2020-01-16T07:40:36-06:00 2019-06-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2018-07-01 453957368 POLK MEDICAL CENTER INC POLK 7065096074 420 E SECOND AVENUE SUITE 102 ROME GA 301613210 CLARICE CABLE CONTROLLER/TAX OFCR 7065096074 2020-01-31 true JACQUELINE G ATKINS P00861721 2298837878 2020-01-15 208.73.87.26 2020-01-16 07:40:36 CS P 3DB754BF4A86932C7270BAD44D636E9B352C5FAB 3DB754BF4A86932C7270BAD44D636E9B352C5FAB 2018 2020-09-23 17:36:50Z FLOYD POLK MEDICAL CENTER KURT STUENKEL 304 TURNER MCCALL BLVD ROME GA 301620233 33677186 false X WWW.POLKHOSPITAL.ORG X 2011 GA POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY. 12 11 0 15 27823 21041 253531 831887 33149773 32217980 645672 540366 17 86953 34048993 33677186 318601 310000 0 13259267 13514222 0 0 11853468 10835087 25431336 24659309 8617657 9017877 66780229 77697143 42574853 42878580 24205376 34818563 POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY. false false 20933262 310000 32277110 POLK MEDICAL CENTER IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING GENERAL ACUTE CARE SERVICES TO THE POLK COUNTY AND NORTHERN HARALSON COUNTY COMMUNITIES. DURING FISCAL YEAR 2019, PATIENT DAYS AT POLK MEDICAL CENTER TOTALED 7,405 AND DISCHARGES TOTALED 130. EMERGENCY ROOM VISITS TOTALED 27,393. 20933262 true true false true false false false false false false true false false false true true true true false false false false false false false false true true true false true true false false false false false false false false false false false false false false false true false false false true 22 0 0 true true false false false false false false false false false false false X 12 11 false false false false true true true true true false false true true true true true false false false false GA X X CLARICE CABLE 7065096074 304 TURNER MCCALL BLVD ROME GA 301610233 KURT STUENKEL PRESIDENT/SE 1.00 52.00 X X 0 1033596 25293 GEORGE A BOSWORTH MD MEMBER 1.00 1.00 X 2750 8250 0 LARRY KUGLAR MEMBER 1.00 1.00 X 2250 5000 0 BRAD WARD MD MEMBER 1.00 1.00 X 2500 4000 0 FRANK SHELLEY CHAIRMAN 1.00 1.00 X X 2250 2500 0 LEE CUMMINGS MEMBER 1.00 X 2750 0 0 NEIL E GORDON MD MEMBER 1.00 X 2750 0 0 TODD BUSSEY MEMBER 1.00 X 2500 0 0 BRUCE CASEY MEMBER 1.00 X 2500 0 0 DARROLL FREEMAN MEMBER 1.00 X 2500 0 0 SONDI SMITH VEST MEMBER 1.00 X 2500 0 0 HAROLD W WYATT JR PAST MEMBER 1.00 X 2250 0 0 OTHEL DOYLE TREY KELLEY MEMBER 1.00 X 0 0 0 RICHARD T SHEERIN CFO (RETIRED 1.00 53.00 X 0 501138 19096 CLARICE CABLE CONTROLLER/T 1.00 43.00 X 0 0 0 MATTHEW GORMAN POLK ADMINIS 40.00 X 0 375239 28814 TIFANI KINARD CHIEF NURSIN 40.00 X 177879 0 15288 DEANA OWEN PHARMACY DIR 40.00 X 170977 0 21774 CHRISTY LINDSEY PHARMACIST 40.00 X 129722 0 7923 LOVEJOY LEIGH PHARMACIST 40.00 X 127291 0 20745 PHILLIP ROBERTS REGISTERED N 40.00 X 126770 0 7378 760139 1929723 146311 14 false true false MORRISON MANAGEMENT SPECIALISTS P O BOX 102289 ATLANTA GA 303682289 FOOD SERVICES 539439 ARAMARK MANAGEMENT SERVICE P O BOX 233 ROME GA 301610233 HOUSEKEEPING 359545 CERNER CORPORATION P O BOX 412702 KANSAS CITY MO 641412702 IT SERVICES 277700 G4S SECURE SOLUTIONS(USA) INC PO BOX 277469 ATLANTA GA 303847469 SECURITY 241804 4 831887 831887 NET PATIENT SERVICE REVENUE 623000 32190157 32190157 REFERENCE LAB 621500 27823 27823 32217980 540366 540366 PURCHASE DISCOUNTS 623000 91148 91148 STATE INCOME TAX REFUND UBI 623000 -4195 -4195 86953 33677186 32277110 27823 540366 310000 310000 27500 27500 10299436 9324301 975135 2441447 2210242 231205 745839 684192 61647 230645 230645 83055 83055 79118 79118 785856 343780 442076 70386 3305 67081 218207 106230 111977 555049 50993 504056 1823480 1673225 150255 1286527 1240468 46059 20099 6336 13763 114721 114721 2638020 2420647 217373 375976 375976 MEDICAL SUPPLIES 1759268 1743538 15730 REPAIRS & MAINTENANCE 549181 525413 23768 LICENSES & TAXES 162951 162269 682 DUES & SUBSCRIPTIONS 35001 13602 21399 47547 47547 24659309 20933262 3726047 0 251090 1531094 6129123 3346102 9646009 6279828 298049 311879 411481 444291 44212418 19582444 27389054 24629974 22351190 39465726 304233 1688249 66780229 77697143 3025952 3001163 34146264 33844184 5402637 6033233 42574853 42878580 X 24205376 34818563 24205376 34818563 66780229 77697143 9017877 1595310 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2591 2591 false SCHEDULE C, PART II-B, LINE 1 THE ORGANIZATION PAYS MEMBERSHIP DUES TO NATIONAL AND STATE ORGANIZATIONS. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THOSE ORGANIZATIONS PARTICIPATE. 838635 838635 28399491 8583715 19815776 50508 9135 41373 14923784 10989594 3934190 24629974 MOB CAPITAL LEASE 2835297 DUE TO RELATED ORGANIZATIONS 1672120 THIRD PARTY PAYMENTS 1525816 6033233 X 35075756 1595310 -170255 1425055 33650701 26485 26485 33677186 24489495 24489495 169814 169814 24659309 SCHEDULE D, PAGE 3, PART X PMCI IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PMCI 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, PMCI 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 MANAGEMENTS EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JUNE 30, 2019 AND 2018 OR FOR THE YEARS THEN ENDED. PMCIS TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. SCHEDULE D, PAGE 4, PART XI, LINE 2D INVESTMENT FEES NETTED IN REVENUES -79,118 REVENUE ACCOUNTS NETTED TO EXPENSE -91,137 SCHEDULE D, PAGE 4, PART XI, LINE 4B CAPITAL CONTRIBUTIONS 26,485 SCHEDULE D, PAGE 4, PART XII, LINE 4B REVENUES NETTED IN EXPENSES 91,137 INVESTMENT FEES 79,118 MISCELLANEOUS EXPENSE -441 true true X true X 1.250000000000 true X 3.250000000000 true true true false true true 1018566 1018566 0.04130 5605917 5678092 13589 11270 2319 0.00010 6638072 5689362 1020885 0.04140 27831 27831 0.00110 310000 310000 0.01260 337831 337831 0.01370 6975903 5689362 1358716 0.05510 true 25349462 12674731 10733982 10791622 -57640 X true true 1 1 POLK MEDICAL CENTER 2360 ROCKMART HIGHWAY CEDARTOWN GA 30125 WWW.POLKHOSPITAL.ORG 115-705 X X X X SWING BED SNF POLK MEDICAL CENTER 1 false false true X X X X X X X X X X 19 true true false true X WWW.POLKHOSPITAL.ORG X X true 19 true WWW.POLKHOSPITAL.ORG false false true X 125.000000000000 325.000000000000 X X X true true X X X X true X WWW.POLKHOSPITAL.ORG X WWW.POLKHOSPITAL.ORG X WWW.POLKHOSPITAL.ORG X X X X X X true X false X X X true X false false FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 3E THE PROCESS OF