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CENTRAL GEORGIA SENIOR HEALTH INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CENTRAL GEORGIA SENIOR HEALTH INC (EIN 58-2345439)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-08-14
IRS object ID
201402269349303535
Schema version
2012v2.1
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)
Timestamp2014-08-14T17:00:40-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN580914992EIN

Preparer Firm Business Name PreparerFirmBusinessName

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

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1FIVE CONCOURSE PARKWAY SUITE 1250AddressLine1
CityATLANTACity
StateGAState
ZIP Code30328ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN582345439EIN

Name Name

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

US Address USAddress

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

Officer Officer

FieldValueIRS element (for citing)
NameRHONDA S PERRYName
TitleEXECUTIVE VICE PRESIDENT/CFOTitle
Date Signed2014-08-14DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameW Edward PhillipsName
PTINP00451499PTIN
Phone4042208494Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1CARLYLE PLACEBusinessNameLine1

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

FieldValueIRS element (for citing)
Business Name Line1ELBERT MCQUEENBusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1691 CHERRY STREET SUITE 400AddressLine1
CityMACONCity
StateGAState
ZIP Code31201ZIPCode
FieldValueIRS element (for citing)
Gross Receipts97948281GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CARLYLEPLACE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1997YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionCONTINUING 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees258TotalNbrEmployees
Total Nbr Volunteers345TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year14546800ProgramServiceRevenuePriorYear
Program Service Revenue CY15499189ProgramServiceRevenueCY
Investment Income Prior Year3561067InvestmentIncomePriorYear
Investment Income Current Year4642468InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year18107867TotalRevenuePriorYear
Total Revenue Current Year20141657TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6595894SalariesEtcPriorYear
Salaries Etc Current Year6846291SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year8207644OtherExpensePriorYear
Other Expenses Current Year8326029OtherExpensesCurrentYear
Total Expenses Prior Year14803538TotalExpensesPriorYear
Total Expenses Current Year15172320TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3304329RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4969337RevenuesLessExpensesCY
Total Assets BOY93689786TotalAssetsBOY
Total Assets EOY99925330TotalAssetsEOY
Total Liabilities BOY83405670TotalLiabilitiesBOY
Total Liabilities EOY80286550TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY10284116NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY19638780NetAssetsOrFundBalancesEOY
Mission DescriptionCENTRAL 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.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense11347863Expense
Revenue15499189Revenue
DescriptionCARLYLE 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.Description
Total Program Service Expense11347863TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiestrueForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109678NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees258NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CONNIE W JONES CPABusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4784054500TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line15300 ZEBULON ROADAddressLine1
CityMACONCity
StateGAState
ZIP Code31210ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelatedOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
ALFRED SAMS
DIRECTOR/VICE CHAIR1.00X000
JAMES ADAMS JR
DIRECTOR1.00X000
JAMES WANSLEY
DIRECTOR1.00X000
JIM MCLENDON
DIRECTOR/CHAIRMAN1.00X000
MARJORIE CARTER
DIRECTOR1.00X000
PATRICIA ROBINSON
DIRECTOR1.00X000
TIMOTHY JACKSON
DIRECTOR1.00X0002.00
ELBERT T MCQUEEN
CEO1.0002792914734849.00X
KENNETH B BANKS
SECRETARY1.00046953931317649.00X
RHONDA S PERRY
TREASURER1.00092217050588049.00X
THOMAS ROCKENBACH JR
EXECUTIVE DIRECTOR50.00158474017659X
ETHEL A CULLINAN
PRESIDENT/CEO0.000404911393124.00X
FieldValueIRS element (for citing)
Total Reportable Comp From Org158474TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2075911TotalReportableCompFrmRltdOrgs
Total Other Compensation887994TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SODEXO INC AND AFFILIATES
PO BOX 536922ATLANTAGA30353FOOD SERVICES1576897
BURGESS DESIGN CENTER & RUG GALLERY
PO BOX 4464MACONGA31208FLOORING SERVICES497250
WARREN & ASSOCIATES INC
PO BOX 6098MACONGA312086098BUILDING CONTRACTOR401078
SUNTRUST BANK
17TH FLOOR 245 PEACHTREE CTR AVEATLANTAGA30303BANKING SERVICES262878
FUNCTIONAL PATHWAYS OF TENNESSEE LLC
P O BOX 102426ATLANTAGA303682426REHAB SERVICES237869
FieldValueIRS element (for citing)
Number Of Contractors GT100 K8NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
RESIDENCY REVENUE6230001474654714746547
MEDICARE/MEDICAID PAYMENT623000633395633395
GUEST MEALS7223204461444614
RESIDENT TRANSPORTATION4800001968519685
GUEST ROOM REVENUE7210001411814118

