2023-05-12T12:52:30-05:00 2022-06-30 KPMG LLP 500 W 5th St Suite 800 Winston Salem NC 27101 990 2021-07-01 871031034 Piedmont Macon North Hospital Inc % MARIE GAFFNEY PIED 4044251303 400 Charter Blvd MACON GA 31210 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2023-05-11 true MARIE GAFFNEY 999009999 SHAWN M HUTCHINSON P01048557 3362753394 2023-05-10 3 2021 2023-04-26 12:10:37Z MR Stephen Daugherty 400 Charter Blvd MACON GA 31210 91319831 false X www.piedmont.org X 2021 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 11 8 287 100 0 0 0 0 0 90846395 0 0 0 473436 0 91319831 0 0 0 0 0 15545105 0 0 0 0 78001717 0 93546822 0 -2226991 0 112978743 0 21450617 0 91528126 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 87531737 90846395 PIEDMONT MACON NORTH HOSPITAL, INC. IS A 103-BED FACILITY LOCATED IN THE CITY OF MACON IN BIBB COUNTY, GEORGIA. OUR PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN MACON AND THE SURROUNDING MIDDLE GEORGIA MARKET, REGARDLESS OF ANY INDIVIUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2022, THE HOSPITAL HAD 2,628 IN-PATIENT ADMISSIONS WITH A TOTAL OF 8,639 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 37,081 AND OUTPAITENT VISITS TOTALED 6,545. SURGICAL SERVICES WERE PROVIDED TO 1,599 PATIENTS. 87531737 true false 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 0 287 true false false false false false false false false false false false false X 11 8 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 Mr Thomas Arnold Treasurer/CFO PHC 1.0 54.0 X 0 1131535 124798 Ms Elizabeth Leddy Secretary/CLO PHC 1.0 54.0 X 0 883982 140202 Mr Stephen D Porter Board Member 1.0 54.0 X 0 745217 114002 MR SCOTT STRONG COO 25.0 30.0 X 0 468418 48165 MR STEPHEN DAUGHERTY CEO 25.0 30.0 X X 0 232438 43428 MS ANGELA WALKER EXECUTIVE DIRECTOR, HR 20.0 20.0 X 0 186321 31558 Ms Allura Mack Executive Director, Nursing 1.0 0.0 X 151842 0 22256 MS ALISHA NEAL CFO 25.0 30.0 X 0 152018 7556 DR CESAR FIGUEROA BOARD MEMBER, VICE CHAIR 1.0 54.0 X 0 141352 12008 DR GEORGE ARIMAH BOARD MEMBER 1.0 0.0 X 0 0 0 MR JEFF BATTCHER BOARD MEMBER 1.0 0.0 X 0 0 0 DR JOSEPH BURNETTE BOARD MEMBER 1.0 0.0 X 0 0 0 MR GRANT GREENWOOD BOARD MEMBER, CHAIR 1.0 0.0 X X 0 0 0 MS MALLORY JONES BOARD MEMBER 1.0 0.0 X 0 0 0 MR TODD JONES BOARD MEMBER 1.0 0.0 X 0 0 0 DR GARRY SIMONS BOARD MEMBER 1.0 0.0 X 0 0 0 MS TARA UNDERWOOD BOARD MEMBER 1.0 0.0 X 0 0 0 151842 3941281 543973 1 false true false NONE 0 0 PATIENT SERVICE REVENUE 622110 90527277 90527277 OTHER OPERATING REVENUE 900099 319118 319118 90846395 0 0 0 406202 406202 0 406202 406202 0 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722310 67234 67234 67234 91319831 90846395 0 473436 X 0 0 0 0 0 0 12993843 11429384 1564459 0 1466161 1289635 176526 1085101 954455 130646 206 206 0 4662 4662 0 0 0 14292392 11625433 2666959 0 13301 11700 1601 1736545 1527465 209080 326048 286792 39256 0 4006440 3524065 482375 4291 3774 517 0 0 4988 4988 0 1704084 1498912 205172 508490 508490 BAD DEBT EXPENSES 40413113 40413113 DRUGS & MEDICAL SUPPLIES 12465800 12465800 HOSPITAL TAX 2354014 2354014 MISCELLANEOUS 167343 147195 20148 93546822 87531737 6015085 0 0 78997844 0 0 0 0 0 -2864346 0 0 0 0 0 0 0 2458144 0 58529 30393506 1749061 0 28644445 0 0 0 0 0 0 0 0 0 5684127 0 112978743 0 11164319 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 10286298 0 21450617 X 0 91528051 0 75 0 91528126 0 112978743 X -2226991 93755117 X false true X true false X 4420000 4420000 14056217 382017 13674200 10003650 1131339 8872311 1913639 235705 1677934 28644445 GOODWILL 5684127 5684127 0 DUE TO RELATED PARTIES 10286298 10286298 X SCHEDULE D, PART X, LINE 2: ASC 740 FOOTNOTE (FKA FIN 48) PHC ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF 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, 2022 and 2021. true true X true X 300. true X true true false true true 115983 115983 0.00220 1370956 1347009 23947 0.00040 1841437 288251 1553186 0.02920 3328376 1635260 1693116 0.03180 25389 25389 0.00050 25389 25389 0.00050 3353765 1635260 1718505 0.03230 true 5055909 10934508 9982618 951890 X true true 1 1 PIEDMONT MACON NORTH HOSPITAL INC 400 CHARTER BOULEVARD MACON GA 31210 HTTPS://WWW.PIEDMONT.ORG/ 011-373 X X X PIEDMONT MACON NORTH HOSPITAL INC 1 true true true X X X X X X X X 21 true true false true X SEE PART V, SECTION C X X true 22 true SEE PART V, SECTION C false true X 300. 300. 