STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

PIEDMONT ROCKDALE HOSPITAL INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
PIEDMONT ROCKDALE HOSPITAL INC (EIN 30-0999841)
Tax period
2017-08-07 to 2018-06-30
Filed
2019-05-14
IRS object ID
201931349349310863
Schema version
2017v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2019-05-14T21:12:39-05:00ReturnTs
Tax Period End2018-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1300 North Greene Street Suite 400AddressLine1Txt
CityGreensboroCityNm
State AbbreviationNCStateAbbreviationCd
ZIP27401ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-08-07TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN300999841EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Piedmont Rockdale Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% MARIE GAFFNEYInCareOfNm
Business Name ControlPIEDBusinessNameControlTxt
Phone7709183000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11412 Milstead AvenueAddressLine1Txt
CityConyersCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30012ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARIE GAFFNEYPersonNm
Person TitleVP CORPORATE FINANCEPersonTitleTxt
Phone4702716007PhoneNum
Signature2019-05-14SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonWHITNEY E BLAIRPreparerPersonNm
PTINP01226647PTIN
Phone3362753394PhoneNum
Preparation2019-05-14PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address167.68.102.5IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id56038220191345000019FederalOriginalSubmissionId
Federal Original Submission Id2019-05-14FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id30FE20AFEDB6FDE969C62894810AC6ABC59330B2AtSubmissionCreationDeviceId
At Submission Filing Device Id5D7B52A41C2226A5E4849843C7D809138903E6FFAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Initial ReturnYes (X)InitialReturnInd
Principal OfficerRICHARD TANZELLAPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11412 Milstead AvenueAddressLine1Txt
CityConyersCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30012ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$146,140,557GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.piedmont.org/locations/piedmont-rockdale/WebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2017FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionTO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee1372TotalEmployeeCnt
Total Volunteers100TotalVolunteersCnt
Total Gross UBI$4,910TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$3,910NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$14,411CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$145,512,095CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$9,020CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$603,394CYOtherRevenueAmt
PY Total Revenue$0PYTotalRevenueAmt
CY Total Revenue$146,138,920CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$49,674,864CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$0PYOtherExpensesAmt
CY Other Expenses$103,949,599CYOtherExpensesAmt
PY Total Expenses$0PYTotalExpensesAmt
CY Total Expenses$153,624,463CYTotalExpensesAmt
PY Revenues Less Expenses$0PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$7,485,543CYRevenuesLessExpensesAmt
Total Assets BOY$0TotalAssetsBOYAmt
Total Assets EOY$99,880,028TotalAssetsEOYAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$91,135,187TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$0NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$8,744,841NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO 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.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$142,994,201ExpenseAmt
Grant$0GrantAmt
Revenue$145,519,245RevenueAmt
DescPIEDMONT ROCKDALE HOSPITAL ("PRH") IS A 138-BED, NON-PROFIT HOSPITAL LOCATED IN THE CITY OF CONYERS IN ROCKDALE COUNTY, GEORGIA. OVER 250 PRIMARY CARE AND SPECIALTY PHYSICIANS COMPRISE THE MEDICAL STAFF AND MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN ROCKDALE COUNTY AND THE GREATER METROPOLITAN ATLANTA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2018, THE HOSPITAL HAD 6,571 IN-PATIENT ADMISSIONS WITH A TOTAL OF 30,658 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 41,316 AND OUTPATIENT VISITS TOTALED 37,595. SURGICAL SERVICES WERE PROVIDED TO 3,498 PATIENTS.Desc
Total Program Service Expenses$142,994,201TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
Info In Schedule O Part VYes (X)InfoInScheduleOPartVInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee1372EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMARIE GAFFNEYPersonNm
Phone4702716007PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12727 PACES FERRY RD BLDG 2 STE 70AddressLine1Txt
CityATLANTACityNm
State AbbreviationGAStateAbbreviationCd
ZIP30339ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeInd
MR RICK SIMONS
CHAIRMAN2.00.0Yes (X)Yes (X)$0$0$0
MR AL SADLER
BOARD MEMBER1.00.0Yes (X)$0$0$0
DR BENETTA DUHART MD
BOARD MEMBER1.00.0Yes (X)$0$0$0
DR CHARLES PECK MD
BOARD MEMBER1.054.0Yes (X)$0$1,248,666$120,700
MS ETHEL BOYLE
BOARD MEMBER1.00.0Yes (X)$0$0$0
DR FRANK PATTON MD
BOARD MEMBER1.00.0Yes (X)$0$0$0
DR JIM DEGIVE MD
BOARD MEMBER1.02.0Yes (X)$0$23,528$0
DR LEIGH HAMBY MD
BOARD MEMBER1.054.0Yes (X)$0$1,495,782$157,027
MS LESLIE WEST
BOARD MEMBER1.00.0Yes (X)$0$0$0
MR RICHARD TANZELLA
