2024-05-14T12:59:26-05:00 2023-06-30 KPMG LLP 303 PEACHTREE ST STE 2000 ATLANTA GA 30308 990 2022-07-01 870963633 Piedmont Cartersville Hospital Inc % MARIE GAFFNEY PIED 4044251303 960 JOE FRANK HARRIS PKWY SE CARTERSVILLE GA 30120 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2024-05-13 true MARIE GAFFNEY 999009999 WHITNEY B HEBRON P01226647 4042223000 2024-05-13 3 2022 2023-04-26 12:10:37Z Lori Rakes 2727 PACES FERRY RD STE 2-700 ATLANTA GA 30339 191327270 false X www.piedmont.org X 2021 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 10 7 1007 100 0 0 0 89310 227209898 189191600 562475 647927 348833 1398433 228121206 191327270 0 0 0 0 54980173 68485737 0 0 0 163579439 130578497 218559612 199064234 9561594 -7736964 561135082 536548436 56862382 26353611 504272700 510194825 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 168350854 0 189191600 PIEDMONT CARTERSVILLE HOSPITAL, INC. IS A 119-BED FACILITY LOCATED IN THE CITY OF CARTERSVILLE IN BARTOW COUNTY, GEORGIA. OUR PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN CARTERSVILLE AND THE GREATER METROPOLITAN ATLANTA MARKET, REGARDLESS OF ANY INDIVIUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2023, THE HOSPITAL HAD 7,308 IN-PATIENT ADMISSIONS WITH A TOTAL OF 39,421 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 48,067 AND OUTPAITENT VISITS TOTALED 34,022. SURGICAL SERVICES WERE PROVIDED TO 4,659 PATIENTS. 168350854 true true false 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 true true false false false true X 0 0 1007 true false false false false false false false false false false false false X 10 7 false false false false true true true true true false false false true true true true true true true false GA X MARIE GAFFNEY 4702716007 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 X Ms Elizabeth Leddy Secretary/CLO PHC 1.0 54.0 X 0 1389485 138711 Mr Thomas Arnold Treasurer/CFO PHC 1.0 54.0 X 0 1173444 130741 Mr Jeffrey Mosley CEO & BOARD MEMBER 55.0 0.0 X X 677103 0 93065 Ms Katie Logan Board Member 1.0 54.0 X 0 605675 87129 Mr Benjamin McDonald CFO 55.0 0.0 X 463176 0 31913 Ms Lori Rakes CEO (AS OF 3/23) 55.0 0.0 X 390861 0 42530 Mr Mark Senger CMO 40.0 0.0 X 377093 0 32088 MS JAN TIDWELL CNO 40.0 0.0 X 325158 0 40826 MR WELLINGTON ROLLE ED FLOW COORDINATOR 40.0 0.0 X 259672 0 23917 MS SHANNON SIMS DIRECTOR - PHARMACY 40.0 0.0 X 195321 0 27514 MR CALVIN EDDINS ED FLOW COORDINATOR 40.0 0.0 X 189633 0 5683 Mr Steven Spivey MD Board Member 1.0 0.0 X 40333 0 0 Dr Jeffrey Brant Board Member 1.0 0.0 X 0 0 0 Mr Ballard Mauldin Board Member 1.0 0.0 X 0 0 0 Mr Wayne Moore Board Member 1.0 0.0 X 0 0 0 Mr Victor Morgan Board Member 1.0 0.0 X 0 0 0 Ms Connie Morris Board Member 1.0 0.0 X 0 0 0 Ms Dana Nichols Board Member 1.0 0.0 X 0 0 0 Mr Marty Sonenshire Board Member, Chair 1.0 0.0 X X 0 0 0 2918350 3168604 654117 97 false true false AYA HEALTHCARE INC 5930 CORNERSTONE CT W STE 300 SAN DIEGO CA 92121 HEALTHCARE STAFFING 13464949 MEDICAL SOLUTIONS LLC 1010 N 102ND STREET SUITE 300 OMAHA NE 68114 HEALTHCARE STAFFING 11683498 HEALTHCARE WORKFORCE LOGISTICS LLC 2655 Northwinds Pkwy ALPHARETTA GA 30009 WORKFORCE MGMT SVCS 5184951 ENVISION PHYSICIAN SERVICES LLC 1A BURTON HILLS BLVD NASHVILLE TN 37215 HEALTHCARE STAFFING 2325311 HEALTHTRUST WORKFORCE SOLUTIONS LLC 1054 BAXTER ST ATHENS GA 30606 HEALTHCARE STAFFING 1780549 31 89110 200 89310 PATIENT SERVICE REVENUE 622110 189180919 189180919 0 0 OTHER OPERATING REVENUE 900099 10681 10681 0 0 189191600 647927 0 0 647927 0 0 1055089 0 1055089 0 1055089 0 0 1055089 0 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722310 343344 0 0 343344 343344 191327270 189191600 0 2046360 0 0 0 0 1251903 1017672 234231 0 0 54057129 43943040 10114089 0 0 9405403 7645652 1759751 0 3771302 3065691 705611 0 0 40522 0 40522 0 0 0 0 0 44728981 36360189 8368792 0 497890 404735 93155 0 10391112 8446935 1944177 0 2753279 2238140 515139 0 0 4908642 3990235 918407 0 25840 21005 4835 0 0 0 1949993 0 1949993 0 0 4796242 3898865 897377 0 1839102 0 1839102 0 BAD DEBT EXPENSE 17318057 17318057 0 0 DRUGS & MEDICAL SUPPLIES 30723749 30723749 0 0 HOSPITAL TAX 3506214 3506214 0 0 MISC. 7098874 5770675 1328199 0 199064234 168350854 30713380 0 281968993 189642050 0 0 0 0 -170138602 -119823394 0 0 0 0 0 0 3438622 3534653 696963 578231 105801590 8903712 79906811 96897878 21194 99378 0 0 0 0 0 0 365241101 365619640 561135082 536548436 28511394 26274589 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28350988 79022 56862382 26353611 X 504271360 510181509 1340 13316 504272700 510194825 561135082 536548436 X -7736964 13659089 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6830000 6830000 54281179 2575091 51706088 1255146 942335 312811 21595717 5386286 16209431 21839548 0 21839548 96897878 GOODWILL 365621640 OTHER ASSETS -2000 365619640 0 DUE TO RELATED PARTIES 0 OTHER LIABILITIES 79022 79022 X SCHEDULE D, PART X, LINE 2: ASC 740 FOOTNOTE (FKA FIN 48) PHC ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF ASC 740, INCOME TAXES (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 UNCERTAIN TAX EXPOSURE ITEMS. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT JUNE 30, 2023 and 2022. true true X true X 300. true X true true false true true 5327896 5327896 0.02930 7271981 5591798 1680183 0.00920 6361287 2717943 3643344 0.02000 18961164 8309741 10651423 0.05850 26080 26080 0.00010 622516 622516 0.00340 10000 10000 0.00010 658596 658596 0.00360 19619760 8309741 11310019 0.06210 3180 3180 21380 21380 18920 18920 43480 43480 true 1763088 28506587 31567064 -3060477 X true true 1 1 PIEDMONT CARTERSVILLE HOSPITAL INC 960 JOE FRANK HARRIS PKWY SE CARTERSVILLE GA 30120 HTTPS://WWW.PIEDMONT.ORG/ 007-567 X X X PIEDMONT CARTERSVILLE HOSPITAL INC 1 true true true X X X X X X X X 21 true false false true X SEE PART V, SECTION C X X true 22 true SEE PART V, SECTION C false true X 300. 