2020-05-15T09:32:30-05:00 2019-06-30 KPMG LLP 300 North Greene Street Suite 400 Greensboro NC 27401 990 2018-07-01 352228583 PIEDMONT MOUNTAINSIDE HOSPITAL INC % MARIE GAFFNEY PIED 7066922441 1266 Highway 515 South Jasper GA 30143 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2020-05-11 true SHAWN HUTCHINSON P01048557 3362753394 2020-05-14 199.206.0.5 56038220201365000015 2020-05-15 P 1272C807EE2CFB18DB9032F475C1250F2D6A8CEA 1272C807EE2CFB18DB9032F475C1250F2D6A8CEA 2018 2020-11-19 02:30:22Z Denise Ray 1266 Highway 515 South Jasper GA 30143 96753690 false X piedmont.org X 2004 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 7 5 556 115 0 0 160458 652127 83898546 95616334 11023 23818 403086 451485 84473113 96743764 67330 54852 0 0 37440322 38786830 0 0 0 51924748 49181382 89432400 88023064 -4959287 8720700 54754547 58875170 8910553 10233163 45843994 48642007 X TO PROVIDE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE IN A PROGRESSIVE ENVIRONMENT, GUIDED BY PHYSICIANS, DELIVERED BY PROFESSIONALS, AND INSPIRED BY THE COMMUNITIES WE SERVE. false false 79228887 54852 95626976 PIEDMONT MOUNTAINSIDE HOSPITAL ("PMH") IS A 52-BED FACILITY LOCATED IN THE CITY OF JASPER IN PICKENS COUNTY, GEORGIA. OVER 200 PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN THE COMMUNITY, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2019, THE HOSPITAL HAD 3,481 IN-PATIENT ADMISSIONS WITH A TOTAL OF 13,450 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 34,731 AND OUTPATIENT VISITS TOTALED 44,650. SURGICAL SERVICES WERE PROVIDED TO 2,751 PATIENTS. 79228887 true true false false false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false true false false false true true false false false true X 0 0 556 true false false false false false false false false false false false false X 7 5 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 ROAD BLDG 2 STE Atlanta GA 30339 Ms Denise Ray PRESIDENT/CEO/CHAIR/PHC CNO 54.0 1.0 X X 693365 0 88777 Mr Jack Dunn Board Member 1.0 0.0 X 0 0 0 Mr Paul Nealey Board Member 1.0 0.0 X 0 0 0 Mr Richard B Hubbard III Board Member 1.0 0.0 X 0 0 0 Ms Rosemarie Spillane Board Member 1.0 0.0 X 0 0 0 Mr Jason Smith Board Member 1.0 0.0 X 0 0 0 Dr Leigh Hamby Board Member 1.0 54.0 X 0 1125728 121832 Mr Michael McAnder Treasurer 1.0 54.0 X 0 1103610 128676 MS ELIZABETH LEDDY SECRETARY 1.0 54.0 X 0 752241 100515 MS LINDSAY GARD CFO 55.0 0.0 X 136167 0 20825 MS MICHELLE BREITFELDER CNO 40.0 0.0 X 232825 0 24998 Ms Pam Mingo Pharmacy Manager 40.0 0.0 X 175663 0 21395 Mr Justin Leal SR. DIRECTOR OF OPERATIONS 40.0 0.0 X 219947 0 11749 Ms Ouida J Corry Pharmacist 40.0 0.0 X 159356 0 9358 Ms DONNA REECE DIRECTOR - PHYSICIAN OUTREACH 40.0 0.0 X 132359 0 23444 Mr Donald Holmes Pharmacist 40.0 0.0 X 172000 0 20797 1921682 2981579 572366 30 false true false MOUNTAINSIDE ANESTHESIA CONSULTANTS 1266 Hwy 515 S JASPER GA 30143 ANESTHESIA 1051388 MOJO CONSULTING LLC 2163 Tayside Crossing KENNESAW GA 30152 CONSULTING 248024 EMERGENCY COVERAGE CORPORATION 1200 Memorial Dr DALTON GA 30720 EMERGENCY CARE 698328 ALLIED UNIVERSAL SECURITY SERVICES 1551 N TUSTIN AVENUE SANTA ANA CA 92705 SECURITY SERVICES 638990 INSIGHT HEALTH CORPORATION 26250 Enterprise Court LAKE FOREST CA 92630 DIAGNOSTIC SERVICES 480443 13 62260 589867 50577 652127 PATIENT SERVICE REVENUE 621110 94979096 94979096 OTHER OPERATING REVENUE 900099 637238 637238 95616334 33744 33744 0 0 0 0 0 9926 -9926 -9926 -9926 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722310 264707 264707 GIFT SHOP 900099 176136 176136 FEE REVENUE 900099 10642 10642 451485 96743764 95626976 464661 54852 54852 0 0 0 1128967 991572 137395 0 30571257 26850735 3720522 0 5136096 4511033 625063 1950510 1713133 237377 110216 110216 14421 13988 433 0 0 0 0 8052687 8052687 340429 340429 6085648 6004355 81293 1408596 1366346 42250 0 2411218 2037429 373789 49604 36573 13031 0 0 1076700 1043489 33211 2379355 2379355 2581497 2504052 77445 622788 604104 18684 DRUGS AND MEDICAL SUPPLIES 11986784 11986784 BAD DEBT EXPENSE 3588374 3588374 HOSPITAL TAX 1021957 1021957 ALL OTHER EXPENSES 7451108 6396779 1054329 88023064 79228887 8794177 0 107182 91105 0 0 0 0 9897954 12011060 0 0 0 0 0 0 1608868 