2019-05-14T17:58:31-05:00 2018-06-30 KPMG LLP 300 North Greene Street Suite 400 Greensboro NC 27401 990 2017-07-01 582179986 PIEDMONT Athens Regional Medical Center Inc % MARIE GAFFNEY PIED 7064757000 1199 PRINCE AVENUE ATHENS GA 30606 MARIE GAFFNEY VP CORP. FINANCE 4702716007 2019-05-14 true SHAWN HUTCHINSON CPA P01048557 3362753394 2019-05-14 167.68.102.5 56038220191345000017 2019-05-14 P 3BDC32D82005B4FB5A5B30B5BF6243933C14C3D8 3BDC32D82005B4FB5A5B30B5BF6243933C14C3D8 2017 2019-02-21 02:37:17Z CHARLES PECK PRESIDENT CEO 1199 PRINCE AVENUE ATHENS GA 30606 505700792 false X WWW.PIEDMONT.ORG/LOCATIONS/PIEDMONT-ATHENS/ X 1987 GA PROVISION OF HEALTHCARE SERVICES. 13 11 3511 600 133889 119500 0 466523 347685823 513048904 147373445 -12583866 3134309 4733719 498193577 505665280 35600 589072 0 0 156847807 202642858 0 0 38737 159195708 268051980 316079115 471283910 182114462 34381370 476703326 449453423 252385720 237820854 224317606 211632569 THE MISSION OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER IS TO IMPROVE THE LIVES AND HEALTH OF THOSE WE TOUCH. false false 441759462 0 513082390 PIEDMONT ATHENS REGIONAL MEDICAL CENTER ("PAR") IS A 360-BED FACILITY LOCATED IN THE CITY OF ATHENS IN CLARKE COUNTY, GEORGIA. OVER 500 PRIMARY CARE AND SPECIALTY PHYSICIANS COMPRISE THE MEDICAL STAFF AND MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN ATHENS AND THE SURROUNDING NORTHEAST GEORGIA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE PERIOD FROM JULY 1, 2017 THROUGH JUNE 30, 2018, THE HOSPITAL HAD 21,427 IN-PATIENT ADMISSIONS WITH A TOTAL OF 95,022 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 85,458 AND OUTPATIENT VISITS TOTALED 274,487. SURGICAL SERVICES WERE PROVIDED TO 13,966 PATIENTS. 441759462 true true false false false false false false false false true false false false false true false true false false false false false false false false true true true true true true false false false false false false false false false false false false false false false true false false false true X 0 0 true 3511 true false false false false false false false false false false X 13 11 false false false false true true true true true false false false true true true true true true true false GA X MARIE GAFFNEY 4702716007 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 DR CHARLES PECK MD PRESIDENT/CEO 42.0 13.0 X X 1248666 0 120700 G MICHAEL SMITH TRUSTEE 3.0 15.0 X 0 0 0 DEXTER L FISHER TRUSTEE 3.0 15.0 X 0 0 0 ALAN REDDISH TRUSTEE 3.0 15.0 X 0 0 0 MICHAEL D GARRETT TRUSTEE 3.0 15.0 X 0 0 0 CHERYL K LEGETTE TRUSTEE 3.0 15.0 X 0 0 0 DR CHARLES L OGBURN III MD trustee 3.0 15.0 X 0 0 0 DR JANE M PARKS MD TRUSTEE 3.0 15.0 X 0 0 0 RICHARD B RUSSELL JR TRUSTEE 3.0 15.0 X 0 0 0 DR DAVID M SAILORS MD TRUSTEE 3.0 15.0 X 0 0 0 TRACEY WORTHINGTON STICE TRUSTEE 3.0 15.0 X 0 0 0 DR SAMUEL K THOMASON DMD CHAIR 3.0 15.0 X 0 0 0 KEVIN BROWN CEO, PHC 3.0 52.0 X X 0 2033444 389020 WENDY J COOK CHIEF FINANCIAL OFFICER 40.0 15.0 X 515450 0 36024 ELIZABETH LEDDY SECRETARY 3.0 52.0 X 0 552329 65569 LARRY EBERT EXC. DIR, STRATEGIC OPS 55.0 0.0 X 252729 0 26031 TIFFANY BURROWS CO-CHAIR PARHH 54.0 1.0 X 70577 0 5532 DR ROBERT SINYARD JR MD VP MEDICAL AFFAIRS 40.0 0.0 X 512314 0 35303 DR GEOFFREY COLE MD VP, ANCILLARY SVCS 40.0 0.0 X 372113 0 31702 JODY CORRY VP IN HOUSE LEGAL 40.0 0.0 X 338278 0 30837 ROBERT FINCH VP HUMAN RESOURCES 40.0 0.0 X 306838 0 24157 NORMAN BURKETT JR VP, PROFESSIONAL SERVICES 40.0 0.0 X 287588 0 34246 LOUIS DUHE VP AND CIO 40.0 0.0 X 272910 0 17374 DIANE TODD vP corp - compliance & ops 40.0 0.0 X 272481 0 25214 DR JAMES APPIAH-PIPPIM MD FACULTY 39.0 1.0 X 258637 87626 21031 TAMMY GILLAND VP FOUNDATION 40.0 0.0 X 218646 0 19424 CATHERINE APALOO faculty program director 40.0 0.0 X 315456 0 30389 TAMARA JACKSON CNO 40.0 0.0 X 277814 0 15065 DOMINIQUE BENNETT CONTROLLER 40.0 0.0 X 269997 0 20995 PAUL COLLAR dir, managed care 40.0 0.0 X 245739 0 29782 DARREL LAWSON exc. dir, revenue cycle 40.0 0.0 X 232672 0 20734 6268905 2673399 999129 155 false true false MEDASSIST INC 1661 LYNDON FARM CT