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NAVICENT HEALTH FOUNDATION INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
NAVICENT HEALTH FOUNDATION INC (EIN 23-7363555)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-08-14
IRS object ID
201422269349304272
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)
Timestamp2014-08-14T17:00:05-05:00Timestamp
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 125AddressLine1
CityATLANTACity
StateGAState
ZIP Code30328ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237363555EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MEDCEN COMMUNITY HEALTH FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMEDCNameControl
Phone4786337388Phone

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

Form 990 IRS990

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

FieldValueIRS element (for citing)
Business Name Line1RHONDA S PERRYBusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1691 CHERRY STREET SUITE 400AddressLine1
CityMACONCity
StateGAState
ZIP Code31201ZIPCode
FieldValueIRS element (for citing)
Gross Receipts50205728GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteMEDCENFOUNDATION.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1973YearFormation
State Legal DomicileGAStateLegalDomicile
Activity Or Mission DescriptionTHE MEDCEN COMMUNITY HEALTH FOUNDATION'S MISSION IS TO MAXIMIZE DONOR RESOURCES TO IMPROVE THE HEALTH OF OUR REGION THROUGH COMMUNITY AND HOSPITAL PARTNERSHIPS. SEE PART III, LINE 1.ActivityOrMissionDescription
Nbr Voting Members Governing Body35NbrVotingMembersGoverningBody
Nbr Independent Voting Members25NbrIndependentVotingMembers
Total Nbr Employees8TotalNbrEmployees
Total Nbr Volunteers1214TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3418903ContributionsGrantsPriorYear
Contributions Grants Current Year3682778ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year3428591InvestmentIncomePriorYear
Investment Income Current Year4177458InvestmentIncomeCurrentYear
Other Revenue Prior Year-296838OtherRevenuePriorYear
Other Revenue Current Year-400081OtherRevenueCurrentYear
Total Revenue Prior Year6550656TotalRevenuePriorYear
Total Revenue Current Year7460155TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1810778GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1570168GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year805223SalariesEtcPriorYear
Salaries Etc Current Year472483SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year41335TotalFundrsngExpCurrentYear
Other Expense Prior Year796250OtherExpensePriorYear
Other Expenses Current Year659418OtherExpensesCurrentYear
Total Expenses Prior Year3412251TotalExpensesPriorYear
Total Expenses Current Year2702069TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3138405RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4758086RevenuesLessExpensesCY
Total Assets BOY71469939TotalAssetsBOY
Total Assets EOY82398445TotalAssetsEOY
Total Liabilities BOY249589TotalLiabilitiesBOY
Total Liabilities EOY239303TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY71220350NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY82159142NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MEDCEN COMMUNITY HEALTH FOUNDATION'S MISSION IS TO MAXIMIZE DONOR RESOURCES TO IMPROVE THE HEALTH OF OUR REGION THROUGH COMMUNITY AND HOSPITAL PARTNERSHIPS. THE FOUNDATION PRIMARILY SUPPORTS THE MEDICAL CENTER OF CENTRAL GEORGIA, INC. (MCCG), IN WHICH CONTRIBUTIONS ARE USED FOR CHARITABLE, MEDICAL, EDUCATIONAL AND SCIENTIFIC PURPOSES.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense1570168Expense
Grants1570168Grants
DescriptionPROGRAM GRANTS WERE PRINCIPALLY TO SUPPORT THE MEDICAL CENTER OF CENTRAL GEORGIA, INC. (MCCG), IN WHICH FUNDS ARE USED FOR CHARITABLE, MEDICAL, EDUCATIONAL AND SCIENTIFIC PURPOSES.Description
Total Program Service Expense1570168TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiestrueForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
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 ContributionstrueDeductibleNonCashContributions
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
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees8NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccounttrueForeignFinancialAccount
Name Of Foreign CountryCJNameOfForeignCountry
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members35NbrVotingGoverningBodyMembers
Number Independent Voting Members25NumberIndependentVotingMembers
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 CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
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 Line1MEDCEN COMMUNITY HEALTH FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4786337388TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1691 CHERRY STREET SUITE 400AddressLine1
CityMACONCity
StateGAState
ZIP Code31201ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (37 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationFormerFormer
ELBERT T MCQUEEN
CEO (INTERIM)1.0049.00XX027929147348
KENNETH BANKS
CORPORATE SECRETARY1.0049.00XX0469539313176
RHONDA PERRY
CORPORATE TREASURER1.0049.00XX0922170505880
CAL HAYS
VICE CHAIR1.00X000
CHRIS R SHERIDAN
TRUSTEE1.00X000
CHRISTOPHER R GREENE
TRUSTEE1.00X000
CYNDEE BUSBEE
TRUSTEE1.00X000
DAN SPEIGHT
TRUSTEE1.00X000
DANNY GIBSON
TRUSTEE1.00X000
DAVID ROZIER
TRUSTEE1.00X000
DENNIS ASHLEY MD
TRUSTEE1.00X000
DOTTIE HOUSER
TRUSTEE1.00X000
DUKE GROOVER
TRUSTEE1.00X000
EMORY JOHNSON MD
TRUSTEE1.00X000
FREDDY GATON MD
TRUSTEE1.00X000
GENE BATTLES MD
TRUSTEE1.00X000
HARRIETTE CARTER
TRUSTEE1.00X000
HELEN RHEA STUMBO
TRUSTEE1.00X000
JAMES MANLEY
TRUSTEE1.00X000
JEFF RUTLEDGE
TRUSTEE1.00X000
JEFF THOMPSON
TRUSTEE1.00X000
KAREN SMITH
TRUSTEE1.00X000
KENNETH CLARK
TRUSTEE1.00X000
KENT BALDSCHUN
TRUSTEE1.00X000
LAMAR SIZEMORE
TRUSTEE1.00X000
LINDA CLAY
TRUSTEE1.00X000
NINFA M SAUNDERS
TRUSTEE1.0049.00X0178847166312
PAM WHITE-COLBERT
TRUSTEE1.00X000
R EARL SMITH
TRUSTEE1.00X000
ROB BETZEL
TRUSTEE1.00X000
SCOTT SEIGEL
CHAIR1.00X000
SUE SANDA
TRUSTEE1.00X000
THOMAS J WICKER
TRUSTEE1.00X000
TIMOTHY E ANDREWS
TRUSTEE1.00X000
TOM GIBBONS
TRUSTEE1.00X000
A DOANLD FAULK JR
FORMER TRUSTEE40.00010565829671X
ETHEL A CULLINAN
PRESIDENT & CEO24.0040491103931X
FieldValueIRS element (for citing)
Total Reportable Comp From Org404911TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2906429TotalReportableCompFrmRltdOrgs
Total Other Compensation1046318TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events879580FundraisingEvents
Related Organizations887781RelatedOrganizations
All Other Contributions1915417AllOtherContributions
Noncash Contributions40337NoncashContributions
Total Contributions3682778TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

