2016-05-02T10:35:13-05:00 2015-07-31 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 31708 990 2014-08-01 263975185 PHOEBE SUMTER MEDICAL CENTER INC PHOE 2299246011 126 HWY 280 WEST AMERICUS GA 317198645 BRIAN CHURCH PPHS CFO 2299246011 2016-04-29 true JEFFREY S WRIGHT P00226270 2298837878 2016-05-02 X 2014 2016-08-17 19:52:53Z BRANDI LUNNEBORG CEO 126 HWY 280 WEST AMERICUS GA 317198645 68291658 false X WWW.PHOEBEPUTNEY.COM X 2009 GA PROVIDING CHARITABLE HEALTHCARE ACTIVITIES. 8 5 481 136 0 40689 56087711 64145936 -377094 -17909 2924326 1890403 58634943 66059119 0 0 21006777 21983811 0 0 35586135 37943050 56592912 59926861 2042031 6132258 78922589 80113663 11056342 6128076 67866247 73985587 PROVIDING CHARITABLE HEALTHCARE ACTIVITIES. false false 49819275 65311389 TO BE THE LEADING PROVIDER OF QUALITY, COST EFFECTIVE, PATIENT-CENTERED HEALTH CARE SERVICES TO ALL RESIDENTS OF SOUTHWEST GEORGIA. PSMC 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. 49819275 true true false false false false false false false false true false false true true true true true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 65 0 481 true false false false false false false false false false false X 8 5 false false false false true true true true true false false true true true true true true false false false GA X X BRIAN CHURCH 2293124068 PO BOX 3770 ALBANY GA 317063770 JOEL WERNICK BD MEMBER/PP 1.00 54.00 X X 0 826090 928219 JOE AUSTIN BD MEMBER/PP 1.00 52.00 X X 0 587292 171118 KERRY LOUDERMILK PAST BM/PPHS 1.00 54.00 X X 0 441039 190998 WALLACE MAYS MD BOARD MEMBER 1.00 40.00 X 0 35659 0 CONNIE BLANCHARD PAST BOARD M 1.00 X 0 0 0 RANDY JONES BOARD MEMBER 1.00 1.00 X 0 0 0 BRAD LAFEVERS CHAIRMAN 1.00 X X 0 0 0 LARA GILL BOARD MEMBER 1.00 1.00 X 0 0 0 ROBBIE LATIMORE EDD VICE CHAIR 1.00 X X 0 0 0 FREDRICK MCLAUGHLIN EDD BOARD MEMBER 1.00 X 0 0 0 JOHN HARDING INTERIM CEO 50.00 1.00 X 149643 0 0 MICHELLE DOGGETT DIRECTOR OF 50.00 0.00 X 85802 0 25076 BRANDI LUNNEBORG CEO 50.00 1.00 X 0 60513 0 CHRISTY HARDIN ASST. DIR PH 40.00 X 142823 0 2749 DARRYL HAWKINS PHARMACY DIR 40.00 0.00 X 141744 0 31330 LORI PAYNE PHARMACIST 40.00 X 137863 0 27680 SUSAN JOHNSON PHARMACIST 40.00 X 133262 0 23331 MATTHEW F MORGAN PHARMACIST 40.00 X 127292 0 20376 TIM TROTTIER REGIONAL OPE 0.00 0.00 X 0 236568 0 918429 2187161 1420877 13 true true false SENTRY ANESTHESIA MANAGEMENT LLC 80 NEWNAN STATION DRIVE SUITE A NEWNAN GA 302653194 ANESTHESIA SVCS 1220287 SOUTHERN REHABILITATION PO BOX 1066 AMERICUS GA 317091066 THERAPY SVCS 738402 GEORGIA PREMIER SONOGRAPHY 213 TRADERS PASS WARNER ROBINS GA 310882211 ULTRASOUND SVCS 460292 EXECUTIVE HEALTH RESOURCES INC PO BOX 822688 PHILADELPHIA PA 191822688 DENIALS MNGMNT 127905 SOUTHERN PATHOLOGY & LABORATORY SERV 126 HWY 280 WEST AMERICUS GA 317198645 MED DIRECTOR 120000 6 40689 40689 PROGRAM SERVICE REVENUE 623000 64145936 64145936 64145936 90054 90054 484918 30100 454818 454818 454818 2094476 2140907 61532 -46431 -61532 -107963 -107963 MIGRANT HEALTH REVENUE 621990 500671 500671 EHR REVENUE 621990 490282 490282 NUTRITION SERVICE REVENUE 722513 310821 310821 133811 133811 1435585 66059119 65270700 747730 X 208021 208021 16763565 14184015 2579550 3833094 3243264 589830 1179131 997688 181443 68500 68500 17516128 14372995 3143133 29621 29621 7394836 6846421 548415 237112 237112 853280 790822 62458 136849 85151 51698 4586673 4250940 335733 1122920 1122920 MEDICAL SUPPLIES 3594485 3594485 REPAIRS & MAINTENANCE 1373290 1196471 176819 LICENSES 777520 50010 727510 RECRUITING 162975 162975 88861 44038 44823 59926861 49819275 10107586 0 10882093 16822372 8769508 9543642 425582 251578 783346 914279 340205 278725 65041496 21110882 