2015-02-06T11:11:59-06:00 2014-03-31 721396621 CARR RIGGS & INGRAMLLC 4360 CHAMBLEE DUNWOODY RD STE 420 ATLANTA GA 30341 990 2013-04-01 510141601 SHEPHERD CENTER INC SHEP 4043507310 2020 PEACHTREE ROAD NW ATLANTA GA 30309 STEPHEN B HOLLEMAN CFO 4043507310 2015-02-04 1 LIJING DAI P01535630 7704576606 2013 2016-03-07 17:11:31Z GARY R ULICNY 2020 PEACHTREE ROAD NW ATLANTA GA 30309 166970940 0 X WWW.SHEPHERD.ORG X 1975 GA SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF SHEPHERD CENTER'S MISSION STATEMENT.SHEPHERD CENTER'S MISSION IS TO HELP PEOPLE WITH A TEMPORARY OR PERMANENT DISABILITY CAUSED BY INJURY OR DISEASE REBUILD THEIR LIVES WITH HOPE, INDEPENDENCE, AND DIGNITY, ADVOCATING FOR THEIR FULL INCLUSION IN ALL ASPECTS OF COMMUNITY LIFE WHILE PROMOTING SAFETY AND INJURY PREVENTION. 24 20 1749 950 127175 -1139 10681134 10640013 148756388 148855868 3324598 3539185 3980492 3894725 166742612 166929791 0 0 0 0 93478887 100972351 0 0 0 54329082 56391542 147807969 157363893 18934643 9565898 346135803 364613088 84798875 75924869 261336928 288688219 X SHEPHERD CENTER'S PRIMARY PURPOSE IS TO PROVIDE ACUTE AND REHABILITATIVE HOSPITAL CARE TO PATIENTS WITH SPINAL CORD INJURIES, ACQUIRED BRAIN INJURIES, MULTIPLE SCLEROSIS, AND OTHER NEUROMUSCULAR AND UROLOGICAL DISEASES. CONTINUED ON SCHEDULE O.WE STRIVE TO BE THE MOST COMPREHENSIVE CATASTROPHIC CARE SPECIALTY HOSPITAL IN THE WORLD COMMITTED TO IMPROVING OUR PATIENTS' LIVES. 0 1 108340101 148855868 IN REFERENCE TO THE PROVISION OF PATIENT CARE SERVICES, SHEPHERD CENTER IS DEDICATED TO HELPING PEOPLE WHO HAVE EXPERIENCED CATASTROPHIC INJURY OR DISEASE REBUILD THEIR LIVES WITH HOPE, DIGNITY, AND INDEPENDENCE, ADVOCATING FOR THEIR FULL INCLUSION IN ALL ASPECTS OF COMMUNITY LIFE. IN THE LAST FISCAL YEAR, SHEPHERD CENTER INCURRED EXPENSES TO PROVIDE SERVICES FOR 1,001 INPATIENT ADMISSIONS, 43,690 INPATIENT DAYS, 46,940 OUTPATIENT VISITS, AND 14,672 DAY PATIENT DAYS. 10304523 7573940 BECAUSE OF THE GENEROUS FINANCIAL SUPPORT OF THE COMMUNITY, SHEPHERD CENTER IS ABLE TO PROVIDE MANY COMMUNITY FUNDED SERVICES THAT ARE NOT AVAILABLE IN OTHER HOSPITALS. SHEPHERD CENTER OFFERS SERVICES SUCH AS FAMILY HOUSING AND TRAINING, EXPANDED THERAPEUTIC RECREATION SERVICES, ASSISTIVE TECHNOLOGY AND ADAPTIVE EQUIPMENT, AND VOCATIONAL TRAINING, AS WELL AS MEDICAL CARE FOR PATIENTS WITHOUT THE ABILITY TO PAY FOR THESE SERVICES. 2725537 2770568 WITH REGARD TO RESEARCH ACTIVITY, SHEPHERD CENTER IS A SITE FOR LEADING-EDGE RESEARCH AND PROVIDES IMPORTANT OUTCOMES TRACKING THAT HELP SHAPE THE FACE OF REHABILITATION IN THE UNITED STATES. OUR VISION IS TO BE A CENTER OF EXCELLENCE IN PATIENT CARE, PARTICIPATING IN RESEARCH THAT WILL ACHIEVE THE HIGHEST OUTCOMES AND IMPROVE THE LIVES OF OUR PATIENTS AND FAMILIES. 121370161 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 440 0 1 1749 1 1 1 0 0 0 0 0 0 0 0 0 X 24 20 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 GA SC FL AL NC X X NORA MANGRUM 4043507320 2020 PEACHTREE RD NW ATLANTA GA 303091402 ALANA SHEPHERD BOARD RECORDING SEC 20.00 20.00 X X 0 0 0 BROCK BOWMAN MD BOARD MEMBER 40.00 0.00 X 468379 0 21605 C TALBOT NUNNALLY III BOARD MEMBER 1.00 0.00 X 0 0 0 CLARK H DEAN BOARD MEMBER 1.00 0.00 X 0 0 0 DAVID F APPLE JR MD BOARD MEMBER 24.00 1.00 X 126315 0 16459 DAVID H FLINT BOARD MEMBER 1.00 0.00 X 0 0 0 DONALD P LESLIE MD MEDICAL DIRECTOR 40.00 1.00 X 665752 0 16905 DOUGLAS LINDAUER BOARD MEMBER 1.00 0.00 X 0 0 0 EMORY A SCHWALL BOARD VP 4.00 0.00 X X 0 0 0 FRED V ALIAS BOARD MEMBER 1.00 0.00 X 0 0 0 GARY ULICNY PHD PRESIDENT/CEO 40.00 1.00 X X 705626 0 31427 GOODLOE H YANCEY III BOARD MEMBER 1.00 0.00 X 0 0 0 GREGORY L ANDERSON JR BOARD MEMBER 1.00 0.00 X 0 0 0 J HAROLD SHEPHERD BOARD MEMBER 1.00 0.00 X 0 0 0 JAMES