2019-05-14T21:52:04-05:00 2018-06-30 KPMG LLP 300 North Greene Street Suite 400 Greensboro NC 27401 990 2017-07-01 582322328 Fayette Community Hospital Inc % MARIE GAFFNEY FAYE 7707197073 1255 Highway 54 West Fayetteville GA 30214 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2019-05-14 true WHITNEY E BLAIR P01226647 3362753394 2019-05-14 167.68.102.5 56038220191345000026 2019-05-14 P A44B9C37BFA5EF1264A4312BD3172D9227A45E08 5D7B52A41C2226A5E4849843C7D809138903E6FF 2017 2020-01-14 16:20:31Z J MICHAEL BURNETT 1255 Highway 54 West Fayetteville GA 30214 399323507 false X WWW.PIEDMONTFAYETTE.COM X 1997 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 10 8 2277 270 8044 7044 67402 37238 379117271 393589230 215903 -31081 4524441 4404827 383925017 398000214 54179 81050 0 0 130822643 136796890 0 0 0 216877421 218378777 347754243 355256717 36170774 42743497 195786300 209332377 33836049 38755791 161950251 170576586 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 327985488 81050 393589230 PIEDMONT FAYETTE HOSPITAL ("PFH") IS A 221-BED FACILITY LOCATED IN FAYETTE 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 FAYETTEVILLE 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 16,018 IN-PATIENT ADMISSIONS WITH A TOTAL OF 69,717 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 80,676 AND OUTPATIENT VISITS TOTALED 100,097. SURGICAL SERVICES WERE PROVIDED TO 11,971 PATIENTS. 327985488 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 false false false false false false false false false false false false true true false false false true X 0 0 2277 true true true false false false false false false false false false X 10 8 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 Michael Behr Board Member 1.0 0.0 X 6412 0 0 Mr J Michael Burnett PRESIDENT & CEO/Board Member 55.0 0.0 X X 996924 0 118910 Mr Mark Gray Board Member 1.0 0.0 X 0 0 0 Mr Gregory A Hurst Board Member (END 12-30-17) 1.0 54.0 X 0 1973760 23776 Ms Lacy S Curry Board Member 1.0 0.0 X 0 0 0 Dr Dave C Lee Board Member 1.0 0.0 X 0 0 0 Dr Elizabeth W Killebrew Board Member (END 12-31-17) 1.0 0.0 X 20582 0 0 Mr Douglas B Warner Board Member 1.0 0.0 X 0 0 0 Dr Russell A Wilson Chairman/Physician 7.0 0.0 X X 114750 0 0 Mr Robert Reeves BOARD MEMBER 1.0 0.0 X 0 0 0 Dr C Howell Tucker Board Member 1.0 0.0 X 0 0 0 Dr Geetha Rao Board Member (Eff. 7-1-17) 1.0 0.0 X 0 0 0 Mr Michael McAnder Treasurer 1.0 54.0 X 0 1029023 124751 Ms Elizabeth Leddy Secretary 1.0 54.0 X 0 552329 65569 Dr Frederick Willms VP of Medical Affairs 55.0 0.0 X 495612 0 23813 Mr Scott Wolfe CFO 55.0 0.0 X 404584 0 24957 Mr David Nipper COO 55.0 0.0 X 363890 0 32462 Ms Rhonda Manos Director of Pharmacy 55.0 0.0 X 204039 0 19930 Ms Cheryl Beard Nursing Admin Supervisor 55.0 0.0 X 183102 0 5543 Ms Merry Heath CNO 55.0 0.0 X 247488 0 18704 Ms Mary McFarland Sr Dir Cardiovasc. 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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, 2018 AND 2017. true true X true X true X true true false true true 18604778 18604778 0.06080 8676049 8415031 261018 0.00080 4327153 470320 3856833 0.01260 31607980 8885351 22722629 0.07420 36071 36071 0.00010 2325493 2325493 0.00760 31834 31834 0.00010 2393398 2393398 0.00780 34001378 8885351 25116027 0.08200 true 11612753 754945 74493645 75648045 -1154400 X true true 1 1 Piedmont Fayette Hospital 1255 Highway 54 West Fayetteville GA 30214 www.piedmontfayette.com 056-550 X X X Piedmont Fayette Hospital 1 false false true X X X X X X X X 16 true false 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 X false false SCHEDULE H, PART V, LINE 5: COMMUNITY REPRESENTATION PIEDMONT FAYETTE HOSPITALS ORIGINAL CHNA WAS CONDUCTED DURING THE HOSPITALS FISCAL YEAR 2013 IN PARTNERSHIP WITH THE HAYSLETT GROUP, THE LEAD CONVENER OF GEORGIAS PARTNER UP FOR PUBLIC HEALTH CAMPAIGN. THE OVERALL HEALTH NEEDS ASSESSMENT EFFORT WAS LED BY THE PIEDMONT HEALTHCARE COMMUNITY BENEFITS TEAM, AND ASSISTED BY COMMUNITY HEALTH ADVISORS (FOR STAKEHOLDER INTERVIEWS). PIEDMONT FAYETTE 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 FAYETTE 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 FAYETTE 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 WHEN PIEDMONT FAYETTE HOSPITAL PERFORMED ITS INITIAL CHNA DURING FY13, IT FOCUSED ON THREE MAIN PRIORITIES AND STARTED WORK ON THOSE PRIORITIES DURING FY14. FIRST, THE HOSPITAL FOCUSED ON INCREASING ACCESS TO APPROPRIATE AND AFFORDABLE CARE FOR LOW- AND NO-INCOME PATIENTS BY DEVELOPING AND EXECUTING A PLAN TO STRENGTHEN ACCESS POINTS TO THOSE PATIENTS. SECOND, THE HOSPITAL SOUGHT OUT TO REDUCE PREVENTABLE READMISSIONS AND EMERGENCY DEPARTMENT RE-ENCOUNTERS, PARTICULARLY AMONG HIGH-RISK PATIENTS, BY INCREASING CARE COORDINATION EFFORTS BETWEEN THE HOSPITAL AND COMMUNITY- BASED PROVIDERS. LASTLY, PIEDMONT FAYETTE HOSPITAL FOCUSED ON REDUCING INSTANCES OF PREVENTABLE HEART DISEASE, OBESITY, AND OBESITY-RELATED DISEASES, INCLUDING DIABETES, BY UTILIZING COMMUNITY-WIDE AWARENESS CAMPAIGNS AND PROVIDING EDUCATION THAT ENCOURAGES COMMUNITY MEMBERS TO REDUCE THEIR HEART DISEASE RISKS THROUGH HEALTHY BEHAVIORS. DURING FY16, PIEDMONT FAYETTE HOSPITAL CONDUCTED ITS SECOND CHNA, AGAIN BY ASSESSING PUBLICLY AVAILABLE DATA, INTERVIEWING COMMUNITY MEMBERS AND STAKEHOLDERS, CONDUCTING FOCUS GROUPS OF VULNERABLE POPULATIONS, INTERVIEWING PIEDMONT BOARD MEMBERS, AND SURVEYING PIEDMONT EMPLOYEES. THROUGH THIS PROCESS, PIEDMONT FAYETTE 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 FAYETTE 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 FAYETTE 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 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 Fayette 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 $355,256,717, LESS BAD DEBT EXPENSE OF $49,374,452 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. PFH 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 47.51% 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 Fayette 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. We also focused primarily on our home county of Fayette County. 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 breast and lung cancer programming; and reduce preventable instances of heart disease, hypertension, 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 Fayette Hospital Board of Directors ratified the CHNA on May 11, 2016. The FY18 Piedmont Fayette Hospital implementation strategy was developed in partnership with hospital leadership and community stakeholders to address the identified priorities listed in the FY16 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 Fayette Hospital leadership and the Piedmont Fayette Hospital Board of Directors. The Piedmont Fayette Hospital Board of Directors approved the implementation strategy to address identified health issues on August 10, 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 Fayette 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 Fayette 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 Fayette Hospital is located in Fayetteville, Georgia. In 2017, approximately 110,306 people live in Fayette County. About one in ten adults in Fayette County were uninsured that year. Approximately 26 percent Fayette County children qualify for free lunch. Unemployment in the county is at 3 percent, which is lower than Georgia's percentage of 5.9. In 2017, approximately 92 percent of the county's high school students will graduate in four years (University of Wisconsin Population Health Institute, County Health Rankings, 2017). There is one primary physician in Fayette for every 910 residents of the county, compared to one for 1,530 for the state. Approximately 13 percent of adults reported they were in poor or fair health, a figure better than the Georgia benchmark of 17 percent. Eleven percent of adult residents have been diagnosed with diabetes. In 2017, one in five adults are notably physically inactive, and a third of adults are considered obese in Fayette County (University of Wisconsin Population Health Institute, County Health Rankings, 2017). SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH Piedmont Fayette 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 Fayette 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. FY18 grant recipients were Fayette Senior Services and the Healing Bridge Clinic. The hospital also processes all laboratory tests for the Fayette C.A.R.E. Clinic and the Healing Bridge Clinic at no cost to the clinics or their patients. The hospital also provides Thomas F. Chapman Family Cancer Wellness program free of charge to all community members, regardless of if they are a Piedmont patient. These services include cancer education, disease-specific nutrition workshops and cooking demonstrations, support groups, counseling and online classes to help support recovery. The hospital also provides Sixty Plus services free of charge to all community members, regardless of if they are a Piedmont patient. These services promote healthy aging by providing a continuum of geriatric specific services, programs, education, support and counseling for older adults and their family caregivers. Piedmont Fayette Hospital also provided health professions education to students and residents training to be health professionals. In FY18, Piedmont Fayette Hospital medical staff oversaw a total 83,649 hours of training at a cost of $2,325,493. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM Piedmont Fayette 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, 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 Fayette Hospital is not required to file a community benefit report; however, the hospital is required to file with the Georgia Department of Community Health information on its indigent and charity care, as well as its Medicaid and Medicare shortfalls. X true true false true false false false false false true false Dr Frederick Willms VP of Medical Affairs 360811 0 111708 0 23093 0 15900 0 7913 0 519425 0 0 0 Mr J Michael Burnett PRESIDENT & CEO/Board Member 423912 0 191630 0 381382 0 102306 0 16604 0 1115834 0 346221 0 Ms Rhonda Manos Director of Pharmacy 181010 0 20534 0 2495 0 9753 0 10177 0 223969 0 0 0 Mr Gregory A Hurst Board Member (END 12-30-17) 0 764367 0 491328 0 718065 0 15900 0 7876 0 1997536 0 639577 Mr John Miles Former CFO 0 266159 0 83373 0 15987 0 16200 0 16179 0 397898 0 0 Mr Scott Wolfe CFO 308786 0 87042 0 8756 0 13666 0 11291 0 429541 0 0 0 Mr Michael McAnder Treasurer 0 581223 0 379072 0 68728 0 117128 0 7623 0 1153774 0 0 Mr David Nipper COO 277152 0 79538 0 7200 0 16200 0 16262 0 396352 0 0 0 Ms Cheryl Beard Nursing Admin Supervisor 97538 0 1110 0 84454 0 3946 0 1597 0 188645 0 0 0 Ms Merry Heath CNO 190400 0 53391 0 3697 0 11943 0 6761 0 266192 0 0 0 Ms Elizabeth Leddy Secretary 0 344306 0 90667 0 117356 0 53125 0 12444 0 617898 0 0 Ms Mary McFarland Sr Dir Cardiovasc. Svcs 151669 0 21897 0 1618 0 10769 0 10056 0 196009 0 0 0 Ms Sandra Biles Dir Inpatient Services 151509 0 17619 0 2298 0 8777 0 15201 0 195404 0 0 0 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS JAMES MICHAEL BURNETT RECEIVED A DISCRETIONARY SPENDING ACCOUNT TOTALING $12,000, A FIXED AMOUNT DETERMINED BY HIS JOB LEVEL. THIS SPENDING ACCOUNT WAS INCLUDED IN MR. BURNETT'S TAXABLE WAGES. SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT FAYETTE 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 J. MICHAEL BURNETT RECEIVED A SERP PAYMENT IN THE AMOUNT OF $346,221. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: MICHAEL MCANDER JOHN MILES SCOTT WOLFE DAVID NATHAN NIPPER FREDERICK WILLMS ELIZABETH LEDDY SHERYL KLINK 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. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2017 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT FAYETTE 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 FAYETTE HOSPITAL ("PFH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT FAYETTE HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT FAYETTE HOSPITAL. FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT FAYETTE 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 FAYETTE 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 FAYETTE HOSPITALS FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATIONS FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PFHS 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, SEC B, LINE 12C: conflict of interest policy COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT 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 FAYETTE 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 FAYETTE 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 ($14,061) BOOK/TAX DIFF $26,902 CHANGES IN TEMP. ($29,142) INTERCOMPANY TRANS. ($34,110,415) CHANGES IN UNRESTR. FUND $9,554 -------------------- TOTAL ($34,117,162) FAYETTE SURGERY CENTER LLC 1255 HIGHWAY 54 WEST Fayetteville GA 30214 Surgery GA 0 PFH 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 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 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 ATHENS REGIONAL FOUNDATION INC 1199 PRINCE AVENUE ATHENS GA 30606 581978389 FUNDRAISING GA 501(C)(3) 12B, II ARMC false PIEDMONT ATHENS REGIONAL HEALTH RESOURCE 1199 PRINCE AVENUE ATHENS GA 30606 581930580 DEVELOPMENT GA 501(C)(3) 12B, II ARMC false PIEDMONT ATHENS REGIONAL MEDICAL CENTER 1199 PRINCE AVENUE ATHENS GA 30606 582179986 HOSPITAL GA 501(C)(3) 3 PHC false ATHENS REGIONAL PHYSICIAN SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 582332921 HEALTHCARE GA 501(C)(3) 12B, II ARMC false ATHENS REGIONAL SPECIALTY SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 271975001 HEALTHCARE GA 501(C)(3) 3 ARMC false REGIONAL FIRSTCARE INC 1199 PRINCE AVENUE ATHENS GA 30606 582362733 URGENT CARE GA 501(C)(3) 12B, II ARMC false COLUMBUS AMBULATORY HEALTHCARE SERVICES 707 CENTER ST COLUMBUS GA 31901 581719867 AMBULATORY GA 501(C)(3) 3 PHC false COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 707 CENTER ST COLUMBUS GA 31901 581719994 HEALTHCARE GA 501(C)(3) 12B, II PHC false COLUMBUS REGIONAL MEDICAL FOUNDATION INC 707 CENTER ST 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 STOCKBRIDGE GA 30281 582200195 HEALTHCARE GA NA 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 CTR 95 COLLIER RD NW STE 4075 ATLANTA GA 30309 582406657 HEALTHCARE GA NA N/A 0 0 false 0 SOUTHERN CRESCENT RADIATION ONCOLOGY CTR 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 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 NA C Corp 0 0 false AMSTER MCRAE INSURANCE COMPANY PO BOX 1159 Grand Cayman KY CJ 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 phc 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 SCHEDULE R, PART I, LINE 1: DISREGARDED ENTITIES THE LIMITED LIABILITY COMPANY LISTED IN SCHEDULE R, PART I, OPERATES AS A DEPARTMENT OF PIEDMONT FAYETTE HOSPITAL AND IS INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LLC AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.