2019-05-15T13:08:03-05:00 2018-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28803 990 2017-07-01 582628502 COLUMBUS REGIONAL SENIOR LIVING INC COLU 7066606102 707 CENTER STREET COLUMBUS GA 31901 ALLEN HOLLADAY CFO 7066606303 2019-05-14 1 AMY BIBBY P00445891 8282542254 24.241.144.70 2019-05-14 16:30:21 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 A22AE24AEF09E58E11297D5713887849BDE471CE 2017 2019-02-21 02:37:17Z M SCOTT HILL 707 CENTER STREET COLUMBUS GA 31901 7094528 0 X COLUMBUSREGIONAL.COM X 2001 GA TO OPERATE A CONTINUING CARE RETIREMENT COMMUNITY OWNED BY THE MEDICAL CENTER HOSPITAL AUTHORITY. 7 5 307 5 0 0 0 0 6775461 7094528 0 0 0 0 6775461 7094528 0 0 0 0 6775461 7094528 0 0 0 0 0 6775461 7094528 0 0 0 0 0 0 0 0 X COLUMBUS REGIONAL SENIOR LIVING, INC. MANAGES A CONTINUING CARE RETIREMENT COMMUNITY PROVIDING INDEPENDENT LIVING FOR OLDER ADULTS AND COMPREHENSIVE HEALTH AND MEDICAL SERVICES, INCLUDING ASSISTED LIVING, ALZHEIMER'S DISEASE CARE AND LONG-TERM NURSING CARE RESIDENTS NEED. COLUMBUS REGIONAL SENIOR LIVING'S CARING PROFESSIONAL STAFF IS COMMITTED TO PROVIDING HIGH QUALITY RETIREMENT LIVING AND PROMOTING A VIBRANT INDEPENDENT LIFESTYLE WHILE MEETING AND EXCEEDING THE PHYSICAL, EMOTIONAL AND SPIRITUAL NEEDS OF OUR RESIDENTS. 0 0 6066544 7094528 COLUMBUS REGIONAL SENIOR LIVING, INC. EMPLOYS THE PROFESSIONAL STAFF AND PERSONNEL NECESSARY TO OPERATE SPRING HARBOR AT GREEN ISLAND, A CONTINUING CARE RETIREMENT COMMUNITY OWNED BY THE MEDICAL CENTER HOSPITAL AUTHORITY. SPRING HARBOR PROVIDES INDEPENDENT LIVING FOR OLDER ADULTS AND COMPREHENSIVE AND MEDICAL SERVICES THEY NEED. THESE SERVICES INCLUDE: ASSISTED LIVING, ALZHEIMER'S DISEASE CARE AND LONG-TERM NURSING CARE. 6066544 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 58 0 1 307 1 0 0 0 0 0 0 0 0 0 0 X 7 5 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X ALLEN HOLLADAY VP OF FINANCE 7066606194 707 CENTER STREET COLUMBUS GA 31901 M SCOTT HILL CHAIRMAN 2.00 48.00 X X 0 1615545 32950 ROBERT KOON DIRECTOR 2.00 X 0 0 0 REBECCA RUMER DIRECTOR 2.00 X 0 0 0 MURRAY SOLOMON DIRECTOR 2.00 X 0 0 0 NORM BENNETT DIRECTOR 2.00 0.25 X 0 0 0 LAURA DREW DIRECTOR 2.00 40.00 X 0 521221 8046 WARREN B STEELE DIRECTOR 2.00 6.00 X 0 0 0 ALLEN R BUTCHER SR. VP & CFO 2.00 48.00 X 0 971470 34445 0 3108236 75441 0 0 1 0 HERITAGE HEALTHCARE 500 SPRINGHOUSE CIR STONE MOUNTAIN GA 30087 PATIENT THERAPY 387181 ASHLEY DRAKE 707 CENTER STREET COLUMBUS GA 31901 RENOVATION WORK 192444 OWENS PAINT LLC 1580 HAM MUL GR RD CATAULA GA 31804 RENOVATION WORK 181041 RIVERCITY CONSTRUCTION PO BOX 8905 COLUMBUS GA 31908 RENOVATION WORK 129657 SAYLER CONSTRUCTION INC 686 TEEL CIRCLE FORTSON GA 