2017-05-11T14:37:45-05:00 2016-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2015-07-01 581955423 CLAYTON GENERAL INC CLAY 7709918010 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 JAMES ADAMS PRESIDENT 7709918010 2017-05-11 1 AMY BIBBY P00445891 8282542254 2017-05-11 2015 2021-01-29 14:40:06Z JAMES ADAMS 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 115651113 0 X WWW.SOUTHERNREGIONAL.ORG X 1991 GA CLAYTON GENERAL, INC. EXISTS TO SERVE THE COMMUNITIES OF THE SOUTHERN CRESCENT OF THE METRO ATLANTA AREA BY IMPROVING THE HEALTH STATUS AND QUALIFY OF LIFE OF ITS CITIZENS. X 1 1 1545 0 31589 -89156 3625059 4225800 208567992 110463716 3271402 364666 9557024 596931 225021477 115651113 2507900 1780750 0 0 87190080 43397663 0 0 0 144384247 145522343 234082227 190700756 -9060750 -75049643 98561834 2851286 109842997 94999896 -11281163 -92148610 X CLAYTON GENERAL, INC. EXISTS TO SERVE THE COMMUNITIES OF THE CLAYTON GENERAL OF THE METRO ATLANTA AREA BY IMPROVING THE HEALTH STATUS AND QUALIFY OF LIFE OF ITS CITIZENS. 0 1 179798544 1780750 110432127 CLAYTON GENERAL, INC. PROVIDED 26,743 DAYS OF ACUTE AND INTENSIVE CARE, TREATED MORE THAN 61,000 OUTPATIENTS, AND PROVIDED EMERGENCY CARE TO 30,057 PATIENTS IN THE EMERGENCY ROOM. CLAYTON GENERAL, INC. ALSO PROVIDED 2,644 DAYS OF CARE TO THE 1,587 BABIES BORN AT CLAYTON GENERAL, INC. OPERATIONAL ASSETS WERE ACQUIRED BY PRIME HEALTHCARE ON FEBRUARY 2, 2016. THE ORGANIZATION CEASED ACTIVITIES ON THIS DATE. 179798544 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 1 56 0 1 1545 1 1 1 0 0 0 0 0 0 0 0 0 X 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 GA X THE ORGANIZATION 7709918010 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 JAMES G ADAMS CHAIRMAN, PRESIDENT 1.00 4.00 X X 1500 0 0 FELICIA FRANKLIN-WARNER BOARD MEMBER (UNTIL FEB 2016) 1.00 X 600 0 0 DANIEL T MCDEVITT MD BOARD MEMBER (UNTIL FEB 2016) 1.00 X 1000 0 0 ANDREA S CALLAWAY BOARD MEMBER (UNTIL FEB 2016) 1.00 X 1400 0 0 REV DR ED J BEST JR BOARD MEMBER (UNTIL FEB 2016) 1.00 X 400 0 0 DON MCMILLIAN MD BOARD MEMBER (UNTIL FEB 2016) 1.00 X 800 0 0 LANDRY MERKISON BOARD MEMBER (UNTIL FEB 2016) 1.00 X 400 0 0 SHERRY K HANCOCK BOARD MEMBER (UNTIL FEB 2016) 1.00 X 0 0 0 GLYNDA B KING BOARD MEMBER (UNTIL FEB 2016) 1.00 X 1200 0 0 RAMONA THURMAN BIVINS BOARD MEMBER (UNTIL FEB 2016) 1.00 X 600 0 0 BARRY ZISCHOLTZ MD BOARD MEMBER (UNTIL FEB 2016) 1.00 X 1000 0 0 RAJU M VANAPALLI MD BOARD MEMBER (UNTIL FEB 2016) 1.00 X 1000 0 0 JOHN MCLAIN VP OF OPERATIONS 40.00 X 320919 0 18096 WILLIE COCHRAN VP MEDICAL AFFAIRS 40.00 X 161718 0 16497 JOE E BAKER VP OF FACILITIES 40.00 X 158898 0 9329 STACY J HANCOCK VP OF HUMAN RESOURCES 40.00 X 173831 0 17592 JIM JUNE DIRECTOR OF REVENUE CYCLES 40.00 X 186908 0 15697 RICHARD K ALLEN VP OF INFORMATION TECH 40.00 X 157144 0 21690 KIM RYAN CEO (UNTIL FEB 2016) 40.00 4.00 X 0 0 0 GEORGE E HOFFMAN JR CFO (UNTIL FEB 2016) 40.00 4.00 X 0 0 0 JAMILA KINCHLOE HIGHEST COMPENSATION EMPLOYEE 40.00 X 111683 0 