2014-02-14T12:16:34-06:00 2013-06-30 621517792 PERSHING YOAKLEY & ASSOCIATES P C ONE CHEROKEE MILLS 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2012-07-01 582628502 COLUMBUS REGIONAL SENIOR LIVING INC COLU 7066606103 707 CENTER STREET COLUMBUS GA 31901 CHARLES A STARK 7066606103 2014-02-14 1 SUSAN P CLARK P00017549 8656730844 2012 2015-11-30 17:44:51Z CHARLES A STARK 707 CENTER STREET COLUMBUS GA 31901 5524295 0 X COLUMBUSREGIONAL.COM X 2001 GA TO OPERATE A CONTINUING CARE RETIREMENT COMMUNITY OWNED BY THE MEDICAL CENTER HOSPITAL AUTHORITY. 7 6 283 0 0 0 0 0 5220436 5524295 0 0 0 0 5220436 5524295 0 0 0 0 5220436 5524295 0 0 0 0 0 5220436 5524295 0 0 951263 295788 951263 295788 0 0 X COLUMBUS REGIONAL SENIOR LIVING, INC. MANAGES A CONTINUING CARE RETIREMENT COMMUNITY PROVIDING INDEPENDENT LIVING FOR OLDER ADULTS AND COMPREHENSIVE HEALTH AND MEDICAL SERVICES, INCLUDING ASSISTED LIVING, ALZHEIMER'S DISEASE CARE AND LONG-TERM NURSING CARE RESIDENTS NEED. COLUMBUS REGIONAL SENIOR LIVING, INC'S CARING PROFESSIONAL STAFF IS COMMITTED TO PROVIDING HIGH QUALITY RETIREMENT LIVING AND PROMOTING A VIBRANT INDEPENDENT LIFESTYLE WHILE MEETING AND EXCEEDING THE PHYSICAL, EMOTIONAL AND SPIRITUAL NEEDS OF OUR RESIDENTS. 0 0 4782470 5524295 COLUMBUS REGIONAL SENIOR LIVING, INC. EMPLOYS THE PROFESSIONAL STAFF AND PERSONNEL NECESSARY TO OPERATE SPRING HARBOR AT GREEN ISLAND, A CONTINUING CARE RETIREMENT COMMUNITY OWNED BY THE MEDICAL CENTER HOSPITAL AUTHORITY. SPRING HARBOR PROVIDES INDEPENDENT LIVING FOR OLDER ADULTS AND COMPREHENSIVE HEALTH AND MEDICAL SERVICES THEY NEED. THESE SERVICES INCLUDE: ASSISTED LIVING, ALZHEIMER'S DISEASE CARE AND LONG-TERM NURSING CARE. 4782470 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 24 0 1 283 1 0 0 0 0 0 0 0 0 0 0 X 7 6 0 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 GA X CHARLES A STARK 7066606484 707 CENTER STREET COLUMBUS GA 31901 SCOTT HILL 2.00 40.00 X X 0 129885 2338 EUGENE A DEMONET 2.00 X 0 0 0 C ROBERT KOON 2.00 X 0 0 0 LAMAR POWERS 2.00 X 0 0 0 CAROLE RUTLAND PHD 2.00 X 0 0 0 REBECCA RUMOR 2.00 X 0 0 0 MURRAY SOLOMON 2.00 X 0 0 0 CHARLES A STARK 2.00 40.00 X 0 889364 201352 ROLAND L THACKER 2.00 40.00 X 0 441879 106748 KAREN SMITH 2.00 40.00 X 0 70810 24448 0 1531938 334886 0 0 1 0 CRSALCS MANAGEMENT 400 LOCUST STREET SUITE 820 DES MOINES IA 50309 MANAGEMENT 450429 HERITAGE HEALTHCARE 536 OLD HOWELL ROAD GREENVILLE SC 29615 THERAPY 233105 SEASONAL CONCEPTS 5901A WARM SPRINGS ROAD COLUMBUS GA 31909 LAWN SERVICE 177894 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 707 CENTER STREET COLUMBUS GA 31901 MANAGEMENT 171600 4 PROGRAM SERVICE REVENU 623000 5524295 5524295 5524295 5524295 5524295 0 0 4460451 3858930 601521 752215 650741 101474 311629 272799 38830 5524295 4782470 741825 0 951263 295788 951263 295788 951263 295788 951263 295788 X 0 0 951263 295788 0 0 X 0 1 X 1 0 X X X 0 0 0 THE MEDICAL CENTER HOSPITAL AUTHORITY INC 580905094 6 0 1 1 0 