31808 RENOVATION WORK 125915 5 PROGRAM SERVICE REVENU 623000 7094528 7094528 7094528 7094528 7094528 0 0 5714153 4974241 739912 1012090 752666 259424 368285 339637 28648 7094528 6066544 1027984 0 0 0 0 0 X 0 0 0 0 0 0 X X 0 1 X 1 0 X X 2 THE MEDICAL CENTER HOSP AUTHORITY 580905094 6 0 0 0 THE MEDICAL CENTER INC 581685139 3 1 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART IV, SECTION A, LINE 1 THE MEDICAL CENTER HOSPITAL AUTHORITY IS A GOVERNMENTAL ENTITY IN THE MUNICIPALITY AND SERVES THE SAME CHARITABLE CLASS AS COLUMBUS REGIONAL SENIOR LIVING WHICH PROVIDES STAFF TO THE HOSPITAL AUTHORITY. PART IV, SECTION D, LINE 3 THE PRESIDENT, CFO, AND SECRETARY OF COLUMBUS REGIONAL SENIOR LIVING SERVE ON THE MEDICAL CENTER BOARD. IN ADDITION, VARIOUS BOARD MEMBERS SERVING ON THE COLUMBUS REGIONAL SENIOR LIVING BOARD ALSO SERVE ON THE MEDICAL CENTER HOSPITAL AUTHORITY BOARD. PART IV, SECTION E, LINE 2A COLUMBUS REGIONAL SENIOR LIVING ACTIVITIES DIRECTLY FURTHER THE EXEMPT PURPOSES OF THE MEDICAL CENTER HOSPITAL AUTHORITY BY PROVIDING MANAGEMENT AND STAFFING TO THE ORGANIZATION. PART IV, SECTION E, LINE 2B COLUMBUS REGIONAL SENIOR LIVING PROVIDES THE MANAGEMENT AND STAFFING FOR THE MEDICAL CENTER HOSPITAL AUTHORITY. THE HOSPITAL AUTHORITY WOULD HAVE TO CONDUCT THE MANAGEMENT AND STAFFING THEMSELVES, IF NOT FOR COLUMBUS REGIONAL SENIOR LIVING. X 2250 2250 130667397 130669647 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 26833 25509 24675 2250 79267 250000 250000 250000 250000 1000000 1500000 0 X PART X, LINE 2: THE SYSTEM IS PRIMARILY COMPRISED OF ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX PURSUANT TO SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. WITH RESPECT TO ANY INCOME GENERATED BY FOR-PROFIT SUBSIDIARIES OR UNRELATED BUSINESS INCOME, THE SYSTEM RECORDS INCOME TAXES USING THE LIABILITY METHOD UNDER WHICH THE DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL ACCOUNTING AND TAX BASES OF ASSETS AND LIABILITIES. DEFERRED TAX ASSETS OR LIABILITIES AT THE END OF EACH PERIOD ARE DETERMINED USING THE CURRENTLY ENACTED TAX RATE EXPECTED TO APPLY TO TAXABLE INCOME IN THE PERIOD THAT THE DEFERRED TAX ASSET OR LIABILITY IS EXPECTED TO BE REALIZED OR TO BE SETTLED. THE SYSTEM HAS EVALUATED ITS TAX POSITIONS AND HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX POSITIONS FOR THE PERIOD ENDED JUNE 30, 2018 AND THE PERIOD ENDED FEBRUARY 28, 2018. FISCAL YEARS ENDED ON OR AFTER JUNE 30, 2014 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. 