2017-06-09T09:37:39-04:00 2016-07-31 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2015-08-01 383647394 PHOEBE WORTH MEDICAL CENTER INC PHOE 2297766961 807 SOUTH ISABELLAPO BOX 545 SYLVESTER GA 317910545 CANDACE GUARNIERI CFO 2297766961 2017-06-09 true JEFFREY S WRIGHT P00226270 2298837878 2017-06-09 X 2015 2021-01-29 14:40:06Z KIM GILMAN PO BOX 545 SYLVESTER GA 317910545 15343734 false X WWW.PHOEBEHEALTH.COM X 2002 GA PROVIDING CHARITABLE HEALTHCARE ACTIVITIES 9 5 222 9 0 475353 464312 14550480 14628814 7024 39827 434787 191477 15467644 15324430 45619 51476 0 7252536 8192960 0 0 8491356 8735303 15789511 16979739 -321867 -1655309 8957980 9768791 13535996 16002116 -4578016 -6233325 PROVIDING CHARITABLE HEALTHCARE ACTIVITIES false false 14721257 51476 14633987 TO BE THE LEADING PROVIDER OF QUALITY, COST EFFECTIVE, PATIENT-CENTERED HEALTH CARE SERVICES TO ALL RESIDENTS OF SOUTHWEST GEORGIA. PWMC PURSUES ITS MISSION THROUGH A PATIENT-CENTERED ENVIRONMENT OF CARE REFLECTING HIGH STANDARDS AND PROMOTING A BALANCE OF PROFESSIONAL PREPARATION AND SERVICE, CONTINUOUS IMPROVEMENT BASED ON OUR CORE VALUES OF PEOPLE, RELATIONSHIPS, REPUTATION, EXCELLENCE, EFFICIENCY AND COMMITMENT. 14721257 true true false true false false false false false false true false false false true true true true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false true 23 0 222 true false false false false false false false false false false X 9 5 false false false false true true true true true false false true true true true true true false false false GA X X CANDACE GUARNIERI CFO 2297766961 PO BOX 545 SYLVESTER GA 317910545 JOEL WERNICK BD MEMBER/PP 1.00 54.00 X X 0 1023106 1166168 JOE AUSTIN BD MEMBER/PP 1.00 53.00 X X 0 848171 180931 DON MONK CHAIRMAN 1.00 0.00 X X 0 0 0 JOHNNY COCHRAN VICE CHAIR 1.00 0.00 X X 0 0 0 CHRIS SHIPP BOARD MEMBER 1.00 0.00 X 0 0 0 MARY KING GIVENS BOARD MEMBER 1.00 1.00 X 0 0 0 WAYNE SENKBEIL BOARD MEMBER 1.00 0.00 X 0 0 0 NATU PATEL MD BOARD MEMBER 1.00 0.00 X 0 0 0 SHIRLEY THOMAS BOARD MEMBER 1.00 0.00 X 0 0 0 BRIAN CHURCH PPHS CFO 1.00 54.00 X 0 268655 18925 KIM GILMAN CEO/CNO 25.00 25.00 X 0 231798 1239 CANDACE GUARNIERI CFO 25.00 25.00 X 0 121489 13461 MISSY EAST MID-LEVEL PR 40.00 0.00 X 115868 3698 17122 TOREY BARTON PHARMACIST 40.00 0.00 X 109186 0 2585 KERRY LOUDERMILK FORMER PPHS 0.00 0.00 X 0 912481 18633 225054 3409398 1419064 2 true true false ARAMARK CORPORATION 25271 NETWORK PLACE CHICAGO IL 606731252 DIETARY SERVICE 548721 THE ROSE GROUP 817 NW 56TH TERRACE SUITE A GAINESVILLE FL 326056401 NURSING SERVICE 107272 2 464312 464312 NET PATIENT SERVICE REVENUE 623000 14628814 14628814 14628814 5827 5827 51660 19304 32356 32356 32356 34000 34000 34000 34000 CAFETERIA 722513 138187 138187 MEDICAL RECORDS 621990 10355 10355 EMPLOYEE PHARMACY 621990 5406 5406 5173 5173 159121 15324430 14633987 226131 X 51476 51476 5800131 5358950 441181 123573 114174 9399 1839041 1699156 139885 430215 397491 32724 116670 116670 63000 63000 4626270 4187508 438762 28488 7417 21071 943682 902474 41208 324205 256182 68023 24391 13928 10463 805132 636202 168930 390112 390112 REPAIRS & MAINTENANCE 624742 468233 156509 MEDICAL SUPPLIES 448119 448119 MISCELLANEOUS 168447 65036 103411 DUES & SUBSCRIPTIONS 121070 63936 57134 50975 50975 16979739 14721257 2258482 0 2453505 3092350 387841 1888121 1721800 168373 161803 98739 165839 10194679 5633788 3913885 4560891 47516 66108 8957980 9768791 1972727 1321798 11563269 14680318 13535996 16002116 X -4578016 -6233325 -4578016 -6233325 8957980 9768791 -1655309 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1932 1932 false SCHEDULE C, PART II-B, LINE 1 PART II-B, LINE 1I THE ORGANIZATION PAYS MEMBERSHIP DUES TO A NATIONAL HEALTHCARE ORGANIZATION. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THE NATIONAL HEALTHCARE ORGANIZATION PARTICIPATE. 175676 175676 3653099 1696567 1956532 6365904 3937221 2428683 4560891 DUE TO PHOEBE PUTNEY HEALTH SYSTEM 14680318 14680318 X 15343734 15343734 -19304 -19304 15324430 16999043 19304 19304 16979739 16979739 SCHEDULE D, PAGE 3, PART X THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE HOSPITAL ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JULY 31, 2016 AND 2015 OR FOR THE YEARS THEN ENDED. THE HOSPITAL'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. SCHEDULE D, PAGE 4, PART XI, LINE 4B RENTAL EXPENSES -19,304 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 19,304 true true X true X 1.250000000000 true X true true false true true 318295 115174 203121 0.01190 782264 307291 474973 0.02790 2103037 1235408 867629 0.05100 3203596 1657873 1545723 0.09080 4389 4106641 3337578 769063 0.04520 51476 51476 0.00300 4389 4158117 3337578 820539 0.04820 4389 7361713 4995451 2366262 0.13900 true 7327072 4490486 2760682 1729804 X true true 1 1 PHOEBE WORTH MEDICAL CENTER INC 807 S ISABELLA STREET SYLVESTER GA 31791 WWW.PHOEBEHEALTH.COM 159-603 X X X X SWB, SNF PHOEBE WORTH MEDICAL CENTER INC 1 false false true X X X X X X X X 16 true false false true X WWW.PHOEBEHEALTH.COM X true 17 true WWW.PHOEBEHEALTH.COM false false true X 125.000000000000 200.000000000000 X X X X X X true true X X X X true X WWWPHOEBEHEALTHCOM X WWWPHOEBEHEALTHCOM X WWWPHOEBEHEALTHCOM X X X X X true X true X X X X X true X false false FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 5 MEMBERS OF THE INTERNAL ASSESSMENT TEAM PERFORMED TEN (10) KEY LEADER INTERVIEWS OF APPROXIMATELY 30 TO 60 MINUTES IN LENGTH. THE PURPOSE OF THE KEY LEADER INTERVIEWS WAS TO GATHER INFORMATION, GAIN KNOWLEDGE AND RECEIVE INPUT REGARDING HEALTH ISSUES FACING THE ORGANIZATION'S SERVICE AREA. THE INTERVIEW SELECTION PROCESS WAS CAREFUL TO INCLUDE REPRESENTATION THAT REFLECTS THE MAKE-UP OF PATIENTS RECEIVING SERVICES IN THE ORGANIZATION'S SERVICE AREA (RELIGIOUS, BUSINESS, POLITICAL, PUBLIC HEALTH, THE ELDERLY, AND AFTER SCHOOL PROGRAMS). A COMMUNITY INPUT SESSION WAS ALSO HELD TO REVIEW DATA AND PROVIDE FEEDBACK ON THE COMMUNITYS VIEW OF PRIORITIES. FOURTEEN (14) INDIVIDUALS PARTICIPATED IN THE INPUT SESSION. PARTICIPANTS WERE ASKED TO MAKE A LIST OF IDEAS THAT COULD IMPROVE THE HEALTH AND WELL-BEING OF THE COMMUNITY. THE PARTICIPANTS WERE THEN PUT INTO SMALL GROUPS TO DISCUSS AND DEVELOP 8 TO 10 IDEAS TO BRING TO THE WHOLE GROUP. FINALLY, ONCE ALL THE IDEAS WERE GATHERED AND PLACED ON A STICKY WALL, EACH PARTICIPANT HAD TO MARK 2 IDEAS THAT THEY CONSIDERED TO BE SIGNIFICANT ISSUES FACING THE COMMUNITY. THE SESSION INCLUDED COMMUNITY PARTICIPANTS SUCH AS: COMMUNITY VOLUNTEERS; MEDICAL PROFESSIONALS; REPRESENTATIVES FROM SOUTHWEST GEORGIA COUNCIL ON AGING, AND WORTH COUNTY CHAMBER OF COMMERCE. FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 11 USING THE CATHOLIC HEALTH ASSOCIATIONS SELECTION FILTER AS A MEANS TO PRIORITIZE COMPETING SIGNIFICANT NEEDS, BELOW IS A LIST OF NEEDS THAT WERE NOT INCLUDED AS PRIORITIES BUT REMAIN A CONCERN TO THE COMMUNITY. 