2011-08-14T20:19:14-05:00 2010-09-30 Pershing Yoakley & Associates P C One Cherokee Mills 2220 Sutherland Knoxville TN 379192363 990 2009-10-01 582345439 CENTRAL GEORGIA SENIOR HEALTH INC CENT 4786331407 691 CHERRY STREET SUITE 400 MACON GA 31201 Rhonda S Perry 4786331407 2011-08-14 1 8656730844 2009 2016-02-24 21:20:13Z Carlyle Place Ethel Cullinan 691 CHERRY STREET SUITE 400 MACON GA 31201 58808490 0 X WWW.CARLYLEPLACE.ORG X 1997 GA Continuing Care Retirement Community offering a fulfilling independent lifestyle experience in a residential setting while providing comprehensive health care services and ammenities to include assisted living, memory care, and skilled nursing, all housed on the same campus. 8 7 289 110 0 0 0 14668382 14339947 1892245 2066962 0 16560627 16406909 0 0 6210077 6134918 0 0 8376797 8908204 14586874 15043122 1973753 1363787 85212712 89065183 85664880 85880645 -452168 3184538 Central Georgia Senior Health, Inc., incorporated on May 2, 1997, is a nonprofit corporation whose primary purpose is to construct, own and operate a continuing care retirement community in Macon, Georgia. It was organized for the well-being of our residents, and sharing our knowledge beyond our community. 0 0 11442557 14339947 Carlyle Place (CP) is a continuing care retirement community (CCRC) offering a fulfilling lifestyle experience in a residential setting, emphasizing healthy, active lifestyles from retirement until the end of life. There are four lifestyle options offered by CP: independent living, assisted living, memory support and skilled nursing. Residents are assured of having their needs met - from retirement through their end-of-life experience, all on one campus and with no need to relocate outside the community. Couples who have varying degrees of health needs may receive as little or as much assistance as needed and remain in close proximity to each other. Carlyle Place is committed to providing a quality life experience in the best environment possible, depending upon need. On site security and a twenty-four hour emergency call system provides residents peace of mind as help is merely a pull-cord away. Independent Living - A resident of CP must be at least sixty-two years of age at the time of residency (in the case of a couple at least one resident must be sixty-two and the other must be at least fifty-five). Independent living choices include garden homes or various size apartments, with access to all amenities including, but not limited to, nutritional meal plans, scheduled transportation, fitness programs and the Wellness Clinic, where an R.N. sees residents for assessment as needed throughout the week. CP's resident centered approach ensures that residents have a huge variety of activity and entertainment options, with emphasis on an active, educational and enjoyable lifestyle. Number of units: 226Assisted Living - Assisted living in Stafford Suites is available. A variety of options for services are available depending upon need - CNAs and LPNs will help residents with maintaining a quality of life as close to independent living as possible, monitoring medications, assisting with physical needs to include bathing and dressing, and providing health monitoring. Rehabilitation services to include physical, occupational, and speech therapies are available as needed. Our resident centered approach ensures that residents have a diversity of activity and entertainment options, adapted as needed to resident's limitations. Number of units: 29Skilled Nursing - Harrington House is CP's skilled nursing facility where residents may go to recuperate from surgery, a life threatening event or illness, or as their health deteriorates, to receive top quality care as they near the end of their lives. Rehabilitation services to include physical, occupational, and speech therapies are available as needed. Our resident centered approach ensures that residents have choices of activity and entertainment options, tailored as needed to resident's limitations. Number of units: 40Memory Care - The Memory Care Unit of Carlyle Place assists residents who are experiencing age-related dementia, Alzheimer's, or other health issues that impact their memories and abilities, ensuring their health and safety. Rehabilitation services to include physical, occupational, and speech therapies are available as needed. Our resident centered approach ensures that residents have choices of activity and entertainment options, modified as needed to resident's abilities. Number of units: 26Carlyle Place is committed to an ongoing relationship with the Middle Georgia Community and serving seniors both within and beyond our walls. The Board, management and staff are committed to sharing their professional knowledge and expertise regarding seniors, as well as, materially supporting geriatric services. Support of the Alzheimer's Association is a salient example. Each year staff is supported in their efforts