2019-05-14T21:47:35-05:00 2018-06-30 KPMG LLP 300 North Greene Street Suite 400 Greensboro NC 27401 990 2017-07-01 582155150 Piedmont Newton Hospital Inc % MARIE GAFFNEY PIED 7707867053 5126 Hospital Drive NE Covington GA 300142566 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2019-05-14 true WHITNEY E BLAIR P01226647 3362753394 2019-05-14 167.68.102.5 56038220191345000027 2019-05-14 P A44B9C37BFA5EF1264A4312BD3172D9227A45E08 5D7B52A41C2226A5E4849843C7D809138903E6FF 2017 2019-02-21 02:37:17Z Dr Eric Bour 5126 Hospital Drive NE Covington GA 300142566 103771547 false X www.piedmont.org X 1995 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 9 5 829 125 8614 7614 34166 38171 95160737 102185306 85870 -35352 2152113 1255335 97432886 103443460 0 0 0 0 46402079 49276758 0 0 0 67300438 66491573 113702517 115768331 -16269631 -12324871 40882766 48127698 23367341 24261237 17515425 23866461 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 99810894 0 102627804 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, 2018, THE HOSPITAL HAD 5,336 IN-PATIENT ADMISSIONS WITH A TOTAL OF 16,959 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 42,922 AND OUTPATIENT VISITS TOTALED 38,563. SURGICAL SERVICES WERE PROVIDED TO 3,604 PATIENTS. 99810894 true true false false false false false false false false true false false false true true false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true false false false true X 0 0 829 true true true false false false false false false false false false X 9 5 false false false false true true true true true false false false true true true true true true true false GA X MARIE GAFFNEY 4702716007 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 X MR GREGORY HURST CHAIRMAN (END 12-30-17) 1.0 54.0 X X 0 1973760 23776 DR LEIGH HAMBY BOARD MEMBER 1.0 54.0 X 0 1495782 157027 DR STEVE MCINTOSH BOARD MEMBER 1.0 0.0 X 0 0 0 DR BRAD JACOBY BOARD MEMBER 1.0 0.0 X 0 0 0 MR WILLIAM D FORTSON JR BOARD MEMBER 1.0 0.0 X 0 0 0 MR GEORGE HART BOARD MEMBER 1.0 0.0 X 0 0 0 MR SAMUEL HAY III CHAIRMAN (EFF. 12-31-17) 1.0 2.0 X X 0 0 0 MR MICHAEL MCANDER TREASURER & BOARD MEMBER 1.0 54.0 X X 0 1029023 124751 DR CHARLES A PECK BOARD MEMBER (EFF 1-1-18) 1.0 54.0 X 0 1248666 120700 DR ERIC S BOUR CEO & BOARD MEM. (EFF 7-1-17) 55.0 0.0 X X 207863 0 21157 MS Elizabeth Leddy Secretary 1.0 54.0 X 0 552329 65569 MR TROY BROOKS CFO 55.0 0.0 X 304408 0 27319 MR William Little CMO 55.0 0.0 X 430201 0 25266 MR William Love Exec Director Patient Services 55.0 0.0 X 181458 0 10561 MR Robert Halliday Director of Pharmacy 55.0 0.0 X 160602 0 15728 MR Steven Spillers Pharmacy Operations Manager 55.0 0.0 X 141993 0 13743 MR SHAYRON BROWN DIRECTOR OF WOMEN'S SERVICES 55.0 0.0 X 150328 0 7415 MS BARBARA KELLEY DIRECTOR - EMERGENCY DEPT. 55.0 0.0 X 134929 0 15597 MR JAMES WEADICK PRESIDENT & CEO (RET 6-30-17) 0.0 0.0 X 517884 0 43771 2229666 6299560 672380 25 true true false MEDICAL SOLUTIONS LLC 1010 NORTH 102ND STREET SUITE 300 OMAHA NE 68114 NURSING SERVICES 1172515 MILSTEAD PATHOLOGY PC 3248 AVALON BLVD CONYERS GA 30013 LAB SERVICES 1542941 RIVERDALE ANESTHESIA ASSOCIATES PC PO BOX 961270 RIVERDALE GA 30296 ANAESTHESIOLOGY 606004 CLARUS LINEN SYSTEMS 7990 SECOND FLAGS DRIVE SUITE A AUSTELL GA 30168 LAUNDRY SERVICES 373618 ALLIED UNIVERSAL SECURITY SERVICES 1551 N TUSTIN AVENUE SANTA ANA CA 92705 SECURITY SERVICES 501100 9 27782 10389 38171 PATIENT SERVICE REVENUE 622110 101910862 101910862 OTHER OPERATING REVENUE 900099 274444 274444 102185306 51394 51394 0 0 575084 178609 396475 0 396475 396475 86746 -86746 -86746 -86746 0 0 0 0 0 0 146502 62732 83771 83771 COUNTY TAX REVENUE 722310 416328 416328 CAFETERIA SALES 900099 323977 323977 FEE REVENUE 900099 26170 26170 8614 8614 775089 103443460 102627804 8614 768871 0 0 0 0 1446225 347553 1098672 0 38682464 34607187 4075277 0 