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 Macon North Hospital, Inc. ("PMN") was created as a new entity on May 24, 2021 and is the 501(c)(3) tax-exempt parent of Macon Northside Hospital LLC, a disregarded entity, which was acquired from HCA Healthcare, a for-profit company. Piedmont filed the PMN 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 PMN'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 12 STAKEHOLDERS WITHIN THE MACON-BIBB COUNTY 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 6A: COMMUNITY HEALTH NEEDS ASSESSMENT THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED FOR BOTH PIEDMONT MACON HOSPITAL, INC. (EIN: 87-1006981) AND PIEDMONT MACON NORTH HOSPITAL, INC. (EIN: 87-1031034). SCHEDULE H, PART V, SECTION B, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT https://www.piedmont.org/media/file/Community-Benefit-Needs-Assessment-PMM .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 MACON NORTH HOSPITAL 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 MACON NORTH HOSPITAL APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE-YEAR PERIOD BEGINNING WITH FY23 ON SEPTEMBER 26, 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-PMM.pdf SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS DURING FY22, PIEDMONT MACON NORTH HOSPITAL CONDUCTED ITS FOURTH CHNA, 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 MACON NORTH HOSPITAL 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 MACON NORTH HOSPITAL 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, AND (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 $93,546,822, LESS BAD DEBT EXPENSE OF $40,413,113 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 DOUBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYER 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. PMNH 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. SCHEDULE H, PART III, 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 PATIENTS 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. FY22 also marked the third year of our FY19 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 2017, 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 1,050 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; and, - 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 Macon serves patients from all over middle Georgia, for purposes of this CHNA, we consider our community to be Macon-Bibb County. We do this in recognition of the direct impact of our tax-exempt status on county residents. In Macon-Bibb County, in 2020, 153,200 people lived in the 249 square mile area. The population density for this area, estimated at 614 persons per square mile, is much greater than the state average population density of 181 people per square mile and the average national population density of 92 persons per square mile. The ZIP code with the highest concentration of people was 31210, where 22 percent of the county's population lived. Macon-Bibb County is mostly urban, as 86 percent of community members live within an urban setting. The ZIP code with the highest concentration of the rural population was 31066 and, like in most of Georgia, rural populations in Macon-Bibb are overwhelmingly white. About 8 percent of the population were veterans in 2020, and the majority were aged 65 and older. Sixteen percent of the population - about 23,500 people - lived with a disability. Most of that population was between the ages of 18 and 64. About 25 percent of the population were 17 or younger, 15.7 percent were over the age of 65, and the remaining population were between the ages of 18-64. Between 2015 and 2019, about 38 percent of all Macon-Bibb County residents were white, 54 percent were African American, 3.25 percent were Hispanic/Latino, 2 percent were Asian, and the remaining 3 percent were comprised of other races. About 3.33 percent identified as being born outside of the US and 1.55 percent of the total population does not have citizenship status. In 2020, 13 percent of the population had no form of insurance. Insurance status and health are inextricably linked. Adults aged 18 to 64 are most likely to be uninsured. In 2020, 19.33 percent of non-elderly adults were uninsured, as compared to 5.6 percent of those under age 18 and 1 percent for those 65 and older. As with other indicators, race matters. Approximately 33 percent of Hispanic/Latino populations were uninsured, 15.6 percent of blacks were uninsured, and 13 percent of whites were uninsured. Between 2015 and 2019, the median household income was $41,334, which is much lower than state and national levels, which are $58,700 and $62,843, respectively. When broken down by the four dominant races in the community, income disparities are evident. Of employers in the community, the largest sector by employment size is health care and social assistance, which employed 19,016 community members at an average annual wage of $59,121 in 2019, according to