2018-05-15T18:49:47-05:00 2017-06-30 KPMG LLP 300 North Greene Street Suite 400 Greensboro NC 27401 990 2016-07-01 205077249 Piedmont Newnan Hospital Inc % MARIE GAFFNEY PIED 6788542470 745 Poplar Road Newnan GA 30265 MARIE GAFFNEY VP CORPORATE FINANCE 4702716007 2018-05-15 true SHAWN HUTCHINSON CPA P01048557 3362753394 2018-05-15 2016 2022-09-23 18:48:47Z Michael Robertson 745 Poplar Road Newnan GA 30265 253962376 false X www.piedmontnewnan.org X 2007 GA TO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. SEE PART III. 8 4 1234 115 0 0 39331 62006 240197731 252732504 -22434 2409 1335822 1047412 241550450 253844331 62610 49920 0 0 73365265 79307892 0 0 0 151648092 161340323 225075967 240698135 16474483 13146196 194734223 193182457 16685358 15411284 178048865 177771173 TO PROVIDE HELATHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE IN A PROGRESSIVE ENVIRONMENT, GUIDED BY PHYSICIANS, DELIVERED BY EXCEPTIONAL PROFESSIONALS, AND INSPIRED BY THE COMMUNITIES WE SERVE. false false 221157759 49920 252828742 PIEDMONT NEWNAN HOSPITAL ("PNH") IS A 136-BED FACILITY LOCATED IN NEWNAN, GEORGIA, AND IS THE SOLE GENERAL HOSPITAL PROVIDER IN COWETA COUNTY. OVER 400 PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN THE CITY OF NEWNAN AND THE GREATER METROPOLITAN ATLANTA AREA, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2017, THE HOSPITAL HAD 9,211 IN-PATIENT ADMISSIONS WITH A TOTAL OF 38,149 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 56,759 AND OUTPATIENT VISITS TOTALED 66,222. SURGICAL SERVICES WERE PROVIDED TO 6,199 PATIENTS. 221157759 true true false false false false false false false false true false false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false true true false false false true X 0 0 true 1234 true false false false false false false false false false false X 8 4 false false false false true true true true true false false false true true true true true true true false GA X MARIE GAFFNEY 4702716007 2727 PACES FERRY RD BLDG 2 STE 70 Atlanta GA 30339 Mr Gregory A Hurst Board Member 1.0 54.0 X 0 1916833 25593 Dr Timothy Baker Board Member 1.0 0.0 X 0 0 0 Dr Kay Crosby Board Member 1.0 0.0 X 0 0 0 Dr Jarrod Huey Board Member 2.0 0.0 X 3572 0 0 Dr Stanley Smith Board Member 1.0 39.0 X 0 540258 36353 Mr MICHAEL ROBERTSON PRESIDENT & CEO 55.0 0.0 X X 730732 0 118552 Mr Andrew McDonald Board Member 1.0 39.0 X 0 330880 31153 Mr Jim Thomasson Board Member 1.0 0.0 X 0 0 0 Mr Michael McAnder SEC: 10/14/16-2/27/17 & TREAS 1.0 54.0 X 0 969938 113846 Mr Jay D Mitchell Secretary THRU 10/14/16 1.0 54.0 X 0 980956 31321 MS ELIZABETH LEDDY SECRETARY FROM 2/27/17 1.0 54.0 X 0 0 0 Mr Jeffrey Folk Chief Medical Officer 55.0 0.0 X 433528 0 34844 Mr John Miles CFO 55.0 0.0 X 348864 0 34537 Mr Jason Smith CHIEF NURSING OFFICER 55.0 0.0 X 247315 0 27464 Ms Cynthia Finney Director of Rehab Services 55.0 0.0 X 153338 0 21162 Mr David Copelan Director of Pharmacy 55.0 0.0 X 196877 0 29632 Ms Pamela Murphy Director of Surgical Services 55.0 0.0 X 166481 0 23998 MS Vicki Kaiser Exec Director Patient Svc 55.0 0.0 X 165783 0 12274 Mr DAVID Nathan Nipper FORMER COO 0.0 55.0 X 0 355668 34469 2446490 5094533 575198 51 true true false MEDICAL SOLUTIONS INC 1010 N 102ND STREET SUITE 300 OMAHA NE 68114 NURSING SERVICES 501507 ALLIED UNIVERSAL SECURITY SERVICES 1551 N TUSTIN AVE SANTA ANA CA 92705 SECURITY SERVICES 309797 2 62006 62006 PATIENT SERVICE REVENUE 621110 252295388 252295388 FITNESS CENTER 621500 237788 237788 OTHER OPERATING REVENUE 900099 199328 199328 252732504 3653 3653 0 0 58389 0 58389 0 58389 58389 0 1244 -1244 -1244 -1244 0 0 0 0 0 0 150548 116801 33747 33747 CAFETERIA SALES 900099 824677 824677 FEE REVENUE 900099 36016 36016 ALL OTHER REVENUE 900099 60222 60222 34361 34361 955276 253844331 252828742 953583 49920 49920 0 0 0 1734696 1526532 208164 0 65634448 57758314 7876134 0 8058262 7091271 966991 3880486 3414828 465658 30321 30321 51066 51066 0 0 0 0 13099366 10591839 2507527 850646 839125 11521 9753890 