2019-05-15T07:37:48-05:00 2018-06-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2017-07-01 453957368 POLK MEDICAL CENTER INC POLK 7065096074 420 E SECOND AVENUE SUITE 102 ROME GA 301613210 RICHARD T SHEERIN CFO 7065096074 2019-05-14 true JACQUELINE G ATKINS P00861721 2298837878 2019-05-13 208.73.87.26 2019-05-15 07:37:48 CD P 3DB754BF4A86932C7270BAD44D636E9B352C5FAB 3DB754BF4A86932C7270BAD44D636E9B352C5FAB 2017 2019-02-21 02:37:17Z KURT STUENKEL 304 TURNER MCCALL BLVD ROME GA 301620233 34065970 false X WWW.POLKHOSPITAL.ORG X 2011 GA POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY. 12 11 0 15 24582 15084 253531 30538769 33149773 87750 645672 88 17 30626607 34048993 326068 318601 0 13920623 13259267 0 0 10670394 11853468 24917085 25431336 5709522 8617657 57480058 66780229 41754821 42574853 15725237 24205376 POLK MEDICAL CENTER, A 501(C)(3) ORGANIZATION, LOCATED IN CEDARTOWN, GA IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING CARE TO THE COMMUNITY REGARDLESS OF THE ABILITY TO PAY. false false 20156913 318601 33125208 POLK MEDICAL CENTER IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING GENERAL ACUTE CARE SERVICES TO THE POLK COUNTY AND NORTHERN HARALSON COUNTY COMMUNITIES. DURING FISCAL YEAR 2018, PATIENT DAYS AT POLK MEDICAL CENTER TOTALED 7,564 AND DISCHARGES TOTALED 102. EMERGENCY ROOM VISITS TOTALED 28,645. 20156913 true true false true false false false false false false true false false false true true true true false false false false false false false false true true true false true true false false false false false false false false false false false false false false false true false false false true 17 0 0 true true false false false false false false false false false X 12 11 false false true false true true true true true false false true true true true true false false false false GA X RICHARD T SHEERIN 7065096074 304 TURNER MCCALL BLVD ROME GA 301610233 KURT STUENKEL PRESIDENT/SE 1.00 51.00 X X 0 2860734 23258 GEORGE A BOSWORTH MD MEMBER 1.00 1.00 X 2750 7000 0 LARRY KUGLAR MEMBER 1.00 1.00 X 2500 4500 0 FRANK SHELLEY MEMBER 1.00 1.00 X 2750 3500 0 BRAD WARD MD MEMBER 1.00 1.00 X 2500 3000 0 BRUCE CASEY MEMBER 1.00 X 2750 0 0 LEE CUMMINGS MEMBER 1.00 X 2750 0 0 HAROLD W WYATT JR CHAIRMAN 1.00 X X 2250 0 0 DARROLL FREEMAN MEMBER 1.00 X 2250 0 0 TODD BUSSEY MEMBER 1.00 X 0 0 0 NEIL E GORDON MD MEMBER 1.00 X 0 0 0 SONDI SMITH VEST MEMBER 1.00 X 0 0 0 RICHARD T SHEERIN CFO 1.00 51.00 X 0 515595 19536 MATTHEW GORMAN POLK ADMINIS 40.00 X 0 313621 25986 DEANA OWEN PHARMACY DIR 40.00 X 165399 0 20741 TIFANI KINARD CHIEF NURSIN 40.00 X 159893 0 13740 CHRISTY LINDSEY PHARMACIST 40.00 X 132801 0 7104 LOVEJOY LEIGH PHARMACIST 40.00 X 128680 0 18223 PHILLIP ROBERTS REGISTERED N 40.00 X 121880 0 0 729153 3707950 128588 19 false true false ARAMARK MANAGEMENT SERVICE P O BOX 233 ROME GA 301610233 HOUSEKEEPING 499860 MORRISON MANAGEMENT SPECIALISTS P O BOX 102289 ATLANTA GA 303682289 FOOD SERVICES 480157 CERNER CORPORATION P O BOX 412702 KANSAS CITY MO 641412702 IT SERVICES 276994 G4S SECURE SOLUTIONS(USA) INC PO BOX 277469 