2011-05-13T08:15:43-05:00 2010-06-30 Pershing Yoakley & Associates P C One Cherokee Mills 220 Sutherland A Knoxville TN 379192363 990 2009-07-01 582002413 GWINNETT HOSPITAL SYSTEM INC GWIN 6783125603 1000 MEDICAL CENTER BOULEVARD LAWRENCEVILLE GA 30046 THOMAS Y MCBRIDE III 6783125603 2011-05-13 1 8656730844 2009 2016-02-24 21:20:13Z Philip R Wolfe 1000 MEDICAL CENTER BOULEVARD LAWRENCEVILLE GA 30046 597368470 0 X WWW.GWINNETTMEDICALCENTER.ORG X 1992 GA Gwinnett Hospital System, Inc. (GHSI) IS A NOT-FOR-PROFIT HEALTHCARE NETWORK THAT PROVIDES AWARD-WINNING HEALTHCARE SERVICES TO THE GWINNETT COMMUNITY AND BEYOND. GHSI HAS CAMPUSES IN DULUTH & LAWRENCEVILLE, GEORGIA. GHSI PROVIDES ACUTE CARE, OUTPATIENT SERVICES, ORTHOPEDIC & NEUROSCIENCE SPECIALTY CARE, TWO EMERGENCY ROOMS & SEVERAL CLINICS AS WELL AS A FULL CONTINUUM OF WELLNESS SERVICES. 5 2 4842 300 731093 332834 11198782 10977083 567127119 578979592 -1951832 7756579 -955623 -344784 575418446 597368470 1138978 3612215 0 253095787 270235251 0 0 283480779 296380773 537715544 570228239 37702902 27140231 772580561 814489437 445520000 481162720 327060561 333326717 GHSI is a not-for-profit healthcare network that provides award-winning healthcare services to the Gwinnett community and beyond. GHSI has campuses in Duluth and Lawrenceville, Georgia. GHSI provides acute care, outpatient services, orthopedic and neuroscience specialty care, as well as a full continuum of wellness services to the community. These facilities employee over 4,000 employees and are affiliated with over 800 physicians. GHSI's goal is to be the leading hospital system in our community by not only effectively treating diseases and injuries, but to provide early intervention and prevention. 0 0 486213620 3612215 573854594 The Hospital's primary program activity is the provision of patient care. The Hospital provided nursing care in the areas of Medical, post-surgical, critical care, and intermediate care. 19526670 4308586 The Hospital provided clinic services for pregnancy, Labor and Delivery, Post partum, and nursery. 933618 471628 the Hospital provided various programs to the community including diabetes and nutrition education, workplace health, lactation, women's services, and community health and wellness. 506673908 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 1 0 1 1 1 1 0 0 0 1 1 1 0 0 1 497 0 1 4842 1 1 1 0 0 0 0 0 0 0 0 5 2 0 0 0 1 1 1 1 1 1 0 0 1 1 0 1 1 1 1 1 1 1 GA X LAVERNE GROVE 6783125603 1000 MEDICAL CENTER BOULEVARD LAWRENCEVILLE GA 30046 Manfred Sandler 5.00 X 21800 0 1514 David McCleskey 5.00 X 2750 0 0 Chung Lee 5.00 X 2000 0 0 Miles Mason III 5.00 X 50000 0 0 Ed Radford 5.00 X 2750 0 0 Philip R Wolfe 60.00 X 886219 0 126379 ALAN BREIR 60.00 X 506048 0 89141 Thomas Y McBride III 60.00 X 515567 0 44668 Jeffrey Nowlin 60.00 X 419659 0 82824 Peter Wheeler 60.00 X 340985 0 77685 Wallace Brown 60.00 X 327987 0 72311 Stephen Nadeau 60.00 X 325908 0 60834 Carol Danielson 60.00 X 305917 0 66164 Lea Bay 60.00 X 280890 0 56258 Jessie T Shepherd 60.00 X 267113 0 54506 Scott Orem 60.00 X 208825 0 53099 James Dennard JR 60.00 X 202169 0 52398 Diana Potts 60.00 X 187404 0 39961 Cathy Dougherty 60.00 X 182262 0 41689 Bonny Richardson 60.00 X 169637 0 34755 Pamela Kauffman 60.00 X 164615 0 41704 Michael Hemphill 60.00 X 156624 0 41254 Jason Chandler 60.00 X 217193 0 48214 Janet Schwalbe 60.00 X 215345 0 35524 Thomas Lynch 60.00 X 227883 0 43412 Romeo P Massoud 60.00 X 619529 0 55816 Michael A Amaral 60.00 X 577792 0 58611 Michael T Stechison 60.00 X 568745 0 51873 Barry Renz 60.00 X 555174 0 59468 Martin Austin 60.00 X 373246 0 51785 Keith Buchanan 5.00 X 52000 0 3978 Thomas J Karr Jr 0.00 X 531357 0 14799 Ronald Corder 60.00 X 303936 0 19574 9769329 0 1480198 174 1 1 0 McKesson Corporation PO Box 98347 Chicago IL 606938347 Software Development & Maintenance 3457375 synthes USA PO Box 8538-662 philadelphia PA 191710662 Surgical Products 2824101 Gwinnett Anesthesia Service PC po box 669 lawrenceville GA 30046 anesthesia 2405422 clint harkins pc 4901 olde towne parkway Ste 300 marietta GA 300684354 collections 1532294 Cardinal Health 200 LLC PO Box 905867 Charlotte NC 282905867 Healthcare Products 1373080 487 4686461 5722986 567636 90508 10977083 PATIENT SERVICE REVENU 621500 567370312 566947749 422563 CLINIC Revenue 4308586 4308586 Discounts 2827528 2827528 CAFETERIA & Parking 2692235 2692235 Trauma Care Revenue 519525 519525 1261406 952876 308530 578979592 7284497 7284497 110660 110660 110660 110660 387832 84250 387832 84250 472082 472082 Baring Focused Interna 87213 87213 INTECH RISK MGD. LG. C 2073 2073 Georgia Behavioral Hea -375 -375 -544355 -544355 -455444 597368470 575211480 731093 10448814 3435235 3435235 176980 176980 9468156 3311375 6156781 201312256 177218709 24093547 12366993 12366993 31927192 31927192 15160654 15160654 956428 956428 815781 5646 810135 483507 483507 507242 507242 39229386 19639247 19590139 1756934 64233 1692701 11339912 8529139 2810773 6381704 1124846 5256858 9815194 9415310 399884 329313 148612 180701 215688 63034 152654 5731446 5731446 33195741 33195741 1982324 1755339 226985 BAD DEBTS 92273132 92273132 MEDICAL AND SURGICAL SU 73355582 73355582 Equipment rental & main 11758460 10873700 884760 6252999 5945335 307664 570228239 506673908 63554331 0 135192806 137452974 10000000 5000000 87968749 90430037 1698594 1698594 853729 1001694 4616240 4781924 5490358 6337838 548910270 256676173 291315531 292234097 213376308 257935934 9872182 8335360 12196064 9280985 772580561 814489437 45491306 43934199 5000000 5000000 10050369 5126543 305425000 322252000 79553325 104849978 445520000 481162720 X 320905703 325569334 5994863 7570288 159995 187095 327060561 333326717 772580561 814489437 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 19820 19820 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Dues paid to Georgia Hospital Association were $82,585. Of this amount, 24%, or $19,820 went for lobbying. 