Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
 
Employer identification number
58-1719994
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) COLUMBUS REGIONAL MEDICAL FOUNDATION INC
707 CENTER STREET
COLUMBUS,GA31901 		58-1501642 501(C)(3) 240,000       GENERAL SUPPORT
(2) COLUMBUS STATE UNIVERSITY
4225 UNIVERSITY AVE
COLUMBUS,GA31907 		58-6043198 501(C)(3) 100,000       GENERAL SUPPORT
(3) AMERICAN CANCER SOCIETY
PO BOX 1382
COLUMBUS,GA31902 		13-1788491 501(C)(3) 26,500       GENERAL SUPPORT
(4) PASTORAL INSTITUTE
PO BOX 8649
COLUMBUS,GA31908 		58-0647764 501(C)(3) 11,000       GENERAL SUPPORT
(5) RONALD MCDONALD HOUSE
1959 HAMILTON RD
COLUMBUS,GA31904 		58-2065776 501(C)(3) 10,480       GENERAL SUPPORT
(6) MARCH OF DIMES
6501 VETERANS PARKWAY 4B
COLUMBUS,GA31909 		58-1846366 501(C)(3) 10,000       GENERAL SUPPORT
(7) UPTOWN COLUMBUS INC
PO BOX 1237
COLUMBUS,GA31902 		58-1521594 501(C)(3) 10,080       GENERAL SUPPORT
(8) MUSCOGEE EDUCATIONAL EXCELLENCE FOUNDATION
1520 13TH AVENUE
COLUMBUS,GA31901 		58-2236445 501(C)(3) 5,000       GENERAL SUPPORT
(9) ST FRANCIS HOSPITAL
PO BOX 84012
COLUMBUS,GA31908 		58-0641240 501(C)(3) 5,280       GENERAL SUPPORT
(10) STEWART COMMUNITY HOME
PO BOX 4279
COLUMBUS,GA31914 		58-1287158 501(C)(3) 5,000       GENERAL SUPPORT
(11) UNITED WAY INC
PO BOX 1157
COLUMBUS,GA31902 		58-0572434 501(C)(3) 45,400       GENERAL SUPPORT


2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
11
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012
Page 2

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: COLUMBUS REGIONAL HEALTHCARE SYSTEM, INC. AND ITS AFFILIATES ACKNOWLEDGE THEIR RESPONSIBILITY AS GOOD CORPORATE CITIZENS TO SUPPORT WORTHWHILE ACTIVITIES, SERVICES AND EFFORTS IN THE COMMUNITY, STATE AND NATION. TO EFFECTIVELY CARRY OUT THAT RESPONSIBILITY AND ENSURE ITS RESOURCES FOR THIS PURPOSE ARE USED IN WAYS WHICH ARE OF LASTING VALUE AND IMPORTANCE, CERTAIN PROCEDURES HAVE BEEN ESTABLISHED TO APPROPRIATELY ALLOCATE CORPORATE RESOURCES TO OUTSIDE AGENCIES, ORGANIZATIONS AND EFFORTS. ALL REQUESTS FOR CHARITABLE CONTRIBUTIONS MUST BE SENT IN WRITING OR THROUGH E-MAIL TO THE COLUMBUS REGIONAL HEALTHCARE SYSTEM SENIOR VICE PRESIDENT FOR STRATEGY, MARKETING AND PUBLIC RELATIONS. REQUESTS MUST BE RECEIVED AT LEAST 45 DAYS BEFORE THE EVENT OR NEED IN ORDER TO BE CONSIDERED. THE SENIOR VICE PRESIDENT FOR STRATEGY, MARKETING AND PUBLIC RELATIONS CONSULTS WITH THE CHIEF COMPLIANCE OFFICER TO ENSURE THAT CHARITABLE CONTRIBUTIONS ARE IN COMPLIANCE WITH THE CORPORATE COMPLIANCE PROGRAM. THE TOTAL AMOUNTS OF FUNDS SET ASIDE FOR PURPOSES OF DONATION OR CONTRIBUTION TO OUTSIDE AGENCIES IS ESTABLISHED DURING THE CORPORATE BUDGET PROCESS AND THE AMOUNT MAY VARY FROM YEAR TO YEAR.
Schedule I (Form 990) 2012


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