2022-11-15T11:32:52-05:00 2021-12-31 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2021-07-01 453957368 POLK MEDICAL CENTER INC POLK 7065096074 420 E SECOND AVENUE SUITE 102 ROME GA 301613210 PHILIP WHEELER CFO 7065096074 2022-11-01 true PHILIP WHEELER 999009999 WILLIAM EDWARD PHILLIPS P00451499 2298837878 2022-11-15 2021 2022-09-23 18:48:47Z FLOYD POLK MEDICAL CENTER KURT STUENKEL 304 TURNER MCCALL BLVD ROME GA 301620233 21458525 false X WWW.FLOYD.ORG X 2011 GA POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY. 10 9 0 76 5113 2900 4286072 822938 33267176 20086946 1514705 451815 41311 96826 39109264 21458525 313884 0 0 14348091 8067057 0 0 10548691 5472933 25210666 13539990 13898598 7918535 101830364 97824042 45057988 32592566 56772376 65231476 POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY. false false 12045167 20086946 POLK MEDICAL CENTER IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING GENERAL ACUTE CARE SERVICES TO THE POLK COUNTY AND NORTHERN HARALSON COUNTY COMMUNITIES. DURING THE SIX MONTH SHORT PERIOD ENDING DECEMBER 31, 2021, PATIENT DAYS AT POLK MEDICAL CENTER TOTALED 4,010. EMERGENCY ROOM VISITS TOTALED 14,378. 12045167 true true false false false false false false false false true false false true true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 17 0 0 true true false false false false false false false false false false false X 10 9 false false true false true true true true true false false true true true true true true false false false GA X X PHILIP WHEELER 7065093012 304 TURNER MCCALL BLVD ROME GA 301610233 KURT STUENKEL PRESIDENT/SE 1.00 53.00 X X 0 2971233 24408 WARREN SONNY RIGAS COO-FLOYD SY 15.00 35.00 X 0 673362 73944 MATTHEW GORMAN POLK ADMINIS 50.00 X 0 531294 59726 CLARICE CABLE INTERIM CFO 1.00 49.00 X 0 432294 48127 TIFANI KINARD ADMINISTRATO 50.00 X 217620 0 18922 DEANA OWEN PHARMACY DIR 50.00 X 189610 0 16133 LEAH S ASHMORE THERAPIST 50.00 X 173300 0 32263 LOVEJOY LEIGH PHARMACIST 50.00 X 141279 0 27079 ANITA J JACKSON DIRECTOR OF 50.00 X 138826 0 20966 ROBERT WADE NURSE X 141829 0 8004 GEORGE A BOSWORTH MD MEMBER 1.00 1.00 X 2000 9000 0 KAY CHUMBLER MEMBER 1.00 2.00 X 2750 7750 0 FRANK SHELLEY CHAIRMAN 1.00 2.00 X X 2750 3875 0 TODD BUSSEY MEMBER 1.00 1.00 X 2750 2000 0 BRITT MADDEN JR MEMBER 1.00 X 2750 0 0 NEIL E GORDON MD MEMBER 1.00 1.00 X 2750 0 0 SONDI SMITH VEST MEMBER 1.00 X 2750 0 0 LEE CUMMINGS MEMBER 1.00 X 2500 0 0 DARROLL FREEMAN MEMBER 1.00 X 2500 0 0 OTHEL DOYLE TREY KELLEY MEMBER (TO 9 1.00 X 1250 0 0 PHILIP WHEELER CFO X 0 0 0 1027214 4630808 329572 21 false true false MORRISON MANAGEMENT SPECIALISTS P O BOX 102289 ATLANTA GA 303682289 FOOD SERVICES 330677 ARAMARK MANAGEMENT SERVICE P O BOX 233 ROME GA 301610233 HOUSEKEEPING 213578 HEALTHCARE WORKFORCE LOGISTICS PO BOX 860573 MINNEAPOLIS MN 55486 NURSING 127608 CERNER CORPORATION P O BOX 412702 KANSAS CITY MO 641412702 IT SERVICES 122392 WHITE COAT SCIENCES 315 BANKHEAD HIGHWAY CARROLLTON GA 30117 LAB 101900 5 162169 660769 822938 NET PATIENT SERVICE REVENUE 623000 20081833 20081833 REFERENCE LAB 621500 5113 5113 20086946 451815 451815 CAFETERIA REVENUE 722210 86789 86789 PURCHASE DISCOUNTS 623000 10037 10037 96826 21458525 20091870 5113 538604 24750 24750 5947821 5551211 396610 1658501 1547879 110622 435985 408352 27633 35689 35689 5036 5036 895678 546390 349288 874 506 368 173027 152450 20577 167324 6198 161126 343858 311914 31944 558292 544074 14218 8854 5585 3269 52841 52841 1433818 1300616 133202 122090 122090 MEDICAL SUPPLIES 1297817 1292584 5233 REPAIRS & MAINTENANCE 324035 280182 43853 LICENSES & TAXES 44651 42833 1818 DUES & SUBSCRIPTIONS 8522 1552 6970 527 527 13539990 12045167 1494823 0 2902954 5106578 8709047 18023413 5847820 5718470 281047 282120 321958 585975 57349615 24488473 18600915 32861142 58701519 30190041 6465104 5056303 101830364 97824042 3189493 2485342 1657523 33251126 2778185 2687881 5839184 25761820 45057988 32592566 X 56772376 65231476 56772376 65231476 101830364 97824042 X 7918535 -88999 629564 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 838635 838635 28399491 12673241 15726250 283152 73912 209240 27828337 11741320 16087017 32861142 LEASED ASSETS 2265128 DUE FROM RELATED PARTIES 1704241 DSH RECEIVABLE 944495 OTHER RECEIVABLES 142439 5056303 POLK FOUNDATION LIABILITY 20000000 MEDICARE ADVANCE PAYMENTS 4238820 THIRD PARTY SETTLEMENTS 1523000 25761820 X SCHEDULE D, PAGE 3, PART X ATRIUM HEALTH INC., ATRIUM HEALTH NAVICENT, ATRIUM HEALTH FLOYD, NCBH, WFUHS, AND VARIOUS AFFILIATES ARE TAX EXEMPT AS DESCRIBED IN SECTION (C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE GENERALLY EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AS A NORTH CAROLINA HOSPITAL AUTHORITY, ATRIUM HEALTH CMHA IS ALSO EXEMPT FROM FEDERAL AND STATE INCOME TAXES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS MADE IN THE COMBINED FINANCIAL STATEMENTS. IF APPLICABLE, UNRELATED BUSINESS INCOME IS REPORTED BY ALL MEMBERS AND SUBSIDIARY ORGANIZATIONS ON IRS FORM 990-T. FISCAL YEARS ENDING ON OR AFTER JUNE 30, 2018 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. THE ENTERPRISE AND ITS SUBSIDIARIES HAVE EVALUATED UNCERTAIN TAX POSITIONS FOR THE FISCAL YEAR ENDED DECEMBER 31, 2021, INCLUDING A QUANTIFICATION OF TAX RISKS IN AREAS SUCH AS UNRELATED BUSINESS INCOME AND TAXATION OF FOR- PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ENTERPRISE'S COMBINED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2021. SCHEDULE D, PAGE 4, PART XIII THE ATRIUM HEALTH ENTERPRISE AND ITS AFFILIATES, INCLUDING THE FILING ORGANIZATION, HAVE EVALUATED UNCERTAIN TAX POSITIONS FOR THE FISCAL YEAR ENDED DECEMBER 31, 2021, INCLUDING A QUANTIFICATION OF TAX RISKS IN AREAS SUCH AS UNRELATED BUSINESS INCOME AND TAXATION OF ITS FOR-PROFIT SUBSIDIARIES. THE EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ATRIUM HEALTH ENTERPRISE'S COMBINED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2021. true true X true X 1.250000000000 true X true true true false true true 998019 998019 0.07370 3487785 3221567 266218 0.01970 4485804 3221567 1264237 0.09340 4485804 3221567 1264237 0.09340 true 1835374 917687 3861678 3823444 38234 X true true 1 1 POLK MEDICAL CENTER 2360 ROCKMART HIGHWAY CEDARTOWN GA 30125 HTTPS://WWW.FLOYD.ORG 115-705 X X X X SWING BED SNF POLK MEDICAL CENTER 1 false false true X X X X X X X X X X 21 true true false true X HTTPS://WWW.FLOYD.ORG X X true 21 true HTTPS://WWW.FLOYD.ORG/ABOUT-FLOYD/PAGE false false true X 125.000000000000 400.000000000000 X X X true true X X X X true X HTTPS://WWW.FLOYD.ORG/PATIENTS-VISITOR X HTTPS://WWW.FLOYD.ORG/PATIENTS-VISITOR X HTTPS://WWW.FLOYD.ORG/PATIENTS-VISITOR X X X X X X true X false X X X X true X false false FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 3E POLK MEDICAL CENTER, INC. AND FLOYD HEALTHCARE MANAGEMENT, INC. BECAME PART OF ATRIUM HEATLH DURING 2021. ATRIUM HEALTH FLOYD CONDUCTED A COMMUNITY SURVEY TO VALIDATE DATA, GIVE MEMBERS OF THE COMMUNITY AN OPPORTUNITY TO COMMENT ON THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT AND TO PROVIDE COMMUNITY-LEVEL INSIGHT INTO THE HEALTH NEEDS FOR EACH OF THE COUNTIES IN OUR PRIMARY SERVICE AREA. RESPONDENTS IDENTIFIED ACCESS TO CARE, CARDIOVASCULAR HEALTH, MENTAL HEALTH ISSUES AND OBESITY AS THE MOST IMPORTANT ISSUES FACING THE FOUR-COUNTY PRIMARY SERVICE AREA. OTHER RESPONSES INCLUDE: 1) ALCOHOL ABUSE 2) ALZHEIMER'S DISEASE 3) CANCER 4) COMMUNITY SAFETY 5) COVID-19 6) DRUG ABUSE 7) ELDER CARE 8) EMERGENCY CARE FOR FISHING AND LAKE COMMUNITIES 9) HEALTH EDUCATION 10)NUTRITION 11)PARENTAL SUPPORT FOR CHILDREN AND TEENS 12)PRESCRIPTION PRICES AN ANALYSIS OF THE HEALTH DATA STATISTICS AND SURVEY RESULTS PROVIDES CLEAR GUIDANCE IN ESTABLISHING THE HEALTH NEEDS OF THE FOUR PRIMARY COUNTIES SERVED BY ATRIUM HEALTH FLOYD: ACCESS TO CARE CARDIOVASCULAR DISEASE MENTAL AND BEHAVIORAL HEALTH NUTRITION AND WELLNESS THE SIGNIFICANT HEALTH NEEDS ARE SUMMARIZED ON PAGES 19 - 21 OF THE CHNA WHICH IS AVAILABLE AT - HTTPS://WWW.FLOYD.ORG/ABOUT-FLOYD/DOCUMENTS/2021-CHNA-POLK-FINAL.PDF. FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 5 ATRIUM HEALTH FLOYD CONDUCTED A COMMUNITY SURVEY TO VALIDATE DATA, GIVE MEMBERS OF THE COMMUNITY AN OPPORTUNITY TO COMMENT ON THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT AND TO PROVIDE COMMUNITY-LEVEL INSIGHT INTO THE HEALTH NEEDS FOR EACH OF THE COUNTIES IN OUR PRIMARY SERVICE AREA. COMMUNITY SURVEY FINDINGS ARE DISCUSSED BEGINNING ON PAGE 14 OF THE CHNA. FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 6A THE 2021 CHNA WAS CONDUCTED IN ASSOCIATION WITH FLOYD MEDICAL CENTER, A 300+ BED ACUTE CARE HOSPITAL LOCATED IN ROME, GA, AND CHEROKEE MEDICAL CENTER, A 60-BED LICENSED ALABAMA HOSPITAL LOCATED IN CENTRE, AL. FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 7D THE 2021 CHNA HAS BEEN DISTRIBUTED UPON REQUEST TO OTHER NON-PROFIT AGENCIES IN THE AREA TO ASSIST WITH GRANTS. COPIES HAVE ALSO BEEN MADE AVAILABLE TO ELECTED OFFICIALS, CHAMBERS OF COMMERCE, AND EDUCATIONAL INSTITUTIONS IN THE AREA. FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 11 ACCESS TO CARE, CARDIOVASCULAR DISEASE, MENTAL HEALTH SERVICES AND NUTRITION WERE SEEN AS SIGNIFICANT CONCERNS THAT AFFECT MANY RESIDENTS. FURTHERMORE, SOME BARRIERS TO ACCESSING CARE CONTINUE TO PREVENT CURRENT PROGRAMS AND INITIATIVES FROM REACHING THE POPULATIONS IN NEED. THESE CHALLENGES PRESENT IMPORTANT OPPORTUNITIES FOR THE FUTURE. AS WE MOVE FORWARD AS AN INTEGRATED COMMUNITY OF HEALTHCARE, SOCIAL SERVICES AND COMMUNITY LEADERSHIP, WE CAN LEVERAGE COMMUNITY ASSETS TO IMPROVE THE HEALTH OF RESIDENTS IN FLOYD, POLK, CHATTOOGA AND CHEROKEE COUNTIES. THE SUMMARY OF COMMUNITY HEALTH NEEDS BEGINS ON PAGE 17 OF THE CHNA. SCHEDULE H, PART I, LINE 7 THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". SEE ALSO THE DESCRIPTION FOR PART III, LINE 2. SCHEDULE H, PART III, LINE 2 AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. SCHEDULE H, PART III, LINE 3 THE FIGURE ON PART III LINE 3 REPRESENTS MANAGEMENT'S ESTIMATE (APPROXIMATELY 50%) BASED ON AN ANALYSIS OF SELF-PAY PATIENTS' ABILITY TO PAY THEIR OUTSTANDING ACCOUNT. THIS ANALYSIS INCLUDES REVIEWING THE PATIENT'S CREDIT HISTORY, INCOME LEVELS AND OVERALL COLLECTIBILITY OF THE ACCOUNT. SCHEDULE H, PART III, LINE 4 SEE THE DISCUSSION OF PRICE CONCESSIONS AND BAD DEBTS WITHIN THE FOOTNOTE ON NET PATIENT SERVICE REVENUE ON PAGES 14-19 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. SCHEDULE H, PART III, LINE 9B FOR PATIENTS RECEIVING ONLY A PORTION OF THEIR BILL AS CHARITY, THE REMAINING PORTION OF THE BILL IS TREATED THE SAME AS ALL OTHER PATIENTS IN REGARDS TO COLLECTIONS. SCHEDULE H, PART VI, LINE 2 ATRIUM HEALTH FLOYD WHICH INCLUDES POLK MEDICAL CENTER, INC. COMPLETED A HEALTH CARE NEEDS ASSESSMENT IN FISCAL YEAR 2021. IN ADDITION, FHMI, THE SOLE MEMBER, DEVELOPS A STRATEGIC PLAN THAT IS UPDATED ANNUALLY. THE STRATEGIC PLAN TAKES INTO CONSIDERATION HEALTH NEEDS FOR POLK MEDICAL CENTER'S SERVICE AREA IN ADDITION TO UTILIZATION OF SERVICES, COMMUNITY PARTICIPATION, AND QUALITY OF SERVICES PROVIDED. SCHEDULE H, PART VI, LINE 3 POLK COMMUNICATES INFORMATION REGARDING A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE THROUGH THE USE OF SIGNAGE IN THE EMERGENCY CARE CENTER, PATIENT REGISTRATION AREAS, IN THE BUSINESS/PATIENT FINANCIAL SERVICES OFFICES, AND IN THE OFFICES OF OUR FINANCIAL COUNSELORS. DURING TIMES OF PREADMISSION, AS WELL AS DURING ON-SITE REGISTRATION, THE ACCESS/REGISTRATION STAFF DISCUSSES FINANCIAL ASSISTANCE POLICIES WITH THE PATIENT/PATIENT'S FAMILY IF APPROPRIATE. AFTER DISCHARGE AND DURING THE "COLLECTION" PERIOD OUR STAFF ONCE AGAIN DISCUSSES OUR FINANCIAL ASSISTANCE POLICIES. IN ADDITION THERE IS A DEMONSTRATED WORD-OF-MOUTH COMMUNICATION OF THESE POLICIES THROUGH OUR PATIENT POPULATION. SCHEDULE H, PART VI, LINE 4 POLK COUNTY HAS AN ESTIMATED 42,600 RESIDENTS AND IS PART OF A FOUR-COUNTY AREA SERVED BY FLOYD POLK MEDICAL CENTER, A 25-BED CRITICAL ACCESS HOSPITAL WITH EMERGENCY MEDICINE, SURGERY AND DIAGNOSTIC IMAGING CAPABILITIES, FLOYD MEDICAL CENTER, A 304-BED ACUTE CARE SAFETY NET HOSPITAL, AND A THIRD, ADVENT HEALTH-OWNED HOSPITAL. THE 2021 CHNA COMMUNITY HEALTH PROFILE DISCUSSION BEGINS ON PAGE 7 OF THE CHNA. SCHEDULE H, PART VI, LINE 5 PATIENT SERVICES: MEETING THE NEEDS OF OUR COMMUNITY 24/7/365 AS A NOT-FOR-PROFIT COMMUNITY HOSPITAL, POLK MEDICAL CENTER PROVIDES THE MEDICAL SERVICES CRITICALLY NECESSARY TO SUPPORT HEALTHY LIVING IN POLK COUNTY. THOSE SERVICES INCLUDE THE FOLLOWING: -BREAST HEALTH -CARDIOLOGY -CORPORATE HEALTH -DIABETES CARE -EMERGENCY CARE -EMERGENCY MEDICAL SERVICES (EMS) -FAMILY MEDICINE -HOSPICE -IMAGING SERVICES -INFUSION THERAPY -LABORATORY SERVICES -OUTPATIENT REHABILITATION -PEDIATRICS -PULMONARY REHABILITATION -SUBACUTE REHABILITATION -URGENT CARE -WOUND CARE CHARITY CARE AND COMMUNITY BENEFITS PERHAPS THE MOST SIGNIFICANT FACTOR IN MEETING COMMUNITY HEALTH NEEDS IS THE CONTINUING COMMITMENT OF POLK MEDICAL CENTER TO PROVIDE COMPREHENSIVE HEALTH CARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. COMMUNITY SERVICE INDIVIDUALLY AND CORPORATELY, POLK MEDICAL CENTER CONTINUES TO BE ACTIVELY INVOLVED IN THE COMMUNITIES WHERE WE HAVE A PRESENCE, LENDING LEADERSHIP, TIME AND OTHER VALUABLE RESOURCES TO EFFORTS TO IMPROVE THE QUALITY OF LIFE FOR FAMILIES IN THE AREA. FOR EXAMPLE: -CARDIOPULMONARY RESUSCITATION, STOP THE BLEED AND FIRST AID EDUCATORS PROVIDE CPR AND FIRST AID TRAINING TO FLOYD EMPLOYEES, EMPLOYEES OF OTHER COMPANIES AND TO MEMBERS OF THE PUBLIC. IN ADDITION, FLOYD'S CHEST PAIN PROGRAM PROVIDES HANDS-ONLY CPR TRAINING IN THE COMMUNITY. -FLOYD EMERGENCY MEDICAL