PRIORITIZING THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IS DISCUSSED ON PAGES 14 THROUGH 18 OF THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH IS AVAILABLE ON THE ORGANIZATION'S WEBSITE. FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 5 POLK MEDICAL CENTER CONDUCTED A COMMUNITY SURVEY TO VALIDATE DATA, GIVE MEMBERS OF THE COMMUNITY AN OPPORTUNITY TO COMMENT ON THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT AND TO PROVIDE COMMUNITY-LEVEL INSIGHT INTO THE HEALTH NEEDS FOR EACH OF THE COUNTIES IN OUR PRIMARY SERVICE AREA. PARTICIPANTS IN THE SURVEY INCLUDED POLK COUNTY HEALTH CARE AND COMMUNITY LEADERS, AND INCLUDED REPRESENTATIVES FROM HEALTH CARE, LAW ENFORCEMENT, CHAMBERS OF COMMERCE, BUSINESS, INDUSTRY, EDUCATION, VOLUNTEERS AND ELECTED OFFICIALS. PARTICIPANTS DEMONSTRATED A COMMUNITY-WIDE KNOWLEDGE AND AN UNDERSTANDING OF COMMUNITY CHALLENGES AND NEEDS. PARTICIPANTS WERE ASKED TO RATE THEIR PERSONAL HEALTH, PROVIDE INFORMATION ABOUT THEIR OWN ACCESS TO HEALTH CARE SERVICES, AS WELL AS TO RATE THE HEALTH OF THE COMMUNITY AND ASSESS THE ISSUES AND BARRIERS TO HEALTH WITHIN THE COMMUNITY. FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 6A THE 2019 CHNA WAS CONDUCTED IN ASSOCIATION WITH FLOYD MEDICAL CENTER, A 300+ BED ACUTE CARE HOSPITAL LOCATED IN ROME, GA, AND CHEROKEE MEDICAL CENTER, A 60-BED LICENSED ALABAMA HOSPITAL LOCATED IN CENTRE, AL. FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 7D THE 2019 CHNA HAS BEEN DISTRIBUTED UPON REQUEST TO OTHER NON-PROFIT AGENCIES IN THE AREA TO ASSIST WITH GRANTS. COPIES HAVE ALSO BEEN MADE AVAILABLE TO ELECTED OFFICIALS, CHAMBERS OF COMMERCE, AND EDUCATIONAL INSTITUTIONS IN THE AREA. FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 11 ACCESS TO CARE, CARDIOVASCULAR DISEASE, MENTAL HEALTH SERVICES AND NUTRITION WERE SEEN AS SIGNIFICANT CONCERNS THAT AFFECT MANY RESIDENTS. THE DISTRIBUTION OF BEHAVIORS AND HEALTH OUTCOMES CONSISTENTLY FOLLOW SOCIAL AND ECONOMIC PATTERNS. FURTHERMORE, SOME BARRIERS TO ACCESSING CARE CONTINUE TO PREVENT CURRENT PROGRAMS AND INITIATIVES FROM REACHING THE POPULATIONS IN NEED. THESE CHALLENGES PRESENT IMPORTANT OPPORTUNITIES FOR THE FUTURE. AS WE MOVE FORWARD AS AN INTEGRATED COMMUNITY OF HEALTH CARE, SOCIAL SERVICES AND COMMUNITY LEADERSHIP, WE CAN LEVERAGE COMMUNITY ASSETS TO IMPROVE THE HEALTH OF RESIDENTS IN FLOYD, POLK, CHATTOOGA AND CHEROKEE COUNTIES. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". SEE ALSO THE DESCRIPTION FOR PART III, LINE 2. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE THE FIGURE ON PART III LINE 3 REPRESENTS MANAGEMENT'S ESTIMATE (APPROXIMATELY 50%) 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. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS SEE THE DISCUSSION OF BAD DEBT EXPENSE ON PAGE 17 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION 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. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION FOR PATIENTS RECEIVING ONLY A PORTION OF THEIR BILL AS CHARITY, THE REMAINING PORTION OF THE BILL IS TREATED THE SAME AS ALL OTHER PATIENTS IN REGARDS TO COLLECTIONS. PART VI, LINE 2 - NEEDS ASSESSMENT POLK MEDICAL CENTER (PMC) COMPLETED A HEALTH CARE NEEDS ASSESSMENT IN POLK COUNTY IN FISCAL YEAR 2019. THIS INCLUDED INTERVIEWS WITH COMMUNITY LEADERS AND HEALTH CARE PROFESSIONALS AND FOCUS GROUPS. IN ADDITION, FHMI, THE SOLE MEMBER, DEVELOPS A STRATEGIC PLAN THAT IS UPDATED ANNUALLY. THE STRATEGIC PLAN TAKES INTO CONSIDERATION HEALTH NEEDS FOR OUR SERVICE AREA IN ADDITION TO UTILIZATION OF SERVICES, COMMUNITY PARTICIPATION, AND QUALITY OF SERVICES PROVIDED. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE POLK COMMUNICATES THIS INFORMATION THROUGH SIGNAGE IN THE EMERGENCY CARE CENTER, PATIENT REGISTRATION AREAS, IN THE BUSINESS/PATIENT FINANCIAL SERVICES OFFICES, AND IN THE OFFICES OF OUR FINANCIAL COUNSELORS. DURING TIMES OF PREADMISSION AS WELL AS ON-SITE REGISTRATION THE ACCESS/REGISTRATION STAFF DISCUSSES POLICIES WITH THE PATIENT/PATIENT'S FAMILY IF APPROPRIATE. AFTER DISCHARGE AND DURING THE "COLLECTION" PERIOD OUR STAFF ONCE AGAIN DISCUSSES OUR FINANCIAL ASSISTANCE POLICIES. IN ADDITION THERE IS A DEMONSTRATED WORD-OF-MOUTH COMMUNICATION OF THESE POLICIES THROUGH OUR PATIENT POPULATION. PART VI, LINE 4 - COMMUNITY INFORMATION POLK COUNTY HAS AN ESTIMATED 41,000 RESIDENTS AND IS PART OF A FOUR-COUNTY AREA SERVED BY FLOYD POLK MEDICAL CENTER, A 25-BED CRITICAL ACCESS HOSPITAL WITH EMERGENCY MEDICINE, SURGERY AND DIAGNOSTIC IMAGING CAPABILITIES, FLOYD MEDICAL CENTER, A 304-BED ACUTE CARE SAFETY NET HOSPITAL, AND A THIRD, HCA-OWNED HOSPITAL. THE LAND AREA OF POLK COUNTY COVERS 301.34 SQUARE MILES, AND THE POPULATION DENSITY IS 132.96 PEOPLE PER SQUARE MILE. NINETEEN PERCENT (19%) OF THESE INDIVIDUALS LIVE IN POVERTY, AND 30% OF THE CHILDREN LIVING IN POLK COUNTY LIVE IN POVERTY. EIGHTY-THREE PERCENT (83%) OF POLK COUNTY STUDENTS ARE ELIGIBLE FOR THE FEDERAL FREE LUNCH PROGRAM. EIGHT-TWO PERCENT (82%) OF POLK COUNTY RESIDENTS HAVE A HIGH SCHOOL DIPLOMA OR GENERAL EDUCATION DEVELOPMENT (GED) CERTIFICATE, AND 12% HAVE A BACHELOR'S DEGREE OR HIGHER. ACCESS TO HEALTH CARE PROVIDERS IS LOW. THERE ARE 13 PRIMARY CARE PHYSICIANS IN POLK COUNTY AND 28 MENTAL HEALTH PROVIDERS. ACCESS TO CARE ALSO IS HAMPERED BY HEALTH CARE COVERAGE. SIXTEEN PERCENT (16%) OF THE COUNTY'S RESIDENTS (6,605 INDIVIDUALS) ARE WITHOUT HEALTH CARE INSURANCE. THE MEDIAN PER HOUSEHOLD INCOME IS 48,090. AN ESTIMATED 19.0% OF THE POLK COUNTY POPULATION IS BELOW THE POVERTY LEVEL. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH FLOYD POLK MEDICAL CENTER GENERATES MORE THAN 51 MILLION IN ECONOMIC ACTIVITY IN THE STATE. POLK HAS ABOUT 201 FULL AND PART-TIME EMPLOYEES. POLK MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL PROVIDING THE FOLLOWING SERVICES TO THE POLK COUNTY AND NORTHERN HARALSON COUNTY COMMUNITIES. "BREAST HEALTH "CARDIOLOGY "CORPORATE HEALTH "DIABETES CARE "EMERGENCY CARE "EMERGENCY MEDICAL SERVICES (EMS) "FAMILY MEDICINE "HOSPICE "IMAGING SERVICES "INFUSION THERAPY "LABORATORY SERVICES "OUTPATIENT REHABILITATION "PEDIATRICS "PULMONARY REHABILITATION "SENIOR ENRICHMENT CENTER "SUBACUTE REHABILITATION "SURGICAL SERVICES "URGENT CARE "WOUND CARE POLK MEDICAL CENTER IS COMMITTED TO PROVIDING HEALTH CARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. IN