D THOMPSON BOARD MEMBER 1.00 0.00 X 0 0 0 JAMES E STEPHENSON BOARD MEMBER 1.00 0.00 X 0 0 0 JAMES H SHEPHERD JR CHAIRMAN 40.00 1.00 X X 314932 0 15439 JAMES M CASWELL JR BOARD MEMBER 1.00 0.00 X 0 0 0 JOHN S DRYMAN BOARD MEMBER 1.00 0.00 X 0 0 0 JULIAN B MOHR BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL L JONES PHD VP RESEARCH 40.00 0.00 X 327969 0 22792 MITCHELL J FILLHABER VP MARKETING 40.00 0.00 X 306777 0 16865 SALLY NUNNALLY JR BOARD MEMBER 1.00 0.00 X 0 0 0 SARA C CHAPMAN JR BOARD MEMBER 1.00 0.00 X 0 0 0 SARAH MORRISON VP CLINICAL SERVICES 40.00 0.00 X 250729 0 22407 SCOTT H SIKES VP FOUNDATION 1.00 40.00 X 263858 0 15217 STEPHEN B GOOT BOARD IMMEDIATE-PAST CORPORATE SEC 2.00 0.00 X X 0 0 0 STEPHEN B HOLLEMAN CFO 40.00 1.00 X X 376029 0 23773 TAMARA KING CHIEF NURSE EXECUTIVE 40.00 0.00 X 223750 0 20519 W CLYDE SHEPHERD III BOARD MEMBER 1.00 0.00 X 0 0 0 WILLIAM C FOWLER BOARD TREASURER 2.00 0.00 X X 0 0 0 WILMA BUNCH VP FACILITIES 40.00 0.00 X 213666 0 16984 BEN THROWER MD PHYSICIAN 40.00 0.00 X 556963 0 22833 ERIK SHAW MD PHYSICIAN 40.00 0.00 X 547324 0 14756 JOHN LIN PHYSICIAN 40.00 0.00 X 442696 0 10601 JOHN MUSSER MD PHYSICIAN 40.00 0.00 X 488043 0 8499 SHERRILL LORING MD PHYSICIAN 40.00 0.00 X 482655 0 6113 6761463 0 303194 132 0 1 0 PIEDMONT HOSPITAL PO BOX 102526 ATLANTA GA 30368 MEDICAL SERVICES 5816552 SIEMENS MEDICAL SOLUTIONS C/O MELLON BANK DEPT AT 120001 DEPT DALLAS TX 753120733 SOFTWARE IMPLEMENTATION 2585759 HYBRIDGE SOLUTIONS INC PO BOX 1077 INMAN SC 29349 COMPUTER CONSULTING SERVICES 2208395 HIMFORMATICS 1735 BUFORD HWY STE 215-311 CUMMING GA 30041 COMPUTER CONSULTING SERVICES 1419164 CAREFUSION SOLUTIONSPYXIS 25082 NETWORK PLACE CHICAGO IL 606731250 EQUIPMENT RENTAL SERVICES 583531 28 1787180 8852833 55274 10640013 NET INPATIENT SERVICE 900099 114174993 114174993 NET OUTPATIENT SERVICE 900099 26676966 26676966 NET DAYPATIENT SERVICE 900099 8003909 8003909 148855868 3520503 3520503 357060 41149 315911 315911 315911 18682 0 18682 18682 18682 CAFETERIA REVENUE 900099 1272018 1272018 ADMINISTRATIVE FEES 532000 64170 64170 RENTAL INCOME 532000 63005 63005 2179621 2179621 3578814 166929791 151351400 127175 4811203 X 7064657 4764065 2300592 75622897 61151273 14471624 2157430 2157430 3727654 3014309 713345 12399713 5054428 7345285 234664 133051 101613 293186 293186 138600 138600 10895973 8686163 2209810 655287 4200 651087 2994309 1611114 1383195 1803935 11264 1792671 2668780 576867 2091913 979612 718711 260901 700607 376990 323617 775465 775465 9375553 1942110 7433443 691617 87716 603901 MEDICAL SUPPLIES 19468784 18346709 1122075 EQUIPMENT RENTAL & MAIN 2730712 1514921 1215791 OTHER DIRECT EXPENSES 1984458 183874 1800584 ALLOCATION OF INDIRECT 0 13192396 -13192396 157363893 121370161 35993732 0 13268418 20513401 15917586 8533858 879918 1525691 31719757 32490435 1404501 1629682 1496937 1763562 235551746 107847035 129060288 127704711 149716325 167501326 2672073 2950422 346135803 364613088 12913077 16049733 39103 55748 65400000 53500000 6446695 6319388 84798875 75924869 X 198734401 214331704 20070512 31395760 42532015 42960755 261336928 288688219 346135803 364613088 X 9565898 8257979 9527414 X X 0 1 X 1 1 1 X 46154 12256 58410 121311751 121370161 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 49024 56528 70818 58410 234780 250000 250000 250000 250000 1000000 1500000 42730 44752 56006 46154 189642 PART II-A SUPPLEMENTAL INFORMATION: SHEPHERD CENTER, INC. EMPLOYS MARK JOHNSON AS DIRECTOR OF ADVOCACY. DURING FISCAL YEAR 2014, HE AND ADVOCACY SPECIALIST, CAROL JONES, WERE INVOLVED IN THE FOLLOWING ACTIVITIES: 1. MAINTAINED ADVOCACY LISTSERV, A LISTING OF ADVOCACY OPPORTUNITIES FOR STAFF AND CONSUMERS (GRASSROOTS - LINE 1A). 