health care central georgia, inc. audit … 2012.pdfhealth care central georgia, inc. macon, georgia...

HEALTH CARECENTRAL GEORGIA, INC.

AUDIT REPORT

FOR THE FISCAL YEAR ENDEDJUNE 30, 2012

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HEALTH CARE CENTRAL GEORGIA, INC.MACON, GEORGIA

TABLE OF CONTENTSJUNE 30, 2012

INTEPENDENT AUDITOR’S REPORT

FINANCIAL STATEMENTS

Statement of Financial Position 2

Statement of Activities 3

Statement of Cash Flows 4

Statement of Functional Expenses 5

Notes to the Fin anc in I Stateine n ts 6—9

GOVERNMENTAL REPORTS

Report on Internal Control Over Financial Reportingand on Compliance and Other Matters based onan Audit of Financial Statements performed inAccordance with Gavcrn;ieiit l uditing Standards 10—Il

1-T&P CLIFTON, LIPFORD, HARDISON & PARKER, LLCJ. Russell Llpford, Jr., CPAMark 0. [tardison, CPAterry. Parker, CPAChristopher S. Edwards, CPALyDn S. Hudson, CPAKevin E. Ltpfard, CPA

Member ofknerlcan institute of

Certified Public Accountantsrrumanw. ClIlton (1 902-1989)

Health Care Central Georgia, Inc.Macon, Georgia

We have audited the accompanying statement of financial position of Health Care CentralGeorgia, Inc., a non-profit organization, as of June 30, 2012, and the related statements ofactivities, cash flows and functional expenses for the fiscal year then ended. These financialstatements are the responsibiliw of the management of Health Care Central Georgia, Inc. Ourresponsibility is to express an opinion on these financial statements based on our audit.

We conducted our audit in accordance with auditing standards generally accepted in the UnitedStates of A merica and the standards applicable to financial audits contained in Go ver,z,nenAtubtuig Sicinc/ards, issued by the Comptroller General of the United States. Those standardsrequire that we plan and perform (lie audit to obtain reasonable assurance about whether thefinancial statements are free of material misstatement. An audit includes examining, on a testbasis, evidence supporting the aniounts and disclosures in the financial statements. An audit alsoincludes assessing the accounting principles used and the significant estimates made bymanagement, as well as evaluating the overall financial statement presentation. We believe thatour audit provides a reasonable basis for our opinion.

In our opinion, the financial statements referred to above present Fairly, in all material respects,the financial position of Health Care Central Georgia. Inc. as of June 30. 2012. and the changes inits net assets and its cash flows for the fiscal year then etided in conformity with accountingprinciples generally accepted in the United States of America.

In accordance with Goicrn,nc’nt :11K/fling .Stanc/a,’cls, we have also issued our report datedDecember 21, 2012, on our consideration ol Health Care Central Georgia, Inc.’s internal controlover financial reporting and on our tests of its compliance with certain provisions of laws.regulations, contracts and grant agreements and other matters. The purpose of that report is to

describe the scope of our testing of internal control over financial reporting and compliance andthe results ol that testing. and not to pros tde an opinion on the internal control over financialreporting or on conip I iance. That report is an integral part of an and it performed in accordancewith Goi’eninunil A nc/fling Stcendcirds and should be considered in assessing the results of our

1503 Bass RoadP.O. Box 6315 Macon, Georgia 31208-6315 www.clhp.com

468 South Houston Lake RoodWarner Robins. Georgia 31088

INDEPENDENT AUDITOR’S REPORT

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Macon, GeorgiaDecember21, 20)2

Phone 478-742-3313 • Fax 478-742-0316 Phone 478-953-0125 I Fax 478-953-0983

FINANCIAL STATEMENTS


STATEMENT OF FINANCIAL POSITIONJUNE 30, 2012

CashGrants receivable

Total Current Assets

$ 193,934187,636

381,570

Property and Equipment:

Computer softwareMachinery and equipmentLess: accumulated depreciation

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9,010

S 390,580

5 2,25120,81360,830

83,894

83,894

64,256242,43 I

306,686

S 390.580

The accompanvin notes are an integral part of these financial statements.

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ASSETS aCurrent Assets:

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558,12894,907

(644,025)

Net Property and Equipment

Total Assets

LIABILITIES AND NET ASSETS

Current Liabilities:

Accounts payableAccrued payroll liabilitiesDeFerred revenue

Total Current Liabilities

Total LiabiliUcs

Net Assets:Temporarily restrictedUnrestricted

Total Net Assets

Total Liabilities and Net Assets

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STATEMENT OF ACTIVITIES

FOR THE FISCAL YEAR ENDED JUNE 30, 2012

Revenue and supportDonationsContract revenueOther revenuesInterest incomeDCHIviorehouseOther Contributed SupportNet assets released from restriction

ExpensesProgram servicesSupporting services

Total expenses

Increase (Decrease) in Net Assets

Net Assets - Beginning oF Year

Net Assets - End of Year

U nrestrictedTemporarily

Restricted Total

5 71,071 S - $ 71,071

350,169 - 350,16965,088 - 65,088

2,642 - 2,642

- 54,240 54,240688,200 - 688.200

- 529,860 529,860

786,373 (786,373) -

1,963,543 (202,274) 1,761,269

1,976,479 - 1,976,479

220,598 - 220,598

2,197,077 - 2,197,077

(233,534) (202,274) (435,809)

475,965 266,530 742,495

S 242,431 S 64,256 $ 306,686

The accon panying notes are an ntegra I part of these financial statements.


STATEMENT OF CASH FLOWSFOR THE FISCAL YEAR ENDED JUNE 30, 2012

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Cash Flows from Operating Activities:Contributed Support Received:

Unrestricted supportRestricted support

Interest receivedCash Paid For:

Salaries and benefitsOperating expenses

Net Cash Provided by (Used for) Operating Activities

Cash Flows from Capital and Related Financing Activities:Purchase of property, plant, and equipment

Net Cash Provided by (Used for) Capital and Related Financing Activities

Cash Flows from lnvestiim Activities:Proceeds from sale of short—term investments

Net Cash Used in Investing Activities

Net Increase (Decrcasc) in Cash and Cash Equivalents

Cash - Beginning of year

Cash - End of year

Reconciliation of Increase in Net Assets toNet Cash Provided by Operating Activities:

Increase (Decrease) in net assets

Adjustments to reconcile increase (decrease)to net cash provided by operating activities:

Depreciation(Increase) decrease in grants receivable(Increase) decrease in other receivablesIncrease (decrease) in accounts payableIncrease (decrease) in accrued liabilitiesIncrease (decrease) in deferred revenue

Total Adjustments

Net Cash Provided by Operating Activities

S 1,174,528604,616

2,642

(868,288)(1,398,740)

(485,243)

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146,604146,604

(338,639)

in net assets

532,574

5 93,934

S (435,809)

3.593(40.3 14)

19(93.310)

19. 74 760.830

(49.435)

S (485,243)

CCCCCCCCCCCCCCCCCCThe accompanying notes are an integral part oftliese financial statements.

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HEALTH CARE CENTRAL GEORGIA, [NC.

MACON, GEORGIA

STATEMENT OF FUNCTIONAL EXPENSES

FOR TRE FISCAL YEAR ENDED JUNE 30, 2012

The accompanying notes are an integral part of these financial statements.

Program Supporting

Services Services Total

Personnel:ManagementSupportProgrammatic personnel expense

Bad DebtDepreciationConferences & staff educationInformation technologyMarketingProgrammatic meetings eNpenseProgrammatic expensesMiscellaneous indirect costsOffice suppliesDevelopmentPassthrough and reimbursement expenses

PostagePrinting & publicationsProfessional feesOccupancyTravel

Total Expenses

S 78,652 S - S 78,652

15,674 30,000 45,674

763,710 - 763,710

16,000 - 16.000

- 3,593 3,593

16,707 - 16,70717,724 - 17,724

- 5,000 5,00018,917 - 18,917

441.582 - 441.582

- 125,626 125,626

16,014 1,779 17,79361,066 18,309 79,375

379,980 - 379,9802,581 860 3,442

5,862 - 5,862

12,650 34,082 46,732

93,157 1,349 94,50636.20! - 36.201

S 1.976,479 S 220.598 $ 2.197,077

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NOTES TO THE FINANCIAL STATEMENTS

HEALTH CARE CENTRAL GEORGIA, INC

NOTES TO THE FINANCIAL STATEMENTS gJUNE3O,2012

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NOTE 1- SUMMARY OF SIGNIFICANT ACCOUNTING POLICIESC

Organization and Nature of Activities CHealth Care Central Georgia, Inc. (the “Organization”) is a nonprofit organization established in2001. The Organization is seeking innovative health solutions and providing compassionateadvocacy for people financially compromised by their medical needs, while reducing the burdenson local health providers. The mission is regional integration of whole person healthcare. Thevision is better health for all people through communities working together. Its stated purpose isto promote regional integration of whole person healthcare for the uninsured.

Basis of Accounting CQ

The financial statements of the Organization have been prepared on the accrual basis ofaccounting in accordance with generally accepted accounting principles.

CFinancial Statement Presentation cThe accompanying financial statements have been prepared in conformity with the disclosure and

display requirements of the Financial Accounting Standards Board (FASB) as set forth inStatement of Financial Accounting Standards No. 117, Financial Statements of Not-for-ProfitOrganizations, dated June 1993. Accordingly, net assets are reported in the following threeclasses: unrestricted net assets, temporarily restricted net assets, and permanently restricted netassets.

Net assets of the temporarily restricted class are created only by donor-imposed or contractrestrictions on their use. All other net assets, including board-designated or appropriated amounts,are legally unrestricted, and are reported as part of the unrestricted class.

CCash and Cash Eq ii ivalents ç

For purposes of the statements of cash flows. the Organization considers all highly liquidinvestments with an initial niaturitv of three months or less to he cash equivalents.

Certificates of Deposit CC

For the fiscal year ended June 30. 2012. investments consisted entirely of certificates of deposit. cIncome Taxes C

I lealth Care Central Georgia, Inc. is a nonprofit organization as described in Section 50I(c)(3) ofthe Internal Revenue Code and is exempt from federal and state income taxes.

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HEALTH CARE CENTRAL GEORGIA, INC.

NOTES TO THE FINANCIAL STATEMENTSJUNE 30, 2012(CONTINUED)

Property and Equipment

Property and equipment acquisitions are recorded at cost, estimated cost, or if donated, at fairmarket value on the date of donation. The organization defines capital equipment as items thatcost over $5,000 per unit and have a life expectancy of at least one year. Depreciation is providedover the estimated useful life of each class of depreciable assets and is computed using thestraight-line method.

Equipment 5 yearsSothvare 3 years

Revenue Recognition

Revenues are displayed in two broad categories. Earned revenues represent fees earned orrevenue generated through the performance or provision of services.

The Organization recognizes all contributed support received as income in the period received.Contributed support is reported as unrestricted or as restricted, depending upon the existence ofdonor stipulations that limit the use of’ the support. When a donor stipulated time restriction ends

or purpose restriction is accomplished, temporarily restricted net assets are reclassified tounrestricted net assets and reported in the statement of activity as net assets released fromrestrictions.

In-kind Support

The organization receives various types of’ in-kind support, including contributed services.

Contributed professional services are recognized if the services received (a) create or enhancelong-lived assets or (b) require specialized skills, are provided by individuals possessing thoseskills, and would typically need to be purchased if not provided by donation. Contributions oftangible assets are recognized at fair market value when received. Any amounts reflected as in-

kind support are offset by like amounts included in expenses. For the fiscal year ended June 30,

2012, no contributed professional services were reported, in accordance with these criteria. The

organization did not report any in-kind support for the fiscal year 2012.

Additionally, the Organization receives services donated by its members that do not meet the two

recognition criteria described above. Accordingly. the value ol’this contributed time has nor been

determined. and is not reflected in the accompanying financial statements.