to raise funds during working hours to support this cause. Additionally, the organization corporately supports the United Way. On staff time, volunteer hours and civic memberships are supported and encouraged. Our residents and staff continually find time to assure that we contribute outside our Carlyle Community. We are in our ninth year of providing lunches for the homeless in Middle Georgia. Personal gift bags are provided to the homeless at Christmas. Bags include useful items such as personal hygiene products, gloves, hats, socks, flashlights, snacks, etc. We have provided personal care items for the Georgia War Veteran's Home in Milledgeville. Items are also given to the Christmas Stocking Program with the Salvation Army, and to the Macon Rescue Mission. Hats and gloves have been provided for children at the Ronald McDonald House. Residents in our Healthcare Neighborhoods provide personal items for Hephzibah Children's Home and the Methodist Home for Children. Some of our residents read at elementary schools in the community. We have also provided books-on-tape for the Georgia Academy for the Blind and provided books for Head Start. The value of Volunteer activities provided by residents and staff for the fiscal year provided was: Support for the homeless - Provides meals monthly to 45 persons plus once per year take personal items and clothing to the homeless. Macon Volunteer Clinic $1,776Children's ministries - Ronald McDonald House, Head Start $554 Community educational programs focusing on different aspects of retirement/aging (Rally for Wellness) $2,000 Habitat for Humanity - non cash contributions $5,585United Way of Central GA $2,000Alzheimer's Association - includes sponsorships, direct resident and staff contributions from various fundraisers and providing assistance to support group plus volunteer hours $19,353 Canned Food Drive non cash contribution $1,182 Carlyle Place encourages support of a development fund that is maintained by Medcen Foundation, a related party. Medcen Foundation maintains and is building funds to supplement the health-related expenses of residents, who through no deliberate fault of their own, deplete their financial resources. 11442557 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 22 0 1 289 1 0 0 0 0 0 0 0 0 0 8 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 GA X Connie W Jones CPA 4784054500 5300 Zebulon Road Macon GA 31210 X Alfred Sams 1.00 X 0 0 0 James Wansley 1.00 X 0 0 0 Patricia Robinson 1.00 X 0 0 0 James Adams Jr 1.00 X 0 0 0 James McLendon 1.00 X 0 0 0 Marjorie Carter 1.00 X 0 0 0 Timothy Jackson 1.00 X 0 0 0 Starr Hutchings Purdue 1.00 X 0 0 0 Rhonda S Perry 1.00 X 0 411183 27511 Ethel A Cullinan 10.00 X 0 255901 11120 Kenneth B Banks 1.00 X 0 316434 31398 A Donald Faulk 1.00 X 0 722579 61910 Alan T Jordan 40.00 X 90608 0 7281 0 1706097 131939 0 0 1 0 Sodexo Inc and Affiliates PO BOX 536922 Atlanta GA 30353 Food Services 1277855 SunTrust Bank 25 Park Place 16th Floor Atlanta GA 30303 Banking Services 225192 Landscape South Inc PO BOX 26998 Macon GA 31008 Landscaping 216359 Rehabcare Group Inc PO BOX 503534 St Louis MO 63150 Rehab Services 215437 Burgess Carpet Center PO BOX 4464 Macon GA 31208 Flooring Services 196484 5 Residency Revenue 623000 13475208 13475208 Medicare/Medicaid Paym 524298 760700 760700 Guest Meals 722320 60795 60795 Resident Transportatio 480000 24625 24625 Guest Room Revenue 721000 10194 10194 8425 8425 14339947 1359392 1359392 43109151 42401581 707570 707570 707570 16406909 14244333 0 2162576 90608 90608 5146026 4218694 927332 17789 17789 455255 352272 102983 425240 327824 97416 350453 350453 76970 76970 108372 108372 446719 32432 414287 142704 142704 48909 48909 67423 67423 779257 716789 62468 57830 30643 27187 19189 10218 8971 1275516 1085584 189932 2908026 2617223 290803 218189 12273 205916 Supplies 1745327 1638508 106819 Sodexo Dining Managemen 322640 322640 Equipment Rental and Ma 111060 21654 89406 Refurbish/repaint expen 76150 76150 Bad debt expense 50456 50456 103014 55803 47211 15043122 11442557 3600565 0 4135321 2106996 435358 1477238 17955 17955 21975 56709 61646242 23278792 40583933 38367450 39014989 46089665 1003181 896354 0 52816 85212712 89065183 930100 771526 35976644 37327680 45900000 44500000 2858136 3281439 85664880 85880645 X -452168 3184538 -452168 3184538 85212712 89065183 X 0 1 1 X 0 X X X 0 0 0 Medical Center of Central GA Inc 582149127 3 1 1 1 0 1 0 1732834 1732834 51556845 17842327 33714518 4765270 3226933 1538337 3471509 2209532 1261977 119784 119784 38367450 DUE TO AFFILIATES 143426 INTEREST RATE SWAP 3109906 Other Current Liabilities 28107 3281439 16406909 15043122 1363787 2896722 -623803 2272919 3636706 16406909 0 16406909 0 16406909 15043122 0 15043122 0 15043122 Part X: Description of Uncertain Tax Positions Under FIN 48: The Company is exempt from income taxes under Section 501(a) as an organization described in section 501(c)(3) of the Internal Revenue