2020-05-15T09:14:59-05:00 2019-06-30 KPMG LLP 300 North Greene Street Suite 400 Greensboro NC 27401 990 2018-07-01 582322328 FAYETTE COMMUNITY HOSPITAL INC % MARIE GAFFNEY FAYE 7707197073 1255 Highway 54 West Fayetteville GA 30214 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2020-05-11 true SHAWN HUTCHINSON P01048557 3362753394 2020-05-14 199.206.0.5 56038220201365000007 2020-05-15 P 1272C807EE2CFB18DB9032F475C1250F2D6A8CEA 1272C807EE2CFB18DB9032F475C1250F2D6A8CEA 2018 2020-09-23 17:36:50Z J MICHAEL BURNETT 1255 Highway 54 West Fayetteville GA 30214 448874048 false X WWW.PIEDMONTFAYETTE.COM X 1997 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. 11 6 2277 285 0 37238 14742 393589230 442761791 -31081 106507 4404827 4913420 398000214 447796460 81050 75984 0 0 136796890 149855572 0 0 0 218378777 223294419 355256717 373225975 42743497 74570485 209332377 227540910 38755791 43140277 170576586 184400633 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 343995115 75984 442761791 PIEDMONT FAYETTE HOSPITAL ("PFH") IS A 221-BED FACILITY LOCATED IN FAYETTE COUNTY, GEORGIA. OVER 500 PRIMARY CARE AND SPECIALTY PHYSICIANS COMPRISE THE MEDICAL STAFF AND MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN FAYETTEVILLE AND THE GREATER METROPOLITAN ATLANTA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2019, THE HOSPITAL HAD 17,294 IN-PATIENT ADMISSIONS WITH A TOTAL OF 76,257 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 89,192 AND OUTPATIENT VISITS TOTALED 104,524. SURGICAL SERVICES WERE PROVIDED TO 12,859 PATIENTS. 343995115 true false 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 true false true false false false false false false false false false false false false true true false false false true X 0 0 2277 true false false false false false false false false false false false false X 11 6 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 Dr Michael Behr Board Member 4.0 0.0 X 11100 0 0 Mr J Michael Burnett PRESIDENT & CEO/Board Member 35.0 20.0 X X 755604 0 95430 Mr Mark Gray Board Member 1.0 0.0 X 0 0 0 Ms Lacy S Curry Board Member 1.0 0.0 X 0 0 0 Dr Dave C Lee Board Member 1.0 0.0 X 0 0 0 Mr Douglas B Warner Board Member 1.0 0.0 X 0 0 0 Dr Russell A Wilson Chairman/Physician 7.0 0.0 X X 116100 0 0 Mr Robert Reeves BOARD MEMBER 1.0 0.0 X 0 0 0 Mr Michael McAnder Treasurer 1.0 54.0 X X 0 1103610 128676 Dr John McNair Board Member 10.0 0.0 X 127950 0 0 Dr Geetha Rao Board Member 1.0 0.0 X 0 0 0 Ms Elizabeth Leddy Secretary 1.0 54.0 X 0 752241 100515 Dr Frederick Willms VP of Medical Affairs 55.0 0.0 X 519426 0 24375 Mr Scott Wolfe CFO 55.0 0.0 X 427206 0 22566 Mr David Nipper COO 55.0 0.0 X 383324 0 32776 Ms Merry Heath CNO 40.0 0.0 X 260562 0 19163 Ms Mary McFarland Sr Dir Cardiovasc. 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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 15186939 15186939 0.04760 10431158 9677406 753752 0.00240 4691318 682692 4008626 0.01260 30309415 10360098 19949317 0.06260 55200 55200 0.00020 2757739 2757739 0.00860 540117 540117 0.00170 40000 40000 0.00010 3393056 3393056 0.01060 33702471 10360098 23342373 0.07320 true 54060380 0 85057772 79976124 5081648 X true true 1 1 Piedmont Fayette Hospital 1255 Highway 54 West Fayetteville GA 30214 www.piedmontfayette.com 056-550 X X X Piedmont Fayette 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 41 key stakeholders and policy makers that represent public health, low-income populations, uninsured and uninsured persons, minorities, chronic conditions, older adults, and lawmakers. These interviews were conducted for people representing the entire region, including Fayette 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. These interviews were conducted for people representing the entire region, including Fayette County. 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/PFH-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 FAYETTE 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 FAYETTE HOSPITAL UNANIMOUSLY APPROVED ITS IMPLEMENTATION STRATEGY FOR THE THREE YEAR PERIOD BEGINNING WITH FY20 ON NOVEMBER 13, 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 FAYETTE 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 FAYETTE 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 FAYETTE 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 FAYETTE 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 FAYETTE 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 FAYETTE HOSPITAL DEVELOPED THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS DURING FY20-22. The PFH Board of Directors unanimously approved the new CHNA on May 8, 2019. Based on the CHNA, PFH 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; (2) REDUCE OPIOID AND RELATED SUBSTANCE