2021-05-17T15:17:37-05:00 2020-06-30 KPMG LLP 303 PEACHTREE ST STE 2000 ATLANTA GA 30308 990 2019-07-01 580566213 PIEDMONT HOSPITAL INC % MARIE GAFFNEY PIED 4044251303 1968 PEACHTREE ROAD NW ATLANTA GA 30309 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2021-05-17 true WHITNEY B HEBRON P01226647 4042223000 2021-05-13 2019 2022-09-23 18:48:47Z DR PATRICK BATTEY 1968 PEACHTREE ROAD NW ATLANTA GA 30309 1110027803 false X WWW.PIEDMONTHOSPITAL.ORG X 1905 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 16 13 4495 550 2997794 0 6578366 38019541 1048375558 1048997740 1658509 1585885 21195394 21424637 1077807827 1110027803 0 0 0 0 309568846 312615327 0 0 0 638986675 669173681 948555521 981789008 129252306 128238795 1589750032 1763549225 720082419 1029427360 869667613 734121865 TO PROVIDE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE IN A PROGRESSIVE ENVIRONMENT, GUIDED BY PHYSICIANS, DELIVERED BY EXCEPTIONAL PROFESSIONALS, AND INSPIRED BY THE COMMUNITIES WE SERVE. false false 872170878 0 1045491674 PIEDMONT HOSPITAL ("PH") IS A 643-BED FACILITY THAT HAS BEEN SERVING THE CITY OF ATLANTA IN FULTON COUNTY, GEORGIA, FOR MORE THAN A CENTURY. OVER 1,000 PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN THE CITY AND THE GREATER METROPOLITAN ATLANTA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2020, THE HOSPITAL HAD 25,303 IN-PATIENT ADMISSIONS WITH A TOTAL OF 134,871 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 51,953 AND OUTPATIENT VISITS TOTALED 266,696. SURGICAL SERVICES WERE PROVIDED TO 22,461 PATIENTS. 872170878 true true false false false false false false false true true false false false true true false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false true true false false false true X 0 0 4495 true true true false false false false false false false false false false false X 16 13 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 Dr Patrick Battey CEO & BOARD MEMBER 54.0 1.0 X X 1102639 0 127904 Mr Michael McAnder Treasurer 1.0 54.0 X 0 1036007 130895 Ms Elizabeth Leddy Secretary 1.0 54.0 X 0 843536 107225 Mr Ed Lovern CHIEF OPERATING OFFICER 55.0 0.0 X 714503 0 91540 Dr Eric Gibney board member 1.0 54.0 X 0 707080 34965 Dr Mark Cohen CHIEF MEDICAL OFFICER 40.0 0.0 X 613497 0 16246 Ms Sheryl Klink CHIEF FINANCIAL OFFICER 55.0 0.0 X 469408 0 34176 Ms Kelly Hulsey CHIEF NURSING OFFICER 40.0 0.0 X 355351 0 19804 Ms Harriet Wells LEAD PHYSICIST 40.0 0.0 X 252337 0 18261 Ms Gabriella Wheeler DIR. - TRANSPLANT IMMUNOLOGY 40.0 0.0 X 236291 0 31519 Mr Joseph Sprinkle EXEC DIR - RADIOLOGY 40.0 0.0 X 241100 0 19446 Dr Xavier Duralde board member 1.0 0.0 X 0 8075 0 Dr Juliet Asher board member 1.0 1.0 X 0 0 0 Mr Steven Citron board member 1.0 0.0 X 0 0 0 Dr Adrian Douglass board member 1.0 0.0 X 0 0 0 Ms Lila Hertz board member 1.0 0.0 X 0 0 0 Mr Bert Levy Chair 1.0 1.0 X X 0 0 0 Mr Bill Linginfelter board member 1.0 0.0 X 0 0 0 Ms Kathie McClure board member 1.0 0.0 X 0 0 0 Mr Andy McGhee board member 1.0 0.0 X 0 0 0 Dr Robert Miller Chair 1.0 0.0 X 0 0 0 Mr Brett Samsky board member 1.0 0.0 X 0 0 0 Mr Dale M Schwartz board member 1.0 0.0 X 0 0 0 Mr Shouky Shaheen board member 1.0 0.0 X 0 0 0 Dr Brian Thomas board member 1.0 0.0 X 0 0 0 3985126 2594698 631981 322 false true false BRASFIELD AND GORRIE LLC PO BOX 11407 BIRMINGHAM AL 352460351 CONSTRUCTION 138951621 MEDICAL SOLUTIONS LLC 1010 N 102ND STREET SUITE 300 OMAHA NE 68114 NURSING STAFFING 8699320 NEOGENOMICS LABORATORIES INC 12701 Commonwealth Dr FT MYERS FL 33913 LAB SERVICES 967964 QUEST DIAGNOSTICS NICHOLS INSTITUTE 14225 Newbrook Dr CHANTILLY VA 20151 lab services 953435 ALLIED UNIVERSAL 1438 W Peachtree St ATLANTA GA 30309 SECURITY SERVICES 878644 42 32393396 5626145 38019541 HEALTHCARE SERVICES 621110 1040481111 1040481111 LAB REVENUE 621500 5791701 3060054 2731647 PARKING REVENUE 900099 2494789 2494789 OTHER OPERATING REVENUE 900099 230139 230139 1048997740 1585885 1585885 0 0 17141820 17141820 0 17141820 266147 16875673 0 0 0 0 0 0 0 0 0 