FY 2019, POLK MEDICAL CENTER PROVIDED 5.5 MILLION IN UNREIMBURSED CARE TO INDIVIDUALS. THE FLOYD POLK MEDICAL CENTER PHARMACY PROVIDED PRESCRIPTION DRUGS AT NO OR MINIMAL COST TO INDIGENT PATIENTS BEING DISCHARGED FROM INPATIENT CARE OR THE EMERGENCY ROOM AT A COST OF 4,030 DURING FY 2019. IN FY 2019, FLOYD POLK MEDICAL CENTER'S OUTREACH IN THE COMMUNITY RESULTED IN 22,557 TOUCH POINTS THROUGH EDUCATIONAL PROGRAMS, SUPPORT GROUPS, AND MEDICAL SUPPORT AT COMMUNITY EVENTS. FLOYD CO-WORKERS CONTRIBUTED 168.5 HOURS TO COMMUNITY ENDEAVORS AT A COST TO THE ORGANIZATION OF 22,557, WHICH INCLUDED: CONDUCTING HEALTH FAIRS PROVIDING SCHOOL-BASED EDUCATION PROGRAMS TO STUDENTS ABOUT AUTOMOBILE SAFETY, BICYCLE SAFETY, SAFE PLAY AND CAREERS PROVIDING DIABETES EDUCATION PROVIDING HEART DISEASE EDUCATION PROVIDING MEDICAL SUPPORT AT SPORTS AND COMMUNITY EVENTS THESE STATISTICS DO NOT TAKE INTO ACCOUNT THE ATHLETIC TRAINERS PROVIDED TO POLK COUNTY SCHOOLS, THE POLK COUNTY PATIENTS SEEN AT THE FLOYD MEDICAL CENTER TRAUMA CENTER OR THE INDIGENT CARE PROVIDED AT FLOYD MEDICAL CENTER TO POLK COUNTY RESIDENTS. AS A COMMUNITY HOSPITAL, POLK IS CONTINUOUSLY LOOKING FOR OPPORTUNITIES TO REACH FARTHER INTO OUR COMMUNITY TO MEET THE NEEDS OF THE FULL SPECTRUM OF INDIVIDUALS WHO SEEK MEDICAL CARE IN THE SERVICE AREA. MEMBERS OF THE POLK TEAM ARE COMMITTED TO THE COMMUNITY IN MANY WAYS. IN FY 2019 POLK CO- WORKERS LOANED THEIR TALENTS AND LEADERSHIP SKILLS TO SCHOOL, CIVIC AND PROFESSIONAL ORGANIZATIONS. INDIGENT OUTPATIENT PHARMACY PROGRAM POLK PROVIDES MAINTENANCE PRESCRIPTION PHARMACEUTICALS TO LOW INCOME UNINSURED OUTPATIENTS AT NO COST TO THE PATIENT THROUGH ITS HOSPITAL PHARMACY. ANY QUALIFIED, LOW INCOME PATIENT DISCHARGED FROM POLK MEDICAL CENTER MAY BE ELIGIBLE TO RECEIVE THE PRESCRIBED MEDICATIONS. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM POLK MEDICAL CENTER, INC. (PMCI) IS A GEORGIA NOT-FOR-PROFIT CORPORATION. ON NOVEMBER 6, 2014, PMCI ENTERED INTO A LEASE AGREEMENT WITH CEDARTOWN- POLK COUNTY HOSPITAL AUTHORITY (CEDARTOWN-POLK AUTHORITY) TO LEASE ALL OF THE ASSETS ASSOCIATED WITH POLK MEDICAL CENTER, A CRITICAL ACCESS HOSPITAL PROVIDING INPATIENT AND OUTPATIENT SERVICES. THIS LEASE HAS AN ORIGINAL 35-YEAR TERM. FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI) IS THE SOLE MEMBER OF PMCI. PURSUANT TO THE LEASE, TRANSFER AND REVERSION AGREEMENT BETWEEN THE HOSPITAL AUTHORITY OF FLOYD COUNTY (HAFC) AND FLOYD HEALTHCARE MANAGEMENT, INC. (LEASE), HAFC LEASED THE OPERATIONS OF FLOYD MEDICAL CENTER, WILLOWBROOKE AT FLOYD, AND HEYMAN HOSPICECARE AT FLOYD AND SUBSTANTIALLY ALL OF ITS NET ASSETS TO FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI), EFFECTIVE JANUARY 1, 1998. THE CONSIDERATION TO BE PAID BY FHMI CONSISTS PRIMARILY OF: PAYMENT OF PRINCIPAL AND INTEREST ON THE HOSPITAL AUTHORITY OF FLOYD COUNTY REVENUE ANTICIPATION CERTIFICATES; PAYMENT EQUAL TO THE CONTRIBUTION HAFC IS REQUIRED TO MAKE TO SATISFY MINIMUM FUNDING OBLIGATIONS UNDER HAFC'S PENSION PLAN WITH RESPECT TO BENEFITS WHICH HAD ACCRUED UNDER SUCH PLAN PRIOR TO THE LEASE; AND THE PROVISION OF HEALTHCARE SERVICES TO INDIGENT, CHARITY AND OTHER NEEDY PATIENTS EQUAL BUT NOT LIMITED TO A MINIMUM DOLLAR AMOUNT ANNUALLY AS SET FORTH IN THE LEASE. FHMI IS A NOT-FOR-PROFIT CORPORATION CREATED IN 1991 BY THE HAFC. FROM NOVEMBER 26, 1991, THROUGH DECEMBER 31, 1997, FHMI MANAGED AND SUPERVISED FLOYD MEDICAL CENTER AND ALL OTHER FACILITIES, PROJECTS AND PROGRAMS OF THE HAFC PURSUANT TO A MANAGEMENT AGREEMENT. EFFECTIVE JANUARY 1, 1998, THE AFORESAID MANAGEMENT AGREEMENT WAS CONVERTED TO A LEASE AGREEMENT UNDER WHICH ALL FACILITIES, PROJECTS AND PROGRAMS OF HAFC WERE LEASED TO FHMI. AT THAT TIME, FHMI BECAME THE LICENSED OPERATOR OF ALL SUCH FACILITIES, PROJECTS AND PROGRAMS. FHMI IS GOVERNED BY AN EIGHTEEN MEMBER BOARD OF DIRECTORS, THREE OF WHOM MUST BE MEMBERS OF THE HAFC. ADDITIONALLY, FHMI HAS CONTRACTUALLY COMMITTED THAT AT LEAST TWO OF ITS DIRECTORS WILL BE FLOYD COUNTY COMMISSIONERS AND TWO OF ITS DIRECTORS WILL BE CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY MEMBERS. FLOYD EMERGENCY PHYSICIANS LLC IS A WHOLLY OWNED SUBSIDIARY OF FHMI WHOSE SOLE PURPOSE IS TO PROVIDE A PHYSICIAN AND MID-LEVEL STAFFING SOLUTION IN THE FLOYD MEDICAL CENTER EMERGENCY CARE CENTER AND THE POLK MEDICAL CENTER EMERGENCY DEPARTMENT. THE FLOYD HEALTHCARE FOUNDATION IS A 501(C)(3) NOT-FOR-PROFIT ORGANIZATION THAT WORKS TO IMPROVE THE HEALTH OF THE COMMUNITIES SERVED BY FLOYD MEDICAL CENTER AND POLK MEDICAL CENTER BY DEVELOPING RELATIONSHIPS AND RAISING FUNDS TO BUILD AND SUPPORT PROGRAMS AND SERVICES THAT MEET IDENTIFIED NEEDS AND FURTHER OUR MISSION. GOVERNED BY ITS OWN VOLUNTEER BOARD OF DIRECTORS AND MANAGED BY A PROFESSIONAL STAFF, THE FOUNDATION RAISES SUPPORT THROUGH VOLUNTEER-LED INITIATIVES THAT PROVIDE FUNDING NOT ONLY FOR FLOYD MEDICAL CENTER BUT ALSO FOR PROGRAMS THAT SEEK TO IMPROVE THE HEALTH OF OUR COMMUNITY. CANCER NAVIGATORS, INC. IS A 501(C)(3) NOT-FOR-PROFIT ORGANIZATION THAT PROVIDES EDUCATION, COUNSELING, AND ACCESS TO RESOURCES FOR CANCER PATIENTS TO HELP THEM EASE DIFFICULT EMOTIONS AND MAINTAIN A SENSE OF CONTROL OVER THEIR DIAGNOSIS AND TREATMENT. true CEDARTOWN-POLK COUNTY HOSPITAL AUTH 424 NORTH MAIN STREET CEDARTOWN GA 301252644 580603152 GOV 310000 CASH CONSTRUCT H2O/SEWER 1 SCHEDULE I, PAGE 1, PART I, LINE 2 POLK MEDICAL CENTER, INC. ENTERED INTO A CONTRACT WITH THE CITY OF CEDARTOWN TO MAKE ANNUAL CONTRIBUTIONS TO THE CITY FOR THE CONSTRUCTION OF NEW WATER AND SEWAGE INFRASTRUCTURE FOR THE NEW HOSPITAL. PURSUANT TO THE AGREEMENT, PMC WILL MAKE PAYMENTS FOR 20 YEARS. ON AN ANNUAL BASIS, MANAGEMENT REVIEWS AND RECONCILES THE ACTIVITY. false true false false false false false false false KURT STUENKEL PRESIDENT/SECRETARY 695444 150869 187283 25293 1058889 RICHARD T SHEERIN CFO (RETIRED 2019) 417875 76951 6312 19096 520234 MATTHEW GORMAN POLK ADMINISTRATOR 291801 82851 587 28814 404053 TIFANI KINARD CHIEF NURSING OFFICE 161230 16320 329 15288 193167 DEANA OWEN PHARMACY DIRECTOR 155823 14690 464 21774 192751 SCHEDULE J, PAGE 1, PART I, LINE 3 NONE OF THE INDIVIDUAL BOARD MEMBERS OR OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION AND THE ORGANIZATION MUST RELY ON THE METHODS EMPLOYED BY THE RELATED ORGANIZATION, FHMI, TO DETERMINE REASONABLE COMPENSATION FOR THE INDIVIDUALS. COMPENSATION