6154854 4262776 -2658501 1750 7757379 3960633 44549 2149672 6154854 0.02400 0.97600 0 1 1 14198383 14198383 256048602 84740289 171308313 14354683 10691195 3663488 255947483 160257524 95689959 8361119 987165 7373954 292234097 Accrued Interest Payable 3902121 Accrued Pension Costs 47521202 Self-Insurance Reserves 9203990 Third Party Settlements 11667859 Asset Retirement Obligation 254217 Interest rate swap 30560942 Executive benefits liability 813957 BOnd expense payable 750690 Minority interest in Gwinnett Endoscopy 175000 104849978 597368470 570228239 27140231 13357703 -21028 -34210750 -20874075 6266156 594731000 13357703 284709 13642412 581088588 507242 15772640 16279882 597368470 569648000 0 569648000 507242 72997 580239 570228239 Part V, Line 4: Description of Intended Use of Endowment Funds: Term Endowment Funds will be used for specific projects or programs of the hospital. Part X: Description of Uncertain Tax Positions Under FIN 48: The Internal Revenue Service has determined that the Hospital is exempt from federal income tax on related income under Internal revenue Code Section 501(a) as an organization described in Section 501(c)(3). The Hospital follows Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) 740, Income Taxes, which addresses the accounting for uncertainty in income tax positions. It also provided guidance on when tax positions are recognized in an entity's financial statements and how the values of any such positions are determined. There is currently no impact on the Hospital's financial statements from application of the provision of ASC 740. Part XI, Line 8 - Other Adjustments: Change in assets of Foundation: -2658502. Change in fair value of interest rate swaps: -7433619. Loss from K-1 investments: 1014263. Minority interest in Gwinnett Endoscopy Services: 282897. Change in pension accounting: -25416245. rounding: 456. Part XII, Line 2d - Other Adjustments: Minority interest in Endoscopy: 282897. rounding: 1812. Part XII, Line 4b - Other Adjustments: Change in FMV of interest rate swap: 7433619. Loss from K-1 Investments: -1014263. HAGC Contribution: 5000000. Noncash Contributions: 90508. Tranfer from Foundation: 4262776. Part XIII, Line 4b - Other Adjustments: Noncash Grants: 69480. Oncology Grant: 1750. rounding: 1767. 1 1 X 1 X 125.000000000000 1 X 200.000000000000 1 1 1 0 1 1 36110268 2539603 33570665 0.07020 61935584 41745746 20189838 0.04220 141904 79730 62174 0.00010 98187756 44365079 53822677 0.11250 159 203172 2854927 322300 2532627 0.00530 31 2586 5157298 1125 5156173 0.01080 8 14244 24651621 20688133 3963488 0.00830 4 1410 581471 581471 0.00120 5 2043 298811 298811 0.00060 207 223455 33544128 21011558 12532570 0.02620 207 223455 131731884 65376637 66355247 0.13870 4 1161 12267 12267 0.00000 2 192213 192213 0.00040 6 1161 204480 204480 0.00040 0 28743366 86917164 95155620 -8238456 X 1 1 Gwinnett Endoscopy Services LLC Endoscopy Services 0.55520 0.00000 0.44480 Gwinnett Medical Center Lawrenceville

1000 Medical Center Boulevard Lawrenceville GA 30046

X X X X Gwinnett Medical Center Duluth

3620 Howell Ferry road Duluth GA 30096

X X X X GWINNETT EXTENDED CARE CENTER

650 PROFESSIONAL DRIVE LAWRENCEVILLE GA 30046

NURSING HOME Part I, Line 7: Line 7a - Charity care costs were calculated using a Medicaid specific cost-to-charge ratio (CCR) from the Medicare cost report. A Medicaid CCR was used because the Medicaid population better represents the utilization and acuity of the Charity population. A CCR was used instead of a cost accounting system because charity write offs may only represent a portion of a patient account being written off and the cost accounting system does not distinguish between the portion of costs written off to charity and other write-offs.Line 7b, 7c & 7g - An RVU based cost accounting system (ADS) was used to estimate the Medicaid FFS & Medicaid Managed Care amounts reported on Line 7b, the Peach Care (GA SCHIP program) reported on Line 7c and the Subsidized Health Services reported on Line 7g. ADS does include information from all patient segments regardless of payor. Part I, Line 7g: Three physician practices/clinics were included in the Subsidized Services category, the OB/GYN Clinic, the Miles and Lib Mason Children's Clinic and the Wound Care Clinic. Each clinic provides services that meet identified community needs. These clinics offer services that the community does not currently otherwise provide. These medical practices provide a significant benefit to the community and do not operate primarily to increase referrals of patients with third party coverage as a majority of the patients are underinsured, uninsured or covered by federal or state insurance plans for at-risk populations (children and pregnant women as an example). In addition, the medical practices are operated efficiently and payments to physicians are reasonable and in-line with the guidelines from the Medical Group Management Association as well as prevailing community rates for physician reimbursement.Expenses at cost for subsidized services for physician clinics have been calculated from total department expenses at cost minus bad debt, Medicaid and charity care.