300. X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINES 1 AND 2: NEW HOSPITAL ENTITY Piedmont Cartersville Hospital, Inc. ("PCH") was created as a new entity on May 24, 2021 and is the 501(c)(3) tax-exempt parent of Cartersville Medical Center LLC, a disregarded entity, which was acquired from HCA Healthcare, a for-profit company. Piedmont filed the PCH Form 1023 application for recognition of exemption under Section 501(c)(3) of the Internal Revenue Code on July 27, 2021, and received its IRS Determination Letter reflecting PCH's status as a 501(c)(3) organization with public charity status 170(b)(1)(A)(iii) on March 21, 2022. The IRS 501(c)(3) status per the Determination Letter is retroactive with an effective date of exemption of May 24, 2021. SCHEDULE H, PART V, SECTION B, LINE 5: COMMUNITY REPRESENTATION AS A PART OF OUR PROCESS, WE INTERVIEWED NEARLY 245 STAKEHOLDERS, POLICY MAKERS AND LAWMAKERS REPRESENTING PUBLIC HEALTH, LOW-INCOME POPULATIONS, MINORITIES, CHRONIC CONDITIONS, OLDER ADULTS, AND OUR COMMUNITIES. THESE INCLUDED 10 STAKEHOLDERS WITHIN THE PIEDMONT CARTERSVILLE COMMUNITY, WHO GAVE THEIR PERSPECTIVES ON COMMUNITY HEALTH THROUGH THE LENS OF THEIR ROLE WITHIN THE COMMUNITY. THESE INTERVIEWS WERE CONDUCTED FOR PEOPLE REPRESENTING THE ENTIRE REGION. SPECIFICALLY, WE INTERVIEWED REPRESENTATIVES OF LOCAL AND REGIONAL PUBLIC HEALTH ENTITIES, MINORITY POPULATIONS, FAITH-BASED COMMUNITIES, LOCAL BUSINESS OWNERS, THE PHILANTHROPIC COMMUNITY, MENTAL HEALTH AGENCIES, ELECTED OFFICIALS AND INDIVIDUALS REPRESENTING OUR MOST VULNERABLE PATIENTS. THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS AND LEADERSHIP FROM ALL 19 HOSPITALS WERE ACTIVELY INFORMED AND ENGAGED THROUGHOUT THIS PROCESS. SCHEDULE H, PART V, SECTION B, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT https://www.piedmont.org/media/file/Community-Benefit-Needs-Assessment-PCH .pdf SCHEDULE H, PART V, LINE 7D: PUBLIC AVAILABILITY OF CHNA IN ADDITION TO MAKING ITS CHNA REPORTS AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT CARTERSVILLE MEDICAL CENTER SENT COPIES TO EACH PARTICIPANT IN THE CHNA PROCESS, DISTRIBUTED THE ASSESSMENTS TO COMMUNITY CENTERS AND OTHER LOCATIONS THAT PRIMARILY SERVE AN UNINSURED POPULATION, SENT COPIES TO LEGISLATIVE AND ELECTED OFFICIALS, AND WIDELY DISTRIBUTED THE ASSESSMENTS TO OTHER PIEDMONT HEALTHCARE HOSPITALS. SCHEDULE H, PART V, LINE 10A: IMPLEMENTATION STRATEGIES WEBSITE THE BOARD OF DIRECTORS FOR PIEDMONT CARTERSVILLE MEDICAL CENTER APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE-YEAR PERIOD BEGINNING WITH FY23 ON SEPTEMBER 20, 2022, WITHIN THE GRACE PERIOD FOLLOWING THE APPROVAL OF THE NEW COMMUNITY HEALTH NEEDS ASSESSMENT. THE FOLLOWING LINK IS FOR THE IMPLEMENTATION STRATEGY EFFECTIVE THROUGH JUNE 30, 2025. https://www.piedmont.org/media/file/Community-Benefit-Implementation-Strat egy-PCH.pdf SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS PIEDMONT CARTERSVILLE MEDICAL CENTER CONDUCTED ITS FOURTH CHNA DURING FY22, AGAIN BY ASSESSING PUBLICLY AVAILABLE DATA, INTERVIEWING COMMUNITY MEMBERS AND STAKEHOLDERS, CONDUCTING FOCUS GROUPS OF VULNERABLE POPULATIONS, INTERVIEWING PIEDMONT BOARD MEMBERS, AND SURVEYING PIEDMONT EMPLOYEES. THROUGH THIS PROCESS, PIEDMONT CARTERSVILLE MEDICAL CENTER DETERMINED AND PRIORITIZED THE COMMUNITY HEALTH NEEDS IT WOULD ADDRESS BASED ON THE NUMBER OF PERSONS AFFECTED, THE SERIOUSNESS OF THE ISSUE, WHETHER THE HEALTH NEED AFFECTED VULNERABLE POPULATIONS, AND THE AVAILABILITY OF COMMUNITY AND HOSPITAL RESOURCES NECESSARY TO ADDRESS THE ISSUE. ALL PRIORITIES ARE VIEWED THROUGH THE LENS OF HEALTH DISPARITIES, WITH PARTICULAR ATTENTION PAID TO IMPROVING OUTCOMES FOR THOSE MOST VULNERABLE DUE TO INCOME AND RACE. BASED ON THE CHNA, PIEDMONT CARTERSVILLE MEDICAL CENTER IS CURRENTLY FOCUSING ON: (1) ENSURING AFFORDABLE ACCESS TO HEALTH, MENTAL, AND DENTAL CARE (2) REDUCING PREVENTABLE INSTANCES OF, AND DEATHS FROM, CANCER (3) PROMOTING HEALTHY BEHAVIORS TO REDUCE PREVENTABLE CONDITIONS, DISEASES, AND ADDICTION (4) REDUCING PREVENTABLE INSTANCES OF, AND DEATHS FROM, HEART DISEASE SCHEDULE H, PART V, LINE 16: FINANCIAL ASSISTANCE POLICY WEBSITES FINANCIAL ASSISTANCE POLICY - HTTPS://WWW.PIEDMONT.ORG/MEDIA/FILE/FINANCIAL-ASSISTANCE-POLICY.PDF FINANCIAL ASSISTANCE APPLICATION - HTTPS://WWW.PIEDMONT.ORG/MEDIA/FILE/FINANCIAL-ASSISTANCE-APPLICATION.PDF FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY - HTTPS://WWW.PIEDMONT.ORG/MEDIA/FILE/FINANCIAL-ASSISTANCE-PLAIN-LANGUAGE-SU MMARY-ENGLISH.PDF SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS SCHEDULE H, PART I, LINE 6A PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT We regularly report to the community our community benefit activities in several ways. Each year, we prepare a systemwide community benefit report that is available to the public through publication on our website. We also make available our IRS Form 990 Schedule H on our website and provide copies to anyone upon request. We also provide information on community benefit programming to local, state, and federal lawmakers through our government affairs office and online at piedmont.org. SCHEDULE H, PART I, LINE 7(F) PERCENT OF TOTAL EXPENSE 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 $199,064,234, LESS BAD DEBT EXPENSE OF $17,318,057 FROM FORM 990, PART IX, LINE 24(A). SCHEDULE H, PART I, LINE 7 FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST 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. SCHEDULE H, PART III, LINES 2-4 BAD DEBT EXPENSE CALCULATION AND FOOTNOTE The provision for bad debts is based upon leadership's assessment of historical and expected net collections considering business and economic conditions, trends in health care coverage and other collection indicators. Periodically, leadership assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category. The results of the review are then used to make any modifications to the provision for bad debts to establish an appropriate allowance for uncollectible receivables. 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. THAT TOTAL WAS THEN ADJUSTED DOWNWARD FOR THE ORGANIZATION'S USE OF PRESUMPTIVE ELIGIBILITY WHEN DETERMINING ITS COMMUNITY BENEFITS. 