2022-05-11T12:38:26-05:00 2021-06-30 KPMG LLP 303 PEACHTREE ST NE STE 2000 ATLANTA GA 30308 990 2020-07-01 352228583 PIEDMONT MOUNTAINSIDE HOSPITAL INC % MARIE GAFFNEY PIED 7066922441 1266 Highway 515 South Jasper GA 30143 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2022-05-10 true MARIE GAFFNEY 999009999 WHITNEY B HEBRON P01226647 4042223000 2022-05-10 2 2020 2022-09-23 18:48:47Z Ms Denise Ray 1266 Highway 515 South Jasper GA 30143 116427490 false X piedmont.org X 2004 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 8 5 628 155 0 0 9487485 5122610 88045887 111005967 19152 3970 454523 294517 98007047 116427064 123053 23082 0 0 41782358 43736375 0 0 0 50084008 61071933 91989419 104831390 6017628 11595674 58693115 64178508 26453499 23453675 32239616 40724833 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 93593759 23082 111022975 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, 2021, THE HOSPITAL HAD 3,625 IN-PATIENT ADMISSIONS WITH A TOTAL OF 16,352 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 28,746 AND OUTPATIENT VISITS TOTALED 46,637. 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OPERATIONS 40.0 0.0 X 244880 0 10715 Ms Pam Mingo PHARMACY MANAGER 40.0 0.0 X 195942 0 24833 Ms Lindsey Gard CFO 55.0 0.0 X 181341 0 30286 Mr Donald Holmes PHARMACIST 40.0 0.0 X 171038 0 23562 Ms Patricia Hopkins PHARMACIST 40.0 0.0 X 165244 0 26819 Ms Ouida Corry PHARMACIST 40.0 0.0 X 160817 0 22793 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 2182043 4712726 719058 40 false true false MOUNTAINSIDE ANESTHESIA CONSULTANTS 1266 Hwy 515 S JASPER GA 30143 ANESTHESIA 1350000 EMERGENCY COVERAGE CORPORATION 1200 Memorial Dr DALTON GA 30720 EMERGENCY CARE 640505 ALLIED UNIVERSAL SECURITY SERVICES 1551 N TUSTIN AVENUE SANTA ANA CA 92705 SECURITY SERVICES 614992 INSIGHT HEALTH CORPORATION 26250 Enterprise Court LAKE FOREST CA 92630 DIAGNOSTIC SERVICES 370908 MEDICAL SOLUTIONS LLC 1010 North 102nd St OMAHA NE 68114 staffing 518782 12 1943677 3178933 140290 5122610 PATIENT SERVICE REVENUE 621110 110333167 110333167 OTHER OPERATING REVENUE 900099 672800 672800 111005967 4396 4396 0 0 0 0 0 426 -426 -426 -426 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722310 199881 199881 GIFT SHOP 900099 77628 77628 FEE REVENUE 900099 17008 17008 294517 116427064 111022975 281479 23082 23082 0 0 0 622061 546356 75705 0 0 34659052 30441045 4218007 0 6237785 5478647 759138 2217477 1947610 269867 86445 86445 13139 12745 394 0 0 0 0 8337135 8337135 207238 207238 5620963 5545877 75086 1468762 1424708 44054 0 2903775 2453629 450146 13770 10153 3617 0 0 1144503 1109201 35302 3363060 3363060 3730716 3618795 111921 892844 866059 26785 DRUGS AND MEDICAL SUPPLIES 14995844 14995844 BAD DEBT EXPENSE 4394580 4394580 HOSPITAL TAX 1146164 1146164 ALL OTHER EXPENSES 12752995 10948446 1804549 104831390 93593759 11237631 0 109944 43564 0 0 0 0 10342582 12954949 0 0 0 0 0 0 1906056 1966919 252042 318531 81605763 49891701 28902008 31714062 0 0 0 0 0 0 17180483 17180483 0 0 58693115 64178508 6232212 6996084 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20221287 16457591 26453499 23453675 X 31395073 36914563 844543 3810270 32239616 40724833 58693115 64178508 X 11595674 -3110457 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1897200 1897200 34629818 19425045 15204773 2477399 1980171 497228 35229369 26025238 9204131 7371977 2461247 4910730 31714062 0 MEDICARE PAYABLE 10359105 OTHER LIABILITIES 6098486 NOTES PAYABLE 0 16457591 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. true true X true X 300. true X true true false true true 6317386 6317386 0.06290 2985791 3113145 0 0.00000 1214605 377568 837037 0.00830 10517782 3490713 7154423 0.07120 110338 110338 0.00110 293240 293240 0.00290 5664 5664 0.00010 409242 409242 0.00410 10927024 3490713 7563665 0.07530 true 2296366 27601552 28511303 -909751 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 18 true false false true X SEE PART VI X X true 19 true SEE PART VI false true X 300. 