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NAVICENT HEALTH FOUNDATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
NAVICENT HEALTH FOUNDATION INC (EIN 23-7363555)
Tax period
2011-10-01 to 2012-09-30
Filed
2013-10-02
IRS object ID
201332759349300023
Schema version
2011v1.2
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)
Timestamp2013-10-02T10:00:22-05:00Timestamp
Tax Period End Date2012-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN581094351EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MCNAIR MCLEMORE MIDDLEBROOKS & CO LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1POST OFFICE BOX ONEAddressLine1
CityMACONCity
StateGAState
ZIP Code312020001ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-10-01TaxPeriodBeginDate

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
TitleTREASURERTitle
Date Signed2013-10-02DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJERRY A WOLFEName
PTINP00030810PTIN
Phone4787466277Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Amended ReturnXAmendedReturn

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 Receipts83968745GrossReceipts
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 Body41NbrVotingMembersGoverningBody
Nbr Independent Voting Members37NbrIndependentVotingMembers
Total Nbr Employees7TotalNbrEmployees
Total Nbr Volunteers1261TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3821736ContributionsGrantsPriorYear
Contributions Grants Current Year3418903ContributionsGrantsCurrentYear
Program Service Revenue Prior Year0ProgramServiceRevenuePriorYear
Program Service Revenue CY0ProgramServiceRevenueCY
Investment Income Prior Year4049396InvestmentIncomePriorYear
Investment Income Current Year3428591InvestmentIncomeCurrentYear
Other Revenue Prior Year-268046OtherRevenuePriorYear
Other Revenue Current Year-296838OtherRevenueCurrentYear
Total Revenue Prior Year7603086TotalRevenuePriorYear
Total Revenue Current Year6550656TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1723702GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1810778GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year691391SalariesEtcPriorYear
Salaries Etc Current Year805223SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year16832TotalFundrsngExpCurrentYear
Other Expense Prior Year660444OtherExpensePriorYear
Other Expenses Current Year796250OtherExpensesCurrentYear
Total Expenses Prior Year3075537TotalExpensesPriorYear
Total Expenses Current Year3412251TotalExpensesCurrentYear
Revenues Less Expenses Prior Year4527549RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3138405RevenuesLessExpensesCY
Total Assets BOY60934658TotalAssetsBOY
Total Assets EOY71469939TotalAssetsEOY
Total Liabilities BOY158510TotalLiabilitiesBOY
Total Liabilities EOY249589TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY60776148NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY71220350NetAssetsOrFundBalancesEOY
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
Expense1810778Expense
Grants1810778Grants
Revenue2251867Revenue
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 Expense1810778TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
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 SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
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 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
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees7NumberOfEmployees
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 ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members41NbrVotingGoverningBodyMembers
Number Independent Voting Members37NumberIndependentVotingMembers
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 OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledGAStatesWhereCopyOfReturnIsFiled
Own WebsiteXOwnWebsite
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 (41 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
CAL HAYS
VICE CHAIR1.00XX000
ETHEL A CULLINAN
PRESIDENT & CEO40.00XX321313013267
KENNETH BANKS
CORPORATE SECRETARY1.00XX0416659451456
RHONDA PERRY
CORPORATE TREASURER1.00XX0576260527222
SCOTT SEIGEL
CHAIR1.00XX000
A DONALD FAULK JR
TRUSTEE1.00X0108437558256
C WARREN SELBY JR
TRUSTEE1.00X000
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 W 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
KENNETH M SAITOW
TRUSTEE1.00X000
KENT BALDSCHUN
TRUSTEE1.00X000
LINDA CLAY
TRUSTEE1.00X000
NINFA M SAUNDERS
TRUSTEE1.00X000
PAM WHITE-COLBERT
TRUSTEE1.00X000
PATSY BASS
TRUSTEE1.00X000
R EARL SMITH
TRUSTEE1.00X000
RICK BONFIM
TRUSTEE1.00X000
ROBERT C BETZEL
TRUSTEE1.00X000
SUE SANDA
TRUSTEE1.00X000
THOMAS E GIBBONS
TRUSTEE1.00X000
THOMAS J WICKER
TRUSTEE1.00X000
TIMOTHY E ANDREWS
TRUSTEE1.00X000
WILLIAM W BAXLEY III
TRUSTEE1.00X000
WITT GAITHER
TRUSTEE1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org321313TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2077294TotalReportableCompFrmRltdOrgs
Total Other Compensation1050201TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Fundraising Events735535FundraisingEvents
Related Organizations1167036RelatedOrganizations
All Other Contributions1516332AllOtherContributions
Noncash Contributions88518NoncashContributions
Total Contributions3418903TotalContributions