Total Revenue ColumnTotalRevenueColumn
0
0
0
0
0

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue0TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1444988TotalRevenueColumn
Exclusion$1,444,988ExclusionAmount

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)
Securities45077962Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities42345492Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities2732470Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column2732470TotalRevenueColumn
Exclusion$2,732,470ExclusionAmount
FieldValueIRS element (for citing)
Cntrbtns Rprtd Fundraising Events879580CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses400081FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-400081TotalRevenueColumn
Exclusion-$400,081ExclusionAmount

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 Column7460155TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$3,777,377ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1570168Total
Program Services1570168ProgramServices

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)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total345406Total
Management And General345406ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total62527Total
Management And General62527ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total40360Total
Management And General40360ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total24190Total
Management And General24190ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total23500Total
Management And General23500ManagementAndGeneral

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)
Total294875Total
Management And General294875ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total89250Total
Program Services0ProgramServices
Management And General89250ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total41335Total
Fundraising41335Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total67026Total
Management And General67026ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total56830Total
Management And General56830ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total7179Total
Management And General7179ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total44731Total
Management And General44731ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total622Total
Management And General622ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total2644Total
Management And General2644ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneral
PRINTING AND PUBLICATIONS2494424944
POSTAGE AND SHIPPING64826482

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2702069Total
Program Services1570168ProgramServices
Management And General1090566ManagementAndGeneral
Fundraising41335Fundraising