48290539 43930614 4070041 4092394 5361275 4280059 78922589 80113663 4090177 4170271 6966165 1957805 11056342 6128076 X 67866247 73985587 67866247 73985587 78922589 80113663 X 6132258 29302 -42220 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1687954 1687954 45103608 9783407 35320201 18080400 11327475 6752925 169534 169534 43930614 BENEFICIAL INTEREST IN FOUNDATION 3159798 EHR RECEIVABLE 686589 OTHER RECEIVABLES 433672 4280059 RELATED PARTY PAYABLES 1698403 THIRD PARTY PAYOR SETTLEMENTS 259402 1957805 X 66089219 66089219 -30100 -30100 66059119 59956961 30100 30100 59926861 59926861 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, 2015 AND 2014 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 -30,100 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 30,100 true true X true X 1.250000000000 true X true true false true true 1407867 787557 620310 0.01030 5726082 7632223 -1906141 6241213 5428496 812717 0.01360 13375162 13848276 -473114 0.02390 16629 133194 133194 0.00220 60 36925 36925 0.00060 11840 7761011 7742638 18373 0.00030 28529 7931130 7742638 188492 0.00310 28529 21306292 21590914 -284622 0.02700 true 20035532 14117434 16082591 -1965157 X true true 1 1 PHOEBE SUMTER MEDICAL CENTER INC 126 HIGHWAY 280 WEST AMERICUS GA 31719 WWW.PHOEBEPUTNEY.COM 129-663 X X X HOSPICE, RHC PHOEBE SUMTER MEDICAL CENTER INC 1 false false true X X X X X X X X X X 13 true false false true X WWW.PHOEBEPUTNEY.COM X true 13 false true false true X 125.000000000000 200.000000000000 X X X X X X true true X X X X true X WWWPHOEBEPUTNEYCOM X X X X X true X true X X X X true X false false FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 5 THE HOSPITAL'S CHIEF EXECUTIVE OFFICER APPOINTED INDIVIDUALS TO SERVE ON THE CHNA HOSPITAL STEERING COMMITTEE (CHSC). THE CHSC IDENTIFIED COMMUNITY LEADERS, PARTNERS, AND REPRESENTATIVES TO INCLUDE IN THE CHNA PROCESS. INDIVIDUALS, AGENCIES, PARTNERS, POTENTIAL PARTNERS, AND OTHERS WERE REQUESTED TO WORK WITH THE HOSPITAL TO 1) ASSESS THE NEEDS OF THE COMMUNITY, 2) REVIEW AVAILABLE COMMUNITY RESOURCES AND 3) PRIORITIZE THE HEALTH NEEDS OF THE COMMUNITY. GROUPS OR INDIVIDUALS, WHO REPRESENT MEDICALLY-UNDERSERVED POPULATIONS, LOW INCOME POPULATIONS, MINORITY POPULATIONS, AND POPULATIONS WITH CHRONIC DISEASES, WERE INCLUDED. THE HOSPITAL IDENTIFIED OVER 75 COMMUNITY MEMBERS TO PARTICIPATE IN THE CHNA PROCESS. TWO-HOUR COMMUNITY HEALTH INPUT MEETINGS (COMMUNITY MEETINGS) AND ONE-HOUR COMMUNITY STAKEHOLDER INTERVIEWS (INTERVIEWS) WERE ESSENTIAL PARTS OF THE CHNA PROCESS. THREE COMMUNITY MEETINGS AND 10 STAKEHOLDER INTERVIEWS WERE CONDUCTED IN ORDER TO OBTAIN THE COMMUNITY'S INPUT INTO THE HEALTH NEEDS OF SUMTER COUNTY. EACH COMMUNITY MEETING WAS DRIVEN BY AN AGENDA PLANNED IN ADVANCE. SIGN-IN SHEETS AND EVALUATIONS WERE ALSO USED. THE COMMUNITY HEALTH PROFILE WAS SHARED WITH THE PARTICIPANTS AT EACH MEETING. PARTICIPANTS WERE ASKED ABOUT THEIR OBSERVATIONS ON THE HEALTH DATA PRESENTED IN THE PROFILE. IN ADDITION, PARTICIPANTS WERE REQUESTED TO PROVIDE INPUT AS TO NEEDS THAT MAY NOT HAVE BEEN IDENTIFIED IN THE PROFILE. QUESTIONS AND EXCHANGE WERE ENCOURAGED, WITH THE OBJECTIVE THAT PARTICIPANTS WOULD INCREASE THEIR UNDERSTANDING OF WHAT THE DATA MEANT IN TERMS OF THE BURDEN OF CHRONIC DISEASES, THE IMPACT OF THE DEMOGRAPHICS OF THE POPULATION ON HEALTH SERVICES, AND HEALTH STATUS, HEALTH BEHAVIORS, AS WELL AS, ACCESS TO HEALTHCARE. AS THE GROUP DISCUSSED THE HEALTH PROBLEMS OR HEALTH ISSUES, THE FACILITATOR MADE A LIST OF THE HEALTH PROBLEMS THE COMMUNITY PARTICIPANTS SAID WERE IMPORTANT. AT THE END OF THE DISCUSSION PRIORITY ISSUES WERE IDENTIFIED. THESE PRIORITIES DID NOT REFLECT PROGRAMS, SERVICES OR APPROACHES TO RESOLVING PROBLEMS, BUT RATHER HEALTH ISSUES TO BE ADDRESSED. COMMUNITY PARTICIPANTS INCLUDED PHYSICIANS AND OTHER MEDICAL PROFESSIONALS; EDUCATORS; ENTREPRENEURS AND OTHER BUSINESSMEN AND WOMEN; PROFESSIONALS; REPRESENTATIVES FROM THE DEPARTMENT OF LABOR, HOUSING AUTHORITY, LAW ENFORCEMENT, AND THE HEALTH DEPARTMENT; RELIGIOUS LEADERS. FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 11 THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND RELATED IMPLEMENTATION PLAN ARE WIDELY PUBLICIZED ON THE HOSPITAL'S WEBSITE AT HTTP://WWW.PHOEBEPUTNEY.COM/PHOEBE-SUMTER-MEDICAL-CENTER/PHOEBE-SUMTER- MEDICAL-CENTER-CHNA PROGRESS ON CHNA IMPLEMENTATION STRATEGIES 2014-2015: PSMC HAS DONE A NUMBER OF ACTIONS AND INITIATIVES TO ADDRESS THE FINDINGS OF THE LATEST COMMUNITY HEALTH NEEDS ASSESSMENT. THE FIRST PRIORITY WAS ACCESS TO CARE - PROVIDERS AND PREVENTION, AND THIS WAS ADDRESSED IN A NUMBER OF WAYS. ONE WAY WAS THAT PSMC PARTNERED WITH SEEDCO TO INFORM THE PUBLIC ABOUT THE AFFORDABLE HEALTH CARE ACT IN MARCH 2014. MORE THAN 160 PEOPLE ATTENDED THIS EVENT. PSMC ALSO WORKED HAND IN HAND WITH THE LOCAL HEALTH DEPARTMENT TO INCREASE AWARENESS AND PREVENTION EDUCATION. THIS INFORMATION WAS DISTRIBUTED AT ALL THREE PSMC COMMUNITY HEALTH FAIRS (WOMEN'S IN MAY; CHILDREN'S IN JUNE AND MEN'S IN SEPTEMBER) AS WELL AS OTHER COMMUNITY OUTREACH EVENTS THAT INCLUDED RELAY FOR LIFE, LOCAL FESTIVALS, ETC. PSMC ALSO WORKED IN CONJUNCTION WITH ITS CLINIC IN ELLAVILLE TO ADDRESS THE NEEDS OF THE MIGRANT FARM WORKERS AND HISPANIC POPULATION, WHICH INCLUDED A HEALTH FAIR SPECIFICALLY FOR MIGRANT WORKERS. LAST BUT NOT LEAST, PSMC ADDRESSED THE NEEDS OF THE SENIOR POPULATION BY PARTICIPATING IN A NUMBER OF EVENTS THAT INCLUDE INNOVATIVE SENIOR SOLUTIONS SENIOR FALL FESTIVAL AND AREA AGENCY ON AGING'S ANNUAL SENIOR PICNIC. PSMC ALSO CONTINUES TO WORK CLOSE WITH MAGNOLIA MANOR TO ADDRESS THE NEEDS OF THEIR SENIOR POPULATION AS WELL. IN ADDITION, PSMC CONDUCTED A MEETING OF CONCERNED STAKEHOLDERS FROM ITS 8 COUNTY COVERAGE AREA (SUMTER, SCHLEY, MARION, WEBSTER, DOOLY, MACON, TAYLOR AND STEWART) AND EVENTUALLY ESTABLISHED A REGIONAL ADVISORY COUNCIL (RAC) IN JUNE 2015. THE RAC IDENTIFIED GAPS IN THE HEALTHCARE CONTINUUM OF ALL 8 COUNTIES AND WILL CONTINUE TO WORK WITH PSMC TO PROVIDE ACCESS TO CARE TO EVERYONE IN THEIR RESPECTIVE COUNTY. PSMC ALSO ANNOUNCED PLANS FOR TOWN HALL MEETINGS IN ALL 8 COUNTIES TO SPEAK TO COMMUNITIES TO FIND OUT WHAT THEIR NEEDS WERE AS IT RELATES TO ACCESS TO CARE. THE SECOND PRIORITY WAS OBESITY, AND PSMC ADDRESSED THIS NEED IN A NUMBER OF WAYS. A DIETITIAN WAS ON HAND FOR ALL OF THE COMMUNITY HEALTH FAIRS TO TALK ABOUT THE IMPORTANCE OF A HEALTHY DIET. PSMC ALSO REACHED OUT TO LOCAL BUSINESSES TO WORK WITH THEM ON WAYS THEY CAN MAKE THEIR EMPLOYEES HEALTHIER, AND PARTICIPATED IN A NUMBER OF HEALTH DAYS IN THE COMMUNITY. THIS INCLUDES THE CITY OF AMERICUS EMPLOYEES, SUMTER COUNTY EMPLOYEES AND SUMTER EMC EMPLOYEES. ANOTHER WAY OBESITY WAS ADDRESSED WAS WITH PSMC'S BARIATRIC PROGRAM. STARTING IN 2013, THE PROGRAM HAS GIVEN A CHANCE TO MORBIDLY OBESE PEOPLE TO LOSE WEIGHT ONCE AND FOR ALL. A TOTAL OF 24 CASES HAVE BEEN DONE SO FAR, AND WITH THE ADDITION OF THE GASTRIC BYPASS SURGERY, THE NUMBER OF PEOPLE IN THE PROGRAM IN ALL LIKELIHOOD TO INCREASE IN THE COMING YEARS. THE THIRD PRIORITY WAS CANCER, AS SOUTHWEST GEORGIA HAS ONE OF THE HIGHEST RATES OF CANCER IN THE STATE. PSMC'S ONCOLOGY AND HEMATOLOGY CLINIC SERVES THE NEEDS OF THE PEOPLE OF SOUTHWEST GEORGIA, AND IS ONE OF THE BUSIEST IN THE STATE. REPRESENTATIVES FROM THE CLINIC PARTICIPATE IN ALL OF OUR HEALTH FAIRS AND COMMUNITY OUTREACH EVENTS, AND PSMC IS ALSO THE PREMIER