2013-12-05T09:24:33-06:00 2012-09-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2011-10-01 582359398 OCONEE REGIONAL MEDICAL CENTER INC OCON 4784543520 821 NORTH COBB STREET MILLEDGEVILLE GA 31061 BRENDA QUALLS 4784543520 2013-12-05 1 AMY BIBBY P00445891 8282542254 2011 2016-03-07 17:11:31Z X BRENDA QUALLS 821 NORTH COBB STREET MILLEDGEVILLE GA 31061 76707936 0 X WWW.OCONEEREGIONAL.COM X 1997 GA TO PROVIDE HEALTHCARE SERVICES TO ALL PATIENTS WITHIN THE ORGANIZATION'S SERVICE AREA. 13 11 824 239 1767683 -21145 183478 397966 78458098 75479811 149258 134121 127291 696038 78918125 76707936 27410 10909 0 0 34598110 32469256 0 0 0 53380147 47030772 88005667 79510937 -9087542 -2803001 61679483 58762277 35809335 33734656 25870148 25027621 X THE MISSION OF OCONEE REGIONAL MEDICAL CENTER IS TO PROVIDE HIGH QUALITY, SAFE, COMPASSIONATE, PATIENT-FOCUSED HEALTHCARE. 0 0 64834812 10909 73712128 OCONEE REGIONAL MEDICAL CENTER IS A 140-BED GENERAL, ACUTE-CARE INSTITUTION, OFFERING A WIDE RANGE OF SPECIALIZED SERVICES AND PROGRAMS. SUCH SERVICES INCLUDE ACUTE MEDICAL/SURGICAL CARE, A BLOOD BANK, CANCER CENTER UNIT, CARDIOVASCULAR LABORATORY, CT & MRI SCANNERS, LITHOTRIPSY, MAMMOGRAPHY, MEDICAL/SURGICAL INTENSIVE CARE UNIT, OB/GYN, ORTHOPEIC SURGERY, OUTPATIENT SURGERY, PEDIATRIC CARE, PHARMACY DIAGNOSTIC RADIOLOGY, 24-HOUR EMERGENCY SERVICE, LAPAROSCOPIC SURGERY, LASER SURGERY, PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, POST-OPERATIVE RECOVERY ROOM, PROGRESSIVE CARE UNIT, AND RESPIRATORY CARE SERVICES.IT IS THE POLICY OF OCONEE REGIONAL MEDICAL CENTER TO ADMIT AND TREAT ALL PERSONS WITHOUT REGARD TO RACE, COLOR, SEX, HANDICAP, NATIONAL ORIGIN, OR RELIGIOUS CREED. ADMISSION REQUIREMENTS AND ASSIGNMENTS OF HOSPITAL FACILITIES ARE THE SAME FOR ALL PERSONS. THERE ARE NO DISTINCTIONS IN ELIGIBILITY FOR RECEIVING ANY PATIENT CARE SERVICES. HOSPITAL FACILITIES ARE AVAILABLE TO ALL PATIENTS AND VISITORS. INDIVIDUALS AND ORGANIZATIONS HAVING OCCASION TO REFER PATIENTS FOR ADMISSION OR RECOMMEND OCONEE REGIONAL MEDICAL CENTER ARE ADVISED TO DO SO WITHIN THE HOSPITAL'S POLICY TO PROVIDE QUALITY HEALTHCARE TO ALL PERSONS.FOR THE YEAR ENDED SEPTEMBER 30, 2012, THE CENTER PROVIDED INDIGENT AND CHARITY CARE AT A COST OF APPROXIMATELY $2,055,884. THE CENTER ALSO PROVDES CARE TO PATIENTS COVERED BY MEDICARE/MEDICAID AT A TOTAL SHORTFALL OF $2,055,884 AND $2,505,336 FOR MEDICARE AND MEDICAID, RESPECTIVELY. THE CENTER ALSO PROVIDED SUPPORT TO LOCAL CHARITABLE ORGANIZATIONS AND A COMMUNITY HEALTH FAIR AT A COST OF APPROXIMATELY $10,909. THE CENTER ALSO PROVIDES A SITE FOR MEDICAL STUDENTS TO COMPLETE CLINICAL ROTATIONS FOR NURSING AND RADIOLOGY, AS WELL AS HOSTING A MONTHLY PUBLIC EDUCATION SERIES ENTITLED "TO YOUR HEALTH". 