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 Column1508877TotalRevenueColumn
Exclusion$1,508,877ExclusionAmount

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)
Securities79040965Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities77121251Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1919714Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1919714TotalRevenueColumn
Exclusion$1,919,714ExclusionAmount
FieldValueIRS element (for citing)
Cntrbtns Rprtd Fundraising Events735535CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses296838FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-296838TotalRevenueColumn
Exclusion-$296,838ExclusionAmount

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

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 Column6550656TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$3,131,753ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1810778Total
Program Services1810778ProgramServices

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)
Total405533Total
Management And General405533ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total263137Total
Management And General263137ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total39072Total
Management And General39072ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total46652Total
Management And General46652ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total50829Total
Management And General50829ManagementAndGeneral

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)
Total22500Total
Management And General22500ManagementAndGeneral

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)
Total301984Total
Management And General301984ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total83934Total
Management And General83934ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total104499Total
Management And General104499ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total53603Total
Management And General53412ManagementAndGeneral
Fundraising191Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total0Total

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralFundraisingFundraising
PRINTING AND PUBLICATIONS4932548470855
POSTAGE AND SHIPPING1266512665
MISCELLANEOUS ADMINISTRATIVE16774015195415786

All Other Expenses AllOtherExpenses

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

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3412251Total
Program Services1810778ProgramServices
Management And General1584641ManagementAndGeneral
Fundraising16832Fundraising

Total Joint Costs TotalJointCosts

FieldValueIRS element (for citing)
Total0Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY283352BOY
EOY94055EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1254344BOY
EOY1062380EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY125165BOY
EOY109645EOY
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)
BOY58945120BOY
EOY69878139EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY93177BOY
EOY92220EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY60934658BOY
EOY71469939EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY106510BOY
EOY208239EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY52000BOY
EOY41350EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY158510BOY
EOY249589EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6375758BOY
EOY7254252EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY54400390BOY
EOY63966098EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY60776148BOY
EOY71220350EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY60934658BOY
EOY71469939EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3138405ReconcilationRevenueExpenses
Reconcilation Other Changes7305797ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
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 Years2917826CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2069091CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3170103CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2439430CurrentTaxYearMinus1Year
Current Tax Year2443831CurrentTaxYear
Total13040281Total

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 Years2917826CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2069091CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3170103CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2439430CurrentTaxYearMinus1Year
Current Tax Year2443831CurrentTaxYear
Total13040281Total
FieldValueIRS element (for citing)
Public Support Total17013040281PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1130069CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years962066CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1140423CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1109625CurrentTaxYearMinus1Year
Current Tax Year1508877CurrentTaxYear
Total5851060Total

Net UBI NetUBI

FieldValueIRS element (for citing)
Total0Total

Other Income170 OtherIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Total Support18891341TotalSupport
Gross Receipts From Admissions Etc0GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.69020PublicSupportPertcentage170
Public Support Pertcent Prior Year0.72100PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170
General ExplanationOTHER INCOME, SCHEDULE A, PART II, LINE 10, 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

