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2004 Annual Hospital Questionnaire Completion Status Report As Of 2004 Annual Hospital Questionnaire Completion Status Report As of 7/19/2005 Hospital Operational Status as of the Close Date Survey Authorized County Hospital of Report Year Received Signature 2004 Year Summary 179 Surveys Expected 176 Surveys Completed 98.3% Incomplete Baldwin Central State Hospital-Medical/Surgical Closed Med/Surg in 2004 Bibb Macon Behavioral Health System Operational Fulton Southwest Hospital And Medical Center Operational Complete Appling Appling Hospital Operational 4/28/2005 Dale Spell Bacon Bacon County Hospital Operational 4/22/2005 Cindy R. Turner Baldwin Central State Hospital - Psychiatric Operational 3/30/2005 Frezalia Oliver Services Division Baldwin Oconee Regional Medical Center Operational 5/23/2005 Brian L. Riddle Barrow Barrow Community Hospital Operational 3/23/2005 James O. Litchford Bartow Cartersville Medical Center Operational 4/14/2005 Keith Sandlin Ben Hill Dorminy Medical Center Operational 5/10/2005 Bruce Shepard Berrien Berrien County Hospital Operational 3/31/2005 Richard Langosch Bibb Macon Northside Hospital Operational 3/22/2005 Bernard A. Costello Bibb HealthSouth Central Georgia Operational 3/23/2005 Elbert McQueen Rehabilitation Hospital Bibb Medical Center of Central Georgia Operational 3/24/2005 A. Donald Faulk, Jr. Bibb Coliseum Psychiatric Center Operational 3/25/2005 Mark W. Nichols Bibb Coliseum Medical Centers Operational 3/25/2005 Michael S. Boggs Bleckley Bleckley Memorial Hospital Operational 3/28/2005 Cary Martin Brooks Brooks County Hospital Operational 3/25/2005 J William Sellers Bulloch Willingway Hospital Operational 3/24/2005 Barbara S. Reid Bulloch East Georgia Regional Medical Center Operational 4/5/2005 Bradley K. Nurkin Burke Burke Medical Center Operational 3/25/2005 Jennifer A. Royal Butts Sylvan Grove Hospital Operational 5/3/2005 Lisa Napier Calhoun Calhoun Memorial Hospital Operational 5/6/2005 Peggy W. Pierce Camden Camden Medical Center Operational 3/25/2005 Michael D. Scherneck, VP & CFO Candler Candler County Hospital Operational 4/1/2005 Michael Alexander Tuesday, July 19, 2005 Page 1 of 7 Hospital Operational Status as of the Close Date Survey Authorized County Hospital of Report Year Received Signature Carroll Tanner Medical Center/Villa Rica Operational 4/22/2005 Larry N. Steed Carroll Tanner Medical Center/Carrollton Operational 4/22/2005 Richard McConahy Catoosa Hutcheson Medical Center Operational 3/25/2005 David M. Snyder Charlton Charlton Memorial Hospital Operational 3/28/2005 Merita Hinnant Chatham Candler Hospital Operational 3/25/2005 Paul P. Hinchey Chatham St. Joseph's Hospital Operational 3/25/2005 Paul P. Hinchey Chatham Georgia Regional Hospital-Savannah Operational 3/25/2005 Dr. Frank Drummond Chatham Memorial Health University Medical Operational 4/1/2005 Robert A. Colvin Center Chatham Coastal Harbor Treatment Center Operational 5/20/2005 Ray Heckerman Cherokee Northside Hospital-Cherokee Operational 5/25/2005 Billy Hayes Clarke Athens Regional Medical Center Operational 3/28/2005 John A. Drew Clarke St. Mary's Hospital Operational 4/8/2005 Thomas E. Fitz, Jr Clayton Anchor Hospital