300. X true true X X X X true X SEE PART VI X SEE PART VI X SEE PART VI 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 31 key stakeholders and policy makers that represent public health, low-income populations, uninsured and uninsured persons, minorities, chronic conditions, older adults, and lawmakers. Further, in December 2018 and December 2019, 22 key stakeholders within the Piedmont Mountainside community provided their thoughts on community health, community assets and the role of the hospital in addressing unmet community health needs via a web survey. Below are the results of that survey. These interviews were conducted for people representing the entire region, including Pickens County. 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 11 hospitals were actively informed and engaged throughout this process. SCHEDULE H, PART V, SECTION B, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE https://www.piedmont.org/media/file/PMH-FY19-CHNA-Strategy.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, SECTION B, LINE 10A: IMPLEMENTATION STRATEGIES WEBSITE THE BOARD OF DIRECTORS FOR PIEDMONT MOUNTAINSIDE HOSPITAL UNANIMOUSLY APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE YEAR PERIOD BEGINNING WITH FY20 ON AUGUST 23, 2019, 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, 2022. THE IMPLEMENTATION STRATEGY IS PROVIDED AFTER THE COMMUNITY HEALTH NEEDS ASSESSMENT IN THE FOLLOWING LINK. https://www.piedmont.org/media/file/PMH-FY19-CHNA-Strategy.pdf SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS DURING FY16, PIEDMONT MOUNTAINSIDE HOSPITAL CONDUCTED ITS SECOND 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. BASED ON THE CHNA, PIEDMONT MOUNTAINSIDE HOSPITAL IS CURRENTLY FOCUSING ON: (1) MAINTAINING AND INCREASING ACCESS TO AFFORDABLE CARE FOR LOW- AND NO-INCOME PATIENTS, INCLUDING INCREASED EFFORTS AT ELIMINATING HEALTH DISPARITIES; (2) INCREASING ACCESS TO AND AWARENESS OF CANCER-RELATED PROGRAMMING, INCLUDING LOW-COST MAMMOGRAMS, TO QUALIFYING WOMEN THROUGH PARTNERSHIP PROGRAMS; (3) REDUCING PREVENTABLE READMISSIONS AND EMERGENCY DEPARTMENT RE-ENCOUNTERS, PARTICULARLY AMONG HIGH-RISK PATIENTS, WITH A FOCUS ON CHRONIC DISEASE MANAGEMENT; (4) MAINTAINING AND GROWING EFFORTS AROUND SENIOR HEALTH; AND (5) REDUCING PREVENTABLE INSTANCES OF HEART DISEASE, HYPERTENSION, AND STROKE THROUGH EDUCATIONAL AWARENESS AND PROMOTION OF HEALTHY BEHAVIORS, INCLUDING EFFORTS TO REDUCE TOBACCO USE. PIEDMONT MOUNTAINSIDE HOSPITAL DEVELOPED THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS DURING FY20-22. The PMH Board of Directors unanimously approved the new CHNA on August 23, 2019. Based on the CHNA, PMH will focus on the following: (1) INCREASE ACCESS TO APPROPRIATE AND AFFORDABLE HEALTH AND MENTAL CARE FOR ALL COMMUNITY MEMBERS, AND ESPECIALLY THOSE WHO ARE UNINSURED AND THOSE WITH LOW INCOMES; AND (2) REDUCE OPIOID AND RELATED SUBSTANCE ABUSE AND OVERDOSE DEATHS. 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 PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A 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 copies of our IRS Form 990 Schedule H on our website and available to anyone upon request. We also provide information on community benefit programming to local, state, and federal lawmakers through our government affairs office. PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7(F) 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 $104,831,390, LESS BAD DEBT EXPENSE OF $4,394,580 FROM FORM 990, PART IX, LINE 24(B). FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7 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. BAD DEBT EXPENSE CALCULATION AND FOOTNOTE SCHEDULE H, PART III, LINES 2-4 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. MEDICARE SHORTFALLS AS COMMUNITY BENEFIT SCHEDULE H, PART III, LINE 8 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. We believe our Medicare shortfall reported on Part III, Line 7 of Schedule H, should be considered a community benefit as the IRS community benefit standard includes the provision of care to elderly and Medicare patients. 