2022-05-11T13:27:43-05:00 2021-06-30 KPMG LLP 303 PEACHTREE ST STE 2000 ATLANTA GA 30308 990 2020-07-01 582179986 PIEDMONT ATHENS REGIONAL MEDICAL CENTER INC % MARIE GAFFNEY PIED 7064757000 1199 PRINCE AVENUE ATHENS GA 30606 MARIE GAFFNEY VP CORP. 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 MR J MICHAEL BURNETT 1199 PRINCE AVENUE ATHENS GA 30606 586558385 false X WWW.PIEDMONT.ORG/LOCATIONS/PIEDMONT-ATHENS/ X 1987 GA PROVISION OF HEALTHCARE SERVICES. 12 8 3190 700 0 0 29407699 10050000 482099674 589181945 335398 1010549 -9689820 -13684109 502152951 586558385 980700 333745 0 0 217748974 233078087 0 0 0 273207457 287565650 491937131 520977482 10215820 65580903 420292220 481881509 297785095 278454060 122507125 203427449 THE MISSION OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER IS TO IMPROVE THE LIVES AND HEALTH OF THOSE WE TOUCH. false false 473604080 271245 570664597 PIEDMONT ATHENS REGIONAL MEDICAL CENTER ("PAR") IS A 360-BED FACILITY LOCATED IN THE CITY OF ATHENS IN CLARKE COUNTY, GEORGIA. OVER 500 PRIMARY CARE AND SPECIALTY PHYSICIANS COMPRISE THE MEDICAL STAFF AND MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN ATHENS AND THE SURROUNDING NORTHEAST GEORGIA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE FISCAL YEAR ENDED JUNE 30, 2021, THE HOSPITAL HAD 21,432 PATIENT ADMISSIONS WITH A TOTAL OF 99,277 OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 78,171 OUTPATIENT VISITS TOTALED 257,365. SURGICAL SERVICES WERE PROVIDED TO 14,242 PATIENTS. 473604080 true true false false false false false false false false true false false false true true false true false false false false false false false false true true true false true true false false false false false false false false false false false false false false false true false false false true X 0 0 3190 true false false false false false false false false false false true false X 12 8 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 X Mr Michael Mandl Board Member 1.0 54.0 X 0 1430051 169167 Mr Michael McAnder Treasurer (End 7/20) 1.0 54.0 X 0 1284929 72127 Mr J Michael Burnett CEO 47.0 8.0 X X 1022934 0 119889 Ms Elizabeth Leddy Secretary 1.0 54.0 X 0 843802 126625 Mr Thomas Arnold Treasurer (Eff 7/20) 1.0 54.0 X 0 827550 92917 Mr Robert Sinyard VP MEDICAL AFFAIRS 55.0 0.0 X 609035 0 29577 Ms Wendy Cook Chief Financial Officer 55.0 0.0 X 529427 0 36518 Dr Geoffrey Cole VP, ANCILLARY SVCS 55.0 0.0 X 505510 0 27351 Mr Jason Smith COO 55.0 0.0 X 389644 0 30005 Mr Larry Ebert FORMER EXC DIR STRAT OPS 0.0 55.0 X 0 371688 34258 Ms Tamara Jackson CNO 55.0 0.0 X 360727 0 24090 Dr Catherine Apaloo FACULTY PROGRAM DIRECTOR 40.0 0.0 X 350724 0 31097 Ms Jody Corry VP IN HOUSE LEGAL 55.0 0.0 X 346678 0 28863 Dr James Appiah-Pippim Director, Residency Program 40.0 0.0 X 347593 0 25704 Mr Norman Burkett VP, PROFESSIONAL SERVICES 55.0 0.0 X 276656 0 32844 Dr Akua Biritwum PHYSICIAN 40.0 0.0 X 243187 0 27989 Ms Diane Todd Exec. Dir. Operations 40.0 0.0 X 247381 0 20889 Dr Keisha Bonhomme PHYSICIAN 40.0 0.0 X 245424 0 17123 Dr Carolann Eisenhart Board Member 20.0 4.0 X 116680 0 0 Dr David Sailors Board Member 1.0 5.0 X 6400 0 0 Mr Dexter L Fisher Board Member 1.0 4.0 X 0 0 0 Ms Cheryl Legette Board Member 1.0 5.0 X 0 0 0 Mr Alan Reddish Board Member 1.0 4.0 X 0 0 0 Ms Kim Ripps Board Member 1.0 4.0 X 0 0 0 Ms Jenny Terrell Board Member 1.0 4.0 X 0 0 0 Dr Samuel K Thomason Board Member 1.0 4.0 X 0 0 0 Mr Tony Townley Board Member 1.0 4.0 X 0 0 0 Dr Jonathan D Woody Board Member 1.0 4.0 X 0 0 0 5598000 4758020 947033 174 true true false MEDICAL CENTER ANESTHESIOLOGY OF AT 1199 Prince Ave ATHENS GA 30606 ANESTHESIA 60888406 GEORGIA EMERGENCY MEDICINE SPECIALI 1199 Prince Ave ATHENS GA 30606 ER SERVICES 26258317 ATHENS PULMONARY ALLERGY PC 3320 Old Jefferson Rd ATHENS GA 30607 MEDICAL SERVICES 24970764 ATHENS RADIOLOGY ASSOCIATES PC 1199 PRINCE AVE ATHENS GA 30606 RADIOLOGY 7205625 DPR CONSTRUCTION 3301 Windy Ridge Pkwy ATLANTA GA 30339 CONSTRUCTION 24363635 31 10050000 10050000 HEALTHCARE SERVICES 622110 571883883 571883883 PHARMACY 900099 6329552 6329552 PARKING 900099 48951 48951 OTHER OPERATING REVENUE 900099 10919559 10919559 589181945 150760 150760 0 0 2818445 2818445 0 2818445 2818445 859789 859789 859789 859789 0 0 0 0 0 0 421509 0 421509 421509 CAFETERIA SALES 722210 1544334 1544334 PARTNERSHIP GAIN/LOSS 900099 -20253436 -20253436 RESEARCH 900099 10720 10720 1774319 1774319 -16924063 586558385 570664597 5843788 333745 333745 0 0 0 1807895 1703218 104677 0 0 184758110 174060615 10697495 0 34279596 32294807 1984789 12232486 11524225 708261 298341 298341 273378 273378 0 0 0 0 44545283 41748429 2796854 1279009 996020 282989 23271748 23158420 113328 10101163 7575872 2525291 0 10374413 8599047 1775366 16676 14861 1815 0 41503 37295 4208 6569281 6569281 0 23313538 17485153 5828385 3916644 3916644 MEDICAL SUPPLIES & DRUGS 108573396 108573396 BAD DEBT EXPENSE 25212833 25212833 TAXES 6047695 6047695 OTHER EXPENSES 23730749 14238449 9492300 520977482 473604080 47373402 0 26615004 15465681 0 0 0 0 61007418 73490018 0 0 0 0 0 0 10581636 10723356 5041520 6683689 447910235 76809729 312872386 371100506 0 0 0 0 0 0 0 0 4174256 4418259 420292220 481881509 123236629 82436586 0 0 326859 564309 174221607 166983937 0 0 0 0 0 0 0 0 0 28469228 297785095 278454060 X 122507125 203427449 0 0 122507125 203427449 420292220 481881509 X 65580903 15339421 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 29508855 29508855 182967765 33401678 149566087 2180 927 1253 97302787 39017654 58285133 138128648 4389470 133739178 371100506 0 MISCELLANEOUS PAYABLES 35293 LEASE PAYABLE 28433935 28469228 X Schedule D, Part X, Line 2 ASC 740 Footnote 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 true false true true 33915125 33915125 0.06840 21550774 20248703 1302071 0.00260 8104747 7876347 228400 0.00050 63570646 28125050 35445596 0.07150 67131 67131 0.00010 2341120 2341120 0.00470 981271 981271 0.00200 341316 341316 0.00070 3730838 3730838 0.00750 67301484 28125050 39176434 0.07900 25000 25000 0.00010 25000 25000 0.00010 true 12442087 128444511 101170817 27273694 X true true NONE 1 1 PIEDMONT ATHENS REGIONAL MED CENTER 1199 PRINCE AVENUE ATHENS GA 30606 WWW.PIEDMONT.ORG 029-007 X X X 1 PIEDMONT ATHENS REGIONAL MED CENTER 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 SCH H, PART V, SECTION B, LINE 5: COMMUNITY REPRESENTATION As a part of our process to represent the broad interests of the community, we interviewed 31 state and regional stakeholders and policy makers that represent public health, low-income populations, uninsured and uninsured persons, minorities, chronic conditions and older adults, as well as elected officials and lawmakers. These stakeholders have a particular expertise or knowledge of the community. 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. These interviews were conducted for people representing the entire region, including Clarke County. The Piedmont Healthcare board of directors and leadership from all 11 hospitals were actively informed and engaged throughout this process. SCH H, PART V, SECTION B, LINE 7A COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE https://www.piedmont.org/media/file/PAR-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 ATHENS REGIONAL MEDICAL CENTER 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. SCH H, PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY THE BOARD OF DIRECTORS FOR PIEDMONT ATHENS REGIONAL MEDICAL CENTER UNANIMOUSLY APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE YEAR PERIOD BEGINNING WITH FY20 ON OCTOBER 24, 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 POLICY IS LOCATED AFTER THE COMMUNITY HEALTH NEEDS ASSESSMENT IN THE FOLLOWING LINK. https://www.piedmont.org/media/file/PAR-FY19-CHNA-Strategy.pdf SCH H, PART V, SECTION B, LINE 11: Addressing Community Health Needs In 2015, the then-Athens Regional Health System administration and board approved the hospital's Community Health Needs Assessment (CHNA), which was developed using primary and secondary data, internal hospital data, findings from key stakeholder interviews and other relevant community-based information. The CHNA identified several key health priorities, which were developed using four key criteria: 1) the number of people affected, 2) the severity of the problem, 3) the health system's ability to impact, and 4) the extent to which other organizations are already meeting the need. From the CHNA findings, and in partnership with hospital leadership and community stakeholders, Athens Regional Health System developed its implementation strategy to address the identified priorities listed in the 2015 CHNA. The initial implementation strategy was approved by