2015-05-19T14:48:41-05:00 2014-07-31 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2013-08-01 383647394 PHOEBE WORTH MEDICAL CENTER INC PHOE 2297766961 807 SOUTH ISABELLAPO BOX 545 SYLVESTER GA 317910545 KERRY LOUDERMILK PPHS CFO 2297766961 2015-05-15 true JEFFREY S WRIGHT P00226270 2298837878 2015-05-19 X 2013 2016-02-25 16:41:14Z KIM GILMAN CEO PO BOX 545 SYLVESTER GA 317910545 14867978 false X WWW.PHOEBEPUTNEY.COM X 2002 GA PROVIDING CHARITABLE HEALTHCARE ACTIVITIES 9 5 260 9 0 468000 468000 13267651 13764102 12800 -20353 1193170 600104 14941621 14811853 45619 50869 0 9093714 8050841 0 0 7700699 7716588 16840032 15818298 -1898411 -1006445 11304470 9596180 14554174 13852329 -3249704 -4256149 PROVIDING CHARITABLE HEALTHCARE ACTIVITIES false false 13053846 50869 14193439 TO BE THE LEADING PROVIDER OF QUALITY, COST EFFECTIVE, PATIENT-CENTERED HEALTH CARE SERVICES TO ALL RESIDENTS OF SOUTHWEST GEORGIA. PWMC PURSUES ITS MISSION THROUGH A PATIENT-CENTERED ENVIRONMENT OF CARE REFLECTING HIGH STANDARDS AND PROMOTING A BALANCE OF PROFESSIONAL PREPARATION AND SERVICE, CONTINUOUS IMPROVEMENT BASED ON OUR CORE VALUES OF PEOPLE, RELATIONSHIPS, REPUTATION, EXCELLENCE, EFFICIENCY AND COMMITMENT. 13053846 true true false true false false false false false false true false false false true true true true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false true 190 0 260 true false false false false false false false false false false X 9 5 false false false false true true true true true false false true true true true true true false false false GA X X KERRY LOUDERMILK PPHS CFO 2293124068 PO BOX 3770 ALBANY GA 317063770 JOEL WERNICK BD MEMBER/PP 1.00 53.00 X X 0 796528 1003659 JOE AUSTIN BD MEMBER/PP 1.00 52.00 X X 0 476321 115289 JOHNNY COCHRAN VICE CHAIR 1.00 X X 0 0 0 LARRY DAUGHERTY DMD BOARD MEMBER 1.00 X 0 0 0 MARY KING GIVENS BOARD MEMBER 1.00 X 0 0 0 IRENE HALL BOARD MEMBER 1.00 X 0 0 0 DON MONK CHAIRMAN 1.00 0.00 X X 0 0 0 NATU PATEL MD BOARD MEMBER 1.00 X 0 0 0 SHIRLEY THOMAS BOARD MEMBER 1.00 X 0 0 0 KERRY LOUDERMILK PPHS CFO 1.00 53.00 X 0 468743 141437 KIM GILMAN CEO 40.00 X 0 151848 4188 CANDACE GUARNIERI CFO 40.00 X 0 95704 15543 TIM TROTTIER SVP REG OPER 15.00 35.00 X 0 301369 25611 DEENA HOOD PHARM DIRECT 40.00 X 107748 0 18897 107748 2290513 1324624 1 false true false ARAMARK CORPORATION 25271 NETWORK PLACE CHICAGO IL 606731252 DIETARY SERVICE 239431 THE ROSE GROUP 817 NW 56TH TERRACE SUITE A GAINESVILLE FL 326056401 NURSING SERVICE 210870 WORTH EMERGENCY GROUP LLC PO BOX 82368 LAFAYETTE LA 705982368 EMERG MEDICINE 206289 ACCOUNTABLE HEALTHCARE STAFFING PO BOX 650539 DALLAS TX 752650539 NURSING SERVICE 112607 4 468000 468000 NET PATIENT SERVICE REVENUE 623000 13764102 13764102 13764102 10586 10586 52360 25186 27174 27174 27174 30939 -30939 -30939 -30939 EHR REVENUE 621990 420874 420874 CAFETERIA 