2016-05-16T11:32:29-05:00 2015-06-30 KPMG LLP 300 NORTH GREENE STREET SUITE 400 GREENSBORO NC 27401 990 2014-07-01 205077249 Piedmont Newnan Hospital Inc % MARIE GAFFNEY PIED 6788542470 745 Poplar Road Newnan GA 30265 TERESA L WILSON VP CORPORATE FINANCE 2016-05-12 SHAWN M HUTCHINSON P01048557 3362753394 2014 2016-12-15 16:53:06Z Michael Robertson 745 Poplar Road Newnan GA 30265 208267616 false X www.piedmontnewnan.org X 2007 GA SEE PART III 6 3 1097 115 0 0 516779 55540 176327361 205912429 35275 -1486787 1047731 1101991 177927146 205583173 165560 126704 0 0 57785899 65580903 0 0 0 128087455 138274555 186038914 203982162 -8111768 1601011 509337288 198718040 417550607 16028980 91786681 182689060 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 187420282 126704 206020781 PIEDMONT NEWNAN HOSPITAL ("PNH") IS A 136-BED FACILITY LOCATED IN NEWNAN, GEORGIA, AND IS THE SOLE GENERAL HOSPITAL PROVIDER IN COWETA COUNTY. OVER 300 PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN THE CITY OF NEWNAN AND THE GREATER METROPOLITAN ATLANTA AREA, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2015, THE HOSPITAL HAD 8,012 IN-PATIENT ADMISSIONS WITH A TOTAL OF 32,866 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 54,257 AND OUTPATIENT VISITS TOTALED 58,249. SURGICAL SERVICES WERE PROVIDED TO 5,583 PATIENTS. 187420282 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 true false true false false false false false false false false false false false false true true false false false true X 0 0 true 1097 true false false false false false false false false false false X 6 3 false false false false true true true true true false false false true true true true true true true false GA X MARIE GAFFNEY 6788426007 2727 PACES FERRY RD BLDG 2 STE 70 Atlanta GA 30339 Mr Gregory A Hurst Board Member 1.0 54.0 X 0 1692430 595112 Dr Timothy Baker Board Member 1.0 0.0 X 0 0 0 Mr Wm Ronald Duffey Board Member 1.0 2.0 X 0 0 0 Dr Truett Jarrard Board Member 1.0 0.0 X 0 0 0 Dr Stanley Smith Board Member 1.0 39.0 X 0 469677 54845 Mr MICHAEL ROBERTSON PRES & CEO/Chairman 55.0 0.0 X X 0 721764 219775 Mr Charlie Hall Treasurer 1.0 54.0 X 0 976469 283195 Mr Jay D Mitchell Secretary 1.0 54.0 X 0 739299 229289 Mr Jeffrey Folk Chief Medical Officer 55.0 0.0 X 397821 0 39644 Mr John Miles CFO 55.0 0.0 X 310251 0 43699 Mr DAVID Nathan Nipper Chief Operating Officer 55.0 0.0 X 289838 0 28304 Ms Anna Ivory VP of Organizational Quality 55.0 0.0 X 233927 0 15351 Mr Jason Smith CHIEF NURSING OFFICER 55.0 0.0 X 162062 0 10521 Ms Alison L Middleton NEONATAL NURSE MANAGER 55.0 0.0 X 169864 0 13703 Mr David Copelan Director of Pharmacy 55.0 0.0 X 165273 0 20254 Ms Pamela Murphy Director of Surgical Services 55.0 0.0 X 150480 0 21950 Ms Debbie Gramling Former Secretary 0.0 0.0 X 0 159779 6170 Ms SHERI DE SHAZO FORMER CHIEF NURSING OFFICER 0.0 0.0 X 265928 0 4239 2145444 4759418 1586051 39 true true false MEDICAL SOLUTIONS INC 1010 N 102ND STREET SUITE 300 OMAHA NE 68114 NURSING SERVICES 1697661 ALLIANCE LAUNDRY AND TEXTILE SERVIC 7990 SECOND FLAGS DRIVE SUITE A AUSTELL GA 30168 LAUNDRY 955922 SYNERGY HEALTH NORTH AMERICA INC 4501 EAST ACLINE DRIVE TAMPA FL 33605 STERILIZATION 526796 FMD LITHOTRIPSY SERVICES 1850 LEE ROAD SUITE 122B WINTER PARK FL 32789 LITHOTRIPSY 324300 DVA RENAL HEALTHCARE INC PO BOX 781607 PHILADELPHIA PA 191781607 RENAL SERVICES 320045 10 55540 55540 PATIENT SERVICE REVENUE 621110 205912429 205912429 205912429 62802 62802 0 0 117748 0 117748 0 117748 117748 1036038 2585627 -1549589 -1549589 -1549589 0 0 134882 98816 36006 36006 CAFETERIA SALES 900099 614567 614567 WELLNESS REVENUE 621300 225318 225318 FEE REVENUE 900099 