6684869 5836760 848109 2463200 2115396 347804 13237 13237 166035 166035 0 0 0 0 8085141 6576413 1508728 351433 28014 323419 7878927 5972101 1906826 2156030 1634271 521759 0 1482075 1375422 106653 2805 1752 1053 0 0 980377 980377 3642279 3642279 1706546 1586510 120036 1233294 922884 310410 BAD DEBT EXPENSE 19638207 19638207 DRUGS & MEDICAL SUPPLIES 11431848 11431848 HOSPITAL TAX 851592 851592 ADMINISTRATIVE EXPENSES 6871747 6871747 115768331 99810894 15957437 0 1164346 628818 0 0 0 0 10063459 12183034 0 0 0 0 0 0 2707435 2647937 553680 444109 34447110 4084118 24259340 30362992 0 0 0 0 0 0 0 0 2134506 1860808 40882766 48127698 6614658 8741199 0 0 0 0 14341502 12506988 0 0 0 0 0 0 0 0 2411181 3013050 23367341 24261237 X 19167188 23708083 -1651763 158378 0 0 17515425 23866461 40882766 48127698 X -12324871 18675907 X false true X true false X 1270100 1270100 17362349 1681748 15680601 692129 180975 511154 9769530 2221395 7548135 5353002 5353002 30362992 0 OTHER LIABILITIES 38524 MEDICARE PAYABLE 2974526 3013050 X SCHEDULE D, PART X, LINE 2: ASC 740 FOOTNOTE (FKA FIN 48) PHC ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF THE INCOME TAXES TOPIC OF THE ASC (ASC 740). UNDER THE REQUIREMENTS OF ASC 740, TAX-EXEMPT ORGANIZATIONS MAY BE REQUIRED TO RECORD AN OBLIGATION AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS UNCERTAIN TAX EXPOSURE ITEMS. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT JUNE 30, 2018 AND 2017. true true X true X true X true true false true true 10790877 10790877 0.11230 4093076 4482309 -389233 0.00000 1043483 632558 410925 0.00430 15927436 5114867 10812569 0.11660 23571 23571 0.00030 975237 975237 0.01040 3184 3184 38072 38072 0.00040 1040064 1040064 0.01110 16967500 5114867 11852633 0.12770 true 4633238 284949 21089846 21799447 -709601 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 16 true true false true X SEE PART VI X X true 17 true SEE PART VI false true X 200. 300. 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 SCHEDULE H, PART V, LINE 5: COMMUNITY REPRESENTATION PIEDMONT NEWTON HOSPITAL'S ("PNtH") ORIGINAL CHNA WAS CONDUCTED DURING THE HOSPITAL'S FISCAL YEAR 2013. IN ADDITION, ONE-HOUR COMMUNITY STAKEHOLDER INTERVIEWS WERE CONDUCTED. A TOTAL OF 20 STAKEHOLDER INTERVIEWS WERE INCLUDED IN THE ASSESSMENT PROCESS. PARTICIPANTS WERE GIVEN AN OUTLINE OF HEALTH NEEDS TOPICS BUT ALSO ENCOURAGED TO IDENTIFY OTHER NEEDS WHICH MAY NOT APPEAR ON THE LIST FOR DISCUSSION. TOPICS INCLUDED: DEMOGRAPHICS, HEALTH STATUS, CHRONIC DISEASES, HEALTH BEHAVIORS, AND ACCESS TO CARE AMONG OTHERS. PARTICIPANTS IN THE HEALTH INPUT MEETINGS WERE REPRESENTATIVE OF A CROSS-SECTION OF PROVIDERS AND PUBLIC INTEREST INDIVIDUALS, SUCH AS: HOSPITAL PERSONNEL FROM EDUCATION, EMERGENCY DEPARTMENT, DIETITIAN; SCHOOL SYSTEM PERSONNEL TEACHERS, SUPERINTENDENT, MENTAL HEALTH CLINICIAN; MENTAL HEALTH PERSONNEL - DIRECTOR OF BUSINESS DEVELOPMENT; COUNTY COMMISSION COMMISSIONER WHO IS ALSO A RN BY TRAINING; PHYSICIANS HOSPITALISTS, FAMILY PRACTICE. OTHER SPECIALTY SERVICES SUCH AS DFACS, REFUGE PREGNANCY CENTER, FAITHWORKS, SENIOR SERVICES CENTER, AND THE CHAMBER OF COMMERCE WERE ALSO REPRESENTED IN THE PANEL OF PARTICIPANTS. PIEDMONT NEWTON HOSPITAL CONDUCTED ITS SECOND CHNA DURING FISCAL YEAR 2016. STAKEHOLDERS WERE CONTINUALLY ENGAGED DURING BOTH ASSESSMENTS, WITH A PARTICULAR FOCUS ON THOSE GROUPS, ORGANIZATIONS, AND INDIVIDUALS REPRESENTING THE MOST VULNERABLE MEMBERS OF THE HOSPITALS COMMUNITY. SPECIFICALLY, PIEDMONT NEWTON HOSPITAL INTERVIEWED REPRESENTATIVES OF LOCAL AND REGIONAL PUBLIC HEALTH ENTITIES, MINORITY POPULATIONS, THE FAITH-BASED COMMUNITIES, LOCAL BUSINESS OWNERS, THE PHILANTHROPIC COMMUNITY, MENTAL HEALTH AGENCIES, ELECTED OFFICIALS, AND OTHER RELEVANT COMMUNITY STAKEHOLDERS. ADDITIONALLY, THE HOSPITAL CONDUCTED FOCUS GROUPS MADE UP OF LOW-INCOME AND UNINSURED