDERSON 1.00 X 0 0 0 ROBERTA ANDREWS MD 1.00 X 0 0 0 TIMOTHY JACKSON 1.00 X 0 0 0 A DONALD FAULK JR 1.00 X 0 1084375 58256 KENNETH B BANKS 1.00 X 0 416659 451456 RHONDA S PERRY 1.00 X 0 576260 527222 BETH A GREER 50.00 X 265098 0 30025 DAWN COLE 50.00 X 264884 0 48510 JAMES M CUNNINGHAM 50.00 X 535785 0 25893 JOSEPH LAVELLE 49.00 X 633771 12389 979828 JUDY C PAULL 50.00 X 249528 0 9555 TOMMY L SANDS JR 50.00 X 300484 0 41360 WILLIAM R AVENEL 50.00 X 307886 0 13436 KRISHNA N PATEL MD 50.00 X 358061 0 37044 MARCIA HUTCHINSON MD 50.00 X 344096 0 42278 RANDAL SUGERMAN 50.00 X 322728 0 11639 SHEREE H WOLFENDEN 50.00 X 321994 0 15406 TIMOTHTY M LONGAKER MD 50.00 X 420526 0 47032 4324841 2089683 2338940 208 false true false THE NEXUS MEDICAL GROUP 840 PINE STREET SUITE 770 MACON GA 31201 ANESTHESIOLOGIST SERVICES 15496555 ANGELICA TEXTILE SERVICES PO BOX 535122 ATLANTA GA 303535122 LINEN PROCESSING 3057799 GEORGIA MAGNETIC IMAGING 770 PINE STREET SUITE L-15 MACON GA 31201 IMAGING SERVICES 2724896 COGENT HEALTHCARE 5410 MARYLAND WAY SUITE 300 BRENTWOOD TN 37027 HOSPITALIST SERVICES 1937248 KING & SPALDING PO BOX 116133 ATLANTA GA 303686133 LEGAL SERVICES 1798982 114 76518 7042579 1085099 8204196 PATIENT CHARGES 621500 673975484 666670035 7305449 SUPPORT & SERVICES REVENUE 561000 8655443 8315501 339942 DOB RENTAL INCOME 531120 4736411 4736411 SERVICE CHARGES 621990 1250973 1250973 PARKING FEES 812930 961151 961151 125067 125067 0 0 689704529 10110815 10110815 0 0 2333640 285945 2047695 0 2047695 2047695 467208801 756172 455493343 1930795 11715458 -1174623 10540835 10540835 0 0 0 CG PET, LLC 621400 1073213 1073036 177 CG HEALTH NETWORK, LLC 541900 28731 9655 19076 0 0 0 0 1101944 721710014 684228373 7645391 21632054 30444174 30444174 0 0 0 3010492 3010492 0 232948625 227128920 5819705 21488247 21197002 291245 32567760 31903941 663819 16810894 16282333 528561 0 2774049 2774049 0 110970 110970 0 1606615 1606615 87982115 58072372 29909743 1721659 1400471 321188 5882032 5422637 459395 1526278 428399 1097879 0 7472773 7416175 56598 2488859 2275303 213556 0 65230 5045 60185 6028206 6028206 0 38894274 29779769 9114505 8875784 148353 8727431 MEDICAL SUPPLIES 125740194 125679723 60471 BAD DEBTS 41386362 41386362 EQUIP. RENTAL, MAINT & MINOR EQ. 9279670 7731691 1547979 PROVIDER TAXES 7813105 7813105 9392064 8176056 1216008 0 696310431 630326652 65983779 0 0 52480469 21818314 125194997 145180603 18521393 21127305 6616926 7575725 3534760 3744664 824651317 462078436 353900037 362572881 375027074 429940286 157252475 166700107 2723520 1702734 9442765 7642037 1104694416 1168004656 53254212 53283176 147892469 148457264 177253777 215945708 378400458 417686148 X 726293958 750318508 726293958 750318508 1104694416 1168004656 X 25399583 -1375033 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 42499 false false true 68470 110969 false Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 LOBBYING EXPENSES INCLUDE A PORTION OF DUES PAID TO VARIOUS ORGANIZATIONS (I.E., AMERICAN ACADEMY OF ANESTHESIOLOGIST ASSISTANTS, GEORGIA HOSPITAL ASSOCIATION, NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS, GEORGIA CHAMBER OF COMMERCE.) ALSO, CONTRACTED INDIVIDUAL TO LOBBY ON THE ORGANIZATIONS BEHALF. 