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column40830TotalRevenueColumn
Related Or Exempt Function Income40831RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue15499189TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column953488TotalRevenueColumn
Exclusion$953,488ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities81495604Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities77806624Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities3688980Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column3688980TotalRevenueColumn
Exclusion$3,688,980ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

Total Revenue ColumnTotalRevenueColumn
0
0
0

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column20141657TotalRevenueColumn
Related Or Exempt Function Income15499189RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$4,642,468ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total136677Total
Management And General136677ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5094130Total
Program Services4086693ProgramServices
Management And General1007438ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total189731Total
Management And General189731ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1013207Total
Program Services831091ProgramServices
Management And General182116ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total412546Total
Program Services301332ProgramServices
Management And General111213ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total178752Total
Management And General178752ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total22812Total
Management And General22812ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total167847Total
Management And General167847ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total425507Total
Program Services78717ProgramServices
Management And General346790ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total204237Total
Management And General204237ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total29347Total
Management And General29347ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total39452Total
Management And General39452ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total729873Total
Program Services658285ProgramServices
Management And General71588ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total60699Total
Program Services35460ProgramServices
Management And General25239ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total19627Total
Program Services7252ProgramServices
Management And General12375ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1104191Total
Program Services993772ProgramServices
Management And General110419ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2392285Total
Program Services2153057ProgramServices
Management And General239229ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total244624Total
Program Services12023ProgramServices
Management And General232601ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES18585851732659125926
SODEXO DINING MANAGEMENT FEES375499375499
EQUIPMENT RENTAL AND MAINTENANCE23460219412215191
REFURBISHMENT EXPENSES107131107131

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total130959Total
Program Services62612ProgramServices
Management And General68347ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total15172320Total
Program Services11347863ProgramServices
Management And General3824457ManagementAndGeneral
Fundraising0Fundraising

Total Joint Costs TotalJointCosts

FieldValueIRS element (for citing)
Total0Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY256007BOY
EOY782311EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY935633BOY
EOY1041736EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY17955BOY
EOY15148EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY66895BOY
EOY76424EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis64969711LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec30588300LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY35852276BOY
EOY34381411EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY49098374BOY
EOY54996522EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY6730710BOY
EOY8033337EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY682699BOY
EOY575871EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY49237BOY
EOY22570EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY93689786BOY
EOY99925330EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY412234BOY
EOY511410EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY36698751BOY
EOY35534793EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY42155000BOY
EOY40925000EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY4139685BOY
EOY3315347EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY83405670BOY
EOY80286550EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY10284116BOY
EOY19638780EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10284116BOY
EOY19638780EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY93689786BOY
EOY99925330EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses4969337ReconcilationRevenueExpenses
Reconcilation Other Changes4385327ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement BothXFinancialStatementBoth
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type2XSupportingOrg509a3Type2
Certification CheckboxXCertificationCheckbox
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1MEDICAL CENTER OF CENTRAL GEORGIABusinessNameLine1
FieldValueIRS element (for citing)
EIN582149127EIN
Type Of Organization3TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Supported Organization NotifiedtrueSupportedOrganizationNotified
Organized In UStrueOrganizedInUS
Amount$0Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs
Sum Of Amounts0SumOfAmounts
General ExplanationSCHEDULE A, PART I, LINE 11H, DESCRIPTION OF NON-MONETARY SUPPORT, MEDICAL CENTER OF CENTRAL GEORGIA: CENTRAL GEORGIA SENIOR HEALTH OPERATES A SENIOR LIVING FACILITY IN SUPPORT OF THE HEALTHCARE SERVICES OFFERED BY THE MEDICAL CENTER OF CENTRAL GEORGIA. BOTH ORGANIZATIONS ARE COMMONLY CONTROLLED BY CENTRAL GEORGIA HEALTH SYSTEMS, INC.GeneralExplanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1732834OtherCostOrOtherBasis
Book Value1732834BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis51974820OtherCostOrOtherBasis
Depreciation22760876Depreciation
Book Value29213944BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis7038707OtherCostOrOtherBasis
Depreciation4754640Depreciation
Book Value2284067BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3953541OtherCostOrOtherBasis
Depreciation2850848Depreciation
Book Value1102693BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis269809OtherCostOrOtherBasis
Depreciation221936Depreciation
Book Value47873BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings34381411TotalOfBookValueLandBuildings