DETERMINATION BY FHMI 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 KURT STUENKEL 0 176,053 0 SCHEDULE J, PART III MR. STUENKEL AND MR. SHEERIN ARE COMPENSATED BY FLOYD HEALTHCARE MANAGEMENT, INC. (EIN: 58-1973570) FOR SERVICES AS THE CEO AND CFO, RESPECTIVELY, OF FLOYD HEALTHCARE MANAGEMENT, INC. THEY RECEIVE NO COMPENSATION FROM THE FILING ORGANIZATION. THE CEO PARTICIPATES IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS FUNDED ANNUALLY IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON-QUALIFIED RETIREMENT PLAN, AND AS SUCH THE ANNUAL FUNDING PAYMENTS PAID INTO IT ARE TAXABLE TO THE PARTICIPANT IN THE YEAR IN WHICH MADE. EFFECTIVE WITH CALENDAR YEAR 2009, MR. STUENKEL'S SERP IS A CASH-BASED PROGRAM. ADDITIONALLY, OF THE 1,033,596 LISTED AS COMPENSATION FOR MR. KURT STUENKEL IN FORM 990 PART VII SECTION A, 150,869 REPRESENTS A PERFORMANCE-BASED PAYMENT ARISING FROM THE 2018 PERFORMANCE PERIOD AND 176,053 REPRESENTS THE NONQUALIFIED 457(F) PLAN. ACCORDINGLY, MR. STUENKEL'S SALARY FOR 2018 WOULD HAVE BEEN 706,674 EXCLUDING THE 2018 PORTION OF THE INCENTIVE-BASED PAYMENT AND THE 457(F)PLAN AMOUNT. BONUS/INCENTIVE PAY ALL MEMBERS OF THE EXECUTIVE TEAM FOR FHMI PARTICIPATE IN AN INCENTIVE COMPENSATION PLAN UNDER WHICH ANNUAL YEAR-END BONUSES ARE PAID BASED ON INDIVIDUAL AND CORPORATE-WIDE ACHIEVEMENT OF SPECIFIC GOALS AND OBJECTIVES. ONE OF THE GOALS RELATES TO THE RELATED ORGANIZATION'S NET INCOME. THE BONUSES ARE AWARDED ON A CASH-BASED SYSTEM. A CEDARTOWN POLK COUNTY HOSP AUTH REVENUE BONDS 2016 SERIES 580603152 150759AR9 2016-04-13 30415000 RETIRE BANK LOAN FOR CONSTRUCTION, ACQUISITION, RENOVATION, EXPANSION, false false false A 170000 34834415 338636 34495779 2014 false false true true A false false false false false false true A false false false false false false false false false A false SCHEDULE K - DIFFERENCES IN ISSUE PRICE EXPLANATION CEDARTOWN POLK COUNTY HOSP AUTH THE 2016 SERIES REVENUE BOND PROCEEDS INCLUDES A PREMIUM IN THE AMOUNT OF 4,419,415. SCHEDULE K - PURPOSE OF ISSUE DESCRIPTION CEDARTOWN POLK COUNTY HOSP AUTH INSTALLATION AND EQUIPPING OF THE POLK MEDICAL CENTER. FORM 990, PAGE 6, PART VI, LINE 6 FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI) IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 7A FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI), A RELATED ORGANIZATION, HAS THE POWER TO APPOINT ELEVEN OF THE TWELVE MEMBER GOVERNING BODY WHILE THE PRESIDENT/CEO OF FHMI IS THE FINAL MEMBER OF THE BOARD. FORM 990, PAGE 6, PART VI, LINE 7B PRIOR APPROVAL OF FHMI IS REQUIRED FOR ANY OF THE FOLLOWING ACTIONS: DISSOLUTION; SALE, MERGER OR DISPOSITION; ADOPTION OF CAPITAL OR OPERATING BUDGETS; SELECT OR REMOVE THE ADMINISTRATOR; INCUR INDEBTEDNESS IN EXCESS OF 1,000,000; TAKE ANY ACTION ON THE LEASE OR CONTRACT BETWEEN THE CORPORATION AND CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY; AMEND THE CORPORATE ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PAGE 6, PART VI, LINE 11B THE ORGANIZATION'S CEO, CFO, CONTROLLER, LEGAL COUNSEL AND EMPLOYEES OF FHMI REVIEW THE FORM 990 FOR FINANCIAL AND DISCLOSURE ACCURACY. PRIOR TO ITS FILING, A COPY OF THE ORGANIZATION'S 990 RETURN IS