Code of 1986, as amended. The Company has evaluated its tax positions and determined that they do not have any material unrecognized tax benefits or obligations as of September 30, 2010. Part XI, Line 8 - Other Adjustments: Change in Interest Rate Swap: -623803. X X X X X 0 0 0 0 0 0 0 1 0 Rhonda S Perry 0 364579 0 3000 0 43604 0 22829 0 4682 0 438694 0 0 Ethel A Cullinan 0 193822 0 0 0 62079 0 2875 0 8245 0 267021 0 0 Kenneth B Banks 0 244306 0 0 0 72128 0 18063 0 13335 0 347832 0 0 A Donald Faulk 0 605874 0 0 0 116705 0 51620 0 10290 0 784489 0 0 Part I, Line 7 This program is administered by the CEO. A budget for the program is established for reward and recognition of executives and organizational leaders who go above and beyond the scope of their responsibilities. For example, they may complete a project, lead an organizational initiative, or excel in an area that represents excellence under one of our organizational pillars - Quality, Service Excellence, Our People, Growth, Financial Performance. Near the end of the fiscal year, nominations are solicited from the leadership team. A proposed for allocation of the award is developed and presented to the HR Committee of the Board for review, discussion, and approval (prior to distribution). Macon-Bibb County Hospital Authority 581034851 55553RCC7 2009-09-01 45900000 Refunding of bonds issued in 2000 to construct the facility 0 0 45900000 45900000 2009 0 1 1 1 0 1 0 0 0 0.00340 0.00000 0.00340 1 0 1 1 SunTrust Bank 20.000000000000 0 0 0 Form 990, Part VI, Section A, line 6 Central Georgia Health Systems, Inc., a related 501 (c)(3) organization, is the sole member of the organization. Form 990, Part VI, Section A, line 7a Central Georgia Health Systems, Inc., a related 501 (c)(3) organization, has certain reserve powers as well as the power to appoint, approve and remove board members of Central Georgia Senior Health, Inc. Form 990, Part VI, Section A, line 7b Central Georgia Health Systems, Inc., a related 501 (c)(3) organization, has certain reserve powers as well as the power to appoint, approve and remove board members of Central Georgia Senior Health, Inc. Form 990, Part VI, Section B, line 11 The Form 990 was prepared by an independent certified public accountant from information provided by management from audited financial statements (prepared by another CPA). It was reviewed by Central Georgia Senior Health, Inc.'s financial management. A copy of the form 990 was provided to each board member prior to filing the return with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The department of Audit and Compliance issues COI disclosure forms annually to our board members, administration and directors. Audit and Compliance receives, reviews and documents all potential conflicts (perceived and real.) The results are taken to the Compliance Committee where the real conflicts of interest are discussed and a plan for corrective action is developed. The corrective action recommendations are take 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 COI disclosure form. Form 990, Part VI, Section B, line 15 The Compensation Committee of the Board of Directors 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. It should be noted that Dr. Cullinan's total compensation includes amounts for services to other affiliated organizations. 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. Form 990, Part VI, Section C, line 19 The organization provides copies of its governing documents upon request. Central GA Rehab Hospital LLC 3351 Northside Drive Macon GA 31210 300371539 Rehabilitation Services GA N/A Central Georgia Medical Properties LLC 777 Hemlock St MSC 111 Macon GA 31201 Physician relationships GA N/A Central Georgia Health Systems Inc 691 Cherry Street Suite 400 Macon GA 31201 582149127 System Parent/Management GA 501 (c)(3) 11 N/A Health Services of Central Georgia Inc 691 Cherry Street Suite 400 Macon GA 31201 582307485 Healthcare Services GA 501 (c)(3) 3 N/A Medcen Community Health Foundation Inc 858 High Street Macon GA 31201 237363555 Fundraising GA 501 (c)(3) 7 N/A Medical Center of Central Georgia Inc 691 Cherry Street Suite 400 Macon GA 31201 582149128 Hospital GA 501 (c)(3) 3 N/A Secure Health Plans of Georgia LLC 3920 Arkwright Road Suite 400 Macon GA 31208 582306549 MANAGED CARE GA N/A Central Georgia PET LLC 1650 Hardeman Avenue Macon GA 31201 371464470 MEDICAL IMAGING CENTER GA N/A Central Georgia Health Ventures Inc 691 Cherry Street Macon GA 31201 582164989 MANAGEMENT GA N/A C Central Georgia Home Care Services Inc 691 Cherry Street Macon GA 31201 582457422 MEDICAL EQUIPMENT SALES GA N/A C Centra Indemnity Ltd PO Box 1363 Grand Cayman CJ INSURANCE CJ N/A C Centra Professional Indemnity Ltd PO Box 1363 Grand Cayman CJ INSURANCE CJ N/A C American Eagle Insurance Co RRG 40 Main Street Suite 500 Burlington VA 05401 161645557 RISK MANAGEMENT VA N/A C 0 0 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0