2016-05-16T10:27:32-05:00 2015-06-30 KPMG LLP 300 NORTH GREENE STREET SUITE 400 GREENSBORO NC 27401 990 2014-07-01 582322328 Fayette Community Hospital Inc % MARIE GAFFNEY FAYE 7707197073 1255 Highway 54 West Fayetteville GA 30214 TERESA L WILSON VP CORPORATE FINANCE 3362753394 2016-05-12 true SHAWN M HUTCHINSON P01048557 3362753394 2014 2016-12-15 16:53:06Z PIEDMONT FAYETTE HOSPITAL J MICHAEL BURNETT 1255 Highway 54 West Fayetteville GA 30214 324413804 false X WWW.PIEDMONTFAYETTE.COM X 1997 GA SEE PART III 11 6 1735 250 0 327090 114802 301266777 318822229 118600 187069 4528267 4404451 306240734 323528551 41145 14559 0 0 104876662 108488824 0 0 0 172307028 175020141 277224835 283523524 29015899 40005027 1101927120 147267588 719709546 35557914 382217574 111709674 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 261262642 14559 318853594 PIEDMONT FAYETTE HOSPITAL ("PFH") IS A 189-BED FACILITY LOCATED IN THE CITY OF FAYETTEVILLE IN FAYETTE COUNTY, GEORGIA. OVER 500 PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF 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, 2015, THE HOSPITAL HAD 13,171 IN-PATIENT ADMISSIONS WITH A TOTAL OF 57,273 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 67,555 AND OUTPATIENT VISITS TOTALED 95,711. SURGICAL SERVICES WERE PROVIDED TO 11,100 PATIENTS. 261262642 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 1735 true false false false false false false false false false false X 11 6 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 DR ERIC WELLONS Board Member/MED STAFF PRES 2.0 0.0 X 6300 0 0 Mr J Michael Burnett PRESIDENT & CEO 55.0 0.0 X X 555724 0 171289 Dr Wyndham G Mortimer Board Member 1.0 0.0 X 0 0 0 Mr Gregory A Hurst Board Member 1.0 54.0 X 0 1692430 595112 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 Charles W Pettus Board Member 1.0 39.0 X 0 731363 30815 Dr James Sams Board Member 1.0 54.0 X 0 524810 163194 Mr Douglas B Warner Board Member 1.0 0.0 X 0 0 0 Dr Russell A Wilson Board Member/On-Call Physician 10.0 0.0 X 91300 0 0 MS VICKI TURNER BOARD MEMBER 1.0 1.0 X 0 0 0 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 Dr Frederick Willms VP of Medical Affairs 55.0 0.0 X 439500 0 38751 Ms Sheryl Klink Chief Financial Officer 55.0 0.0 X 344849 47581 Mr Tracey Coker VP Clinical & Support Services 55.0 0.0 X 219802 0 42952 Ms Judith Long Chief Nursing Officer 55.0 0.0 X 256091 0 16810 Mr James D Coleman Director of Pharmacy 55.0 0.0 X 184314 0 47570 Ms Mary McFarland Director of Cardio Services 55.0 0.0 X 157519 0 30891 Ms Rhonda Manos Director of Pharmacy 55.0 0.0 X 159170 0 34258 Ms Sandra Biles Director of Surgical Services 55.0 0.0 X 163263 0 34471 Ms Debbie Gramling Former Secretary 0.0 0.0 X 0 159779 6170 Mr John Miles Former CFO 0.0 55.0 X 0 310251 43699 2577832 5134401 1816047 62 true true false Alliance Laundry Textile Services 7990 Second Flags Dr Ste A AUSTELL GA 30168 Laundry Services 1565996 Brasfield and Gorrie LLC PO Box 11407 BIRMINGHAM AL 352460351 Construction 1112976 DELPHI HEALTHCARE PARTNERS INC BROOKVIEW CENTRE WAY SUITE 400 KNOXVILLE TN 37919 ED ON-CALL COVERAGE 1005287 MEDICAL SOLUTIONS INC 1010 N 102ND STE 300 OMAHA NE 68114 NURSING SERVICES 1441348 Pediatric Emergency Medicine Associ 2247 Salient Rd MARIETTA GA 300641360 Emergency Med Svcs 671973 16 114802 114802 PATIENT SERVICE REVENUE 621110 318660679 318660679 FITNESS CENTER REHAB 621300 161550 161550 318822229 187069 187069 0 0 3668772 867501 2801271 0 2801271 2801271 0 0 0 333785 17752 316033 316033 CAFETERIA SALES 900099 1187986 1187986 VENDING SALES 900099 67796 67796 OTHER OPERATING REVENUE 900099 31365 31365 1287147 323528551 318853594 4560155 14559 14559 0 0 0 1571328 1304202 267126 0 90328517 74972669 15355848 0 10964416 9100465 1863951 5624563 4668388 956175 0 28243 28243 0 0 0 0 16993068 16993068 1204056 1204056 14613279 14502699 110580 5101685 4795584 306101 0 3076890 2953814 123076 68098 44322 23776 0 56192 47385 8807 6354176 6163551 190625 8889797 8889797 10801262 10153186 648076 3586953 3371736 215217 BAD DEBT EXPENSE 41144692 41144692 MEDICAL SUPPLIES & DRUGS 43601032 43601032 HOSPITAL TAX 3513667 3513667 MISCELLANEOUS EXPENSE 15987051 15027826 959225 283523524 261262642 22260882 0 2401335 261926 0 0 122331 26852 44910580 42514673 0 0 0 0 0 0 4171135 4208838 881297 1145718 216301769 118100176 104459453 98201593 0 0 0 0 0 0 907988 907988 944073001 0 1101927120 147267588 18512294 20337592 0 0 0 0 0 0 0 0 0 0 15476206 14883666 0 0 685721046 336656 719709546 35557914 X 380890387 110404226 1327187 1305448 0 0 382217574 111709674 1101927120 147267588 X 40005027 -310512927 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7419672 7419672 100757096 43356487 57400609 4703998 3812904 891094 101495945 70930785 30565160 1925058 0 1925058 98201593 0 MISCELLANEOUS LIABILITIES 336656 336656 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 5373025 0 5373025 0.02220 6586227 6205784 380443 0.00160 4517122 1201138 3315984 0.01370 16476374 7406922 9069452 0.03750 66327 0 66327 0.00030 2319033 0 2319033 0.00960 1000 0 1000 2386360 0 2386360 0.00990 18862734 7406922 11455812 0.04740 true 41144692 1234341 65225359 67632563 -2407204 X true true 1 1 Piedmont Fayette Hospital 1255 Highway 54 West Fayetteville GA 30214 www.piedmontfayette.com X X X Piedmont Fayette Hospital 1 false false true X X X X X X X X 13 true false false true X WWW.PIEDMONTFAYETTE.ORG X X true 13 true WWW.PIEDMONTFAYETTE.ORG false false true X 200. 300. X X true true X X X true X WWW.PIEDMONTFAYETTE.ORG X WWW.PIEDMONTFAYETTE.ORG X WWW.PIEDMONTFAYETTE.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 FAYETTE HOSPITAL'S MOST RECENT CHNA BEGAN WITH A REVIEW OF PUBLICLY AVAILABLE HEALTH AND SOCIOECONOMIC DATA. THE DATA WAS COMPILED AND ANALYZED BY THE HAYSLETT GROUP, THE LEAD CONVENER OF GEORGIA'S "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). 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. PIEDMONT FAYETTE HOSPITAL THEN INTERVIEWED A VARIETY OF STAKEHOLDERS, INCLUDING ELECTED OFFICIALS, PUBLIC SAFETY OFFICIALS, PUBLIC HEALTH REPRESENTATIVES, REPRESENTATIVES FROM SOCIAL SERVICE AGENCIES, AND OTHER COMMUNITY LEADERS. IN AUGUST 2012, PFH CONDUCTED A FOCUS GROUP OF LOW-INCOME AND UNINSURED PATIENTS WHO WERE RECEIVING CARE AT THE FAYETTE CARE CLINIC. ALL INTERVIEWS, FOCUS GROUPS, AND MEETINGS INFORMED THE CHNA PROCESS, INCLUDING THE IDENTIFICATION OF KEY HEALTH PRIORITIES AND DEVELOPMENT OF IMPLEMENTATION PLAN STRATEGIES. 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 FAYETTE 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 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. 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 FAYETTE HOSPITAL DOES NOT PROVIDE MENTAL HEALTH SERVICES IN-HOUSE. FURTHER, AS A HEALTHCARE PROVIDER, PIEDMONT FAYETTE 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 FAYETTE HOSPITAL, INC'S ("PFH") COMMUNITY BENEFITS IS FOUND WITHIN PIEDMONT HEALTHCARE, INC'S (PIEDMONT FAYETTE 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 PFH 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 $283,523,524, LESS BAD DEBT EXPENSE OF $41,144,692 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. 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, 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 FAYETTE 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 20.47 PERCENT OF PFH'S PATIENT SERVICE REVENUE. PFH'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 PFH'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 FAYETTE 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 DATA WAS COMPILED AND ANALYZED BY THE HAYSLETT GROUP, THE LEAD CONVENER OF GEORGIA'S "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). 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. PIEDMONT FAYETTE HOSPITAL THEN INTERVIEWED A VARIETY OF STAKEHOLDERS, INCLUDING ELECTED OFFICIALS, PUBLIC SAFETY OFFICIALS, PUBLIC HEALTH REPRESENTATIVES, REPRESENTATIVES FROM SOCIAL SERVICE AGENCIES, AND OTHER COMMUNITY LEADERS. IN AUGUST 2012, PFH CONDUCTED A FOCUS GROUP OF LOW-INCOME AND UNINSURED PATIENTS WHO WERE RECEIVING CARE AT THE FAYETTE CARE CLINIC. ALL INTERVIEWS, FOCUS GROUPS, AND MEETINGS INFORMED THE CHNA PROCESS, INCLUDING THE IDENTIFICATION OF KEY HEALTH PRIORITIES AND DEVELOPMENT OF IMPLEMENTATION PLAN STRATEGIES. FROM THESE MEETINGS, THE HOSPITAL DEVELOPED ITS IMPLEMENTATION PLAN. THE PIEDMONT FAYETTE HOSPITAL BOARD OF DIRECTORS THEN APPROVED THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN ON MAY 08, 2013. DURING FISCAL YEAR 2015, PIEDMONT FAYETTE HOSPITAL CREATED A COMMUNITY BENEFIT-SPECIFIC ANNUAL REPORT AVAILABLE TO THE PUBLIC THAT HIGHLIGHTED ITS PROGRESS ON THE 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 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 FAYETTE 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 FAYETTE 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 FAYETTE HOSPITAL IS LOCATED IN FAYETTE COUNTY WHERE, IN 2014, APPROXIMATELY 109,000 PEOPLE LIVED. AN ESTIMATED 7.7 PERCENT OF HOUSEHOLDS LIVE BELOW THE POVERTY LINE, WHICH IS LOWER THAN GEORGIA'S AVERAGE OF 18.2 PERCENT. ONE OUT OF FIVE FAYETTE CHILDREN QUALIFIES FOR FREE LUNCH AND SEVEN PERCENT OF THE CHILDREN IN THE COUNTY ARE UNINSURED. THE UNEMPLOYMENT RATE IN FAYETTE COUNTY IS 7.2 PERCENT, WHICH IS BELOW GEORGIA'S RATE OF 8.2 PERCENT. ALMOST 94 PERCENT OF FAYETTE COUNTY RESIDENTS HAVE A HIGH SCHOOL DIPLOMA, A FIGURE HIGHER THAN