the Athens Regional Health System Board of Directors on November 24, 2015. Athens Regional joined the Piedmont Healthcare system as Piedmont Athens Regional Medical Center ("PARMC") in October 2016. In March 2017, the Piedmont Health System community benefit team, in partnership with PAR leadership, redrafted the implementation strategy to align it with system priorities and to reflect the shift in ownership. Core strategies from the original were maintained, and several priorities were combined as they share strategies. PARMC has attempted to increase access to care and services by providing financial assistance and covering any short-falls for low and no-income populations through free and reduced-cost care to qualifying patients through Piedmont Healthcare's Financial Assistance Policy. PARMC has also continued to support care for Medicaid populations through coverage of cost shortfalls and by enrolling qualifying patients with vendors. PARMC has also maintained a partnership with Mercy Clinic for the provision of free pharmaceuticals. PARMC also identified supporting cardiovascular, cerebrovascular, and respiratory health and combating obesity and diabetes as a community need. PARMC provides grant funding to community based non-profits to help at-risk populations directly. Further, PARMC provides a variety of healthy lifestyle community education programing, including nutrition counseling, smoke-free campaigns, and other lifestyle classes at the local YMCA. PARMC has also remained accredited for stroke and cardiovascular services. The PARMC Board of Directors unanimously approved the new CHNA on May 23, 2019. Based on the CHNA, PARMC 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; (2) REDUCE OPIOID AND RELATED SUBSTANCE ABUSE AND OVERDOSE DEATHS; (3) DECREASE DEATHS FROM LUNG AND BREAST CANCER AND INCREASE ACCESS TO CANCER PROGRAMMING FOR THOSE LIVING WITH THE DISEASE; AND (4) PROMOTE HEALTHY WEIGHTS AND BEHAVIORS AS TO DECREASE PREVENTABLE INSTANCES OF HEART DISEASE, STROKE, DIABETES, HYPERTENSION, AND OTHER RELATED CHRONIC CONDITIONS. SCH H, PART V, SECTION B, 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 PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCH 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 our IRS Form 990 Schedule H on our website and provide copies to anyone upon request. We also provide information on community benefit programming to local, state, and federal lawmakers through our government affairs office and online. 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 $520,977,482, LESS BAD DEBT EXPENSE OF $25,212,833 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 INCOMPLETE 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. PIEDMONT ATHENS REGIONAL MEDICAL CENTER 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 SCH 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, 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 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. SCH 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 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. Generally speaking, 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 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 communities, 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, and especially those who are uninsured and those with low incomes; . Decrease deaths from cancer and increase access to cancer programming for those with living the disease, with a focus on lung and breast cancer; . Promote healthy weights and behaviors as to decrease preventable instances of heart disease, stroke, diabetes, hypertension and other related chronic conditions; and . Reduce opioid and related substance 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 CHNA was unanimously approved by the hospital Board of Directors on May 23, 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 unanimously approved by our board of directors on October 24, 2019. SCH 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, which also includes 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. The guide is in both English and Spanish. SCH H, PART VI, LINE 4: COMMUNITY INFORMATION We are in Athens-Clarke County, where an average 126,176 people lived in the 119.22 square mile area between 2015 and 2019. The population density for this area, estimated at 