2012-05-14T16:00:11-05:00 2011-06-30 CHERRY BEKAERT & HOLLAND LLP 1029 GREENE STREET AUGUSTA GA 30901 990 2010-07-01 581705662 GEORGIA REHABILITATION INSTITUTE INC GEOR 7068238779 1355 INDEPENDENCE DRIVE AUGUSTA GA 309011037 MICHAEL A HARRELL 7068238779 2012-05-14 1 ELIZABETH MORRISON 7067243557 2012-05-14 2010 2016-02-24 21:20:13Z MICHAEL A HARRELL 1355 INDEPENDENCE DRIVE AUGUSTA GA 309011037 20021309 0 X WWW.WRH.ORG X 1986 GA MEDICAL REHABILITATION FOLLOWING TEMPORARY ILLNESS, INJURY, OR LIFE-CHANGING DISABILITY 9 8 257 9 0 0 201526 199387 20838112 19712887 58288 109035 0 0 21097926 20021309 0 0 0 0 13673598 12567397 0 0 0 7611385 8291486 21284983 20858883 -187057 -837574 18750768 18008023 15671339 15347402 3079429 2660621 X WALTON REHABILITATION HOSPITAL RESTORES ABILITY, HOPE, AND INDEPENDENCE TO PEOPLE WHO NEED MEDICAL REHABILITATION AND/OR COMMUNITY SUPPORT FOLLOWING TEMPORARY ILLNESS, INJURY, OR A LIFE-CHANGING DISABILITY. 0 0 17393179 19712887 CHOOSING WHERE TO RECEIVE YOUR HEALTH CARE IS AN IMPORTANT DECISION. PATIENTS WHO CHOOSE TO COME TO WALTON REHABILITATION HEALTH SYSTEM BENEFIT FROM OUR CONTINUUM OF CARE IN REHABILITATION, WHICH INCLUDES:A SPECIALIZED REHABILITATION HOSPITAL ACCREDITED IN REHABILITATION AND WITH A SPECIALTY CERTIFICATION IN STROKE, OFFERING STATE-OF-THE-ART CARE PROVIDED BY COMPASSIONATE, HIGHLY-TRAINED HEALTH CARE PROFESSIONALS IN THE AREAS OF STROKE, BRAIN INJURY, SPINAL CORD INJURY, AMPUTATION, ORTHOPEDIC REHABILITATION AND GENERAL REHABILITATION;OUTPATIENT THERAPY CENTERS IN AUGUSTA AND AIKEN, STAFFED BY DEDICATED THERAPISTS USING THE LATEST EQUIPMENT AND THERAPIES, INCLUDING THE AREA'S ONLY HEATED AQUATIC THERAPY POOL;PHYSICIAN SERVICES WITH FELLOWSHIP-TRAINED SPECIALISTS TO MANAGE PAIN, HEADACHE, OTHER MUSCULOSKELETAL CONDITIONS AS WELL AS FOLLOW-UP CARE FOR SURVIVORS OF STROKE, BRIAN INJURY AND SPINAL CORD INJURY;A TRANSITIONAL LIVING CENTER THAT ASSISTS BRAIN INJURY AND STROKE SURVIVORS IN RELEARNING ACTIVITIES OF DAILY LIVING AS THEY TRANSITION FROM HOSPITAL TO HOME;COMMUNITY SERVICES, INCLUDING SUPPORT GROUPS, SPORTS AND LEISURE PROGRAMS, HARRISON HEIGHTS ASSISTED AND INDEPENDENT LIVING, AS WELL AS ACCESSIBLE/AFFORDABLE HOUSING;OTHER SPECIALIZED SERVICES, INCLUDING WOUND CARE AND INFUSION.AS A CENTER OF EXCELLENCE IN REHABILITATION , WALTON EXCELS IN PROVIDING HIGH-QUALITY CARE TO PATIENTS, SUCCESSFUL OUTCOMES AND CUTTING-EDGE TECHNOLOGY. OUR EXTENSIVE REHABILITATION SERVICES ARE OFFERED TO TREAT A WIDE RANGE OF CONDITIONS. REGARDLESS OF YOUR CONDITION, WE ENSURE YOU WILL BE PLEASED WITH THE CARE YOU RECEIVE FROM OUR EXPERT TEAM OF MEDICAL PROFESSIONALS WHO WILL WORK WITH YOU TO DEVELOP A TREATMENT PLAN AND HELP YOU MEET YOUR REHABILITATION GOALS.WALTON TAKES MORE MEDICALLY COMPLEX REHAB PATIENTS THAN THE NATIONAL AVERAGE, OUR DISCHARGE TO HOME RATE > 70% IS HIGHER THAN THE NATIONAL AVERAGE, AND OUR FUNCTIONAL INDEX MEASURE (FIM) SCORES ARE EXCELLENT WHICH RESULT IN BETTER FUNCTIONAL INDEPENDENCE FOR THE PATIENTS. 