THE MEDICAL CENTER INC 581685139 3 1 1 1 0 2 0 X 32191 32191 518575354 518607545 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 31169 27379 32330 32191 123069 250000 250000 250000 250000 1000000 1500000 0 DUE FROM HOSPITAL AUTHORITY 295788 295788 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: COLUMBUS REGIONAL SENIOR LIVING, INC. IS EXEMPT FROM FEDERAL INCOME TAX UNDER 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. AT JUNE 30, 2013, MANAGEMENT DOES NOT BELIEVE THE ORGANIZATION HOLDS ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE UNDER ASC 740. 0 1 0 0 0 0 0 0 0 CHARLES A STARK 0 630970 0 255000 0 3394 0 185750 0 15602 0 1090716 0 0 ROLAND L THACKER 0 317235 0 111250 0 13394 0 92050 0 14698 0 548627 0 0 PART I, LINE 4B EMPLOYER CONTRIBUTION TO 457(F) EXECUTIVE RETIREMENT BENEFIT PLAN: CHARLES STARK $ 182,000 ROLAND THACKER $ 57,400 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS A MANAGEMENT AGREEMENT WITH CRSA MANAGEMENT LLC. THE MANAGEMENT AGREEMENT WAS NEGOTIATED AT ARM'S LENGTH. CRSA MANAGEMENT EMPLOYS THE EXECUTIVE DIRECTOR OF COLUMBUS REGIONAL SENIOR LIVING. ALL OTHER PROFESSIONAL STAFF AND SUPPORT PERSONNEL ARE EMPLOYED BY COLUMBUS REGIONAL SENIOR LIVING. FORM 990, PART VI, SECTION A, LINE 6 THE BOARD OF DIRECTORS OF COLUMBUS REGIONAL SENIOR LIVING, INC. IS APPOINTED BY THE BOARD OF COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. - A RELATED 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF COLUMBUS REGIONAL SENIOR LIVING, INC. IS APPOINTED BY THE BOARD OF COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. - A RELATED 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS OF COLUMBUS REGIONAL SENIOR LIVING, INC. IS APPOINTED BY THE BOARD OF COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. - A RELATED 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 INFORMATION FOR FORM 990 WAS PROVIDED TO AN INDEPENDENT CPA FIRM FOR PREPARATION OF RETURN. AFTER RETURN WAS PREPARED IT WAS REVIEWED BY THE PRESIDENT AND CEO OF THE ORGANIZATION. CURRENTLY, A COPY OF THE FORM 990 IS NOT PROVIDED TO THE GOVERNING BODY PRIOR TO FILING. THE BOARD IS PROVIDED A THOROUGH AND CONDENSED OVERVIEW OF INFORMATION ON THE FORM 990 BY THE PRESIDENT OF THE ORGANIZATION. PRESENTATION OF THIS INFORMATION TO THE BOARD WILL BE MADE AS CLOSE TO THE FILING DATE AS POSSIBLE, BUT MAY NOT BE PRIOR TO THE FILING DATE. FORM 990, PART VI, SECTION B, LINE 12C COLUMBUS REGIONAL HEALTHCARE SYSTEM AND ITS AFFILIATES ARE ACCOUNTABLE TO GOVERNMENTAL AUTHORITIES AS WELL AS TO MEMBERS OF THE PUBLIC FOR BOTH THE INTEGRITY OF ITS ACTIONS AS WELL AS PERCEPTIONS AS RELATED TO THOSE ACTIONS. CONSEQUENTLY, THERE EXISTS BETWEEN COLUMBUS REGIONAL AND THE PUBLIC THE FIDUCIARY RESPONSIBILITY WHICH CARRIES WITH IT A BROAD AND UNBENDING DUTY OF LOYALTY AND FIDELITY. COLUMBUS REGIONAL AGENTS (I.E., BOARD MEMBERS, MANAGEMENT, EMPLOYEES, CONTRACTED PARTIES AND CREDENTIALED STAFF) HAVE THE