2024-05-14T12:59:26-05:00 2023-06-30 KPMG LLP 303 PEACHTREE ST STE 2000 ATLANTA GA 30308 990 2022-07-01 352228583 PIEDMONT MOUNTAINSIDE HOSPITAL INC % MARIE GAFFNEY PIED 7066922441 1266 Highway 515 South Jasper GA 30143 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2024-05-13 true MARIE GAFFNEY 999009999 WHITNEY B HEBRON P01226647 4042223000 2024-05-13 3 2022 2023-04-26 12:10:37Z Ms Denise Ray 1266 Highway 515 South Jasper GA 30143 147101767 false X piedmont.org X 2004 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 8 5 649 155 0 0 11140423 2941931 127510787 143733194 -2650 -191619 405037 426642 139053597 146910148 49928 52185 0 0 49470871 51253255 0 0 0 69724674 73646623 119245473 124952063 19808124 21958085 81688203 78701998 41668792 27633622 40019411 51068376 TO PROVIDE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE IN A PROGRESSIVE ENVIRONMENT, GUIDED BY PHYSICIANS, DELIVERED BY PROFESSIONALS, AND INSPIRED BY THE COMMUNITIES WE SERVE. false false 112869158 52185 143745969 PIEDMONT MOUNTAINSIDE HOSPITAL ("PMH") IS A 62-BED FACILITY LOCATED IN THE CITY OF JASPER IN PICKENS COUNTY, GEORGIA. OVER 200 PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN THE COMMUNITY, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2023, THE HOSPITAL HAD 3,724 IN-PATIENT ADMISSIONS WITH A TOTAL OF 16,208 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 33,031 AND OUTPATIENT VISITS TOTALED 58,708. SURGICAL SERVICES WERE PROVIDED TO 2,590 PATIENTS. 112869158 true true false false false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false true false false false true true false false false true X 0 0 649 true false false false false false false false false false false false false X 8 5 false false false false true true true true true false false false true true true true true true true false GA X MARIE GAFFNEY 4702716007 2727 PACES FERRY ROAD BLDG 2 STE Atlanta GA 30339 X Ms Elizabeth Leddy Secretary/CLO PHC 1.0 54.0 X 0 1389485 138711 Dr Leigh Hamby Board Member 1.0 54.0 X 0 1188028 140776 Mr Thomas Arnold TREASURER/CFO PHC 1.0 54.0 X 0 1173444 130741 Ms Denise Ray CEO/CHAIR/BOARD MEMBER 55.0 0.0 X X 807508 0 104007 Dr John Schnars Board Member 1.0 54.0 X 0 706687 32470 DR MOIZ MASTER PHYSICIAN 40.0 0.0 X 508854 0 24785 Mr Justin Leal SR. 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OPERATIONS 40.0 0.0 X 292923 0 16840 MS MICHELLE BREITFELDER CNO 55.0 0.0 X 267622 0 32182 MS OUIDA CORRY PHARMACIST 40.0 0.0 X 211003 0 26168 MS CARRIE HOLBERT NURSING SUPERVISOR 40.0 0.0 X 218648 0 12927 Ms Lindsey Gard CFO 55.0 0.0 X 193509 0 32698 Mr Michael McAnder FORMER TREASURER/CFO PHC 0.0 0.0 X 0 150106 0 Mr Richard Hubbard III Board Member 1.0 0.0 X 0 0 0 Mr Gregory Hurst Board Member 1.0 0.0 X 0 0 0 Mr Paul Nealey Board Member 1.0 0.0 X 0 0 0 Mr Jason Smith Board Member 1.0 0.0 X 0 0 0 Dr Rosemarie Spillane Board Member 1.0 0.0 X 0 0 0 2500067 4607750 692305 84 true true false MEDICAL SOLUTIONS LLC 1010 NORTH 102ND ST OMAHA NE 68114 HEALTHCARE STAFFING 5412053 FORTIS HEALTH LLC 3950 AUSTELL RD AUSTELL GA 30106 SKILLED NURSING 2430129 AYA HEALTHCARE INC 5930 CORNERSTONE CT W STE 300 SAN DIEGO CA 92121 HEALTHCARE STAFFING 1713096 EMERGENCY COVERAGE CORPORATION 1200 MEMORIAL DR DALTON GA 30720 EMERGENCY CARE 641684 INSIGHT HEALTH CORPORATION 1001 N HIGHLAND AVE MURFREESBORO TN 37130 RADIOLOGY SERVICES 430317 12 2941931 88999 2941931 PATIENT SERVICE REVENUE 621110 143006163 143006163 0 0 OTHER OPERATING REVENUE 900099 727031 727031 0 0 143733194 0 0 0 0 0 0 0 191619 -191619 -191619 0 0 -191619 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722310 281458 0 0 281458 GIFT SHOP 900099 132409 0 0 132409 FEE REVENUE 900099 12775 12775 0 0 426642 146910148 143745969 0 222248 52185 52185 0 0 0 1060731 931640 129091 0 0 40072610 35195773 4876837 0 0 7539339 6621801 917538 0 2580575 2266519 314056 0 302814 302814 0 0 30727 29805 922 0 0 0 0 0 10719843 10719843 0 0 268527 268527 0 0 6361138 6276165 84973 0 1514620 1469190 45430 0 0 2938668 2483113 455555 0 27998 20643 7355 0 0 0 865852 839145 26707 0 3065575 0 3065575 0 3911625 3794277 117348 0 1012667 982287 30380 0 DRUGS AND MEDICAL SUPPLIES 15735133 15735133 0 BAD DEBT EXPENSE 11482089 11482089 0 HOSPITAL TAX 1196361 1196361 0 ALL OTHER EXPENSES 14212986 12201848 2011138 0 124952063 112869158 12082905 0 58314 50339 0 0 0 0 28377849 24728036 0 0 0 0 0 0 2141200 2061402 369654 494272 92594045 58406579 33560703 34187466 0 0 0 0 0 0 17180483 17180483 0 0 81688203 78701998 8804305 9616605 0 0 0 0 0 0 0 0 0 0 0 0 0 0 32864487 18017017 41668792 27633622 X 32688502 44156067 7330909 6912309 40019411 51068376 81688203 78701998 X 21958085 -10909120 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1897200 1897200 35146296 21683539 13462757 2536751 2308482 228269 40764178 30411782 10352396 12249620 4002776 8246844 34187466 0 MEDICARE PAYABLE 10124662 OTHER LIABILITIES 7892355 18017017 X SCHEDULE D, PART X, LINE 2: ASC 740 FOOTNOTE (FKA FIN 48) PHC ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF ASC 740, INCOME TAXES (ASC 740). UNDER THE REQUIREMENTS OF ASC 740, TAX-EXEMPT ORGANIZATIONS MAY BE REQUIRED TO RECORD AN OBLIGATION AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS UNCERTAIN TAX EXPOSURE ITEMS. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT JUNE 30, 2023 AND 2022. true true X true X 300. true X true true false true true 4031010 4031010 0.03550 3323622 2710788 612834 0.00540 1700921 1148664 552257 0.00490 9055553 3859452 5196101 0.04580 48750 48750 0.00040 560321 560321 0.00490 158007 158007 0.00140 31150 31150 0.00030 798228 798228 0.00700 9853781 3859452 5994329 0.05280 29695 29695 0.00030 7750 7750 0.00010 3280 3280 24850 24850 0.00020 65575 65575 0.00060 true 1514406 27874344 28239323 -364979 X true true 1 1 Piedmont Mountainside Hospital 1266 Highway 515 South Jasper GA 30145 https://www.piedmont.org/ 056-550 X X X Piedmont Mountainside Hospital 1 false false true X X X X X X X X 21 true false false true X SEE PART V X X true 22 true SEE PART V false true X 300. 300. X X true true X X X X true X SEE PART V X SEE PART V X SEE PART V X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, LINE 5: COMMUNITY REPRESENTATION As a part of our process, we interviewed nearly 245 stakeholders, policy makers and lawmakers representing public health, low-income populations, minorities, chronic conditions, older adults, and our communities. These included 8 stakeholders within the Pickens and Gilmer communities, who gave their perspectives on community health through the lens of their role within the community. These interviews were conducted for people representing the entire region. Specifically, we interviewed representatives of local and regional public health entities, minority populations, faith-based communities, local business owners, the philanthropic community, mental health agencies, elected officials and individuals representing our most vulnerable patients. The Piedmont Healthcare board of directors and leadership from all 19 hospitals were actively informed and engaged throughout this process. SCHEDULE H, PART V, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE https://www.piedmont.org/media/file/Community-Benefit-Needs-Assessment-PMH .pdf SCHEDULE H, PART V, LINE 7D: PUBLIC AVAILABILITY OF CHNA IN ADDITION TO MAKING ITS CHNA REPORTS AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT MOUNTAINSIDE HOSPITAL SENT COPIES TO EACH PARTICIPANT IN THE CHNA PROCESS, DISTRIBUTED THE ASSESSMENTS TO COMMUNITY CENTERS AND OTHER LOCATIONS THAT PRIMARILY SERVE AN UNINSURED POPULATION, SENT COPIES TO LEGISLATIVE AND ELECTED OFFICIALS, AND WIDELY DISTRIBUTED THE ASSESSMENTS TO OTHER PIEDMONT HEALTHCARE HOSPITALS. SCHEDULE H, PART V, LINE 10A: IMPLEMENTATION STRATEGIES WEBSITE THE BOARD OF DIRECTORS FOR PIEDMONT MOUNTAINSIDE HOSPITAL APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE-YEAR PERIOD BEGINNING WITH FY23 ON AUGUST 26, 2022, WITHIN THE GRACE PERIOD FOLLOWING THE APPROVAL OF THE NEW COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING LINK IS FOR THE IMPLEMENTATION STRATEGY EFFECTIVE THROUGH JUNE 30, 2025. https://www.piedmont.org/media/file/Community-Benefit-Implementation-Strat egy-PMH.pdf SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS PIEDMONT MOUNTAINSIDE HOSPITAL CONDUCTED ITS FOURTH CHNA DURING FY22, AGAIN BY ASSESSING PUBLICLY AVAILABLE DATA, INTERVIEWING COMMUNITY MEMBERS AND STAKEHOLDERS, CONDUCTING FOCUS GROUPS OF VULNERABLE POPULATIONS, INTERVIEWING PIEDMONT BOARD MEMBERS, AND SURVEYING PIEDMONT EMPLOYEES. THROUGH THIS PROCESS, PIEDMONT MOUNTAINSIDE HOSPITAL DETERMINED AND PRIORITIZED THE COMMUNITY HEALTH NEEDS IT WOULD ADDRESS BASED ON THE NUMBER OF PERSONS AFFECTED, THE SERIOUSNESS OF THE ISSUE, WHETHER THE HEALTH NEED AFFECTED VULNERABLE POPULATIONS, AND THE AVAILABILITY OF COMMUNITY AND HOSPITAL RESOURCES NECESSARY TO ADDRESS THE ISSUE. All priorities are viewed through the lens of health disparities, with particular attention paid to improving outcomes for those most vulnerable due to income and race. BASED ON THE CHNA, PIEDMONT MOUNTAINSIDE HOSPITAL IS CURRENTLY FOCUSING ON: (1) ENSURING AFFORDABLE ACCESS TO HEALTH, MENTAL, AND DENTAL CARE (2) PROMOTING MENTAL WELL-BEING (3) PROMOTING HEALTH BEHAVIORS TO REDUCE INSTANCES OF PREVENTABLE CONDITIONS SCHEDULE H, PART V, LINE 16: FINANCIAL ASSISTANCE POLICY WEBSITES FINANCIAL ASSISTANCE POLICY - https://www.piedmont.org/media/file/Financial-Assistance-Policy.pdf FINANCIAL ASSISTANCE APPLICATION - https://www.piedmont.org/media/file/Financial-Assistance-Application.pdf FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY - https://www.piedmont.org/media/file/Financial-Assistance-Plain-Language-Su mmary-English.pdf SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS SCHEDULE H, PART I, LINE 6A PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT We regularly report to the community our community benefit activities in several ways. Each year, we prepare a systemwide community benefit report that is available to the public through publication on our website. We also make available our IRS Form 990 Schedule H on our website and provide copies to anyone upon request. We also provide information on community benefit programming to local, state, and federal lawmakers through our government affairs office and online at piedmont.org. SCHEDULE H, PART I, LINE 7(F) PERCENT OF TOTAL EXPENSE THE DENOMINATOR USED FOR THE CALCULATION OF COLUMN (F), PERCENT OF TOTAL EXPENSE, WAS THE AMOUNT OF TOTAL FUNCTIONAL EXPENSES ON FORM 990, PART IX, LINE 25, COLUMN (A) OF $124,952,063, LESS BAD DEBT EXPENSE OF $11,482,089 FROM FORM 990, PART IX, LINE 24(B). SCHEDULE H, PART I, LINE 7 FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST A RATIO OF PATIENT CARE COST TO CHARGES, CONSISTENT WITH WORKSHEET 2, WAS USED TO REPORT THE AMOUNTS IN PART I, LINES 7A-7D. FOR AMOUNTS ON LINES 7E-7K, ACTUAL EXPENSES FOR EACH COMMUNITY BENEFIT ACTIVITY ARE TRACED AND REPORTED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. SCHEDULE H, PART III, LINES 2-4 BAD DEBT EXPENSE CALCULATION AND FOOTNOTE The provision for bad debts is based upon leadership's assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Periodically, leadership assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category. The results of the review are then used to make any modifications to the provision for bad debts to establish an appropriate allowance for uncollectible receivables. THE AMOUNT REPORTED ON PART III, LINE 3, WAS DETERMINED BY TAKING THE AVERAGE ACCEPTANCE RATE FOR ALL CHARITY CARE APPLICATIONS RECEIVED DURING THE YEAR MULTIPLIED BY THE NUMBER OF DENIALS THAT WERE ATTRIBUTABLE TO INSUFFICIENT INFORMATION. THAT TOTAL WAS THEN ADJUSTED DOWNWARD FOR THE ORGANIZATION'S USE OF PRESUMPTIVE ELIGIBILITY WHEN DETERMINING ITS COMMUNITY BENEFITS. BAD DEBT EXPENSE FOOTNOTE FROM CONSOLIDATED, AUDITED FINANCIAL