- Ob/GYN Clinic costs $1,129,477 with a net community benefit expense of $137,363- Miles and Lib Mason Children's Clinic costs $355,881 with a net community benefit expense of $209,495- Wound Care Clinic costs $956,619 with a net community benefit expense of $464,715 Part I, Line 7f: $92,273,132 in bad debt expenses were subtracted from Form 990, Part IX, line 25 for purposes of calculating the percentage in this column. Part III, Line 4: The costs reported on line 2 were arrived at using an overall Cost to charge ration (CCR) calculated per Worksheet 2 instructions with a couple of exceptions. Bad Debt costs were subtracted when coming up with shortfall amounts for Medicare, Medicaid, Peach Care and Subsidized Services so that those costs would not be double counted in the Bad Debt shortfall calculation. Therefore, it is not necessary to subtract charges and costs for those populations when calculating the overall CCR on Worksheet 2 as those payors are being accounted for in the Bad Debt charges written off. Discounts and payments on patient accounts are reflected in the patient balance prior to accounts being written off to bad debt. The hospital's financial statements do not include a footnote related to bad debt expense. Bad debts are reflected in the financial statements as an operating expense line item labeled "Provision for uncollectible accounts" in the Statement of Operations. Part III, Line 8: The cost reported on line 6 are per the Medicare cost report and were calculated based on cost-to-charge ratios. The amounts reported on lines 5 & 6 only include Medicare Part A costs and payments. Other Medicare shortfall (for Medicare Pt C, physician services, fee schedule, etc)is $4,850,167. The portion of the Medicare shortfall reported on line 7 that should be treated as a community benefit is $3,193,675 which represents the shortfall related to those patients that had Medicaid as a secondary payor and therefore deemed indigent for Medicare bad debt purposes. Part III, Line 9b: The Credit and Collection Policy describes how uninsured patients can receive a prompt pay discount. The policy describes the availability of the financial assistance program and indicates that an application for financial assistance is part of the process for financially securing accounts and indicates that Senior Financial Counselors are on staff to process the applications. In addition, the policy dictates that an approved financial assistance application qualifies an account as financially secured. Patients approved for free care are not billed or requested to pay as their total account balance is written off to indigent care. Patients approved for discounted care through the charity criteria are only billed for the balance left after the charity adjustment is made to their accounts. Patients are allowed to enter into a payment plan agreement to satisfy their out of pocket costs. Part V: n/a Part VI, Line 2: Over the past decade, our hospitals have conducted a community health needs assessment in collaboration with the Gwinnett County Health Department to assess the healthcare needs of residents of Gwinnett County. The majority of the patients who utilize our hospitals are residents of Gwinnett County; however, we also serve individuals from surrounding counties such as Barrow, Jackson and Walton. The health needs assessment provides a snapshot of our community in the areas of demographics including: population, economics, education, housing, labor, transportation and public assistance as well as providing five-year trend data measuring mortality and hospital morbidity rates by disease states, select notifiable diseases, and maternal/infant health. The last health status report was published in 2007. This report was made available to the public through mailings to city, county, state and federal government representatives; to community service organizations; and upon request. The report is also available on our website. The information contained in the needs assessment is updated between published reports through secondary vital statistics data provided by the Online Analytical Statistical Information System (OASIS), which is a toolset that allows access to the Georgia Division of Public Health's standardized health data repository. Data from the U.S. Census Bureau, Centers for Disease Control and Prevention (CDC) and the comparisons to the U.S. Department of Health and Human Services' Health People 2010 objectives are also included in the report. The information provided to answer Question 4 "Community information" was taken from updated information from our needs assessment.In