2022-06-09T08:15:23-05:00 2021-07-31 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2020-08-01 383647394 PHOEBE WORTH MEDICAL CENTER INC PHOE 2297766961 807 SOUTH ISABELLAPO BOX 545 SYLVESTER GA 317910545 CANDACE GUARNIERI CFO 2297766961 2022-06-07 true CANDACE GUARNIERI 999009999 STEPHEN D HARRELL P01554887 2298837878 2022-06-07 X 2020 2022-09-23 18:48:47Z KIM GILMAN PO BOX 545 SYLVESTER GA 317910545 19117949 false X WWW.PHOEBEHEALTH.COM X 2002 GA PROVIDING CHARITABLE HEALTHCARE ACTIVITIES 9 6 220 8 5109 3027 1697530 2512279 15245296 16286320 20714 3113 156496 288348 17120036 19090060 45619 45619 0 8163418 8413440 0 0 9234860 9846868 17443897 18305927 -323861 784133 19840331 18817624 23834835 22027995 -3994504 -3210371 PROVIDING CHARITABLE HEALTHCARE ACTIVITIES false false 14571027 45619 16293970 TO BE THE LEADING PROVIDER OF QUALITY, COST EFFECTIVE, PATIENT-CENTERED HEALTH CARE SERVICES TO ALL RESIDENTS OF SOUTHWEST GEORGIA. PWMC PURSUES ITS MISSION THROUGH A PATIENT-CENTERED ENVIRONMENT OF CARE REFLECTING HIGH STANDARDS AND PROMOTING A BALANCE OF PROFESSIONAL PREPARATION AND SERVICE, CONTINUOUS IMPROVEMENT BASED ON OUR CORE VALUES OF PEOPLE, RELATIONSHIPS, REPUTATION, EXCELLENCE, EFFICIENCY AND COMMITMENT. FOR FURTHER INFORMATION, PLEASE SEE SCHEDULE H PART VI COMMUNITY INFORMATION SECTION. 14571027 true true false true false false false false false false true false false true true true true true false false false false false false false false true true true false true false false false false false false false false false false false false false true false false false true 30 0 220 true true true false false false false false false false false false false false X 9 6 false false false false true true true true true false false false true true true true true false false false GA X X CANDACE GUARNIERI CFO 2297766961 PO BOX 545 SYLVESTER GA 317910545 LARRY JOE AUSTIN PPMH CEO 1.00 50.00 X 0 1356139 140990 SCOTT STEINER BD MBR/PPHS 1.00 55.00 X X 0 820295 218327 BRIAN CHURCH BD MBR/PPHS 1.00 55.00 X X 0 614157 163484 KIM GILMAN CEO/CNO 25.00 25.00 X 0 251428 59142 GRACE DAVIS MD BOARD MEMBER 1.00 40.00 X 0 180867 0 BENJAMIN LEE HUDSON PHARMACIST 40.00 X 137419 0 25153 CANDACE GUARNIERI CFO 25.00 25.00 X 0 125501 25648 STACEY BARBEE DIREC BUS/CL 1.00 40.00 X 0 104581 21374 LAURIE MARTIN PHYSICAL THE 40.00 X 110439 0 3413 JOHNNY COCHRAN VICE CHAIR 1.00 X X 0 0 0 MARY KING GIVENS BOARD MEMBER 1.00 1.00 X 0 0 0 JOHN A NESMITH JR BOARD MEMBER 1.00 X 0 0 0 DON MONK CHAIRMAN 1.00 1.00 X X 0 0 0 CHRIS SHIPP BOARD MEMBER 1.00 X 0 0 0 SHIRLEY THOMAS BOARD MEMBER 1.00 X 0 0 0 247858 3452968 657531 2 true true false MEDICAL SOLUTIONS LLC P O BOX 310737 DES MOINES IA 503310737 CONTRACT STAFF 152287 POWELL CONTRACT SERVICES 129 LAKE ESTATE DRIVE ASHBURN GA 31714 CONSTRUCTION 118391 ACE TECHNOLOGIES 7428 SONNY ROGERS MEMORIAL DR HAHIRA GA 31632 CONTRACTOR 112036 3 2320415 191864 2512279 NET PATIENT SERVICE REVENUE 623000 16281211 16281211 REFERENCE LAB 621500 5109 5109 16286320 3113 3113 39924 27889 12035 12035 12035 EMPLOYEE PHARMACY 722513 149583 149583 CAFETERIA 446110 112184 112184 MISCELLANEOUS REVENUES 621990 12546 12546 2000 213 1787 276313 19090060 16293970 5109 278702 X 45619 45619 6154636 5659919 494717 125108 115975 9133 1695455 1571687 123768 438241 406249 31992 64500 64500 5632734 3886462 1746272 7115 1564 5551 490457 468069 22388 687 687 295988 155098 140890 17869 4765 13104 31314 26730 4584 803118 420834 382284 506546 60777 445769 MEDICAL SUPPLIES 1114775 1114775 REPAIRS & MAINTENANCE 430796 416777 14019 DUES & SUBSCRIPTIONS 198863 68219 130644 CLINIC LOSS 135180 116079 19101 116926 30742 86184 18305927 14571027 3734900 0 10491445 8026075 1856577 2351051 206298 184300 70985 151648 15976687 8936139 6711500 7040548 503526 1064002 19840331 18817624 1072069 1570598 681390 585391 22081376 19872006 23834835 22027995 X -3994504 -3210371 -3994504 -3210371 19840331 18817624 784133 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2463 2463 false SCHEDULE C, PART II-B, LINE 1 PART II-B, LINE 1I THE ORGANIZATION PAYS MEMBERSHIP DUES TO A NATIONAL HEALTHCARE ORGANIZATION. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THE NATIONAL HEALTHCARE ORGANIZATION PARTICIPATE. 175676 175676 6245462 2751051 3494411 9546029 6185088 3360941 9520 9520 7040548 THIRD PARTY SETTLEMENTS 616389 OTHER ASSETS 447613 1064002 DUE TO PHOEBE PUTNEY HEALTH SYSTEM 18538488 CARES ACT REFUNDABLE ADVANCE 1333518 19872006 X 19117949 19117949 -27889 -27889 19090060 18333816 27889 27889 18305927 18305927 SCHEDULE D, PAGE 3, PART X THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE HOSPITAL ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEETS FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JULY 31, 2021 AND 2020 OR FOR THE YEARS THEN ENDED. THE HOSPITAL'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE SCHEDULE D, PAGE 4, PART XI, LINE 4B RENTAL EXPENSES -27,889 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 27,889 true true X true X 1.250000000000 true X true true false true true 1636788 1636788 0.08930 2956231 2260662 695569 0.03790 4593019 2260662 2332357 0.12720 4790712 4075783 714929 0.03900 63726 63726 0.00350 4854438 4075783 778655 0.04250 9447457 6336445 3111012 0.16970 true 4201304 126039 3700786 3678138 22648 X true true 1 1 PHOEBE WORTH MEDICAL CENTER INC 807 S ISABELLA STREET SYLVESTER GA 31791 WWW.PHOEBEHEALTH.COM 159-603 X X X X SWB, SNF PHOEBE WORTH MEDICAL CENTER INC 1 false false true X X X X X X X X X X 19 true false false true X WWW.PHOEBEHEALTH.COM X true 19 true WWW.PHOEBEHEALTH.COM false false true X 125.000000000000 400.000000000000 X X X X X true true X X X X true X WWW.PHOEBEHEALTH.COM X WWW.PHOEBEHEALTH.COM X WWW.PHOEBEHEALTH.COM X X X X X X true X false X X X X X true X false false FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 3E THE PRIORITIZATION OF SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IS IDENTIFIED AND THE METHODOLOGY FOR PRIORITIZING EACH NEED IS DESCRIBED ON PAGES 21-23 OF THE 2019 CHNA. FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 5 THE INTERNAL ASSESSMENT TEAM, 16 MEMBERS IN ALL, WAS A BLEND OF HOSPITAL STAFF, AND STRATEGIC COMMUNITY PARTNERS LOCATED IN WORTH COUNTY, GA. EARLY ON, HOSPITAL LEADERSHIP MADE THE DECISION TO USE THE MULTIPLE ORGANIZATION PARTNERSHIP MODEL AS THE APPROACH TO DETERMINE HOW THE COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE CONDUCTED. THIS APPROACH ENGAGES MULTIPLE ORGANIZATIONS, PROVIDES A BROADER FOCUS, AND ALLOWS GREATER INPUT IN NEED IDENTIFICATION AND DETERMINING APPROPRIATE STRATEGY FOR ACTION. MEMBERS OF THE INTERNAL ASSESSMENT TEAM PERFORMED KEY LEADER INTERVIEWS, THE PURPOSE OF WHICH WAS TO GATHER INFORMATION, GAIN KNOWLEDGE AND RECEIVE INPUT REGARDING HEALTH ISSUES FACING THE ORGANIZATION'S SERVICE AREA. THE INTERVIEW SELECTION PROCESS WAS CAREFUL TO INCLUDE REPRESENTATION THAT REFLECTS THE MAKE-UP OF PATIENTS RECEIVING SERVICES IN THE ORGANIZATION'S SERVICE AREA (RELIGIOUS, MEDICAL PRACTICES, COMMUNITY VOLUNTEERS, BUSINESS, POLITICAL, PUBLIC HEALTH, AND THE ELDERLY). FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 11 USING THE CATHOLIC HEALTH ASSOCIATION'S SELECTION FILTER AS A MEANS TO PRIORITIZE COMPETING SIGNIFICANT NEEDS, BELOW IS A LIST OF NEEDS THAT WERE NOT INCLUDED AS PRIORITIES BUT REMAIN A CONCERN TO THE COMMUNITY. 1) TRANSPORTATION: VULNERABLE POPULATIONS HAVE ACCESS TO MEDICAID VAN OPTION. 2) CANCER: PHOEBE PUTNEY MEMORIAL HOSPITAL OFFERS ONCOLOGY CLINIC AND CHEMO SERVICES IN WORTH COUNTY. 3) SPECIALTY CARE PHYSICIANS: PHOEBE WORTH IS ACTIVELY SEEKING COLLABORATION WITHIN ITS HEALTH SYSTEM TO EXPAND SPECIALTY CARE SERVICES IN WORTH COUNTY. 4) HOMELESSNESS: OTHER COUNTY AGENCIES WORKING TO ADDRESS. 