Total Joint Costs TotalJointCosts

FieldValueIRS element (for citing)
Total0Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY94055BOY
EOY92400EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1062380BOY
EOY913858EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY109645BOY
EOY109918EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis233500LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec0LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY233500BOY
EOY233500EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY69878139BOY
EOY62904574EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY18056028EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY92220BOY
EOY88167EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY71469939BOY
EOY82398445EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY208239BOY
EOY191803EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY41350BOY
EOY47500EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY249589BOY
EOY239303EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7254252BOY
EOY8848420EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY63966098BOY
EOY73310722EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY71220350BOY
EOY82159142EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY71469939BOY
EOY82398445EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses4758086ReconcilationRevenueExpenses
Reconciliation Unrealized Invest6180706ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

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

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2069091CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3170103CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2439430CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2443831CurrentTaxYearMinus1Year
Current Tax Year3682778CurrentTaxYear
Total13805233Total

Tax Rev Levied For Org Benefit170 TaxRevLeviedForOrgBenefit170

FieldValueIRS element (for citing)
Total0Total

Value Srvc Fclts Furnished By Govt ValueSrvcFcltsFurnishedByGovt

FieldValueIRS element (for citing)
Total0Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2069091CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3170103CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2439430CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2443831CurrentTaxYearMinus1Year
Current Tax Year3682778CurrentTaxYear
Total13805233Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total228096AmountsSubstContributorsTotal
Public Support Total17013577137PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years962066CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1140423CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1109625CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1508877CurrentTaxYearMinus1Year
Current Tax Year1444988CurrentTaxYear
Total6165979Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Total Support19971212TotalSupport
Gross Receipts From Admissions Etc0GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.69120PublicSupportPertcentage170
Public Support Pertcent Prior Year0.69020PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170
General ExplanationSCHEDULE A, PART II, LINE 10, OTHER INCOME, DESCRIPTION - , COLUMN A - , COLUMN B - , COLUMN C - , COLUMN D - , COLUMN E - , COLUMN F - 0;GeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance63966098BeginningOfYearBalance
Contributions2775419Contributions
Investment Earnings Or Losses8524451InvestmentEarningsOrLosses
Grants Or Scholarships1955246GrantsOrScholarships
End Of Year Balance73310722EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance54400390BeginningOfYearBalance
Contributions2229769Contributions
Investment Earnings Or Losses9326628InvestmentEarningsOrLosses
Grants Or Scholarships1990689GrantsOrScholarships
End Of Year Balance63966098EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance53202798BeginningOfYearBalance
Contributions2729345Contributions
Investment Earnings Or Losses475647InvestmentEarningsOrLosses
Grants Or Scholarships2007400GrantsOrScholarships
End Of Year Balance54400390EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance47685726BeginningOfYearBalance
Contributions2753040Contributions
Investment Earnings Or Losses4067839InvestmentEarningsOrLosses
Grants Or Scholarships1303807GrantsOrScholarships
End Of Year Balance53202798EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance46724730BeginningOfYearBalance
Contributions1501245Contributions
Investment Earnings Or Losses346094InvestmentEarningsOrLosses
Grants Or Scholarships886343GrantsOrScholarships
End Of Year Balance47685726EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis233500OtherCostOrOtherBasis
Book Value233500BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Book Value0BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Book Value0BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings233500TotalOfBookValueLandBuildings