1,058.36 persons per square mile, is greater than the national average population density of 91.93 persons per square mile. Between 2015 to 2019, about 63 percent of all Athens-Clarke County residents were white, 28 percent were African American, and the remaining 6.8 percent were comprised of other races. The median age of people living within the county was 28, much lower than state and national averages. About 17 percent of the population were 18 or younger, 11 percent were over the age of 65, and 72 percent were between ages of 18-64. Ten percent identified as being born outside of the US and 7 percent do not possess US citizenship status. Between 2015 and 2019, there were an average 48,844 households, and a slight majority were made up of families. 51 percent were non-family households and 49.4 percent were family households. Of all households, 23 percent were households with children and 13.1 percent were married family households with children. Single male family households with children accounted for 1.7 percent single female family households with children was 8.3 percent. Nearly ten percent of households did not have motor vehicles. Forty-two percent of households had housing costs that exceeded more than 30 percent of total household income in 2017, indicating a cost burdened household more likely to face overall financial difficulty. Cost-burdened rental households accounted for 53.9 percent of all households and owner-occupied households with mortgage that are cost burdened was 27.8 percent. The owner-occupied households without mortgage that are cost burdened was 13.1 percent. Housing quality of occupied units with one or more substandard condition was 42 percent. Households lacking complete plumbing facilities were less than one percent (0.29 percent) and housing units lacking telephone services was 2.5 percent. Between 2015 and 2019, the median household income was $38,623, and African Americans had a much lower median household income at $29,394. Twelve percent did not graduate high school, 20 percent graduated just high school, 22 percent obtained a bachelor's degree, and 22 percent attained a graduate or professional degree. During that same time, About 6 percent of the population were considered 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." The Labor Force Participant Rate within the County was 60.9 percent. Three percent of adults were unemployed in 2021, a figure lower than the national average of 5.4 percent. Thirty percent of the county - about 38,000 people - lived in poverty each year on average between 2015 and 2019. During that same time, 33 percent of children in Athens-Clarke County lived in poverty, a figure that has steadily increased over the last ten years. It is significantly higher than the state average of 22 percent. Ninety-two percent of public-school children were eligible for the free or reduced priced lunch program during the 2018-2019 school year, which is higher than the state average of 60 percent. Under-served children are statistically less likely to graduate high school or attend college and are nearly twice as likely to become under-served adults than their counterparts. Athens-Clarke County ranked 41st out of all counties in Georgia for health outcomes and ranked 20th out of all Georgia counites regarding health factors. Due to their health factor ranking, Athens-Clarke County is considered among the healthiest of counties in Georgia. In Athens-Clarke County, 13.5 percent of residents were uninsured in 2019, and minorities were far more likely as their white counterparts to be uninsured. Thirteen percent of the population received SNAP benefits. There were five designated health professional shortage areas in the community in 2021: two primary care shortage areas, two mental health shortage areas and one dental health shortage area. In Athens-Clarke County, various public health factors such as cancer prevention included 37 percent of female Medicare beneficiaries received a mammogram. Eighty-seven percent of Medicare enrollees with diabetes received a Hemoglobin A1c test. Athens-Clarke County found a total of 3,828 per 100,000 hospitalizations were preventable. Athens-Clarke County cancer-related statistics included an incidence of cancer were 448.8 cases per 100,000 people. Breast cancer had the high prevalence at 137.8 cases per 100,000 