5) DRUGS AND SUBSTANCE ABUSE: OTHER HEALTHCARE SOURCES AVAILABLE IN COUNTY. A COMPLETE COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY PRIORITIES, AND IMPLEMENTATION PLAN CAN BE FOUND AT HTTPS://WWW.PHOEBEHEALTH.COM/LOCATIONS/PHOEBE-WORTH-MEDICAL-CENTER/PHOEBE- WORTH-MEDICAL-CENTER-CHNA FACILITY 1, PHOEBE WORTH MEDICAL CENTER, INC. - PART V, LINE 20E WRITTEN NOTICE OF THE AVAILABILITY OF FINANCIAL ASSISTANCE IS INCLUDED ON HOSPITAL PATIENT STATEMENTS, AND ON WRITTEN COMMUNICATIONS SENT BY CONTRACTED THIRD PARTY COLLECTION AGENCIES. THESE AGENCIES MAY REFER ACCOUNTS FOR REPORTING TO MAJOR CREDIT BUREAUS, AFTER A SERIES OF STATEMENTS AND LETTERS ARE SENT THROUGHOUT MULTIPLE COLLECTION CYCLES. 1 PHOEBE WORTH FAMILY MEDICAL CENTER 1014 WEST FRANKLIN STREET SYLVESTER GA 31791 RHC SCHEDULE H, PART I, LINE 7, COLUMN (F) IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN (F), THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990, PART IX, LINE 25: FORM 990, PART IX, LINE 25 18,305,927 ADD: EXPENSES REPORTED IN PART VIII 27,889 DENOMINATOR FOR COLUMN (F) 18,333,816 SCHEDULE H, PART I, LINE 7 THE COST WAS CALCULATED USING THE COST-TO-CHARGE RATIO AS CALCULATED USING WORKSHEET 2 FROM THE IRS FORM 990 INSTRUCTIONS. THE COST ON LINE 7I WAS GENERATED FROM THE ORGANIZATION'S ACCOUNTING RECORDS. SCHEDULE H, PART III, LINE 2 THE AMOUNTS ON PART III, LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. SCHEDULE H, PART III, LINE 3 THE FIGURE ON PART III LINE 3 REPRESENTS MANAGEMENT'S ESTIMATE (APPROXIMATELY 3%) BASED ON AN ANALYSIS OF SELF PAY PATIENTS' ABILITY TO PAY THEIR OUTSTANDING ACCOUNT. THIS ANALYSIS INCLUDES REVIEWING THE PATIENT'S CREDIT HISTORY, INCOME LEVELS AND OVERALL COLLECTIBILITY OF THE ACCOUNT. SCHEDULE H, PART III, LINE 4 SEE FOOTNOTE FOR THE NET PATIENT SERVICE REVENUE ON PAGES 9-14 ON THE ACCOMPANYING AUDITED FINANCIAL STATEMENTS FOR THE DISCUSSION RELATING TO UNINSURED PATIENTS, IMPLICIT PRICE CONCESSIONS, AND BAD DEBTS. SCHEDULE H, PART III, LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. SCHEDULE H, PART III, LINE 9B THE ORGANIZATION PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE ORGANIZATION WRITES OFF PATIENT ACCOUNTS RECEIVABLE BALANCES FOR PATIENTS QUALIFYING FOR CHARITY CARE OR FINANCIAL ASSISTANCE AND DOES NOT MAKE FURTHER COLLECTION EFFORTS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENTS HAVE TRADITIONALLY LED TO THE CREATION OF COMMUNITY-BASED DELIVERY SYSTEMS THAT EXPAND ACCESS TO HEALTH CARE, MEET THE NEEDS OF THE PEOPLE AND BUILD HEALTHY COMMUNITIES IN THE BROADEST SENSE BY IMPACTING MAJOR DETERMINANTS, SUCH AS ECONOMIC DEVELOPMENT, EMPLOYMENT, CHILDREN'S SAFETY, EDUCATION AND ADEQUATE HOUSING. THE ORGANIZATION CONDUCTS REGULAR NEEDS ASSESSMENT THROUGH FORMAL AND INFORMAL SURVEYS AND PROCESSES, INCLUDING COLLABORATIONS WITH PUBLIC AND COMMUNITY AGENCIES. THROUGH STRATEGIC PLANNING AND COMMUNITY INTERVIEWS, THE ORGANIZATION DEVELOPS PROGRAMS AND SERVICES THAT CONSIDER THE ECONOMIC IMPERATIVES OF THE REGION, THE EFFECT OF LEGISLATION AND THE INVOLVEMENT OF OTHER COMMUNITY-BASED ORGANIZATIONS AND PARTNERS. THE ORGANIZATION REGULARLY CONDUCTS FOCUS GROUPS IN THE COMMUNITY TO UNDERSTAND ISSUES AFFECTING ITS PATIENTS, AND HAS CREATED PROGRAMS IN RESPONSE TO HEALTH DISPARITIES PREVALENT IN THE AREA. THE ORGANIZATION ALSO COLLECTS HEALTH NEEDS INFORMATION FROM NURSES, WHO PROVIDE DIRECT CARE TO STUDENTS AND STAFF AND WHO COLLABORATE WITH OTHER AGENCIES TO DEVELOP HEALTH AWARENESS AND DISEASE PREVENTION PROGRAMS. THE ORGANIZATION ALSO CONDUCTS REGULAR PHYSICIAN WORKFORCE STUDIES THROUGH ITS STRATEGIC PLANNING ARM TO DETERMINE UNMET PHYSICIAN NEEDS AND BARRIERS TO ACCESSING CARE. THE ORGANIZATION MEASURES THE SUCCESS OF ITS COMMITMENT BY HOW WELL IT KEEPS PEOPLE HEALTHY AND HOW WELL IT IMPACTS THE SOCIAL/CULTURAL BONDS THAT WILL SECURE THE COMMUNITIES OF THE FUTURE. THE HOSPITAL LAST CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2019. A COMPLETE COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY PRIORITIES, AND