ABUSE AND OVERDOSE DEATHS; (3) DECREASE DEATHS FROM ALL CANCERS. WITH A FOCUS ON LUNG AND BREAST CANCER; (4) REDUCE PREVENTABLE INSTANCES OF AND DEATHS FROM HEART DISEASE; (5) REDUCE RATES OF OBESITY AND INCREASE ACCESS TO HEALTHY FOODS AND RECREATIONAL ACTIVITIES; (6) REDUCE PREVENTABLE INSTANCES OF DIABETES AND INCREASE ACCESS TO CARE FOR THOSE LIVING WITH THE DISEASE; AND (7) SUPPORT SENIOR HEALTH AND HEALTHY AGING. SCHEDULE H, PART V, LINE 16: FINANCIAL ASSISTANCE POLICY WEBSITES 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 Fayette 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 $373,225,975, LESS BAD DEBT EXPENSE OF $54,060,380 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. PFH 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 the 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 25.30% of the 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 Fayette 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 Fayette Hospital conducted its third triennial CHNA. The Piedmont Fayette CHNA was led by the Piedmont Healthcare community benefits team, with significant input and direction from Piedmont Fayette leadership, including the Executive Director of Patient Services, and the Piedmont Fayette Board of Directors, who provided input on the assessment at their March 13, 2019, board meeting. Process The CHNA started first with a definition of our community. We defined the hospital's primary population as the hospital's home county, due to the impact of its 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 Clayton County. 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 was 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 this 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 will 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, and especially those who are uninsured and those with low incomes . Decrease deaths from all cancers, with a focus on lung and breast cancers . Reduce instances of and deaths from heart disease . Reduce preventable instances of diabetes and increase access to care for those living with the disease . Reduce rates of obesity and increase access to healthy foods and recreational activities . Reduce opioid-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 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 Fayette Hospital Board of Directors on May 08, 2019. The Piedmont Fayette 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 Fayette Hospital leadership and the Piedmont Fayette 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. The CHNA implementation strategy was approved November 13, 2019. SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY Piedmont Fayette 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 Fayette 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 Fayette 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 our financial assistance policy to our partner clinics and others who work closely with low-income populations. We offer assistance in understanding the policy, how it relates to their populations and receive feedback in ways our 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 our hospitals and is digitally available online. Copies are provided in both English and Spanish. In FY19, we distributed approximately 15,000 copies of this guide throughout the Fayette community. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION Piedmont Fayette Hospital is located in Fayetteville, Georgia. In 2017, the last year for which Census data were available, approximately 110,306 people lived in Fayette County. The county skewed older, with a third of the county as 55+, and white, with about 70 percent of the population having self-reported as Caucasian. In 2017, the median household income was $84,861, much higher than both state and national averages. Most people owned their own home in Fayette County, about 80 percent in 2017, a rate much higher than state and national averages. In 2017, the top industries for employed residents were, in order: transportation and warehousing, education, healthcare and social assistance, accommodation and food services, and professional/scientific/technical services. Three percent of adults were unemployed in 2017, a figure a percentage point better than state and national averages. There were 10,602 veterans living in Fayette County in 2017. More than half served in the Gulf War, and about one in five lived with a disability. About 18 percent of the county is rural, with more limited access to community assets. In Fayette 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 was the top cause of premature death in Fayette County between 2013 and 2017, with a total staggering 1,838 community members that took their own lives. Heart disease was the second leading cause of premature death and accidental poisoning the third. Breast, lung and colon cancers were the sixth, seventh and tenth leading causes of death between 2013 and 2017, respectively. 