2021-05-17T20:46:34-05:00 2020-06-30 KPMG LLP 303 PEACHTREE ST NE STE 2000 ATLANTA GA 30308 990 2019-07-01 352228583 PIEDMONT MOUNTAINSIDE HOSPITAL INC % MARIE GAFFNEY PIED 7066922441 1266 Highway 515 South Jasper GA 30143 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 Ms Denise Ray 1266 Highway 515 South Jasper GA 30143 98007047 false X piedmont.org X 2004 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 8 5 598 135 0 0 652127 9487485 95616334 88045887 23818 19152 451485 454523 96743764 98007047 54852 123053 0 0 38786830 41782358 0 0 0 49181382 50084008 88023064 91989419 8720700 6017628 58875170 58693115 10233163 26453499 48642007 32239616 TO PROVIDE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE IN A PROGRESSIVE ENVIRONMENT, GUIDED BY PHYSICIANS, DELIVERED BY PROFESSIONALS, AND INSPIRED BY THE COMMUNITIES WE SERVE. false false 83146468 123053 88053173 PIEDMONT MOUNTAINSIDE HOSPITAL ("PMH") IS A 52-BED FACILITY LOCATED IN THE CITY OF JASPER IN PICKENS COUNTY, GEORGIA. OVER 200 PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN THE COMMUNITY, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2020, THE HOSPITAL HAD 3,325 IN-PATIENT ADMISSIONS WITH A TOTAL OF 14,207 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 31,122 AND OUTPATIENT VISITS TOTALED 43,288. SURGICAL SERVICES WERE PROVIDED TO 2,174 PATIENTS. 83146468 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 false false false false false false false false true false false false true true false false false true X 0 0 598 true false false false false false false false false false false false false X 8 5 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 ROAD BLDG 2 STE Atlanta GA 30339 X Dr Leigh Hamby Board Member 1.0 54.0 X 0 1097513 126333 Mr Michael McAnder Treasurer 1.0 54.0 X 0 1036007 130895 Ms Elizabeth Leddy Secretary 1.0 54.0 X 0 843536 107225 Ms Denise Ray CEO/CHAIR/BOARD MEMBER 55.0 0.0 X X 768596 0 92105 Dr John Schnars Board Member (BEG 2/20) 7.0 48.0 X 0 691260 0 Ms Michelle Breitfelder CNO 55.0 0.0 X 253266 0 26982 Mr Justin Leal SR. DIR. OPERATIONS 40.0 0.0 X 236206 0 11003 Ms Pam Mingo PHARMACY MANAGER 40.0 0.0 X 188807 0 23075 Ms Lindsey Gard CFO 55.0 0.0 X 173715 0 23115 Mr Donald Holmes PHARMACIST 40.0 0.0 X 171245 0 21828 Ms Ouida Corry PHARMACIST 40.0 0.0 X 159979 0 17109 Ms Patricia Hopkins PHARMACIST 40.0 0.0 X 152114 0 24289 Mr Jack Dunn Board Member (END 5/20) 1.0 0.0 X 0 0 0 Mr Richard Hubbard III Board Member 1.0 0.0 X 0 0 0 Mr Paul Nealey Board Member 1.0 0.0 X 0 0 0 Mr Jason Smith Board Member 1.0 0.0 X 0 0 0 Dr Rosemarie Spillane Board Member 1.0 0.0 X 0 0 0 2103928 3668316 603959 34 false true false MOUNTAINSIDE ANESTHESIA CONSULTANTS 1266 Hwy 515 S JASPER GA 30143 ANESTHESIA 1050434 EMERGENCY COVERAGE CORPORATION 1200 Memorial Dr DALTON GA 30720 EMERGENCY CARE 699193 ALLIED UNIVERSAL SECURITY SERVICES 1551 N TUSTIN AVENUE SANTA ANA CA 92705 SECURITY SERVICES 650984 INSIGHT HEALTH CORPORATION 26250 Enterprise Court LAKE FOREST CA 92630 DIAGNOSTIC SERVICES 538122 MEDICAL SOLUTIONS LLC 1010 North 102nd St OMAHA NE 68114 staffing 582266 15 8152693 1334792 112191 9487485 PATIENT SERVICE REVENUE 621110 87354939 87354939 OTHER OPERATING REVENUE 900099 690948 690948 88045887 19152 19152 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722310 254627 254627 GIFT SHOP 900099 192610 192610 FEE REVENUE 900099 7286 7286 454523 98007047 88053173 0 466389 123053 123053 0 0 0 597789 525038 72751 0 33436188 29367004 4069184 0 5644397 4957474 686923 2103984 1847929 256055 190068 190068 4887 4740 147 0 0 0 0 6290321 6290321 302882 302882 6327036 6242519 84517 1425467 1382711 42756 0 2662916 2250108 412808 37013 27290 9723 0 0 1047535 1015224 32311 1618202 1618202 3457222 3353506 103716 954751 926109 28642 DRUGS AND MEDICAL SUPPLIES 11778971 11778971 BAD