ATLANTA GA 303847469 SECURITY 266120 4 253531 253531 NET PATIENT SERVICE REVENUE 623000 33032872 33032872 EHR REVENUE 623000 92319 92319 REFERENCE LAB 621500 24582 24582 33149773 662649 662649 16977 -16977 -16977 -16977 PURCHASE DISCOUNTS 623000 17 17 17 34048993 33125208 24582 645672 318601 318601 20500 20500 10015408 9074452 940956 2492900 2258567 234333 730459 669591 60868 1112282 1112282 68199 68199 44595 44595 1008388 239230 769158 56678 4478 52200 231923 134653 97270 502991 62700 440291 1829583 1676630 152953 1361997 1228161 133836 20511 9601 10910 117428 117428 2642712 2421781 220931 733968 733968 MEDICAL SUPPLIES 1354945 1340977 13968 REPAIRS & MAINTENANCE 667054 558622 108432 DUES & SUBSCRIPTIONS 43968 20379 23589 LICENSES & TAXES 21569 21012 557 34677 50 34627 25431336 20156913 5274423 0 920153 251090 6716641 6129123 5836762 9646009 237145 298049 377259 411481 43965420 16576366 30210194 27389054 12851977 22351190 329927 304233 57480058 66780229 2279215 3025952 34458933 34146264 5016673 5402637 41754821 42574853 X 15725237 24205376 15725237 24205376 57480058 66780229 8617657 -137518 X false true X true false X false false false false false false false false true 2543 2543 false SCHEDULE C, PART II-B, LINE 1 THE ORGANIZATION PAYS MEMBERSHIP DUES TO NATIONAL AND STATE ORGANIZATIONS. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THOSE ORGANIZATIONS PARTICIPATE. 838635 838635 28399491 6858600 21540891 50508 6852 43656 14676786 9710914 4965872 27389054 MOB CAPITAL LEASE 2907597 DUE TO RELATED ORGANIZATIONS 1360209 THIRD PARTY PAYMENTS 1134831 5402637 X 33858279 -137518 -53196 -190714 34048993 34048993 25378140 25378140 53196 53196 25431336 SCHEDULE D, PAGE 3, PART X PMCI IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. PMCI APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, PMCI ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENTS EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JUNE 30, 2018 AND 2017 OR FOR THE YEARS THEN ENDED. PMCIS TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. SCHEDULE D, PAGE 4, PART XI, LINE 2D CHARITABLE DONATIONS EXPENSE -8,601 INVESTMENT FEES -44,595 SCHEDULE D, PAGE 4, PART XII, LINE 4B CHARITABLE DONATIONS EXPENSE 8,601 INVESTMENT FEES 44,595 true true X true X 1.250000000000 true X 3.250000000000 true true true false true true 1155811 1155811 0.04540 5834065 5723228 110837 0.00440 1033 757 276 6990909 5723985 1266924 0.04980 138133 138133 0.00540 1114 1114 310000 310000 0.01220 449247 449247 0.01770 7440156 5723985 1716171 0.06750 true 21877298 11594968 10270441 10336077 -65636 X true true 1 1 POLK MEDICAL CENTER 2360 ROCKMART HIGHWAY CEDARTOWN GA 30125 WWW.POLKHOSPITAL.ORG 115-705 X X X X SWING BED SNF POLK MEDICAL CENTER 1 false false true X X X X X X X X 16 true false false true X WWW.POLKHOSPITAL.ORG X X true 16 true WWW.POLKHOSPITAL.ORG false false true X 125.000000000000 325.000000000000 X X X true true X X X X true X WWW.POLKHOSPITAL.ORG X WWW.POLKHOSPITAL.ORG X WWW.POLKHOSPITAL.ORG X X X X X X true X false X X X true X false false FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 