addition to the published report, our Planning department identifies hospital-based needs using admission/discharge and other utilization data. Over the years, our hospitals have responded to physicians who identified unmet needs of pregnant women and their infants by providing services through the OB/GYN Clinic. The local health department requested our support for the care of sick infants and children which led us to open the Miles & Lib Mason Children's Clinic.The community benefit plan is updated annually. This plan describes how the hospitals and support facilities address identified community health needs. Each year programs are evaluated for efficiency, effectiveness, outcomes and community collaboration; then, administration sets the organization's priorities for community needs through department budgeting for each community benefit program. The organization's Community Health & Wellness Council, an internal community benefit committee with representatives from 35 departments from both hospitals, is tasked with the annual plan update. Then the plan is reviewed and approved by hospital administration and is presented to the GHS Board of Directors for their input, review and approval.Community health needs are identified by our organization primarily through morbidity and mortality vital statistics. Major health problems in our community are identified by monitoring morbidity through statistics associated with the leading causes of hospitalization (not including Emergency Department visits). In Gwinnett County, the leading causes of hospitalization are:1. Pregnancy with childbirth complications2. Major cardiovascular diseases, including heart attack and stroke3. Respiratory diseases (influenza/pneumonia, asthma)4. External causes , including accidents and injuries (falls ranked as the number one reason for hospital admissions and motor vehicle crashes (MVC) ranked second)5. Cancer 6. Metabolic diseases (including diabetes)Mortality is another measure for establishing community health needs. The leading causes of premature death are important to evaluate because in many situations these may be preventable. Gwinnett County has an unusual age distribution pattern with 72 percent of the population under the age of 45. The leading causes of premature death (when ranked by years of life lost rates) are:1. External causes - unintentional injuries or accidents (e.g., MVCs, poisonings, falls) and intentional injuries (e.g., suicides, homicides)2. Cancer 3. Major cardiovascular diseases4. Respiratory diseases including chronic obstructive pulmonary disease and asthma 5. Metabolic diseases including diabetesIn our organization, some identified need areas are served by more clinical programs than others. Cardiovascular disease (heart conditions and strokes), cancer, emergency and trauma services, respiratory diseases (asthma, COPD, flu and pneumonia), diabetes, maternal/ infant health, injury prevention and wellness programs are areas we concentrate our efforts to improve community health.There are identified community health needs which our hospitals currently only provide minimal support since the hospital does not currently have medical units or outreach programs to treat these conditions. For example, although we triage patients with mental health and substance abuse problems in our emergency service areas, our organization does not have a facility to treat mental and behavioral conditions. There is a private for-profit mental health and substance abuse hospital in our community. Additionally the state of Georgia provides mental health services through the Gwinnett Rockdale Newton Community Service Board. Our GMC-Lawrenceville campus has a Level III Neonatal Intensive Care Unit and a 12-bed pediatric emergency department; however, the hospital does not have a primary focus on inpatient pediatrics (after the neonate period). In Gwinnett County, there is a wide range of pediatric healthcare services available through Children's Healthcare of Atlanta. Part VI, Line 3: Every patient registered at a GHS facility is provided a "Billing and Collection Information" document. This document advises the patient about the hospital's financial assistance program. The inpatient handbook also instructs patients on how to seek and apply for financial assistance through our team of Financial Counselors. In addition, patient bills include contact information for seeking financial assistance via telephone or by email at financialcounselor@gwinnettmedicalcenter.org. The hospital system's website also includes information about applying for financial assistance. Patient billing statements inform patients that the financial assistance policy and applications are on the website for easy access. The financial assistance assessment form is available in the facility and on the website in English, Spanish, Korean and Vietnamese.Financial Counselors meet with all uninsured patients who are admitted as an inpatient or who have a scheduled procedure or high dollar imaging test. Patients who are unable to pay deposits for medical service are also referred to a financial counselor by the patient registration staff. There is a financial counselor assigned to walk-ins Monday through Friday to ensure that