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 PAYOR CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBT TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. PCH 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. Part III, Section B, line 8 MEDICARE SHORTFALLS AS COMMUNITY BENEFIT The amount reported on Part III, Line 6, was calculated in accordance with Schedule H instructions by utilizing our 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 provide 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. We believe our Medicare shortfall reported on Part III, Line 7 of Schedule H, should be considered a community benefit as the IRS community benefit standard includes the provision of care to elderly and Medicare patients. IRS Revenue Ruling 69-545 provides, in part, that hospitals serving patients with governmental health insurance, such as Medicare, is an indication we operate to promote health in the community. Our policy is to treat Medicare patients, regardless of the extent to which Medicare pays for the treatment. For many services, Medicare's reimbursement is less than the cost of the care provided, resulting in shortfalls that are to be absorbed by us in honor of our commitment to treat elderly patients. Many of these patients live on a low, fixed income, and would qualify for financial assistance or other means-tested programs, absent from their enrollment in Medicare. SCHEDULE H, PART III, LINE 9(B) COLLECTION PRACTICES 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. SCHEDULE H, PART VI, LINE 2: NEEDS ASSESSMENT As a designated 501(c)(3) nonprofit hospital, we are required by the Internal Revenue System to conduct a triennial community health needs assessment (CHNA), in accordance with regulations put forth by the IRS following the 2010 Patient Protection and Affordable Care Act (ACA). Through this assessment, we hope to better understand local health challenges, identify health trends in our community, determine gaps in the current health delivery system and craft a plan to address those gaps and the identified health needs. In FY22, we conducted our fourth triennial CHNA and FY23 was the first year for activities outlined in its subsequent Implementation Strategy. The CHNA was led by the Piedmont Healthcare community benefits team and consulting organization Public Goods Group, with input and direction from Piedmont leadership and Piedmont Healthcare's Department of External Affairs. Process The CHNA started with a definition of our community, which is our home county due to the impact of our tax-exempt status. Property taxes make up the largest segment of a hospital's tax exemption, which impacts county revenues. Because of this, we aim to ensure that we are providing ample benefit to our county and its residents. Additionally, we take into consideration patient origin, especially that of our lower-income patients such as those who qualify for financial assistance or receive insurance coverage through Medicaid. Our secondary communities are considered the areas in which we have the highest concentration of patients fitting that criterion, including ones from nearby communities. Once we established our primary and secondary communities, we then conducted an analysis of available public health data. This included resources from: US Census, US Health and Human Services' Community Health Status Indicators, US Department of Agriculture, Economic Research Service, National Center for Education Statistics, Kaiser Family Foundation's State Health Facts, American Heart Association, County Health Rankings and Georgia Online Analytical Statistical Information System (OASIS). All figures within the CHNA were for 2020, unless otherwise noted. Health indicators are estimates provided by County Health Rankings and hospital data were internally sourced. We then interviewed key stakeholders who have a particular expertise or knowledge of our communities. Specifically, we interviewed representatives of local and regional public health entities, minority populations, faith-based communities, local business owners, the philanthropic community, mental health agencies, elected officials and individuals representing our most vulnerable patients. An internal survey was also conducted throughout the healthcare system for both clinical and non-clinical employees. Information was gathered on knowledge and understanding of community benefit and current programs, as well as suggestions for how we can better serve our patients and communities. Approximately 1,053 employees spanning the system responded. Additionally, we conducted a community-based survey that was widely advertised to the community. Once both qualitative and quantitative data was gathered, we authored the preliminary report, which was then vetted and reviewed by hospital and health system leadership. In this report, we identified several key community health needs that emerged during the assessment process. The chosen priorities were recommended by the community benefit department with sign-off from hospital and board leadership. The following criteria were used to establish the priorities: - The number of persons affected; - The seriousness of the issue; - Whether the health need particularly affected persons living in poverty or reflected health disparities; and, - Availability of community and/or hospital resources to address the need. All priorities are viewed through the lens of health disparities, with particular attention paid to improving outcomes for those most vulnerable due to income and race. The priorities we chose reflected a collective agreement on what hospital leadership, staff and the community felt was most important and within our ability to positively impact the issue. Once priorities were approved by the board of directors, we then authored the CHNA and presented our findings and recommendations to the hospital's board of directors for their