2012-05-15T16:47:31-04:00 2011-06-30 ERNST & YOUNG US LLP 55 IVAN ALLEN JR BLVD STE 1000 ATLANTA GA 30308 990 2010-07-01 582322328 FAYETTE COMMUNITY HOSPITAL INC FAYE 7707197073 1255 HIGHWAY 54 WEST FAYETTEVILLE GA 30214 JOHN MILES 2012-05-15 4048748300 2010 2016-02-24 21:20:13Z PIEDMONT FAYETTE HOSPITAL DARRELL CUTTS PRESIDENTCEO 1255 HIGHWAY 54 WEST FAYETTEVILLE GA 30214 243707633 false X WWW.FAYETTEHOSPITAL.ORG X 1997 GA TO PROVIDE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE IN A PROGRESSIVE ENVIRONMENT, GUIDED BY PHYSICIANS, DELIVERED BY EXCEPTIONAL PROFESSIONALS, AND INSPIRED BY THE COMMUNITIES WE SERVE. 8 7 1577 0 0 0 257339 755377 202752535 237220104 27528 -61129 4320937 4747213 207358339 242661565 0 0 0 0 84423267 100603889 0 0 0 103784581 117988063 188207848 218591952 19150491 24069613 250315519 343384807 102424541 73975713 147890978 269409094 X TO PROVIDE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE IN A PROGRESSIVE ENVIRONMENT, GUIDED BY PHYSICIANS, DELIVERED BY EXCEPTIONAL PROFESSIONALS, AND INSPIRED BY THE COMMUNITIES WE SERVE. false false 210142578 0 237548842 Fayette Community Hospital, Inc., hereafter referred to and Doing Business As Piedmont Fayette Hospital, Inc. ("PFH") provides needed medical care to the Fayetteville community regardless of any individual's ability to pay for services. During FY2011, PFH provided inpatient and outpatient services totaling $21,888,292 to 10,206 indigent or charity cases. For the year ended June 30, 2011, the Hospital had 12,188 in-patient admissions with a total 48,578 days of in-patient hospitalization. ER visits totaled 61,632 and outpatient visits totaled 133,803. Surgical services were provided to 10,539 patients. (See Schedule O for additional information.) 210142578 true true false false false false false false false true false false true true true false 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 false true 131 0 true 1577 true false false false false false false false false false false X 8 7 false false false false true true true true true false false false true true true true true true true false GA X SHERYL KLINK CFO 7707197073 1255 HIGHWAY 54 WEST FAYETTEVILLE GA 30214 X DR FRANK N COLE 1.0 X 0 0 0 DR WILLIAM T COOK 1.0 X 0 0 0 MR JOEL H COWAN SR 1.0 X 0 0 0 DR WYNDHAM G MORTIMER 1.0 X 0 0 0 MS CINDY RAMPLEY 1.0 X 0 0 0 DR JAMES C SAMS 1.0 X 0 0 0 MS VICKI TURNER 1.0 X 0 35155 7975 MR RONALD DUFFEY 1.0 X 0 0 0 MR W DARRELL CUTTS 55.0 X 495046 0 58746 MR CHARLIE HALL 1.0 X 0 610821 83119 MS DEBBIE W GRAMLING 1.0 X 0 148811 32636 MR JOHN MILES 50.0 X 255772 0 47395 MR MICHAEL BURNETT 55.0 X 268034 0 46246 MS LISA HEDENSTROM 55.0 X 228541 0 40202 MR TRACEY COKER 55.0 X 196575 0 24525 DR FREDERICK WILLMS 55.0 X 349947 0 54297 MR JAMES D COLEMAN 55.0 X 158438 0 42613 MR THOMAS OBERST 40.0 X 145917 0 40518 DR ANGELA SWAYNE 40.0 X 201778 0 24252 MS CATHERINE CRISLER 55.0 X 149318 0 29445 MS JUDITH W DAVIS 55.0 X 140972 0 37387 2590338 794787 569356 52 false true false E C PRICE GENERAL CONTRACTORS INC 3155 PRESIDENTIAL DR STE 100 ATLANTA GA 30340 GENERAL CONTRACTORS 560913 HARRIS FRITZ AND ASSOCIATES INC 141 SOUTH AVENUE MARIETTA GA 30060 ARCHITECTURAL 457302 BRASFIELD AND GORRIE LLC PO BOX 11407 BIRMINGHAM AL 352460351 CONSTRUCTION 1642720 EXECUTIVE HEALTH RESOURCES INC PO BOX 822688 PHILADELPHIA PA 191822688 Compliance Services 364917 ALLIANCE LAUNDRY AND TEXTILE SVCS 7990 