19915914 19915914 384560055 169694095 214865960 5443555 4254126 1189429 374919337 286759462 88159875 39812456 1370753 38441703 362572881 0 0 INVESTMENTS HEDGE FUNDS, MANAGED FUTURES AND OTHER ALTENATIVE INVESTMENTS 166700107 F 166700107 0 OTHER CURRENT LIABILITIES 2029516 RESERVE - MEDICAL/DENTAL 5587000 POST RETIREE HEALTH INSURANCE RESERVE 2170085 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 7614792 OTHER MISC. PAYABLES 3081976 CURRENT PORTION OF LONG-TERM DEBT 6975000 ACCRUED PENSION BENEFIT LIABILITY 123656689 OTHER LONG TERM LIABILITIES 939052 DUE TO AFFILIATES 15057598 FIN 47 ASSET RETIREMENT OBLIGATION 3792979 POST RETIREMENT HEALTH INS. 32536398 SWAP 2005 BONDS 12504623 215945708 FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 MCCG 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, 2012. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. true true X true X 1.25 true X true true true false true true 25764790 0 25764790 0.03930 110495191 102636093 7859098 0.01200 0 0 0 0.00000 0 0 136259981 102636093 33623888 0.05130 175309 0 175309 0.00030 18682083 8267440 10414643 0.01590 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 0 18857392 8267440 10589952 0.01620 0 0 155117373 110903533 44213840 0.06750 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 true 41386362 0 162986921 159943815 3043106 X true true CENTRAL GEORGIA PET LLC IMAGING 0.6667 0.3333 CENTRAL GEORGIA HEALTH NETWORK LLC PHO 0.29 0.71 1 1 THE MEDICAL CENTER OF CENTRAL GA INC

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HOSPICE Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 COST TO CHARGE RATIO FROM WORKSHEET 2. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 41,386,362 Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 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 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. MCCG'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS 98% OF SELF-PAY ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2012 AND 2011. COST REPORT PART III, LINE 6 THE MEDICARE COSTS SHOWN ON LINE 6 WERE COMPUTED USING THE ORGANIZATION'S MEDICARE COST REPORT FOR THE PERIOD. Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b 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-OFFAS PROVIDED IN THE FINANCIAL ASSISTANCE POLICY. THE ORGANIZATION REVIEWS THE FINANCIAL ACTIVITY ON OTHER ACCOUNTS TO DETERMINE IF THE ACCOUNTS SHOULD BE TURNED OVER TO OUTSIDE COLLECTIONS. IF A PATIENT ACCOUNT TURNED OVER TO COLLECTIONS IS LATER DETERMINED TO QUALIFY AS FINANCIAL ASSISTANCE, THE ACCOUNT IS BROUGHT BACK FROM COLLECTIONS AND THE ACCOUNT WRITTEN OFF. Means used to determine amounts billed Schedule H, Part V Section B, Line 19d (1) THE MEDICAL CENTER OF CENTRAL GA INC - HOSPITAL FACILITY USED AN ESTIMATE OF THE AVERAGE OF THE THREE LOWEST COMMERCIALLY INSURED RATES.; OTHER OPERATIONS PART V, SECTION C THE MEDICAL CENTER OF CENTRAL GEORGIA ALSO OPERATES A HOSPICE. Needs assessment. Schedule H, Part VI, Line 2 A COMMUNITY NEEDS ASSESSMENT WAS PERFORMED IN 2012 ON BEHALF OF THE MEDICAL CENTER OF CENTRAL GEORGIA (MCCG) BY PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC). PRC IS A NATIONALLY RECOGNIZED HEALTHCARE CONSULTING FIRM WHICH HAS CONDUCTED HUNDREDS OF COMMUNITY NEEDS ASSESSMENTS SICNE 1994. THE SURVEY AREA INCLUDED THE PRIMARY SERVICE AREAS FOR MCCG 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. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 PATIENTS ARE INFORMED OF AVAILABLE ASSISTANCE BY THE FOLLOWING METHODS: THE PATIENT IS NOTIFIED UPON ADMISSION OF THE FINANCIAL ASSISTANCE POLICY; SIGNAGE AT ALL ACCESS POINTS INTO THE ORGANIZATION NOTIFIES PATIENTS AND GUESTS OF THE POLICY; AND ALL BILLINGS INCLUDE INFORMATION TO CONTACT THE BUSINESS OFFICE TO APPLY FOR ASSISTANCE. WE ALSO IDENTIFY ALL PATIENTS WITHOUT INSURANCE AND WORK WITH THEM TO OBTAIN MEDICAID COVERAGE IF POSSIBLE. Community information. Schedule H, Part VI, Line 4 THE PRIMARY SERVICE AREA IS BIBB CRAWFORD, HOUSTON, JONES MONROE, PEACH AND TWIGGS COUNTIES. THERE ARE TWENTY-ONE COUNTIES IN THE SECONDARY SERVICE AREA. THE CURRENT POPULATION IN THE PRIMARY SERVICE AREA IS 406,725 AND THE SECONDARY SERVICE AREA HAS A POPULATION OF 389,460. MCCG IS THE TERTIARY HOSPITAL FOR THE CENTRAL GEORGIA REGION. Promotion of community health Schedule H, Part VI, Line 5 THE ORGANIZATION IS PART OF A MULTI-ENTITY HEALTHCARE SYSTEM THAT PROVIDES MEDICAL SERVICES TO THE COMMUNITY. THE ORGANIZATION HAS A BOARD COMPRISED OF MEMBERS OF THE COMMUNITY. THE MEDICAL STAFF OF THE HOSPITAL 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 TO THE COMMUNITY. Affiliated health care system Schedule H, Part VI, Line 6 THE ORGANIZATION IS PART OF CENTRAL GEORGIA HEALTH SYSTEMS, INC., A MULTI-ENTITY HEALTHCARE SYSTEM. OTHER ORGANIZATIONS IN THE SYSTEM INCLUDE: CENTRAL GEORGIA HEALTH SYSTEMS INC. - SERVES AS THE PARENT ENTITY OF THE HEALTH SYSTEM. IT ALSO OPERATES CENTRAL GEORGIA REHABILITATION HOSPITAL, INC. 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. - 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. State filing of community benefit report Schedule H, Part VI, Line 7 GA true HEALTH SERVICES OF CENTRAL GEORGIA INC 691 CHERRY ST SUITE 400 MACON GA 31201 582307485 501(C) (3) 18876872 INTERCOMPANY CENTRAL GEORGIA HEALTH SYSTEMS INC 691 CHERRY STREET SUITE 400 MACON GA 31201 582149127 501(C) (3) 11567302 INTERCOMPANY 2 0 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 MCCG REQUIRES ALL ORGANIZATIONS THAT RECEIVE FUNDS TO PRESENT PROOF OF THEIR NON PROFIT STATUS. false true false false false false false true false JOSEPH LAVELLE 421903 12389 137058 0 74810 0 968388 0 11440 0 1613599 12389 0 0 MARCIA HUTCHINSON MD 254045 0 53309 0 36742 0 33764 0 8514 0 386374 0 0 0 KRISHNA N PATEL MD 293153 0 17000 0 47908 0 25604 0 11440 0 395105 0 0 0 SHEREE H WOLFENDEN 308140 0 700 0 13154 0 14971 0 435 0 337400 0 0 0 A DONALD FAULK JR 0 705308 0 279203 0 99864 0 47359 0 10897 0 1142631 0 0 KENNETH B BANKS 0 260723 0 75751 0 80185 0 436765 0 14691 0 