1) TRANSPORTATION: VULNERABLE POPULATIONS HAVE ACCESS TO MEDICAID VAN OPTION. 2) CHILD AND ADULT OBESITY: THE COUNTY HEALTH DEPARTMENT AND SCHOOL SYSTEM ARE ADDRESSING THIS NEED. 3) ASTHMA AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD): THE COMMUNITY DID NOT ADDRESS IT AS A SIGNIFICANT NEED. 4) TEEN PREGNANCY AND UNPLANNED PREGNANCY: THE TEEN PREGNANCY RATE IN WORTH COUNTY IS BELOW THE 2020 WORLD HEALTH ORGANIZATION BENCHMARK. 5) LOW BIRTH WEIGHT INFANTS: THERE ARE NO BIRTHING CENTERS OR OB/GYN PHYSICIANS LOCATED IN WORTH COUNTY. 6) LUNG CANCER: THE WORTH COUNTY CANCER INCIDENT RATE IS NOTABLY BETTER THAN THE SURROUNDING COUNTIES AND THE U.S. 50 PERCENTILE. 7) BREAST CANCER: THE WORTH COUNTY CANCER INCIDENT RATE IS NOTABLY BETTER THAN THE SURROUNDING COUNTIES AND THE U.S. 50 PERCENTILE. 8) ALZHEIMER'S DISEASE: THE SOUTHWEST GEORGIA COUNCIL ON AGING OFFERS EDUCATION AND SUPPORT FOR CAREGIVERS IN THE COMMUNITY. 9) SEXUALLY TRANSMITTED DISEASES (STD): THE STD RATE HAS BEEN NOTED TO BE ON THE DECLINE FOR WORTH COUNTY. A COMPLETE COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY PRIORITIES, AND IMPLEMENTATION PLAN CAN BE FOUND AT HTTP://WWW.PHOEBEHEALTH.COM/LOCATIONS/PHOEBE-WORTH- MEDICAL-CENTER/PHOEBE- WORTH-MEDICAL-CENTER-CHNA FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 13B HOUSEHOLD INCOMES OVER 200% OF FPG WHERE THE PATIENT HAS A CATASTROPHIC ILLNESS IS ELIGIBLE FOR CASTASTROPHIC STATUS WHICH PROVIDES FOR DISCOUNTED CHARGES FOR CARE. FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 20E PAYMENT PLANS WERE MADE AVAILABLE FOR THOSE NOT ELIGIBLE FOR ASSISTANCE. FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 22D THE MINIMUM PERCENTAGE DISCOUNT APPLIED TO FAP ELIGIBLE INDIVIDUALS SHALL BE CALCULATED ON AN ANNUAL BASIS. AMOUNTS GENERALLY BILLED IS DETERMINED BY DIVIDING THE SUM OF CLAIMS PAID THE PREVIOUS FISCAL YEAR BY MEDICARE FEE- FOR-SERVICE AND ALL PRIVATE HEALTH INSURANCE, INCLUDING PAYMENTS RECEIVED FROM BENEFICIARIES AND INSURED PATIENTS, BY THE SUM OF THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS. 1 PHOEBE WORTH FAMILY MEDICAL CENTER 1014 WEST FRANKLIN STREET SYLVESTER GA 31791 RHC PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 16,979,739 ADD: EXPENSES REPORTED IN PART VIII 19,304 DENOMINATOR FOR COLUMN (F) 16,999,043 PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE COST WAS CALCULATED USING THE COST-TO-CHARGE RATIO AS CALCULATED USING WORKSHEET 2 FROM THE IRS FORM 990 INSTRUCTIONS. THE COST OF ON LINE 7I WAS GENERATED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY THE AMOUNTS ON PART III, LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS SEE PAGES 6 AND 7 ON THE ACCOMPANYING AUDITED FINANCIAL STATEMENTS FOR THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE DISCLOSURE. PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION THE ORGANIZATION PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES FOR PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS. PART VI, LINE 2 - NEEDS ASSESSMENT NEEDS ASSESSMENTS HAVE TRADITIONALLY LED TO