LOUISVILLE KY 40223 REVENUE CYCLE 469935 GEORGIA NEUROLOGICAL SURGERY 2142 W BROAD ST ATHENS GA 30606 SURGICAL SERVICES 357000 IPA ONE 10712 SOUTH 1300 EAST SANDY UT 84094 MEDICAL EQUIP LEASE 370156 MEDMANAGEMENT 1500 URBAN CENTER DR BIRMINGTON AL 35242 MEDICARE COMPLIANCE 533833 CAPITOL MEDIA SOLUTIONS LLC 750 HAMMOND DR ATLANTA GA 30328 ADVERTISING SERVICES 552482 20 100025 80000 286498 466523 HEALTHCARE SERVICES 622110 502827457 502827457 PHARMACY 900099 5633913 5633913 OTHER OPERATING REVENUE 900099 4290689 4290689 PARKING 900099 296845 133889 162956 513048904 -12548354 -12548354 0 0 2488505 2488505 0 2488505 2488505 35512 -35512 -35512 -35512 0 0 0 0 0 0 360563 0 360563 360563 CAFETERIA SALES 722210 1851165 1851165 ALL OTHER REVENUE 900099 33486 33486 1884651 505665280 512785545 133889 -7720677 276788 276788 312284 312284 0 0 4734557 4460426 274131 0 157790250 148654195 9136055 0 28653245 26994222 1659023 11464806 10800993 663813 913442 913442 530403 530403 6006 6006 0 0 0 51205591 47996186 3209405 2448974 1961631 487343 16268790 16189564 79226 0 0 10271365 8513633 1757732 263656 234958 28698 0 183315 164730 18585 0 0 27293715 20470286 6823429 3898420 3898420 MEDICAL SUPPLIES & DRUGS 93499085 93499085 BAD DEBT EXPENSE 56132944 56132944 TAXES 5097537 5097537 FUNDRAISING SUPPLIES 38737 38737 471283910 441759462 29485711 38737 86778037 55986543 0 0 0 4301 79943019 60939623 0 0 0 0 0 0 9146818 9513753 9477229 8041183 339272432 34595139 291358223 304677293 0 0 0 10290727 0 0 0 0 0 0 476703326 449453423 59328760 50259727 0 0 0 346546 192987935 187214581 0 0 0 0 0 0 0 0 69025 0 252385720 237820854 X 224317606 211632569 0 0 0 0 224317606 211632569 476703326 449453423 X 34381370 11028592 -58094999 X false true X true false X 30368855 30368855 186739997 13593840 173146157 2595555 2087637 507918 96241929 18913662 77328267 23326096 23326096 304677293 0 0 X Form Sch 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, 2018 AND 2017. true true true X true X true true true false false 2416886 2416886 0.00580 21552437 21380271 172166 0.00040 1043483 632558 410925 0.00090 25012806 22012829 2999977 0.00710 100181 100181 0.00020 1294022 1294022 0.00310 1117784 1117784 0.00270 891893 891893 0.00210 3403880 3403880 0.00810 28416686 22012829 6403857 0.01520 true 56132944 674585 112461778 101800200 10661578 X true true NONE 1 1 PIEDMONT ATHENS REGIONAL MED CENTER 1199 PRINCE AVENUE ATHENS GA 30606 WWW.PIEDMONT.ORG 029-007 X X X 1 PIEDMONT ATHENS REGIONAL MED CENTER 1 false true true X X X X X X X X 15 true false false true X SEE PART VI X true 17 true SEE PART VI false true X 200. 300. X X X X true true X X X X true X SEE PART VI X SEE PART VI X SEE PART VI X X X X X X true X false X X X X true X false false SCH H, PART V, SECTION B, LINE 2 ATHENS REGIONAL HEALTH SYSTEM CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2015. ATHENS REGIONAL HEALTH SYSTEM IS THE FORMER PARENT OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER, PRIOR TO THE ACQUISITION OF THE MEDICAL CENTER BY PIEDMONT HEALTHCARE. SCH H, PART V, SECTION B, LINE 3 ATHENS REGIONAL CONDUCTED A 2015 CHNA. ATHENS REGIONAL HEALTH SYSTEM IS THE FORMER PARENT OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER (SEE SECTION C). SCH H, PART V, SECTION B, LINE 5 ATHENS REGIONAL HEALTH SYSTEM CONSULTED THE FOLLOWING ENTITIES WHEN CONDUCTING ITS MOST RECENT CHNA: ONLINE ANALYTICAL STATISTICAL INFORMATION SYSTEM WISCONSIN COUNTY HEALTH RANKINGS TICKER-NATIONAL RESEARCH CORPORATION THE STATE OF GEORGIA DEPARTMENT OF PUBLIC HEALTH NORTHEAST GEORGIA HEALTH DISTRICT PIEDMONT ATHENS REGIONAL MEDICAL CENTER OUR DAILY BREAD WHATEVER IT TAKES INITIATIVE ATHENS NEIGHBORHOOD HEALTH ATHENS NURSES CLINIC ADVANTAGE BEHAVIORAL HEALTH SYSTEM CHILDREN'S HEALTHCARE OF ATLANTA HEALTH PLAN SELECT ST. MARY'S HEALTH SYSTEM MERCY HEALTH CENTER AIDS ATHENS ATHENS PBJ INTER-COMMUNITY COUNCIL WITH ATHENS HOUSING AUTHORITY BOYS AND GIRLS CLUB AT GARNETT RIDGE ATHENS COMMUNITY COUNCIL ON AGING SCH H, PART V, SECTION B, LINE 6A ATHENS REGIONAL HEALTH SYSTEM CONDUCTED A JOINT 2015 CHNA WITH