IMPLEMENTATION PLAN CAN BE FOUND AT HTTPS://WWW.PHOEBEHEALTH.COM/LOCATIONS/PHOEBE-WORTH-MEDICAL-CENTER/PHOEBE- WORTH-MEDICAL-CENTER-CHNA SCHEDULE H, PART VI, LINE 3 THE BOARD HAS CLEARLY WRITTEN FINANCIAL ASSISTANCE POLICY THAT IS AVAILABLE ON THE ORGANIZATION'S WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND CHARITY CARE. PATIENT EDUCATION ON THE ORGANIZATION'S FINANCIAL ASSISTANCE IS CONDUCTED DURING PRE-REGISTRATION, THROUGH FLOOR VISITS BY BUSINESS OFFICE REPRESENTATIVES FOR PATIENTS THAT STRESS CONCERN IN MEETING THE FINANCIAL OBLIGATIONS FOR THEIR SERVICES, AND THROUGH OUR CUSTOMER SERVICE DEPARTMENT. BROCHURES ARE PROMINENTLY DISPLAYED AT EACH REGISTRATION BOOTH. THE BUSINESS OFFICE CONTINUOUSLY PROVIDES UPDATED MATERIAL TO PHYSICIAN OFFICES FOR ISSUANCE TO THEIR PATIENTS THAT HIGHLIGHT THE FINANCIAL ASSISTANCE PROGRAM AND POLICIES. THE PATIENT STATEMENTS HIGHLIGHT THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY AND ENCOURAGES PATIENTS TO CALL FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART VI, LINE 4 WORTH COUNTY IS PHOEBE WORTH'S PRIMARY SERVICE AREA. THERE ARE APPROXIMATELY 20,300 RESIDENTS OF WORTH COUNTY WITH A RACIAL MIX OF 70% CAUCASIAN, 28% AFRICAN AMERICAN AND 2% OTHER. POPULATION PROJECTIONS FOR WORTH COUNTY SHOW MINOR OVERALL POPULATION GROWTH, WITH AGES 65+ HAVING THE GREATEST GROWTH RATE. THE AVERAGE HOURLY WAGE FOR WORTH COUNTY IS 17.88, WHICH IS LOW COMPARED TO SURROUNDING CITIES AND GEORGIA. BASED ON A 40 HOUR WORK WEEK, WORTH COUNTY'S AVERAGE ANNUAL WAGES ARE EQUAL TO 37,180, WHICH IS DOWN FROM 2012 DATA REPORTED AT 38,800. SCHEDULE H, PART VI, LINE 5 THE ORGANIZATION AND ITS VOLUNTEER BOARD IS COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS, AS WELL AS PHYSICIAN MEMBERS. THE ORGANIZATION'S EMERGENCY CENTER IS OPERATED 24/7 AND OPEN TO ALL PERSONS, REGARDLESS OF ABILITY TO PAY. THE BOARD MAINTAINS OPEN MEDICAL STAFF POLICIES WITH PRIVILEGES AVAILABLE TO ALL QUALIFYING PHYSICIANS. THE BOARD HAS A CLEARLY WRITTEN FINANCIAL ASSISTANCE POLICY THAT IS AVAILABLE ON THE ORGANIZATION'S WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED ON THE AVAILABILITY OF FREE AND CHARITY CARE. THE ORGANIZATION HAS A MULTI-PRONGED APPROACH TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES: INCREASING ACCESS, BUILDING CAPACITY, INVESTING IN "UPSTREAM" PROGRAMS THAT GET AT THE CAUSE OF DISEASE AND ILLNESS, BUILDING COMMUNITY PARTNERSHIPS, ADVOCATING CHANGE, AND DEVELOPING LEADERSHIP. SURPLUS FUNDS ARE REINVESTED IN RESOURCES TO IMPROVE THE DELIVERY OF MEDICAL AND HEALTH CARE SERVICES. PRIMARY CARE IS FIRST AND CREATES A PROFOUND IMPACT ON THE COMMUNITIES SERVED. PRIMARY CARE SERVICES ARE ESTABLISHED IN AREAS WHERE RESIDENTS ARE MOST LIKELY TO SUFFER FROM SEVERE MANPOWER SHORTAGES, HIGH POVERTY LEVELS AND A LACK OF ACCESS TO CARE. SCHEDULE H, PART VI, LINE 6 PHOEBE PUTNEY HEALTH SYSTEM, INC. (PPHS) IS THE NOT-FOR-PROFIT PARENT COMPANY OF PHOEBE PUTNEY MEMORIAL HOSPITAL, INC. (PPMH), A NOT-FOR-PROFIT ENTITY, PHOEBE PUTNEY HEALTH VENTURES, INC. (PPHV), A FOR-PROFIT CORPORATION, PHOEBE PHYSICIAN GROUP, INC. (PPG), A NOT-FOR-PROFIT CORPORATION, PHOEBE WORTH MEDICAL CENTER, INC. (PWMC), A NOT-FOR-PROFIT ENTITY, PHOEBE SUMTER MEDICAL CENTER, INC. (PSMC), A NOT-FOR-PROFIT ENTITY, AND PHOEBE FOUNDATION, INC. (PF), A NOT-FOR-PROFIT ENTITY. PPMH IS LOCATED IN ALBANY, GEORGIA, IS AN ACUTE CARE HOSPITAL, WHICH OPERATES SATELLITE CLINICS IN THE SURROUNDING COUNTIES. IT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SOUTHWEST GEORGIA. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. PPHV ENGAGES IN HEALTHCARE AND RELATED ACTIVITIES IN FURTHERANCE OF THE EXEMPT PURPOSES OF PPHS AND PPMH. PWMC, LOCATED IN SYLVESTER, GEORGIA, IS A 25 BED RURAL CRITICAL ACCESS HOSPITAL. IT PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES FOR RESIDENTS OF WORTH COUNTY, GEORGIA. PSMC, LOCATED IN AMERICUS, GEORGIA, IS AN ACUTE CARE HOSPITAL. IT PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR RESIDENTS OF SUMTER COUNTY, GEORGIA. PPG WAS ESTABLISHED TO ORGANIZE AND OPERATE MEDICAL PRACTICES EXCLUSIVELY FOR THE BENEFIT OF PPMH, PWMC, AND PSMC. PF WAS ESTABLISHED TO RAISE FUNDS OF ANY KIND OR CHARACTER TO BE USED EXCLUSIVELY FOR CHARITABLE, MEDICAL, EDUCATIONAL AND SCIENTIFIC PURPOSES AT OR IN CONNECTION WITH EACH AND EVERY NON-PROFIT ORGANIZATION OF WHICH PPHS IS THE SOLE MEMBER, AND ANY OTHER NON-PROFIT HOSPITAL WHICH IS MANAGED OR CONTROLLED BY PPHS WHETHER THROUGH OWNERSHIP, MANAGEMENT CONTRACT OR OTHERWISE. SCHEDULE H, PART VI, LINE 7 GEORGIA SCHEDULE H, PART VI SERVICE TO THE COMMUNITY PHOEBE WORTH MEDICAL CENTER (PWMC) IS A NOT-FOR-PROFIT HEALTH CARE ORGANIZATION THAT EXISTS TO SERVE THE COMMUNITY. PWMC HAS NO STOCKHOLDERS OR OWNERS, AND IS PART OF THE NOT-FOR-PROFIT PHOEBE PUTNEY HEALTH SYSTEM, INC. AFTER OPERATING EXPENSES ARE COVERED, ANY REMAINING REVENUES ARE REINVESTED IN THE OPERATION OF PWMC IN ORDER TO ENHANCE OUR ABILITY TO CARRY OUT OUR LOCAL MISSION OF TAKING CARE OF OUR COMMUNITIES' CITIZENS. THE HOSPITAL PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS WHICH COVER MANY GEORGIANS HEALTH CARE NEEDS, AND BY SO DOING, FOREGOES SOME CHARGES AND HAS UNREIMBURSED EXPENSES. THE HOSPITAL ALSO OFFERS FINANCIAL ASSISTANCE TO INDIVIDUALS UNABLE TO PAY FOR THEIR HEALTHCARE SERVICES. INDIGENT FINANCIAL ASSISTANCE, OR FREE CARE, IS OFFERED TO PATIENTS WHOSE HOUSEHOLD INCOME IS AT OR BELOW 125% OF THE FEDERAL POVERTY GUIDELINES. PATIENTS WHOSE INCOME LEVEL IS BETWEEN 126% - 400% OF THE FEDERAL POVERTY LEVELS WILL BE CLASSIFIED AS CHARITY AND RECEIVE THEIR NEEDED HEALTHCARE SERVICES AT A DISCOUNTED RATE. THE FOLLOWING TABLE SUMMARIZES THE AMOUNTS OF CHARGES FORGONE (I.E., CONTRACTUAL ADJUSTMENTS) AND ESTIMATES THE LOSSES INCURRED BY THE HOSPITAL DUE TO INADEQUATE PAYMENTS BY THESE PROGRAMS AND FOR INDIGENT/CHARITY SERVICES. THE HOSPITAL ALSO OPERATES A RURAL HEALTH CLINIC (RHC) WHICH ALSO FOREGOES SOME CHARGES AND HAS COSTS NOT REIMBURSED THROUGH PATIENTS QUALIFYING FOR THESE SAME INDIGENT AND CHARITY PROGRAMS. THE AMOUNTS LISTED BELOW ARE ALL INCLUSIVE OF BOTH HOSPITAL AND CLINIC ACTIVITIES. ESTIMATED CHARGES UNREIMBURSED FOREGONE COST MEDICARE 8,000,000 4,000,000 MEDICAID 5,000,000 2,000,000 INDIGENT/CHARITY CARE 4,000,000 2,000,000 TOTALS 17,000,000 8,000,000 THE FOLLOWING IS A SUMMARY OF THE COMMUNITY BENEFIT ACTIVITIES AND HEALTH IMPROVEMENT SERVICES OFFERED BY THE HOSPITAL AND ILLUSTRATES THE ACTIVITIES AND DONATIONS DURING FISCAL YEAR 2021. I. FINANCIAL AND IN-KIND SUPPORT THE HOSPITAL SUPPORTS THE COMMUNITY THROUGH PROVIDING SPACE TO THE WORTH COUNTY BOARD OF COMMISSIONERS. THE COUNTY UTILIZES THE SPACE AS ONE OF THE COUNTY'S EMERGENCY MANAGEMENT SERVICE (EMS) LOCATIONS. THE 2,710 SQUARE FEET OF SPACE INCLUDES A GARAGE/BAY, HOUSING AREA AND STORAGE SPACE. THE FAIR MARKET VALUE OF THE HOSPITAL'S CONTRIBUTION OF SPACE TOTALS 17,615 PER YEAR. THE HOSPITAL SUPPORTS THE COMMUNITY THROUGH PROVIDING OFFICE SPACE FOR ASPIRE BEHAVIORAL HEALTH SO THAT THEY ARE ABLE TO OFFER MORE BEHAVIORAL HEALTH SERVICES TO THE CITIZENS OF WORTH COUNTY. THE SUPPORT PROVIDES MUCH NEEDED MENTAL HEALTH SERVICES AS DETERMINED BY OUR COMMUNITY HEALTH NEEDS ASSESSMENT. THE FAIR MARKET VALUE OF THE HOSPITAL'S CONTRIBUTION OF SPACE TOTALS 490 PER YEAR. THE HOSPITAL SUPPORTS THE HEALTH DEPARTMENT THROUGH CONTRIBUTIONS TOWARDS THEIR PROGRAMS DIRECTED AT EDUCATING, SCREENING, TREATING, AND ASSISTING WITH THE COSTS OF SUPPLIES AND MEDICATIONS FOR LOW INCOME INDIVIDUALS BATTLING HIGH BLOOD PRESSURE AND DIABETES. THE FINANCIAL SUPPORT ENABLES THE HEALTH DEPARTMENT TO OPERATE ITS STROKE AND HEART ATTACK PREVENTION (SHAPP) AND DIABETES PROGRAM. THE HOSPITAL'S CONTRIBUTION TOTALED 45,619. THE HOSPITAL ENGAGES WITH THE COMMUNITY IN VARIOUS OTHER WAYS AS WELL. DURING FISCAL YEAR 2021, MANY OF OUR NORMAL COMMUNITY BENEFIT EVENTS WERE CANCELED DUE TO THE COVID PANDEMIC AND THE NEED TO CONTINUE EFFORTS TO REDUCE POSSIBLE CONTACT AND SPREAD OF THE VIRUS. HOWEVER, THE HOSPITAL SERVED A TREMENDOUS COMMUNITY ROLE IN PROVIDING ACCESS TO THE COVID VACCINE. THE HOSPITAL WORKED WITH THE LOCAL HEALTH DEPARTMENT AND PHOEBE PUTNEY HEALTH SYSTEM, INC. AND INVESTED RESOURCES TO RESHAPE A PORTION OF ITS DAILY OPERATIONS IN ORDER TO BEGIN PROVIDING THE COVID VACCINE IN DECEMBER 2020. DURING THE INITIAL VACCINE ROLLOUT, THE HOSPITAL PROVIDED 4,053 VACCINES THROUGH ITS HOSPITAL BASED VACCINE CLINIC AND CONTINUES TO OFFER VACCINES AND TESTING THROUGH ITS RURAL HEALTH CLINIC. true WORTH COUNTY HEALTH DEPARTMENT 1012 W FRANKLIN STREET SYLVESTER GA 317911978 581568404 GOV 45619 SEE PART IV 1 SCHEDULE I, PAGE 1, PART I, LINE 2 THE WORTH COUNTY HEALTH DEPARTMENT SENDS A LETTER TO PWMC ASKING FOR FINANCIAL ASSISTANCE RELATED TO SPECIFIC PROGRAMS THAT ARE PROVIDED BY THE HEALTH DEPARTMENT. ONCE RECEIVED, PWMC'S BOARD APPROVES THE AMOUNT OF ASSISTANCE TO THE HEALTH DEPARTMENT. THE FUNDS THAT ARE GIVEN TO THE HEALTH DEPARTMENT ARE DEEMED TO BE USED FOR THE SPECIFIC PURPOSES MENTIONED IN THE ORIGINAL LETTER FROM THE HEALTH DEPARTMENT. IN 2021, PWMC WORKED WITH THE HEALTH DEPARTMENT TO ENABLE THEM TO SUPPORT TWO HEALTH PREVENTION TYPE PROGRAMS. ONE PROGRAM WAS STROKE AND HEART ATTACK PREVENTION (SHAPP), THE SECOND PROGRAM WAS A DIABETES PROGRAM. false true false false false false false false false LARRY JOE AUSTIN PPMH CEO 511411 844728 117052 23938 1497129 821323 SCOTT STEINER BD MBR/PPHS CEO 698914 100000 21381 191151 27176 1038622 BRIAN CHURCH BD MBR/PPHS CFO 593963 20194 134024 29460 777641 KIM GILMAN CEO/CNO 250383 1045 57878 1264 310570 GRACE DAVIS MD BOARD MEMBER 180867 180867 BENJAMIN LEE HUDSON PHARMACIST 136726 600 93 4207 20946 162572 CANDACE GUARNIERI CFO 125410 91 2002 23646 151149 SCHEDULE J, PAGE 1, PART I, LINE 3 NONE OF THE INDIVIDUAL BOARD MEMBERS OR OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION. THE FILING ORGANIZATION, INSTEAD, RELIES ON THE METHODS USED BY PPHS, THE SOLE MEMBER, TO ESTABLISH COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. COMPENSATION DETERMINATION BY PPHS INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. SCHEDULE J, PAGE 1, PART I, LINE 4 LARRY JOE AUSTIN 0 108,502 0 BRIAN CHURCH 0 125,474 0 KIM GILMAN 0 50,329 0 BENJAMIN LEE HUDSON 0 182,601 0 SCHEDULE J, PART III SCHEDULE J, PART I, LINE 4 - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS: DEFERRED COMPENSATION PLAN 457(B): THE DEFERRED COMPENSATION PLAN IS AN ADDITIONAL RETIREMENT PLAN OFFERED THROUGH PHOEBE PUTNEY. THE 457(B) PLAN IS AN ELIGIBLE DEFERRED COMPENSATION PLAN THAT ALLOWS ONE TO DEFER ADDITIONAL DOLLARS TOWARDS RETIREMENT. HIGHLIGHTS INCLUDE: O NOT LIMITED BY THE AMOUNTS DEFERRED INTO THE PHOEBE 403(B) O PLAN IS SUBJECT TO ANNUAL DEFERRAL LIMITS SET BY THE IRS O PER IRS REGULATIONS, EACH PARTICIPANT IS A GENERAL UNSECURED CREDITOR OF THE PLAN SPONSOR. AN ELIGIBLE EMPLOYEE IS ONE WHO IS DETERMINED BY THE EMPLOYER TO BE A MEMBER OF A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES WITHIN THE MEANING OF SECTIONS 201(2), 301(A)(3), AND 401(A)(1) OF ERISA. SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) 457(F): PPHS RELIES ON AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, SURVEYS, WELL DOCUMENTED METHODS AND BOARD APPROVAL TO ESTABLISH TOTAL COMPENSATION OF THE CEO AND EXECUTIVE OFFICERS. CERTAIN BOARD APPROVED EMPLOYEES ARE ELIGIBLE TO PARTICIPATE IN A SERP THAT PROVIDES CERTAIN DEFINED ANNUAL PAY CREDITS THAT ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE. THE PURPOSE OF THE SERP IS TO PROVIDE A LONG-TERM INCENTIVE AND RETIREMENT BENEFIT FOR AFFECTED EXECUTIVES CONSISTENT WITH THE BENEFIT AVAILABLE TO EMPLOYEES NOT IMPACTED BY IRS COMPENSATION LIMITS ON DEFINED BENEFIT PLANS. THE AMOUNTS REPORTED AS SUPPLEMENTAL EXECUTIVE RETIREMENT COMPENSATION FOR ELIGIBLE EMPLOYEES IN SCHEDULE J REPRESENT CREDITED, BUT NOT VESTED, BENEFITS, AND THE AMOUNTS ARE AVAILABLE IN FUTURE PERIODS TO THE EMPLOYEE SUBJECT TO CONTINUING EMPLOYMENT. PPHS MAINTAINS OWNERSHIP OF THE FUNDS ALLOCATED TO EACH PARTICIPANT UNTIL VESTING AND PAYMENT. FOR A PARTICIPANT IN THE SERP PRIOR TO 1/1/2017 (A "GRANDFATHERED PARTICIPANT"), WITH PAY CREDITS FOR PLAN YEARS BEGINNING PRIOR TO 1/1/2020, THE INITIAL VESTING DATE WILL OCCUR ON THE DATE THE PARTICIPANT ATTAINS FIVE YEARS OF PARTICIPATION UNDER THE PLAN. AFTER THE INITIAL VESTING DATE, A GRANDFATHERED PARTICIPANT SHALL HAVE A NEW VESTING DATE ONCE EVERY 5 YEARS. THESE ADDITIONAL VESTING DATES WILL OCCUR ON THE 5TH ANNIVERSARY OF EACH VESTING DATE AFTER THE INITIAL VESTING DATE. ON EACH VESTING DATE, A GRANDFATHERED PARTICIPANT WILL BECOME 100% VESTED IN AN AMOUNT EQUAL TO THE PARTICIPANT'S ACCOUNT BALANCE REDUCED BY ANY PAY CREDITS CREDITED TO THE ACCOUNT FOR THE 2 MOST RECENT PLAN YEARS. GRANDFATHERED PARTICIPANTS WITH PAY CREDITS FOR PLAN YEARS BEGINNING ON OR AFTER 1/1/2020, EACH YEAR'S ANNUAL PAY CREDIT PLUS SUBSEQUENT EARNINGS AND/OR LOSSES WILL VEST AFTER 5 YEARS OF CONTINUOUS EMPLOYMENT. EACH CONTRIBUTION IS SUBJECT TO A SEPARATE AND INDEPENDENT 5 YEAR CONTINUOUS EMPLOYMENT REQUIREMENT. FOR PARTICIPANTS INITIALLY PARTICIPATING IN THE SERP AFTER 12/31/2016 (A "CONTEMPORARY PARTICIPANT"), EACH YEAR'S ANNUAL PAY CREDIT PLUS SUBSEQUENT EARNINGS AND/OR LOSSES WILL 100% VEST ON THAT PAY CREDITS' 5TH ANNIVERSARY, PROVIDED THAT THE PARTICIPANT REMAINS IN THE CONTINUOUS EMPLOYMENT THROUGHOUT THE 5-YEAR PERIOD FOR EACH ANNUAL PAY CREDIT. IF ANY ELIGIBLE PARTICIPANT ATTAINS NORMAL RETIREMENT AGE PRIOR TO SEPARATION FROM SERVICE, THEY SHALL VEST IN 100% OF THE ACCOUNT BALANCE. ONCE VESTED, EACH PARTICIPANT SHALL RECEIVE A DISTRIBUTION OF THEIR ENTIRE VESTED AMOUNT WITHIN A REASONABLE PERIOD NOT TO EXCEED 2.5 MONTHS. THIS DISTRIBUTION IS TREATED AS REPORTABLE COMPENSATION TO THE PARTICIPANT AND IS INCLUDED IN PART II, COLUMN B(III). THEREFORE, PART II, COLUMN B(III) INCLUDES PRIOR YEAR SERP DEFERRALS PREVIOUSLY REPORTED IN PART II, COLUMN C. ANY DISTRIBUTION AMOUNT INCLUDED IN PART II, COLUMN B(III) THAT WAS PREVIOUSLY REPORTED IN PRIOR PERIODS AS DEFERRED COMPENSATION IN PART II, COLUMN C IS DISCLOSED IN PART II, COLUMN F. SCHEDULE J, PART II, COLUMN B(II) CERTAIN EXECUTIVE OFFICERS AND PHYSICIANS ARE ELIGIBLE FOR BONUS/INCENTIVE PAYMENTS. THESE BONUSES ARE DETERMINED BASED ON THE ACHIEVEMENT OF VARIOUS ORGANIZATIONAL AND PERSONAL PERFORMANCE GOALS ESTABLISHED BY A FORMAL PROCESS IN KEEPING WITH THE ORGANIZATION'S TAX-EXEMPT STATUS. COMPENSATION PROCESS FOR TOP OFFICIAL AS DETERMINED BY PPHS THE ORGANIZATION'S FORMAL PROCESS FOR DETERMINING TOTAL COMPENSATION FOR THE CEO IS INTENDED TO PROVIDE REASONABLE COMPENSATION FOR ACCOMPLISHING THE ORGANIZATION'S MISSION, ACHIEVE ITS STRATEGIC GOALS, TO RECOGNIZE PERFORMANCE, AND TO OPERATE IN KEEPING WITH THE ORGANIZATION'S OBLIGATIONS AS A TAX-EXEMPT CHARITABLE ORGANIZATION. THE EXECUTIVE COMPENSATION COMMITTEE OF THE PPHS'S BOARD OF DIRECTORS CONDUCTS AN ANNUAL REVIEW OF THE COMPENSATION OF THE CEO. THE COMMITTEE RETAINS A QUALIFIED INDEPENDENT COMPENSATION CONSULTANT TO CONDUCT COMPETITIVE MARKET ANALYSIS OF THE MARKET RANGES OF BASE, INCENTIVE AND TOTAL CASH COMPENSATION. THE INFORMATION THE COMMITTEE MAY CONSIDER CAN INCLUDE BUT IS NOT LIMITED TO THE PERFORMANCE OF AN INDIVIDUAL, THE PERFORMANCE OF THE ORGANIZATION, AN INDIVIDUAL'S LENGTH OF SERVICE, CREDENTIALS AND EXPERIENCE, THE ELEMENTS OF TOTAL COMPENSATION AND SALARY HISTORY, THE ORGANIZATION'S COMPENSATION TARGETS, AND COMPARABILITY DATA, INCLUDING THE DATA PREPARED BY THE INDEPENDENT CONSULTANT AND REVIEWED WITH THE COMMITTEE. THE COMMITTEE INCORPORATES A FORMAL PERFORMANCE APPRAISAL PROCESS IN THE CEO COMPENSATION REVIEW. IT UTILIZES A MULTI-PERSPECTIVE APPROACH AND PERFORMANCE MEASURES WHICH ARE LINKED TO THE ORGANIZATION'S LONG-TERM STRATEGIC PLAN AND ACHIEVEMENT OF ANNUAL SYSTEM OBJECTIVES. THE CEO IS NOT PRESENT WHEN THE COMMITTEE DISCUSSES AND ESTABLISHES HIS COMPENSATION. FORM 990, PAGE 6, PART VI, LINE 6 THE SOLE MEMBER OF PHOEBE WORTH MEDICAL CENTER, INC. SHALL BE PHOEBE PUTNEY HEALTH SYSTEM, INC. (PPHS). FORM 990, PAGE 6, PART VI, LINE 7A THE BOARD OF DIRECTORS OF PPHS, THE SOLE MEMBER, SHALL APPOINT ALL DIRECTORS OF THE FILING ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 7B THE SOLE MEMBER, PPHS, SHALL HAVE THE FOLLOWING RESPONSIBILITIES: - THE MEMBER SHALL APPOINT OR REMOVE THE ORGANIZATION'S DIRECTORS. - THE MEMBER SHALL SELECT OR REMOVE THE ORGANIZATION'S OFFICERS. - THE MEMBER SHALL APPROVE ALL AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY MAY BECOME EFFECTIVE. - THE MEMBER SHALL APPROVE ANY ANNUAL OPERATING OR CAPITAL BUDGETS. - THE MEMBER SHALL APPOINT OR REMOVE THE INDEPENDENT AUDITORS. FORM 990, PAGE 6, PART VI, LINE 11B THE INDEPENDENT ACCOUNTING FIRM THAT PREPARES THE FORM 990 (BASED UPON INFORMATION PROVIDED BY THE ORGANIZATION) PROVIDES A COMPLETE COPY OF THE RETURN WITH APPLICABLE SCHEDULES TO BE REVIEWED BY MANAGEMENT. MANAGEMENT PERFORMS A DETAILED REVIEW WHICH CONSISTS OF REVIEWING THE FINANCIAL DATA, THE NARRATIVES DISCLOSED, AND OTHER FACTS PRESENTED ON THE RETURN. UPON REVIEW, THE FORM 990 IS THEN FORWARDED TO THE FINANCE COMMITTEE FOR THEIR REVIEW, TO GAIN THEIR COMMENTS AND APPROVAL. UPON APPROVAL FROM THE FINANCE COMMITTEE, THE FORM 990 AND RELATED SCHEDULES ARE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW AND FEEDBACK. ONCE THE FORM 990 IS REVIEWED BY ALL APPLICABLE PARTIES, A COPY OF THE FINAL VERSION IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PAGE 6, PART VI, LINE 12C ON AN ANNUAL BASIS, PHOEBE WORTH MEDICAL CENTER, INC. (PWMC) BOARD MEMBERS AS WELL AS ALL OFFICERS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. THIS QUESTIONNAIRE IS ADMINISTERED BY THE PHOEBE PUTNEY HEALTH SYSTEM (PPHS) COMPLIANCE DEPARTMENT AND THE DOCUMENT ASKS EACH INDIVIDUAL TO DISCLOSE ANY PERSONAL, BUSINESS, OR OTHER AFFILIATIONS AND MONETARY AMOUNT IF APPLICABLE THAT THEY OR THEIR IMMEDIATE FAMILY MEMBERS HAVE HAD WITHIN THE PAST 12 MONTHS WITH PWMC OR ANY RELATED ENTITIES. ALL RESPONSES ARE THEN EVALUATED BY THE PPHS COMPLIANCE DEPARTMENT. IN THE CASE OF AN EXISTING CONFLICT, THE INDIVIDUAL WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL TO SUCH TRANSACTIONS. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES AVAILABLE TO THE PUBLIC ITS CONFLICT OF INTEREST AND AUDITED FINANCIAL STATEMENTS ON THE ORGANIZATION'S WEBSITE, BY PROVIDING COPIES UPON REQUEST, AND BY INSPECTION AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION. FORM 990, PART IX, LINE 11G CONTRACT STAFFING 105,780 0 0 PHYSICIAN FEES 3,067,245 0 0 CONTRACT SERVICES 111,221 1,655,341 0 CONSULTANT FEES 563,228 0 0 COLLECTION SERVICES 38,988 90,931 0 TOTAL 3,886,462 1,746,272 0 PHOEBE PUTNEY HEALTH SYSTEM INC PO BOX 3770 ALBANY GA 317063770 582001014 HEALTHCARE GA 501C3 12C NA false PHOEBE PUTNEY MEMORIAL HOSPITAL INC PO BOX 3770 ALBANY GA 317063770 581928247 HEALTHCARE GA 501C3 3 PPHS false PHOEBE PHYSICIAN GROUP INC PO BOX 3770 ALBANY GA 317063770 263792403 HEALTHCARE GA 501C3 10 PPHS false PHOEBE SUMTER MEDICAL CENTER INC 126 HIGHWAY 280 WEST AMERICUS GA 317198645 263975185 HEALTHCARE GA 501C3 3 PPHS false PHOEBE FOUNDATION INC PO BOX 3770 ALBANY GA 317063770 581847104 FOUNDATION GA 501C3 12A PPHS false PHOEBE DORMINY MEDICAL CENTER INC PO BOX 3770 ALBANY GA 317063770 452041878 HEALTHCARE GA 501C3 3 PPHS false PHOEBE PUTNEY HEALTH VENTURES INC PO BOX 3770 ALBANY GA 317063770 581963401 HEALTHCARE GA N/A false PHOEBE PUTNEY INDEMNITY LTD 113 S CHURCH ST 5TH FL QUEENSGATE GRAND CAYMAN CJ KY1-1102 981492026 INSURANCE CJ N/A false false false false false true false false false false false false false true false true false true false false