2022-05-11T12:20:55-05:00 2021-06-30 KPMG LLP 303 PEACHTREE ST STE 2000 ATLANTA GA 30308 990 2020-07-01 581503902 Piedmont Healthcare Inc % MARIE GAFFNEY PIED 4044251303 1800 Howell Mill Road Suite 850 Atlanta GA 30318 MARIE GAFFNEY VP CORPORATE FINANCE 4044251303 2022-05-10 true MARIE GAFFNEY 999009999 WHITNEY B HEBRON P01226647 4042223000 2022-05-10 2 2020 2022-09-23 18:48:47Z KEVIN BROWN 1800 Howell Mill Road Ste 850 Atlanta GA 30318 207681365 false X www.piedmont.org X 1983 GA PIEDMONT HEALTHCARE, INC. ("PHC") IS ORGANIZED TO BENEFIT, MANAGE THE FUNCTIONS OF, AND CARRY OUT THE CHARITABLE PURPOSES OF ITS SUBSIDIARY ORGANIZATIONS. 18 14 3971 14 0 0 51834 21552 136484171 196869145 20574406 7701110 20605616 3089558 177716027 207681365 1026094 0 0 0 37994582 52771770 0 0 0 139620584 133910757 178641260 186682527 -925233 20998838 1673982148 1865070040 311441370 409057121 1362540778 1456012919 PIEDMONT HEALTHCARE, INC., ("PHC") IS ORGANIZED EXCLUSIVELY FOR THE BENEFIT OF, TO MANAGE THE FUNCTIONS OF, AND TO CARRY OUT THE CHARITABLE, SCIENTIFIC, AND EDUCATIONAL PURPOSES OF ITS SUBSIDIARY ORGANIZATIONS. false false 165395406 0 198845123 PIEDMONT HEALTHCARE, INC. ("PHC"), IS THE TAX-EXEMPT PARENT OF ITS PUBLICLY SUPPORTED SUBSIDIARIES (LISTED IN SCHEDULE R ATTACHED). PHC PROVIDES CENTRALIZED MANAGEMENT SERVICES TO ITS SUBSIDIARIES, INCLUDING ACCOUNTING, HUMAN RESOURCES, IT, FINANCIAL MANAGEMENT, AND ADVISORY SUPPORT. THESE CENTRALIZED SERVICES RESULT IN GREATER OPERATING EFFICIENCIES AND ALLOW ITS SUBSIDIARY ORGANIZATIONS TO BETTER PROVIDE OUTSTANDING HEALTHCARE AND EDUCATION TO THEIR SURROUNDING COMMUNITIES. 165395406 true false false true false false false false false false true false true true false true false true false true true false false false false false false false false true false false false false false false false false false false false false false true true true false false true X 1636 0 true 3971 true false true CJ false false false false false false false false false false true false X 18 14 false false false false false false false true true false false true true true true true true true true false GA X MARIE GAFFNEY 4702716007 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 X Mr Kevin Brown Board Member & CEO, PHC 54.0 1.0 X X 3031924 0 385923 Mr Michael Mandl Exec. Vice President 53.0 2.0 X 1430051 0 169167 Mr Sidney Kirschner Chief Philanthropy Officer 53.0 2.0 X 1422289 0 118077 Mr Michael McAnder CFO & Treasurer (End 7/20) 38.0 17.0 X 1284929 0 72127 Dr Leigh Hamby MD PHC CMO 52.0 3.0 X 1177022 0 132747 Mr Christopher Lloyd President Piedmont Clinic 50.0 5.0 X 925280 0 123780 Ms Elizabeth Leddy CHIEF LEGAL OFF & Sec. 38.0 17.0 X 843802 0 126625 Mr Thomas Arnold CFO & Treasurer (Eff 7/20) 38.0 17.0 X X 827550 