2020-05-15T09:40:11-05:00 2019-06-30 KPMG LLP 300 North Greene Street Suite 400 Greensboro NC 27401 990 2018-07-01 582155150 PIEDMONT NEWTON HOSPITAL % MARIE GAFFNEY PIED 7707867053 5126 Hospital Drive NE Covington GA 300142566 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2020-05-11 true SHAWN HUTCHINSON P01048557 3362753394 2020-05-14 199.206.0.5 56038220201365000016 2020-05-15 P 1272C807EE2CFB18DB9032F475C1250F2D6A8CEA 1272C807EE2CFB18DB9032F475C1250F2D6A8CEA 2018 2021-01-29 14:40:06Z Dr Eric Bour 5126 Hospital Drive NE Covington GA 300142566 116037097 false X www.piedmont.org X 1995 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 10 4 829 135 0 38171 64492 102185306 114292912 -35352 44556 1255335 1334786 103443460 115736746 0 0 0 0 49276758 49988044 0 0 0 66491573 58423230 115768331 108411274 -12324871 7325472 48127698 59120561 24261237 22462012 23866461 36658549 X 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 92341026 0 114763655 PIEDMONT NEWTON HOSPITAL ("PNtH") IS A 97-BED, NON-PROFIT HOSPITAL LOCATED IN THE CITY OF COVINGTON IN NEWTON COUNTY, GEORGIA. OVER 250 PRIMARY CARE AND SPECIALTY PHYSICIANS COMPRISE THE MEDICAL STAFF AND MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN NEWTON COUNTY AND THE GREATER METROPOLITAN ATLANTA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2019, THE HOSPITAL HAD 5,336 IN-PATIENT ADMISSIONS WITH A TOTAL OF 17,863 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 44,047 AND OUTPATIENT VISITS TOTALED 41,568. 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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, 2019 AND 2018. true true X true X 300. true X true true false true true 8606242 8606242 0.09370 3746462 3821630 -75168 0.00000 744540 880515 -135975 0.00000 13097244 4702145 8395099 0.09370 22200 22200 0.00020 830326 830326 0.00900 3733 3733 0.00010 40000 40000 0.00040 896259 896259 0.00970 13993503 4702145 9291358 0.10340 true 16747008 20882956 22912846 -2029890 X true true 1 1 PIEDMONT NEWTON HOSPITAL INC 5126 HOSPITAL DRIVE NE COVINGTON GA 300142566 WWW.PIEDMONT.ORG 107-518 X X X PHYSICIAN CLINICS PIEDMONT NEWTON HOSPITAL INC 1 false false true X X X X X X X X 18 true false false true X SEE PART VI X X true 17 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, 42 key stakeholders within the Piedmont Newton 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 Newton 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/PntH-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 NEWTON 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 NEWTON HOSPITAL UNANIMOUSLY APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE YEAR PERIOD BEGINNING WITH FY20 ON AUGUST 15, 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, 2019. https://www.piedmont.org/media/file/2017-19-Implementation-Strategies.pdf SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS IN 2013 PNtH PARTNERED WITH THE NEWTON COUNTY COMMUNITY PARTNERSHIP (NCCP) AND HEALTHY NEWTON TO CHANGE THE APPROACH FROM A MULTIPLE AND A PARALLEL EFFORT TO A COORDINATED AN COLLABORATIVE PROCESS WITH A UNITED GOAL OF FULLY IMPLEMENTING THE NEWTON COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN. THE PLAN WAS FINALIZED FEBRUARY 2014 AND IS POSTED ON THE GWINNETT, NEWTON, ROCKDALE HEALTH DEPARTMENT SITE (WWW.GNRHEALTH.COM) AND ON THE NCCP SITE (WWW.NEWTONPARTNERSHIP.ORG). THE CORE LEADERSHIP TEAM WAS IDENTIFIED IN FEBRUARY, 2014, TO COORDINATE THE IMPLEMENTATION OF WORKABLE INITIATIVES AND ACTIVITIES. THE TEAM MEETS MONTHLY ON THE 2ND TUESDAY OF EACH MONTH. THE CORE LEADERSHIP TEAM CONSISTS OF: NCCP, GNR HEALTH DEPARTMENT, NMC, NEWTON COUTNY SCHOOLS, VIEW POINT HEALTH (MENTAL HEALTH) AND HEARTS FOR FAMILIES. THE TEAM IDENTIFIED 5 PRIORITY TOPICS FROM TOP 9 IDENTIFIED IN NMC COMMUNITY ASSESSMENT: 1. ACCESS TO CARE (NMC LEAD) 2. ACCESS TO MENTAL HEALTH SERVICES (VPH LEAD) 3. OBESITY & DIABETES WITH A FOCUS ON HEALTHY BODY WEIGHT FOR CHILDREN (NCCP AND PUBLIC HEALTH LEAD) 4. TOBACCO USE PREVENTION (PUBLIC HEALTH AND NCCP) 5. TEEN LIFESTYLE ISSUES (NCCP LEAD) DURING FY16, PIEDMONT NEWTON HOSPITAL CONDUCTED ITS SECOND CHNA, 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 NEWTON 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 NEWTON 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 NEWTON HOSPITAL DEVELOPED THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS DURING FY18. PIEDMONT NEWTON HOSPITAL DEVELOPED THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS DURING FY20-22. The PNTH Board of Directors unanimously approved the new CHNA on MAY 16, 2019. Based on the CHNA, PNTH 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 PREVENTABLE EMERGENCY DEPARTMENT RE-ENCOUNTERS AND HOSPITAL READMISSIONS; (3) REDUCE OPIOID AND RELATED SUBSTANCE ABUSE AND OVERDOSE DEATHS; (4) DECREASE DEATHS FROM ALL CANCERS AND INCREASE ACCESS TO CANCER PROGRAMMING, WITH A FOCUS ON LUNG CANCER; AND (5) 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 1 NEWTON MEDICAL CENTER HOME HEALTH 5126 HOSPITAL DRIVE COVINGTON GA 30209 HOME HEALTH AGENCY SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A Piedmont Newton 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 $108,411,274 LESS BAD DEBT EXPENSE OF $16,747,008 FROM FORM 990, PART IX, LINE 24(A). 