PATIENTS, AS WELL AS CONSUMER AND PATIENT ADVOCATES REPRESENTING A VARIETY OF VULNERABLE PATIENTS. ALL INTERVIEWS, FOCUS GROUPS AND MEETINGS INFORMED THE CHNA PROCESSES, INCLUDING THE IDENTIFICATION OF KEY HEALTH PRIORITIES AND DEVELOPMENT OF IMPLEMENTATION PLAN STRATEGIES. SCHEDULE H, PART V, LINE 6A: HOSPITALS INCLUDED IN CURRENT CHNA PROCESS DURING FY16, THE PIEDMONT HEALTHCARE SYSTEM CONDUCTED THE SECOND CHNA FOR SIX OF ITS TAX-EXEMPT HOSPITALS. EACH INDIVIDUAL HOSPITAL'S COMMUNITY WAS ASSESSED AND PRIORITY NEEDS WERE IDENTIFIED BASED ON THE SIX COMMUNITIES' DISCREET CHARACTERISTICS. THE RESULTS OF THE ASSESSMENTS WERE COMPILED AND PUBLISHED IN A SINGLE CHNA REPORT. THE HOSPITALS INCLUDED IN THE PROCESS WERE PIEDMONT HOSPITAL (EIN: 58-1503902); PIEDMONT FAYETTE HOSPITAL (EIN: 58-2322328); PIEDMONT HENRY HOSPITAL (EIN: 58-2200195); PIEDMONT MOUNTAINSIDE HOSPITAL (EIN: 35-2228583); PIEDMONT NEWNAN HOSPITAL (EIN: 20-5077249); AND PIEDMONT NEWTON HOSPITAL (EIN: 58-2155150). SCHEDULE H, PART V, SECTION B, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE https://www.piedmont.org/media/file/2016-CHNA-Full-Report.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 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. 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 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 system's website. A report on Piedmont Newton Hospital's community benefits is also found both 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. 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 $115,768,331, LESS BAD DEBT EXPENSE OF $19,638,207 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. 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 the 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 44.59% of the 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 In FY16, Piedmont Newton Hospital conducted its second triennial community health needs assessment (CHNA), which was accomplished by analyzing publicly-available community and internal patient data, interviewing community members and stakeholders (including those with a special knowledge of public health and vulnerable populations), conducting focus groups of vulnerable populations, interviewing Piedmont board members and surveying Piedmont employees on the health issues they feel our community and patients face. For the purposes of this CHNA, we defined vulnerable community members as those who are uninsured, underinsured, have low or no incomes, have chronic conditions, are elderly, who face housing and/or food instability, those who don't speak English well or at all, and/or face particular challenges when attempting to access the health care system. In the CHNA, we identified our top health priorities to address over a three-year period. These were: increase access to care and health services for low- and no-income patients; reduce preventable re-admissions and emergency department re-encounters; increase access to and awareness of cancer programming; and reduce preventable instances of heart disease, obesity and stroke. Priorities were chosen based on the number of persons affected, the seriousness of the issue, whether the health need affected vulnerable populations, and availability of community and hospital resources to address the need. The Piedmont Newton Hospital Board of Directors ratified the CHNA on May 19, 2016. The FY17 Piedmont Newton Hospital implementation strategy was developed in partnership with hospital leadership and community stakeholders to address the identified priorities listed in the 2016 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. The Piedmont Newton Hospital Board of Directors approved the implementation strategy to address identified health issues on September 23, 2016. SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY 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 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 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. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION Piedmont Newton Hospital is located in Covington, Georgia. In 2017, more than 105,473 people lived in Newton County. Fifty-two percent of the county's residents were white, 43 percent were African American and 5 percent were Hispanic or Latino. Fifteen percent of county residents lived with a disability in 2017. Fifteen percent of adults in Newton County were uninsured in 2017. During the 2015-2016 school year, 69 percent of Newton County children qualified for free lunch. Unemployment in the county was 6 percent in 2017, which was slightly higher than Georgia's percentage of 5.4 percent. In 2017, approximately 81 percent of the county's high school students will graduate in four years (University of Wisconsin Population Health Institute, County Health Rankings, 2018). There was one primary physician in Newton for every 2,780 residents of the county in 2017, compared to one for 1,030 for the state. That year, 19 percent of adults reported they were in poor or fair health, a figure in line with the Georgia benchmark of 19 percent. In 2017, nearly one in three adults were notably physically inactive, a third were considered obese and 18 percent smoked (University of Wisconsin Population Health Institute, County Health Rankings, 2018). SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH Piedmont Newton 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 FY17, Piedmont Newton 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. The three grant recipients in FY18 were: A Child's Voice Child Advocacy Center, the Newton County Community Partnership and the Willing Helpers Medical Center. The hospital also provided pharmaceutical support to the Willing Helpers clinic at no charge to the clinic or its patients. 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. Piedmont Newton Hospital also provided health professions education to students and residents training to be health professionals. In FY18, Piedmont Newton Hospital medical staff oversaw a total 32,535 hours of training at a cost of $975,237. 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 GREGORY HURST CHAIRMAN (END 12-30-17) 0 764368 0 491328 0 718064 0 15900 0 7876 0 1997536 0 0 DR LEIGH HAMBY BOARD MEMBER 0 559110 0 364416 0 572256 0 140459 0 16568 0 1652809 0 516049 MR JAMES WEADICK PRESIDENT & CEO (RET 6-30-17) 193623 0 108727 0 215534 0 38765 0 5006 0 561655 0 27067 0 MR MICHAEL MCANDER TREASURER & BOARD MEMBER 0 581223 0 379072 0 68728 0 117128 0 7623 0 1153774 0 0 MR TROY BROOKS CFO 236006 0 55066 0 13336 0 16200 0 11119 0 331727 0 0 0 MR William Little CMO 312991 0 98175 0 19035 0 13263 0 12003 0 455467 0 0 0 MR William Love Exec Director Patient Services 159196 0 21934 0 328 0 9089 0 1472 0 192019 0 0 0 MR Robert Halliday Director of Pharmacy 143389 0 13297 0 3916 0 9631 0 6097 0 176330 0 0 0 MR Steven Spillers Pharmacy Operations Manager 134628 0 6201 0 1164 0 7622 0 6121 0 155736 0 0 0 MS Elizabeth Leddy Secretary 0 344306 0 90667 0 117356 0 53125 0 12444 0 617898 0 0 DR CHARLES A PECK BOARD MEMBER (EFF 1-1-18) 0 586715 0 190412 0 471539 0 83250 0 37450 0 1369366 0 83250 DR ERIC S BOUR CEO & BOARD MEM. (EFF 7-1-17) 107174 0 0 0 100689 0 17500 0 3657 0 229020 0 0 0 MR SHAYRON BROWN DIRECTOR OF WOMEN'S SERVICES 137020 0 12604 0 704 0 6076 0 1339 0 157743 0 0 0 MS BARBARA KELLEY DIRECTOR - EMERGENCY DEPT. 90879 0 10790 0 33260 0 3193 0 12404 0 150526 0 0 0 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS DR. ERIC BOUR RECEIVED A DISCRETIONARY SPENDING ACCOUNT TOTALING $4,615, 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 WEADICK, DR. CHARLES PECK AND DR. LEIGH HAMBY RECEIVED SERP PAYMENTS IN