CEO35.020.0Yes (X)Yes (X)$0$544,865$45,086
MR VINCE EVANS
BOARD MEMBER1.00.0Yes (X)$0$0$0
MR MICHAEL MCANDER
TREASURER1.054.0Yes (X)$0$1,029,023$124,751
MS ELIZABETH LEDDY
SECRETARY1.054.0Yes (X)$0$552,329$65,569
MR MARTY WYNN
CFO55.00.0$0$0$0Yes (X)
DR GEOFFREY COLE MD
CMO20.035.0$0$372,112$31,702Yes (X)
MS LEIGHA FALLIS RN
CNO55.00.0$0$149,200$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,415,505TotReportableCompRltdOrgAmt
Total Other Compensation$544,835TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MEDICAL SOLUTIONS LLC
1010 NORTH 102ND STREET SUITE 300OMAHANE68114NURSING SERVICES$2,369,905
EPIC LLC
3045 Chastain Meadows Pkwy NWMARIETTAGA30066DISASTER RECOVERY$113,323
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
All Other Contributions$14,411AllOtherContributionsAmt
Total Contributions$14,411TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE622110$145,472,753$145,472,753
OTHER OPERATING REVENUE900099$39,342$39,342
FieldValueIRS element (for citing)
Total Program Service Revenue$145,512,095TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$10,657TotalRevenueColumnAmt
Exclusion$10,657ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$170,929RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$170,929RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$170,929TotalRevenueColumnAmt
Exclusion$170,929ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$1,637OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$1,637OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$1,637TotalRevenueColumnAmt
Exclusion-$1,637ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$44,713GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$44,713TotalRevenueColumnAmt
Exclusion$44,713ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
CAFETERIA SALES722310$375,692$375,692
FEE REVENUE900099$7,150$7,150
QUALIFIED TRANSPORT. FRINGE900099$4,910$4,910
FieldValueIRS element (for citing)
Other Revenue Total$387,752OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$146,138,920TotalRevenueColumnAmt
Related Or Exempt Func Income$145,519,245RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$4,910UnrelatedBusinessRevenueAmt
Exclusion$600,354ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$450,090TotalAmt
Program Services$108,165ProgramServicesAmt
Management And General$341,925ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$40,280,918TotalAmt
Program Services$36,037,241ProgramServicesAmt
Management And General$4,243,677ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$5,758,908TotalAmt
Program Services$5,028,276ProgramServicesAmt
Management And General$730,632ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,184,948TotalAmt
Program Services$2,735,234ProgramServicesAmt
Management And General$449,714ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$18,004,511TotalAmt
Program Services$14,644,869ProgramServicesAmt
Management And General$3,359,642ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$35,081TotalAmt
Program Services$2,796ProgramServicesAmt
Management And General$32,285ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,561,957TotalAmt
Program Services$3,457,891ProgramServicesAmt
Management And General$1,104,066ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$122,419TotalAmt
Program Services$92,794ProgramServicesAmt
Management And General$29,625ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,614,623TotalAmt
Program Services$1,498,432ProgramServicesAmt
Management And General$116,191ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$12,189TotalAmt
Program Services$7,614ProgramServicesAmt
Management And General$4,575ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,211,186TotalAmt
Program Services$2,055,654ProgramServicesAmt
Management And General$155,532ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$228,147TotalAmt
Program Services$170,724ProgramServicesAmt
Management And General$57,423ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
BAD DEBT EXPENSE$55,404,143$55,404,143
DRUGS & MEDICAL SUPPLIES$19,223,318$19,223,318
HOSPITAL TAX$2,520,078$2,520,078
ADMINISTRATIVE EXPENSES$11,947$6,972$4,975

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$153,624,463TotalAmt
Program Services$142,994,201ProgramServicesAmt
Management And General$10,630,262ManagementAndGeneralAmt
Fundraising$0FundraisingAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XYes (X)InfoInScheduleOPartXInd

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$17,825EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$19,292,889EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,436,798EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$677,130EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$51,532,806LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$2,230,559LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$49,302,247EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$27,153,139EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$99,880,028EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$11,210,515EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$79,924,672EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$91,135,187EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$8,759,177EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY-$14,336EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$8,744,841EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$99,880,028EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$7,485,543ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$16,230,384OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,958,141OtherCostOrOtherBasisAmt