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. PNTH 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. BAD DEBT METHODOLOGY Schedule H, Part III, Line 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. 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 Newton 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 19.79% of Piedmont Newton 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 Newton 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 Newton Hospital conducted its second triennial community health needs assessment (CHNA). The Piedmont Newton CHNA was led by the Piedmont Healthcare community benefits team, with input and direction from Piedmont Newton leadership and direct input from board members both at a February 2018 board meeting and through individual meetings with hospital leadership, including the hospital's chief executive officer and chief financial officer. Process The CHNA started first with a definition of our community. We defined the hospital's primary population as the hospital's home county, due to the impact of its 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 DeKalb County. 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 was 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 guide our community benefit work. They are, in no order: . Increase access points for 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 all cancers, with a focus on lung cancer . Reduce preventable instances of and deaths from heart disease . Reduce preventable emergency department re-encounters and hospital readmissions . 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. This community health needs assessment was unanimously approved by the Piedmont Newton Hospital board of directors on May 16, 2019. The Piedmont Newton 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 Newton Hospital leadership and the Piedmont Newton 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. The CHNA implementation strategy was approved August 15, 2019. SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY Piedmont Newton 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 Newton 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 Newton 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 FY19, we distributed approximately 3,400 copies of this guide throughout the Newton community. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION Piedmont Newton Hospital is located in Covington, Georgia. In 2017, the last year Census data was available, approximately 99,958 people lived in Newton County. That year, about 54 percent of all Newton County residents were white, 41 percent were African American, about 5 percent were Hispanic. The median household income was $52,784 in 2017, lower than both state and national averages. The median age of people living within the county was 36 in 2017. In 2017, an estimated 85 percent of county residents graduated high school, right on par with the state average of 86 percent. Sixty-one percent of county residents have attended at least some college in 2017, a statistic on par with the state but far below the national average. Of the estimated 46,324 who were employed in 2017, most worked in educational services/health care/social assistance, manufacturing and retail, in that order. There were about 7,277 veterans living in the county in 2017, with half having served in the Gulf War and nearly a third having served in Vietnam. Nineteen percent of those veterans lived with a disability, and about 14 percent lived below the poverty level. About 6 percent of households spoke a language other than English at home in 2017, with the majority of those households speaking Spanish. Most people -- about 70 percent -- owned their home in 2017, a number higher than the state average of 63 percent. In Newton County, like with the rest of Georgia, heart disease is the number one cause of both age-adjusted and premature death, 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. Motor vehicle crashes were the top cause of premature death in Newton County between 2013 and 2017, with a total staggering 3,341 community members having died due to a motor vehicle accident. Heart disease was the second top cause of premature death and homicide the third. Suicide and lung cancer were the fourth and fifth leading causes of premature death between 2013 and 2017, respectively. In Newton County, 19 percent of the adult population was uninsured in 2018, and 13 percent of the total population was uninsured that year. People without insurance coverage have less access to care than people who are insured. Access to dental care also presents issues. There were 17 dentists for every 100,000 people in 2015, a figure nearly three times below the state average and four times below the national average. Community members have reported an average 4.3 and 4.0 poor or fair physical and mental health days, respectively, and 19 percent of Newton County residents reported their health as poor or fair. All three indicators have worsened since our last CHNA. Preventable hospital stays among Medicare enrollees has steadily decreased over the last few years, from 96 preventable stays per every 1,000 enrollees in 2007 to 58 preventable stays per every 1,000 enrollees in 2015. This is still higher than state and national averages. Fifteen percent of the population lived with at least one disability in 2017, which was higher than the state average of 12 percent. The highest concentration of disabled populations in the southern part of the county. The infant mortality rate in Newton County is on par with the state averages, at 7.5 infant deaths per every 1,000 births in 2017. That year, 10 percent of all babies born were at a low birth weight, and with African American infants most likely to be born at a low birth weight. The number one cause of age-adjusted deaths for both men and women each year in 2017 in Newton County was ischemic heart and vascular disease. In that year alone, 246 people died from heart disease. In 2017, 40 Newton County community members died from stroke. Between 2012 and 2016, the death rate from stroke averaged 44.5 people per every 100,000 people annually, which is higher than both state and national averages. Approximately 13.3 percent of adults lived with diabetes in Newton County in 2015, a figure slightly higher than state and national averages (11 percent and 9 percent, respectively). In 2015, 24 percent of Medicare beneficiaries lived with diabetes. The numbers may be higher for Medicare beneficiaries because that population is more likely to be tested routinely for the disease. Breast cancer ranked 11th and colon, rectum and anal cancers ranked 13th in age-adjusted deaths between 2013 and 2017. Overall, while breast cancer death rates have declined over the last several years, so has prevention. In 2015, only 59 percent of eligible Medicare enrollees said they had a mammogram sometime within the previous two years, a figure down by about 13 percent from three years previous. Rates of new breast cancer diagnoses rates are high at 133 per every 100,000 residents in 2015, a figure above the state and national average of 125 per every 100,000 residents. In Newton, white women are more likely to be diagnosed with the disease than their minority counterparts. Chronic obstructive pulmonary disease was the fifth leading cause of age-adjusted death between 2013 and 2017. The most common cause of the disease is smoking and long-term exposure to other lung irritants. Obesity rates are higher than state and national averages in Newton County, and likely contributes to a number of diseases, including heart disease, stroke and diabetes. Smoking rates are the same as the state average, as is binge drinking. Long commutes are also higher in Newton County than in the rest of the state -- 16 percent drove more than 60 minutes to work in 2016, and most drive alone. A 2017 study showed that those with long commutes tend to be more depressed, have more work-related stress, get less sleep and are more likely to be obese. The violent crime rate was 381.8 per every 100,000 county residents, a figure relatively on par with the state average of 378 and the national average of 380 per every 100,000 residents. Mental health and behavioral disorders (not including suicide) was the third leading cause of age-adjusted death for all county residents between 2013 and 2017. Suicide was the fourth cause of premature deaths for whites and the 8th leading cause of premature death for other races between 2013 and 2017. It was most common among males aged 25 to 34 years of age. There was one mental health provider for every 1,114 county residents in the county in 2017, a rate much worse than the state and national averages of one provider for every 813 and 493 residents, respectively. While there was a drop in overall rates of poisoning by substance abuse at Piedmont Newton between 2017 and 2018, there was a significant increase in almost all diagnoses related to opioid use between those years for inpatients and those presenting at the emergency department, combined. This shows that the problem is worsening for our patients. Opioid prescriptions are down. In 2007, there were approximately 88.3 retail opioid prescriptions dispensed per 100 persons, according to the CDC. That number has dropped to 75.8 in 2017. Even so, Newton County remains much higher than the national average of 58.7 per 100 people and state average of 70.9. We aren't able to tell how many prescriptions are going to a single person, just the