GEORGIA'S RATE. FAYETTE COUNTY HAS ONE PRIMARY CARE PHYSICIAN FOR EVERY 896 RESIDENTS, COMPARED TO THE GEORGIA RATIO OF ONE PRIMARY CARE PHYSICIAN FOR EVERY 1,572 RESIDENTS. ABOUT 13 PERCENT OF ADULTS IN FAYETTE COUNTY ARE CURRENTLY UNINSURED, WHICH IS LESS THAN GEORGIA'S RATE OF 21 PERCENT. APPROXIMATELY SEVEN PERCENT OF THE OVERALL ADULT POPULATION HAS REPORTED THEY WERE UNABLE TO SEE A DOCTOR IN 2015 DUE TO COST, AND NINE PERCENT REPORTED THEY WERE IN "POOR OR FAIR HEALTH" WHICH IS LOWER THAN THE GEORGIA RATE OF 16 PERCENT. THERE IS ONE MENTAL HEALTH PROVIDER PER 718 RESIDENTS WHILE THE STATE AVERAGES ONE PROVIDER PER 914 RESIDENTS. FAYETTE COUNTY RESIDENTS REPORTED SUFFERING 2.9 "POOR MENTAL HEALTH DAYS" IN THE PRIOR MONTH. ABOUT 11 PERCENT OF ADULT RESIDENTS HAVE BEEN DIAGNOSED WITH DIABETES, AN AMOUNT EQUAL TO THE GEORGIA AVERAGE. IT IS NOTABLE THAT 22 PERCENT OF THE FAYETTE POPULATION IS INACTIVE AND 25 PERCENT IS OBESE. FURTHER, APPROXIMATELY 155 PERSONS DIE ANNUALLY IN FAYETTE COUNTY DUE TO HEART DISEASE, AND OVER 21 PERCENT OF THE POPULATION HAS BEEN DIAGNOSED WITH HYPERTENSION. 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 FISCAL YEAR 2015, PIEDMONT FAYETTE INCREASED ITS NUMBER OF PRIMARY COMMUNITY BENEFIT PROGRAMS BY 38 PERCENT. SOME OF ITS NEW PROGRAMS INCLUDED: CONTINUING THE SAMS CARE PROGRAM, WHICH CREATED PARTNERSHIPS WITH THE FAYETTE C.A.R.E. CLINIC TO STRENGTHEN HOSPITAL-CLINIC COMMUNICATIONS THROUGH SHARED MEDICAL RECORDS AND EXPAND THE CLINIC'S CAPACITY WITH ADDITIONAL STAFF; CONTINUING THE "LIVE BETTER FAYETTE" PROGRAM, WHICH WORKS TO FOSTER COMMUNITY COLLABORATION WITH MORE THAN 20 LOCAL ORGANIZATIONS AND GRASSROOTS HEALTH IMPROVEMENT PROGRAMS; CONTINUING ITS COMMUNITY WALKING PROGRAM CALLED "WALK WITH A DOC"; IMPLEMENTING A COMMUNITY HAND-WASHING CAMPAIGN CALLED "CATCH ME CLEAN" TO REDUCE INSTANCES OF INFECTIOUS DISEASE, PARTICULARLY THE INFLUENZA VIRUS; OFFERING ACCESS TO PIEDMONT'S CANCER WELLNESS CENTER, WHICH PROVIDES A BROAD SPECTRUM OF COMPREHENSIVE, INDIVIDUALIZED SUPPORT FROM THE POINT OF DETECTION AND DIAGNOSIS AND 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 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 FAYETTE 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 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. true THE JOSEPH SAMS SCHOOL INC 280 BRANDYWINE BOULEVARD FAYETTEVILLE GA 30214 581584379 501(C)(3) 7000 SPONSORSHIP - DINNER, DANCE, AND AUCTION EVENT 1 0 SCHEDULE I, PART I, LINE 2: MONITORING THE USE OF GRANT FUNDS MONEY IS GIVEN TO CHARITABLE ORGANIZATIONS WHICH PRIMARILY PROMOTE HEALTH CARE CAUSES. THE GRANTS ARE ADMINISTERED AND MONITORED THROUGH THE ORGANIZATION'S PUBLIC RELATIONS DEPARTMENT. X true true true true false false false false false true false 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 Dr Frederick Willms VP of Medical Affairs 323359 0 91661 0 24480 0 25855 0 12896 0 478251 0 0 0 Mr J Michael Burnett PRESIDENT & CEO 362106 0 168720 0 24898 0 154621 0 16668 0 727013 0 0 0 Ms Sheryl Klink Chief Financial Officer 263879 0 76313 0 4657 0 29306 0 18275 0 392430 0 0 0 Mr Tracey Coker VP Clinical & Support Services 165835 0 46508 0 7459 0 33215 0 9737 0 262754 0 0 0 Ms Judith Long Chief Nursing Officer 191731 0 54072 0 10288 0 8327 0 8483 0 272901 0 0 0 Mr James D Coleman Director of Pharmacy 151321 0 18341 0 14652 0 34506 0 13064 0 231884 0 0 0 Ms Mary McFarland Director of Cardio Services 136340 0 19744 0 1435 0 19843 0 11048 0 188410 0 0 0 Ms Rhonda Manos Director of Pharmacy 148484 0 8463 0 2223 0 22011 0 12247 0 193428 0 0 0 Mr Gregory A Hurst Board Member 0 700210 0 399082 0 593138 0 586180 0 8932 0 2287542 0 0 Dr Charles W Pettus Board Member 0 727209 0 0 0 4154 0 10400 0 20415 0 762178 0 0 Dr James Sams Board Member 0 304965 0 179200 0 40645 0 150448 0 12746 0 688004 0 0 Mr John Miles Former CFO 0 238209 0 68704 0 3338 0 25569 0 18130 0 353950 0 0 Ms Debbie Gramling Former Secretary 0 77032 0 0 0 82747 0 1699 0 4471 0 165949 0 0 Ms Sandra Biles Director of Surgical Services 141037 0 20119 0 2107 0 22336 0 12135 0 197734 0 0 0 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS JAMES MICHAEL BURNETT RECEIVED A DISCRETIONARY SPENDING ACCOUNT TOTALING $11,769, 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, LINES 4A & 4B: SUPPLEMENTAL COMPENSATION INFORMATION DEBBIE GRAMLING RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $78,593 DURING CALENDAR YEAR 2014. 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: JAY MITCHELL FREDERICK WILLMS J. MICHAEL BURNETT SHERYL KLINK JOHN MILES JAMES SAMS TRACEY COKER 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 2014 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, SECTION 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 HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PFH'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 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 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 FAYETTE 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 $(310,587,753) OF INTERCOMPANY TRANSFERS OF LIABILITIES; AND BOOK/TAX DIFFERENCES RELATED TO REVENUE RECOGNITION OF $74,826. FAYETTE SURGERY CENTER LLC 1255 HIGHWAY 54 WEST Fayetteville GA 30214 Surgery GA 0 0 PFH PIEDMONT HEALTHCARE INC 1800 HOWELL MILL ROAD SUITE 850 Atlanta GA 30318 581503902 Management GA 501(c)(3) 11c 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) 11B PHC false CENTER FOR HEALTH AND LEARNING INC 3001 MERCER UNIVERSITY DR ATLANTA GA 30341 262442849 EDUCATION GA 501(C)(3) 11A NA false HENRY RADIATION ONCOLOGY CENTER LLC 275 PROFESSIONAL COURT STE A STOCKBRIDGE GA 30281 582200195 HEALTHCARE GA NA N/A 0 0 0 0.00000 PEACHTREE ORTHOPAEDIC SURGERY CENTER 2001 PEACHTREE RD NE STE 705 ATLANTA GA 30309 582562721 SURGERY GA NA N/A 0 0 0 0.00000 DIGESTIVE HEALTHCARE OF GA ENDOSCOPY CTR 95 COLLIER RD NW STE 4075 ATLANTA GA 30309 582406657 HEALTHCARE GA NA N/A 0 0 0 0.00000 PIEDMONT MEDICAL CARE CORPORATION 2727 PACES FERRY RD STE 1-1100 Atlanta GA 30339 582092768 Healthcare GA NA C Corp 0 0 0.00000 false THE PIEDMONT CLINIC INC 2727 PACES FERRY RD STE 1-1100 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 KY1-1102 CJ 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 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.