2011-08-14T20:23:19-05:00 2010-09-30 Pershing Yoakley & Associates P C One Cherokee Mills 2220 Sutherland Knoxville TN 379192363 990 2009-10-01 582149128 MEDICAL CENTER OF CENTRAL GEORGIA INC MEDI 4786331407 691 CHERRY STREET SUITE 400 MACON GA 31201 Rhonda S Perry 4786331407 2011-08-14 1 8656730844 2009 2016-02-24 21:20:13Z A Donald Faulk Jr 691 CHERRY STREET SUITE 400 MACON GA 31201 1096327472 0 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 7 5473 622 7546702 -108292 25395548 19599629 628737866 669571025 -3591492 21508753 2908048 2643498 653449970 713322905 9541041 11421169 0 292562502 291922782 0 0 327505076 341723085 629608619 645067036 23841351 68255869 1002495328 1092576580 329107508 352736424 673387820 739840156 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. 1 0 582492852 11421169 672214523 The Medical Center of Central Georgia (MCCG) is a designated Level I 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 people. The Medical Center has over 4,653 employees and a medical staff of over 530 physicians. MCCG is the second largest hospital in Georgia with a capacity of 637 beds including medical-surgical, obstetric, pediatric, psychiatric, cardiac intensive care, neuro intensive care, pediatric intensive care, and cardiac surgery intensive care. MCCG provides a broad range of community-based, outpatient diagnostic, primary care, urgent-care services, extensive home health and hospice care services. MCCG is the primary academic hospital for Mercer University School of Medicine, providing residency programs for over 100 residents. MCCG operates the Medical Center of Central Georgia (the "Main Hospital"), the Children's Hospital, the Children's Health Center, medical office buildings (the "Doctors Office Buildings"), the Hospice of Central Georgia (the "Hospice"), the Wellness Center, the Family Health Center, three urgent care centers (the "Med Center"), Central Georgia Home Health (the "Home Health Agency") and certain other facilities and services (the "Miscellaneous Facilities and Services"). The Main Hospital, the Children's Hospital, the Children's Health Center, the Doctors Office Buildings, the Hospice, the Wellness Center, the Family Health Center, the Urgent Care Centers, the Home Health Agency, the Miscellaneous Facilities and Services and the Rehabilitation Hospital referred to below are collectively referred to herein as the "Healthcare Premises."The Main Hospital is a full-service acute care hospital. It consists of a free-standing 1,545,839 square foot facility on nine levels and is located 90 miles south of Atlanta in Macon, Georgia. The Main Hospital and the Children's Hospital (defined below) are currently licensed for 637 beds. In addition, the Main Hospital has 72 observation beds and makes 34 beds available through a lease arrangement to a long-term acute care provider.The Main Hospital maintains an active affiliation with Secure Health Plans of Georgia, a network of central Georgia hospitals and physician providers. It is the largest hospital within a 90 mile radius, the second largest hospital in Georgia and serves the entire central Georgia population.The Main Hospital is the primary teaching hospital for Mercer University School of Medicine. The following residency programs are offered by Mercer at the Main Hospital: General Surgery, Internal Medicine, Obstetrics and Gynecology and Pediatrics. In addition, nurses may earn a Master of Science in Anesthesia through Mercer at the Main Hospital.The Main Hospital has one of the largest cardiac care programs outside of Atlanta. It averages more than 695 open-heart surgeries annually and is equipped with the latest technological advancements to provide a full range of cardiovascular services.The Main Hospital has also been designated by the Georgia Department of Human Resources as the only Level One Trauma Center in Central Georgia. The Emergency Center treats an estimated 56,650 patients