people with an average of 77 average new cases annually. Prostate cancer held the next highest prevalence at 122.7 cases per 100,000 people with 58 average new cases annually. Lung and bronchus cancer rates were 54.6 cases per 100,000 people with 55 average new cases annually. Colon and rectum cancer rates were 38.4 cases per 100,000 people with 38 average new cases annually. Bladder cancer rates were the lowest at 20.7 cases per 100,000 people with 21 average new cases annually. In the county, chronic conditions such as asthma accounted for 5.1 percent of Medicare beneficiaries in 2020. There were 24.8 percent Medicare beneficiaries with heart disease and 60 percent with high blood pressure. Adults with a BMI over 39, considered as obese, was 29 percent. There were 21.3 percent of adults who self-reported having poor or fair health in 2020, the last year for which information was available. Cancer was the number one cause of age-adjusted death between 2015 and 2019 and accounted for a total of 717 deaths. 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. There was a total of 1,181 premature deaths and this equated to 25,301 lost years of potential life and a rate of 6,904 per 100,000 people. In 2021, Athens-Clarke County reported 20,316 COVID-19 cases and 186 COVID-19 related deaths. 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, health care 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. Athens-Clarke County had a vaccine coverage index of 0.70 as reported by the CDC in 2021. There were 24 recreation and fitness facilities per 100,000 people. This is high for the county, which is a good sign for access to places for physical activity. In relation to healthy food accessibility, there are 105.4 fast food establishments per 100,000 people and 43.3 percent of census tracts in the county would be considered a food desert (13 tracts). This is a large public health concern for the County. There are about 22.3 grocery store establishments per 100,000 people and 9.4 SNAP authorized food stores. 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. SCH H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH We actively promote the health of our community through clinic-hospital partnerships, 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 did have a significant impact on our proactive community benefit programs, as We canceled all in-person events and classes as of early March 2020, with many not yet having resumed. We created programming responsive to the pandemic, including our migration to online platforms for vital community-based programming. We prioritized increasing access points for affordable health and mental care by providing free-of-charge lab services to partner clinic Mercy Health Center. We provided $21,727.65 in lab services to Mercy Health Center. We provided $847,806 in funding to the Community Care Clinic to provide specialty services to all patients, particularly low-income, high-need patients. Additionally, we supported education to build the health workforce. We allocated $125,000 to Athens Technical College, supporting education to 61 residents, 682 students and interns, and 54 shadow interns. The students and interns included nursing, physician assistants, pharmacy, respiratory, rehab, social work, paramedic, surg/tech, and radiology. We also provided free parking to patients who qualify for financial assistance or Medicaid and receive, which totaled $341,316 in FY21. We explored opportunities to provide place-based care, such as a mobile unit targeting high-risk patients and opening new clinics locally. In partnership with Senator Frye and the Georgia Department of Public Health (DPH), We researched to develop multiple Mobile Health Units regionally and statewide. In alignment with this priority, we provided in-community vaccinations at local gyms, the Boys and Girls Clubs, churches, and the parking lots during Food Bank distribution. We provided funding for support prescription access for low-income patients to both the Community Care Clinic and Mercy Health Center for a total $89,000. We also provided $18,354.04 to support transportation services for necessary care. In our support for our schools and our community's children, we built clinics at both Gaines Elementary and Hilsman Middle School. The clinics are now fully functional. We also provided place-based prevention education, chronic disease management education, screenings, and health and social services referrals. The total costs for health education supplies totaled $691.40. From January to May 2021, we conducted 45 in-person education sessions that hosted 388 participants. During the pandemic, we dedicated community education staff hours to vaccine clinics. However, most classes were adapted to videos and online platforms in response and had a total of 54 participants. We provided phone coaching for 658 heart failure patients post-discharge. We also provided 16 self-study programs to employers in two counties with a total of 308 participants. We offered stroke awareness educational materials and blood pressure screenings at health fairs and community events to achieve and maintain stroke certification. We conducted one community class with 40 participants. We prioritized decreasing lung and breast cancer deaths and increasing access to cancer programming by increasing access to mammogram screenings. By using an "It's the Journey" grant and hospital funds, we provided 51 screening mammograms, 34 diagnostic mammograms, 18 ultrasounds and eight biopsies, with no cancers diagnosed. The Memory Management Unity (MMU) was retired in June 2020. We moved the 3D mammography unit to the Oncology Hematology Center (OHC), which increased the number of patients screened. We held mammogram appointments on the fourth Tuesday of each month to allow easier scheduling of patients for the Athens Nurses Clinic. We have replaced the day of free mammograms with grant funding. The American Cancer Society has granted $5,000 dollars to provide additional screening mammograms and partner on the "Return to Screening" project. The "Return to Screening" project will provide education and outreach materials to the community. In FY21, we provided comprehensive, evidence-based psychosocial support for cancer patients and their families, spending $9,225 dollars to assist 1,059 community members dealing with cancer. We also increased local awareness of and local opportunities for lung cancer screening. In November, we held a Lung Screen Day to screen Community Care Clinic patients who meet necessary criteria and uninsured status. We will resume Courage to Quit smoking cessation classes at Mercy Health Center in August 2021, while virtual Courage to Quit lessons will launch in October 2021. Outreach to cancer patients continued without interruption via telehealth and the introduction of in-person support programs in April 2021. These programs included massage, healing touch, and support groups. We hope to resume cancer screening and target eligible patients who deferred cancer screening throughout 2020 and early 2021 due to COVID risk. We prioritized promoting healthy weight and behavior to prevent diseases by offering family programs to instill healthy behavior changes, which totaled $869.99 with 124 patient encounters. We also provided ongoing education, training, and support for community members on weight management. We canceled most programs related to weight management due to COVID-19, though YMCA provided 120 phone coaching sessions, with our support. In 2021, we directed significant resources toward COVID-19 vaccine delivery. Additional focus was placed on mitigating the impact of COVID-19-related stress among our employees with dog therapy visits throughout the first half of the year. Our staff hours were dedicated to community vaccine clinics and out in the community. Georgia Department of Public Health, Athens Technical College of Public Health students, Innovative Healthcare Institute nurses and phlebotomists, Piedmont Athens Regional Graduate Medical Education residents, and our community health and relations team worked together to provide COVID-19 vaccinations out in the community. SCH 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 benefit department coordinates the community benefit activities on behalf of all hospitals throughout the system. This includes conducting the triennial CHNA and 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. SCH 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 its indigent and charity care, as well as its Medicaid and Medicare shortfalls. true ENVISION ATHENS 301 COLLEGE AVE ATHENS GA 30601 000000000 GOVT 11000 PROGRAM SUPPORT AMERICAN CANCER SOCIETY 105 WEST PARK DR ATHENS GA 30606 131788491 501(C)(3) 7500 PROGRAM SUPPORT ATHENS TECHNICAL COLLEGE 800 US HWY 29 N ATHENS GA 30601 581824771 501(C)(3) 250000 PROGRAM SUPPORT 3 SCHEDULE I, PART I, LINE 2 MONITORING THE USE OF GRANT FUNDS MONEY IS GIVEN TO CHARITABLE ORGANIZATIONS WHICH PRIMARILY PROMOTE HEALTH CARE CAUSES. THE GRANTS ARE ADMINISTERED AND MONITORED THROUGH THE ORGANIZATION'S PUBLIC RELATIONS DEPARTMENT. SCHEDULE I, PART III, LINE 1B NUMBER OF RECIPIENTS GRANTS TO INDIVIDUALS WERE MADE TO RESIDENTS OF THE GREATER ATHENS CLARKE COMMUNITY IN SUPPORT OF PARMC'S COMMUNITY BENEFIT. PROGRAMS WERE CONDUCTED IN SUPPORT OF PARMC'S IMPLEMENTATION STRATEGY AND TO COMBAT THE LARGEST IDENTIFIED NEEDS OF THE COMMUNITY. X X false true false true false false false false false false false Mr J Michael Burnett CEO 508307 0 374282 0 140345 0 99024 0 20865 0 1142823 0 81924 0 Mr Michael Mandl Board Member 0 778484 0 564842 0 86725 0 156690 0 12477 0 1599218 0 0 Mr Robert Sinyard VP MEDICAL AFFAIRS 422667 0 153517 0 32851 0 0 0 29577 0 638612 0 0 0 Dr Geoffrey Cole VP, ANCILLARY SVCS 352427 0 123398 0 29685 0 17100 0 10251 0 532861 0 0 0 Ms Jody Corry VP IN HOUSE LEGAL 283696 0 60980 0 2002 0 16150 0 12713 0 375541 0 0 0 Mr Norman Burkett VP, PROFESSIONAL SERVICES 221577 0 48680 0 6399 0 16636 0 16208 0 309500 0 0 0 Mr Jason Smith COO 281227 0 101785 0 6632 0 17100 0 12905 0 419649 0 0 0 Ms Tamara Jackson CNO 255905 0 92241 0 12581 0 8665 0 15425 0 384817 0 0 0 Mr Larry Ebert FORMER EXC DIR STRAT OPS 0 266166 0 99131 0 6391 0 16733 0 17525 0 405946 0 0 Ms Wendy Cook Chief Financial Officer 368362 0 134135 0 26930 0 17100 0 19418 0 565945 0 0 0 Dr Catherine Apaloo FACULTY PROGRAM DIRECTOR 341053 0 0 0 9671 0 0 0 31097 0 381821 0 0 0 Dr Akua Biritwum PHYSICIAN 239339 0 0 0 3848 0 14602 0 13387 0 271176 0 0 0 Dr James Appiah-Pippim Director, Residency Program 314629 0 0 0 32964 0 16351 0 9353 0 373297 0 0 0 Ms Diane Todd Exec. Dir. Operations 201147 0 43517 0 2717 0 13083 0 7806 0 268270 0 0 0 Dr Keisha Bonhomme PHYSICIAN 241785 0 0 0 3639 0 8743 0 8380 0 262547 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 COMPANION TRAVEL AND CLUB DUES BOARD TRUSTEES ARE PROVIDED COMPANION TRAVEL - TAXABLE AMOUNT INCLUDED IN COMPENSATION. OFFICERS ARE PROVIDED SOCIAL CLUB DUES - TAXABLE AMOUNT INCLUDED IN COMPENSATION. ELIZABETH LEDDY, THOMAS ARNOLD, MICHAEL MANDL, AND J. MICHAEL BURNETT 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 ATHENS REGIONAL MEDICAL CENTER 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 4b J. MICHAEL BURNETT RECEIVED A PAYMENT OF $81,924 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 MICHAEL MANDL SCHEDULE J, PART I, LINE 5A & 6A CONTINGENT COMPENSATION EXECUTIVE AND LEADERSHIP POSITIONS ARE ELIGIBLE TO PARTICIPATE IN A VARIABLE PAY PLAN. GROSS REVENUES AND NET EARNINGS ARE VARIABLE PAY PLAN FACTORS. THIS PLAN PROVIDES INCENTIVES BASED ON SYSTEM PERFORMANCE. THE RESULTS ARE BASED ON THE ACCOMPLISHMENT OF SPECIFIC STRATEGIC OBJECTIVES INVOLVING: (1) SUSTAINED AND IMPROVED FINANCIAL PERFORMANCE AND EFFICIENCY; (2) EMPLOYEE SATISFACTION AND RETENTION; (3) IMPROVED CUSTOMER SATISFACTION INCLUDING MEMBERS, PHYSICIANS, PATIENTS, AND EMPLOYEES; (4) MAINTENANCE AND IMPROVEMENT IN QUALITY AND CLINICAL OUTCOMES. THE PERFORMANCE SCORECARD IS DETERMINED ANNUALLY AND APPROVED BY THE BENEFITS AND COMPENSATION COMMITTEE OF THE BOARD. THE PLAN WILL BE DISALLOWED BASED ON LOSS OF THE JOINT COMMISSION ACCREDITATION OR A VIOLATION OF THE BOND COVENANTS. SCHEDULE J, PART I, LINE 7 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. A THE HOSPITAL AUTHORITY OF CLARKE COUNTY GA 586003375 181685JM1 2016-11-16 178225000 SEE PART VI false false false A 17725000 0 208099492 0 0 208092160 7332 0 0 0 0 0 2016 false true true true A false false false false 0 false false false true A false false false true false false 0 false 0 false true A true SCHEDULE K, PART I, COLUMN F The proceeds of the Series 2019 bonds were used to redeem the Series 2007 bonds issued in January, 2007, and the Series 2012 Bonds issued in March, 2012. Sch K, Part IV, Line 2 Bond A: The rebate calculation was last performed on November 19, 2019. No rebate due. FORM 990, PART V, LINE 1A FORM 1096 FILINGS ALL FORM 1096 FILINGS FOR THE ORGANIZATION ARE FILED BY PIEDMONT HEALTHCARE, INC. (EIN 58-1503902) FORM 990, PART VI, SECTION