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis233500InvestmentCostOrOtherBasis
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
Federal Income Tax Liability0FederalIncomeTaxLiability
Total Of Amounts0TotalOfAmounts
Total Revenue6550656TotalRevenue
Total Expenses3412251TotalExpenses
Excess Or Deficit For Year3138405ExcessOrDeficitForYear
Net Unrealized GL On Investments7305797NetUnrealizedGLOnInvestments
Other$0OtherAmount
Total Adjustments7305797TotalAdjustments
Excess Or Deficit Per FS10444202ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt13851307TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments7305797NetUnrealizedGainsInvestments
Other Revenues0OtherRevenues
Revenue Not Rptd F9907305797RevenueNotRptdF990
Revenue Subtotal6545510RevenueSubtotal
Investment Expenses Not Included301984InvestmentExpensesNotIncluded
Other Revenues Not Included-296838OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt5146RevenueNotRptdOnFinStmt
Total Revenue Per Form9906550656TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt3407105TotExpensesEtcAuditedFinclStmt
Other Expenses Included296838OtherExpensesIncluded
Expenses Not Rptd F990296838ExpensesNotRptdF990
Expenses Subtotal3110267ExpensesSubtotal
Investment Expenses Not Included2301984InvestmentExpensesNotIncluded2
Other Expenses Not Included0OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt301984ExpensesNotRptdOnFinStmt
Total Expenses Per Form9903412251TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Other revenues in form 990 not in audited financial statementsSchedule D, Part XII, Line 4bFUNDRAISING EXPENSES - -296838;
Other expenses in audited financial statements not in form 990Schedule D, Part XIII, Line 2dFUNDRAISING EXPENSES - 296838;

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

FieldValueIRS element (for citing)
RegionCENTRAL AMERICA AND THE CARIBBEANRegion
Type Of Activities ConductedINVESTMENTSTypeOfActivitiesConducted
Total Expenditures3207000TotalExpenditures
FieldValueIRS element (for citing)
Total Amount Spent3207000TotalAmountSpent
Transfer To Foreign CorpfalseTransferToForeignCorp
Interest In Foreign TrustfalseInterestInForeignTrust
Own Foreign CorptrueOwnForeignCorp
Passive Foreign Invest CofalsePassiveForeignInvestCo
Foreign PartnershiptrueForeignPartnership
Boycott CountriesfalseBoycottCountries

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1CMN BROADCASTNameOfEvent1
Gross Receipts Event1426012GrossReceiptsEvent1
Charitable Contributions Event1426012CharitableContributionsEvent1
Gross Revenue Event10GrossRevenueEvent1
Other Direct Expenses Event1133214OtherDirectExpensesEvent1
Name Of Event2CELEBRITY CLASSICNameOfEvent2
Gross Receipts Event2248793GrossReceiptsEvent2
Charitable Contributions Event2248793CharitableContributionsEvent2
Gross Revenue Event20GrossRevenueEvent2
Other Direct Expenses Event2130638OtherDirectExpensesEvent2
Total Number Of Other Events1TotalNumberOfOtherEvents
Gross Receipts Other Events60730GrossReceiptsOtherEvents
Charitable Contrib Other Events60730CharitableContribOtherEvents
Gross Revenue Other Events0GrossRevenueOtherEvents
Other Direct Expenses Other Events32986OtherDirectExpensesOtherEvents
Gross Receipts Total735535GrossReceiptsTotal
Charitable Contributions Total735535CharitableContributionsTotal
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 Events296838OtherDirectExpensesTotalEvents
Direct Expense Summary Events296838DirectExpenseSummaryEvents
Net Income Summary-296838NetIncomeSummary

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
MEDICAL CENTER OF CENTRAL GEORGIA INC
691 CHERRY STREET SUITE 400MACONGA31201582149128501(C)(3)1543559SUPPORT MCCG
MEDICAL CENTER OF PEACH COUNTY INC
1960 HWY 247 CONNECTORBYRONGA31008453765471501(C)(3)170000SUPPORT MEDICAL CENTER OF PEACH COUNTY
DAYBREAK CENTER DEPAUL USA
174 WALNUT STREETMACONGA31201352338110501(C)(3)12000SUPPORT DAYBREAK CENTER
SALVATION ARMY
1955 BROADWAYMACONGA31201580660607501(C)(3)5500SUPPORT SALVATION ARMY PROGRAMS
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants4TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedures for monitoring use of grant fundsIdentifier
Return ReferenceSchedule I, Part I, Line 2ReturnReference
ExplanationPROGRAM 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.Explanation

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 (4 entries)

Base 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
206535061381053397023700108970334580000
KENNETH BANKS
02607230757510801850436765014691086811500
RHONDA PERRY
039272401316260519100522431047910110348200
A DONALD FAULK JR
070530802792030998640473590108970114263100