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 actually 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. COLLECTION PRACTICES SCHEDULE H, PART III, LINE 9(B) 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 provide 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 FY19, we conducted our third triennial community health needs assessment (CHNA). FY21 marked Year Two of the subsequent Implementation Strategy. Our CHNA was led by the Piedmont Healthcare community benefits team, with significant input and direction from hospital leadership, including the director of community relations and our hospital Board of Directors, which formed a subcommittee to help determine final priorities. Process The CHNA started first with a definition of our community, of which we determined was 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, and 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 community, 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. 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. Nearly 900 employees spanning the system responded. Additionally, we conducted a community-based survey in which local stakeholders were asked their thoughts on unmet community health needs and our role in addressing those needs. These stakeholders included local leaders, nonprofit representatives, elected officials and those with a unique knowledge of the challenges vulnerable populations face. We also evaluated previous community benefit, hospital and community interventions identified in our last CHNA implementation strategies through three lenses: impact, outcomes, and sustainability. Interventions and programming considered to have a high score on all three were included in this CHNA and our subsequent strategy. This included our community benefit grants program, our charitable clinic-hospital partnerships, and our heart- and stroke-focused community programming. Finally, we conducted direct interviews with 31 state and regional stakeholders and policymakers, with each representing a specific group that tends to be adversely impacted by issues of health equity. These groups included but are not limited to Georgians for a Healthy Future, Georgia Watch, ConsiderHealth, the Community Foundation for Greater Atlanta, the Georgia Charitable Care Network, the Medical Association of Georgia and Healthy Mothers, Healthy Babies. Additionally, we sought and received feedback on our CHNA from public health. Our priorities A key component of the CHNA is to identify the top health priorities we'll address over fiscal years 2020, 2021 and 2022. These priorities will guide our community benefit work. They are, in no order: . Increase access to appropriate and affordable health and mental care for all community members . Reduce opioid, substance and nicotine abuse and overdose deaths 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, and that is demonstrated through our implementation strategies. Several key community health needs 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. 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. While the priorities reflect clinical access and certain conditions, 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 community health needs assessment was unanimously approved by the Piedmont Mountainside Hospital board of directors on May 17, 2019. Our implementation strategy was developed in partnership with hospital leadership and community stakeholders to address the identified priorities in our FY19 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. As mentioned above, we included proven and successful interventions and programming, investing further in work we felt was successful in addressing unmet health needs. THE CHNA IMPLEMENTATION STRATEGY WAS APPROVED AUGUST 23, 2019. 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, within the Conditions of Admission form, and posted notices in key areas of the hospital. These locations are the emergency room, at admitting and registration departments, our business office, and patient financial services office 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 understand the policy and how it relates to their populations and receive feedback in ways our financial assistance programming could be improved. Finally, Piedmont Healthcare annually publishes a directory of services and programs for low-income community members, and within this resource guide are extensive directions and advice on how to apply for our patient financial assistance program. Also, in this guide is information on how to apply for certain government assistance programs, resources to help prepare and file tax returns, as well as detailed resources for local sliding scale and free mental, dental and health resources. This guide is widely distributed to the community via hardcopy, is available within our hospitals and is digitally available online. This guide is available in both English and Spanish. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION We are in in Pickens County, where an average 31,387 people lived across a 232.06 square mile area between 2015 and 2019. The population density for this area, estimated at 135.25 persons per square mile, is greater than the national average population density of 94 people per square mile. During that time, Pickens County was 27 percent urban and 73 percent rural. The median age of people living within Pickens County was 45 and was evenly split between male and female. Twenty percent of the population were 18 or younger, 21 percent were over the age of 65 and 58 percent were between ages 18-64. In Pickens County, 11 percent of the population over 18 identify as a veteran and 18 percent of those veterans identified as having a disability. Less than one percent of the population had limited English proficiency, which references the populations aged 5 and older who speak a language other than English at home and speak English less than "very well." About 2 percent of the population were born outside of the United States and are considered foreign born while 1 percent do not hold US citizen status. This data point does not include individuals who may hold Green Card permissions. Two percent of adults were unemployed in 2021, a figure lower than the national unemployment rate of 3.9 percent. While the Labor Force Participation Rate was 58 percent. Thirteen percent of Pickens County lived in poverty between 2015 and 2019. During that same period, 15 percent of children in Pickens County lived in poverty, a figure that has steadily increased over the last ten years. It is significantly lower than the state average of 18.5 percent. When broken down by race, African American and Asian children were much more likely to live in poverty than any other race. Nearly 51 percent of public-school children were eligible for the free or reduced priced lunch program during the 2018-2019 school year, which is lower than the 2014-15 state average of 62 percent. Twenty-two percent of the population has attended some college, 32 percent obtained an associate degree or higher. Thirty-two percent graduated high school only and 15 percent of the population did not graduate high school. The Pickens County graduation rate (ACGR) during 2015 to 2019 was 93 percent. Thirty-two percent of children aged three to four years old attended preschool. From 2015 to 2019 there were about 7 percent of young people not enrolled in school and were also unemployed. In Pickens County, between 2015 to 2019 there were a total number of 11,868 households, and a quarter were occupied by renters. Approximately 71 percent of all households were occupied by families. Twenty-two percent of households had housing costs that exceeded more than 30 percent of total household income from 2015 to 2019, indicating a cost burdened household more likely to face overall financial difficulty. Thirty-six percent of rental households, 22 percent of owner-occupied households with a mortgage, and 12 percent of owner-occupied households without a mortgage were cost burdened. Nearly a fourth of all occupied homes were considered to have substandard conditions, and Housing quality of occupied homes with one or more substandard condition was 24 percent; 3 percent of households completely lacked kitchen facilities, 3 percent lacked telephone services, and less than one percent lacked plumbing facilities. In Pickens County, 11 percent of county residents were uninsured from 2015 to 2019. Roughly 12 percent of the population received SNAP benefits. For every 1,000 teen girls aged 15 to 18 in Fayette County, roughly 32 gave birth to a child on average each year between 2013 and 2019. Children born to teens are statistically much more likely to experience adverse health and socioeconomic issues as they grow older. Approximately, 9 percent of all live births were considered low birth weight births. As of 2019, there were about 14 recreation and fitness facilities per 