STATEMENTS: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBT TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. PMH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE ARE NOT REPORTED AS REVENUE. SCHEDULE H, PART III, LINE 8 MEDICARE SHORTFALLS AS COMMUNITY BENEFIT The amount reported on Part III, Line 6, was calculated in accordance with Schedule H instructions by utilizing our allowable Medicare cost as reported in the Medicare cost report, which is based on a cost to charge ratio. However, the allowable costs in the Medicare cost report do not reflect the actual cost of providing care to patients since the Medicare cost report excludes many direct patient care costs that are essential to provide quality healthcare for Medicare patients. For example, certain coverage fees to physicians, cost of Medicare C and D, and other similar direct patient care expenses are specifically excluded from allowable cost in the Medicare Cost Report. We believe our Medicare shortfall reported on Part III, Line 7 of Schedule H, should be considered a community benefit as the IRS community benefit standard includes the provision of care to elderly and Medicare patients. IRS Revenue Ruling 69-545 provides, in part, that hospitals serving patients with governmental health insurance, such as Medicare, is an indication we operate to promote health in the community. Our policy is to treat Medicare patients, regardless of the extent to which Medicare pays for the treatment. For many services, Medicare's reimbursement is less than the cost of the care provided, resulting in shortfalls that are to be absorbed by us in honor of our commitment to treat elderly patients. Many of these patients live on a low, fixed income, and would qualify for financial assistance or other means-tested programs, absent from their enrollment in Medicare. SCHEDULE H, PART III, LINE 9(B) COLLECTION PRACTICES INITIAL SCREENINGS OF ALL INPATIENT, EMERGENCY, AND SURGERY ENCOUNTERS, AS WELL AS MOST OUTPATIENT VISITS, ARE CONDUCTED BY FINANCIAL COUNSELORS IN ORDER TO IDENTIFY ANY AVAILABLE INSURANCE OR OTHER COVERAGE FOR EACH PATIENT. COUNSELORS CONTACT PATIENTS AND THEIR FAMILIES DIRECTLY, EITHER IN PERSON OR BY LETTER, TO ASSIST THE FAMILY IN IDENTIFYING ANY PROGRAMS FOR WHICH THE PATIENT/SERVICE MAY QUALIFY (INCLUDING MEDICAID, STATE CHILDREN'S HEALTH INSURANCE PROGRAM ("SCHIP"), PRIVATE OR GOVERNMENT INSURANCE COVERAGE, AND CHARITY ASSISTANCE). IF THE FAMILY CANNOT BE TIMELY LOCATED OR IS UNCOOPERATIVE, RELATED ACCOUNTS ARE TRANSFERRED TO AN INTERNAL COLLECTION DEPARTMENT FOR FURTHER ATTEMPTS TO OBTAIN PAYMENT OR, IF THE PATIENT MAY QUALIFY FOR ASSISTANCE, TO SECURE A FINANCIAL ASSISTANCE APPLICATION. THE ORGANIZATION'S DEBT COLLECTION POLICY AND PROCEDURES PROHIBIT ANY COLLECTION EFFORTS FOR THE PORTION OF A PATIENT ACCOUNT BALANCE THAT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. SCHEDULE H, PART VI, LINE 2: NEEDS ASSESSMENT As a designated 501(c)(3) nonprofit hospital, we are required by the Internal Revenue Service to conduct a triennial community health needs assessment (CHNA) in accordance with regulations put forth by the IRS following the 2010 Patient Protection and Affordable Care Act (ACA). Through this assessment, we hope to better understand local health challenges, identify health trends in our community, determine gaps in the current health delivery system and craft a plan to address those gaps and the identified health needs. In FY22, we conducted our fourth triennial CHNA and FY23 was the first year for activities outlined in its subsequent Implementation Strategy. The CHNA was led by the Piedmont Healthcare community benefits team and consulting organization Public Goods Group, with input and direction from Piedmont leadership and Piedmont Healthcare's Department of External Affairs. Process The CHNA started with a definition of our community, which is our home county due to the impact of our tax-exempt status. Property taxes make up the largest segment of a hospital's tax exemption, which impacts county revenues. Because of this, we aim to ensure that we are providing ample benefit to our county and its residents. Additionally, we take into consideration patient origin, especially that of our lower-income patients such as those who qualify for financial assistance or receive insurance coverage through Medicaid. Our secondary communities are considered the areas in which we have the highest concentration of patients fitting that criterion, including ones from nearby communities. Once we established our primary and secondary communities, we then conducted an analysis of available public health data. This included resources from: US Census, US Health and Human Services' Community Health Status Indicators, US Department of Agriculture, Economic Research Service, National Center for Education Statistics, Kaiser Family Foundation's State Health Facts, American Heart Association, County Health Rankings and Georgia Online Analytical Statistical Information System (OASIS). All figures within the CHNA were for 2020, unless otherwise noted. Health indicators are estimates provided by County Health Rankings, and hospital data were sourced internally. We then interviewed key stakeholders who have expertise or knowledge of our communities. Specifically, we interviewed representatives of local and regional public health entities, minority populations, faith-based communities, local business owners, the philanthropic community, mental health agencies, elected officials and individuals representing our most vulnerable patients. An internal survey was also conducted throughout the healthcare system for both clinical and non-clinical employees. Information was gathered on knowledge and understanding of community benefit and current programs, as well as suggestions for how we can better serve our patients and communities. Approximately 1,100 employees spanning the system responded. Additionally, we conducted a community-based survey that was widely advertised to the community. Once both qualitative and quantitative data were gathered, we authored the preliminary report, which was then vetted and reviewed by hospital and health system leadership. In this report, we identified several key community health needs that emerged during the assessment process. The chosen priorities were recommended by the community benefit department with signoff from hospital and board leadership. The following criteria were used to establish the priorities: - The number of people affected. - The seriousness of the issue. - Whether the health need disproportionately affected people living in poverty or reflected health disparities. - The availability of community and/or hospital resources to address the need. All priorities were viewed through the lens of health disparities, with particular attention paid to improving outcomes for those most vulnerable due to income and race. The priorities we chose reflected a collective agreement on what hospital leadership, staff and the community felt was most important and within our ability to positively impact the issue. Once priorities were approved by the board of directors, we then authored the CHNA and presented our findings and recommendations to the hospital's board of directors for their input and approval. Our priorities A key component of the CHNA is to identify the top health priorities we will address over fiscal years 2023, 2024 and 2025. These priorities will guide our community benefit work. They are, in no order: - Ensure affordable access to health, mental health and dental care. - Promote mental well-being. - Promote healthy behaviors to reduce instances of preventable conditions. With each priority, we work to achieve greater health equity by reducing the impact of poverty and other socioeconomic indicators. This means that health equity is built into each priority, which is demonstrated through our implementation strategies. Our subsequent implementation strategy was developed in partnership with hospital leadership and community stakeholders to address the identified priorities in our FY22 community health needs assessment. The implementation strategy was designed to be executed over a three-year period and included specific metrics by which we would be able to evaluate our work and its impact. The implementation strategy was developed by utilizing community feedback from the assessment in partnership with the system community benefits department, our leadership and our board of directors. We included proven and successful interventions and programming, investing further in work we felt was successful in addressing unmet health needs. SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY We understand that not everyone can pay their hospital bill due to their insurance status or a limited income, and because of this, we offer financial assistance to qualifying patients. Notification about financial assistance includes, but is not limited to, a dedicated contact number, notices in patient bills, and posted notices in key areas of the hospital. These locations are the emergency room, admitting and registration departments, our business office, and patient financial services offices that are located on site. We also publish and widely publicize a plain language summary of this financial assistance care policy on our website, as well as the full policy. Referral of patients for financial assistance may be made by any staff or medical staff member at the hospital, including physicians, nurses, financial counselors, social workers, case managers, chaplains, and religious sponsors. A request for financial assistance may be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws. Additionally, we provide copies of our financial assistance policy to our partner clinics and others who work closely with low-income populations. We help our partners in understanding the policy, how it relates to their populations, and receive feedback in ways our financial assistance programming could be improved. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION While Piedmont Mountainside serves patients from all over northeast Georgia, we consider our community to be Pickens and Gilmer counties. We do this in recognition of the direct impact of our tax-exempt status on county residents. In both counties, an average of 64,000 people lived in the nearly 660-square-mile area each year between 2017 and 2021. The population density for this area, estimated at about 100 people per square mile, is much lower than the state average population density of nearly 200 people per square mile and is on par with the national average population density. The ZIP code with the highest population is 30534, which includes Dawsonville and is home to nearly half the total population for both counties combined. The two counties are mostly rural, with 80 percent of the population living in a designated rural area and only 20 percent of community members living within an urban setting. Like in most of Georgia, these rural populations are mostly white and between the ages of 18 and 64. Both counties are growing, with an average population jump of 12 percent between the 2010 and 2020 census. Between 2017 and 2021, an average of 11 percent of the population were veterans, and the most common age range of veterans was between 65 and 74. Nearly 20 percent of the population - about 12,000 people - lived with a disability, and most of that population was over the age of 65. Between 2017 and 2021, about 90 percent of Gilmer and Pickens residents were white, about one percent were African American, less than one percent were Asian and about eight percent were Hispanic/Latino. About four percent of the population were born outside of the US, and 2.15 percent of those did not have citizenship status. Nearly two percent of households did not speak English at home. In an average year from 2017 to 2021, nearly 15 percent - about 9,200 community members - had no form of insurance. Insurance status and health are inextricably linked. Being uninsured is generally a marker of low income, as the overwhelming majority of those who are uninsured are also within certain ranges of the federal poverty guidelines. This means these populations are also likely to face myriad other social determinants of health (SDH), like housing and food insecurity. Throughout Georgia, adults ages 18 to 64 are most likely to be uninsured, and that's true in both Gilmer and Pickens counties. On average, nearly 22 percent of non-elderly adults were uninsured from 2017 to 2021, a rate higher than the state and national averages of about 18 percent and 12 percent, respectively. The highest concentration of uninsured populations was in Ellijay, where the average of uninsured adults jumps to 20 percent of the population. Between 2017 and 2021, the median household income in Gilmer County was $60,504, and the median household income in Pickens County was $71,637. Of employers in the community, the largest sector (by number of employees) in 2019 was retail trade, which employed 3,168 community members at an average wage of $27,523, according to the US Department of Commerce. Manufacturing was the second largest sector, with 2,507 people employed at an average wage of $50,792. Construction was the third largest sector, with 2,442 people employed at an average wage of $16,167. According to the US Department of Labor, in May 2023, more than 28,600 people in the community were part of the labor force, and only 920 - about three percent - were unemployed. This rate is on par with the state average, but less than the national average of nearly four percent. This figure has steadily decreased over the last decade, the current rate being nearly one third of the unemployment rate in 2013. From 2017 to 2021, 14 percent of the two counties' population lived at or below 100 percent of the federal poverty guidelines. In 2022, a family of four with a total household income of $27,750 or less lived at or below the poverty guideline. As shown, Gilmer families are more likely to live in poverty than those in Pickens County. Of the more than 25,000 total occupied households in both counties, an average of about 5,700 - 23 percent - of the population lived in cost-burdened households each year from 2017 to 2021, meaning their housing costs were 30 percent or more of the total household income. Gilmer and Pickens comprised similar percentages of cost-burdened households. Approximately nine percent of combined county households had costs that exceeded 50 percent of the household income, which places a household in significant financial strain. Low food access is defined as living more than one mile (urban) or 10 miles (rural) from the nearest supermarket, supercenter or large grocery store. This indicator is relevant because it highlights populations and geographies facing food insecurity. According to the 2019 Food Access Research Atlas database, a combined 18 percent of both counties' populations have low food access, meaning about 10,000 community members may struggle to access healthy foods. This is lower than the state and national rates of about 31 percent and 22 percent, respectively. In 2020, in both counties combined, 73 percent of adults ages 18 and older saw a doctor for a routine checkup the previous year, a measure that is likely overreported and is lower than both state and national averages. For Medicare recipients, this number jumps to 88 percent of adult beneficiaries, which is above both state and national averages. Heart disease is a leading cause of death in both Gilmer and Pickens counties. Between 2016 and 2020, the age-adjusted rate was 191 deaths for every 100,000 people, which is higher than both state and national rates, which were 178 and 165 heart-related deaths per 100,000 people, respectively. When adjusting for gender, we see that men are far more likely to die from heart disease than women, at a rate of nearly 230 male deaths per 100,000 people, compared to a rate of about 160 deaths for women. Between 2016 and 2020, there were nearly 180 deaths due to stroke, representing an age-adjusted death rate of 36 deaths per 100,000 people, combined for both counties. Like with heart disease, men are more likely to die from stroke than women, as are minority populations. The hospitalization rates for heart disease and stroke among Medicare recipients have generally decreased over the last five years. The average cardiovascular disease hospitalization rate between 2017 and 2019 was 13 hospitalizations per 1,000 Medicare beneficiaries, combined for both counties. This is higher than the state and national rates of about 12 and 11 percent, respectively. The hospitalization rate for stroke is also slightly above state and national rates, with 10 hospitalizations per 1,000 Medicare beneficiaries, as compared to the state and national rate of about nine and eight percent, respectively. Between 2018 and 2020, the average 30-day readmission rate for heart failure patients was 19 percent, which is slightly lower than the state and national averages. The readmission rate for heart attack patients was 15 percent, which is also slightly lower than the state and national averages. Readmission measures are estimates of the rate of unplanned readmission to an acute care hospital in the 30 days after discharge from a hospitalization due to heart failure or heart attack. Breast screening rates have remained relatively steady over the last few years; in 2020, the last year for which data are available, nearly 70 percent of all women ages 50-74 reported having had a mammogram within the two previous years. This is below the state and national averages of 74 percent and 78 percent, respectively. Approximately 68 percent of community members had a colonoscopy at some point in their lives, and 81 percent of women ages 21 to 25 had a pap smear within the last two years. In 2019, more than 6,000 adults ages 20 and older had a diagnosis of diabetes, equaling more than nine percent of the combined counties' population. This is lower than the state rate of 10 percent, but is an increase from the two years previous, when the rate held steady at less than nine percent. Diabetes is a prevalent problem in the US, and often indicates an unhealthy lifestyle and a greater risk of further health issues. In 2020, nearly three percent of the combined counties' population had a diagnosis of kidney disease, a rate on par with the state and national rates. In 2019, 30 percent of adults ages 18 and older reported having high cholesterol, combined for both counties. Too much cholesterol increases the risk of heart disease and stroke, two of the main causes of death within the community. In 2019, 31 percent of adults ages 18 and older had a diagnosis of high blood pressure, combined for both counties. High blood pressure can damage arteries by making them less elastic, which decreases the flow of blood and oxygen to the heart and leads to heart disease. SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH We actively promote the health of our community through clinic-hospital partnerships, community-based health screenings, educational activities, community-building activities, the operation of a 24-hour emergency department available to the entire community, the operation of an emergency room open to all members of the community without regard to ability to pay, a governance board composed of community members, use of surplus revenue for facilities improvement, patient care, and medical training, education, and research, the provision of inpatient hospital care for all persons in the community able to pay, including those covered by Medicare and Medicaid, and an open medical staff with privileges available to all qualifying physicians. In FY23, Piedmont Healthcare launched the Empowering You platform to connect community members and patients with resources to address social determinant of health issues. Powered by FindHelp.org, Piedmont clinicians and case managers can search and refer patients to supporting organizations. In FY23, Piedmont Mountainside Hospital actively supported local initiatives for continued community health, including the Knights of Columbus, Gilmer City Chamber, Georgia Mountains Hospice, American Legion Post 149, and others. Additionally, we supported the Big Bear Charity Concert benefiting Ruth House Ministries, The Timothy House, and the Good Shepherd Clinic of Dawson County. We supplied Lightning Oxygen Supplies Kits for Pickens County Public Safety and donated $12,000 to Pickens County EMS for a LUCAS chest compression device, a game-changer in CPR that allows emergency workers to focus on life-saving tasks while the device provides continuous compressions. Sharing our space and supplies, we donated medical supplies to all Pickens and Gilmer County school nurses and provided meeting spaces to community groups. We also hosted quarterly blood drives in partnership with Blood Assurance. Piedmont Mountainside's stroke coordinator provided Hands-Only CPR training and information about stroke and heart attack symptoms at the first annual Good Samaritan Health and Wellness Jamboree. Good Samaritan is committed to providing quality healthcare to members of the community and removing barriers to care and is a longstanding partner of the hospital. We also provided leadership in addressing the COVID-19 pandemic, hosting calls with community leaders and distributing CEO Monthly Newsletters to more than 300 residents in Pickens and Gilmer counties. In FY23, we continued providing health services, volunteering at Bethesda Free Clinic, conducting screenings at AEMC Wellness Employee health fairs, and performing vision and hearing screenings at Pickens County Junior High School. Piedmont Mountainside also participated in the Dalton State Health Fair and provided blood pressure checks, body mass index monitoring, and other screenings for students of the Dalton State Ellijay Campus. The Piedmont Mountainside Breast Cancer Thrive Fund is a star initiative in our cancer support in our community. This fund helped support breast cancer patients in our local communities. The fund also held its annual Breast Cancer Thrive 5K run to raise funds for breast cancer initiatives, patient care supplies, clinical and patient education, support programs, and more. Piedmont Mountainside also hosted monthly breast cancer support group meetings. Piedmont Mountainside took a hands-on role in promoting healthy aging in FY23. At both Gilmer and Pickens County senior centers, we provided monthly educational presentations on nutrition, DNR, and signs and symptoms of stroke, reaching more than 100 senior citizens in our community. Piedmont Mountainside leadership engaged with students at the First Annual Pickens County High School Career Boot camp, which focused on manufacturing and healthcare industries. The event, hosted by Pickens County Chamber of Commerce and the high school, aimed to introduce student to these growing fields. Youth Leadership Pickens is a free program developed by the Pickens County Chamber of Commerce. Piedmont Mountainside staff participated in career interview sessions with 11th and 12th grade students interested in pursuing healthcare careers. Led by our care management department, we worked to connect our aging population to needed resources, access to care, and appropriate utilization of resources. We continued to provide a Licensed Medical Social Worker (LMSW) to work in the emergency department to evaluate patients and work with high risk, low-income patients who are treated and a have a need for services. The LMSW assists with referrals to community resources and are available post-discharge as well. Our goal is to link patients with community resources to ensure their ongoing medical needs are addressed as well as their psychosocial needs. We continued working with Good Samaritan Health and Wellness to ensure patients who meet the criteria above have access to care. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM We are part of Piedmont Healthcare, a regional not-for-profit organization, and the parent company of 19 hospitals, the Piedmont Physicians Group, the Piedmont Heart Institute, the Piedmont Clinic, and the Piedmont Healthcare Foundation. Our community relations team works directly with the community. Our community benefit department oversees the community benefit activities on behalf of all hospitals throughout the system, and this includes conducting the triennial CHNA and subsequent implementation strategy, ensuring the financial assistance policy is communicated to the community, maintaining the community benefit webpage, authoring the community benefit annual report, preparing board materials, developing and executing the community benefit grants program and compiling all community benefit figures. Each hospital and certain departments of Piedmont Healthcare execute community benefit programming, such as our revenue department, which oversees the financial assistance program. SCHEDULE H, PART VI, LINE 7: STATE OF FILING OF COMMUNITY BENEFIT REPORT We are not required to file a community benefit report; however, we are required to file with the Georgia Department of Community Health information on our indigent and charity care, as well as our Medicaid and Medicare shortfalls. X true true true true false false false false false true false Dr Leigh Hamby Board Member 0 686405 0 306142 0 195481 0 122549 0 18227 0 1328804 0 104249 Ms Denise Ray CEO/CHAIR/BOARD MEMBER 482964 0 177944 0 146600 0 86852 0 17155 0 911515 0 68552 0 Dr John Schnars Board Member 0 546007 0 0 0 160680 0 16332 0 16138 0 739157 0 0 Ms Lindsey Gard CFO 163075 0 23310 0 7124 0 0 0 32698 0 226207 0 0 0 Mr Justin Leal SR. DIR. OPERATIONS 242515 0 33230 0 17178 0 7646 0 9194 0 309763 0 0 0 DR MOIZ MASTER PHYSICIAN 396206 0 88250 0 24398 0 10579 0 14206 0 533639 0 0 0 Mr Michael McAnder FORMER TREASURER/CFO PHC 0 0 0 0 0 150106 0 0 0 0 0 150106 0 0 Mr Thomas Arnold TREASURER/CFO PHC 0 640918 0 356487 0 176039 0 115097 0 15644 0 1304185 0 96797 Ms Elizabeth Leddy Secretary/CLO PHC 0 547780 0 295524 0 546181 0 117950 0 20761 0 1528196 0 490447 MS MICHELLE BREITFELDER CNO 204200 0 47829 0 15593 0 15490 0 16692 0 299804 0 0 0 MS CARRIE HOLBERT NURSING SUPERVISOR 76521 0 120 0 142007 0 12927 0 0 0 231575 0 0 0 MS OUIDA CORRY PHARMACIST 153705 0 240 0 57058 0 9737 0 16431 0 237171 0 0 0 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS ELIZABETH LEDDY, THOMAS ARNOLD, DENISE RAY, AND DR. LEIGH HAMBY RECEIVED A DISCRETIONARY SPENDING ACCOUNT TOTALING $12,000, A FIXED AMOUNT DETERMINED BY THEIR JOB LEVEL. THIS SPENDING ACCOUNT WAS INCLUDED IN THEIR TAXABLE WAGES. SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT MOUNTAINSIDE HOSPITAL IS SET BY THE ENTITY'S PARENT, PIEDMONT HEALTHCARE, INC. PLEASE SEE THE SCHEDULE O NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A & 15B FOR ADDITIONAL INFORMATION. SCHEDULE J, PART I, LINE 4A: SEVERANCE PAYMENTS MICHAEL MCANDER RECEIVED A SEVERANCE PAYMENT DURING CALENDAR YEAR 2022 IN THE AMOUNT OF $150,106. SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL COMPENSATION INFORMATION THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THEIR SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS: LEIGH HAMBY: $104,249 DENISE RAY: $ 68,552 THOMAS ARNOLD: $ 96,797 ELIZABETH LEDDY: $490,447 SCHEDULE J, PART I, LINE 7: NON-FIXED PAYMENTS CERTAIN EMPLOYEES PARTICIPATED IN AN "ANNUAL INCENTIVE PLAN" UNDER WHICH THEY RECEIVED NON-FIXED PAYMENTS BASED ON JOB LEVEL AND SEVERAL DIFFERENT PERFORMANCE METRICS. X 3 88999 FMV false true true SCHEDULE M, PART I, LINE 32B: THIRD-PARTY ASSISTANCE WITH CONTRIBUTIONS PIEDMONT HEALTHCARE ENGAGES SUNTRUST BANK TO ASSIST WITH THE MANAGEMENT AND SALE OF ITS NON-CASH STOCK GIFTS. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2022 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT MOUNTAINSIDE HOSPITAL BY ITS SOLE MEMBER, PIEDMONT HEALTHCARE, INC. (EIN 58-1503902), PURSUANT TO AN AGREEMENT WITH THE IRS TO FILE ALL FORMS 1099 FOR THE PIEDMONT HEALTHCARE SYSTEM ON A COMBINED BASIS. FORM 990, PART VI, SECTION A, LINE 6: ORGANIZATION'S SOLE MEMBER PIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT MOUNTAINSIDE HOSPITAL ("PMH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT MOUNTAINSIDE HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT MOUNTAINSIDE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT MOUNTAINSIDE HOSPITAL'S BOARD POLICIES AND DECISIONS MUST BE FILED, IMMEDIATELY AFTER ADOPTION, WITH THE SECRETARY OF THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS. SUCH POLICIES AND DECISIONS OF THE PIEDMONT MOUNTAINSIDE HOSPITAL BOARD OF DIRECTORS ARE NOT SUBJECT TO THE APPROVAL OF OR RATIFICATION BY THE PIEDMONT HEALTHCARE BOARD, BUT SHOULD THE NEED ARISE, THEY MAY BE RESCINDED BY THE PIEDMONT HEALTHCARE BOARD THROUGH A MAJORITY VOTE OF ITS DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B: 990 REVIEW PROCESS INFORMATION NEEDED TO PREPARE PIEDMONT MOUNTAINSIDE HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PMH'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S TAX DIRECTOR AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. PRIOR TO FILING, COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., THE ORGANIZATION'S SOLE MEMBER, FOR BOARD REVIEW. FORM 990, PART VI, SECTION B, LINE 12C: CONFLICT OF INTEREST POLICY COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARE'S CHIEF COMPLIANCE OFFICER. ALL SENIOR LEADERS, BOARD MEMBERS, PHYSICIAN EMPLOYEES, NURSE PRACTITIONERS/PHYSICIAN ASSISTANTS AND EMPLOYEES AND NON-EMPLOYEES ENGAGED IN RESEARCH ARE REQUIRED TO ANNUALLY DISCLOSE ALL MATTERS WHICH COULD POTENTIALLY CONSTITUTE A CONFLICT OF INTEREST. MATTERS DISCLOSED UNDER THE POLICY MUST BE REVIEWED IN WRITING BY THE PIEDMONT HEALTHCARE CONFLICT OF INTEREST COMMITTEE IN ORDER TO DETERMINE WHETHER A CONFLICT EXISTS AND, IF SO, WHETHER TO ELIMINATE OR MANAGE THE CONFLICT. ALL BOARD MEMBERS AND EMPLOYEES OF PIEDMONT MOUNTAINSIDE HOSPITAL ARE PROVIDED TRAINING ON CONFLICT OF INTEREST ISSUES, INCLUDING REPORTING REQUIREMENTS, AT NEW EMPLOYEE ORIENTATION AND AT LEAST ANNUALLY THEREAFTER. NONCOMPLIANCE WITH THE CONFLICT OF INTEREST POLICY MUST BE REPORTED TO PIEDMONT HEALTHCARE'S SENIOR VICE PRESIDENT OF COMPLIANCE FOR INVESTIGATION, AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. FORM 990, PART VI, SECTION B, LINE 15A, 15B: EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT MOUNTAINSIDE HOSPITAL IS SET BY THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC. THE PIEDMONT HEALTHCARE, INC., BOARD OF DIRECTOR'S EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("THE COMMITTEE") IS COMPOSED OF AT LEAST THREE MEMBERS OF THE PHC BOARD OF DIRECTORS, SERVING TERMS OF THREE YEARS, AND THE MAJORITY OF WHICH ARE COMMUNITY DIRECTORS WHO GENERALLY DO NOT HAVE CONFLICTS OF INTEREST RELATED TO FULFILLMENT OF THE DUTIES AS OUTLINED BELOW. THE COMMITTEE OVERSEES EXECUTIVE PERFORMANCE AND COMPENSATION ON BEHALF OF THE PHC BOARD, SUBJECT TO THE ULTIMATE AUTHORITY AND OVERSIGHT OF THE BOARD. THE COMMITTEE ALSO FORMULATES POLICIES AND MAKES DECISIONS IN ORDER TO ENSURE A HIGH LEVEL OF EXECUTIVE PERFORMANCE. THE COMMITTEE IS AUTHORIZED TO ACT ON BEHALF OF THE PHC BOARD AS SET OUT IN ITS CHARTER, AND THE COMMITTEE IS ALSO CHARGED WITH PROVIDING RECOMMENDATIONS AND PERIODIC REPORTS TO THE PHC BOARD REGARDING EXECUTIVE PERFORMANCE AND COMPENSATION. ALL DECISIONS AND COMPARABILITY DATA ARE DOCUMENTED IN THE COMMITTEE MEETING MINUTES. FUNCTIONS OF THE COMMITTEE - ASSESS AND IMPLEMENT POLICIES REGARDING PERFORMANCE, COMPENSATION AND BENEFITS OF THE PRESIDENT/CEO AND OTHER EXECUTIVES AS DETERMINED BY THE COMMITTEE - SELECT AN EXECUTIVE COMPENSATION CONSULTANT WHO REPORTS TO THE COMMITTEE - ANNUALLY REVIEW THE PRESIDENT/CEO SUCCESSION PLAN - FORMULATE AND IMPLEMENT ANNUAL PERFORMANCE OBJECTIVES FOR THE PRESIDENT/CEO, AND REVIEW AND APPROVE ANNUALLY RECOMMENDATIONS FROM THE PRESIDENT/CEO RELATING TO COMPENSATION, PERFORMANCE OBJECTIVES, AND SUCCESSION PLANS FOR EVP EXECUTIVES - ANNUALLY ASSESS PRESIDENT/CEO PERFORMANCE; IF NECESSARY, IMPLEMENT ACTION PLAN WITH PRESIDENT/CEO INPUT TO IMPROVE HIS/HER PERFORMANCE; ADJUST COMPENSATION AS APPROPRIATE; THE COMMITTEE CHAIR SHALL CONSULT WITH THE PHC GOVERNANCE COMMITTEE CHAIR AND THE PHC BOARD CHAIR AND SHALL COORDINATE THE ANNUAL PERFORMANCE REVIEW OF THE PHC PRESIDENT/CEO, UNLESS THE PHC BOARD CHAIR HAS A REAL OR PERCEIVED CONFLICT OF INTEREST, IN WHICH CASE THE COMMITTEE CHAIR SHALL DETERMINE THE PROPER REVIEW PROCESS - REVIEW AND APPROVE LONG-TERM AND SHORT-TERM GOALS TO BE USED IN CONNECTION WITH EVP COMPENSATION PROGRAMS AS RECOMMENDED BY THE PRESIDENT/CEO AND VALIDATED BY THE COMPENSATION CONSULTANT - PERIODICALLY REVIEW COMPENSATION, IF ANY, FOR THE PHC BOARD CHAIR AND ALL BOARD CHAIRS OF THE PHC SUBSIDIARIES - ESTABLISH OTHER POLICIES AND PROCEDURES, AND PERFORM OTHER TASKS, RELATED TO EXECUTIVE PERFORMANCE AND COMPENSATION, INCLUDING BUT NOT LIMITED TO, APPROVAL OF EXECUTIVE EMPLOYMENT CONTRACTS AND BENEFITS - PERIODICALLY REPORT SIGNIFICANT DECISIONS AND ANY ADDITIONAL REQUESTED INFORMATION TO THE PHC BOARD. FORM 990, PART VI, SECTION C, LINE 19: DISCLOSURE OF DOCUMENTS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THESE DOCUMENTS SHOULD BE REQUESTED FROM PIEDMONT HEALTHCARE, INC.'S LEGAL COUNSEL. FORM 990, PART XI, LINE 9: RECONCILIATION OF NET ASSETS CONTRIBUTIONS ($ 2,941,931) UNALLOCATED EXPENSES ($ 4,276,172) BOOK/TAX DIFFERENCES ($ 38,528) CHANGE IN TEMP $ 2,460,057 INTERCOMPANY TRANSFER ($ 6,112,546) ------------------------------------------ TOTAL ($10,909,120) Sleep Services of Jasper LLC 1266 Highway 515 South Jasper GA 30143 Medical GA 0 0 PMH PIEDMONT HEALTHCARE INC 1800 HOWELL MILL RD STE 850 ATLANTA GA 30318 581503902 MANAGEMENT GA 501(c)(3) 12C, III-FI NA false PIEDMONT HOSPITAL Inc 1968 PEACHTREE ROAD NW ATLANTA GA 30309 580566213 HOSPITAL GA 501(c)(3) 3 PHC false FAYETTE COMMUNITY HOSPITAL INC 1255 HIGHWAY 54 WEST FAYETTEVILLE GA 30214 582232328 HOSPITAL GA 501(c)(3) 3 phc false COLUMBUS REGIONAL SENIOR LIVING INC 707 CENTER STREET COLUMBUS GA 31901 582628502 HEALTHCARE GA 501(c)(3) 12C, III-FI PHC false PIEDMONT NEWNAN HOSPITAL INC 745 POPLAR ROAD NEWNAN GA 30265 205077249 HOSPITAL GA 501(c)(3) 3 phc false PIEDMONT HEALTHCARE FOUNDATION INC 2001 PEACHTREE ROAD 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PIEDMONT CLINIC INC 2727 PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 582005358 HEALTHCARE GA NA C-CORP 0 0 0.00000 false PIEDMONT HEART INSTITUTE PHYSICIANS INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 260593850 HEALTHCARE GA NA C-CORP 0 0 0.00000 false AMSTER MCRAE INSURANCE COMPANY SPC PO BOX 1159 Grand Cayman CJ KY1-1102 981734069 Related Insur CJ NA C-CORP 0 0 0.00000 false COLUMBUS HEALTHCARE RESOURCES PO BOX 790 COLUMBUS GA 31902 581717754 HEALTHCARE GA NA C-CORP 0 0 0.00000 false COLUMBUS HEALTH SERVICES INC PO BOX 790 COLUMBUS GA 31902 581640939 HEALTHCARE GA CRHS C-CORP 0 0 0.00000 false UNIVERSITY HEALTH RESOURCES INC 1350 WALTON WAY AUGUSTA GA 30901 581601372 HEALTHCARE GA NA C-CORP 0 0 0.00000 false UNIVERSITY HOSPITAL AIKEN INC 1350 WALTON WAY AUGUSTA GA 30901 472713774 HOSPITAL SC NA C-CORP 0 0 0.00000 false false false false false false false false false false false false false false false false true true false false SCHEDULE R, PART I, LINE 1: DISREGARDED ENTITIES THE LIMITED LIABILITY COMPANY LISTED IN SCHEDULE R, PART I, OPERATES AS A DEPARTMENT OF PIEDMONT MOUNTAINSIDE HOSPITAL AND IS INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LLC AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.