ST. MARY'S HEALTHCARE SYSTEM. SCH H, PART V, SECTION B, LINE 7A COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE https://www.piedmont.org/media/file/2015-CHNA-Athens.pdf SCH H, PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY https://www.piedmont.org/media/file/2017-19-Implementation-Strategies.pdf SCH H, PART V, SECTION B, LINE 11 In 2015, the then-Athens Regional Health System administration and board approved the hospitals Community Health Needs Assessment (CHNA), which was developed using primary and secondary data, internal hospital data, findings from key stakeholder interviews and other relevant community-based information. The CHNA identified several key health priorities, which were developed using four key criteria: 1) the number of people affected, 2) the severity of the problem, 3) the health systems ability to impact, and 4) the extent to which other organizations are already meeting the need. From the CHNA findings, and in partnership with hospital leadership and community stakeholders, Athens Regional Health System developed its implementation strategy to address the identified priorities listed in the 2015 CHNA. The initial implementation strategy was approved by the Athens Regional Health System Board of Directors on November 24, 2015. Athens Regional joined the Piedmont Healthcare system as Piedmont Athens Regional Medical Center ("PARMC") in October 2016. In March 2017, the Piedmont Health System community benefit team, in partnership with PAR leadership, redrafted the implementation strategy to align it with system priorities and to reflect the shift in ownership. Core strategies from the original were maintained, and several priorities were combined as they share strategies. PARMC has attempted to increase access to care and services by providing financial assistance and covering any short-falls for low and no-income populations through free and reduced-cost care to qualifying patients through Piedmont Healthcares Financial Assistance Policy. PARMC has also continued to support care for Medicaid populations through coverage of cost shortfalls and by enrolling qualifying patients with vendors. PARMC has also maintained a partnership with Mercy Clinic for the provision of free pharmaceuticals. PARMC also identified supporting cardiovascular, cerebrovascular, and respiratory health and combating obesity and diabetes as a community need. PARMC provides grant funding to community based non-profits to help at-risk populations directly. Further, PARMC provides a variety of healthy lifestyle community education programing, including nutrition counseling, smoke-free campaigns, and other lifestyle classes at the local YMCA. PARMC has also remained accredited for stroke and cardiovascular services. SCH H, PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITES FINANCIAL ASSISTANCE POLICY - https://www.piedmont.org/media/file/Financial-Assistance-Policy.pdf FINANCIAL ASSISTANCE APPLICATION - https://www.piedmont.org/media/file/Financial-Assistance-Application.pdf FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY - https://www.piedmont.org/media/file/Financial-Assistance-Plain-Language-Su mmary-English.pdf Sch H, Part I, Line 6a A report on our community benefit activities can be found online, it is widely distributed to the public through both printed copies made available to community members upon request and through publication on the systems website. A report on Piedmont Athens Regional Hospitals community benefits is also found both within the health care systems annual report and the health care systems 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 systems website. Additionally, the report was mailed to hospital and system board members, state and local elected officials and other key stakeholders. SCH H, PART I, LINE 7 PIEDMONT ATHENS REGIONAL MEDICAL CENTER IS IN THE PROCESS OF DEVELOPING AND IMPLEMENTING A COSTING SYSTEM. HOWEVER, CURRENTLY, A COST TO CHARGE RATIO WAS USED TO CALCULATE THE AMOUNTS SHOWN IN PART 1, LINE 7. Sch H, Part III, Line 4 The provision