0 CAFETERIA 900099 1777314 1777314 FITNESS CENTER 713940 785134 785134 RESEARCH 900099 681184 681184 1039185 1039185 4282817 1110027803 1045491673 2997794 23518795 0 0 0 0 2299212 2166088 133124 0 253234441 238572167 14662274 0 40781591 38420337 2361254 16300083 15356308 943775 642580 642580 185172 185172 0 0 0 0 75848231 71085966 4762265 3022567 2266925 755642 60796455 60500389 296066 15967914 11975935 3991979 0 20330959 16851736 3479223 320731 285821 34910 0 0 22689128 22689128 16793832 16793832 32799842 24599881 8199961 5999291 5999291 MEDICAL SUPPLIES AND DRUGS 250605979 250605979 BAD DEBT EXPENSE 87631098 87631098 INTERCOMPANY ALLOCATION 51297134 30778280 20518854 GA PROVIDER FEE 13153611 13153611 11089157 7920357 3168800 981789008 872170878 109618130 0 26005752 28365221 0 0 125507 124733 117486417 123827834 0 0 0 0 79601 0 22374510 23332485 5355602 4864324 1348258578 684531464 541230377 663727114 836464684 864862318 2989453 2989453 0 0 22310683 22259401 15327446 29196342 1589750032 1763549225 106303587 201706106 0 0 0 0 497355093 670816426 0 0 0 0 64042799 61575300 0 0 52380940 95329528 720082419 1029427360 X 828650743 690844883 41016870 43276982 869667613 734121865 1589750032 1763549225 X 128238795 -3201133 -260583410 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 836464684 50000 28946279 598645 864862318 799179366 37848909 563591 836464684 542134040 199779151 57903617 637442 799179366 422942375 50000000 69781742 590077 542134040 417326858 6283439 667921 422942376 1.00000 true false 28692697 28692697 290315835 192406274 97913561 16360395 12903759 3456636 579515156 471296285 108218871 433370495 7925146 425445349 663727114 0 INTEREST RATE SWAPS 33591511 OTHER DEFERRALS 61738017 95329528 X SCHEDULE D, PART V, LINE 4: INTENDED USES FOR ENDOWMENT FUNDS ASSETS LIMITED AS TO USE PRIMARILY INCLUDE ASSETS UNDER INDENTURE AGREEMENTS AND DESIGNATED ASSETS SET ASIDE BY THE BOARD OF DIRECTORS FOR FUTURE CAPITAL ACQUISITIONS. THE BOARD RETAINS CONTROL OF DESIGNATED ASSETS AND MAY AT ITS DISCRETION SUBSEQUENTLY USE THESE ASSETS FOR OTHER PURPOSES. 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, 2020 AND 2019. true true X true X 300. true X true true false true true 24615404 24615404 0.02750 20700176 17692876 3007300 0.00340 13846251 2473235 11373016 0.01270 59161831 20166111 38995720 0.04360 23700 23700 0.00010 4232207 4232207 0.00470 367952 367952 0.00040 170000 170000 0.00020 4793859 4793859 0.00540 63955690 20166111 43789579 0.04900 25000 25000 25000 25000 true 19325766 0 200420683 235128258 -34707575 X true true Peachtree ORTHO Orthopedic Surgery 0.15 0.85 Digestive Healthcare Endo/GI Surgery 0.15 0.85 1 1 PIEDMONT HOSPITAL INC 1968 PEACHTREE ROAD NW ATLANTA GA 30309 WWW.PIEDMONThospital.ORG 060-139 X X X PIEDMONT HOSPITAL INC false false true X X X X X X X X 18 true false false true X SEE PART V X X true 19 true SEE PART V false true X 300. 300. X true true X X X X true X SEE PART V X SEE PART V X SEE PART V X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, 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, 91 key stakeholders within the Piedmont Hospital 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 Fulton 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/PAH-FY19-CHNA-Strategy.pdf SCHEDULE H, PART V, LINE 7D: PUBLIC AVAILABILITY OF CHNA IN ADDITION TO MAKING ITS CHNA AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT 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 STRATEGY THE BOARD OF DIRECTORS FOR PIEDMONT HOSPITAL UNANIMOUSLY APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE YEAR PERIOD BEGINNING WITH FY20 ON SEPTEMBER 17, 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 LOCATED AFTER THE COMMUNITY HEALTH NEEDS ASSESSMENT IN THE FOLLOWING LINK. https://www.piedmont.org/media/file/PAH-FY19-CHNA-Strategy.pdf SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS WHEN PIEDMONT HOSPITAL PERFORMED ITS INITIAL CHNA DURING FY13, IT FOCUSED ON THREE MAIN PRIORITIES AND STARTED WORK ON THOSE