input and approval. Our priorities A key component of the CHNA is to identify the top health priorities we will address over fiscal years 2023, 2024, and 2025. These priorities will guide our community benefit work. They are, in no order: - Ensure affordable access to health, mental, and dental care - Reduce preventable instances of and deaths from cancer - Promote healthy behaviors to reduce preventable conditions, diseases, and addiction - Reduce preventable instances of and deaths from heart disease With each priority, we work to achieve greater health equity by reducing the impact of poverty and other socioeconomic indicators. This means that health equity is built into each priority, which is demonstrated through our implementation strategies. Our subsequent implementation strategy was developed in partnership with hospital leadership and community stakeholders to address the identified priorities in our FY22 community health needs assessment. The implementation strategy was designed to be executed over a three-year period and included specific metrics by which we would be able to evaluate our work and its impact. The implementation strategy was developed by utilizing community feedback from the assessment in partnership with the system community benefits department, our leadership, and our board of directors. We included proven and successful interventions and programming, investing further in work we felt was successful in addressing unmet health needs. SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY We understand that not everyone can pay their hospital bill due to their insurance status or a limited income, and because of this, we offer financial assistance to qualifying patients. Notification about financial assistance includes, but is not limited to, a dedicated contact number, notices in patient bills, and posted notices in key areas of the hospital. These locations are the emergency room, admitting and registration departments, our business office, and patient financial services offices that are located on site. We also publish and widely publicize a plain language summary of this financial assistance care policy on our website, as well as the full policy. Referral of patients for financial assistance may be made by any staff or medical staff member at the hospital, including physicians, nurses, financial counselors, social workers, case managers, chaplains, and religious sponsors. A request for financial assistance may be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws. Additionally, we provide copies of our financial assistance policy to our partner clinics and others who work closely with low-income populations. We help our partners in understanding the policy, how it relates to their populations, and receive feedback in ways our financial assistance programming could be improved. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION While Piedmont Cartersville serves patients from a 10-county area, we consider our community to be Bartow County. We do this in recognition of the direct impact of our tax-exempt status on county residents. In Bartow County, approximately 108,000 people lived in the 460-square-mile area on average each year between 2017 and 2021. The population density for this area, estimated at 235 people per square mile, is greater than the state average population density of 184 people per square mile and the national average population density of 92 people per square mile. The ZIP code with the highest concentration of people was 30101 (Acworth), which 58 percent of the county's population called home. Bartow County is mostly urban, as about 61 percent of community members live within an urban setting. The ZIP code with the highest concentration of the rural population was 30139 (Fairmont) and, like in most of Georgia, rural populations in Bartow are overwhelmingly white. Bartow County is growing, having seen a nine percent increase in total population between 2010 and 2020. Approximately seven percent of the county's population were veterans on yearly average from 2017 to 2021, and most were non-elderly adults. About 12 percent of the population - more than 13,000 people - lived with a disability in Bartow County. Most of that population were under the age of 65. In Bartow County, about 24 percent of the population were 17 or younger, 14 percent were over the age of 65, and the remaining population were between the ages of 18 and 64. Between 2017 and 2021, on yearly average, about 76 percent of all Bartow County residents were white, 10 percent were African American, and about nine percent were Hispanic/Latino. Approximately five percent identified as being born outside of the US, and nearly three percent of the county's population did not have citizenship status. On average between the years 2017 and 2021, about 15 percent of the population had no form of insurance. Insurance status and health are inextricably linked. Being uninsured is generally a marker of low income, as the overwhelming majority of those who are uninsured are also within certain ranges of the federal poverty guidelines. This means these populations are also likely to face myriad other social determinants of health (SDH), like housing and food insecurity. Between 2017 and 2021, the median household income was $65,559, which is on par with the state level, but lower than the national level of $69,021. When broken down by the four dominant races in the community, income disparities are evident. Of employers in the community, the largest sector by number of employees is manufacturing, which employed more than 10,500 community members at an average annual wage of $67,978 in 2019, according to the US Department of Commerce. Retail trade was the second largest sector, with about 5,900 people employed at an average annual wage of $32,213. Government and government enterprises was the third largest sector, with about 5,400 people employed at an average annual wage of $63,656. According to the 2017-2021 American