3E THE PROCESS OF PRIORITIZING THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY IS DISCUSSED ON PAGES 17 THROUGH 24 OF THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH IS AVAILABLE ON THE ORGANIZATION'S WEBSITE. FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 5 THE CHNA UTILIZED A PARTICIPATORY, COLLABORATIVE APPROACH AND EXAMINED HEALTH IN ITS BROADEST CONTEXT. THE ASSESSMENT PROCESS INCLUDED THE FOLLOWING: O REVIEW OF PREVIOUS CHNA O SYNTHESIZING EXISTING DATA ON SOCIAL, ECONOMIC, AND HEALTH INDICATORS IN POLK, FLOYD AND CHATTOOGA COUNTIES O INDIVIDUAL COMMUNITY SURVEYS O FOCUS GROUPS WITH A RANGE OF DIVERSE INDIVIDUALS - INCLUDING PROVIDERS, ELECTED OFFICIALS, COMMUNITY-BASED ORGANIZATIONAL STAFF AND COMMUNITY RESIDENTS FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 7D THE 2016 CHNA HAS BEEN DISTRIBUTED UPON REQUEST TO OTHER NON-PROFIT AGENCIES IN THE AREA TO ASSIST WITH GRANTS. COPIES HAVE ALSO BEEN MADE AVAILABLE TO ELECTED OFFICIALS, CHAMBERS OF COMMERCE, AND EDUCATIONAL INSTITUTIONS IN THE AREA. FACILITY 1, POLK MEDICAL CENTER - PART V, LINE 11 ACCESS TO CARE, CARDIOVASCULAR DISEASE, MENTAL HEALTH SERVICES AND HEALTHY NUTRITION DISEASE WERE DETERMINED IN THE 2016 CHNA TO BE SIGNIFICANT CONCERNS THAT AFFECT MANY RESIDENTS. THE DISTRIBUTION OF BEHAVIORS AND HEALTH OUTCOMES CONSISTENTLY FOLLOW SOCIAL AND ECONOMIC PATTERNS. FURTHERMORE, SOME BARRIERS TO ACCESSING CARE CONTINUE TO PREVENT CURRENT PROGRAMS AND INITIATIVES FROM REACHING THE POPULATIONS IN NEED. THESE CHALLENGES PRESENT IMPORTANT OPPORTUNITIES FOR THE FUTURE. AS WE MOVE FORWARD AS AN INTEGRATED COMMUNITY OF HEALTH CARE, SOCIAL SERVICE AND COMMUNITY LEADERSHIP, WE CAN LEVERAGE COMMUNITY ASSETS TO IMPROVE THE HEALTH OF RESIDENTS IN POLK, FLOYD AND CHATTOOGA COUNTIES. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". SEE ALSO THE DESCRIPTION FOR PART III, LINE 2. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCE THE FIGURE ON PART III LINE 3 REPRESENTS MANAGEMENT'S ESTIMATE (APPROXIMATELY 53%) BASED ON AN ANALYSIS OF SELF-PAY PATIENTS' ABILITY TO PAY THEIR OUTSTANDING ACCOUNT. THIS ANALYSIS INCLUDES REVIEWING THE PATIENT'S CREDIT HISTORY, INCOME LEVELS AND OVERALL COLLECTIBILITY OF THE ACCOUNT. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS SEE THE ALLOWANCE FOR DOUBTFUL ACCOUNTS ON PAGES 7 AND 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION FOR PATIENTS RECEIVING ONLY A PORTION OF THEIR BILL AS CHARITY, THE REMAINING PORTION OF THE BILL IS TREATED THE SAME AS ALL OTHER PATIENTS IN REGARDS TO COLLECTIONS. PART VI, LINE 2 - NEEDS ASSESSMENT POLK MEDICAL CENTER (PMC) COMPLETED A HEALTH CARE NEEDS ASSESSMENT IN POLK COUNTY IN FISCAL YEAR 2016. THIS INCLUDED INTERVIEWS WITH COMMUNITY LEADERS AND HEALTH CARE PROFESSIONALS AND FOCUS GROUPS. IN ADDITION, THE AUTHORITY DEVELOPS A STRATEGIC PLAN THAT IS UPDATED ANNUALLY. THE STRATEGIC PLAN TAKES INTO CONSIDERATION HEALTH NEEDS FOR OUR SERVICE AREA IN ADDITION TO UTILIZATION OF SERVICES, COMMUNITY PARTICIPATION, AND QUALITY OF SERVICES PROVIDED. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE POLK COMMUNICATES THIS INFORMATION THROUGH SIGNAGE IN THE EMERGENCY CARE CENTER, PATIENT REGISTRATION AREAS, IN THE BUSINESS/PATIENT FINANCIAL SERVICES OFFICES, AND IN THE OFFICES OF OUR FINANCIAL COUNSELORS. DURING TIMES OF PREADMISSION AS WELL AS ON-SITE REGISTRATION THE ACCESS/REGISTRATION STAFF DISCUSSES POLICIES WITH THE PATIENT/PATIENT'S FAMILY IF APPROPRIATE. AFTER DISCHARGE AND DURING THE "COLLECTION" PERIOD OUR STAFF ONCE AGAIN DISCUSSES OUR FINANCIAL ASSISTANCE POLICIES. IN ADDITION THERE IS A DEMONSTRATED WORD-OF-MOUTH COMMUNICATION OF THESE POLICIES THROUGH OUR PATIENT POPULATION. PART VI, LINE 4 - COMMUNITY INFORMATION POLK COUNTY HAS AN ESTIMATED 41,000 RESIDENTS AND IS PART OF A THREE-COUNTY AREA SERVED BY FLOYD POLK MEDICAL CENTER, A 25-BED CRITICAL ACCESS HOSPITAL WITH EMERGENCY MEDICINE, SURGERY AND DIAGNOSTIC IMAGING CAPABILITIES, FLOYD MEDICAL CENTER, A 304-BED ACUTE CARE SAFETY NET HOSPITAL, AND A THIRD, HCA-OWNED HOSPITAL. THE POPULATION BASE IS APPROXIMATELY 72.3% CAUCASIAN, 13.0% AFRICAN AMERICAN, 12.8% HISPANIC OR LATINO AND 3.4% OTHER RACES. NORTHWEST GEORGIA IS A MEDICAL AND EDUCATION HUB. MANUFACTURING IS THE COUNTY'S LARGEST INDUSTRY. THE TOP 10 EMPLOYERS ARE: -MEGGITT POLYMERS AND COMPOSITES -POLK COUNTY SCHOOL DISTRICT -HON COMPANY -TIP TOP POULTRY -AT&T COMMUNICATIONS -POLK COUNTY GOVERNMENT -ANGELICA TEXTILE SERVICES -JEFFERSON SOUTHERN CORPORATION -WAL-MART -EBY-BROWN THE MEDIAN PER HOUSEHOLD INCOME IS 39,356. AN ESTIMATED 18.6% OF THE POLK COUNTY POPULATION IS BELOW THE POVERTY LEVEL AND ABOUT 67.2 PERCENT OF POLK RESIDENTS OWN THEIR OWN HOMES. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH POLK MEDICAL CENTER GENERATES MORE THAN 45 MILLION IN ECONOMIC ACTIVITY IN THE STATE. POLK HAS ABOUT 201 FULL AND PART-TIME EMPLOYEES. POLK MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL PROVIDING THE FOLLOWING SERVICES TO THE POLK COUNTY AND NORTHERN HARALSON COUNTY COMMUNITIES. BREAST HEALTH CARDIAC REHABILITATION CARDIOLOGY DIAGNOSTIC RADIOLOGY EMERGENCY ROOM EMERGENCY MEDICAL SERVICES FAMILY MEDICINE HOSPICE OUTPATIENT REHAB AND SPORTS MEDICINE SENIOR ENRICHMENT PROGRAM SUB-ACUTE REHABILITATION PROGRAM SURGERY WOUND CARE URGENT CARE POLK MEDICAL CENTER IS COMMITTED TO PROVIDING HEALTH CARE SERVICES TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. IN FY 2018, POLK MEDICAL CENTER PROVIDED 3.5 MILLION IN UNREIMBURSED CARE TO INDIVIDUALS. THE POLK MEDICAL CENTER PHARMACY PROVIDED PRESCRIPTION DRUGS AT NO OR MINIMAL COST TO INDIGENT PATIENTS BEING DISCHARGED FROM INPATIENT CARE OR THE EMERGENCY ROOM AT A COST OF 1,874 DURING FY 2018. POLK MEDICAL CENTER CO-WORKERS AND VOLUNTEERS REACHED APPROXIMATELY 30,500 POLK COUNTY RESIDENTS THROUGH COMMUNITY ENDEAVORS AT AN EXPENSE OF 138,133 IN FY 2018: CONDUCTING HEALTH FAIRS PROVIDING SCHOOL-BASED EDUCATION PROGRAMS TO STUDENTS ABOUT AUTOMOBILE SAFETY, BICYCLE SAFETY, SAFE PLAY AND CAREERS PROVIDING DIABETES EDUCATION PROVIDING HEART DISEASE EDUCATION PROVIDING MEDICAL SUPPORT AT SPORTS AND COMMUNITY EVENTS AS A COMMUNITY HOSPITAL, POLK IS CONTINUOUSLY LOOKING FOR OPPORTUNITIES TO REACH FARTHER INTO OUR COMMUNITY TO MEET THE NEEDS OF THE FULL SPECTRUM OF INDIVIDUALS WHO SEEK MEDICAL CARE IN THE SERVICE AREA. MEMBERS OF THE POLK TEAM ARE COMMITTED TO THE COMMUNITY IN MANY WAYS. IN FY 2018 POLK CO- WORKERS LOANED THEIR TALENTS AND LEADERSHIP SKILLS TO SCHOOL, CIVIC AND PROFESSIONAL ORGANIZATIONS. INDIGENT OUTPATIENT PHARMACY PROGRAM POLK PROVIDES MAINTENANCE PRESCRIPTION PHARMACEUTICALS TO LOW INCOME UNINSURED OUTPATIENTS AT NO COST TO THE PATIENT THROUGH ITS HOSPITAL PHARMACY. ANY QUALIFIED, LOW INCOME PATIENT DISCHARGED FROM POLK MEDICAL CENTER MAY BE ELIGIBLE TO RECEIVE THE PRESCRIBED MEDICATIONS. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM THE CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY IS A HOSPITAL AUTHORITY CREATED AND ORGANIZED UNDER THE GEORGIA HOSPITAL AUTHORITIES LAW. IT IS THE OWNER OF POLK MEDICAL CENTER A 25-BED, CRITICAL ACCESS HOSPITAL LOCATED IN CEDARTOWN, GA. THE POLK AUTHORITY CONSISTS OF A SELF-PERPETUATING SIX- PERSON BOARD, ALL OF WHOM ARE POLK COUNTY RESIDENTS. IN 2011 THE POLK AUTHORITY SOLICITED PROPOSALS RESPECTING THE LEASE AND OPERATION OF POLK MEDICAL CENTER. FLOYD HEALTHCARE MANAGEMENT INC. (FHMI) AND THE HOSPITAL AUTHORITY OF FLOYD COUNTY (HAFC) JOINTLY RESPONDED TO THE REQUEST FOR PROPOSALS BY SUBMITTING A PROPOSAL UNDER WHICH THE FOLLOWING TRANSACTIONS AND UNDERTAKINGS WOULD OCCUR: (1) HAFC WOULD LEASE POLK MEDICAL CENTER FROM THE POLK AUTHORITY AND OPERATE IT FOR A PERIOD OF UP TO FIVE YEARS; (2) FHMI WOULD CREATE A NON-PROFIT CORPORATION TO BE CALLED POLK MEDICAL CENTER INC. (PMCI), WHICH WOULD HAVE A BOARD OF DIRECTORS COMPRISED OF NINE PERSONS APPOINTED BY FHMI, THREE OF WHOM WOULD BE RESIDENTS OF FLOYD COUNTY AND SIX OF WHOM WOULD BE RESIDENTS OF POLK COUNTY; (3) PMCI WOULD BE ENGAGED BY HAFC TO MANAGE THE DAY-TO-DAY OPERATION OF POLK MEDICAL CENTER DURING THE TERM OF THE AFORESAID FIVE-YEAR LEASE; (4) PMCI AND FHMI WOULD UNDERTAKE TO CONSTRUCT A NEW, 25-BED REPLACEMENT HOSPITAL ON LAND ALREADY OWNED BY THE POLK AUTHORITY ON THE OUTSKIRTS OF CEDARTOWN, WITH CONSTRUCTION TO BE COMPLETED WITHIN FIVE YEARS; AND (5) UPON COMPLETION OF CONSTRUCTION, THE FIVE-YEAR LEASE WOULD TERMINATE, AND OWNERSHIP OF THE NEW HOSPITAL WOULD RESIDE IN THE POLK AUTHORITY, WHICH WOULD IN TURN LEASE IT TO PMCI FOR A PERIOD OF 35 YEARS. THE FOREGOING PROPOSAL WAS ACCEPTED BY THE POLK AUTHORITY, AND IN LATE 2011, AGREEMENTS BY AND AMONG FHMI, PMCI, HAFC AND THE POLK AUTHORITY WERE EXECUTED, INCLUDING THE FIVE-YEAR LEASE AGREEMENT AND A HOSPITAL CONSTRUCTION AGREEMENT. ON APRIL 1, 2012 THE FIVE-YEAR LEASE AGREEMENT COMMENCED AT WHICH TIME HAFC BECAME THE LICENSED OPERATOR OF POLK MEDICAL CENTER, WITH THE NEWLY CREATED PMCI ENGAGED TO PROVIDE DAY-TO-DAY MANAGEMENT OF THE HOSPITAL'S OPERATION. EFFECTIVE NOVEMBER 5, 2014, THE AUTHORITY'S LEASE FOR POLK MEDICAL CENTER FROM THE CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY ENDED. ACCORDINGLY, THE OPERATIONS, ASSETS AND LIABILITIES OF POLK MEDICAL CENTER TRANSFERRED TO CEDARTOWN-POLK AUTHORITY. FHMI IS A NOT-FOR-PROFIT CORPORATION CREATED IN 1991 BY THE HAFC. FROM NOVEMBER 26, 1991, THROUGH DECEMBER 31, 1997, FHMI MANAGED AND SUPERVISED FLOYD MEDICAL CENTER AND ALL OTHER FACILITIES, PROJECTS AND PROGRAMS OF THE HAFC PURSUANT TO A MANAGEMENT AGREEMENT. EFFECTIVE JANUARY 1, 1998, THE AFORESAID MANAGEMENT AGREEMENT WAS CONVERTED TO A LEASE AGREEMENT UNDER WHICH ALL FACILITIES, PROJECTS AND PROGRAMS OF HAFC WERE LEASED TO FHMI. AT THAT TIME, FHMI BECAME THE LICENSED OPERATOR OF ALL SUCH FACILITIES, PROJECTS AND PROGRAMS. FHMI IS GOVERNED BY AN EIGHTEEN MEMBER BOARD OF DIRECTORS, THREE OF WHOM MUST BE MEMBERS OF THE HAFC. ADDITIONALLY, FHMI HAS CONTRACTUALLY COMMITTED THAT AT LEAST TWO OF ITS DIRECTORS WILL BE FLOYD COUNTY COMMISSIONERS AND TWO OF ITS DIRECTORS WILL BE CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY MEMBERS. FLOYD EMERGENCY PHYSICIANS LLC IS A WHOLLY OWNED SUBSIDIARY OF FHMI WHOSE SOLE PURPOSE IS TO PROVIDE A PHYSICIAN AND MID-LEVEL STAFFING SOLUTION IN THE FLOYD MEDICAL CENTER EMERGENCY CARE CENTER AND THE POLK MEDICAL CENTER EMERGENCY DEPARTMENT. THE FLOYD HEALTHCARE FOUNDATION IS A 501(C)(3) NOT-FOR-PROFIT ORGANIZATION THAT WORKS TO IMPROVE THE HEALTH OF THE COMMUNITIES SERVED BY FLOYD MEDICAL CENTER AND POLK MEDICAL CENTER BY DEVELOPING RELATIONSHIPS AND RAISING FUNDS TO BUILD AND SUPPORT PROGRAMS AND SERVICES THAT MEET IDENTIFIED NEEDS AND FURTHER OUR MISSION. GOVERNED BY ITS OWN VOLUNTEER BOARD OF DIRECTORS AND MANAGED BY A PROFESSIONAL STAFF, THE FOUNDATION RAISES SUPPORT THROUGH VOLUNTEER-LED INITIATIVES THAT PROVIDE FUNDING NOT ONLY FOR FLOYD MEDICAL CENTER BUT ALSO FOR PROGRAMS THAT SEEK TO IMPROVE THE HEALTH OF OUR COMMUNITY. CANCER NAVIGATORS, INC. IS A 501(C)(3) NOT-FOR-PROFIT ORGANIZATION THAT PROVIDES EDUCATION, COUNSELING, AND ACCESS TO RESOURCES FOR CANCER PATIENTS TO HELP THEM EASE DIFFICULT EMOTIONS AND MAINTAIN A SENSE OF CONTROL OVER THEIR DIAGNOSIS AND TREATMENT. true CEDARTOWN-POLK COUNTY HOSPITAL AUTH 424 NORTH MAIN STREET CEDARTOWN GA 301252644 580603152 GOV 310000 CASH CONSTRUCT H2O/SEWER 1 SCHEDULE I, PAGE 1, PART I, LINE 2 POLK MEDICAL CENTER, INC. ENTERED INTO A CONTRACT WITH THE CITY OF CEDARTOWN TO MAKE ANNUAL CONTRIBUTIONS TO THE CITY FOR THE CONSTRUCTION OF NEW WATER AND SEWAGE INFRASTRUCTURE FOR THE NEW HOSPITAL. PURSUANT TO THE AGREEMENT, PMC WILL MAKE PAYMENTS FOR 20 YEARS. ON AN ANNUAL BASIS, MANAGEMENT REVIEWS AND RECONCILES THE ACTIVITY. false true false false false false false false false KURT STUENKEL PRESIDENT/SECRETARY 677895 1162596 1020243 23258 2883992 RICHARD T SHEERIN CFO 410980 95851 8764 19536 535131 MATTHEW GORMAN POLK ADMINISTRATOR 241845 69751 2025 25986 339607 DEANA OWEN PHARMACY DIRECTOR 147177 17777 445 20741 186140 TIFANI KINARD CHIEF NURSING OFFICE 144007 15591 295 13740 173633 SCHEDULE J, PAGE 1, PART I, LINE 3 NONE OF THE INDIVIDUAL BOARD MEMBERS OR OFFICERS ARE COMPENSATED BY THE FILING ORGANIZATION AND THE ORGANIZATION MUST RELY ON THE METHODS EMPLOYED BY THE RELATED ORGANIZATION, FHMI, TO DETERMINE REASONABLE COMPENSATION FOR THE INDIVIDUALS. COMPENSATION DETERMINATION BY FHMI INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT AND SURVEYS, AND BOARD APPROVAL. THESE METHODS ARE WELL DOCUMENTED. SCHEDULE J, PAGE 1, PART I, LINE 4 KURT STUENKEL 0 1,004,542 0 SCHEDULE J, PART III MR. STUENKEL AND MR. SHEERIN ARE COMPENSATED BY FLOYD HEALTHCARE MANAGEMENT, INC. (EIN: 58-1973570) FOR SERVICES AS THE CEO AND CFO, RESPECTIVELY, OF FLOYD HEALTHCARE MANAGEMENT, INC. THEY RECEIVE NO COMPENSATION FROM THE FILING ORGANIZATION. THE CEO PARTICIPATES IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS FUNDED ANNUALLY IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON-QUALIFIED RETIREMENT PLAN, AND AS SUCH THE ANNUAL FUNDING PAYMENTS PAID INTO IT ARE TAXABLE TO THE PARTICIPANT IN THE YEAR IN WHICH MADE. EFFECTIVE WITH CALENDAR YEAR 2009, MR. STUENKEL'S SERP IS A CASH-BASED PROGRAM. ADDITIONALLY, OF THE 2,860,734 LISTED AS COMPENSATION FOR MR. KURT STUENKEL IN FORM 990 PART VII SECTION A, 180,879 REPRESENTS A PERFORMANCE BASED PAYMENT ARISING FROM THE 2017 PERFORMANCE PERIOD, 981,717 REPRESENTS A RETENTION BONUS, AND 1,004,542 REPRESENTS THE NONQUALIFIED SERP PLAN. ACCORDINGLY, MR. STUENKEL'S SALARY FOR 2017 WOULD HAVE BEEN 693,596 EXCLUDING THE 2017 PORTION OF THE INCENTIVE BASED PAYMENT AND THE SERP PLAN AMOUNT. BONUS/INCENTIVE PAY ALL MEMBERS OF THE EXECUTIVE TEAM FOR FHMI PARTICIPATE IN AN INCENTIVE COMPENSATION PLAN UNDER WHICH ANNUAL YEAR-END BONUSES ARE PAID BASED ON INDIVIDUAL AND CORPORATE-WIDE ACHIEVEMENT OF SPECIFIC GOALS AND OBJECTIVES. ONE OF THE GOALS RELATES TO THE RELATED ORGANIZATION'S NET INCOME. THE BONUSES ARE AWARDED ON A CASH-BASED SYSTEM. A CEDARTOWN POLK COUNTY HOSP AUTH REVENUE BONDS 2016 SERIES 580603152 150759AR9 2016-04-13 30415000 RETIRE BANK LOAN FOR CONSTRUCTION, ACQUISITION, RENOVATION, EXPANSION, false false false A 90000 34834415 338636 34495779 2014 false false true true A false false false false false false true A false false false false false false false false false A false SCHEDULE K - DIFFERENCES IN ISSUE PRICE EXPLANATION CEDARTOWN POLK COUNTY HOSP AUTH THE 2016 SERIES REVENUE BOND PROCEEDS INCLUDES A PREMIUM IN THE AMOUNT OF 4,419,415. SCHEDULE K - PURPOSE OF ISSUE DESCRIPTION CEDARTOWN POLK COUNTY HOSP AUTH INSTALLATION AND EQUIPPING OF THE POLK MEDICAL CENTER. FORM 990, PAGE 6, PART VI, LINE 4 EFFECTIVE JULY 2017, THE BYLAWS WERE AMENDED TO INCREASE THE NUMBER OF VOTING BOARD MEMBERS FROM NINE TO TWELVE, THE THREE ADDITIONAL MEMBERS SHALL IN SOME WAY BE SIGNIFICANTLY CONNECTED TO POLK COUNTY AT THE TIME OF APPOINTMENT. FORM 990, PAGE 6, PART VI, LINE 6 FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI) IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 7A FLOYD HEALTHCARE MANAGEMENT, INC. (FHMI), A RELATED ORGANIZATION, HAS THE POWER TO APPOINT ELEVEN OF THE TWELVE MEMBER GOVERNING BODY WHILE THE PRESIDENT/CEO OF FHMI IS THE FINAL MEMBER OF THE BOARD. FORM 990, PAGE 6, PART VI, LINE 7B PRIOR APPROVAL OF FHMI IS REQUIRED FOR ANY OF THE FOLLOWING ACTIONS: DISSOLUTION; SALE, MERGER OR DISPOSITION; ADOPTION OF CAPITAL OR OPERATING BUDGETS; SELECT OR REMOVE THE ADMINISTRATOR; INCUR INDEBTEDNESS IN EXCESS OF 1,000,000; TAKE ANY ACTION ON THE LEASE OR CONTRACT BETWEEN THE CORPORATION AND CEDARTOWN-POLK COUNTY HOSPITAL AUTHORITY; AMEND THE CORPORATE ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PAGE 6, PART VI, LINE 11B THE ORGANIZATION'S CEO, CFO, CONTROLLER, LEGAL COUNSEL AND EMPLOYEES OF FHMI REVIEW THE FORM 990 FOR FINANCIAL AND DISCLOSURE ACCURACY. PRIOR TO ITS FILING, A COPY OF THE ORGANIZATION'S 990 RETURN IS POSTED ON THE BOARD OF DIRECTORS' SECURE WEBSITE FOR THEIR REVIEW. MANAGEMENT WILL SEND AN EMAIL NOTIFYING MEMBERS OF ITS POSTING. FORM 990, PAGE 6, PART VI, LINE 12C POLK MEDICAL CENTER, INC. (PMCI) HAS A WRITTEN POLICY RESPECTING CONFLICTS OF INTEREST AND DISCLOSURE OF SAME. GENERALLY SPEAKING, THE POLICY REQUIRES ANY "COVERED PERSON" WHO BELIEVES HE/SHE HAS A CONFLICT OF INTEREST TO: -DISCLOSE THE EXISTENCE AND NATURE OF THE CONFLICT OF INTEREST (INCLUDING ALL FACTS KNOWN RESPECTING THE SUBJECT MATTER) TO THE CHAIRMAN OF THE BOARD; -PLAY NO PART, DIRECTLY OR INDIRECTLY, IN THE DELIBERATION OR VOTE OF THE BOARD OF DIRECTORS WITH RESPECT TO THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS; AND -ABSENT HIMSELF/HERSELF FROM THAT PORTION OF THE MEETING AT WHICH THE CONFLICT OF INTEREST IS DISCUSSED. THE DEFINITION OF A "COVERED PERSON" INCLUDES ALL BOARD MEMBERS, OFFICERS AND MEMBERS OF SENIOR MANAGEMENT OF PMCI. WHEN A COVERED PERSON DISCLOSES A POTENTIAL CONFLICT OF INTEREST TO THE BOARD CHAIRMAN, THE CHAIRMAN IS OBLIGED TO BRING THE MATTER TO THE ATTENTION OF THE FULL BOARD. THE BOARD DETERMINES WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. IF THE BOARD DETERMINES THAT THERE IS A CONFLICT OF INTEREST, THE TRANSACTION OR MATTER GIVING RISE TO THE CONFLICT OF INTEREST MAY NOT PROCEED UNLESS THE BOARD DETERMINES, BY A MAJORITY VOTE, THAT, DESPITE THE CONFLICT OF INTEREST, THE TRANSACTION/MATTER IS NEVERTHELESS IN THE CORPORATION'S BEST INTEREST AND IS FAIR AND REASONABLE TO THE CORPORATION. IN ADDITION TO THE REQUIREMENT THAT A COVERED PERSON DISCLOSE A POTENTIAL CONFLICT OF INTEREST AT THE TIME IT ARISES, EACH COVERED PERSON IS ALSO REQUIRED TO SUBMIT, ON AN ANNUAL BASIS, A `CONFLICT AND DISCLOSURE OF INTEREST QUESTIONNAIRE'. THIS MULTI-QUESTION DOCUMENT SERVES AS A REMINDER AND PROMPTS EACH COVERED PERSON TO PONDER THOSE AREAS AND SITUATIONS WHERE A POTENTIAL CONFLICT MIGHT EXIST. ADDITIONALLY, ANY PROPOSED TRANSACTION AT PMCI WHICH INVOLVES AN "INSIDER" (I.E., A BOARD MEMBER, OFFICER, MANAGER, ETC.) IS SCRUTINIZED, WITH THE ASSISTANCE OF CORPORATE LEGAL COUNSEL, FROM THE STANDPOINT OF WHETHER THE TRANSACTION WILL RESULT IN ANY EXCESS BENEFIT TO THE INSIDER. TYPICALLY THIS INVOLVES OBTAINING APPROPRIATE DATA REGARDING COMPARABILITY WHICH IS PROVIDED TO THE BOARD FOR ITS USE IN DETERMINING THAT THE CONSIDERATION BEING PAID TO THE INSIDER AS A PART OF THE TRANSACTION IS REASONABLE AND DOES NOT EXCEED THE VALUE OF THE BENEFIT RECEIVED BY PMCI. FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC WHEN THE REQUEST IS MADE AT THE ADMINISTRATIVE OFFICE OF THE FILING CORPORATION. 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