722513 131256 131256 OTHER REVENUE 621990 8463 8463 12337 12337 572930 14811853 14193439 150414 X 50869 50869 6335737 5545590 790147 74971 65621 9350 1179045 1032003 147042 461088 403584 57504 163960 163960 2525 2525 86064 86064 2422 2422 3458545 2854221 604324 21166 8102 13064 1105448 1008551 96897 319931 248442 71489 31537 25315 6222 708571 558424 150147 409738 130859 278879 REPAIRS & MAINTENANCE 646821 506934 139887 MEDICAL SUPPLIES 520971 520971 MISCELLANEOUS 122845 25761 97084 DUES & SUBSCRIPTIONS 116044 66177 49867 15818298 13053846 2764452 0 3752984 2206833 388679 388667 1985286 1919257 137791 141742 141724 134147 10139134 5802497 4843653 4336637 54353 468897 11304470 9596180 2185778 2008081 12368396 11844248 14554174 13852329 X -3249704 -4256149 -3249704 -4256149 11304470 9596180 -1006445 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2422 2422 false SCHEDULE C, PART II-B, LINE 1 THE ORGANIZATION PAYS MEMBERSHIP DUES TO A NATIONAL HEALTHCARE ORGANIZATION. A PORTION OF THE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THE NATIONAL HEALTHCARE ORGANIZATION PARTICIPATES. 175676 175676 4376582 1327913 3048669 5586876 4474584 1112292 4336637 DUE TO PHOEBE PUTNEY HEALTH SYSTEM 11844248 11844248 X 14837039 25186 25186 14811853 14811853 15843484 25186 25186 15818298 15818298 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, 2014 AND 2013 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 2D RENTAL EXPENSES 25,186 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 25,186 true true X true X true X 2.250000000000 true true false true true 1373327 420377 952950 0.06010 1423963 1380160 43803 0.00280 2797290 1800537 996753 0.06290 4136543 2396920 1739623 0.10980 45619 45619 0.00290 4182162 2396920 1785242 0.11270 6979452 4197457 2781995 0.17560 true 3758010 5018346 4685052 333294 X true true 1 1 PHOEBE WORTH MEDICAL CENTER INC 807 S ISABELLA STREET SYLVESTER GA 31791 WWW.PHOEBEPUTNEY.COM 159-603 X X X X SWB SNF PHOEBE WORTH MEDICAL CENTER INC 1 true X X X X X X X X X X 13 true false true X WWW.PHOEBEPUTNEY.COM X X X X X X X false false true true 200.000000000000 true 225.000000000000 true X X true true X X X true false X X X X true X false false FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 3 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 40 COMMUNITY MEMBERS TO PARTICIPATE IN THE CHNA PROCESS. TWO-HOUR COMMUNITY HEALTH INPUT MEETINGS (COMMUNITY MEETINGS) AND ONE-HOUR COMMUNITY STAKEHOLDER INTERVIEWS (STAKEHOLDER INTERVIEWS) WERE ESSENTIAL PARTS OF THE CHNA PROCESS. TWO COMMUNITY MEETINGS AND FIVE STAKEHOLDER INTERVIEWS WERE CONDUCTED IN ORDER TO OBTAIN THE COMMUNITY'S INPUT INTO THE HEALTH NEEDS OF WORTH 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 DISCUSSIONS 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 INDICATED 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 