SECOND FLAGS DRIVE STE A AUSTELL GA 30168 LAUNDRY 892892 18 755377 755377 PATIENT SERVICE REVENUE 622110 236962459 236962459 FITNESS CENTER REHAB SERVICES 713940 257645 257645 237220104 0 0 0 4116375 585176 3531199 3531199 3531199 22605 83734 -61129 -61129 -61129 0 0 385500 377158 8342 8342 CAFETERIA SALES 722310 804869 804869 VENDING SALES 525920 38065 38065 OTHER OPERATING 900099 364738 364738 1207672 242661565 237584842 4321346 0 0 0 0 2065326 0 2065326 0 0 83503979 81740422 1763557 0 2857237 2371507 485730 0 6985434 5797910 1187524 0 5191913 4309288 882625 0 0 228536 0 228536 0 0 0 0 0 7139032 7139032 0 0 328828 0 328828 0 9780498 9706488 74010 0 0 0 5577753 5354643 223110 0 57389 37352 20037 0 0 67993 57336 10657 0 7101730 6888678 213052 0 4916559 4916559 0 0 11454320 10767061 687259 0 0 BAD DEBT 27943415 27943415 PURCHASED LAB SERVICES 1637939 1637939 MEDICAL SUPPLIES 37102028 37102028 OTHER 4652043 4372920 279123 218591952 210142578 8449374 0 360283 820944 35754896 34428302 28095 28095 3767367 3330569 1582517 1317513 195438873 76842221 124660204 118596652 0 1391607 84162157 183471125 250315519 343384807 19531296 13654202 17127613 17191473 65765632 43130038 102424541 73975713 X 147872028 269267461 18950 141633 147890978 269409094 250315519 343384807 X 24069613 97448503 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7419672 7419672 82716570 37059357 45657213 4519532 658822 3860710 99801450 39124042 60677408 981649 0 981649 118596652 DUE FROM RELATED PARTIES 183537263 MISCELLANEOUS RECEIVABLES -66138 183471125 0 DUE TO RELATED PARTIES 40138068 MISCELLANEOUS 77220 SELF INSURANCE RESERVES 1159000 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1755750 43130038 ASC 740 FOOTNOTE (FKA FIN 48) SCHEDULE D, PART X, LINE 2 ON JULY 1, 2007, PIEDMONT FAYETTE HOSPITAL ADOPTED FIN 48. The Company accounts for income taxes under the provisions of the Income Taxes Topic of ASC (ASC 740). Under the requirements of ASC 740, tax-exempt organizations may be required to record an obligation as the result of a tax position they have historically taken on various tax exposure items. There were no material uncertain tax positions as of June 30, 2011. true true X true X 125. true X true true true false true true 5399162 0 5399162 0.02830 13243657 12130725 1112932 0.00580 18642819 12130725 6512094 0.03410 196291 0 196291 0.00100 474917 0 474917 0.00250 21707 0 21707 0.00010 27219 0 27219 0.00010 720134 0 720134 0.00370 19362953 12130725 7232228 0.03780 true 7656568 382828 67910590 72039710 -4129120 X true true 1 1 PIEDMONT FAYETTE HOSPITAL

1255 HIGHWAY 54 WEST FAYETTEVILLE GA 30214

X X X PIEDMONT FAYETTE HOSPITAL 1 1. REQUIRED DESCRIPTIONS SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A PIEDMONT HEALTHCARE, INC. (PIEDMONT FAYETTE HOSPITAL'S SOLE MEMBER), PREPARES A WRITTEN COMMUNITY BENEFIT REPORT WHICH CONTAINS THE COMMUNITY BENEFIT REPORT FOR PIEDMONT FAYETTE HOSPITAL ("PFH"). THIS REPORT IS MADE AVAILABLE TO THE PUBLIC. PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7(F) THE DENOMINATOR USED FOR THE CALCULATION OF COLUMN (F), PERCENT OF TOTAL EXPENSE, WAS THE AMOUNT OF TOTAL FUNCTIONAL EXPENSES ON FORM 990, PART IX, LINE 25, COLUMN (A) of $218,591,952, LESS BAD DEBT EXPENSE OF $27,943,415 FROM FORM 990, PART IX, LINE 24(A). FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7 A RATIO OF PATIENT CARE COST TO CHARGES, CONSISTENT WITH WORKSHEET 2, WAS