THE CREATION OF COMMUNITY-BASED DELIVERY SYSTEMS THAT EXPAND ACCESS TO HEALTH CARE, MEET THE NEEDS OF THE PEOPLE AND BUILD HEALTHY COMMUNITIES IN THE BROADEST SENSE BY IMPACTING MAJOR DETERMINANTS, SUCH AS ECONOMIC DEVELOPMENT, EMPLOYMENT, CHILDREN'S SAFETY, EDUCATION AND ADEQUATE HOUSING. THE ORGANIZATION CONDUCTS REGULAR NEEDS ASSESSMENT THROUGH FORMAL AND INFORMAL SURVEYS AND PROCESSES, INCLUDING COLLABORATIONS WITH PUBLIC AND COMMUNITY AGENCIES. THROUGH STRATEGIC PLANNING AND COMMUNITY INTERVIEWS, THE ORGANIZATION DEVELOPS PROGRAMS AND SERVICES THAT CONSIDER THE ECONOMIC IMPERATIVES OF THE REGION, THE EFFECT OF LEGISLATION AND THE INVOLVEMENT OF OTHER COMMUNITY-BASED ORGANIZATIONS AND PARTNERS. THE ORGANIZATION REGULARLY CONDUCTS FOCUS GROUPS IN THE COMMUNITY TO UNDERSTAND ISSUES AFFECTING ITS PATIENTS, AND HAS CREATED PROGRAMS IN RESPONSE TO HEALTH DISPARITIES PREVALENT IN THE AREA. THE ORGANIZATION ALSO COLLECTS HEALTH NEEDS INFORMATION FROM NURSES, WHO PROVIDE DIRECT CARE TO STUDENTS AND STAFF AND WHO COLLABORATE WITH OTHER AGENCIES TO DEVELOP HEALTH AWARENESS AND DISEASE PREVENTION PROGRAMS. THE ORGANIZATION ALSO CONDUCTS REGULAR PHYSICIAN WORKFORCE STUDIES THROUGH ITS STRATEGIC PLANNING ARM TO DETERMINE UNMET PHYSICIAN NEEDS AND BARRIERS TO ACCESSING CARE. THE ORGANIZATION MEASURES THE SUCCESS OF ITS COMMITMENT BY HOW WELL IT KEEPS PEOPLE HEALTHY AND HOW WELL IT IMPACTS THE SOCIAL/CULTURAL BONDS THAT WILL SECURE THE COMMUNITIES OF THE FUTURE. THE HOSPITAL LAST CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2016. A COMPLETE COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY PRIORITIES, AND IMPLEMENTATION PLAN CAN BE FOUND AT HTTP://WWW.PHOEBEHEALTH.COM/LOCATIONS/PHOEBE-WORTH- MEDICAL-CENTER/PHOEBE- WORTH-MEDICAL-CENTER-CHNA PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE BOARD HAS CLEARLY WRITTEN FINANCIAL ASSISTANCE POLICY THAT IS AVAILABLE ON THE ORGANIZATION'S WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND CHARITY CARE. PATIENT EDUCATION ON THE ORGANIZATION'S FINANCIAL ASSISTANCE IS CONDUCTED DURING PRE-REGISTRATION, THROUGH FLOOR VISITS BY BUSINESS OFFICE REPRESENTATIVES FOR PATIENTS THAT STRESS CONCERN IN MEETING THE FINANCIAL OBLIGATIONS FOR THEIR SERVICES, AND THROUGH OUR CUSTOMER SERVICE DEPARTMENT. BROCHURES ARE PROMINENTLY DISPLAYED AT EACH REGISTRATION BOOTH. THE BUSINESS OFFICE CONTINUOUSLY PROVIDES UPDATED MATERIAL TO PHYSICIAN OFFICES FOR ISSUANCE TO THEIR PATIENTS THAT HIGHLIGHT THE FINANCIAL ASSISTANCE PROGRAM AND POLICIES. THE PATIENT STATEMENTS HIGHLIGHT THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND ENCOURAGES PATIENTS TO CALL FOR FINANCIAL ASSISTANCE. PART VI, LINE 4 - COMMUNITY INFORMATION WORTH COUNTY IS PHOEBE WORTHS PRIMARY SERVICE AREA. THERE ARE APPROXIMATELY 21,678 RESIDENTS OF WORTH COUNTY WITH A RACIAL MIX OF 70% WHITE, 28% AFRICAN AMERICAN AND 2% ALL OTHERS. POPULATION PROJECTIONS FOR WORTH COUNTY SHOW OVERALL POPULATION GROWTH, WITH AGES 65+ HAVING THE GREATEST GROWTH RATE. THE HOUSEHOLD MEDIAN INCOME FOR WORTH COUNTY AVERAGED 38,800 DURING 2012 WHICH IS A THIRD LESS THAN THE GEORGIA STATE AVERAGE. THE AVERAGE CENSUS TRACT PER CAPITA INCOME IS 19,073 OR 78% OF THE NATIONAL AVERAGE. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH THE ORGANIZATION AND ITS VOLUNTEER BOARD IS COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS, AS WELL AS PHYSICIAN MEMBERS. THE ORGANIZATION'S EMERGENCY CENTER IS OPERATED 24/7 AND OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. THE BOARD MAINTAINS OPEN MEDICAL STAFF POLICIES WITH PRIVILEGES AVAILABLE TO ALL QUALIFYING PHYSICIANS. THE BOARD HAS A CLEARLY WRITTEN FINANCIAL ASSISTANCE POLICY THAT IS AVAILABLE ON THE ORGANIZATION'S WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND CHARITY CARE. THE ORGANIZATION HAS A MULTI-PRONGED APPROACH TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES: INCREASING ACCESS, BUILDING CAPACITY, INVESTING IN "UPSTREAM" PROGRAMS THAT GET AT THE CAUSE OF DISEASE AND ILLNESS, BUILDING COMMUNITY PARTNERSHIPS, ADVOCATING CHANGE, AND DEVELOPING LEADERSHIP. SURPLUS FUNDS ARE REINVESTED IN RESOURCES TO IMPROVE THE DELIVERY OF MEDICAL AND HEALTH CARE SERVICES. PRIMARY CARE IS FIRST AND CREATES A PROFOUND IMPACT ON THE COMMUNITIES SERVED. PRIMARY CARE SERVICES ARE ESTABLISHED IN AREAS WHERE RESIDENTS ARE MOST LIKELY TO SUFFER FROM SEVERE MANPOWER SHORTAGES, HIGH POVERTY LEVELS AND A LACK OF ACCESS TO CARE. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM PHOEBE PUTNEY HEALTH SYSTEM, INC. (PPHS) IS THE NOT-FOR-PROFIT PARENT COMPANY OF PHOEBE PUTNEY MEMORIAL HOSPITAL, INC. (PPMH), A NOT-FOR-PROFIT ENTITY, PHOEBE PUTNEY HEALTH VENTURES, INC. (PPHV), A FOR-PROFIT CORPORATION, PHOEBE PHYSICIAN GROUP, INC. (PPG), A NOT-FOR-PROFIT CORPORATION, PHOEBE WORTH MEDICAL CENTER, INC. (PWMC), A NOT-FOR-PROFIT ENTITY, PHOEBE SUMTER MEDICAL CENTER, INC. (PSMC), A NOT-FOR-PROFIT ENTITY, AND PHOEBE FOUNDATION, INC. (PF), A NOT-FOR-PROFIT ENTITY. PPMH IS LOCATED IN ALBANY, GEORGIA, IS AN ACUTE CARE HOSPITAL, WHICH OPERATES SATELLITE CLINICS IN THE SURROUNDING COUNTIES. IT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SOUTHWEST GEORGIA. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. PPHV ENGAGES IN HEALTHCARE AND RELATED ACTIVITIES IN FURTHERANCE OF THE EXEMPT PURPOSES OF PPHS AND PPMH. PWMC IS LOCATED IN SYLVESTER, GEORGIA, IS A 25 BED RURAL CRITICAL ACCESS HOSPITAL. IT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WORTH COUNTY, GEORGIA. PSMC IS LOCATED IN AMERICUS, GEORGIA, IS AN ACUTE CARE HOSPITAL. IT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SUMTER COUNTY, GEORGIA. PPG WAS ESTABLISHED TO ORGANIZE AND OPERATE MEDICAL PRACTICES EXCLUSIVELY FOR THE BENEFIT OF PPMH, PWMC, AND PSMC. PF WAS ESTABLISHED TO RAISE FUNDS OF ANY KIND OR CHARACTER TO BE USED EXCLUSIVELY FOR CHARITABLE, MEDICAL, EDUCATIONAL AND SCIENTIFIC PURPOSES AT OR IN CONNECTION WITH EACH AND EVERY NON-PROFIT ORGANIZATION OF WHICH PPHS IS THE SOLE MEMBER, AND ANY OTHER NON-PROFIT HOSPITAL WHICH IS MANAGED OR CONTROLLED BY PPHS WHETHER THROUGH OWNERSHIP, MANAGEMENT CONTRACT OR OTHERWISE. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT GEORGIA ADDITIONAL INFORMATION SERVICE TO THE COMMUNITY PHOEBE WORTH MEDICAL CENTER (PWMC) IS A NOT-FOR-PROFIT HEALTH CARE ORGANIZATION THAT EXISTS TO SERVE THE COMMUNITY. PWMC HAS NO STOCKHOLDERS OR OWNERS, AND IS PART OF THE NOT-FOR-PROFIT PHOEBE PUTNEY HEALTH SYSTEM, INC. AFTER OPERATING EXPENSES ARE COVERED, ANY REMAINING REVENUES ARE REINVESTED IN THE OPERATION OF PWMC IN ORDER TO ENHANCE OUR ABILITY TO CARRY OUT OUR LOCAL MISSION OF TAKING CARE OF OUR COMMUNITIES' CITIZENS. IN 2016, PWMC WORKED WITH THE WORTH COUNTY HEALTH DEPARTMENT TO ENABLE THEM TO SUPPORT TWO HEALTH PREVENTION TYPE PROGRAMS. ONE PROGRAM WAS STROKE AND HEART ATTACK PREVENTION (SHAPP), THE SECOND PROGRAM WAS A DIABETES PROGRAM. THE COST TO PWMC WAS 45,619. PWMC PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS WHICH COVER MANY GEORGIAN'S HEALTH CARE NEEDS, AND BY SO DOING, FOREGOES SOME CHARGES AND HAS UNREIMBURSED EXPENSES. CHARGES FOREGONE, DESCRIBED AS CONTRACTUAL ADJUSTMENTS, AND COSTS NOT REIMBURSED, DESCRIBED AS INDIGENT OR CHARITY CARE ARE OUTLINED BELOW. PWMC ALSO OPERATES A RURAL HEALTH CLINIC (RHC) WHICH ALSO FOREGO SOME CHARGES AND HAVE COSTS NOT REIMBURSED THROUGH PATIENTS QUALIFYING FOR THESE SAME INDIGENT AND CHARITY PROGRAMS. THE AMOUNTS LISTED BELOW ARE ALL INCLUSIVE OF BOTH HOSPITAL AND CLINIC ACTIVITIES. ESTIMATED CHARGES UNREIMBURSED FOREGONE COST MEDICARE 7,000,000 3,000,000 MEDICAID 5,000,000 2,000,000 INDIGENT/CHARITY CARE 1,000,000 0 TOTALS 13,000,000 5,000,000 PATIENTS WHOSE INCOME FALLS BELOW 125% OF FEDERAL POVERTY GUIDELINES ARE ELIGIBLE TO APPLY FOR ASSISTANCE THROUGH THE INDIGENT PROGRAM. true WORTH COUNTY HEALTH DEPARTMENT 1012 W FRANKLIN STREET SYLVESTER GA 317911978 581568404 GOV 45619 SEE PART IV 1 SCHEDULE I, PAGE 1, PART I, LINE 2 THE WORTH COUNTY HEALTH DEPARTMENT SENDS A LETTER TO PWMC ASKING FOR FINANCIAL ASSISTANCE RELATED TO SPECIFIC PROGRAMS THAT ARE PROVIDED BY THE HEALTH DEPARTMENT. ONCE RECEIVED, PWMC'S BOARD APPROVES THE AMOUNT OF ASSISTANCE TO THE HEALTH DEPARTMENT. THE FUNDS THAT ARE GIVEN TO THE HEALTH DEPARTMENT ARE DEEMED TO BE USED FOR THE SPECIFIC PURPOSES MENTIONED IN THE ORIGINAL LETTER FROM THE HEALTH DEPARTMENT. IN 2016, PWMC WORKED WITH THE HEALTH DEPARTMENT TO ENABLE THEM TO SUPPORT TWO HEALTH PREVENTION TYPE PROGRAMS. ONE PROGRAM WAS STROKE AND HEART ATTACK PREVENTION (SHAPP), THE SECOND PROGRAM WAS A DIABETES PROGRAM. true true false false false false false false false JOEL WERNICK BD MEMBER/PPHS CEO 784703 227910 10493 1149207 16961 2189274 JOE AUSTIN BD MEMBER/PPHS COO 459214 111249 277708 160561 20370 1029102 274470 BRIAN CHURCH PPHS CFO 244907 23529 219 4769 14156 287580 KIM GILMAN CEO/CNO 192541 38202 1055 1239 233037 KERRY LOUDERMILK FORMER PPHS CFO 243688 100599 568194 5393 13240 931114 SCHEDULE J, PAGE 1, PART I, LINE 3 NONE OF THE INDIVIDUAL BOARD MEMBERS OR OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION. THE FILING ORGANIZATION, INSTEAD, RELIES ON THE METHODS USED BY PPHS, THE SOLE MEMBER, TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY PPHS INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. SCHEDULE J, PAGE 1, PART I, LINE 4 JOEL WERNICK 0 1,094,723 0 JOE AUSTIN 0 154,899 0 KERRY LOUDERMILK 558,324 0 0 SCHEDULE J, PART III SCHEDULE J, PART I, LINE 4 - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: DEFERRED COMPENSATION PLAN 457(B): THE DEFERRED COMPENSATION PLAN IS AN ADDITIONAL RETIREMENT PLAN OFFERED THROUGH PHOEBE PUTNEY. THE 457(B) PLAN IS AN ELIGIBLE DEFERRED COMPENSATION PLAN THAT ALLOWS ONE TO DEFER ADDITIONAL DOLLARS TOWARDS RETIREMENT. HIGHLIGHTS INCLUDE: O NOT LIMITED BY THE AMOUNTS DEFERRED INTO THE PHOEBE 403(B) O PLAN IS SUBJECT TO ANNUAL DEFERRAL LIMITS SET BY THE IRS O PER IRS REGULATIONS, EACH PARTICIPANT IS A GENERAL UNSECURED CREDITOR OF THE PLAN SPONSOR. SENIOR VICE PRESIDENTS AND ABOVE AND PHYSICIANS MAKING OVER 120,000 ARE ELIGIBLE TO PARTICIPATE IN THE 457(B) PLAN. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) 457(F): PPHS RELIES ON AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, SURVEYS, WELL DOCUMENTED METHODS AND BOARD APPROVAL TO ESTABLISH TOTAL COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. CERTAIN BOARD APPROVED EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN A SERP. THE PURPOSE OF THE SERP IS TO PROVIDE A RETIREMENT BENEFIT FOR AFFECTED EXECUTIVES CONSISTENT WITH THE BENEFIT AVAILABLE TO EMPLOYEES NOT IMPACTED BY IRS COMPENSATION LIMITS ON DEFINED BENEFIT PLANS. THE SERP BENEFITS FOR ELIGIBLE EMPLOYEES ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. THE AMOUNTS REPORTED AS SUPPLEMENTAL EXECUTIVE RETIREMENT COMPENSATION FOR ELIGIBLE EMPLOYEES REPRESENT CREDITED, BUT NOT VESTED, RETIREMENT BENEFITS, AND THE AMOUNTS ARE AVAILABLE IN FUTURE PERIODS TO THE EMPLOYEE SUBJECT TO CONTINUING EMPLOYMENT. PPHS MAINTAINS OWNERSHIP OF THE FUNDS ALLOCATED TO EACH PARTICIPANT UNTIL VESTING AND PAYMENT. PRIOR TO NORMAL RETIREMENT AGE, PPHS RETAINS AT LEAST TWO YEARS OF BENEFITS WHICH ARE SUBJECT TO CONTINUING EMPLOYMENT FOR THE PARTICIPANT TO RECEIVE THE FUNDS AT THE NEXT VESTING DATE. THE PLAN IS A DEFINED CONTRIBUTION ACCOUNT BASED AND PARTICIPANT DIRECTED INVESTMENT PROGRAM THAT IS EMPLOYER FUNDED. A SUBSTANTIAL PORTION OF THE AMOUNTS REPORTED IN COLUMN C OF SCHEDULE J, PART II (RETIREMENT AND OTHER DEFERRED COMPENSATION) ARE THE CURRENT YEAR DEFERRALS FOR ELIGIBLE PARTICIPANTS IN THE SERP. THE CURRENT YEAR DEFERRALS ARE REPORTED IN THE PART I, LINE 4 TABLE ABOVE. A PARTICIPANT'S FIRST VESTING DATE WILL OCCUR ON THE DATE THE PARTICIPANT ATTAINS FIVE YEARS OF PARTICIPATION UNDER THE PLAN. IF AN ELIGIBLE PARTICIPANT ATTAINS NORMAL RETIREMENT AGE PRIOR TO THIS SEPARATION FROM SERVICE, THEY SHALL VEST IN 100% OF THE ACCOUNT BALANCE. ONCE VESTED, EACH PARTICIPANT SHALL RECEIVE A DISTRIBUTION OF THEIR ENTIRE VESTED AMOUNT WITHIN A REASONABLE PERIOD NOT TO EXCEED 2.5 MONTHS. THIS DISTRIBUTION IS TREATED AS REPORTABLE COMPENSATION TO THE PARTICIPANT AND IS INCLUDED IN PART II, COLUMN B(III). THEREFORE, PART II, COLUMN B(III) INCLUDES PRIOR YEAR SERP DEFERRALS PREVIOUSLY REPORTED IN PART II, COLUMN C. ANY DISTRIBUTION AMOUNT INCLUDED IN PART II, COLUMN B(III) THAT WAS PREVIOUSLY REPORTED IN PRIOR PERIODS AS DEFERRED COMPENSATION IN PART II, COLUMN C IS DISCLOSED IN PART II, COLUMN F. THE FOLLOWING PARTICIPANTS VESTED AND RECEIVED PAYMENT OF SERP BENEFITS IN THE 2015 CALENDAR YEAR. JOE AUSTIN 274,470 (PARTIAL VESTING - MULTI-YEAR VESTED AMOUNT) SCHEDULE J, PART II, COLUMN B(II) CERTAIN EXECUTIVE OFFICERS AND PHYSICIANS ARE ELIGIBLE FOR BONUS/INCENTIVE PAYMENTS. THESE BONUSES ARE DETERMINED BASED ON THE ACHIEVEMENT OF VARIOUS ORGANIZATIONAL AND PERSONAL PERFORMANCE GOALS ESTABLISHED BY A FORMAL PROCESS IN KEEPING WITH THE ORGANIZATION'S TAX-EXEMPT STATUS. FORM 990, PAGE 6, PART VI, LINE 6 THE SOLE MEMBER OF PHOEBE WORTH MEDICAL CENTER, INC. SHALL BE PHOEBE PUTNEY HEALTH SYSTEM, INC. (PPHS). FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD OF DIRECTORS OF PPHS, THE SOLE MEMBER, SHALL APPOINT ALL DIRECTORS OF THE FILING ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 7B THE SOLE MEMBER, PPHS, SHALL HAVE THE FOLLOWING RESPONSIBILITIES: - THE MEMBER SHALL APPOINT OR REMOVE THE ORGANIZATION'S DIRECTORS. - THE MEMBER SHALL SELECT OR REMOVE THE ORGANIZATION'S OFFICERS. - THE MEMBER SHALL APPROVE ALL AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY MAY BECOME EFFECTIVE. - THE MEMBER SHALL APPROVE ANY ANNUAL OPERATING OR CAPITAL BUDGETS. - THE MEMBER SHALL APPOINT OR REMOVE THE INDEPENDENT AUDITORS. FORM 990, PAGE 6, PART VI, LINE 11B THE INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 (BASED UPON INFORMATION PROVIDED BY THE ORGANIZATION) PROVIDES A COMPLETE COPY OF THE RETURN WITH APPLICABLE SCHEDULES TO BE REVIEWED BY MANAGEMENT. MANAGEMENT PERFORMS A DETAILED REVIEW WHICH CONSISTS OF REVIEWING THE FINANCIAL DATA, THE NARRATIVES DISCLOSED, AND OTHER FACTS PRESENTED ON THE RETURN. UPON REVIEW, THE FORM 990 IS THEN FORWARDED TO THE FINANCE COMMITTEE FOR THEIR REVIEW, TO GAIN THEIR COMMENTS AND APPROVAL. UPON APPROVAL FROM THE FINANCE COMMITTEE, THE FORM 990 AND RELATED SCHEDULES ARE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND FEEDBACK. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES, A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PAGE 6, PART VI, LINE 12C ON AN ANNUAL BASIS, PHOEBE WORTH MEDICAL CENTER, INC. (PWMC) BOARD MEMBERS AS WELL AS ALL OFFICERS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. THIS QUESTIONNAIRE IS ADMINISTERED BY THE PHOEBE PUTNEY HEALTH SYSTEM (PPHS) COMPLIANCE DEPARTMENT AND THE DOCUMENT ASKS EACH INDIVIDUAL TO DISCLOSE ANY PERSONAL, BUSINESS, OR OTHER AFFILIATIONS AND MONETARY AMOUNT IF APPLICABLE THAT THEY OR THEIR IMMEDIATE FAMILY MEMBERS HAVE HAD WITHIN THE PAST 12 MONTHS WITH PWMC OR ANY RELATED ENTITIES. ALL RESPONSES ARE THEN EVALUATED BY THE PPHS COMPLIANCE DEPARTMENT. IN THE CASE OF AN EXISTING CONFLICT, THE INDIVIDUAL WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL TO SUCH TRANSACTIONS. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES AVAILABLE TO THE PUBLIC ITS CONFLICT OF INTEREST AND AUDITED FINANCIAL STATEMENTS ON THE ORGANIZATION'S WEBSITE, BY PROVIDING COPIES UPON REQUEST, AND BY INSPECTION AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION. FORM 990, PART IX, LINE 11G PHYSICIAN FEES 3,216,810 0 0 COLLECTION SERVICES 0 94,393 0 CONSULTANT FEES 946,098 0 0 CONTRACT SERVICES 24,600 344,369 0 PHOEBE PUTNEY HEALTH SYSTEM INC PO BOX 3770 ALBANY GA 317063770 582001014 HEALTHCARE GA 501C3 11C NA false PHOEBE PUTNEY MEMORIAL HOSPITAL INC PO BOX 3770 ALBANY GA 317063770 581928247 HEALTHCARE GA 501C3 3 PPHS false PHOEBE PHYSICIAN GROUP INC PO BOX 3770 ALBANY GA 317063770 263792403 HEALTHCARE GA 501C3 9 PPHS false PHOEBE SUMTER MEDICAL CENTER INC 126 HIGHWAY 280 WEST AMERICUS GA 317198645 263975185 HEALTHCARE GA 501C3 3 PPHS false PHOEBE FOUNDATION INC PO BOX 3770 ALBANY GA 317063770 581847104 FOUNDATION GA 501C3 11A PPHS false SOUTH GEORGIA SHARED SERVICES INC 417 WEST THIRD AVENUE ALBANY GA 317011943 462746977 COOPERATIV GA 501C3 3 PPHS false PHOEBE DORMINY MEDICAL CENTER INC PO BOX 3770 ALBANY GA 317063770 452041878 HEALTHCARE GA 501C3 3 PPHS false PHOEBE PUTNEY HEALTH VENTURES INC PO BOX 3770 ALBANY GA 317063770 581963401 HEALTHCARE GA N/A false false false false false true false false false false false false false true false true false true false false