annually. The Main Hospital is the only healthcare facility in Macon that has a Surgery Trauma Team on standby 24 hours a day. It's EMS has twenty one ambulances and three critical care neonatal/pediatric intensive care units that respond to emergencies within a 750-square mile coverage area in Baldwin, Bibb, Jones and Twiggs counties. The critical care units responds with a specialized team to locations as far as Valdosta GA.More than 26,642 surgical procedures are performed at the Main Hospital annually. The Surgery Center features twenty state-of-the-art operating suites, a comprehensive Endodiagnostic Center, an Ambulatory Surgery Center with 8-10 additional operating room suites, a variety of specialty units for post-anesthesia care, outpatient care and short-term care. A pediatric outpatient surgery program "Just For Kids" greatly increases the convenience and efficiency of the Surgery Center.Children's Hospital. The Children's Hospital is located on the same campus as the Main Hospital. The Children's Hospital opened in March 2003 in what was the Middle Georgia Hospital. It has one of the most comprehensive pediatric healthcare programs in the State and is the only facility in central Georgia dedicated to children. The Children's Hospital has a pediatric intensive care unit, a neonatal intensive care unit and an oncology program. The Children's Hospital and the Main Hospital are collectively referred to herein as the "Medical Center."Children's Health Center. The Children's Health Center is a medical clinic located across the street from the Medical Center. It offers a comprehensive array of child-focused services. The Children's Health Center serves as the training and education facility for pediatric residents learning to provide primary care to underserved and underinsured children. Nurse practitioners provide well-child checks and chronic care follow-up. The Children's Health Center also has specialty clinics and on-site lab and radiology services. The Crescent House is located within the Children's Health Center. The Crescent House offers services for victims of child abuse.Doctors Office Buildings. The Doctors Office Buildings consist of 21 medical office buildings in the Central Georgia region with a total of 602,520 total square feet, 382,524 leasable square feet, 283,647 leased square feet and a 74% occupancy rate. Hospice. Hospice of Central Georgia provides care for patients with life limiting illnesses who are no longer seeking curative treatment. Most hospice services are provided in patient homes. Services provided are coordinated by a Registered Nurse and include nurse aides, social workers, volunteers and bereavement services. Hospice of Central Georgia opened its newly constructed inpatient facility, Pine Pointe Hospice of Central Georgia, to its first patient on September 20, 2010. Pine Pointe offers 15 spacious patient rooms and includes sleeping accommodations for one family member. All inpatients will have 24/7 access to an interdisciplinary team of professionals to assist with all aspects of care and treatmentUrgent Care Centers. There are three urgent care centers, Med Center North, Med Center East and Med Center Northwest. Each facility operates 12 hours per day seven days a week and is staffed with a physician, registered nurse(s), diagnostic technician(s) (that is trained in radiology and laboratory procedures), and patient account specialist. Each facility is able to treat a wide range of medical conditions including orthopedic injuries, minor trauma, pediatric and metabolic conditions. Each facility is equipped with point of care testing, laboratory diagnostic equipment, 12 LEAD electro cardiograms and digital radiology equipment to highlight some of the technology utilized at each facility.Wellness Center. The wellness center is available to the community. In addition to offering classes and programs that address specific health