2013-08-14T11:00:08-05:00 2012-09-30 580914992 DRAFFIN & TUCKER LLP FIVE CONCOURSE PARKWAY SUITE 1250 ATLANTA GA 30328 990 2011-10-01 582149127 CENTRAL GEORGIA HEALTH SYSTEMS INC CENT 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 43878891 false X WWW.MCCG.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. 7 6 413 0 176480 0 0 0 36232984 40004876 -2396 -1167516 4864423 3872062 41095011 42709422 62400 56000 0 0 27690138 38438500 0 0 0 10268904 10369529 38021442 48864029 3073569 -6154607 42029443 52036669 854516 9171000 41174927 42865669 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 IN SUPPORT OF THEIR MISSION TO PROVIDE HEALTHCARE SERVICES IN CENTRAL GEORGIA. false false 23985727 56000 22080328 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. 13653883 17996346 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. 37639610 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 0 413 true true true true CJ false false false false false false false false X 7 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 X A KENNETH HARPER MD 1.00 X 0 0 0 CONNIE CATER 1.00 X 0 0 0 HELEN RHEA STUMBO 1.00 X 0 0 0 HENRY KOPLIN 1.00 X 0 0 0 MICK ANDERSON MD 1.00 X 0 0 0 RUTH KNOX 1.00 X 0 0 0 STARR PURDUE 1.00 X 0 0 0 TIMOTHY JACKSON 1.00 X 0 0 0 A DONALD FAULK JR 47.00 X 1084375 0 58256 KENNETH B BANKS 46.00 X 416659 0 451456 RHONDA S PERRY 46.00 X 576260 0 527222 ELBERT T MCQUEEN 49.00 X 280082 0 34229 CYNTHIA C BUSBEE 50.00 X 157898 0 18274 JUDY K WARE 50.00 X 163540 0 15618 KAREN M FARR 50.00 X 192545 0 26105 KATHERINE L BOWEN 50.00 X 182196 0 21596 LORI W CASSIDY 50.00 X 234769 0 28399 3288324 0 1181155 40 false true false ALSTON BIRD LLP P O BOX 933124 ATLANTA GA 311933124 LEGAL SERVICES 502974 KAUFMAN HALL 5202 OLD ORCHARD RD ST N700 SKOKIE IL 60077 CONSULTING SERVICES 448333 DIXON HUGHES PLLC P O BOX 3049 ASHEVILLE NC 288023049 AUDIT SERVICES 397606 KING AND SPALDING P O BOX 116133 ATLANTA GA 303686133 LEGAL SERVICES 317376 MUNDER CAPITAL 480 PIERCE ST BIRMINGHAM MI 48009 INVESTMENT MANAGEMENT SERVICE 227965 8 0 MEDICARE.MEDICAID REVENUE 621990 17102003 17102003 PATIENT REVENUE 621990 833032 833032 REBATE REVENUE 621990 434710 434710 CAFETERIA SALES 621990 43503 43503 SUPPORT REVENUE 541200 21553323 21385131 168192 38305 30017 8288 0 40004876 1953 1953 0 0 0 0 0 0 -1169469 0 1169469 -1169469 -1169469 0 0 0 PARTNERSHIP INVESTMENTS 3872062 248278 3623784 0 0 0 0 3872062 42709422 40076674 176480 2456268 56000 56000 0 0 0 3584618 3584618 0 19921514 17561593 2359921 3195780 2972472 223308 10128003 9679201 448802 1608585 1284108 324477 0 857444 857444 281235 281235 13102 13102 0 724587 724587 3051731 1880603 1171128 148546 148546 1229394 1128744 100650 17291 12056 5235 0 494696 404063 90633 195672 131835 63837 0 28171 13297 14874 0 0 108312 79390 28922 806438 297295 509143 EQUIPMENTAL RENTAL & MAINT 1815354 1801462 13892 TAXES & LICENSES 334038 67426 266612 DUES & SUBSCRIPTIONS 78797 6427 72370 GIFTS/ENTERTAINMENT & AWARDS 65008 60529 4479 119713 54563 65150 0 48864029 37639610 11224419 0 0 3372305 1245022 2236745 2417102 93770 94938 129198 530612 2103825 1625469 415890 478356 0 0 26425270 22698480 9356265 24572159 42029443 52036669 854516 1848235 0 7322765 854516 9171000 X 41174927 42865669 41174927 42865669 42029443 52036669 X -6154607 7845349 X false true true X false X X X false false false MEDICAL CENTER OF CENTRAL GEORGIA 582149128 