1884060 172384 243273 68305827 40840638 25787676 27465189 0 0 0 0 0 0 17180483 17180483 0 0 54754547 58875170 4635633 5212615 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4274920 5020548 8910553 10233163 X 45650832 48212229 193162 429778 0 0 45843994 48642007 54754547 58875170 X 8720700 -5922687 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1897200 1897200 32907263 17055421 15851842 2360764 1644723 716041 28522349 22140494 6381855 2618251 2618251 27465189 0 MEDICARE PAYABLE 3882002 OTHER LIABILITIES 1063856 NOTES PAYABLE 74690 5020548 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, 2019 AND 2018. true true X true X 300. true X true true false true true 7780751 7780751 0.09220 3231109 3081191 149918 0.00180 1100112 347592 752520 0.00890 12111972 3428783 8683189 0.10290 64451 64451 0.00080 433578 433578 0.00510 86849 86849 0.00100 584878 584878 0.00690 12696850 3428783 9268067 0.10980 true 3588374 0 26352651 28630319 -2277668 X true true 1 1 Piedmont Mountainside Hospital 1266 Highway 515 South Jasper GA 30145 https://www.piedmont.org/ 112-619 X X X Piedmont Mountainside Hospital 1 false false true X X X X X X X X 18 true false false true X SEE PART VI X X true 17 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, LINE 5: COMMUNITY REPRESENTATION As a part of our process, we interviewed 31 key stakeholders and policy makers that represent public health, low-income populations, uninsured and uninsured persons, minorities, chronic conditions, older adults, and lawmakers. Further, in December 2018 and December 2019, 22 key stakeholders within the Piedmont Mountainside community provided their thoughts on community health, community assets and the role of the hospital in addressing unmet community health needs via a web survey. Below are the results of that survey. These interviews were conducted for people representing the entire region, including Pickens County. Specifically, we interviewed representatives of local and regional public health entities, minority populations, faith-based communities, local business owners, the philanthropic community, mental health agencies, elected officials and individuals representing our most vulnerable patients. The Piedmont Healthcare board of directors and leadership from all 11 hospitals were actively informed and engaged throughout this process. SCHEDULE H, PART V, SECTION B, LINE 7A: COMMUNITY HEALTH NEEDS ASSESSMENT WEBSITE https://www.piedmont.org/media/file/PMH-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 MOUNTAINSIDE 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, SECTION B, LINE 10A: IMPLEMENTATION STRATEGIES WEBSITE THE BOARD OF DIRECTORS FOR PIEDMONT MOUNTAINSIDE HOSPITAL UNANIMOUSLY APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE YEAR PERIOD BEGINNING WITH FY20 ON AUGUST 23, 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, 2019. https://www.piedmont.org/media/file/2017-19-Implementation-Strategies.pdf SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS WHEN PIEDMONT MOUNTAINSIDE HOSPITAL PERFORMED ITS INITIAL CHNA DURING FY13, IT FOCUSED ON THREE MAIN PRIORITIES AND STARTED WORK ON THOSE PRIORITIES DURING FY14. FIRST, THE HOSPITAL FOCUSED ON INCREASING ACCESS TO APPROPRIATE AND AFFORDABLE CARE FOR LOW- AND NO-INCOME PATIENTS BY DEVELOPING AND EXECUTING A PLAN TO STRENGTHEN ACCESS POINTS TO THOSE PATIENTS. SECOND, THE HOSPITAL SOUGHT OUT TO REDUCE PREVENTABLE READMISSIONS AND EMERGENCY DEPARTMENT RE-ENCOUNTERS, PARTICULARLY AMONG HIGH-RISK PATIENTS, BY INCREASING CARE COORDINATION EFFORTS BETWEEN THE HOSPITAL AND COMMUNITY- BASED PROVIDERS. LASTLY, PIEDMONT MOUNTAINSIDE HOSPITAL FOCUSED ON REDUCING INSTANCES OF PREVENTABLE HEART DISEASE, OBESITY, AND OBESITY-RELATED DISEASES, INCLUDING DIABETES, BY UTILIZING COMMUNITY-WIDE AWARENESS CAMPAIGNS AND PROVIDING EDUCATION THAT ENCOURAGES COMMUNITY MEMBERS TO REDUCE THEIR HEART DISEASE RISKS THROUGH HEALTHY BEHAVIORS. DURING FY16, PIEDMONT MOUNTAINSIDE HOSPITAL CONDUCTED ITS SECOND CHNA, AGAIN BY ASSESSING PUBLICLY AVAILABLE DATA, INTERVIEWING COMMUNITY MEMBERS AND STAKEHOLDERS, CONDUCTING FOCUS GROUPS OF VULNERABLE POPULATIONS, INTERVIEWING PIEDMONT BOARD MEMBERS, AND SURVEYING PIEDMONT