all patients who are seeking assistance are interviewed at their convenience. Part VI, Line 4: Gwinnett Hospital System serves the area in and around Gwinnett County, Georgia. Gwinnett County is located in the northeast suburbs of the metropolitan Atlanta area and is 98 percent urban. This is the 50th largest county in the state of Georgia by land mass (432.73 square miles) and the second largest by population (808,167 residents in 2009). The population of Gwinnett County has increased by 37.3 percent since 2000. By 2007, Gwinnett had grown to become the 66th most populated county in the nation. Three census tracts are designated medically underserved areas (CT 0503.12, CT 0504.19 and CT 0504.21) in Gwinnett County. There is one Federally Qualified Health Center in Gwinnett County (Norcross) serving residents from these census tracts as well as other Gwinnett County residents.Gwinnett County has one for-profit general acute care hospital, Emory Eastside Medical Center in Snellville. Other hospitals are also located in surrounding counties of the metropolitan Atlanta area. SummitRidge Hospital in Lawrenceville is a for-profit hospital serving mental health and substance abuse patients.The population has become more racially and ethnically diverse with representation from across the nation and around the world. In 2009, the U.S. Census Bureau estimated the Gwinnett County population to be 49.2 percent non-Hispanic Whites, 22.1 percent non-Hispanic Blacks, 18 percent Hispanics, 9.6 percent non-Hispanic Asians and 2.5 percent was non-Hispanic Others (American Indian or Alaska Native, Native Hawaiian or Pacific Islander, Multiracial or Unknown).Gwinnett County has an unusual age distribution pattern with 72 percent of the population under the age of 45. Because of this distribution pattern, the median age of the total population from 2000 through 2007 was 33.8 years of age; when viewed by race and ethnicity, the median age of non-Hispanic Whites was 34.7, non-Hispanic Blacks 29.1 and Hispanics 25.1. Thirty percent of the population was under 18 years of age and 6.8 percent was 65 years of age and older.The U.S. Census Bureau estimate for 2008 reported there were 178,712 females between the ages of 13 and 44 in Gwinnett County. This age-range is usually considered the childbearing years.According to the Centers for Medicare and Medicaid Services (CMS), the percentage of Medicaid recipients compared to the total Gwinnett County population has increased from 15.8 percent in 2004 to 16.6 percent in 2008 or 131,310 recipients. According to the CMS in 2007, there were 51,104 Medicare beneficiaries in Gwinnett County.The lack of health insurance coverage is a significant barrier to accessing needed healthcare. In 2005, the U.S. Census Bureau Small Area Health Insurance estimated 24 percent of Gwinnett residents were uninsured; however, there is strong likelihood that this percentage has increased dramatically due to the recent economic downturn.The U.S. Census Bureau's American Community Survey 3-Year Estimates for 2006-2008 provides a representation of average characteristics of the population and is not representative of a single point in time. From these surveys, the following information has been made available about Gwinnett County residents.- There were 256,000 households in Gwinnett. Families make up 75 percent of the households; 57 percent married-couple families and 18 percent other families. People living alone make up 20 percent of the population.- Eighty-seven percent of residents 25 years of age and over had at least graduated from high school and 36 percent had a bachelor's degree or higher. Thirteen percent of residents were not enrolled in school, had not graduated from high school, and were considered to have dropped out of school.- Twenty-four percent of the population was foreign born.- Of individuals at least five years of age, 30 percent spoke a language other than English at home; of that 30 percent, 51 percent spoke Spanish. In addition, of those who spoke another language, 50 percent reported they did not speak English "very well."- Seventy-four percent of the population 16 years of age and older are in the labor force. - The median income of households was $66,846.- Nine percent of residents were below the poverty level. Thirteen percent of children under 18 were below the poverty level, compared with eight percent of the people 65 years of age and over. Seven percent of all families and 20 percent of families with a female head of household and no husband present had incomes below the poverty level.- Four percent of the households did not have telephones.