POSTED ON THE BOARD OF DIRECTORS' SECURE WEBSITE FOR THEIR REVIEW. MANAGEMENT WILL SEND AN EMAIL NOTIFYING MEMBERS OF ITS POSTING. FORM 990, PAGE 6, PART VI, LINE 12C POLK MEDICAL CENTER, INC. (PMCI) HAS A WRITTEN POLICY RESPECTING CONFLICTS OF INTEREST AND DISCLOSURE OF SAME. GENERALLY SPEAKING, THE POLICY REQUIRES ANY "COVERED PERSON" WHO BELIEVES HE/SHE HAS A CONFLICT OF INTEREST TO: -DISCLOSE THE EXISTENCE AND NATURE OF THE CONFLICT OF INTEREST (INCLUDING ALL FACTS KNOWN RESPECTING THE SUBJECT MATTER) TO THE CHAIRMAN OF THE BOARD; -PLAY NO PART, DIRECTLY OR INDIRECTLY, IN THE DELIBERATION OR VOTE OF THE BOARD OF DIRECTORS WITH RESPECT TO THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS; AND -ABSENT HIMSELF/HERSELF FROM THAT PORTION OF THE MEETING AT WHICH THE CONFLICT OF INTEREST IS DISCUSSED. THE DEFINITION OF A "COVERED PERSON" INCLUDES ALL BOARD MEMBERS, OFFICERS AND MEMBERS OF SENIOR MANAGEMENT OF PMCI. WHEN A COVERED PERSON DISCLOSES A POTENTIAL CONFLICT OF INTEREST TO THE BOARD CHAIRMAN, THE CHAIRMAN IS OBLIGED TO BRING THE MATTER TO THE ATTENTION OF THE FULL BOARD. THE BOARD DETERMINES WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. IF THE BOARD DETERMINES THAT THERE IS A CONFLICT OF INTEREST, THE TRANSACTION OR MATTER GIVING RISE TO THE CONFLICT OF INTEREST MAY NOT PROCEED UNLESS THE BOARD DETERMINES, BY A MAJORITY VOTE, THAT, DESPITE THE CONFLICT OF INTEREST, THE TRANSACTION/MATTER IS NEVERTHELESS IN THE CORPORATION'S BEST INTEREST AND IS FAIR AND REASONABLE TO THE CORPORATION. IN ADDITION TO THE REQUIREMENT THAT A COVERED PERSON DISCLOSE A POTENTIAL CONFLICT OF INTEREST AT THE TIME IT ARISES, EACH COVERED PERSON IS ALSO REQUIRED TO SUBMIT, ON AN ANNUAL BASIS, A `CONFLICT AND DISCLOSURE OF INTEREST QUESTIONNAIRE'. THIS MULTI-QUESTION DOCUMENT SERVES AS A REMINDER AND PROMPTS EACH COVERED PERSON TO PONDER THOSE AREAS AND SITUATIONS WHERE A POTENTIAL CONFLICT MIGHT EXIST. ADDITIONALLY, ANY PROPOSED TRANSACTION AT PMCI WHICH INVOLVES AN "INSIDER" (I.E., A BOARD MEMBER, OFFICER, MANAGER, ETC.) IS SCRUTINIZED, WITH THE ASSISTANCE OF CORPORATE LEGAL COUNSEL, FROM THE STANDPOINT OF WHETHER THE TRANSACTION WILL RESULT IN ANY EXCESS BENEFIT TO THE INSIDER. TYPICALLY THIS INVOLVES OBTAINING APPROPRIATE DATA REGARDING COMPARABILITY WHICH IS PROVIDED TO THE BOARD FOR ITS USE IN DETERMINING THAT THE CONSIDERATION BEING PAID TO THE INSIDER AS A PART OF THE TRANSACTION IS REASONABLE AND DOES NOT EXCEED THE VALUE OF THE BENEFIT RECEIVED BY PMCI. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC WHEN THE REQUEST IS MADE AT THE ADMINISTRATIVE OFFICE OF THE FILING CORPORATION. FLOYD HEALTHCARE MANAGEMENT INC 304 TURNER MCCALL BLVD ROME GA 301620233 581973570 ACUTE CARE GA 501C3 3 NA false HOSPITAL AUTHORITY OF FLOYD COUNTY 304 TURNER MCCALL BLVD ROME GA 301620233 586001173 HEALTHCARE GA 501C3 3 NA false FLOYD HEALTH CARE FOUNDATION INC 304 TURNER MCCALL BLVD ROME GA 30161 581375074 FOUNDATION GA 501C3 12A FHMI false CANCER NAVIGATORS INC 255 W 5TH STREET SUITE 300 ROME GA 301652817 030397867 HEALTHCARE GA 501C3 7 FHMI false false false false false true false false false false false true true true true true false false true false