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 Fayette County, 7 percent of the total population was uninsured in 2017, and 10 percent of the adult population was uninsured that year. Community members have reported an average 3.2 and 3.3 poor or fair physical and mental health days, respectively, and a total 13 percent of Fayette County residents reported their health as poor or fair. All three indicators have worsened since our last CHNA. Statewide, race matters when it comes to poor health status. Approximately 26 percent of Hispanics reported being in poor health in 2017, as compared to their white and African American counterparts (18 percent and 19 percent, respectively). Information on other races was not available. Preventable hospital stays among Medicare enrollees significantly decreased over the last few years, from 51 preventable stays per 1,000 enrollees in 2007 to 38 preventable stays in 2015. Medicare enrollees tend to receive proper health screenings, with overall rates above state and national averages. Nine 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 southern part of the county. The infant mortality rate in Fayette County is far less than state and national averages, at 4.8 infant deaths per every 1,000 births in 2017. That year, 7 percent of all babies born were at a low birth weight, and with African American infants most likely to be born at a low birth weight. The number one cause of age-adjusted deaths and premature deaths for both men and women each year between 2013 and 2017 in Fayette County was ischemic heart and vascular disease. During that time, 1,674 people died from this disease. Between 2013 and 2017, 228 Fayette County community members died from stroke, making it the third leading cause of age-adjusted death. This equals a death rate of 35 people per every 100,000 people. This is higher than both state and national averages. Approximately 11 percent of adults lived with diabetes in Fayette County in 2015, a figure relatively in line with state and national averages (11 percent and 9 percent, respectively). In 2015, 24 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 Fayette County. In 2017 alone, 162 people died from cancer. Of those, lung cancer kills the most Fayette County members. Breast cancer ranked 11th in age-adjusted death, and colon, rectum and anal cancers ranked 13th between 2013 and 2017. Overall, breast cancer death rates have declined over the last several years, but so has prevention. In 2015, only 69 percent of Medicare enrollees said they had a mammogram sometime within the previous two years, a figure down by about 10 percent from three years previous. Rates of new breast cancer diagnoses rates are high at 143.6 per every 100,000 residents, a figure high above the state and national average of 125 per every 100,000 residents. African Americans are more likely to be diagnosed with the disease than whites. Chronic obstructive pulmonary disease was the fifth leading cause of age-adjusted death between 2013 and 2017. The most common cause of the disease is smoking. Obesity rates are higher than state and national averages in Fayette County, and contributes to a number of diseases, including heart disease, stroke and diabetes. Smoking rates are much lower than the state average, as is binge drinking. Long commutes are also higher in Fayette County than in the rest of the state - 13 percent drove more than 30 minutes to work in 2016, and most drive alone. A 2017 study showed that those with long commutes tend to be more depressed, have more work-related stress, get less sleep and are more likely to be obese. The violent crime rate was 80.1 per every 100,000 county residents, a figure significantly less than the state average of 378 and 380 per every 100,000 residents. Mental health and behavioral disorders were the second leading cause of death for all county residents between 2013 and 2017. Suicide was the top cause of premature deaths for whites between 2013 and 2017. It was most common among males aged 25 to 34 years of age. There was one mental health provider for every 634 residents in the county in 2017, a rate better than the state and national averages of one provider for every 813 and 493 residents, respectively. Opioid prescriptions are a significant issue in the Fayette County community, with a total 79.2 opioid prescriptions written per every 100 people in 2017. Fayette is above both state and national averages of 70.9 and 58.7 per every 100 people, respectively. Please note we aren't able to tell how many prescriptions were written to a single person. We only know the overall figure, meaning a single person could have several prescriptions. Statewide, the age-adjusted opioid death rate was 9.7 per every 100,000 people, a 10 percent change in rate from 2016. This shows the issue is only continuing to worsen. There were 14 total deaths from all drug overdoses in Fayette County, which is a 50 percent increase from 2007. Twenty-six percent of those living in poverty in the county did not graduate high school in the 2015-2016 school year. 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, a significant figure. In 2016, 38 percent of the population had limited access to healthy foods and a 17 percent have no access to healthy foods. 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 reasonably short travel time. There were 102 fast food restaurants in Fayette County in 2019, a figure that's much higher, per capita, than state and national averages. Twenty-five 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. Fifty-six percent of children read at a proficient level in 4th grade testing, a statistic better than state and national averages. Twenty-six percent of children qualified for free or reduced cost lunch in the 2015-2016 school year, a statistic that represents poverty and food instability. Fayette County is less than half of the 2017 state average of 62 percent. For every 1,000 teen girls aged 15 to 18 in Fayette County, 12 gave birth to a child on average each year between 2010 and 2016. Children born to teen mothers are statistically much more likely to experience adverse health and soc SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH Piedmont Fayette 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 Fayette Hospital offered various proactive community benefit programs meant to boost the health of the community it serves. To start, hospital also processes all laboratory tests for the Fayette C.A.R.E. Clinic and the Healing Bridge Clinic at no cost to the clinics or their patients. For Fayette C.A.R.E. Clinic, the hospital provides Epic electronic medical records ambulatory system free of charge to the clinic, allowing for increased connectivity and supporting a continuum of care between the clinic and hospital. In FY19, Piedmont Fayette also provided support to local not-for-profit organizations through its community benefit grants program. These grants support local programming that directly address the unmet health needs identified in our FY16 CHNA and implementation strategy. In Fy19, the hospital provided direct funding to Fayette Senior Services for its Live Well, Ride Well program; the Fayette C.A.R.E. Clinic for its Steps to C.A.R.E. programming; and Healing Bridge Clinic, for its wellness clinic. The hospital also provides Thomas F. Chapman Family Cancer Wellness program free of charge to all community members, regardless of if they are a Piedmont patient. These services include cancer education, disease-specific nutrition workshops and cooking demonstrations, support groups, counseling and online classes to help support recovery. Additionally, the hospital provides Sixty Plus services free of charge to all community members, regardless of if they are a Piedmont patient. These services promote healthy aging by providing a continuum of geriatric specific services, programs, education, support and counseling for older adults and their family caregivers. Piedmont Fayette Hospital also provided health professions education to students and residents training to be health professionals. In FY19, Piedmont Fayette Hospital medical staff oversaw a total 93,736 hours of training at a cost of $2,757,739. Piedmont Fayette is the host site for Project SEARCH, an internship program in partnership with Fayette County Schools. Project SEARCH's primary focus is to secure competitive employment for high functioning individuals with learning differences. In FY19, students interned in dietary services (retail and inpatient), fitness/rehab, patient access, a medical/surgical unit, and nutrition services. Upon successful completion of the nine-month program, students can be eligible for employment consideration. In FY19, the hospital maintained its "Catch Me Clean" campaign, which utilizes hand hygiene stations in all 25 Fayette County School to promote the importance of hand hygiene to reduce the spread of infections. The hospital also continued ImPACT, a Concussion Testing and Protocols program, in partnership with FCBOE to provide a baseline score to all student athletes for future concussion testing. If a concussion is suspected during the athletic season, a follow-up test is administered to see if the results have changed from the baseline. Additionally, and as mentioned above, Piedmont Fayette 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 our financial assistance programs. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM Piedmont Fayette 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, 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, including 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 Fayette 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. true The Joseph Sams School 280 BRANDYWINE BLVD Fayetteville GA 30214 581584379 501(C)(3) 6000 EVENT SPONSOR FAYETTE SENIOR SERVICES 4 Center Dr fayetteville GA 30214 581364158 501(c)(3) 7500 PROGRAM SUPPORT 2 0 SCHEDULE I, PART I, LINE 2: MONITORING THE USE OF GRANT FUNDS CORPORATE SPONSORSHIPS: MONEY IS GIVEN TO CHARITABLE ORGANIZATIONS WHICH PRIMARILY PROMOTE HEALTH CARE CAUSES. THE GRANTS ARE ADMINISTERED AND MONITORED THROUGH THE ORGANIZATION'S PUBLIC RELATIONS DEPARTMENT. X true true false true false false false false false true false Dr Frederick Willms VP of Medical Affairs 371609 0 116930 0 30887 0 16500 0 7875 0 543801 0 0 0 Mr J Michael Burnett PRESIDENT & CEO/Board Member 437689 0 219248 0 98667 0 78888 0 16542 0 851034 0 62388 0 Mr Scott Wolfe CFO 318645 0 99345 0 9216 0 11180 0 11386 0 449772 0 0 0 Mr Michael McAnder Treasurer 0 598784 0 408746 0 96080 0 121042 0 7634 0 1232286 0 0 Mr David Nipper COO 284843 0 90781 0 7700 0 16500 0 16276 0 416100 0 0 0 Ms Merry Heath CNO 194664 0 60938 0 4960 0 12332 0 6831 0 279725 0 0 0 Ms Elizabeth Leddy Secretary 0 422090 0 288072 0 42079 0 84235 0 16280 0 852756 0 0 Ms Mary McFarland Sr Dir Cardiovasc. Svcs 156302 0 24992 0 1689 0 11242 0 10069 0 204294 0 0 0 Ms Sandra Biles Dir Inpatient Services 162895 0 20285 0 8278 0 9801 0 6266 0 207525 0 0 0 MS RHONDA MANOS Dir Pharmacy 186627 0 23436 0 4837 0 10009 0 9892 0 234801 0 0 0 DR ANGELA SWAYNE CMO 190385 106277 0 0 5153 47119 7662 8838 400 828 203600 163062 0 0 MS SHERYL KLINK FORMER CFO 0 359864 0 99063 0 15277 0 16500 0 16506 0 507210 0 0 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS JAMES MICHAEL BURNETT RECEIVED A DISCRETIONARY SPENDING ACCOUNT TOTALING $12,923, A FIXED AMOUNT DETERMINED BY HIS JOB LEVEL. THIS SPENDING ACCOUNT WAS INCLUDED IN MR. BURNETT'S TAXABLE WAGES. SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT FAYETTE 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 J. MICHAEL BURNETT RECEIVED A SERP PAYMENT IN THE AMOUNT OF $62,388. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: MICHAEL MCANDER SCOTT WOLFE DAVID NATHAN NIPPER FREDERICK WILLMS ELIZABETH LEDDY SHERYL KLINK SCHEDULE J, PART I, LINE 7: NON-FIXED PAYMENTS CERTAIN EMPLOYEES PARTICIPATED IN AN "ANNUAL INCENTIVE PLAN" UNDER WHICH THEY RECEIVED NON-FIXED BONUS PAYMENTS BASED ON JOB LEVEL AND SEVERAL DIFFERENT PERFORMANCE METRICS. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2018 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT FAYETTE 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 FAYETTE HOSPITAL ("PFH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT FAYETTE HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT FAYETTE HOSPITAL. FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT FAYETTE 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 FAYETTE 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 FAYETTE HOSPITALS FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATIONS FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PFHS 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 FAYETTE 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 FAYETTE 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 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 ($4,000) BOOK/TAX DIFF $26,613 CHANGES IN TEMP. ($11,997) INTERCOMPANY TRANS. ($53,490,875) UNALLOCATED EXPENSES ($7,509,158) CHANGES IN UNRESTR. FUND $243,214 OTHER CHANGES ($235) -------------------- TOTAL ($60,746,438) FAYETTE SURGERY CENTER LLC 1255 HIGHWAY 54 WEST Fayetteville GA 30214 Surgery GA 0 0 PFH PIEDMONT HEALTHCARE INC 1800 HOWELL MILL ROAD SUITE 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 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 HEALTHCARE FOUNDATION INC 2001 PEACHTREE ROAD NE SUITE 400 Atlanta GA 30309 581272768 FUNDRAISING GA 501(c)(3) 12B, II 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 ATHENS REGIONAL SPECIALTY SERVICES INC 1199 PRINCE AVENUE ATHENS GA 30606 271975001 HEALTHCARE GA 501(C)(3) 3 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 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 NA C Corp 0 0 0.00000 false AMSTER MCRAE INSURANCE COMPANY PO BOX 1159 Grand Cayman KY CJ 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 FAYETTE 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.