Community Survey, more than 53,500 people in the community were part of the labor force, and more than 1,600 - about three percent - were unemployed as of July 2023. This figure has increased slightly since last year, when in July 2022, less than three percent of the labor force was unemployed. When looking back further, the current rate is one third of the unemployment rate in 2012. In 2021, 12 percent of the county's population lived at or below the federal poverty guidelines, and about 31 percent lived at 200 percent of these guidelines. In 2022, the federal poverty guidelines represented a family of four as having a total household income of $27,750. Even when living at twice these guidelines, families are likely unable to afford many of life's basics. By far, the poorest ZIP code within Bartow County is 30161 (Rome), where nearly 40 percent of the population lived at or below 200 percent of poverty on yearly average from 2017 to 2021. In Bartow County, like most of the state, minorities are more likely to live in poverty. For example, on average, about 18 percent of Hispanic/Latino populations and 17 percent of Black populations were living at or below poverty, as compared to 11 percent of the white population. Of the more than 38,000 average total occupied households in Bartow County from 2017 to 2021, nearly 9,500 - about 25 percent of the population - lived in cost-burdened households, in which housing costs are 30 percent or more of total household income. Approximately 11 percent of households had costs that exceeded 50 percent of the household income, which places the household in significant financial strain. In Bartow County, in 2019, four of the county's 15 census tracts were food deserts, as shown in the map to the right. More than 23,000 people lived within these census tracts. These tracts almost directly correspond with census tracts demonstrating retailers who are authorized to take SNAP benefits. In Bartow County, like with most of the state, those retailers tend to be convenience and discount stores that carry limited, if any, healthy foods. Increasingly, discount stores like Dollar General do have some sort of produce section, but that is inconsistent among communities. Low food access is defined as living more than one mile (urban) or 10 miles (rural) from the nearest supermarket, supercenter, or large grocery store. This indicator is relevant because it highlights populations and geographies facing food insecurity. According to the 2019 Food Access Research Atlas database, about 30 percent of the total population in the county have low food access, meaning about 30,300 county residents may struggle to access healthy foods. This is on par with the state rate. ZIP code 30102 (Acworth) has the highest rate of low food access at nearly 50 percent of the population. In 2021, about 76 percent of adults aged 18 or older saw a doctor for a routine checkup the previous year, a measure that is likely over-reported and is lower than both state and national averages. For Medicare recipients, this number jumps to about 88 percent of adult beneficiaries, which is above both state and national averages. Routine checkups are a critical component to maintaining good health and identifying conditions that can be treated affordably in a community-based setting. Absent that, even simple-to-treat conditions can escalate to deeper issues, eventually requiring more intensive care, later-stage diagnoses, or reduced life expectancy. Heart disease is a leading cause of death for both women and men in Bartow County. On yearly average from 2016 to 2020, the age-adjusted death rate was about 222 deaths for every 100,000 people, which is between the state and national averages of 178 and 165 heart-related deaths per 100,000 people, respectively. In 2021, nearly six percent of county adults had a diagnosis of heart disease. Between 2016 and 2020, there were approximately 250 deaths due to stroke, representing an age-adjusted death rate of about 47 deaths per every 100,000 people. Men are far more likely to die from stroke than women, as are Black populations. The yearly average rate of hospitalization due to cardiovascular disease from 2017 to 2019 was 20 hospitalizations per every 1,000 Medicare beneficiaries, which is much higher than the state and national rates of about 12 and 11, respectively. The hospitalization rate for stroke is also above state and national rates, with 10 hospitalizations per every 1,000 Medicare beneficiaries, as compared to the state rate of about nine and the national rate of eight. These hospitalization rates for heart disease and stroke among Medicare recipients have remained relatively steady over the last five years. Although heart disease leads in county deaths, cancer remains a critical issue within the community. The cancer incidence rate for Bartow County each year on average between 2016 and 2020 was about 486 per every 100,000, which equates to an average diagnosis rate of nearly 600 new cases each year. Screening rates among Medicare beneficiaries is in line with state and national rates, except for breast cancer screening. In 2021, 31 percent of Medicare beneficiaries had a mammogram, as compared the state and national rate of 33 percent. In 2019, nearly nine percent of county adults aged 20 and older had diabetes, a figure lower than the state rate of 10 percent. Diabetes is a prevalent problem in the US, often indicating an unhealthy lifestyle, and it puts individuals at risk for further health issues. When looking at ZIP codes, rates shift. For example, ZIP code 30104 (Aargon) had a diabetes diagnosis rate of 10 percent. Chronic kidney disease, also called chronic kidney failure, involves a gradual loss of kidney function. The kidneys filter waste and excess fluids from the blood, which are then removed in the urine. Advanced chronic SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH We actively promote the health of our community through clinic-hospital partnerships; community-based