for bad debts is based upon managements 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. SCH H, PART III, LINE 8 The amount reported on Part III, Line 6, was calculated in accordance with Schedule H instructions and utilizing the organizations 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 the hospitals 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 48.34 percent of the hospitals patient service revenue . The hospitals policy is to treat Medicare patients, regardless of the extent to which Medicare actually pays for the treatment. For many services, Medicares 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 hospitals commitment to treat elderly patients. SCH H, PART VI, LINE 2 The 2015-2016 Athens Regional Health System/St. Marys Healthcare Systems Community Health Needs Assessment (CHNA) was produced as a joint undertaking entered into by both regional healthcare providers to satisfy the requirements of Section 501(r) of the IRS code. Community Connection of Northeast Georgia, a 501(c)(3) Athens-based nonprofit corporation with which the two hospitals contracted, produced the present report, which provides an overview of the health needs in the 17-county catchment area served by the hospitals. In keeping with the ACA requirement, contained within this report are reflections of both the health needs in the region served by the hospital as well as the health-promoting assets and community-based resources upon which the community depends for its current state of heath. Special attention has been given to the identification of health disparities, the needs of vulnerable populations, and the unmet health needs of the region. On behalf of the hospital, Community Connection conducted 27 key informant interviews, 15 focus groups and a widespread online community survey. Community Connection also extensively analyzed community-based data. In the CHNA, we identified our top health priorities to address over a three-year period. These were: cardiovascular health, cerebrovascular health, cancer, HIV/AIDS and STDs, respiratory health, mental health and substance abuse, diabetes and obesity, maternal and infant health, access to care, and injury prevention and safety. As a note, at the time the CHNA was conducted, the hospital was not part of the Piedmont Healthcare system and conducted operations as Athens Regional Medical Center. SCH H, PART VI, LINE 3 Patient education of availability of assistance: Piedmont Healthcare understands that not everyone will have 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 Athens Regional 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 Athens Regional Hospital also publishes and widely publicizes a plain language summary of this financial assistance care policy on its facility website, which will include 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. SCH H, PART VI, LINE 4 Piedmont Athens Regional Hospital is located in Athens, Georgia, and considers Clarke County its home county for the purposes of its community benefit programming. In 2017, 123,554 people live in Clarke County. Sixty-two percent of the county was white, 27 percent was black and 10 percent was Hispanic/Latino and 1 percent is Asian. Fourteen percent of total Clarke County residents were uninsured in 2017, and nearly one in five non-elderly adults were uninsured. (US Census, American Community Survey, 2017) Ninety-two percent of children qualified for free or reduced cost for free lunch in the 2015-2016 school year, as compared to a state average of 62 percent and a national average of 52 percent. For the 2015-2016 school year, 80 percent of the countys high school students graduated within four years (National Center for Education Statistics). Unemployment was at 3.7 percent in 2018, which is close to state and national averages (US Department of Labor, Bureau of Labor Statistics). In 2015, there was one primary care physician for every 1,490 residents of the county, compared to one for 1,030 for the state. Twenty-three percent of adults reported they were in poor or fair health, a figure above the Georgia average of 19 percent. In 2017, 22 percent of adults smoked, 22 percent were physically inactive, and 26 percent were obese (University of Wisconsin Population Health Institute, County Health Rankings, 2018, with data years ranging from 2014 to 2017). SCH H, PART VI, LINE 5 Piedmont Athens Regional Hospital actively promotes the health of its community through community-based health screenings, educational 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. In FY18, Piedmont Athens Regional 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 FY16 CHNA and implementation strategy. Grant recipients in FY18 were: Athens Community Council on Aging, Clarke County Department of Health (Northeast Health District WIC), Extra Special People, MedLink Georgia, Mercy Health Center and P.L.A.C.E.S. (Promoting Local Agriculture and Cultural Experiences). Other community partners included: Athens-Clarke County Diversion Center, Athena Gardens, Athens Nurses Clinic, Early Psychosis Intervention, Clinic of Advantage, Athens-Clarke School System, Jackson County Senior Center, Mt. Pleasant Community Church, Oconee County Senior Center, Oconee County Senior Center, Womens Services of Advantage Behavioral Health, Ebenezer Baptist, Our Daily Bread of Action Ministries, Athens Land Trusts West Broad Farmers Market, Jackson County School System, Oconee County, City of Auburn and City of Commerce. Partnerships vary with each organization, though often include health education and outreach, such as promotion of healthy behaviors, including smoking cessation. In FY18, Piedmont Athens Piedmont Hospital also provided health professions education to students and residents training to be health professionals. That year, the hospital oversaw training at a cost of $6,967,495. SCH H, PART VI, LINE 6 Piedmont Athens Regional 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 Healthcares 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. SCH H, PART VI, LINE 7 Piedmont Athens Regional 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 UNIVERSITY OF GEORGIA ATHLETIC ASSOCIATION PO BOX 1472 ATHENS GA 30603 580652518 501(C)(3) 10000 GENERAL SUPPORT ATHENS AREA COMMUNITY FOUNDATION PO BOX 1543 ATHENS GA 30603 261838979 501(c)(3) 25000 GENERAL SUPPORT ENVISION ATHENS 301 COLLEGE AVE ATHENS GA 30601 000000000 gov't 11000 GENERAL SUPPORT ATHENS NURSES CLINIC 240 NORTH AVE ATHENS GA 30601 582490925 501(c)(3) 42888 GENERAL SUPPORT STATE BOTANICAL GARDEN OF GEORGIA 2450 S MILLEDGE AVENUE ATHENS GA 30605 237182479 501(c)(3) 7500 GENERAL SUPPORT FAMILY CONNECTION OF ATHENS PO BOX 1904 ATHENS GA 30603 582204209 501(c)(3) 10000 GENERAL SUPPORT ACC-SANE 3035 LEXINGTON RD ATHENS GA 30605 582203027 501(c)(3) 36423 GENERAL SUPPORT ATHENS COMMUNITY COUNCIL ON AGING 135 HOYT ST ATHENS GA 30601 580977680 501(c)(3) 7500 GENERAL SUPPORT MERCY HEALTH CARE 700 OGLETHORPE AVE ATHENS GA 30606 582603523 501(c)(3) 39512 GENERAL SUPPORT 9 COMMUNITY BENEFIT 312284 SCHEDULE I, PART I, LINE 2 MONITORING THE USE OF GRANT FUNDS MONEY IS GIVEN TO CHARITABLE ORGANIZATIONS WHICH PRIMARILY PROMOTE HEALTH CARE CAUSES. THE GRANTS ARE ADMINISTERED AND MONITORED THROUGH THE ORGANIZATION'S PUBLIC RELATIONS DEPARTMENT. SCHEDULE I, PART III, LINE 1B NUMBER OF RECIPIENTS GRANTS TO INDIVIDUALS WERE MADE TO RESIDENTS OF THE GREATER ATHENS-CLARKE COMMUNITY IN SUPPORT OF PARMC'S COMMUNITY BENEFIT. PROGRAMS WERE CONDUCTED IN SUPPORT OF PARMC'S IMPLEMENTATION STRATEGY AND TO COMBAT THE LARGEST IDENTIFIED NEEDS OF THE COMMUNITY. X X false true false true false false false false false false false DR CHARLES PECK MD PRESIDENT/CEO 586715 0 190412 0 471539 0 83250 0 37450 0 1369366 0 83250 0 KEVIN BROWN CEO, PHC 0 1071546 0 831267 0 130631 0 372452 0 16568 0 2422464 0 0 WENDY J COOK CHIEF FINANCIAL OFFICER 355371 0 62544 0 97535 0 18000 0 18024 0 551474 0 0 0 ELIZABETH LEDDY SECRETARY 0 344306 0 90667 0 117356 0 53125 0 12444 0 617898 0 0 LARRY EBERT EXC. DIR, STRATEGIC OPS 211182 0 18038 0 23509 0 12097 0 13934 0 278760 0 0 0 DR ROBERT SINYARD JR MD VP MEDICAL AFFAIRS 406593 0 62728 0 42993 0 0 0 35303 0 547617 0 0 0 DR GEOFFREY COLE MD VP, ANCILLARY SVCS 283802 0 45279 0 43032 0 20318 0 11384 0 403815 0 0 0 JODY CORRY VP IN HOUSE LEGAL 272300 0 42269 0 23709 0 19556 0 11281 0 369115 0 0 0 ROBERT FINCH VP HUMAN RESOURCES 237420 0 36337 0 33081 0 17085 0 7072 0 330995 0 0 0 NORMAN BURKETT JR VP, PROFESSIONAL SERVICES 220380 0 35170 0 32038 0 16500 0 17746 0 321834 0 0 0 LOUIS DUHE VP AND CIO 230592 0 35073 0 7245 0 10315 0 7059 0 290284 0 0 0 DIANE TODD vP corp - compliance & ops 198086 0 31364 0 43031 0 14477 0 10737 0 297695 0 0 0 DR JAMES APPIAH-PIPPIM MD FACULTY 257067 62394 0 0 1570 25232 14675 3744 1960 652 275272 92022 0 0 TAMMY GILLAND VP FOUNDATION 171526 0 17956 0 29164 0 12694 0 6730 0 238070 0 0 0 CATHERINE APALOO faculty program director 284025 0 0 0 31431 0 12112 0 18277 0 345845 0 0 0 TAMARA JACKSON CNO 242020 0 25374 0 10420 0 8387 0 6678 0 292879 0 0 0 DOMINIQUE BENNETT CONTROLLER 160778 0 26577 0 82642 0 11902 0 9093 0 290992 0 0 0 PAUL COLLAR dir, managed care 196925 0 26450 0 22364 0 12228 0 17554 0 275521 0 0 0 DARREL LAWSON exc. dir, revenue cycle 202294 0 27127 0 3251 0 14018 0 6716 0 253406 0 0 0 SchEDULE J, Part I, Line 1a COMPANION TRAVEL AND CLUB DUES BOARD TRUSTEES ARE PROVIDED COMPANION TRAVEL - TAXABLE AMOUNT INCLUDED IN COMPENSATION. OFFICERS ARE PROVIDED SOCIAL CLUB DUES - TAXABLE AMOUNT INCLUDED IN COMPENSATION. OTHER COMPENSATION ITEMS THE FOLLOWING INDIVIDUALS RECEIVED A DISCRETIONARY SPENDING ACCOUNT, A FIXED AMOUNT DETERMINED BY JOB LEVEL. THIS RESPECTIVE AMOUNTS WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE WAGES. KEVIN BROWN: $36,429 DR. CHARLES PECK: $9,462 ELIZABETH LEDDY: $10,154 SCHEDULE J, Part I, Line 1b PIEDMONT ATHENS REGIONAL MEDICAL CENTER, INC. DOES NOT HAVE A WRITTEN POLICY REGARDING PAYMENTS OR REIMBURSEMENT OF EXPENSES ON LINE 1A. HOWEVER, COMPANION TRAVEL FOR BOARD MEMBERS ATTENDING OVERNIGHT EVENTS WAS APPROVED BY CHARLES PECK, CEO OF ATHENS REGIONAL HEALTH SERVICES, INC. SCHEDULE J, PART I, LINE 3 COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER IS SET BY THE ENTITY'S PARENT, PIEDMONT HEALTHCARE, INC. PLEASE SEE THE SCHEDULE O NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A & 15B FOR ADDITIONAL INFORMATION. SCHEDULE J, Part I, Line 4a SEVERANCE PAYMENT CERTAIN OFFICERS HAVE WRITTEN SEVERANCE AGREEMENTS WITH THE EMPLOYER. THIS SEVERANCE AGREEMENT TYPICALLY PROVIDES THAT IN THE EVENT OF INVOLUNTARY TERMINATION THE OFFICER WILL CONTINUE TO RECEIVE THE OFFICER'S BASE COMPENSATION FOR A PERIOD OF 24 MONTHS FOLLOWING THE OFFICER'S DATE OF TERMINATION. THE OFFICER IS ALSO ENTITLED AS ADDITIONAL SEVERANCE ANY OTHER BENEFITS TO WHICH HE WOULD HAVE BEEN ENTITLED HAD THE EXECUTIVE REMAINED AN EMPLOYEE. THE VALUE OF THE OTHER BENEFITS ARE MADE AVAILABLE TO THE OFFICER IN ACTUAL BENEFITS OR EQUIVALENT VALUE TO THE EXTENT PERMITTED IN LAW AND BY UNDERLYING CONTRACTS THAT MAY SUPPORT SUCH BENEFITS. NO INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN THE CURRENT YEAR. SCHEDULE J, Part I, Line 4b SUPPLEMENTAL COMPENSATION INFORMATION DR. CHARLES PECK RECEIVED PAYMENTS TOTALING $83,250. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: KEVIN BROWN ELIZABETH LEDDY WENDY COOK SCHEDULE J, PART I, LINE 5A & 6A CONTINGENT COMPENSATION EXECUTIVE AND LEADERSHIP POSITIONS ARE ELIGIBLE TO PARTICIPATE IN A VARIABLE PAY PLAN. GROSS REVENUES AND NET EARNINGS ARE VARIABLE PAY PLAN FACTORS. THIS PLAN PROVIDES INCENTIVES BASED ON SYSTEM PERFORMANCE. THE RESULTS ARE BASED ON THE ACCOMPLISHMENT OF SPECIFIC STRATEGIC OBJECTIVES INVOLVING (1) SUSTAINED AND IMPROVED FINANCIAL PERFORMANCE AND EFFICIENCY (2) EMPLOYEE SATISFACTION AND RETENTION (3) IMPROVED CUSTOMER SATISFACTION INCLUDING MEMBERS, PHYSICIANS, PATIENTS, AND EMPLOYEES (4) MAINTENANCE AND IMPROVEMENT IN QUALITY AND CLINICAL OUTCOMES. THE PERFORMANCE SCORECARD IS DETERMINED ANNUALLY AND APPROVED BY THE BENEFITS AND COMPENSATION COMMITTEE OF THE BOARD. THE PLAN WILL BE DISALLOWED BASED ON LOSS OF THE JOINT COMMISSION ACCREDITATION OR A VIOLATION OF THE BOND COVENANTS. SCHEDULE J, PART I, LINE 7 EFFECTIVE OCTOBER 1, 2016, CERTAIN EMPLOYEES PARTICIPATED IN AN "ANNUAL INCENTIVE PLAN" UNDER WHICH THEY RECEIVED NON-FIXED BONUS PAYMENTS BASED ON JOB LEVEL AND SEVERAL DIFFERENT PERFORMANCE METRICS. A THE HOSPITAL AUTHORITY OF CLARKE COUNTY GA 586003375 181685JM1 2016-11-16 178225000 REFINANCING false false false A 5275000 0 208099492 0 0 208092160 7332 0 0 0 0 0 2016 true false true true A false false false false 0 false false false true A false true false false false false 0 false 0 false true A true FORM 990, PART V, LINE 1A FORM 1096 FILINGS ALL FORM 1096 FILINGS FOR THE ORGANIZATION ARE FILED BY PIEDMONT HEALTHCARE, INC. (EIN 58-1503902) FORM 990, PART VI, SECTION A, LINE 6 ORGANIZATION'S SOLE MEMBER PIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER ("PAR"). FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT ATHENS REGIONAL MEDICAL CENTERS SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY PIEDMONT ATHENS REGIONAL MEDICAL CENTERS BOARD POLICIES AND DECISIONS MUST BE FILED, IMMEDIATELY AFTER ADOPTION, WITH THE SECRETARY OF THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS. SUCH POLICIES AND DECISIONS OF THE PIEDMONT ATHENS REGIONAL MEDICAL CENTER BOARD OF DIRECTORS ARE NOT SUBJECT TO THE APPROVAL OF OR RATIFICATION BY THE PIEDMONT HEALTHCARE BOARD, BUT SHOULD THE NEED ARISE, THEY MAY BE RESCINDED BY THE PIEDMONT HEALTHCARE BOARD THROUGH A MAJORITY VOTE OF ITS DIRECTORS. FORM 990, PART VI, LINE 11B PRIOR TO FILING, COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., THE ORGANIZATIONS SOLE MEMBER, FOR BOARD REVIEW. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARES CHIEF COMPLIANCE OFFICER. ALL SENIOR LEADERS, BOARD MEMBERS, PHYSICIAN EMPLOYEES, NURSE PRACTITIONERS/PHYSICIAN ASSISTANTS AND EMPLOYEES AND NON-EMPLOYEES ENGAGED IN RESEARCH ARE REQUIRED TO ANNUALLY DISCLOSE ALL MATTERS WHICH COULD POTENTIALLY CONSTITUTE A CONFLICT OF INTEREST. MATTERS DISCLOSED UNDER THE POLICY MUST BE REVIEWED IN WRITING BY THE PIEDMONT HEALTHCARE CONFLICT OF INTEREST COMMITTEE IN ORDER TO DETERMINE WHETHER A CONFLICT EXISTS AND, IF SO, WHETHER TO ELIMINATE OR MANAGE THE CONFLICT. ALL BOARD MEMBERS AND EMPLOYEES OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER ARE PROVIDED TRAINING ON CONFLICT OF INTEREST ISSUES, INCLUDING REPORTING REQUIREMENTS, AT NEW-EMPLOYEE ORIENTATION AND AT LEAST ANNUALLY THEREAFTER. NONCOMPLIANCE WITH THE CONFLICT OF INTEREST POLICY MUST BE REPORTED TO PIEDMONT HEALTHCARES 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, SECTION B, LINE 15A, 15B EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT ATHENS REGIONAL MEDICAL CENTER IS SET BY THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC. THE PIEDMONT HEALTHCARE, INC., BOARD OF DIRECTORS 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. FUNCTIONS OF THE COMMITTEE -ASSESS AND IMPLEMENT POLICIES REGARDING PERFORMANCE, COMPENSATION AND BENEFITS OF THE PRESIDENT/CEO AND OTHER EXECUTIVES AS DETERMINED BY THE COMMITTEE -SELECT AN EXECUTIVE COMPENSATION CONSULTANT WHO REPORTS TO THE COMMITTEE -ANNUALLY REVIEW THE PRESIDENT/CEO SUCCESSION PLAN -FORMULATE AND IMPLEMENT ANNUAL PERFORMANCE OBJECTIVES FOR THE PRESIDENT/CEO, AND REVIEW AND APPROVE ANNUALLY RECOMMENDATIONS FROM THE PRESIDENT/CEO RELATING TO COMPENSATION, PERFORMANCE OBJECTIVES, AND SUCCESSION PLANS FOR EVP EXECUTIVES -ANNUALLY ASSESS PRESIDENT/CEO PERFORMANCE; IF NECESSARY, IMPLEMENT ACTION PLAN WITH PRESIDENT/CEO INPUT TO IMPROVE HIS/HER PERFORMANCE; ADJUST COMPENSATION AS APPROPRIATE; THE COMMITTEE CHAIR SHALL CONSULT WITH THE PHC GOVERNANCE COMMITTEE CHAIR AND THE PHC BOARD CHAIR AND SHALL COORDINATE THE ANNUAL PERFORMANCE REVIEW OF THE PHC PRESIDENT/CEO, UNLESS THE PHC BOARD CHAIR HAS A REAL OR PERCEIVED CONFLICT OF INTEREST, IN WHICH CASE THE COMMITTEE CHAIR SHALL DETERMINE THE PROPER REVIEW PROCESS -REVIEW AND APPROVE LONG TERM AND SHORT TERM GOALS TO BE USED IN CONNECTION WITH EVP COMPENSATION PROGRAMS AS RECOMMENDED BY THE PRESIDENT/CEO AND VALIDATED BY THE COMPENSATION CONSULTANT -PERIODICALLY REVIEW COMPENSATION, IF ANY, FOR THE PHC BOARD CHAIR AND ALL BOARD CHAIRS OF THE PHC SUBSIDIARIES -ESTABLISH OTHER POLICIES AND PROCEDURES, AND PERFORM OTHER TASKS, RELATED TO EXECUTIVE PERFORMANCE AND COMPENSATION, INCLUDING BUT NOT LIMITED TO, APPROVAL OF EXECUTIVE EMPLOYMENT CONTRACTS AND BENEFITS -PERIODICALLY REPORT SIGNIFICANT DECISIONS AND ANY ADDITIONAL REQUESTED INFORMATION TO THE PHC BOARD FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURE OF GOVERNING, CONFLICT OF INTEREST AND FINANCIAL DOCUMENTS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THESE DOCUMENTS SHOULD BE REQUESTED FROM PIEDMONT HEALTHCARE, INC.'S LEGAL COUNSEL. FORM 990, PART XI, LINE 9 RECONCILIATION OF NET ASSETS CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF ($60,560,037) INTERCOMPANY TRANSFERS OF LIABILITIES AND BOOK/TAX DIFFERENCES OF $2,465,038. FORM 990 PART IX LINE 11G DESCRIPTION:SERVICE/MAINTENANCE CONTRACTS TOTAL FEES:16608399 FORM 990 PART IX LINE 11G DESCRIPTION:PMCC PRACTICE SUPPORT TOTAL FEES:12253569 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PHYSICIAN SUPPORT TOTAL FEES:9875490 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACTED PROFESSIONAL SERVIC TOTAL FEES:7940774 FORM 990 PART IX LINE 11G DESCRIPTION:GENERAL CONTRACT LABOR TOTAL FEES:1864105 FORM 990 PART IX LINE 11G DESCRIPTION:ADMINISTRATIVE SERVICES TOTAL FEES:2463254 FORM 990 PART IX LINE 11G DESCRIPTION:AMBULANCE-TRANSPORTATION TOTAL FEES:200000 PIEDMONT HEALTHCARE INC 1800 HOWELL MILL ROAD SUITE 850 ATLANTA GA 30318 581503902 MANAGEMENT GA 501(c)(3) 12B, III-F NA false PIEDMONT HOSPITAL Inc 1968 PEACHTREE ROAD NW ATLANTA GA 30309 580566213 HOSPITAL GA 501(c)(3) 3 PHC false FAYETTE COMMUNITY HOSPITAL INC 1255 HIGHWAY 54 WEST FAYETTEVILLE GA 30214 582232328 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT MOUNTAINSIDE HOSPITAL INC 1266 HIGHWAY 515 SOUTH JASPER GA 30143 352228583 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT NEWNAN HOSPITAL INC 745 POPLAR ROAD NEWNAN GA 30265 205077249 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT HEALTHCARE FOUNDATION INC 2001 PEACHTREE ROAD NE SUITE 400 ATLANTA GA 30309 581272768 FUNDRAISING GA 501(c)(3) 12B, II PHC false PIEDMONT HENRY HOSPITAL INC 1133 EAGLES LANDING PKWY STOCKBRIDGE GA 30281 582200195 HOSPITAL GA 501(c)(3) 3 PHC false HENRY DEVELOPMENT VENTURES INC 1133 EAGLES LANDING PKWY STOCKBRIDGE GA 30281 582200734 RE HOLDING GA 501(c)(2) N/A PHH false CENTER FOR HEALTH AND LEARNING INC 3001 MERCER UNIVERSITY DR ATLANTA GA 30341 262442849 EDUCATION GA 501(C)(3) 12A, I NA false PIEDMONT NEWTON HOSPITAL INC 5126 HOSPITAL DRIVE NE COVINGTON GA 30014 582155150 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT HEART INSTITUTE INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 263553500 HOSPITAL GA 501(C)(3) 7 PHC false PIEDMONT ATHENS REGIONAL HEALTH RESOURCE 1199 PRINCE AVENUE ATHENS GA 30606 581930580 DEVELOPMENT GA 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HEALTHCARE GA NA N/A 0 0 false 0 false GEORGIA HEALTH COLLABORATIVE LLC 2727 PACES FERRY RD BLDG 2 STE 20 ATLANTA GA 30339 461500639 HEALTHCARE GA NA N/A 0 0 false 0 false PIEDMONT MEDICAL CARE CORPORATION 2727 PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 582092768 HEALTHCARE GA PHC C-CORP 0 0 false THE PIEDMONT CLINIC INC 2727 PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 582005358 HEALTHCARE GA PHC C-CORP 0 0 false PIEDMONT HEART INSTITUTE PHYSICIANS INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 260593850 HEALTHCARE GA PHC C-CORP 0 0 false AMSTER MCRAE INSURANCE COMPANY PO BOX 1159 GRAND CAYMAN GRAND CAYMAN CJ ky1-1102 980427603 Related InsurANCE CJ PHC C-CORP 0 0 false PIEDMONT WELLSTAR HEALTHPLANS INC 2859 PACES FERRY ROAD SUITE 600 ATLANTA GA 30339 461922499 HEALTH INSURANCE GA PHC C-CORP 0 0 false COLUMBUS HEALTHCARE RESOURCES PO BOX 790 COLUMBUS GA 31902 581717754 HEALTHCARE GA PHC C CORP 0 0 false false false false false false false false false true false false true true 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