USED TO REPORT THE AMOUNTS IN PART I, LINES 7A-7D. FOR AMOUNTS ON LINES 7E-7K, ACTUAL EXPENSES FOR EACH COMMUNITY BENEFIT ACTIVITY ARE TRACED AND REPORTED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. BAD DEBT EXPENSE FOOTNOTE SCHEDULE H, PART III, LINE 4 BASED ON PRIOR EXPERIENCE AND CERTAIN DEMOGRAPHICS AND OTHER INFORMATION OBTAINED DURING ADMISSION, THE ORGANIZATION BELIEVES A PORTION OF THE BAD DEBT EXPENSES AT COST IS ATTRIBUTABLE TO PATIENTS THAT WOULD OTHERWISE QUALIFY FOR CHARITY CARE. DESPITE ITS BEST EFFORTS TO EDUCATE PATIENTS ABOUT QUALIFYING FOR ITS CHARITY CARE PROGRAM (AS DISCUSSED IN PART VI, QUESTION 3 BELOW), MANY UNINSURED PATIENTS EITHER REFUSE OR FAIL TO COMPLETE A CHARITY CARE APPLICATION OR PROVIDE SUFFICIENT INFORMATION AT THE TIME OF ADMISSION, DURING THEIR STAY, OR AFTER BEING DISCHARGED TO QUALIFY FOR ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THE AMOUNT REPORTED ON PART III, LINE 3, WAS DETERMINED BY TAKING THE AVERAGE ACCEPTANCE RATE FOR ALL CHARITY CARE APPLICATIONS RECEIVED DURING THE YEAR MULTIPLIED BY THE NUMBER OF DENIALS THAT WERE ATTRIBUTABLE TO INSUFFICIENT INFORMATION. BAD DEBT EXPENSE FOOTNOTE FROM CONSOLIDATED, AUDITED FINANCIAL STATEMENTS: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYER CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. PFH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE ARE NOT REPORTED AS REVENUE. MEDICARE SHORTFALLS AS COMMUNITY BENEFIT SCHEDULE H, PART III, LINE 8 THE AMOUNT REPORTED ON PART III, SECTION B, LINE 6 WAS CALCULATED IN ACCORDANCE WITH THE SCHEDULE H INSTRUCTIONS AND UTILIZING THE ORGANIZATION'S ALLOWABLE MEDICARE COST AS REPORTED IN THE MEDICARE COST REPORT, WHICH IS BASED ON A COST TO CHARGE RATIO. HOWEVER, THE ALLOWABLE COSTS IN THE MEDICARE COST REPORT DO NOT REFLECT THE ACTUAL COST OF PROVIDING CARE TO PATIENTS SINCE THE MEDICARE COST REPORT EXCLUDES MANY DIRECT PATIENT CARE COSTS THAT ARE ESSENTIAL TO PROVIDING QUALITY HEALTHCARE FOR MEDICARE PATIENTS. FOR EXAMPLE, CERTAIN COVERAGE FEES TO PHYSICIANS, COST OF MEDICARE C AND D, AND OTHER SIMILAR DIRECT PATIENT CARE EXPENSES ARE SPECIFICALLY EXCLUDED FROM ALLOWABLE COST IN THE MEDICARE COST REPORT. THE ORGANIZATION BELIEVES THAT THE ENTIRE $4,129,120 OF MEDICARE SHORTFALL REPORTED ON LINE 7 OF SCHEDULE H, PART III SHOULD BE CONSIDERED COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: FIRST, THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. IRS REVENUE RULING 69-545 PROVIDES, IN PART, THAT HOSPITALS SERVING PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING, FOR EXAMPLE, MEDICARE, IS AN INDICATION THAT THE HOSPITAL OPERATES FOR THE PROMOTION OF HEALTH IN THE COMMUNITY. SECOND, DURING FISCAL YEAR 2011, MEDICARE ACCOUNTED FOR 29 PERCENT OF PFH'S PATIENT SERVICE REVENUE. PIEDMONT FAYETTE HOSPITAL'S POLICY IS TO TREAT MEDICARE PATIENTS REGARDLESS OF THE EXTENT TO WHICH MEDICARE ACTUALLY COVERS THE COSTS OF THAT TREATMENT. FOR MANY OF THE MEDICAL SERVICES PROVIDED BY THE HOSPITAL, MEDICARE DOES NOT PROVIDE SUFFICIENT REIMBURSEMENT TO COVER THE COST OF PROVIDING CARE TO THE PATIENTS. RESULTING MEDICARE SHORTFALLS MUST BE ABSORBED BY PIEDMONT FAYETTE HOSPITAL IN ORDER TO CONTINUE TREATING ELDERLY MEDICARE PATIENTS IN THE FAYETTEVILLE COMMUNITY. FURTHER, IT IS EXPECTED THAT REIMBURSEMENT UNDER THE MEDICARE PROGRAM WILL CONTINUE TO DECLINE AND THEREFORE MAY FURTHER LIMIT ACCESS TO