SPONSOR AT THE YEARLY RELAY FOR LIFE, THE MAIN FUNDRAISER FOR THE AMERICAN CANCER SOCIETY. LAST YEAR ALONE PSMC RAISED MORE THAN 20,000 FOR THE FIGHT AGAINST CANCER, AND IS NORMALLY ONE OF THE LEADING FUNDRAISERS FOR THIS EVENT. IN ADDITION, PSMC CREATED ITS OWN ENTITY, FRIENDS AGAINST CANCER, TO RAISE MONEY FOR LOCAL CANCER PATIENTS AND THEIR FAMILIES FOR BASIC NEEDS SUCH AS MEDICINE, TRAVEL, ETC. PSMC ALSO HELD ITS YEARLY BREAST CANCER AWARENESS WALK, WHICH WAS ATTENDED BY MORE THAN 700 PEOPLE AND RAISED FUNDS FOR LOCAL BREAST CANCER PATIENTS AND THEIR FAMILIES. DIABETES IS VERY PREVALENT IN OUR GEOGRAPHICAL AREA, AND IT WAS THE FOURTH PRIORITY ON OUR NEEDS ASSESSMENT LIST. KEEPING IN MIND THAT THE RATE OF JUVENILE DIABETES CONTINUES TO RISE, WE ADDRESSED THIS WITH OUR CHILDREN'S HEALTH CONFERENCE LAST SUMMER. IN ADDITION TO PROVIDING WAYS TO KEEP THE CHILDREN HEALTHY AND ACTIVE, THE IMPORTANT COMPONENT OF A HEALTHY DIET WAS ALSO ADDRESSED. GLUCOSE AND CHOLESTEROL SCREENINGS WERE PROVIDED AT EACH HEALTH CONFERENCE, WHICH WAS ATTENDED BY A COMBINED TOTAL OF MORE THAN 800 PEOPLE. PSMC ALSO HOLDS A MONTHLY DIABETES SUPPORT GROUP MEETING. THE FIFTH PRIORITY WAS TEEN BIRTH RATE, AND IN CONJUNCTION WITH THE LOCAL HEALTH DEPARTMENT THIS ITEM WAS ADDRESSED AT PSMC'S CHILDREN'S HEALTH FAIR. COMMUNITY WORK PLAN FOR ACCESS TO CARE - TRANSPORTATION CHNA PAGE REFERENCE - PAGES 91, 93-94 IT IS BEYOND THE HOSPITAL'S MISSION AND FINANCIAL RESOURCES TO PROVIDE TRANSPORTATION. THE HOSPITAL WILL INCREASE ACCESS TO HEALTH SERVICES BY PROVIDING SCREENINGS AND OTHER FORMS OF PREVENTIVE CARE IN COMMUNITY LOCATIONS OTHER THAN THE HOSPITAL'S MAIN CAMPUS. THE HOSPITAL WILL PROVIDE A COMMUNITY RESOURCE DIRECTORY THAT WILL GUIDE INDIVIDUALS TO TRANSPORTATION SERVICES. FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 13H OTHER FACTORS THAT WERE USED TO CALCULATE AMOUNTS CHARGED TO PATIENTS INCLUDED THE NUMBER OF INDIVIDUALS IN A HOUSEHOLD. FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 16I PHYSICIAN OFFICES, CLINICS, AND OTHER FACILITIES ARE CONTACTED, AS NEEDED, REGARDING THE AVAILABILITY OF THE FAP. FACILITY 1, PHOEBE SUMTER MEDICAL CENTER, INC. - PART V, LINE 22D PSMC DETERMINES THE PATIENTS ABILITY TO PAY BASED ON THE FINANCIAL ASSISTANCE POLICY (FAP) AND PROVIDES FREE OR DISCOUNTED CARE AS INDICATED. PATIENTS WHO ARE ELIGIBLE FOR THE FAP WILL NOT BE BILLED GROSS CHARGES FOR EMERGENCY AND MEDICALLY NECESSARY CARE. THE CHARGES BILLED FAP-APPROVED PATIENTS WILL BE DISCOUNTED BY A PERCENTAGE DETERMINED IN ACCORDANCE WITH IRS REGULATIONS. 2 PHOEBE SUMTER HOSPICE 126 HWY 280 WEST AMERICUS GA 31719 HOSPICE ELLAVILLE PRIMARY MEDICINE 72 BROAD STREET ELLAVILLE GA 31806 RURAL HEALTH CLINIC 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 59,926,861 ADD: EXPENSES REPORTED IN PART VIII 30,100 DENOMINATOR FOR COLUMN (F) 59,956,961 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. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY AMOUNTS INCLUDED 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 ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR RESOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS WAS APPROXIMATELY 94% OF SELF-PAY ACCOUNTS RECEIVABLE AT JULY 31, 2015 AND 2014. DUE TO AN INCREASE IN SELF-PAY REVENUE, AN INCREASE IN RATES, AND A REDUCTION IN PATIENTS QUALIFYING FOR CHARITY CARE SERVICES, THE HOSPITAL'S SELF-PAY WRITEOFFS INCREASED 4,796,000 FROM 8,172,000 FOR FISCAL YEAR 2014 TO 12,968,000 FOR FISCAL YEAR 2015. FOR SIMILAR REASONS, THE PROVISION FOR BAD DEBTS INCREASED FROM 15,410,000 IN 2014 TO 20,036,000 IN 2015. 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 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 2013. THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND RELATED IMPLEMENTATION PLAN ARE WIDELY PUBLICIZED ON THE HOSPITAL'S WEBSITE AT HTTP://WWW.PHOEBEPUTNEY.COM/PHOEBE-SUMTER-MEDICAL-CENTER/PHOEBE-SUMTER- MEDICAL-CENTER-CHNA PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE BOARD HAS CLEARLY WRITTEN FINANCIAL ASSISTANCE POLICIES THAT ARE AVAILABLE ON THE ORGANIZATION 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, 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 AND ENCOURAGE PATIENTS TO CALL FOR FINANCIAL ASSISTANCE. PART VI, LINE 4 - COMMUNITY INFORMATION SUMTER COUNTY IS LOCATED IN THE SOUTHWESTERN PART OF CENTRAL GEORGIA, AND HAS A POPULATION OF 32,819. THE HOSPITAL IS LOCATED IN THE COUNTY SEAT OF AMERICUS. THE SURROUNDING AREAS OF AMERICUS ARE DIVERSE IN TERMS OF RURAL AND URBAN AREAS. THE POPULATION DISTRIBUTION AMONG RURAL AND URBAN AREAS IS 58 PERCENT URBAN AND 42 PERCENT RURAL. ONLY 2.5 PERCENT OF SUMTER COUNTYS LAND AREA IS URBAN WHILE 97.5 PERCENT IS RURAL. THE PERCENTAGE OF RESIDENTS AGED 55 AND OLDER INCREASED FROM 2000 TO 2010. THIS INCREASE IDENTIFIED AN IMMEDIATE NEED FOR DELIVERY OF HEALTHCARE THAT SERVES INDIVIDUALS WITH CHRONIC CONDITIONS. THE HISPANIC POPULATION INCREASED, ALTHOUGH THIS SEGMENT REMAINED A SMALL PORTION OF THE POPULATION. 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., A NOT-FOR-PROFIT ENTITY, PHOEBE PUTNEY HEALTH VENTURES, INC., A FOR-PROFIT CORPORATION, PHOEBE PHYSICIAN GROUP, INC., A NOT-FOR-PROFIT CORPORATION, PHOEBE WORTH MEDICAL CENTER, INC., A NOT-FOR-PROFIT ENTITY, PHOEBE SUMTER MEDICAL CENTER, INC., A NOT-FOR-PROFIT ENTITY, AND PHOEBE FOUNDATION, INC., A NOT-FOR-PROFIT ENTITY. PHOEBE PUTNEY MEMORIAL HOSPITAL, INC. (PPMH), 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. PHOEBE PUTNEY HEALTH VENTURES, INC. ENGAGES IN HEALTHCARE AND RELATED ACTIVITIES IN FURTHERANCE OF THE EXEMPT PURPOSES OF PPHS AND PPMH. PHOEBE WORTH MEDICAL CENTER, INC. (PWMC), 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. PHOEBE SUMTER MEDICAL CENTER, INC. (PSMC), LOCATED IN AMERICUS, GEORGIA, IS AN ACUTE CARE HOSPITAL. IT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SUMTER COUNTY, GEORGIA. PHOEBE PHYSICIAN GROUP, INC. WAS ESTABLISHED TO ORGANIZE AND OPERATE MEDICAL PRACTICES EXCLUSIVELY FOR THE BENEFIT OF PPMH, PWMC, AND PSMC. PHOEBE FOUNDATION, INC. 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 PHOEBE PUTNEY MEMORIAL HOSPITAL, INC. OR THE HOSPITAL AUTHORITY OF ALBANY-DOUGHERTY COUNTY, GEORGIA. PHOEBE FOUNDATION, INC. MAY ALSO RAISE FUNDS FOR ANY ORGANIZATION FOR WHICH PPHS IS THE SOLE MEMBER. SUMTER REGIONAL HOSPITAL FOUNDATION, INC. WAS ESTABLISHED TO RAISE FUNDS TO SUPPORT PSMC. SUMTER REGIONAL HOSPITAL FOUNDATION, INC.'S BYLAWS PROVIDE THAT THE MAJORITY OF ALL FUNDS RAISED, EXCEPT FOR FUNDS ACQUIRED FOR THE OPERATION OF THE FOUNDATION, BE DISTRIBUTED TO OR BE HELD FOR THE BENEFIT OF THE HOSPITAL. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT GEORGIA ADDITIONAL INFORMATION PHOEBE SUMTER MEDICAL CENTER, INC. (PSMC), FORMERLY SUMTER REGIONAL HOSPITAL, IS A NOT-FOR-PROFIT HEALTH CARE ORGANIZATION THAT EXISTS TO SERVE THE COMMUNITY. PSMC OPENED IN 1953 TO SERVE THE COMMUNITY BY CARING FOR THE SICK REGARDLESS OF THEIR ABILITY TO PAY. AS A NOT-FOR-PROFIT HOSPITAL, PSMC HAS NO STOCKHOLDERS OR OWNERS. ALL REVENUE AFTER EXPENSES IS REINVESTED IN THE MISSION TO CARE FOR THE CITIZENS OF THE COMMUNITY - INTO CLINICAL CARE, HEALTH PROGRAMS, STATE-OF-THE-ART TECHNOLOGY AND FACILITIES, RESEARCH, AND TEACHING AND TRAINING OF MEDICAL PROFESSIONALS NOW AND FOR THE FUTURE. PSMC OPERATES AS A CHARITABLE ORGANIZATION CONSISTENT WITH THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(C)(3) AND THE "COMMUNITY BENEFIT STANDARD" OF IRS REVENUE RULING 69-545. PSMC TAKES SERIOUSLY ITS RESPONSIBILITY AS THE COMMUNITY'S SAFETY NET HOSPITAL AND HAS A STRONG RECORD OF MEETING AND EXCEEDING THE CHARITABLE CARE AND THE ORGANIZATIONAL AND OPERATIONAL STANDARDS REQUIRED FOR FEDERAL TAX-EXEMPT STATUS. PSMC DEMONSTRATES A CONTINUED AND EXPANDING COMMITMENT TO MEETING ITS MISSION AND SERVING THE CITIZENS BY PROVIDING COMMUNITY BENEFITS. A COMMUNITY BENEFIT IS A PLANNED, MANAGED, ORGANIZED, AND MEASURED APPROACH TO MEETING IDENTIFIED COMMUNITY HEALTH NEEDS, REQUIRING A PARTNERSHIP BETWEEN THE HEALTHCARE ORGANIZATION AND THE COMMUNITY TO BENEFIT RESIDENTS THROUGH PROGRAMS AND SERVICES THAT IMPROVE HEALTH STATUS AND QUALITY OF LIFE. PSMC IMPROVES THE HEALTH AND WELLBEING OF SOUTHWEST GEORGIA THROUGH CLINICAL SERVICES, EDUCATION, RESEARCH, AND PARTNERSHIPS THAT BUILD HEALTH CAPACITY IN THE COMMUNITY. PSMC PROVIDES COMMUNITY BENEFITS FOR ALL CITIZENS AS WELL AS FOR THE MEDICALLY UNDERSERVED. PSMC CONDUCTS COMMUNITY NEEDS ASSESSMENTS AND PAYS CLOSE ATTENTION TO THE NEEDS OF LOW INCOME AND OTHER VULNERABLE PERSONS AND THE COMMUNITY AT LARGE. PSMC OFTEN WORKS WITH COMMUNITY GROUPS TO IDENTIFY NEEDS, STRENGTHEN EXISTING COMMUNITY PROGRAMS, AND PLAN NEWLY NEEDED SERVICES. IT PROVIDES A WIDE- RANGING ARRAY OF COMMUNITY BENEFIT SERVICES DESIGNED TO IMPROVE COMMUNITY HEALTH AND THE HEALTH OF INDIVIDUALS AND TO INCREASE ACCESS TO HEALTH CARE, IN ADDITION TO PROVIDING FREE AND DISCOUNTED SERVICES TO PEOPLE WHO ARE UNINSURED AND UNDERINSURED. DRAWING ON A DYNAMIC AND FLEXIBLE STRUCTURE, THE COMMUNITY BENEFIT PROGRAMS ARE DESIGNED TO RESPOND TO ASSESSED NEEDS AND ARE FOCUSED ON UPSTREAM PREVENTION. PSMC PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS AND IS ONE OF THE LEADING PROVIDERS OF MEDICAID SERVICES IN GEORGIA. THE FOLLOWING TABLE SUMMARIZES THE AMOUNTS OF CHARGES FOREGONE (I.E., CONTRACTUAL ADJUSTMENTS) AND ESTIMATES THE LOSSES INCURRED BY PSMC DUE TO INADEQUATE PAYMENTS BY THESE PROGRAMS AND FOR INDIGENT/CHARITY SERVICES. THIS TABLE DOES NOT INCLUDE DISCOUNTS OFFERED BY PSMC UNDER MANAGED CARE AND OTHER AGREEMENTS: CHARGES ESTIMATED FOREGONE UNREIMBURSED COST MEDICARE 57,000,000 18,000,000 MEDICAID 22,000,000 7,000,000 INDIGENT/CHARITY 5,000,000 1,000,000 84,000,000 26,000,000 THE FOLLOWING IS A SUMMARY OF THE COMMUNITY BENEFIT ACTIVITIES AND HEALTH IMPROVEMENT SERVICES OFFERED BY PSMC AND ILLUSTRATES THE ACTIVITIES AND DONATIONS DURING FISCAL YEAR 2015. I. COMMUNITY HEALTH IMPROVEMENT SERVICES A. COMMUNITY HEALTH EDUCATION KID'S CONFERENCE PSMC HELD ITS 3RD ANNUAL KIDS CONFERENCE ON AUGUST 9, 2014 AND PROVIDED SCREENINGS FOR DIABETES, CHOLESTEROL, BLOOD PRESSURE, HEARING AND VISION, HEALTH INFORMATION, SPEAKERS AND FELLOWSHIP FOR MORE THAN 250 ATTENDEES. THE PROGRAMS TARGET CHILDREN AT RISK OF POOR HEALTH STATUS. THE PROGRAMS TARGET UNINSURED OR UNDERINSURED CHILDREN WITHOUT A PRIMARY CARE PHYSICIAN OR KNOWLEDGE OF RECOMMENDED PREVENTIVE HEALTH CARE SERVICES. PSMC INCURRED EXPENSES OF 4,814 FOR THIS EVENT. MEN'S HEALTH CONFERENCES PSMC HELD THE 6TH ANNUAL MEN'S HEALTH CONFERENCE ON SEPTEMBER 13, 2014 THAT PROVIDED HEALTH SCREENINGS FOR PSA, CHOLESTEROL, BLOOD PRESSURE, HEARING AND VISION, HEALTH INFORMATION, SPEAKERS, AND FELLOWSHIP TO MORE THAN 200 ATTENDEES. THE HEALTH CONFERENCE PROGRAMS PROVIDE OUTREACH, HEALTH SCREENINGS, EDUCATIONAL PROGRAMS, AND HEALTH CONFERENCES AND EVENTS. THESE PROGRAMS TARGET MEN AT RISK OF POOR HEALTH STATUS. THE PROGRAMS TARGET UNINSURED OR UNDERINSURED MEN WITHOUT A PRIMARY CARE PHYSICIAN OR KNOWLEDGE OF RECOMMENDED PREVENTIVE HEALTH CARE SERVICES. PSMC INCURRED EXPENSES OF 6,190 FOR THIS EVENT. WOMEN'S HEALTH CONFERENCES PSMC HELD ITS 6TH ANNUAL WOMEN'S HEALTH CONFERENCE ON MAY 16, 2015 THAT PROVIDED SCREENINGS FOR GLUCOSE AND CHOLESTEROL, BLOOD PRESSURE, HEARING AND VISION, HEALTH INFORMATION, SPEAKERS AND FELLOWSHIP FOR MORE THAN 250 ATTENDEES. THE HEALTH CONFERENCE PROGRAMS PROVIDE OUTREACH, HEALTH SCREENINGS, EDUCATIONAL PROGRAMS, AND HEALTH CONFERENCES AND EVENTS. THESE PROGRAMS TARGET WOMEN AT RISK OF POOR HEALTH STATUS. THE PROGRAMS TARGET UNINSURED OR UNDERINSURED WOMEN WITHOUT A PRIMARY CARE PHYSICIAN OR KNOWLEDGE OF RECOMMENDED PREVENTIVE HEALTH CARE SERVICES. PSMC INCURRED EXPENSES OF 8,519 FOR THIS EVENT. B. COMMUNITY BASED CLINICAL SERVICES FLU SHOTS AND HEALTH SCREENINGS PSMC PROVIDES FREE FLU SHOTS TO VOLUNTEERS. IN 2015, THE CORPORATION ADMINISTERED 186 FLU SHOTS AT AN UNREIMBURSED COST OF 2,820. SCHOOL NURSE PROGRAM PSMC PROVIDES NURSES IN FOUR ELEMENTARY SCHOOLS, TWO MIDDLE SCHOOLS, AND THREE HIGH SCHOOLS IN SUMTER COUNTY WITH A GOAL OF CREATING ACCESS TO CARE FOR STUDENTS, ASSESSING THE HEALTH CARE STATUS OF EACH POPULATION REPRESENTED AND EFFECTIVELY ESTABLISHING REFERRALS FOR ALL HEALTH CARE NEEDS. DURING THE 2014/2015 SCHOOL YEAR, THE SCHOOL NURSE PROGRAM COVERED 15,743 STUDENT VISITS. THIS PROGRAM OPERATED AT A LOSS OF 87,457 IN 2015. C. HEALTH CARE SUPPORT SERVICES INDIGENT FINANCIAL ASSISTANCE PATIENTS WHOSE INCOME IS BELOW 125% OF THE FEDERAL POVERTY LEVELS ARE CLASSIFIED AS INDIGENT AND RECEIVE CARE AT NO COST. CHARITY FINANCIAL ASSISTANCE PATIENTS WHOSE INCOME LEVEL IS BETWEEN 126% - 200% OF THE FEDERAL POVERTY LEVELS WILL BE CLASSIFIED AS CHARITY. THESE PATIENTS WILL BE RESPONSIBLE FOR A PERCENTAGE OF THE HOSPITAL CHARGES. THIS PERCENTAGE WILL BE BASED ON CALCULATIONS USING THE FEDERAL POVERTY LEVELS THAT ARE PUBLISHED IN THE "FEDERAL REGISTER" EACH YEAR. IF IT IS DETERMINED THE PATIENT RESPONSIBILITY WILL BE AN UNDUE HARDSHIP ON THE PATIENT/GUARANTOR, THESE CASES WILL BE REVIEWED ON AN INDIVIDUAL BASIS WITH THE PHOEBE CARES SUPERVISOR FOR POSSIBLE CATASTROPHIC CHARITY BASED ON SLIDING SCALE GUIDELINES. CATASTROPHIC FINANCIAL ASSISTANCE PATIENTS WHOSE INCOME EXCEEDS 200% OF THE FEDERAL POVERTY LEVELS AND WHOSE HOSPITAL CHARGES EXCEED 25% OF THEIR ANNUAL INCOME, RESULTING IN EXCESSIVE HARDSHIP, ARE ELIGIBLE FOR A DISCOUNT UP TO 75% OF THE PATIENT BALANCE. THE PATIENT MAY PAY THE REMAINING BALANCE OVER 24 MONTHS. II. HEALTH PROFESSIONS EDUCATION PSMC RECOGNIZES THAT TO CONTINUOUSLY IMPROVE THE ORGANIZATION'S LONG-TERM VALUE TO OUR COMMUNITY AND OUR CUSTOMERS, TO ENCOURAGE LIFE-LONG LEARNING AMONG EMPLOYEES AND TO ACHIEVE A WORLD-CLASS EMPLOYER STATUS, IT IS IN THE ORGANIZATION'S BEST INTEREST TO PROVIDE OPPORTUNITIES THAT WILL ASSIST ELIGIBLE EMPLOYEES IN PURSUING FORMAL, HEALTHCARE RELATED EDUCATIONAL OPPORTUNITIES. IN FISCAL YEAR 2015, PSMC PROVIDED 36,925 IN CLINICAL SUPERVISION AND TRAINING OF NURSING STUDENTS. APPROXIMATELY 60 STUDENTS RECEIVED CLINICAL INSTRUCTION FROM OUR FACILITY. III. COMMUNITY BENEFIT OPERATIONS PSMC INCURRED 23,394 IN SUPPORT STAFF COSTS TO SUPPORT ITS COMMUNITY BENEFIT EFFORTS. true true false false false false false false false JOEL WERNICK BD MEMBER/PPHS CEO 817914 8176 904664 23555 1754309 JOE AUSTIN BD MEMBER/PPHS COO 480882 100000 6410 147284 23834 758410 KERRY LOUDERMILK PAST BM/PPHS CFO 431048 9991 167309 23689 632037 DARRYL HAWKINS PHARMACY DIRECTOR 141490 254 3025 28305 173074 LORI PAYNE PHARMACIST 137863 2087 25593 165543 SUSAN JOHNSON PHARMACIST 133180 82 2629 20702 156593 TIM TROTTIER REGIONAL OPERATIONS 236568 236568 SCHEDULE J, PAGE 1, PART I, LINE 3 NONE OF THE INDIVIDUAL BOARD MEMBERS OR OFFICERS, WITH THE EXCEPTION LISTED