THE AMOUNT OF $27,067, $83,250 AND $516,049, 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, AND 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 5095000 0 9010590 1239285 0 0 178600 0 0 8751400 0 0 2007 false false true true B 8760000 0 17225000 1114219 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 V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2017 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 HOSPITALS 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 HOSPITALS 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 HOSPITALS FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATIONS FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PNTHS 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 ORGANIZATIONS 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 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 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 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, SEC B, LINE 15A, 15B: EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT NEWTON HOSPITAL 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. 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 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 ($28,911) CHANGE IN UNRESTRICTED $100,644 BOOK/TAX DIFFERENCES $12,285 CHANGE IN TEMP $1,810,139 INTERCOMPANY TRANSFERS $16,781,750 ------------------ TOTAL $18,675,907 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 HENRY DEVELOPMENT VENTURES INC 1133 EAGLES LANDING PKWY STOCKBRIDGE GA 30281 582200734 RE HOLDING GA 501(C)(2) N/A PHH false PIEDMONT HEART INSTITUTE INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 263553500 HEALTHCARE GA 501(C)(3) 7 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 CENTER FOR HEALTH AND LEARNING INC 3001 MERCER UNIVERSITY DRIVE ATLANTA GA 30341 262442849 EDUCATION GA 501(C)(3) 12A, I PHC false COLUMBUS AMBULATORY HEALTHCARE SERVICES 707 CENTER ST COLUMBUS GA 31901 581719867 AMBULATORY GA 501(C)(3) 3 PHC false COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 707 CENTER ST COLUMBUS GA 31901 581719994 HEALTHCARE GA 501(C)(3) 12B, II PHC false COLUMBUS REGIONAL MEDICAL FOUNDATION INC 707 CENTER ST COLUMBUS GA 31901 581501642 FUNDRAISING GA 501(C)(3) 7 PHC false THE MEDICAL CENTER INC 710 CENTER ST COLUMBUS GA 31901 581685139 HOSPITAL GA 501(c)(3) 3 PHC false HUGHSTON HOSPITAL INC 707 CENTER ST COLUMBUS GA 31901 331216751 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT ROCKDALE HOSPITAL INC 1412 MILSTEAD AVE CONYERS GA 30012 300999841 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT WALTON HOSPITAL INC 2151 WEST SPRING ST MONROE GA 30655 824194264 HOSPITAL GA 501(C)(3) 3 PHC false HENRY RADIATION ONCOLOGY CENTER LLC 275 PROFESSIONAL COURT STE A RIVERDALE GA 30274 582200195 RADIATION GA PHH N/A 0 0 false 0 PEACHTREE ORTHOPAEDIC SURGERY CENTER 2001 PEACHTREE RD NE STE 705 ATLANTA GA 30309 582562721 SURGERY GA NA N/A 0 0 false 0 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 SOUTHERN CRESCENT RADIATION ONCOLOGY CEN 275 PROFESSIONAL COURT STE A RIVERDALE GA 30274 464307929 RADIATION GA NA N/A 0 0 false 0 GRIFFIN RADIATION ONCOLOGY CENTER LLC 275 PROFESSIONAL COURT STE A RIVERDALE GA 30274 464307692 RADIATION GA NA N/A 0 0 false 0 FOUR WINDS HEALTH LLC 3350 RIVERWOOD PKWY STE 1850 ATLANTA GA 30339 451273930 HEALTHCARE GA NA N/A 0 0 false 0 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 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 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 CJ KY1-1102 980427603 RELATED INSURANCE CJ PHC C-CORP 0 0 false PIEDMONT WELLSTAR HEALTHPLANS INC 2859 PACES FERRY RD STE 600 ATLANTA GA 30339 461922499 HEALTH INSURANCE GA NA C-CORP 0 0 false COLUMBUS HEALTHCARE RESOURCES PO BOX 790 COLUMBUS GA 31902 581717754 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