43567 43567 64785 64785 948237 205583173 206020781 -493148 126704 126704 0 0 0 992226 873159 119067 0 54908940 48319867 6589073 0 6273172 5520391 752781 3406565 2997777 408788 39591 39591 63111 63111 0 0 0 0 12433503 10053438 2380065 808778 797824 10954 7795946 7353176 442770 3311897 2483923 827974 0 3905202 3275366 629836 58349 40316 18033 0 13108 13108 7562060 7562060 5811765 5811765 11023670 10163941 859729 1831217 1831217 BAD DEBT EXPENSE 45527212 45527212 MEDICAL SUPPLIES & DRUGS 23050446 23050446 HOSPITAL TAX 1358269 1358269 OTHER MISCELLANEOUS EXPENSE 13680431 10260323 3420108 203982162 187420282 16561880 0 X 227816 1329631 0 0 64944 9194 23797873 22160087 0 0 0 0 0 0 2028610 2713997 680267 810381 215291232 46783497 177948642 168507735 0 0 0 0 3187015 3187015 0 0 301402121 0 509337288 198718040 14383476 15947722 0 0 0 0 0 0 0 0 0 0 354649 0 0 0 402812482 81258 417550607 16028980 X 89280781 180831531 2505900 1857529 0 0 91786681 182689060 509337288 198718040 X 1601011 89301368 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14784271 14784271 124425428 11462959 112962469 1727786 123090 1604696 57255895 33550848 23705047 17097852 1646600 15451252 168507735 0 MISCELLANEOUS OTHER LIABILITIES 81258 81258 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 TAX EXPOSURE ITEMS. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT JUNE 30, 2015 AND 2014. true true X true X true X true true false true true 3324679 0 3324679 0.02100 7301145 6705500 595645 0.00380 1844850 1098104 746746 0.00470 12470674 7803604 4667070 0.02950 55639 0 55639 0.00040 1417050 0 1417050 0.00890 205000 0 205000 0.00130 951 0 951 1678640 0 1678640 0.01060 14149314 7803604 6345710 0.04010 true 45527212 1365816 37568319 40430387 -2862068 X true true 1 1 Piedmont Newnan Hospital Inc 745 Poplar Road Newnan GA 30265 www.piedmontnewnan.org X X X Piedmont Newnan Hospital Inc 1 false false true X X X X X X X X 13 true false false true X www.piedmontnewnan.org X X true 13 true www.piedmontnewnan.org false false true X 200. 300. X X X true true X X X true X www.piedmontnewnan.org X www.piedmontnewnan.org X www.piedmontnewnan.org 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 NEWNAN HOSPITAL'S MOST RECENT CHNA BEGAN WITH A REVIEW OF PUBLICLY AVAILABLE HEALTH AND SOCIOECONOMIC DATA. THE PRIMARY SOURCES OF THIS DATA INCLUDED THE US CENSUS, US HEALTH AND HUMAN SERVICES' COMMUNITY HEALTH STATUS INDICATORS, COUNTY HEALTH RANKINGS, AND GEORGIA ONLINE ANALYTICAL STATISTICAL INFORMATION SYSTEM (OASIS). STAKEHOLDERS WERE CONTINUALLY ENGAGED DURING THIS PROCESS, WITH A PARTICULAR FOCUS ON THOSE GROUPS, ORGANIZATIONS, AND INDIVIDUALS REPRESENTING THE MOST VULNERABLE MEMBERS OF THE HOSPITAL'S COMMUNITY. SPECIFICALLY, PIEDMONT NEWNAN 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, IN AUGUST 2012, THE HOSPITAL CONDUCTED A FOCUS GROUP OF LOW-INCOME AND UNINSURED PATIENTS CURRENTLY RECEIVING CARE AT THE COWETA SAMARITAN CLINIC, WHICH PROVIDES HEALTH CARE SERVICES TO LOW-INCOME, UNINSURED COWETA COUNTY RESIDENTS. IN THE THIRD QUARTER OF FISCAL YEAR 13, PIEDMONT NEWNAN HOSPITAL HELD TWO PUBLIC COMMUNITY MEETINGS TO DISCUSS THE HEALTH NEEDS ASSESSMENT AND HOW TO BEST ADDRESS THE IDENTIFIED PRIORITIES. FROM THESE MEETINGS, THE HOSPITAL DEVELOPED ITS IMPLEMENTATION PLAN. SCHEDULE H, PART V, LINE 7D: PUBLIC AVAILABILITY OF CHNA IN ADDITION TO MAKING ITS CHNA AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT NEWNAN HOSPITAL SENT A COPY TO EACH PARTICIPANT IN THE CHNA (ABOUT 200 PEOPLE), DISTRIBUTED THE ASSESSMENT TO COMMUNITY CENTERS AND OTHER LOCATIONS THAT PRIMARILY SERVE AN UNINSURED POPULATION, SENT A COPY TO LEGISLATIVE AND ELECTED