0 1 0 0 0 0 0 0 0 M SCOTT HILL CHAIRMAN 0 723263 0 534328 0 357954 0 1255 0 31695 0 1648495 0 0 LAURA DREW DIRECTOR 0 308729 0 143462 0 69030 0 3930 0 4116 0 529267 0 0 ALLEN R BUTCHER SR. VP & CFO 0 455865 0 310903 0 204702 0 6842 0 27603 0 1005915 0 0 PART I, LINE 4B THE COLUMBUS REGIONAL HEALTHCARE SYSTEM MAINTAINS A SERP PLAN THAT VESTS EVERY 3 YEARS FOR ITS PARTICIPATING OFFICERS. THE LAST VESTING OCCURRED ON 6/30/2014; THE NEXT VESTING DATE WILL OCCUR ON 6/30/2017. EMPLOYER CONTRIBUTIONS TO 457(F) EXECUTIVE RETIREMENT BENEFIT PLAN: SCOTT HILL $ 355,200 ALLEN BUTCHER 200,700 LAURA DREW 67,300 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS A MANAGEMENT AGREEMENT WITH CRSA MANAGEMENT LLC. THE MANAGEMENT AGREEMENT WAS NEGOTIATED AT ARM'S LENGTH. CRSA MANAGEMENT EMPLOYS THE EXECUTIVE DIRECTOR OF COLUMBUS REGIONAL SENIOR LIVING. ALL OTHER PROFESSIONAL STAFF AND SUPPORT PERSONNEL ARE EMPLOYED BY COLUMBUS REGIONAL SENIOR LIVING. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. - A RELATED 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF COLUMBUS REGIONAL SENIOR LIVING, INC. IS APPOINTED BY THE BOARD OF COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. - A RELATED 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF COLUMBUS REGIONAL SENIOR LIVING, INC. DETERMINES THE ISSUES THAT ARE BROUGHT UP FOR DISCUSSION AND MOST ITEMS CAN BE APPROVED ALONG WITH THE EXECUTIVE TEAM OF COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. - A RELATED 501(C)(3) ORGANIZATION. CAPITAL EXPENDITURES IN EXCESS OF $500,000 MUST BE APPROVED BY THE COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 11B INFORMATION FOR FORM 990 WAS PROVIDED TO AN INDEPENDENT CPA FIRM FOR PREPARATION OF THE RETURN. AFTER THE RETURN WAS PREPARED IT WAS REVIEWED BY THE CFO OF THE ORGANIZATION. THE BOARD IS PROVIDED WITH A THOROUGH AND CONDENSED OVERVIEW OF INFORMATION ON THE FORM 990 AT THE BOARD MEETING BY THE CFO OF THE ORGANIZATION ASSISTED BY THE INDEPENDENT CPA PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C COLUMBUS REGIONAL HEALTHCARE SYSTEM AND ITS AFFILIATES ARE ACCOUNTABLE TO GOVERNMENTAL AUTHORITIES AS WELL AS TO MEMBERS OF THE PUBLIC FOR BOTH THE INTEGRITY OF ITS ACTIONS AS WELL AS PERCEPTIONS AS RELATED TO THOSE ACTIONS. CONSEQUENTLY, THERE EXISTS BETWEEN COLUMBUS REGIONAL AND THE PUBLIC THE FIDUCIARY RESPONSIBILITY WHICH CARRIES WITH IT A BROAD AND UNBENDING DUTY OF LOYALTY AND FIDELITY. COLUMBUS REGIONAL AGENTS (I.E., BOARD MEMBERS, MANAGEMENT, EMPLOYEES, CONTRACTED PARTIES AND CREDENTIALED STAFF) HAVE THE RESPONSIBILITY OF ADMINISTERING THE AFFAIRS OF THE ORGANIZATION HONESTLY AND PRUDENTLY, AND OF EXERCISING THE BEST CARE, SKILL AND JUDGMENT FOR THE SOLE BENEFIT OF COLUMBUS REGIONAL. THOSE AGENTS SHALL EXERCISE THE UTMOST GOOD FAITH IN ALL TRANSACTIONS INVOLVED IN THEIR DUTIES AND