- Three percent of the households did not have access to a car, truck or van for private use. Part VI, Line 5: Community building activities include programs that address root causes of health problems and are captured in the categories of coalition building and workforce development in an effort to enhance public health. Our organization did not participate in these activities to increase referrals or to fulfill regulatory requirements or current standards-of-care.Coalition building includes participation of the Chaplaincy, Coordinated Care, Physician Services and the Community Benefit & Research departments. These departments participate in community coalitions and other collaborative efforts to address safety and health issues to promote the health of the community; for examples, Gwinnett Fire Services Critical Incident Stress Management Team, Child Protection Task Force and the YMCA Board of Directors.Our community collaborations continue to support our vision and mission and further tie us to the community we serve. The organization has actively participated with the Gwinnett Coalition for Health and Human Services for 20 years as a founding and permanent member. This coalition is a county-level organization with representatives from 56 board members from county government, state government, services providers, schools, corporate/professional services, funders and other community groupsthat serves the community through initiatives driven by its subcommittees (e.g., Executive Committee, Board of Directors, Great Days of Service, Research and Accountability Committee and the Task Force for the Youth Survey Fact Book).We collaborate with AIDGwinnett, J. M. Tull - Gwinnett YMCA, Gwinnett United in Drug Education, Inc. (GUIDE), Gwinnett Foster Children's Foundation and Boy Scouts' Medical Explorers program. Our organization works closely with the Gwinnett Chamber of Commerce and actively participates in Partnership Gwinnett, which is a comprehensive plan that partners government, education, healthcare and business in an economic development plan. In addition to the Chamber, GHS is involved with individual cities in the county.GHS is involved with state and county government agencies including Georgia Department of Health and Human Services, Gwinnett Public Health Department, GRN Community Service Board, Georgia Trauma Care Network Commission, Georgia State Office of Emergency Medical Services and Trauma, Partnership Against Domestic Violence (PADV), Gwinnett County Rape Crisis Center, Gwinnett County Justice System, Gwinnett County Police Department, Gwinnett County Public Library, Gwinnett County Public School System, Department of Family Children Services (DFCS), Department of Aging Services (DAS), Gwinnett County Senior Services and the Georgia Medicare Foundation.GHS works with national agencies which have local chapters including the American Heart Association, American Red Cross, March of Dimes, American Stroke Association, American Cancer Society, American Diabetes Association and the United Way.Our efforts in workforce development include recruiting physicians across multiple specialties for community practices according to community needs established in the 2010 Physician Needs Assessment. The organization's primary purpose in these efforts is to assist in community physician recruitment to improve access to care in our community. Part VI, Line 6: Our vision is to be the health system of choice in our community by enhancing the health of our patients and other customers. We live that vision by joining with physicians, community and other healthcare organizations to treat injury and disease as well as providing preventive and early intervention care. The GHS Board of Directors is comprised of independent community leaders dedicated to providing quality healthcare for our community. In general, our volunteer board members are persons who reside in our primary service area and neither they (nor their family members)are employees or contractors of the organization.Medical staff privileges in the hospitals are available to all qualified physicians as determined through a detailed credentialing process. GHS has over 800 affiliated physicians with 590 physicians in the active or active-provisional categories providing healthcare services at both GMC-Lawrenceville and GMC-Duluth campuses.The organization reinvests all profits back into physician and staff training, and facilities and equipment to continually improve patient care. In contrast to investor-owned hospitals, no part of net earnings directly or indirectly benefits any private shareholders or individuals.Full-time Emergency Departments are operated at both the GMC-Lawrenceville and GMC-Duluth campuses. No one requiring emergency care is denied treatment regardless of their ability to pay. The total number of discharges from both Emergency Departments was 134,058 for fiscal year 2010. The 60-bed Emergency Department at GMC-Lawrenceville is one of the busiest in Georgia. This location has a 12-bed Children's Emergency Center, an accredited Chest Pain Center and is designated as a Level II Trauma Center providing 24 hours a day, seven days a week trauma team coverage serving residents of Gwinnett County and the surrounding area. Only 15 of the state's 152 acute-care hospitals are designated trauma centers.Both GMC-Lawrenceville and GMC-Duluth hospitals and all facilities participate in Medicare, Medicaid, CHAMPUS and PeachCare as appropriate for services provided. Part VI, Line 7: Gwinnett Hospital System is a licensed 553 bed healthcare organization with two acute-care hospitals: Gwinnett Medical Center-Lawrenceville (GMC-L) and Gwinnett Medical Center-Duluth (GMC-D). GMC-L and GMC-D serve areas of both Gwinnett County and to a lesser extent several surrounding counties. In addition to the medical-surgical hospitals, the