Book Value$3,958,141BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$34,674,356OtherCostOrOtherBasisAmt
Depreciation$1,186,895DepreciationAmt
Book Value$33,487,461BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$0OtherCostOrOtherBasisAmt
Depreciation$0DepreciationAmt
Book Value$0BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,793,798OtherCostOrOtherBasisAmt
Depreciation$1,043,664DepreciationAmt
Book Value$10,750,134BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,106,511OtherCostOrOtherBasisAmt
Depreciation$0DepreciationAmt
Book Value$1,106,511BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$49,302,247TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp

FieldValueIRS element (for citing)
DescGOODWILLDesc
Book Value$27,153,139BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Other Assets$27,153,139TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
INTERUNIT PAYABLE$79,481,876
MEDICARE PAYABLE$442,796
FieldValueIRS element (for citing)
Total Liability$79,924,672TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PART X, LINE 2: ASC 740 FOOTNOTE (FKA FIN 48)FormAndLineReferenceDesc
ExplanationPHC 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, 2018 AND 2017.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportfalseAnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,392,872TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$5,392,872NetCommunityBenefitExpnsAmt
Total Expense0.05490TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,244,417TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,414,773DirectOffsettingRevenueAmt
Net Community Benefit Expns-$170,356NetCommunityBenefitExpnsAmt

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,302,894TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,302,894NetCommunityBenefitExpnsAmt
Total Expense0.01330TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,940,183TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,414,773DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,525,410NetCommunityBenefitExpnsAmt
Total Expense0.06820TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$524,394TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$524,394NetCommunityBenefitExpnsAmt
Total Expense0.00530TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$524,394TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$524,394NetCommunityBenefitExpnsAmt
Total Expense0.00530TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$11,464,577TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$4,414,773DirectOffsettingRevenueAmt
Net Community Benefit Expns$7,049,804NetCommunityBenefitExpnsAmt
Total Expense0.07350TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$10,185,827BadDebtExpenseAmt
Bad Debt Expense Attributable$626,530BadDebtExpenseAttributableAmt
Reimbursed By Medicare$21,046,852ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$20,006,085CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$1,040,767MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PIEDMONT ROCKDALE HOSPITAL INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11412 MILSTEAD AVENUEAddressLine1Txt
CityCONYERSCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30012ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.PIEDMONT.ORGWebsiteAddressTxt
State License122-726StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Facility Reporting Group1FacilityReportingGroupCd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1PIEDMONT ROCKDALE HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYYes (true)FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYYes (true)TaxExemptHospitalCYOrPYInd
CHNA ConductedfalseCHNAConductedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE PART VIFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE PART VIFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE PART VIFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr PrvtYes (X)LookBackMedicaidMedcrPrvtInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, LINES 1 AND 2: NEW HOSPITAL ENTITYPIEDMONT ROCKDALE HOSPITAL, INC. ("PRH") WAS CREATED AS A NEW ENTITY ON AUGUST 1, 2017 FOLLOWING THE PURCHASE OF THE ASSETS OF ROCKDALE MEDICAL CENTER, INC. FROM LIFEPOINT HEALTH, LLC, A FOR-PROFIT COMPANY. DURING FY18, THE INTERNAL REVENUE SERVICE GRANTED PRH'S TAX-EXEMPT STATUS, RETROACTIVE TO ITS DATE OF ORGANIZATION.
SCHEDULE H, PART V, LINE 3: COMMUNITY HEALTH NEEDS ASSESSMENTPIEDMONT ROCKDALE HOSPITAL, INC. ("PRH") WAS CREATED AS A NEW ENTITY ON AUGUST 1, 2017 FOLLOWING THE PURCHASE OF THE ASSETS OF ROCKDALE MEDICAL CENTER, INC. FROM LIFEPOINT HEALTH, LLC, A FOR-PROFIT COMPANY. AS PRH WAS CREATED AS A NEW ENTITY AND DID NOT EXIST AS A NOT-FOR-PROFIT HOSPITAL PRIOR TO PIEDMONT HEALTHCARE'S ACQUISITION OF THESE ASSETS, NO COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED. PURSUANT TO THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R), PIEDMONT HEALTHCARE WILL COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT FOR PRH AND ITS SURROUNDING COMMUNITY WITHIN THE FIRST THREE YEARS OF PRH'S EXISTENCE.