9199918 553972 3609656 2707242 902414 0 4110429 3447494 662935 61814 42710 19104 0 16649 16649 6848083 6848083 6849202 6849202 9640399 8888550 751849 1719613 1719613 BAD DEBT EXPENSE 54000971 54000971 MEDICAL SUPPLIES & DRUGS 30713765 30713765 HOSPITAL TAX 1853572 1853572 OTHER MISCELLANEOUS EXPENSE 18130881 13598161 4532720 240698135 221157759 19540376 0 X 1874287 76423 0 0 1618 23968 24714625 26025494 0 0 0 0 0 0 2563408 2433779 593347 669229 229170748 68404199 160887502 160766549 0 0 0 0 3187015 3187015 0 0 912421 0 194734223 193182457 16473082 15098202 0 0 0 0 0 0 0 0 0 0 0 0 0 0 212276 313082 16685358 15411284 X 176946694 176775544 1102171 995629 0 0 178048865 177771173 194734223 193182457 X 13146196 -13423888 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13783759 13783759 127135484 19134716 108000768 1800056 295158 1504898 67344095 47327725 20016370 19107354 1646600 17460754 160766549 0 MISCELLANEOUS OTHER LIABILITIES 313082 313082 X SCHEDULE D, PART X, LINE 2: ASC 740 FOOTNOTE (FKA FIN 48) PHC ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF THE INCOME TAXES TOPIC OF THE ASC (ASC 740). UNDER THE REQUIREMENTS OF ASC 740, TAX-EXEMPT ORGANIZATIONS MAY BE REQUIRED TO RECORD AN OBLIGATION AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS TAX EXPOSURE ITEMS. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT JUNE 30, 2017 AND 2016. true true X true X true X true true false true true 9504324 0 9504324 0.05090 6907919 7745309 -837390 2026617 383793 1642824 0.00880 18438860 8129102 10309758 0.05970 56424 0 56424 0.00030 1776958 0 1776958 0.00950 71610 0 71610 0.00040 55144 0 55144 0.00030 1960136 0 1960136 0.01050 20398996 8129102 12269894 0.07020 true 54000971 1620029 30569244 29323097 1246147 X true true 1 1 Piedmont Newnan Hospital Inc 745 Poplar Road Newnan GA 30265 www.piedmontnewnan.org X X X Piedmont Newnan Hospital Inc 1 false false true X X X X X X X X 16 true true false true X www.piedmontnewnan.org X X true 17 true www.piedmontnewnan.org false false true X 200. 300. X X X X true true X X X X true X www.piedmontnewnan.org X www.piedmontnewnan.org X www.piedmontnewnan.org X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, LINE 5: COMMUNITY REPRESENTATION PIEDMONT NEWNAN HOSPITAL'S ("PNH") ORIGINAL CHNA WAS CONDUCTED DURING THE HOSPITAL'S FISCAL YEAR 2013 IN PARTNERSHIP WITH THE HAYSLETT GROUP, THE LEAD CONVENER OF GEORGIA'S PARTNER UP FOR PUBLIC HEALTH CAMPAIGN. THE OVERALL HEALTH NEEDS ASSESSMENT EFFORT WAS LED BY THE PIEDMONT HEALTHCARE COMMUNITY BENEFITS TEAM, AND ASSISTED BY COMMUNITY HEALTH ADVISORS (FOR STAKEHOLDER INTERVIEWS). PIEDMONT NEWNAN HOSPITAL CONDUCTED ITS SECOND CHNA DURING FISCAL YEAR 2016. STAKEHOLDERS WERE CONTINUALLY ENGAGED DURING BOTH ASSESSMENTS, WITH A PARTICULAR FOCUS ON THOSE GROUPS, ORGANIZATIONS, AND INDIVIDUALS REPRESENTING THE MOST VULNERABLE MEMBERS OF THE HOSPITALS COMMUNITY. SPECIFICALLY, PIEDMONT NEWNAN HOSPITAL INTERVIEWED REPRESENTATIVES OF LOCAL AND REGIONAL PUBLIC HEALTH ENTITIES, MINORITY POPULATIONS, THE FAITH-BASED COMMUNITIES, LOCAL BUSINESS OWNERS, THE PHILANTHROPIC COMMUNITY, MENTAL HEALTH AGENCIES, ELECTED OFFICIALS, AND OTHER RELEVANT COMMUNITY STAKEHOLDERS. ADDITIONALLY, THE HOSPITAL CONDUCTED FOCUS GROUPS MADE UP OF LOW-INCOME AND UNINSURED PATIENTS, AS WELL AS CONSUMER AND PATIENT ADVOCATES REPRESENTING A VARIETY OF VULNERABLE PATIENTS. ALL INTERVIEWS, FOCUS GROUPS AND MEETINGS INFORMED THE CHNA PROCESSES, INCLUDING THE IDENTIFICATION OF KEY HEALTH PRIORITIES AND DEVELOPMENT OF IMPLEMENTATION PLAN STRATEGIES. SCHEDULE H, PART V, LINE 6A: HOSPITALS INCLUDED IN CURRENT CHNA PROCESS DURING FY16, THE PIEDMONT HEALTHCARE SYSTEM CONDUCTED THE SECOND CHNA FOR SIX OF ITS TAX-EXEMPT HOSPITALS. EACH INDIVIDUAL HOSPITALS COMMUNITY WAS ASSESSED AND PRIORITY NEEDS WERE IDENTIFIED BASED ON THE SIX COMMUNITIES DISCREET CHARACTERISTICS. THE RESULTS OF THE ASSESSMENTS WERE COMPILED AND PUBLISHED IN A SINGLE CHNA REPORT. THE HOSPITALS INCLUDED IN THE PROCESS WERE PIEDMONT HOSPITAL (EIN: 58-1503902); PIEDMONT FAYETTE HOSPITAL (EIN: 58-2322328); PIEDMONT HENRY HOSPITAL (EIN: 58-2200195); PIEDMONT MOUNTAINSIDE HOSPITAL (EIN: 35-2228583); PIEDMONT NEWNAN HOSPITAL (EIN: 20-5077249); AND PIEDMONT NEWTON HOSPITAL (EIN: 58-2155150). SCHEDULE H, PART V, LINE 7D: PUBLIC AVAILABILITY OF CHNA IN ADDITION TO MAKING ITS CHNA AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT NEWNAN HOSPITAL SENT COPIES TO EACH PARTICIPANT IN THE CHNA PROCESS, DISTRIBUTED THE ASSESSMENTS TO COMMUNITY CENTERS AND OTHER LOCATIONS THAT PRIMARILY SERVE AN UNINSURED POPULATION, SENT COPIES TO LEGISLATIVE AND ELECTED OFFICIALS, AND WIDELY DISTRIBUTED THE ASSESSMENTS TO OTHER PIEDMONT HEALTHCARE HOSPITALS. SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDS WHEN PIEDMONT NEWNAN HOSPITAL PERFORMED ITS INITIAL CHNA DURING FY13, IT FOCUSED ON THREE MAIN PRIORITIES AND STARTED WORK ON THOSE PRIORITIES DURING FY14. FIRST, THE HOSPITAL FOCUSED ON INCREASING ACCESS TO APPROPRIATE AND AFFORDABLE CARE FOR LOW- AND NO-INCOME PATIENTS BY DEVELOPING AND EXECUTING A PLAN TO STRENGTHEN ACCESS POINTS TO THOSE PATIENTS. SECOND, THE HOSPITAL SOUGHT OUT TO REDUCE PREVENTABLE READMISSIONS AND EMERGENCY DEPARTMENT RE-ENCOUNTERS, PARTICULARLY AMONG HIGH-RISK PATIENTS, BY INCREASING CARE COORDINATION EFFORTS BETWEEN THE HOSPITAL AND COMMUNITY- BASED PROVIDERS. LASTLY, PIEDMONT NEWNAN HOSPITAL FOCUSED ON REDUCING INSTANCES OF PREVENTABLE OBESITY AND OBESITY-RELATED DISEASES, INCLUDING DIABETES, BY UTILIZING COMMUNITY-WIDE AWARENESS CAMPAIGNS AND PROVIDING EDUCATION THAT ENCOURAGES COMMUNITY MEMBERS TO REDUCE THEIR RISKS THROUGH HEALTHY BEHAVIORS. DURING FY16, PIEDMONT NEWNAN HOSPITAL CONDUCTED ITS SECOND CHNA, AGAIN BY ASSESSING PUBLICLY AVAILABLE DATA, INTERVIEWING COMMUNITY MEMBERS AND STAKEHOLDERS, CONDUCTING FOCUS GROUPS OF VULNERABLE POPULATIONS, INTERVIEWING PIEDMONT BOARD MEMBERS, AND SURVEYING PIEDMONT EMPLOYEES. THROUGH THIS PROCESS, PIEDMONT NEWNAN HOSPITAL DETERMINED AND PRIORITIZED THE COMMUNITY HEALTH NEEDS IT WOULD ADDRESS BASED ON THE NUMBER OF PERSONS AFFECTED, THE SERIOUSNESS OF THE ISSUE, WHETHER THE HEALTH NEED AFFECTED VULNERABLE POPULATIONS, AND THE AVAILABILITY OF COMMUNITY AND HOSPITAL RESOURCES NECESSARY TO ADDRESS THE ISSUE. BASED ON THE CHNA, PNH WILL FOCUS ON: (1) MAINTAINING AND INCREASING ACCESS TO AFFORDABLE CARE FOR LOW- AND NO-INCOME PATIENTS, INCLUDING INCREASED EFFORTS AT ELIMINATING HEALTH DISPARITIES; (2) INCREASING ACCESS TO AND AWARENESS OF CANCER-RELATED PROGRAMMING, INCLUDING LOW-COST MAMMOGRAMS TO QUALIFYING WOMEN THROUGH PARTNERSHIP PROGRAMS; (3) REDUCING PREVENTABLE READMISSIONS AND EMERGENCY DEPARTMENT RE-ENCOUNTERS, PARTICULARLY AMONG HIGH-RISK PATIENTS WITH A FOCUS ON CHRONIC DISEASE MANAGEMENT; AND (4) REDUCING PREVENTABLE INSTANCES OF HEART DISEASE, HYPERTENSION, AND STROKE THROUGH EDUCATIONAL AWARENESS AND PROMOTION OF HEALTHY BEHAVIORS, INCLUDING EFFORTS TO REDUCE TOBACCO USE. PIEDMONT NEWNAN HOSPITAL DEVELOPED THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS DURING FY17. SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A A REPORT ON PIEDMONT NEWNAN HOSPITAL, INCS COMMUNITY BENEFITS IS FOUND WITHIN PIEDMONT HEALTHCARE, INCS (PIEDMONT NEWNAN HOSPITAL'S SOLE MEMBER) ANNUAL REPORT, WHICH IS WIDELY DISTRIBUTED TO THE PUBLIC BOTH THROUGH PRINTED COPIES MADE AVAILABLE TO COMMUNITY MEMBERS UPON REQUEST AND THROUGH PUBLICATION ON THE PIEDMONT HEALTHCARE WEBSITE. ADDITIONALLY, THE REPORT WAS MAILED TO PNH AND PIEDMONT HEALTHCARE BOARD MEMBERS, STATE AND LOCAL ELECTED OFFICIALS, AND OTHER KEY STAKEHOLDERS. 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 $240,698,135, LESS BAD DEBT EXPENSE OF $54,000,971 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 BASED ON PRIOR EXPERIENCE AND CERTAIN DEMOGRAPHICS AND OTHER INFORMATION OBTAINED DURING ADMISSION, THE ORGANIZATION BELIEVES A PORTION OF THE BAD DEBT EXPENSES AT COST IS ATTRIBUTABLE TO PATIENTS THAT WOULD OTHERWISE QUALIFY FOR CHARITY CARE. DESPITE ITS BEST EFFORTS TO EDUCATE PATIENTS ABOUT QUALIFYING FOR ITS CHARITY CARE PROGRAM (AS DISCUSSED IN PART IV, QUESTION 3 BELOW), MANY UNINSURED PATIENTS DO NOT COMPLETE A CHARITY CARE APPLICATION OR PROVIDE SUFFICIENT INFORMATION AT THE TIME OF ADMISSION, DURING THEIR STAY, OR AFTER BEING DISCHARGED TO QUALIFY FOR ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. 