3 true true true 0 1 0 AMOUNT OF SUPPORT, SCHEDULE A, PART I, LINE 11H(VII), CENTRAL GEORGIA HEALTH SYSTEMS, INC. IS THE FUNCTIONALLY INTERGRATED PARENT ENTITY OF THE MEDICAL CENTER OF CENTRAL GEORGIA, INC. CGHS IS RESPONSIBLE FOR STRATEGIC PLANNING, FINANCIAL MANAGEMENT AND RESOURCE ALLOCATION FOR MCCG AND ITS AFFILIATED ENTITIES., false false false false false true 7500 true 902 false true 4700 13102 false Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 LOBBYING EXPENSES FOR DUES PAID TO THE GEORGIA CHAMBER OF COMMERCE, AND THE LOBBYIST ANNUAL REGISTRATION OF $300 PAID TO THE GA GOVERNMENT TRANSPARENCY AND CAMPAIGN FINANCE COMMISSION. 0 0 0 2103825 1625469 478356 0 478356 INVESTMENTS IN AFFILIATES 20418784 C INVESTMENTS IN SUBSIDARY 2279696 C 22698480 WORKERS COMP ESCROW 275000 MISCELLANEOUS RECEIVABLE 967016 THIRD PARTY MEDICARE SETTLEMENT 385983 DUE FROM AFFILIATES 16139400 OTHER RECEIVABLE - PEACH REGIONAL MEDICAL CTR. 380173 457B DEFERRED COMPENSATION 6424587 24572159 0 457B DEFERRED COMPENSATION 6424587 SERP LIABILITY 898178 7322765 FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 CGHS 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. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 93360320 0 0 93360320 true false true true true false INVESTMENT SCHEDULE F, PART I, LINE 3(F) 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. QUALIFIED ELECTING FUND SCHEDULE F, PART IV, LINE 4 BLACKSTONE PARK AVENUE NON-TAXABLE, 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 TAXABLE INCOME IS EARNED OR REPORTED AS A RESULT OF THIS INVESTMENT. Method used to account for expenditures on organization's financial statements Schedule F, Part I, Line 3 CENTRAL AMERICA AND THE CARIBBEAN: ACCRUAL true true X true X 1.25 true X true true false true true 759510 0 759510 0.01550 239796 0 239796 0.00490 0 0 0 0.00000 0 0 999306 0 999306 0.02040 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 999306 0 999306 0.02040 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 34438 0 10512111 8279110 2233001 X true true 1 1 CENTRAL GA REHABILITATION HOSPITAL INC

3351 NORTHSIDE DRIVE MACON GA 31210

X REHABILITATION CENTRAL GA REHABILITATION HOSPITAL INC 1 true true 125 true 200 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 BAD DEBT PART I, LINE 7 BAD DEBT EXPENSE IN THE AMOUNT OF $34,438 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. Community benefit report prepared by related organization Schedule H, Part I, Line 6a MEDICAL CENTER OF CENTRAL GEORGIA Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 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. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 0 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 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 DOUBTFULL ACCOUNTS FOR SELF-PAY PATIENTS WAS 98% OF SELF-PAY ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2012 AND 2011. 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 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. Means used to determine amounts billed Schedule H, Part V Section B, Line 19d (1) CENTRAL GA REHABILITATION HOSPITAL INC - HOSPITAL FACILTY USED AN ESTIMATE OF THE AVERAGE OF THE THREE LOWEST COMMERCIALLY INSURED RATES.; Needs assessment. Schedule H, Part VI, Line 2 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. 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 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. 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. A RECENT ESTIMATE OF POPULATION IN THE PRIMARY SERVICE AREA IS 406,725 AND THE SECONDARY SERVICE AREA HAS A POPULATION OF 389,460. Promotion of community health Schedule H, Part VI, Line 5 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. Affiliated health care system Schedule H, Part VI, Line 6 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. State filing of community benefit report Schedule H, Part VI, Line 7 GA true COMMUNITY HEALTH WORKS 300 MULBERRY ST STE 603 MACON GA 31201 582624455 501(C)(3) 40000 CONTINUING EDUC,CHILDHOOD OBESITY, TRAINING SUSAN G KOMEN BREAST CANCER INC 248 TOM HILL SR BLVD MACON GA 31210 752881536 501(C)(3) 5000 2011 RACE FOR THE CURE-BREAST CANCER AWARENESS AMERICAN CANCER SOCIETY P O BOX 4406 MACON GA 31208 580659875 501(C)(3) 6000 PROMOTE CANCER AWARENESS EDUCATION FIRST 577 MULBERRY ST SUITE 1030 MACON GA 31201 311815650 501(C)(3) 5000 CHILDREN/TEACHER RECOGNITION AND EDUCATION 4 0 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 CGHS REQUIRES ALL ORGANIZATIONS THAT RECEIVE SPONSORSHIPS TO PROVIDE PROOF OF THEIR NON PROFIT STATUS. X X X X X false true false false false false false true false A DONALD FAULK JR 705308 0 279203 0 99864 0 47359 0 10897 0 1142631 0 0 0 KENNETH B BANKS 260723 0 75751 0 80185 0 436765 0 14691 0 868115 0 0 0 RHONDA S PERRY 392724 0 131626 0 51910 0 522431 0 4791 0 1103482 0 0 0 ELBERT T MCQUEEN 190866 0 49151 0 40065 0 26225 0 8004 0 314311 0 0 0 JUDY K WARE 146128 0 500 0 16912 0 4178 0 11440 0 179158 0 0 0 KAREN M FARR 136481 0 30963 0 25101 0 25670 0 435 0 218650 0 0 0 KATHERINE L BOWEN 138918 0 30039 0 13239 0 10156 0 11440 0 203792 0 0 0 CYNTHIA C BUSBEE 112166 0 27088 0 18644 0 3583 0 14691 0 176172 0 0 0 LORI W CASSIDY 176129 0 35730 0 22910 0 19885 0 8514 0 263168 0 0 0 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 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 $16,901 KEN BANKS $ 9,835 DON FAULK $21,128 ELBERT MCQUEEN $4,724 Non-fixed payments Schedule J, Part I, Line 7 THIS 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). 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 (AUDITED BY AN INDEPENDENT ACCOUNTANT). 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. 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 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. Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b 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. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 CGHS PROVIDES COPIES OF ITS GOVERNING AND OTHER CORPORATE DOCUMENTS UPON REQUEST. Average number of hours devoted per week to related organization Form 990, Part VII, Section A, Column B A. DONALD FAULK, JR. - MEDICAL CENTER OF CENTRAL GEORGIA 1 MEDCEN COMMUNITY HEALTH FOUNDATION 1 CENTRAL GEORGIA SENIOR HEALTH 1 KENNETH B. BANKS - MEDICAL CENTER OF CENTRAL GEORGIA 1 HEALTH SERVICES OF CENTRAL GEORGIA 1 MEDCEN COMMUNITY HEALTH FOUNDATION 1 CENTRAL GEORGIA SENIOR HEALTH 1 RHONDA S. PERRY - MEDICAL CENTER OF CENTRAL GEORGIA 1 HEALTH SERVICES OF CENTRAL GEORGIA 1 MEDCEN COMMUNITY HEALTH FOUNDATION 1 CENTRAL GEORGIA SENIOR HEALTH 1 ELBERT T. MCQUEEN - CENTRAL GEORGIA SENIOR HEALTH 1 Other changes in net assets or fund balances Form 990, Part XI, Line 5 INTERCO. 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