2023-05-12T12:52:30-05:00 2022-06-30 KPMG LLP 500 W 5TH ST STE 800 WINSTON SALEM NC 27101 990 2021-07-01 352228583 PIEDMONT MOUNTAINSIDE HOSPITAL INC % MARIE GAFFNEY PIED 7066922441 1266 Highway 515 South Jasper GA 30143 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2023-05-11 true MARIE GAFFNEY 999009999 SHAWN M HUTCHINSON P01048557 3362753394 2023-05-10 3 2021 2023-04-26 12:10:37Z Ms Denise Ray 1266 Highway 515 South Jasper GA 30143 139056247 false X piedmont.org X 2004 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 8 5 640 155 0 0 5122610 11140423 111005967 127510787 3970 -2650 294517 405037 116427064 139053597 23082 49928 0 0 43736375 49470871 0 0 0 61071933 69724674 104831390 119245473 11595674 19808124 64178508 81688203 23453675 41668792 40724833 40019411 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 107509756 49928 127527245 PIEDMONT MOUNTAINSIDE HOSPITAL ("PMH") IS A 52-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, 2022, THE HOSPITAL HAD 3,874 IN-PATIENT ADMISSIONS WITH A TOTAL OF 17,892 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 30,440 AND OUTPATIENT VISITS TOTALED 51,839. SURGICAL SERVICES WERE PROVIDED TO 2,509 PATIENTS. 107509756 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 0 640 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 Dr Leigh Hamby Board Member 1.0 54.0 X 0 1211455 138570 Mr Thomas Arnold TREASURER/CFO PHC 1.0 54.0 X 0 1131535 124798 Ms Elizabeth Leddy Secretary/CLO PHC 1.0 54.0 X 0 883982 140202 Mr Michael McAnder FORMER TREASURER/CFO PHC 0.0 0.0 X 0 972687 0 Ms Denise Ray CEO/CHAIR/BOARD MEMBER 55.0 0.0 X X 836477 0 99515 Dr John Schnars Board Member 1.0 54.0 X 0 630515 30223 MS MICHELLE BREITFELDER CNO 55.0 0.0 X 275700 0 29894 Mr Justin Leal SR. 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OPERATIONS 40.0 0.0 X 286032 0 12996 DR MOIZ MASTER PHYSICIAN 40.0 0.0 X 225549 0 2566 Ms Pam Mingo PHARMACY MANAGER 40.0 0.0 X 199516 0 23312 Ms Lindsey Gard CFO 55.0 0.0 X 188372 0 31206 Mr Donald Holmes PHARMACIST 40.0 0.0 X 183089 0 24638 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 2194735 4830174 657920 70 true true false MOUNTAINSIDE ANESTHESIA CONSULTANTS 1266 Hwy 515 S JASPER GA 30143 ANESTHESIA 2222768 MEDICAL SOLUTIONS LLC 1010 NORTH 102ND ST OMAHA NE 68114 STAFFING 1550717 EMERGENCY COVERAGE CORPORATION 1200 MEMORIAL DR DALTON GA 30720 EMERGENCY CARE 756309 AYA HEALTHCARE INC 5930 CORNERSTONE CT W STE 300 SAN DIEGO CA 92121 STAFFING 491587 ADVANCE REHABILITATION CONSULTING 224 SHORTER AVE NW ROME GA 30165 REHAB SERVICES 409160 13 7066883 4073540 180009 11140423 PATIENT SERVICE REVENUE 621110 126942123 126942123 OTHER OPERATING REVENUE 900099 568664 568664 127510787 0 0 0 0 0 0 2650 -2650 -2650 -2650 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722310 252961 252961 GIFT SHOP 900099 135618 135618 FEE REVENUE 900099 16458 16458 405037 139053597 127527245 385929 X 49928 49928 0 0 0 1012933 889659 123274 0 38939297 34200385 4738912 0 6972723 6124143 848580 2545918 2236080 309838 45440 45440 72221 70054 2167 0 0 0 0 13293258 13293258 0 0 52904 52904 5614631 5539630 75001 1504553 1459425 45128 0 2876653 2430712 445941 22889 16876 6013 0 0 1060041 1027344 32697 3025923 3025923 3708910 3597643 111267 819764 795171 24593 DRUGS AND MEDICAL SUPPLIES 16978750 16978750 BAD DEBT EXPENSE 5598353 5598353 HOSPITAL TAX 1295026 1295026 ALL OTHER EXPENSES 13755358 11808975 1946383 0 119245473 107509756 11735717 0 43564 58314 0 0 0 0 12954949 28377849 0 0 0 0 0 0 1966919 2141200 318531 369654 87205511 53644808 31714062 33560703 0 0 0 0 0 0 17180483 17180483 0 0 64178508 81688203 6996084 8804305 0 0 0 0 0 0 0 0 0 0 0 0 0 0 16457591 32864487 23453675 41668792 X 36914563 32688502 3810270 7330909 40724833 40019411 64178508 81688203 X 19808124 -20513546 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1897200 1897200 34684649 20628554 14056095 2536751 2158045 378706 36723729 28125553 8598176 11363182 2732656 8630526 33560703 0 MEDICARE PAYABLE 7874982 OTHER LIABILITIES 24989505 32864487 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, 2022 AND 2021. true true X true X 300. true X true true false true true 4769671 4769671 0.04200 3734409 3544998 189411 0.00170 1402517 434374 968143 0.00850 9906597 3979372 5927225 0.05220 123721 123721 0.00110 275791 275791 0.00240 105690 105690 0.00090 505202 505202 0.00440 10411799 3979372 6432427 0.05660 15790 15790 0.00010 250 250 15790 15790 0.00010 31830 31830 0.00020 true 844483 29804017 29105982 698035 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 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 DURING FY22, PIEDMONT MOUNTAINSIDE HOSPITAL CONDUCTED ITS FOURTH CHNA, 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 $119,245,473, LESS BAD DEBT EXPENSE OF $5,598,353 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. 