CARE FOR ELDERLY PATIENTS DUE TO THE ANTICIPATED REDUCTION OF PARTICIPATION IN THE MEDICARE PROGRAM BY HEALTHCARE PROVIDERS IN THE COMMUNITY. AS A RESULT, NONPROFIT HOSPITALS AND/OR COUNTY HOSPITAL DISTRICTS WILL LIKELY BEAR THE MAJORITY OF THE FINANCIAL BURDEN OF TREATING MEDICARE PATIENTS. THIRD, PIEDMONT FAYETTE HOSPITAL RELIEVES A FINANCIAL BURDEN ON THE FEDERAL AND STATE GOVERNMENTS TO PAY FOR ALL OF THE SERVICES PROVIDED TO MEDICARE PATIENTS. FOURTH, THE STATE OF GEORGIA REQUIRES NON-PROFIT HOSPITALS TO PROVIDE A MINIMAL LEVEL OF COMMUNITY BENEFIT IN ORDER TO OBTAIN EXEMPTION FROM STATE AND LOCAL TAXES. ACCORDING TO GEORGIA STATE LAW, THE UNREIMBURSED COST OF MEDICARE IS CONSIDERED TO BE COMMUNITY BENEFIT. FIFTH, MANY OF THE MEDICARE PARTICIPANTS HAVE LOW, FIXED INCOMES AND THEREFORE WOULD QUALIFY FOR CHARITY CARE OR OTHER MEANS-TESTED GOVERNMENT PROGRAMS, ABSENT BEING ENROLLED IN THE MEDICARE PROGRAM. COLLECTION PRACTICES SCHEDULE H, PART III, LINE 9(B) INITIAL SCREENINGS OF ALL INPATIENT, EMERGENCY, AND SURGERY ENCOUNTERS, AS WELL AS MOST OUTPATIENT VISITS, ARE CONDUCTED BY FINANCIAL COUNSELORS IN ORDER TO IDENTIFY ANY AVAILABLE INSURANCE OR OTHER COVERAGE FOR EACH PATIENT. COUNSELORS CONTACT PATIENTS AND THEIR FAMILIES DIRECTLY, EITHER IN PERSON OR BY LETTER, TO ASSIST THE FAMILY IN IDENTIFYING ANY PROGRAMS FOR WHICH THE PATIENT/SERVICE MAY QUALIFY (INCLUDING MEDICAID, STATE CHILDREN'S HEALTH INSURANCE PROGRAM ("SCHIP"), PRIVATE OR GOVERNMENT INSURANCE COVERAGE, AND CHARITY ASSISTANCE). IF THE FAMILY CANNOT BE TIMELY LOCATED OR IS UNCOOPERATIVE, RELATED ACCOUNTS ARE TRANSFERRED TO AN INTERNAL COLLECTION DEPARTMENT FOR FURTHER ATTEMPTS TO OBTAIN PAYMENT OR, IF THE PATIENT MAY QUALIFY FOR ASSISTANCE, TO SECURE A FINANCIAL ASSISTANCE APPLICATION. THE ORGANIZATION'S DEBT COLLECTION POLICY AND PROCEDURES PROHIBIT ANY COLLECTION EFFORTS FOR THE PORTION OF A PATIENT ACCOUNT BALANCE THAT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. 2. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2: NEEDS ASSESSMENT PIEDMONT HEALTHCARE HAS PARTNERED WITH THE GEORGIA STATE UNIVERSITY PUBLIC HEALTH DEPARTMENT TO ASSESS THE HEALTHCARE NEEDS OF OUR COMMUNITY. IN MARCH 2010, PIEDMONT HEALTHCARE PARTNERED WITH THE GEORGIA STATE UNIVERSITY INSTITUTE OF PUBLIC HEALTH AS TO FORMALLY ASSESS THE HEALTHCARE NEEDS OF THE METROPOLITAN ATLANTA COMMUNITY THROUGH THE USE OF PRIMARY AND SECONDARY DATA AND STAKEHOLDER INPUT TO ESTABLISH COMMUNITY NEED WITH A FOCUS ON THE FOLLOWING AREAS: POPULATION DEMOGRAPHIC PROFILE; HEALTH BURDENS; COMMUNITY-BASED HEALTH CARE AND SOCIAL SERVICE ASSETS AND NEEDS; COMMUNITY MEMBERS AND PIEDMONT STAFF PERCEPTIONS; AND, EMERGENCY DEPARTMENT USE TRENDS. THE INFORMATION WAS THEN USED TO DESIGN AND EXECUTE A SYSTEMATIC APPROACH TO PHC'S COMMUNITY BENEFITS PROGRAMMING AS TO BETTER ADDRESS THE HEALTH NEEDS THAT WERE IDENTIFIED, WITH A PARTICULAR FOCUS ON THE MORE VULNERABLE MEMBERS OF THE COMMUNITY. PHC USED THE COMMUNITY HEALTH NEEDS ASSESSMENT AS ITS BENCHMARK IN ESTABLISHING STANDARDS FOR PROGRAMMATIC EFFECTIVENESS, WHICH ARE REGULARLY REVIEWED AND EVALUATED. 3. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBITY FOR ASSISTANCE IN ORDER TO INFORM AND EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS, OR UNDER THE HOSPITAL'S CHARITY CARE POLICY, THE HOSPITAL FOLLOWS THE FOLLOWING PROCEDURES: - REGISTRARS REVIEW PROGRAM GUIDELINES WITH PATIENTS; - BROCHURES THAT EXPLAIN PAYMENT AND FINANCIAL ASSISTANCE OPTIONS ARE AVAILABLE IN REGISTRATION AREAS; - THE HOSPITAL'S WEBSITE AND ALL BILLING STATEMENTS PROVIDE CONTACT INFORMATION FOR PATIENT FINANCIAL SERVICES; - PATIENT FINANCIAL SERVICES REPRESENTATIVES EXPLAIN THE PERTINENT POLICY TO THE PATIENT AND PROVIDE ANY FORMS THAT NEED TO BE COMPLETED BY THE PATIENT; - ALL UNINSURED PATIENTS ARE SCREENED FOR CHARITY ELIGIBILITY WITH AN AUTOMATIC ONLINE SERVICE (SEARCH AMERICA), AND FOR MEDICAID ELIGIBILITY USING A THIRD PARTY (BOTH SERVICES ARE FREE OF CHARGE TO THE PATIENT); - INDIGENT CARE CAN BE AUTHORIZED AT REGISTRATION. 4. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION PIEDMONT FAYETTE HOSPITAL FOCUSES PRIMARILY ON THE COMMUNITY WITHIN A 20 MILE RADIUS OF THE HOSPITAL ADDRESS AND SERVES INDIVIDUALS IN THAT COMMUNITY WHO ARE UNINSURED, UNDERINSURED, AND UNDERSERVED, AS WELL AS THOSE IN NEED OF HEALTH EDUCATION. 5. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH PIEDMONT HEALTHCARE WORKS WITH COMMUNITY PARTNERS THAT COMBINE EDUCATION AND SUPPORT TO PROMOTE HEALTHY LIFESTYLES TO MEMBERS OF THE COMMUNITY. THROUGH ONE SUCH PROGRAM, HEALTHMPOWERS, PHC PROVIDES NUTRITION AND FITNESS MATERIALS TO STUDENTS AND TEACHERS AT GARDEN HILLS ELEMENTARY SCHOOL IN ATLANTA, AS WELL AS TRAINING FOR THE TEACHERS TO INCORPORATE INTO REGULAR CURRICULUM. HEALTHMPOWERS, SPECIALIZES IN THE DEVELOPMENT OF THE MATERIALS AND MONITORS THE PROGRESS OF THE TEACHERS AND STUDENTS OVER THE ENTIRE SCHOOL YEAR. WITH NO EXTRA WORK ON THE SCHOOL'S PART, STUDENTS LEARN WAYS TO INCORPORATE FRUITS AND VEGETABLES INTO THEIR DIETS, AS WELL THE IMPORTANCE OF EXERCISING EACH DAY. THE STUDENTS ARE THEN ABLE TO SHARE THIS KNOWLEDGE WITH THEIR PARENTS AND ENCOURAGE THEM TO DEVELOP HEALTHIER LIFESTYLES. ADDITIONAL PROGRAMS OFFERED TO THE COMMUNITY INCLUDE WOMEN, MEN, AND FAMILY-FOCUSED HEALTH EXPOS, AS WELL AS MINORITY COMMUNITY FAIRS, WHERE PARTICIPANTS RECEIVE FREE HEALTH SCREENINGS AND CAN ATTEND EDUCATIONAL SEMINARS. A LONG-STANDING PROGRAM WITH MEDSHARE INTERNATIONAL OFFERS MEDICAL EQUIPMENT AND SUPPLIES TO VULNERABLE AREAS, NATIONWIDE AND WORLDWIDE, WHICH PIEDMONT HOSPITALS ARE ABLE TO DONATE RATHER THAN WASTE WHEN THEY ARE CONSIDERED TO NOT BE IN OPTIMAL CONDITION OR HAVE EXPIRED. 6. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM") SERVING THE HEALTHCARE NEEDS OF NORTH GEORGIA AND, SPECIFICALLY, THE METROPOLITAN ATLANTA AREA. THE SYSTEM EXISTS TO PROVIDE PROGRESSIVE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE TO ALL MEMBERS OF ITS COMMUNITY. COMMUNITY BENEFITS ARE GENERATED THROUGH THE PROVISION OF CHARITY CARE, GOVERNMENT-SPONSORED PROGRAMS (SUCH AS MEDICAID AND MEDICARE), MEDICAL RESEARCH, MEDICAL EDUCATION, COMMUNITY HEALTH IMPROVEMENT SERVICES, DONATIONS TO OTHER NONPROFIT HEALTH CARE PROVIDERS, AND MANY OTHER COMMUNITY SERVICE ACTIVITIES. IN FISCAL YEAR 2011, THE PIEDMONT HEALTHCARE SYSTEM INCLUDED FOUR FULL-SERVICE HOSPITALS, A PHILANTHROPIC FOUNDATION, A CARDIOVASCULAR RESEARCH INSTITUTE, A PHYSICIAN NETWORK, AMBULATORY SURGERY CENTERS, AND OTHER HEALTH CARE PROVIDERS, ALL OF WHICH FALL UNDER THE COMMON CONTROL OF PIEDMONT HEALTHCARE, INC., PIEDMONT FAYETTE HOSPITAL'S SOLE MEMBER. AS PART OF THE PIEDMONT HEALTHCARE SYSTEM, CERTAIN AFFILIATES MAKE GRANTS AND/OR CONTRIBUTIONS TO OTHER RELATED NONPROFIT AFFILIATES TO HELP FINANCIALLY SUPPORT AND/OR FUND WORTHY COMMUNITY BENEFITS ACTIVITIES. 