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 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.
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 $486,919 KEN BANKS $411,258 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 $16,901 DON FAULK $21,128 KEN BANKS $ 9,835

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTraded

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions7NumberOfContributions
Noncash Contribs Rptd F99088518NoncashContribsRptdF990
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 UsedtrueThirdPartiesUsed

Form990 Schedule M Part II Form990ScheduleMPartII (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Explanations of reporting method for number of contributionsSchedule M, Part ISECURITIES - PUBLICLY TRADED: NUMBER OF CONTRIBUTIONS
Third parties used to solicit, process, or sell noncash contributionsSchedule M, Part I, Line 32bCONTRIBUTED SECURITIES ARE PROCESSED AND SOLD BY THIRD PARTY INVESTMENT MANAGERS.
Number of contributions or items contributed.Schedule M, part I, column (b), Line 9NUMBER OF CONTRIBUTIONS

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION EMPLOYEESFORM 990, PART I, LINE 5COMPENSATION 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.
Members or stockholders electing members of governing bodyForm 990, Part VI, Section A, Line 7aBOARD MEMBERS ARE ELECTED BY ACTION OF THE BOARD OF TRUSTEES, UPON APPROVAL OF THE FOUNDATION'S 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 IS REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES PRIOR TO FILING.
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.
Process used to establish compensation of other officers/key employeesForm 990, Part VI, Section B, Line 15bTHE 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 TO THE BOARD OF TRUSTEES.
Average number of hours devoted per week to related organizationForm 990, Part VII, Section A, Column BKENNETH BANKS - AT LEAST 40 HOURS PER WEEK RHONDA PERRY - AT LEAST 40 HOURS PER WEEK A. DONALD FAULK JR. - AT LEAST 40 HOURS PER WEEK
MANAGEMENT AND GENERAL EXPENSESFORM 990, PART IX, COLUMN (C)MANAGEMENT AND GENERAL EXPENSES IN THE AMOUNT OF $1,167,036 WERE PAID BY A RELATED ORGANIZATION (SEE FORM 990, PART VIII, LINE 1D).
Other changes in net assets or fund balancesForm 990, Part XI, Line 5NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - 7305797;
AMENDED RETURNSCHEDULE J, PART ITHIS RETURN IS BEING AMENDED TO DISCLOSE THE RESPONSES TO SCHEDULE J, PART I, QUESTIONS 3 - 9, AND THE RELATED SUPPLEMENTAL INFORMATION. THIS INFORMATION WAS INADVERTENTLY OMITTED WHEN ORIGINALLY FILED.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CENTRAL GEORGIA HEALTH SYSTEMS INC
691 CHERRY STREET SUITE 400MACONGA31201582149127PARENT COMPANY - MCCGGA501(C)(3)11NAfalse
CENTRAL GEORGIA SENIOR HEALTH INC
691 CHERRY STREET SUITE 400MACONGA31201582345439RETIREMENT COMMUNITYGA501(C)(3)11CENTRAL GEORIGA HEALTH SYSTEMS INCfalse
HEALTH SERVICES OF CENTRAL GEORGIA INC
691 CHERRY STREET SUITE 400MACONGA31201582307485HEALTH CARE PROVIDERGA501(C)(3)3CENTRAL GEORIGA HEALTH SYSTEMS INCfalse
MEDICAL CENTER OF GEORGIA INC
691 CHERRY STREET SUITE 400MACONGA31201582149128HOSPITALGA501(C)(3)3NAfalse
MEDICAL CENTER OF PEACH COUNTY INC
1960 HWY 247BYRONGA31008453765471HOSPITALGA501(C)(3)N/ACENTRAL GEORGIA HEALTH SYSTEMSfalse

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1General Or Managing PartnerGeneralOrManagingPartner
SECURE HEALTH PLANS OF GEORGIA LLC
577 MULBERRY STREET SUITE 1000MACONGA31201582306549MANAGED CAREGANAfalse
CENTRAL GEORGIA PET LLC
1650 HARDEMAN AVENUEMACONGA31201371464470MEDICAL IMAGING CENTERGANAfalse

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
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