100,000 people. There were 71 fast food restaurants in Pickens County in 2019 and no place in Pickens County was considered a food desert. A food desert is an area where it is difficult to buy affordable and/or good-quality fresh food. As of 2019, there were about 17 grocery store establishments per 100,000 people in Pickens County and 10 retailers per 10,000 people that were SNAP-authorized food stores. Various health behavior indicators showed that 19 percent of adults reported excessive drinking of alcohol and 15 percent binge drinking in the last 30 days. In 2018, about 17 percent of adults were current smokers (lower than the national average). There were nearly 21 percent of adults who reported having no leisure time for physical activity. In Pickens County, between 2014 and 2018, on average each year, the cancer incidence rate was 603 cases per every 100,000 people. Breast cancer had the highest incidence during this period at 145 cases per 100,000 people and with 32 new cases diagnosed each year. Prostate cancer followed second highest at 137 cases per 100,000 people and 35 new cases annually. Lung and bronchus cancer had an incidence rate of 83 cases per 100,000 people and 43 new cases annually. Melanoma of the skin had an incidence rate of 56 cases per 100,000 people with 26 new cases annually. Lastly, colon and rectum cancer had an incidence rate of 52 cases per 100,000 people with 23 new cases annually. Chronic condition health indicators for Pickens County showed that 5 percent of Medicare beneficiaries had asthma, 23 percent had diabetes, 28 percent had heart disease and 63 percent had high blood pressure. Nine percent of adults were diagnosed with diabetes in 2019. In Pickens County, cancer was the number one cause of both age-adjusted and premature death between 2015 and 2019. Age-adjusted allows communities with different age structures to be compared. Premature death is when death happens before the average age for a given community. From 2017-19, Pickens County had 514 premature deaths and 7,651 years of potential life lost. In 2021, Pickens County reported a total of 5,684 COVID-19 cases and 375 COVID-19 deaths per 100,000 people. About 19 percent of adults were fully vaccinated and 17 percent of adults were hesitant about receiving the vaccine. The COVID-19 vaccine Coverage index (CVAC) ranks states and counties on barriers to coverage through 28 indicators across 5 themes: historic under vaccination, sociodemographic barriers, resource-constrained health system, healthcare accessibility barriers, and irregular care-seeking behaviors. The CVAC can help contextualize progress to widespread COVID-19 vaccine coverage, identifying underlying community-level factors that could be driving suboptimal rollout to inform precision solutions. Pickens County had a vaccine coverage index of 0.39 as reported by the CDC in 2021. Sources for all statistics in this section: U.S. Census 2017 ACS Demographic and Housing Estimate, University of Wisconsin Population Health Institute, County Health Rankings, 2018, with indicators ranging from 2012 to 2019, and the Georgia Online Analytical Statistical Information System. SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH In FY21, 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 significantly impacted our proactive community benefit programs, as we canceled all in-person events and classes as of early March 2020. We created programming responsive to the pandemic, including our migration to online platforms for vital community-based programming. At the beginning of the COVID pandemic, our leadership recognized the lack of effective communication between key stakeholders in the communities we serve. We initiated WebEx meetings that included Our leadership, state, county, and city government officials, Georgia Department of Public Health representatives, law enforcement officials, county school board officials, court system officials, and community members. Calls were held daily, bi-weekly and weekly dependent on the state of the pandemic. During the COVID-19 pandemic, we worked with the Gilmer County Health Department by utilizing the Community Building to hold COVID-19 vaccine clinics for the community. We created a managed care program for low-income patients that utilizes a licensed medical social worker to work with high-risk, low-income patients who have presented at the emergency department with the condition that will need ongoing care. We staffed an LMSW in the emergency department. The LMSW evaluates high-risk and low-income patients who present a need for services, assists patients with referrals to community resources, and is available for post-discharge from the emergency department. We aim to link patients with community resources to ensure medical and psychosocial wellbeing. We continued to work with Good Samaritan Health and Wellness, a local Federally Qualified Health Center that provides vital health services to low-income community members. We worked to reduce opioid, nicotine, and related substance abuse and overdose deaths by providing meaningful leadership in its community and partnering with others to combat opioid abuse. We created and deployed a PSA campaign on e-cigarette use among teens and adults. We distributed and displayed the campaign via community partners throughout the hospital and community. We actively supported messaging and efforts of Pickens County Sheriff's Department to address illegal e-vaping among underage teens. Due to the pandemic, we have not moved forward with our partnership with the Pickens County Sheriff's Department and other community resources. We convened a local task force comprised of community stakeholders, the school system, law enforcement, and parents to develop effective strategies to reduce e-cigarette use. Due to the pandemic, we have not moved forward with our partnership with the Pickens County Sheriff's Department and other community resources. We recognized the need for community leaders to come together to share information regarding the COVID-19 pandemic and its impact on the local communities. We hosted community leaders and government officials from Pickens and Gilmer counties and the cities Jasper, East Ellijay, and Ellijay in a weekly conference call to share the latest updates on COVID-19 statistics and recommended guidelines. We sent a team of leaders to assist Pickens County schools with conducting a risk assessment on the individual schools and the infection control processes they implemented before bringing students back to in-person education. Our staff members participated in community COVID-19 vaccine clinics. We also started a Bamlanivimab clinic at the hospital and provided the much-needed monoclonal antibody treatment to our community members close to home while eliminating the need to travel to Atlanta for treatments. 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 16 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 system 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 false true false false false false false true false Dr Leigh Hamby Board Member 0 594907 0 418830 0 163285 0 112971 0 19776 0 1309769 0 95871 Ms Denise Ray CEO/CHAIR/BOARD MEMBER 430889 0 252605 0 118255 0 81842 0 14960 0 898551 0 64742 0 Dr John Schnars Board Member 0 530965 0 0 0 48458 0 17100 0 12513 0 609036 0 0 Ms Michelle Breitfelder CNO 183656 0 67896 0 9480 0 15511 0 13708 0 290251 0 0 0 Ms Lindsey Gard CFO 148299 0 33042 0 0 0 0 0 30286 0 211627 0 0 0 Mr Justin Leal SR. DIR. OPERATIONS 201316 0 43292 0 272 0 2926 0 7789 0 255595 0 0 0 Ms Pam Mingo PHARMACY MANAGER 161464 0 23931 0 10547 0 11343 0 13490 0 220775 0 0 0 Mr Donald Holmes PHARMACIST 148906 0 725 0 21407 0 10146 0 13416 0 194600 0 0 0 Ms Ouida Corry PHARMACIST 145739 0 725 0 14353 0 9352 0 13441 0 183610 0 0 0 Ms Patricia Hopkins PHARMACIST 154789 0 725 0 9730 0 7861 0 18958 0 192063 0 0 0 Mr Michael McAnder Treasurer (End 7/20) 0 357162 0 0 0 927767 0 66931 0 5196 0 1357056 0 498228 Mr Thomas Arnold Treasurer (Eff 7/20) 0 424857 0 245916 0 156777 0 79670 0 13247 0 920467 0 62570 Ms Elizabeth Leddy Secretary 0 459494 0 335067 0 49241 0 109035 0 17590 0 970427 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 $12,000, A FIXED AMOUNT DETERMINED BY THEIR JOB LEVEL. MICHAEL MCANDER RECEIVED A DISCRETIONARY SPENDING AMOUNT TOTALING $7,385. 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 4: SUPPLEMENTAL COMPENSATION INFORMATION DENISE RAY RECEIVED A PAYMENT OF $64,742 FROM HER SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. DR. LEIGH HAMBY RECEIVED A PAYMENT OF $95,871 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. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: ELIZABETH LEDDY 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. X 6 140290 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 2020 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, SEC 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, 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 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, SEC B, LINE 15A, 15B: EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT FAYETTE 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 CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF: CONTRIBUTIONS ($3,316,237) UNALLOCATED EXPENSES ($5,181,870) BOOK/TAX DIFFERENCES $50,713 CHANGE IN TEMP $2,967,217 INTERCOMPANY TRANSFER $2,369,720 ------------------ TOTAL ($3,110,457) 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 PIEDMONT HENRY HOSPITAL INC 1133 Eagles Landing Parkway Stockbridge GA 30281 582200195 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 RD NE STE 400 Atlanta GA 30309 581272768 Fundraising GA 501(c)(3) 12B, II PHC false PIEDMONT HEART INSTITUTE INC 95 Collier Road NW STE 2045 Atlanta GA 30309 263553500 Healthcare GA 501(c)(3) 10 PHC false PIEDMONT NEWTON HOSPITAL INC 5126 HOSPITAL DRIVE NE COVINGTON GA 30014 582155150 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT ATHENS REGIONAL FOUNDATION INC 1199 PRINCE AVENUE ATHENS GA 30606 581978389 FUNDRAISING GA 501(C)(3) 12B, II ARMC false PIEDMONT ATHENS REGIONAL HEALTH RESOURCE 1199 PRINCE AVENUE ATHENS GA 30606 581930580 DEVELOPMENT GA 501(c)(3) 12B, II ARMC false PIEDMONT ATHENS REGIONAL MEDICAL CENTER 1199 PRINCE AVENUE ATHENS GA 30606 582179986 HOSPITAL GA 501(c)(3) 3 PHC false ATHENS REGIONAL PHYSICIAN SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 582332921 HEALTHCARE GA 501(C)(3) 12B, II ARMC false REGIONAL FIRSTCARE INC 1199 PRINCE AVENUE ATHENS GA 30606 582362733 URGENT CARE GA 501(C)(3) 12B, II ARMC false ATHENS REGIONAL SPECIALTY SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 271975001 HEALTHCARE GA 501(C)(3) 3 ARMC 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 false 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 false PIEDMONT WALTON HOSPITAL INC 2151 WEST SPRING ST MONROE GA 30655 824194264 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT CARTERSVILLE HOSPITAL INC 960 JOE FRANK HARRIS PKWY SE CARTERSVILLE GA 30120 870963633 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT EASTSIDE HOSPITAL INC 1700 MEDICAL WAY SNELLVILLE GA 30078 870982886 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT MACON HOSPITAL INC 350 HOSPITAL DR MACON GA 31217 871006981 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT MACON NORTH HOSPITAL INC 400 CHARTER BLVD MACON GA 31210 871031034 HOSPITAL GA 501(C)(3) 3 PHC false COLUMBUS REGIONAL SENIOR LIVING INC 707 CENTER ST columbus GA 31901 582628502 healthcare GA 501(c)(3) 12C, III-FI phc false PEACHTREE ORTHOPAEDIC SURGERY CENTER 2001 PEACHTREE RD 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 RD NW STE 4075 ATLANTA GA 30309 582406657 HEALTHCARE GA NA NONE 0 0 false 0 false 0.00000 PIED URG CARE WELL 3350 RVWD PKWY atl GA 30339 841916875 urgent care GA NA NONE 0 0 false 0 false 0.00000 GEORGIA HEALTH COLLABORATIVE LLC 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 461500639 HEALTHCARE GA NA NONE 0 0 false 0 false 0.00000 Piedmont Medical Care Corporation 2727 Paces Ferry Rd Ste 1-1100 Atlanta GA 30339 582092768 Healthcare GA PHC C Corp 0 0 0.00000 false The Piedmont Clinic Inc 2727 Paces Ferry Rd Ste 1-1100 Atlanta GA 30339 582005358 Healthcare GA PHC C Corp 0 0 0.00000 false Piedmont Heart Institute Physicians Inc 95 Collier Road NW Ste 2045 Atlanta GA 30309 260593850 Healthcare GA PHC C Corp 0 0 0.00000 false Amster McRae Insurance Company PO BOX 1159 Grand Cayman Grand Cayman CJ KY1-1102 980427603 Related Insur CJ PHC C Corp 0 0 0.00000 false PIEDMONT WELLSTAR HEALTHPLANS INC 2859 PACES FERRY RD STE 600 ATLANTA GA 30339 461922499 HEALTH INSUR. GA PHC C CORP 0 0 0.00000 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 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.