17636 JANIE HINTON HIGHEST COMPENSATION EMPLOYEE 40.00 X 144062 0 17620 VIRGINIA DICKSON HIGHEST COMPENSATION EMPLOYEE 40.00 X 139560 0 11302 SCOTT BLACKLEY HIGHEST COMPENSATION EMPLOYEE 40.00 X 136558 0 84 ERNEST BEDSAUL HIGHEST COMPENSATION EMPLOYEE 40.00 X 136070 0 18689 1837251 0 164232 52 0 1 0 COMPLETERX 3100 S GESSNER STE 640 HOUSTON TX 77063 PHARMACY MANAGEMENT 6400000 SOUND PHYSICIANS PO BOX 742936 LOS ANGELES CA 900742936 HOSPITALISTS 3194640 DISTRIBUTION COOPERATIVE 5356 EAST PONCE DE LEON AVE 100 STONE MOUNTAIN GA 30083 MEDICAL SUPPLIES 2461627 GEORGIA POWER 96 ANNEX ATLANTA GA 30396 ELECTRICITY 2293473 HEWLETT PACKARD FINANCIAL PO BOX 402582 ATLANTA GA 303842582 EQUIPMENT LEASES 2076798 118 4225800 4225800 PATIENT SERVICE 623000 110106353 110106353 MEDICAID EHR PAYMENT 623000 325774 325774 LAB OUTREACH 621500 31589 31589 110463716 14784 14784 754 754 395486 0 395486 395486 395486 349128 0 349128 349128 349128 MISCELLANEOUSE INCOME 900099 99143 99143 PAID PARKING REVENUE 621990 52911 52911 CAFETERIA REVENUE 624200 49391 49391 201445 115651113 110432127 31589 961597 1780750 1780750 1099992 1099992 32133626 30766302 1367324 1706533 1579837 126696 5983392 5539176 444216 2474120 2290437 183683 100438 100438 2546413 2546413 41500 41500 13541 13541 15364950 13473077 1891873 118947 118947 2143098 1933351 209747 969646 969496 150 2761374 2761106 268 17075 4851 12224 35706 -4883 40589 357341 357341 7959629 5317511 2642118 BANKRUPTCY LOSS 53983919 53983919 BAD DEBT 33994028 33994028 MEDICAL SUPPLIES 16964324 16964324 PATIENT RELATED EXPENSE 3991925 3991925 4158489 4095996 62493 190700756 179798544 10902212 0 5450 0 4841214 0 21602517 0 724254 0 2972033 46555 1556982 634874 201961 199000 60678746 2961 4541772 1048323 335719 126530 250570 0 1052577 992043 98561834 2851286 43860502 40657760 17175175 2720362 48807320 51621774 109842997 94999896 X -13141512 -94008959 1860349 1860349 -11281163 -92148610 98561834 2851286 X -75049643 -352881 -5464921 X X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16292 16292 0 PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE GEORGIA HOSPITAL ASSOCIATION (GHA). THIS ORGANIZATION ENGAGES IN LOBBYING FOR THE BENEFIT OF THEIR MEMBERSHIP BODIES, AND A PORTION OF THE MEMBERSHIP DUES PAID TO THE ORGANIZATION IS ATTRIBUTABLE TO LOBBYING EXPENDITURES. FOR THE YEAR, THE PORTION OF DUES ATTRIBUTABLE TO LOBBYING EXPENDITURES WAS $16,292 FOR GHA. 201961 199000 2961 2961 OTHER RECEIVABLES 990603 DEFAULTS 1440 992043 INSURANCE RESERVE 15940143 PHYSICIAN DINING 7236 UNFUNDED PENSION LIABILITY 35614696 PROFESSIONAL FEES PAYABLE -47130 MORRISON'S DEBT FORGIVENESS 31829 DUE TO AFFILIATES 75000 51621774 1 1 1 X 125.000000000000 1 X 1 0 0 3504126 3504126 0.01840 24763143 21099313 3663830 0.01920 28267269 21099313 7167956 0.03760 15014700 6182081 8832619 0.04630 15014700 6182081 8832619 0.04630 43281969 27281394 16000575 0.08390 1 33994028 19330686 19137902 192784 X 1 1 1 SPIVEY STATION ASC REAL ESTATE MANAGEMENT 0.45410 0.48000 1 1 CLAYTON GENERAL INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 X X X CLAYTON GENERAL INC 1 0 0 1 X X X X X X X X X 13 1 1 0 1 X SOUTHERNREGIONAL.ORG X 1 13 1 SOUTHERNREGIONAL.ORG 0 0 1 X 125.000000000000 300.000000000000 X X X X X X 1 1 X X X X 1 X X X 1 0 1 X 0 0 CLAYTON GENERAL, INC. PART V, SECTION B, LINE 5: SEVENTEEN INDIVIDUAL COMMUNITY STAKEHOLDERS WERE INTERVIEWED AND ONE FOCUS GROUP OF NINE PATIENTS AND FAMILY ADVISORS (PFA) WAS CONDUCTED BY THE STRATEGIC PLANNING OFFICE. THESE STAKEHOLDERS INCLUDED A MIX OF INTERNAL AND EXTERNAL REPRESENTATIVES TO SRMC, PASTORS, PUBLIC HEALTH OFFICIALS, HEALTH CARE PROVIDERS, SOCIAL AGENCY REPRESENTATIVES, GOVERNMENT LEADERS, AND BOARD MEMBERS. SEE APPENDIX B OF THE CHNA FOR INDIVIDUAL STAKEHOLDER NAMES. CLAYTON GENERAL, INC. PART V, SECTION B, LINE 6A: EMORY UNIVERSITY HOSPITAL, EMORY UNIVERSITY HOSPITAL MIDTOWN, EMORY JOHNS CREEK HOSPITAL, SAINT JOSEPH'S HOSPITAL, WESLEY WOODS GERIATRIC HOSPITAL, WESLEY WOODS LONG-TERM ACUTE CARE HOSPITAL, EMORY ADVENTIST HOSPITAL CLAYTON GENERAL, INC. PART V, SECTION B, LINE 11: THE HOSPITAL IS TAKING THE FOLLOWING ACTIONS TO ADDRESS SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA:INCREASE DIABETES AWARES OUTREACHEXPAND EFFORTS TO REDUCE SMOKING AND TOBACCO USEINCREASE ACCESS TO WEIGHT LOSS MANAGEMENT PROGRAMSEXPAND AND ENHANCE CARDIOVASCULAR DISEASE & STROKE AWARENESS AND EDUCATIONEXPAND CANCER PREVENTION PROGRAMS AND ACCESS TO CAREADDRESS FETAL MORTALITY WITH COMMUNITY PARTNERSHIPS AND ACCESSINCREASE AWARENESS OF PREVENTABLE INFECTIOUS DISEASES CLAYTON GENERAL, INC. PART V, SECTION B, LINE 22D: THE HOSPITAL'S FAP PROVIDES A DISCOUNT FOR INDIVIDUALS THAT QUALIFY UNDER THE POLICY'S PROVISIONS. THE HOSPITAL HAS MADE PLANS TO IMPLEMENT A METHOD OF DETERMINING AMOUNTS GENERALLY BILLED (AGB) PER THE RECENTLY RELEASED PROPOSED REGULATIONS UNDER SECTION 1.501(R), HOWEVER GIVEN THE HIGH LEVEL OF DISCOUNT AVAILABLE UNDER THE CURRENT POLICY, THE ORGANIZATION IS CONFIDENT THAT ITS POLICIES ARE WELL WITHIN GUIDELINES. PART I, LINE 7: THE ORGANIZATION UTILIZED THE RATIO OF COST TO CHARGE INFORMATION FROM WORKSHEET 2 OF SCHEDULE H, FORM 990. PART I, LINE 7G: THE SUBSIDIZED HEALTH SERVICES LISTED ON LINE 7G ARE RELATED TO EMERGENCY ROOM SERVICES AND WOMEN'S COMMUNITY CARE SERVICES PROVIDED TO THE RESIDENTS OF THE SOUTHERN CRESCENT. PART III, LINE 4: THE ORGANIZATION FOLLOWS THE METHOD DESCRIBED IN HFMA STATEMENT 15. THE COSTING METHODOLOGY WAS BASED ON THE WORKSHEET C FROM THE FY 2014 COST REPORT, AND THE COST TO CHARGE RATIO WAS APPLIED TO BAD DEBT EXPENSE TO CALCULATE BAD DEBT EXPENSE AT COST. PART III, LINE 8: THE METHODOLOGY USED FOR THIS SECTION WAS WORKSHEET 2, SCHEDULE H OF THE FORM 990. PART III, LINE 9B: PATIENTS ARE SCREENED BASED ON COUNTY OF RESIDENCE, INCOME LEVELS, AND WHETHER THE MEDICAL CARE IS CONSIDERED CATASTROPHIC IN NATURE. DEPENDING ON THE CRITERIA, PATIENT'S BILLS ARE REDUCED BY ADJUSTMENTS TO CHARITY OR INDIGENT CARE USING THE SPECIFIC GUIDELINES IN THE POLICY. INCOME CRITERIA ARE BASED ON VARIOUS PERCENTAGES OF FEDERAL POVERTY GUIDELINES (FPG). THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES WHEN THEY QUALIFY FOR INDIGENT CARE / CHARITY CARE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS. PART VI, LINE 2: HEALTH NEEDS ARE GENERALLY ASSESSED THROUGH A STRATEGIC PLANNING PROCESS THAT LOOKS AT THE PRIMARY AND SECONDARY SERVICE AREAS FOR TRENDS IN AGE, INCOME, AND USE RATES FOR VARIOUS SERVICES OR ILLNESSES. COMMUNITY NEEDS ARE ALSO BASED ON A NEEDS ASSESSMENT RELATED TO VARIOUS PHYSICIAN SPECIALTIES, FOR EXAMPLE, THE SERVICE AREA HAS NEEDS FOR PRIMARY CARE PHYSICIANS. THE ORGANIZATION WORKS WITH LOCAL PHYSICIAN PRACTICES TO SHAPE THIS INFORMATION AND ENCOURAGE VARIOUS PHYSICIAN RECRUITMENT ACTIVITIES. HEALTH NEEDS ARE ALSO INDIRECTLY ASSESSED BY ANALYZING TRENDS FOR SERVICES OFFERED AT THE ORGANIZATION AND THE HEALTH STATUS OF THOSE PATIENTS. PART VI, LINE 3: THE ORGANIZATION INFORMS AND EDUCATES PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE BY POSTED SIGNS, FORMS, AND EMAILS. PART VI, LINE 4: THE ORGANIZATION SERVES THE PATIENTS IN THE SOUTHERN CRESCENT OF THE METRO ATLANTA AREA. OUR PRIMARY SERVICE AREA INCLUDES CLAYTON COUNTY, FAYETTE COUNTY, HENRY COUNTY, AND PORTIONS OF SOUTH FULTON COUNTY. THE SOUTHERN CRESCENT IS A LARGE DIVERSE COMMUNITY, AND THE ORGANIZATION OFFERS SERVICES TO MEET THESE VARIED NEEDS. THE MAJOR SERVICES THE ORGANIZATION OFFERS IN THE SOUTHERN CRESCENT ARE OB SERVICES, NEONATOLOGY, GYNECOLOGICAL, ONCOLOGY & HEMATOLOGY, NEUROLOGY, NEUROSURGERY, ORTHOPEDICS, VASCULAR CARE, CARDIOLOGY AND INTERVENTIONAL CARDIOLOGY, ACUTE REHABILITATION, OP IMAGING, OP SURGERY & GASTROENTEROLOGY, EMERGENCY CARE, AND WOMEN'S COMMUNITY CARE. PART VI, LINE 5: THE ORGANIZATION PROMOTES HEALTH IN THE COMMUNITY THROUGH 90 SECOND HEALTH BREAK COMMERCIALS, SPRING INTO HEALTHY LIVING CONFERENCE, HEALTH SCREENINGS AND SPONSORSHIPS. THE ORGANIZATION HAS A COMMUNITY BASED BOARD OF DIRECTORS AND IS ALSO LINKED TO THE COMMUNITY THROUGH THE CLAYTON COUNTY HOSPITAL AUTHORITY (CCHA), WHICH IS A GOVERNMENT ENTITY.EXCESS FUNDS FROM THE OPERATION OF THE ORGANIZATION ARE REDIRECTED BACK TO THE MISSION OF THE ORGANIZATION THROUGH THE PURCHASE OF EQUIPMENT, MAINTAINING / UPGRADING THE FACILITIES, DEVELOPING NEW SERVICES TO BENEFIT THE COMMUNITY, OR FUNDING OPERATIONS. PART VI, LINE 7, REPORTS FILED WITH STATES GA 1 CLAYTON COUNTY CHAMBER OF COMMERCE 2270 MT ZION ROAD JONESBORO GA 30236 580801495 501(C)(6) 8250 OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE CLAYTON GENERAL GROUP 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 581955425 501(C)(3) 1542500 OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE CLAYTON GENERAL REAL ESTATE 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 581955424 501(C)(3) 230000 OPERATIONAL SUPPORT AND PROGRAM ASSISTANCE 2 1 PART I, LINE 2: APPROVED EDUCATION PROGRAMS DURING PERIODS OF SIGNIFICANT LABOR SHORTAGES ARE ELIGIBLE