OFFICIALS, AND WIDELY DISTRIBUTED THE ASSESSMENT TO OTHER PIEDMONT HEALTHCARE HOSPITALS. SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS WHEN PIEDMONT NEWNAN 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 NEWNAN HOSPITAL FOCUSED ON REDUCING INSTANCES OF PREVENTABLE OBESITY AND OBESITY-RELATED DISEASES, INCLUDING DIABETES, BY UTILIZING COMMUNITY-WIDE AWARENESS CAMPAIGNS AND PROVIDING EDUCATION THAT ENCOURAGES COMMUNITY MEMBERS TO REDUCE THEIR RISKS THROUGH HEALTHY BEHAVIORS. OTHER KEY HEALTH ISSUES EMERGED DURING THE FY13 CHNA THAT WERE NOT THE FOCUS OF THE IMPLEMENTATION PLAN FOR FY14 THROUGH FY16. THESE ISSUES INCLUDED MENTAL HEALTH AND TRANSPORTATION. WITH RESPECT TO MENTAL HEALTH, THE HOSPITAL DID NOT HAVE THE RESOURCES TO MAKE A MEANINGFUL IMPACT ON THE ISSUE AS PIEDMONT NEWNAN HOSPITAL DOES NOT PROVIDE MENTAL HEALTH SERVICES IN-HOUSE. FURTHER, AS A HEALTHCARE PROVIDER, PIEDMONT NEWNAN HOSPITAL IS UNABLE TO SIGNIFICANTLY INFLUENCE TRANSPORTATION OFFERINGS OR TRANSPORTATION-RELATED PROBLEMS IN THE COMMUNITY. HOWEVER, THE HOSPITAL WILL CONTINUE TO SUPPORT AWARENESS AND EXPLORE COMMUNITY-BASED PARTNERSHIPS AROUND THESE TWO ISSUES. SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A A REPORT ON PIEDMONT NEWNAN HOSPITAL, INC'S ("PNH") COMMUNITY BENEFITS IS FOUND WITHIN PIEDMONT HEALTHCARE, INC'S (PIEDMONT NEWNAN HOSPITAL'S SOLE MEMBER) ANNUAL REPORT, WHICH IS WIDELY DISTRIBUTED TO THE PUBLIC BOTH THROUGH PRINTED COPIES MADE AVAILABLE TO COMMUNITY MEMBERS UPON REQUEST AND THROUGH PUBLICATION ON THE PIEDMONT HEALTHCARE WEBSITE. ADDITIONALLY, THE REPORT WAS MAILED TO PNH AND PIEDMONT HEALTHCARE 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 $203,982,162, LESS BAD DEBT EXPENSE OF $45,527,212 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 BASED ON PRIOR EXPERIENCE AND CERTAIN DEMOGRAPHICS AND OTHER INFORMATION OBTAINED DURING ADMISSION, THE ORGANIZATION BELIEVES A PORTION OF THE BAD DEBT EXPENSES AT COST IS ATTRIBUTABLE TO PATIENTS THAT WOULD OTHERWISE QUALIFY FOR CHARITY CARE. DESPITE ITS BEST EFFORTS TO EDUCATE PATIENTS ABOUT QUALIFYING FOR ITS CHARITY CARE PROGRAM (AS DISCUSSED IN PART IV, QUESTION 3 BELOW), MANY UNINSURED PATIENTS DO NOT COMPLETE A CHARITY CARE APPLICATION OR PROVIDE SUFFICIENT INFORMATION AT THE TIME OF ADMISSION, DURING THEIR STAY, OR AFTER BEING DISCHARGED TO QUALIFY FOR ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. 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 PAYER CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. PHC'S PRESENTATION OF THE PROVISION FOR BAD DEBT AT THE REPORTING ENTITY LEVEL IS BASED ON AN ENTITY-WIDE ASSESSMENT OF SIGNIFICANCE. PNH 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, SECTION B, LINE 6 WAS CALCULATED IN ACCORDANCE WITH THE 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 PROVIDING 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 EXCLUDED FROM ALLOWABLE COST IN THE MEDICARE COST REPORT. THE ORGANIZATION BELIEVES THAT PIEDMONT NEWNAN 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 18.24 PERCENT OF PNH'S PATIENT SERVICE REVENUE. PNH'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 PNH'S COMMITMENT TO TREAT ELDERLY PATIENTS. MANY OF THESE PATIENTS LIVE ON A LOW, FIXED INCOME, AND WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER MEANS-TESTED PROGRAMS, ABSENT THEIR ENROLLMENT IN MEDICARE. 