SCHEDULE H, PART V, LINE 16: FINANCIAL ASSISTANCE POLICY WEBSITESFINANCIAL 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

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART VI, LINE 1: REQUIRED DISCLOSURESPUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A PIEDMONT ROCKDALE HOSPITAL, INC. ("PRH") WAS CREATED AS A NEW ENTITY ON AUGUST 1, 2017 FOLLOWING THE PURCHASE OF THE ASSETS OF ROCKDALE MEDICAL CENTER, INC. FROM LIFEPOINT HEALTH, LLC, A FOR-PROFIT COMPANY. AS PRH WAS CREATED AS A NEW ENTITY AND DID NOT EXIST AS A NOT-FOR-PROFIT HOSPITAL PRIOR TO PIEDMONT HEALTHCARE'S ACQUISITION OF THESE ASSETS, NO COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED. PURSUANT TO THE REQUIREMENTS OF INTERNAL REVENUE CODE SECTION 501(R), PIEDMONT HEALTHCARE WILL COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT FOR PRH AND ITS SURROUNDING COMMUNITY WITHIN THE FIRST THREE YEARS OF PRH'S EXISTENCE. 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 $153,624,463, LESS BAD DEBT EXPENSE OF $55,404,143 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. PRH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE ARE NOT REPORTED AS REVENUE. MEDICARE SHORTFALLS AS COMMUNITY BENEFIT SCHEDULE H, PART III, LINE 8 The amount reported on Part III, Line 6, was calculated in accordance with Schedule H instructions 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 45.53% 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 ASSESSMENTIn 2017, Piedmont Healthcare purchased Piedmont Rockdale, then known as Rockdale Medical Center, a for-profit hospital owned by LifePoint Health, a for-profit company based in Tennessee. Because of that, the hospital was not required to file a community health needs assessment with the IRS. That said, the hospital has always maintained ties to its community, and in the process of purchasing the hospital, Piedmont Healthcare took the opportunity to fully understand potential community unmet health needs. This included regular communication with community stakeholders, engagement with lawmakers and the gathering of hospital- and community-based data. Additionally, the hospital is a part of Piedmont Healthcare's FY19 CHNA.
SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITYPatient education of availability of assistance: Piedmont Healthcare understands that not everyone will have 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 Rockdale 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 Rockdale Hospital also publishes and widely publicizes a plain language summary of this financial assistance care policy on its facility website, which will include 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 INFORMATIONPiedmont Rockdale Hospital is located in Conyers, Georgia. In 2017, 88,842 people lived in Rockdale County. That year, the county was predominately African-American - about 51 percent. White populations comprise 36 percent, and Hispanic or Latino populations comprised 10 percent. Asian, Native American and Native Hawaiian/Pacific Islanders comprised the remaining 3 percent of the population (US Census American Community Survey, 2017). Fifteen percent of Rockdale County is uninsured, and non-elderly adult uninsured rates are particularly high at 22 percent. Nine percent of children are uninsured. Seventy percent of children qualified for free or reduced cost for free lunch in the 2015-2016 school year, as compared to a state average of 62 percent and a national average of 52 percent. That same school year, 82 percent of the county's high school students graduated within four years (National Center for Education Statistics). Unemployment was at 4.2 percent in 2018, which is higher than both state and national averages (US Department of Labor, Bureau of Labor Statistics). In Rockdale County, in 2017, there was one primary care physician for every 2,330 residents of the county, compared to the state average of one for 1,030 residents. Approximately 15 percent of adults reported they were in poor or fair health, a figure better than the Georgia benchmark of 19 percent. Eighteen percent of adults smoked, nearly a third were obese and a fifth were physically inactive. (University of Wisconsin Population Health Institute, County Health Rankings, 2018, with data years ranging from 2014 to 2017). Twelve percent of adult residents lived with diabetes in 2015 (Center for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion).
SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHPiedmont Rockdale Hospital actively promotes the health of its community through community-based health screenings, educational 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 FY18, Piedmont Rockdale provided health professions education to students and residents training to be health professionals. That year, the hospital oversaw training at a cost of $524,397.
SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEMPiedmont Rockdale 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 REPORTPiedmont Rockdale 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.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt
DR CHARLES PECK MD
BOARD MEMBER$0$586,715$0$190,412$0$471,539$0$83,250$0$37,450$0$1,369,366$83,250
DR LEIGH HAMBY MD
BOARD MEMBER$0$559,110$0$364,416$0$572,256$0$140,459$0$16,568$0$1,652,809$516,049
MR RICHARD TANZELLA
CEO$0$342,360$0$106,698$0$95,807$0$28,625$0$16,461$0$589,951$324,654
MR MARTY WYNN
CFO$0$0$0$0$0$0$0$0$0$0$0$0$0$0
DR GEOFFREY COLE MD
CMO$0$283,802$0$45,279$0$43,031$0$20,318$0$11,384$0$403,814$0$0
MS LEIGHA FALLIS RN
CNO$0$149,200$0$0$0$0$0$0$0$0$0$149,200$0$0
MR MICHAEL MCANDER
TREASURER$0$581,223$0$379,072$0$68,728$0$117,128$0$7,623$0$1,153,774$0$0
MS ELIZABETH LEDDY
SECRETARY$0$344,306$0$90,667$0$117,356$0$53,125$0$12,444$0$617,898$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTORTHE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT ROCKDALE 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 INFORMATIONDR. CHARLES PECK AND DR. LEIGH HAMBY RECEIVED SERP PAYMENTS IN THE AMOUNT OF $83,250 AND $516,049, RESPECTIVELY. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: MICHAEL MCANDER ELIZABETH LEDDY RICHARD TANZELLA
SCHEDULE J, PART IIPURSUANT TO THE PURCHASE AGREEMENT FROM LIFEPOINT HEALTH, PIEDMONT HEALTHCARE, INC. AND LIFEPOINT HEALTH AGREED TO HAVE EXECUTIVES OF PIEDMONT ROCKDALE HOSPITAL, INC. REMAIN EMPLOYED BY LIFEPOINT HEALTH UNTIL JANUARY 1, 2018. PIEDMONT IN TURN REIMBURSED LIFEPOINT HEALTH THROUGH AN EMPLOYEE LEASE AGREEMENT FOR ALL COMPENSATION. AS PIEDMONT ROCKDALE HOSPITAL IS A FISCAL YEAR FILER, ALL COMPENSATION INFORMATION IS DETERMINED BASED ON THE FORM W-2S ISSUED FOR PAYMENTS DURING CALENDAR YEAR 2017. AS A RESULT, PIEDMONT ROCKDALE HOSPITAL DID NOT REPORT COMPENSATION AS PAID BY THE FILING ENTITY FOR ANY INDIVIDUAL REPORTED ON THE FORM 990, PART VII, SECTION A.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (15 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILEDALL CALENDAR YEAR 2017 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT ROCKDALE 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 MEMBERPIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT ROCKDALE HOSPITAL ("PRH").
FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODYTHE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT ROCKDALE HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT ROCKDALE HOSPITAL.
FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODYPIEDMONT ROCKDALE 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 ROCKDALE 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 PROCESSINFORMATION NEEDED TO PREPARE PIEDMONT ROCKDALE HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PRH'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S TAX DIRECTOR AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. PRIOR TO FILING, COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., THE ORGANIZATION'S SOLE MEMBER, FOR BOARD REVIEW.
FORM 990, PART VI, SECTION B, LINE 12C: CONFLICT OF INTERESTCOMPLIANCE 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 ROCKDALE 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 COMPENSATIONCOMPENSATION FOR EXECUTIVES OF PIEDMONT ROCKDALE 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 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 DOCUMENTSGOVERNING 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 VII, SECTION APURSUANT TO THE PURCHASE AGREEMENT FROM LIFEPOINT HEALTH, PIEDMONT HEALTHCARE, INC. AND LIFEPOINT HEALTH AGREED TO HAVE EXECUTIVES OF PIEDMONT ROCKDALE HOSPITAL, INC. REMAIN EMPLOYED BY LIFEPOINT HEALTH UNTIL JANUARY 1, 2018. PIEDMONT IN TURN REIMBURSED LIFEPOINT HEALTH THROUGH AN EMPLOYEE LEASE AGREEMENT FOR ALL COMPENSATION. AS PIEDMONT ROCKDALE HOSPITAL IS A FISCAL YEAR FILER, ALL COMPENSATION INFORMATION IS DETERMINED BASED ON THE FORM W-2S ISSUED DURING CALENDAR YEAR 2017. AS A RESULT, PIEDMONT ROCKDALE HOSPITAL DID NOT REPORT COMPENSATION AS PAID BY THE FILING ENTITY FOR ANY INDIVIDUAL REPORTED ON THE FORM 990, PART VII, SECTION A.
FORM 990, PART XI, LINE 9: RECONCILIATION OF NET ASSETSCHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF: CHANGE IN UNRESTRICTED $290,669 CHANGE IN TEMP ($14,335) INTERCOMPANY TRANSFERS $15,958,960 QUALIFIED TRANSPORTATION FRINGE BENEFIT UBTI ($4,910) ------------------ TOTAL $16,230,384
FORM 990 PART IX LINE 11GDESCRIPTION:GENERAL CONTRACT LABOR TOTAL FEES:3805214
FORM 990 PART IX LINE 11GDESCRIPTION:PURCHASED SERVICES TOTAL FEES:9383510
FORM 990 PART IX LINE 11GDESCRIPTION:PHYSICIAN SUPPORT TOTAL FEES:3176091
FORM 990 PART IX LINE 11GDESCRIPTION:MAINTENANCE TOTAL FEES:1563414
FORM 990 PART IX LINE 11GDESCRIPTION:MISCELLANEOUS SERVICES TOTAL FEES:76282

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (23 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
PIEDMONT HEALTHCARE INC
1800 HOWELL MILL ROAD SUITE 850ATLANTAGA30318581503902MANAGEMENTGA501(c)(3)12C, III-FINAfalse
PIEDMONT HOSPITAL INC
1968 PEACHTREE ROAD NWATLANTAGA30309580566213HOSPITALGA501(c)(3)3PHCfalse
FAYETTE COMMUNITY HOSPITAL INC
1255 HIGHWAY 54 WESTFAYETTEVILLEGA30214582322328HOSPITALGA501(C)(3)3PHCfalse
PIEDMONT MOUNTAINSIDE HOSPITAL INC
1266 HIGHWAY 515 SOUTHJASPERGA30143352228583HOSPITALGA501(C)(3)3PHCfalse
PIEDMONT HENRY HOSPITAL INC
1133 EAGLES LANDING PKWYSTOCKBRIDGEGA30281582200195HOSPITALGA501(C)(3)3PHCfalse
HENRY DEVELOPMENT VENTURES INC
1133 EAGLES LANDING PKWYSTOCKBRIDGEGA30281582200734RE HOLDINGGA501(C)(2)N/APHHfalse
PIEDMONT HEART INSTITUTE INC
95 COLLIER ROAD NW STE 2045ATLANTAGA30309263553500HEALTHCAREGA501(C)(3)7PHCfalse
PIEDMONT NEWNAN HOSPITAL INC
745 POPLAR ROADNEWNANGA30265205077249HOSPITALGA501(C)(3)3PHCfalse
PIEDMONT NEWTON HOSPITAL INC
5126 HOSPITAL DRIVE NECOVINGTONGA30014582155150HOSPITALGA501(C)(3)3PHCfalse
PIEDMONT HEALTHCARE FOUNDATION INC
2001 PEACHTREE ROAD NE SUITE 400ATLANTAGA30309581272768FUNDRAISINGGA501(C)(3)12B, IIPHCfalse
PIEDMONT ATHENS REGIONAL FOUNDATION INC
1199 PRINCE AVENUEATHENSGA30606581978389FUNDRAISINGGA501(c)(3)12B, IIARMCfalse
PIEDMONT ATHENS REGIONAL HEALTH RESOURCE
1199 PRINCE AVENUEATHENSGA30606581930580DEVELOPMENTGA501(C)(3)12B, IIARMCfalse
PIEDMONT ATHENS REGIONAL MEDICAL CENTER
1199 PRINCE AVENUEATHENSGA30606582179986HOSPITALGA501(C)(3)3PHCfalse
ATHENS REGIONAL PHYSICIAN SERVICES INC
1199 PRINCE AVENUEATHENSGA30606582332921HEALTHCAREGA501(C)(3)12B, IIARMCfalse
ATHENS REGIONAL SPECIALTY SERVICES INC
1199 PRINCE AVENUEATHENSGA30606271975001HEALTHCAREGA501(C)(3)3ARMCfalse
REGIONAL FIRSTCARE INC
1199 PRINCE AVENUEATHENSGA30606582362733URGENT CAREGA501(C)(3)12B, IIARMCfalse
CENTER FOR HEALTH AND LEARNING INC
3001 MERCER UNIVERSITY DRIVEATLANTAGA30341262442849EDUCATIONGA501(c)(3)12A, IPHCfalse
COLUMBUS AMBULATORY HEALTHCARE SERVICES
707 CENTER STCOLUMBUSGA31901581719867AMBULATORYGA501(C)(3)3PHCfalse
COLUMBUS REGIONAL HEALTHCARE SYSTEM INC
707 CENTER STCOLUMBUSGA31901581719994HEALTHCAREGA501(C)(3)12B, IIPHCfalse
COLUMBUS REGIONAL MEDICAL FOUNDATION INC
707 CENTER STCOLUMBUSGA31901581501642FUNDRAISINGGA501(C)(3)7PHCfalse
THE MEDICAL CENTER INC
710 CENTER STCOLUMBUSGA31901581685139HOSPITALGA501(c)(3)3PHCfalse
HUGHSTON HOSPITAL INC
707 CENTER STCOLUMBUSGA31901331216751HOSPITALGA501(C)(3)3PHCfalse
PIEDMONT WALTON HOSPITAL INC
2151 WEST SPRING STMONROEGA30655824194264HOSPITALGA501(C)(3)3PHCfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerIndUBI Code VUBICodeVAmt
HENRY RADIATION ONCOLOGY CENTER LLC
275 PROFESSIONAL COURT STE ARIVERDALEGA30274582200195RADIATIONGAPHHN/A$0$0falsefalse
PEACHTREE ORTHOPAEDIC SURGERY CENTER
2001 PEACHTREE RD NE STE 705ATLANTAGA30309582562721ORTHOPAEDICGAPHCN/A$0$0falsefalse$0
DIGESTIVE HEALTHCARE OF GA ENDOSCOPY CEN
95 COLLIER RD NW STE 4075ATLANTAGA30309582406657HEALTHCAREGAPHCN/A$0$0falsefalse$0
SOUTHERN CRESCENT RADIATION ONCOLOGY CEN
275 PROFESSIONAL COURT STE ARIVERDALEGA30274464307929healthcareGAPHCN/A$0$0falsefalse$0
GRIFFIN RADIATION ONCOLOGY CENTER LLC
275 PROFESSIONAL COURT STE ARIVERDALEGA30274464307692HEALTHCAREGAPHCN/A$0$0falsefalse$0
FOUR WINDS HEALTH LLC
3350 RIVERWOOD PKWY STE 1850ATLANTAGA30339451273930HEALTHCAREGAPHCN/A$0$0falsefalse$0
GEORGIA HEALTH COLLABORATIVE LLC
2727 PACES FERRY RD BLDG 2 STE 70ATLANTAGA30339461500639HEALTHCAREGAPHCN/A$0$0falsefalse$0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
PIEDMONT MEDICAL CARE CORPORATION
2727 PACES FERRY RD STE 1-1100ATLANTAGA30339582092768HEALTHCAREGAPHCC CORP$0$00.00000false
THE PIEDMONT CLINIC INC
2727 PACES FERRY RD STE 1-1100ATLANTAGA30339582005358HEALTHCAREGAPHCC CORP$0$00.00000false
PIEDMONT HEART INSTITUTE PHYSICIANS INC
95 COLLIER ROAD NW STE 2045ATLANTAGA30309260593850HEALTHCAREGAPHCC CORP$0$00.00000false
AMSTER MCRAE INSURANCE COMPANY
980427603RELATED INSURANCEPHCC CORP$0$00.00000falsePO BOX 1159GRAND CAYMANCJKY1-1102CJ
PIEDMONT WELLSTAR HEALTHPLANS INC
2859 PACES FERRY RD STE 600ATLANTAGA30339461922499HEALTH INSURANCEGAPHCC CORP$0$00.00000false
COLUMBUS HEALTHCARE RESOURCES
PO BOX 790COLUMBUSGA31902581717754HEALTHCAREGACRHSC CORP$0$00.00000false
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd