2023-05-12T12:52:29-05:00 2022-06-30 KPMG LLP 500 W 5TH ST STE 800 WINSTON SALEM NC 27101 990 2021-07-01 581978389 PIEDMONT ATHENS REGIONAL FOUNDATION INC % MARIE GAFFNEY PIED 7064757000 1199 PRINCE AVENUE ATHENS GA 30606 MARIE GAFFNEY VP, CORP 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 MR J MICHAEL BURNETT 1199 PRINCE AVENUE ATHENS GA 30606 521986 false X WWW.PIEDMONT.ORG/LOCATIONS/PIEDMONT-ATHENS X 1985 GA TO OPERATE FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC. AND AFFILIATED ENTITIES. 23 17 0 300 0 0 3282430 1734210 0 0 1454404 -1257224 -4604 -14333 4732230 462653 75000 0 0 0 0 0 0 0 0 3033 0 78033 0 4654197 462653 11480511 10885119 88544 0 11391967 10885119 X THE CORPORATION WAS ORGANIZED TO BE OPERATED, AND AT ALL TIMES SHALL BE OPERATED, EXCLUSIVELY FOR THE BENEFIT OF OR TO CARRY OUT THE PURPOSES OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC., AND SUCH OTHER EXEMPT ORGANIZATIONS CONTROLLED BY OR AFFILIATED WITH PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC., BY ASSISTING SAID ORGANIZATIONS IN FUND RAISING AND FUND MANAGEMENT, MAKING GRANTS, GIFTS, AND OTHER DISTRIBUTIONS TO SAID ORGANIZATIONS; AND BY ENGAGING IN SUCH OTHER ACTIVITIES AS MAY BENEFIT OR FURTHER THE PURPOSES OF SAID ORGANIZATION AND TO ENGAGE IN ANY AND ALL ACTIVITIES CONSISTENT WITH AND IN FURTHERANCE OF THE ABOVE PURPOSE. false false 0 0 0 REALIZING THAT PIEDMONT ATHENS REGIONAL MEDICAL CENTER AND ITS AFFILIATES RELY UPON THE GENEROSITY AND VISION OF COMMUNITY MINDED CITIZENS, THE PIEDMONT ATHENS REGIONAL FOUNDATION ("PARF") PROVIDES THE VOLUNTEER LEADERSHIP THAT ASSURES PIEDMONT ATHENS REGIONAL MEDICAL CENTER'S PHILANTHROPIC SUPPORT IS GENERATED, STEWARDED AND TRANSFORMED INTO VALUABLE GIFTS MEETING THE IMMEDIATE AND FUTURE HEALTHCARE NEEDS OF THE REGION. 0 true true false false false false false false false false true false false true false true false true false false false false false false true false false false false true false false false false false false false false true false false false false true false false false true X 0 0 0 false false false false true true true true false false false false false false false X 23 17 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 RD BLDG 2 STE ATHENS GA 30339 Mr Thomas Arnold TREASURER/CFO PHC 1.0 54.0 X 0 1131535 124798 Mr Sidney Kirschner Board Member 1.0 54.0 X 0 1121518 121022 Mr J Michael Burnett CEO, PARMC 1.0 54.0 X 0 1049307 125114 Ms Elizabeth Leddy SECRETARY/CLO PHC 1.0 54.0 X 0 883982 140202 Mr Michael McAnder FORMER Treasurer 0.0 0.0 X 0 972687 0 Dr Catherine Marti Board Member 1.0 54.0 X 0 729596 30284 MS WENDY COOK CFO, PARMC 1.0 54.0 X 0 528780 37511 Dr Jonathan Murrow Board Member 1.0 54.0 X 0 496548 38467 DR CATHERINE APALOO BOARD MEMBER 1.0 54.0 X 0 361105 31797 MS BECKY WALTMAN BOARD MEMBER 1.0 54.0 X 0 188310 30622 Mr Philip E Bettendorf Board Member 1.0 0.0 X 0 0 0 Mr Robert D Heath Board Member 1.0 0.0 X 0 0 0 Ms Kathy Hoard Board Member 1.0 0.0 X 0 0 0 Mr Tom S Landrum Board Member/CHAIR 1.0 0.0 X X 0 0 0 Ms Tammy Lindsay Board Member 1.0 0.0 X 0 0 0 Mr Carl Nichols Board Member/VICE CHAIR 1.0 0.0 X 0 0 0 Mr J Richard Parker II Board Member 1.0 0.0 X 0 0 0 Mr Leonard J Sapera Board Member 1.0 0.0 X 0 0 0 MR DARYL BLOODSAW BOARD MEMBER 1.0 0.0 X 0 0 0 MR SCOTT COLLINS BOARD MEMBER 1.0 0.0 X 0 0 0 MR JODY PATTON BOARD MEMBER 1.0 0.0 X 0 0 0 MS BECKY SAMS BOARD MEMBER 1.0 0.0 X 0 0 0 MS JENNIFER SCOTT BOARD MEMBER 1.0 0.0 X 0 0 0 MS APRIL SORROW BOARD MEMBER 1.0 0.0 X 0 0 0 MS JENNY TERRELL BOARD MEMBER 1.0 0.0 X 0 0 0 MS XERNONA THOMAS PHD BOARD MEMBER 1.0 0.0 X 0 0 0 DR RONALD WALPERT II BOARD MEMBER 1.0 0.0 X 0 0 0 0 7463368 679817 0 true true false NONE 0 66432 26000 1641778 77369 1734210 0 -1257224 0 0 -1257224 0 0 0 0 0 0 45000 66432 59333 -14333 0 -14333 0 0 0 0 0 0 0 462653 0 0 -1271557 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4240453 3598144 0 0 49449 577216 674807 624807 0 0 0 0 0 0 0 0 0 0 350000 350000 350000 6165802 5030259 0 0 0 0 0 0 0 704693 11480511 10885119 88544 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 88544 0 X 9758488 8841994 1633479 2043125 11391967 10885119 11480511 10885119 X 462653 -969501 X false true X true false X X 1 PIEDMONT ATHENS REGIONAL MEDICAL CENTER INC 582179986 3 true 0 0 1 0 0 true false false false false false false false false false false false false false false true RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 350000 350000 0 0 0 350000 DUE FROM RELATED PARTIES 704693 704693 0 0 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. DOGWOOD CLASSIC 45767 25767 20000 13745 MINT JUBILEE 65665 40665 25000 45588 0 0 0 0 0 111432 66432 45000 59333 59333 -14333 true true false false false false false false false Mr Sidney Kirschner Board Member 0 596359 0 345037 0 180122 0 108409 0 12613 0 1242540 0 91009 Dr Catherine Marti Board Member 0 691547 0 0 0 38049 0 17400 0 12884 0 759880 0 0 Dr Jonathan Murrow Board Member 0 442783 0 0 0 53765 0 17400 0 21067 0 535015 0 0 Mr J Michael Burnett CEO, PARMC 0 565114 0 329652 0 154541 0 103470 0 21644 0 1174421 0 86070 Mr Michael McAnder FORMER Treasurer 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 DR CATHERINE APALOO BOARD MEMBER 0 350478 0 0 0 10627 0 0 0 31797 0 392902 0 0 MS BECKY WALTMAN BOARD MEMBER 0 176531 0 10672 0 1107 0 11238 0 19384 0 218932 0 0 MS WENDY COOK CFO, PARMC 0 394713 0 116188 0 17879 0 17400 0 20111 0 566291 0 0 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: THOMAS ARNOLD $93,750 SIDNEY KIRSCHNER $91,009 J. MICHAEL BURNETT $86,070 ELIZABETH LEDDY PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN BUT DID NOT RECEIVE A CURRENT YEAR PAYMENT. X 3 70632 FMV X QUILTS BY COTTON PATCH QUILTERS 1 1876 FMV X MISC. DONATIONS 2 4861 FMV false false false SCHEDULE M, PART I, LINE 9, COLUMN B THESE CONTRIBUTIONS CONSIST OF SHARES OF PUBLICLY TRADED COMPANIES AND FUNDS FROM DONORS TO THE PIEDMONT ATHENS REGIONAL FOUNDATION, INC. THE AMOUNT REPORTED IN COLUMN B CONSISTS OF THE NUMBER OF DONORS AND DONATIONS RATHER THAN THE NUMBER OF UNDERLYING SHARES. FORM 990, PART I, LINES 5 & 15, PART VII, AND PART IX, LINE 7 EMPLOYEES AND SALARY EXPENSE PIEDMONT ATHENS REGIONAL FOUNDATION, INC., (PARF) DOES NOT DIRECTLY COMPENSATE ITS EMPLOYEES OR EXECUTIVES. RATHER, EMPLOYEES OF THE ORGANIZATION ARE COMPENSATED BY PARF'S SOLE MEMBER, PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2021 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT ATHENS REGIONAL FOUNDATION BY ITS ULTIMATE PARENT, 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 ATHENS REGIONAL MEDICAL CENTER, INC., (EIN: 58-2179986) IS THE SOLE MEMBER OF PIEDMONT ATHENS REGIONAL FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT ATHENS REGIONAL MEDICAL CENTER'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT ATHENS REGIONAL FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT ATHENS REGIONAL FOUNDATION, INC'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 ATHENS REGIONAL FOUNDATION 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, LINE 11B: 990 REVIEW PROCESS INFORMATION NEEDED TO PREPARE PIEDMONT ATHENS REGIONAL FOUNDATION'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PIEDMONT ATHENS REGIONAL FOUNDATION AND PIEDMONT ATHENS REGIONAL MEDICAL CENTER'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S TAX DEPARTMENT 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, 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 ATHENS REGIONAL FOUNDATION 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 CHIEF COMPLIANCE OFFICER FOR INVESTIGATION, AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. FORM 990, PART VI, LINE 15A: EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT ATHENS REGIONAL FOUNDATION 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, LINE 19: DOCUMENTS AND POLICIES 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: CHANGES IN NET ASSETS CHANGE IN EQUITY $ 409,646 EVENTS FROM FOUNDATION $ 14,333 INTERCOMPANY TRANSFERS $ 340,730 CONTRIBUTIONS ($1,734,210) -------------------------------------------- TOTAL ($ 969,501) 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 PIEDMONT MOUNTAINSIDE HOSPITAL INC 1266 HIGHWAY 515 SOUTH JASPER GA 30143 352228583 HOSPITAL GA 501(c)(3) 3 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 NE SUITE 400 ATLANTA GA 30309 581272768 FUNDRAISING GA 501(c)(3) 12B, II phc false PIEDMONT HENRY HOSPITAL INC 1133 EAGLES LANDING PKWY 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