DEBT EXPENSE 2806021 2806021 HOSPITAL TAX 1108519 1108519 ALL OTHER EXPENSES 10072197 8646981 1425216 91989419 83146468 8842951 0 91105 109944 0 0 0 0 12011060 10342582 0 0 0 0 0 0 1884060 1906056 243273 252042 72624733 43722725 27465189 28902008 0 0 0 0 0 0 17180483 17180483 0 0 58875170 58693115 5212615 6232212 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5020548 20221287 10233163 26453499 X 48212229 31395073 429778 844543 48642007 32239616 58875170 58693115 X 6017628 -22420019 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1897200 1897200 33932485 18213657 15718827 2384619 1807724 576895 33685363 23701344 9984020 725066 0 725066 28902008 0 MEDICARE PAYABLE 19323529 OTHER LIABILITIES 860413 NOTES PAYABLE 37345 20221287 X SCHEDULE D, PART X, LINE 2: ASC 740 FOOTNOTE (FKA FIN 48) PHC ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF THE INCOME TAXES TOPIC OF THE ASC (ASC 740). UNDER THE REQUIREMENTS OF ASC 740, TAX-EXEMPT ORGANIZATIONS MAY BE REQUIRED TO RECORD AN OBLIGATION AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS UNCERTAIN TAX EXPOSURE ITEMS. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT JUNE 30, 2020 AND 2019. true true X true X 300. true X true true false true true 8737977 8737977 0.09800 3061149 2759213 301936 0.00340 1148813 323547 825266 0.00930 12947939 3082760 9865179 0.11070 59930 59930 0.00070 518714 518714 0.00580 0 0 0.00000 0 0 0.00000 52286 52286 0.00060 630930 630930 0.00710 13578869 3082760 10496109 0.11780 19875 19875 0.00020 6448 6448 0.00010 6000 6000 0.00010 17283 17283 0.00020 49606 49606 0.00060 true 1680744 0 24576308 28843819 -4267511 X true true 1 1 Piedmont Mountainside Hospital 1266 Highway 515 South Jasper GA 30145 https://www.piedmont.org/ 056-550 X X X Piedmont Mountainside Hospital 1 false false true X X X X X X X X 18 true false false true X SEE PART VI X X true 19 true SEE PART VI false true X 300. 300. X true true X X X X true X SEE PART VI X SEE PART VI X SEE PART VI X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, LINE 5: COMMUNITY REPRESENTATION As a part of our process, we interviewed 31 key stakeholders and policy makers that represent public health, low-income populations, uninsured and uninsured persons, minorities, chronic conditions, older adults, and lawmakers. Further, in December 2018 and December 2019, 22 key stakeholders within the Piedmont Mountainside community provided their thoughts on community health, community assets and the role of the hospital in addressing unmet community health needs via a web survey. Below are the results of that survey. These interviews were conducted for people representing the entire region, including Pickens County. Specifically, we interviewed representatives of local and regional public health entities, minority populations, faith-based communities, local business owners, the philanthropic community, mental health agencies, elected officials and individuals representing our most vulnerable patients. The Piedmont Healthcare board of directors and leadership from all 11 hospitals were actively informed and engaged throughout this process. SCHEDULE H, PART V, SECTION B, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE https://www.piedmont.org/media/file/PMH-FY19-CHNA-Strategy.pdf SCHEDULE H, PART V, LINE 7D: PUBLIC AVAILABILITY OF CHNA IN ADDITION TO MAKING ITS CHNA REPORTS AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT MOUNTAINSIDE HOSPITAL SENT COPIES TO EACH PARTICIPANT IN THE CHNA PROCESS, DISTRIBUTED THE ASSESSMENTS TO COMMUNITY CENTERS AND OTHER LOCATIONS THAT PRIMARILY SERVE AN UNINSURED POPULATION, SENT COPIES TO LEGISLATIVE AND ELECTED OFFICIALS, AND WIDELY DISTRIBUTED THE ASSESSMENTS TO OTHER PIEDMONT HEALTHCARE HOSPITALS. SCHEDULE H, PART V, SECTION B, LINE 10A: IMPLEMENTATION STRATEGIES WEBSITE THE BOARD OF