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 DURING FISCAL YEAR 2013, PIEDMONT NEWNAN HOSPITAL CONDUCTED AND RATIFIED A FORMAL NEEDS ASSESSMENT AND IMPLEMENTATION PLAN. THE ASSESSMENT BEGAN WITH A REVIEW OF PUBLICLY AVAILABLE HEALTH AND SOCIOECONOMIC DATA. THE PRIMARY SOURCES OF THIS DATA INCLUDED THE US CENSUS, US HEALTH AND HUMAN SERVICES' COMMUNITY HEALTH STATUS INDICATORS, COUNTY HEALTH RANKINGS, AND GEORGIA ONLINE ANALYTICAL STATISTICAL INFORMATION SYSTEM (OASIS). STAKEHOLDERS WERE CONTINUALLY ENGAGED DURING THIS PROCESS, WITH A PARTICULAR FOCUS ON THOSE GROUPS, ORGANIZATIONS, AND INDIVIDUALS REPRESENTING THE MOST VULNERABLE MEMBERS OF THE HOSPITAL'S COMMUNITY. SPECIFICALLY, PIEDMONT NEWNAN 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, IN AUGUST 2012, THE HOSPITAL CONDUCTED A FOCUS GROUP OF LOW-INCOME AND UNINSURED PATIENTS CURRENTLY RECEIVING CARE AT THE COWETA SAMARITAN CLINIC, WHICH PROVIDES HEALTH CARE SERVICES TO LOW-INCOME, UNINSURED COWETA COUNTY RESIDENTS. IN THE THIRD QUARTER OF FISCAL YEAR 13, PIEDMONT NEWNAN HOSPITAL HELD TWO PUBLIC COMMUNITY MEETINGS TO DISCUSS THE HEALTH NEEDS ASSESSMENT AND HOW TO BEST ADDRESS THE IDENTIFIED PRIORITIES. FROM THESE MEETINGS, THE HOSPITAL DEVELOPED ITS IMPLEMENTATION PLAN. THE PIEDMONT NEWNAN HOSPITAL BOARD OF DIRECTORS THEN APPROVED THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN THROUGH A UNANIMOUS VOTE ON MAY 16, 2013. DURING FISCAL YEAR 2015, PIEDMONT NEWNAN HOSPITAL CREATED A COMMUNITY BENEFIT-SPECIFIC ANNUAL REPORT AVAILABLE TO THE PUBLIC THAT HIGHLIGHTED THE PROGRESS ON ITS FY13 CHNA IMPLEMENTATION PLAN PRIORITIES AND ACTION ITEMS. THIS REPORT ALSO INCLUDED INFORMATION ON THE HOSPITAL'S COMMUNITY PARTNERS AND STAKEHOLDERS, AND UPDATED COMMUNITY HEALTH DATA AND STATISTICS FOR EACH OF ITS SERVICE COMMUNITIES. SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY 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, PIEDMONT NEWNAN HOSPITAL OFFERS FINANCIAL ASSISTANCE TO QUALIFYING PATIENTS. INFORMATION ABOUT AND CONTACT NUMBERS FOR FINANCIAL ASSISTANCE ARE PROVIDED IN NOTICES INSERTED IN PATIENT BILLS AND POSTED IN EMERGENCY ROOMS, IN THE CONDITIONS OF ADMISSION FORM, AT ADMITTING AND REGISTRATION DEPARTMENTS, AT HOSPITAL BUSINESS OFFICES, AT PATIENT FINANCIAL SERVICES OFFICES THAT ARE LOCATED ON FACILITY CAMPUSES, AND AT OTHER PUBLIC PLACES THE HOSPITAL MAY ELECT, INCLUDING LOCAL LOW-COST CLINICS PRIMARILY TREATING UNINSURED POPULATIONS. PIEDMONT NEWNAN HOSPITAL ALSO PUBLISHES AND WIDELY PUBLICIZES A SUMMARY OF THIS FINANCIAL ASSISTANCE CARE POLICY ON ITS FACILITY WEBSITE, WHICH INCLUDES A LINK TO THE FULL POLICY AND APPLICATION. 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. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION PIEDMONT NEWNAN HOSPITAL IS LOCATED SOUTHWEST OF ATLANTA IN COWETA COUNTY. IN 2015, OVER 133,000 PEOPLE LIVED IN COWETA COUNTY. THE COUNTY SEAT IS NEWNAN, AND ALTHOUGH CONSIDERED AN URBAN COUNTY DUE TO ITS POPULATION, OVER HALF THE POPULATION LIVES IN RURAL AREAS OF THE COUNTY. ABOUT ONE IN FOUR ADULTS IN COWETA COUNTY WAS UNINSURED IN 2015, AND ONE IN TEN CHILDREN WAS UNINSURED. APPROXIMATELY 13 PERCENT OF COWETA COUNTY HOUSEHOLDS LIVE BELOW THE POVERTY LINE, AND NEARLY 39 PERCENT OF THE CHILDREN IN NEWNAN COUNTY QUALIFY FOR FREE LUNCH. UNEMPLOYMENT IN THE COUNTY IS AT 7.4 PERCENT, WHICH IS SLIGHTLY LESS THAN THE STATE AVERAGE. APPROXIMATELY 88 PERCENT OF THE COUNTY HAS A HIGH SCHOOL DEGREE. THERE IS ONE PRIMARY CARE PHYSICIAN IN COWETA COUNTY FOR EVERY 2,219 OF ITS RESIDENTS, COMPARED TO ONE PRIMARY CARE PHYSICIAN FOR EVERY 914 STATE RESIDENTS. APPROXIMATELY 17 PERCENT OF THE OVERALL ADULT POPULATION HAS REPORTED THEY WERE UNABLE TO SEE A DOCTOR IN 2014 DUE TO COST, AND 17 PERCENT REPORTED THEY WERE IN POOR OR FAIR HEALTH, A FIGURE SLIGHTLY HIGHER THAN GEORGIA'S AVERAGE OF 16 PERCENT. MORE THAN 11 PERCENT OF ADULT RESIDENTS HAVE BEEN DIAGNOSED WITH DIABETES. ONE IN FOUR ADULTS ARE NOTABLY PHYSICALLY INACTIVE, AND CLOSE TO ONE IN THREE ARE CONSIDERED OBESE. SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH PIEDMONT NEWNAN 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 FISCAL YEAR 2015, PIEDMONT NEWNAN INCREASED ITS NUMBER OF PRIMARY COMMUNITY BENEFIT PROGRAMS BY 25 PERCENT. SOME OF ITS PROGRAMS INCLUDED: CONTINUING THE SAMS CARE PROGRAM, WHICH CREATED A PARTNERSHIP WITH THE COWETA SAMARITAN CLINIC TO STRENGTHEN HOSPITAL-CLINIC COMMUNICATIONS THROUGH SHARED MEDICAL RECORDS AND EXPAND THE CLINIC'S CAPACITY WITH ADDITIONAL STAFF; CONTINUING ITS COMMUNITY WALKING PROGRAM CALLED "WALK WITH A DOC"; CONTINUING ITS COMMUNITY EDUCATION PROGRAMMING AROUND NUTRITION, INCLUDING A SCHOOL-BASED COMMUNITY GARDENING PROGRAM AT WESTERN ELEMENTARY IN NEWNAN AND A GARDENING PROGRAM WITH THE BOYS & GIRLS CLUB; OFFERING ACCESS TO PIEDMONT'S CANCER WELLNESS CENTER, WHICH PROVIDES A BROAD SPECTRUM OF COMPREHENSIVE, INDIVIDUALIZED SUPPORT AND FROM THE POINT OF DETECTION AND DIAGNOSIS THROUGHOUT CARE AND TREATMENT; PROVIDING PIEDMONT HEALTHCARE'S "SIXTY PLUS" PROGRAMMING WHICH PROMOTES EFFICIENT AND EFFECTIVE UTILIZATION OF HEALTHCARE RESOURCES THROUGH READMISSION REDUCTION INTERVENTIONS, COMPLEX CARE COORDINATION, FACILITATING COMMUNITY PARTNERSHIPS, AND COALITION BUILDING AND PROVIDER TRAINING AND SYMPOSIUMS; AND COMPOSING A LOW-INCOME COMMUNITY RESOURCE GUIDE TO BE DISTRIBUTED IN HOSPITALS, TO PATIENTS, AND THROUGHOUT THE COMMUNITY. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM 6. AFFILIATED HEALTH CARE SYSTEM THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM") SERVING THE HEALTHCARE NEEDS OF NORTH GEORGIA AND, SPECIFICALLY, THE METROPOLITAN ATLANTA AREA. THE SYSTEM EXISTS TO PROVIDE PROGRESSIVE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE TO ALL MEMBERS OF ITS COMMUNITY. COMMUNITY BENEFITS ARE GENERATED THROUGH THE PROVISION OF CHARITY CARE, GOVERNMENT-SPONSORED PROGRAMS (SUCH AS MEDICAID AND MEDICARE), MEDICAL RESEARCH, MEDICAL EDUCATION, COMMUNITY HEALTH IMPROVEMENT SERVICES, DONATIONS TO OTHER NONPROFIT HEALTH CARE PROVIDERS, AND MANY OTHER COMMUNITY SERVICE ACTIVITIES. IN FISCAL YEAR 2015, THE PIEDMONT HEALTHCARE SYSTEM INCLUDED FIVE FULL-SERVICE HOSPITALS, A PHILANTHROPIC FOUNDATION, A CARDIOVASCULAR RESEARCH INSTITUTE, A PHYSICIAN NETWORK, AMBULATORY SURGERY CENTERS, AND OTHER HEALTH CARE PROVIDERS, ALL OF WHICH FALL UNDER THE COMMON CONTROL OF PIEDMONT HEALTHCARE, INC., PIEDMONT NEWNAN HOSPITAL'S SOLE MEMBER. THE SYSTEM'S FIVE HOSPITALS ARE PIEDMONT HOSPITAL, A 488-BED ACUTE TERTIARY CARE FACILITY IN ATLANTA; PIEDMONT FAYETTE HOSPITAL, A 189-BED, ACUTE-CARE COMMUNITY HOSPITAL IN FAYETTEVILLE; PIEDMONT MOUNTAINSIDE HOSPITAL, A 52-BED COMMUNITY HOSPITAL IN JASPER; PIEDMONT NEWNAN HOSPITAL, A 136-BED, ACUTE-CARE COMMUNITY HOSPITAL IN NEWNAN; AND PIEDMONT HENRY HOSPITAL, A 215-BED ACUTE-CARE COMMUNITY HOSPITAL IN STOCKBRIDGE. AS PART OF THE PIEDMONT HEALTHCARE SYSTEM, CERTAIN AFFILIATES MAKE GRANTS AND/OR CONTRIBUTIONS TO OTHER RELATED NONPROFIT AFFILIATES TO HELP FINANCIALLY SUPPORT AND/OR FUND WORTHY COMMUNITY BENEFITS ACTIVITIES. SCHEDULE H, PART VI, LINE 7: STATE OF FILING OF COMMUNITY BENEFIT REPORT PIEDMONT NEWNAN HOSPITAL IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT; HOWEVER, THE HOSPITAL IS REQUIRED TO FILE WITH THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH INFORMATION ON ITS INDIGENT AND CHARITY CARE, AS WELL AS ITS MEDICAID AND MEDICARE SHORTFALLS. true COMMUNITY WELCOME HOUSE PO BOX 1631 NEWNAN GA 30264 581917626 501(c)(3) 5250 Contribution WEST GEORGIA TECHNICAL COLLEGE FOUNDATION PO BOX 225 WACO TX 30182 581816825 501(C)(3) 61500 CONTRIBUTION SUPPORT NEWNAN COWETA CHAMBER OF COMMERCE 23 BULLSBORO DRIVE NEWNAN GA 30263 580532006 501(C)(6) 16438 SPONSORSHIP 2 1 SCHEDULE I, PART I, LINE 2: Documentation of Grants MONEY IS GIVEN TO CHARITABLE ORGANIZATIONS WHICH PRIMARILY PROMOTE HEALTH CARE CAUSES. THE GRANTS ARE ADMINISTERED AND MONITORED THROUGH THE ORGANIZATION'S PUBLIC RELATIONS DEPARTMENT. true true false false false false false true false Mr Jeffrey Folk Chief Medical Officer 294470 0 84507 0 18844 0 23123 0 16521 0 437465 0 0 0 Mr John Miles CFO 238209 0 68704 0 3338 0 25569 0 18130 0 353950 0 0 0 Mr DAVID Nathan Nipper Chief Operating Officer 221348 0 64740 0 3750 0 12246 0 16058 0 318142 0 0 0 Ms Anna Ivory VP of Organizational Quality 181089 0 51493 0 1345 0 7706 0 7645 0 249278 0 0 0 Mr Jason Smith CHIEF NURSING OFFICER 100626 0 61200 0 236 0 5910 0 4611 0 172583 0 0 0 Ms Alison L Middleton NEONATAL NURSE MANAGER 136411 0 33296 0 157 0 5401 0 8302 0 183567 0 0 0 Mr David Copelan Director of Pharmacy 147654 0 17306 0 313 0 4993 0 15261 0 185527 0 0 0 Ms SHERI DE SHAZO FORMER CHIEF NURSING OFFICER 28193 0 0 0 237735 0 1198 0 3041 0 270167 0 0 0 Mr Gregory A Hurst Board Member 0 700210 0 399082 0 593138 0 586180 0 8932 0 2287542 0 0 Dr Stanley Smith Board Member 0 463084 0 0 0 6593 0 33187 0 21658 0 524522 0 0 Mr Charlie Hall Treasurer 0 450387 0 275624 0 250458 0 268619 0 14576 0 1259664 0 0 Mr Jay D Mitchell Secretary 0 436573 0 266765 0 35961 0 210888 0 18401 0 968588 0 0 Ms Debbie Gramling Former Secretary 0 77032 0 0 0 82747 0 1699 0 4471 0 165949 0 0 Mr MICHAEL ROBERTSON PRES & CEO/Chairman 0 438387 0 250903 0 32474 0 201113 0 18662 0 941539 0 0 Ms Pamela Murphy Director of Surgical Services 130307 0 19133 0 1040 0 6259 0 15691 0 172430 0 0 0 SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT NEWNAN HOSPITAL IS SET AND PAID THROUGH DECEMBER 31, 2014, BY THE ENTITY'S PARENT, PIEDMONT HEALTHCARE, INC. BEGINNING JANUARY 1, 2015, THE COMPENSATION WAS PAID BY PIEDMONT NEWNAN HOSPITAL. PLEASE SEE THE SCHEDULE O NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A & 15B FOR ADDITIONAL INFORMATION. SCHEDULE J, PART I, LINE 4A: SUPPLEMENTAL COMPENSATION INFORMATION DEBBIE GRAMLING AND SHERI DE SHAZO RECEIVED SEVERANCE PAYMENTS TOTALING $78,593 AND $237,500, RESPECTIVELY, DURING CALENDAR YEAR 2014. SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL COMPENSATION INFORMATION GREGORY A. HURST AND CHARLIE HALL RECEIVED PAYMENTS TOTALING $549,601 AND $214,686, RESPECTIVELY, FROM THEIR SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: MICHAEL ROBERTSON JAY MITCHELL JEFFREY FOLK JOHN MILES DAVID (NATHAN) NIPPER 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 I, LINE 4 AND PART VI, LINE 1B: INDEPENDENT BOARD MEMBERS PIEDMONT NEWNAN HOSPITAL'S ("PNH") BOARD OF DIRECTORS IS COMPRISED OF SIX VOTING MEMBERS, THREE OF WHICH ARE INDEPENDENT BASED UPON IRS GUIDELINES. WHILE PNH'S INDEPENDENT BOARD MEMBERS DO NOT CONSTITUTE A MAJORITY OF THE BOARD OF DIRECTORS, ANY DECISIONS MADE BY THE PNH BOARD MAY BE RESCINDED BY THE BOARD OF DIRECTORS OF PNH'S SOLE MEMBER, PIEDMONT HEALTHCARE, INC. IN ADDITION, PIEDMONT HEALTHCARE APPOINTS THE MEMBERS OF THE PNH BOARD, SETS COMPENSATION FOR PNH'S EXECUTIVES, AND MONITORS PNH'S COMPLIANCE WITH PIEDMONT HEALTHCARE POLICIES AND PROCEDURES. THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS IS COMPRISED OF A MAJORITY OF INDEPENDENT MEMBERS, AND THEREFORE PNH IS EFFECTIVELY GOVERNED BY AN INDEPENDENT BOARD. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2014 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT NEWNAN 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 NEWNAN HOSPITAL ("PNH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT NEWNAN HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT NEWNAN HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT NEWNAN 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 NEWNAN 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 NEWNAN HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PNH'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S TAX DIRECTOR AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. PRIOR TO FILING, COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., THE ORGANIZATION'S SOLE MEMBER, FOR BOARD REVIEW. FORM 990, PART VI, SECTION B, LINE 12C: CONFLICT OF INTEREST POLICY COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARE'S CHIEF COMPLIANCE OFFICER. ALL SENIOR LEADERS, BOARD MEMBERS, PHYSICIAN EMPLOYEES, NURSE PRACTITIONERS/PHYSICIAN ASSISTANTS AND EMPLOYEES AND NON-EMPLOYEES ENGAGED IN RESEARCH ARE REQUIRED TO ANNUALLY DISCLOSE ALL MATTERS WHICH COULD POTENTIALLY CONSTITUTE A CONFLICT OF INTEREST. MATTERS DISCLOSED UNDER THE POLICY MUST BE REVIEWED IN WRITING BY THE PIEDMONT HEALTHCARE CONFLICT OF INTEREST COMMITTEE IN ORDER TO DETERMINE WHETHER A CONFLICT EXISTS AND, IF SO, WHETHER TO ELIMINATE OR MANAGE THE CONFLICT. ALL BOARD MEMBERS AND EMPLOYEES OF PIEDMONT NEWNAN HOSPITAL ARE PROVIDED TRAINING ON CONFLICT OF INTEREST ISSUES, INCLUDING REPORTING REQUIREMENTS, AT NEW-EMPLOYEE ORIENTATION AND AT LEAST ANNUALLY THEREAFTER. NONCOMPLIANCE WITH THE CONFLICT OF INTEREST POLICY MUST BE REPORTED TO PIEDMONT HEALTHCARE'S SENIOR VICE PRESIDENT OF COMPLIANCE FOR INVESTIGATION, AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. FORM 990, PART VI, SECTION B, LINE 15A, 15B: EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT NEWNAN HOSPITAL IS SET BY THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC. THE PIEDMONT HEALTHCARE, INC., BOARD OF DIRECTOR'S EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("THE COMMITTEE") IS COMPOSED OF AT LEAST THREE MEMBERS OF THE PHC BOARD OF DIRECTORS, SERVING TERMS OF THREE YEARS, AND THE MAJORITY OF WHICH ARE COMMUNITY DIRECTORS WHO GENERALLY DO NOT HAVE CONFLICTS OF INTEREST RELATED TO FULFILLMENT OF THE DUTIES AS OUTLINED BELOW. THE EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("COMMITTEE") OVERSEES EXECUTIVE PERFORMANCE AND COMPENSATION ON BEHALF OF THE PHC BOARD, SUBJECT TO THE ULTIMATE AUTHORITY AND OVERSIGHT OF THE BOARD. THE COMMITTEE ALSO FORMULATES POLICIES AND MAKES DECISIONS IN ORDER TO ENSURE A HIGH LEVEL OF EXECUTIVE PERFORMANCE. THE COMMITTEE IS AUTHORIZED TO ACT ON BEHALF OF THE PHC BOARD AS SET OUT IN ITS CHARTER, AND THE COMMITTEE IS ALSO CHARGED WITH PROVIDING RECOMMENDATIONS AND PERIODIC REPORTS TO THE PHC BOARD REGARDING EXECUTIVE PERFORMANCE AND COMPENSATION. FUNCTIONS OF THE COMMITTEE - ASSESS AND IMPLEMENT POLICIES REGARDING PERFORMANCE, COMPENSATION AND BENEFITS OF THE PRESIDENT/CEO AND OTHER EXECUTIVES AS DETERMINED BY THE COMMITTEE - SELECT AN EXECUTIVE COMPENSATION CONSULTANT WHO REPORTS TO THE COMMITTEE - ANNUALLY REVIEW THE PRESIDENT/CEO SUCCESSION PLAN - FORMULATE AND IMPLEMENT ANNUAL PERFORMANCE OBJECTIVES FOR THE PRESIDENT/CEO, AND REVIEW AND APPROVE ANNUALLY RECOMMENDATIONS FROM THE PRESIDENT/CEO RELATING TO COMPENSATION, PERFORMANCE OBJECTIVES, AND SUCCESSION PLANS FOR EVP EXECUTIVES - ANNUALLY ASSESS PRESIDENT/CEO PERFORMANCE; IF NECESSARY, IMPLEMENT ACTION PLAN WITH PRESIDENT/CEO INPUT TO IMPROVE HIS/HER PERFORMANCE; ADJUST COMPENSATION AS APPROPRIATE; THE COMMITTEE CHAIR SHALL CONSULT WITH THE PHC GOVERNANCE COMMITTEE CHAIR AND THE PHC BOARD CHAIR AND SHALL COORDINATE THE ANNUAL PERFORMANCE REVIEW OF THE PHC PRESIDENT/CEO, UNLESS THE PHC BOARD CHAIR HAS A REAL OR PERCEIVED CONFLICT OF INTEREST, IN WHICH CASE THE COMMITTEE CHAIR SHALL DETERMINE THE PROPER REVIEW PROCESS - REVIEW AND APPROVE LONG TERM AND SHORT TERM GOALS TO BE USED IN CONNECTION WITH EVP COMPENSATION PROGRAMS AS RECOMMENDED BY THE PRESIDENT/CEO AND VALIDATED BY THE COMPENSATION CONSULTANT - PERIODICALLY REVIEW COMPENSATION, IF ANY, FOR THE PHC BOARD CHAIR AND ALL BOARD CHAIRS OF THE PHC SUBSIDIARIES - ESTABLISH OTHER POLICIES AND PROCEDURES, AND PERFORM OTHER TASKS, RELATED TO EXECUTIVE PERFORMANCE AND COMPENSATION, INCLUDING BUT NOT LIMITED TO, APPROVAL OF EXECUTIVE EMPLOYMENT CONTRACTS AND BENEFITS - PERIODICALLY REPORT SIGNIFICANT DECISIONS AND ANY ADDITIONAL REQUESTED INFORMATION TO THE PHC BOARD FORM 990, PART VI, SECTION C, LINE 19: DISCLOSURE OF 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 $(630,615) OF BOOK/TAX DIFFERENCES RELATED TO THE TIMING OF REVENUE RECOGNITION; AND $89,931,983 IN INTERCOMPANY TRANSFERS OF LIABILITIES. PIEDMONT CYBERKNIFE LLC 745 POPLAR ROAD NEWNAN GA 30265 MEDICAL GA 0 0 PNH NEWNAN REGIONAL RADIATION THERAPY CENTER 745 POPLAR ROAD NEWNAN GA 30265 MEDICAL GA 0 0 PNH PIEDMONT HEALTHCARE INC 1800 Howell Mill Road Suite 850 ATLANTA GA 30318 581503902 Management GA 501(C)(3) 11 C NA false PIEDMONT HOSPITAL INC 1968 PEACHTREE ROAD NW ATLANTA GA 30309 580566213 HOSPITAL GA 501(C)(3) 3 PHC false FAYETTE COMMUNITY HOSPITAL INC 1255 HIGHWAY 54 WEST FAYETTEVILLE GA 30214 582232328 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT MOUNTAINSIDE HOSPITAL INC 1266 HIGHWAY 515 SOUTH JASPER GA 30143 352228583 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT HEALTHCARE FOUNDATION INC 2001 Peachtree Road NE Suite 400 ATLANTA GA 30309 581272768 FUNDRAISING GA 501(C)(3) 11 B PHC false PIEDMONT HEART INSTITUTE INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 263553500 HEALTHCARE GA 501(C)(3) 7 PHC false PIEDMONT HENRY HOSPITAL INC 1133 Eagles Landing Pkwy Stockbridge GA 30281 582200195 Hospital GA 501(C)(3) 3 PHC false HENRY DEVELOPMENT VENTURES INC 1133 Eagles Landing Pkwy Stockbridge GA 30281 582200734 RE Holding GA 501(C)(2) N/A PHH false CENTER FOR HEALTH AND LEARNING INC 3001 MERCER UNIVERSITY DRIVE ATLANTA GA 30341 262442849 EDUCATION GA 501(C)(3) 11 A NA false HENRY RADIATION ONCOLOGY CENTER LLC 275 PROFESSIONAL COURT SUITE A STOCKBRIDGE GA 30281 582200195 HEALTHCARE GA NA N/A 0 0 0 0.00000 PEACHTREE ORTHOPAEDIC SURGERY CENTER 2001 PEACHTREE RD NE SUITE 705 ATLANTA GA 30309 582562721 SURGERY GA NA N/A 0 0 0 0.00000 DIGESTIVE HEALTHCARE OF GA ENDOSCOPY CTR 95 COLLIER ROAD NW SUITE 4075 ATLANTA GA 30309 582406657 HEALTHCARE GA NA N/A 0 0 0 0.00000 PIEDMONT MEDICAL CARE CORPORATION 2727 PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 582092768 HEALTHCARE GA NA C-CORP 0 0 0.00000 false THE PIEDMONT CLINIC INC 2727 PACES FERRY ROAD ATLANTA GA 30339 582005358 HEALTHCARE GA NA C-CORP 0 0 0.00000 false PIEDMONT HEART INSTITUTE PHYSICIANS INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 260593850 HEALTHCARE GA NA C-CORP 0 0 0.00000 false AMSTER MCRAE INSURANCE COMPANY PO BOX 1159 GRAND CAYMAN GRAND CAYMAN CJ KY 1-1102 980427603 RELATED INSURANCE CJ NA C-CORP 0 0 0.00000 false PIEDMONT WELLSTAR HEALTHPLANS INC 2859 PACES FERRY RD STE 600 ATLANTA GA 30339 461922499 HEALTH INSURANCE GA NA C-CORP 0 0 0.00000 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 COMPANIES LISTED IN SCHEDULE R, PART I, OPERATE AS DEPARTMENTS OF PIEDMONT NEWNAN HOSPITAL AND ARE INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LLCS AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.