PRIORITIES DURING FY14. FIRST, THE HOSPITAL FOCUSED ON INCREASING ACCESS TO APPROPRIATE AND AFFORDABLE CARE FOR LOW- AND NO-INCOME PATIENTS BY DEVELOPING AND EXECUTING A PLAN TO STRENGTHEN ACCESS POINTS TO THOSE PATIENTS. SECOND, THE HOSPITAL SOUGHT OUT TO REDUCE PREVENTABLE READMISSIONS AND EMERGENCY DEPARTMENT RE-ENCOUNTERS, PARTICULARLY AMONG HIGH-RISK PATIENTS, BY INCREASING CARE COORDINATION EFFORTS BETWEEN THE HOSPITAL AND COMMUNITY-BASED PROVIDERS. LASTLY, PIEDMONT HOSPITAL FOCUSED ON REDUCING INSTANCES OF PREVENTABLE HEART DISEASE AND HYPERTENSION BY UTILIZING COMMUNITY-WIDE AWARENESS CAMPAIGNS AND PROVIDING EDUCATION THAT ENCOURAGES COMMUNITY MEMBERS TO REDUCE THEIR HEART DISEASE RISKS THROUGH HEALTHY BEHAVIORS. DURING FY16, PIEDMONT 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 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 2016 CHNA, PIEDMONT HOSPITAL FOCUSED 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; AND (4) REDUCING PREVENTABLE INSTANCES OF HEART DISEASE, HYPERTENSION, AND STROKE THROUGH EDUCATIONAL AWARENESS AND PROMOTION OF HEALTHY BEHAVIORS, INCLUDING EFFORTS TO REDUCE TOBACCO USE. PIEDMONT HOSPITAL DEVELOPED THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS DURING FY18. PIEDMONT HOSPITAL DEVELOPED THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS DURING FY20-22. The PAH Board of Directors unanimously approved the new CHNA on APRIL 17, 2019. Based on the CHNA, PAH 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 CANCERS AND INCREASE ACCESS TO CANCER PROGRAMMING FOR THOSE LIVING WITH THE DISEASE (4) REDUCE PREVENTABLE INSTANCES OF AND DEATHS FROM HEART DISEASE. 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 Piedmont Hospital regularly reports to the community its community benefit activities in several ways. Each year, the hospital prepares a systemwide community-benefit report that is widely distributed to the public through emailed versions sent to community stakeholders and community organizations, printed copies made available to community members upon request, and publication on the system's website. The hospital also makes available copies of its IRS Form 990 Schedule H on its website and available to anyone upon request. Additionally, the hospital presents its community benefit work within the health care system's annual report and the health care system's foundation annual report, which is widely distributed to the public through both printed copies made available to community members upon request and through publication on the system's website. Additionally, the report was mailed to hospital and system board members, state and local elected officials and other key stakeholders. The hospital provides information on community benefit programming to local, state and federal lawmakers through our government affairs office. Finally, the hospital issues media alerts on key community benefit programming, such as its community benefit grants program, to the public, and provides an annual impact report demonstrating the outcomes from those grants. 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 $981,789,008 LESS BAD DEBT EXPENSE OF $87,631,098 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 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 double accounts based upon historical write-off experience by payer 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. PIEDMONT HOSPITAL 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 the organization's 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. The organization believes that Piedmont Hospital's 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 the hospital operates to promote health in the community. Additionally, Medicare accounted for 50.23 percent of Piedmont Hospital's patient service revenue. Charity care accounts for an additional 2.65 percent of Piedmont Hospital's patient service revenue. Piedmont Hospital's 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 the hospital in honor of