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CENTRAL GEORGIA SENIOR HEALTH INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
CENTRAL GEORGIA SENIOR HEALTH INC (EIN 58-2345439)
Tax period
2013-10-01 to 2014-09-30
Filed
2015-08-17
IRS object ID
201502299349301210
Schema version
2013v4.0
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)
Return2015-08-17T09:00:20-05:00ReturnTs
Tax Period End2014-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN580914992PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DRAFFIN & TUCKER LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1FIVE CONCOURSE PARKWAY SUITE 1250AddressLine1
CityATLANTACity
StateGAState
ZIP Code30328ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN582345439EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CENTRAL GEORGIA SENIOR HEALTH INCBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlCENTBusinessNameControlTxt
Phone4786331407PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1691 CHERRY STREETAddressLine1
CityMACONCity
StateGAState
ZIP Code31201ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRHONDA S PERRYPersonNm
Person TitleEXECUTIVE VICE PRESIDENT/CFOPersonTitleTxt
Signature2015-08-13SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonW Edward PhillipsPreparerPersonNm
PTINP00451499PTIN
Phone4042208494PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1CARLYLE PLACEBusinessNameLine1

Principal Ofcr Business Address PrincipalOfcrBusinessAddress

FieldValueIRS element (for citing)
Business Name Line1ELBERT MCQUEENBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1691 CHERRY STREETAddressLine1
CityMACONCity
StateGAState
ZIP Code31201ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$75,650,482GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CARLYLEPLACE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1997FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionCONTINUING CARE RETIREMENT COMMUNITY OFFERING A FULFILLING INDEPENDENT LIFESTYLE EXPERIENCE IN A RESIDENTIAL SETTING WHILE PROVIDING COMPREHENSIVE HEALTH CARE SERVICES AND AMMENITIES TO INCLUDE ASSISTED LIVING, MEMORY CARE, AND SKILLED NURSING, ALL HOUSED ON THE SAME CAMPUS.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee194TotalEmployeeCnt
Total Volunteers350TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$15,499,189PYProgramServiceRevenueAmt
CY Program Service Revenue$14,510,090CYProgramServiceRevenueAmt
PY Investment Income$4,642,468PYInvestmentIncomeAmt
CY Investment Income$7,308,828CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$20,141,657PYTotalRevenueAmt
CY Total Revenue$21,818,918CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$6,846,291PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$7,417,567CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$8,326,029PYOtherExpensesAmt
CY Other Expenses$8,515,478CYOtherExpensesAmt
PY Total Expenses$15,172,320PYTotalExpensesAmt
CY Total Expenses$15,933,045CYTotalExpensesAmt
PY Revenues Less Expenses$4,969,337PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$5,885,873CYRevenuesLessExpensesAmt
Total Assets BOY$99,925,330TotalAssetsBOYAmt
Total Assets EOY$103,566,053TotalAssetsEOYAmt
Total Liabilities BOY$80,286,550TotalLiabilitiesBOYAmt
Total Liabilities EOY$84,575,492TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$19,638,780NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$18,990,561NetAssetsOrFundBalancesEOYAmt