the US Department of Commerce. Retail trade was the second largest sector, with 12,013 people employed at an average annual wage of $32,290. Finance and insurance were the third largest sector, with 11,764 people employed at an average annual wage of $59,634. According to the 2015-2019 American Community Survey, 68,412 people in the community were part of the labor force, and only 57 percent participated. Approximately 4 percent of the population were unemployed as of March 2022, a rate higher than state and national averages. This figure has steadily decreased since last year, when in March 2021, 5.6 percent of the labor force was unemployed. When looking back further, the rate is nearly three times less than the unemployment rate in 2012. In 2020, 25 percent of the county lived at or below the Federal Poverty Level (FPL), a startlingly high number. By far, the poorest ZIP code within Macon-Bibb County is 31201, where 43 percent of the population lived in poverty in 2020. In Macon-Bibb County, like most of the state, minorities are more likely to live in poverty. For example, in 2020, 34 percent of blacks and 37 percent of Hispanic/Latino populations lived at or below poverty, as compared to 12 percent of whites. In Macon-Bibb County, nearly 20 percent of households received SNAP benefits in December 2020, representing about 11,500 households. Black populations are far more likely to receive SNAP benefits than any other demographic. Only 6 percent of SNAP beneficiaries are white, and the remaining 94 percent are minority households. The ZIP code with the highest amount of SNAP recipients was 31206, where more than a third of residents received SNAP benefits. Of the 58,116 total occupied households in Macon-Bibb County in 2019, about 34 percent lived in cost burdened households, in which housing costs are 30 percent or more of total household income. Approximately 17 percent of households had costs that exceeded 50 percent of the household income, which places the household in significant financial strain. In Macon-Bibb County, in 2019, 15 of the county's 44 census tracts were food deserts, as shown in the map to the right. About 47,059 people lived within these census tracts. These tracts almost directly correspond with census tracts demonstrating retailers who are authorized to take SNAP benefits. In Macon-Bibb 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 0.5 mile 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 2021 Food Access Research Atlas database, nearly a third of the total population in the county have low food access, meaning about 50,000 county residents may struggle to access healthy foods. This is worse than the state and national rates of 30.89 percent and 22.22 percent, respectively. ZIP code 31066 has the worst rate of low food access at 81 percent. In 2019, about 80 percent of adults aged 18 or older saw a doctor for a routine check-up the previous year, a measure that is slightly higher than both state and national averages. For Medicare recipients, this number jumps to 87 percent of adult beneficiaries, which is above both state and national averages. In 2020, the age-adjusted death rate was 273 deaths for every 100,000 people, which is far worse than both state and national rates, which were 72.4 and 91.5 heart-related deaths per 100,000 people, respectively. Between 2016 and 2020, there were 393 deaths due to stroke, representing an age-adjusted death rate of 44 deaths per every 100,000 people. Men are more likely to die from stroke than women, as are black populations. The hospitalization rates for heart disease and stroke among Medicare recipients have steadily decreased over the last five years. The cardiovascular disease hospitalization rate in 2018 was 16 hospitalizations per every 1,000 Medicare beneficiaries, which is higher than the state and national rates of 12.2 and 11.8, respectively. The hospitalization rate for stroke, though, is on par with state and national rates, with 8.9 hospitalizations per every 1,000 Medicare beneficiaries, as compared to the state rate of 9.3 and the national rate of 8.4. Although heart disease leads in county deaths, cancer remains a critical issue within the community. The cancer incidence rate for Macon-Bibb County each year, on average between 2014 and 2018, was 496.5 per every 100,000, which equates to a diagnosis rate of an average 879 new cases each year. In 2019, 13 percent of adults aged 20 and older had diabetes, which is higher than the state rate of 9.8 percent. Diabetes is a prevalent problem in the US, often indicating an unhealthy lifestyle and puts individuals at risk for further health issues. Diabetes itself is