0 92917 Mr Geoffrey Brown Chief Information Officer 55.0 0.0 X 797355 0 91779 Ms Michelle Fisher Pres. Prim Care & Ret Svcs 54.0 1.0 X 746357 0 98973 Ms Vicki Cansler Chief HR Officer 54.0 1.0 X 735257 0 85138 Mr Douwe Bergsma Chief Marketing Officer 54.0 1.0 X 592177 0 60451 Mr Robert Cross VP - Gov Reimbursement 55.0 0.0 X 519881 0 29545 Mr Shannon Glover VP - Managed Care 55.0 0.0 X 488836 0 34354 Dr Todd Schmidt MD Chair 1.0 20.0 X X 0 82863 0 Dr Fred Willms MD Board Member 1.0 5.0 X 0 11550 0 Dr David Sailors MD Board Member 1.0 10.0 X 0 6400 0 Dr Monica Hum MD Board Member 1.0 4.0 X 0 4500 0 Mr Tye Darland Board Member 1.0 0.0 X 0 0 0 Mr Martin Davis Board Member 1.0 0.0 X 0 0 0 Mr David Hanna Vice Chair 1.0 0.0 X 0 0 0 Mr Samuel Burney Hay III Board Member 1.0 1.0 X 0 0 0 Mr James H Hopkins Board Member 1.0 0.0 X 0 0 0 Mr Gary T Jones Board Member 1.0 0.0 X 0 0 0 Ms Cheryl Legette Board Member 1.0 4.0 X 0 0 0 Ms Amy Medendorp Board Member 1.0 1.0 X 0 0 0 Dr Moiz Master MD Board Member 1.0 39.0 X 0 0 0 Mr John Somerhalder Board Member 1.0 0.0 X 0 0 0 Mr Warren Steele Board Member 1.0 0.0 X 0 0 0 Dr Craig Wright MD Board Member 1.0 0.0 X 0 0 0 14822710 105313 1621603 568 false true false CUMBERLAND GROUP 300 GALLERIA PARKWAY ATLANTA GA 30339 CONSULTING SERVICES 8740428 HEALTHCARE FINANCIAL RESOURCES LLC 830 N MEACHAM ROAD SCHAUMBURG IL 60173 REVENUE CYCLE MGT 4597970 PURCHASING power llc 2727 Paces Ferry Rd ATLANTA GA 30339 employee benefits 2717750 MEDLYTIX LLC 675 Mansell Rd 100 ROSWELL GA 30076 healthcare consult. 2463400 MODUSONE HEALTH LLC 2170 Defoor Hills Rd NW ATLANTA GA 30078 HEALTHCARE CONSULT. 2398750 88 21552 21552 MANAGEMENT SERVICES TO AFFILIATES 561000 125061516 125061516 COST OF CAPITAL ALLOCATION 900099 71807629 71807629 196869145 7701110 7701110 0 0 799888 799888 0 799888 799888 0 0 0 0 0 0 0 0 0 0 RESEARCH REVENUE 900099 1113580 1113580 OTHER OPERATING REVENUE 900099 1176090 1176090 2289670 207681365 198845123 8814690 0 0 0 0 12848448 8351491 4496957 0 30713178 19963566 10749612 320429 208279 112150 6109114 3970924 2138190 2780601 1807391 973210 1073409 1073409 921646 921646 225126 225126 396641 396641 0 596821 596821 13766744 13766744 3105427 3105427 13286593 13286593 1203864 1203864 0 11922990 11922990 61349 61349 0 0 43850512 43850512 0 42778918 42778918 0 PHO ASSESSMENT 697852 697852 SUBSCRIPTIONS 22865 22865 186682527 165395406 21287121 0 1017171224 1048577991 0 0 22376292 76349558 8271271 6088502 0 0 0 0 0 0 0 0 47056563 60850068 570764792 323555636 216867414 247209156 0 0 0 0 89068330 118726987 189378 189378 272981676 307078400 1673982148 1865070040 289480241 375879030 0 0 21938768 33178091 0 0 0 0 0 0 0 0 0 0 22361 0 311441370 409057121 X 1361877276 1454475739 663502 1537180 1362540778 1456012919 1673982148 1865070040 X 20998838 258710334 -450 -186236581 X false true X true false X X 12 PIEDMONT HOSPITAL INC 580566213 3 true 18473940 0 FAYETTE COMMUNITY HOSPITAL INC DBA PIEDMONT FAYETTE HOSPITAL 582322328 3 true 6113593 0 PIEDMONT MOUNTAINSIDE HOSPITAL INC 352228583 3 true 1047536 0 PIEDMONT NEWNAN HOSPITAL INC 205077249 3 true 5855412 0 PIEDMONT HEART INSTITUTE INC 263553500 7 true 160157 0 PIEDMONT HENRY HOSPITAL INC 582200195 3 true 6788478 0 PIEDMONT NEWTON HOSPITAL INC 582155150 3 false 1419098 0 PIEDMONT ATHENS REGIONAL MEDICAL CENTER INC 582179986 3 false 11103690 0 PIEDMONT ROCKDALE HOSPITAL INC 300999841 3 false 1840677 0 PIEDMONT WALTON HOSPITAL INC 824194264 3 false 828809 0 THE MEDICAL CENTER INC 581685139 3 false 5081907 0 HUGHSTON HOSPITAL INC 331216751 3 false 2083791 0 PIEDMONT CARTERSVILLE HOSPITAL INC 870963633 3 false 0 0 PIEDMONT EASTSIDE HOSPITAL INC 870982886 3 false 0 0 PIEDMONT MACON HOSPITAL INC 871006981 3 false 0 0 PIEDMONT MACON NORTH HOSPITAL INC 871031034 3 false 0 0 16 60797088 0 false false false false false false false false false false false false false false false true true false X true true SCHEDULE A, PART IV, SECTION A, LINE 1: NOT LISTED IN GOVERNING DOCUMENTS DURING FISCAL YEARS 2016 THROUGH 2018, PIEDMONT HEALTHCARE PURCHASED THE FOLLOWING ENTITIES: PIEDMONT NEWTON HOSPITAL, INC. (EIN: 58-2155150, FKA NEWTON MEDICAL CENTER); PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC. (EIN: 58-2179986, FKA ATHENS REGIONAL MEDICAL CENTER) AND ITS SUBSIDIARIES; PIEDMONT WALTON HOSPITAL, INC. (EIN: 82-4194264, FKA CLEARVIEW REGIONAL MEDICAL CENTER); PIEDMONT ROCKDALE HOSPITAL, INC. (EIN: 30-0999841, FKA ROCKDALE MEDICAL CENTER); THE MEDICAL CENTER, INC. (EIN: 58-1685139) AND ITS SUBSIDIARIES, AND; HUGHSTON HOSPITAL, INC. (EIN: 33-1216751) AND ITS SUBSIDIARIES. DURING FISCAL YEAR 2021, PIEDMONT HEALTHCARE CREATED FOUR NEW ENTITIES TO ULTIMATELY OPERATE 501(C)(3) HOSPITALS: PIEDMONT CARTERSVILLE HOSPITAL, INC. (EIN: 87-0963633) PIEDMONT EASTSIDE HOSPITAL, INC. (EIN: 87-0982886) PIEDMONT MACON HOSPITAL, INC. (EIN: 87-1006981) PIEDMONT MACON NORTH HOSPITAL, INC. (EIN: 87-1031034) WHILE THE AFOREMENTIONED ORGANIZATIONS ARE NOT EXPLICITLY NAMED AS SUPPORTED ORGANIZATIONS IN PHC'S GOVERNING DOCUMENTS, THEY ARE INCORPORATED INTO THE DOCUMENTS BY VIRTUE OF REFERENCE TO PHC'S EXEMPT PURPOSE OF SUPPORTING ITS TAX-EXEMPT SUBSIDIARIES. AS OF THEIR PURCHASE BY PHC, THE ENTITIES BECAME WHOLLY-OWNED SUBSIDIARIES AND SUPPORTED ORGANIZATIONS OF PIEDMONT HEALTHCARE. SCHEDULE A, PART IV, SECTION E, LINE 3A: POWER TO ELECT SUBSIDIARY BOARDS PURSUANT TO THE PROVISIONS OF ITS CHARTER AND BYLAWS, THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE APPOINTS ALL OF THE MEMBERS OF THE BOARDS OF DIRECTORS OF EACH OF ITS SUPPORTED SUBSIDIARY ENTITIES. SCHEDULE A, PART IV, SECTION E, LINE 3B: DIRECTION OVER SUPPORTED ORGS THE POLICIES AND DECISIONS OF EACH OF PIEDMONT HEALTHCARE'S SUPPORTED SUBSIDIARY ENTITY BOARDS OF DIRECTORS MUST BE FILED, IMMEDIATELY AFTER ADOPTION, WITH THE SECRETARY OF THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS. SUCH POLICIES AND DECISIONS OF THE SUBSIDIARY BOARDS 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. THE PROGRAMS AND ACTIVITIES OF EACH OF PIEDMONT HEALTHCARE'S SUPPORTED SUBSIDIARY ORGANIZATIONS, INCLUDING SERVICES OFFERED, ANNUAL OPERATING BUDGETS, AND APPOINTMENT AND COMPENSATION OF SENIOR EXECUTIVES, ARE DETERMINED BY OR SUBJECT TO THE REVIEW OF PIEDMONT HEALTHCARE'S EXECUTIVE LEADERSHIP AND BOARD OF DIRECTORS. false false false false false false true 396641 false false 396641 false SCHEDULE C, PART II-B, LINE 1(G): LOBBYING ACTIVITIES HEALTH CARE POLICY IS CRITICAL TO ALL AMERICANS, AND PIEDMONT HEALTHCARE BELIEVES THAT HEALTH CARE PROVIDERS MUST PARTICIPATE IN SHAPING HEALTH CARE POLICY BY INTERACTING WITH NATIONAL, STATE, AND LOCAL REPRESENTATIVES AND THEIR STAFF MEMBERS TO HELP THEM BETTER UNDERSTAND THE COMPLEXITIES AND RAMIFICATIONS OF KEY HEALTH CARE POLICIES INCLUDING, WITHOUT LIMITATION, THOSE RELATED TO UNINSURED AND INDIGENT PATIENT NEEDS, AS WELL AS THE IMPORTANCE OF ASSURING THE DELIVERY OF COST-EFFICIENT, QUALITY HEALTH CARE. DURING FISCAL YEAR 2021, PIEDMONT HEALTHCARE ENGAGED A CONTRACT LOBBYIST TO, ALONG WITH PIEDMONT HEALTHCARE'S VICE PRESIDENT OF GOVERNMENT RELATIONS, REPRESENT THE INTERESTS OF THE ORGANIZATION AND ITS SUBSIDIARIES BEFORE FEDERAL, STATE, AND LOCAL ELECTED OFFICIALS AND REGULATORS. LOBBYING EXPENSE REPORTED HEREIN INCLUDES A PORTION OF THE SALARY PROVIDED TO THE VICE PRESIDENT OF GOVERNMENT RELATIONS, AS WELL AS EXPENSES RELATED TO THE ACTIVITIES OF OUTSIDE LOBBYISTS. 820769 820769 19101833 12457336 6644497 40152505 16828357 23324148 341151395 294269943 46881452 169538290 0 169538290 247209156 FAYETTE COMMUNITY HOSPITAL 43679729 C PIED MOUNTAINSIDE HOSPITAL 43407781 C AMSTER-MCRAE INSURANCE COMPANY 120000 C CENTER FOR HEALTH & LEARNING 1425000 C COLUMBUS REG. HEALTH SYS. 435820 C BUCKHEAD SURG. CTR. 2612157 C ENCOMPASS REHAB JV 27046500 C 118726987 DUE FROM RELATED PARTIES 223489752 OTHER CURRENT ASSETS 77407126 INVEST ONCOLOGY PARTNERSHIP 6178870 INVEST GA HEALTH COLLABORATIVE 2652 INVEST IN 660 CHEROKEE 0 307078400 0 DUE TO RELATED PARTIES 0 0 X SCHEDULE D, PART X, LINE 2: ASC 740 FOOTNOTE (FKA FIN 48) PHC ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF THE INCOME TAXES TOPIC OF THE ASC (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, 2021 AND 2020. Central America and the Caribbean 0 0 Program Services Insurance Premiums 28550354 Central America and the Caribbean 0 0 Investments 101852131 0 0 0 0 130402485 130402485 true false true false false false SCHEDULE F, PART I: ACCOUNTING METHOD USED ALL AMOUNTS REPORTED ON SCHEDULE F, PART I, LINE 3 WERE DETERMINED USING THE ACCRUAL METHOD OF ACCOUNTING. X X X true true X X X X false true false false false false false true false Mr Kevin Brown Board Member & CEO, PHC 1339779 0 1174927 0 517218 0 364429 0 21494 0 3417847 0 347329 0 Mr Michael McAnder CFO & Treasurer (End 7/20) 357162 0 0 0 927767 0 66931 0 5196 0 1357056 0 498228 0 Mr Thomas Arnold CFO & Treasurer (Eff 7/20) 424857 0 245916 0 156777 0 79670 0 13247 0 920467 0 62570 0 Ms Elizabeth Leddy CHIEF LEGAL OFF & Sec. 459494 0 335067 0 49241 0 109035 0 17590 0 970427 0 0 0 Dr Leigh Hamby MD PHC CMO 594907 0 418830 0 163285 0 112971 0 19776 0 1309769 0 95871 0 Ms Michelle Fisher Pres. Prim Care & Ret Svcs 409260 0 238736 0 98361 0 79197 0 19776 0 845330 0 62097 0 Mr Michael Mandl Exec. Vice President 778484 0 564842 0 86725 0 156690 0 12477 0 1599218 0 0 0 Mr Christopher Lloyd President Piedmont Clinic 546109 0 315452 0 63719 0 115514 0 8266 0 1049060 0 0 0 Mr Sidney Kirschner Chief Philanthropy Officer 547985 0 400774 0 473530 0 105630 0 12447 0 1540366 0 88530 0 Mr Douwe Bergsma Chief Marketing Officer 327334 0 118740 0 146103 0 51333 0 9118 0 652628 0 0 0 Mr Robert Cross VP - Gov Reimbursement 304570 0 111586 0 103725 0 17100 0 12445 0 549426 0 0 0 Mr Geoffrey Brown Chief Information Officer 421768 0 246696 0 128891 0 79305 0 12474 0 889134 0 63460 0 Ms Vicki Cansler Chief HR Officer 398542 0 226964 0 109751 0 76466 0 8672 0 820395 0 59366 0 Mr Shannon Glover VP - Managed Care 346564 0 128033 0 14239 0 17100 0 17254 0 523190 0 0 0 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS FIRST-CLASS TRAVEL: THE FOLLOWING INDIVIDUAL WAS PERMITTED (PURSUANT TO THEIR CONTRACTS) TO FLY FIRST-CLASS DURING CALENDAR YEAR 2020. FIRST-CLASS TRAVEL IS NOT REPORTED ON THE EMPLOYEE'S FORM W-2, HOWEVER, THE COMPANY IS REIMBURSED FOR ANY PERSONAL EXPENSES INCURRED BY THE EMPLOYEE. KEVIN BROWN TRAVEL FOR COMPANIONS: CERTAIN EXECUTIVES ARE PERMITTED TO TRAVEL WITH COMPANIONS WHEN IT IS APPROPRIATE FOR THE BUSINESS EVENT AND PURPOSE. TRAVEL FOR COMPANIONS IS REVIEWED ON A CASE BY CASE BASIS AND IS REIMBURSED BY THE EMPLOYEE, PAID ON BEHALF OF THE EMPLOYEE, OR TREATED AS TAXABLE INCOME, AS APPROPRIATE AND IN COMPLIANCE WITH COMPANY POLICY. DISCRETIONARY SPENDING ACCOUNTS: THE FOLLOWING EMPLOYEES RECEIVED DISCRETIONARY SPENDING ACCOUNTS IN FIXED AMOUNTS DETERMINED BY JOB LEVEL. THESE SPENDING ACCOUNTS WERE INCLUDED IN EACH EMPLOYEE'S TAXABLE WAGES: KEVIN BROWN $37,700 MICHAEL MANDL $12,000 SIDNEY KIRSCHNER $12,000 MICHAEL MCANDER $7,385 DR. LEIGH HAMBY $12,000 CHRISTOPHER LLOYD $12,000 ELIZABETH LEDDY $12,000 THOMAS ARNOLD $12,000 GEOFFREY BROWN $12,000 MICHELLE FISHER $12,000 VICKI CANSLER $12,000 DOUWE BERGSMA $10,615 SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS KEVIN BROWN RECEIVED A PAYMENT OF $347,329 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. GEOFFREY BROWN RECEIVED A PAYMENT OF $63,460 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. MICHAEL MCANDER RECEIVED A PAYMENT OF $498,228 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THOMAS ARNOLD RECEIVED A PAYMENT OF $62,570 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. VICKI CANSLER RECEIVED A PAYMENT OF $59,366 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. MICHELLE FISHER RECEIVED A PAYMENT OF $62,097 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. DR. LEIGH HAMBY RECEIVED A PAYMENT OF $95,871 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. SIDNEY KIRSCHNER RECEIVED A PAYMENT OF $88,530 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: ELIZABETH LEDDY DOUWE BERGSMA CHRISTOPHER LLOYD MICHAEL MANDL SCHEDULE J, PART I, LINE 7: NON-FIXED PAYMENTS CERTAIN EMPLOYEES PARTICIPATED IN AN "ANNUAL INCENTIVE PLAN" UNDER WHICH THEY RECEIVED NON-FIXED BONUS PAYMENTS BASED ON JOB LEVEL AND SEVERAL DIFFERENT PERFORMANCE METRICS. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED IN CALENDAR YEAR 2020, PIEDMONT HEALTHCARE, INC., FILED FORMS 1099 ON BEHALF OF ITSELF AND EACH OF ITS SUBSIDIARIES, 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 7B: DECISIONS OF GOVERNING BODY ALL RESOLUTIONS ADOPTED AND ALL BUSINESS TRANSACTED BY PHC'S BOARD OF DIRECTORS REQUIRES THE AFFIRMATIVE VOTE OF A MAJORITY OF THE DIRECTORS PRESENT AT THE TIME OF VOTING, AS LONG AS A QUORUM (MAJORITY OF DIRECTORS CURRENTLY IN OFFICE) IS REPRESENTED AT THE MEETING. FORM 990, PART VI, SECTION B, LINE 11B: 990 REVIEW PROCESS INFORMATION NEEDED TO PREPARE PIEDMONT HEALTHCARE'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT AND REVIEWED BY PHC'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE'S TAX DEPARTMENT AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SEC 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 HEALTHCARE 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, SEC B, LINE 15A & 15B: EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT HEALTHCARE IS SET BY ITS BOARD OF DIRECTORS AND BY THE BOARD'S EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE. THE PIEDMONT HEALTHCARE, INC., BOARD OF DIRECTOR'S EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("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 CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF: BOOK/TAX DIFFERENCES $792,047 CHANGE IN EQUITY $1,138,034 TRANSFER OF LIABILITIES ($188,166,662) ------------------------- TOTAL ($186,236,581) Piedmont Hospital Inc 1968 Peachtree Road NW Atlanta GA 30309 580566213 Hospital GA 501(c)(3) 3 PHC true FAYETTE COMMUNITY HOSPITAL INC 1255 Highway 154 West Fayetteville GA 30214 582322328 Hospital GA 501(c)(3) 3 PHC true Piedmont Mountainside Hospital INC 1266 Highway 515 South Jasper GA 30143 352228583 Hospital GA 501(c)(3) 3 PHC true Piedmont Newnan Hospital INC 745 POPLAR ROAD Newnan GA 30265 205077249 Hospital GA 501(c)(3) 3 PHC true Piedmont HEALTHCARE Foundation INC 2001 PEACHTREE ROAD NE SUITE 400 Atlanta GA 30309 581272768 Fundraising GA 501(c)(3) 12B, II PHC true Piedmont Heart Institute Inc 95 COLLIER ROAD NW STE 2045 Atlanta GA 30309 263553500 Healthcare GA 501(c)(3) 10 PHC true PIEDMONT HENRY HOSPITAL INC 1133 EAGLES LANDING PARKWAY STOCKBRIDGE GA 30281 582200195 HOSPITAL GA 501(c)(3) 3 PHC true PIEDMONT NEWTON HOSPITAL INC 5126 HOSPITAL DRIVE NE COVINGTON GA 30014 582155150 HOSPITAL GA 501(C)(3) 3 PHC true PIEDMONT ATHENS REGIONAL FOUNDATIONINC 1199 PRINCE AVENUE ATHENS GA 30606 581978389 FUNDRAISING GA 501(C)(3) 12B, II PARMC false PIEDMONT ATHENS REGIONAL HLTH RESOURCES 1199 PRINCE AVENUE ATHENS GA 30606 581930580 DEVELOPMENT GA 501(C)(3) 12B, II PARMC false PIEDMONT ATHENS REGIONAL MEDICAL CENTER 1199 PRINCE AVENUE ATHENS GA 30606 582179986 HOSPITAL GA 501(C)(3) 3 PHC true ATHENS REGIONAL PHYSICIAN SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 582332921 HEALTHCARE GA 501(C)(3) 12B, II PARMC false ATHENS REGIONAL SPECIALTY SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 271975001 HEALTHCARE GA 501(C)(3) 3 PARMC false REGIONAL FIRSTCARE INC 1199 PRINCE AVENUE ATHENS GA 30606 582362733 URGENT CARE GA 501(C)(3) 12B, II PARMC false COLUMBUS AMBULATORY HEALTHCARE SERVICES 707 CENTER ST COLUMBUS GA 31901 581719867 AMBULATORY GA 501(C)(3) 3 CRHS false COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 707 CENTER ST COLUMBUS GA 31901 581719994 HEALTHCARE GA 501(C)(3) 12B, II PHC true COLUMBUS REGIONAL MEDICAL FOUNDATION INC 707 CENTER ST COLUMBUS GA 31901 581501642 FUNDRAISING GA 501(C)(3) 7 CRHS false THE MEDICAL CENTER INC 710 CENTER ST COLUMBUS GA 31901 581685139 HOSPITAL GA 501(C)(3) 3 CRHS false HUGHSTON HOSPITAL INC 707 CENTER ST COLUMBUS GA 31901 331216751 HOSPITAL GA 501(C)(3) 3 CRHS false PIEDMONT ROCKDALE HOSPITAL INC 1412 MILSTEAD AVE CONYERS GA 30012 300999841 HOSPITAL GA 501(C)(3) 3 PHC true PIEDMONT WALTON HOSPITAL INC 2151 WEST SPRING ST MONROE GA 30655 824194264 HOSPITAL GA 501(C)(3) 3 PHC true PIEDMONT CARTERSVILLE HOSPITAL INC 960 JOE FRANK HARRIS PKWY SE CARTERSVILLE GA 30120 870963633 hospital GA 501(c)(3) 3 PHC true PIEDMONT EASTSIDE HOSPITAL INC 1700 MEDICAL WAY SNELLVILLE GA 30170 870982886 HOSPITAL GA 501(c)(3) 3 PHC true PIEDMONT MACON HOSPITAL INC 350 HOSPITAL DR MACON GA 31217 871006981 HOSPITAL GA 501(c)(3) 3 PHC true PIEDMONT MACON NORTH HOSPITAL INC 400 CHARTER BLVD MACON GA 31210 871031034 HOSPITAL GA 501(c)(3) 3 PHC true COLUMBUS REGIONAL SENIOR LIVING INC 707 CENTER ST COLUMBUS GA 31901 582628502 HEALTHCARE GA 501(C)(3) 12C, III-FI PHC true PEACHTREE ORTHOPAEDIC SURGERY CENTER 2001 PEACHTREE ROAD NE STE 705 ATLANTA GA 30309 582562721 SURGERY GA NA NONE 0 0 false 0 false 0.00000 DIGESTIVE HEALTHCARE OF GA ENDOSCOPY CTR 95 COLLIER ROAD NW STE 4075 ATLANTA GA 30309 582406657 HEALTHCARE GA NA NONE 0 0 false 0 0.00000 GEORGIA HEALTH COLLABORATIVE LLC 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 461500639 HEALTHCARE GA NA RELATED -4334 2653 false 0 false 0.50000 PIED URG CARE WELL 3350 RVWD PKWY ATL GA 30339 841916875 URGENT CARE GA NA RELATED 8355222 62178926 false 0 false 0.41390 Piedmont Medical Care Corporation 2727 Paces Ferry Road suite 1-1100 Atlanta GA 30339 582092768 Healthcare GA PHC C-CORP -8468674 258735880 1.00000 true THE PIEDMONT CLINIC INC 2727 Paces Ferry Road suite 1-1100 Atlanta GA 30339 582005358 Healthcare GA PHC C-CORP 4852908 25071774 1.00000 false PIEDMONT HEART INSTITUTE PHYSICIANS INC 95 COLLIER ROAD NW STE 2045 Atlanta GA 30309 260593850 Healthcare GA PHC C-CORP -19795645 99295002 1.00000 true Amster McRae Insurance Company PO BOX 1159 Grand Cayman CJ KY 1-1102 980427603 Related Insur CJ PHC C-CORP 16264368 138637687 1.00000 true PIEDMONT WELLSTAR HEALTHPLANS INC 2859 PACES FERRY RD STE 600 ATLANTA GA 30339 461922499 HEALTH INSUR. GA NA C-CORP 0 0 0.50000 false COLUMBUS HEALTHCARE RESOURCES PO BOX 790 COLUMBUS GA 31902 581717754 HEALTHCARE GA crhs 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 true false false true true false false false false false false false false false false true false false false PIEDMONT HOSPITAL INC P 34878433 ACTUAL FAYETTE COMMUNITY HOSPITAL INC P 13284848 ACTUAL PIEDMONT MEDICAL CARE CORPORATION A(iv) 1136845 ESTIMATE PIEDMONT HEART INSTITUTE PHYSICIANS A(iv) 212500 ACTUAL PIEDMONT HOSPITAL INC A(iv) 799888 ESTIMATE PIEDMONT MOUNTAINSIDE HOSPITAL INC P 3363060 ACTUAL PIEDMONT NEWNAN HOSPITAL INC P 8491346 ACTUAL Piedmont Henry Hospital Inc P 12158756 ACTUAL PIEDMONT NEWTON HOSPITAL INC P 3743497 ACTUAL PIEDMONT ATHENS REGIONAL MEDICAL CENTER INC P 19463140 ACTUAL PIEDMONT ROCKDALE HOSPITAL INC P 6421771 ACTUAL PIEDMONT WALTON HOSPITAL INC P 2434795 ACTUAL ATHENS REGIONAL PHYSICIAN SVCS INC P 1323920 ACTUAL ATHENS REGIONAL SPECIALTY SVCS P 2313055 ACTUAL PIEDMONT HEART INSTITUTE INC P 258697 ACTUAL REGIONAL FIRSTCARE INC P 639134 ACTUAL HUGHSTON HOSPITAL p 3241320 ACTUAL The Medical Center p 14380506 ACTUAL COLUMBUS AMBULATORY HEALTHCARE SERVICES P 2313055 ACTUAL PIEDMONT CLINIC P 16312 ACTUAL