MissionCENTRAL GEORGIA SENIOR HEALTH, INC., INCORPORATED ON MAY 2, 1997, IS A NONPROFIT CORPORATION WHOSE PRIMARY PURPOSE IS TO CONSTRUCT, OWN AND OPERATE A CONTINUING CARE RETIREMENT COMMUNITY IN MACON, GEORGIA. IT WAS ORGANIZED FOR THE WELL-BEING OF OUR RESIDENTS, AND SHARING OUR KNOWLEDGE BEYOND OUR COMMUNITY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$11,930,430ExpenseAmt
Revenue$14,510,090RevenueAmt
DescCARLYLE PLACE (CP) IS A CONTINUING CARE RETIREMENT COMMUNITY (CCRC) OFFERING A FULFILLING LIFESTYLE EXPERIENCE IN A RESIDENTIAL SETTING, EMPHASIZING HEALTHY, ACTIVE LIFESTYLES FROM RETIREMENT UNTIL THE END OF LIFE. THERE ARE FOUR LIFESTYLE OPTIONS OFFERED BY CP: INDEPENDENT LIVING, ASSISTED LIVING, MEMORY SUPPORT AND SKILLED NURSING. RESIDENTS ARE ASSURED OF HAVING THEIR NEEDS MET - FROM RETIREMENT THROUGH THEIR END-OF-LIFE EXPERIENCE, ALL ON ONE CAMPUS AND WITH NO NEED TO RELOCATE OUTSIDE THE COMMUNITY. COUPLES WHO HAVE VARYING DEGREES OF HEALTH NEEDS MAY RECEIVE AS LITTLE OR AS MUCH ASSISTANCE AS NEEDED AND REMAIN IN CLOSE PROXIMITY TO EACH OTHER. CARLYLE PLACE IS COMMITTED TO PROVIDING A QUALITY LIFE EXPERIENCE IN THE BEST ENVIRONMENT POSSIBLE, DEPENDING UPON NEED. ON SITE SECURITY AND A TWENTY-FOUR HOUR EMERGENCY CALL SYSTEM PROVIDE RESIDENTS PEACE OF MIND AS HELP IS MERELY A PULL-CORD AWAY.Desc
Total Program Service Expenses$11,930,430TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesYes (true)ForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsYes (true)TaxExemptBondsInd
Invest Tax Exempt BondsfalseInvestTaxExemptBondsInd
Escrow AccountfalseEscrowAccountInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document69IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee194EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CONNIE W JONES CPABusinessNameLine1
FieldValueIRS element (for citing)
Phone4784054500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line15300 ZEBULON ROADAddressLine1
CityMACONCity
StateGAState
ZIP Code31210ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
ALFRED SAMS
DIRECTOR1.00Yes (X)$0$0$0
JAMES ADAMS JR
DIRECTOR/ VICE CHAIR1.00Yes (X)$0$0$0
JAMES WANSLEY
DIRECTOR/CHAIRMAN1.00Yes (X)$0$0$01.00
JIM MCLENDON
DIRECTOR1.00Yes (X)$0$0$02.00
MARJORIE CARTER
DIRECTOR1.00Yes (X)$0$0$01.00
TIMOTHY JACKSON
DIRECTOR1.00Yes (X)$0$0$03.00
ELBERT T MCQUEEN
CHIEF EXECUTIVE OFFICER/SVP POST ACUTE SERVICES1.00$0$233,257$26,26349.00Yes (X)
KENNETH B BANKS
COPORATE SECRETARY/SVP/CHIEF LEGAL COUNSEL1.00$0$585,748$179,23249.00Yes (X)
RHONDA S PERRY
CHIEF FINANCIAL OFFICER/EVP1.00$0$1,285,717$88,43749.00Yes (X)
CONNIE W JONES
DIRECTOR OF FINANCIAL SERVICES50.00$100,666$0$9,362Yes (X)
THOMAS ROCKENBACH JR
EXECUTIVE DIRECTOR50.00$131,562$0$24,509Yes (X)
A DONALD FAULK JR
CEO CGHS$0$171,300$02.00Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$232,228TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,276,022TotReportableCompRltdOrgAmt
Total Other Compensation$327,803TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K2IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
SODEXO INC AND AFFILIATES
PO BOX 536922ATLANTAGA30353FOOD SERVICES$1,477,476
REHAB CARE GROUP INC
PO BOX 503534ST LOUISMO631503534PHYSICAL THERAPIES$349,979
SUNTRUST BANK
17TH FLOOR 245 PEACHTREE CTR AVEATLANTAGA30303BANKING SERVICES$252,640
LANDSCAPE SOUTH INC
PO BOX 26998MACONGA31008LANDSCAPING$207,762
BURGESS CARPET CENTER
PO BOX 4464MACONGA31208FLOORING SERVICES$192,522
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K7CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RESIDENCY REVENUE623000$13,729,349$13,729,349
MEDICARE/MEDICAID PAYMENT623000$652,934$652,934
GUEST MEALS722320$51,456$51,456
RESIDENT TRANSPORTATION480000$22,100$22,100
GUEST ROOM REVENUE721000$13,104$13,104

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$41,147TotalRevenueColumnAmt
Related Or Exempt Func Income$41,147RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$14,510,090TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,166,151TotalRevenueColumnAmt
Exclusion$1,166,151ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$59,974,241SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$53,831,564SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$6,142,677SecuritiesAmt
Other$0OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,142,677TotalRevenueColumnAmt
Exclusion$6,142,677ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

Total Revenue ColumnTotalRevenueColumnAmt
$0
$0
$0

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$21,818,918TotalRevenueColumnAmt
Related Or Exempt Func Income$14,510,090RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$7,308,828ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$5,341,415TotalAmt
Program Services$4,171,268ProgramServicesAmt
Management And General$1,170,147ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$130,325TotalAmt
Management And General$130,325ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,529,944TotalAmt
Program Services$1,263,528ProgramServicesAmt
Management And General$266,416ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$415,883TotalAmt
Program Services$304,944ProgramServicesAmt
Management And General$110,939ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$188,028TotalAmt
Management And General$188,028ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$43,721TotalAmt
Management And General$43,721ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$276,333TotalAmt
Management And General$276,333ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$441,575TotalAmt
Program Services$91,212ProgramServicesAmt
Management And General$350,363ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$190,273TotalAmt
Management And General$190,273ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$31,691TotalAmt
Management And General$31,691ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$44,781TotalAmt
Management And General$44,781ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$832,965TotalAmt
Program Services$726,875ProgramServicesAmt
Management And General$106,090ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$46,361TotalAmt
Program Services$27,440ProgramServicesAmt
Management And General$18,921ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$15,355TotalAmt
Program Services$10,319ProgramServicesAmt
Management And General$5,036ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,030,769TotalAmt
Program Services$927,692ProgramServicesAmt
Management And General$103,077ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,373,472TotalAmt
Program Services$2,136,125ProgramServicesAmt
Management And General$237,347ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$219,649TotalAmt
Program Services$12,005ProgramServicesAmt
Management And General$207,644ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SUPPLIES$2,011,982$1,857,614$154,368
SODEXO DINING MANAGEMENT FEES$324,947$324,947
EQUIPMENT RENTAL AND MAINTENANCE$230,805$22,407$208,398
REFURBISHMENT EXPENSES$78,958$78,958

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$133,813TotalAmt
Program Services$54,054ProgramServicesAmt
Management And General$79,759ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$15,933,045TotalAmt
Program Services$11,930,430ProgramServicesAmt
Management And General$4,002,615ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Joint Costs TotalJointCostsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$782,311BOYAmt
EOY$1,502,189EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,041,736BOYAmt
EOY$605,180EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$15,148BOYAmt
EOY$12,159EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$76,424BOYAmt
EOY$73,344EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$66,132,814LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$32,844,512LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$34,381,411BOYAmt
EOY$33,288,302EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$54,996,522BOYAmt
EOY$58,372,287EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$8,033,337BOYAmt
EOY$9,223,048EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$575,871BOYAmt
EOY$469,042EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$22,570BOYAmt
EOY$20,502EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$99,925,330BOYAmt
EOY$103,566,053EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$511,410BOYAmt
EOY$405,409EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$35,534,793BOYAmt
EOY$10,560,271EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$40,925,000BOYAmt
EOY$39,650,000EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,315,347BOYAmt
EOY$33,959,812EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$80,286,550BOYAmt
EOY$84,575,492EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$19,638,780BOYAmt
EOY$18,990,561EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$19,638,780BOYAmt
EOY$18,990,561EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$99,925,330BOYAmt
EOY$103,566,053EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$5,885,873ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$6,534,092OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type2Yes (X)SupportingOrgType2Ind
CertificationYes (X)CertificationInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MEDICAL CENTER OF CENTRAL GEORGIABusinessNameLine1
FieldValueIRS element (for citing)
EIN582149127EIN
Organization Type3OrganizationTypeDesc
Governing Document ListedYes (true)GoverningDocumentListedInd
Supported Org NotifiedYes (true)SupportedOrgNotifiedInd
US OrganizedYes (true)USOrganizedInd
Support$0SupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt

Form990 Schedule A Part IV Form990ScheduleAPartIVGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule A, Part I, Line 11h, Description of non-monetary SupportFormAndLineReferenceDesc
ExplanationMEDICAL CENTER OF CENTRAL GEORGIA: CENTRAL GEORGIA SENIOR HEALTH OPERATES A CONTINUING CARE RETIREMENT COMMUNITY AS A TYPE II SUPPORTING ORGANIZATION OF THE MEDICAL CENTER OF CENTRAL GEORGIA. BOTH ORGANIZAIONS ARE CONTROLLED BY CENTRAL GEORGIA HEALTH SYSTEMS.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,732,834OtherCostOrOtherBasisAmt
Book Value$1,732,834BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$51,974,820OtherCostOrOtherBasisAmt
Depreciation$24,264,448DepreciationAmt
Book Value$27,710,372BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,873,218OtherCostOrOtherBasisAmt
Depreciation$5,225,232DepreciationAmt
Book Value$2,647,986BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,282,133OtherCostOrOtherBasisAmt
Depreciation$3,107,952DepreciationAmt
Book Value$1,174,181BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$269,809OtherCostOrOtherBasisAmt
Depreciation$246,880DepreciationAmt
Book Value$22,929BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$33,288,302TotalBookValueLandBuildingsAmt

Financial Derivatives FinancialDerivativesGrp

FieldValueIRS element (for citing)
Book Value$0BookValueAmt
Method ValuationFMethodValuationCd

Closely Held Equity Interests CloselyHeldEquityInterestsGrp

FieldValueIRS element (for citing)
Book Value$0BookValueAmt

Other Securities OtherSecuritiesGrp (3 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
BANK LOANS$1,789,526F
DISTRESSED DEBT$953,741F
OTHER INVESTMENTS$6,479,781F
FieldValueIRS element (for citing)
Total Book Value Securities$9,223,048TotalBookValueSecuritiesAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

AmtAmtDescDesc
$0
$1,839,610INTEREST RATE SWAP
$1,227,205DUE TO AFFILIATES
$30,892,997ENTRANCE FEES PAYABLE
FieldValueIRS element (for citing)
Total Liability$33,959,812TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$22,171,398TotalRevEtcAuditedFinclStmtAmt
Other Revenue$387,415OtherRevenueAmt
Revenue Not Reported$387,415RevenueNotReportedAmt
Revenue Subtotal$21,783,983RevenueSubtotalAmt
Other Revenues Not Included$34,935OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$34,935RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$21,818,918TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$17,599,632TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$1,701,522OtherExpensesIncludedAmt
Expenses Not Reported$1,701,522ExpensesNotReportedAmt
Expenses Subtotal$15,898,110ExpensesSubtotalAmt
Other Expenses Not Included$34,935OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$34,935ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$15,933,045TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule D, Part X, Line 2, FIN 48 (ASC 740) footnoteCARLYLE PLACE IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. CARLYLE PLACE HAS EVALUATED ITS TAX POSITIONS AND DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2014. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.
Schedule D, Part XI, Line 2d, Other revenues in audited financial statements not in form 990CHANGE IN INTEREST RATE SWAP - 387415;
Schedule D, Part XI, Line 4b, Other revenues in form 990 not in audited financial statementsRECLASSIFICATION - 34935;
Schedule D, Part XII, Line 2d, Other expenses in audited financial statements not in form 990UNREALIZED LOSSES - 1701520; ROUNDING - 2;
Schedule D, Part XII, Line 4b, Other expenses in form 990 not in audited financial statementsRECLASSIFICATION - 34935;

Schedule F IRS990ScheduleF

Account Activities Outside US AccountActivitiesOutsideUSGrp

FieldValueIRS element (for citing)
RegionCENTRAL AMERICA AND THE CARIBBEANRegionTxt
Offices0OfficesCnt
Type Of Activities ConductedINVESTMENTSTypeOfActivitiesConductedTxt
Region Total Expenditures$953,741RegionTotalExpendituresAmt
FieldValueIRS element (for citing)
Total Office0TotalOfficeCnt
Total Spent$953,741TotalSpentAmt
Transfer To Foreign CorpfalseTransferToForeignCorpInd
Interest In Foreign TrustfalseInterestInForeignTrustInd
Foreign Corp OwnershipfalseForeignCorpOwnershipInd
Passive Foreign Investmest CofalsePassiveForeignInvestmestCoInd
Foreign PartnershipYes (true)ForeignPartnershipInd
Boycott CountriesfalseBoycottCountriesInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule F, Part I, Line 3, Method to account for expenditures on org.'s financial statementsCENTRAL AMERICA AND THE CARIBBEAN: ACCRUAL
Schedule F, Part I, Line 3, Method to account for expenditures on org.'s financial statementsCENTRAL AMERICA AND THE CARIBBEAN: ACCRUAL

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
A DONALD FAULK JR
CEO CGHS$0$171,300$0$0$0$0$0$0$0$0$0$171,300$0$0
RHONDA S PERRY
CHIEF FINANCIAL OFFICER/EVP$0$415,192$0$0$0$870,525$0$79,515$0$8,922$0$1,374,154$0$870,111
ELBERT T MCQUEEN
CHIEF EXECUTIVE OFFICER/SVP POST ACUTE SERVICES$0$227,376$0$0$0$5,881$0$13,576$0$12,687$0$259,520$0$0
THOMAS ROCKENBACH JR
EXECUTIVE DIRECTOR$130,956$0$0$0$606$0$2,599$0$21,910$0$156,071$0$0$0
KENNETH B BANKS
COPORATE SECRETARY/SVP/CHIEF LEGAL COUNSEL$0$282,868$0$0$0$302,880$0$157,183$0$22,049$0$764,980$0$278,853

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 3, Arrangement used to establish the top management official's compensationTHE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CENTRAL GEORGIA HEALTH SYSTEMS, INC. ENGAGES AN EXECUTIVE CONSULTING FIRM PERIODICALLY 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. OUR HUMAN RESOURCES DEPARTMENT SURVEYS THOSE EMPLOYED OUTSIDE OF THE EXECUTIVE LEADERSHIP TEAM USING TOOLS THAT PROVIDE COMPARABLE DATA IN OUR MARKET AREA TO ENSURE THE COMPENSATION IS IN LINE WITH OTHER HEALTH CARE ORGANIZATIONS.
Schedule J, Part I, Line 4b, Supplemental nonqualified retirement planMCCG 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 DID NOT PERFORM AS ANTICIPATED. DURING 2009 MCCG SUSPENDED ALL PREMIUM PAYMENTS AND REEVALUATED THE EFFECTIVENESS OF THE PROGRAM FOR ALL CURRENT PARTICIPANTS. DURING CALENDAR YEAR 2009 THE MCCG BOARD OF DIRECTORS, AFTER CONSULTATION WITH COMPENSATION AND LEGAL ADVISERS, ADOPTED A RESOLUTION TO MAKE PAYMENTS TO THE RETIRED PARTICIPANTS IN THE SEBP. IN CONSIDERATION FOR THE RECEIPT OF SUCH PAYMENT, THE RETIRED EXECUTIVES SURRENDERED SUBSTANTIALLY ALL RIGHTS AND BENEFITS (OTHER THAN A SMALL DEATH BENEFIT) UNDER THE SEBP TO THE ORGANIZATION. SUBSEQUENTLY, A SIMILAR DECISION WAS MADE DURING FISCAL YEAR ENDED SEPTEMBER 30, 2011 FOR THE REMAINING (EMPLOYED) PARTICIPANTS WITH ANY PAYMENTS TO BE MADE DEPENDENT ON THE INDIVIDUAL CONTINUING TO PROVIDE SUBSTANTIAL SERVICES TO A SPECIFIED FUTURE DATE. IN ADDITION, MCCG AND ITS AFFILIATED ORGANIZATIONS ADOPTED A SERP PROGRAM FOR CERTAIN EXECUTIVES EFFECTIVE FOR SERVICES RENDERED ON OR AFTER JANUARY 1, 2010. THIS PROGRAM PROVIDES FOR ANNUAL ACCOUNT VESTING IF THE PARTICIPANT IS EMPLOYED ON DECEMBER 31 OF THE THIRD YEAR AFTER THE ACCOUNT IS CREATED. THE BENEFIT EQUALS THE ANNUAL INCREASE IN THE PRESENT VALUE OF A LIFETIME ANNUITY PAYABLE COMMENCING AT A SPECIFIED TARGETED FUTURE DATE. THE ANNUTIY IS EQUAL TO A SPECIFIC PERCENTAGE OF FINAL AVERAGE EARNINGS (GENERALLY 60%) LESS (1) THE EXPECTED ANNUAL SEBP PAYMENT USED IN CALCULATING THE SEBP LUMP SUM PAYMENT, (2) THE ANNUAL BENEFIT PROVIDED UNDER THE DEFINED BENEFIT PLAN, AND (3) 100% OF THE PARTICIPANT'S SOCIAL SECURITY BENEFIT. DURING THE YEAR, THE FOLLOWING BENEFITS WERE ACCRUED: RHONDA PERRY $ 46,523 KEN BANKS $137,154 IN ADDITION, CGHS ADOPTED A RETENTION PAYMENT PLAN EFFECTIVE OCTOBER 1, 2011 DESIGNED TO ENCOURAGE DESIGNATED EMPLOYEES TO CONTINUE THEIR EMPLOYMENT. UNDER THE PLAN, CGHS MAY SELECT A RETENTION CREDIT EQUAL TO A PERCENTAGE OF THE EXECUTIVE'S BASE SALARY. THE CREDIT IS REDUCED BY THE VALUE OF LIFE INSURANCE COVERAGE PROVIDED TO THE EXECUTIVE. IN GENERAL, THE PLAN IS SUBJECT TO VESTING AT THE END OF THE THIRD PLAN YEAR AFTER THE ACCOUNT WAS CREATED OR AGE 65 IF EARLIER, AND IS SUBJECT TO FORFEITURE IF THE EXECUTIVE VOLUNTARILY SEPARATES FROM SERVICE. DURING THE YEAR THE FOLLOWING BENEFITS ACCRUED UNDER THIS PLAN: RHONDA PERRY $31,986 KEN BANKS $18,083 ELBERT MCQUEEN $10,638 THE FOLLOWING NONQUALIFIED RETIREMENT PLAN BENEFITS WERE REPORTED AS TAXABLE INCOME TO VESTED INDIVIDUALS: RHONDA PERRY $870,111 KEN BANKS $278,853 A DONALD FAULK $126,644
Schedule J, Part I, Line 7, Non-fixed paymentsTHIS PROGRAM IS ADMINISTERED BY THE CEO OF CENTRAL GEORGIA HEALTH SYSTEMS, INC. THE DISCRETIONARY INCENTIVE PROGRAM WAS ESTABLISHED FOR REWARD AND RECOGNITION OF EXECUTIVES AND ORGANIZATIONAL LEADERS WHO GO ABOVE AND BEYOND THE SCOPE OF THEIR RESPONSIBILITIES.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1MACON-BIBB COUNTY HOSPITAL AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Bond Issuer EIN581034851BondIssuerEIN
CUSIP55553RCC7CUSIPNum
Bond Issued2009-09-01BondIssuedDt
Issue Price$45,900,000IssuePriceAmt
PurposeREFUNDING OF BONDS ISSUED IN 2000 TO CONSTRUCT THE FACILITYPurposeDesc
DefeasedfalseDefeasedInd
On Behalf Of IssuerfalseOnBehalfOfIssuerInd
Pool FinancingfalsePoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$6,250,000RetiredAmt
Bond Defeased$0BondDefeasedAmt
Total Proceeds$45,900,000TotalProceedsAmt
In Reserve Fund$0InReserveFundAmt
Capitalized Interest$0CapitalizedInterestAmt
Refunding Escrow$0RefundingEscrowAmt
Issuance Costs From Proceeds$0IssuanceCostsFromProceedsAmt
Credit Enhancement$0CreditEnhancementAmt
Working Capital Expenditures$0WorkingCapitalExpendituresAmt
Capital Expenditures$0CapitalExpendituresAmt
Other Spent Proceeds$45,900,000OtherSpentProceedsAmt
Unspent$0UnspentAmt
Substantial Completion2001SubstantialCompletionYr
Current RefundingYes (true)CurrentRefundingInd
Advance RefundingfalseAdvanceRefundingInd
Final Allocation MadeYes (true)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (true)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedPropertyInd
Any Lease ArrangementsYes (true)AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd PropYes (true)MgmtContractBondFincdPropInd
Engage Bond Counsel ContractsfalseEngageBondCounselContractsInd
Any Research AgreementsfalseAnyResearchAgreementsInd
Private Bus Use By Others0.00340PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.00340TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt TestfalseBondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed PropfalseChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (true)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiledInd
Rebate Not Due YetfalseRebateNotDueYetInd
Exception To RebateYes (true)ExceptionToRebateInd
No Rebate DueYes (true)NoRebateDueInd
Variable Rate IssueYes (true)VariableRateIssueInd
Hedge Identified In Bks And RecYes (true)HedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