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 ORGANIZATIONS 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 MANAGEMENTS 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 PAYER CATEGORY. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. PHCS PRESENTATION OF THE PROVISION FOR BAD DEBT AT THE REPORTING ENTITY LEVEL IS BASED ON AN ENTITY-WIDE ASSESSMENT OF SIGNIFICANCE. PNH 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. COLLECTION PRACTICES SCHEDULE H, PART III, LINE 9(B) INITIAL SCREENINGS OF ALL INPATIENT, EMERGENCY, AND SURGERY ENCOUNTERS, AS WELL AS MOST OUTPATIENT VISITS, ARE CONDUCTED BY FINANCIAL COUNSELORS IN ORDER TO IDENTIFY ANY AVAILABLE INSURANCE OR OTHER COVERAGE FOR EACH PATIENT. COUNSELORS CONTACT PATIENTS AND THEIR FAMILIES DIRECTLY, EITHER IN PERSON OR BY LETTER, TO ASSIST THE FAMILY IN IDENTIFYING ANY PROGRAMS FOR WHICH THE PATIENT/SERVICE MAY QUALIFY (INCLUDING MEDICAID, STATE CHILDREN'S HEALTH INSURANCE PROGRAM ("SCHIP"), PRIVATE OR GOVERNMENT INSURANCE COVERAGE, AND CHARITY ASSISTANCE). IF THE FAMILY CANNOT BE TIMELY LOCATED OR IS UNCOOPERATIVE, RELATED ACCOUNTS ARE TRANSFERRED TO AN INTERNAL COLLECTION DEPARTMENT FOR FURTHER ATTEMPTS TO OBTAIN PAYMENT OR, IF THE PATIENT MAY QUALIFY FOR ASSISTANCE, TO SECURE A FINANCIAL ASSISTANCE APPLICATION. THE ORGANIZATION'S DEBT COLLECTION POLICY AND PROCEDURES PROHIBIT ANY COLLECTION EFFORTS FOR THE PORTION OF A PATIENT ACCOUNT BALANCE THAT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. SCHEDULE H, PART VI, LINE 2: NEEDS ASSESSMENT DURING FISCAL YEAR 2016, PIEDMONT NEWNAN HOSPITAL CONDUCTED AND RATIFIED ITS SECOND FORMAL NEEDS ASSESSMENT. THE ASSESSMENT BEGAN WITH A REVIEW OF PUBLICLY AVAILABLE HEALTH AND SOCIOECONOMIC DATA THAT WAS THEN COMPILED AND ANALYZED IN COOPERATION WITH GEORGIA STATE UNIVERSITYS GEORGIA HEALTH POLICY CENTER (GHPC). DATA WAS GATHERED FOR THE ENTIRE PIEDMONT HEALTHCARE SERVICE REGION, WHICH WAS DETERMINED TO COVER APPROXIMATELY 20 COUNTIES. THE OVERALL HEALTH NEEDS ASSESSMENT EFFORT WAS LED BY THE PIEDMONT HEALTHCARE COMMUNITY BENEFITS TEAM WITH ASSISTANCE PROVIDED THROUGHOUT BY THE GHPC. STAKEHOLDERS WERE CONTINUALLY ENGAGED DURING THIS PROCESS, WITH A PARTICULAR FOCUS ON THOSE GROUPS, ORGANIZATIONS, AND INDIVIDUALS REPRESENTING THE MOST VULNERABLE MEMBERS OF THE HOSPITALS COMMUNITY. SPECIFICALLY, PIEDMONT NEWNAN HOSPITAL INTERVIEWED REPRESENTATIVES OF LOCAL AND REGIONAL PUBLIC HEALTH ENTITIES, MINORITY POPULATIONS, THE FAITH-BASED COMMUNITIES, LOCAL BUSINESS OWNERS, THE PHILANTHROPIC COMMUNITY, MENTAL HEALTH AGENCIES, ELECTED OFFICIALS, AND OTHER RELEVANT COMMUNITY STAKEHOLDERS. FURTHER, THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS AND EXECUTIVE LEADERSHIP FROM EACH OF THE HOSPITALS IN THE PIEDMONT HEALTHCARE SYSTEM WERE ACTIVELY INFORMED AND ENGAGED THROUGHOUT THE ASSESSMENT. PIEDMONT NEWNAN HOSPITAL ALSO CONDUCTED TWO FOCUS GROUPS MADE UP OF LOW-INCOME AND UNINSURED PATIENTS. THESE FOCUS GROUPS PROVIDED THE HOSPITAL WITH INPUT ON THE EFFECTIVENESS OF ITS COMMUNITY BENEFIT EFFORTS TO DATE AND SUGGESTED FOCUS AREAS AND OPPORTUNITIES FOR IMPROVEMENT. IN ADDITION, AN INTERNAL SURVEY WAS CONDUCTED THROUGHOUT THE HEALTHCARE SYSTEM FOR BOTH CLINICAL AND NON-CLINICAL EMPLOYEES. INFORMATION WAS GATHERED ON THE EMPLOYEES KNOWLEDGE AND UNDERSTANDING OF COMMUNITY BENEFIT AND PIEDMONT HEALTHCARES CURRENT PROGRAMS, AS WELL AS SUGGESTIONS FOR HOW THE SYSTEM CAN BETTER SERVE ITS PATIENTS AND COMMUNITIES. APPROXIMATELY 775 EMPLOYEES FROM ACROSS THE PIEDMONT HEALTHCARE SYSTEM RESPONDED TO THE SURVEY. THE PIEDMONT NEWNAN HOSPITAL BOARD OF