EMPLOYEES. THROUGH THIS PROCESS, PIEDMONT MOUNTAINSIDE HOSPITAL DETERMINED AND PRIORITIZED THE COMMUNITY HEALTH NEEDS IT WOULD ADDRESS BASED ON THE NUMBER OF PERSONS AFFECTED, THE SERIOUSNESS OF THE ISSUE, WHETHER THE HEALTH NEED AFFECTED VULNERABLE POPULATIONS, AND THE AVAILABILITY OF COMMUNITY AND HOSPITAL RESOURCES NECESSARY TO ADDRESS THE ISSUE. BASED ON THE CHNA, PIEDMONT MOUNTAINSIDE HOSPITAL IS CURRENTLY FOCUSING ON: (1) MAINTAINING AND INCREASING ACCESS TO AFFORDABLE CARE FOR LOW- AND NO-INCOME PATIENTS, INCLUDING INCREASED EFFORTS AT ELIMINATING HEALTH DISPARITIES; (2) INCREASING ACCESS TO AND AWARENESS OF CANCER-RELATED PROGRAMMING, INCLUDING LOW-COST MAMMOGRAMS, TO QUALIFYING WOMEN THROUGH PARTNERSHIP PROGRAMS; (3) REDUCING PREVENTABLE READMISSIONS AND EMERGENCY DEPARTMENT RE-ENCOUNTERS, PARTICULARLY AMONG HIGH-RISK PATIENTS, WITH A FOCUS ON CHRONIC DISEASE MANAGEMENT; (4) MAINTAINING AND GROWING EFFORTS AROUND SENIOR HEALTH; AND (5) REDUCING PREVENTABLE INSTANCES OF HEART DISEASE, HYPERTENSION, AND STROKE THROUGH EDUCATIONAL AWARENESS AND PROMOTION OF HEALTHY BEHAVIORS, INCLUDING EFFORTS TO REDUCE TOBACCO USE. PIEDMONT MOUNTAINSIDE HOSPITAL DEVELOPED THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS DURING FY20-22. The PMH Board of Directors unanimously approved the new CHNA on August 23, 2019. Based on the CHNA, PMH will focus on the following: (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; AND (2) REDUCE OPIOID AND RELATED SUBSTANCE ABUSE AND OVERDOSE DEATHS. SCHEDULE H, PART V, LINE 16: FINANCIAL ASSISTANCE POLICY WEBSITES FINANCIAL ASSISTANCE POLICY - https://www.piedmont.org/media/file/Financial-Assistance-Policy.pdf FINANCIAL ASSISTANCE APPLICATION - https://www.piedmont.org/media/file/Financial-Assistance-Application.pdf FINANCIAL ASSISTANCE PLAIN LANGUAGE SUMMARY - https://www.piedmont.org/media/file/Financial-Assistance-Plain-Language-Su mmary-English.pdf SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A Piedmont Mountainside 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 our 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 $88,023,064, LESS BAD DEBT EXPENSE OF $3,588,374 FROM FORM 990, PART IX, LINE 24(A). 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. PMH 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. BAD DEBT METHODOLOGY Schedule H, Part III, Line 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. 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 and 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 exclude from allowable cost in the Medicare Cost Report. The organization believes that Piedmont Mountainside 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 17.24% of Piedmont Mountainside Hospital's patient service revenue. The 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 the hospital's commitment to treat elderly patients. 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 Mountainside 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, we hope to better understand local health challenges, identify health trends in our community, determine gaps in the current health delivery system and craft a plan to address those gaps and the identified health needs. In FY19, Piedmont Mountainside Hospital conducted its third triennial community health needs assessment (CHNA). The Piedmont Mountainside CHNA was led by the Piedmont Healthcare community benefits team, with input and direction from Piedmont Mountainside leadership. Process The CHNA started first with a definition of our community. We started first with the hospital's home county, due to the impact of our tax-exempt status. We 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 our county. Additionally, we take into consideration patient origin, and especially that of our lower-income patients, such as those who qualify for financial assistance or receive insurance coverage through Medicaid. Our secondary communities are considered the areas in which we have the highest concentration of patients fitting that criteria, including ones from nearby communities, including Gilmer County, where we have a freestanding emergency department. Once we established our primary and secondary community, we