organization also includes the Gwinnett Women's Pavilion and the Gwinnett Extended Care Center on the GMC-Lawrenceville campus as well as the Glancy Rehabilitation Center in Duluth. Gwinnett Hospital System is part of the Gwinnett Health System. Other affiliated organizations include: Gwinnett Health System, Inc. - the nonprofit parent organization of Gwinnett Hospital System and its affiliates. Gwinnett Medical Center Foundation - a nonprofit philanthropic organization that supports the Gwinnett Hospital System by raising money for The Miles and Lib Mason Children's Clinic, capital equipment purchases for the GMC-Duluth and GMC-Lawrenceville hospitals, cardiovascular services, cancer care, children's and women's services, neuroscience, orthopedicas and a variety of other programs.Gwinnett Medical Properties - a nonprofit organziation that owns medical properties in and around Gwinnett County for the purpose of aiding Gwinnett Hospital Systems in fulfilling its mission.Gwinnett Medical Services - a nonprofit organization whose mission is to operate physician clinics in and around Gwinnett County. GA 1 Gwinnett Hospital System Foundation Inc 1000 Medical Center Blvd Lawrenceville GA 30045 581828486 501(c)(3) 433485 operating expenses Gwinnett Medical Services inc 1000 Medical Center Blvd Lawrenceville GA 30046 582143107 501(c)(3) 3000000 Operating Expenses 2 Educational Scholarships 43 107500 FMV of Cash Blood Glucose Meters 951 57060 Manufacturer's Price Blood Glucose Meters INSULIN START KITS 414 12420 Manufacturer's Price Insulin Start Kits Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Grants were made to a related 501(c)(3) organization. X X X 1 1 X X X X X X 1 1 0 0 0 0 0 0 0 Philip R Wolfe 551419 0 197028 0 137772 0 93605 0 32774 0 1012598 0 0 0 ALAN BREIR 318696 0 95803 0 91549 0 51456 0 37685 0 595189 0 0 0 Thomas Y McBride III 317107 0 94112 0 104348 0 21463 0 23205 0 560235 0 0 0 Jeffrey Nowlin 284153 0 84532 0 50974 0 44918 0 37906 0 502483 0 0 0 Peter Wheeler 231369 0 60275 0 49341 0 44691 0 32994 0 418670 0 0 0 Wallace Brown 222478 0 50944 0 54565 0 49933 0 22378 0 400298 0 0 0 Stephen Nadeau 220173 0 50268 0 55467 0 35996 0 24838 0 386742 0 0 0 Carol Danielson 218644 0 39800 0 47473 0 34485 0 31679 0 372081 0 0 0 Lea Bay 206124 0 42060 0 32706 0 25195 0 31063 0 337148 0 0 0 Jessie T Shepherd 182036 0 45084 0 39993 0 25097 0 29409 0 321619 0 0 0 Scott Orem 153089 0 39046 0 16690 0 27249 0 25850 0 261924 0 0 0 James Dennard JR 170507 0 21796 0 9866 0 20451 0 31947 0 254567 0 0 0 Diana Potts 132142 0 15731 0 39531 0 18013 0 21948 0 227365 0 0 0 Cathy Dougherty 126485 0 22387 0 33390 0 14080 0 27609 0 223951 0 0 0 Bonny Richardson 131575 0 25046 0 13016 0 10605 0 24150 0 204392 0 0 0 Pamela Kauffman 113290 0 17587 0 33738 0 14726 0 26978 0 206319 0 0 0 Michael Hemphill 126882 0 0 0 29742 0 12758 0 28496 0 197878 0 0 0 Jason Chandler 154192 0 0 0 63001 0 20814 0 27400 0 265407 0 0 0 Janet Schwalbe 147009 0 38947 0 29389 0 21482 0 14042 0 250869 0 0 0 Thomas Lynch 157624 0 40963 0 29296 0 20415 0 22997 0 271295 0 0 0 Romeo P Massoud 376638 0 54575 0 188316 0 22014 0 33802 0 675345 0 0 0 Michael A Amaral 504716 0 0 0 73076 0 23393 0 35218 0 636403 0 0 0 Michael T Stechison 530007 0 0 0 38738 0 23393 0 28480 0 620618 0 0 0 Barry Renz 426455 0 3814 0 124905 0 26405 0 33063 0 614642 0 0 0 Martin Austin 270939 0 58217 0 44090 0 16658 0 35127 0 425031 0 0 0 Keith Buchanan 0 0 52000 0 0 0 0 0 3978 0 55978 0 0 0 Thomas J Karr Jr 0 0 0 0 531357 0 0 0 14799 0 546156 0 0 0 Ronald Corder 17500 0 9972 0 276464 0 3913 0 15661 0 323510 0 0 0 Part I, Line 4a Part I, Line 4a: Thomas Karr $ 14,215 Ronald Corder $234,143 Part I, Line 4b: Employer Contributions to 457(f) Executive Retirement Benefit Plan Philip Wolfe 72,252 Alan Bier 31,167 Jeffery Nowlin 27,500 Wallace Brown 22,468 Peter Wheeler 15,963 Stephen Nadeau 14,309 Jessie T. Shepherd 9,500 Lea Bay 7,960 Thomas Lynch 8,151 James Dennard 5,208 Scott Orem 7,446 Janet Schwalbe 7,428 Diana Potts 5,531 Carol Danielson 22,400 Pamela Kauffman 6,141 Jason Chandler 8,741 Payment from a Split Dollar Insurance Plan Thomas Karr $516,979 Hospital Authority of Gwinnett County Georgia 586011878 403732DE7 2009-11-12 32855000 Current refunding of 7/26/07 Issue 0 0 hospital Authority of Gwinnett County Georgia 586011878 403732DS6 2009-11-12 37745000 Current refunding of 7/26/07 Issue 0 0 hospital Authority of Gwinnett County Georgia 586011878 403732DU1 2009-11-12 19240000 Current refunding of 7/26/07 Issue 0 0 hospital Authority of Gwinnett County Georgia 586011878 403732DZ0 2009-11-12 61095000 Current refunding of 7/26/07 Issue 0 0 hospital Authority of Gwinnett County Georgia 586011878 403732CT5 2008-05-22 34750000 Current refunding of 7/26/07 Issue 0 0 32855000 32855000 1 0 1 1 37745000 37745000 1 0 1 1 19240000 19240000 1 0 1 1 61095000 61095000 2007 1 0 1 1 34025000 34025000 2008 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 hospital Authority of Gwinnett County Georgia 586011878 403732CV0 2008-05-22 59925000 Current refunding of 7/26/07 Issue 0 0 HOSPITAL AUTHORITY OF GWINNETT COUNTY GEORGIA 586011878 403732EQ9 2009-11-24 78635000 Renovation & Expansion and Current refunding of 5/22/08 Issue 0 0 56625000 56625000 1 0 1 1 78635000 60075000 454320 18105680 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 0 1 0 0 0 0 Thomas Y McBride III Loan premium payment for split dollar Life Insurance X 1698594 1698594 0 1 1 1698594 Tracy Waldrop Daughter of Board Member Ed Radford 56958 Tracy is employed by the Organization. 