Financial Derivatives FinancialDerivatives

FieldValueIRS element (for citing)
Book Value0BookValue
Method Of ValuationFMethodOfValuation

Closely Held Equity Interests CloselyHeldEquityInterests

FieldValueIRS element (for citing)
Book Value0BookValue

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
DISTRESSED DEBT440226F
BANK LOANS1714011F
OTHER INVESTMENTS5879100F
FieldValueIRS element (for citing)
Total Of Book Value Securities8033337TotalOfBookValueSecurities
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATES$1,088,322
INTEREST RATE SWAP$2,227,025
$0
FieldValueIRS element (for citing)
Total Of Amounts3315347TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt24491423TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments3513099NetUnrealizedGainsInvestments
Other Revenues872228OtherRevenues
Revenue Not Rptd F9904385327RevenueNotRptdF990
Revenue Subtotal20106096RevenueSubtotal
Other Revenues Not Included35561OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt35561RevenueNotRptdOnFinStmt
Total Revenue Per Form99020141657TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt15136759TotExpensesEtcAuditedFinclStmt
Other Expenses Included0OtherExpensesIncluded
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal15136759ExpensesSubtotal
Other Expenses Not Included35561OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt35561ExpensesNotRptdOnFinStmt
Total Expenses Per Form99015172320TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FIN 48 (ASC 740) footnoteSchedule D, Part X, Line 2CARLYLE 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, 2013. FISCAL YEARS ENDING ON OR AFTER SEPTEMBER 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES.
Other revenues in audited financial statements not in form 990Schedule D, Part XI, Line 2dINTEREST RATE SWAP CHANGE IN FMV - 872228;
Other revenues in form 990 not in audited financial statementsSchedule D, Part XI, Line 4bRECLASSIFIED BOOK EXPENSES - 35561;
Other expenses in form 990 not in audited financial statementsSchedule D, Part XII, Line 4bRECLASSIFIED BOOK EXPENSES - 35561;

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

FieldValueIRS element (for citing)
RegionCENTRAL AMERICA AND THE CARIBBEANRegion
Number Of Offices0NumberOfOffices
Number Of Employees0NumberOfEmployees
Type Of Activities ConductedINVESTMENTSTypeOfActivitiesConducted
Total Expenditures440226TotalExpenditures
FieldValueIRS element (for citing)
Total Number Of Offices0TotalNumberOfOffices
Total Number Of Employees0TotalNumberOfEmployees
Total Amount Spent440226TotalAmountSpent
Transfer To Foreign CorpfalseTransferToForeignCorp
Interest In Foreign TrustfalseInterestInForeignTrust
Own Foreign CorpfalseOwnForeignCorp
Passive Foreign Invest CofalsePassiveForeignInvestCo
Foreign PartnershiptrueForeignPartnership
Boycott CountriesfalseBoycottCountries