A, LINE 6 ORGANIZATION'S SOLE MEMBER PIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER ("PAR"). FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT ATHENS REGIONAL MEDICAL CENTER'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY PIEDMONT ATHENS REGIONAL MEDICAL CENTER'S BOARD POLICIES AND DECISIONS MUST BE FILED, IMMEDIATELY AFTER ADOPTION, WITH THE SECRETARY OF THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS. SUCH POLICIES AND DECISIONS OF THE PIEDMONT ATHENS REGIONAL MEDICAL CENTER BOARD OF DIRECTORS ARE NOT SUBJECT TO THE APPROVAL OF OR RATIFICATION BY THE PIEDMONT HEALTHCARE BOARD, BUT SHOULD THE NEED ARISE, THEY MAY BE RESCINDED BY THE PIEDMONT HEALTHCARE BOARD THROUGH A MAJORITY VOTE OF ITS DIRECTORS. FORM 990, PART VI, LINE 11B INFORMATION NEEDED TO PREPARE PIEDMONT ATHENS REGIONAL MEDICAL CENTER'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. The INFORMATION IS REVIEWED BY PNH'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, SECTION 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 ATHENS REGIONAL MEDICAL CENTER 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 B, LINE 15A, 15B EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER 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 GOVERNING, CONFLICT OF INTEREST AND FINANCIAL 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 CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF: UNALLOCATED EXPENSES ($9,159,982) BOOK/TAX DIFF $584,690 CHANGES IN TEMP. $1,866,039 INTERCOMPANY TRANS. $21,784,273 CHANGES IN UNRESTR. FUND $264,401 -------------------- TOTAL $15,339,421 PIEDMONT HEALTHCARE INC 1800 HOWELL MILL ROAD SUITE 850 ATLANTA GA 30318 581503902 MANAGEMENT GA 501(c)(3) 12B, III-FI NA false PIEDMONT HOSPITAL Inc 1968 PEACHTREE ROAD NW ATLANTA GA 30309 580566213 HOSPITAL GA 501(c)(3) 3 PHC false FAYETTE COMMUNITY HOSPITAL INC 1255 HIGHWAY 54 WEST FAYETTEVILLE GA 30214 582232328 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT MOUNTAINSIDE HOSPITAL INC 1266 HIGHWAY 515 SOUTH JASPER GA 30143 352228583 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT NEWNAN HOSPITAL INC 745 POPLAR ROAD NEWNAN GA 30265 205077249 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT HEALTHCARE FOUNDATION INC 2001 PEACHTREE ROAD NE SUITE 400 ATLANTA GA 30309 581272768 FUNDRAISING GA 501(c)(3) 12B, II PHC false PIEDMONT HENRY HOSPITAL INC 1133 EAGLES LANDING PKWY STOCKBRIDGE GA 30281 582200195 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT NEWTON HOSPITAL INC 5126 HOSPITAL DRIVE NE COVINGTON GA 30014 582155150 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT HEART INSTITUTE INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 263553500 HOSPITAL GA 501(C)(3) 10 PHC false PIEDMONT ATHENS REGIONAL HEALTH RESOURCE 1199 PRINCE AVENUE ATHENS GA 30606 581930580 DEVELOPMENT GA 501(C)(3) 12B, II PARMC true PIEDMONT ATHENS REGIONAL FOUNDATION INC 1199 PRINCE AVENUE ATHENS GA 30606 581978389 FUNDRAISING GA 501(C)(3) 12B, II PARMC true ATHENS REGIONAL SPECIALTY SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 271975001 HEALTHCARE GA 501(C)(3) 3 PARMC true ATHENS REGIONAL PHYSICIAN SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 582332921 HEALTHCARE GA 501(C)(3) 12B, II PARMC true REGIONAL FIRSTCARE INC 1199 PRINCE AVENUE ATHENS GA 30606 582362733 URGENT CARE GA 501(C)(3) 12B, II PARMC true 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) 12B, 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 SURGERY 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 RIVERWOOD PKWY STE 1850 ATLANTA GA 30339 841916875 HEALTHCARE GA NA NONE 0 0 false 0 false 0.00000 GEORGIA HEALTH COLLABORATIVE LLC 2727 PACES FERRY RD BLDG 2 STE 20 ATLANTA GA 30339 461500639 HEALTHCARE GA NA NONE 0 0 false 0 false 0.00000 PIEDMONT MEDICAL CARE CORPORATION 2727 PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 582092768 HEALTHCARE GA PHC C-CORP 0 0 0.00000 false THE PIEDMONT CLINIC INC 2727 PACES FERRY ROAD SUITE 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 CJ ky1-1102 980427603 Related Insur CJ PHC C-CORP 0 0 0.00000 false PIEDMONT WELLSTAR HEALTHPLANS INC 2859 PACES FERRY ROAD SUITE 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 PIEDMONT ATHENS REGIONAL PHYSICIANS SERVICES p 558343 FMV PIEDMONT ATHENS REGIONAL SPECIALTY PHYSICIANS Q 12924286 FMV REGIONAL FIRSTCARE P 3205961 FMV