SERVICES, SUPPLEMENTED BY OTHER FLOYD DEPARTMENTS, IS A FIXTURE AT COMMUNITY EVENTS THROUGHOUT THE YEAR, PROVIDING ONSITE AMBULANCE BACK-UP, FIRST AID STATIONS AND MEDICAL SUPPORT WHEN IT IS NEEDED. -POLK MEDICAL CENTER EMPLOYEES MADE THE COVID-19 VACCINE AVAILABLE TO THE PUBLIC THROUGH THE ON-SITE CLINIC. -FLOYD IS HEAVILY INVESTED IN LOCAL SCHOOLS. IN ADDITION TO THE APPROXIAMATELY 8,000 STUDENTS AND 530 EMPLOYEES WHO ARE COVERED BY THE SCHOOL NURSES PROVIDED IN POLK COUNTY SCHOOLS, FLOYD PROVIDES HEALTH AND SAFETY TRAINING PROGRAMS AND CAREER DAY SPEAKERS TO STUDENTS THROUGHOUT THE AREA. AS PART OF THOSE EFFORTS, FLOYD, OF WHICH POLK MEDICAL CENTER IS A PART, SUPPLIES CERTIFIED ATHLETIC TRAINERS TO BOTH HIGH SCHOOLS IN POLK COUNTY. -FLOYD PROVIDES MAINTENANCE PRESCRIPTION PHARMACEUTICALS TO LOW-INCOME UNINSURED OUTPATIENTS AT NO COST TO THE PATIENT THROUGH ITS HOSPITAL PHARMACY. ANY QUALIFIED, LOW-INCOME PATIENT BEING DISCHARGED FROM POLK MEDICAL CENTER MAY BE ELIGIBLE TO RECEIVE THE PRESCRIBED MEDICATIONS. -THE FLOYD HEALTH SYSTEM'S MOBILE MAMMOGRAPHY COACH, OPERATED BY THE BREAST CENTER AT FLOYD, IS EQUIPPED WITH STATE-OF-THE-ART, DIGITAL MAMMOGRAPHY EQUIPMENT AND IS USED TO REACH OUT TO THE MOSTLY RURAL AND UNDERSERVED AREAS IN AND AROUND THE FOUR-COUNTY SERVICE AREA. THE GOAL OF THIS PROGRAM IS TO REACH WOMEN WHO HAVE NEVER HAD A MAMMOGRAM, IN HOPE OF REDUCING THE BREAST CANCER MORTALITY RATE IN OUR REGION, WHICH IS AMONG THE HIGHEST IN THE NATION. -AS A NOT-FOR-PROFIT COMMUNITY HOSPITAL, POLK MEDICAL CENTER IS CONTINUOUSLY LOOKING FOR OPPORTUNITIES TO REACH FARTHER INTO OUR COMMUNITY TO MEET THE NEEDS OF THE FULL SPECTRUM OF INDIVIDUALS WHO SEEK MEDICAL CARE IN NORTHWEST GEORGIA AND NORTHEAST ALABAMA. WE CURRENTLY HAVE SEVERAL OUTREACH PROGRAMS AIMED AT IMPROVING ACCESS TO HEALTH CARE IN OUR COMMUNITY. -MEMBERS OF THE POLK AND FLOYD HEALTH SYSTEM TEAM ARE COMMITTED TO THE COMMUNITY IN MANY WAYS. A PARTIAL LIST OF RECENT LEADERSHIP ROLES POLK EMPLOYEES HELD INCLUDES: -MEMBER, KIWANIS CLUB OF POLK COUNTY BOARD OF DIRECTORS -CHAIR, POLK COUNTY CHAMBER OF COMMERCE BOARD OF DIRECTORS -MEDICAL REPRESENTATIVE, POLK COUNTY COLLEGE AND CAREER ACADEMY -MEMBER, POLK COUNTY WATER AUTHORITY BOARD OF DIRECTORS -CHAIR, ROCKMART FARMERS MARKET BOARD OF DIRECTORS PMCI'S GOVERNING BODY IS PRIMARILY COMPRISED OF PERSONS WHO ARE NOT EMPLOYEES, CONTRACTORS (NOR FAMILY MEMBERS THEREOF), AND RESIDE IN THE PRIMARY SERVICE AREA. THE HOSPITAL'S MEDICAL STAFF IS OPEN TO ALL QUALIFIED PHYSICIANS IN THE REGION. FUNDS RECEIVED FROM OPERATIONS, AFTER OPERATING EXPENSES, ARE USED TO SUPPORT VARIOUS OUTREACH EFFORTS DESCRIBED IN SCHEDULE H AND THE COMMUNITY BENEFIT REPORT; TO FURTHER IMPROVEMENT IN PATIENT CARE. SCHEDULE H, PART VI, LINE 6 POLK MEDICAL CENTER, INC. (PMCI) IS A GEORGIA NOT-FOR-PROFIT CORPORATION. ON NOVEMBER 6, 2014, PMCI ENTERED INTO A LEASE AGREEMENT WITH CEDARTOWN- POLK COUNTY HOSPITAL AUTHORITY (CEDARTOWN-POLK AUTHORITY) TO LEASE ALL OF THE ASSETS ASSOCIATED WITH POLK MEDICAL CENTER, A CRITICAL ACCESS HOSPITAL PROVIDING INPATIENT AND OUTPATIENT SERVICES. THIS LEASE HAS AN ORIGINAL 35-YEAR TERM. FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI) IS THE SOLE MEMBER OF PMCI. PURSUANT TO THE LEASE, TRANSFER AND REVERSION AGREEMENT BETWEEN THE HOSPITAL AUTHORITY OF FLOYD COUNTY (HAFC) AND FLOYD HEALTHCARE MANAGEMENT, INC. (LEASE), HAFC LEASED THE OPERATIONS OF FLOYD MEDICAL CENTER, FLOYD