17393179 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 1 0 1 46 0 1 257 1 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 GA X X V J NAPLES 7068238779 1355 INDEPENDENCE DRIVE AUGUSTA GA 30901 THOMAS BLANCHARD III 1.00 X 0 0 0 NORMAN CHUTKAN MD 1.00 X 0 0 0 BROCK DANIELS SPHR 1.00 X 0 0 0 DON HOWARD 1.00 X 0 0 0 DONALD SHAPIRO 1.00 X 0 0 0 RHETT N SINCLAIR CFP CLU 1.00 X 0 0 0 PRESTON SIZEMORE SR 1.00 X 0 0 0 BRENT SMITH 1.00 X 0 0 0 ROBERT TAYLOR 1.00 X 0 0 0 DENNIS B SKELLEY 40.00 X X X 223457 0 36696 MICHAEL A HARRELL 40.00 X 130162 0 21791 ROBERT ORSINI 40.00 X 96234 0 12481 ELIZABETH MILLER 40.00 X 90415 0 14105 JENNIFER YANG 40.00 X X 158685 0 20359 ANDREW DENNISON 40.00 X X 176588 0 20414 JOHN NICHOLSON 40.00 X X 155468 0 20029 JEREMY HERTZA 40.00 X 106820 0 15298 1137829 0 161173 6 0 1 0 PHARMACARE SVCS 111 N CAUSEWAY BLVD MANDEVILLE LA 70448 PHARMACY MANAGEMENT SERVICES 978232 MEDEX ASSOCIATES LLC 811 13TH STREET STE 10 AUGUSTA GA 30901 PHYSICIAN SERVICES 356277 REFLECTX SERVICES INC 15072 COLLECTIONS CTR DR CHICAGO IL 60693 THERAPY STAFF 288823 MEDICAL STAFFING NETWORK PO BOX 840416 DALLAS TX 75284 NURSING STAFF 250638 UNIVERSITY HOSPITAL 1350 WALTON WAY AUGUSTA GA 30910 LAB SERVICE 208162 9 199387 199387 PATIENT SERVICE REVENU 621110 18588624 18588624 OTHER PROG SERV REVENU 621110 656355 656355 MAINTENANCE & MANAGE 722210 419047 419047 CAFETERIA AND VENDING 722210 48861 48861 19712887 75392 75392 33643 33643 33643 33643 20021309 19712887 0 109035 430902 430902 9130757 7742063 1388694 2267969 1980086 287883 737769 702866 34903 29505 29505 65800 65800 345930 293598 52332 777900 766131 11769 61692 40631 21061 26562 18613 7949 569936 569936 959670 959670 PURCHASED SERVICES 2107893 1169717 938176 COSTS OF GOODS SOLD ALL 957189 957189 SUPPLIES AND MINOR EQ 788459 496424 292035 ADMINISTRATIVE & GENERA 668993 668993 PURCHASED SERVICES - NU 379940 379940 552017 552017 20858883 17393179 3465704 0 76526 81876 2419944 1453269 2917399 3399062 58770 59465 601828 620113 26755976 17077493 10282418 9678483 2393883 2715755 18750768 18008023 1673203 1806603 12142000 11717000 1856136 1823799 15671339 15347402 X 3079429 2660621 3079429 2660621 18750768 18008023 X -837574 418766 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1388258 