DIRECTORS APPROVED ITS CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT IN JUNE, 2016. A FORMAL IMPLEMENTATION STRATEGY WAS COMPLETED FOR EACH PIEDMONT HEALTHCARE HOSPITAL FACILITY, INCLUDING PIEDMONT NEWNAN HOSPITAL, DURING FY17. THE IMPLEMENTATION POLICY WAS DEVELOPED IN PARTNERSHIP WITH HOSPITAL LEADERSHIP AND COMMUNITY STAKEHOLDERS TO ADDRESS THE IDENTIFIED PRIORITIES LISTED IN THE 2016 CHNA. THE IMPLEMENTATION STRATEGY WILL BE EXECUTED OVER THE NEXT THREE FISCAL YEARS. IT UTILIZES COMMUNITY FEEDBACK FROM THE CHNA AND THE ASSISTANCE OF THE PIEDMONT HEALTHCARE SYSTEMS COMMUNITY BENEFITS DEPARTMENT, PIEDMONT NEWNAN HOSPITAL EXECUTIVE LEADERSHIP, AND THE ORGANIZATIONS BOARD OF DIRECTORS. PRIORITIES ADDRESSED IN THE IMPLEMENTATION STRATEGY INCLUDE INCREASING ACCESS TO HEALTHCARE SERVICES FOR LOW- AND NO-INCOME PATIENTS; REDUCING PREVENTABLE RE-ADMISSIONS AND EMERGENCY DEPARTMENT RE-ENCOUNTERS; INCREASING ACCESS TO AND AWARENESS OF BREAST CANCER PROGRAMMING; REDUCING PREVENTABLE INSTANCES OF HEART DISEASE, STROKE, OBESITY AND OBESITY-RELATED DISEASES; AND GROWING EFFORTS AROUND SENIOR HEALTH. PRIORITIES WERE CHOSEN BASED ON THE NUMBER OF PERSONS AFFECTED, THE SERIOUSNESS OF THE ISSUE, WHETHER THE HEALTH NEED AFFECTED VULNERABLE POPULATIONS, AND AVAILABILITY OF COMMUNITY AND HOSPITAL RESOURCES TO ADDRESS THE NEED. THE PIEDMONT NEWNAN HOSPITAL BOARD OF DIRECTORS APPROVED THE IMPLEMENTATION STRATEGY TO ADDRESS IDENTIFIED HEALTH ISSUES ON SEPTEMBER 15, 2016. SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY 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, PIEDMONT NEWNAN HOSPITAL OFFERS FINANCIAL ASSISTANCE TO QUALIFYING PATIENTS. INFORMATION ABOUT AND CONTACT NUMBERS FOR FINANCIAL ASSISTANCE ARE PROVIDED IN NOTICES INSERTED IN PATIENT BILLS AND POSTED IN EMERGENCY ROOMS, IN THE CONDITIONS OF ADMISSION FORM, AT ADMITTING AND REGISTRATION DEPARTMENTS, AT HOSPITAL BUSINESS OFFICES, AT PATIENT FINANCIAL SERVICES OFFICES THAT ARE LOCATED ON FACILITY CAMPUSES, AND AT OTHER PUBLIC PLACES THE HOSPITAL MAY ELECT, INCLUDING LOCAL LOW-COST CLINICS PRIMARILY TREATING UNINSURED POPULATIONS. PIEDMONT NEWNAN HOSPITAL ALSO PUBLISHES AND WIDELY PUBLICIZES A SUMMARY OF THIS FINANCIAL ASSISTANCE CARE POLICY ON ITS FACILITY WEBSITE, WHICH INCLUDES A LINK TO THE FULL POLICY AND APPLICATION. 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. IN FY16, PIEDMONT HEALTHCARE WORKED TO IMPROVE ITS EXISTING FINANCIAL ASSISTANCE POLICY TO COVER MORE OF ITS PATIENT POPULATION AND IMPLEMENTED THE NEW POLICY DURING FY17. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION PIEDMONT NEWNAN HOSPITAL IS LOCATED SOUTHWEST OF ATLANTA IN COWETA COUNTY. IN 2017, OVER 138,427 PEOPLE LIVED IN COWETA COUNTY. THE COUNTY SEAT IS NEWNAN, AND ALTHOUGH CONSIDERED AN URBAN COUNTY DUE TO ITS POPULATION, OVER HALF THE POPULATION LIVES IN RURAL AREAS OF THE COUNTY. ABOUT SEVENTEEN PERCENT OF ADULTS IN COWETA COUNTY WERE UNINSURED IN 2017, AND SEVEN PERCENT OF CHILDREN WERE UNINSURED. OVER 43 PERCENT OF THE CHILDREN IN NEWNAN COUNTY QUALIFY FOR FREE LUNCH. UNEMPLOYMENT IN THE COUNTY IS AT 5.2 PERCENT, WHICH IS SLIGHTLY LESS THAN THE STATE AVERAGE OF 5.9 PERCENT. APPROXIMATELY 70 PERCENT OF THE COUNTY HAS A HIGH SCHOOL DEGREE. THERE IS ONE PRIMARY CARE PHYSICIAN IN COWETA COUNTY FOR EVERY 2,050 OF ITS RESIDENTS, COMPARED TO ONE PRIMARY CARE PHYSICIAN FOR EVERY 1,530 STATE RESIDENTS. APPROXIMATELY 13 PERCENT REPORTED THEY WERE IN POOR OR FAIR HEALTH, A FIGURE LOWER THAN GEORGIAS AVERAGE OF 17 PERCENT. MORE THAN 11 PERCENT OF ADULT RESIDENTS HAVE BEEN DIAGNOSED WITH DIABETES. ONE IN FOUR ADULTS ARE NOTABLY PHYSICALLY INACTIVE, AND CLOSE TO ONE IN THREE ARE CONSIDERED OBESE. SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH PIEDMONT NEWNAN 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 FISCAL YEAR 2017, PIEDMONT NEWNAN OFFERED VARIOUS PROACTIVE COMMUNITY BENEFIT PROGRAMS. SOME OF THESE PROGRAMS INCLUDED: LAUNCHING THE PIEDMONT COMMUNITY BENEFIT GRANTS