Form990 Schedule F Part V Form990ScheduleFPartV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Method used to account for expenditures on organization's financial statementsSchedule F, Part I, Line 3CENTRAL AMERICA AND THE CARIBBEAN: ACCRUAL
Method used to account for expenditures on organization's financial statementsSchedule F, Part I, Line 3CENTRAL AMERICA AND THE CARIBBEAN: ACCRUAL

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
RHONDA S PERRY
TREASURER041558301076290398958050094004940014280500394451
KENNETH B BANKS
SECRETARY0300769058142011062802981160150600782715090209
ETHEL A CULLINAN
PRESIDENT/CEO022913005352701222540908030230408842036248
THOMAS ROCKENBACH JR
EXECUTIVE DIRECTOR13124102250204731025990150600176133000
ELBERT T MCQUEEN
CEO022593404289901045803915308195032663900

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Arrangement used to establish the top management official's compensationSchedule J, Part I, Line 3THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CENTRAL GEORGIA HEATLH SYSTEMS, INC. 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. 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.
RELATED PARTY COMPENSATIONSCHEDULE J, PART I, LINE 3THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CENTRAL GEORGIA HEATLH SYSTEMS, INC. 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 ITS 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.
Supplemental nonqualified retirement planSchedule J, Part I, Line 4bMCCG 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. 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 $441,235 KEN BANKS $256,213 A PORTION OF THIS ACCRUAL IS A CATCH-UP ACCRUAL DETERMINED FOR SERVICES RENDERED SINCE JANUARY 1, 2010 THAT HAVE NOT BEEN PREVIOUSLY ACCRUED. 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 EXCUTIVE VOLUNTARILY SEPARATES FROM SERVICE. DURING THE YEAR THE FOLLOWING BENEFITS ACCRUED UNDER THIS PLAN: RHONDA PERRY $29,634 KEN BANKS $17,309 ELBERT MCQUEEN $7,819
Non-fixed paymentsSchedule J, Part I, Line 7THIS 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 PROPOSAL FOR ALLOCATION OF THE AWARD IS DEVELOPED AND PRESENTED TO THE HR COMMITTEE OF THE BOARD FOR REVIEW, DISCUSSION, AND APPROVAL (PRIOR TO DISTRIBUTION).

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1MACON-BIBB COUNTY HOSPITAL AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN581034851IssuerEIN
CUSIP Number55553RCC7CUSIPNumber
Date Issued2009-09-01DateIssued
Issue Price45900000IssuePrice
Description Of PurposeREFUNDING OF 2000 ISSUE DATED 5/31/2000 TO CONSTRUCT THE FACILITYDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired4975000AmountRetired
Amount Bond Defeased0AmountBondDefeased
Total Proceeds45900000TotalProceeds
Amount In Reserve Fund0AmountInReserveFund
Capitalized Interest0CapitalizedInterest
Refunding Escrow0RefundingEscrow
Issuance Costs From Proceeds0IssuanceCostsFromProceeds
Credit Enhancement0CreditEnhancement
Working Capital Expenditures0WorkingCapitalExpenditures
Capital Expenditures0CapitalExpenditures
Other Spent Proceeds45900000OtherSpentProceeds
Amount Unspent0AmountUnspent
Year Of Subst Completion2001YearOfSubstCompletion
Current RefundingtrueCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementstrueAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtytrueMngmentCntrctBondFinancdPrprty
Engage Bond Counsel ContractsfalseEngageBondCounselContracts
Any Research AgreementsfalseAnyResearchAgreements
Engage Bond Counsel ResearchfalseEngageBondCounselResearch
Prcntge Prvt Business Use By Others0.00340PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00340TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay TestfalseBondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed PropfalseChangeInUseBondFinancedProp
Prcntge Bond Financed Prop0PrcntgeBondFinancedProp
Remedial Action TakenfalseRemedialActionTaken
Non Qualified Bond Remed ProcdrstrueNonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiled
Rebate Not Due YettrueRebateNotDueYet
Exception To RebatetrueExceptionToRebate
No Rebate DuefalseNoRebateDue
Variable Rate IssuetrueVariableRateIssue
Hedge Identified In Books And RecdstrueHedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1SUNTRUST BANKBusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge20.0TermOfHedge
Superintegrated HedgefalseSuperintegratedHedge
Hedge TerminatedfalseHedgeTerminated
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Gross Proceeds InvestedfalseGrossProceedsInvested
Written Proc To Monitor ReqstrueWrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective ActionfalseProcToUndertkCorrectiveAction