RESPONSIBILITY OF ADMINISTERING THE AFFAIRS OF THE ORGANIZATION HONESTLY AND PRUDENTLY, AND OF EXERCISING THE BEST CARE, SKILL AND JUDGMENT FOR THE SOLE BENEFIT OF COLUMBUS REGIONAL. THOSE AGENTS SHALL EXERCISE THE UTMOST GOOD FAITH IN ALL TRANSACTIONS INVOLVED IN THEIR DUTIES AND SHALL NOT USE THEIR POSITIONS WITH COLUMBUS REGIONAL OR KNOWLEDGE GAINED FOR THEIR PERSONAL BENEFIT IN ANY MANNER. THE INTEREST OF THE ORGANIZATION MUST BE THE FIRST PRIORITY IN ALL RELATED DECISIONS AND ACTIONS. THIS POLICY IS ALSO DIRECTED TOWARD ANYONE WHO HAS PROPRIETARY INFORMATION CONCERNING COLUMBUS REGIONAL. IT IS THE POLICY OF COLUMBUS REGIONAL HEALTHCARE SYSTEM AND ITS AFFILIATES, IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, ASSOCIATED AGENTS MUST ANNUALLY DISCLOSE THE EXISTENCE OF A FINANCIAL OR OTHERWISE BENEFICIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE CHIEF COMPLIANCE OFFICER ASSOCIATED WITH THE PROPOSED CONFLICTING TRANSACTION OR ARRANGEMENT. A CONFLICT OF INTEREST MAY ARISE IN THE RELATIONSHIPS WITH COLUMBUS REGIONAL AGENTS WITH PERSONS AND FIRMS SUPPLYING GOODS AND SERVICES TO THE ORGANIZATION; PERSONS AND FIRMS FROM WHOM THE COMPANY LEASES PROPERTY AND EQUIPMENT; PERSONS AND FIRMS WITH WHOM COLUMBUS REGIONAL IS DEALING OR PLANNING TO DEAL IN CONNECTION WITH THE GIFT, PURCHASE OR SALE OF REAL ESTATE, SECURITIES OR OTHER PROPERTY; COMPETING OR AFFINITY ORGANIZATIONS; DONORS, MEMBERS OR OTHERS SUPPORTING THE ORGANIZATION; AGENCIES, ORGANIZATIONS AND ASSOCIATIONS WHICH AFFECT THE OPERATIONS OF THE COMPANY; AND FAMILY MEMBERS, FRIENDS AND OTHER EMPLOYEES. CONFLICTS OF INTEREST MAY ARISE IN A NUMBER OF DIFFERENT CIRCUMSTANCES AND TRANSACTIONS. IT IS ASSUMED THAT COLUMBUS REGIONAL AGENTS WILL RECOGNIZE SUCH AREAS AND RELATION BY ANALOGY. TRANSACTIONS WITH PARTIES WITH WHOM A CONFLICTING INTEREST EXISTS MAY BE UNDERTAKEN ONLY IF ALL OF THE FOLLOWING ARE OBSERVED: THE CONFLICT OF INTEREST IS FULLY DISCLOSED; THE PERSON WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION; A COMPETITIVE BID OR COMPARABLE VALUATION EXISTS FOR PURCHASING OR RELATED DECISIONS; AND THE CHIEF COMPLIANCE OFFICER IN CONSULTATION WITH OTHERS AS APPROPRIATE HAS DETERMINED THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION. ALL DISCLOSURES MUST BE MADE TO THE CHIEF COMPLIANCE OFFICER (OR IF SHE/HE IS THE ONE WITH THE CONFLICT, THEN THE BOARD CHAIR), WHO WILL BRING THE MATTER TO THE ATTENTION OF THE BOARD AS NECESSARY. THE CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH OTHERS AS APPROPRIATE, SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR AND REASONABLE TO COLUMBUS REGIONAL. THE DECISION OF THE CHIEF COMPLIANCE OFFICER AND/OR BOARD ON THESE MATTERS WILL REST IN THEIR SOLE DISCRETION AND THEIR CONCERN MUST BE FOR THE WELFARE OF COLUMBUS REGIONAL IN THE ADVANCEMENT OF ITS PURPOSE. EACH MEMBER OF MANAGEMENT AND EMPLOYEES WITH DELEGATED POWERS WHO CAN INFLUENCE THE ACTIONS OF COLUMBUS REGIONAL SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY AND COMPLETED THE DISCLOSURE STATEMENT; HAS READ AND UNDERSTANDS THE POLICY; AND HAS AGREED TO COMPLY WITH THE POLICY. IN ADDITION, SHOULD A POTENTIAL CONFLICT OCCUR DURING THE YEAR BUT PRIOR TO THE ANNUAL DISCLOSURE, THE INDIVIDUAL IS OBLIGATED TO CONTACT THE COMPLIANCE OFFICER AND UPDATE THEIR DISCLOSURE STATEMENT IN A TIMELY MANNER. IF THE CHIEF COMPLIANCE OFFICER HAS REASONABLE CAUSE TO BELIEVE A COLUMBUS REGIONAL AGENT HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, HE/SHE SHALL INFORM THAT INDIVIDUAL OF THE BASIS OF SUCH BELIEF AND AFFORD HIM/HER THE OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE INDIVIDUAL'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE CHIEF COMPLIANCE OFFICER DETERMINES THE INDIVIDUAL HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, HE/SHE SHALL FORWARD THE INFORMATION TO THE HUMAN RESOURCES DEPARTMENT AND/OR THE BOARD OF DIRECTORS TO TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 COLUMBUS REGIONAL TAKES VERY SERIOUSLY THE RESPONSIBILITY TO APPROPRIATELY AND EFFECTIVELY MANAGE THE EXECUTIVE COMPENSATION AND BENEFITS PROGRAM FOR ITS KEY EXECUTIVES. SETTING THE COMPENSATION OF THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, APPROVING THE COMPENSATION OF OTHER SENIOR EXECUTIVES, AND OVERSEEING THE EXECUTIVE COMPENSATION PROGRAM AS A WHOLE, ARE THE RESPONSIBILITIES OF THE COMPENSATION COMMITTEE OF THE BOARD. TO ASSIST THE COMMITTEE, THE BOARD HAS ENGAGED THE SERVICES OF A NATIONALLY RECOGNIZED EXECUTIVE COMPENSATION CONSULTING FIRM. COLUMBUS REGIONAL'S EXECUTIVE COMPENSATION PROGRAM IS DESIGNED TO ATTRACT AND RETAIN HIGHLY QUALIFIED EXECUTIVES TO FULFILL COLUMBUS REGIONAL'S MISSION OF PROMOTING THE HEALTH AND HEALING OF PATIENTS. COLUMBUS REGIONAL'S PEER GROUP CONSISTS OF NON-PROFIT HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE AND COMPLEXITY FROM ACROSS THE NATION. BASE SALARIES OF EXECUTIVES ARE POSITIONED AT SPECIFIC PERCENTILE TARGETS OF COLUMBUS REGIONAL'S PEER GROUP. CURRENT STUDIES INDICATE THAT OUR BASE SALARIES ARE AT TARGETED LEVELS. COLUMBUS REGIONAL STRIVES TO PROVIDE ALL EXECUTIVES WITH RETIREMENT BENEFITS THAT ARE EQUIVALENT FOR ALL EMPLOYEES. RETIREMENT CONTRIBUTIONS ARE BASED ON A CLEARLY STATED INCOME REPLACEMENT TARGET AS DETERMINED BY RETIREMENT PLAN CONSULTANTS. THE GOAL OF COLUMBUS REGIONAL IS TO PROVIDE MARKET COMPETITIVE COMPENSATION AND BENEFITS PROGRAMS FOR ALL EMPLOYEES AT ALL LEVELS OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY, AS WELL AS FINANCIAL STATEMENTS AND OTHER GOVERNING DOCUMENTS, ARE NOT MADE AVAILABLE TO THE PUBLIC. COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 707 CENTER STREET COLUMBUS GA 31901 581719994 HEALTH SYSTEM MANAGEMENT GA 501(C)(3) LINE 11B, II N/A 0 THE MEDICAL CENTER INC 707 CENTER STREET COLUMBUS GA 31901 581685139 ACUTE CARE HOSPITAL GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 0 COLUMBUS AMBULATORY HEALTHCARE SERVICES INC 707 CENTER STREET COLUMBUS GA 31901 581719867 AMBULATORY CARE GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 0 COLUMBUS REGIONAL MEDICAL FOUNDATION INC 707 CENTER STREET COLUMBUS GA 31901 581501642 FUNDRAISING GA 501(C)(3) LINE 7 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 0 DOCTOR'S HOSPITAL INC 707 CENTER STREET COLUMBUS GA 31901 261739383 ACUTE CARE HOSPITAL GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 0 HUGHSTON HOSPITAL INC 707 CENTER STREET COLUMBUS GA 31901 331216751 ORTHOPEDIC HOSPITAL GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 0 COLUMBUS REGIONAL AUXILIARY (FKA MEDICAL CENTER AUXILIARY) 707 CENTER STREET COLUMBUS GA 31901 580917974 HOSITAL AUXILIARY GA 501(C)(3) LINE 11C, III-FI THE MEDICAL CENTER INC 0 CRHS LONG TERM AND HOME CARE INC 707 CENTER STREET COLUMBUS GA 31901 581719867 NURSING HOME GA 501(C)(3) LINE 3 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 0 DOCTOR'S HOSPITAL AUXILIARY 616 19TH STREET COLUMBUS GA 31901 581295777 HOSITAL AUXILIARY GA 501(C)(3) LINE 11C, III-FI DOCTOR'S HOSPITAL INC 0 THE MEDICAL CENTER HOSPITAL AUTHORITY INC 707 CENTER STREET COLUMBUS GA 31901 580905094 HOSP AUTHORITY GA 501(C)(3) LINE 3 N/A 0 EVERGREEN MEDICAL GROUP LLC PO BOX 790 COLUMBUS GA 31902 582244760 MEDICAL SERVICES GA N/A COLUMBUS DIAGNOSTIC IMAGING 116 INTRACOASTAL POINTE DR 300 JUPITER FL 33477 262291768 DIAGNOSTIC IMAGING GA N/A COLUMBUS HEALTH SERVICES INC 707 CENTER STREET COLUMBUS GA 31901 581640939 PHARMACIES GA N/A C 0 COLUMBUS HEALTHCARE RESOURCES INC 707 CENTER STREET COLUMBUS GA 31901 581717754 PROPERTY MANAGEMENT GA N/A C 0 WOMEN'S MEDICAL SERVICES 707 CENTER STREET COLUMBUS GA 31901 581695456 MANAGEMENT GA N/A C 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 707 CENTER STREET COLUMBUS GA 31901 581719994 X 0 32191 32191 36365500 36397691 1000000 250000 0 0 0 CRHS LONG TERM & HOME CARE INC 707 CENTER STREET COLUMBUS GA 31901 581778572 0 0 0 443610 443610 88722 22181 0 0 0 COLUMBUS AMBULATORY HEALTHCARE SERVICES 707 CENTER STREET COLUMBUS GA 31901 581719867 0 0 0 29975750 29975750 1000000 250000 0 0 0 COLUMBUS REGIONAL SENIOR LIVING INC 707 CENTER STREET COLUMBUS GA 31901 582628502 0 0 0 5524295 5524295 426215 106554 0 0 0 COLUMBUS REGIONAL AUXILIARY 707 CENTER STREET COLUMBUS GA 31901 580917974 0 0 0 687315 687315 128097 32024 0 0 0 DOCTOR'S HOSPITAL INC 707 CENTER STREET COLUMBUS GA 31901 261739383 0 0 0 56062657 56062657 1000000 250000 0 0 0 HUGHSTON HOSPITAL INC 707 CENTER STREET COLUMBUS GA 31901 331216751 0 0 0 63013437 63013437 1000000 250000 0 0 0 THE MEDICAL CENTER INC 707 CENTER STREET COLUMBUS GA 31901 581685139 0 0 0 323099234 323099234 1000000 250000 0 0 0 COLUMBUS REGIONAL MEDICAL FOUNDATION INC 707 CENTER STREET COLUMBUS GA 31901 581501642 0 0 0 3350691 3350691 317535 79384 0 0 0 DOCTOR'S HOSPITAL AUXILIARY 616 19TH STREET COLUMBUS GA 31901 581295777 0 0 0 52865 52865 10573 2643 0 0 0