FAMILY AND CHILDREN SERVICES, HOUSING AUTHORITY, AND THE HEALTH DEPARTMENT. FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 5C A COMPLETE COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT HTTP://WWW.PHOEBEPUTNEY.COM/MEDIA/FILE/PHOEBEWORTH/CHNA_PHOEBE %20WORTH_2013.PDF FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 7 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 WORTH MEDICAL CENTER, INC. - PART V, LINE 20D PWMC DETERMINES THE PATIENT'S 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 FAMILY MEDICAL CENTER 354 E WASHINGTON AVENUE ASHBURN GA 31714 RHC PHOEBE WORTH FAMILY MEDICAL CENTER 1014 WEST FRANKLIN STREET SYLVESTER GA 31791 RHC PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION THE NET COST ASSOCIATED WITH THE EMERGENCY ROOM DEPARTMENT REPORTED ON SCHEDULE H, PART 7G IS 1,739,623. 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 15,839,132 ADD: EXPENSES REPORTED IN PART VIII 4,353 DENOMINATOR FOR COLUMN (F) 15,843,485 PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE COST OF FINANCIAL ASSISTANCE AND SUBSIDIZED HEALTH SERVICES WAS CALCULATED USING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 OF THE IRS FORM 990 INSTRUCTIONS. THE COST OF ON LINE 7I WAS GENERATED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY THE AMOUNTS ON PART III, LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS 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 SOURCES 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 FISCAL YEAR 2014 INCREASED APPROXIMATELY 2% AS A PERCENTAGE OF ACCOUNTS RECEIVABLE COMPARED TO FISCAL YEAR 2013. THE INCREASE WAS DUE TO AN INCREASE IN SELF-PAY VOLUME DURING FISCAL YEAR 2014. 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. PROGRESS ON CHNA IMPLEMENTATION STRATEGIES 2013-2014 PRIORITY: ADOLESCENT LIFESTYLE INCLUDING ALCOHOL, TOBACCO AND DRUGS 1. "A NIGHT OUT AGAINST CRIME" IS A COMMUNITY EVENT HELD AND HOSTED BY THE SYLVESTER POLICE DEPARTMENT ON THE FIRST FRIDAY IN AUGUST. THIS ANNUAL EVENT IS AN EFFORT ON THE PART OF LOCAL LAW ENFORCEMENT TO EDUCATE THE COMMUNITY OF CRIME PREVENTION. EACH YEAR, PHOEBE WORTH PARTICIPATES AS A SPONSOR FOR THE EVENT IN THE FORM OF MONETARY DONATIONS. 2. ANNUALLY, PHOEBE WORTH COLLABORATES WITH COUNTY EMS AND HELPS SPONSOR THE FUNCTIONING OF A SAFETY AWARENESS DAY. THIS IS A DAY WHERE OUR COUNTY EMS ALONG WITH OTHER PUBLIC SAFETY GROUPS, PUT ON A FULL-SCALE DISASTER FOR OUR COUNTY'S HIGH SCHOOL KIDS. REAL CARS AND KIDS (ACTING) AS VICTIMS. THIS YEAR WAS DRINKING AND DRIVING, LAST YEAR WAS MARIJUANA AND DRIVING. THIS IS FULL SCALE ACCIDENT WITH FIRE/RESCUE, POLICE, THE CORONER AND HELICOPTERS. AS PART OF THE PRESENTATION AND IN KEEPING WITH THE FULLNESS OF REALITY, THE CARS ARE CUT OPEN AND KIDS ARE TRANSPORTED AWAY VIA AMBULANCE, CORONER VAN OR HELICOPTER. THE PRESENTATION IS FOLLOWED BY SPEAKING TO THE KIDS ABOUT THESE TYPES OF LIFESTYLE DECISIONS AND THE CONSEQUENCES OF SUCH DECISIONS. PRIORITY: OBESITY AND DIABETES 1. PHOEBE WORTH HOSTED ITS FIRST WOMEN'S HEALTH FAIR ON OCTOBER 25TH. THE FAIR OFFERED OUR COMMUNITY'S LADIES WITH A FREE HEALTH SCREEN, COMPLIMENTARY BREAKFAST AND LUNCH, A EXERCISE DEMONSTRATION, A NUTRITIONAL DEMOSTRATION, A BREAST SELF EXAM DEMONSTRATION AND THEN A Q&A SESSION WITH A LOCAL PHYSICIAN SPECIALIZING IN BREAST HEALTH. THE FREE HEALTH SCREENS PROVIDED ACCESS TO MULTIPLE HEALTH FACTORS INCLUDING, BMI, BLOOD PRESSURE, CHOLESTEROL LEVELS, AND BLOOD SUGAR LEVELS. WE PLAN TO OFFER OUR MALE COMMUNITY MEMBERS A HEALTH FAIR IN THE SPRING OF 2015. 2. PHOEBE WORTH MAKES ANNUAL CONTRIBUTIONS TO THE WORTH COUNTY HEALTH DEPARTMENT FOR THE OPERATIONS OF THEIR STROKE AND HEART ATTACK PREVENTION PROGRAM (SHAPP) AND DIABETES PROGRAM. OUR ANNUAL CONTRIBUTION OF 45,619 ALLOWS THE HEALTH DEPARTMENT TO PROVIDE PROGRAMS TO EDUCATE, SCREEN AND TREAT LOW-INCOME, UNINSURED, OR UNDERINSURED PATIENTS AGE 18 YEARS OR OLDER WHO ARE DIAGNOSED WITH PRIMARY HYPERTENSION AND/OR DIABETES. PATIENTS ARE PROVIDED ACCESS TO OBTAINING NECESSARY LAB WORK, MEDICATIONS, EXTENSIVE EDUCATION AND FOLLOW UP. OUR FUNDING ALSO ALLOWS THE PROGRAM TO OFFER 24 HOUR PHONE COVERAGE TO DEAL WITH CRITICAL LABS. PRIORITY: ACCESS TO CARE-PROVIDERS AND PREVENTION 1. DURING THE SPRING OF 2014, PHOEBE WORTH HOSTED AN AFFORDABLE CARE ACT EVENT FOCUSING ON THE HEALTH INSURANCE EXCHANGE OUR HOSPITAL PARTNERED WITH A FEDERALLY FUNDED TEAM TASKED WITH ENROLLING PEOPLE IN THE HEALTH INSURANCE EXCHANGE FOR A ONE DAY EVENT. AT THE EVENT WE SPOKE WITH 51 ATTENDEES, ASSISTED 22 ATTENDEES, AND ENROLLED 8. WE ALSO OFFERED THE ASSISTANCE OF A STAFF MEMBER AND THE TECHNOLOGY REQUIRED FOR ENROLLING IN THE EXCHANGE AT OUR HOSPITAL 2 DAYS A WEEK FOR SEVERAL MONTHS. WE ARE PLANNING OUR NEXT EVENT FOR THE ACA ON DECEMBER 13TH. PRIORITY: MENTAL HEALTH 1. CURRENTLY WORKING ON COMPILING A DRAFT RESOURCE DIRECTORY. OUR PLANS ARE TO CREATE A BOUND DIRECTORY TO PROVIDE TO LOCAL HEALTHCARE FACILITIES FOR DISTRIBUTION TO THE COMMUNITY. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE BOARD HAS CLEARLY WRITTEN INDIGENT AND CHARITY CARE 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 INDIGENT AND CHARITY CARE PROGRAMS ARE 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, AND THE PHOEBE CARES 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 CHARITY PROGRAM AND ENCOURAGE PATIENTS TO CALL FOR FINANCIAL ASSISTANCE. PART VI, LINE 4 - COMMUNITY INFORMATION WORTH COUNTY IS LOCATED IN THE SOUTHWESTERN PART OF GEORGIA. THE CITY OF ALBANY IS IN CLOSE PROXIMITY TO THE COUNTY. WORTH COUNTY HAS A TOTAL LAND AREA OF 570 SQUARE MILES. WORTH COUNTY INCLUDES THE CITIES AND TOWNS OF SYLVESTER, POULAN, OAKFIELD, SUMNER, AND WARWICK. THE POPULATION DISTRIBUTION IS 30.8 PERCENT URBAN AND 69.2 PERCENT RURAL. ALMOST ALL OF WORTH COUNTY'S LAND AREA IS RURAL. IN 2010, WORTH COUNTY'S RESIDENT POPULATION WAS 21,630, WHICH WAS A SLIGHT DECREASE FROM 2000. FROM 2010 TO 2015, THE POPULATION IS PREDICTED TO INCREASE BY 2.9 PERCENT. THE POPULATION IS PREDICTED TO INCREASE TO 22,258 IN 2015 AND 22,700 IN 2020. ACCORDING TO THE 2010 CENSUS, 14 PERCENT OF WORTH COUNTY'S POPULATION WAS AGE 65 AND OVER. IN GEORGIA, THE AVERAGE PERCENTAGE OF THE POPULATION AGE 65 OR OLDER WAS 10.7 PERCENT COMPARED TO 13.1 PERCENT FOR THE U.S. POPULATION PROJECTIONS INDICATE THAT THE COUNTY POPULATION WILL INCREASE BY 2.9 PERCENT FROM 2010 TO 2015. ACCORDING TO 2010 U.S. CENSUS RECORDS, WORTH COUNTY'S POPULATION WAS 70.3 PERCENT WHITE, 27.6 PERCENT BLACK, AND 1.5 PERCENT HISPANIC. THE HISPANIC POPULATION, ALTHOUGH SMALL, INCREASED BY 36 PERCENT FROM 2000 TO 2010. MOST OF THE PRIMARY JOBS (6,470) LOCATED WITHIN WORTH COUNTY WERE CENTERED WITHIN THE MOST POPULOUS CITY IN THE COUNTY WHICH IS SYLVESTER. HEALTH CARE AND SOCIAL ASSISTANCE WAS THE MAJOR INDUSTRY SECTOR BY JOB COUNT IN WORTH COUNTY AT 14.4 PERCENT OF THE JOBS. THIS WAS FOLLOWED BY RETAIL (13.4 PERCENT) AND MANUFACTURING (11.2 PERCENT). 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. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT GEORGIA ADDITIONAL INFORMATION SERVICE TO THE COMMUNITY PHOEBE WORTH MEDICAL CENTER (HOSPITAL) IS A NOT-FOR-PROFIT HEALTH CARE ORGANIZATION THAT EXISTS TO SERVE THE COMMUNITY. THE HOSPITAL HAS NO STOCKHOLDERS OR OWNERS, AND IS PART OF THE NOT-FOR-PROFIT PHOEBE PUTNEY HEALTH SYSTEM, INC. AFTER OPERATING EXPENSES ARE COVERED, ANY REMAINING REVENUES ARE REINVESTED IN THE OPERATION OF THE HOSPITAL IN ORDER TO ENHANCE OUR ABILITY TO CARRY OUT OUR LOCAL MISSION OF TAKING CARE OF OUR COMMUNITIES' CITIZENS. IN 2014, WE WORKED WITH THE WORTH COUNTY HEALTH DEPARTMENT TO ENABLE THEM TO SUPPORT TWO HEALTH PREVENTION TYPE PROGRAMS. ONE PROGRAM WAS STROKE AND HEART ATTACK PREVENTION (SHAPP), THE SECOND PROGRAM WAS A DIABETES PROGRAM. THE COST TO THE HOSPITAL WAS 45,619. THE HOSPITAL PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS WHICH COVER MANY GEORGIAN'S HEALTH CARE NEEDS, AND BY SO DOING, FOREGOES SOME CHARGES AND HAS UNREIMBURSED EXPENSES. CHARGES FOREGONE, DESCRIBED AS CONTRACTUAL ADJUSTMENTS, AND COSTS NOT REIMBURSED, DESCRIBED AS INDIGENT OR CHARITY CARE ARE OUTLINED BELOW. THE HOSPITAL ALSO OPERATES TWO RURAL HEALTH CLINICS (RHCS) WHICH ALSO FOREGO SOME CHARGES AND HAVE COSTS NOT REIMBURSED THROUGH PATIENTS QUALIFYING FOR THESE SAME INDIGENT AND CHARITY PROGRAMS. THE AMOUNTS LISTED BELOW ARE ALL INCLUSIVE OF BOTH HOSPITAL AND CLINIC ACTIVITIES. ESTIMATED CHARGES UNREIMBURSED FOREGONE COST MEDICARE 6,000,000 3,000,000 MEDICAID 3,000,000 2,000,000 INDIGENT/CHARITY CARE 3,000,000 1,000,000 