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Classes of members or stockholdersForm 990, Part VI, Section A, Line 6CENTRAL GEORGIA HEALTH SYSTEMS, INC., A RELATED 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF THE ORGANIZATION.
Members or stockholders electing members of governing bodyForm 990, Part VI, Section A, Line 7aCENTRAL 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.
Decisions requiring approval by members or stockholdersForm 990, Part VI, Section A, Line 7bCENTRAL 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.
Review of form 990 by governing bodyForm 990, Part VI, Section B, Line 11bTHE 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.
Conflict of interest policyForm 990, Part VI, Section B, Line 12cTHE 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.
Process used to establish compensation of other officers/key employeesForm 990, Part VI, Section B, Line 15bTHE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF CENTRAL GEORGIA HEALTH SYSTEMS, INC. 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 ITS 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.
Governing documents, conflict of interest policy and financial statements available to the publicForm 990, Part VI, Section C, Line 19THE ORGANIZATION PROVIDES COPIES OF ITS GOVERNING DOCUMENTS UPON REQUEST.
FORMER OFFICER COMPENSATIONFORM 990, PART VII, SECTION A, LINE 3ETHEL CULLINAN, FORMER PRESIDENT AND CEO, RETIRED FROM HER POSITION AS CEO FROM BOTH CENTRAL GEORGIA SENIOR HEALTH AND MEDCEN COMMUNITY HEALTH FOUNDATION DURING APRIL 2012. SHE IMMEDIATELY BEGAN PROVIDING CONSULTING SERVICES TO CENTRAL GEORGIA HEALTH SYSTEMS, INC. FOR THE BENEFIT OF SEVERAL AFFILIATES OF CGHS. HER COMPENSATION ON FORM 990 REFLECTS SALARY AND BENEFITS THROUGH MARCH 2012 AND HER COMPENSATION AS A CONSULTANT.
Other changes in net assets or fund balancesForm 990 , Part XI, Line 9INTEREST RATE SWAP CHANGE IN FMV - 872228; UNREALIZED GAINS - 3513099;

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodePrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CENTRAL GEORGIA HEALTH SYSTEMS INC
691 CHERRY STREET SUITE 400MACONGA31201PARENT/STRATEIC PLANNING AND FINANCIAL MANAGEMENTGA501(C)(3)Type III - FINAfalse
HEALTH SERVICES OF CENTRAL GEORGIA INC
691 CHERRY STREET SUITE 400MACONGA31201HEALTHCARE SERVICESGA501(C)(3)3CENTRAL GEORGIA HEALTH SYSTEMSfalse
MEDCEN COMMUNITY HEALTH FOUNDATION INC
858 HIGH STREETMACONGA31201FUNDRAISINGGA501(C)(3)7NAfalse
MEDICAL CENTER OF GEORGIA INC
691 CHERRY STREET SUITE 400MACONGA31201HOSPITALGA501(C)(3)3CENTRAL GEORGIA HEALTH SYSTEMSfalse
THE MEDICAL CENTER OF PEACH COUNTY INC
1960 HWY 247BYRONGA31008HOSPITALGA501(C)(3)3CENTRAL GEORGIA HEALTH SYSTEMSfalse

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeType
SECURE HEALTH PLANS OF GEORGIA LLC
577 MULBERRY STREET SUITE 1000MACONGA31201582306549MANAGED CAREGANAN/A
CENTRAL GEORGIA PET LLC
1650 HARDEMAN AVENUEMACONGA31201371464470MEDICAL IMAGING CENTERGANAN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityAddress Line1AddressForeign/AddressLine1Province Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryLegal Domicile Foreign CountryLegalDomicileForeignCountry
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 Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg