2023-11-14T10:56:22-06:00 2022-12-31 990 2022-01-01 453957368 POLK MEDICAL CENTER INC POLK 7065096074 420 E SECOND AVENUE SUITE 102 ROME GA 301613210 PHILIP WHEELER CFO 7065096074 2023-11-14 PHILIP WHEELER 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z FLOYD POLK MEDICAL CENTER KURT STUENKEL 304 TURNER MCCALL BLVD ROME GA 301620233 68199123 0 X WWW.FLOYD.ORG X 2011 GA TO IMPROVE HEALTH, ELEVATE HOPE AND ADVANCE HEALING - FOR ALL. 12 11 0 8 40711 34468 822938 1869206 20086946 65625973 451815 663707 96826 40237 21458525 68199123 0 0 0 0 8067057 16074963 0 0 0 5472933 33118739 13539990 49193702 7918535 19005421 97824042 96604967 32592566 14584628 65231476 82020339 POLK MEDICAL CENTER IS A 25 BED CRITICAL ACCESS HOSPITAL WHOSE MISSION IS TO IMPROVE HEALTH, ELEVATE HOPE AND ADVANCE HEALING TO THE COMMUNITY IT SERVES. 0 0 46835048 65625973 THE ORGANIZATION OPERATES A 25-BED, CRITICAL ACCESS HOSPITAL THAT PROVIDES HEALTH CARE SERVICES TO POLK COUNTY AND NORTHERN HARALSON COUNTY WITH SUPPORT FROM ATRIUM HEALTH FLOYD HEALTH SYSTEM'S COMPREHENSIVE NETWORK OF CARE. THE ORGANIZATION PROVIDES A LEVEL IV TRAUMA CENTER, INPATIENT REHABILITATION, IMAGING, LAB WORK, AND INFUSION THERAPY. DURING 2022, ATRIUM HEALTH POLK MEDICAL CENTER HAD APPROXIMATELY 7,900 PATIENT DAYS AND OVER 26,400 EMERGENCY ROOM VISITS. 46835048 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 13 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 GA X X PHILLIP WHEELER 7065096074 304 TURNER MCCALL BOULEVARD ROME GA 30161 KURT STUENKEL BOARD MEMBER, PRES/SCRTY 1.00 39.00 X X 0 1395359 43026 FRANK SHELLEY CHAIR 1.00 2.00 X X 2500 3375 0 GEORGE A BOSWORTH MD BOARD MEMBER 1.00 2.00 X 2000 2875 0 KAY CHUMBLER BOARD MEMBER 1.00 2.00 X 2700 5825 0 TODD BUSSEY BOARD MEMBER 1.00 1.00 X 2250 2750 0 BRITT MADDEN JR BOARD MEMBER 1.00 0.00 X 2750 0 0 NEIL E GORDON MD BOARD MEMBER 1.00 0.00 X 2750 0 0 SONDI SMITH VEST BOARD MEMBER 1.00 0.00 X 2750 0 0 LEE CUMMINGS BOARD MEMBER (TO 6/22) 1.00 0.00 X 1000 0 0 DARROLL FREEMAN BOARD MEMBER (TO 6/22) 1.00 0.00 X 1750 0 0 DOUGLAS E ELLIOTT BOARD MEMBER 1.00 0.00 X 2000 0 0 DARRIN KINES BOARD MEMBER 1.00 0.00 X 500 0 0 MARY MILLER BOARD MEMBER 1.00 0.00 X 500 0 0 DARCY MORRIS BOARD MEMBER 1.00 0.00 X 2500 0 0 E CLARICE CABLE INTERIM CFO (TO 6/22) 1.00 39.00 X 0 429809 61008 PHILIP WHEELER CFO (FR 6/22) 1.00 39.00 X 0 190650 6696 TIFANI KINARD ADMINISTRATOR 40.00 0.00 X 0 252408 34414 WARREN SONNY RIGAS COO (TO 6/22) 15.00 25.00 X 0 653472 42615 TOMMY MANNING CORP COUNSEL 1.00 39.00 X 0 565628 77947 MATTHEW GORMAN VP CORP/NTWRK ST 39.00 1.00 X 0 475437 62656 DEANA OWEN PHARMACY DIRECTOR 40.00 0.00 X 0 188135 18815 LEAH S