2021-05-17T15:17:31-05:00 2020-06-30 KPMG LLP 300 North Greene Street Suite 400 Greensboro NC 27401 990 2019-07-01 824194264 Piedmont Walton Hospital Inc % MARIE GAFFNEY PIED 7702678461 2151 West Spring Street MONROE GA 30655 MARIE GAFFNEY VP CORPORATE FINANCE 2021-05-17 WHITNEY B HEBRON P01226647 3362753394 2021-05-13 2019 2022-09-23 18:48:47Z MR LARRY EBERT 2151 West Spring Street MONROE GA 30655 71826183 false X www.piedmont.org/locations/piedmont-walton/ X 2018 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 7 4 451 80 0 0 1923 1514606 57891379 69894045 29418 42227 369831 375305 58292551 71826183 0 0 0 0 27941201 29907449 0 0 0 43719664 44165319 71660865 74072768 -13368314 -2246585 49671640 51912402 6816970 61490558 42854670 -9578156 X TO PROVIDE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE IN A PROGRESSIVE ENVIRONMENT, GUIDED BY PHYSICIANS, DELIVERED BY EXCEPTIONAL PROFESSIONALS, AND INSPIRED BY THE COMMUNITIES WE SERVE. false false 62723445 0 69905928 PIEDMONT WALTON HOSPITAL ("PWH") IS A 77-BED, NON-PROFIT HOSPITAL LOCATED IN THE CITY OF CONYERS IN WALTON COUNTY, GEORGIA. OVER 250 PRIMARY CARE AND SPECIALTY PHYSICIANS COMPRISE THE MEDICAL STAFF AND MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN WALTON COUNTY AND THE GREATER METROPOLITAN ATLANTA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2020, THE HOSPITAL HAD 3,005 IN-PATIENT ADMISSIONS WITH A TOTAL OF 10,840 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 31,829 AND OUTPATIENT VISITS TOTALED 16,225. SURGICAL SERVICES WERE PROVIDED TO 2,532 PATIENTS. 62723445 true true false false false false false false false true false false true true true false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true false false false true X 0 0 451 true false false false false false false false false false false false false X 7 4 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 Michael McAnder Treasurer 1.0 54.0 X 0 1036007 130895 Mr J Michael Burnett Board Member 1.0 54.0 X 0 891386 109446 Ms Elizabeth Leddy Secretary 1.0 54.0 X 0 843536 107225 Ms Vicki A Cansler Board Member 1.0 54.0 X 0 693346 81884 Dr Robert Sinyard CMO 20.0 35.0 X 0 571078 34176 Mr Larry Ebert CEO & Board Member 55.0 0.0 X X 360737 0 26927 Mr Marvin Wynn CFO (EFF. 5/20) 5.0 50.0 X 0 267900 27649 Mr Michael Wynne DIRECTOR - PHARMACY 40.0 0.0 X 168121 0 20969 Ms Rose Dennis exec. Dir. - patient svcs 40.0 0.0 X 164252 0 22082 Ms Candice Frix CNO 55.0 0.0 X 142908 0 19027 Mr Jeffrey Braswell dir. - emergency svcs 40.0 0.0 X 148470 0 5047 Mr Venel Pierre Louis RN 40.0 0.0 X 129846 0 6660 Mr Dan Curry Board Member 1.0 0.0 X 0 0 0 Mr Patrick Dally Board Member 1.0 0.0 X 0 0 0 Mr Wm Ronald Duffey Board Member 1.0 4.0 X 0 0 0 Mr Coleman Landers Chair 1.0 0.0 X 0 0 0 1114334 4303253 591987 18 false true false WALTON ANESTHESIA ASSOCIATES PC 2151 West Spring St MONROE GA 30655 ANESTHESIA 753100 THERAPEUTIC GI ASSOCIATES LLC 2151 W SPRING ST MONROE GA 30655 GASTROENTEROLOGY SVC 607500 HHS ENVIRONMENTAL SERVICES 12495 Silver Creek Road DRIPPING SPRINGS TX 78620 JANITORIAL SERVICES 488693 DIVERSIFIED CLINICAL SERVICES INC 5220 Belfort Rd JACKSONVILLE FL 32256 HEALTHCARE SERVICES 454928 ATHENS ORTHOPEDIC CLINIC PA 1765 Old West Broad St ATHENS GA 30606 ORTHOPEDIC SERVICES 290649 11 1514483 123 1514606 PATIENT SERVICE REVENUE 622110 69823016 69823016 OTHER OPERATING REVENUE 900099 71029 71029 69894045 42227 42227 0 0 363422 363422 0 363422 363422 0 0 0 0 0 0 0 0 0 0 FEE REVENUE 900099 11883 11883 11883 71826183 69905928 0 405649 0 0 0 0 366212 88007 278205 0 24358859 21792603 2566256 0 3574188 3120731 453457 1608190 1381114 227076 0 21873 21873 0 0 0 0 7489813 6092215 1397598 249940 19923 230017 4459669 3380358 1079311 2526076 1914766 611310 0 2371752 2201077 170675 7918 4946 2972 0 0 828826 828826 2535293 2535293 2059960 1915065 144895 854944 639762 215182 DRUGS & MEDICAL SUPPLIES 9140293 9140293 BAD DEBT EXPENSE 9087351 9087351 HOSPITAL TAX 1123487 1123487 ADMINISTRATIVE EXPENSES 1408124 821747 586377 74072768 62723445 11349323 0 58577311 45517979 0 0 0 0 -50135310 -35864869 0 0 0 0 0 0 1225961 1202163 314146 199926 25257367 3617325 14473028 21640042 0 0 0 0 0 0 0 0 25216504 19217161 49671640 51912402 6320035 7367953 0 0 0 0 0 37759547 0 0 0 0 0 0 0 0 496935 16363058 6816970 61490558 X 42854530 -9577626 140 -530 42854670 -9578156 49671640 51912402 X -2246585 -50186241 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2189458 2189458 14651933 1160647 13491287 0 0 0 7332771 2456678 4876093 1083205 0 1083204 21640042 GOODWILL 18938257 UNAMORTIZED ISSUE COSTS 278904 19217161 0 MEDICARE PAYABLE 16363058 16363058 X SCHEDULE D, PART X, LINE 2: ASC 740 FOOTNOTE (FKA FIN 48) PHC ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF THE INCOME TAXES TOPIC OF THE ASC (ASC 740). UNDER THE REQUIREMENTS OF ASC 740, TAX-EXEMPT ORGANIZATIONS MAY BE REQUIRED TO RECORD AN OBLIGATION AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS UNCERTAIN TAX EXPOSURE ITEMS. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT JUNE 30, 2020 AND 2019. true true X true X 300. true X true true false true true 6460931 0 6460931 0.09940 2958223 2691761 5649984 0.08690 1118480 326072 1444552 0.02220 10537634 3017833 13555467 0.20850 23700 0 23700 0.00030 619067 0 619067 0.00950 87000 0 87000 0.00130 0 0 0 0.00000 30000 0 30000 0.00050 759767 0 759767 0.01160 11297401 3017833 14315234 0.22010 true 2862232 11528200 14096852 -2568652 X true true 1 1 PIEDMONT WALTON HOSPITAL INC 2151 WEST SPRING STREET MONROE GA 30655 www.piedmont.org 147-613 X X X 1 PIEDMONT WALTON HOSPITAL INC 1 true true true X X X X X X X X 18 true true false true X SEE PART VI X X true 19 true SEE PART VI false true X 300. 300. X true true X X X X true X SEE PART VI X SEE PART VI X SEE PART VI X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, LINES 1 AND 2: NEW HOSPITAL ENTITY PIEDMONT WALTON HOSPITAL, INC. ("PWH") WAS CREATED AS A NEW ENTITY ON JANUARY 26, 2018, FOLLOWING THE PURCHASE OF THE ASSETS OF CLEARVIEW REGIONAL MEDICAL CENTER, INC. FROM QUORUM HEALTH CORP., A FOR-PROFIT COMPANY. PIEDMONT WALTON HOSPITAL WAS GRANTED ITS TAX EXEMPT STATUS ON JUNE 11, 2019, RETROACTIVE TO THE HOSPITAL'S DATE OF ORGANIZATION, JANUARY 26, 2018. SCHEDULE H, PART V, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE https://www.piedmont.org/media/file/PWH-FY19-CHNA-Strategy.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 WALTON 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 STRATEGY THE BOARD OF DIRECTORS FOR PIEDMONT WALTON HOSPITAL, INC. UNANIMOUSLY APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE YEAR PERIOD BEGINNING WITH FY20 ON OCTOBER 16, 2019, 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, 2022, WHICH IS CONTAINED AT THE END OF THE DOCUMENT https://www.piedmont.org/media/file/PWH-FY19-CHNA-Strategy.pdf SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS WHEN PIEDMONT HEALTHCARE, INC. FIRST ACQUIRED THE ASSETS OF PIEDMONT WALTON HOSPITAL, INC., THE HOSPITAL HAD A GRACE PERIOD FOR PIEDMONT HEALTHCARE TO PREPARE AND APPROVE A COMMUNITY HEALTH NEEDS ASSESSMENT FOR PIEDMONT WALTON HOSPITAL. THE INITIAL CHNA FOR PIEDMONT WALTON HOSPITAL WAS UNANIMOUSLY APPROVED BY ITS BOARD OF DIRECTORS ON APRIL 17, 2019, WITHIN THE GRACE PERIOD. BASED ON THE CHNA, PIEDMONT WALTON HOSPITAL WILL FOCUS ON: (1) INCREASE ACCESS TO APPROPRIATE AND AFFORDABLE HEALTH AND MENTAL CARE FOR ALL COMMUNITY MEMBERS, AND ESPECIALLY THOSE WHO ARE UNINSURED AND THOSE WITH LOW INCOMES; (2) REDUCE OPIOID AND RELATED SUBSTANCE ABUSE AND OVERDOSE DEATHS; (3) DECREASE DEATHS FROM CANCER AND INCREASE ACCESS TO CANCER PROGRAMMING FOR THOSE LIVING WITH THE DISEASE, WITH A FOCUS ON LUNG CANCER; AND (4) PROMOTE HEALTHY WEIGHTS AND BEHAVIORS AS TO DECREASE PREVENTABLE INSTANCES OF HEART DISEASE AND DIABETES. SCHEDULE H, PART V, LINE 16: FINANCIAL ASSISTANCE 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 DISCLOSURES PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A Piedmont Walton Hospital regularly reports to the community its community benefit activities in several ways. Each year, the hospital prepares a systemwide community-benefit report that is widely distributed to the public through emailed versions sent to community stakeholders and community organizations, printed copies made available to community members upon request, and publication on the system's website. The hospital also makes available copies of its IRS Form 990 Schedule H on its website and available to anyone upon request. Additionally, the hospital presents its community benefit work within the health care system's annual report and the health care system's foundation annual report, which is widely distributed to the public through both printed copies made available to community members upon request and through publication on the system's website. Additionally, the report was mailed to hospital and system board members, state and local elected officials and other key stakeholders. The hospital provides information on community benefit programming to local, state and federal lawmakers through its government affairs office. Finally, the hospital issues media alerts on key community benefit programming, such as its community benefit grants program, to the public, and provides an annual impact report demonstrating the outcomes from those grants. PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7(F) THE DENOMINATOR USED FOR THE CALCULATION OF COLUMN (F), PERCENT OF TOTAL EXPENSE, WAS THE AMOUNT OF TOTAL FUNCTIONAL EXPENSES ON FORM 990, PART IX, LINE 25, COLUMN (A) OF $74,072,768, LESS BAD DEBT EXPENSE OF $9,087,351 FROM FORM 990, PART IX, LINE 24(B). FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7 A RATIO OF PATIENT CARE COST TO CHARGES, CONSISTENT WITH WORKSHEET 2, WAS USED TO REPORT THE AMOUNTS IN PART I, LINES 7A-7D. FOR AMOUNTS ON LINES 7E-7K, ACTUAL EXPENSES FOR EACH COMMUNITY BENEFIT ACTIVITY ARE TRACED AND REPORTED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. BAD DEBT EXPENSE CALCULATION AND FOOTNOTE SCHEDULE H, PART III, LINES 2-4 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 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. PIEDMONT WALTON HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE ARE NOT REPORTED AS REVENUE. MEDICARE SHORTFALLS AS COMMUNITY BENEFIT SCHEDULE H, PART III, LINE 8 The amount reported on Part III, Line 6, was calculated in accordance with Schedule H instructions by utilizing the organization's allowable Medicare cost as reported in the Medicare cost report, which is based on a cost to charge ratio. However, the allowable costs in the Medicare cost report do not reflect the actual cost of providing care to patients since the Medicare cost report excludes many direct patient care costs that are essential to 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. The organization believes that Piedmont Walton Hospital's 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 the hospital operates to promote health in the community. Additionally, Medicare accounted for 43.75% percent of Piedmont Walton Hospital's patient service revenue. Piedmont Walton Hospital's policy is to treat Medicare patients, regardless of the extent to which Medicare actually 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 the hospital in honor of Piedmont Walton Hospital's 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. COLLECTION PRACTICES SCHEDULE H, PART III, LINE 9(B) INITIAL SCREENINGS OF ALL INPATIENT, EMERGENCY, AND SURGERY ENCOUNTERS, AS WELL AS MOST OUTPATIENT VISITS, ARE CONDUCTED BY FINANCIAL COUNSELORS IN ORDER TO IDENTIFY ANY AVAILABLE INSURANCE OR OTHER COVERAGE FOR EACH PATIENT. COUNSELORS CONTACT PATIENTS AND THEIR FAMILIES DIRECTLY, EITHER IN PERSON OR BY LETTER, TO ASSIST THE FAMILY IN IDENTIFYING ANY PROGRAMS FOR WHICH THE PATIENT/SERVICE MAY QUALIFY (INCLUDING MEDICAID, STATE CHILDREN'S HEALTH INSURANCE PROGRAM ("SCHIP"), PRIVATE OR GOVERNMENT INSURANCE COVERAGE, AND CHARITY ASSISTANCE). IF THE FAMILY CANNOT BE TIMELY LOCATED OR IS UNCOOPERATIVE, RELATED ACCOUNTS ARE TRANSFERRED TO AN INTERNAL COLLECTION DEPARTMENT FOR FURTHER ATTEMPTS TO OBTAIN PAYMENT OR, IF THE PATIENT MAY QUALIFY FOR ASSISTANCE, TO SECURE A FINANCIAL ASSISTANCE APPLICATION. THE ORGANIZATION'S DEBT COLLECTION POLICY AND PROCEDURES PROHIBIT ANY COLLECTION EFFORTS FOR THE PORTION OF A PATIENT ACCOUNT BALANCE THAT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. SCHEDULE H, PART VI, LINE 2: NEEDS ASSESSMENT As a designated 501(c)(3) nonprofit hospital, Piedmont Walton Hospital is required by the Internal Revenue System to provide 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, the hospital worked to better understand local health challenges, identify health trends in its community, determine gaps in the current health delivery system and create a plan to address those gaps and the identified health needs. In FY19, Piedmont Walton Hospital conducted its first triennial CHNA, as the entity was previously a for-profit organization. FY20 marked Year One of the three-year implementation strategy. The Piedmont Walton Hospital CHNA was led by the Piedmont Healthcare community benefits team, with input and direction from Piedmont Walton Hospital leadership, with the hospital's chief executive officer as the primary responsible party. Process The CHNA started first with a definition of its community. We defined the hospital's primary population as the hospital's home county, due to the impact of its tax-exempt status. The hospital estimate property taxes make up the largest segment of a hospital's tax exemption. Because of this, we want to ensure that we are providing equal benefit to its county. Additionally, the hospital takes into consideration patient origin, and especially that of its lower-income patients, such as those who qualify for financial assistance or receive insurance coverage through Medicaid. The hospital's secondary communities are considered the areas in which we have the highest concentration of patients fitting that criteria, including ones from nearby counties. Once the hospital established its primary and secondary community, it 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 were for 2017, unless otherwise noted. Health indicators are estimates provided by County Health Rankings and hospital data were provided by the hospital. 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, evaluation of current programs, as well as suggestions for how we can better serve its patients and communities. Nearly 900 employees spanning the system responded. Additionally, we conducted a community-based survey in which local stakeholders were asked their thoughts on unmet community health needs and the hospital's role in addressing those needs. These stakeholders included local leaders, nonprofit representatives, elected officials and those with a unique knowledge of the challenges vulnerable populations face. Finally, we conducted direct interviews with 31 state and regional stakeholders and policymakers, with each representing a specific group that tends to be adversely impacted by issues of health equity. These groups included but are not limited to Georgians for a Healthy Future, Georgia Watch, ConsiderHealth, the Community Foundation for Greater Atlanta, the Georgia Charitable Care Network, the Medical Association of Georgia and Healthy Mothers, Healthy Babies. Additionally, we sought and received feedback on its CHNA from public health. Our priorities A key component of the CHNA is to identify the top health priorities the hospital will address over fiscal years 2020, 2021 and 2022. These priorities guide all community benefit work. They are, in no order: . Increase access points for appropriate and affordable health, dental and mental care for all community members, and especially those who are uninsured and those with low incomes . Decrease deaths from cancer and increase access to cancer programming for those with living the disease, with a focus on lung cancer . Promote healthy weights and behaviors as to decrease preventable instances of heart disease and diabetes . Reduce opioid and related substance abuse and overdose deaths 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, and that is demonstrated through the hospital's implementation strategies. How we determined our priorities: Several key community health needs 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. The priorities we chose reflected a collective agreement on what hospital leadership, staff and the community felt was most important and within the hospital's ability to positively impact the issue. While the priorities reflect clinical access and certain conditions, 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 Piedmont Walton Hospital implementation strategy was developed in partnership with hospital leadership and community stakeholders to address the identified priorities in our FY19 CHNA. 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, Piedmont Walton Hospital leadership and the Piedmont Walton Hospital Board of Directors. The hospital included proven and successful interventions and programming, investing further in work we felt was successful in addressing unmet health needs. The implementation strategy was unanimously approved by the Piedmont Walton Hospital Board of Directors on October 16, 2019. SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY Piedmont Walton Hospital understands that not everyone has the ability to 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 available at Piedmont Walton Hospital includes providing a dedicated contact number, which is disseminated by the hospital to patients by various means. These include but are not limited to the publication of notices in patient bills and by posting notices in emergency rooms, in the Conditions of Admission form, at admitting and registration departments, hospital business offices, and patient financial services offices that are located on facility campuses, and at other public places the hospital may elect, including availability at local low-cost clinics primarily treating uninsured populations. Piedmont Walton Hospital also publishes and widely publicizes a plain language summary of this financial assistance care policy on its facility website, which includes a link to 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. Finally, we provide copies of the hospital's financial assistance policy to partner clinics and others who work closely with low-income populations. The hospital provides assistance in understanding the policy, how it relates to their populations and receive feedback in ways financial assistance programming could be improved. Additionally, Piedmont Healthcare annually publishes a directory of services and programs for low-income community members, and within this resource guide are extensive directions and advice on how to apply for patient financial assistance. Also, in this guide is information on how to apply for certain government assistance programs, resources to help prepare and file tax returns, as well as detailed resources for local sliding scale and free mental, dental and health resources. This guide is widely distributed to the community via hardcopy, is available within all Piedmont Healthcare hospitals and is digitally available online. Copies are provided in both English and Spanish. In FY20, we distributed approximately 5,500 copies of this guide throughout the Walton community, which was updated to reflect any changes brought on by the advent of COVID-19, as many nonprofits serving vulnerable populations shifted or ceased operations. We continue to update this guide, to the best of our ability. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION Piedmont Walton Hospital is located in Monroe, Georgia, and considers its primary community to be its home county of Walton County. On average, between 2015 and 2019, approximately 91,442 people lived in Walton County's 327 square miles. The majority of the community is white -- about 78 percent. The county slightly skewed female. Walton County is growing, with an increase of about 38 percent in population between 2000 and 2010. Hispanic or Latino populations alone grew by 131 percent during that time. On average, between 2015 and 2019, the median household income was $61,599, in line with the state and national averages of $52,977 and $57,652, respectively. During those years, the median age was 39. On average, between 2015 and 2019,12 percent of the county lived at or below the poverty level - about 10,901 people. Approximately 4.3 percent of adults were unemployed in 2020, a figure better than state and national averages. Eighteen percent of children in Walton County lived in poverty between 2015 and 2019, on average. Poor children are statistically less likely to graduate high school and are nearly twice as likely to become poor adults and, should they have children, continue a circle of poverty that's difficult to break. These children are also more likely to experience dental issues, anxiety problems and higher rates of accidental injury. There were 4,783 veterans living in Walton County on average each year between 2015 and 2019, making up about 7 percent of the population, and the largest age group for veterans was 35 to 54, and the overwhelming majority were male. Most lived with some sort of disability. In Walton County, like with the rest of Georgia, heart disease was the number one cause of both age-adjusted and premature death between 2015 and 2019. Age-adjusted death rates allows communities with different age structures to be compared. In comparison, premature death is when death happens before the average age for a given community. Between 2015 and 2019, the second leading cause of premature death was accidental poisoning and exposure to noxious substances. Other top causes, in order, were motor vehicle accidents, suicide, lung cancer, hypertension/hypertensive renal and heart disease, certain conditions originating in the perinatal period, all COPD except asthma, cerebrovascular disease and diabetes. As evidenced in this list, the impact of issues related to unhealthy behaviors was significant, indicating a clear need for more aggressive interventions. In Walton County, 12 percent of the total population was uninsured each year on average between 2015 and 2019, and 17 percent of the adult population was uninsured during that time. Rates for children and elderly populations were much lower at 6 percent for children and less than 2 percent for those 65 and older. This equals about 10,620 people who have no form of insurance coverage to pay for necessary care. Community members have reported an average 3.4 poor or fair physical and 3.8 poor mental health days. A total 17 percent of Walton County residents reported their health as poor or fair. These are all on par with the state average. Preventable hospital stays among Medicare enrollees averaged 4,974 preventable hospital events per every 100,000 enrollees in 2017. This figure is better than state and national rates. Thirteen percent of the population lived with at least one disability on average each year between 2015 and 2019. The highest concentration of disabled populations in the central part of the county. On average, between 2006 and 2012, 8.3 percent of all babies born were at a low birth weight, and with African American infants far more likely to be born at a low birth weight than any other race. In 2017, 228 Walton County community members died from cerebrovascular disease, which includes stroke. While stroke impacts all patients, like with most health measures, the lower income and less educated a person is, a the more likely he or she is to experience more severe repercussions, such as death, for several reasons, including limited health literacy, difficulty affording care and necessary prescriptions and unhealthy behaviors. Overall, between 2015 and 2019, lung cancer was the second leading cause of age-adjusted death and the 4th leading cause of premature death. Colon, rectum and anal cancers were the 12th leading cause of premature death and breast cancer was the 15th leading cause of premature death. Below is a map of age-adjusted cancer deaths by census tract those years. The darker the color, the more deaths that occurred in that area of the county. Knowing where these deaths occur helps us focus hospital efforts on screening and care for patients at high-risk for cancer, as there are likely underlying social determinants of health contributing to death rates. Adult obesity rates were high in Walton County at 28 percent of all county residents as obese. This contributes to a number of diseases, including heart disease, stroke and diabetes. Seventeen percent of residents smoke, which is the state average as well. Smoking is a key contributor to cancer, and in particular lung cancer, which has a devastating effect on Walton County residents. Fifty-three percent of county residents commute more than 60 minutes or more to work, a rate far higher than the state average of 42 percent. Eighty-three percent of commuters from Walton County drive alone, which contributes to depression. The violent crime rate was 302 per every 100,000 county residents, a figure less than the state average rate of 388. Mental health and behavioral disorders were the 5th leading cause of age-adjusted death for all county residents between 2015 and 2019. Suicide was the 4th leading cause of premature deaths for all races between 2015 and 2019. It was most common among white males aged 25 to 34 years of age. There was one mental health provider for every 1,420 residents in the county in 2017, a rate far worse than the state average of one provider for every 730 residents. Like in the rest of the state, opioid prescriptions are an issue in the Walton County community, with a total 23.5 opioids prescriptions written per every 100 people in 2019. Please note we aren't able to tell how many scripts were written to a single person. We only know the overall figure, meaning a single person could have several prescriptions. Twenty-eight percent of households live in substandard housing, meaning it has at least one major issue, such as no plumbing or too many occupants. In 2016, 51 percent of the population had no reasonable access to healthy foods in 2015. These patients live in what's called a food desert, meaning there is no food outlet with healthy food options, such as produce, within a reasonable travel time. Of the 15 census tracts in Walton County, seven were in a food desert. There were 54 fast food restaurants in Walton County in 2018, a figure that's better, per capita, than state and national averages. There are nine grocery stores, and the per capita rate is worse than state and national averages. Twenty-nine percent of households had housing costs that exceeded more than 30 percent of total household income between 2015 and 2019, indicating a cost burdened household more likely to face overall financial difficulty. This is directly linked to having trouble paying medical bills. Approximately 974 Walton County households had no motor vehicle in 2017, which can present significant barriers to accessing care and other primary needs, such as groceries, due to very limited public transportation options in the county. Thirty-six percent of children lived in single-parent homes in 2019, a statistic that can indicate financial insecurity at home. In the 2018 to 2019 school year, 46 percent of children qualified for free or reduced cost lunch, a statistic that represents poverty and food instability. The state average was 62 percent. For every 1,000 teen girls aged 15 to 18 in Walton County, 27 gave birth to a child on average each year between 2012 and 2018. Children born to teen are statistically much more likely to experience adverse health and socioeconomic issues as they grow older. Sources for all statistics in this section: U.S. Census 2017 ACS Demographic and Housing Estimate, University of Wisconsin Population Health Institute, County Health Rankings, 2018, with indicators ranging from 2012 to 2019, and the Georgia Online Analytical Statistical Information System. SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH Piedmont Walton Hospital actively promotes the health of its community through clinic-hospital partnerships, the community benefit grants programs, 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, and 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. It's important to note that COVID-19 did have a significant impact on our proactive community benefit programs, as all in-person events and classes were canceled as of early March 2020. We worked to create programming that was responsive to the pandemic, including our migrating to online platforms for vital community-based programming. Piedmont Walton actively partners with groups in the community, including local charitable clinics. In FY20, we continued to provide funding for a full-time nurse practitioner working at not-for-profit charitable clinic F.I.S.H. Medical and Dental Clinic, with a total 1,550 patients seen during that time. The annual cost for that nurse practitioner was approximately $87,000 in FY20. Additionally, each month, a Piedmont physician leads a community-based walking program in which the doctor also answers general health questions and promote overall healthiness. In FY20, Piedmont Walton Hospital awarded approximately $30,000 in funding to two not-for-profit organizations whose programs aligned with the hospital's FY19 CHNA. Recipients and funded programs were: Team Up Mentoring, for their Team Up for Wellness program and Walton County Senior Citizen's Council, non-emergency transport programming. Both organizations successfully completed work that was fully in-line with our CHNA. In FY20, Piedmont Walton also provided health professions education to students and residents training to be health professionals. That year, the hospital oversaw health professions training hours at a total cost of $619,067. This is an increase over FY19, despite COVID-19 impacting some educational programs. As part of a Piedmont Healthcare systemwide effort, Piedmont Walton was an active participant in anti-opioid work, which included: active participation on the systemwide task force, tracking opioid prescriptions within the hospital and by providers, utilizing Epic EMR tools to monitor opioid use, offering patients and the community ways to safely dispose of unused medication, and providing ongoing education on opioid prescribing. The advent of COVID-19 precluded local take-back day activities, in which we'd traditionally partner with local law enforcement to host an event in which local residents