DIRECTORS FOR PIEDMONT MOUNTAINSIDE HOSPITAL UNANIMOUSLY APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE YEAR PERIOD BEGINNING WITH FY20 ON AUGUST 23, 2019, WITHIN THE GRACE PERIOD FOLLOWING THE APPROVAL OF THE NEW COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING LINK IS FOR THE IMPLEMENTATION STRATEGY EFFECTIVE THROUGH JUNE 30, 2022. THE IMPLEMENTATION STRATEGY IS PROVIDED AFTER THE COMMUNITY HEALTH NEEDS ASSESSMENT IN THE FOLLOWING LINK. https://www.piedmont.org/media/file/PMH-FY19-CHNA-Strategy.pdf SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS WHEN PIEDMONT MOUNTAINSIDE 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 MOUNTAINSIDE HOSPITAL FOCUSED ON REDUCING INSTANCES OF PREVENTABLE HEART DISEASE, OBESITY, AND OBESITY-RELATED DISEASES, INCLUDING DIABETES, 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 MOUNTAINSIDE HOSPITAL CONDUCTED ITS SECOND CHNA, AGAIN BY ASSESSING PUBLICLY AVAILABLE DATA, INTERVIEWING COMMUNITY MEMBERS AND STAKEHOLDERS, CONDUCTING FOCUS GROUPS OF VULNERABLE POPULATIONS, INTERVIEWING PIEDMONT BOARD MEMBERS, AND SURVEYING PIEDMONT EMPLOYEES. THROUGH THIS PROCESS, PIEDMONT MOUNTAINSIDE HOSPITAL DETERMINED AND PRIORITIZED THE COMMUNITY HEALTH NEEDS IT WOULD ADDRESS BASED ON THE NUMBER OF PERSONS AFFECTED, THE SERIOUSNESS OF THE ISSUE, WHETHER THE HEALTH NEED AFFECTED VULNERABLE POPULATIONS, AND THE AVAILABILITY OF COMMUNITY AND HOSPITAL RESOURCES NECESSARY TO ADDRESS THE ISSUE. BASED ON THE CHNA, PIEDMONT MOUNTAINSIDE HOSPITAL IS CURRENTLY FOCUSING ON: (1) MAINTAINING AND INCREASING ACCESS TO AFFORDABLE CARE FOR LOW- AND NO-INCOME PATIENTS, INCLUDING INCREASED EFFORTS AT ELIMINATING HEALTH DISPARITIES; (2) INCREASING ACCESS TO AND AWARENESS OF CANCER-RELATED PROGRAMMING, INCLUDING LOW-COST MAMMOGRAMS, TO QUALIFYING WOMEN THROUGH PARTNERSHIP PROGRAMS; (3) REDUCING PREVENTABLE READMISSIONS AND EMERGENCY DEPARTMENT RE-ENCOUNTERS, PARTICULARLY AMONG HIGH-RISK PATIENTS, WITH A FOCUS ON CHRONIC DISEASE MANAGEMENT; (4) MAINTAINING AND GROWING EFFORTS AROUND SENIOR HEALTH; AND (5) REDUCING PREVENTABLE INSTANCES OF HEART DISEASE, HYPERTENSION, AND STROKE THROUGH EDUCATIONAL AWARENESS AND PROMOTION OF HEALTHY BEHAVIORS, INCLUDING EFFORTS TO REDUCE TOBACCO USE. PIEDMONT MOUNTAINSIDE HOSPITAL DEVELOPED THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS DURING FY20-22. The PMH Board of Directors unanimously approved the new CHNA on August 23, 2019. Based on the CHNA, PMH will focus on the following: (1) INCREASE ACCESS TO APPROPRIATE AND AFFORDABLE HEALTH AND MENTAL CARE FOR ALL COMMUNITY MEMBERS, AND ESPECIALLY THOSE WHO ARE UNINSURED AND THOSE WITH LOW INCOMES; AND (2) REDUCE OPIOID AND RELATED SUBSTANCE ABUSE AND OVERDOSE DEATHS. SCHEDULE H, PART V, LINE 16: FINANCIAL ASSISTANCE POLICY WEBSITES FINANCIAL ASSISTANCE POLICY - https://www.piedmont.org/media/file/Financial-Assistance-Policy.pdf FINANCIAL ASSISTANCE APPLICATION - https://www.piedmont.org/media/file/Financial-Assistance-Application.pdf FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY - https://www.piedmont.org/media/file/Financial-Assistance-Plain-Language-Su mmary-English.pdf SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A Piedmont Mountainside 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 $91,989,419, LESS BAD DEBT EXPENSE OF $2,806,021 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. PMH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE ARE NOT REPORTED AS REVENUE. MEDICARE SHORTFALLS AS COMMUNITY BENEFIT SCHEDULE H, PART III, LINE 8 The amount reported on Part III, Line 6, was calculated in accordance with Schedule H instructions and 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 exclude from allowable cost in the Medicare Cost Report. The organization believes that Piedmont Mountainside 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 56.37% of Piedmont Mountainside Hospital's patient service revenue. Charity care accounted for a further 8.91% of Piedmont Mountainside Hospital's patient service revenue. The 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 the hospital's commitment to treat elderly patients. 