ASHMORE THERAPIST 40.00 0.00 X 0 162459 25837 LOVEJOY LEIGH PHARMACIST 40.00 0.00 X 0 150553 22543 PHILLIP ROBERTS ER NURSE 40.00 0.00 X 0 171485 7193 KENYA TEEMS RESP THERAPIST 40.00 0.00 X 0 150588 15263 25950 4800808 418013 0 0 1 0 HEALTHCARE WORKFORCE LOGISTICS PO BOX 860573 MINNEAPOLIS MN 55486 CONTRACT LABOR 1013797 ARAMARK MANAGEMENT SERVICE PO BOX 978839 DALLAS TX 75397 FACILITY SERVICES 437372 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 303682289 DIETARY SERVICES 432902 WHITE COAT SCIENCES 315 BANKHEAD HWY CARROLLTON GA 30117 LAB SERVICES 144600 4 1477335 391871 1869206 PATIENT SERVICE REVENUE 622110 65506084 65465373 40711 OTHER HEALTHCARE REVENUE 621990 119889 119889 65625973 571773 571773 91934 0 91934 91934 91934 GIFT SHOP REVENUE 459420 40237 40237 40237 68199123 65585262 40711 703944 28588 14294 14294 14464292 13136181 1328111 509703 462392 47311 1072380 973914 98466 69800 69800 931 931 64650 43660 20990 3394621 3059112 335509 6766 5738 1028 35367 31341 4026 42711 37849 4862 1622249 1437582 184667 33959 30093 3866 6463 5727 736 102532 69243 33289 2448300 2282353 165947 331241 293535 37706 INCOME TAXES 3436 3436 BAD DEBT 22176329 22176329 MEDICAL SUPPLIES 2708684 2708684 MISC 38466 34089 4377 32234 28565 3669 49193702 46835048 2358654 0 5106578 6129966 18023413 24190031 5718470 7492259 282120 281177 585975 222226 58439596 26902980 32861142 31536616 30190041 23680692 5056303 3072000 97824042 96604967 2485342 1816182 32999 1657523 0 2687881 0 25761820 12735447 32592566 14584628 X 65231476 82020339 65231476 82020339 97824042 96604967 X 19005421 -1995653 -220905 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 931 931 0 PART II-B, LINE 1: THE ORGANIZATION PAYS MEMBERSHIP DUES TO NATIONAL AND STATE ORGANIZATIONS. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THOSE ORGANIZATIONS PARTICIPATE. 838635 838635 43351058 14601808 28749250 13276568 12301172 975396 973335 973335 31536616 POLK FOUNDATION LIABILITY 8926741 THIRD PARTY SETTLEMENTS 1223508 OPERATING LEASE PAYABLE 71314 CAPITAL LEASE 2513884 12735447 X PART X, LINE 2: THE ORGANIZATION HAS EVALUATED UNCERTAIN TAX POSITIONS FOR ITS CALENDAR YEAR ENDED DECEMBER 31, 2022 AND SHORT PERIOD ENDED DECEMBER 31, 2021, INCLUDING A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF ITS JOINT VENTURES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ORGANIZATION'S FINANCIAL STATEMENTS FOR THE CALENDAR YEAR ENDED DECEMBER 31, 2022 AND SHORT PERIOD ENDED DECEMBER 31, 2021. 