conditions, the Wellness Center is equipped with an indoor track; an indoor pool; basketball, volleyball and racquetball courts; weight training and cardiovascular equipment; and saunas for men and women. Personal training, aerobics and fitness classes, nutrition and weight-loss classes, and arthritis aquatics with supervised childcare are also available at the Wellness Center. Family Health Center. The Family Health Center is home to the Family Medicine Residency training program which is conducted in affiliation with Mercer. The Family Health Center features 36 examination rooms, individual resident and faculty offices, on-site lab and x-ray facilities and several well-equipped procedure rooms for colposcopy, minor surgical procedures, casting and exercise treadmill testing. 582492852 1 1 0 1 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 0 1 501 0 5473 1 1 1 0 0 0 0 0 0 0 0 9 7 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 GA X RHONDA S PERRY 4786331452 777 hemlock st Macon GA 31201 A Kenneth HarperMD 1.00 X 0 0 0 David Danzie 1.00 X 0 0 0 Dan Slagle 1.00 X 0 0 0 EMORY JOHNSON MD 1.00 X 0 0 0 Joan Walton 1.00 X 0 0 0 NANCY ANDERSON 1.00 X 0 0 0 William M MATTHEWS 1.00 X 0 0 0 Connie Cater 1.00 X 0 0 0 Roberta Andrews MD 1.00 X 0 0 0 A DONALD FAULK JR 1.00 X 0 722579 61910 KENNETH B BANKS 1.00 X 0 316434 31398 RHONDA S PERRY 1.00 X 0 411183 27511 BARBARA STICKEL 40.00 X 342487 0 88684 BETH PEARSON 40.00 X 207852 0 25699 DAWN COLE 40.00 X 214123 0 35960 James M Cunningham 40.00 X 457664 0 49539 JOSEPH LAVELLE 40.00 X 423774 0 30907 MARCIA HUTCHINSON MD 40.00 X 266048 0 44509 PAT D'ERRICO 40.00 X 233451 0 5331 TOM SANDS jr 40.00 X 236445 0 33694 William R Avenel 40.00 X 183927 0 9811 ANDREW GALLOWAY 1.00 X 577815 0 60717 Krishan Patel MD 40.00 X 355919 0 26330 Timothy Longaker MD 40.00 X 381882 0 31568 William Butler MD 40.00 X 524911 0 39747 Adam Nauss 40.00 X 314840 0 18890 DEBRA ORR 40.00 X 503750 0 0 MICHAEL VADEN 40.00 X 721824 0 17481 Michael Gilstrap 40.00 X 1490259 0 0 Larry C Parks 40.00 X 487769 0 0 7924740 1450196 639686 207 1 1 0 The Nexus Medical Group 840 Pine Street Suite 770 Macon GA 31201 Anesthesiologist Fees 15453546 Angelica Textile Services PO Box 535122 Atlanta GA 303535122 Linen Processing 3466331 King & Spalding PO Box 30368-6133 Atlanta GA 303686133 Legal Services 2959021 GEORGIA MAGNETIC Imaging 770 Pine Street Suite L-15 macon GA 31201 Imaging Services 2440866 Cogent Healthcare 5410 Maryland Way Ste 300 Brentwood TN 37027 Hospitalist Services 2058416 88 10983544 7925246 690839 19599629 PATIENT CHARGES 621500 661428518 654238860 7189658 SUPPORT & SERVICE REVE 561000 3436252 3079208 357044 HEALTH AND WELLNESS 621300 1868657 1868657 Partnership Patient Re 900003 1055033 1055033 PARKING FEES 812930 943363 943363 839202 839202 669571025 11156635 11156635 7677297 4863673 2813624 2813624 2813624 387982997 510015 376542790 1598104 11440207 -1088089 10352118 10352118 Loss on Bond Defeasanc 900099 -170126 -170126 -170126 713322905 663724458 7546702 22452116 11421169 11421169 2853968 2666455 187513 1487656 1389913 97743 230952433 215778257 15174176 9491124 9491124 31011588 31008299 3289 16126013 15404641 721372 4941734 4941734 226006 6900 219106 1437250 1437250 74642932 53140269 21502663 1113441 1104457 8984 4144589 3635518 509071 1138586 147521 991065 6158218 6093068 65150 1875692 1725488 150204 8372 402 7970 6400516 6400516 33704021 27635373 6068648 10578549 212180 10366369 MEDICAL SUPPLIES 119749835 119749174 661 BAD DEBT 52386403 52386403 Equipment Rental & Main 9149955 7866063 1283892 NUTRITIONAL SUPPLIES 5055186 5029623 25563 Non-operating Expense 3837624 3837624 5174176 4925165 249011 645067036 582492852 62574184 0 41942750 50357617 23821888 31110000 122265531 116558893 17565272 19565362 1360164 1049364 5925713 5957987 2686657 13904041 790545836 443311562 335428535 347234274 371986000 422038000 70996041 69001820 2225851 2819280 6290926 