often a killer, and leads in causes of deaths for minorities, particularly Hispanic/Latino populations. In 2019, 4 percent of the county's population had a diagnosis of kidney disease, a rate worse than the state and national percentages of 3.22 percent and 3.1 percent, respectively. In 2019, 33.3 percent of adults 18 and older reported having high cholesterol of the total population. Too much cholesterol puts you at risk for heart disease and stroke, two of the main causes of death within the county. In 2019, 27.7 percent of adults 18 and older had a diagnosis of high blood pressure. High blood pressure can damage your arteries by making them less elastic, which decreases the flow of blood and oxygen to your heart and leads to heart disease. 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. Please note that Piedmont Macon became a nonprofit organization in August 2021 and therefore did not have a robust community benefit plan in place due to its previous status as a for-profit hospital. That said, we did conduct several activities within the community. Also note the below activities were conducted jointly with Piedmont Macon Medical Center. We prioritized increasing access points for affordable health care by providing pro bono physician support and funding to partner charitable clinic Community Health Care Systems. We funded the salaries of the internal medicine residents for patient care, as well as $366,510 in funding to Community Health Care Systems. Additionally, we supported education to build the health workforce. Through our CHOICE program (Creating Healthier Outcomes by Increasing Clinical Experience), we provided 12 senior level registered nursing students on site training and a $4000 scholarship each. We continued to provide a physician residency program for Internal Medicine, Psychiatry and Emergency Medicine physicians, providing placement for 87 residents during this year. We provided funding for diagnostic services for the working uninsured through the Macon Volunteer Clinic. Additionally, we provided strategic guidance and support through board participation from our Chief Medical Officer. We provided free mental health assessments and referrals to community members who sought support through our Lifeline "crisis line" department of Piedmont Behavioral Health. Additionally, we offered support groups on campus for those battling addiction. We also provided place-based prevention education, chronic disease management education, screenings, and health and social services referrals throughout the community. We conducted eight in-person sessions that hosted over 400 participants. We offered stroke awareness educational materials and blood pressure screenings at health fairs and community events to achieve and maintain stroke certification. We prioritized decreasing lung and breast cancer deaths and increasing access to cancer programming by increasing access to mammogram and lung screenings. In October, we offered discounted mammograms and in November and May, we held lung screening days at a discounted rate to screen patients who meet necessary criteria. Additionally, in FY22, we provided comprehensive, evidence-based psychosocial support for cancer patients and their families, through oncology nurse navigation, assisting 318 community members dealing with cancer. Piedmont Macon's Helping Hands Grief supportive services provided both group and individual grief sessions for those in the community who were experiencing the effects of losing a significant other. Emotional, grief, and pastoral support was provided during group and individual sessions monthly. We helped 30 community members throughout the year. We provide psychiatry support to the residents of Daybreak, a shelter that provides Macon's homeless population with health care, food, showers, laundry, and a safe place to sleep when the temperature is below freezing. Through our psychiatry residency, we offer mental health support to those in need. Additionally, in February, we participated in Daybreak's Sleep Out event and spent the night outdoors in tents to call attention to the homeless situation in Macon. As part of the Sleep Out, our team raised money for the shelter. After the event, we donated our tents and sleeping bags to help others in need. Piedmont Macon distributed 8,800 donated COVID-19 test kits to mid-state organizations that served low-income, underserved, and high-risk populations. The kits were donated by Georgia Pacific to Piedmont Healthcare, which dispersed them to their hospitals across the state. In Macon, the agencies receiving the kits included the Macon Volunteer Clinic, Brookdale Warming Center, the Weekend Lunch Program at Christ Church, the Community Action Agency, and Community Health Care Systems. Piedmont Macon and Macon North have been longtime supporters of the backpack initiative in Macon. That program relies on volunteers, including two teams of Piedmont employees, who pack backpacks monthly, which are given each Friday to more than 2,200 children in Bibb County and several surrounding counties. The backpacks are filled with various items, including drinks, protein, fruit, and snacks, and are given to the children who have been identified as possibly going hungry at home during weekends. Additionally, 20 Piedmont volunteers delivered the filled backpacks three Fridays a month to the schools. After having to cancel because of COVID-19 concerns for the past few years, the Region 5 EMS for Children's Picnic came resumed activities in May 2022, with more than 200 parents and children attending. The hot dog picnic was hosted by Piedmont Macon North Hospital on its campus, which provided plenty of room for 15 Emergency Medical Service agencies, two fire department and two air ambulance services to participate. Children were able to get up-close peeks at the various ambulances and learned about various topics, including hands-only CPR, choking hazards, helmet safety and fire safety. They also participated in a region-wide coloring contest and were given free coloring books at no cost to their families. 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 Stephen D Porter Board Member 0 463160 0 226176 0 55881 0 93556 0 20446 0 859219 0 0 Mr Thomas Arnold Treasurer/CFO PHC 0 589164 0 343028 0 199343 0 111150 0 13648 0 1256333 0 93750 Ms Elizabeth Leddy Secretary/CLO PHC 0 500109 0 317466 0 66407 0 122353 0 17849 0 1024184 0 0 MS ALISHA NEAL CFO 0 129532 0 22000 0 486 0 0 0 7556 0 159574 0 0 MR SCOTT STRONG COO 0 266978 0 56475 0 144965 0 18762 0 29403 0 516583 0 0 MS ANGELA WALKER EXECUTIVE DIRECTOR, HR 0 140225 0 18947 0 27149 0 9994 0 21564 0 217879 0 0 MR STEPHEN DAUGHERTY CEO 0 175193 0 39253 0 17992 0 36619 0 6809 0 275866 0 0 DR CESAR FIGUEROA BOARD MEMBER, VICE CHAIR 0 101015 0 0 0 40337 0 5793 0 6215 0 153360 0 0 Ms Allura Mack Executive Director, Nursing 132968 0 17077 0 1797 0 9486 0 12770 0 174098 0 0 0 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS Elizabeth Leddy, Thomas Arnold, and Stephen Porter received a discretionary spending account totaling $13,385, a fixed amount determined by their job level. Stephen Daugherty received a discretionary spending account totaling $6,000. 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 Macon North 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 THOMAS ARNOLD RECEIVED A PAYMENT OF $93,750 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: Stephen Daugherty ELIZABETH LEDDY Stephen Porter 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 2021 Forms 1099 were filed on behalf of Piedmont Macon North 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 MACON NORTH HOSPITAL ("PMNH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT MACON NORTH HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT MACON NORTH HOSPITAL. FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT MACON NORTH 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 MACON NORTH 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 MACON NORTH HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PMNH'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 MACON NORTH 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 Macon North 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: RECONCILIATION OF NET ASSETS CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF: INTERCOMPANY TRANSFER OF LIABILITIES $66,989,293 CHANGE IN UNRESTRICTED FUNDS $75 TIMING DIFFERENCES $26,765,749 --------------------------- TOTAL $93,755,117 FORM 990 PART IX LINE 11G DESCRIPTION:GENERAL CONTRACT LABOR TOTAL FEES:5530607 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASE/CONTRACT SERVICES TOTAL FEES:6022748 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PHYSICIAN SUPPORT TOTAL FEES:2358211 FORM 990 PART IX LINE 11G DESCRIPTION:SERVICE/MAINTENANCE CONTRACTS TOTAL FEES:380826 MACON NORTHSIDE HOSPITAL LLC 400 Charter Blvd MACON FL 31210 621736985 HEALTHCARE GA 0 0 PMnH 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 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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 COMPANY LISTED IN SCHEDULE R, PART I, OPERATES AS A DEPARTMENT OF PIEDMONT MACON NORTH HOSPITAL AND IS INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LIMITED LIABILITY COMPANY AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.