Operational 4/5/2005 Trey Carter Clayton Southern Regional Medical Center Operational 5/13/2005 Edward J. Bonn Clinch Clinch Memorial Hospital Operational 5/3/2005 Bill Forbes Cobb Devereux Georgia Treatment Network Operational 3/25/2005 Mario Bolivar Cobb Ridgeview Institute Operational 3/25/2005 Monica Tippett Cobb WellStar Cobb Hospital Operational 3/28/2005 Robert A. Lipson, MD Cobb WellStar Windy Hill Hospital Operational 3/28/2005 Robert A. Lipson, MD Cobb WellStar Kennestone Hospital Operational 3/28/2005 Robert A. Lipson, MD Cobb Emory-Adventist Hospital Operational 4/11/2005 Dennis Kiley Coffee Coffee Regional Medical Center Operational 3/25/2005 George L. Heck Colquitt Colquitt Regional Medical Center Operational 3/25/2005 James R. Lowry Colquitt Turning Point Hospital Operational 4/6/2005 Ben Marion Cook Memorial Hospital of Adel Operational 6/24/2005 Bill Hawley Coweta Newnan Hospital West Operational 5/27/2005 Mr. Richard Hubbard Coweta Newnan Hospital Operational 5/31/2005 Mr. Richard Hubbard Crisp Crisp Regional Hospital Operational 4/11/2005 Wayne Martin Dade Wildwood Lifestyle Center & Hospital Operational 3/9/2005 Derrick Hamilton Decatur Memorial Hospital of Bainbridge Operational 3/23/2005 James G. Peak DeKalb Laurel Heights Hospital Operational 3/2/2005 Shawn Lemon Tuesday, July 19, 2005 Page 2 of 7 Hospital Operational Status as of the Close Date Survey Authorized County Hospital of Report Year Received Signature DeKalb Children's Healthcare of Atlanta at Operational 3/24/2005 Dr. James Tally Egleston DeKalb Northlake Medical Center, LLC Operational 3/28/2005 Robbin Moore DeKalb DeKalb Medical Center Operational 3/28/2005 Eric Norwood DeKalb Emory Dunwoody Medical Center Operational 3/30/2005 Thomas Gilbert DeKalb Georgia Regional Hospital-Atlanta Operational 4/1/2005 Ronald C. Hogan DeKalb Decatur Hospital Operational 4/1/2005 Homer Wright DeKalb Emory University Hospital Operational 4/13/2005 Jimmy Hatcher DeKalb Wesley Woods Geriatric Hospital Operational 4/13/2005 Peter Basler DeKalb Peachford Behavioral Health System of Operational 6/10/2005 Matt Crouch Atlanta Dodge Dodge County Hospital Operational 4/26/2005 Ken Stegner Dougherty Palmyra Medical Centers Operational 3/25/2005 Allen Golson Dougherty Phoebe Putney Memorial Hospital Operational 4/11/2005 Joel Wernick Douglas WellStar Douglas Hospital Operational 3/28/2005 Robert A. Lipson, MD Douglas Inner Harbour Hospital Operational 6/14/2005 Ron J. Scroggy Early Early Memorial Hospital Operational 3/25/2005 J. William Sellers Effingham Effingham Hospital Operational 5/6/2005 Don Tomberlin, Sr. Elbert Elbert Memorial Hospital Operational 3/23/2005 Mark LeNeave Emanuel Emanuel Medical Center Operational 5/26/2005 H.D.Cannington Evans Evans Memorial Hospital Operational 5/6/2005 Ronald M. Gilliard Fannin Fannin Regional Hospital Operational 3/24/2005 Barry Mousa Fayette Fayette Community Hospital Operational 3/25/2005 John Miles Floyd Redmond Regional Medical Center Operational 3/25/2005 Brenda Waltz Floyd Floyd Medical Center Operational 3/25/2005 Kurt Stuenkel Floyd Northwest Georgia Regional Hospital Operational 4/6/2005 Karl Schwarzkopf, Ph.D. Forsyth Northside Hospital Forsyth Operational 5/25/2005 Robert A. Putnam Franklin Cobb Memorial Hospital Operational 3/25/2005 John Herron Fulton Shepherd Center Operational 3/22/2005 Gary R. Ulicny Fulton Children's Healthcare of Atlanta at Operational 3/24/2005 Dr. James Tally Scottish Rite Fulton South Fulton Medical Center Operational 3/25/2005 Chris Hummer Fulton Kindred Hospital-Atlanta Operational 3/25/2005 Craig A. Hoover Tuesday, July 19, 2005 Page 3 of 7 Hospital Operational Status as of the Close Date Survey Authorized County Hospital of Report Year Received Signature Fulton North Fulton Regional Hospital Operational 3/25/2005 Elizabeth Lamkin Fulton Atlanta Medical Center Operational 3/25/2005 William J. Masterton Fulton Piedmont Hospital Operational 3/29/2005 Robert Maynard Fulton Emory Crawford Long Hosptial Operational 4/13/2005 Albert K. Blackwelder, FACHE Fulton Saint Joseph's Hospital of Atlanta Operational 4/19/2005 Bonnie Phipps Fulton Grady Memorial Hospital Operational 5/6/2005 Dr. Andrew Agwunobi Fulton Hughes Spalding Children's Hospital Operational 5/6/2005 Dr. Andrew Agwunobi Fulton Northside Hospital Operational 5/25/2005 Robert Quattrocchi Fulton Hillside Hospital Operational 5/25/2005 Teresa Stoker Gilmer North Georgia Medical Center Operational 4/3/2005 Jeff Dunn Glynn Southeast Georgia Regional Medical Operational 3/25/2005 Michael D. Scherneck, Center VP & CFO Glynn Focus By the Sea Operational 3/28/2005 Russ Dean Gordon Gordon Hospital Operational 3/25/2005 Carlene Jamerson Grady Grady General Hospital Operational 3/25/2005 J William Sellers Greene Minnie G. Boswell Memorial Hospital Operational 3/25/2005 Floyd D. Bounds 3/25/2005 Gwinnett Emory Eastside Medical Center Operational 4/5/2005 Les Beard Gwinnett Joan Glancy Memorial Hospital Operational 5/2/2005 Franklin M. Rinker Gwinnett Gwinnett Medical Center Operational 5/4/2005 Franklin M. Rinker Habersham Habersham County Medical Center Operational 3/23/2005 James A. Peterson Hall Northeast Georgia Medical Center Operational 6/9/2005 James E. Gardner, Jr. Haralson Higgins General Hospital Operational 4/22/2005 Robbie Smith Hart Hart County Hospital Operational 3/25/2005 Jerry Wise Henry Henry Medical Center Operational 3/25/2005 G. Sam Ahern Houston Perry Hospital Operational 4/6/2005 Frank Aaron Houston Houston Medical Center Operational 4/6/2005 Frank Aaron Irwin Irwin County Hospital Operational 3/25/2005 Sue Spivey Jackson BJC Medical Center Operational 3/24/2005 Jim Yarborough Jasper Jasper Memorial Hospital Operational 5/23/2005 David Owens Jeff Davis Jeff Davis Hospital Operational 3/15/2005 RICHARD J MCCLEMENTS Tuesday, July 19, 2005 Page 4 of 7 Hospital Operational Status as of the Close Date Survey Authorized County Hospital of Report Year Received Signature Jefferson Jefferson Hospital Operational 5/24/2005 Rita G. Culvern Jenkins Jenkins County Hospital Operational 3/18/2005 Alvin Burke Lanier Louis Smith Memorial Hospital Operational 5/25/2005 Neil W. Ginty Laurens Fairview Park Hospital Operational 4/19/2005 James E. Raynor Liberty Liberty Regional Medical Center Operational 3/25/2005 Martha F. Traylor Lowndes Smith Northview Hospital Operational 3/25/2005 Shamb Purohit, CFO Lowndes South Georgia Medical Center Operational
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