PROGRAM WHICH OFFERS GRANT OPPORTUNITIES TO LOCAL NONPROFIT ORGANIZATIONS THAT PROVIDE SPECIFIC TO HEALTH-RELATED SERVICES AND PROGRAMS THAT ADDRESS THE UNMET HEALTH NEEDS IDENTIFIED IN THE HOSPITALS 2016 COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY; CONTINUING THE SAMS CARE PROGRAM, WHICH CREATED A PARTNERSHIP WITH THE COWETA SAMARITAN CLINIC TO STRENGTHEN HOSPITAL-CLINIC COMMUNICATIONS THROUGH SHARED MEDICAL RECORDS AND EXPAND THE CLINICS CAPACITY WITH ADDITIONAL STAFF; OFFERING ACCESS TO PIEDMONT'S CANCER WELLNESS CENTER, WHICH PROVIDES A BROAD SPECTRUM OF COMPREHENSIVE, INDIVIDUALIZED SUPPORT AND FROM THE POINT OF DETECTION AND DIAGNOSIS THROUGHOUT CARE AND TREATMENT; PROVIDING PIEDMONT HEALTHCARES SIXTY PLUS PROGRAMMING WHICH PROMOTES EFFICIENT AND EFFECTIVE UTILIZATION OF HEALTHCARE RESOURCES THROUGH READMISSION REDUCTION INTERVENTIONS, COMPLEX CARE COORDINATION, FACILITATING COMMUNITY PARTNERSHIPS, AND COALITION BUILDING AND PROVIDER TRAINING AND SYMPOSIUMS; AND COMPOSING A LOW-INCOME COMMUNITY RESOURCE GUIDE TO BE DISTRIBUTED IN HOSPITALS, TO PATIENTS, AND THROUGHOUT THE COMMUNITY. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM") SERVING THE HEALTHCARE NEEDS OF NORTH GEORGIA AND, SPECIFICALLY, THE METROPOLITAN ATLANTA AREA. THE SYSTEM EXISTS TO PROVIDE PROGRESSIVE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE TO ALL MEMBERS OF ITS COMMUNITY. COMMUNITY BENEFITS ARE GENERATED THROUGH THE PROVISION OF CHARITY CARE, GOVERNMENT-SPONSORED PROGRAMS (SUCH AS MEDICAID AND MEDICARE), MEDICAL RESEARCH, MEDICAL EDUCATION, COMMUNITY HEALTH IMPROVEMENT SERVICES, DONATIONS TO OTHER NONPROFIT HEALTH CARE PROVIDERS, AND MANY OTHER COMMUNITY SERVICE ACTIVITIES. IN FISCAL YEAR 2017, THE PIEDMONT HEALTHCARE SYSTEM INCLUDED SEVEN FULL-SERVICE HOSPITALS, TWO PHILANTHROPIC FOUNDATIONS, A CARDIOVASCULAR RESEARCH INSTITUTE, A PHYSICIAN NETWORK, AMBULATORY SURGERY CENTERS, AND OTHER HEALTH CARE PROVIDERS, ALL OF WHICH FALL UNDER THE COMMON CONTROL OF PIEDMONT HEALTHCARE, INC., PIEDMONT FAYETTE HOSPITALS SOLE MEMBER. THE SYSTEMS SEVEN HOSPITALS ARE PIEDMONT HOSPITAL, A 643-BED ACUTE TERTIARY CARE FACILITY IN ATLANTA; PIEDMONT FAYETTE HOSPITAL, A 221-BED, ACUTE-CARE COMMUNITY HOSPITAL IN FAYETTEVILLE; PIEDMONT MOUNTAINSIDE HOSPITAL, A 52-BED COMMUNITY HOSPITAL IN JASPER; PIEDMONT NEWNAN HOSPITAL, A 136-BED, ACUTE-CARE COMMUNITY HOSPITAL IN NEWNAN; PIEDMONT HENRY HOSPITAL, A 215-BED ACUTE-CARE COMMUNITY HOSPITAL IN STOCKBRIDGE; PIEDMONT NEWTON HOSPITAL, A 97-BED ACUTE-CARE COMMUNITY HOSPITAL IN COVINGTON; AND PIEDMONT ATHENS REGIONAL MEDICAL CENTER, A 360-BED ACUTE-CARE HOSPITAL AND REGIONAL REFERRAL CENTER. AS PART OF THE PIEDMONT HEALTHCARE SYSTEM, CERTAIN AFFILIATES MAKE GRANTS AND/OR CONTRIBUTIONS TO OTHER RELATED NONPROFIT AFFILIATES TO HELP FINANCIALLY SUPPORT AND/OR FUND WORTHY COMMUNITY BENEFITS ACTIVITIES. SCHEDULE H, PART VI, LINE 7: STATE OF FILING OF COMMUNITY BENEFIT REPORT PIEDMONT NEWNAN HOSPITAL IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT; HOWEVER, THE HOSPITAL IS REQUIRED TO FILE WITH THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH INFORMATION ON ITS INDIGENT AND CHARITY CARE, AS WELL AS ITS MEDICAID AND MEDICARE SHORTFALLS. true COMMUNITY WELCOME HOUSE PO BOX 1631 NEWNAN GA 30264 581917626 501(c)(3) 6000 EVENT SPONSORSHIP 1 0 SCHEDULE I, PART I, LINE 2: Documentation of Grants MONEY IS GIVEN TO CHARITABLE ORGANIZATIONS WHICH PRIMARILY PROMOTE HEALTH CARE CAUSES. THE GRANTS ARE ADMINISTERED AND MONITORED THROUGH THE ORGANIZATIONS PUBLIC RELATIONS DEPARTMENT. X true true false true false false false false false true false Mr Jeffrey Folk Chief Medical Officer 311105 0 105762 0 16661 0 15900 0 18944 0 468372 0 0 0 Mr John Miles CFO 256049 0 87395 0 5420 0 15900 0 18637 0 383401 0 0 0 Mr DAVID Nathan Nipper FORMER COO 0 266532 0 82680 0 6456 0 15884 0 18585 0 390137 0 0 Mr Jason Smith CHIEF NURSING OFFICER 184161 0 62664 0 490 0 15029 0 12435 0 274779 0 0 0 Ms Cynthia Finney Director of Rehab Services 133230 0 18390 0 1718 0 9392 0 11770 0 174500 0 0 0 Mr David Copelan Director of Pharmacy 160479 0 22228 0 14170 0 11905 0 17727 0 226509 0 Mr Michael McAnder SEC: 10/14/16-2/27/17 & TREAS 0 564255 0 356500 0 49183 0 104390 0 9456 0 1083784 Mr Gregory A Hurst Board Member 0 729306 0 455448 0 732079 0 15900 0 9693 0 1942426 684530 Dr Stanley Smith Board Member 0 488038 0 0 0 52220 0 15900 0 20453 0 576611 Mr Jay D Mitchell Secretary THRU 10/14/16 0 364196 0 283927 0 332833 0 15900 0 15421 0 1012277 297318 Mr MICHAEL ROBERTSON PRESIDENT & CEO 438830 0 238357 0 53545 0 99460 0 19092 0 849284 0 Ms Pamela Murphy Director of Surgical Services 139055 0 24267 0 3159 0 10201 0 13797 0 190479 0 Mr Andrew McDonald Board Member 0 315368 0 0 0 15512 0 15900 0 15253 0 362033 MS Vicki Kaiser Exec Director Patient Svc 65176 0 1150 0 99457 0 10182 0 2092 0 178057 0 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS MICHAEL ROBERTSON RECEIVED A DISCRETIONARY SPENDING ACCOUNT TOTALING $12,000, A FIXED AMOUNT DETERMINED BY HIS JOB LEVEL. THIS SPENDING ACCOUNT WAS INCLUDED IN MR. ROBERTSONS TAXABLE WAGES. SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT NEWNAN HOSPITAL IS SET BY THE ENTITY'S PARENT, PIEDMONT HEALTHCARE, INC. PLEASE SEE THE SCHEDULE O NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A & 15B FOR ADDITIONAL INFORMATION. SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL COMPENSATION INFORMATION GREGORY A. HURST AND JAY MITCHELL RECEIVED PAYMENTS TOTALING $684,530 AND $297,318, RESPECTIVELY, FROM THEIR SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: JEFFREY FOLK MICHAEL MCANDER JOHN MILES DAVID (NATHAN) NIPPER MICHAEL ROBERTSON JASON SMITH SCHEDULE J, PART I, LINE 7: NON-FIXED PAYMENTS CERTAIN EMPLOYEES PARTICIPATED IN AN "ANNUAL INCENTIVE PLAN" UNDER WHICH THEY RECEIVED NON-FIXED BONUS PAYMENTS BASED ON JOB LEVEL AND SEVERAL DIFFERENT PERFORMANCE METRICS. FORM 990, PT I, LN 4 AND PT VI, LN 1B: INDEPENDENT BOARD MEMBERS PIEDMONT NEWNAN HOSPITAL'S ("PNH") BOARD OF DIRECTORS IS COMPRISED OF EIGHT VOTING MEMBERS, FOUR OF WHICH ARE INDEPENDENT BASED UPON IRS GUIDELINES. WHILE PNHS INDEPENDENT BOARD MEMBERS DO NOT CONSTITUTE A MAJORITY OF THE BOARD OF DIRECTORS, ANY DECISIONS MADE BY THE PNH BOARD MAY BE RESCINDED BY THE BOARD OF DIRECTORS OF PNHS SOLE MEMBER, PIEDMONT HEALTHCARE, INC. IN ADDITION, PIEDMONT HEALTHCARE APPOINTS THE MEMBERS OF THE PNH BOARD, SETS COMPENSATION FOR PNHS EXECUTIVES, AND MONITORS PNHS COMPLIANCE WITH PIEDMONT HEALTHCARE POLICIES AND PROCEDURES. THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS IS COMPRISED OF A MAJORITY OF INDEPENDENT MEMBERS, AND THEREFORE PNH IS EFFECTIVELY GOVERNED BY AN INDEPENDENT BOARD. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2016 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT NEWNAN HOSPITAL BY ITS SOLE MEMBER, PIEDMONT HEALTHCARE, INC. (EIN 58-1503902), PURSUANT TO AN AGREEMENT WITH THE IRS TO FILE ALL FORMS 1099 FOR THE PIEDMONT HEALTHCARE SYSTEM ON A COMBINED BASIS. FORM 990, PART VI, SECTION A, LINE 6: ORGANIZATION'S SOLE MEMBER PIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT NEWNAN HOSPITAL ("PNH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT NEWNAN HOSPITALS SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT NEWNAN HOSPITAL. FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT NEWNAN HOSPITALS 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 NEWNAN HOSPITAL BOARD OF DIRECTORS ARE NOT SUBJECT TO THE APPROVAL OF OR RATIFICATION BY THE PIEDMONT HEALTHCARE BOARD, BUT SHOULD THE NEED ARISE, THEY MAY BE RESCINDED BY THE PIEDMONT HEALTHCARE BOARD THROUGH A MAJORITY VOTE OF ITS DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B: 990 REVIEW PROCESS INFORMATION NEEDED TO PREPARE PIEDMONT NEWNAN HOSPITALS FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATIONS FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PNHS CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.S TAX DEPARTMENT AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. PRIOR TO FILING, COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., THE ORGANIZATIONS SOLE MEMBER, FOR BOARD REVIEW. FORM 990, PART VI, SEC B, LINE 12C: CONFLICT OF INTEREST POLICY COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARES 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 NEWNAN 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 HEALTHCARES SENIOR VICE PRESIDENT OF COMPLIANCE FOR INVESTIGATION, AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. FORM 990, PART VI, SEC B, LINE 15A, 15B: EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT NEWNAN HOSPITAL IS SET BY THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC. THE PIEDMONT HEALTHCARE, INC., BOARD OF DIRECTORS EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("THE COMMITTEE") IS COMPOSED OF AT LEAST THREE MEMBERS OF THE PHC BOARD OF DIRECTORS, SERVING TERMS OF THREE YEARS, AND THE MAJORITY OF WHICH ARE COMMUNITY DIRECTORS WHO GENERALLY DO NOT HAVE CONFLICTS OF INTEREST RELATED TO FULFILLMENT OF THE DUTIES AS OUTLINED BELOW. THE EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE OVERSEES EXECUTIVE PERFORMANCE AND COMPENSATION ON BEHALF OF THE PHC BOARD, SUBJECT TO THE ULTIMATE AUTHORITY AND OVERSIGHT OF THE BOARD. THE COMMITTEE ALSO FORMULATES POLICIES AND MAKES DECISIONS IN ORDER TO ENSURE A HIGH LEVEL OF EXECUTIVE PERFORMANCE. THE COMMITTEE IS AUTHORIZED TO ACT ON BEHALF OF THE PHC BOARD AS SET OUT IN ITS CHARTER, AND THE COMMITTEE IS ALSO CHARGED WITH PROVIDING RECOMMENDATIONS AND PERIODIC REPORTS TO THE PHC BOARD REGARDING EXECUTIVE PERFORMANCE AND COMPENSATION. ALL DECISIONS AND COMPARABILITY DATA ARE DOCUMENTED IN THE COMMITTEE MEETING MINUTES. FUNCTIONS OF THE COMMITTEE - ASSESS AND IMPLEMENT POLICIES REGARDING PERFORMANCE, COMPENSATION AND BENEFITS OF THE PRESIDENT/CEO AND OTHER EXECUTIVES AS DETERMINED BY THE COMMITTEE - SELECT AN EXECUTIVE COMPENSATION CONSULTANT WHO REPORTS TO THE COMMITTEE - ANNUALLY REVIEW THE PRESIDENT/CEO SUCCESSION PLAN - FORMULATE AND IMPLEMENT ANNUAL PERFORMANCE OBJECTIVES FOR THE PRESIDENT/CEO, AND REVIEW AND APPROVE ANNUALLY RECOMMENDATIONS FROM THE PRESIDENT/CEO RELATING TO COMPENSATION, PERFORMANCE OBJECTIVES, AND SUCCESSION PLANS FOR EVP EXECUTIVES - ANNUALLY ASSESS PRESIDENT/CEO PERFORMANCE; IF NECESSARY, IMPLEMENT ACTION PLAN WITH PRESIDENT/CEO INPUT TO IMPROVE HIS/HER PERFORMANCE; ADJUST COMPENSATION AS APPROPRIATE; THE COMMITTEE CHAIR SHALL CONSULT WITH THE PHC GOVERNANCE COMMITTEE CHAIR AND THE PHC BOARD CHAIR AND SHALL COORDINATE THE ANNUAL PERFORMANCE REVIEW OF THE PHC PRESIDENT/CEO, UNLESS THE PHC BOARD CHAIR HAS A REAL OR PERCEIVED CONFLICT OF INTEREST, IN WHICH CASE THE COMMITTEE CHAIR SHALL DETERMINE THE PROPER REVIEW PROCESS - REVIEW AND APPROVE LONG TERM AND SHORT TERM GOALS TO BE USED IN CONNECTION WITH EVP COMPENSATION PROGRAMS AS RECOMMENDED BY THE PRESIDENT/CEO AND VALIDATED BY THE COMPENSATION CONSULTANT - PERIODICALLY REVIEW COMPENSATION, IF ANY, FOR THE PHC BOARD CHAIR AND ALL BOARD CHAIRS OF THE PHC SUBSIDIARIES - ESTABLISH OTHER POLICIES AND PROCEDURES, AND PERFORM OTHER TASKS, RELATED TO EXECUTIVE PERFORMANCE AND COMPENSATION, INCLUDING BUT NOT LIMITED TO, APPROVAL OF EXECUTIVE EMPLOYMENT CONTRACTS AND BENEFITS - PERIODICALLY REPORT SIGNIFICANT DECISIONS AND ANY ADDITIONAL REQUESTED INFORMATION TO THE PHC BOARD FORM 990, PART VI, SECTION C, LINE 19: DISCLOSURE OF DOCUMENTS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THESE DOCUMENTS SHOULD BE REQUESTED FROM PIEDMONT HEALTHCARE, INC.'S LEGAL COUNSEL. FORM 990, PART XI, LINE 9: RECONCILIATION OF NET ASSETS CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF $(55,299) OF BOOK/TAX DIFFERENCES RELATED TO THE TIMING OF REVENUE RECOGNITION; AND $(13,368,589) IN INTERCOMPANY TRANSFERS OF LIABILITIES. 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SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LLCS AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.