Financial Derivatives FinancialDerivatives

FieldValueIRS element (for citing)
Book Value0BookValue

Closely Held Equity Interests CloselyHeldEquityInterests

FieldValueIRS element (for citing)
Book Value0BookValue

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionALTERNATIVE INVESTMENTSDescription
Book Value18056028BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities18056028TotalOfBookValueSecurities
Federal Income Tax Liability0FederalIncomeTaxLiability
Total Of Amounts0TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Intended uses of endowment fundsSchedule D, Part V, Line 4THE ORGANIZATION'S TEMPORARILY RESTRICTED NET ASSETS ARE HELD FOR THE BENEFIT AND SUPPORT OF THE MEDICAL CENTER OF CENTRAL GEORGIA, INC.
FIN 48 (ASC 740) footnoteSchedule D, Part X, Line 2CENTRAL GEORGIA HEALTH SYSTEMS, INC., MCCG, HSCG, CGSH, AND MEDCEN (MEDCEN COMMUNITY HEALTH FOUNDATION, INC.) ARE ORGANIZATIONS EXEMPT FROM FEDERAL INCOME TAX, PURSUANT TO SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. CPI IS A FOREIGN CORPORATION NOT SUBJECT TO THE TAX IN THE UNITED STATES. PET, CGRH AND SHPG ARE ORGANIZED UNDER GEORGIA LAW AND THE INTERNAL REVENUE CODE AS LIMITED LIABILITY COMPANIES ("LLC"). THE MEMBERS OF AN LLC REPORT TAXABLE INCOME OR LOSS ON THEIR CORPORATE OR INDIVIDUAL TAX RETURNS. CGHS'S SHARE OF INCOME FROM PET, CGRH AND SHPG OPERATIONS IS NOT CONSIDERED UNRELATED BUSINESS INCOME ("UBI") AND IS THEREFORE, NOT SUBJECT TO TAX. CGHV AND AMERICAN EAGLE ARE SUBJECT TO INCOME TAX. WITH RESPECT TO ITS FOR-PROFIT SUBSIDIARIES, CGHS ACCOUNTS FOR INCOME TAXES IN ACCORDANCE WITH THE LIABILITY METHOD UNDER WHICH DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL ACCOUNTING AND TAX BASES OF ASSETS AND LIABILITIES. DEFERRED TAX ASSETS OR LIABILITIES AT THE END OF EACH PERIOD ARE DETERMINED USING THE CURRENTLY ENACTED TAX RATE EXPECTED TO APPLY TO TAXABLE INCOME IN THE PERIODS THAT THE DEFERRED TAX ASSET OR LIABILITY IS EXPECTED TO BE RECOGNIZED. CGHS AND AFFILIATES HAVE EVALUATED THEIR TAX POSITIONS AND HAVE DETERMINED THAT THEY DO NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2013. FISCAL YEARS ENDING ON AFTER SEPTEMBER 30, 2010 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES.

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

FieldValueIRS element (for citing)
RegionCENTRAL AMERICA AND THE CARIBBEANRegion
Type Of Activities ConductedINVESTMENTSTypeOfActivitiesConducted
Total Expenditures7701094TotalExpenditures
FieldValueIRS element (for citing)
Total Amount Spent7701094TotalAmountSpent
Transfer To Foreign CorpfalseTransferToForeignCorp
Interest In Foreign TrustfalseInterestInForeignTrust
Own Foreign CorptrueOwnForeignCorp
Passive Foreign Invest CotruePassiveForeignInvestCo
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 G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1CMN BROADCASTNameOfEvent1
Gross Receipts Event1499815GrossReceiptsEvent1
Charitable Contributions Event1499815CharitableContributionsEvent1
Gross Revenue Event10GrossRevenueEvent1
Other Direct Expenses Event1165447OtherDirectExpensesEvent1
Name Of Event2CELEBRITY CLASSICNameOfEvent2
Gross Receipts Event2253949GrossReceiptsEvent2
Charitable Contributions Event2253949CharitableContributionsEvent2
Gross Revenue Event20GrossRevenueEvent2
Other Direct Expenses Event2122480OtherDirectExpensesEvent2
Total Number Of Other Events2TotalNumberOfOtherEvents
Gross Receipts Other Events125816GrossReceiptsOtherEvents
Charitable Contrib Other Events125816CharitableContribOtherEvents
Gross Revenue Other Events0GrossRevenueOtherEvents
Other Direct Expenses Other Events112154OtherDirectExpensesOtherEvents
Gross Receipts Total879580GrossReceiptsTotal
Charitable Contributions Total879580CharitableContributionsTotal
Gross Revenue Total Events0GrossRevenueTotalEvents
Cash Prizes Total Events0CashPrizesTotalEvents
Non Cash Prizes Total Events0NonCashPrizesTotalEvents
Rent Facility Costs Total Events0RentFacilityCostsTotalEvents
Food And Beverage Total Events0FoodAndBeverageTotalEvents
Entertainment Total Events0EntertainmentTotalEvents
Other Direct Expenses Total Events400081OtherDirectExpensesTotalEvents
Direct Expense Summary Events400081DirectExpenseSummaryEvents
Net Income Summary-400081NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1MEDICAL CENTER OF CENTRAL GEORGIA INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1691 CHERRY STREET SUITE 400AddressLine1
CityMACONCity
StateGAState
ZIP Code31201ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient582149128EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant1515312AmountOfCashGrant
Purpose Of GrantSUPPORT MCCGPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
MONITORING PROCEDURESSCHEDULE I, PART I, LINE 2PROGRAM GRANTS WERE PRINCIPALLY TO SUPPORT THE MEDICAL CENTER OF CENTRAL GEORGIA, INC. (MCCG), A RELATED TAX-EXEMPT ORGANIZATION, FOR USE IN CHARITABLE, MEDICAL, EDUCATIONAL AND SCIENTIFIC ACTIVITIES. THE DISTRIBUTION OF GRANT FUNDS IS APPROVED AND MONITORED BY MANAGEMENT AND THE BOARD OF TRUSTEES.
Procedures for monitoring use of grant fundsSchedule I, Part I, Line 2PROGRAM GRANTS WERE PRINCIPALLY TO SUPPORT THE MEDICAL CENTER OF CENTRAL GEORGIA, INC. (MCCG), IN WHICH FUNDS ARE USED FOR CHARITABLE, MEDICAL, EDUCATIONAL AND SCIENTIFIC PURPOSES. THE USE OF GRANT FUNDS IS APPROVED AND MONITORED BY THE BOARD OF TRUSTEES.