TOTALS 12,000,000 6,000,000 PATIENTS WHOSE INCOME FALLS BELOW 225% OF FEDERAL POVERTY GUIDELINES ARE ELIGIBLE TO APPLY FOR ASSISTANCE THROUGH THE INDIGENT PROGRAM. true WORTH COUNTY HEALTH DEPARTMENT 1012 W FRANKLIN STREET SYLVESTER GA 317911978 581568404 GOV 45619 SEE PART IV 1 SCHEDULE I, PAGE 1, PART I, LINE 2 THE WORTH COUNTY HEALTH DEPARTMENT SENDS A LETTER TO PWMC ASKING FOR FINANCIAL ASSISTANCE RELATED TO SPECIFIC PROGRAMS THAT ARE PROVIDED BY THE HEALTH DEPARTMENT. ONCE RECEIVED, PWMC'S BOARD APPROVES THE AMOUNT OF ASSISTANCE TO THE HEALTH DEPARTMENT. THE FUNDS THAT ARE GIVEN TO THE HEALTH DEPARTMENT ARE DEEMED TO BE USED FOR THE SPECIFIC PURPOSES MENTIONED IN THE ORIGINAL LETTER FROM THE HEALTH DEPARTMENT. IN 2014, PWMC WORKED WITH THE HEALTH DEPARTMENT TO ENABLE THEM TO SUPPORT TWO HEALTH PREVENTION TYPE PROGRAMS. ONE PROGRAM WAS STROKE AND HEART ATTACK PREVENTION (SHAPP), THE SECOND PROGRAM WAS A DIABETES PROGRAM. true true false false false false false false false JOEL WERNICK BD MEMBER/PPHS CEO 789660 6868 987888 15771 1800187 JOE AUSTIN BD MEMBER/PPHS COO 464774 11547 96697 18592 591610 KERRY LOUDERMILK PPHS CFO 415992 42500 10251 122531 18906 610180 KIM GILMAN CEO 144715 7133 2908 1280 156036 TIM TROTTIER SVP REG OPERATIONS 232951 68418 5100 20511 326980 SCHEDULE J, PAGE 1, PART I, LINE 3 NONE OF THE INDIVIDUAL BOARD MEMBERS OR OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION AND THE ORGANIZATION MUST RELY ON THE METHODS EMPLOYED BY THE RELATED ORGANIZATION, PHOEBE PUTNEY HEALTH SYSTEM, INC (PPHS), TO DETERMINE REASONABLE COMPENSATION FOR THE INDIVIDUALS. SCHEDULE J, PAGE 1, PART I, LINE 4 JOEL WERNICK 0 930,735 0 JOE AUSTIN 0 79,900 0 KERRY LOUDERMILK 0 76,500 0 TIM TROTTIER 66,426 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 115,000 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 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 WORTH MEDICAL CENTER, INC. SHALL BE PHOEBE PUTNEY HEALTH SYSTEM, INC. (PPHS). FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD OF DIRECTORS OF PHOEBE PUTNEY HEALTH SYSTEM, INC. (PPHS), THE PARENT ORGANIZATION, HAS THE RIGHT TO APPOINT 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 SELECT OR REMOVE THE ORGANIZATION'S OFFICERS. - THE MEMBER SHALL APPROVE ALL AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY MAY BECOME EFFECTIVE. - THE MEMBER SHALL APPROVE ANY ANNUAL OPERATING OR CAPITAL BUDGETS. - THE MEMBER SHALL APPOINT OR REMOVE THE INDEPENDENT AUDITORS. FORM 990, PAGE 6, PART VI, LINE 11B THE INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 (BASED UPON INFORMATION PROVIDED BY THE ORGANIZATION) PROVIDES A COMPLETE COPY OF THE RETURN WITH APPLICABLE SCHEDULES TO BE REVIEWED BY MANAGEMENT. MANAGEMENT PERFORMS A DETAILED REVIEW WHICH CONSISTS OF REVIEWING THE FINANCIAL DATA, THE NARRATIVES DISCLOSED, AND OTHER FACTS PRESENTED ON THE RETURN. UPON REVIEW, THE FORM 990 IS THEN FORWARDED TO THE FINANCE COMMITTEE FOR THEIR REVIEW, TO GAIN THEIR COMMENTS AND APPROVAL. UPON APPROVAL FROM THE FINANCE COMMITTEE, THE FORM 990 AND RELATED SCHEDULES ARE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND FEEDBACK. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES, A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PAGE 6, PART VI, LINE 12C ON AN ANNUAL BASIS, PHOEBE WORTH MEDICAL CENTER, INC. (PWMC) BOARD MEMBERS AS WELL AS ALL OFFICERS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. THIS QUESTIONNAIRE IS ADMINISTERED BY THE PHOEBE PUTNEY HEALTH SYSTEM (PPHS) COMPLIANCE DEPARTMENT AND THE DOCUMENT ASKS EACH INDIVIDUAL TO DISCLOSE ANY PERSONAL, BUSINESS, OR OTHER AFFILIATIONS AND MONETARY AMOUNT IF APPLICABLE THAT THEY OR THEIR IMMEDIATE FAMILY MEMBERS HAVE HAD WITHIN THE PAST 12 MONTHS WITH PWMC OR ANY RELATED ENTITIES. ALL RESPONSES ARE THEN EVALUATED BY THE PPHS COMPLIANCE DEPARTMENT. IN THE CASE OF AN EXISTING CONFLICT, THE INDIVIDUAL WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL TO SUCH TRANSACTIONS. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES AVAILABLE TO THE PUBLIC ITS CONFLICT OF INTEREST AND AUDITED FINANCIAL STATEMENTS ON THE ORGANIZATION'S WEBSITE, BY PROVIDING COPIES UPON REQUEST, AND BY INSPECTION AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION. FORM 990, PART IX, LINE 11G PHYSICIAN FEES 2,621,911 0 0 CONSULTANT FEES 40,919 492,033 0 COLLECTION SERVICES 0 112,291 0 PURCHASED SERVICES 191,391 0 0 PHOEBE PUTNEY HEALTH SYSTEM INC PO BOX 3770 ALBANY GA 317063770 582001014 HEALTHCARE GA 501C3 11C NA false PHOEBE PUTNEY MEMORIAL HOSPITAL INC PO BOX 3770 ALBANY GA 317063770 581928247 HEALTHCARE GA 501C3 3 PPHS false PHOEBE PHYSICIAN GROUP INC PO BOX 3770 ALBANY GA 317063770 263792403 HEALTHCARE GA 501C3 9 PPHS false PHOEBE SUMTER MEDICAL CENTER INC 126 HIGHWAY 280 WEST AMERICUS GA 317198645 263975185 HEALTHCARE GA 501C3 3 PPHS false PHOEBE FOUNDATION INC PO BOX 3770 ALBANY GA 317063770 581847104 FOUNDATION GA 501C3 11A PPHS false SOUTH GEORGIA SHARED SERVICES INC 417 WEST THIRD AVENUE ALBANY GA 317011943 462746977 COOPERATIV GA 501C3 3 PPHS false PHOEBE PUTNEY HEALTH VENTURES INC PO BOX 3770 ALBANY GA 317063770 581963401 HEALTHCARE GA N/A false PHOEBE DORMINY MEDICAL CENTER INC PO BOX 3770 ALBANY GA 317063770 452041878 HEALTHCARE GA N/A false false false false false true false false false false false false false true false true false true false false SCHEDULE R PHOEBE DORMINY MEDICAL CENTER'S TAX-EXEMPT STATUS WAS REVOKED ON DECEMBER 15, 2013. THE ORGANIZATION IS CURRENTLY IN THE PROCESS OF REINSTATING THEIR TAX-EXEMPT STATUS. SOUTH GEORGIA SHARED SERVICES, INC. HAS APPLIED FOR RECOGNITION OF EXEMPTION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE APPLICATION IS STILL PENDING.