64834812 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 79 0 1 824 1 1 1 0 CJ 0 0 0 0 0 0 0 0 X 13 11 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X X BRENDA QUALLS 4784573550 PO BOX 690 MILLEDGEVILLE GA 31059 X CAY QUATTLEBAUM 2.00 X X 0 0 0 DAVID GROSECLOSE 2.00 X X 0 0 0 PAUL DEAN 2.00 X X 0 0 0 TED ZARKOWSKY 2.00 X X 0 0 0 ANDY COWART 2.00 X 0 0 0 GEORGE GRIMES MD 2.00 X 161641 0 0 DON HEACOCK MD 2.00 X 4650 0 0 RAM PURI MD 2.00 X 59040 0 0 JAMES SMITH MD 2.00 X 301 0 0 JEFF CRISP 2.00 X 0 0 0 PHYLLIS PARKS-VEAL PHARMD 2.00 X 0 0 0 VANESSA WALKER 2.00 X 0 0 0 CHARLIE ROSS 2.00 X 0 0 0 REBECCA J AYCOCK 40.00 X 359181 0 29679 JAMES ALAN HORTON 40.00 X 214624 0 26642 DEBORAH REVIS ALMAUHY 40.00 X 146651 0 11195 BRENDA K QUALLS 40.00 X 183704 0 20237 DAVID T PERRY 40.00 X 182541 0 16189 MOLLIE F THOMAS 24.00 X 105087 0 14988 DEBORAH BLOCK 40.00 X 87712 0 14655 JOSEPH R EVANS 40.00 X 145764 0 10958 DEANNE HERRING 40.00 X 122682 0 10190 STACEY OVERTON 40.00 X 115638 0 13847 JAMES FREDERICK 40.00 X 113944 0 23716 JOSEPH HILLIAR 40.00 X 111430 0 9899 2114590 0 202195 20 0 1 0 LOGOS EMERGENCY SPECIALISTS 232 COUNTRY CREEK ROAD MACON GA 31220 EMERGENCY PHYSICIAN SERVICES 3884128 BCAS INC PO BOX 1707 MILLEDGEVILLE GA 31061 ANESTHESIA SERVICES 1380000 ARAMARK CTS 12483 COLLECTIONS CENTER DR CHICAGO IL 60693 DIETARY SERVICES 1286976 ENDURACARE ACUTE CARE SERVICES DEPARTMENT AT 952922 ATLANTA GA 31192 PT, OT, SP SERVICES 1027033 ARAMARK HEALTHCARE FACILITIES JP MORGAN LOCKBOX ACCOUNT 24863 NET CHICAGO IL 606731248 DIETARY SERVICES 668463 17 125000 272966 397966 NET PATIENT SERVICE RE 621400 75479811 73712128 1767683 75479811 8757 8757 125364 125364 136935 0 136935 136935 136935 HITECH 900099 375549 375549 MISCELLANEOUS REVENUE 900099 160297 160297 FITNESS CENTER 713940 23257 23257 559103 76707936 73712128 1767683 830159 10909 10909 1372423 239012 1133411 25194758 21580605 3614153 458208 376326 81882 3596290 2953632 642658 1847577 1528893 318684 438180 118396 319784 346891 346891 96000 96000 45890 45890 13848390 13497545 350845 70575 18213 52362 5122254 2702920 2419334 291938 23809 268129 1284691 1284691 35884 19113 16771 1453210 1453210 4383408 4383408 1390196 961851 428345 BAD DEBT EXPENSE 8830502 8830502 MEDICAL SUPPLIES 8141511 8141511 PROVIDER TAX 1093674 1093674 MISCELLANEOUS EXPENSE 95065 95065 62513 62513 79510937 64834812 14676125 0 160002 1130651 3750722 4022170 9868882 9070352 91290 1723312 1567018 1305673 906333 102787306 74263239 31194040 28524067 11611143 10681417 1974419 2860269 61679483 58762277 5665451 5678357 5464 25416570 24468914 2928967 1388775 1798347 2193146 35809335 33734656 X 25870148 25027621 25870148 25027621 61679483 58762277 X -2803001 1960474 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 45890 45890 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE ORGANIZATION CONTRIBUTES TO CAPITAL AFFAIRS, AN ORGANIZATION THAT LOBBIES ON BEHALF OF ITS MEMBERSHIP BODY. THE ORGANIZATION'S ADDRESS IS: 215 PIEDMONT AVENUE, NE, SUITE 301 / ATLANTA, GA 30308 2387438 2387438 46564230 31406390 15157840 53631949 42856849 10775100 203689 203689 28524067 ESTIMATED THIRD-PARTY SETTLEMENTS 2156814 INTEREST RATE SWAP LIABILITY 36332 2193146 76707936 79510937 -2803001 1989975 -91290 61789 1960474 -842527 69929198 1989975 1989975 67939223 8768713 8768713 76707936 70680435 0 70680435 8830502 8830502 79510937 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: INCOME TAXES- THE SYSTEM AND ITS AFFILIATES, EXCEPT FOR ORHV, PCC AND OSWC, HAVE BEEN RECOGNIZED AS ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) AND, THEREFORE, RELATED INCOME IS GENERALLY NOT SUBJECT TO FEDERAL AND STATE INCOME TAXES. ORHV, PCC AND OSWC ACCOUNT FOR INCOME TAXES IN ACCORDANCE WITH FOR-PROFIT ACCOUNTING GUIDANCE. THE SYSTEM 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 AND 2011. FISCAL YEARS ENDING ON AND AFTER SEPTEMBER 30, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT 61,789. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT -61,789. BAD DEBT EXPENSE 8,830,502. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES PART XIII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 8,830,502. 1 1 1 X 125.000000000000 1 X 1 1 1 0 0 3149558 889978 2259580 0.03200 5093908 4247755 846153 0.01200 5113943 4548433 565510 0.00800 13357409 9686166 3671243 0.05200 10909 10909 0.00020 10909 10909 0.00020 13368318 9686166 3682152 0.05220 10500 10500 0.00010 1 100 100 0.00000 125207 125207 0.00180 1 135807 135807 0.00190 1 4158099 1558871 17780396 19785944 -2005548 X 1 1 1 1 OCONEE REGIONAL MEDICAL CENTER

821 NORTH COBB STREET MILLEDGEVILLE GA 31061

X X X SKILLED NURSING UNIT OCONEE REGIONAL MEDICAL CENTER 1 1 1 125.000000000000 1 250.000000000000 1 X 1 1 X X X 1 0 1 X 0 0 PART I, LINE 7: WORKSHEET 2 OF THE 2011 SCHEDULE H INSTRUCTIONS WAS USED TO COMPUTE A COST-TO-CHARGES RATIO USED TO CALCULATE CHARITY CARE AND UNREIMBURSED MEDICAID AT COST. PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $8,830,502. PART II: COMMUNITY BUILDING ACTIVITIES INCLUDED THE FOLLOWING:1. CONTRIBUTIONS TO UNITED WAY, RELAY FOR LIFE, BOYS AND GIRLS CLUB, LOCAL MEMORIAL FUN RUNS, PARTNERS FOR PROGRESS, AND THE GEORGIA AMPUTEE GOLF TOURNAMENT TO