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 PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 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
ETHEL A CULLINAN
PRESIDENT & CEO229130053527012225409080302304088420362480
KENNETH BANKS
CORPORATE SECRETARY0300769058142011062802981160150600782715090209
RHONDA PERRY
CORPORATE TREASURER041558301076290398958050094004940014280500394451
NINFA M SAUNDERS
TRUSTEE01590870001976001655550757034515900
ELBERT T MCQUEEN
CEO (INTERIM)022593404289901045803915308195032663900
A DOANLD FAULK JR
FORMER TRUSTEE0728616023209609587002160945501066253021128

Form990 Schedule J Part III Form990ScheduleJPartIII (2 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.
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 EXECUTIVE 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

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions5NumberOfContributions
Noncash Contribs Rptd F99040337NoncashContribsRptdF990
Method Of Determining RevenuesMARKET VALUEMethodOfDeterminingRevenues
FieldValueIRS element (for citing)
Number Of8283 Received0NumberOf8283Received
Any Property That Must Be HeldfalseAnyPropertyThatMustBeHeld
Review Process Unusual NC GiftstrueReviewProcessUnusualNCGifts
Third Parties UsedfalseThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Explanations of reporting method for number of contributionsSchedule M, Part ISECURITIES - PUBLICLY TRADED: NUMBER OF CONTRIBUTIONS (5 SEPARATE CONTRIBUTIONS FROM 5 CONTRIBUTORS)
Number of contributions or items contributed.Schedule M, part I, column (b), Line 9NUMBER OF CONTRIBUTIONS (5 SEPARATE CONTRIBUTIONS FROM 5 CONTRIBUTORS)