2. SUPPORTED EFFORTS TO INCREASE AND IMPROVE HOME AND COMMUNITY BASED SERVICES (GRASSROOTS - LINE 1A). 3. PARTICIPATED IN GEORGIA'S ANNUAL DISABILITY DAY AT THE CAPITOL, FEBRUARY 20, 2014 (DIRECT LOBBYING - LINE 1B). 4. PROMOTED PASSAGE OF THE DISABILITY TREATY, HTTP://DISABILITYTREATY.ORG 5. CHAIRED THE ADA LEGACY PROJECT, HTTP://ADALEGACY.COM 6. SERVED ON THE ADVISORY BOARD OF RESPECTABILITY, A NATIONAL, NON-PROFIT, NON-PARTISAN ORGANIZATION WHOSE MISSION IS TO RESHAPE THE ATTITUDES OF AMERICAN SOCIETY SO THAT PEOPLE WITH DISABILITIES CAN MORE FULLY PARTICIPATE AND CONTRIBUTE TO SOCIETY (GRASSROOTS - LINE 1A). 42532015 428740 42960755 42320276 211739 42532015 41432723 887553 42320276 43555890 -2123167 41432723 43196059 359831 43555890 1.00000 0 0 16628506 16628506 101422890 35726265 65696625 107096872 71279563 35817309 10403478 841207 9562271 127704711 ANNUITIES PAYABLE 6319388 6319388 X PART V, LINE 4: SHEPHERD CENTER HAS ESTABLISHED MULTIPLE PERMANENT ENDOWMENT FUNDS TO SUPPORT A VARIETY OF COMMUNITY FUNDED PROGRAMS SUCH AS RECREATION THERAPY, HOUSING, ASSISTIVE TECHNOLOGY AND MANY OTHER PROGRAMS THAT ARE NOT TRADITIONALLY OFFERED IN OTHER HOSPITALS. THESE PROGRAMS ENSURE SHEPHERD CENTER PROVIDES A FULL AND EXPANDED CONTINUUM OF CARE THAT HELPS FULFILL OUR MISSION OF HELPING PATIENTS REBUILD THEIR LIVES TO THE FULLEST EXTENT POSSIBLE. PART X, LINE 2: THE CENTER APPLIES THE PROVISIONS OF ACCOUNTING STANDARDS FOR INCOME TAXES. THESE PROVISIONS REQUIRE THAT A TAX POSITION BE RECOGNIZED OR DERECOGNIZED BASED ON A "MORE-LIKELY-THAN-NOT" THRESHOLD. THIS APPLIES TO POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE CENTER DOES NOT BELIEVE ITS CONSOLIDATED FINANCIAL STATEMENTS INCLUDE ANY MATERIAL UNCERTAIN TAX POSITIONS. 1 1 1 X 250.000000000000 0 1 1 1 0 1 1 1 1916 3209785 500 3209285 0.02040 1 970 2461110 2461110 0.01560 2 2886 5670895 500 5670395 0.03600 69 16995 5939230 222356 5716874 0.03630 2 362 253197 253197 0.00160 9 4311 867683 406783 460900 0.00290 37 350 3394892 85002 3309890 0.02100 1 61 20000 20000 0.00010 118 22079 10475002 714141 9760861 0.06190 120 24965 16145897 714641 15431256 0.09790 1 1500 670662 46650 624012 0.00400 1 12275 136909 0 136909 0.00090 3 961 177672 177672 0.00110 5 14736 985243 46650 938593 0.00600 0 831862 0 14030613 20462447 -6431834 X 1 1 1 1 SHEPHERD CENTER INC 2020 PEACHTREE ROAD NW ATLANTA GA 30309 X X SHEPHERD CENTER INC 1 1 X X X X X X X X X 12 1 0 1 X SHEPHERD.ORG X X X X X X X 1 0 1 1 250.000000000000 0 1 X X X X X X X X 1 1 X X X X 0 0 0 X X 0 0 SHEPHERD CENTER, INC. PART V, SECTION B, LINE 11: SEE PART VI, LINE 3 EXPLANATION FOR A COMPLETE DISCLOSURE OF HOW DISCOUNTED ELIGIBILITY IS DETERMINED. SHEPHERD CENTER, INC. PART V, SECTION B, LINE 12I: FAMILY SIZE SHEPHERD CENTER, INC. PART V, SECTION B, LINE 14G: WHEN PATIENTS ARE SCHEDULED OR AN ADMISSION REFERRAL IS MADE, APPROPRIATE FINANCIAL SCREENING IS PROVIDED. SHEPHERD CENTER, INC. PART V, SECTION B, LINE 20D: SHEPHERD CENTER DISCOUNTS CARE FOR PATIENTS WHO HAVE THE ABILITY TO PAY USING THE AVERAGE DISCOUNT APPLICABLE TO ALL OUR MANAGED CARE CONTRACTS. 2 SHEPHERD PATHWAYS 1942 CLAIRMONT ROAD DECATUR GA 30033 OUTPATIENT CENTER SERVING BRAIN INJURY PATIENTS BEYOND THERAPY TENNESSEE 277 MALLORY STATION FRANKLIN TN 37067 OUTPATIENT CENTER PROVIDING INTENSIVE REHABILITATION SERVICES PART II, COMMUNITY BUILDING ACTIVITIES: SHEPHERD CENTER'S COMMUNITY BUILDING ACTIVITIES ARE CONCENTRATED IN THE FOLLOWING AREAS:ADVOCACYSHEPHERD CENTER'S ADVOCACY PROGRAM IS RESPONSIBLE FOR THE FOLLOWING:1.SERVE AS A PRIMARY LIAISON BETWEEN SHEPHERD CENTER AND THE DISABILITY COMMUNITY.2.PROVIDE DAY-TO-DAY EXPERTISE ON DISABILITY RIGHTS ISSUES.3.PROMOTE DISABILITY RIGHTS.4.SUPPORT THE DEVELOPMENT OF LOCAL AND NATIONAL CAMPAIGNS RELATED TO HOME AND COMMUNITY