SUPPORT LOCAL HEALTH AND SOCIAL PROGRAMS.2. CONTRIBUTION AND PARTICIPATION IN THE LEADERSHIP BALDWIN PROGRAM.3. PARTICIPATION IN NATIONAL CHILDRENS' STUDY (INCLUDING SERVING ON THE COMMUNITY ADVISORY BOARD FOR THIS STUDY).4. PHYSICIAN RECRUITING AND PAYMENTS ON GUARANTEES FOR OB/GYNS NEW TO THE COMMUNITY. THIS IS THE COST TO HELP ESTABLISH THE NEW PHYSICIAN IN THE MEDICALLY UNDERSERVED COMMUNITY. THE TOTAL AMOUNT SPENT WAS $125,207. PART III, LINE 4: THE IRS WORKSHEETS WERE UTILIZED TO DETERMINE THE COST-TO-CHARGE RATIO.ACCOUNTS RETURNED TO US FROM THE COLLECTION AGENCY FOR CLAIMS WHERE THERE WERE NO ASSETS, THE PATIENT IS DECEASED, OR THE AGENCY BELIEVED THAT THERE WAS NO CHANCE OF COLLECTION TOTAL $4,158,099. MULTIPLY THE THE CALCULATED COST / CHARGE RATIO HERE OF 37.49% YIELDS $1,558,871. PART III, LINE 8: THE TOTAL AMOUNT OF THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. THERE ARE MEMBERS IN OUR COMMUNITY THAT ARE RESIDENTS OF THE GEORGIA WAR VETERANS HOME AND OF CENTRAL STATE HOSPITAL WHO ARE MEDICARE BENEFICIARIES. ALTHOUGH ORMC IS REIMBURSED BY MEDICARE FOR THESE PARTICULARLY FRAGILE PATIENTS UNDER THE PROSPECTIVE PAYMENT RULES, THESE PATIENTS ARE TYPICALLY MORE SEVERLY ILL, HAVE MULTIPLE COMPLICATIONS AND LONGER LENGTHS OF STAY THAN THE AVERAGE MEDICARE PATIENT. WE TREAT ALL MEDICARE PATIENTS THAT PRESENT TO OUR HOSPITAL (IF WE AHVE AVAILABLE THE NEEDED SERVICE). PROVIDING SERVICES TO COMMUNITY MEMBERS AT LESS THAN COST IS CERTAINLY A BENEFIT TO THOSE MEMBERS. PART III, LINE 9B: ACCOUNTS FOR PATIENTS WHO MEET THE CRITERIA FOR FINANCIAL ASSISTANCE ARE WRITTEN OFF TO INDIGENT /CHARITY ACCOUNTS AND NO ATTEMPTS ARE MADE TO COLLECT FROM THE PATIENT. FOR ALL OTHER ACCOUNTS IF OTHER INFORMATION IS KNOWN TO THE COLLECTOR, SUCH AS PATIENT IS DECEASED AND THERE IS NO RECORD OF ESTATE, OR PATIENT MET CHARITY REQUIREMENTS IN PREVIOIUS YEARS AND IT IS KNOWN THAT HIS OR HER CIRCUMSTANCES HAVE NOT CHANGED, FOR INSTANCE, THE ACCOUNT IS WRITTEN OFF TO CHARITY AND NOT SENT TO COLLECTIONS. WE MAKE EVERY EFFORT TO ASSIST PATIENTS TO PROVIDE DOCUMENTATION TO QUALIFY FOR FINANCIAL ASSISTANCE. OCONEE REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 13G: ANY PATIENT THAT DOES NOT HAVE FULL INSURANCE COVERAGE IS APPROACHED WITH AN APPLICATION FOR FINANCIAL ASSISTANCE. OCONEE REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 19D: THE HOSPITAL'S FAP PROVIDES A DISCOUNT FOR INDIVIDUALS THAT QUALIFY UNDER THE POLICY'S PROVISIONS. THE HOSPITAL HAS MADE PLANS TO IMPLEMENT A METHOD OF DETERMINING AMOUNTS GENERALLY BILLED (AGB) PER THE RECENTLY RELEASED PROPOSED REGULATIONS UNDER SECTION 1.501(R), HOWEVER GIVEN THE HIGH LEVEL OF DISCOUNT AVAILABLE UNDER THE CURRENT POLICY, THE ORGANIZATION IS CONFIDENT THAT ITS POLICIES ARE WELL WITHIN GUIDELINES. PART VI, LINE 2: ONGOING DISCUSSIONS WITH LOCAL MEDICAL STAFF, INTERNAL CASE MANAGEMENT AND DISCHARGE PLANNING PERSONNEL, COMMUNITY BOARD MEMBERS AND LOCAL LEADERS PROVIDE INFORMATION ON THE HEALTH NEEDS OF THE POPULATION WE SERVE. IN ADDITION, PERIODICALLY IN CONJUNCTION WITH STRATEGIC PLANNING, A MEDICAL STAFF DEVELOPMENT PLAN IS CREATED. THIS PROCESS LOOKS AT GAPS IN LOCAL PHYSICIAN SPECIALITY COVERAGE AND HOW TO FILL THOSE GAPS. A COMMUNITY HEALTH NEEDS ASSESSMENT IS BEING CONDUCTED IN FY 2013. PART VI, LINE 3: INFORMATION ON FINANCIAL ASSISTANCE IS POSTED IN ALL REGISTRATION AREAS. ALL UNINSURED PATIENTS RECEIVE PRINTED MATERIAL. THERE ARE THREE FULL TIME FINANCIAL COUNSELORS THAT MEET WITH ALL REFERRED PATIENTS AND FAMILIES. PATIENTS ARE REFERRED BY CASE MANAGEMENT, ADMISSIONS STAFF, AND PATIENT INQUIRY. BILLING NOTICES INCLUDE INFORMATION ON AVAILABLE FINANCIAL ASSISTANCE WITH CONTACT INFORMATION. PART VI, LINE 4: PRIMARY SERVICE AREA INCLUDES MILLEDGEVILLE (ZIP CODE 31061 AND HADDOCK (ZIP CODE 31033). SECONDARY SERVICE AREA INCLUDES BALDWIN COUNTY, PORTIONS OF PUTNAM, HANCOCK, AND WASHINGTON COUNTIES. PRIMARY SERVICE AREA HAS A POPULATION OF 47,981. SECONDARY SERVICE AREAS HAVE A POPULATION OF 81,460. THE PSA SENIOR POPULATION 15.7% OF THE TOTAL AND IS PROJECTED TO GROW BY 15.9% FROM 2009-2014. IN THE PSA 35.3% OF THE ADULT POPULATION HAS A HIGH SCHOOL DEGREE (COMPARED WITH 28.65% FOR GEORGIA) WITH 17.1% HAVING SOME COLLEGE WORK. CURRENT UNEMPLOYMENT IN BALDWIN COUNTY IS OVER 12%. MILLEDGEVILLE IS ALSO HOME TO SEVERAL STATE PRISONS, GEORGIA WAR VETERANS HOME, AND CENTRAL STATE HOSPITAL WHOSE POPULATIONS WE SERVE FOR MEDICAL CARE NEEDS. MILLEDGEVILLE IS CONSIDERED A MEDICALLY UNDERSERVED AREA. PART VI, LINE 5: ALL SURPLUS FUNDS ARE RETAINED BY THE ORGANIZATION. THROUGH THE CAPITAL PLANNING AND BUDGETING PROCESS, MILLIONS OF DOLLARS ARE REINVESTED IN PLANT AND EQUIPMENT EACH YEAR TO ENABLE ORMC TO PROVIDE MODERN, QUALITY CARE TO PATIENTS. NEW PROGRAMS ARE CONSIDERED AND EVALUATED BASED ON THE COLLECTIVE KNOWLEDGE OF THE COMMUNITY AND PATIENTS WE SERVE.ORMC IS THE ONLY HOSPITAL IN BALDWIN COUNTY AND MAINTAINS AN OPEN MEDICAL STAFF. BOARD MEMBERS REPRESENT A CROSS SECTION OF OUR COMMUNITY. ORMC ESTABLISHED AN OBSTETRICS CLINIC TO PROVIDE PRENATAL AND OB SERVICES TO PATIENTS WHO DO NOT HAVE ACCESS TO A PRIVATE PHYSICIAN DUE TO PAYOR SOURCE. WE HAVE COLABORATED WITH A LOCAL CHURCH SPONSORED MEDICAL CLINIC THAT SERVES PATIENTS ON A SLIDING SCALE AND WE ARE PREPARING FOR THE POSSIBILITY OF A FEDERALLY QUALIFIED HEALTH CENTER TO HELP PROVIDE BASIC MEDICAL CARE TO THE UNDERSERVED POPULATION WHO OTHERWISE DO NOT HAVE ACCESS. PART VI, LINE 6: ORMC'S ROLE IS TO PROVIDE HEALTHCARE TO RESIDENTS OF OUR SERVICE AREA. ALL PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT RECEIVE SERVICES OR TREATMENT IN ACCORDANCE WITH EMTALA. ORMC IS THE LARGEST ORGANIZATION WITHIN THE SYSTEM. REPORTS FILED WITH STATES PART VI, LINE 7 GA X 1 1 X X X 0 0 0 1 0 0 0 0 0 GEORGE GRIMES MD 0 0 0 0 161641 0 0 0 0 0 161641 0 0 0 REBECCA J AYCOCK 343652 0 8250 0 7279 0 7937 0 21742 0 388860 0 0 0 JAMES ALAN HORTON 206055 0 4950 0 3619 0 13008 0 13634 0 241266 0 0 0 DEBORAH REVIS ALMAUHY 141701 0 4950 0 0 0 3296 0 7899 0 157846 0 0 0 BRENDA K QUALLS 178754 0 4950 0 0 0 12398 0 7839 0 203941 0 0 0 DAVID T PERRY 174537 0 4950 0 3054 0 4069 0 12120 0 198730 0 0 0 JOSEPH R EVANS 144684 0 1080 0 0 0 3376 0 7582 0 156722 0 0 0 PART I, LINE 1A THE ORGANIZATION PAYS COUNTRY CLUB DUES FOR CERTAIN OFFICERS OF THE ORGANIZATION. ANY PERSONAL USE PORTION IS INCLUDED IN THE EMPLOYEE'S FORM W-2. PART I, LINE 5 THE ORGANIZATION HAS A PERFORMANCE BONUS PROGRAM IN PLACE AVAILABLE TO ALL EMPLOYEES. CRITERIA FOR THIS PROGRAM ARE SET BY THE BOARD OF DIRECTORS, AND ONE OF THE CRITERIA IS BASED ON NET REVENUES. SEE SCHEDULE J, PART II, COLUMN (B)(II) FOR DETAILS. BRIAN D AYCOCK FAMILY RELATIONSHIP TO OFFICER REBECCA AYCOCK 84207 COMPENSATION FOR SERVICES AS EMPLOYEE (SPECIAL PROJECTS MANAGER) 0 FORM 990, PART VI, SECTION A, LINE 7A NOMINEES TO THE BOARD OF DIRECTORS MUST BE RATIFIED BY THE BOARD OF OCONEE REGIONAL HEALTH SYSTEMS, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. UPON COMPLETION, THE RETURN WAS REVIEWED BY MANAGEMENT AND WAS SENT TO ALL VOTING BOARD MEMBERS TO REVIEW. SUBSEQUENTLY THE RETURN WAS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ANNUALLY SIGN A STATEMENT. ALL STATEMENTS HAVE TO BE SIGNED BY A MEMBER OF SENIOR LEADERSIP. ANY CONFLICTS OF INTEREST ARE REPORTED IN THE ANNUAL AUDIT COMPLETED BY EXTERNAL AUDITORS. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS CURRENT COMPENSATION PACKAGES AND AGREEMENTS OF MEMBERS OF SENIOR LEADERSHIP ANNUALLY, AND COMPARES THE OFFERS TO A SURVEY OF SALARY RANGES FOR COMPARATIVELY SITUATED HEALTHCARE ORGANIZATIONS. BENCHMARKS STUDIED ARE REPORTED BY THE GEORGIA HOSPITAL ASSOCIATION AND OTHERS BASED ON BED SIZE, VOLUMES, AND GEOGRAPHIC AREA. THE BOARD APPROVES THE COMPENSATION FOR THE CEO, AND APPROVES AN OVERALL PERCENTAGE INCREASE FOR THE VICE PRESIDENTS, FOR WHICH THE CEO DETERMINES ULTIMATE DISTRIBUTION. FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE ORGANIZATION'S FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. COMPENSATION TO BOARD MEMBERS FORM 990, PART VII, LINE 1 BOARD MEMBERS GEORGE GRIMES AND RAM PURI RECEIVE COMPENSATION FOR MEDICAL DIRECTOR SERVICES, AS WELL AS PAYMENTS FOR MEDICAL SERVICES, TO THE ORGANIZATION, LISTED IN COLUMN (D) OF PART VII, LINE 1. NO PORTION OF THESE AMOUNTS ARE FOR SERVICES AS A MEMBER OF THE BOARD OF DIRECTORS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,989,975. PRIOR PERIOD ADJUSTMENTS: -91,290. CHANGE IN VALUE OF INTEREST RATE SWAP AGREEMENT 61,789. TOTAL TO FORM 990, PART XI, LINE 5: 1,960,474. CONSOLIDATED FINANCIAL STATEMENTS: FORM 990, PART XI, LINE 2 THE ORGANIZATION RECEIVES AUDITED FINANCIAL STATEMENTS ON A CONSOLIDATED BASIS WITH ITS CORPORATE PARENT, OCONEE REGIONAL HEALTH SYSTEMS, AND OTHER AFFILIATED ENTITIES. FORM 990, PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. REASON FOR AMENDMENT: THE 2011 FORM 990 WAS AMENDED TO REFLECT THE CORRECT OWNERSHIP OF A RELATED CORPORATION, OCONEE REGIONAL HEALTH VENTURES, INC., AND TO ADD AN ADDITIONAL RELATED ENTITY, OCONEE REGIONAL HEALTH SYSTEM SEGREGATED PORTFOLIO. OCONEE REGIONAL HEALTH VENTURES (ORHV) IS 100% OWNED BY A RELATED ORGANIZATION, OCONEE REGIONAL HEALTH SYSTEMS, INC. ORHV HAS A LIMITED RELATIONSHIP WITH OCONEE REGIONAL MEDICAL CENTER, INC., AND SCHEDULE R PART IV HAS BEEN CHANGED TO REFLECT THE CORRECT RELATIONSHIP. OCONEE REGIONAL HEALTH SYSTEM SEGREGATED PORTFOLIO IS 100% OWNED BY A RELATED ORGANIZATION, OCONEE REGIONAL HEALTH SYSTEMS, INC. OCONEE REGIONAL HEALTH SYSTEMS INC PO BOX 690 MILLEDGEVILLE GA 31061 582359394 HEALTHCARE GA 501(C)(3) LINE 11A, I N/A 0 OCONEE REGIONAL HEALTH SERVICES INC PO BOX 690 MILLEDGEVILLE GA 31061 582359397 HEALTHCARE GA 501(C)(3) LINE 11A, I OCONEE REGIONAL HEALTH SYSTEMS INC 0 OCONEE REGIONAL EMERGENCY MEDICAL SERVICES INC PO BOX 690 MILLEDGEVILLE GA 31061 582643857 HEALTHCARE GA 501(C)(3) LINE 11A, I OCONEE REGIONAL HEALTH SYSTEMS INC 0 OCONEE REGIONAL HEALTHCARE FOUNDATION INC 821 NORTH COBB STREET MILLEDGEVILLE GA 31061 582359396 FUNDRAISING AND SUPPORT GA 501(C)(3) LINE 11A, I OCONEE REGIONAL HEALTH SYSTEMS INC 0 OCONEE REGIONAL SENIOR LIVING PO BOX 690 MILLEDGEVILLE GA 31061 582455613 HEALTHCARE GA 501(C)(3) LINE 11A, I OCONEE REGIONAL HEALTH SYSTEMS INC 0 JASPER HEALTH SERVICES INC PO BOX 690 MILLEDGEVILLE GA 31061 582510435 HEALTHCARE GA 501(C)(3) LINE 3 N/A 0 OCONEE REGIONAL HEALTH VENTURES INC PO BOX 690 MILLEDGEVILLE GA 31061 582528516 ANCILLARY HEALTHCARE GA N/A C OCONEE REGIONAL HEALTH SYSTEM SEGREGATED PORTFOLIO 62 FORUM LANE 3RD FLOOR GRAND CAYMAN CJ INSURANCE CJ N/A C 1 0 0 1 1 0 0 0 1 0 1 0 0 0 0 1 1 1