FOR TUITION REIMBURSEMENT. EMPLOYEES MUST APPLY PRIOR TO THE START OF THE COURSE. WITHIN 30 DAYS OF SUCCESSFUL COMPLETION OF THE COURSE, THE EMPLOYEE MUST SUBMIT A COPY OF THEIR GRADE, AND THE ORIGINAL TUITION RECEIPT FROM THE INSTITUTION TO THE HUMAN RESOURCES DEPARTMENT FOR PROCESSING. EMPLOYEES MUST COMPLETE THE COURSE WHILE EMPLOYED AT THE HOSPITAL. THE FILING ORGANIZATION MONITORS TAX EXEMPT PURPOSE COMPLIANCE FOR THE USE OF FUNDS GRANTED TO ITS SUPPORTING ORGANIZATIONS THROUGH A SHARED MANAGEMENT TEAM. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 JOHN MCLAIN VP OF OPERATIONS 320919 0 0 0 0 0 722 0 17374 0 339015 0 0 0 WILLIE COCHRAN VP MEDICAL AFFAIRS 161718 0 0 0 0 0 1769 0 14728 0 178215 0 0 0 JOE E BAKER VP OF FACILITIES 158898 0 0 0 0 0 1215 0 8114 0 168227 0 0 0 STACY J HANCOCK VP OF HUMAN RESOURCES 173831 0 0 0 0 0 218 0 17374 0 191423 0 0 0 JIM JUNE DIRECTOR OF REVENUE CYCLES 186908 0 0 0 0 0 3341 0 12356 0 202605 0 0 0 RICHARD K ALLEN VP OF INFORMATION TECH 157144 0 0 0 0 0 519 0 21171 0 178834 0 0 0 JANIE HINTON HIGHEST COMPENSATION EMPLOYEE 144062 0 0 0 0 0 236 0 17384 0 161682 0 0 0 VIRGINIA DICKSON HIGHEST COMPENSATION EMPLOYEE 139560 0 0 0 0 0 198 0 11104 0 150862 0 0 0 ERNEST BEDSAUL HIGHEST COMPENSATION EMPLOYEE 136070 0 0 0 0 0 1983 0 16706 0 154759 0 0 0 PART I, LINE 1A SPOUSE TRAVEL EXPENSES ARE REIMBURSED WHEN HIS/HER ATTENDANCE IS NECESSARY AND ESSENTIAL. SPOUSAL TRAVEL EXPENSES REQUIRE PRIOR APPROVAL. REIMBURSEMENT SHALL BE LIMITED TO TRANSPORTATION EXPENSE NOT TO EXCEED THE AIR TRAVEL RATE IN COACH CLASS AND OUT-OF-POCKET EXPENSES WITH RESPECT LODGING AND FOOD. REIMBURSEMENT SHALL BE LIMITED TO LODGING BASED ON DOUBLE ACCOMODATION. THE POLICY RECOGNIZES THAT GOVERNING BOARD MEMBERS ARE OFTEN PLACED IN SOCIAL SITUATIONS AT SUCH MEETINGS AND WOULD REPRESENT THE HOSPITAL OPTIMALLY WITH THE ASSISTANCE OF THEIR SPOUSES. PART I, LINE 1B A FORMAL POLICY EXISTS, AND RECEIPTS AND APPROVAL ARE REQUIRED BEFORE REIMBUSREMENT FORMS ARE PROCESSED THROUGH THE ACCOUNTING DEPARTMENT FOR PAYMENT. OPERATING ASSETS 2016-02-01 80867447 COST 208065139 PRIME HEALTHCARE FOUNDATION 16850 BEAR VALLEY RD STE 200 VICTORVILLE CA 92395 501(C)(3) 0 0 0 0 FORM 990, PART III, LINE 3 CLAYTON GENERAL OPERATIONAL ASSETS WERE ACQUIRED BY PRIME HEALTHCARE ON FEBRUARY 2, 2016. THE ORGANIZATION CEASED ACTIVITIES ON THIS DATE. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HIRED AND DELEGATED MANAGEMENT DUTIES TO EMORY HEALTHCARE. EMORY HEALTHCARE PROVIDED THE CEO, KIM RYAN, AND CFO, GEORGE HOFFMAN. THE CEO WAS COMPENSATED $225,282 AND THE CFO WAS COMPENSATED $203,428. FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURN WAS PREPARED BY AN INDEPENDENT ACCOUNTANT. THE COMPLETED IRS FORM 990 TAX RETURN WAS PROVIDED TO THE BOARD. BOARD MEMBERS REVIEWED THE TAX RETURN BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS AND SENIOR MANAGEMENT. ANY POTENTIAL CONFLICT IS DISCUSSED WITH THE BOARD OF DIRECTORS (ABSENT THE MEMBER WITH THE POTENTIAL