overall figure. For the 2015-2016 school year, the graduation rate was 94 percent, much higher than the state average of 82 percent. That said, about 16 percent of the county's adult population does not have a high school diploma. In 2016, a third of county residents did not have access to a large grocery store in 2017, meaning there are limited places for county residents to buy healthy foods. This is worse than the state average of 22 percent. In 2016, 11 percent of the population has limited access to healthy foods and 17 percent report having extended periods when they aren't sure how their families will eat. Forty-three percent of children lived in single parent homes in 2017, which is statistically linked to lower graduation rates and higher poverty rates. The majority of these single parent homes are led by women, and 29 percent of those households are at or below the federal poverty level. Sixty-nine percent of children qualified for free or reduced cost lunch in the 2015-2016 school year, a statistic that represents poverty and food instability. Newton County is higher than the state average of 62 percent. For every 1,000 teen girls aged 15 to 18 in Newton County, 32 gave birth to a child on average each year between 2010 and 2016. This impacts minorities more than their white counterparts. In Newton, African American and Hispanic or Latina teen birth rates were 15.2 and 35.8 teen births per every 1,000 teen women, respectively. Twenty-four percent of children in Newton County lived in poverty in 2017, a figure that has steadily gotten worse over the last ten years. Poor children are statistically less likely to graduate high sc SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH Piedmont Newton 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. Also, in FY19, Piedmont Newton Hospital awarded approximately $40,000 in funding to three not-for-profit organizations whose programs aligned with our FY16 CHNA. The three grant recipients in FY19 were: A Child's Voice Child Advocacy Center, who provides forensic medical examinations to children who have been assaulted; the Newton County Community Partnership, for its Be Healthy Newton program; and the Willing Helpers Medical Center, to support general operations. The hospital also provided pharmaceutical support to the Willing Helpers clinic at no charge to the clinic or its patients, as well as the provision of certain specialty care services. Additionally, the hospital's chief medical officer regularly volunteered his services and organizational guidance, and the hospital's chief executive officer located and donated new medical space to house the clinic, at no charge. The hospital provided services through the Women's Diagnostic Center including navigation services, support groups, the Hope Boutique, educational programming, and breast cancer awareness and prevention events in the Newton community. The hospital also supported the Newton County Resource Court, which works to identify alternative judgements and solutions for those convicted of certain non-violent crimes but may have mitigating circumstances. The hospital's support included health screenings, health education and referrals to community-based providers. The hospital also provided Resource Court participants with household and hygiene items. Piedmont Newton Hospital also provided health professions education to students and residents training to be health professionals. In FY19, Piedmont Newton Hospital medical staff oversaw a total 26,694 hours of training at a cost of $830,326. As part of a Piedmont Healthcare systemwide effort, Piedmont Newton 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. Piedmont Newton Hospital also actively participated in local take-back day activities in FY19 by promoting and supporting a community drive for local residents to safely dispose of medications. Additionally, and as mentioned above, Piedmont Newton 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. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM Piedmont Newton 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 Newton 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 Mr Michael Burnett Board Member 0 437689 0 219248 0 98667 0 78888 0 16542 0 851034 0 62388 Dr Eric Bour CEO & BOARD MEMBER 291322 0 143000 0 21405 0 56145 0 15894 0 527766 0 0 0 Dr Leigh Hamby Board Member 0 581251 0 396758 0 147719 0 105326 0 16506 0 1247560 0 88826 Dr Norris Little CMO & Board Member 321506 0 102525 0 25962 0 10047 0 11979 0 472019 0 0 0 Dr Renee Riley Board Member 0 784442 0 0 0 45283 0 16500 0 16413 0 862638 0 0 Mr Troy Brooks CFO (END 7/18) 127575 0 0 0 330116 0 13788 0 4118 0 475597 0 0 0 Mr William Love Exec. Dir. - Patient Svcs 168851 0 33221 0 346 0 9451 0 1493 0 213362 0 0 0 Mr Jeremiah Bame CNO 152898 0 53690 0 9399 0 13121 0 6476 0 235584 0 0 0 Ms Lauren Matthews CFO (EFF. 12/19) 140995 0 18456 0 9189 0 10163 0 6139 0 184942 0 0 0 Ms Leigh Wilson Dir. - Pharmacy 137011 0 20800 0 343 0 7693 0 14931 0 180778 0 0 0 Mr Mark Arneson Dir. - Laboratory 135658 0 17810 0 1433 0 2529 0 1391 0 158821 0 0 0 Mr Michael McAnder Treasurer & Board Member 0 598784 0 408746 0 96080 0 121042 0 7634 0 1232286 0 0 Ms Elizabeth Leddy Secretary 0 422090 0 288072 0 42079 0 84235 0 16280 0 852756 0 0 Mr Alan Slutsky Pharmacist 110791 133 43926 6880 632 162362 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS DR. ERIC BOUR RECEIVED A DISCRETIONARY SPENDING ACCOUNT TOTALING $12,923, A FIXED AMOUNT DETERMINED BY HIS JOB LEVEL. THIS SPENDING ACCOUNT WAS INCLUDED IN DR. BOUR'S TAXABLE WAGES. SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT NEWTON 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 JAMES BURNETT AND DR. LEIGH HAMBY RECEIVED SERP PAYMENTS IN THE AMOUNT OF $62,388 AND $88,826, RESPECTIVELY. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: MICHAEL MCANDER TROY BROOKS ELIZABETH LEDDY DR. ERIC BOUR WILLIAM LITTLE 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 NEWTON COUNTY HOSPITAL AUTHORITY 586004174 2006-04-27 8930000 4TH FLOOR ADDITION TO HOSPITAL false false false B NEWTON COUNTY HOSPITAL AUTHORITY 586004174 2007-05-30 17225000 ADVANCED REFUND OF 1999 BONDS false false false A 5665000 0 9010590 1239285 0 0 178600 0 0 8751400 0 0 2007 false false true true B 10030000 0 17225000 114219 0 16989001 235999 0 0 0 0 0 2012 false true true true A false false false false 0 false false false true B false false false false 0 false false false true A false false false true false false 0 false 0 false true B false false false true false false 0 false 0 false true A true B true SCHEDULE K, PART II, LINE 3: TOTAL PROCEEDS FROM ISSUE TOTAL PROCEEDS INCLUDES TOTAL INVESTMENT EARNING FROM SINKING FUND OF $80,590. SCHEDULE K, PART IV, LINE 2C: REBATE CALCULATION NEWTON COUNTY HOSPITAL AUTHORITY 04/27/17 NEWTON COUNTY HOSPITAL AUTHORITY 03/06/17 FORM 990, PART I, LINE 4 AND PART VI, LINE 1B: INDEPENDENT BOARD MEMBERS PIEDMONT NEWTON HOSPITAL'S ("PNTH") BOARD OF DIRECTORS IS COMPRISED OF TEN VOTING MEMBERS, FOUR OF WHICH ARE INDEPENDENT BASED UPON IRS GUIDELINES. WHILE PNTH ITSELF DOES NOT HAVE AN INDEPENDENT BOARD OF DIRECTORS, ANY DECISIONS MADE BY THE PNTH BOARD MAY BE RESCINDED BY THE BOARD OF DIRECTORS OF PNTH'S SOLE MEMBER, PIEDMONT HEALTHCARE, INC. IN ADDITION, PIEDMONT HEALTHCARE APPOINTS THE MEMBERS OF THE PNTH BOARD, SETS COMPENSATION FOR PNTH'S EXECUTIVES, AND MONITORS PNTH'S COMPLIANCE WITH PIEDMONT HEALTHCARE POLICIES AND PROCEDURES. THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS IS COMPRISED OF A MAJORITY OF INDEPENDENT MEMBERS, AND THEREFORE PNTH IS EFFECTIVELY GOVERNED BY AN INDEPENDENT BOARD. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2018 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT NEWTON 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 NEWTON HOSPITAL ("PNtH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT NEWTON HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT NEWTON HOSPITAL. FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT NEWTON 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 NEWTON 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 NEWTON HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PNTH'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, SECTION B, LINE 12C: CONFLICT OF INTEREST 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 NEWTON 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 NEWTON HOSPITAL IS SET BY THE BOARD OF DIRECTORS OF AND PAID ON BEHALF OF THE HOSPITAL BY 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 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 LIMITED TO, APPROVAL OF EXECUTIVE EMPLOYMENT CONTRACTS AND BENEFITS. 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 ($26,364) CHANGE IN UNRESTRICTED $180,784 BOOK/TAX DIFFERENCES $22,563 CHANGE IN TEMP $2,253,793 INTERCOMPANY TRANSFERS $5,838,162 UNALLOCATED EXPENSES ($2,802,322) ------------------ TOTAL $5,466,616 PIEDMONT HEALTHCARE INC 1800 HOWELL MILL ROAD SUITE 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 582322328 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 HENRY HOSPITAL INC 1133 EAGLES LANDING PKWY STOCKBRIDGE GA 30281 582200195 HOSPITAL GA 501(C)(3) 3 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 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 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 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 DIGESTIVE HEALTHCARE OF GA ENDOSCOPY CEN 95 COLLIER RD NW STE 4075 ATLANTA GA 30309 582406657 HEATHCARE GA NA N/A 0 0 false 0 false FOUR WINDS HEALTH LLC 3350 RIVERWOOD PKWY STE 1850 ATLANTA GA 30339 451273930 HEALTHCARE GA NA N/A 0 0 false 0 false 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 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 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 NA 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