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION EMPLOYEESFORM 990, PART V, LINE 2BCOMPENSATION FOR FOUNDATION EMPLOYEES WAS PAID BY THE MEDICAL CENTER OF CENTRAL GEORGIA, INC. (MCCG; EIN: 58-2149128), AND W-2S WERE ISSUED BY MCCG AS AGENT FOR THE FOUNDATION.
Classes of members or stockholdersForm 990, Part VI, Section A, Line 6CENTRAL GEORGIA HEALTH SYSTEMS, INC., A RELATED 501(C)(3) ORGANIZATION, IS THE FOUNDATION'S SOLE MEMBER. THE SOLE MEMBER MUST APPROVE IN ADVANCE CHANGES IN GOVERNANCE, CHANGES IN ORGANIZATIONAL STRUCTURE (INCLUDING THE FORMATION OF SUBSIDIARIES OR JOINT VENTURES, DISSOLUTIONS OR LIQUDIATIONS, AND MERGERS OR CONSOLIDATIONS) AND AMENDING OR TERMINATING LEASE AGREEMENTS.
Members or stockholders electing members of governing bodyForm 990, Part VI, Section A, Line 7aTHE CHIEF EXECUTIVE OFFICER OF CENTRAL GEORGIA HEALTH SYSTEMS, INC. IS AN EX OFFICIO VOTING MEMBER OF THE BOARD OF THE FOUNDATION. IN ADDITON, OTHER BOARD MEMBERS ARE ELECTED BY ACTION OF THE FOUNDATIONS'S BOARD OF TRUSTEES, UPON APPROVAL BY THE SOLE MEMBER, CENTRAL GEORGIA HEALTH SYSTEMS, INC.
Decisions requiring approval by members or stockholdersForm 990, Part VI, Section A, Line 7bCERTAIN ORGANIZATIONAL ACTIONS OF THE BOARD OF TRUSTEES ARE SUBJECT TO APPROVAL BY THE FOUNDATION'S SOLE MEMBER, CENTRAL GEORGIA HEALTH SYSTEMS, INC.
Review of form 990 by governing bodyForm 990, Part VI, Section B, Line 11bTHE FORM 990 WAS PREPARED BY HEALTH SYSTEM PERSONNEL FROM INFORMATION PROVIDED BY MANAGEMENT AND FROM CONSOLIDATED FINANCIAL STATEMENTS (AUDITED BY AN INDEPENDENT CPA FIRM). IT IS REVIEWED IN DETAIL BY OUR OUTSIDE TAX ADVISOR (ANOTHER INDEPENDENT CPA). THE FORM 990 WAS PROVIDED TO EACH MEMBER OF THE BOARD OF TRUSTEES PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE.
Conflict of interest policyForm 990, Part VI, Section B, Line 12cTHE CORPORATE DEPARTMENT OF AUDIT AND COMPLIANCE ISSUES CONFLICT OF INTEREST DISCLOSURE FORMS ANNUALLY TO OUR BOARD MEMBERS, ADMINISTRATION AND DIRECTORS. THE DEPARTMENT OF AUDIT AND COMPLIANCE RECEIVES, REVIEWS AND DOCUMENTS ALL POTENTIAL CONFLICTS (PERCEIVED AND REAL). THE RESULTS ARE TAKEN TO THE COMPLIANCE COMMITTEE WHERE THE REAL DISCLOSURES ARE DISCUSSED FOR CORRECTIVE ACTION. THE CORRECTIVE ACTION SUGGESTIONS ARE TAKEN TO THE VARIOUS BOARDS AND ADMINISTRATION FOR IMPLEMENTATION. ANY TIME A CHANGE IN A RELATIONSHIP OR NEW POTENTIAL CONFLICT EVOLVES, THE INDIVIDUAL MUST AMEND THEIR CONFLICT OF INTEREST DISCLOSURE FORM.
Process used to establish compensation of top management officialForm 990, Part VI, Section B, Line 15aTHE COMPENSATION COMMITTEE OF THE CORPORATE BOARD OF DIRECTORS ENGAGES AN EXECUTIVE CONSULTING FIRM EVERY 2 TO 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 HUMAN RESOURCES, THE CHIEF OPERATING OFFICER, AND THE CHIEF EXECUTIVE OFFICER 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. KEY EMPLOYEES AND OTHERS OUTSIDE OF THE EXECUTIVE LEADERSHIP TEAM HAVE COMPENSATION SET BY HR GUIDELINES AND/OR MARKET COMPENSATION STUDIES.
Governing documents, conflict of interest policy and financial statements available to the publicForm 990, Part VI, Section C, Line 19INFORMATION WILL BE MADE AVAILABLE UPON REQUEST SUBMITTED TO THE BOARD OF TRUSTEES.
FOMER 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.

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 COMPANY - MCCGGA501(C)(3)11 - Type III - FINAfalse
CENTRAL GEORGIA SENIOR HEALTH INC
691 CHERRY STREET SUITE 400MACONGA31201RETIREMENT COMMUNITYGA501(C)(3)11 - Type IICENTRAL GEORIGA HEALTH SYSTEMS INCfalse
HEALTH SERVICES OF CENTRAL GEORGIA INC
691 CHERRY STREET SUITE 400MACONGA31201HEALTH CARE PROVIDERGA501(C)(3)3CENTRAL GEORIGA HEALTH SYSTEMS INCfalse
MEDICAL CENTER OF GEORGIA INC
691 CHERRY STREET SUITE 400MACONGA31201HOSPITALGA501(C)(3)3NAfalse
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 400MACONGA31201582164989MANAGEMENT & HOMECARE SERVICESGANAC CORPORATION
CENTRA PROFESSIONAL INDEMNITY LTD
INSURANCE - FOREIGN CORP.NAC CORPORATIONPO BOX 1363GRAND CAYMANCJCJ
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
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 OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg