2022-05-11T15:56:04-05:00 2021-06-30 KPMG LLP 303 PEACHTREE ST STE 2000 ATLANTA GA 30308 990 2021-05-24 871031034 Piedmont Macon North Hospital Inc % MARIE GAFFNEY PIED 4044251303 400 Charter Blvd MACON GA 31210 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2022-05-10 true MARIE GAFFNEY 999009999 WHITNEY B HEBRON P01226647 4042223000 2022-05-10 2020 2022-09-23 18:48:47Z X MR Stephen Daugherty 400 Charter Blvd MACON GA 31210 0 false X www.piedmont.org X 2021 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 3 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 0 0 0 TO PROVIDE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE IN A PROGRESSIVE ENVIRONMENT, GUIDED BY PHYSICIANS, DELIVERED BY EXCEPTIONAL PROFESSIONALS, AND INSPIRED BY THE COMMUNITIES WE SERVE. false false 0 0 0 PIEDMONT MACON NORTH HOSPITAL, INC. WAS CREATED IN MAY OF 2021 WITH PLANS TO OWN AND OPERATE A HOSPITAL UNDER THE PROVISIONS OF INTERNAL REVENUE CODE SECTION 501(A) AND 501(C)(3) TAX EXEMPTION. THE HOSPITAL WILL FOLLOW THE FINANCIAL ASSISTANCE POLICIES AS SET FORTH BY ITS PARENT, PIEDMONT HEALTHCARE, INC., AND IN COMPLIANCE WITH INTERNAL REVENUE CODE SECTION 501(R). PIEDMONT MACON NORTH HOSPITAL, INC. FILED ITS FORM 1023 Application for Recognition of Exemption Under Section 501(c)(3) of the Internal Revenue Code ON JULY 27, 2021, AFTER THE CLOSE OF ITS FIRST FISCAL YEAR, BUT WITHIN ITS FIRST 27 MONTHS OF EXISTENCE. 0 true false false false false false false false false false false false false false false true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false false false false false false false false X 3 0 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 70 ATLANTA GA 30339 Mr Michael Mandl Board Member 1.0 54.0 X 0 1430051 169167 Ms Elizabeth Leddy Secretary & Board Member 1.0 54.0 X X 0 843802 126625 Mr Thomas Arnold Treasurer 1.0 54.0 X 0 827550 92917 Mr Stephen D Porter Board Member 1.0 54.0 X 0 767744 98678 0 3869147 487387 0 false true false NONE 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 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 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 0 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 0 0 0 0 0 0 0 0 0 X false true X true false X 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. false true false false false false false false false Mr Michael Mandl Board Member 0 778484 0 564842 0 86725 0 156690 0 12477 0 1599218 0 0 Mr Stephen D Porter Board Member 0 425454 0 238850 0 103440 0 81088 0 17590 0 866422 0 0 Mr Thomas Arnold Treasurer 0 424857 0 245916 0 156777 0 79670 0 13247 0 920467 0 62570 Ms Elizabeth Leddy Secretary & Board Member 0 459494 0 335067 0 49241 0 109035 0 17590 0 970427 0 0 SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL COMPENSATION INFORMATION THOMAS ARNOLD RECEIVED A PAYMENT OF $62,570 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: STEPHEN PORTER MICHAEL MANDL ELIZABETH LEDDY FORM 990, PART VI, SECTION A, LINE 1B: INDEPENDENT BOARD MEMBERS PIEDMONT MACON NORTH HOSPITAL ("PMNH") HAD THREE BOARD MEMBERS FOR THE FISCAL YEAR ENDED JUNE 30, 2021. ALL BOARD MEMBERS ARE COMPENSATED BY RELATED ENTITIES UNDER THE PIEDMONT HEALTHCARE CORPORATE STRUCTURE. THE ENTITY CONDUCTED NO ACTIVITIES AS OF THE END OF THE YEAR. ALTHOUGH NOT INDEPENDENT, THE BOARD OF THE PARENT ENTITIY, PIEDMONT HEALTHCARE, INC., IS INDEPENDENT AND HAS AUTHORITY OVER ALL ACTIVITIES OF PMNH. FORM 990, PART VI, SECTION A, LINE 6 PIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT MACON NORTH HOSPITAL ("PMNH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT MACON NORTH HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT MACON NORTH HOSPITAL. FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT MACON NORTH 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 MACON NORTH 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 MACON NORTH HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PMNH'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, 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 MACON NORTH 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 CHIEF COMPLIANCE OFFICER FOR INVESTIGATION, AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. 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. 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