868115 0 0 RHONDA S PERRY 0 392724 0 131626 0 51910 0 522431 0 4791 0 1103482 0 0 JUDY C PAULL 239344 0 2000 0 8184 0 3252 0 6303 0 259083 0 0 0 BETH A GREER 187802 0 39358 0 37938 0 15334 0 14691 0 295123 0 0 0 DAWN COLE 180640 0 39358 0 44886 0 37613 0 10897 0 313394 0 0 0 JAMES M CUNNINGHAM 389914 0 97505 0 48366 0 17379 0 8514 0 561678 0 0 0 TOMMY L SANDS JR 218222 0 45396 0 36866 0 26669 0 14691 0 341844 0 0 0 WILLIAM R AVENEL 217670 0 49903 0 40313 0 4922 0 8514 0 321322 0 0 0 TIMOTHTY M LONGAKER MD 364980 0 17000 0 38546 0 36135 0 10897 0 467558 0 0 0 RANDAL SUGERMAN 266282 0 17000 0 39446 0 3125 0 8514 0 334367 0 0 0 Arrangement used to establish the top management official's compensation Schedule J, Part I, Line 3 MCCG RELIES UPON THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CENTRAL GEORGIA HEALTH SYSTEMS TO ESTABLISH COMPENSATION. THE COMPENSATION COMMITTEE 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 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. Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b 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 HAVE NOT PERFORMED AS ANTICIPATED. DURING 2009 MCCG DETERMINED THAT IT WOULD SUSPEND ALL PREMIUM PAYMENTS AND REEVALUATE 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 $486,919 KEN BANKS $411,258 A PORTION OF THIS ACCRUAL IS A CATCH-UP ACCRUAL DETERMINED FOR SERVICES RENDERED SINCE JANUARY 1, 2010 THAT HAVE NOT BEEN PREVIOUSLY ACCRUED. 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 PERCENTAGGE 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 $16,901 DON FAULK $21,128 KEN BANKS $ 9,835 Non-fixed payments Schedule J, Part I, Line 7 AN AWARD PROGRAM IS ADMINISTERED BY THE CEO. A BUDGET FOR THE PROGRAM IS ESTABLISHED FOR REWARD AND RECOGNITION OF EXECUTIVES AND ORGANIZATIONAL LEADERS WHO GO ABOVE AND BEYOND THE SCOPE OF THEIR RESPONSIBILITIES. FOR EXAMPLE, THEY MAY COMPLETE A PROJECT, LEAD AN ORGANIZATIONAL INITIATIVE, OR EXCEL IN AN AREA THAT REPRESENTS EXCELLENCE UNDER ONE OF OUR ORGANIZATIONAL PILLARS - QUALITY, SERVICE EXCELLENCE, OUR PEOPLE, GROWTH, FINANCIAL PERFORMANCE. NEAR THE END OF THE FISCAL YEAR, NOMINATIONS ARE SOLICITED FROM THE LEADERSHIP TEAM. A PROPOSAL FOR ALLOCATION OF THE AWARD IS DEVELOPED AND PRESENTED TO THE HR COMMITTEE OF THE BOARD FOR REVIEW, DISCUSSION, AND APPROVAL (PRIOR TO DISTRIBUTION). 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SPLIT INS LOAN X 1012536 1484393 false true true VIRGIL COOPER - SPLIT INS LOAN X 358905 429314 false true true GAAP ADJUSTMENT TO CSV X -1891558 -12359686 false true true 21127305 New program services Form 990, Part III, Line 2 DURING THE FISCAL YEAR, MCCG ENTERED INTO AN INTERIM HOSPITAL MANAGMENT AGREEMENT WITH THE HOSPITAL AUTHORITY OF PEACH COUNTY, A 25 BED CRITICAL ACCESS FACILITY IN NEARBY PEACH COUNTY. THE HOSPTIAL AUTHORITY OF PEACH COUNTY AND CENTRAL GEORGIA HEALTH SYSTEMS HAVE ENTERED AN AGREEMENT TO BUILD A NEW PEACH COUNTY CRITICAL ACCESS HOSPITAL WHICH WILL BE A CONTOLLED MEMBER OF CENTRAL GEORGIA HEALTH SYSTEMS. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 CENTRAL GEORGIA HEALTH SYSTEM, INC. (A RELATED 501(C)(3) ORGANIZATION) IS SOLE MEMBER OF THE MEDICAL CENTER OF CENTRAL GEORGIA, INC. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a CENTRAL GEORGIA HEALTH SYSTEM, INC, (A RELATED 501(C)(3) ORGANIZATIONS APPOINTS CERTAIN MEMBERS OF THE BOARD. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b CERTAIN ACTIONS OF THE BOARD MUST BE APPROVED BY THE BOARD OF CENTRAL GEORGIA HEALTH SYSTEM, INC., A RELATED 501(C)(3) ORGANIZATION. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b THE FORM 990 WAS PREPARED BY HOSPITAL PERSONNEL FROM INFORMATION PROVIDED BY MANAGEMENT AND FROM AUDITED FINANCIAL STATEMENTS (PREPARED BY AN INDEPENDENT ACCOUNTANT). IT WAS REVIEWED BY OUR OUTSIDE TAX ADVISOR (ANOTHER INDEPENDENT ACCOUNTANT) AND BY FINANCIAL MANAGEMENT OF THE MEDICAL CENTER OF CENTRAL GEORGIA. A COPY OF THE FORM 990 WAS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE. Conflict of interest policy Form 990, Part VI, Section B, Line 12c 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. Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE COMPENSATION COMMITTEE OF THE CENTRAL GEORGIA HEALTH SYSTEMS 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 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. Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b THE COMPENSATION COMMITTEE OF THE CENTRAL GEORGIA HEALTH SYSTEMS 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 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. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 MCCG PROVIDES COPIES OF ITS GOVERNING AND OTHER COMPANY DOCUMENTS UPON REQUEST. Average number of hours devoted per week to related organization Form 990, Part VII, Section A, Column B JOSEPH LAVELLE - HEALTH SERVICES OF CENTRAL GEORGIA 1 A. DONALD FAULK, JR. - CENTRAL GEORGIA HEALTH SYSTEMS 47 CENTRAL GEORGIA SENIOR HEALTH 1 MEDCEN COMMUNITY HEALTH FOUNDATION 1 KENNETH B. BANKS - CENTRAL GEORGIA HEALTH SYSTEMS 46 HEALTH SERVICES OF CENTRAL GEORGIA 1 MEDCEN COMMUNITY HEALTH FOUNDATION 1 CENTRAL GEORGIA SENIOR HEALTH 1 RHONDA S. PERRY - CENTRAL GEORGIA HEALTH SYSTEMS 46 HEALTH SERVICES OF CENTRAL GEORGIA 1 MEDCEN COMMUNITY HEALTH FOUNDATION 1 CENTRAL GEORGIA SENIOR HEALTH 1 Other changes in net assets or fund balances Form 990, Part XI, Line 5 NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -41501503; RETIREMENT PLAN AUDIT ADJUSTMENTS - 36310178; POST RETIREMENT BENEFIT AUDIT ADJUSTMENTS - 7807841; TAX/BOOK PARTNERSHIP DIFFERENCES - -211418; INTEREST RATE SWAP - -1062744; CSV ADJ-SERP - -2605912; FIN 47 ACCRETION - -36472; FIN 47 CHG IN ESTIMATE - -54628; OTHER CHANGE IN FUND BALANCE - -20374; ROUNDING - -1; INVESTMENTS PART IV, QUESTION 14B CENTRAL GEORGIA HEALTH SYSTEMS OWNS CERTAIN INVESTMENTS SUBJECT TO DISCLOSURE ON SCHEDULE F AND TO ADDITIONAL INFORMATION RETURN REPORTING REQUIREMENTS. THESE INVESTMENTS ARE HELD FOR THE BENEFIT OF THE MEDICAL CENTER OF CENTRAL GEORGIA AND FOR FINANCIAL STATEMENT PURPOSES ARE REFLECTED ON THE BALANCE SHEET OF MCCG. 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