12979942 1002495328 1092576580 55684064 64363365 164451320 156813392 108972124 131559667 329107508 352736424 X 673387820 739840156 673387820 739840156 1002495328 1092576580 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 200000 1 18000 0 1 42702 260702 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Lobbying expenses include a portion of dues paid to various organizations (i.e., American Hospital Association, Georgia Hospital Association, NACH, GCC. 18906856 18906856 378316372 154292400 224023972 6480436 4850772 1629664 360882472 282714098 78168374 25959700 1454292 24505408 347234274 Mortgage Backed Securities 69001820 F 69001820 ACCRUED PENSION 72453339 OTHER Current Liabilities 13159988 OTHER Long Term LIabilities 8429647 Asset Retirement Obligation 3976766 Post Retiree Health Insurance Reserve 23779839 Due to Affiliates 9760088 131559667 713322905 645067036 68255869 15284462 -17087995 -1803533 66452336 704061000 1077795 5001379 6079174 697981826 15341079 15341079 713322905 634838000 4863673 4863673 629974327 15092709 15092709 645067036 Part X: Description of Uncertain Tax Positions Under FIN 48: 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, 2010. Part XI, Line 8 - Other Adjustments: Unrealized Loss on pension: -17225694. Partnership book/tax difference: 137586. Rounding: 113. Part XII, Line 2d - Other Adjustments: Rental Expenses (Reclassification): 4863673. Partnership Income: 137586. rounding: 120. Part XII, Line 4b - Other Adjustments: Grants: 10399364. expenses netted w/ rev(rounding): 3681000. Contributions in Net Assets: 1260715. Part XIII, Line 2d - Other Adjustments: RENTAL EXPENSES: 4863673. Part XIII, Line 4b - Other Adjustments: GRANT NETTED AGAINST REV FOR BOOK PURPOS: 11373669. contributions to related entities: 37500. expenses netted w/ rev(rounding): 3681540. 1 1 X 1 X 125.000000000000 1 X 1 1 0 1 1 24108547 4230353 19878194 0.03350 95377646 96197637 -819991 0.00000 119486193 100427990 19058203 0.03350 1417919 17302 1400617 0.00240 14068232 12063672 2004560 0.00340 149451 149451 0.00030 15635602 12080974 3554628 0.00610 135121795 112508964 22612831 0.03960 1 16395113 264532586 240172755 24359831 X 1 1 Central Georgia PET LLC Imaging 0.66670 0.33330 Central Georgia Health Network LLC PHO 0.29000 0.71000 The Medical Center of Central GA Inc

777 Hemlock Street Macon GA 31201

X X X X X Part I, Line 3c: Inpatient/Special Services and Catastrophic Income Scales have three different Indigent/Charity Levels:Level 1 - Incomes less than 125% of Poverty LevelLevel 2 - Incomes greater than or equal to 125% of Poverty Level, but not greater than 200% of the Poverty Level.Level 3 - Incomes greater than 200% of Poverty Level or "Catastrophic Medical Indigency" outlined in MCCG Policy 3-207, paragraph 7. Part 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 schedule H worksheet 2 instructions. Part I, Line 7f: Bad debt expense in the amount of $52,386,403 was subtracted from total expenses per Form 990, Part IX, Line 25 for purposes of calculating the percentage for Line 7, column (f). Part 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 schedule H worksheet 2 instructions. Part III, Line 8: The Medicare costs shown on Line 6 were computed using the organization's Medicare cost report for the period. Part 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 financial 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. Part V: The Medical Center of Central Georgia also operates a Hospice. Part VI, Line 2: We have not yet performed a community health needs assessment. However, MCCG works with Community Health Works (a regional health promotion organization)to help improve the health in the the central Georgia region. MCCG currently participates in community meeting to research ways to impact citizens with diabetes and obesity. Part VI, Line 3: Signs are posted at all access points into the organization discussing the availablity of financial assistance. 