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FAYETTE COMMUNITY HOSPITAL INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
FAYETTE COMMUNITY HOSPITAL INC (EIN 58-2322328)
Tax period
2016-07-01 to 2017-06-30
Filed
2018-05-15
IRS object ID
201831359349314253
Schema version
2016v3.1
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)
Return2018-05-15T19:13:38-05:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt

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 Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN582322328EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Fayette Community Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% MARIE GAFFNEYInCareOfNm
Business Name ControlFAYEBusinessNameControlTxt
Phone7707197073PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11255 Highway 54 WestAddressLine1Txt
CityFayettevilleCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30214ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARIE GAFFNEYPersonNm
Person TitleVP CORPORATE FINANCEPersonTitleTxt
Phone4702716007PhoneNum
Signature2018-05-15SignatureDt

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSHAWN M HUTCHINSONPreparerPersonNm
PTINP01048557PTIN
Phone3362753394PhoneNum
Preparation2018-05-15PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJ MICHAEL BURNETTPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11255 Highway 54 WestAddressLine1Txt
CityFayettevilleCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30214ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$385,015,132GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PIEDMONTFAYETTE.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1997FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionTO PROVIDE COMPASSIONATE AND SUSTAINABLE HEALTHCARE IN A PROGRESSIVE ENVIRONMENT. SEE PART III.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee1947TotalEmployeeCnt
Total Volunteers250TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$83,022PYContributionsGrantsAmt
CY Contributions Grants$67,402CYContributionsGrantsAmt
PY Program Service Revenue$349,817,098PYProgramServiceRevenueAmt
CY Program Service Revenue$379,117,271CYProgramServiceRevenueAmt
PY Investment Income$139,252PYInvestmentIncomeAmt
CY Investment Income$215,903CYInvestmentIncomeAmt
PY Other Revenue$4,581,174PYOtherRevenueAmt
CY Other Revenue$4,524,441CYOtherRevenueAmt
PY Total Revenue$354,620,546PYTotalRevenueAmt
CY Total Revenue$383,925,017CYTotalRevenueAmt
PY Grants And Similar Paid$58,883PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$54,179CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$120,205,029PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$130,822,643CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$206,708,195PYOtherExpensesAmt
CY Other Expenses$216,877,421CYOtherExpensesAmt
PY Total Expenses$326,972,107PYTotalExpensesAmt
CY Total Expenses$347,754,243CYTotalExpensesAmt
PY Revenues Less Expenses$27,648,439PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$36,170,774CYRevenuesLessExpensesAmt
Total Assets BOY$162,832,400TotalAssetsBOYAmt
Total Assets EOY$195,786,300TotalAssetsEOYAmt
Total Liabilities BOY$42,382,362TotalLiabilitiesBOYAmt
Total Liabilities EOY$33,836,049TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$120,450,038NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$161,950,251NetAssetsOrFundBalancesEOYAmt
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$321,693,120ExpenseAmt
Grant$61,179GrantAmt
Revenue$379,117,271RevenueAmt
DescPIEDMONT FAYETTE HOSPITAL ("PFH") IS A 221-BED FACILITY LOCATED IN FAYETTE COUNTY, GEORGIA. OVER 500 PRIMARY CARE AND SPECIALTY PHYSICIANS COMPRISE THE MEDICAL STAFF AND MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN FAYETTEVILLE AND THE GREATER METROPOLITAN ATLANTA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2017, THE HOSPITAL HAD 14,494 IN-PATIENT ADMISSIONS WITH A TOTAL OF 65,428 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 73,562 AND OUTPATIENT VISITS TOTALED 96,930. SURGICAL SERVICES WERE PROVIDED TO 11,365 PATIENTS.Desc
Total Program Service Expenses$321,693,120TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
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 AssetsfalseReportOtherAssetsInd
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 OrganizationsYes (true)GrantsToOrganizationsInd
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 EntityYes (true)DisregardedEntityInd
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
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee1947EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
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 Members12GoverningBodyVotingMembersCnt
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

Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
Mr Michael Behr
Board Member1.00.0Yes (X)$0$0$0
Mr J Michael Burnett
PRESIDENT & CEO/Board Member55.00.0Yes (X)$632,367$0$111,460Yes (X)
Mr Mark Gray
Board Member1.00.0Yes (X)$0$0$0
Mr Gregory A Hurst
Board Member1.054.0Yes (X)$0$1,916,833$25,593
Ms Lacy S Curry
Board Member1.00.0Yes (X)$0$0$0
Dr Dave C Lee
Board Member1.00.0Yes (X)$0$0$0
Dr Charles W Pettus
Board Member1.039.0Yes (X)$0$799,454$30,016
Dr Elizabeth W Killebrew
Board Member3.00.0Yes (X)$22,200$0$0
Mr Douglas B Warner
Board Member1.00.0Yes (X)$0$0$0
Dr Russell A Wilson
Chairman/Physician7.00.0Yes (X)$109,950$0$0Yes (X)
Mr Robert Reeves
BOARD MEMBER1.00.0Yes (X)$0$0$0
Dr C Howell Tucker
Board Member1.00.0Yes (X)$0$0$0
Mr Jay D Mitchell
Secretary thru 10/14/161.054.0$0$980,956$31,321Yes (X)
Mr Michael McAnder
Sec: 10/14/16-2/27/17 & Treas1.054.0$0$969,938$113,846Yes (X)
Ms Elizabeth Leddy
Secretary from 2/27/171.054.0$0$0$0Yes (X)
Dr Frederick Willms
VP of Medical Affairs55.00.0$431,350$41,102$25,624Yes (X)
Mr Scott Wolfe
CFO55.00.0$392,747$0$26,644Yes (X)
Mr David Nipper
COO55.00.0$355,668$0$34,469Yes (X)
Mr Thomas Oberst
Pharmacist40.00.0$185,678$0$23,856Yes (X)
Ms Rhonda Manos
Director of Pharmacy55.00.0$194,845$0$21,752Yes (X)
Mr Edward Miller
Medical Physicist40.00.0$179,174$0$6,086Yes (X)
Ms Cheryl Beard
Nursing Admin Supervisor55.00.0$181,194$0$9,060Yes (X)
Ms Merry Heath
CNO55.00.0$229,999$0$22,127Yes (X)
Ms Sheryl Klink
Former CFO0.055.0$0$471,429$34,944Yes (X)
Mr John Miles
Former CFO0.055.0$0$348,864$34,537Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,915,172TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$5,528,576TotReportableCompRltdOrgAmt
Total Other Compensation$551,335TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K75IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
ALLIED UNIVERSAL SECURITY SERVICES
1551 N TUSTIN AVESANTA ANACA92705SECURITY Services$630,348
Brasfield and Gorrie LLC
PO Box 11407BIRMINGHAMAL352460351Construction$33,012,373
BDR PARTNERS LLC
1756 CENTURY BLVD NEATLANTAGA30345BUSINESS DEVELOPMENT$709,662
MEDICAL SOLUTIONS INC
1010 N 102ND STE 300OMAHANE68114NURSING SERVICES$1,699,895
SECURADYNE SYSTEMS MID-ATLANTIC
4048 FLOWERS ROAD STE 200ATLANTAGA30360SECURITY SERVICES$304,347
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K10CntrctRcvdGreaterThan100KCnt
All Other Contributions$67,402AllOtherContributionsAmt
Total Contributions$67,402TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE621110$378,961,908$378,961,908
FITNESS CENTER REHAB621300$147,234$147,234
OTHER OPERATING REVENUE900099$8,129$8,129
FieldValueIRS element (for citing)
Total Program Service Revenue$379,117,271TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$145,741TotalRevenueColumnAmt
Exclusion$145,741ExclusionAmt

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$3,833,727RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$987,542RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$2,846,185RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,846,185TotalRevenueColumnAmt
Exclusion$2,846,185ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$109,198OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$39,035OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$70,163OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$70,162TotalRevenueColumnAmt
Exclusion$70,162ExclusionAmt
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$338,454GrossSalesOfInventoryAmt
Cost Of Goods Sold$63,538CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$274,916TotalRevenueColumnAmt
Exclusion$274,916ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
CAFETERIA SALES900099$1,335,867$1,335,867
VENDING SALES900099$67,473$67,473
FieldValueIRS element (for citing)
Other Revenue Total$1,403,340OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$383,925,017TotalRevenueColumnAmt
Related Or Exempt Func Income$379,117,271RelatedOrExemptFuncIncomeAmt
Exclusion$4,740,344ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$54,179TotalAmt
Program Services$54,179ProgramServicesAmt