7. STATE OF FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7: STATE OF FILING OF COMMUNITY BENEFIT REPORT PIEDMONT HEALTHCARE, INC., FILES THE COMMUNITY BENEFIT REPORT FOR ITS HEALTHCARE SYSTEM IN THE STATE OF GEORGIA. false true false false false true true false false MR W DARRELL CUTTS 347899 0 135183 0 11964 0 52392 0 6354 0 553792 0 0 0 MR MICHAEL BURNETT 203318 0 53931 0 10785 0 35056 0 11190 0 314280 0 0 0 MS LISA HEDENSTROM 176712 0 46464 0 5365 0 32039 0 8163 0 268743 0 0 0 MR TRACEY COKER 148265 0 39008 0 9302 0 17347 0 7178 0 221100 0 0 0 MR CHARLIE HALL 0 407719 0 156975 0 46127 0 73201 0 9918 0 693940 0 0 MS DEBBIE W GRAMLING 0 120396 0 24802 0 3613 0 22132 0 10504 0 181447 0 0 MR JAMES D COLEMAN 138624 0 9921 0 9893 0 32564 0 10049 0 201051 0 0 0 MR THOMAS OBERST 136101 0 0 0 9816 0 30793 0 9725 0 186435 0 0 0 DR ANGELA SWAYNE 194974 0 6650 0 154 0 17640 0 6612 0 226030 0 0 0 MS CATHERINE CRISLER 130532 0 12592 0 6194 0 24255 0 5190 0 178763 0 0 0 DR FREDERICK WILLMS 261209 0 68068 0 20670 0 48300 0 5997 0 404244 0 0 0 MS JUDITH W DAVIS 139866 0 0 0 1106 0 32579 0 4808 0 178359 0 0 0 MR JOHN MILES 198804 0 52764 0 4204 0 34270 0 13125 0 303167 0 0 0 COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR FORM 990, SCHEDULE J, PART I, LINE 3 THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT FAYETTE HOSPITAL IS SET BY THE ENTITY'S PARENT, PIEDMONT HEALTHCARE, INC. PLEASE SEE THE SCHEDULE O NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A & 15B FOR ADDITIONAL INFORMATION. SUPPLEMENTAL COMPENSATION INFORMATION FORM 990, SCHEDULE J, PART I, LINE 4B CHARLIE HALL PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS. BONUSES FORM 990, PART VII AND SCHEDULE J, PART I LINES 6A & 6B BONUSES ARE PAID ANNUALLY TO CERTAIN EMPLOYEES BASED ON VARIOUS METRICS, INCLUDING NET EARNINGS. PROGRAM SERVICES FORM 990, PART III, LINE 4A FAYETTE COMMUNITY HOSPITAL, INC., HEREAFTER REFERRED TO AND DOING BUSINESS AS PIEDMONT FAYETTE HOSPITAL, INC., ("PFH") IS A PRIVATE, NOT-FOR-PROFIT ORGANIZATION AND IS A MEMBER OF PIEDMONT HEALTHCARE. THE PIEDMONT PROMISE ASSURES THAT FAYETTEVILLE COMMUNITY RECEIVES WORLD-CLASS CARE THAT FEELS DOWN TO EARTH. PFH'S DOCTORS, NURSES, AND STAFF UNDERSTAND THAT TRUE HEALING COMES NOT ONLY FROM ADVANCED MEDICAL TECHNOLOGY, BUT ALSO FROM A WARM, CARING TOUCH. THAT TOUCH CAN BE FELT THROUGH PFH'S COMMUNITY OUTREACH PROGRAMS. PFH IS COMMITTED TO IDENTIFYING AND FULFILLING THE NEEDS OF THE UNDERSERVED IN ITS SURROUNDING COMMUNITY. THE HOSPITAL HAS MADE A COMMITMENT TO PROVIDE NO LESS THAN THREE PERCENT OF ITS REVENUE DIRECTLY TO THE COMMUNITY THROUGH OUTREACH PROGRAMS AND INDIGENT AND CHARITY CARE. THIS COMMITMENT IS FULFILLED THROUGH DIRECT FINANCIAL SUPPORT, IN ADDITION TO PROGRAMS, EVENTS, AND SERVICES DESIGNED TO IMPROVE THE OVERALL HEALTH OF THE FAYETTEVILLE COMMUNITY. PFH PARTICIPATES IN HEALTH EDUCATION PROGRAMS, SCREENINGS, AND HEALTH FAIRS, AND PROVIDES SUPPORT ACTIVITIES FOR INDIVIDUALS IN THE COMMUNITY LIVING WITH SERIOUS OR CHRONIC HEALTH CONDITIONS. FURTHER, TO MAXIMIZE ITS IMPACT ON THE SURROUNDING AREA, PFH PARTNERS WITH SEVERAL NON-PROFIT ORGANIZATIONS SUCH AS THE AMERICAN RED CROSS AND THE SOUTH REGION SERVICE CENTER TO GAUGE AND FULFILL THE NEEDS OF ITS COMMUNITY. ORGANIZATION'S SOLE MEMBER FORM 990, PART VI, SECTION A, LINE 6 PIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT FAYETTE HOSPITAL. ELECTION OF GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF PIEDMONT HEALTHCARE APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT FAYETTE HOSPITAL. DECISIONS OF GOVERNING BODY FORM 990, PART VI, SECTION A, LINE 7B PIEDMONT FAYETTE HOSPITAL'S BOARD POLICIES AND DECISIONS MUST BE FILED, IMMEDIATELY AFTER ADOPTION, WITH THE SECRETARY OF THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS. SUCH POLICIES AND DECISIONS OF THE PIEDMONT FAYETTE HOSPITAL BOARD OF DIRECTORS ARE NOT SUBJECT TO THE APPROVAL OF OR RATIFICATION BY THE PIEDMONT HEALTHCARE BOARD, BUT SHOULD THE NEED ARISE, THEY MAY BE RESCINDED BY THE PIEDMONT HEALTHCARE BOARD THROUGH A MAJORITY VOTE OF ITS DIRECTORS. 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B INFORMATION NEEDED TO PREPARE PIEDMONT FAYETTE HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PFH'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S TAX COMPLIANCE MANAGER AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., PRIOR TO FILING. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARE'S VICE PRESIDENT OF COMPLIANCE. ALL SENIOR LEADERS, BOARD MEMBERS, PHYSICIAN EMPLOYEES, AND EMPLOYEES ENGAGED IN RESEARCH ARE REQUIRED TO ANNUALLY DISCLOSE ALL MATTERS WHICH COULD POTENTIALLY CONSTITUTE A CONFLICT OF INTEREST. MATTERS DISCLOSED UNDER THE POLICY MUST BE REVIEWED IN WRITING BY THE REPORTING INDIVIDUAL'S SUPERVISING MANAGER AND THEN BY THE PIEDMONT HEALTHCARE CONFLICT OF INTEREST COMMITTEE IN ORDER TO DETERMINE WHETHER A CONFLICT EXISTS AND, IF SO, WHETHER TO ELIMINATE OR MANAGE THE CONFLICT. ALL BOARD MEMBERS AND EMPLOYEES OF PIEDMONT FAYETTE HOSPITAL ARE PROVIDED TRAINING ON THE REQUIREMENTS OF THE CONFLICT OF INTEREST POLICY AT NEW-EMPLOYEE ORIENTATION AND AT LEAST ANNUALLY THEREAFTER. NONCOMPLIANCE WITH THE CONFLICT OF INTEREST POLICY MUST BE REPORTED TO PIEDMONT HEALTHCARE'S VICE PRESIDENT OF COMPLIANCE FOR INVESTIGATION AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. EXECUTIVE COMPENSATION FORM 990, PART VI, SECTION B, LINES 15A & 15B COMPENSATION FOR EXECUTIVES OF PIEDMONT FAYETTE HOSPITAL IS SET BY THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC. THE PIEDMONT HEALTHCARE, INC., BOARD OF DIRECTORS EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("THE COMMITTEE") IS COMPOSED OF AT LEAST THREE MEMBERS, SERVING TERMS OF THREE YEARS, AND THE MAJORITY OF WHICH ARE COMMUNITY DIRECTORS WHO GENERALLY DO NOT HAVE CONFLICTS OF INTEREST RELATED TO FULFILLMENT OF THE DUTIES AS OUTLINED BELOW. THE COMMITTEE HAS BEEN AUTHORIZED BY THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS TO PERFORM THE FOLLOWING FUNCTIONS: -SELECT AN EXTERNAL EXECUTIVE COMPENSATION CONSULTANT ("THE CONSULTANT"). THE COMMITTEE HAS UTILIZED THE SERVICES OF INTEGRATED HEALTHCARE STRATEGIES (FORMERLY CLARK CONSULTING) FOR THE PAST SEVERAL YEARS. -WORK WITH THE PRESIDENT/CEO TO FORMULATE AND IMPLEMENT ANNUAL PERFORMANCE OBJECTIVES. THE COMMITTEE MEETS ANNUALLY WITH PIEDMONT HEALTHCARE'S CEO AND KEY SENIOR EXECUTIVES. -TO REVIEW AND APPROVE EXECUTIVE PERFORMANCE OBJECTIVES FOR THE FISCAL YEAR. -ANNUALLY ASSESS PRESIDENT/CEO PERFORMANCE. THE COMMITTEE MEETS ANNUALLY WITH THE CEO AND KEY SENIOR EXECUTIVES. -TO REVIEW THE ACCOMPLISHMENTS OF THE EXECUTIVE PERFORMANCE OBJECTIVES AFTER THE CLOSE OF THE FISCAL YEAR. -ASSESS AND IMPLEMENT POLICIES REGARDING PRESIDENT/CEO PERFORMANCE AND COMPENSATION. THE COMMITTEE HAS DEVELOPED AN EXECUTIVE COMPENSATION PHILOSOPHY AND REVIEWS THE PHILOSOPHY ANNUALLY. THE COMMITTEE SEEKS INPUT AND GUIDANCE FROM THE CONSULTANT TO ENSURE THAT THE PHILOSOPHY IS REASONABLE AND COMPARABLE TO THAT OF SIMILAR ORGANIZATIONS. -APPROVE LONG- AND SHORT-TERM GOALS TO BE USED IN CONNECTION WITH EXECUTIVE STAFF COMPENSATION PROGRAM AS RECOMMENDED BY THE PRESIDENT/CEO AND VALIDATED BY THE COMPENSATION CONSULTANT. THE COMMITTEE MEETS ANNUALLY WITH THE CEO AND KEY SENIOR EXECUTIVES AS WELL AS THE CONSULTANT TO REVIEW SALARY ADJUSTMENTS AND INCENTIVE PAY FOR THE CEO, SENIOR EXECUTIVES, AND EXECUTIVES THROUGHOUT THE ORGANIZATION. THE COMMITTEE MEETS WITH THE CONSULTANT ANNUALLY TO RECEIVE INPUT AND RECOMMENDATIONS TO ENSURE THAT SALARY ADJUSTMENTS, INCENTIVES, AND BENEFITS ARE REASONABLE AND COMPARABLE TO THOSE OF LIKE ORGANIZATIONS. -PERFORM ANY TASKS RELATED TO EXECUTIVE PERFORMANCE AND COMPENSATION, INCLUDING BUT NOT LIMITED TO, APPROVAL OF EXECUTIVE EMPLOYMENT CONTRACTS, AND EXECUTIVE BENEFITS. THE COMMITTEE SEEKS INPUT FROM THE CONSULTANT, AS WELL AS EXTERNAL LEGAL ADVISORS, WHEN IT IS NECESSARY TO DEVELOP AND/OR AMEND EXECUTIVE EMPLOYMENT CONTRACTS AND BENEFITS. DISCLOSURE OF GOVERNING, CONFLICT OF INTEREST AND FINANCIAL DOCUMENTS FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THESE DOCUMENTS SHOULD BE REQUESTED FROM PIEDMONT HEALTHCARE, INC'S LEGAL COUNSEL. RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 5 CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 5 ARE PRIMARILY COMPRISED OF TRANSFERS BETWEEN THE ORGANIZATION AND ITS PARENT OR OTHER RELATED ORGANIZATIONS OF APPROXIMATELY $96.7 MILLION, AS WELL AS RESTRICTED CONTRIBUTIONS OF APPROXIMATELY $100,000. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MS VICKI TURNER TITLE:BOARD MEMBER HOURS:39 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MR RONALD DUFFEY TITLE:BOARD MEMBER HOURS:2 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MR CHARLIE HALL TITLE:TREASURER HOURS:54 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MS DEBBIE W GRAMLING TITLE:SECRETARY HOURS:54 PIEDMONT HEALTHCARE INC 1968 PEACHTREE ROAD NW ATLANTA GA 30309 581503902 MANAGEMENT GA 501(C)(3) 11 III-OTH NA PIEDMONT HOSPITAL INC 1968 PEACHTREE ROAD ATLANTA GA 30309 580566213 HOSPITAL GA 501(C)(3) 3 PHC PIEDMONT MOUNTAINSIDE HOSPITAL INC 1266 HIGHWAY 515 SOUTH JASPER GA 30143 352228583 HOSPITAL GA 501(C)(3) 3 PHC PIEDMONT NEWNAN HOSPITAL INC 745 POPLAR ROAD NEWNAN GA 30265 205077249 HOSPITAL GA 501(C)(3) 3 PHC PIEDMONT HEALTHCARE FOUNDATION INC 1968 PEACHTREE ROAD ATLANTA GA 30309 581272768 FUNDRAISING GA 501(C)(3) 11 III-OTH PHC PIEDMONT HEART INSTITUTE INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 263553500 HEALTHCARE GA 501(C)(3) 7 PHC PIEDMONT MEDICAL CARE CORPORATION 2727 PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 264422348 HEALTHCARE GA NA C-CORP 0 0 0.00000 THE PIEDMONT CLINIC INC 2727 PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 582005358 HEALTHCARE GA NA C-CORP 0 0 0.00000 PIEDMONT HEART INSTITUTE PHYSICIANS INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 260593850 HEALTHCARE GA NA C-CORP 0 0 0.00000 AMSTER MCRAE INSURANCE COMPANY GOVERNORS SQUARE 2ND FLOOR BLDG 3 GRAND CAYMAN CJ KY 1-1102 INSURANCE CJ NA C-CORP 0 0 0.00000 false false true false false false false false false false false false false false true true false false