BEHAVIORAL HEALTH, AND HEYMAN HOSPICECARE AT FLOYD AND SUBSTANTIALLY ALL OF ITS NET ASSETS TO FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI), EFFECTIVE JANUARY 1, 1998. THE CONSIDERATION TO BE PAID BY FHMI CONSISTS PRIMARILY OF: PAYMENT OF PRINCIPAL AND INTEREST ON THE HOSPITAL AUTHORITY OF FLOYD COUNTY REVENUE ANTICIPATION CERTIFICATES; PAYMENT EQUAL TO THE CONTRIBUTION HAFC IS REQUIRED TO MAKE TO SATISFY MINIMUM FUNDING OBLIGATIONS UNDER HAFC'S PENSION PLAN WITH RESPECT TO BENEFITS WHICH HAD ACCRUED UNDER SUCH PLAN PRIOR TO THE LEASE; AND THE PROVISION OF HEALTHCARE SERVICES TO INDIGENT, CHARITY AND OTHER NEEDY PATIENTS EQUAL BUT NOT LIMITED TO A MINIMUM DOLLAR AMOUNT ANNUALLY AS SET FORTH IN THE LEASE. FHMI IS A NOT-FOR-PROFIT CORPORATION CREATED IN 1991 BY THE HAFC. FROM NOVEMBER 26, 1991, THROUGH DECEMBER 31, 1997, FHMI MANAGED AND SUPERVISED FLOYD MEDICAL CENTER AND ALL OTHER FACILITIES, PROJECTS AND PROGRAMS OF THE HAFC PURSUANT TO A MANAGEMENT AGREEMENT. EFFECTIVE JANUARY 1, 1998, THE AFORESAID MANAGEMENT AGREEMENT WAS CONVERTED TO A LEASE AGREEMENT UNDER WHICH ALL FACILITIES, PROJECTS AND PROGRAMS OF HAFC WERE LEASED TO FHMI. AT THAT TIME, FHMI BECAME THE LICENSED OPERATOR OF ALL SUCH FACILITIES, PROJECTS AND PROGRAMS. FHMI IS GOVERNED BY AN EIGHTEEN MEMBER BOARD OF DIRECTORS, THREE OF WHOM MUST BE MEMBERS OF THE HAFC. ADDITIONALLY, FHMI HAS CONTRACTUALLY COMMITTED THAT AT LEAST TWO OF ITS DIRECTORS WILL BE FLOYD COUNTY COMMISSIONERS AND TWO OF ITS DIRECTORS WILL BE CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY MEMBERS. THE FLOYD HEALTHCARE FOUNDATION IS A 501(C)(3) NOT-FOR-PROFIT ORGANIZATION THAT WORKS TO IMPROVE THE HEALTH OF THE COMMUNITIES SERVED BY FLOYD MEDICAL CENTER AND POLK MEDICAL CENTER BY DEVELOPING RELATIONSHIPS AND RAISING FUNDS TO BUILD AND SUPPORT PROGRAMS AND SERVICES THAT MEET IDENTIFIED NEEDS AND FURTHER OUR MISSION. GOVERNED BY ITS OWN VOLUNTEER BOARD OF DIRECTORS AND MANAGED BY A PROFESSIONAL STAFF, THE FOUNDATION RAISES SUPPORT THROUGH VOLUNTEER-LED INITIATIVES THAT PROVIDE FUNDING NOT ONLY FOR FLOYD MEDICAL CENTER BUT ALSO FOR PROGRAMS THAT SEEK TO IMPROVE THE HEALTH OF OUR COMMUNITY. CANCER NAVIGATORS, INC. IS A 501(C)(3) NOT-FOR-PROFIT ORGANIZATION THAT PROVIDES EDUCATION, COUNSELING, AND ACCESS TO RESOURCES FOR CANCER PATIENTS TO HELP THEM EASE DIFFICULT EMOTIONS AND MAINTAIN A SENSE OF CONTROL OVER THEIR DIAGNOSIS AND TREATMENT. false true false false false false false false false KURT STUENKEL PRESIDENT/SECRETARY 440188 2006600 524445 14500 9908 2995641 WARREN SONNY RIGAS COO-FLOYD SYSTEM 464823 164600 43939 36915 37029 747306 MATTHEW GORMAN POLK ADMINISTRATOR 356151 149800 25343 24546 35180 591020 CLARICE CABLE INTERIM CFO 302684 115100 14510 13048 35079 480421 TIFANI KINARD ADMINISTRATOR 191746 25277 597 18922 236542 DEANA OWEN PHARMACY DIRECTOR 168200 20635 775 16133 205743 LEAH S ASHMORE THERAPIST 172662 500 138 32263 205563 LOVEJOY LEIGH PHARMACIST 140362 500 417 27079 168358 ANITA J JACKSON DIRECTOR OF NURSING 121069 16701 1056 20966 159792 SCHEDULE J, PAGE 1, PART I, LINE 3 NO OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION AND BOARD MEMBERS ARE PAID ONLY A SMALL STIPEND. THE ORGANIZATION RELIES UPON THE METHODS EMPLOYED BY FHMI, A RELATED ORGANIZATION TO PROVIDE OVERSIGHT TO DETERMINE REASONABLE COMPENSATION FOR THE INDIVIDUALS. COMPENSATION DETERMINATION BY FHMI INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. SCHEDULE J, PAGE 1, PART I, LINE 4 WARREN "SONNY" RIGAS 0 36,915 0 MATTHEW GORMAN 0 24,546 0 CLARICE CABLE 0 13,048 0 SCHEDULE J, PART III MR. STUENKEL AND MS. CABLE ARE COMPENSATED BY FLOYD HEALTHCARE MANAGEMENT, INC. (EIN: 58-1973570) FOR SERVICES AS THE CEO AND INTERIM CFO, RESPECTIVELY, OF FLOYD HEALTHCARE MANAGEMENT, INC. THEY RECEIVE NO COMPENSATION FROM THE FILING ORGANIZATION. THE CEO PARTICIPATES IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS FUNDED ANNUALLY IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON-QUALIFIED RETIREMENT PLAN, AND AS SUCH THE ANNUAL FUNDING PAYMENTS PAID INTO IT ARE TAXABLE TO THE PARTICIPANT IN THE YEAR IN WHICH MADE. EFFECTIVE WITH CALENDAR YEAR 2009, MR. STUENKEL'S SERP IS A CASH-BASED PROGRAM. BONUS/INCENTIVE PAY ALL MEMBERS OF THE EXECUTIVE TEAM FOR FHMI PARTICIPATE IN AN INCENTIVE COMPENSATION PLAN UNDER WHICH ANNUAL YEAR-END BONUSES ARE PAID BASED ON INDIVIDUAL AND CORPORATE-WIDE ACHIEVEMENT OF SPECIFIC GOALS AND OBJECTIVES. ONE OF THE GOALS RELATES TO THE RELATED ORGANIZATION'S NET INCOME. THE BONUSES ARE AWARDED ON A CASH-BASED SYSTEM. FORM 990, PAGE 6, PART VI, LINE 4 THE FILING ORGANIZATION'S BYLAWS WERE AMENDED EFFECTIVE JULY 1, 2021 TO CHANGE THE FILING ORGANIZATION'S FISCAL YEAR FROM ONE ENDING JUNE 30 TO ONE ENDING DECEMBER 31. FORM 990, PAGE 6, PART VI, LINE 6 FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI) IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 7A FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI), A RELATED ORGANIZATION, HAS THE POWER TO APPOINT ELEVEN OF THE TWELVE MEMBER GOVERNING BODY WHILE THE PRESIDENT/CEO OF FHMI IS THE FINAL MEMBER OF THE BOARD. FORM 990, PAGE 6, PART VI, LINE 7B PRIOR APPROVAL OF FHMI IS REQUIRED FOR ANY OF THE FOLLOWING ACTIONS: DISSOLUTION; SALE, MERGER OR DISPOSITION; ADOPTION OF CAPITAL OR OPERATING BUDGETS; SELECT OR REMOVE THE ADMINISTRATOR; INCUR INDEBTEDNESS IN EXCESS OF 1,000,000; TAKE ANY ACTION ON THE LEASE OR CONTRACT BETWEEN THE CORPORATION AND CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY; AMEND THE CORPORATE ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PAGE 6, PART VI, LINE 11B THE ORGANIZATIONS EXECUTIVE TEAM AND INTERNAL LEGAL COUNSEL REVIEW THE FORM 990 PRIOR TO FILING. THE ORGANIZATIONS BOARD OF MEMBERS RECEIVES A COPY OF THE FORM 990 FOR REVIEW PRIOR TO ITS FILING VIA POSTING ON THE BOARD OF MEMBERS SECURE WEBSITE. FORM 990, PAGE 6, PART VI, LINE 12C POLK MEDICAL CENTER, INC. (PMCI) HAS A WRITTEN POLICY RESPECTING CONFLICTS OF INTEREST AND DISCLOSURE OF SAME. GENERALLY SPEAKING, THE POLICY REQUIRES ANY "COVERED PERSON" WHO BELIEVES HE/SHE HAS A CONFLICT OF INTEREST TO: -DISCLOSE THE EXISTENCE AND NATURE OF THE CONFLICT OF INTEREST (INCLUDING ALL FACTS KNOWN RESPECTING THE SUBJECT MATTER) TO THE CHAIRMAN OF THE BOARD; -PLAY NO PART, DIRECTLY OR INDIRECTLY, IN THE DELIBERATION OR VOTE OF THE BOARD OF DIRECTORS WITH RESPECT TO THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS; AND -ABSENT HIMSELF/HERSELF FROM THAT PORTION OF THE MEETING AT WHICH THE CONFLICT OF INTEREST IS DISCUSSED. THE DEFINITION OF A "COVERED PERSON" INCLUDES ALL BOARD MEMBERS, OFFICERS AND MEMBERS OF SENIOR MANAGEMENT OF PMCI. WHEN A COVERED PERSON DISCLOSES A POTENTIAL CONFLICT OF INTEREST TO THE BOARD CHAIRMAN, THE CHAIRMAN IS OBLIGED TO BRING THE MATTER TO THE ATTENTION OF THE FULL BOARD. THE BOARD DETERMINES WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. IF THE BOARD DETERMINES THAT THERE IS A CONFLICT OF INTEREST, THE TRANSACTION OR MATTER GIVING RISE TO THE CONFLICT OF INTEREST MAY NOT PROCEED UNLESS THE BOARD DETERMINES, BY A MAJORITY VOTE, THAT, DESPITE THE CONFLICT OF INTEREST, THE TRANSACTION/MATTER IS NEVERTHELESS IN THE CORPORATION'S BEST INTEREST AND IS FAIR AND REASONABLE TO THE CORPORATION. IN ADDITION TO THE REQUIREMENT THAT A COVERED PERSON DISCLOSE A POTENTIAL CONFLICT OF INTEREST AT THE TIME IT ARISES, EACH COVERED PERSON IS ALSO REQUIRED TO SUBMIT, ON AN ANNUAL BASIS, A `CONFLICT AND DISCLOSURE OF INTEREST QUESTIONNAIRE'. THIS MULTI-QUESTION DOCUMENT SERVES AS A REMINDER AND PROMPTS EACH COVERED PERSON TO PONDER THOSE AREAS AND SITUATIONS WHERE A POTENTIAL CONFLICT MIGHT EXIST. ADDITIONALLY, ANY PROPOSED TRANSACTION AT PMCI WHICH INVOLVES AN "INSIDER" (I.E., A BOARD MEMBER, OFFICER, MANAGER, ETC.) IS SCRUTINIZED, WITH THE ASSISTANCE OF CORPORATE LEGAL COUNSEL, FROM THE STANDPOINT OF WHETHER THE TRANSACTION WILL RESULT IN ANY EXCESS BENEFIT TO THE INSIDER. TYPICALLY THIS INVOLVES OBTAINING APPROPRIATE DATA REGARDING COMPARABILITY WHICH IS PROVIDED TO THE BOARD FOR ITS USE IN DETERMINING THAT THE CONSIDERATION BEING PAID TO THE INSIDER AS A PART OF THE TRANSACTION IS REASONABLE AND DOES NOT EXCEED THE VALUE OF THE BENEFIT RECEIVED BY PMCI. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC WHEN THE REQUEST IS MADE AT THE ADMINISTRATIVE OFFICE OF THE FILING CORPORATION. FORM 990, PART XI, LINE 9 ASSET VALUATION ADJUSTMENT 15,600,628 EQUITY TRANSFER ATRIUM 35,165,742 LOSS ON BOND DEFEASEMENT -2,272,791 EQUITY TRANSFER ESCROW -47,864,015 TOTAL 629,564 ON JULY 14, 2022, FLOYD HEALTHCARE MANAGEMENT, INC. ENTERED INTO A MEMBER SUBSTITUTION AGREEMENT WITH THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY ("CMHA") AND AH GEORGIA, INC., A NORTH CAROLINA NONPROFIT CORPORATION AND WHOLLY-OWNED SUBSIDIARY OF CMHA WHEREBY AH GEORGIA, INC. BECAME THE SOLE MEMBER OF FHMI. FHMI IS THE SOLE MEMBER OF POLK MEDICAL CENTER, INC. ("PMCI"). IN CONSIDERATION FOR BECOMING A PART OF THE CMHA HEALTHCARE SYSTEM, FUNDS WERE TRANSFERRED TO PMCI. PMCI IN TURN AGREED TO TRANSFER SUBSTANTIAL FUNDS TO A NEWLY FORMED FOUNDATION, THE FLOYD-POLK HEALTHCARE FOUNDATION, INC. ONCE THAT ORGANIZATION OBTAINED ITS DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE. THE FUNDS WERE TRANSFERRED TO AN ESCROW ACCOUNT PENDING FINAL APPROVAL BY THE IRS (WHICH WAS OBTAINED AFTER YEAR END). FLOYD HEALTHCARE MANAGEMENT INC 304 TURNER MCCALL BLVD ROME GA 301620233 581973570 HEALTHCARE GA 501C3 3 AH GEORGIA false HOSPITAL AUTHORITY OF FLOYD COUNTY 304 TURNER MCCALL BLVD ROME GA 301620233 586001173 HEALTHCARE GA 501C3 3 NA false FLOYD HEALTH CARE FOUNDATION INC 304 TURNER MCCALL BLVD ROME GA 30161 581375074 FUNDRAISIN GA 501C3 12A FHMI false CANCER NAVIGATORS INC 255 W 5TH STREET SUITE 300 ROME GA 301652817 030397867 HEALTHCARE GA 501C3 7 FHMI false AH GEORGIA INC PO BOX 32862 CHARLOTTE NC 282322861 831707383 HEALTHCARE NC 501C3 10 CMHA false THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY 1000 BLYTHE BLVD CHARLOTTE NC 28203 560529945 HEALTHCARE NC N/A false FLOYD-POLK HEALTHCARE FOUNDATION 304 TURNER MCCALL BLVD ROME GA 30165 872546864 FUNDRAISIN GA 501C3 12A NA false true false false false false false false false false false true false true false true false false false false