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$2,036,571TotalAmt
Program Services$1,690,354ProgramServicesAmt
Management And General$346,217ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$108,632,251TotalAmt
Program Services$90,164,768ProgramServicesAmt
Management And General$18,467,483ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$13,714,633TotalAmt
Program Services$11,383,145ProgramServicesAmt
Management And General$2,331,488ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$6,439,188TotalAmt
Program Services$5,344,526ProgramServicesAmt
Management And General$1,094,662ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$61,698TotalAmt
Management And General$61,698ManagementAndGeneralAmt

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$22,470,320TotalAmt
Program Services$22,470,320ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,133,014TotalAmt
Management And General$1,133,014ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$15,884,286TotalAmt
Program Services$15,764,088ProgramServicesAmt
Management And General$120,198ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$5,734,160TotalAmt
Program Services$5,390,110ProgramServicesAmt
Management And General$344,050ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$5,036,894TotalAmt
Program Services$4,835,418ProgramServicesAmt
Management And General$201,476ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$76,854TotalAmt
Program Services$50,021ProgramServicesAmt
Management And General$26,833ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$34,315TotalAmt
Program Services$28,937ProgramServicesAmt
Management And General$5,378ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$5,963,447TotalAmt
Program Services$5,784,544ProgramServicesAmt
Management And General$178,903ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$10,747,190TotalAmt
Program Services$10,747,190ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$10,742,418TotalAmt
Program Services$10,097,873ProgramServicesAmt
Management And General$644,545ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$3,233,007TotalAmt
Program Services$3,039,027ProgramServicesAmt
Management And General$193,980ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
BAD DEBT EXPENSE$66,844,824$66,844,824
MEDICAL SUPPLIES & DRUGS$50,112,745$50,112,745
HOSPITAL TAX$3,615,638$3,615,638
MISCELLANEOUS EXPENSE$15,186,611$14,275,413$911,198

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$347,754,243TotalAmt
Program Services$321,693,120ProgramServicesAmt
Management And General$26,061,123ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$521,903BOYAmt
EOY$651,011EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

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

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$115,071BOYAmt
EOY$66,994EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$38,988,604BOYAmt
EOY$41,049,778EOYAmt

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$3,948,582BOYAmt
EOY$4,825,966EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,032,686BOYAmt
EOY$1,098,993EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$287,010,460LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$139,824,890LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$115,392,507BOYAmt
EOY$147,185,570EOYAmt

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$907,988BOYAmt
EOY$907,988EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,925,059BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$162,832,400BOYAmt
EOY$195,786,300EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$27,820,707BOYAmt
EOY$19,841,030EOYAmt

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$14,279,451BOYAmt
EOY$13,738,197EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

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

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$282,204BOYAmt
EOY$256,822EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$42,382,362BOYAmt
EOY$33,836,049EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$119,312,930BOYAmt
EOY$160,970,421EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,137,108BOYAmt
EOY$979,830EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

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

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$120,450,038BOYAmt
EOY$161,950,251EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$162,832,400BOYAmt
EOY$195,786,300EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$36,170,774ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$5,329,439OtherChangesInNetAssetsAmt
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 B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

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$7,332,672OtherCostOrOtherBasisAmt
Book Value$7,332,672BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$158,330,200OtherCostOrOtherBasisAmt
Depreciation$51,254,390DepreciationAmt
Book Value$107,075,810BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$4,703,998OtherCostOrOtherBasisAmt
Depreciation$4,551,356DepreciationAmt
Book Value$152,642BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,305,034OtherCostOrOtherBasisAmt
Depreciation$84,019,144DepreciationAmt
Book Value$27,285,890BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,338,556OtherCostOrOtherBasisAmt
Book Value$5,338,556BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$147,185,570TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS LIABILITIESDesc
Amt$256,822Amt
FieldValueIRS element (for citing)
Total Liability$256,822TotalLiabilityAmt
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 TAX EXPOSURE ITEMS. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT JUNE 30, 2017 AND 2016.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 ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$10,912,254TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,912,254NetCommunityBenefitExpnsAmt
Total Expense0.03880TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$9,016,289TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$7,900,546DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,115,743NetCommunityBenefitExpnsAmt
Total Expense0.00400TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,934,890TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$449,690DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,485,200NetCommunityBenefitExpnsAmt
Total Expense0.01240TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$23,863,433TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$8,350,236DirectOffsettingRevenueAmt
Net Community Benefit Expns$15,513,197NetCommunityBenefitExpnsAmt
Total Expense0.05520TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$438,353TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$438,353NetCommunityBenefitExpnsAmt
Total Expense0.00160TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,904,727TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,904,727NetCommunityBenefitExpnsAmt
Total Expense0.00680TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$552,189TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$552,189NetCommunityBenefitExpnsAmt
Total Expense0.00200TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$207,855TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$207,855NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,103,124TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$3,103,124NetCommunityBenefitExpnsAmt
Total Expense0.01110TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$26,966,557TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$8,350,236DirectOffsettingRevenueAmt
Net Community Benefit Expns$18,616,321NetCommunityBenefitExpnsAmt
Total Expense0.06630TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$66,844,824BadDebtExpenseAmt
Bad Debt Expense Attributable$2,005,345BadDebtExpenseAttributableAmt
Reimbursed By Medicare$45,539,359ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$47,214,974CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$1,675,615MedicareSurplusOrShortfallAmt