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 System 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. FY22 also marked the third year of our FY19 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 2017, unless otherwise noted. Health indicators are estimates provided by County Health Rankings and hospital data were internally sourced. We then interviewed key stakeholders who have a particular 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 1,053 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 was 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 sign-off from hospital and board leadership. The following criteria were used to establish the priorities: - The number of persons affected; - The seriousness of the issue; - Whether the health need particularly affected persons living in poverty or reflected health disparities; and, - Availability of community and/or hospital resources to address the need. 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. 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, 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 61,801 people lived in the 658.27 square mile area each year between 2015 and 2019. The population density for this area, estimated at 94 persons per square mile, is much less than the state average population density of 181 people per square mile and is on par with the national average population density of 92 persons per square mile. The ZIP code with the highest population is 30534, which is 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. as 69 percent of community members live 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, and saw a population jump of 12 percent between the 2010 and 2020 Census. About 11 percent of the population were veterans in 2020, and the most common age range 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 2015 to 2019, about 86 percent of Gilmer and Pickens residents were white, less than a percent were African American, less than a percent were Asian, and 7 percent were Hispanic/Latino. About 5 percent of the population were born outside of the US and 3 percent of those do not have citizenship status. Nearly 2 percent of households do not speak English at home. In 2020, approximately 15.21 percent - about 9,323 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 that are uninsured are also within certain ranges of the FPL. This means these populations are also likely to face the myriad of other social determinants of health (SDH), like housing and food insecurity. Throughout Georgia, adults aged 18 to 64 are most likely to be uninsured, and that's true in both Gilmer and Pickens counties. In 2020, 22 percent of non-elderly adults were uninsured, a rate higher than the state and national averages of 19 percent and 13 percent, respectively. The highest concentration of uninsured populations was in Cherry Log and Ellijay, where the percent of uninsured adults jumps to a quarter of the population. Between 2015 and 2019, the median household income in Gilmer County was $52,625 and the median household income in Pickens County was $67,631. Of employers in the community, the largest sector by employment size in 2019 was retail trade, which employed 3,168 community members at an average wage of $27,792, 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 February 2022, 28,426 people in the community were part of the labor force, and only 821 -- about 2.9 percent -- were unemployed. This figure has steadily decreased since last year, when in January 2021, 3.2 percent of the labor force was unemployed. When looking back further, the rate is nearly three time less than the unemployment rate in 2012. In 2020, 13.44 percent of the two counties' population lived at or below 100 percent of the Federal Poverty Level (FPL). In 2022, a family of four with a total household income of $27,750 or less lived at or below the FPL. As shown, Gilmer families tend to live in more poverty than those in Pickens County. In 2020, the 23,889 total occupied households in both counties, about 5,500 - 23 percent - of live in cost burdened households, in which housing costs are 30 percent or more of total household income. Households in Gilmer were slightly more likely to be cost burdened than Pickens. Approximately ten percent of combined county households had costs that exceeded 50 percent of the household income, which places the household in significant financial strain. Low food access is defined as living more than 0.5 mile 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 2021 Food Access Research Atlas database, a combined 18 percent of both counties' population have low food access, meaning about 10,000 community members may struggle to access healthy foods. This is better than the state and national rates of 30.89 percent and 22.22 percent, respectively. In 2020, approximately 15.21 percent -- about 9,323 community members -- had no form of insurance, and 22 percent of adults aged 18 to 64 went uncovered. ZIP codes 30522 (Cherry Log), 30513 (Blue Ridge), and 30540 (Ellijay) had the highest number of uninsured adults. Collectively, these rates have declined over the last few years. In 2019, in both counties combined, 78 percent of adults aged 18 or older saw a doctor for a routine check-up the previous year, a measure that is likely over-reported and is lower than both state and national averages. For Medicare recipients, this number jumps to 88.12 percent of adult beneficiaries, which is above both state and national averages. Heart disease is a leading cause of death for in both Gilmer and Pickens counties. In 2020, the age-adjusted rate was 190.9 deaths for every 100,000 people, which is higher than both state and national rates, which were 178 and 164.8 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 228.2 male deaths per every 100,000 people, as opposed to a rate of 157.5 deaths for women. Between 2016 and 2020, there were 177 deaths due to stroke, representing an age-adjusted death rate of 37.5 deaths per every 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 rate for heart disease and stroke among Medicare recipients have generally decreased over the last five years. The cardiovascular disease hospitalization rate in 2018 was 13 hospitalizations per every 1,000 Medicare beneficiaries, combined for both counties. This is higher than the state and national rates of 12.2 and 11.8, respectively. The hospitalization rate for stroke is also slightly above state and national rates, with 9.5 hospitalizations per every 1,000 Medicare beneficiaries, as compared to the state rate of 9.3 and the national rate of 8.4. Between 2015 and 2018, the average 30-day readmission rate for heart failure patients was 19.30, which is slightly better than state and national averages. The readmission rate for heart attack patients was 15.3, which is also slightly better than 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 attack. Breast screening rates have remained relatively steady over the last few years and, in 2018, the last year for which data is available, 72.3 percent of all women aged 50-74 reported having had a mammogram within the two previous years. This is below the state and national averages of 77.1 percent and 74.8 percent, respectively. Approximately 65 percent of community members had a colonoscopy at some point in their lives, and 84 percent of women aged 21 to 25 had a pap smear within the last two years. In 2019, 6,157 of adults aged 20 and older had diabetes, equaling 9.3 percent of the combined counties' population. This is higher than the state rate of 9.8 percent. Diabetes is a prevalent problem in the US, often indicating an unhealthy lifestyle and puts individuals at risk for further health issues. This is an increase from the two years previous, when the rate was 8.5 percent in 2017 and 2018. In 2019, 3.6 percent of the combined counties' population had a diagnosis of kidney disease, a rate slightly higher than the state and national percentages of 3.22 percent and 3.1 percent, respectively. In 2019, one-third of adults 18 and older reported having high cholesterol, combined for both counties. Too much cholesterol puts you at risk for heart disease and stroke, two of the main causes of death within the community. In 2019, 38.3 percent of adults 18 and older had a diagnosis of high blood pressure, combined for both counties. High blood pressure can damage your arteries by making them less elastic, which decreases the flow of blood and oxygen to your heart and leads to heart disease. SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH In FY22, we actively promoted the health of our community through our 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. It's important to note that COVID-19 still significantly impacted our proactive community benefit programs, though we were able to maintain some programming via online portals and limited in-person events. 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. Deployment of the Public Service Announcement campaign is ongoing with collaboration of the hospital, Pickens Sheriff's office, Pickens Court System, and is led by the Appalachian Court System District Attorney. Due to the COVID pandemic we have not been able to move forward with our partnerships with the Pickens County Sheriff's office and other community partners. In FY22, we continued to provide leadership to our local community leaders on the impact of the COVID pandemic in our community. PMH hosted calls as needed with community leaders, government officials from Pickens and Gilmer counties as well as city officials from Jasper, East Ellijay and Ellijay, and State Department of Public Health leaders to connect all participants and provide real time information on the pandemic. 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 660885 0 363406 0 187164 0 118124 0 20446 0 1350025 0 100724 Ms Denise Ray CEO/CHAIR/BOARD MEMBER 468931 0 230027 0 137519 0 83955 0 15560 0 935992 0 66555 0 Dr John Schnars Board Member 0 546104 0 0 0 84411 0 15846 0 14377 0 660738 0 0 Ms Lindsey Gard CFO 158284 0 30088 0 0 0 0 0 31206 0 219578 0 0 0 Mr Justin Leal SR. DIR. OPERATIONS 224578 0 41165 0 20289 0 4947 0 8049 0 299028 0 0 0 Ms Pam Mingo PHARMACY MANAGER 171056 0 21792 0 6668 0 9369 0 13943 0 222828 0 0 0 Mr Donald Holmes PHARMACIST 153676 0 625 0 28788 0 10742 0 13896 0 207727 0 0 0 DR MOIZ MASTER PHYSICIAN 161166 0 19167 0 45216 0 0 0 2566 0 228115 0 0 0 Mr Michael McAnder FORMER TREASURER/CFO PHC 0 0 0 0 0 972687 0 0 0 0 0 972687 0 0 Mr Thomas Arnold TREASURER/CFO PHC 0 589164 0 343028 0 199343 0 111150 0 13648 0 1256333 0 93750 Ms Elizabeth Leddy Secretary/CLO PHC 0 500109 0 317466 0 66407 0 122353 0 17849 0 1024184 0 0 MS MICHELLE BREITFELDER CNO 198268 0 61828 0 15604 0 15672 0 14222 0 305594 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 $13,385, 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 2021 IN THE AMOUNT OF $972,687. SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL COMPENSATION INFORMATION THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THEIR SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS: LEIGH HAMBY: $100,724 DENISE RAY: $ 66,555 THOMAS ARNOLD: $ 93,750 ELIZABETH LEDDY PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN BUT DID NOT RECEIVE A CURRENT YEAR PAYMENT. 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 5 180009 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 2021 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 ($ 4,091,534) UNALLOCATED EXPENSES ($ 5,976,151) BOOK/TAX DIFFERENCES ($ 44,290) CHANGE IN TEMP $ 3,559,496 INTERCOMPANY TRANSFER ($13,961,067) ------------------------------------------ TOTAL ($20,513,546) FORM 990 PART IX LINE 11G DESCRIPTION:GENERAL CONTRACT LABOR TOTAL FEES:9408516 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN CONTRACT LABOR TOTAL FEES:3600930 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES TOTAL FEES:283812 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 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PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 582092768 HEALTHCARE GA NA C-CORP 0 0 false THE PIEDMONT CLINIC INC 2727 PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 582005358 HEALTHCARE GA NA C-CORP 0 0 false PIEDMONT HEART INSTITUTE PHYSICIANS INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 260593850 HEALTHCARE GA NA C-CORP 0 0 false AMSTER MCRAE INSURANCE COMPANY PO BOX 1159 Grand Cayman CJ KY1-1102 980427603 Related Insurance CJ NA C-CORP 0 0 false COLUMBUS HEALTHCARE RESOURCES PO BOX 790 COLUMBUS GA 31902 581717754 HEALTHCARE GA NA C-CORP 0 0 false COLUMBUS HEALTH SERVICES INC PO BOX 790 COLUMBUS GA 31902 581640939 HEALTHCARE GA CRHS C-CORP 0 0 false UNIVERSITY HEALTH RESOURCES INC 1350 WALTON WAY AUGUSTA GA 30901 581601372 HEALTHCARE GA NA C-CORP 0 0 false UNIVERSITY HOSPITAL AIKEN INC 1350 WALTON WAY AUGUSTA GA 30901 472713774 HOSPITAL SC NA C-CORP 0 0 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.