BASED SERVICES (HCBS), ACCESSIBLE, AFFORDABLE, INTEGRATED HOUSING, AFFORDABLE, INTEGRATED HOUSING, REUSE EFFORTS AND INCLUSIVE EMERGENCY MANAGEMENT.5.SERVE ON AMERIGROUP'S AGING AND DISABILITY ADVISORY BOARDIN FYE 2014 MARK JOHNSON, DIRECTOR OF ADVOCACY AT SHEPHERD CENTER, PROMOTED EFFORTS TO INCREASE AND IMPROVE HOME AND COMMUNITY BASED SERVICES AND DISABILITY EMPLOYMENT AWARENESS.HOUSINGHAVING THE FAMILIES AND LOVED ONES INVOLVED IN REHABILITATION AFTER A CATASTROPHIC INJURY IS IMPERATIVE TO THE SUCCESSFUL TRANSITION TO COMMUNITY, HOME, WORK AND/OR SCHOOL. SHEPHERD CENTER OFFERS COMPLIMENTARY HOUSING FOR 30 DAYS FOR FAMILIES WHO TRAVEL MORE THAN 60 MILES FROM ATLANTA TO GET TO SHEPHERD CENTER. THIS SUPPORT IS CRUCIAL AND APPRECIATED BY FAMILIES AS IT ENABLES THEM TO FOCUS ON THEIR LOVED ONE GETTING BETTER AND NOT THE FINANCIAL BURDENS AND STRESS THAT COMES WITH MOVING FROM HOME FOR CARE. COMPLIMENTARY HOUSING IS ALSO OFFERED FOR DAY PROGRAM PATIENTS AS A WAY TO EXPERIENCE WHAT THEY HAVE LEARNED IN THE INPATIENT SETTING AND PUT IT TO WORK IN A SAFE ENVIRONMENT. THE HOUSING PROGRAM HELPS ALLEVIATE STRESS AND UNCERTAINTY AS PATIENTS TRANSITION BACK TO THEIR HOME AND COMMUNITY. IN ORDER TO PROVIDE A PEER SUPPORT COMMUNITY FOR MILITARY PATIENTS, HOUSING IS PROVIDED AT BISCAYNE PLACE, AN APARTMENT COMPLEX WITHIN TWO MILES OF SHEPHERD CENTER. MOST EVERY FAMILY MEMBER THAT STAYS IN THE WOODRUFF FAMILY RESIDENCE CENTER HAS SHARED THAT, BY HAVING HOUSING AVAILABLE TO THEM, SHEPHERD CENTER HAS ALLEVIATED THE STRESS AND WORRY OF TRYING TO FIND AND PAY FOR A PLACE TO STAY. PLUS, THEY ARE SO CLOSE TO THEIR LOVED ONES AT THE HOSPITAL, IT GIVES THEM A SENSE OF SECURITY AND CONVENIENCE THEY WOULDN'T HAVE HAD OTHERWISE. INJURY PREVENTIONBRIDGET METZGER, A FORMER SPINAL CORD INJURY CASE MANAGER WAS HIRED IN OCTOBER, 2012 TO DIRECT SHEPHERD CENTER'S NEW INJURY PREVENTION PROGRAM. MAJOR PROJECTS IN THE FIRST YEAR INCLUDED:- MIDDLE SCHOOL TBI & SCI PREVENTION SCIENCE CURRICULUM, WHICH REACH APPROXIMATELY 1300 SEVENTH GRADE STUDENTS IN COBB COUNTY SCHOOLS.- PRODUCTION OF TWO EXCELLENT 35-MINUTE VIDEOS OF OUR VISITS WITH FORMER PATIENTS AND STAFF TO CAMPBELL MIDDLE SCHOOL IN SPRING 2013. THE VIDEOS ARE A POWERFUL TOOL FOR SCHOOLS TO TEACH STUDENTS ABOUT TBI AND SCI, CAREERS IN THE FIELD, WHAT LIFE IS LIKE AFTER INJURY AND HOW YOUNG PEOPLE CAN AVOID GETTING HURT THEMSELVES.- FIRST ANNUAL EMPLOYEE SAFE DRIVING WEEK, APRIL 2013.- PEDESTRIAN SAFETY CAMPAIGN WITH A FOCUS ON PEACHTREE STREET, SEPTEMBER 2013. PART III, LINE 4: AS STATED IN THE FOOTNOTES OF SHEPHERD CENTER'S FINANCIAL STATEMENTS, THE CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS NET REVENUE OR ACCOUNTS RECEIVABLE.THE CENTER MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY AND THE ESTIMATED COSTS OF THOSE SERVICES AND SUPPLIES. THE AMOUNTS OF CHARGES FOREGONE, BASED ON ESTABLISHED RATES, AND ESTIMATED COSTS AND EXPENSES INCURRED TO PROVIDE CHARITY CARE IN FY 2014 WERE $8,752,406 AND $3,198,195, RESPECTIVELY, RESULTING IN A 36.54% COST FACTOR. THIS COST FACTOR WAS APPLIED TO GROSS BAD DEBT EXPENSE OF $2,276,533 TO GET THE AMOUNT ON PART III, LINE TWO. PART III, LINE 9B: ACCORDING TO SHEPHERD CENTER'S DEBT COLLECTION POLICY, ALL PATIENTS ARE ASKED TO COMPLETE A FINANCIAL SCREENING AT THE TIME OF REGISTRATION. IF A PATIENT IS APPROVED FOR ASSISTANCE BASED ON THE FINANCIAL DATA SUPPLIED, ANY PATIENT BALANCES WILL BE APPLIED TO A CHARITY ALLOWANCE BASED ON THE HOSPITAL'S FINANCIAL ASSISTANCE TO PATIENTS POLICY. PART VI, LINE 2: SHEPHERD CENTER'S MISSION IS TO HELP PEOPLE WITH A TEMPORARY OR PERMANENT DISABILITY CAUSED BY INJURY OR DISEASE REBUILD THEIR LIVES WITH HOPE, INDEPENDENCE AND DIGNITY, ADVOCATING FOR THEIR FULL INCLUSION IN ALL ASPECTS OF COMMUNITY LIFE WHILE PROMOTING SAFETY AND INJURY PREVENTION. SHEPHERD CENTER IS COMMITTED TO PROVIDING THE RESOURCES AND TOOLS OUR PATIENTS NEED TO FACILITATE THE SUCCESSFUL TRANSITION BACK TO LIFE AND COMMUNITY AFTER A CATASTROPHIC INJURY.FROM DAY ONE, SHEPHERD CENTER HAS FOCUSED ON PATIENT-CENTERED CARE AND HAS DEVELOPED A CONTINUUM THAT IS UNIQUE IN THE SETTING OF AN ACUTE CARE, REHABILITATION HOSPITAL. BECAUSE OF THE VALUE-ADDED PROGRAMS OFFERED AT SHEPHERD CENTER, OUR PATIENTS HAVE THE RESOURCES TO RE-LEARN ACTIVITIES OF DAILY LIVING AND ACHIEVE THE GOALS THEY SET FOR THEMSELVES POST-INJURY. THOSE GOALS INCLUDE RETURNING TO HOME, SCHOOL AND/OR WORK. THEY ALSO INCLUDE "GETTING THEIR LIFE BACK" IN REGARD TO REGAINING THE ABILITY TO ENJOY LIFE THROUGH SOCIAL EVENTS, HOBBIES, AND LEISURE ACTIVITIES, AS WELL AS PROVIDING FOR THEMSELVES AND THEIR FAMILY. THE VALUE-ADDED PROGRAMS AID IN REGAINING ONE'S LIFE AND REBUILDING THEIR HOPE, BUT ARE OFTEN NOT REIMBURSED BY INSURANCE OR MEDICARE/MEDICAID. THEY ARE ESSENTIAL IN A PATIENT'S SUCCESSFUL RECOVERY. SHEPHERD CENTER BELIEVES THESE PROGRAMS DIRECTLY CONTRIBUTE TO THE MUCH GREATER THAN AVERAGE CLINICAL OUTCOMES ACHIEVED BY OUR PATIENTS. SHEPHERD CENTER'S RETURN TO HOME AND COMMUNITY RATES FOR SPINAL CORD INJURY PATIENT ARE 87 PERCENT AS COMPARED TO THE NATIONAL AVERAGE OF 73 PERCENT AND FOR BRAIN INJURY PATIENTS 93 PERCENT AS COMPARED TO THE NATIONAL AVERAGE OF 65 PERCENT. SHEPHERD CENTER'S CLINICAL OUTCOMES HAVE BEEN RECOGNIZED SINCE 2000 AS A TOP 10 REHABILITATION HOSPITAL BY U.S. WORLD & NEWS REPORT. PART VI, LINE 3: IT IS SHEPHERD CENTER'S POLICY TO EXTEND ITS SERVICES TO AS MANY PATIENTS AS IT CAN WITHIN THE FINANCIAL RESOURCES THAT ARE AVAILABLE. THOSE WHO DO NOT HAVE FINANCIAL RESOURCES TO PAY FOR THEIR CARE WILL BE CONSIDERED FOR FINANCIAL ASSISTANCE. IT IS CRITICAL TO SAFEGUARD FUNDS AVAILABLE FOR THIS PURPOSE BY ASSURING THAT THIS ASSISTANCE PROGRAM IS THE "PAYER OF LAST RESORT" AND IS ONLY PROVIDED TO THOSE WHO HAVE PROVEN AN INABILITY TO PAY.WHEN PATIENTS ARE SCHEDULED OR AN ADMISSION REFERRAL IS MADE, APPROPRIATE FINANCIAL SCREENING IS PROVIDED. THE FIRST STEP OF THIS SCREENING WILL INCLUDE DETERMINING WHETHER THIRD PARTY PAYER RESOURCES ARE AVAILABLE TO COVER THE COST OF CARE FOR THE INPATIENT OR DAY PATIENT CHARGES IN FULL. IF THERE ARE NO THIRD PARTY PAYER RESOURCES AVAILABLE, OR THERE IS EXPECTED TO BE PATIENT LIABILITY BALANCES DUE AFTER INSURANCE, THE FINANCIAL COUNSELOR WILL COMPLETE A "PRE-SCREENING" USING THE FINANCIAL ASSISTANCE SCREENING FORM. IF FINANCIAL RESOURCES DO NOT APPEAR TO BE AVAILABLE AND THE PATIENT LIABILITY IS EXPECTED TO EXCEED $5,000, THE PATIENT OR GUARANTOR WILL BE ASKED TO COMPLETE A "PATIENT FINANCIAL EVALUATION" FORM TO OBTAIN ADDITIONAL INFORMATION THAT WILL FURTHER ASSIST IN THE ASSESSMENT OF THEIR ELIGIBILITY FOR CHARITY ASSISTANCE. THE PATIENT OR GUARANTOR WILL BE REQUIRED TO COMPLETE THE APPLICATION IN FULL AND PROVIDE SUPPORTING EVIDENCE TO SUBSTANTIATE INCOME. MINIMUM SUPPORTING EVIDENCE FOR INCOME INCLUDES:- PAY STUBS REPRESENTING CURRENT INCOME OF HOUSEHOLD.- ANYTHING THAT PROVIDES PROOF OF INCOME, I.E., W2S, PRIOR YEAR INCOME TAX FORMS, LETTERS FROM EMPLOYERS ETC. - IF NO INCOME, LETTER FROM PERSON PROVIDING ROOM & BOARD TO PATIENT IS REQUIRED.ONCE THE FINANCIAL ASSISTANCE FORM IS COMPLETE THE FINANCIAL COUNSELOR WILL REVIEW TO ASSURE THAT SUPPORTING DOCUMENTATION IS ATTACHED, PROVIDE ALL THE CALCULATIONS REQUIRED, AND PROVIDE A PRELIMINARY ASSESSMENT OF ELIGIBILITY. ELIGIBILITY WILL BE BASED ON THE CRITERIA ESTABLISHED BY SHEPHERD CENTER AS FOLLOWS:A. CURRENT INCOME MUST NOT EXCEED 250% OF THE FEDERAL POVERTY GUIDELINES FOR THE CURRENT YEAR. B. IF INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES, ADDITIONAL INFORMATION MAY BE REQUIRED FROM THE PATIENT OR GUARANTOR TO DETERMINE IF ASSISTANCE CAN BE GRANTED BASED ON A "MEDICALLY NEEDY" SITUATION RESULTING FROM THE CATASTROPHIC EVENT NECESSITATING ADMISSION TO SHEPHERD CENTER.IF THE PATIENT STILL DOES NOT MEET CRITERIA, THE FINANCIAL COUNSELOR WILL ESTABLISH DEPOSIT REQUIREMENTS BASED ON THE EXPECTED LENGTH OF STAY AND WILL OFFER THE PATIENT PAYMENT OPTIONS INCLUDING, BUT NOT LIMITED TO: (SEE ALSO FINANCIAL ARRANGEMENTS POLICY FOR SELF PAY PATIENTS)- BANK LOAN- VISA/MASTERCARD/DISCOVER/AMERICAN EXPRESS- NINETY-(90) DAY PAYMENT PLAN, AS DETAILED IN THE CREDIT & COLLECTIONS POLICY IF THE PRELIMINARY ASSESSMENT APPROVES THE PATIENT FOR FINANCIAL ASSISTANCE, THE FINANCIAL COUNSELOR WILL PRESENT THE PACKET TO THE MANAGER OF PATIENT FINANCIAL SERVICES FOR REVIEW AND QUALIFICATION APPROVAL. IN ADDITION, THE PROGRAM DIRECTOR WILL SIGN TO APPROVE THAT THE USE OF FUNDS MEETS CLINICAL APPROPRIATENESS FOR THEIR AREA. FOR INPATIENTS AND DAY PATIENTS, THE PATIENT WILL NEED TO MEET ASSET REQUIREMENTS. EXPECTATION WOULD BE THAT ASSETS OTHER THAN THOSE LISTED BELOW AND DISPOSABLE INCOME AFTER REASONABLE LIVING EXPENSES WOULD BE USED TO SATISFY A PORTION OR ALL OF THE FINANCIAL REQUIREMENTS OF THE PATIENT'S CARE. ASSETS THAT MAY BE EXCLUDED FROM CONSIDERATION ARE:- PATIENT'S HOME WITH NO MORE THAN 25% OR $25,000 EQUITY, WHICHEVER IS LESS. THE REQUIREMENTS TO USE HOME EQUITY CAN BE WAIVED IF THE PATIENT IS UNABLE TO MAKE PAYMENTS ON ADDITIONAL DEBT.- IF THE PATIENT HAS APPLIED FOR GEORGIA MEDICAID, THE FINANCIAL ASSISTANCE PROGRAM FORM SHOULD BE COMPLETED AND IF SUCH CHARGES ARE ULTIMATELY NOT COVERED OR UNCOLLECTIBLE THE PATIENT IS DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE. ALL FINANCIAL AND OTHER MITIGATING CIRCUMSTANCES ARE REVIEWED BY THE MANAGER OF PATIENT FINANCIAL SERVICES WHO THEN MAKES THE FINAL DECISION REGARDING ELIGIBILITY. IF ASSISTANCE IS NOT APPROVED THE FINANCIAL COUNSELOR WILL COORDINATE THE NOTIFICATION TO THE PATIENT. PAYMENT ARRANGEMENTS WILL BE COMPLETED AS LISTED ABOVE AND BASED ON THE FINANCIAL ARRANGEMENTS POLICY. IF APPROVED FOR FULL ASSISTANCE OR ASSISTANCE FOR PATIENT LIABILITY OVER INSURANCE AMOUNTS, THE FINANCIAL COUNSELOR WILL NOTIFY THE PATIENT. THE COVERED AMOUNT WILL BE WRITTEN-OFF PURSUANT TO ESTABLISHED POLICY AFTER DISCHARGE OR INSURANCE IS FINALIZED. PART VI, LINE 4: SHEPHERD CENTER DEFINES COMMUNITY BENEFIT AS A PLANNED, ORGANIZED, AND MEASURED APPROACH TO SERVICES AND ACTIVITIES THAT SPECIFICALLY ADDRESS THE HEALTHCARE NEEDS OF PEOPLE WITH SPINAL CORD AND BRAIN INJURY, MULTIPLE SCLEROSIS, CHRONIC PAIN, OTHER NEUROMUSCULAR DISEASES, AS WELL AS THE FAMILY OR LOVED ONES IMPACTED. PATIENTS AT SHEPHERD CENTER GET MORE THAN MEDICAL CARE, BUT RECEIVE THE FULL CONTINUUM OF CARE -- FROM EVALUATION AND MEDICAL TREATMENT TO REHABILITATION AND LIFELONG SUPPORT PROGRAMS -- THAT EXTENDS BACK TO THEIR COMMUNITIES. OUR PATIENT POPULATION HAS UNIQUE NEEDS THAT ARE TYPICALLY UNDERSERVED, WHICH MAKES SHEPHERD AN IMPORTANT LIFELINE AND RESOURCE FOR OUR PATIENTS THROUGHOUT THEIR LIFE. SHEPHERD CENTER'S COMMUNITY INCLUDES CURRENT PATIENTS AND THEIR FAMILY, AS WELL AS FORMER PATIENTS AND THEIR FAMILY.SHEPHERD CENTER TAKES A LEADERSHIP ROLE IN EDUCATING HEALTHCARE PROFESSIONALS (PHYSICIANS, NURSES, AND THERAPISTS) WHO SPECIALIZE IN SPINAL CORD AND BRAIN INJURY REHABILITATION. WE ALSO SERVE AS A STRONG COMMUNITY ADVOCATE, MONITORING LEGISLATION AND RELATED ISSUES THAT IMPACT THE DISABILITY COMMUNITY. SHEPHERD CENTER'S REACH EXTENDS BEYOND METRO ATLANTA TO ALL OF GEORGIA, THE UNITED STATES AND THE WORLD, AS THE LEADING SPECIALTY HOSPITAL FOR THIS PATIENT POPULATION. AS A RECOGNIZED ADVOCATE FOR PEOPLE