1388258 16373835 9637454 6736381 8993883 7440039 1553844 9678483 FUNDED DEPRECIATION 2314691 DEFERRED DEBT ISSUES COSTS, NET 192243 OTHER ASSETS 208821 2715755 ESTIMATED 3RD PARTY SETTLEMENT 920000 INTEREST RATE SWAP 588186 BOND INTEREST PAYABLE 130098 NOTES PAYABLE 185515 1823799 20021309 20858883 -837574 418766 418766 -418808 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE SYSTEM HAS EVALUATED THE EFFECT OF GAAP ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES THAT BECAME EFFECTIVE LAST YEAR. THE SYSTEM (EXCLUSIVE OF WALTON INNOVATIONS) IS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE SYSTEM IS SUBJECT TO FEDERAL INCOME TAX ON UNRELATED BUSINESS INCOME. MANAGEMENT BELIEVES THAT THE SYSTEM CONTINUES TO SATISFY THE REQUIREMENTS OF A TAX-EXEMPT ORGANIZATION AT JUNE 30, 2011. MANAGEMENT HAS EVALUATED ALL OTHER TAX POSITIONS THAT COULD HAVE A SIGNIFICANT EFFECT ON THE CONSOLIDATED FINANCIAL STATEMENTS AND DETERMINED THE SYSTEM HAD NO UNCERTAIN INCOME TAX POSITIONS AT JUNE 30, 2011. PART XI, LINE 8 - OTHER ADJUSTMENTS: UNREALIZED GAIN ON MARKETABLE SECURITIES 186,418. LOSS ON BOND DERIVATIVE 232,348. 1 1 1 X 1 X 1 1 0 1 1 564331 0 564331 0.02700 619834 506454 380282 0.01820 1184165 506454 944613 0.04520 1184165 506454 944613 0.04520 1 207691 8964816 8008861 955955 X 1 1 1 1 WALTON REHABILITATION HOSPITAL

1355 INDEPENDENCE DRIVE AUGUSTA GA 30901

X REHABILITATION HOSPITAL WALTON REHABILITATION HOSPITAL 1 0 1 1 200.000000000000 1 200.000000000000 1 X 1 1 X 1 X 1 X X X X 0 X X 0 0 2 HARISON HEIGHTS

3648 WALTON WAY EXTENSION AUGUSTA GA 30909

ASSISTED LIVING HOME WALTON WEST

2501 CENTER WEST PARKWAY AUGUSTA GA 30909

TRANSITIONAL LIVING CENTER & POST-ACUTE REHABILITATION PROGRAM PART II: 1 PART III, LINE 8: PART 1, LINE 3C - N/A1. PART 1, LINE 7, COLUMM (F) = $207,691PART 1, LINE 7, WORKSHEET 2, RATIO OF PATIENT CARE COSTS TO CHARGES WAS BASED ON TOTAL EXPENSES NET OF BAD DEBT, LESS OTHER REVENUE FROM THE AUDITED FINANCIAL STATEMENT. THE ADJUSTED PATIENT CARE COST WAS DIVIDED BY THE GROSS PATIENT CHARGES.PART III, LINE 4, BAD DEBT AT COST WAS BASED ON THE MEDICARE COST REPORT CHARGES CONVERTED TO COST BASED ON THE WORKSHEET 2 RATIO, LESS THE DIRECT REIMBURSEMENT FROM MEDICAID.PART III, LINE 8 - THE MEDICARE COST REPORT WITH ACTUAL DATA WAS USED TO SHOW THE REVENUE RECEIVED AND COSTS AS COMPUTED BY THE MEDICARE COST REPORT, COST TO CHARGE FORMULAS, AND SPECIFIC GUIDELINE ALLOCATIONS.PART III, LINE 9B - THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY FROM THE STATE OF GEORGIA CERTIFICATE OF NEEDS DATA; REFERRAL AND FEEDBACK TRENDS FROM LOCAL