Piedmont Hospital 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, Piedmont Hospital is 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, Piedmont Hospital conducted its third triennial community health needs assessment (CHNA). FY20 marked Year One of the subsequent Implementation Strategy. The Piedmont Hospital CHNA was led by the Piedmont Healthcare community benefits team, with significant input and direction from Piedmont Hospital leadership, including the director of community relations and the Piedmont Hospital Board of Directors, which formed a subcommittee to help determine final priorities. Process The CHNA started first with a definition of our community. We started first with the hospital's home county, due to the impact of our tax-exempt status. We estimate property taxes make up the largest segment of a hospital's tax exemption. Because of this, we want to ensure that we are providing equal benefit to our county. 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 criteria, 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 are for 2017, unless otherwise noted. Health indicators are estimates provided by County Health Rankings and hospital data were provided by the hospital. 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 the hospital's 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 . 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. How we determined our priorities: 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 Piedmont Hospital 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, Piedmont Hospital leadership and the Piedmont Hospital 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. SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY Piedmont Hospital understands that not everyone has the ability to 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 available at Piedmont Hospital includes providing a dedicated contact number, which is disseminated by the hospital to patients by various means. These include but are not limited to the publication of notices in patient bills and by posting notices in emergency rooms, in the Conditions of Admission form, at admitting and registration departments, hospital business offices, and patient financial services offices that are located on facility campuses, and at other public places the hospital may elect, including availability at local low-cost clinics primarily treating uninsured populations. Piedmont Hospital also publishes and widely publicizes a plain language summary of this financial assistance care policy on its facility website, which includes a link to 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. Finally, we provide copies of our financial assistance policy to our partner clinics and others who work closely with low-income populations. We offer assistance in understanding the policy, how it relates to their populations and receive feedback in ways our financial assistance programming could be improved. Additionally, 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 patient financial assistance. 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. Copies are provided in both English and Spanish. In FY20, we distributed approximately 3,000 copies of this guide throughout the Atlanta community. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION Piedmont Hospital is located in Fulton County, which we consider to be our primary community. A total of 1,036,200 people live in the 526.74 square mile report area defined for this assessment according to the U.S. Census Bureau American Community Survey 2015-19 5-year estimates. The population density for this area, estimated at 1,967.20 persons per square mile, is greater than the national average population density of 91.93 persons per square mile. During those years, about 45 percent of all Fulton County residents were white, 44 percent were African American, and other races made up the remaining 12 percent. The median age of people living within the county was 