CONFLICT). IF IT IS DETERMINED THAT CONFLICT EXISTS, THEN THE BOARD MAY HAVE THE MEMBER EITHER RESIGN OR REMOVE THE CONFLICT, OR THEY MOVE FORWARD WITH THE TRANSACTION IF SPECIFIC FACTS ARE PRESENT. IF THE LATER SITUATION TAKES PLACE, THEN THE MEMBER IS EXCLUDED FROM DISCUSSIONS AND THE VOTE FOR THAT TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS AUTHORIZES THE COMPENSATION PACKAGE OF EXECUTIVIES UTILIZING THE VHA GEORGIA SURVEY OF EXECUTIVE COMPENSATION AND OTHER APPROPRIATE SURVEYS. THE SURVEY IS REVIEWED TO ENSURE COMPETITIVE WAGES AND BENEFITS FOR THE CEO, CFO, OTHER OFFICERS, AND KEY EMPLOYEES OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION COMPLIES WITH THE OPEN RECORDS LAW. UPON WRITTEN REQUEST, GOVERNING DOCUMENTS DEEMED ACCESSIBLE TO THE PUBLIC UNDER THE LAW CAN BE VIEWED IN THE OFFICE OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. FORM 990, PART XI, LINE 9: BANKRUPTCY -3,011,621. CONTRIBUTIONS FROM RELATED ORGANIZATIONS -4,225,800. TRANSFERS OF CAPITAL - BANKRUPTCY 1,772,500. PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. CLAYTON GENERAL GROUP INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 581955425 HEALTHCARE GA 501(C)(3) 3 CLAYTON GENERAL INC 1 CLAYTON GENERAL FOUNDATION INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 581983516 FUNDRAISING GA 501(C)(3) LINE 11, TYPE II CLAYTON GENERAL INC 1 SOUTHERN REGIONAL MEDICAL CENTER AUXILIARY 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 582027384 GIFT SHOP AND VOLUNTEER GA 501(C)(3) LINE 11, TYPE II CLAYTON GENERAL INC 1 CLAYTON GENERAL ASC INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 582541044 HEALTHCARE GA 501(C)(3) LINE 11, TYPE II CLAYTON GENERAL INC 1 CLAYTON COUNTY HOSPITAL AUTHORITY TRUST COMPANY LIABILITY TRUST 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 582016041 LIABILITY INSURANCE GA 501(C)(3) LINE 11, TYPE II CLAYTON GENERAL INC 1 CLAYTON GENERAL REAL ESTATE INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 581955424 REAL ESTATE MANAGEMENT GA 501(C)(3) LINE 11, TYPE II CLAYTON GENERAL INC 1 SPIVEY STATION ASC BUILDING LP TWO SUN COURT STE 350 NORCROSS GA 30092 263323060 RENTAL GA CLAYTON GENERAL INC RELATED 38837 698549 0 0 0.45410 SOUTHLAKE ASC LLP 4000 CORPORATE CENTER DR MORROW GA 30260 582272588 SURGICAL GA N/A CLAYTON GENERAL SERVICES INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 208774854 EQUIPMENT LEASE GA SOUTH REGIONAL HEALTH SYSTEM INC C 411 42972 1.00000 1 SOUTHERN CRESCENT HEALTH NETWORK INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 582220817 PHYSICIAN NETWORK GA SOUTH REGIONAL HEALTH SYSTEM INC C 5922 1.00000 1 SPIVEY STATION MANAGEMENT ASSOCIATION INC 11 UPPER RIVERDALE RD SW RIVERDALE GA 30274 260629861 HEALTHCARE GA SOUTH REGIONAL HEALTH SYSTEM INC C 1.00000 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 SOUTHLAKE ASC LLP B 500000 CLAYTON COUNTY HOSPITAL AUTHORITY TRUST B 3470800 CLAYTON GENERAL REAL ESTATE INC B 100000 CLAYTON GENERAL SERVICES INC B 155000