0 Miles Mason III Md Board Member of GHSI 48583 Board services and medical Services 0 Manfred Sandler Board Member of GHSI 23314 Board services and medical services 0 Cardiovascular Group Medical Practice of Board Member Manfred Sandler 289180 Medical Services provided by group 0 X 90508 FMV 0 0 0 0 Form 990, Part VI, Section A, line 5 A check for $360,000 was cashed through our checking account. As soon as GHSI became aware that the check was going to be paid from our account, we notified the bank. However, the check was inadvertently cashed by the bank. GHSI completed a police report and notified the bank. Our bank worked with the bank sending the check through and subsequently all funds were returned to our account. GHSI runs postive or control pay daily to prevent such events. Form 990, Part VI, Section A, line 6 The sole member of Gwinnett Hospital System, Inc. is Gwinnett Health System,Inc., a related 501(c)(3) organization. Form 990, Part VI, Section A, line 7a The board of directors of Gwinnett Hospital System, Inc. is appointed by the Gwinnett Health System, Inc., a related 501(c)(3) organization. Form 990, Part VI, Section A, line 7b Certain actions of the board of directors of Gwinnett Hospital System, Inc. must be approved by the board of directors of Gwinnett Health System, Inc., a related 501(c)(3) organization. Form 990, Part VI, Section B, line 11 GHSI makes a copy of the 990 available to all Board Members through a secure website. It is also presented to the Finance Committee of the Board each year. Form 990, Part VI, Section B, line 12c A conflict of interest questionnaire is discussed and distributed annually to each Board Member. The Legal department is responsible for insuring these are signed and returned. Legal monitors all transactions involving conflicts of interest with board members. Approval for any loans, payments, honorariums, trip or travel reimbursements, services, products, entertainment, prizes or awards provided to any Board Member must be approved by an Administrative Officer or his/her designee. The CEO must obtain the approval of the Chairman of the Board (and payments to the CEO are approved by another Administrative Officer.) In Addition, Human Resources sends out a conflict of interest policy and disclosure form to officers and key employees every 3-5 years. Form 990, Part VI, Section B, line 15 Gwinnett Hospital System, Inc. (GHSI) Board of Directors has established a Compensation Committee made up of various Board Members who review compensation of the CEO, top management and other key employees. This Compensation Committee is responsible for the review and approval of the salary of the CEO. The CEO is responsible for determining the salaries of top management with oversight by the Compensation Committee of the Board of Directors. An independent professional executive compensation consulting company hired by the Board provides salary and benefit survey information and makes recommendations to the Compensation Committee regarding compensation of the CEO, top management and key employees. These periodic surveys are conducted to ensure the salaries and benefits for GHSI executives and other disqualified parties are compensated appropriately at fair market value. Form 990, Part VI, Section C, line 19 Governing documents are filed and available on the Georgia Secretary of State website or through that office. These can also be obtained by contacting GHSI. Limited financial information is available online through the Community Benefit Report as well as our Annual Report, both of which are available on line at www.gwinnettmedicalcenter.org. Gwinnett Hospital's conflict of interest policy can be obtained by contacting GHSI. GHSI is under obligation to disclose to bond holders pertinent financial information in the Annual Disclosure Documents. Contact information for GHSI can be obtained at www.gwinnettmedicalcenter.org. Gwinnett Hospital System Physician's Group LLC 1000 Medical Center Blvd Lawrenceville GA 30046 204553410 physician services GA -9714136 1877888 N/A Gwinnett Health System Inc 1000 Medical Center Boulevard Lawrenceville GA 30046 582135755 Parent of Gwinnett Hospital GA 501C(3) 11 N/A Gwinnett Hospital System Foundation 1755 North Brown Road 100 Lawrenceville GA 30043 581828486 Fundraising organization for GHSI GA 501C(3) 7 N/A Gwinnett Medical Services Inc 1000 Medical Center Boulevard Lawrenceville GA 30046 582143107 Physicians Practice Owner GA 501C(3) 3 N/A Gwinnett Medical Properties Inc 1000 Medical Center Boulevard Lawrenceville GA 30046 582132516 Property Holding GA 501C(3) 11 N/A Gwinnett Endoscopy Services Inc 3855 Pleasant Hill Road Suite 130 Duluth GA 30096 262905890 Endoscopy Healthcare GA N/A related 16464 684446 0 1 Gwinnett Managed care Inc 1000 medical center boulevard lawrenceville GA 30046 582135759 PHO GA N/A C 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 Gwinnett Endoscopy Services LLC D 26642