Functional Allocation of Expenses

The costs of providing the various programs and other activities have been summarized on afunctional basis in the statement of activities. Accordingly, certain costs have been allocated

among the programs and supporting services benefited.

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Estimates C

The preparation of financial statements in conformity with generally accepted accounting

principles requires management to make estimates and assumptions that affect certain reported

amounts and disclosures. Accordingly, actual results could differ from those estimates.

Restricted and Unrestricted SupportC

Support that is restricted by the donor is reported as an increase in unrestricted net assets if the

restriction expires in the reporting period in which the support is recognized. All other donor

restricted support is reported as an increase in temporarily or permanently restricted net assets,

depending on the nature of the restriction. When a restriction expires (that is, when a stipulated

time restriction ends or a purpose restriction is accomplished), temporarily restricted net assets

are reclassified to unrestricted net assets and reported in the statement of activities as net assets

released From restrictions. C

NOTE 2—CASH AND DEPOSITSC

As of June 30, 2012. the carrying amount of the Organization’s deposits was $193,934 and the cbank balance was $269,909.

Accounts at an institution are insured by the Federal Deposit Insurance Corporation (FDIC) up to C$250,000. As of June 30, 2012, the Organization’s uninsured cash balances total 518,417.

NOTE 3-GRANTS RECEIVABLE (

Grants receivable represent funds earned For the period ending June 30, 2012, which have not

been received. All grants receivable are considered earned support and are expected to mature in

the next fiscal year. Based upon management estimates, no allowance For uncollectible

receivables has been provided.C

NOTE 4-TEMPORARILY RESTRICTED NET ASSETS

Temporarily restricted net assets consisted of the Following at June 30. 2012: CC

DC[l/FQHC $ 36.343

Georgia Cancer Coalition 24.677

Strong4l.ife 3,236

S 64.256Total tonparily rtricted net assets

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NOTE 5-PROPERTY AND EQUIPMENT

At June 30, 2012, property, equipment and related accumulated depreciation were as follows:

Computer software $ 558,128Machinery & equipment 94,907

Total property and equipment 653,035Less accumulated depreciation (644.025)

Net capital assets $

Depreciation expense

NOTE 6- CLAIMS AND LITIGATION

In the ordinary course olconducting business, the organization may become involved in lawsuits,

administrative and other proceedings. The organization’s attorney has advised that there are 110

known potential liabilities that will impair the organization’s financial position as of the date ofthis report.

NOTE 7-INCOME TAXES

The Organization is exempt from Federal income taxes under Section 501(c)(3) of the InternalRevenue Code, except on net income derived from unrelated business activities. For the yearended June 30, 2O2, the Organization is taking the position that all income is derived as a resultof its tax exempt purpose and there is no income derived Form unrelated business activities. As aresult, no tax liability has been recorded. The Organization believes that it has appropriatesupport for any tax positions taken, and as such, does not have any uncertain tax positions that arematerial to the financial statements.

NOTE S — EVALUATION OF SUBSEQUENT EVENTS

The Organization has evaluated subseqtieiit events through December 21, 2012. the date whichthe financial statements \ere available to be issued.

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GOVERNMENTAL REPORTS

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CLIoN, LIPFORD, HARDISON & PARKER, LLCJ. Russell Liptord, Jr.. CPA Member of

Mark 0. Hardison, CPA American institute of

Terry I. Parker, CPACertified Public Accountants

Christopher S. Edwards, CPA Truman W. Clifton (1902-1989)

Lviii, S. Hudson, CPAKevin E. Lipford, CPA

REPORT ON INTERNAL CONTROL OVER FINANCIAL REPORTINGAND ON COMPLIANCE AND OTHER MATTERS BASED ON AN AUDITOF FINANCIAL STATEMENTS PERFORMED IN ACCORDANCE WITH

GOVERNMENTA UDITING STANDARDS

Board of DirectorsHealth Care Central Georgia, Inc.Macon, Georgia

We have audited the financial statements of Health Care Central Georgia, Inc. (a non-profitorganization) as of and for the fiscal year ended June 30, 20 12, and have issued our report thereondated December 21, 2012. We conducted our audit in accordance with auditing standards generallyaccepted in tile United States of America and the standards applicable to financial audits containedin Government Auditing &andards, issued by the Comptroller General of the United States.

Internal Control Over Financial Reporting

In planning and performing our audit, we considered Health Care Central Georgia, Inc.’s intemalcontrol over financial reporting as a basis for designing our auditing procedures for the purpose of’expressing our opinion on the financial statements, but not for the purpose of expressing an opinionon the effectiveness of Health Care Central Georgia’s internal control over financial reporting.Accordingly, we do not express an opinion on the effectiveness of i-lealth Care Central Georgia’sinternal control over financial reporting.

A deficiency in internal control exists when the design or operation of a control does not allowmanagement or employees, in the normal course of performing their assigned functions, to prevent,or detect and correct misstatements on a timely basis. A material i;’eakness is a deficiency, orcombination of deficiencies, in internal control such that there is a reasonable possibility that amaterial misstatement of the entitys financial statements will not he prevented, or detected andcorrected on a timely basis.

Our consideration of the internal control over financial reporting was for the limited purposedescribed in the first paragraph of this section and was not designed to identi all deficiencies ininternal control over financial reporting that might be deficiencies, significant deficiencies, ormaterial weaknesses. We did not identify any deficiencies in internal control over financialreporting that we consider to be material weakne.ses. as defined above.

101503 Bass Road 468 South Houston Lake Rood

PC. Box 6315 Macon, Georgia 31208-6315 www.clhp.com Worner Robins, Georgia 31088

Phone 478-742-3313 ‘ Fax 478-742-0316 Phone 478-953-0125 • Fox 478-953-0983

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Board of DirectorsHealth Care Central Georgia, Inc.Page Two

Compliance and Other Matters

As part of obtaining reasonable assurance about whether Health Care Central Georgia, Inc.’sfinancial statements are free of material misstatement, we performed tests of its compliance withcertain provisions of laws, regulations, contracts and grant agreements, noncompliance with whichcould have a direct and material effect on the determination of financial statement amounts.However, providing an opinion on compliance with those provisions was not an objective of ouraudit, and accordingly, we do not express such an opinion. The results of our tests disclosed noinstances of noncompliance or other matters that are required to be reported under GovernmentA ziditing Standards.

We noted certain matters that we reported to management of Health Care Central Georgia, Inc. in aseparate letter dated December 21, 2012.

This report is intended solely for the information and use of the audit committee, management, andthe Board of Directors of Health Care Central Georgia, Inc. and is not intendedbe used by anyone other than these specified parties.

December 2 I, 201 2

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CLIoN, LIPFORD, HARDISON & PAR1R, LLCJ. Russell Llpford, Jr. CPA Member ofMark 0. Hardison, CPA American Institute of

Teiry I. Parker, CPACerill led Public Acccuntants

Chdstopher S. Edwards, CPA Truman W. Clifton (1902-1989)

Lynn S. Hudson, CPAKevin E, Llpford. CPA

December21, 20)2

Audit CommitteeF-Iealtli Care Central Georgia, Inc.Macon. Georgia

\Ve have audited the financial statements of Health Care Central Georgia. Inc. for the fiscal yearended June 30, 2012 and have issued our report thereon dated December 21, 2012. Professional

standards require that provide you with information about our responsibilities tinder generallyaccepted ailditing standards and Govenunent Auditing Stc,nclcn-ds as well as certain infbrmationrelated to the planned scope and timing of our audit. We have communicated such informationn our letter to you dated June 5. 2012. Professional standards also require that we communicate

to you the [bllowing information related to our audit.

Sian i ficant Audit Findi n as

Qualitative Aspects of Accounting Practices

Management is responsible for the selection and use of appropriate accounting policies. Thesigni uicant accounting policies tised by Health Care of Central Georgia. Inc. are described in\ote I to the financial statements. No new accounting policies were adopted and the applicationof existing policies was not changed during the current fiscal year. We noted no transactionsentered into by the Organization during the year for which there is a lack of authoritativeguidance or consensus. All signiFicant transactions have been recognized in the financialstatements iii the proper period.

Accounting estimates are an integral part of the Financial statements prepared by nlanageilieiltand arc based on nianageinenCs knowledge and experience about past and cul-rent events andass ii I1 Pt 0 nsa ho Lit flit tre eve Its - Certain accou nfl ng C st mates are part ic a I a rly sensitive becauseof their significance to the financial statements and because of the possi hi I tv thai future eventsaffecting them may differ significantly From those expected. The most sensitive estimatesaffecting the financial statements were:

Management’s estimate of the allowance for grants receivable is based on historical grantrevenues, historical loss levels, and an analysis of the collectability of individual grants.Managements estiniate of the allocation of expenses is based on time and space utilized forprogram versus administrative functions. We evaluated the key factors and assuniptionsused to develop the estimates in determining that they are reasonable in relation to thefinancial statements taken as a whole.

1503 Bass Road 468 South Houston Lake RoadP.O. Box 6315 Macon, GeorgIa 31208-6315 wwwclhp.com Warner Robins, GeorgIa 31088

Phone 478-742-3313 1 Fax 478-742-0316 Phone 478-953-0125 • Fax 478-953-0983

Health Care Central Georgia, Inc.December 21, 2012Page 2

Difficulties Encountered in Performing the Audit

We encountered no significant difficulties in dealing with management in performing andcompleting our audit.

Corrected and Uncorrected Misstatements

Professional standards require us to accumulate all known and likely misstatements dentihedduring the audit, other than those that are trivial, and communicate them to the appropriate levelof management. Management has corrected all such misstatements.

Disa2reements with Management

For purposes of this communication, professional standards define a disagreement withmanagement as a financial, reporting, or auditing matter, whether or not resolved to oursatisfaction, that could be significant to the financial statements or the auditor’s report. We arepleased to report that no stick disagreements arose during the course of our audit.

Management Representations

We have requested certain representations from management that are included in themanagement representation letter dated December 21, 2012.

Management Consultations with Other Independent Accountants

In sonic cases, management nay decide to consult with other accountants about auditing andaccounting matters, similar to obtaining a “second opinion” on certain situations. If aconsultation involves application of an accounting principle to the Organization’s financialstatements or a deternunation of the type of auditor’s opinion that may be expressed on thosestatements, our professional standards require the consulting accountant to check with us todetermine that the consultant has all the relevant fhcts. To our knowledge, other than the servicesprovided by’ Charles Hall. CPA, there were no other consultations with other accountants.

Other Atidit Findings or Issues

We generally discuss a variety of matters, including the application of accounting principles andauditing standards, with management each year prior to retention as the organization’s auditors.However, these discussions occurred in the normal course of our professional relationship andour responses were not a condition to our retention.


Oilier Inflirnurlion

Financial Condition

For the fiscal year ended June 30, 2012, the organization reflects unrestricted net assets of$242,431 and temporarily restricted net assets of $64,256. Current assets total $38 1,570consisting primarily of cash, certificates oF deposit and receivables. Current liabilities total$83,894. consisting primarily of deferred revenue totaling $60,830. Net assets declinedsubstantially in 2012 and budgets should be monitored closely in fiscal year 2013 to insureagainst continuing declines.

Expense Allocation

During our audit, it was noted that the organization did not tise a consistent basis for allocatinggeneral and administrative expenses. Additionally, when these expenses were allocated, theallocation was based on an estimated percentage rather than a basis that more accuratelyrepresented the true cost allocations. Employee time sheets or effort reports (acttial or estimated)arc txpically used to Facilitate the allocation of expenses to each finctional area. Theorganization should establish a formal methodology’ to record the general and administrativeexpenses into a separate functional area and, on a periodic basis, those expenses be allocatedbased on a percentage of staff time. A formal expense allocation method would effectivelyallocate overhead to the various programs and proj ects in a more reasonable manner that Followsthe labor effort.

Federal Award Programs

During fiscal year 2012. the organization recorded the activity of the federal grant programwithin the same department as non—Federal programs. The activity of the federal grant programshould be recorded in a separate department, with no other activity recorded to this program.This will allow the organization to properly track the activity oF the federal grant program andhelp determi ic iFa Single Atidit would be necessary.

Pay roll Reconciliation

During fiscal year 2012, the organization began recorded both salary and non—salary nctivitywithin the same general ledger accounts. The salary expense should be recorded into separateaccount with no other activity posted to these accounts. This will allow the organization toproperly reconcile their payroll activity to the general ledger.

We appreciate the cooperation and assistance provided to us during the audit. IF you have anyquestions or need any additional information concerning these matters, please contact us.


This infomiation is intended solely for the use of the board of directors and management ofHealth Care Central Georgia, Inc. and is not intended to be and should not be used by anyoneother than these specified parties.

Sincerely,

.LC.CLIFTON, LIPEORD. I-IA

Jr., CPA

For the 2011 calendar year, or tax year beginning

_______________________ __________

Check if opptcable: C

IAddress change

____________________

Name change

Initial return

Terminated

Amended return

ApplLcation pending F Name and address ot principal officer

SANE AS C ABOVETax-exempt status f5] 501 (c)(3) 501(c)Website: WWW. CHWG. ORG

_______________

- H(c) Group exemption number

K Form of organization: Corporation [] Trust F] Association Other fL Year of Formation: 2001 _JM state of legal domicile:

IParti Summary -

______________

1 Briefly describe the organization’s mission or most significant activities: THE MISSION OF HEALTH CARE CENTRALEQRI_WLB]ONMUN,ITY HEALTh WORI(S1.1S_TQ.mPEQVEThEHE&LTa DE_ALIJ_ENThPIL

- ZI?BE DRAM IA]?IQN WQRi(S _TO_ TILES _QOAL JN _TBE _AREAS QE YRE,VflTIDN AND - - - -

icELES._DISEAEMNAGNENI,_A1D_THE_INPROVEMEN_QE HEALTECARE DELIVERL2 Check this box — H if the organization discontinued its operations or disposed of more than 25% of its net assets.3 Number of voting members of the governing body (Part VI, line la)4 Number of independent voting members of the governing body (Part VI, line lb) 45 Total number of individuals employed in calendar year 2011 (Part V, line 2a) 276 Total number of volunteers (estimate if necessary) 6 1 25

< 7a Total unrelated business revenue from Part VIII, column (C), line 12 7ab Net unrelated business taxable income from Form 990-T, line 34 7b

8 Contributions and grants (Part VIII, line lh)

___________________ __________________

9 Program service revenue (Part VIII, line 2g)10 Investment income (Part VIII, column (A), lines 3,4, and 7d)

___________________ ____________________

11 Other revenue (Part VIII, column (A), lines 5, Gd, Sc, 9c, bc, and lie)

___________________ ____________________

— 12 Total revenue — add lines 8 through 11 (must equal Part VIII, column (A). line 12)13 Grants and similar amounts paid (Part IX, column (A), lines 1-3)14 Benefits paid to or for members (Part IX, column (A), line 4)

___________________ ____________________

15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)

___________________ ____________________

16a Professional fundraising fees (Part IX, column (A), line lie)

b Total fundraising expenses (Part IX, column (D), line 25)

_______________________

17 Other expenses (Part IX, column (A), lines ha-lid, llf-24e)

_________ __________

18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25)19 Revenue less expenses. Subtract line 18 from line 12

20 Total assets (Part X, line 16)

___________________ ____________________

21 Total liabilities (Part X, line 26)

___________________ ____________________

22 Net assets or fund balances. Subtract line 21 from line 20rPkt ii I Siqnature Blockunder penalties of penury, I declare that I have examined this return, including accorelpanvino schedules and statements, and to the best of my knowledge and belief, it is true, correct, andcompleie. ueclarat,on of preparer (other than otlicer) is based on all information of which meparer has any knowledge.

fr ISign signature of officer Date

Here FRED AL4MONS PRESIDENT & CEOType or print name and title.

Print/Type preparer’s name Preparer’s signature ‘ Date check H ifPTIN

Paid J. RUSSELL LIPFORD, JR. self-employed P00172758

Preparer Firms name CLIFTON LIPFORD HARDISON & PARKER L.L.C.Use Only Firm’s address 1503 BASS RD Firm’s EIN 58—2253342

MACON, GA 31210—7511 Phone no. (478) 742—3313May the IRS discuss this return with the preparer shown above? (see instructions) Yes No

Form 990

Department of the TreasuryInternal Revenue Service

Return of Organization Exempt From Income TaxUnder section 501(c), 527, or4947(a)(1) of the Internal Revenue Code

(except black lung benefit trust or private foundation)

The organization may have to use a copy of this return to satisfy state reporting requirements.

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0MB No. 1545-0047

2011

HEALTH CARE CENTRAL GEORGIA, INCDBA COMMUNITY HEALTH WORKS300 MULBERRY STREET #603MACON, GA 31201

Open to PublicInspection

.2011, and ending 6/30 2012D Employer Identification Number

58 —2 624455E Telephone number

478 254—5200

) (insert no.) F]4947(a)(1)or [‘1527

G Gross receipts $ 1,761,269.I 1-1(a) Is this a group return for affiliates? F]

H(b) Are all affiliates included? F] y j No

-l If ‘No,’ attach a list, (see instructions)

a,SCenV

PrIor Year1, 838, 181 -

0.0.

Current Year1,408, 459.

469,336. 350,169.7,474. 2,641.

37, 623.

_______________

0V

CV0.

II

II

2,352,614.64, 178.

1,761,269.85,822.

826,427. 888,036.

1,329,725.2;220, 330.

132, 284.

1,223,219.2,197,077.

Beginning of Current Year—435,808.

End of Year839,122. 390,580.96,627. 83,893.

742.495. _Q6,

BAA For Paperwork Reduction Act Notice, see the separate instructions. ‘rEEAoI 13L 08/18111 Form 990 (2011)

Form99O(2011) HEALTH CARE CENTRAL GEORGIA, INC. 58-2624455 Page2

I Part III Statement of Program Service Accomplishments-— Check if Schedule 0 contains a response to,y question in this Part IlL r1

1 Briefly describe the organization’s mission:

SEE SCHEDULE 0

2 Did the organization undertake any significant program services during the year which were not listed on the prior

Form 990 or 990•EZ’ Yes No

If ‘Yes,’ describe these new services on Schedule 0.3 Did the organization cease conducting, or make significant changes in how it conducts, any program services7 Yes No

If ‘Yes,’ describe these changes on Schedule 0.4 Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses.

Section 501(c)(3) and 501(c)(4) organizations and seclion 4947(a)(1) trusts are required to report the amount of grants and allocations toothers, the total expenses, and revenue, if any, for each program service reported,

4a (Code: — ) (Expenses $ 690, 914. including grants of $

________

) (Revenue $

___________

THE ORGANIZATION HAS IMPLEMENTED COMMUNITY BASED CANCER CONTROL PROGRAMS INCLUDINGPROGRAMS TO IMPROVE ACCESS TO SCREENINGS, PATIENT NAVIGATION SERVICES, COMMUNITYEDUCATIONAL AWARENESS CAMPAIGNS, AND OTHER ACTIVITIES SURROUND LUNG CANCER, -- —

COLORECTAL CANCER, BREAST CANCER, PROSTATE CANCER, CERVICAL CANCER, SKIN CANCER, ANDOTHER FORMS OF CANCER.

4b (Code: (Expenses $ 473,432. including grants of$__________________ ) (Revenue $ 77,022.

THE ORGANIZATION HAS IMPLEMENTED PROGRAMS TO INCREASE THE UTILIZATION OF HEALTHINFORMATION TECHNOLOGY (HIT) BY THE MEDICAL COMMUNITY AND TO HELP HEAIJTHCARE -

PROVIDERS TO BETTER UTILIZE HIT TO PROVIDE EFFICIENT, EVIDENCE BASED HEALTHCARESERVICES. THESE INITIATIVES ARE INTENDED TO IMPROVE THE QUALITY OF HEALTHCAREDELIVERY IN THE ORGANIZATION’S REGION.

4c (Code: ,) (Expenses $ .!zi?r including grants of $ 8S822. ) (Revenue $ 215, 125.THE ORGANIZATION HAS IMPLEMENTED SEVERAL PROGRAMS TO INCREASE PREVENTIVE ACTIVITIESAND IMPROVE WELLNESS IN OUR COMMUNITY. THESE ACTIVITIES INCLUDE PROGRAMS TO COMBATCHILDEOD OBESITY1 INCREASE ACCESS TO HEALTHY FO AND BUILD COMMUNITY -

COLLABORATION AROUND IMPROVING THE HEALTH OF CENTRAL GEORGIA.

4d Other program services. (Describe in Schedule 0,) SEE SCHEDULE 0(Expenses $ 344,005. including grants of_ - $ ) (Revenue $ 58,022.

4e Total program service expenses 1, 976, 479.BAA TEEAO1O2L 07/05/11 Form 990 (2011)

Form 990 (2011) HEALTH CARE CENTRAL GEORGIA, INC. 58—2624455 Page 3

P Part IV I Checklist of Required Schedules -

Yes No

1 Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If ‘Yes,’ completeSchedule A 1

2 Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)’ 2 X

3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidatesfor public office? If ‘Yes,’ compfete Schedule C, Part I X

4 Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) electionin effect during the tax year? If ‘Yes,’complete Schedule C, Part II 4 X

5 Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,assessments, or similar amounts as defined in Revenue Procedure 98-19? If ‘Yes,’complete Schedule C, Part Ill 5 X

6 Did the, organization maintain any donor advised funds or any similar funds or accounts for which donors have the rightto provide advice on the distribution or investment of amounts in such funds or accounts? If ‘Yes,’ complete Schedule 0,Partl 6 X

7 Did the organization receive or hold a conservation easement, including easements to preserve open space, theenvironment, historic land areas or historic structures? If ‘Yes,’ complete ScheduleD, Part II 7 X

8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If ‘Yes,’complete Schedule D, Part III 8 X -

9 Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X;or provide credit counseling, debt management, credit repair, or debt negotiation services? If ‘Yes,’ completeSchedule D, Part IV 9 X

10 Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments,permanent endowments, or quasi-endowments? If ‘Yes,’ complete Schedule D, Part V 10 X

11 If the organization’s answer to any of the following questions is ‘Yes’, then complete Schedule D, Parts VI, VII, VIII, IX,or X as applicable.

a Did the organization report an amount for land, buildings and equipment in Part X, line 10? If ‘Yes,’ complete ScheduleD, Part VI ha X

b Did the organization report an amount for investments— other securities in Part X, line 12 that is 5% or more of its totalassets reported in Part X, line 16? If ‘Yes,’ complete ScheduleD, Part VII 11 b X

c Did the organization report an amount for investments— program related in Part X, line 13 that is 5% or more of its totalassets reported in Part X, line 16? If ‘Yes,’ complete ScheduleD, Part VIII 11 c X

d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reportedin Part X, line 16? If ‘Yes,’ complete ScheduleD, Part IX lid X

e Did the organization report an amount for other liabilities in Part X, line 25? If ‘Yes,’ complete ScheduleD, PartX lie, , X

f Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addressesthe organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If ‘Yes,’ complete ScheduleD, Part X lit -— X

12a Did the organization obtain separate, independent audited financial statements for the tax year? If ‘Yes,’ completeSchedule D, Parts XI, XII, and XIII i2a X

b Was the organization included in consolidated, independent audited financial statements for the tax year? If ‘Yes,’ andif the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional 12b X

13 Is the organization a school described in section 170(b)(1)(A)(ii)? If ‘Yes,’ complete Schedule E 13 X14a Did the organization maintain an office, employees, or agents outside of the United States’ i4a X

b Did the orQanization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising,business, investment, and program service activities outside the United States, or aggregate foreign investments valuedat $100,000 or more? If ‘Yes,’ complete Schedule F, Parts land IV 14b X

15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organizationor entity located outside the United States? If ‘Yes,’ complete Schedule F, Parts II and IV 15 X

16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance toindividuals located outside the United States? If ‘Yes,’ complete Schedule F, Parts III and IV 16 — X

17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,column (A), lines 6 and lie? If ‘Yes,’ complete Schedule G, Part I (see instructions) 17 X

18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII,lines Ic and 8a? If ‘Yes,’ complete Schedule C, Pad II 18 - X

19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If ‘Yes,’complete Schedule C, Part III 19 X

20 aDid the organization operate one or more hospital facilities? If ‘Yes,’ complete Schedule H 20 Xb If ‘Yes’ to line 20a, did the organization attach a copy of its audited financial statements to this return?.,..,..,.,,.,,, 2Db

BAA IEEAO103L 01123/12 Form 990 (2011)

FormS9O(2011) HEALTH CARE CENTRAL GEORGIA, INC. 58-2624455 Page4

I Part IV I Checklist of Required Schedules (continued)

______

., - —

Yes No

21 Did the organization report more than $5,000 of grants and other assistance to governments and organizations in theUnited States on Part IX, column (A), line 1? If Yes,’complete Schedule I, Parts land II 21 X

22 Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on PartIX, column (A), line 2? If ‘Yes,’ complete Schedule I, Parts land III 22 X

23 Did the organization answer ‘Yes’ to Part VII, Section A, line 3,4, or 5 about compensation of the organization’s currentand former officers, directors, trustees, key employees, and highest compensated employees? If ‘Yes,’ completeSchedule J 23 X

24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as ofthe last day of the year, and that was issued after December 31, 2002? If ‘Yes,’ answer lines 24b through 24d andcomplete Schedule K. If ‘No, ‘go to line 25 24a X

b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception’ 24b

c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defeaseany tax-exempt bonds’ 24c

d Did the organization act as an ‘on behalf of’ issuer for bonds outstanding at any time during the year’ 24d

25a Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with adisqualified person during the year? If ‘Yes,’ complete Schedule L, Part I....,,,,.,,,,,,,,,,,,,,,,.,,,,,,,,,,,.,,.. 25a

b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, andthat the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If ‘Yes,’ completeSchedule L, Part I 25b X

26 Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, ordisqualified person outstanding as of the end of the organization’s tax year? If ‘Yes,’complete Schedule L, Pad II

________

27 Did the organization provide a grantor other assistance to an officer, director, trustee, key employee, substantialcontributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family memberof any of these persons? If ‘Yes,’ complete Schedule L, Part III

28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IVinstructions for applicable filing thresholds, conditions, and exceptions):

a A current or former officer, director, trustee, or key employee? If ‘Yes,’ complete Schedule 1.. Part IV

b A family member of a current or former officer, director, trustee, or key employee? If ‘Yes,’ completeSchedule L, Part IV

cAn entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was anofficer, director, trustee, or direct or indirect owner? If ‘Yes,’ complete Schedule L, Part IV

29 Did the organization receive more than $25,000 in non-cash contributions? If ‘Yes,’ complete Schedule M

30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservationcontributions? If ‘Yes,’ complete Schedule M

31 Did the organization liquidate, terminate, or dissolve and cease operations? If ‘Yes.’ complete Schedule N, Part I....,.

32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If ‘Yes,’ completeSchedule N, Pad It

33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations secttons301.7701-2 and 301.7701 -3? If ‘Yes,’ complete ScheduleR, Pad I

34 Was the organization related to any tax-exempt or taxable entity? If ‘Yes,’ complete Schedule P. Parts II, III, IV, and V,line? 34 IX

35a Did the organization have a controlled entity within the meaning of section 512(b)(13)’ 35a — X

b Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaningof section 512(b)(13)? If ‘Yes,’ complete ScheduleR, Pad V. line 2 X

36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable relatedorganization? If ‘Yes,’ complete Schedule R, Part V, line 2 ,,,, X

37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that istreated as a partnership for federal income tax purposes? If ‘Yes,’ complete Schedule R, Part VI 1L —

38 Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11 and 19?Note. All Form 990 filers are required to complete Schedule 0 I 38 X

BAA Form99O(2011)

26 X

.33 K

1’EEAO1O4L 07/05111

Form99O(2011) HEALTH CARE CENTRAL GEORGIA, INC 58-2624455Wan Vi Statements Regarding Other IRS Filings and Tax Compliance

Check if Schedule 0 contains a response to any question in this Part V

1 a Enter the number reported in Box 3 of Form 1096, Enter -0- if not applicable 1 a!I, Enter the number of Forms W-2G included in line la. Enter .0. if not applicable ib! 0

2a 27

c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming(gambling) winnings to prize winners7

2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return

________________________

b If at least one is reported on line 2a, did the organization file all required federal employment tax returns7Note. If the sum of lines 1 a and 2a is greater than 250, you may be required to e-file. (see instructions)

3a Did the organization have unrelated business gross income of $1,000 or more during the year7b If ‘Yes’ has it filed a Form 990-T for this year? If ‘No, provide an explanation in Schedule 0 3b

4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, afinancial account in a foreign country (such as a bank account, securities account, or other financial account)7

b If ‘Yes,’ enter the name of the foreign country:

_________

See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.

5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year’b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction7

c If ‘Yes,’ to line 5a or Sb, did the organization file Form 8886-T?.

6a Does the organizatien have annual gross receipts that are normally greater than $100,000, and did the organizationsolicit any contributions that were not tax deductible7

b If ‘Yes,’ did the organization include with every solicitation an express statement that such contributions or gifts werenot tax deductible7

7 Organizations that may receive deductible contributions under section 170(c).

a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods andservices provided to the payor7

b If ‘Yes,’ did the organization notify the donor of the value of the goods or services provided7c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file

Form 8282’d If ‘Yes,’ indicate the number of Forms 8282 filed during the year 7d!e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract’

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract7

g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899as required’

h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file aForm 1098•C’

B Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did thesupporting organization, or a donor advised fund maintained by a sponsoring organization, have excess businessholdings at any time during the year’

9 Sponsoring organizations maintaining donor advised funds.

a Did the organization make any taxable distributions under section 4966’

b Did the organization make a distribution to a donor, donor advisor, or related person’10 Section 501(c)Q) organizations. Enter:

a Initiation fees and capital contributions included on Part VIII, line 12 ba,

b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

11 Section 501(c)(12) organizations. Enter:

a Gross income from members or shareholders

b Gross income from other sources (Do not net amounts due or paid to other sourcesagainst amounts due or received from them.) iij

12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041

b If ‘Yes,’ enter the amount of tax-exempt interest received or accrued during the year

- —

13 Section 501(c)(29) qualified nonprofit health insurance issuers.a Is the organization licensed to issue qualified health plans in more than one state7

Note. See the instructions for additional information the organization must report on Schedule 0.

b Enter the amount of reserves the organization is required to maintain by the states inwhich the organization is licensed to issue qualified health plans 13b

c Enter the amount of reserves on hand 13c

14a Did the organization receive any payments for indoor tanning services during the tax year’b If ‘Yes,’ has it filed a Form 720 to report these payments? If ‘No,’ provide an explanation in Schedule 0

Page 5

14

=-L1Yes No

ic X

x2b

Sa x

xa

x

x

5a

SbSc

6a

Sb

1W7a

7b

_________

7c

S

ax

x1xx

le

7f

7hr

8

9a

9b

12a

13a

14a14b

x

BAA TEEAO1O5L 07/05/fl Form 990 (2011)


Part VI I Governance, Management and Disclosure For each ‘Yes’ response to lines 2 through 7b below, and fora ‘No’ response to line Ba, 8b, or lOb below, describe the circumstances, processes, or changes inSchedule 0. See instructions.Check if Schedule 0 contains a response to any question in this Part VI [xl

Section A. Governing Body and Management

1 a Enter the number of voting members of the governing body at the end of the tax yearIf there are material differences in voting rights among membersof the governing body, or if the governing body delegated broadauthority to an executive committee or similar committee, explain in ScheduleD.

b Enter the number of voting members included in line la above, who are independent

2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any otherofficer, director, trustee or key employee7

3 Did the organization delegate control over management duties customarily performed by or under the direct supervisionof officers, directors or trustees, or key employees to a management company or other person7

4 Did the organization make any significant changes to its governing documentssince the prior Form 990 was filed7

5 Did the organization become aware during the year of a significant diversion of the organization’s assets76 Did the organization have members or stockholders7

7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or moremembers of the governing body7

b Are any governance decisions of the organization reserved to (or subject to approval by) members,stockholders, or other persons other than the governing body7

B Did the organization contemporaneously document the meetings held or written actions undertaken during the year bythe following:

a The governing body’b Each committee with authority to act on behalf of the governing body7

9 Is there any officer, director or trustee, or key employee listed in Part VII, Section A, who cannot be reached at theorganization’s mailing address? If ‘Yes,’ provide the names and addresses in Schedule 0 — —

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

lOa Did the organization have local chapters, branches, or affiliates?..................,...,.,,,,,..,,.,,,.,,.,,,,,.

______

I, If ‘Yes,’ did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure theiroperations are consistent with the organization’s exemptpurposes2.....................................................,..,..,..,.

11 a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form7,...,,,..,.,,..,.,,....b Describe in Schedule 0 the process, if any, used by the organization to review this Form 990. SEE SCHEDULE 0

12a Did the organization have a written conflict of interest policy? If ‘No,’go to line 13..........................,..,.,,..,.b Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise

to

c Did the organization regularly and consistently monitor and enforce compliance with the policy? If ‘Yes,’ describe inSchedule Ohowthis is done...... SEE. SCHEDULE. C

13 Did the organization have a written whistleblower policy714 Did the organization have a written document retention and destruction policyZ.......................................

15 Did the process for determining compensation of the following persons include a review and approval by independentpersons, comparability data, and contemporaneous substantiation of the deliberation and decision?

a The organization’s CEO, Executive Director, or top management official,.. SEE. SCHEDULE .0

_________

b Other officers of key employees of the organization. , , SEE , SCHEDULE. .0........................................

__________

If ‘Yes’ to line 15a or 15b, describe the process in Schedule 0. (See instructions.)

16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with ataxable entity during the year’

b If ‘Yes,’ did the organization follow a written policy or procedure requiring the organization to evaluate itsparticipation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard theorganization’s exempt status with respect to such arrangements’ — —

Section C. Disclosure17 List the states with which a copy of this Form 990 is required to be filed GA18 Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (5D1(c)(3)s only) available for public

inspection. Indicate how you make these available. Check all that apply.Own website Another’s website Upon request

19 Describe in Schedule 0 whether (and if so, how) the organization makes its governing documents, conflict of interest policy, and financial statements available totbepublicduringthetaxyear. SEE SCHEDULE 0

20 State the name, physical address, and telephone number of the person who possesses the books and records of the organization:•FRED ANMONS 300 MULBERRY STREET STE 603 MACON GA 31201 478-254-5200

BAA TEEAO1O6L 01/23/12 Form 990 (2011)

1 19

lb

Yes No

18

2

3

456

7a

x

x

xxx

x

jx

x

7b

8aSb

x

9

Yes No

ba

______

X

lob11 a

12a X

12b X

12c

1314

xxx

15a Xl5b X

16a

a1Gb

x

I—a

Form 990 (2011) HEALTH CARE CENTRAL GEORGIA, INC. 58-262 4455

I Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, andIndependent ContractorsCheck if Schedule 0 contains a response to any question in this Part VII Fl

Section A. Officers. Directors, Trustees, Key Employees, and Hicihest Compensated Employees1 a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the

organization’s tax year.• List all of the organization’s current officers directors, trustees (whether individuals or organizations), regardless of amount of

compensation. Enter -0- in columns (D), (E), and (F’) if no compensation was paid.• List all of the organization’s current key employees, if any. See instructions for definition of ‘key employee.’• List the organization’s five current highest compensated employees (other than an officer, director, trustee, or key employee) who

received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and anyrelated organizations.

• List all of the organization’s former officers, key employees, and highest compensated employees who received more than $100000 ofreportable compensation from the organization and any related organizations.

• List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of theorganization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensatedemployees; and former such persons.

Fl Check this box if neither the organizatior nor any related organization compensated any current officer, director, or trustee.(C)

PosLtiarr(A) (B) (do not check more than one boe, (0) (E) (F)

Name and title Average uniess person is both an officer Raportabie Raportabie Estimafedhours and a director/trustee) compensation from compensation horn amount of other

per week -. — — —— the organization reiated organizations compensation

(describe s C C” gr çN-2/1099-MISC CN-2/1o99MIsc) from thehours for

.g, i° — organization

related 5 2 a 5 and reiatedOrganza. a — . — organizationstronsin — o —

schedule . . j0)

O

QL cMy_?4?TLN -

BOARD MEMBER 0.5 X 0. 0. 0.JgDONFAULK -

BOARD MEMBER 1.5 XX 0. 0. 0.)FREDGATON -

CHAIRI4AN 2 XX 0. 0. 0.ç4) gICHQ KATZ

-

SECRETARY 0.5 XX 0. 0. 0.TQ.M.. MCMICHAELTREASURER 2 XX 0. 0. 0.

BOARD MEMBER 3 X 0. 0. 0.

- Ø KATHERINE MCLEODBOARD MEMBER 1 X 0. 0. 0.

(ç) ETHEL CULL INANBOARD MEMBER 2 X 0. 0. 0.

. 2 IikNQN HPYPYBOARD MEMBER 0.5 X 0. 0. 0.

jiG) NANCY PEEDBOARD MEMBER 0.5 X 0. 0. 0.

jii) IVAN ALLENBOARD MEMBER 1 X 0. 0. 0.

(12) FRED A&4MONSCEO 60 XX 61,518. 0. 0.

(13) MELVIN WALKERBOARD MEMBER 1 X 0. 0.! 0.

(14) BILL BINABOARD MEMBER 1 X 0. 0. 0.

Page 7

BAA TEEAOIO7L 07/06/11 Form 990 (2011)


Part VII I Section A. Officers, Directors, and Highest Compensated Employees (cone(C)

Position(A) (B) (do not check more than one (D) (E) (F)

Name and title Average box, unless person is both an Reportable Reportable Estimatedhours officer arid a director/trustee) compensation from compensation from amount of otherper the organization related organizations compensation

week 51 5’ 0 ‘ I i (W.2/1099’MLSC) (W.2/1Og-MI5c) from the(describ p. g ‘a. — organization

a — —I E in ID andretatedhours 0. . organizations

0 — ° 0

related iorgani- eJ ? azations

schO) i

os JAMES SINGLETONBOARD MEMBER 1.5 X 0. 0. 0.

(16) KAY FLOYDBOARD MEMBER 0.5 X 0. 0. 0.

(17) SAM HART I -

BOARD MEMBER 1 X o.! 0. o.p MILTON SAMPSON —

BOARDMEMBER 1 X —— 0. 0. 0.

cffiZZffi&LBOARD MEMBER 1 X 0. o.I 0.

,(20j GGDENTFORMER CEO 40 X 118,790. 0. 0.

{2J)

ç2g)

(23)

{2)

2)

lbSub4otal ,E’E 180,308. 0. 0.

c Total from continuation sheets to Part VII, Section A ‘a 0. 0

dTotal(addlineslbandlc) ‘a 180,308., 0. 0.

2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation

from the organization ‘a 1Yes I No

3 Did the organization list any former officer, director or trustee, key employee, or highest compensated employeeon line Ia? If ‘Yes, ‘compleCe Schedule J for such individual 3 X

4 For any individual listed on line la, is the sum of reportable compensation and other compensation from Lthe organization and related organizations greater than $150,000? If Yes’ complete Schedule J for ‘ -

such individual L X5 Did any person listed on line la receive or accrue compensation from any unrelated organization or indivtdual

for services rendered to the organization? If ‘Yes,’ complete Schedule J for such person 5 I X

Section B. Independent Contractors

________________ _____

1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of— compensation from the organization. RjpQ compensation for the calendar year ending with or within the organization’s taxyL

(A) (B) (C)Name and bus;ness address Description of services — Compensation

-- :-- 3* -. 4____. z2 Total number of independent contractors (including but not limited to those listed above) who received more than

$100,000 in compensation from the organization 0

BAA TEEA0I0SL ol/oEfll Form 990 (2011)

FormS9O(2011) HEALTH CARE CENTRAL GEORGIA, INC. 58-2624455 Page9I Part VIII I Statement of Revenue

______ ____

fl (A) (B) (C) (D)-, Total revenue Related or Unrelated Revenue

exempt business excluded from taxfunction revenue under sectionsrevenue 512, 513, or 514

1 a Federated campaigns 1 ab Membership dues lbc Fundraising events 1 c

= d Related organizations 1 d“5,c e Government grants (contributions). . . . 1 e

I All other contributions, gifts, grants, andsimilar amounts not included above... 1 I 1,408,459.

g Nonoash contributions included in Ins 1 alt: $

______________________

.

3< h Total. Add lines la-li 1,408,459. .

Business Code — — —

2a CONTRACT REVENUE 900020 350,169. 350,169.= I, I_____________________________

[ I______________________________d I___________________________________________________________C I II All other program service revenue. . . I I

_________

El gTotal.Addlines2a-2t H 350,169.1 •‘.

32,641.

Investment income (including dividends, interest andother similar amounts)

Income from investment of tax-exempt bond proceeds.Royalties

6a Gross rentsb Less: rental expenses.

c Rental income or (loss) . - -

d Net rental income or (loss)

7 a Gross amourt from sa’es ofasse:s other than inventory.

Less: cost or other basisand s&es eacensesGain or (loss)

_____________

Net gain or (loss) .............

Gross income from fundraising events(not including $

__________

of contributions reported on line lc).See Part IV, line 18Less: direct expensesNet income or (loss) from fundraisinig

Gross income from gaming activities.See Part IV, line 19 aLess: direct expenses bNet income or (loss) from gaming activities

Gross sales of inventory, less returnsand allowances a

Less: cost of goods sold bNet income or (loss) from sales of inventory

11 a

bC

d All other revenue

____________

e Total. Add lines 11 a-l 1 d12 Total revenue. See instructions h 1,761,269.

. 2,641.4

5

I.

(,) Reai

C,) secur;t,es

‘a

b

C

d

8a

bC

9a

bC

Oa

bC

1

M,scaiianeous Revenue

BAA TEEAO109L 07/06/11 Form 990 (2011)

Do not include amounts reported on lines6!a, 7b, Sb, Sb, and lOb of Part VIIL

Grants and other assistance to governmentsand organizations in the United Slates. SeePart IV, line 21Grants and other assistance to individuals inthe United States. See Part IV, line 22

Grants and other assistance to governments,organizations, and individuals outside theUnited States. See Part IV, lines 15 and 16...

Benefits paid to or for membersCompensation of current officers, directors,trustees, and key employees

Compensation not included above, todisqualified persons (as defined undersection 4958(0(1)) and persons describedin section 4958(c)(3)(B)

Other salaries and wages

Pension plan accruals and contributions(include section 401(k) and section 403(b)employer contributions)

Other employee benefits

Payroll taxes

Fees for services (nan-employees):

a Management

bLegal

c Accounting

d Lobbying

e Profess anal fundra:sing services. See Part IV, line 17

Investment management fees

g Other

Advertising and promotion

Office expenses

Information technology

Royalties

Occupancy

Travel

Payments of travel or entertainmentexpenses for any federal, state, or localpublic officials

Conferences, conventions, and meetingsInterest

Payments to affiliates

Depreciation, depletion, and amortization

InsuranceOther expenses. Itemize expenses notcovered above (List miscellaneous expensesin line 24e. II line 24e amount exceeds 10%of tine 25, column (A) amount, list tine 24eexpenses on Schedule 03

a PASSTMROUGH & REIMBURSED EXPEN

b PROGRAMMATIC EXPENSES

C MISCELLANEOUS INDIRECT 0STS

d DEVELOPMENT

e All other expenses

Total functional expenses. Add lines 1 through 24e

Joint costs. Complete this line only ifthe organization reported in column (B)joint costs from a combined educationalcampaign and fundraising solicitation,

Check here if following

— SOP 98-2 (ASC 958•720 )

BAA

FormB9O(2011) HEALTH CARE CENTRAL GEORGIA, INC. 58-2624455 PagelO

I Part IX Statement of Functional ExpensesSection 507(c) (3) and 501(c) (4) organizations must complete all columns.All other organizations must complete column (A) but are not required to complete columns (B), (C), and (0.

Check if Schedule 0 contains a response to any question in this Part IX [1(A) ‘ (B) (C) (D)

Total expenses Program service Management and Fundraisingexpenses general expenses expenses

85,822. 85,822

:

______________

E$‘• . .

132,750. 132,750. 0. 0.

0. 0. 0. 0.

755,286. 725,286. 30,000.

1

2

3

4

5

6

7

S

9

10

11

12

1314

15

161718

1920

21

22

2324

25

26

ê*1’w S— a,

94,506.’ 93,157.. 1,349.36,201. 36,201.

——-—

--— 3,593.’ . 3,593.

355,760.L 355,760.125,626.1 125,626.1

61,066. 18,309.148,178. 106,457. 41,721.

2,197,077. 1,976,479. 220,598. 0.

Form 990 (2011)

TEEA0I1OL 01/26/12

Form 990 (2011) HEALTH CARE CENTRAL GEORGIA, INC. 58-2624455 Page 11

I Part X Balance Sheet

Cash — non-interest-bearingSavings and temporary cash investments

Pledges and grants receivable, net

Accounts receivable, net

Receivables from current and former officers, directors, trustees, key employees,and highest compensated employees. Complete Part II of Schedule L

Receivables from other disqualified persons (as defined under section 4958(0(1)),persons described in section 4958(c)(3)(B), and contributing employers andsponsoring organizations of section 501 (c)(9) voluntary employees’ beneficiaryorganizations (see instructions)

7 Notes and loans receivable, net

B Inventories for sale or use

9 Prepaid expenses and deferred charges

—‘

ba Land, buildings, and equipment: cost or other basis.Complete Part VI of Schedule D iDa

b Less: accumulated depreciation lab11 Investments — publicly traded securities

12 Investments — other securities. See Part IV, line 11

13 Investments — program-related. See Part IV, line 11

14 Intangible assets

15 Other assets. See Part IV, line ii

16 Total assets. Add lines 1 through 15 (must equal line 34)....17 Accounts payable and accrued expenses18 Grants payable19 Deferred revenue

20 Tax-exempt bond liabilities

Escrow or custodial account liability. Complete Part IV of ScheduleD

Payables to current and former officers, directors, trustees, key employees,highest compensated employees, and disqualified persons. Complete Part IIof Schedule L

23 Secured mortgages and notes payable to unrelated third parties

24 Unsecured notes and loans payable to unrelated third parties

25 Other liabilities (including federal income tax, payables to related third parties,and other liabilities not included on lines 17-24). Complete Part X of Schedule D. -

26 Total liabilities. Add lines 17 through 25

6

20

I 21

__________________

22

___________

23

_____________________

24

_____________________

25

___________

96,627. 26 83,893.

12

34

5

6

(A)Beginning of year

532, 574.

_4.

147,322.

ASSETS

(B)End of year

193, 934.

187, 636.

123

4

5

653,035.644,025. 12,603

789

lOc 9,010.

1112131419.

15

839,122.

16 390,580.

L

21‘22

Ii.

TES

96.627. 171819

—— 23,063.-

-- 60,830.

N - Organizations that follow SEAS 117. check here [j] and complete lines

27 through 29 and lines 33 and 34.

27 Unrestricted net assets i 475,965 27 242,431.28 Temporarily restricted net assets 266, 530 28 64, 256.29 Permanently restricted net assets 29

R Organizations that do not follow SEAS 117, check here-

and complete

lines 30 through 34. I________30 Capital stock or trust principal, or current funds 30

31 Paid-in or capital surplus, or land, building, or equipment fund 31

32 Retained earnings, endowment, accumulated income, or other funds 32

c 33 Total net assets or fund balances 742,495 33 306,687.

I 34 Total liabilities and net assets/fund balances 839, 122 - 34 390, 580.

I

BAA Form 990 (2011)

TEEAO111L 07/06/11

Form99O(2011) HEALTH CARE CENTRAL GEORGIA, INC. 58-2624455I Part XI Reconciliation of Net Assets

Check if Schedule 0 contains a response to any question in this Part XL Fl1 Total revenue (must equal Part VIII, column (A), line 12

____________

2 Total expenses (must equal Part IX, column (A), line 25)

___________________

3 Revenue less expenses. Subtract line 2 from line 1

______

4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A))5 Other changes in net assets or fund balances (explain in Schedule 0)

___________________

6 Net assets or fund balances at end of year. Combine lines 3,4, and 5 (must equal Part X, line 33,column (B))

_______

Part XII I Financial Statements and Reporting—

Check if Schedule 0 contains a response to any question in this Part XII

1 Accounting method used to prepare the Form 990: Fl Cash Accrual Fl Other

_________________________

! the organization changed its method of accounting from a prior year or checked ‘Other,’ explainIn Schedule 0.

2a Were the organization’s financial statements compiled or reviewed by an independent accountant7b Were the organization’s financial statements audited by an independent accountant’

c If ‘Yes’ to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,review, or compilation of its financial statements and selection of an independent accountant’

If the organization changed either its oversight process or selection process during the tax year, explainin Schedule 0.

Pace 12

1,761,269.2 2,197,077.

.

.4.-- 0.

6—_____

Yes

x

I

No

x

x

d If ‘Yes’ to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on aseparate basis, consolidated basis, or both:

Separate basis Fl Consolidated basis Fl Both consolidated and separate basis

3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the SingleAudit Act and 0MB Circular A-133’

b If ‘Yes,’ did the organization undergo the required audit or audits? If the organization did not undergo the required auditor audits, explain why in Schedule 0 and describe any steps taken to underqo such audits

2b

a3a

SbBAA Form 990 (2011)

TEEAO1I2L 07/06/11

Public Charity Status and Public SupportComplete it the organization is a section 501(c)(3) organization or a section

4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. See separate instructions.Name of the organization HEALTH CARE CENTRAL GEORGIA, INC. Employer identification number

DBA COMMUNITY HEALTH WORKS 58-2624455

I Part I [Reason for Public charity Status (All organizations must complete this part.) See instructions.The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

1 A church, convention of churches or association of churches described in section 170(b)(1)(A)(i).2 A school described in section 170(b)(1)(A)Qi). (Attach Schedule E.)3 A hospital or a cooperative hospital service organization described in section 170(bXl)(A)(iii).4 A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital’s

name, city, and state:

H An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section170(b)(1)(A)Øv). (Complete Part Il.)

6 A federal, state, or local government or governmental unit described in section 170(bXl)(A)(v).7 X An organization that normally receives a substantial part of its support from a governmental unit or from the general public described

in section 170(b)(1)(A)(vi). (Complete Part II.)8 H A community trust described in section 170(b)m(A)(vi) (Complete Part II.)

H An organization that normally receives: (1) more than 33-1/3% of its support from contributions, membership fees, and gross receiptsfrom activities related to its exempt functions — subject to certain exceptions, and (2) no more than 33-1/3% of its support from grossinvestment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization afterJune 30, 1975. See section 509(a)(2). (Complete Part Ill.)

10 An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or carry out the purposes of one ormore publicly supported organizations described in section 509(a)(i) or section 509(a)(2). See section 509(a)(3). Check the box thatdescribes the type of supporting organization and complete lines lie through lih.

a Type I b Type II c H Type Ill — Functionally integrated d H Type Ill — Other

e H By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified personsother than foundation managers and other than one or more publicly supported organizations described in section 509(a)(i) orsection 509(a)(2).If the organization received a written determination from the IRS that is a Type I, Type II or Type Ill supporting organization,check this box

g Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?

__________

Yes] No(i) A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii)

below, the governing body of the supported organization’

(ii) A family member of a person described in (i) above’

(iii) A 35% controlled entity of a person described in (i) or (ii) above’Provide the followinq information about the supported orqanization(s).

llgØ); 11g(ii)

llg(iii)

Ci) Name of supported (ii) E1N (iii)Type of organizat,on Ov) is the (v) Did you notify (vi) is the (vii) Amount of supportorganization (described on rines 1.9 organization in the organization in organization in

above or mc section coiumn (I) listed in column (I) of column (I)(see instructions)) your governing your support? organized in the

document? U.s.?

Yes No Yes No Yes No

(A)

(B)

(C)

(D)

(E)

Total

SCHEDULE A(Form 990 or 990-EZ)

Department of the Treasurynternai Revenue Service

0MB No. 1545-0047

2011Open to Public

Inspection

h

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule A (Form 990 or 990-EZ) 2011

TEE.40401 L 09/28/11

Schedule A (Form 990 or 990-EZ) 2011 HEALTH CARE CENTRAL GEORGIA. INC. 58 —2 624455 Page 2

I Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part Ill. If theorganization fails to qualify under the tests listed below, please complete Part Ill.)

Section A. Public Supportcalendar year (or fiscal yearbeginning in)

________ _______________ ___________ _______________ _______________

1 Gifts, grants, contributions, andmembersh[p fees received. (Do notinclude any ‘unusual grants.)

___________________ ___________ _________

2 Tax revenues levied for theorganization’s benefit andeither paid to or expendedon its behalf

_______________ _______________ _______________ _______________ _______________

3 The value of services orfacilities furnished by agovernmental unit to theorganization without charge....

______________ ______________ ______________ ______________ ______________

Total. Add lines 1 through 3...

______________ ______________ ______ ______________ ______________

The portion of total

_______

contributions by each person(other than a governmentalunit or publicly supportedorganization) included on line 1that exceeds 2% of the amountshown on line 11, column (f).

6 Public support. Subtract lineSfrom line 4

Section B. Total Supportcalendar year (or fiscal yearbeginning in)

7 Amounts from line 4

_____ ______

8 Gross income from interest,dividends, payments receivedon securities loans, rents,royalties and income fromsimilar sources

________________ _______________ _______________ _______________ _______________

9 Net income from unrelatedbusiness activities, whether ornot the business is regularlycarried on

______________ ______________ ______________ ______________ ______________

10 Other income. Do not includegain or loss from the sale ofcapital assets (Explain inPart IV.). SEE. PART. IV..

___________ __________ __________ __________ __________

11 Total support. Add lines 7through 10

_______________ ______________ ______________ ______________ ______________

13 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth taxorganization, check this box and stop here

Section C. Computation of Public Sunort Percentaae

year as a section 501 (c)(3)

14 Public support percentage for 2011 (line 6, column (f) divided by line 11, column (f)) 1415 Public support percentage from 2010 Schedule A, Part II, line 14 15

99.06%98.39%

16a 33-113% supporttest —2011. If the organization did not check the box on line 13, and the line 14 is 33-1/3% or more, check this boxand stop here. The organization qualifies as a publicly supported organization

b 33-113% supporttest —2010. If the organization did not check a box online 13 or 16a, and line 15 is 33-1/3% or more, check this boxand stop here. The organization qualifies as a publicly supported organization H

17a 10%-facts-and-circumstances test — 2011. If the organization did not check a box online 13, lEa, or 16b, and line 14 is 10%or more, and if the organization meets the ‘facts-and-circumstances’ test, check this box and stop here. Explain in Part IV howthe organization meets the ‘facts-and-circumstances’ test. The organization qualities as a publicly supported organization H

b 10%-facts-and-circumstances test —2010. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10%or more, and if the organization meets the ‘facts-and-circumstances’ test, check this box and stop here. Explain in Part IV how theorganization meets the ‘facts-and-circumstances’ test. The organization qualifies as a publicly supported organizatioa

18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructionsBAA Schedule A (Form 990 or 990-EZ) 2011

(a) 2007 (b) 2008 (c) 2009 I (d) 2010 (e) 2011 (f) Total

45

1,470,185. 1L469,_927.. L1P1L82.?. L838,181. IL4P.L4.

0.

0.1,470,185. 1,469,927. 1,803,828. 1,838,181. 1,408,459. 7,990,580.

.-

I,

1, vHfl3 1./ ‘A “

a, -,,t

. 2tk’ e/

(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (0 Total

0.

7,990,580.

L4flL185. bifl• .1LP.L.?IL LPL181. L4PPjii:

35,325. 13,630. 8,919. 7,414. 2,642. 67,930.

___________

0.

7,670. 7,670.

___________8,066,180

12 Gross receipts from related activities, etc (see instructions) 1,012,750.

TEEAO4O2L 05125/11

Section A. Public SupportCalendar year (or fiscal yr beginning n)

1 Gifts, grants, contributionsand membership feesreceived. (Do not includeany ‘unusual grants.!)

________________

2 Gross receipts from admissions! merchandise sold orservices performed, or facilitiesfurnished in any activity that isrelated to the organization’stax-exempt purpose

3 Gross receipts from activitiesthat are not an unrelated tradeor business under section 513

4 Tax revenues levied for theorganization’s benefit andeither paid to or expended onits behalf

_______________

5 The value of services orfacilities furnished by agovernmental unit to theorganization without charge. -.

_______________

6 Total. Add lines 1 through S .. -

_______________

7a Amounts included on lines 1,2, and 3 received fromdisqualified persons

b Amounts included on lines 2and 3 received from other thandisqualified persons thatexceed the greater of $5,000 or1% of the amount on line 13for the year

c Add lines 7a and 7b

8 Public support (Subtract line7c from line 6.)

Section B. Total Support —

Calendar year (or fiscal yr beginning in) - (a) 2007

9 Amounts from line 6

_____________

ba Gross income from interest,dividends, payments receivedon securities loans, rents,royalties and income fromsimilar sources

____________

b Unrelated business taxableincome (less section 511taxes) from businessesacquired after June 30, 1975. -

___________

c Add lines ba and lOb

___________

11 Net irsome from ur.reated bjsinessa:tvi:ies ret ir,:;Ldea in line lOb,whether or not the business isregularly carried on

_______________

12 Other income. Do not includegain or loss from the sale ofcapital assets (Explain inPart IV.)

___________

13

________________

14

ScheduleA(Form9900r99O-EZ)2011 HEALTH CARE CENTRAL GEORGIA, INC. 58-2624455 Page3IPirt Ill Support Schedule for Organizations Described in Section 509(a)(2)

(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II, If the organization failsto quahfy under the tests listed below, please complete Part II.)

(a) 2007 (la) 2008 (c) 2009 (d) 2010 (e)201 1—— (0 Total

(b) 2008 (c) 2009 (20b0 (e)2011 (0 Total

Total support. tAdd ins 9, lOc, ii, and 12.)

___________________ ___________________ ___________________ ___________________ ___________________ _____________________

First five years. If the rorm 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501 (c)(3)organization, check this box and stop here p. El

Section C. Computation of Public Support Percentage15 Public support percentage for 2011 (lineS, column (f) divided by line 13, column CD) 1516 Public support percentage from 2010 Schedule A, Part III, line iS 16

Section D. Computation of Investment Income Percentage17 Investment income percentage for 2011 (line 1Cc, column (f) divided by line 13, column (0) 1718 Investment income percentage from 2010 Schedule A, Part III, line 17 1819a 33-113% support tests — 2011. If the organization did not check the box on line 14, and line 15 is more than 33-1/3%, and line 17

is not more than 33-1/3%, check this box and stop here. The organization qualifies as a publicly supported organization Db 33-113% support tests — 2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33-1/3%, and

line 18 is not more than 33-1/3%, check this box and stop here. The organization qualifies as a publicly supported organization2D Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions

BAA TEEAO4O3L 05/25/11 Schedule A (Form 990 or 990-EZ) 2011

ScheduleA(Form990or990-EZ)2011 HEALTH CARE CENTRAL GEORGIA, INC. 58—2624455 Page4

I Part IV I Supplemental Information. Complete this part to provide the explanations required by Part II, line 10;Part II, line 17a or 17b; and Part Ill, line 12. Also complete this part for any additional information.(See instructions).

____________

BAA Schedule A (Form 990 or 990-EZ) 2011

1EEAO4O4L 05/25/11

2011 SCHEDULE A, PART IV - SUPPLEMENTAL INFORMATION PAGE 5HEALTH CARE CENTRAL GEORGIA, INC.

DBA COMMUNITY HEALTH WORKS 58-2624455

PART II, LINE 10- OTHER INCOME

NATURE AND SOURCE 2011 2010 2009 2008 2007

MISCELLANEOUS

___________ ___________ ___________ ___________

7,670.TOTAL $ 0. $ 0. $ 0. $ 0. $ 7,670.

Schedule B I PUBLIC DISCLOSURE COPY ° Th45.0047

(Form 99Q 990-EZ, Schedule of ContributorsDepartment of the Treasury Attach to Form 990, Form 99OEZ, or Form 990-PFInternai Revenue Service

Name of the organization HEALTH CARE CENTRAL GEORGIA, INC Employer identification nunber

OBA COMMUNITY HEALTH WORKS

_________________

j58—2624455

________

Organization type (check one):Filers of: Section:Form 990 or 990-EZ X 501 (c)( 3 ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF 501 (c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation501 (c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructrons.

General Rule

DFor an organization filing Form 990, 990EZ. or 990-PF that received, during the year, $5,000 or more (in money or property) from any onecontributor. (Complete Parts I and II.)

Special Rules

For a sect:on 501(c)(3) organization filing Form 990 or 990-El that met the 33-113% support lest of the regulations under sections509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the greater of (1) $5,000 or(2)2% of the amount on (i) Form 990, Part VIII, line 1 h or (U) Form 990-EZ, line 1. Complete Parts I and II.

D For a section 501(c)Q), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,total contributions of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, orthe prevention of cruelty to children or animals. Complete Parts I, II, and Ill.

U For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-El that received from any one contributor, during the year,contributions for use exclusively for religious, charitable. etc. purposes. but these contributions did not total to more than $1,000.If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc.purpose. Do not complete any of the parts unIess the General Rule applies to this organization because it received nonexclusivelyreligious, charitable, etc. contributions of $5,000 or more during the year . $

____________________

Caution: An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990EZ, or990-PF) but it must answer ‘No’ on Part IV. line 2. of its Form 990; or check the box on line H of its Form 990EZ or on Part I, line 2, of itsForm 990PF, to certify that it does not meet the filing requirements of Schedule B (Form 990. 990-EZ. or 990PF).

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990, Schedule B (Form 990, 990-El, or 990-PF) (2011)990E2, or 990-PF.

TEEAO7OIL. 01/16/12

Schedule B (Form 990, 990-EZ, or 990-PF) (2011 Pane 1 of 2 of PartiName of organization Employer identification number

HEALTH CARE CENTRAL GEORGIA, INC. 58-2624455

Part I I Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.

(a) (b) — — (c) (d)Number Name, address, and ZIP + 4 Total Type of contribution

contributions

1 Person XPayroll

$ 61L740. Noncash

(Complete Part II if thereis a noncash contribution.)

(a)— (b) (c) (ci)

Number Name, address, and ZIP + 4 Total Type of contributioncontributions

2 Person XPayroll

s_3j;1q0p Noncash


——I—- —.___ — — —— —

(a) (b) (c) (ci)Number. Name, address, and ZIP + 4 Total Type of contribution

contnbutions

3- -

. PersonPayroll

—- $ 69469j Noncash


(a) (b) I (c) (d)Number Name, address, and ZIP + 4 Total

. Type of contributioncontnbutions

4 I Person •Xp

. Payroll

$ 693,075. Noncash

I (Complete Part II if thereis a noncash contribution.)

(a) (b) (c) (d)Number Name, address, and ZIP + 4 Total Type of contribution

; contnbutions

5 Person XPayroll

- -$ 13i.L.54: Noncash



, contributions

6 Person XPayroll

. $_. Z°2L8.P: Noncash


BAA . TEEAO7O2L 08/30/11 Schedule B (Form 990, 990-EZ, or 990-PF) 2O11)

Schedule B (Form 990, 990-EZ, or 990-PF) (2011) Page 2 of 2 of Part 1Name of organization Employer identification number


F Part I J Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.


contributions

7 Person XPayroll

$ LQ°L Noncash


(a) —— —— (b) (c) — (d)Number Name, address, and ZIP + 4 Total Type of contribution

contributions

8 Person XPayroll

$ 5t1r Noncash



contributions

Person

Payroll$ Noncash


(a) . (b) (c) (d)Number Name, address, and ZIP + 4 Total Type of contribution

contributions

Person

Payroll$ Noncash


(a) (I,) (c) (d)Number Name, address, and ZIP + 4 Total Type of contribution

contributions

PersonPayroll

$ Noncash



contributions

Person

Payroll$ Noncash


BAA TEEAO702L 08/30/11 Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Schedule B (Form 990, 990-EZ, or 990PF) (2011) Pane 1 to 1 of Part II

Name of organization Employer Identification number


I Part II Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.

(a) (b) (c) I (d)

No. from Description of noncash property given FMV (or estimate) Date received

Part I (see instructions)

N/A

$____________________

(a) (b) (c) (ci)



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Part I i (see instructions)

S_____________________

(a) (b) (c) (d)No. from Description of noncash property given FMV (or estimate) Date received


$________________________

BAA Schedule B (Form 990, 990-EZ, or 990.PF) (2011)

TEEAO7O3L 08/30/11

Schedule B (Form 990, 990-EZ, or 990-PF) (2011) Page 1 to 1 of Part IllName ol organization Employer Identification number

HEALTH CARE CENTRAL GEORGIA, INC. 58-2624455Part Ill Exclusively religious, charitable, etc, individual contributions to section 501(c)(7), (8), or(1O)

organizations that total more than $1 ,000 for the year.complete cols (a) through (e) and the following line entry.

For organizations completing Part Ili, enter total of exclusively religious, charitable, etc,contributions of $1,000 or iess for the year. (Enter this information once. See instructions.) $ N/AUse duplicate copies of Part Ill if additional space is needed.

(a) I (b) (c) (d)No.frorj__ Purpose of gift -- Use of gift -_____________ — Description of how gift is held - —

N/A

-

zI -.-

(e)Transfer of gift

Transferee’s name, address, and ZiP +4 —— I Relationship of transferor to transferee

(a) (b) (c) (d)No. from Purpose of gift Use of gift Description of how gift is heid

Part I-

(e)Transfer of gift

Transferee’s name, address, and ZIP + 4 Relationship of transferor to transferee

--- J(a) (b) (c) (d)

No. from Purpose of gift Use of gift Description of how gift is heidPart i

(e)Transfer of gift


(a) (b) (c) I (d)No. from Purpose of gift Use of gift Description of how gift is heid

Part I

(e)Transfer of gift


BAA Schedule B (Form 990, 99OEZ, or 990-PF) (2011)TEEA07O4L 08/30(11

0MB No. 15450047SCHEDULED

(Form 990) Supplemental Financial Statements

Complete if the organization answered ‘Yes,’ to Form 990,Department of the Treasury Part IV, lines 6,7,8,9,10, ha, lib, lic, lid, lie, hf, 12a, ori2b.internal Revenue Service Attach to Form 990. See separate instructions.

fl 2011

Name of the organization Employer Identirication number

HEALTH CARE CENTRAL GEORGIA, INC.DEA COMMUNITY HEALTH WORKS 58-2624455

I Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete ifthe organization answered ‘Yes’ to Form 990, Part IV, line 6.

(a) Donor advised funds (b) Funds and other accounts

1 Total number at end of year

2 Aggregate contributions to (during year)

3 Aggregate grants from (during year)

4 Aggregate value at end of year

5 Did the organization inform all donors and donor advisors in writing that the assets held in donor advisedfunds are the organization’s property, subject to the organization’s exclusive legal control’ DYes D No

6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can beused only for charitable purposes and not for the benefit of the donor or donor advisor, or for any otherpurpose conferring impermissible private benefit’ DYes No

!Part II I Conservation Easements. Complete if the organization answered ‘Yes’ to Form 990, Part IV, line 7.

1 Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) EPreservation of an historically important land area

Ii Protection of natural habitat Preservation of a certified historic structure

[J Preservation of open space

2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on thelast day of the tax year.

____________________-.

. —

I Held at the End of the Tax Year

a Total number of conservation easements 2a’ --

b Total acreage restricted by conservation easements 2b —— —.

c Number of conservation easements on a certified historic structure included in (a) 2c

d Number of conservation easements included in (c) acquired after 8117106, and not on a historicstructure listed in the National Register 2d

3 Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during thetax year

________________

4 Number of states where property subject to conservation easement is located •

5 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations,and enforcement of the conservation easements it holds’ DYes D No

6 Staff and volunteer hours devoted to monitoring, inspecting. and enforcing conservation easements during the year

7 Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year

8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)’ DYes No

9 In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, andinclude, if applicable, the text of the footnote to the organization’s financial statements that describes the organization’s accounting forconservation easements.

Part III I Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.

Complete if the organization answered ‘Yes’ to Form 990, Part IV, line 8.

ha If the organization elected, as permitted under SPAS 116 (ASC 958), not to report in its revenue statement and balance sheet works ofart, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide,in Part XIV, the text of the footnote to its financial statements that describes these items.

b If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide thefollowing amounts relating to these items:

(i) Revenues included in Form 990, Part VIII, line 1.....,......,.........,,..,..,.,....................... • $

____________________

(ii) Assets included in Form 990, Part X.,,,,..,,.....,,....,,.....,,..,,,,..,,,...,,,.,.,,.,..,.....,,., $

______________________

2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the followingamounts required to be reported under SFAS 116 (ASC 958) relating to these items:

a Revenues included in Form 990, Part VIII, line 1 ,.,,,,.,,,.,,.,..,,..,,,,...,.,,...................... ‘$

bAssets included in Form 990, Part X

Open to PublicInspection

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990. TEEA33O1L 05/25/11 Schedule D (Form 990) 2011

ScheduleD Worm 990) 2011 HEALTH CARE CENTRAL GEORGIA, INC. 58—2624455 Page 2

I Part Ill Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)3 Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection

items (check all that apply):

a Public exhibition d Loan or exchange programs

b Scholarly research e Other — -- — ——

___________________________________________________

c Preservation for future generations

4 Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in

Part XIV.

5 During the year, did the organization solicitor receive donations of art, historical treasures, or other similar

assets to be sold to raise funds rather than to be maintained as part of the organization’s collection’ [1 Yes Fl No

[ Part IV Escrow and Custodial Arrangements. Complete if the organization answered Yes to Form 990, Part IV,line 9, or reported an amount on Form 990, Part X, line 21.

1 a Is the organization an agent, trustee, custodian, or other intermediary for contributions or other assets not

included on Form 990, Part X’ Yes DNa

b if ‘Yes,’ explain the arrangement in Part XIV and complete the following table:

[ Amountc Beginning balance 1 c

d Additions during the year 1 d

e Distributions during the year 1 e

I Ending balance 1 1 — —

2a Did the organization include an amount on Form 990. Part X, line 21’ . Yes Nob If ‘Yes,’ explain the arrangement in Part XIV.

I Part VI Endowment Funds. Complete if the orqanization answered ‘Yes’ to Form 990, Part IV, line 10.(a) CLrrent year (b) Prior year (c) Two yers back (d) Th’ee years tack (e) Four years tack

1 a Beginning of year balance...... -

b Contributions

c Net investment earnings, gains,

and lossesd Grants or scholarshipse Other expenditures for facilities

and programs 1 .

I Administrative expenses.

g End of year balance I2 Provide the estimated percentage of the current year end balance (line lg, column (a)) held as:

a Board designated or quasi-endowment •

b Permanent endowment -

c Temporarily restricted endowment •

The percentages in lines 2a, 2b, and 2c should equal 100%.

3a Are there endowment funds not in the possession of the organization that are held and administered for theorganization by: Yes No(I) unrelated organizations 3aQ)(ii) related organizations 3aØi)

I, If ‘Yes’ to 3a(ii), are the related organizations listed as required on ScheduleR’ 3b4 Describe in Part XIV the intended uses of the organization’s endowment funds.

Part VilLand, Buildings, and Equipment. See Form 990, Part X, line 10,Description of property (a) Cost or other basis (I,) Cost or other (c) Accumulated (d) Book value

(investment) basis (other) depreciation1 a Land

b Buildingsc Leasehold improvements.......,.....,..,..dEquipmenl 94,907 85,897. 9,010.eDiher 558,128 558,128. 0.

Total. Add lines 1 a through le. (Column (d) must equal Form 990, Part X, column (B), line 70(c).) 1’ 9,010.BAA Schedule D (Form 990) 2011

TEEA3302L 01/16/12

ScheduleD (Form 990)2011 HEALTH CARE CENTRAL GEORGIA, INC. 58—2624455rPart VII Investments — Other Securities. See Form 990, Part X, line 12. N/A -

(a) Description of security or category (I,) Book value (c) Method of valuation:

(including name of security) Cost or end-of-year market value

(1) Financial derivatives

(2) Closely-held equity interests

(3) Other

(A)

(B)

(C)

(D)

(E)

(F)

(0)

(H)

(I)

Total. (Column (b) must equal Form 990 Pan X, column (8) line 72.).

I Part Villi Investments — Program Related. See Form 990, Part X, line 13. N/A

(a) Description of investment type (Li) Book value (c) Method of valuation:Cost or end-of-year market value

-

(2)

-

cL(5)

-ffiQL --_________

(8)

--_______________

(10)

Total. (Column (b) must equal Form 990, Partx, column(S) line 73.)..

I Part IX I Other Assets. See Form 990, Part X, line 15. N/A

- -

(a) Description—— I (PX Book value

._Q2(2)

(4)(5)

(6)(7)

(8)(9)

(10)

Total. (Column (b) must equal Form 990, Part X, column (B), line 75.)

I Part X I Other Liabilities. See Form 990, Part X, line 25.(a) Description of liability (b) Book value

(1) Federal_income_taxes

(2)—_________________ 4

*1

(4) : t2’(5)(6)(7)

(8)(9)

.ilP1.________ ... --_____

(11) - . ——____________________

Total. (Column (b) must equal Form 990, Part X. column (8)1/ne 25.)....’

2 FIN 48 (ASC 740) Footnote- In Part XIV, provide the text of the footnote to the organization’s financial statements that reports theorganization’s liability for uncertain tax positions under FIN 48 (ASC 740).

‘‘1

Page 3

BAA TEEA3303L 01/23/12 ScheduleD (Form 990) 2011

Schedule D (Form 990) 2011 HEALTH CARE CENTRAL GEORGIA, INC 58—2624 455 Page 4

I Part Xl I Reconciliation of Change in Net Assets from Form 990 to Audited Financial Statements1 Total revenue (Form 990, Part VIII, column (A), line 12) .,,

2 Total expenses (Form 990, Part IX, column (A), line 25)3 Excess or (deficit) for the year. Subtract line 2 from line 14 Net unrealized gains (losses) on investments5 Donated services and use of facilities6 Investment expenses7 Prior period adjustments8 Other (Describe in Part XIV.)9 Total adjustments (net). Add lines 4 through 8

10 Excess or (deficit) for the year per audited financial statements. Combine lines 3 and 9

_1J269.2,197,077.

—435, 808.

—435.808.Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return

1 Total revenue, gains, and other support per audited financial statements .., 1 1,761,269.2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:

a Net unrealized gains on investments 2ab Donated services and use of facilities 1_gc Recoveries of prior year grants

___________________

d Other (Describe in Part XIV.) [_gg

___________________

e Add lines 2a through 2d 2e

___________________

3 Subtract line 2e from line 1

____________________

4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:a Investment expanses not included on Form 990, Part VIII, line 7b 4a

____________________

bOther (Describe in Part XIV,) 4b

____________________

cAddlines4aand4h 4c

_________________

5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 72.) 5 1, 761, 269.Part XIII I Reconciliation of Expenses per Audited Financial Statements With Expenses per Return

1 Total expenses and losses per audited financial statements2 Amounts included on line 1 but not on Form 990, Part IX, line 25:

a Donated services and use of facilitiesb Prior year adlustmentsc Other lossesci Other (Describe in Part XIV.)a Add lines 2a through 2d

3 Subtract line 2e from line 1

4 Amounts included on Form 990, Part IX, line 25, but not on line 1:a Investment expenses not included on Form 990, Part VIII. line 7bb Other (Describe in Part XIV.) -

c Add lines 4a and 4h5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 78.).

2b

I 2c

I 2d

I Part XIV I Supplemental InformationComplete this part to provide the descriptions required for Part II, lines 3,5, and 9; Part III, lines la and 4; Part IV, lines lb and 2b;Part V, line 4; Part X, line 2; Part XI, tineS; Part XII, lines 2d and 4b; and Part XtII, lines 2d and 4b. Also complete this part to provideany additional information.

3 1,761,269.

1’

2a

2,197,077.

4aAb!

3 2,197,077.

I4c

2,197,077.

BAA TEEA33O4L 05/25/11 Schedule D (Form 990) 2011

Schedule D (Form 990) 2011 HEALTH CARE CENTRAL GEORGIA, INC. 58—2624455 Page 5

PAEWS1 Supplemental Information (continued)

BAA TEEA33O5L 05/25/Il Schedule D (Form 990) 2011

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Compensation InformationFor certain Officers, Directors, Trustees, Key Employees, and Highest

Compensated Employees

Complete if the organization answered Yes to Form 990, Part IV, line 23.Attach to Form 990. See separate instructions.

Name of the organization Employer Identification number

HEALTH CARE CENTRAL GEORGIA. INC. 58-2624455I Part I Questions Regarding Compensation

1 a Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form 990, PartVII, Section A, line la, Complete Part Ill to provide any relevant information regarding these items.

Ii If any of the boxes on line la are checked, did the organization follow a written policy regarding payment orreimbursement or provision of all of the expenses described above? If No, complete Part Ill to explain 1P

2 Did the organization require substantiat:on prior to reimbursing or allowing expenses incurred by all officers, directors,trustees, and the CEO/Executive Director, regarding the items checked in line 1a7

3 Indicate which, if any, of the following the filing organization used lo establish the compensation of the organizationsCEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a related organization toestablish compensation of the CEO/Executive Director. Explain in Part Ill.

4 During the year, did any person listed in Form 990, Part VII, Section A. line la with respect to the filing organizationor a related organization:

a Receive a severance payment or change-of-control payment’b Participate in, or receive payment from, a supplemental nonqualified retirement plan’

_________

c Participate in, or receive payment from, an equity-based compensation arrangement

If ‘Yes’ to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part Ill.

Only section 501(cX3) and 501(cX4) organizations must complete lines 5-9.

5 For persons listed in Form 990, Part VII, Section A, line la, did the organization pay or accrue any compensationcontingent on the revenues of:

______

a The organization

______________

b Any related organi2ation

__________

If ‘Yes’ to line Sa or 5b, describe in Part III.

6 For persons listed in Form 990, Part VII, Section A. line la, did the organization pay or accrue any compensationcontingent on the net earnings of:

a The organization’b Any related organization’

If ‘Yes’ to line 6a or 6b, describe in Part III.

7 For persons listed in Form 990, Part VII, Section A, line la, did the organization provide any non-fixed payments notdescribed in lines Sand 6? If ‘Yes,’ describe in Part Ill

B Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the initialcontract exception described in Regulations section 53.4958-4(a)(3)? If ‘Yes,’ describe in Part III

9 If ‘Yes’ to lineR, did the organization also follow the rebuttable presumption procedure described in Regulationssection 53.4958-6(c) ’

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 Schedule J (Form 990) 2011

SCHEDULE J(Form 990)

Department of the Treasuryinternal Revenue Service

0MB No. 1545.0047

2011Open to Public

Inspection

First-class or charter travelTravel for companions

Tax indemnification and gross-up paymentsDiscretionary spending account

Housing allowance or residence for personal use

Payments for business use of personal residence

Health or social club dues or initiation feesPersonal services (e.g., maid, chauffeur, chef)

Compensation committee

Independent compensation consultant

Form 990 of other organizations

I Written employment contract

I Compensation survey or studyApproval by the board or compensation committee

Yes No

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SCHEDULE 0 Supplemental Information to Form 990 or 990-EZ0MB No. l54sO47

(Form 990 or 990.EZ) 2011Complete to provide information for responses to specific questions on

— Form 990 or 99a-EZ or to provide any additional information. Open to PublicAttach to Form 990 or 990-EZ. Inspection

Norne of the o’gan zahor. HEALTH CARE CENTRAL GEORGIA, INC. Employer identflcation number

DBA COMMUNITY HEALTH WORKS

________

58-2624455

-- FQRM_99fl,flflTIII LINE I - PPGANIZATJQN MIS.SIQN

-

- _gIp1pf H_EALTJj cw EgAJJ GEJRGI (p/B/A qgsj

IMPROVE THE HEALTH OF ALL CENTRAL GEORGIANS. THE ORGANIZATION WORKS TO THIS GOAL IN

- . APflS Q YPN MP NSSJ SflS.E. MNT_ P pjg I QEtIT OF

HEALTHCARE DELIVERY.

- FORM 990, PART IlI LINE

OTHER OPERATING PROGRAMS

FORM 990, PART VI, LINE 118 - FORM 990 REVIEW PROCESS

THE 990 IS REVIEWED BY THE CEO AND CFO AND IS THEN PRESENTED TO THE BOARD FOR

REVIEW.

FORM 990, PART VI, LINE 12C - EXPLANA11ON OF MONORING AND ENFORCEMENT OF CONFLICTS

THE BOARD MEMBERS REVIEW AND DISCLOSE ANY CONFLICTS WHEN THEY BEGIN THEIR TERN.THE

POLICY IS MONITORED ANNUALLY.

FORM 990, PART VI, LINE iSA - COMPENSATION REVIEW & APPROVAL PROCESS FOR CEO, EXEC. DIR., OR TOP MGTII

THE PERSONNEL COMMITTEE REVIEWS THR CURRENT MARKET, NATIONAL SALARY SURVEYS AND

OTHER ORGANIZATIONS. THE EXECUTIVE DIRECTOR IS COMPENSATED BASED ON THIS REVIEW AND

PERFORI4ANCE.

FORM 990, PART VI, LINE 15B - COMPENSATION REVIEW & APPROVAL PROCESS FOR OFFICERS & KEY EMPLOYEES

THE PERSONNEL COMMITTEE USES A NATIONAL SURVEY PREPARED BY NCHN AND OTHER

ORGANIZATIONS.

FORM 990, PART VI, LINE 19- OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE

A COPY OF THE ANNUAL AUDIT REPORT IS ON THE ORGANIZATION’S WEBSITE AND IS AVAILABLE

UPON REQUEST ALONG WITH THE GOVERNING DOCUMENTS.

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. 1tEA49O1L 07114111 Schedule 0 (Form 990 or 990-EZ) 2011

health care central georgia, inc. audit … 2012.pdfhealth care central georgia, inc. macon, georgia...

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