LIVING WITH DISABILITIES, SHEPHERD CENTER HAS CHANGED THE LANDSCAPE IN ATLANTA AND BEYOND TO BE MORE RECEPTIVE OF PEOPLE WITH DISABILITIES LIVING IN OUR COMMUNITY. SHEPHERD CENTER HAS TREATED PATIENTS FROM ALL 50 STATES AND NEARLY 50 FOREIGN COUNTRIES. PART VI, LINE 7, REPORTS FILED WITH STATES GA X X X X X 0 0 0 0 0 1 0 0 0 BROCK BOWMAN MD BOARD MEMBER 450879 0 17500 0 0 0 8717 0 12888 0 489984 0 0 0 DONALD P LESLIE MD MEDICAL DIRECTOR 537842 0 127910 0 0 0 12388 0 4517 0 682657 0 0 0 GARY ULICNY PHD PRESIDENT/CEO 525316 0 180310 0 0 0 18712 0 12715 0 737053 0 0 0 JAMES H SHEPHERD JR CHAIRMAN 238236 0 76696 0 0 0 10250 0 5189 0 330371 0 0 0 MICHAEL L JONES PHD VP RESEARCH 312969 0 15000 0 0 0 11245 0 11547 0 350761 0 0 0 MITCHELL J FILLHABER VP MARKETING 269277 0 37500 0 0 0 4150 0 12715 0 323642 0 0 0 SARAH MORRISON VP CLINICAL SERVICES 233229 0 17500 0 0 0 11498 0 10909 0 273136 0 0 0 SCOTT H SIKES VP FOUNDATION 250858 0 13000 0 0 0 5775 0 9442 0 279075 0 0 0 STEPHEN B HOLLEMAN CFO 299928 0 76101 0 0 0 11058 0 12715 0 399802 0 0 0 TAMARA KING CHIEF NURSE EXECUTIVE 206250 0 17500 0 0 0 11481 0 9038 0 244269 0 0 0 WILMA BUNCH VP FACILITIES 196166 0 17500 0 0 0 11500 0 5484 0 230650 0 0 0 BEN THROWER MD PHYSICIAN 531743 0 25220 0 0 0 11113 0 11720 0 579796 0 0 0 ERIK SHAW MD PHYSICIAN 527124 0 20200 0 0 0 6124 0 8632 0 562080 0 0 0 JOHN LIN PHYSICIAN 426196 0 16500 0 0 0 6084 0 4517 0 453297 0 0 0 JOHN MUSSER MD PHYSICIAN 483043 0 5000 0 0 0 0 0 8499 0 496542 0 0 0 SHERRILL LORING MD PHYSICIAN 464205 0 18450 0 0 0 6113 0 0 0 488768 0 0 0 PART I, LINE 6 THE SHEPHERD CENTER'S BOARD OF DIRECTORS APPROVED A "SHEPHERD SHARE" BONUS TO QUALIFIED EMPLOYEES FOR FY 2014, THAT WAS PAID IN FY 2015. THIS YEAR'S BONUS WAS BASED ON VARIOUS FACTORS, ALONG WITH NET EARNINGS. THE BOARD'S DETERMINATION OF THE AWARD WEIGHED MORE HEAVILY ON PATIENT OUTCOMES, CUSTOMER SERVICE(INTERNAL AND EXTERNAL)AND OTHER JUDGMENTAL FACTORS SINCE BUDGETARY GOALS WERE NOT MET. A DEVELOPMENT AUTHORITY OF FULTON COUNTY 581506878 359900ZT7 2009-11-04 56000000 PROVIDE FUNDS TO REFUND 4/20/05 ISSUE FOR HOSPITAL EXPANSION 0 0 0 B DEVELOPMENT AUTHORITY OF FULTON COUNTY 581506878 359597EB3 2010-12-02 13900000 PROVIDE FUNDS TO REFUND 9/29/97 ISSUE FOR HOSPITAL RENOVATIONS 0 0 0 A 4800000 56000000 56000000 2007 1 0 1 1 B 11600000 13900000 13900000 1998 1 0 1 1 A 0 1 1 0 0 0.00000 0.01400 0.01400 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 LINDA SHEPHERD FAMILY MEMBER 37351 EMPLOYEE 0 JULIE WHITE FAMILY MEMBER 69532 EMPLOYEE 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (D) DESCRIPTION OF TRANSACTION: EMPLOYEE COMPENSATION X 925 FAIR MARKET VALUE X 34 1027080 FAIR MARKET VALUE X 1 2355 FAIR MARKET VALUE X VARIOUS GIFTS 21 51994 FAIR MARKET VALUE 0 1 0 PART I, LINE 33: SHEPHERD CENTER USES THE ACCRUAL METHOD OF ACCOUNTING. SECURITY DONATIONS ARE RECEIVED BY SHEPHERD CENTER FOUNDATION AND PASSED THROUGH TO SHEPHERD CENTER. THESE SECURITIES ARE LIQUIDATED IMMEDIATELY AND THE PROCEEDS ARE RECORDED DIRECTLY TO THE TEMPORARILY AND PERMANENTLY RESTRICTED NET ASSETS PORTION OF THE BALANCE SHEET. AS EXPENSES ARE INCURRED, THESE FUNDS ARE RELEASED FROM RESTRICTION AND ONLY THEN BECOME AN ELEMENT OF REVENUE. WE REPORT THE ENTIRE AMOUNT OF THESE DONATIONS ON SCHEDULE M FOR TRANSPARENCY SINCE THE AMOUNT ON THE STATEMENT OF REVENUE, LINE 1G DOES NOT FULLY REPRESENT THE NON-CASH DONATIONS RECEIVED. FORM 990, PART III, LINE 3 SHEPHERD CENTER DISCONTINUED ITS OUTPATIENT SATELLITE PROGRAM IN FRANKLIN, TN, KNOWN AS BEYOND THERAPY TENNESSEE. FORM 990, PART VI, SECTION A, LINE 2 FAMILY RELATIONSHIP: JAMES SHEPHERD (CHAIRMAN OF THE BOARD), ALANA SHEPHERD(RECORDING SECRETARY), J. HAROLD SHEPHERD (BOARD MEMBER), AND W. CLYDE SHEPHERD, III (BOARD MEMBER). FAMILY & BUSINESS RELATIONSHIP: LINDA SHEPHERD (EMPLOYEE) FAMILY & BUSINESS RELATIONSHIP: JULIE WHITE (EMPLOYEE) FAMILY & BUSINESS RELATIONSHIP: REID ULICNY (EMPLOYEE) FAMILY & BUSINESS RELATIONSHIP: MICHAEL MORRISON (EMPLOYEE) BUSINESS RELATIONSHIP: JAMES E. STEPHENSON BUSINESS RELATIONSHIP: DAVID H. FLINT BUSINESS RELATIONSHIP: JULIAN B. MOHR BUSINESS RELATIONSHIP: DAVID F. APPLE JR. M.D. FORM 990, PART VI, SECTION B, LINE 11 THE FORM IS PREPARED BY CARR, RIGGS & INGRAM, LLC WITH THE ASSISTANCE OF THE ACCOUNTING STAFF AT THE SHEPHERD CENTER. THE RETURN IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER WITH FURTHER CONSULTATION WITH CRI FOR ALL QUESTIONS THAT ARE UNCLEAR AS TO MEANING AND INTENT. THE CHIEF FINANCIAL OFFICER THEN REVIEWS THE FORM 990 WITH THE CHAIRMAN OF THE BOARD, THE CHIEF EXECUTIVE OFFICER, AND THE VICE PRESIDENT OF SHEPHERD CENTER FOUNDATION FOR THEIR INPUT AND APPROVAL. THE SHEPHERD CENTER PROVIDES EACH MEMBER OF THE BOARD WITH A FINAL COPY OF THE FILED 990 UPON COMPLETION OF THE PROCESS. FORM 990, PART VI, SECTION B, LINE 12C THE SHEPHERD CENTER BOARD OF DIRECTORS ARE PRESENTED WITH A CONFLICT OF INTEREST QUESTIONNAIRE ON AN ANNUAL BASIS AND THEY INDICATE THEIR COMPLIANCE BY SIGNING THE DOCUMENT, WHICH IS KEPT ON FILE IN ADMINISTRATION. IN ADDITION, ON AN ANNUAL BASIS, THE SHEPHERD CENTER ACCOUNTING STAFF AS WELL AS THE CHIEF FINANCIAL OFFICER REVIEW ALL 1099'S BEFORE DISTRIBUTION FOR BOARD MEMBER NAMES/COMPANIES. THE STAFF ALSO CHECK WITH THE DEVELOPMENT OFFICE FOR ANY ADDITIONAL INFORMATION REGARDING BOARD MEMBER AFFILIATIONS WITH OTHER ENTITIES WITH WHICH THE SHEPHERD CENTER DOES BUSINESS. FORM 990, PART VI, SECTION B, LINE 15 THE SHEPHERD CENTER UTILIZES A BOARD COMPENSATION COMMITTEE TO DETERMINE COMPENSATION FOR THE CEO AND OTHER EXECUTIVE MANAGEMENT. THIS COMMITTEE UTILIZES OUTSIDE CONSULTANTS (FOR EXAMPLE, SULLIVAN COTTER), INDUSTRY COMPENSATION SURVEYS, AND REVIEWS OF SIMILAR ORGANIZATIONS' FORM 990 TO DETERMINE APPROPRIATENESS OF COMPENSATION. THE SHEPHERD CENTER UTILIZES TOWER WATSON DATA SERVICES COMPENSATION SURVEYS TO DETERMINE WHETHER OR NOT A COMPENSATION PACKAGE IS IN LINE WITH OUR REGION AND RELATIVE BED SIZE. THE HUMAN RESOURCES DIRECTOR ANALYZES THE DATA AND GETS APPROVAL FROM THE CEO. FORM 990, PART VI, SECTION C, LINE 18 AVAILABLE UPON REQUEST AND ALSO IS LISTED FOR PUBLIC USE ON GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST. FORM 990, PART IX: SHEPHERD CENTER HAS ALLOCATED A PORTION OF THE EXPENSES OF THESE INDIRECT COST CENTERS TO PROGRAM SERVICE EXPENSE: DEPRECIATION, ENGINEERING, INFORMATION SYSTEMS, COMMUNICATIONS, QUALITY AND OUTCOMES MANAGEMENT, SECURITY, SEATING CLINIC, TRANSPORATION, COMPLIANCE AND AUDIT, RISK MANAGEMENT, CODING AUDIT, AND RENOVATIONS. FORM 990, PART XI, LINE 9: CHANGES IN TEMPORARILY RESTRICTED NET ASSETS 11,325,248. CHANGES IN INTERCOMPANY ACCOUNTS -2,226,563. CHANGES IN PERMANENTLY RESTRICTED NET ASSETS 428,740. ROUNDING -11. FORM 990, PART XI, LINE 2C NO CHANGE HAS OCCURRED FROM PRIOR YEAR. FORM 990,SCHEDULE M SUPPLEMENTAL INFORMATION: SHEPHERD CENTER USES THE ACCRUAL METHOD OF ACCOUNTING. SECURITY DONATIONS ARE RECEIVED BY SHEPHERD CENTER FOUNDATION AND SHEPHERD CENTER. THESE SECURITIES ARE LIQUIDATED IMMEDIATELY AND THE PROCEEDS ARE RECORDED DIRECTLY TO THE TEMPORARILY AND PERMANENTLY RESTRICTED NET ASSETS PORTION OF THE BALANCE SHEET. AS EXPENSES ARE INCURRED, THESE FUNDS ARE RELEASED FROM RESTRICTION AND ONLY THEN BECOME AN ELEMENT OF REVENUE. WE REPORT THE ENTIRE AMOUNT OF THESE DONATIONS ON SCHEDULE M FOR TRANSPARENCY SINCE THE AMOUNT ON THE STATEMENT OF REVENUE, LINE 1G DOES NOT FULLY REPRESENT THE NON-CASH DONATIONS RECEIVED. 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