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. 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. Part VI, Line 6: MCCG provides the majority of the indigent care to the central Georgia region. The hospital operates a large clinic system with the majority of those patients either indigent or covered by Medicaid. The hospital also provides medical education in the form of five residency training programs for 106 residents and 5 fellows. Additionally, MCCG provides many programs throughout the community in form of health fairs, health education classes, and the financial support of community based health providers.MCCG has an open medical staff. The Board of Directors is comprised of community members and staff physicians. All surplus funds are put back into the organization to ensure quality staffing and the most modern and advanced buildings and equipment available. 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: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. GA 1 Mercer University 1550 College Street macon GA 31207 680566167 501(c)(3) 5000 Sponsorship of physician relocation EDUCATION FIRST PO BOX 169 Macon GA 31201 311815650 501(c)(3) 5000 TEACHER OF THE YEAR/IMAGINATION LIBRARY Health Services of Central Georgia Inc 691 Cherry Street Suite 400 Macon GA 31201 582307485 501(c)(3) 11373669 Intercompany 3 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Mccg requires All organizations that receive funds to present their 501(c)(3) letter as proof of their non profit status. X 0 0 X X X X X 1 1 0 0 0 0 0 1 0 A DONALD FAULK JR 0 605874 0 0 0 116705 0 51620 0 10290 0 784489 0 0 KENNETH B BANKS 0 244306 0 0 0 72128 0 18063 0 13335 0 347832 0 0 RHONDA S PERRY 0 364579 0 3000 0 43604 0 22829 0 4682 0 438694 0 0 BARBARA STICKEL 265910 0 1000 0 75577 0 82535 0 6149 0 431171 0 0 0 BETH PEARSON 172303 0 2500 0 33049 0 12364 0 13335 0 233551 0 0 0 DAWN COLE 165394 0 4000 0 44729 0 26064 0 9896 0 250083 0 0 0 James M Cunningham 390496 0 3000 0 64168 0 41294 0 8245 0 507203 0 0 0 JOSEPH LAVELLE 343236 0 3000 0 77538 0 17041 0 13866 0 454681 0 0 0 MARCIA HUTCHINSON MD 227087 0 0 0 38961 0 36264 0 8245 0 310557 0 0 0 PAT D'ERRICO 65689 0 0 0 167762 0 550 0 4781 0 238782 0 0 0 TOM SANDS jr 183240 0 1000 0 52205 0 20359 0 13335 0 270139 0 0 0 William R Avenel 163401 0 0 0 20526 0 4417 0 5394 0 193738 0 0 0 ANDREW GALLOWAY 12600 0 0 0 565215 0 43236 0 17481 0 638532 0 0 0 Krishan Patel MD 288733 0 27222 0 39964 0 15246 0 11084 0 382249 0 0 0 Timothy Longaker MD 336466 0 3883 0 41533 0 21278 0 10290 0 413450 0 0 0 William Butler MD 468301 0 0 0 56610 0 25659 0 14088 0 564658 0 0 0 Adam Nauss 298202 0 0 0 16638 0 5750 0 13140 0 333730 0 0 0 DEBRA ORR 0 0 0 0 503750 0 0 0 0 0 503750 0 0 0 MICHAEL VADEN 0 0 0 0 721824 0 0 0 17481 0 739305 0 223443 0 Michael Gilstrap 0 0 0 0 1490259 0 0 0 0 0 1490259 0 2603 0 Larry C Parks 0 0 0 0 487769 0 0 0 0 0 487769 0 0 0 Part I, Line 1a $3,596 was paid as a temporary housing allowance. The allowance was negotiated as part of a relocation package and included in the taxable income of the recipient. Part I, Lines 4a-b: Severance Payments Andrew Galloway - $257,005 Michael L. Vaden - $217,300 Pat D'Errico - $101,670 Employer payment from 457(f) Executive Supplemental Retirement Plan Andrew Galloway $301,385 Debra Orr $503,750 Larry Parks $487,769 Michael Gilstrap $1,487,656 Michael Vaden $488,224 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. 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 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). Macon-Bibb County Hospital Authority 581034851 55553rcd5 2009-09-02 37600000 Refunding 2003 issue 0 0 Macon-Bibb County Hospital Authority 581034851 55553rcn3 2009-09-24 81345501 Refunding 2005 issue 0 0 37600000 37600000 1 0 1 1 81345501 80000000 1345501 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 0 0 0 0 0 0 Alfred D Faulk Split Dollar Ins. Loan X 4764065 6377313 0 1 1 Alfred D Faulk Split Dollar Ins. Loan X 458584 572026 0 1 1 alfred d faulk split dollar ins. loan X 115000 125775 0 1 1 Andrew Galloway Split Dollar Ins. Loan X 375677 502892 0 1 1 Andrew Galloway Split Dollar Ins. Loan X 150000 187106 0 1 1 Andrew Galloway Split Dollar Ins. Loan X 230000 281810 0 1 1 andrew galloway split dollar ins. loan X 230000 266939 0 1 1 andrew galloway split dollar ins. loan X 203992 223106 0 1 1 Barb Stickel Split Dollar Ins. Loan X 979436 1311102 0 1 1 Barb Stickel Split Dollar Ins. Loan X 219691 274037 0 1 1 Barb Stickel split dollar ins. loan X 235540 257610 0 1 1 Beth Pearson Split Dollar Ins. Loan X 20000 26773 0 1 1 Beth Pearson split dollar ins. loan X 25000 31184 0 1 1 Beth Pearson Split Dollar Ins. Loan X 25000 30632 0 1 1 beth pearson split dollar ins. loan X 21000 22968 0 1 1 Beth Peason Split Dollar Ins. Loan X 25000 29015 0 1 1 Dawn Cole Split Dollar Ins. Loan X 53000 70947 0 1 1 Dawn Cole split dollar ins. loan X 58000 72348 0 1 1 Dawn Cole Split Dollar Ins. Loan X 58000 71065 0 1 1 Dawn Cole Split Dollar Ins. Loan X 58000 67315 0 1 1 Dawn Cole split dollar ins. loan X 55000 60153 0 1 1 Debbie Orr Split Dollar Ins. Loan X 349590 467973 0 1 1 Debbie Orr Split Dollar Ins. Loan X 143606 179130 0 1 1 elbert mcqueen split dollar ins. loan X 61000 66716 0 1 1 Ethel Cullinan Split Dollar Ins. Loan X 636204 851640 0 1 1 Ethel Cullinan Split Dollar Ins. Loan X 37479 46751 0 1 1 ethel cullinan split dollar ins. loan X 161243 176351 0 1 1 Joseph Lavelle Split Dollar Ins. Loan X 110000 147249 0 1 1 Joseph Lavelle Split Dollar Ins. Loan X 110000 137212 0 1 1 joseph lavelle split dollar ins. loan X 170000 208294 0 1 1 joseph lavelle Split Dollar Ins. Loan X 170000 197303 0 1 1 joseph lavelle split dollar ins. loan X 135000 147649 0 1 1 Ken Banks Split Dollar Ins. Loan X 228829 306317 0 1 1 Ken Banks Split Dollar Ins. Loan X 82000 102284 0 1 1 Ken Banks Split Dollar Ins. Loan X 82000 100471 0 1 1 Ken Banks Split Dollar Ins. Loan X 82000 95170 0 1 1 Ken Banks Split Dollar Ins. Loan X 48000 52497 0 1 1 Larry Parks Split Dollar Ins. Loan X 359594 481362 0 1 1 Larry Parks Split Dollar Ins. Loan X 150000 187106 0 1 1 Larry Parks Split Dollar Ins. Loan X 150000 183789 0 1 1 larry parks split dollar ins. loan X 108904 126394 0 1 1 Louis Goolsby MD Split Dollar Ins. Loan X 953762 1276732 0 1 1 Louis Goolsby MD Split Dollar INS. LOAN X 269000 335544 0 1 1 Louis Goolsby MD split dollar ins. loan X 269000 329595 0 1 1 Louis Goolsby MD Split Dollar Ins. Loan X 269000 312203 0 1 1 marcia hutchinson split dollar ins. loan X 155000 169523 0 1 1 Michael Gilstrap Split Dollar Ins. Loan X 2941423 3937473 0 1 1 Michael Gilstrap Split Dollar Ins. Loan X 451034 562609 0 1 1 michael gilstrap split dollar ins. loan X 250000 273424 0 1 1 Michael Vaden Split Dollar Ins. Loan X 232111 310711 0 1 1 Michael Vaden split dollar ins. loan X 110000 137212 0 1 1 Michael Vaden Split Dollar Ins. Loan X 110000 134779 0 1 1 Michael Vaden Split Dollar Ins. Loan X 110000 127666 0 1 1 michael vaden split dollar ins. loan X 76000 83121 0 1 1 Patricia D'Errico Split Dollar Ins. Loan X 50000 66931 0 1 1 Patricia D'Errico Split Dollar Ins. Loan X 50000 62369 0 1 1 Patricia D'Errico Split Dollar Ins. Loan X 50000 61263 0 1 1 patricia d'errico split dollar ins. loan X 50000 58030 0 1 1 patricia d'errico split dollar ins. loan X 49000 53591 0 1 1 Raymond T Olmer Split Dollar Ins. Loan X 2191396 2933465 0 1 1 Raymond T Olmer Split Dollar Ins. Loan X 222887 278023 0 1 1 raymond t olmer split dollar ins. loan X 184000 201240 0 1 1 Rhonda Perry Split Dollar Ins. Loan X 509455 681971 0 1 1 Rhonda Perry Split Dollar Ins. Loan X 260000 324317 0 1 1 Rhonda Perry Split Dollar Ins. Loan X 260000 318567 0 1 1 Rhonda perry split dollar ins. loan X 260000 301757 0 1 1 Rhonda Perry split dollar ins. loan X 143000 156399 0 1 1 Tom Sands Jr split dollar ins. loan X 30000 40160 0 1 1 Tom Sands jr Split Dollar Ins. Loan X 34000 42411 0 1 1 Tom Sands jr Split Dollar Ins. Loan X 34000 41658 0 1 1 Tom sands jr split dollar ins. loan X 34000 39461 0 1 1 Tom Sands jr Split Dollar Ins. Loan X 30000 32811 0 1 1 Virgil Cooper Split Dollar Ins. Loan X 1012536 1355409 0 1 1 Virgil Cooper split dollar ins. loan X 358905 392534 0 1 1 GAAP Adjustment to CSV X -1891558 -10991371 0 1 1 19565362 Margaret Sutherland Daughter of Board Member 26736 Ms. Sutherland is the Daughter of Emory Johnson, board member. Ms. Sutherland works for the Medical Center of Central Georgia, Inc. as a nurse. 0 Howard Moore McDuffie PC Georgia Slagle, wife of board member Dan Slagle, is partner with firm 19083 Georgia Slagle, wife of board member Dan Slagle, is partner with the accounting firm of Howard, moore, McDuffie, P.C. This accounting firm is engaged to perform audits of the retirement plans. 0 Form 990, Part III, line 2 New Program Services Hospice of Central Georgia opened its newly constructed inpatient facility, Pine Pointe Hospice of Central Georgia, to its first patient on September 20, 2010. Pine Pointe offers 15 spacious patient rooms and includes sleeping accommodations for one family member. All inpatients will have 24/7 access to an interdisciplinary team of professionals to assist with all aspects of care and treatment. 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. 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. 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. Form 990, Part VI, Section B, line 11 The 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 was reviewed by Medical Center of Central Georgia'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 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 individual must amend their COI disclosure form. Form 990, Part VI, Section B, line 15 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 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 19 MCCG provides copies of its governing and other company documents upon request. Form 990, Part VII Contact Addresses for Officers, Directors, Etc ANDREW GALLOWAY - 99 Wolfcreek Drive, macon, GA 31210. DEBRA ORR - 1166 Eagle Circle, Townsend, GA 31221. MICHAEL VADEN - P.O.Box 1657, Tullahoma, TN 37388. PAT D'ERRICO - 407 Sleppy Ln, Warner Robbins, GA 31088. Michael Gilstrap - P.O.Box 272, Byron, GA 31008. Central Georgia Medical Properties LLC 777 Hemlock St MSC 111 Macon GA 31201 Physician relationships GA 0 0 N/A Central GA Rehab Hospital LLC 3351 Northside Drive Macon GA 31210 300371539 Rehabilitation Hospital GA 0 0 N/A Central Georgia Health Systems Inc 691 Cherry Street Suite 400 Macon GA 31201 582149127 Healthcare Services, Parent Entity/Strategic & Financial Management GA 501(c)(3) 11 N/A Health Services of Central Georgia Inc 691 Cherry Street Suite 400 macon GA 31201 582307485 healthcare Services GA 501(c)(3) 3 N/A Medcen Community Health Foundation Inc 858 High Street macon GA 31201 237363555 Fundraising GA 501(c)(3) 7 N/A Central Georgia Senior Health Inc 691 Cherry Street Suite 400 macon GA 31201 582345439 Assisted Living GA 501(c)(3) 7 N/A Secure Health Plans of Georgia LLC 3920 Arkwright Road Suite 400 Macon GA 31201 582306549 Managed Care GA N/A Centra Georgia PET LLC 1650 Hardeman Avenue macon GA 31201 371464470 Medical Imaging Center GA N/A Related 1991570 569239 0 0 Central Georgia Health Ventures Inc 691 Cherry Street Macon GA 31201 582164989 Management GA N/A C Central Georgia Home Care Services Inc 691 Cherry Street macon GA 31201 582457422 Medical Equipment Sales GA N/A C Centra Indemnity LTD PO 1363 Grand Cayman Grand Cayman CJ Insurance CJ N/A C Centra Professional Indemnity LTD pO 1363 grand Cayman grand Cayman CJ Insurance CJ N/A C American Eagle Insurance Co RRG 40 Main Street Suite 500 Burlington VT 05401 161645557 Insurance/Risk Management VT N/A C 0 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 Central Georgia PET LLC R 625000