1 1 1 X 1 X 1 1 1 0 1 1 2212387 2212387 0.08190 7127546 6096003 1031543 0.03820 9339933 6096003 3243930 0.12010 9339933 6096003 3243930 0.12010 1 2488936 0 16240434 11246424 4994010 X 1 1 1 1 POLK MEDICAL CENTER 2360 ROCKMART HIGHWAY CEDARTOWN GA 30125 HTTPS://WWW.FLOYD.ORG 115-705 X X X X SWING BED SNF ATRIUM HEALTH POLK MEDICAL CENTER 1 0 0 1 X X X X X X X X X 21 1 1 0 1 X HTTPS://WWW.FLOYD.ORG/ABOUT-FLOYD/PAGES/REPORTS.ASPX X 1 21 1 HTTPS://WWW.FLOYD.ORG/ABOUT-FLOYD/PAGES/REPORTS.ASPX 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X WWW.FLOYD.ORG/PATIENTS-VISITORS/BILLING/PAGES/DEFAULT.ASPX X WWW.FLOYD.ORG/PATIENTS-VISITORS/BILLING/PAGES/DEFAULT.ASPX X WWW.FLOYD.ORG/PATIENTS-VISITORS/BILLING/PAGES/DEFAULT.ASPX X X X X X X 1 X 0 X X X X 1 X 0 0 ATRIUM HEALTH POLK MEDICAL CENTER PART V, SECTION B, LINE 5: DURING THE CONDUCTION OF ITS MOST RECENT CHNA, THE HOSPITAL FACILITY SOUGHT COMMUNITY INPUT THROUGH A COMMUNITY HEALTH SURVEY CONDUCTED BY THE HOSPITAL FACILITY TO VALIDATE DATA, GIVE MEMBERS OF THE COMMUNITY AN OPPORTUNITY TO COMMENT ON THE PREVIOUS CHNA, AND TO PROVIDE COMMUNITY-LEVEL INSIGHT INTO THE HEALTH NEEDS OF THE PRIMARY SERVICE AREAS. THE SURVEY WAS SOLICITED ELECTRONICALLY AND PARTICIPANTS WERE RECRUITED FROM HOSPITAL PATIENT-FAMILY ADVISORY PANELS, VOLUNTEER ADVISORY AND ADVOCACY GROUPS, AND COMMUNITY LEADERS, BOTH ELECTED AND VOLUNTEER. ADDITIONALLY, THE HOSPITAL FACILITY USED SECONDARY DATA SOURCES INCLUDING NATIONAL AND STATE SOURCES PROVIDING TARGET VIEWS OF THE PROGRAM SERVICE AREA; AS WELL AS, HOSPITAL-SPECIFIC DATA. ATRIUM HEALTH POLK MEDICAL CENTER PART V, SECTION B, LINE 6A: THE CURRENT CHNA WAS CONDUCTED WITH ATRIUM HEALTH FLOYD MEDICAL CENTER, ATRIUM HEALTH FLOYD CHEROKEE MEDICAL CENTER AND ATRIUM HEALTH POLK MEDICAL CENTER, ALL RELATED HOSPITAL FACILITIES. ATRIUM HEALTH POLK MEDICAL CENTER PART V, SECTION B, LINE 11: THE HOSPITAL FACILITY'S MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA") IDENTIFIED NUMEROUS COMMUNITY HEALTH NEEDS AND CONCERNS. EACH IDENTIFIED HEALTH NEED WAS REVIEWED AND PRIORITIZED BASED ON THE BURDEN OF THE HEALTH NEED, THE FEASIBILITY OF INTERVENTIONS, AND THE IMPORTANCE THE COMMUNITY PLACES ON ADDRESSING THE HEALTH NEED. THE FOLLOWING HEALTH NEEDS WERE PRIORITIZED BY THE HOSPITAL FACILITY IN ITS MOST RECENT CHNA INCLUDE ACCESS TO CARE, CARDIOVASCULAR DISEASE, MENTAL HEALTH SERVICES, AND NUTRITION. THE HOSPITAL FACILITY IMPLEMENTATION STRATEGY OUTLINES THE PROGRAMS AND RESOURCES THE HOSPITAL FACILITY WILL USE TO ADDRESS THE ABOVE MENTIONED PRIORITIZED HEALTH NEEDS. ALL EFFORTS IN COMBINATION WITH THE HOSPITAL'S VALUE OF NONDISCRIMINATION AND COMPASSIONATE CARE ARE DESIGNED TO MEET THE SIGNIFICANT HEALTH NEEDS OF THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT. THE HOSPITAL FACILITY ACKNOWLEDGES THE IMPORTANCE OF ALL COMMUNITY HEALTH NEEDS THAT WERE IDENTIFIED IN THE CHNA; HOWEVER, THE HOSPITAL FACILITY'S RESOURCES AND ASSETS WERE BEST ALIGNED TO FOCUS ON THE PRIORITIZED NEEDS MENTIONED ABOVE. THE CHNA PROVIDES A COMPREHENSIVE LIST OF AVAILABLE RESOURCES IN THE COMMUNITY FOR THOSE NEEDS THAT WERE NOT PRIORITIZED BY THE HOSPITAL FACILITY. ALTHOUGH NOT PRIORITIZED, THE HOSPITAL FACILITY WILL CONTINUE TO PARTNER WITH COMMUNITY AND NON-PROFIT ORGANIZATIONS TO HELP ADDRESS THESE NEEDS. ATRIUM HEALTH POLK MEDICAL CENTER PART V, SECTION B, LINE 13B: THE HOSPITAL USES A PRESUMPTIVE PROCESS TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY FOR (CATEGORY II) SERVICES. PART I, LINE 3C: THE FINANCIAL ASSISTANCE PROGRAMS ARE DESIGNED TO ENSURE ASSISTANCE IS PROVIDED TO PATIENTS DEMONSTRATING A FINANCIAL NEED AND TO ENSURE THE ORGANIZATION COMPLIES WITH ANY REQUIRED FEDERAL OR STATE REGULATIONS RELATED TO FINANCIAL ASSISTANCE. THOSE ELIGIBLE FOR FINANCIAL ASSISTANCE WILL NEVER BE BILLED MORE THAN THE AMOUNTS GENERALLY BILLED (AGB) TO ANINSURED PATIENT. THE ORGANIZATION USES THE LOOK-BACK METHOD TO CALCULATE AGB. PART I, LINE 6A: THE ORGANIZATION PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT THAT IS AVAILABLE ON ITS WEBSITE. PART I, LN 7 COL(F): THE ORGANIZATION'S PATIENT BAD DEBT EXPENSE PER THE AUDITED FINANCIAL STATEMENTS WAS $22,176,329 FOR THE YEAR ENDED DECEMBER 31, 2022. THIS AMOUNT IS NOT INCLUDED IN THE CALCULATION OF CHARITY CARE FOR PART I, LINE 7. PART III, LINE 2: AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. PART III, LINE 4: FOOTNOTE 2.J (PATIENT SERVICE REVENUE) ON PAGE 30 OF THE AUDITED FINANCIAL STATEMENTS DESCRIBES THE TREATMENT OF BAD DEBT. PART III, LINE 8: MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. PART III, LINE 9B: THE HOSPITAL MAKES A REASONABLE EFFORT TO DETERMINE AN INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE BEFORE ENGAGING IN ANY COLLECTION ACTIONS. ALL COLLECTION ACTIONS WILL BE SUSPENDED IF THE INDIVIDUAL SUBMITS A COMPLETED FAP APPLICATION DURING THE APPLICATION PERIOD, OR IF THE INDIVIDUAL SUBMITS AN INCOMPLETE APPLICATION DURING THE APPLICATION PERIOD THAT IS SUBSEQUENTLY COMPLETED WITHIN A REASONABLE TIME AFTER THE HOSPITAL REQUESTS FURTHER INFORMATION. IF THE INDIVIDUAL IS DETERMINED NOT TO BE ELIGIBLE FOR A FULL DISCOUNT UNDER THE FAP, ANY COLLECTION ACTIVITIES WILL BE RESUMED AS TO THE OUTSTANDING BALANCE OWED. IF THE INDIVIDUAL IS DETERMINED TO BE ELIGIBLE FOR ASSISTANCE UNDER THE FAP, APPROPRIATE MEASURES ARE TAKEN TO REFUND ANY AMOUNTS OWED TO THE INDIVIDUAL AND REVERSE OR MODIFY COLLECTION ACTIONS CONSISTENT WITH THE NEW BALANCE OWED AFTER APPLYING THE APPLICABLE FAP DISCOUNTS. PART VI, LINE 2: THE HOSPITAL FACILITY'S MOST RECENT CHNA WAS BASED ON A SET OF BEST PRACTICES FOR COMMUNITY HEALTH ASSESSMENTS WITH THE PURPOSE OF IDENTIFYING REGIONAL PRIORITY AREAS TO FOCUS ON FOR CY2022 TO CY2024. THE PROCESS WAS DESIGNED TO RELY ON EXISTING PUBLIC DATA, DIRECTLY ENGAGING COMMUNITY STAKEHOLDERS, AND COLLABORATE WITH LOCAL PUBLIC HEALTH AND OTHER HEALTH CARE PROVIDERS. COMMUNITY FEEDBACK IN THE FORM OF A COMMUNITY HEALTH SURVEY AND INTERVIEWS WITH COMMUNITY LEADERS, HEALTHCARE PROFESSIONALS, AND FOCUS GROUPS. THE HOSPITAL FACILITY DEVELOPED AN IMPLEMENTATION STRATEGY TO IDENTIFY THE MEANS THROUGH WHICH IT PLANS TO ADDRESS THOSE PRIORITIZED. BEYOND PROGRAMS ADDRESSED IN THE IMPLEMENTATION STRATEGY, THE HOSPITAL FACILITY WILL CONTINUE TO ADDRESS MANY OF THE PRIORITIES BY PROVIDING CARE TO ALL, REGARDLESS OF ABILITY TO PAY. PART VI, LINE 3: THE ORGANIZATION USES A VARIETY OF MEANS TO EDUCATE AND INFORM PATIENTS OF THEIR FINANCIAL ASSISTANCE OPTIONS. INFORMATION REGARDING FINANCIAL ASSISTANCE CAN BE FOUND ON THE HOSPITAL FACILITY'S WEBSITE, CONSPICUOUSLY DISPLAYED SIGNAGE THROUGHOUT THE HOSPITAL FACILITY, PATIENT BILL STATEMENTS, AND FROM TEAMMATES DURING CONVERSATIONS CONCERNING A PATIENT'S LIABILITY FOR SERVICES DURING PREADMISSION, DISCHARGE, AND THE "COLLECTION" PERIOD. PART VI, LINE 4: THE FILING ORGANIZATION ATRIUM HEALTH POLK MEDICAL CENTER, ALONG WITH RELATED ORGANIZATION FLOYD HEALTH CARE MANAGEMENT, INC. (DBA ATRIUM HEALTH FLOYD MEDICAL CENTER AND DBA ATRIUM HEALTH CHEROKEE MEDICAL CENTER), HAS A PRIMARY SERVICE AREA WHICH SERVES FOUR COUNTIES: CHATTOOGA, FLOYD, POLK, ALL LOCATED IN GEORGIA AND CHEROKEE COUNTY IN ALABAMA. BELOW IS A DEMOGRAPHIC SNAPSHOT OF THE POPULATION OF SERVICING AREA:TOTAL POPULATION: 192,096 (2021)INCOME:-MEDIAN HOUSEHOLD INCOME: $41,600 (CHATTOOGA), $50,500 (FLOYD), $47,900 (POLK), $46,000 (CHEROKEE)-PERCENT IN POVERTY: 19% (CHATTOOGA), 18% (FLOYD), 18% (POLK), 14% (CHEROKEE)EDUCATION: % OF HIGH SCHOOL GRADUATES: 86% (CHATTOOGA), 92% (FLOYD), 80% (POLK), 94% (CHEROKEE)PERCENT UNINSURED: 14% (CHATTOOGA), 13% (FLOYD), 16% (POLK), 9% (CHEROKEE) PART VI, LINE 5: THE ORGANIZATION IS COMMITTED TO BEING RESPONSIVE TO THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES THROUGH A NUMBER OF PROGRAM ACTIVITIES AND COMMUNITY HEALTH IMPROVEMENT INITIATIVES. THE ORGANIZATION HAS ADOPTED AND MAINTAINED A FINANCIAL ASSISTANCE POLICY, PROVIDES SUBSIDIZED HEALTH SERVICES TO PATIENTS IN NEED, AND ACCEPT ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OPERATES AN EMERGENCY ROOM THAT IS OPEN 24/7. THE GOVERNING BOARD IS COMPRISED OF LEADERS WITHIN THE COMMUNITY THE HOSPITAL SERVES. FUNDS ARE REINVESTED IN HEALTH IMPROVEMENT INITIATIVES TO BETTER SERVE THE COMMUNITY HEALTH NEEDS, INCLUDING PROVIDING SCHOOL-BASED CHILD SAFETY PROGRAMS, ATHLETIC TRAINERS TO POLK COUNTY HIGH SCHOOLS, MOBILE MAMMOGRAPHY, CPR TRAININGS, COMMUNITY HEALTH SCREENINGS AND HEALTH FAIRS, HEALTH CARE INTERNSHIPS, EXTERNSHIPS AND SHADOWING OPPORTUNITIES, AND SUPPORT FOR COMMUNITY-WIDE INITIATIVES WITH HEALTH PARTNERS. PART VI, LINE 6: THE FILING ORGANIZATION IS PART OF ADVOCATE HEALTH, WHICH IS HEADQUARTERED IN CHARLOTTE, NORTH CAROLINA, AND IS THE THIRD-LARGEST NONPROFIT HEALTH SYSTEM IN THE UNITED STATES, CREATED FROM THE COMBINATION OF ATRIUM HEALTH AND ADVOCATE AURORA HEALTH. TOGETHER WITH AN INTEGRATED GROUP OF 501(C)(3) HOSPITALS, PHYSICIAN NETWORKS, OTHER HEALTHCARE PROVIDERS, THE ORGANIZATION IS COMMITTED TO PROVIDING SIGNIFICANT BENEFITS TO THE COMMUNITIES IT SERVES ACROSS NORTHWEST GEORGIA AND NORTHEAST ALABAMA. EACH HOSPITAL ORGANIZATION IN THE ADVOCATE HEALTH SYSTEM REPORTS ITS OWN COMMUNITY BENEFIT ON FORM 990, SCHEDULE H. THE CONSOLIDATED COMMUNITY BENEFIT TOTAL OF THE HEALTH SYSTEM IS REPORTED AT HTTPS://WWW.FLOYD.ORG/ABOUT-FLOYD/PAGES/REPORTS.ASPX. PART VI, LINE 7, REPORTS FILED WITH STATES GA 1 1 0 0 0 0 0 0 0 KURT STUENKEL BOARD MEMBER, PRES/SCRTY 0 842379 0 357510 0 195470 0 12200 0 30826 0 1438385 0 0 WARREN SONNY RIGAS COO (TO 6/22) 0 197637 0 88100 0 367735 0 36931 0 5684 0 696087 0 36915 TOMMY MANNING CORP COUNSEL 0 408451 0 86200 0 70977 0 54988 0 22959 0 643575 0 0 MATTHEW GORMAN VP CORP/NTWRK ST 0 357076 0 79000 0 39361 0 41053 0 21603 0 538093 0 0 E CLARICE CABLE INTERIM CFO (TO 6/22) 0 282814 0 110300 0 36695 0 39504 0 21504 0 490817 0 0 TIFANI KINARD ADMINISTRATOR 0 232393 0 13718 0 6297 0 21645 0 12769 0 286822 0 0 DEANA OWEN PHARMACY DIRECTOR 0 175216 0 11960 0 959 0 8263 0 10552 0 206950 0 0 PHILIP WHEELER CFO (FR 6/22) 0 154104 0 25000 0 11546 0 2776 0 3920 0 197346 0 0 LEAH S ASHMORE THERAPIST 0 115947 0 15958 0 30554 0 6909 0 18928 0 188296 0 0 PHILLIP ROBERTS ER NURSE 0 130260 0 24920 0 16305 0 6830 0 363 0 178678 0 0 LOVEJOY LEIGH PHARMACIST 0 148812 0 1073 0 668 0 6309 0 16234 0 173096 0 0 KENYA TEEMS RESP THERAPIST 0 115841 0 11383 0 23364 0 6196 0 9067 0 165851 0 0 PART I, LINES 4A-B CERTAIN DIRECTORS, OFFICERS, AND KEY EMPLOYEES OF THE FILING ORGANIZATION PARTICIPATED IN AND/OR RECEIVED PAYMENTS FROM A NON-QUALIFIED DEFERRED COMPENSATION PLAN (RESTORATION OR SERP) AND/OR RECEIVED PAYMENTS FOR SEVERANCE. THE DETERMINATION OF THE PAYMENT AMOUNT FROM NON-QUALIFIED DEFERRED COMPENSATION PLANS FOLLOWED THE EMPLOYMENT ORGANIZATION'S COMPENSATION PROCEDURES. THE FOLLOWING DIRECTORS, OFFICERS, AND KEY EMPLOYEES RECEIVED PAYMENTS FOR SEVERANCE AND/OR PAYMENTS FROM NON-QUALIFIED DEFERRED COMPENSATION PLANS DURING THE CURRENT TAX YEAR: SEVERANCE PAYMENTS: WARREN "SONNY" RIGAS $304,866 NON-QUALIFIED DEFERRED COMPENSATION PAYMENTS: TOMMY MANNING $46,173 WARREN "SONNY" RIGAS $37,893 MATTHEW GORMAN $38,535 E. CLARICE CABLE $14,651 KURT STUENKEL $168,949 FORM 990, PART VI, SECTION A, LINE 6 FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI) IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI), A RELATED ORGANIZATION, HAS THE POWER TO APPOINT ELEVEN OF THE TWELVE MEMBER GOVERNING BODY WHILE THE PRESIDENT/CEO OF FHMI IS THE FINAL MEMBER OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B PRIOR APPROVAL OF FHMI IS REQUIRED FOR ANY OF THE FOLLOWING ACTIONS: DISSOLUTION; SALE, MERGER OR DISPOSITION; ADOPTION OF CAPITAL OR OPERATING BUDGETS; SELECT OR REMOVE THE ADMINISTRATOR; INCUR INDEBTEDNESS IN EXCESS OF $1,000,000; TAKE ANY ACTION ON THE LEASE OR CONTRACT BETWEEN THE CORPORATION AND CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY; AMEND THE CORPORATE ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES COPIES OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND QUESTIONS PRIOR TO ITS FILING. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW AND COMMENT, THE REVISED FORM 990 IS REDISTRIBUTED TO ALL DIRECTORS PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A REPORT NOTING THE MODIFICATIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ITS OFFICERS, DIRECTORS AND KEY EMPLOYEES TO ANNUALLY REVIEW THE CONFLICT OF INTEREST POLICY AND DETERMINE ANY POTENTIAL CONFLICTS OF INTEREST. ANY POTENTIAL CONFLICTS NOTED IN THE QUESTIONNAIRE ARE REVIEWED BY A STANDING COMMITTEE FOR APPROPRIATE RESOLUTION. ALL MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO DETERMINE AND REPORT ANNUALLY, AND AS THEY ARISE, ANY POTENTIAL CONFLICTS OF INTEREST TO THE SECRETARY OF THE BOARD OF DIRECTORS. THE RESOLUTION OF POTENTIAL AND ACTUAL CONFLICTS IS SUBJECT TO THE APPROVAL OF THE CHAIR OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION PAYS NO COMPENSATION TO OFFICERS, DIRECTORS AND KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS, DIRECTORS AND KEY EMPLOYEES WAS PAID BY RELATED ORGANIZATIONS, CHARLOTTE MECKLENBURG HOSPITAL AUTHORITY (CMHA) AND FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI) AND THE DETERMINATION OF THE COMPENSATION OF SUCH INDIVIDUALS IS CONDUCTED VIA THE PROCESS UTILIZED BY THE FLOYD HEALTHCARE MANAGEMENT (FHMI) BOARD, AS FOLLOWS: THE DIVERSITY, INCLUSION, & COMPENSATION COMMITTEE (THE "COMMITTEE") OF THE ATRIUM HEALTH, INC. BOARD OF DIRECTORS HAS AUTHORITY AS THE FHMI BOARD DELEGATES TO IT, FOR THE REVIEW AND APPROVAL OF SENIOR EXECUTIVE COMPENSATION, INCLUDING SENIOR EXECUTIVE INCENTIVE PLANS. NO MEMBER OF THE COMMITTEE IS AN EMPLOYEE OF THE FILING ORGANIZATION. THE COMMITTEE RELIES UPON AN EXTERNAL, INDEPENDENT COMPENSATION CONSULTANT EXPERIENCED IN HEALTHCARE TO PROVIDE THE COMMITTEE WITH COMPENSATION COMPARABILITY DATA FOR NEW EXECUTIVE POSITION APPOINTMENTS AND FOR COMPENSATION REVIEWS FOR EXISTING EXECUTIVES. THE CONSULTANT, WHICH IS RETAINED DIRECTLY BY THE COMMITTEE, PROVIDES THIRD-PARTY INFORMATION AND EVALUATES THE COMPETITIVENESS AND REASONABLENESS OF EXECUTIVE COMPENSATION AND BENEFITS PROGRAMS IN RELATION TO MARKET PRACTICES FOR SIMILARLY SITUATED HEALTHCARE ORGANIZATIONS. THE COMMITTEE MAKES ITS DECISIONS WITH RESPECT TO EXECUTIVE COMPENSATION IN ACCORDANCE WITH THE FILING ORGANIZATION POLICIES, IRS REGULATIONS, AND STANDARD CORPORATE GOVERNANCE PRACTICES. SUCH POLICIES INCLUDE ADHERENCE TO EXECUTIVE COMPENSATION PHILOSOPHY AND REVIEW PROCESSES; PROCESSES ENSURING COMMITTEE MEMBER AND COMPENSATION CONSULTANT INDEPENDENCE; USE OF VALID MARKET COMPARISONS OF DATA FROM HEALTHCARE ORGANIZATIONS OF SIMILAR SIZE, STRUCTURE, AND COMPLEXITY AND ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS, PER IRS GUIDELINES. MINUTES OF THE DELIBERATIONS OF THE COMMITTEE ARE MAINTAINED IN THE ATRIUM HEALTH, INC. LEGAL DEPARTMENT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON REQUEST. THE ORGANIZATION'S BYLAWS ARE NOT PUBLISHED, BUT PROVISIONS FROM THE BYLAWS ARE INCLUDED AS NECESSARY IN THE ORGANIZATION'S POLICIES AND ARE ATTACHED TO THE FORM 1023 FILED FOR THE ORGANIZATION WITH THE IRS, WHICH IS PUBLICLY AVAILABLE. THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON REQUEST. FORM 990, PART XI, LINE 9: INTERCOMPANY TRANSFER -220,905. FLOYD HEALTHCARE MANAGEMENT INC 304 TURNER MCCALL BLVD ROME GA 301620233 581973570 HEALTHCARE GA 501C3 LINE 3 AH GEORGIA 0 FLOYD HEALTH CARE FOUNDATION INC 304 TURNER MCCALL BLVD ROME GA 301620233 581375074 FOUNDATION GA 501C3 LINE 12A, I FHMI 0 CANCER NAVIGATORS INC 255 W 5TH STREET SUITE 300 ROME GA 301652817 030397867 EDUCATION GA 501C3 LINE 7 FHMI 0 AH GEORGIA INC PO BOX 32861 CHARLOTTE NC 282322861 831707383 HOLDING CO. NC 501C3 LINE 7 CMHA 0 THE CHARLOTE-MECKLENBURG HOSPITAL AUTHORITY 1000 BLYTHE BLVD CHARLOTTE NC 28203 560529945 HEALTHCARE NC NC POLITICAL SUBDIVI N/A 0 FLOYD-POLK HEALTHCARE FOUNDATION 304 TURNER MCCALL BLVD ROME GA 301620233 872546864 FOUNDATION GA 501C3 LINE 12A, I N/A 0 ADVOCATE HEALTH INC 1000 BLYTHE BLVD CHARLOTTE NC 28203 884157429 HEALTHCARE NC 501(C)(3) LINE 12B, II 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 1