then conducted an analysis of available public health data. This included resources from: US Census, US Health and Human Services' Community Health Status Indicators, US Department of Agriculture, Economic Research Service, National Center for Education Statistics, Kaiser Family Foundation's State Health Facts, American Heart Association, County Health Rankings and Georgia Online Analytical Statistical Information System (OASIS). All figures are 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 and current programs, as well as suggestions for how we can better serve our 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. We also evaluated previous community benefit, hospital and community interventions identified in our last CHNA implementation strategies through three lenses: impact, outcomes and sustainability. Interventions and programming considered to have a high score on all three were included in our CHNA and our subsequent strategy. This included our community benefit grants program, our charitable clinic-hospital partnerships and our heart- and stroke-focused community programming. 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 our CHNA from public health. Our priorities A key component of the CHNA is to identify the top health priorities we'll address over fiscal years 2020, 2021 and 2022. These priorities guide our community benefit work. They are, in no order: . Increase access to appropriate and affordable health and mental care for all community members . Reduce opioid, substance and nicotine 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 priority, and that is demonstrated through our 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 our 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 community health needs assessment was unanimously approved by the Piedmont Mountainside Hospital board of directors on May 17, 2019. The Piedmont Mountainside Hospital implementation strategy was developed in partnership with hospital leadership and community stakeholders to address the identified priorities in our FY19 community health needs assessment. The implementation strategy was designed to be executed over a three-year period and included specific metrics by which we would be able to evaluate our work and its impact. The implementation strategy was developed by utilizing community feedback from the assessment in partnership with the system community benefits department, Piedmont Mountainside Hospital leadership and the Piedmont Mountainside Hospital Board of Directors. As mentioned above, we included proven and successful interventions and programming, investing further in work we felt was successful in addressing unmet health needs. SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY Patient education of availability of assistance: Piedmont Healthcare 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 Mountainside 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 Mountainside 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. 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. This guide is widely distributed to the community via hardcopy, is available within our hospitals and is digitally available online. Copies are provided in both English and Spanish. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION In 2017, the last year for which Census data were available, approximately 30,343 people lived in Pickens County and 73 percent, lived in a rural community. The county is overwhelmingly white -- about 96 percent, of the population self-reported as Caucasian in 2017. In 2017, the median household income was $61,542, higher than both state and national averages. That year, the median age of people living within the county was 45. A fifth of the population were 18 or younger, 21 percent, were over the age of 65 and the rest were in between. The population skewed slightly female. In 2017, the top industries for employed residents were, in order: retail, manufacturing, health care and social assistance, construction and professional services. For the 2015-2016 school year, the graduation rate was 94 percent, much higher than the state average of 82 percent. That said, about 16 percent, of