SHALL NOT USE THEIR POSITION WITH COLUMBUS REGIONAL OR KNOWLEDGE GAINED FOR THEIR PERSONAL BENEFIT IN ANY MANNER. THE INTEREST OF THE ORGANIZATION MUST BE THE FIRST PRIORITY IN ALL RELATED DECISIONS AND ACTIONS. THIS POLICY IS ALSO DIRECTED TOWARD ANYONE WHO HAS PROPRIETARY INFORMATION CONCERNING COLUMBUS REGIONAL. IT IS THE POLICY OF COLUMBUS REGIONAL HEALTHCARE SYSTEM AND ITS AFFILIATES, IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, ASSOCIATED AGENTS MUST ANNUALLY DISCLOSE THE EXISTENCE OF A FINANCIAL OR OTHERWISE BENEFICIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE CHIEF COMPLIANCE OFFICER ASSOCIATED WITH THE PROPOSED CONFLICTING TRANSACTION OR ARRANGEMENT. A CONFLICT OF INTEREST MAY ARISE IN THE RELATIONSHIPS WITH COLUMBUS REGIONAL AGENTS WITH PERSONS AND FIRMS SUPPLYING GOODS AND SERVICES TO THE ORGANIZATION; PERSONS AND FIRMS FROM WHOM THE COMPANY LEASES PROPERTY AND EQUIPMENT; PERSONS AND FIRMS WITH WHOM COLUMBUS REGIONAL IS DEALING OR PLANNING TO DEAL IN CONNECTION WITH THE GIFT, PURCHASE OR SALE OF REAL ESTATE, SECURITIES OR OTHER PROPERTY; COMPETING OR AFFINITY ORGANIZATIONS; DONORS, MEMBERS OR OTHERS SUPPORTING THE ORGANIZATION; AGENCIES, ORGANIZATIONS AND ASSOCIATIONS WHICH AFFECT THE OPERATIONS OF THE COMPANY; AND FAMILY MEMBERS, FRIENDS AND OTHER EMPLOYEES. CONFLICTS OF INTEREST MAY ARISE IN A NUMBER OF DIFFERENT CIRCUMSTANCES AND TRANSACTIONS. IT IS ASSUMED THAT COLUMBUS REGIONAL AGENTS WILL RECOGNIZE SUCH AREAS AND RELATION BY ANALOGY. TRANSACTIONS WITH PARTIES WITH WHOM A CONFLICTING INTEREST EXISTS MAY BE UNDERTAKEN IF ALL OF THE FOLLOWING ARE OBSERVED: THE CONFLICT OF INTEREST IS FULLY DISCLOSED; THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION; A COMPETITIVE BID OR COMPARABLE VALUATION EXISTS FOR PURCHASING OR RELATED DECISIONS; AND THE CHIEF COMPLIANCE OFFICE IN CONSULTATION WITH OTHERS AS APPROPRIATE HAS DETERMINED THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. ALL DISCLOSURES MUST BE MADE TO THE CHIEF COMPLIANCE OFFICER (OR IF SHE/HE IS THE ONE WITH THE CONFLICT, THEN THE BOARD CHAIR) WHO WILL BRING THE MATTER TO THE ATTENTION OF THE BOARD AS NECESSARY. THE CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH OTHERS AS APPROPRIATE, SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR AND REASONABLE TO COLUMBUS REGIONAL. THE DECISION OF THE CHIEF COMPLIANCE OFFICER AND/OR BOARD ON THESE MATTERS WILL REST IN THEIR SOLE DISCRETION AND THEIR CONCERN MUST BE FOR THE WELFARE OF COLUMBUS REGIONAL IN THE ADVANCEMENT OF ITS PURPOSE. EACH MEMBER OF MANAGEMENT AND EMPLOYEES WITH DELEGATED POWERS WHO CAN INFLUENCE THE ACTIONS OF COLUMBUS REGIONAL SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY AND COMPLETED THE DISCLOSURE STATEMENT; HAS READ AND UNDERSTANDS THE POLICY; AND HAS AGREED TO COMPLY WITH THE POLICY. IN ADDITION, SHOULD A POTENTIAL CONFLICT OCCUR DURING THE YEAR BUT PRIOR TO THE ANNUAL DISCLOSURE, THE INDIVIDUAL IS OBLIGATED TO CONTACT THE CHIEF COMPLIANCE OFFICER AND UPDATE THEIR DISCLOSURE STATEMENT IN A TIMELY MANNER. IF THE CHIEF COMPLIANCE OFFICER HAS REASONABLE CAUSE TO BELIEVE A COLUMBUS REGIONAL AGENT HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, HE/SHE SHALL INFORM THAT INDIVIDUAL OF THE BASIS OF SUCH BELIEF AND AFFORD HIM/HER THE OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE INDIVIDUAL'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE CHIEF COMPLIANCE OFFICER DETERMINES THE INDIVIDUAL HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, HE/SHE SHALL FORWARD THE INFORMATION TO THE HUMAN RESOURCES DEPARTMENT AND/OR THE BOARD OF DIRECTORS TO TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 COLUMBUS REGIONAL TAKES VERY SERIOUSLY THE RESPONSIBILITY TO APPROPRIATELY AND EFFECTIVELY MANAGE THE EXECUTIVE COMPENSATION AND BENEFITS PROGRAM FOR ITS KEY EXECUTIVES. SETTING THE COMPENSATION OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, APPROVING THE COMPENSATION OF OTHER SENIOR EXECUTIVES, AND OVERSEEING THE EXECUTIVE COMPENSATION PROGRAM AS A WHOLE, ARE THE RESPONSIBILITIES OF THE COMPENSATION COMMITTEE OF THE BOARD. TO ASSIST THE COMMITTEE, THE BOARD HAS ENGAGED THE SERVICES OF A NATIONALLY RECOGNIZED EXECUTIVE COMPENSATION CONSULTING FIRM. COLUMBUS REGIONAL'S EXECUTIVE COMPENSATION PROGRAM IS DESIGNED TO ATTRACT AND RETAIN HIGHLY QUALIFIED EXECUTIVES TO FULFILL COLUMBUS REGIONAL'S MISSION OF PROMOTING THE HEALTH AND HEALING OF PATIENTS. COLUMBUS REGIONAL'S PEER GROUP CONSISTS OF NON-PROFIT HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE AND COMPLEXITY FROM ACROSS THE NATION. BASE SALARIES OF EXECUTIVES ARE POSITIONED AT SPECIFIC PERCENTILE TARGETS OF COLUMBUS REGIONAL'S PEER GROUP. CURRENT STUDIES INDICATE THAT OUR BASE SALARIES ARE AT TARGETED LEVELS. COLUMBUS REGIONAL STRIVES TO PROVIDE ALL EXECUTIVES WITH RETIREMENT BENEFITS THAT ARE EQUIVALENT FOR ALL EMPLOYEES. RETIREMENT CONTRIBUTIONS ARE BASED ON A CLEARLY STATED INCOME REPLACEMENT TARGET AS DETERMINED BY RETIREMENT PLAN CONSULTANTS. THE GOAL OF COLUMBUS REGIONAL IS TO PROVIDE MARKET COMPETITIVE COMPENSATION AND BENEFITS PROGRAMS FOR ALL EMPLOYEES AT ALL LEVELS OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY, AS WELL AS FINANCIAL STATEMENTS AND OTHER GOVERNING DOCUMENTS, ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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