35, slightly younger than state and national averages. Twenty-two percent of the population were 18 or younger, 66 percent were between 18 and 64 and 12 percent were 65 and older. Between 2015 and 2019, the median household income was $69,673. African Americans had a much lower median household income at $43,605. Seventy-five percent of the population has, at a minimum, attended some college (with 59 percent having obtained an associate degree or higher), and 18 percent only graduated high school. Approximately 7 percent of the population did not obtain a high school diploma. Generally speaking, household income and educational attainment are related. Approximately 6.5 percent of adults were unemployed in 2020, a figure higher than the state average of 5.4 percent. Thirty-four 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. Fourteen percent of the county - about 144,224 people - lived in poverty each year on average between 2015 and 2019. During that same time, 21 percent of children in Fulton 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. When broken down by race, 34 percent of African American children and only 4 percent of white children lived in poverty. Fifty-five 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 state average of 60 percent. Poor children are statistically less likely to graduate high school or attend college and are nearly twice as likely to become poor adults than their non-poor counterparts. In Fulton County, 10.3 percent of residents were uninsured in 2019, and blacks were three times as likely as their white counterparts to be uninsured. Non-elderly adults by far were the most likely to be uninsured, with 14 percent of those age 18 to 64 as having no insurance coverage during that time period. About 5 percent of the population were 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." In Fulton County, like with the rest of Georgia, heart disease was the number one cause of both age-adjusted death between 2015 and 2019, and this holds true for all races. 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. Homicide was the leading cause of premature death in Fulton County between 2015 and 2018, with a total 25,438 deaths during that time. There were 30 designated health professional shortage areas in the community in 2021: 12 primary care shortage areas, nine mental health shortage areas and nine dental health shortage areas. There was one dentist for every 1,420 people in 2019, one primary care physician for every 920 people, and one mental health provider for every 420 people. Community members have reported an average 3.1 and 3.4 poor physical and mental health days, respectively. Fifteen percent of Fulton residents reported their health as poor or fair. Approximately 15,000 people lived with HIV in 2018, resulting in a rate of 1,707.2 per every 100,000 people, which is significantly higher than state and national rates of 624.9 and 372.8 per every 100,000 people, respectively. HIV is a life-threatening communicable disease that disproportionately affects minority populations and may also indicate the prevalence of unsafe sex practices. Chlamydia rates were much higher than both and national averages in 2018, with 804.3 infections per every 100,000 people. This is most prevalent among African American populations. In 2019, there were approximately 71.7 retail opioid prescriptions dispensed per 100 persons, according to the CDC. We aren't able to tell how many prescriptions are going to a single person, just the overall figure. This is an increase over 2018 prescription rates, when there were 44.2 retail opioid prescriptions dispensed per 100 people. For every 1,000 teen girls aged 15 to 18 in Fulton County, 21 birth gave birth to a child on average each year between 2012 and 2018. African American teens were three times as likely to have a baby than their white counterparts. Children born to teen are statistically much more likely to experience adverse health and socioeconomic issues as they grow older. 