the county's adult population does not have a high school diploma. There were 2,695 veterans living in Pickens County in 2017. Most served in Vietnam. About a third of all veterans are disabled, and about 10 percent, live below the poverty level. In Pickens County, like with the rest of Georgia, heart disease is the number one cause of both age-adjusted and premature death, and this holds true for all races. Age-adjusted allows communities with different age structures to be compared. Premature death is when death happens before the average age for a given community. Suicide is the second leading cause of premature death for all races, with a staggering 893 deaths by self-harm within a four-year year period. Lung cancer was the third leading causes of premature death, accidental poisoning the fourth and motor vehicle crashes the fifth. Most indicators for premature death are related to unhealthy behaviors and mental health and indicate a need for further community-based interventions for high-risk community members, including efforts to curb tobacco use and resources for those struggling with depression, anxiety and other mental health issues. In Pickens County, 12 percent, of adults were uninsured in 2017, and minorities comprise 90 percent. There were three designated health professional shortage areas in the community in 2016, all of which are located just southeast of Georgia. Shortage areas were: one primary care, one mental health and one dental health. There were only 30 dentists for every 100,000 people in 2015, a figure far below state average and national rates, indicating a strong need for increased access to dental care. Community members have reported an average 3.4 and 3.6 poor or fair physical and mental health days. Poor or fair health days have decreased since our last CHNA in 2016, though poor or fair days have increased. A total 13 percent, of Pickens County residents reported their health as poor or fair. This is a slight decrease since our last CHNA. Preventable hospital stays among Medicare enrollees averaged 39.5 preventable hospital events per every 1,000 enrollees in 2015. This figure is better than state and national averages. Medicare enrollees tend to receive proper health screenings, with rates above state and national averages. Eleven percent, of the population lived with at least one disability in 2017, which was lower than the state average of 12 percent. The highest concentration of disabled populations in the western part of the county. The infant mortality rate in Pickens County is far less than state and national averages. During that same time, 7 percent, of all babies born were at a low birth weight, with African American children more likely to be born at a low birth weight than their white, Asian and Hispanic or Latino counterparts. Approximately 12 percent, of adults lived with diabetes in Pickens County in 2015, a figure higher than state and national averages (11 percent, and 9 percent, respectively). In 2015, 22 percent, of Medicare beneficiaries lived with diabetes. The numbers may be higher for Medicare beneficiaries because that population is more likely to be tested routinely for the disease. Cancer continues to have a devastating impact in Pickens County. Lung cancer was the 2nd leading cause of age-adjusted death, and 122 people died from the disease between 2013 and 2017. There are increasing incidences of colon, rectum and anal cancers, which ranked 13th in age-adjusted deaths between 2013 and 2017. Breast cancer death rates have declined over the last several years, but so has prevention. In 2015, only 56 percent, of Medicare enrollees said they had a mammogram sometime within the previous two years, a figure significantly down from 68 percent in 2009. There are many unhealthy behavior indicators prevalent in the community Chronic obstructive pulmonary disease is the third leading cause of age-adjusted death and is caused almost exclusively from smoking. Firearm fatalities are an issue in Pickens County with a rate above the state average and more than twice the national average in 2017. Patients presenting at Piedmont Mountainside with diagnoses related to alcohol abuse jumped by 