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 Mountainside 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 Mountainside Hospital conducted its third triennial community health needs assessment (CHNA). FY20 marked Year One of the CHNA's subsequent three-year implementation strategy. The Piedmont Mountainside CHNA was led by the Piedmont Healthcare community benefits team, with input and direction from Piedmont Mountainside leadership. 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, including Gilmer County, where we have a freestanding emergency department. 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 our 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 guide our community benefit work. They are, in no order: . Increase access to appropriate and affordable health and mental care for all community members . Reduce opioid, substance and nicotine abuse and overdose deaths With each priority, we work to achieve greater health equity by reducing the impact of poverty and other socioeconomic indicators. This means that health equity is built into each priority, and that is demonstrated through our implementation strategies. 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 community health needs assessment was unanimously approved by the Piedmont Mountainside Hospital board of directors on May 17, 2019. The Piedmont Mountainside 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 Mountainside Hospital leadership and the Piedmont Mountainside 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 Patient education of availability of assistance: Piedmont Healthcare 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 Mountainside 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 Mountainside 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. 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. 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. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION Piedmont Mountainside Hospital is located in Pickens County, which we consider to be our primary community. A total of 31,387 people live in the 232.06 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 135.25 persons per square mile, is greater than the national average population density of 91.93 persons per square mile. During those years, about 90 percent of all Pickens County residents were white, 9 percent were Hispanic and 1 percent were African American. The median age of people living within the county was 45, older than state and national averages. Twenty percent of the population were 18 or younger, 21 percent were over the age of 65 and the rest were in between. Between 2015 and 2019, the median household income was $67,631. Fifty-four percent of the population has, at a minimum, attended some college (with 32 percent having obtained an associate degree or higher), and 9 percent did not graduate high school. Generally speaking, household income and educational attainment are related. Nearly 15 percent of the population did not receive their high school diploma. Nearly 4 percent of adults were unemployed in 2020, a figure better than the national average of 5.4 percent. Twenty-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. Ten percent of the county - about 19,070 people - lived in poverty each year on average between 2015 and 2019. This is much better than the state average of 15 percent. During that same time, 15 percent of children in Pickens County lived in poverty, a figure that is significantly lower than the state average of 22 percent. Fifty-two 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 Pickens County, only 10.62 percent of the population were uninsured in 2019, which is lower than the state and national averages of 13.2 and 8.8 percent, respectively. Non-elderly adults by far were the most likely to be uninsured, with 16 percent of those age 18 to 64 as having no insurance coverage during that time period, as compared to 4.9 percent of children and less than 1 percent of seniors and elderly adults. In Pickens County, like with the rest of Georgia, heart disease was the number one cause of both age-adjusted and premature 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. 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. There was one dentist for every 2,430 people in 2019, one primary care physician for every 2,430 people, and one mental health provider for every 1,450 people. All are far worse than the state averages of 1,960:1, 1,530:1 and 1,450:1, respectively. Community members have reported an average 3.2 and 3.7 poor physical and mental health days, respectively. Thirteen percent of Pickens residents reported their health as poor or fair. Approximately 816 people lived with HIV in 2018. HIV is a life-threatening communicable disease that disproportionately affects minority populations and may also indicate the prevalence of unsafe sex practices. To that point, both chlamydia and gonorrhea rates were far below both and national averages in 2018, with 205.8 chlamydia infections per every 100,000 people and 47.5 gonorrhea infections per every 100,000 people. In 2019, there were approximately 32.7 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. It's important to note that this number increased sharply in 2019 and is among the worst in the state. For every 1,000 teen girls aged 15 to 18 in Pickens County, 34 birth gave birth to a child on average each year between 2012 and 2018. African American and Hispanic teens were more 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 Mountainside 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. At the beginning of the COVID pandemic PMH leadership recognized the lack of effective communication between key stakeholders in the communities we serve. PMH initiated WebEx calls/meetings which included PMH leadership, state, county and city government officials, Georgia Department of Public Health representatives, law enforcement officials, county school board officials, court system officials, and members of the community. Calls were held daily, bi-weekly and weekly based on the current surge of the pandemic. In FY20, Piedmont Mountainside offered various proactive community benefit programs, including the continuation of the Piedmont community benefit grants program, which offers grant opportunities to local nonprofit organizations providing specific to health-related services and programs that address the unmet health needs identified in our FY19 CHNA and implementation strategy. We provided $50,000 in grants funding in FY20 grantees for five organizations: Gilmer County EMS (opioid-related work), Good Samaritan Clinic, Highland Rivers, Pickens County Council on Child Abuse and Pickens County Sheriff's Department. Piedmont Mountainside Hospital financially supported its local Federally Qualified Health System -- Good Samaritan Clinic - as well as Pickens County Sheriff's Department with one-time donations to support two programs. One is JumpStart, an eight-week community health initiative and wellness program designed to improve cardiovascular health-and more specifically, reducing blood pressure, which is offered free of charge to the public, and the program combines exercise, nutrition, and clinical education in a weekly two-hour class format. In addition to the financial support, PMH has a leadership member who participates on the Good Samaritan Board of Directors and additional leaders provide support by volunteering at the clinic. PMH also partnered with Pickens County Sheriff's Department with their new "Project Lifesaver" program. The program helps to locate individuals with cognitive disorders such as Alzheimer's, dementia, autism and other special needs groups who are prone to the life-threatening behavior of wandering. Piedmont Mountainside Hospital also provided health professions education to students and residents training to be health professionals. In FY20, Piedmont Mountainside Hospital medical staff oversaw training at a cost of $518,714. As part of a Piedmont Healthcare systemwide effort, Piedmont Mountainside 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. Piedmont Mountainside Hospital has dedicated registered nurses and medical social workers located in the emergency department to provide direct assistance to high-risk, low-income patients by connecting them with community resources (FQHC, nursing homes, etc.) who can provide the necessary services these patients require. These are employed at a cost to the hospital. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM Piedmont Mountainside 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. This includes 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 Mountainside 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. true REINHARDT UNIVERSITY 7300 Reinhardt Cir WALESKA GA 30183 580603153 501(c)(3) 75000 SCHOLARSHIP 1 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. X true true false true false false false false false true false Dr Leigh Hamby Board Member 0 603164 0 337910 0 156439 0 108957 0 17376 0 1223846 0 0 Ms Denise Ray CEO/CHAIR/BOARD MEMBER 437556 0 218720 0 112320 0 79037 0 13068 0 860701 0 0 0 Dr John Schnars Board Member (BEG 2/20) 0 691260 0 0 0 0 0 0 0 0 0 691260 0 0 Ms Michelle Breitfelder CNO 185107 0 59373 0 8786 0 15135 0 11847 0 280248 0 0 0 Ms Lindsey Gard CFO 144961 0 28754 0 0 0 0 0 23115 0 196830 0 0 0 Mr Justin Leal SR. DIR. OPERATIONS 198808 0 37136 0 262 0 4180 0 6823 0 247209 0 0 0 Ms Pam Mingo PHARMACY MANAGER 163309 0 20907 0 4591 0 11441 0 11634 0 211882 0 0 0 Mr Donald Holmes PHARMACIST 142372 0 500 0 28373 0 10239 0 11589 0 193073 0 0 0 Ms Ouida Corry PHARMACIST 145732 0 500 0 13747 0 8943 0 8166 0 177088 0 0 0 Ms Patricia Hopkins PHARMACIST 144560 0 500 0 7054 0 7733 0 16556 0 176403 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 DENISE RAY RECEIVED A DISCRETIONARY SPENDING ACCOUNT TOTALING $12,923, A FIXED AMOUNT DETERMINED BY HER JOB LEVEL. THIS SPENDING ACCOUNT WAS INCLUDED IN MS. RAY'S TAXABLE WAGES. SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT MOUNTAINSIDE HOSPITAL IS SET BY THE ENTITY'S PARENT, PIEDMONT HEALTHCARE, INC. PLEASE SEE THE SCHEDULE O NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A & 15B FOR ADDITIONAL INFORMATION. SCHEDULE J, PART I, LINE 4: SUPPLEMENTAL COMPENSATION INFORMATION SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 4B DENISE RAY AND LEIGH HAMBY RECEIVED PAYMENTS TOTALING $62,237 AND $92,157, RESPECTIVELY, FROM THEIR SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: MICHELLE BREITFELDER 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. X 3 112191 FMV false true true SCHEDULE M, PART I, LINE 32B: THIRD-PARTY ASSISTANCE WITH CONTRIBUTIONS PIEDMONT HEALTHCARE ENGAGES SUNTRUST BANK TO ASSIST WITH THE MANAGEMENT AND SALE OF ITS NON-CASH STOCK GIFTS. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2019 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT MOUNTAINSIDE HOSPITAL BY ITS SOLE MEMBER, PIEDMONT HEALTHCARE, INC. (EIN 58-1503902), PURSUANT TO AN AGREEMENT WITH THE IRS TO FILE ALL FORMS 1099 FOR THE PIEDMONT HEALTHCARE SYSTEM ON A COMBINED BASIS. FORM 990, PART VI, SECTION A, LINE 6: ORGANIZATION'S SOLE MEMBER PIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT MOUNTAINSIDE HOSPITAL ("PMH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT MOUNTAINSIDE HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT MOUNTAINSIDE HOSPITAL. FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT MOUNTAINSIDE HOSPITAL'S BOARD POLICIES AND DECISIONS MUST BE FILED, IMMEDIATELY AFTER ADOPTION, WITH THE SECRETARY OF THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS. SUCH POLICIES AND DECISIONS OF THE PIEDMONT MOUNTAINSIDE HOSPITAL BOARD OF DIRECTORS ARE NOT SUBJECT TO THE APPROVAL OF OR RATIFICATION BY THE PIEDMONT HEALTHCARE BOARD, BUT SHOULD THE NEED ARISE, THEY MAY BE RESCINDED BY THE PIEDMONT HEALTHCARE BOARD THROUGH A MAJORITY VOTE OF ITS DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B: 990 REVIEW PROCESS INFORMATION NEEDED TO PREPARE PIEDMONT MOUNTAINSIDE HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PMH'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S TAX DIRECTOR AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. PRIOR TO FILING, COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., THE ORGANIZATION'S SOLE MEMBER, FOR BOARD REVIEW. FORM 990, PART VI, SEC B, LINE 12C: CONFLICT OF INTEREST POLICY COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARE'S CHIEF COMPLIANCE OFFICER. ALL SENIOR LEADERS, BOARD MEMBERS, PHYSICIAN EMPLOYEES, NURSE PRACTITIONERS/PHYSICIAN ASSISTANTS AND EMPLOYEES AND NON-EMPLOYEES ENGAGED IN RESEARCH ARE REQUIRED TO ANNUALLY DISCLOSE ALL MATTERS WHICH COULD POTENTIALLY CONSTITUTE A CONFLICT OF INTEREST. MATTERS DISCLOSED UNDER THE POLICY MUST BE REVIEWED IN WRITING BY THE PIEDMONT HEALTHCARE CONFLICT OF INTEREST COMMITTEE IN ORDER TO DETERMINE WHETHER A CONFLICT EXISTS AND, IF SO, WHETHER TO ELIMINATE OR MANAGE THE CONFLICT. ALL BOARD MEMBERS AND EMPLOYEES OF PIEDMONT MOUNTAINSIDE HOSPITAL ARE PROVIDED TRAINING ON CONFLICT OF INTEREST ISSUES, INCLUDING REPORTING REQUIREMENTS, AT NEW EMPLOYEE ORIENTATION AND AT LEAST ANNUALLY THEREAFTER. NONCOMPLIANCE WITH THE CONFLICT OF INTEREST POLICY MUST BE REPORTED TO PIEDMONT HEALTHCARE'S SENIOR VICE PRESIDENT OF COMPLIANCE FOR INVESTIGATION, AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. FORM 990, PART VI, SEC B, LINE 15A, 15B: EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT FAYETTE HOSPITAL IS SET BY THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC. THE PIEDMONT HEALTHCARE, INC., BOARD OF DIRECTOR'S EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("THE COMMITTEE") IS COMPOSED OF AT LEAST THREE MEMBERS OF THE PHC BOARD OF DIRECTORS, SERVING TERMS OF THREE YEARS, AND THE MAJORITY OF WHICH ARE COMMUNITY DIRECTORS WHO GENERALLY DO NOT HAVE CONFLICTS OF INTEREST RELATED TO FULFILLMENT OF THE DUTIES AS OUTLINED BELOW. THE 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 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THESE DOCUMENTS SHOULD BE REQUESTED FROM PIEDMONT HEALTHCARE, INC.'S LEGAL COUNSEL. FORM 990, PART XI, LINE 9: RECONCILIATION OF NET ASSETS CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF: CONTRIBUTIONS ($1,225,810) UNALLOCATED EXPENSES ($9,313,788) BOOK/TAX DIFFERENCES ($481) CHANGE IN TEMP $660,517 INTERCOMPANY TRANSFER ($12,540,457) ------------------ TOTAL ($22,420,019) Sleep Services of Jasper LLC 1266 Highway 515 South Jasper GA 30143 Medical GA 0 0 PMH Piedmont Healthcare Inc 1800 HOWELL MILL RD STE 850 ATLANTA GA 30318 581503902 Management GA 501(c)(3) 12C, III-FI NA false PIEDMONT HOSPITAL INC 1968 Peachtree Road NW Atlanta GA 30309 580566213 Hospital GA 501(c)(3) 3 PHC false FAYETTE COMMUNITY HOSPITAL INC 1255 Highway 54 West Fayetteville GA 30214 582232328 Hospital GA 501(c)(3) 3 PHC false PIEDMONT HENRY HOSPITAL INC 1133 Eagles Landing Parkway Stockbridge GA 30281 582200195 Hospital GA 501(c)(3) 3 PHC false PIEDMONT NEWNAN HOSPITAL INC 745 Poplar Road Newnan GA 30265 205077249 Hospital GA 501(c)(3) 3 PHC false PIEDMONT HEALTHCARE FOUNDATION INC 2001 PEACHTREE RD NE STE 400 Atlanta GA 30309 581272768 Fundraising GA 501(c)(3) 12B, II PHC false PIEDMONT HEART INSTITUTE INC 95 Collier Road NW STE 2045 Atlanta GA 30309 263553500 Healthcare GA 501(c)(3) 10 PHC false PIEDMONT NEWTON HOSPITAL INC 5126 HOSPITAL DRIVE NE COVINGTON GA 30014 582155150 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT ATHENS REGIONAL FOUNDATION INC 1199 PRINCE AVENUE ATHENS GA 30606 581978389 FUNDRAISING GA 501(C)(3) 12B, II ARMC false PIEDMONT ATHENS REGIONAL HEALTH RESOURCE 1199 PRINCE AVENUE ATHENS GA 30606 581930580 DEVELOPMENT GA 501(c)(3) 12B, II ARMC false PIEDMONT ATHENS REGIONAL MEDICAL CENTER 1199 PRINCE AVENUE ATHENS GA 30606 582179986 HOSPITAL GA 501(c)(3) 3 PHC false ATHENS REGIONAL PHYSICIAN SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 582332921 HEALTHCARE GA 501(C)(3) 12B, II ARMC false REGIONAL FIRSTCARE INC 1199 PRINCE AVENUE ATHENS GA 30606 582362733 URGENT CARE GA 501(C)(3) 12B, II ARMC false ATHENS REGIONAL SPECIALTY SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 271975001 HEALTHCARE GA 501(C)(3) 3 ARMC false COLUMBUS AMBULATORY HEALTHCARE SERVICES 707 CENTER ST COLUMBUS GA 31901 581719867 AMBULATORY GA 501(C)(3) 3 CRHS false COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 707 CENTER ST COLUMBUS GA 31901 581719994 HEALTHCARE GA 501(C)(3) 12B, II PHC false COLUMBUS REGIONAL MEDICAL FOUNDATION INC 707 CENTER ST COLUMBUS GA 31901 581501642 FUNDRAISING GA 501(C)(3) 7 CRHS false THE MEDICAL CENTER INC 710 CENTER ST COLUMBUS GA 31901 581685139 HOSPITAL GA 501(C)(3) 3 CRHS false HUGHSTON HOSPITAL INC 707 CENTER ST COLUMBUS GA 31901 331216751 HOSPITAL GA 501(C)(3) 3 CRHS false PIEDMONT ROCKDALE HOSPITAL INC 1412 MILSTEAD AVE CONYERS GA 30012 300999841 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT WALTON HOSPITAL INC 2151 WEST SPRING ST MONROE GA 30655 824194264 HOSPITAL GA 501(C)(3) 3 PHC false PEACHTREE ORTHOPAEDIC SURGERY CENTER 2001 PEACHTREE RD NE STE 705 ATLANTA GA 30309 582562721 SURGERY GA NA N/A 0 0 false 0 false 0.00000 DIGESTIVE HEALTHCARE OF GA ENDOSCOPY CTR 95 COLLIER RD NW STE 4075 ATLANTA GA 30309 582406657 HEALTHCARE GA NA N/A 0 0 false 0 false 0.00000 FOUR WINDS HEALTH LLC 3350 RIVERWOOD PKWY STE 1850 ATLANTA GA 30339 451273930 HEALTHCARE GA NA N/A 0 0 false 0 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 Ste 1-1100 Atlanta GA 30339 582092768 Healthcare GA PHC C Corp 0 0 0.00000 false The Piedmont Clinic Inc 2727 Paces Ferry Rd Ste 1-1100 Atlanta GA 30339 582005358 Healthcare GA PHC C Corp 0 0 0.00000 false Piedmont Heart Institute Physicians Inc 95 Collier Road NW Ste 2045 Atlanta GA 30309 260593850 Healthcare GA PHC C Corp 0 0 0.00000 false Amster McRae Insurance Company PO BOX 1159 Grand Cayman Grand Cayman CJ KY1-1102 980427603 Related Insur CJ PHC C Corp 0 0 0.00000 false PIEDMONT WELLSTAR HEALTHPLANS INC 2859 PACES FERRY RD STE 600 ATLANTA GA 30339 461922499 HEALTH INSUR. GA PHC C CORP 0 0 0.00000 false COLUMBUS HEALTHCARE RESOURCES PO BOX 790 COLUMBUS GA 31902 581717754 HEALTHCARE GA CRHS C-CORP 0 0 0.00000 false Columbus Health Services Inc PO BOX 790 COLUMBUS GA 31902 581640939 HEALTHCARE GA CRHS C CORP 0 0 0.00000 false false false false false false false false false false false false false false false false true true false false SCHEDULE R, PART I, LINE 1: DISREGARDED ENTITIES THE LIMITED LIABILITY COMPANY LISTED IN SCHEDULE R, PART I, OPERATES AS A DEPARTMENT OF PIEDMONT MOUNTAINSIDE HOSPITAL AND IS INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LLC AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.