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 Piedmont Hospital actively promotes the health of its community through clinic-hospital partnerships, our community benefit grants programs, 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 all in-person events and classes were canceled as of early March 2020. We worked to create programming that was responsive to the pandemic, including our migrating to online platforms for vital community-based programming. In FY20, Piedmont Hospital offered numerous proactive community benefit programs meant to boost the health of the community it serves. This includes the provision of laboratory and diagnostic services to two local charitable clinics - the Grant Park Clinic and the Center for Black Women's Wellness - as well as Federally Qualified Health Center Good Samaritan Health Center Atlanta. This came at a total cost of $367,952 in FY20. This includes support for programming through the system's community benefit grants program, which provides funding to local not-for-profit organizations whose programs and mission align with Piedmont Hospital's CHNA. In FY20, we provided $170,000 in funds to 12 nonprofit organizations. Those were: Breakthru House, Foundation of Wesley Woods, St. Jude's Recovery Center, Urban Health and Wellness, Covenant House Georgia, Gateway Center, the Good Samaritan Health Center, Atlanta Legal Aid Society, Mercy Housing Southeast, Clarkston Community Health, Community Advanced Practice Nurses and Odyssey Family Counseling Center. Additionally, and as mentioned above, Piedmont Hospital provided to the general public a bilingual community resource guide, which gives information on community resources for lower income populations as well as plain language details on our financial assistance programs. In FY20, Piedmont Hospital also provided health professions education to students and residents training to be health professionals. That year, the hospital oversaw training at a cost of $4.2 million. As part of a Piedmont Healthcare systemwide effort, Piedmont Hospital was an active participant in anti-opioid work, which included: active participation on the systemwide task force, tracking opioid prescriptions within the hospital and by providers, utilizing Epic EMR tools to monitor opioid use, offering patients and the community ways to safely dispose of unused medication, and providing ongoing education on opioid prescribing. The advent of COVID-19 precluded local take-back day activities, in which we'd traditionally partner with local law enforcement to host an event in which local residents were encouraged to bring in any unused prescriptions for safe disposal. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM Piedmont Hospital is a part of Piedmont Healthcare, a regional not-for-profit organization and the parent company of 11 hospitals, the Piedmont Physicians Group, the Piedmont Heart Institute, the Piedmont Clinic and the Piedmont Healthcare Foundation. Piedmont Healthcare's community benefit department coordinates the community benefit activities on behalf of all hospitals throughout the system. 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 provide key input and execute programming, such as our revenue department, which oversees and executes the financial assistance policy and program. SCHEDULE H, PART VI, LINE 7: STATE OF FILING OF COMMUNITY BENEFIT REPORT Piedmont Hospital is not required to file a community benefit report; however, the hospital is 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. X true true false true false false false false false true false Dr Patrick Battey CEO & BOARD MEMBER 640751 0 278597 0 183291 0 113985 0 13919 0 1230543 0 97185 0 Dr Eric Gibney board member 0 612713 0 0 0 94367 0 16800 0 18165 0 742045 0 0 Mr Ed Lovern CHIEF OPERATING OFFICER 416057 0 180602 0 117844 0 79801 0 11739 0 806043 0 63011 0 Ms Sheryl Klink CHIEF FINANCIAL OFFICER 370646 0 82009 0 16753 0 16800 0 17376 0 503584 0 0 0 Dr Mark Cohen CHIEF MEDICAL OFFICER 468635 0 102644 0 42218 0 4375 0 11871 0 629743 0 0 0 Ms Kelly Hulsey CHIEF NURSING OFFICER 283123 0 61459 0 10769 0 12521 0 7283 0 375155 0 0 0 Ms Gabriella Wheeler DIR. - TRANSPLANT IMMUNOLOGY 214370 0 19233 0 2688 0 14693 0 16826 0 267810 0 0 0 Mr Joseph Sprinkle EXEC DIR - RADIOLOGY 210898 0 27490 0 2712 0 12548 0 6898 0 260546 0 0 0 Ms Harriet Wells LEAD PHYSICIST 241510 0 10534 0 293 0 11434 0 6827 0 270598 0 0 0 Mr Michael McAnder Treasurer 0 613592 0 345604 0 76811 0 123395 0 7500 0 1166902 0 0 Ms Elizabeth Leddy Secretary 0 448895 0 251848 0 142793 0 89849 0 17376 0 950761 0 0 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS THE FOLLOWING EMPLOYEES EACH RECEIVED A DISCRETIONARY SPENDING ACCOUNT IN THE AMOUNT INDICATED. SPENDING ACCOUNTS WERE INCLUDED IN THE EMPLOYEES' TAXABLE WAGES: PATRICK BATTEY $12,923 EDWARD LOVERN $12,923 SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT 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 4B: SUPPLEMENTAL COMPENSATION INFORMATION EDWARD LOVERN RECEIVED A PAYMENT OF $63,001 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. DR. PATRICK BATTEY RECEIVED A PAYMENT OF $97,185 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: MARK COHEN KELLY HULSEY SHERYL KLINK MICHAEL MCANDER 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. A Development Authority of Fulton County 581506878 36005FGE9 2019-11-07 283775000 Building false false false B Development Authority of Fulton County 582629223 000000000 2014-11-19 64095000 SEE PART VI false false false C Development Authority of Fulton County 581506878 3599006J1 2014-11-19 23635000 CONSTRUCTION/PURCHASE OF EQUIP. false false false D Development Authority of Fulton County 582629223 3599008H3 2016-11-16 197555000 CONSTRUCTION false false false A 0 0 307712331 0 0 0 0 0 0 294826022 0 12886309 false false false B 10935000 0 64095000 0 0 0 0 0 0 0 64095000 0 2014 true false true true C 0 0 26008208 0 0 0 651 0 0 26007557 0 0 2014 false false true true D 10355000 0 216997587 0 0 193876754 3348 0 0 23117485 0 0 2020 true false true true A false true false true false 0.01000 0.01000 true false false true B false true true true false 0.01000 0.01000 false false false true C false false true true false 0.01000 0.01000 false false false true D false true true true false 0.01000 0.00000 0.01000 true false false true A false true false false false false 0 false 0 false true B false false false true true false 0 false 0 false true C false false false true true false 0 false 0 false true D false true false false false false 0 false 0 false true A true B true C true D true SCHEDULE K, PART I, COL. F Bond B: Proceeds were used to refinance the Series 2009B Bond that was issued on 11/23/2009. SCHEDULE K, PART IV, LINE 2C: REBATE CALCULATIONS BOND B AND BOND C: THE REBATE CALCULATIONS FOR THE 2014 SERIES A AND SERIES B DEVELOPMENT AUTHORITY OF FULTON COUNTY REVENUE BOND ISSUES WERE LAST PERFORMED ON NOVEMBER 19, 2016. NO REBATE DUE. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2019 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT 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 HOSPITAL, INC ("PH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT HOSPITAL. FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT 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 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 HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PIEDMONT HOSPITAL'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S TAX DEPARTMENT AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. PRIOR TO FILING, COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., THE ORGANIZATION'S SOLE MEMBER, FOR BOARD REVIEW. FORM 990, PART VI, SEC B, LINE 12C: CONFLICT OF INTEREST POLICY COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARE'S CHIEF COMPLIANCE OFFICER. ALL SENIOR LEADERS, BOARD MEMBERS, PHYSICIAN EMPLOYEES, NURSE PRACTITIONERS/PHYSICIAN ASSISTANTS AND EMPLOYEES AND NON-EMPLOYEES ENGAGED IN RESEARCH ARE REQUIRED TO ANNUALLY DISCLOSE ALL MATTERS WHICH COULD POTENTIALLY CONSTITUTE A CONFLICT OF INTEREST. MATTERS DISCLOSED UNDER THE POLICY MUST BE REVIEWED IN WRITING BY THE PIEDMONT HEALTHCARE CONFLICT OF INTEREST COMMITTEE IN ORDER TO DETERMINE WHETHER A CONFLICT EXISTS AND, IF SO, WHETHER TO ELIMINATE OR MANAGE THE CONFLICT. ALL BOARD MEMBERS AND EMPLOYEES OF PIEDMONT HOSPITAL ARE PROVIDED TRAINING ON CONFLICT OF INTEREST ISSUES, INCLUDING REPORTING REQUIREMENTS, AT NEW EMPLOYEE ORIENTATION AND AT LEAST ANNUALLY THEREAFTER. NONCOMPLIANCE WITH THE CONFLICT OF INTEREST POLICY MUST BE REPORTED TO PIEDMONT HEALTHCARE'S CHIEF COMPLIANCE OFFICER FOR INVESTIGATION, AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. FORM 990, PART VI, SEC B, LINE 15A, 15B: EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT 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 EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("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. 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 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: RECONCILIATION OF NET ASSETS CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF: BOOK/TAX DIFFERENCES ($2,050,698) CONTRIBUTIONS ($5,626,145) UNALLOCATED EXPENSES ($39,896,539) CHANGE IN FUNDS $20,742,280 INTERCOMPANY TRANSFERS ($236,012,420) CHANGE IN FUNDS $2,260,112 -------------------- TOTAL ($260,583,410) CTMR MANAGEMENT LLC 1968 PEACHTREE RD NW ATLANTA GA 30309 MEDICAL GA 0 0 PH PCL-II LLC 1968 PEACHTREE RD NW ATLANTA GA 30309 MEDICAL GA 0 0 PH PIEDMONT WEST AMBULATORY SURGERY CENTER 1800 Howell Mill Rd Ste 200 ATLANTA GA 30318 264422348 SURGERY GA 0 0 PH CCA OF ATLANTA LLC 1968 PEACHTREE ROAD NW ATLANTA GA 30309 MEDICAL DE 0 0 PH Piedmont Healthcare INC 1800 HOWELL MILL ROAD SUITE 850 Atlanta GA 30318 581503902 HC Management GA 501(C)(3) 12C, III-FI NA false FAYETTE COMMUNITY HOSPITAL INC 1255 HIGHWAY 154 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 HEART INSTITUTE INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 263553500 HEALTHCARE GA 501(C)(3) 10 PHC false PIEDMONT HENRY HOSPITAL INC 1133 EAGLES LANDING PARKWAY 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 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 ATHENS REGIONAL SPECIALTY SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 271975001 HEALTHCARE GA 501(C)(3) 3 ARMC false REGIONAL FIRSTCARE INC 1199 PRINCE AVENUE ATHENS GA 30606 582362733 URGENT CARE GA 501(C)(3) 12B, II ARMC false COLUMBUS AMBULATORY HEALTHCARE SERVICES 707 CENTER ST COLUMBUS GA 31901 581719867 AMBULATORY GA 501(C)(3) 3 PHC 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 ATLANTA GA 31901 581501642 FUNDRAISING GA 501(C)(3) 7 PHC false THE MEDICAL CENTER INC 710 CENTER ST COLUMBUS GA 31901 581685139 HOSPITAL GA 501(C)(3) 3 PHC false HUGHSTON HOSPITAL INC 707 CENTER ST COLUMBUS GA 31901 331216751 HOSPITAL GA 501(c)(3) 3 PHC 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 Peachtree OrthopAedic Surgery Center 2001 Peachtree Road NE Suite 705 Atlanta GA 30309 582562721 SURGERY GA NA RELATED 880707 164087 false 0 false 0.15000 Digestive Healthcare of Georgia 95 Collier Road NW suite 4075 Atlanta GA 303091721 582406657 HEALTHCARE GA NA RELATED 204327 243658 false 0 false 0.15000 FOUR WINDS HEALTH LLC 3350 RIVERWOOD PKWY STE 1850 ATLANTA GA 30339 451273930 HEALTHCARE GA NA N/A 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 N/A 0 0 false 0 false 0.00000 PIEDMONT MEDICAL CARE CORPORATION 2727 PACES FERRY RD 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 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 true false false false false false true true false false SCHEDULE R, PART I, LINE 1: DISREGARDED ENTITIES THE LIMITED LIABILITY COMPANIES LISTED IN SCHEDULE R, PART I, OPERATE AS DEPARTMENTS OF PIEDMONT HOSPITAL AND ARE INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LIMITED LIABILITY COMPANIES AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.