health screenings; educational activities; community building activities; the operation of a 24-hour emergency department available to the entire community; the operation of an emergency room open to all members of the community without regard to ability to pay; a governance board composed of community members; use of surplus revenue for facilities improvement, patient care, medical training, education, and research; the provision of inpatient hospital care for all persons in the community able to pay, including those covered by Medicare and Medicaid; and an open medical staff with privileges available to all qualifying physicians. In FY23, Piedmont Healthcare launched the Empowering You platform to connect community members and patients with resources to address social determinant of health issues. Powered by FindHelp.org, Piedmont clinicians and case managers can search and refer patients to supporting organizations. Piedmont Cartersville provided hands-on training, support and supplies for Stop the Bleed, CPR, Early Heart Attack Care and Narcan at the Business and Industry Safety Council meeting at the Chamber of Commerce. EMS liaison Brad Cothran provided a drug use and overdose presentation at the Youth Explosion summer camp, in partnership with the Bartow County Drug Task Force, Cartersville Fire Department and Airlife. Piedmont Cartersville sponsored the 8th Annual EMS Summit, a free event for first responders, including EMS, fire, and law enforcement personnel. The event had approximately 200 attendees, and continuing education hours were offered. We also supported health workforce education by providing training, education, resources, and equipment to students in work-based learning and Certified Nurse Assistant (CNA) programs at Cartersville City Schools and Bartow County Schools. Our active involvement extended to assisting Cartersville High School in developing its CNA program. Additionally, our staff volunteered to participate in an interview panel and observed end-of-year presentations by work-based learning and career pathway students, including health science students. Piedmont Cartersville actively engaged in youth outreach through Teen Maze, a collaborative effort providing middle and high school students firsthand experiences of decision consequences. Operating a booth simulating an emergency room, we demonstrated the results of traumatic events, with an annual participation ranging from 800-1200 students. As a trauma grant beneficiary, Piedmont Cartersville has been a presenting sponsor and participant over the past two years. Piedmont Cartersville was the lead sponsor for the 2-week Advocate for Children and Cartersville Elementary School campaign fundraiser, Kids Helping Kids, for child abuse awareness and prevention. We provided free sports participation physicals for Bartow County children for Special Olympics. Approximately 110 physicals were completed. Piedmont Cartersville also provided free first aid and/or hydration stations at a community car show, a Chamber of Commerce picnic, a first responders 5K and more. At the Thanksgiving Dinner and Health Fair, we partnered with New Frontier of Bartow County to feed more than 1,000 community members Thanksgiving dinner and provide free blood pressure and blood sugar screenings. In support of the Compassion Care Center, Piedmont Cartersville hosted their Mobile Medical Clinic Service Awareness Day. The clinic focuses on bringing primary care to vulnerable populations in Bartow County that are uninsured or underinsured. For new and expectant parents, we offered free childbirth education, as well as breastfeeding and newborn care classes at Piedmont Cartersville. For patients and community members living with diabetes, we offered free diabetes education classes that included healthy nutrition information. We provided blood pressure screenings and education information for prevention and heart attack and stroke at the Senior Day at Cartersville Farmer's Market. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM We are part of Piedmont Healthcare, a regional not-for-profit organization and the parent company of 19 hospitals, the Piedmont Physicians Group, the Piedmont Heart Institute, the Piedmont Clinic and the Piedmont Healthcare Foundation. Our community relations team works directly with the community. Our community benefit department oversees the community benefit activities on behalf of all hospitals throughout the system, and this includes conducting the triennial CHNA and subsequent implementation strategy, ensuring the financial assistance policy is communicated to the community, maintaining the community benefit webpage, authoring the community benefit annual report, preparing board materials, developing and executing the community benefit grants program and compiling all community benefit figures. Each hospital and certain departments of Piedmont Healthcare execute community benefit programming, such as our revenue department, which oversees the financial assistance program. SCHEDULE H, PART VI, LINE 7: STATE OF FILING OF COMMUNITY BENEFIT REPORT We are not required to file a community benefit report; however, we are required to file with the Georgia Department of Community Health information on our indigent and charity care, as well as our Medicaid and Medicare shortfalls. X true true false true false false false false false true false Mr Thomas Arnold Treasurer/CFO PHC 0 640918 0 356487 0 176039 0 115097 0 15644 0 1304185 0 96797 Ms Elizabeth Leddy Secretary/CLO PHC 0 547780 0 295524 0 546181 0 117950 0 20761 0 1528196 0 490447 Ms Katie Logan Board Member 0 366742 0 161055 0 77878 0 73864 0 13265 0 692804 0 0 Mr Jeffrey Mosley CEO & BOARD MEMBER 378558 0 127500 0 171045 0 73263 0 19802 0 770168 0 0 0 Mr Benjamin McDonald CFO 292265 0 61625 0 109286 0 18300 0 13613 0 495089 0 0 0 Ms Lori Rakes CEO (AS OF 3/23) 276210 0 58437 0 56214 0 18300 0 24230 0 433391 0 0 0 Mr Mark Senger CMO 304455 0 63750 0 8888 0 16321 0 15767 0 409181 0 0 0 MR WELLINGTON ROLLE ED FLOW COORDINATOR 71822 0 180 0 187670 0 11974 0 11943 0 283589 0 0 0 MS SHANNON SIMS DIRECTOR - PHARMACY 179536 0 15237 0 548 0 11922 0 15592 0 222835 0 0 0 MR CALVIN EDDINS ED FLOW COORDINATOR 87849 0 180 0 101604 0 5463 0 220 0 195316 0 0 0 MS JAN TIDWELL CNO 224506 0 47813 0 52839 0 16758 0 24068 0 365984 0 0 0 Schedule J, Part I, Line 1A: Other Compensation Items Elizabeth Leddy, Thomas Arnold, Katie Logan, and Jeffrey Mosley received a discretionary spending account totaling $12,000, a fixed amount determined by their job level. This spending account was included in their taxable wages. Schedule J, Part I, Line 3: Compensation of the CEO/Executive Director The compensation for the President/CEO of Piedmont Cartersville 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. SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL COMPENSATION INFORMATION THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THEIR SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS: THOMAS ARNOLD $ 96,797 ELIZABETH LEDDY $490,447 JEFFREY MOSLEY AND KATIE LOGAN PARTICIPATED IN SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS. Schedule J, Part I, Line 7: Non-Fixed Payments Certain employees participated in an "annual incentive plan" under which they received non-fixed bonus payments based on job level and several different performance metrics. Form 990, Part V, Line 1A: Number of Forms 1099 Filed All calendar year 2022 Forms 1099 were filed on behalf of Piedmont Cartersville Hospital by its sole member, Piedmont Healthcare, Inc. (EIN: 58-1503902), pursuant to an agreement with the IRS to file all Forms 1099 for the Piedmont Healthcare system on a combined basis. FORM 990, PART VI, SECTION A, LINE 6: ORGANIZATION'S SOLE MEMBER PIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT CARTERSVILLE HOSPITAL ("PCH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT CARTERSVILLE HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT CARTERSVILLE HOSPITAL. FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT CARTERSVILLE 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 CARTERSVILLE 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. FORM 990, PART VI, SECTION B, LINE 11B: 990 REVIEW PROCESS INFORMATION NEEDED TO PREPARE PIEDMONT CARTERSVILLE HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PCH'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S TAX DEPARTMENT AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. PRIOR TO FILING, COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., THE ORGANIZATION'S SOLE MEMBER, FOR BOARD REVIEW. FORM 990, PART VI, SEC B, LINE 12C: CONFLICT OF INTEREST POLICY COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARE'S CHIEF COMPLIANCE OFFICER. ALL SENIOR LEADERS, BOARD MEMBERS, PHYSICIAN EMPLOYEES, NURSE PRACTITIONERS/PHYSICIAN ASSISTANTS AND EMPLOYEES AND NON-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 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 CARTERSVILLE HOSPITAL ARE PROVIDED TRAINING ON CONFLICT OF INTEREST ISSUES, INCLUDING REPORTING REQUIREMENTS, AT NEW EMPLOYEE ORIENTATION AND AT LEAST ANNUALLY THEREAFTER. NONCOMPLIANCE WITH THE CONFLICT OF INTEREST POLICY MUST BE REPORTED TO PIEDMONT HEALTHCARE'S chief compliance officer FOR INVESTIGATION, AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. Form 990, Part VI, Sec B, Line 15a, 15b: Executive Compensation Compensation for executives of Piedmont Cartersville Hospital is set by the board of directors of Piedmont Healthcare, Inc. The Piedmont Healthcare, Inc., board of director's executive performance and compensation committee ("The Committee") is composed of at least three members of the PHC board of directors, 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 oversees executive performance and compensation on behalf of the PHC board, subject to the ultimate authority and oversight of the board. The committee also formulates policies and makes decisions in order to ensure a high level of executive performance. The committee is authorized to act on behalf of the PHC board as set out in its charter, and the committee is also charged with providing recommendations and periodic reports to the PHC board regarding executive performance and compensation. All decisions and comparability date are documented in the committee meeting minutes. Functions of the committee - Assess and implement policies regarding performance, compensation and benefits of the president/CEO and other executives as determined by the committee - Select an executive compensation consultant who reports to the committee - Annually review the President/CEO succession plan - Formulate and implement annual performance objectives for the President/CEO, and review and approve annually recommendations from the President/CEO relating to compensation, performance objectives, and succession plans for EVP executives - Annually assess President/CEO performance; If necessary, implement action plan with President/CEO input to improve his/her performance; adjust compensation as appropriate; the committee chair shall consult with the PHC governance committee chair and the PHC board chair and shall coordinate the annual performance review of the PHC president/CEO, unless the PHC board chair has a real or perceived conflict of interest, in which case the committee chair shall determine the proper review process - Review and approve long-term and short-term goals to be used in connection with EVP compensation programs as recommended by the President/CEO and validated by the compensation consultant - Periodically review compensation, if any, for the PHC board chair and all board chairs of the PHC subsidiaries - Establish other policies and procedures, and perform other tasks, related to executive performance and compensation, including but not limited to, approval of executive employment contracts and benefits - Periodically report significant decisions and any additional requested information to the PHC board. FORM 990, PART VI, SECTION C, LINE 19: DISCLOSURE OF DOCUMENTS 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. FORM 990, PART XI, LINE 9: CHANGES IN NET ASSETS INTERCOMPANY TRANSFER $13,726,336 CHANGE IN UNRESTRICTED FUNDS $ 11,976 BOOK/TAX DIFFERENCES $ 10,087 CONTRIBUTION ($ 89,310) ---------------------------------------------------------- TOTAL $13,659,089 FORM 990 PART IX LINE 11G DESCRIPTION:GENERAL CONTRACT LABOR TOTAL FEES:33061743 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL SERVICE CONTRACT TOTAL FEES:10200 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN SUPPORT TOTAL FEES:10649551 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE CONTRACT LABOR TOTAL FEES:1007487 CARTERSVILLE MEDICAL CENTER LLC 960 JOE FRANK HARRIS PARKWAY SE CARTERSVILLE GA 30120 582433438 HEALTHCARE GA 0 0 PCH INC CARTERSVILLE OCCUPATIONAL MED CENTER LL 1800 HOWELL MILL ROAD STE 850 ATLANTA GA 30318 582513472 HEALTHCARE GA 0 0 CMC LLC AR HOLDING 2 LLC 1800 HOWELL MILL ROAD STE 850 ATLANTA GA 30318 611512503 HOLDING CO. GA 0 0 CMC LLC PIEDMONT HEALTHCARE INC 1800 HOWELL MILL RD STE 850 ATLANTA GA 30318 581503902 HC MANAGEMENT GA 501(c)(3) 12C, III-FI NA false PIEDMONT HOSPITAL Inc 1968 PEACHTREE ROAD NW ATLANTA GA 30309 580566213 HOSPITAL GA 501(c)(3) 3 PHC false FAYETTE COMMUNITY HOSPITAL INC 1255 HIGHWAY 54 WEST FAYETTEVILLE GA 30214 582232328 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT MOUNTAINSIDE HOSPITAL INC 1266 HIGHWAY 515 SOUTH JASPER GA 30143 352228583 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT NEWNAN HOSPITAL INC 745 POPLAR ROAD NEWNAN GA 30265 205077249 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT HEALTHCARE FOUNDATION INC 2001 PEACHTREE RD NE STE 400 ATLANTA GA 30309 581272768 FUNDRAISING GA 501(c)(3) 12B, II PHC false PIEDMONT HENRY HOSPITAL INC 1133 EAGLES LANDING PKWY STOCKBRIDGE GA 30281 582200195 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT NEWTON HOSPITAL INC 5126 HOSPITAL DRIVE NE COVINGTON GA 30014 582155150 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT ATHENS REGIONAL FOUNDATION INC 1199 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31901 581501642 FUNDRAISING GA 501(C)(3) 7 CRHS false HUGHSTON HOSPITAL INC 707 CENTER STREET COLUMBUS GA 31901 331216751 HOSPITAL GA 501(C)(3) 3 CRHS false PIEDMONT ROCKDALE HOSPITAL INC 1412 MILSTEAD AVE CONYERS GA 30012 300999841 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT WALTON HOSPITAL INC 2151 WEST SPRING ST MONROE GA 30655 824194264 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT HEART INSTITUTE INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 263553500 HEALTHCARE GA 501(C)(3) 10 PHC false COLUMBUS AMBULATORY HEALTHCARE SERVICES 707 CENTER STREET COLUMBUS GA 31901 581719867 AMBULATORY GA 501(C)(3) 3 CRHS false COLUMBUS REGIONAL SENIOR LIVING INC 707 CENTER STREET COLUMBUS GA 31901 582628502 HEALTHCARE GA 501(C)(3) 12C, III-FI PHC false PIEDMONT EASTSIDE HOSPITAL INC 1700 MEDICAL WAY snellville GA 30078 870982886 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT MACON HOSPITAL INC 350 HOSPITAL DR MACON GA 31217 871006981 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT MACON NORTH HOSPITAL INC 400 CHARTER BLVD MACON GA 31210 871031034 HOSPITAL GA 501(C)(3) 3 PHC false UNIVERSITY HEALTH SERVICES INC 1350 WALTON WAY AUGUSTA GA 30901 581581103 HOSPITAL GA 501(C)(3) 3 PHC false UNIVERSITY MCDUFFIE COUNTY REG MED CTR 1350 WALTON WAY AUGUSTA GA 30901 454166209 HOSPITAL GA 501(C)(3) 3 PHC false UNIVERSITY HEALTH CARE FOUNDATION INC 2260 WRIGHTSBORO ROAD AUGUSTA GA 30904 581343550 FUNDRAISING GA 501(C)(3) 7 UHS false UNIVERSITY EXTENDED CARE INC 1350 WALTON WAY AUGUSTA GA 30901 581581105 HEALTHCARE GA 501(C)(3) 3 UHS false AUGUSTA RESOURCE CENTER ON AGING INC 1350 WALTON WAY AUGUSTA GA 30901 581728812 HEALTHCARE GA 501(C)(3) 10 PHC false GA SURG CTR PCHTREE 2061 PEACHTREE RD STE 100 ATLANTA GA 30309 582394271 SURGERY GA NA NONE 0 0 false 0 false ORTHOATLANTA SURGERY CENTER FAYETTEVILLE 900 CIRCLE 75 PKWY SE STE 1700 ATLANTA GA 30339 202961633 SURGERY GA NA NONE 0 0 false 0 false ATHENS ASC HOLDINGS LLC 2142 W BROAD ST BLDG 100 STE 100 ATHENS GA 30606 454014891 SURGERY GA NA NONE 0 0 false 0 false COLUMBUS DIAGNOSTIC IMAGING CTR 116 INTRACOASTAL POINTE DR 300 JUPITER FL 33477 262291768 IMAGING GA NA NONE 0 0 false 0 false THE SURGERY CTR LLC 100 FIRST COURT COLUMBUS GA 31909 582520623 SURGERY GA NA NONE 0 0 false 0 false PIEDMONT ENCOMPASS REHAB HOSPITALS LLC 9001 LIBERTY PKWY BIRMINGHAM AL 35242 853544795 HEALTHCARE DE NA NONE 0 0 false 0 false COLISEUM SAME DAY SURGERY CTR LP 340 HOSPITAL DR MACON GA 31217 621805346 SURGERY GA NA NONE 0 0 false 0 false Piedmont Medical Care Corporation 2727 Paces Ferry Road suite 1-1100 Atlanta GA 30339 582092768 Healthcare GA NA C CORP 0 0 false THE PIEDMONT CLINIC INC 2727 Paces Ferry Road suite 1-1100 Atlanta GA 30339 582005358 Healthcare GA NA C CORP 0 0 false PIEDMONT HEART INSTITUTE PHYSICIANS INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 260593850 Healthcare GA NA C CORP 0 0 false COLUMBUS HEALTHCARE RESOURCES PO BOX 790 COLUMBUS GA 31902 581717754 Healthcare GA NA C CORP 0 0 false Columbus Health Services Inc PO BOX 790 COLUMBUS GA 31902 581640939 Healthcare GA NA C CORP 0 0 false Amster McRae Insurance Company SPC PO BOX 1159 GRAND CAYMAN CJ KY1-1102 981734069 RELATED INSUR CJ NA C CORP 0 0 false UNIVERSITY HEALTH RESOURCES INC PO BOX 790 COLUMBUS GA 31901 581601372 HEALTHCARE GA NA C-CORP 0 0 false UNIVERSITY HOSPITAL AIKEN INC 1350 WALTON WAY AUGUSTA GA 30901 472713774 HOSPITAL SC NA C-CORP 0 0 false false false false false false false false false false false false false false false false true true false false SCHEDULE R, PART I, LINE 1: DISREGARDED ENTITIES THE LIMITED LIABILITY COMPANIES LISTED IN SCHEDULE R, PART I, OPERATE AS DEPARTMENTS OF PIEDMONT CARTERSVILLE HOSPITAL AND ARE INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LIMITED LIABILITY COMPANIES AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.