FieldValueIRS element (for citing)
Business Name Line1SUNTRUST BANKBusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge20.0TermOfHedgePct
Superintegrated HedgefalseSuperintegratedHedgeInd
Hedge TerminatedfalseHedgeTerminatedInd
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGICInd
Term Of GIC0.0TermOfGICPct
Gross Proceeds InvestedfalseGrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (true)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionfalseProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Sch K, Part IV, Line 2c, ISSUER NAME: MACON-BIBB COUNTY HOSPITAL AUTHORITY: No Rebate Due.THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 09/11/2014.
SCHEDULE K, PART VI, ARBITRAGE EXCEPTIONALL ORIGINAL PROCEEDS, INVESTMENT PROCEEDS AND OTHER GROSS PROCEEDS MET THE 6-MONTH SPENDING EXCEPTION TO THE ARBITRAGE REBATE REQUIREMENTS.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholdersCENTRAL GEORGIA HEALTH SYSTEMS, INC., A RELATED 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF THE ORGANIZATION.
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing bodyCENTRAL GEORGIA HEALTH SYSTEMS, INC., A RELATED 501(C)(3) ORGANIZATION, HAS CERTAIN RESERVE POWERS AS WELL AS THE POWER TO APPROVE AND REMOVE BOARD MEMBERS OF CENTRAL GEORGIA SENIOR HEALTH, INC.
Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholdersCENTRAL GEORGIA HEALTH SYSTEMS, INC., A RELATED 501(C)(3) ORGANIZATION, HAS CERTAIN RESERVE POWERS AS WELL AS THE POWER TO APPROVE AND REMOVE BOARD MEMBERS OF CENTRAL GEORGIA SENIOR HEALTH, INC.
Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing bodyTHE FORM 990 WAS PREPARED BY CENTRAL GEORGIA SENIOR HEALTH PERSONNEL FROM INFORMATION PROVIDED BY MANAGEMENT AND FROM FINANCIAL STATEMENTS (AUDITED BY AN INDEPENDENT CPA FIRM). IT WAS REVIEWED IN DETAIL BY BOTH OUR OUTSIDE TAX ADVISOR (ANOTHER INDEPENDENT CPA) AND BY 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, Sec B, Line 12c, Conflict of interest policyTHE DEPARTMENT OF AUDIT AND COMPLIANCE ISSUES COI DISCLOSURE FORMS ANNUALLY TO OUR BOARD MEMBER, 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. IF NEEDED, CORRECTIVE ACTION RECOMMENDATIONS ARE TAKEN TO THE APPROPRIATE BOARD AND ADMINISTRATION FOR IMPLEMENTATION. ANY TIME A CHANGE IN A RELATIONSHIP OR NEW POTENTIAL CONFLICT EVOLVES, THE INDIVIDUAL MUST AMEND THEIR COI DISCLOSURE FORM. CONFLICTED INDIVIDUALS ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND DECISIONS REGARDING SUCH TRANSACTIONS, BUT MAY PROVIDE INFORMATION IF REQUESTED BY THE COMPLIANCE COMMITTEE.
Form 990, Part VI, Sec C, Line 19, Required documents available to the publicTHE ORGANIZATION PROVIDES COPIES OF ITS GOVERNING DOCUMENTS UPON REQUEST.
FORM 990, PART XI, LINE 9, PRIOR PERIOD ADJUSTMENTTHE PRIOR PERIOD ADJUSTMENT RESULTS FROM A CHANGE IN ACCOUNTING PRINCIPLE RELATED TO REFUNDABLE ADVANCE FEES. DURING THE YEAR ENDED SEPTEMBER 30, 2014, THE ORGANIZATION IMPLEMENTED THE PROVISIONS OF FASB ACCOUNTING STANDARDS UPDATE NO. 2012-01 HEALTH CARE ENTITIES (TOPIC 954). THE AMENDMENTS IN THIS UPDATE RESULTED IN A RECLASSIFICATION OF DEFERRED REVENUE TO A LIABILITY ACCOUNT. PREVIOUSLY AMORTIZED DEFERRED REVENUE WAS ALSO RECORDED TO A LIABILITY ACCOUNT. SINCE THE CHANGE IN ACCOUNTING PRINCIPLE DOES NOT AFFECT THE TIMING OF THE RECOGNITION OF INCOME OR DEDUCTION, THE CHANGE IS NOT A CHANGE IN ACCOUNTING METHOD FOR INCOME TAX PURPOSES. THUS, FORM 3115 IS NOT REQUIRED TO BE FILED.
Form 990 , Part XI, Line 9, Other changes in net assets or fund balancesINTEREST RATE SWAP CHANGE IN FMV - 387415; UNREALIZED GAINS - -1701520; PRIOR PER ADJ FROM CHANGE IN ACCT PRINCIPLE - -5219987;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrganizationControlledOrganizationInd
CENTRAL GEORGIA HEALTH SYSTEMS INC
691 CHERRY STREET SUITE 400MACONGA31201582149127PARENT/STRATEIC PLANNING AND FINANCIAL MANAGEMENTGA501(C)(3)11 - Type III - FINAfalse
HEALTH SERVICES OF CENTRAL GEORGIA INC
691 CHERRY STREET SUITE 400MACONGA31201582307485HEALTHCARE SERVICESGA501(C)(3)3CENTRAL GEORGIA HEALTH SYSTEMSfalse
MEDCEN COMMUNITY HEALTH FOUNDATION INC
858 HIGH STREETMACONGA31201237363555FUNDRAISINGGA501(C)(3)7CENTRAL GEORGIA HEALTH SYSTEMSfalse
MEDICAL CENTER OF GEORGIA INC
691 CHERRY STREET SUITE 400MACONGA31201582149128HOSPITALGA501(C)(3)3CENTRAL GEORGIA HEALTH SYSTEMSfalse
MEDICAL CENTER OF PEACH COUNTY INC
1960 HWY 247BYRONGA31008453765471HOSPITALGA501(C)(3)3CENTRAL GEORGIA HEALTH SYSTEMSfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeTxt
SECURE HEALTH PLANS OF GEORGIA LLC
577 MULBERRY STREET SUITE 1000MACONGA31201582306549MANAGED CAREGANAN/A
CENTRAL GEORGIA PET LLC
1650 HARDEMAN AVENUEMACONGA31201371464470MEDICAL IMAGING CENTERGANAN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Entity TypeEntityTypeTxtAddress Line1ForeignAddress/AddressLine1Province Or StateForeignAddress/ProvinceOrStateCountryForeignAddress/CountryLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
CENTRAL GEORGIA HEALTH VENTURES INC
691 CHERRY STREET SUITE 400MACONGA31201582164989HOME CARE SERVICESGANAC CORPORATION
CENTRA PROFESSIONAL INDEMNITY LTD
INSURANCENAC CORPORATIONPO BOX 1363GRAND CAYMANCJCJ
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd