NAVICENT HEALTH INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
NAVICENT HEALTH INC (EIN 58-2149127)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-14
IRS object ID
201132269349301008
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-08-14T20:17:16-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Pershing Yoakley & Associates P CBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1One Cherokee Mills 2220 SutherlandAddressLine1
CityKnoxvilleCity
StateTNState
ZIP Code379192363ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN582149127EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CENTRAL GEORGIA HEALTH SYSTEMS INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCENTNameControl
Phone4786331407Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1691 CHERRY STREET SUITE 400AddressLine1
CityMACONCity
StateGAState
ZIP Code31201ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRHONDA S PERRYName
TitleSenior VP/CFOTitle
Phone4786331407Phone
Date Signed2011-08-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone8656730844Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonA Donald Faulk JrNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1691 CHERRY STREET SUITE 400AddressLine1
CityMACONCity
StateGAState
ZIP Code31201ZIPCode
FieldValueIRS element (for citing)
Gross Receipts37603668GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.MCCG.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1994YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionCENTRAL 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees401TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI152943TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year19203601ProgramServiceRevenuePriorYear
Program Service Revenue CY30313999ProgramServiceRevenueCY
Investment Income Prior Year4654901InvestmentIncomePriorYear
Investment Income Current Year5709690InvestmentIncomeCurrentYear
Other Revenue Prior Year11335186OtherRevenuePriorYear
Other Revenue Current Year-2442689OtherRevenueCurrentYear
Total Revenue Prior Year35193688TotalRevenuePriorYear
Total Revenue Current Year33581000TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1072605GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY10500221GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year10737352SalariesEtcPriorYear
Salaries Etc Current Year23670135SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5792383OtherExpensePriorYear
Other Expenses Current Year7848863OtherExpensesCurrentYear
Total Expenses Prior Year17602340TotalExpensesPriorYear
Total Expenses Current Year42019219TotalExpensesCurrentYear
Revenues Less Expenses Prior Year17591348RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-8438219RevenuesLessExpensesCY
Total Assets BOY45664176TotalAssetsBOY
Total Assets EOY39722867TotalAssetsEOY
Total Liabilities BOY616807TotalLiabilitiesBOY
Total Liabilities EOY1166997TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY45047369NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY38555870NetAssetsOrFundBalancesEOY
Mission DescriptionCENTRAL 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense20038261Expense
Grants10500221Grants
Revenue13568549Revenue
DescriptionCentral 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.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense12466842Expense
Revenue27091992Revenue
DescriptionCentral 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 and opened in September 1988.Description
FieldValueIRS element (for citing)
Total Program Service Expense32505103TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees401NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account1ForeignFinancialAccount
Name Of Foreign CountryCJNameOfForeignCountry
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1RHONDA S PERRYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4786331452TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1777 Hemlock StreetAddressLine1
CitymACONCity
StateGAState
ZIP Code31201ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Connie Cater
Director-CGHS1.00X000
JAMES TIMOTHY JACKSON
Director-CGHS1.00X000
KIM W JOHNSTON MD
Dir/V Chair CGHS, director1.00X000X
RUTH KNOX
Director-CGHS1.00X000
STARR PURDUE
Chair1.00X000
HENRY KOPLIN
DIRECTOR-CGHS1.00X000
Joan Walton
Director-CGHS1.00X000
A DONALD FAULK JR
President/CEO40.00722579061910X
KENNETH b BANKS
GEN COUNSEL/sec40.00316434031398X
RHONDA S PERRY
SR. VP/Treas40.00411183027511X
ELBERT T MCQUEEN
President/CEO20.00216631024415X
Hubert Epps Jr
DirECTOR of Pharmacy40.00119963025833X
Roger Bloodworth
CGRH Pharmacist40.00115357031740X
Judy K Ware
Director of Audit Services20.00108054013030X
Darren Pearce
Director of Patient Care40.0010019808545X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2110399TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation224382TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Kaufman Hall
5202 Old Orchard Road Ste N700SkokieIL30077Consulting Services319000
Sunbelt Staffing
PO Box 1024640AtlantaGA303684640Temporary Staffing Svcs182382
SunTrust Bank Inc
PO Box 4655AtlantaGA232616489Investment Management Svcs144389
Munder Capital
480 Pierce StreetBirminghamMI48009Investment Management Svcs126426
Davita
5200 Virginia WayBrentwoodTN37024Dialysis Services112986
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Medicare/Medicaid Reve6219901449087914490879
SUPPORT REVENUE5412001384861213695669152943
PATIENT REVENUE62199017676051767605
Rebate Revenue621990157015157015
Cafeteria Sales6219903539635396

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column14492TotalRevenueColumn
Related Or Exempt Function Income14492RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue30313999TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column9732358TotalRevenueColumn
Exclusion$9,732,358ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities4022668Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-4022668Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-4022668TotalRevenueColumn
Exclusion-$4,022,668ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
Other Invest Inc-114045360542-$1,200,995
net Invest (988 Int)-1302236-$1,302,236
FieldValueIRS element (for citing)
Total Other Revenue-2442689TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column33581000TotalRevenueColumn
Related Or Exempt Function Income30221598RelatedOrExemptFunctionIncome
Unrelated Business Revenue152943UnrelatedBusinessRevenue
Exclusion$3,206,459ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total10500221Total
Program Services10500221ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total2153453Total
Program Services1446986ProgramServices
Management And General706467ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total17153967Total
Program Services11488339ProgramServices
Management And General5665628ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total565006Total
Program Services402416ProgramServices
Management And General162590ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2471780Total
Program Services1801041ProgramServices
Management And General670739ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1325929Total
Program Services928248ProgramServices
Management And General397681ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total400601Total
Program Services212319ProgramServices
Management And General188282ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total132755Total
Program Services70360ProgramServices
Management And General62395ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total5735Total
Management And General5735ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total639549Total
Management And General639549ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1773797Total
Program Services1537349ProgramServices
Management And General236448ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total49474Total
Program Services49474ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1150883Total
Program Services1064114ProgramServices
Management And General86769ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total13980Total
Program Services7433ProgramServices
Management And General6547ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total441144Total
Program Services333753ProgramServices
Management And General107391ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total199327Total
Program Services136387ProgramServices
Management And General62940ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total190Total
Program Services74ProgramServices
Management And General116ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total98860Total
Program Services73033ProgramServices
Management And General25827ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total176229Total
Program Services153278ProgramServices
Management And General22951ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
UBI Tax Refund-43956-43956
equipment rental & main17104941354901575004
DUES AND SUBSCRIPTIONS369152187930181222
Expendable Project Cost235090235090
TAXES AND LICENSES1669738822878745

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total328586Total
Program Services230217ProgramServices
Management And General98369ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total42019219Total
Program Services32505103ProgramServices
Management And General9514116ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6929219BOY
EOY1030485EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1856035BOY
EOY2031261EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY93017BOY
EOY93934EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY107002BOY
EOY668718EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis1933216LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1469749LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY459728BOY
EOY463467EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY35672868BOY
EOY26362402EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY546307BOY
EOY9072600EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY45664176BOY
EOY39722867EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY328231BOY
EOY1166997EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY288576BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY616807BOY
EOY1166997EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY45047369BOY
EOY38555870EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY45047369BOY
EOY38555870EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY45664176BOY
EOY39722867EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type3 Func IntXSupportingOrg509a3Type3FuncInt
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1Medical Center of Central GeorgiaBusinessNameLine1
FieldValueIRS element (for citing)
EIN582149128EIN
Type Of Organization7TypeOfOrganization
Listed In Governing Doc1ListedInGoverningDoc
Supported Organization Notified1SupportedOrganizationNotified
Organized In US1OrganizedInUS
Amount$10,399,364Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts10399364SumOfAmounts

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations1GrantsOtherOrganizations
Grants Other Organizations$5,000GrantsOtherOrganizationsAmount
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$735OtherActivitiesAmount
Total Lobbying Expenditures IIB5735TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II-B, Line 1i:Identifier
Return ReferenceExplanation of Other Lobbying Activities:ReturnReference
ExplanationLobbying expenses Included in the Dues paid to various organizations and mileage/parking expenses for officer to attend Trauma Day at the Capital.Explanation

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1933216OtherCostOrOtherBasis
Depreciation1469749Depreciation
Book Value463467BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings463467TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Investments in Subsidiaries23318784C
Investment in Secure Health Plan of Central gA1484997C
Investment in American Eagle1558621C
FieldValueIRS element (for citing)
Total Of Book Value Program Related26362402TotalOfBookValueProgramRelated

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
Receivable-Centra Professional Indemnity272439
Miscellaneous Receivable187
Third Party Medicare Settlement278987
Due from Affiliates8520987
FieldValueIRS element (for citing)
Total Book Value Other Assets9072600TotalBookValueOtherAssets

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierPart X:Identifier
Return ReferenceDescription of Uncertain Tax Positions Under FIN 48:ReturnReference
ExplanationCGHS 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, 2010.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage125.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense568468TotalCommunityBenefitExpense
Net Community Benefit Expense568468NetCommunityBenefitExpense
Percent Of Total Expense0.01360PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense80793TotalCommunityBenefitExpense
Net Community Benefit Expense80793NetCommunityBenefitExpense
Percent Of Total Expense0.00190PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense649261TotalCommunityBenefitExpense
Net Community Benefit Expense649261NetCommunityBenefitExpense
Percent Of Total Expense0.01550PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense649261TotalCommunityBenefitExpense
Net Community Benefit Expense649261NetCommunityBenefitExpense
Percent Of Total Expense0.01550PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense$125,780BadDebtExpenseAmount
Amount Reimbursed By Medicare0AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare0CostOfCareReimbursedByMedicare
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1Central GA Rehabilitation Hospital IncBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line13351 Northside DriveAddressLine1
CityMaconCity
StateGAState
ZIP Code31210ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
OtherRehabilitationOther

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Income Based CriteriaPart I, Line 3c: Total gross income for the previous three months will be used to determine annual income. Patient classifications will be determined in accordance with the MCCG sliding scale for indigent/charity patients. This scale has been adopted by CGRH and was based on the most recently published Federal Poverty Guidelines.IncomeBasedCriteria
Annual Community Benefit ExplnPart I, Line 6a: The community benefit information for Central Georgia Rehabiliation Hospital, Inc. is included in the Medical Center of Central Georgia's annual report to the community.AnnualCommunityBenefitExpln
Costing Method UsedPart I, Line 7: The costing methodology used in determining the amount reported on line 7 is the cost to charge ratio calculated pursuant to The IRS Form 990 Schedule H worksheet 2 instructions.CostingMethodUsed
Percent Of Total Expense ExplnPart I, Line 7f: Bad debt expense in the amount of $96,427 has been removed from total expense.PercentOfTotalExpenseExpln
Bad Debt FootnotePart III, Line 4: The costing methodology used in determining the cost of bad debt expense is the cost to charge ratio calculated pursuant to The IRS Form 990 Schedule H worksheet 2 instructions.BadDebtFootnote
Debt Collection PolicyPart III, Line 9b: Once a patient is determined to qualify for charity care, it is noted in the patient's financial chart and any collection efforts cease. The controller of the organization reviews the finacial activity on other accounts to determine if the account should be turned over to outside collections. If a patient account turned over to collections is later determined to qualify as charity care, the account is brought back from collections and the account written off.DebtCollectionPolicy
Needs AssessmentPart VI, Line 2: We have not yet performed a community health assessment. We do work with Community Health Works (a regional health promotion organization) to improve the health in the region. Currently, the regional emphasis is on diabetes and obesity with community meetings to find ways to make actual improvements in our citizen's health.NeedsAssessment
Patient Education AssistancePart VI, Line 3: Patients will be informed of available assistance by the following method: 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.PatientEducationAssistance
Community InformationPart 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.CommunityInformation
Other InformationPart VI, Line 6: 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. Any surplus funds are used for program services.OtherInformation
Affiliated Health Care SystemPart 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 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. - 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.AffiliatedHealthCareSystem
Reports Filed With StatesGAReportsFiledWithStates

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Grand Opera House
400 Poplar StreetMaconGA31201580566167501c36000Kids Theatre Education
Susan G Komen Breast Cancer Inc
248 Tom Hill Sr BlvdMaconGA31210752881536501c325000Race for the Cure -Breast Cancer Awareness
MEDICAL CENTER OF CENTRAL GA
691 Cherry StreetMaconGA31201582149128501c310399364Intercompany
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: CGHS requires all organizations that receive sponsorships to present their 501c(3) letter as proof of their Non Profit status.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
A DONALD FAULK JR
6058740001167050516200102900784489000
KENNETH b BANKS
244306000721280180630133350347832000
RHONDA S PERRY
36457903000043604022829046820438694000
ELBERT T MCQUEEN
18003800036593015764086510241046000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Line 7ReturnReference
ExplanationThis 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 proposed for allocation of the award is developed and presented to the HR Committee of the Board for review, discussion, and approval (prior to distribution).Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section B, line 11The form 990 was prepared by an independent certified public accountant from information provided by management and from audited financial statements (prepared by another independent accountant). It is reviewed by Central Georgia Health System, Inc.'s financial management. 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, Section B, line 12cThe 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 take to the various boards and administration for implementation. Any time a change in a relationship or new potential conflict evolves, the individual must amend their COI disclosure form.
Form 990, Part VI, Section B, line 15The 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, Section C, line 19CGHS provides copies of its governing and other corporate documents upon request.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsDirect Controlling Entity NADirectControllingEntityNA
Central GA Rehab Hospital LLC
691 cherry streetMaconGA31201300371539Rehabilitation ServicesGA1631300011534000N/A
Central Georgia Medical Properties LLC
777 Hemlock St MSC 111MaconGA31201Physician RelationshipsGA00N/A

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
Central Georgia Senior Health Inc
691 Cherry Street Suite 400MaconGA31201582345439Retirement CommunityGA501c(3)11N/A
Health Services of Central Georgia Inc
691 Cherry Street Suite 400maconGA31201582307485Health Care ProviderGA501c(3)3N/A
Medcen Community Health Foundation Inc
858 High StreetmaconGA31201237363555FundraisingGA501c(3)7N/A
Medical Center of Central Georgia Inc
691 Cherry Street Suite 400maconGA31201582149128HospitalGA501c(3)3N/A

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerDirect Controlling Entity NADirectControllingEntityNAShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssets
Central Georgia PET LLC
1650 Hardeman AvenuemaconGA31201311464470Medical Imaging CenterGAMedical Center of Central Georgia IncRelated00
Secure Health Plans of Georgia Inc
3920 Arkwright Road Suite 400maconGA31208582306549Managed CareGArelated00N/A28796063091442

Form990 Schedule R Part IV Form990ScheduleRPartIV (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Address Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryLegal Domicile Foreign CountryLegalDomicileForeignCountry
Central Georgia Health Ventures Inc
691 Cherry StreetmaconGA31201582164989ManagementGAN/AC203722555882581.00000
Central Georgia Home Care Services Inc
691 Cherry StreetmaconGA31201582457422Medical Equipment SalesGAC-551220494561.00000CGHV
Centra Indemnity LTD
Insurance-186961.00000CGHSPO Box 1363Grand CaymanGrand CaymanCJCJ
Centra Professional Indemnity LTD
insurance11018079972864611.00000CGHSpO Box 1363grand Caymangrand CaymanCJCJ
American Eagle Insurance Co RRG
40 Main Street Suite 500BurlingtonVT05401161645557Risk ManagementVTN/AC0.95000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (59 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Medical Center of Central Georgia
O25747009
medical Center of Central Georgia
B10399364
medical Center of Central Georgia
J1300000
medical Center of Central Georgia
P58026
Central Georgia Health Ventures Inc
R1300000
Central Georgia Home Care Services Inc
P132888
Centra Professional Indemnity
R10000000
Medical Center of Central Georgia
P17104089
Centra Professional Indemnity
R12116126
medical Center of Central Georgia
R9384548
centra Professional Indemnity
Q9384548
Central Georgia Senior Health Inc
R171773
Centra Professional Indemnity
Q171773
health Services of Central Georgia Inc
R968806
Centra Professional Indemnity
Q968806
Central Georgia Rehabilitation Services
R129823
Centra Professional Indemnity
Q129823
Medical Center of Central Georgia
J57756
Central Georgia PET LLC
I57756
medical Center of Central Georgia
Q1158400
Central Georgia PET LLC
R1158400
Medical Center of Central Georgia
O386223
central georgia pET LLC
P386223
Medical Center of Central Georgia
R148519
secure Health
Q148519
centra Professional Indemnity
P953134
Medical Center of Central Georgia
O953134
Health Services of Central Georgia Inc
P11228895
medical Center of Central Georgia
O11228895
Health Services of Central Georgia Inc
P448245
Medical Center of Central Georgia
O448245
Health Services of Central Georgia Inc
O22602564
Medical Center of Central Georgia
P22602564
Medical Center of Central Georgia
C11373669
health Services of Central Georgia Inc
B11373669
medical Center of Central Georgia
J448846
Health Services of Central Georgia Inc
I448846
Medcen Foundation Inc
P1816043
medical Center of Central Georgia
O1816043
medcen Foundation Inc
I53871
Medical Center of Central Georgia
J53871
medcen Foundation Inc
B1869914
medical Center of Central Georgia
C1869914
Central Georgia Senior Health Inc
O1164892
Medical Center of Central Georgia
P1164892
Central Georgia Senior Health Inc
P1459769
medical Center of Central Georgia
O1459769
Central Georgia Health Ventures Inc
P155773
Medical Center of Central Georgia
O155773
Central Georgia Health Ventures Inc
O202677
medical Center of Central Georgia
P202677
Central Georgia Home Care Services Inc
P2744937
medical Center of Central Georgia
O2744937
Medical Center of Central Georgia
J59196
Central Georgia Home Care Services Inc
I59196
Central Georgia Home Care Services Inc
N180000
Medical Center of Central Georgia
N180000
Central Georgia Home Care Services Inc
O2791850
medical Center of Central Georgia
P2791850

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