400 percent between FY16 and FY18. Mental health and behavioral disorders were the fourth leading cause of death for all county residents between 2013 and 2017. We see this particularly in premature death. Suicide was the 2nd leading cause of premature deaths for whites between 2013 and 2017. It is most common among males aged 25 to 34 years of age. There was only one mental health provider for every 1,468 residents in the county in 2017, a rate significantly lower than the state and national averages of one provider for every 813 and 493 residents, respectively. Portions of Pickens County are federally designated as mental health professions shortage areas, meaning there is a serious lack of resources for mental services. Opioid prescriptions are a significant issue in the Pickens County community, with a total 111.5 opioids prescriptions written per very 100 people in 2017. Please note we aren't able to tell how many prescriptions are going to a single person, just the overall figure, meaning a single person could have several prescriptions. This figure is down from 2007, when there were 132.6 retail opioid prescriptions dispensed per every 100 persons. Even so, in 2017, Pickens remained nearly twice the national average of 58.7 prescriptions per every 100 people. The Georgia state average was 70.9 prescriptions per every 100 people. As defined by the World Health Organization, social determinants of health (SDHs are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. Included among these is economic stability, housing stability, food security, adequate income to pay for core services such as utilities, literacy, access to healthy food, access to safe recreational spaces, access to health care and access to services in languages the person understands. SDHs often carry negative health impacts, including increased risk of mortality, poor health and increased cardiovascular disease risks. Because of this, we look specifically at SDH indicators, such as the below. Three percent, of adults were unemployed in 2017, a figure a percentage point better than state and national averages. Thirty-three percent, of those living in poverty in the county did not graduate high school in the 2015-2016 school year. In 2016, 34 percent, of the population had limited access to healthy foods and 15 percent, have no access to healthy foods. These patients live in what's called a food desert, meaning there is no food outlet within a given census area. Seventeen percent reported having extended periods when they aren't sure how they or their families will eat. There were 19 fast food restaurants in Pickens County in 2019, a figure that's much better, per capita, than state and national averages. Twenty-six percent, of households had housing costs that exceeded more than 30 percent, of total household income in 2017, indicating a cost burdened household more likely to face overall financial difficulty. Twenty-four percent, of children lived in single-parent homes in 2017, a statistic often linked to lower graduation rates. Fifty-three percent, of children qualified for free or reduced cost lunch in the 2015-2016 school year, a statistic that represents poverty and food instability. This is an increase from our FY16 CHNA, when about 46 percent, of children qualified for free or reduced cost lunch. Pickens County is also high above the 2017 state average of 62 percent. For every 1,000 teen girls aged 15 to 18 in Pickens County, 52 birth gave birth to a child on average each year between 2010 and 2016. Children born to teen are statistically much more likely to experience adverse health and socioeconomic issues as they grow older. Eleven percent of children in Pickens County lived in poverty in 2017, a figure that has steadily gotten worse over the last SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH Piedmont Mountainside Hospital actively promotes the health of its community through clinic-hospital partnerships, our 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. In FY19, Piedmont Mountainside offered various proactive community benefit programs, including the continuation of the Piedmont community benefit grants program, which offers grant opportunities to local nonprofit organizations providing specific to health-related services and programs that address the unmet health needs identified in our FY16 CHNA and implementation strategy. FY19 grantees and support programming were the Pickens County Council on Child Abuse's Footsteps for Families program and the Good Samaritan Health and Wellness Center's work on addressing health disparities. Piedmont Mountainside Hospital also provided health professions education to students and residents training to be health professionals. In FY19, Piedmont Mountainside Hospital medical staff oversaw a total 11,277 hours of training at a cost of $433,578. As part of a Piedmont Healthcare systemwide effort, Piedmont Mountainside Hospital 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. Piedmont Mountainside Hospital also actively participated in local take-back day activities in FY19 by promoting and supporting a community drive for local residents to safely dispose of medications. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM Piedmont Mountainside 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. This includes our 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 Mountainside 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. X true true false true false false false false false true false MS LINDSAY GARD CFO 123894 0 12273 0 0 0 0 0 20825 0 156992 0 0 0 Ms Pam Mingo Pharmacy Manager 155504 0 15639 0 4520 0 10802 0 10593 0 197058 0 0 0 Mr Justin Leal SR. DIRECTOR OF OPERATIONS 191917 0 27780 0 250 0 5398 0 6351 0 231696 0 0 0 Ms Ouida J Corry Pharmacist 143924 0 200 0 15232 0 8735 0 623 0 168714 0 0 0 Ms DONNA REECE DIRECTOR - PHYSICIAN OUTREACH 118694 0 12178 0 1487 0 8484 0 14960 0 155803 0 0 0 Mr Donald Holmes Pharmacist 141190 0 200 0 30610 0 10266 0 10531 0 192797 0 0 0 Ms Denise Ray PRESIDENT/CEO/CHAIR/PHC CNO 423763 0 163613 0 105989 0 76778 0 11999 0 782142 0 60278 0 Mr Michael McAnder Treasurer 0 598784 0 408746 0 96080 0 121042 0 7634 0 1232286 0 0 MS ELIZABETH LEDDY SECRETARY 0 422090 0 288072 0 42079 0 84235 0 16280 0 852756 0 0 Dr Leigh Hamby Board Member 0 581251 0 396758 0 147719 0 105326 0 16506 0 1247560 0 88826 MS MICHELLE BREITFELDER CNO 180218 0 44522 0 8085 0 13906 0 11092 0 257823 0 0 0 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS DENISE RAY RECEIVED A DISCRETIONARY SPENDING ACCOUNT TOTALING $12,923, A FIXED AMOUNT DETERMINED BY HER JOB LEVEL. THIS SPENDING ACCOUNT WAS INCLUDED IN MS. RAY'S TAXABLE WAGES. SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT MOUNTAINSIDE 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 4: SUPPLEMENTAL COMPENSATION INFORMATION SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 4B DENISE RAY AND LEIGH HAMBY RECEIVED PAYMENTS TOTALING $60,278 AND $88,826, RESPECTIVELY, FROM THEIR SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: MICHELLE BREITFELDER 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. X 256 50577 FMV false true true SCHEDULE M, PART I, LINE 32B: THIRD-PARTY ASSISTANCE WITH CONTRIBUTIONS PIEDMONT HEALTHCARE ENGAGES SUNTRUST BANK TO ASSIST WITH THE MANAGEMENT AND SALE OF ITS NON-CASH STOCK GIFTS. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2018 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT MOUNTAINSIDE 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 MOUNTAINSIDE HOSPITAL ("PMH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT MOUNTAINSIDE HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT MOUNTAINSIDE HOSPITAL. FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT MOUNTAINSIDE 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 MOUNTAINSIDE 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 MOUNTAINSIDE HOSPITALS FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATIONS FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PMHS 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 ORGANIZATIONS SOLE MEMBER, FOR BOARD REVIEW. FORM 990, PART VI, SEC B, LINE 12C: CONFLICT OF INTEREST POLICY COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARE'S CHIEF COMPLIANCE OFFICER. ALL SENIOR LEADERS, BOARD MEMBERS, PHYSICIAN EMPLOYEES, NURSE PRACTITIONERS/PHYSICIAN ASSISTANTS AND EMPLOYEES AND NON-EMPLOYEES ENGAGED IN RESEARCH ARE REQUIRED TO ANNUALLY DISCLOSE ALL MATTERS WHICH COULD POTENTIALLY CONSTITUTE A CONFLICT OF INTEREST. MATTERS DISCLOSED UNDER THE POLICY MUST BE REVIEWED IN WRITING BY THE PIEDMONT HEALTHCARE CONFLICT OF INTEREST COMMITTEE IN ORDER TO DETERMINE WHETHER A CONFLICT EXISTS AND, IF SO, WHETHER TO ELIMINATE OR MANAGE THE CONFLICT. ALL BOARD MEMBERS AND EMPLOYEES OF PIEDMONT 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 SENIOR VICE PRESIDENT OF COMPLIANCE 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 MOUNTAINSIDE 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. FORM 990, PART VI, SECTION C, LINE 19: DISCLOSURE OF DOCUMENTS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THESE DOCUMENTS SHOULD BE REQUESTED FROM PIEDMONT HEALTHCARE, INC.'S LEGAL COUNSEL. FORM 990, PART XI, LINE 9: RECONCILIATION OF NET ASSETS CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF: CONTRIBUTIONS ($650,298) UNALLOCATED EXPENSES ($5,959,262) BOOK/TAX DIFFERENCES ($15,706) CHANGE IN TEMP $286,070 INTERCOMPANY TRANSFER $416,509 ------------------ TOTAL ($5,922,687) Sleep Services of Jasper LLC 1266 Highway 515 South Jasper GA 30143 Medical GA 0 0 PMH Piedmont Healthcare Inc 1800 HOWELL MILL RD STE 850 ATLANTA GA 30318 581503902 Management GA 501(c)(3) 12C, III-FI NA false PIEDMONT HOSPITAL INC 1968 Peachtree Road NW Atlanta GA 30309 580566213 Hospital GA 501(c)(3) 3 PHC false FAYETTE COMMUNITY HOSPITAL INC 1255 Highway 54 West Fayetteville GA 30214 582232328 Hospital GA 501(c)(3) 3 PHC false PIEDMONT HENRY HOSPITAL INC 1133 Eagles Landing Parkway Stockbridge GA 30281 582200195 Hospital GA 501(c)(3) 3 PHC false PIEDMONT NEWNAN HOSPITAL INC 745 Poplar Road Newnan GA 30265 205077249 Hospital GA 501(c)(3) 3 PHC false PIEDMONT HEALTHCARE FOUNDATION INC 2001 PEACHTREE RD NE STE 400 Atlanta GA 30309 581272768 Fundraising GA 501(c)(3) 12B, II PHC false PIEDMONT HEART INSTITUTE INC 95 Collier Road NW STE 2045 Atlanta GA 30309 263553500 Healthcare GA 501(c)(3) 10 PHC false PIEDMONT NEWTON HOSPITAL INC 5126 HOSPITAL DRIVE NE COVINGTON GA 30014 582155150 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT ATHENS REGIONAL FOUNDATION INC 1199 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 REGIONAL FIRSTCARE INC 1199 PRINCE AVENUE ATHENS GA 30606 582362733 URGENT CARE 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) 3 ARMC false COLUMBUS AMBULATORY HEALTHCARE SERVICES 707 CENTER ST COLUMBUS GA 31901 581719867 AMBULATORY GA 501(C)(3) 3 CRHS 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 CRHS false THE MEDICAL CENTER INC 710 CENTER ST COLUMBUS GA 31901 581685139 HOSPITAL GA 501(C)(3) 3 CRHS false HUGHSTON HOSPITAL INC 707 CENTER ST COLUMBUS GA 31901 331216751 HOSPITAL GA 501(C)(3) 3 CRHS false PIEDMONT ROCKDALE HOSPITAL INC 1412 MILSTEAD AVE CONYERS GA 30012 300999841 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT WALTON HOSPITAL INC 2151 WEST SPRING ST MONROE GA 30655 824194264 HOSPITAL GA 501(C)(3) 3 PHC false PEACHTREE ORTHOPAEDIC SURGERY CENTER 2001 PEACHTREE RD NE STE 705 ATLANTA GA 30309 582562721 SURGERY GA NA N/A 0 0 false 0 false DIGESTIVE HEALTHCARE OF GA ENDOSCOPY CTR 95 COLLIER RD NW STE 4075 ATLANTA GA 30309 582406657 HEALTHCARE GA NA N/A 0 0 false 0 false FOUR WINDS HEALTH LLC 3350 RIVERWOOD PKWY STE 1850 ATLANTA GA 30339 451273930 HEALTHCARE GA NA N/A 0 0 false 0 false 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 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 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. GA PHC C CORP 0 0 0.00000 false COLUMBUS HEALTHCARE RESOURCES PO BOX 790 COLUMBUS GA 31902 581717754 HEALTHCARE GA CRHS C-CORP 0 0 0.00000 false Columbus Health Services Inc PO BOX 790 COLUMBUS GA 31902 581640939 HEALTHCARE GA CRHS C CORP 0 0 0.00000 false false false false false false false false false false false false false false false false true true false false SCHEDULE R, PART I, LINE 1: DISREGARDED ENTITIES THE LIMITED LIABILITY COMPANY LISTED IN SCHEDULE R, PART I, OPERATES AS A DEPARTMENT OF PIEDMONT MOUNTAINSIDE HOSPITAL AND IS INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LLC AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.