HOSPITALS; PHYSICIAN FEEDBACK; AND DATA COLLECTED FROM AGENCIES AND ORGANIZATIONS ON INDIVIDUALS WITH PHYSICAL DISABILITIES. PART III, LINE 9B: 2. THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY FROM THE STATE OF GEORGIA CERTIFICATE OF NEEDS DATA; REFERRAL AND FEEDBACK TRENDS FROM LOCAL HOSPITALS; PHYSICIAN FEEDBACK; AND DATA COLLECTED FROM AGENCIES AND ORGANIZATIONS ON INDIVIDUALS WITH PHYSICAL DISABILITIES.3. THE HOSPITAL PROVIDES PATIENT EDUCATION FOR AVAILABILITY FOR ASSISTANCE DURING THE PRE-ADMISSIONS PROCESS AND UPON ADMISSION. A PATIENT INFORMATION BOOKLET IS PROVIDED, AND THE ADMISSIONS REPRESENTATIVE VERBALLY EXPLAINS THE BILLING PROCESS. A CASE MANAGER IS ALSO AVAILABLE TO ASSIST THE PATIENT WITH COORDINATING BILLING ISSUES. A PATIENT ACCOUNT REPRESENTATIVE IS ASSIGNED TO EVERY PATIENT ACCOUNT FOR FOLLOW-UP OR TO PROVIDE ASSISTANCE.4. GRI RESIDES IN RICHMOND COUNTY, GEORGIA, SERVING OVER 539,000 WITHIN A 90-MILE RADIUS. IN 2008, THE DEPARTMENT OF COMMUNITY HEALTH ISSUED A GEORGIA HEALTH DISPARITIES REPORT, WHICH LISTED RICHMOND COUNTY AS HAVING 53% BLACK, 44% WHITE, AND THE REMAINING 3% MOSTLY HISPANIC WITH SOME ASIANS AND AMERICAN INDIANS. APPROXIMATELY 19% OF THE POPULATION IS BELOW THE FEDERAL POVERTY GUIDELINES; 7.5% OF THE ADULT POPULATION COMPLETING LESS THAN THE 9TH GRADE; 9.2% OF THE ADULT POPULATION IS UNEMPLOYED; AND APPROXIMATELY 18% ARE UNINSURED.5. THE GRI GOVERNING BOARD MEMBERS ARE COMPRISED OF CITIZENS WHO RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA AND ARE NEITHER EMPLOYEES NOR CONTRACTORS. GRI BOARD MEMBERS ARE ACTIVE IN THE COMMUNITY AND ARE FOCUSED ON IMPROVING THE HEALTH AND WELFARE OF INDIVIDUALS WITH DISABILITIES IN THE COMMUNITY. OVER 70% OF THE PATIENTS RETURN HOME TO LIVE INDEPENDENTLY. THERE ARE ALSO MANY OTHER SUPPORT PROGRAMS TO ENSURE MAXIMUM INDEPENDENCE IS OBTAINED; RESIDENTIAL COMMUNITY RE-ENTRY; ASSISTED LIVING; DAY TREATMENT COMMUNITY RE-ENTRY; SPORTS AND LEISURE PROGRAMS FOR THE DISABLED; A WEEK-LONG CAMP IS PROVIDED FOR PEDIATRICS WITH BRAIN INJURIES; AS WELL AS SUPPORT GROUPS FOR INDIVIDUALS WITH STROKES AND AMPUTEES. THE ORGANIZATION ALSO HAS A MEDICAL STAFF TO MONITOR AND IMPROVE PATIENT CARE. ALL SURPLUS FUNDS ARE REINVESTED BACK INTO CAPITAL IMPROVEMENTS TO BENEFIT THE PATIENTS OR SUPPORT THE OPERATIONS THAT PROVIDE THOSE SERVICES.6. N/A REPORTS FILED WITH STATES PART VI, LINE 7 GA,SC X X 0 0 0 0 0 0 0 0 0 DENNIS B SKELLEY 223457 0 0 0 0 0 7210 0 29486 0 260153 0 0 0 MICHAEL A HARRELL 130162 0 0 0 0 0 5213 0 16578 0 151953 0 0 0 JENNIFER YANG 158685 0 0 0 0 0 6399 0 13960 0 179044 0 0 0 ANDREW DENNISON 176588 0 0 0 0 0 3600 0 16814 0 197002 0 0 0 JOHN NICHOLSON 155468 0 0 0 0 0 4185 0 15844 0 175497 0 0 0 DEVEOPMENT AUTHORITY OF RICHMOND COUNTY 581309430 2007-12-31 9565000 SPONSORSHIP DISTRIBUTION AND COVENANT NOT TO COMPETE 0 0 0 9565000 2494661 183527 6886812 2007 0 0 1 1 0 0 0 0 1 1 1 1 0 0 0 0 PRESTON SIZEMORE BOARD MEMBER 137961 PRESTON SIZMORE HAS A BUSINESS RELATIONSHIP WITH SIZEMORE, INC. THE ORGANIZATION PAID SIZEMORE, INC FOR SECURITY SERVICES. AN INDEPENDENT EXPENSE REDUCTION CONSULTANT AND RFP'S CONFIRMED THIS ARRANGEMENT WAS THE LOW-COST PROVIDER FOR SERVICE. 0 FORM 990, PART VI, SECTION B, LINE 11 AN INDEPENDENT ACCOUNTING FIRM COMPLETES AN AUDIT OF THE CORPORATION AND THEN PREPARES THE FORM 990 WITH ASSISTANCE FROM THE ACCOUNTING DEPARTMENT STAFF. THE CONTROLLER REVIEWS A PRELIMINARY DRAFT OF THE FORM 990 FOR ACCURACY AND THE FINAL DOCUMENTS ARE REVIEWED BY THE CFO BEFORE SIGNING. FORM 990, PART VI, SECTION B, LINE 12C ALL EMPLOYEES SIGN A CONFLICT OF INTEREST STATEMENT AT ORIENTATION. ALL QUESTIONABLE ISSUES ARE REVIEWED BY THE CFO/CORPORATE COMPLIANCE OFFICER. IF FURTHER REVIEW IS NEEDED, THE PRESIDENT/CEO WILL RESOLVE. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS PERFORMS AN ANNUAL REVIEW OF THE CEO AND EXECUTIVE COMPENSATION PLANS AFTER THE HUMAN RESOURCES DIRECTOR PERFORMS A COMPENSATION ANALYSIS TO ENSURE SALARIES ARE COMPARABLE WITH OTHER HEALHCARE ORGANIZATIONS IN THE AREA. FORM 990, PART VI, SECTION C, LINE 18 FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST AT THE ADMINISTRATION OFFICE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST AT THE ADMINISTRATION OFFICE. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST AT THE ADMINISTRATION OR ACCOUNTING OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNREALIZED GAIN ON MARKETABLE SECURITIES 186,418. LOSS ON BOND DERIVATIVE 232,348. TOTAL TO FORM 990, PART XI, LINE 5: 418,766. AUDIT COMMITTEE FORM 990, PAGE 11 ORGANIZATION'S FINANCE COMMITTEE AND BOARD OF DIRECTORS ASSUME THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. WALTON FOUNDATION FOR INDEPENDENCE INC 1355 INDEPENDENCE DRIVE AUGUSTA GA 30901 582408395 RAISING FUND FOR HOSPITAL GA 501 (C)(3) 7 0 WALTON TECHNOLOGIES INC 1355 INDEPENDENCE DRIVE AUGUSTA GA 30901 412067189 RESEARCH SUPPORT FOR CLINICAL TRIALS, ASSISTIVE TECHNOLOGY DEVELOPMENT GA 501 (C)(3) LINE 11A, I 0 WALTON INNOVATIONS INC 1355 INDEPENDENCE DRIVE AUGUSTA GA 30901 260539414 BUSINESS SUPPORT GA C 1.00000 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 WALTON FOUNDATION FOR INDEPENDENCE P 160277 AUDITED FINANCIAL STATEMENT WALTON INNOVATION P 956825 AUDITED FINANCIAL STATEMENT