BELOW, ARE COMPENSATED BY THE FILING ORGANIZATION AND THE ORGANIZATION MUST RELY 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. JOHN HARDING WAS CONTRACTED BY PSMC AND SERVED AS INTERIM CEO UNTIL NOVEMBER 2014. BRANDI LUNNEBORG BECAME THE CEO OF PSMC IN NOVEMBER 2014 AND IS COMPENSATED BY PPHS. SCHEDULE J, PAGE 1, PART I, LINE 4 JOEL WERNICK 0 851,200 0 JOE AUSTIN 0 126,900 0 KERRY LOUDERMILK 0 131,800 0 TIM TROTTIER 236,568 0 0 SCHEDULE J, PART III PART I, LINE 4 - DEFERRED COMPENSATION PLAN 457(B) THE DEFERRED COMPENSATION PLAN IS AN ADDITIONAL RETIREMENT PLAN OFFERED THROUGH PHOEBE PUTNEY. THE 457(B) PLAN IS A NON-QUALIFIED RETIREMENT 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, CREATING A RISK OF FORFEITURE SENIOR VICE PRESIDENTS AND ABOVE AND PHYSICIANS MAKING OVER 120,000 ARE ELIGIBLE TO PARTICIPATE IN THE 457(B) PLAN. SCHEDULE J, PART II, COLUMN B(II) CERTAIN EXECUTIVE OFFICERS AND PHYSICIANS ARE ELIGIBLE FOR BONUS/INCENTIVE PAYMENTS. THESE PAYMENTS ARE RELIANT ON VARIOUS ORGANIZATIONAL AND PERSONAL GOALS ESTABLISHED BY A FORMAL PROCESS TO RECOGNIZE PERFORMANCE, AND TO OPERATE IN KEEPING WITH THE ORGANIZATION'S OBLIGATIONS AS A TAX-EXEMPT CHARITABLE ORGANIZATION. SCHEDULE J, PART II, COLUMN C A SUBSTANTIAL PORTION OF THE AMOUNT REPORTED IN COLUMN C OF SCHEDULE J, PART II (RETIREMENT AND OTHER DEFERRED COMPENSATION) FOR EMPLOYEES IDENTIFIED IN THE EXPLANATION ABOVE FOR PART I, LINE 4 IS A SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM. THE PURPOSE OF THE PLAN 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 AMOUNTS REPORTED AS SUPPLEMENTAL EXECUTIVE RETIREMENT COMPENSATION FOR AFFECTED EMPLOYEES REPRESENTS CREDITED, BUT NOT VESTED, RETIREMENT BENEFITS AND IS AVAILABLE IN FUTURE PERIODS TO THE EMPLOYEE SUBJECT TO CONTINUING EMPLOYMENT. PPHS MAINTAINS OWNERSHIP OF THE FUNDS ALLOCATED TO THE PARTICIPANT. PRIOR TO NORMAL RETIREMENT AGE, PPHS RETAINS AT LEAST THREE YEARS OF DEPOSITS WHICH ARE SUBJECT TO CONTINUING EMPLOYMENT FOR THE PARTICIPANT TO RECEIVE THE FUNDS. THIS PLAN IS A DEFINED CONTRIBUTION ACCOUNT BASED AND PARTICIPANT DIRECTED INVESTMENT PROGRAM THAT IS EMPLOYER FUNDED. FORM 990, PAGE 6, PART VI, LINE 6 THE SOLE MEMBER OF PHOEBE SUMTER 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 SUMTER MEDICAL CENTER, INC. (PSMC) 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 PSMC 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 PURCHASED SERVICES 7,636,966 3,118,365 0 PHYSICIAN FEES 6,055,088 0 0 CONTRACT LABOR 680,941 22,268 0 CONSULTANT FEES 0 2,500 0 FORM 990, PART XI, LINE 9 RENTAL EXPENSES 30,100 RENTAL EXPENSES -30,100 FORM 990, PART XI, LINE 9 INTEREST IN NET ASSETS OF SUMTER FOUNDATION -42,220 NET DECREASE IN NET ASSETS -42,220 PHOEBE PUTNEY HEALTH SYSTEMS INC PO BOX 3770 ALBANY GA 317063770 582001014 HEALTHCARE GA 501C3 11C NA false PHOEBE PHYSICIAN GROUP INC PO BOX 3770 ALBANY GA 317063770 263792403 HEALTHCARE GA 501C3 9 PPHS false SUMTER REGIONAL HOSPITAL FOUNDATION INC 126 HIGHWAY 280 WEST AMERICUS GA 317198645 581607727 FOUNDATION GA 501C3 11A PSMC true PHOEBE PUTNEY MEMORIAL HOSPITAL INC PO BOX 3770 ALBANY GA 317063770 581928247 HEALTHCARE GA 501C3 3 PPHS false PHOEBE WORTH MEDICAL CENTER INC PO BOX 545 SYLVESTER GA 317910545 383647394 HEALTHCARE GA 501C3 3 PPHS false SOUTH GEORGIA SHARED SERVICES INC 417 WEST THIRD AVENUE ALBANY GA 317011943 462746977 COOPERATIV GA 501C3 3 PPHS false PHOEBE FOUNDATION INC PO BOX 3770 ALBANY GA 317063770 581847104 FOUNDATION GA 501C3 11A 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 true false true false false false false false false false true true true true true false false SUMTER REGIONAL HOSPITAL FOUNDATION N VALUE UNDETERMINED