were encouraged to bring in any unused prescriptions for safe disposal. That said, the Walton County Sheriff's Office does maintain a box year-round in the lobby of their precinct, and we actively routed community members to that box. In FY20, we began cancer support group that meets once a month. This program held its first support group in January 2020. In person meetings were delayed due to COVID, but we were able to resume these meetings via video during the fall. We have a relationship with The Cancer Foundation of Northeast Georgia, which provides services in our community, and we are actively working on ways to help connect community members with the resources available through The Cancer Foundation. In line with our goal of reducing the impact of stroke, our Stroke/Trauma/EMS Coordinator did a presentation at the Loganville TRIAD meeting about stroke signs and symptoms as well as fall awareness and prevention in January 2020. There were approximately 40 seniors in attendance. Additionally, our Stroke/Trauma/EMS Coordinator did a Lunch and Learn presentation on stroke signs and symptoms as well as fall awareness and prevention in Loganville in February 2020 to a group of approximately 35 seniors. Finally, stroke awareness educational materials have been passed out at numerous community events, and our coordinator provides a Stroke Core Curriculum class that is open to our facility, other healthcare facilities and EMS monthly. It is held at least twice a month, and sometimes up to four times per month, when possible. Our Outpatient Nutrition Services Team hosts three support groups that address weight management - two directly and one a bit more indirectly: Weight2Go (general weight management), bariatric-surgical weight management, and the Diabetes Support Group with topics often covering portion control and weight management for disease management. In total, they had 179 participants attend a 2019 support group session. Of those, 112 were Caucasian and 67 were African American. Classes are free and open to the public. Additionally, and as mentioned above, Piedmont Walton Hospital provided to the general public a bilingual community resource guide, which gives information on community resources for lower income populations as well as plain language details on the hospital's financial assistance program. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM Piedmont Walton Hospital is a part of Piedmont Healthcare, a regional not-for-profit organization and the parent company of 11 hospitals, the Piedmont Physicians Group, the Piedmont Heart Institute, the Piedmont Clinic and the Piedmont Healthcare Foundation. Piedmont Healthcare's community benefit department coordinates the community benefit activities on behalf of all hospitals throughout the system. 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 provide key input and execute programming, such as the hospital's revenue department, which oversees and executes the financial assistance policy and program. SCHEDULE H, PART VI, LINE 7: STATE OF FILING OF COMMUNITY BENEFIT REPORT Piedmont Walton Hospital is not required to file a community benefit report; however, the hospital is required to file with the Georgia Department of Community Health information on its indigent and charity care, as well as its Medicaid and Medicare shortfalls. false true false false false false false true false Mr J Michael Burnett Board Member 0 494660 0 216563 0 180163 0 91350 0 18096 0 1000832 0 74550 Ms Vicki A Cansler Board Member 0 406708 0 180243 0 106395 0 74150 0 7734 0 775230 0 57350 Mr Larry Ebert CEO & Board Member 267153 0 87602 0 5982 0 9618 0 17309 0 387664 0 0 0 Mr Marvin Wynn CFO (EFF. 5/20) 0 221546 0 44754 0 1600 0 16251 0 11398 0 295549 0 0 Dr Robert Sinyard CMO 0 427791 0 112279 0 31008 0 0 0 34176 0 605254 0 0 Ms Candice Frix CNO 119199 0 23360 0 349 0 8809 0 10218 0 161935 0 0 0 Mr Michael Wynne DIRECTOR - PHARMACY 148728 0 19207 0 186 0 10288 0 10681 0 189090 0 0 0 Ms Rose Dennis exec. Dir. - patient svcs 135418 0 27360 0 1474 0 10613 0 11469 0 186334 0 0 0 Mr Jeffrey Braswell dir. - emergency svcs 130000 0 16380 0 2090 0 4583 0 464 0 153517 0 0 0 Mr Michael McAnder Treasurer 0 613592 0 345604 0 76811 0 123395 0 7500 0 1166902 0 0 Ms Elizabeth Leddy Secretary 0 448895 0 251848 0 142793 0 89849 0 17376 0 950761 0 0 SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT WALTON 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 VICKI CANSLER RECEIVED A PAYMENT OF $57,350 FROM HER SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. J. MICHAEL BURNETT RECEIVED A PAYMENT OF $74,550 FROM HIS SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: LARRY EBERT MICHAEL MCANDER ELIZABETH LEDDY 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. A Development Authority of Walton County 582137690 933413AY2 2019-11-07 31085000 ASSET PURCHASE false false false A 0 0 37383406 0 0 0 0 0 0 0 37383406 0 2019 false false true true A false false false false 0.01000 0.00000 0.01000 false false true A false true false false false false 0 false 0 false true A true FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2019 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT WALTON 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 WALTON HOSPITAL ("PWH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT WALTON HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT WALTON HOSPITAL. FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT WALTON 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 WALTON 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 WALTON HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PWH'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S TAX DIRECTOR 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, SECTION B, LINE 12C: CONFLICT OF INTEREST 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 MOUNTAINSIDE 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 WALTON 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 EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("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 DATA 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. 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 DISCLOSURE OF GOVERNING, CONFLICT OF INTEREST AND FINANCIAL 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: CHANGE IN TEMP ($669) INTERCOMPANY TRANSFERS ($47,444,222) UNALLOCATED EXPENSES ($2,790,751) BOOK/TAX DIFFERENCES $49,401 ------------------ TOTAL ($50,186,241) FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:4261266 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN SUPPORT TOTAL FEES:1980682 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN SERVICES TOTAL FEES:865710 FORM 990 PART IX LINE 11G DESCRIPTION:MAINTENANCE TOTAL FEES:252785 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL DIRECTOR TOTAL FEES:77450 FORM 990 PART IX LINE 11G DESCRIPTION:TRANSPORTATION TOTAL FEES:48683 FORM 990 PART IX LINE 11G DESCRIPTION:PRINTING TOTAL FEES:3237 PIEDMONT HEALTHCARE INC 1800 HOWELL MILL ROAD SUITE 850 ATLANTA GA 30318 581503902 HEALTHCARE 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 582322328 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 HENRY HOSPITAL INC 1133 EAGLES LANDING PKWY STOCKBRIDGE GA 30281 582200195 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 PIEDMONT NEWNAN HOSPITAL INC 745 POPLAR ROAD NEWNAN GA 30265 205077249 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 HEALTHCARE FOUNDATION INC 2001 PEACHTREE ROAD NE SUITE 400 ATLANTA GA 30309 581272768 FUNDRAISING GA 501(C)(3) 12B, II PHC false PIEDMONT ATHENS REGIONAL FOUNDATION INC 1199 PRINCE AVENUE ATHENS GA 30606 581978389 FUNDRAISING GA 501(C)(3) 12B, II ARMC false PIEDMONT ATHENS REGIONAL HEALTH RESOURCE 1199 PRINCE AVENUE ATHENS GA 30606 581930580 DEVELOPMENT GA 501(C)(3) 12B, II ARMC false PIEDMONT ATHENS REGIONAL MEDICAL CENTER 1199 PRINCE AVENUE ATHENS GA 30606 582179986 HOSPITAL GA 501(C)(3) 3 PHC false ATHENS REGIONAL PHYSICIAN SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 582332921 HEALTHCARE GA 501(C)(3) 12B, II ARMC false ATHENS REGIONAL SPECIALTY SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 271975001 HEALTHCARE GA 501(C)(3) 12B, II ARMC false REGIONAL FIRSTCARE INC 1199 PRINCE AVENUE ATHENS GA 30606 582362733 URGENT CARE GA 501(C)(3) 12B, II ARMC false COLUMBUS AMBULATORY HEALTHCARE SERVICES 707 CENTER ST COLUMBUS GA 31901 581719867 AMBULATORY GA 501(C)(3) 3 PHC false COLUMBUS REGIONAL HEALTHCARE SYSTEM INC 707 CENTER ST COLUMBUS GA 31901 581719994 HEALTHCARE GA 501(C)(3) 12B, II PHC false COLUMBUS REGIONAL MEDICAL FOUNDATION INC 707 CENTER ST COLUMBUS GA 31901 581501642 FUNDRAISING GA 501(C)(3) 7 PHC false THE MEDICAL CENTER INC 710 CENTER ST COLUMBUS GA 31901 581685139 HOSPITAL GA 501(c)(3) 3 PHC false HUGHSTON HOSPITAL INC 707 CENTER ST COLUMBUS GA 31901 331216751 HOSPITAL GA 501(c)(3) 3 PHC false PIEDMONT ROCKDALE HOSPITAL INC 1412 Milstead Avenue CONYERS GA 30112 300999841 HOSPITAL GA 501(C)(3) 3 PHC false PEACHTREE ORTHOPAEDIC SURGERY CENTER 2001 PEACHTREE RD NE STE 705 ATLANTA GA 30309 582562721 ORTHOPAEDIC GA na n/a 0 0 false 0 false 0.00000 DIGESTIVE HEALTHCARE OF GA ENDOSCOPY CEN 95 COLLIER RD NW STE 4075 ATLANTA GA 30309 582406657 HEALTHCARE GA na n/a 0 0 false 0 false 0.00000 FOUR WINDS HEALTH LLC 3350 RIVERWOOD PKWY STE 1850 ATLANTA GA 30339 451273930 HEALTHCARE GA na n/a 0 0 false 0 false 0.00000 GEORGIA HEALTH COLLABORATIVE LLC 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 461500639 HEALTHCARE GA na n/a 0 0 false 0 false 0.00000 PIEDMONT MEDICAL CARE CORPORATION 2727 PACES FERRY RD STE 1-1100 ATLANTA GA 30339 582092768 HEALTHCARE GA PHC C CORP 0 0 0.00000 false THE PIEDMONT CLINIC INC 2727 PACES FERRY RD STE 1-1100 ATLANTA GA 30339 582005358 HEALTHCARE GA PHC C CORP 0 0 0.00000 false PIEDMONT HEART INSTITUTE PHYSICIANS INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 260593850 HEALTHCARE GA PHC C CORP 0 0 0.00000 false AMSTER MCRAE INSURANCE COMPANY PO BOX 1159 GRAND CAYMAN CJ KY1-1102 980427603 RELATED INSUR CJ PHC C CORP 0 0 0.00000 false PIEDMONT WELLSTAR HEALTHPLANS INC 2859 PACES FERRY RD STE 600 ATLANTA GA 30339 461922499 HEALTH INSUR. 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