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 Fayette HospitalBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11255 Highway 54 WestAddressLine1Txt
CityFayettevilleCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30214ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.piedmontfayette.comWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Piedmont Fayette HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.PIEDMONTFAYETTE.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt17ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLWWW.PIEDMONTFAYETTE.ORGStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
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 URLWWW.PIEDMONTFAYETTE.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.PIEDMONTFAYETTE.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.PIEDMONTFAYETTE.ORGFAPSummaryOnWebsiteURLTxt
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 MedicareYes (X)LookBackMedicareInd
Look Back Medicaid Medcr PrvtYes (X)LookBackMedicaidMedcrPrvtInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, LINE 5: COMMUNITY REPRESENTATIONPIEDMONT FAYETTE HOSPITALS ORIGINAL CHNA WAS CONDUCTED DURING THE HOSPITALS FISCAL YEAR 2013 IN PARTNERSHIP WITH THE HAYSLETT GROUP, THE LEAD CONVENER OF GEORGIAS 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 FAYETTE 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 FAYETTE 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 PROCESSDURING 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 CHNAIN ADDITION TO MAKING ITS CHNA AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT FAYETTE HOSPITAL SENT COPIES TO EACH PARTICIPANT IN THE CHNA PROCESS, DISTRIBUTED THE ASSESSMENTS TO COMMUNITY CENTERS AND OTHER LOCATIONS THAT PRIMARILY SERVE AN UNINSURED POPULATION, SENT COPIES TO LEGISLATIVE AND ELECTED OFFICIALS, AND WIDELY DISTRIBUTED THE ASSESSMENTS TO OTHER PIEDMONT HEALTHCARE HOSPITALS.
SCHEDULE H, PART V, LINE 11: ADDRESSING COMMUNITY HEALTH NEEDSWHEN PIEDMONT FAYETTE HOSPITAL PERFORMED ITS INITIAL CHNA DURING FY13, IT FOCUSED ON THREE MAIN PRIORITIES AND STARTED WORK ON THOSE PRIORITIES DURING FY14. FIRST, THE HOSPITAL FOCUSED ON INCREASING ACCESS TO APPROPRIATE AND AFFORDABLE CARE FOR LOW- AND NO-INCOME PATIENTS BY DEVELOPING AND EXECUTING A PLAN TO STRENGTHEN ACCESS POINTS TO THOSE PATIENTS. SECOND, THE HOSPITAL SOUGHT OUT TO REDUCE PREVENTABLE READMISSIONS AND EMERGENCY DEPARTMENT RE-ENCOUNTERS, PARTICULARLY AMONG HIGH-RISK PATIENTS, BY INCREASING CARE COORDINATION EFFORTS BETWEEN THE HOSPITAL AND COMMUNITY- BASED PROVIDERS. LASTLY, PIEDMONT FAYETTE HOSPITAL FOCUSED ON REDUCING INSTANCES OF PREVENTABLE HEART DISEASE, OBESITY, AND OBESITY-RELATED DISEASES, INCLUDING DIABETES, BY UTILIZING COMMUNITY-WIDE AWARENESS CAMPAIGNS AND PROVIDING EDUCATION THAT ENCOURAGES COMMUNITY MEMBERS TO REDUCE THEIR HEART DISEASE RISKS THROUGH HEALTHY BEHAVIORS. DURING FY16, PIEDMONT FAYETTE HOSPITAL CONDUCTED ITS SECOND CHNA, AGAIN BY ASSESSING PUBLICLY AVAILABLE DATA, INTERVIEWING COMMUNITY MEMBERS AND STAKEHOLDERS, CONDUCTING FOCUS GROUPS OF VULNERABLE POPULATIONS, INTERVIEWING PIEDMONT BOARD MEMBERS, AND SURVEYING PIEDMONT EMPLOYEES. THROUGH THIS PROCESS, PIEDMONT FAYETTE HOSPITAL DETERMINED AND PRIORITIZED THE COMMUNITY HEALTH NEEDS IT WOULD ADDRESS BASED ON THE NUMBER OF PERSONS AFFECTED, THE SERIOUSNESS OF THE ISSUE, WHETHER THE HEALTH NEED AFFECTED VULNERABLE POPULATIONS, AND THE AVAILABILITY OF COMMUNITY AND HOSPITAL RESOURCES NECESSARY TO ADDRESS THE ISSUE. BASED ON THE CHNA, PIEDMONT FAYETTE HOSPITAL IS CURRENTLY FOCUSING ON: (1) MAINTAINING AND INCREASING ACCESS TO AFFORDABLE CARE FOR LOW- AND NO-INCOME PATIENTS, INCLUDING INCREASED EFFORTS AT ELIMINATING HEALTH DISPARITIES; (2) INCREASING ACCESS TO AND AWARENESS OF CANCER-RELATED PROGRAMMING, INCLUDING LOW-COST MAMMOGRAMS, TO QUALIFYING WOMEN THROUGH PARTNERSHIP PROGRAMS; (3) REDUCING PREVENTABLE READMISSIONS AND EMERGENCY DEPARTMENT RE-ENCOUNTERS, PARTICULARLY AMONG HIGH-RISK PATIENTS, WITH A FOCUS ON CHRONIC DISEASE MANAGEMENT; (4) MAINTAINING AND GROWING EFFORTS AROUND SENIOR HEALTH; AND (5) REDUCING PREVENTABLE INSTANCES OF HEART DISEASE, HYPERTENSION, AND STROKE THROUGH EDUCATIONAL AWARENESS AND PROMOTION OF HEALTHY BEHAVIORS, INCLUDING EFFORTS TO REDUCE TOBACCO USE. PIEDMONT FAYETTE HOSPITAL DEVELOPED THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS DURING FY17.

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONSPUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A A REPORT ON PIEDMONT FAYETTE HOSPITAL, INC.'S ("PFH") COMMUNITY BENEFITS IS FOUND WITHIN PIEDMONT HEALTHCARE, INC.S (PIEDMONT FAYETTE 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 PFH 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 $347,754,243, LESS BAD DEBT EXPENSE OF $66,844,824 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. PFH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE ARE NOT REPORTED AS REVENUE. MEDICARE SHORTFALLS AS COMMUNITY BENEFIT SCHEDULE H, PART III, LINE 8 THE AMOUNT REPORTED ON PART III, SECTION B, LINE 6 WAS CALCULATED IN ACCORDANCE WITH THE 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 PROVIDING 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 EXCLUDED FROM ALLOWABLE COST IN THE MEDICARE COST REPORT. THE ORGANIZATION BELIEVES THAT PIEDMONT FAYETTE HOSPITALS 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 12.02 PERCENT OF PFHS PATIENT SERVICE REVENUE. PFHS POLICY IS TO TREAT MEDICARE PATIENTS, REGARDLESS OF THE EXTENT TO WHICH MEDICARE ACTUALLY PAYS FOR THE TREATMENT. FOR MANY SERVICES, MEDICARES REIMBURSEMENT IS LESS THAN THE COST OF THE CARE PROVIDED, RESULTING IN SHORTFALLS THAT ARE TO BE ABSORBED BY THE HOSPITAL IN HONOR OF PFHS COMMITMENT TO TREAT ELDERLY PATIENTS. MANY OF THESE PATIENTS LIVE ON A LOW, FIXED INCOME, AND WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER MEANS-TESTED PROGRAMS, ABSENT THEIR ENROLLMENT IN MEDICARE. 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 ASSESSMENTDURING FISCAL YEAR 2016, PIEDMONT FAYETTE HOSPITAL CONDUCTED AND RATIFIED ITS SECOND FORMAL COMMUNITY HEALTH 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 FAYETTE 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 FAYETTE 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 FAYETTE 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 FAYETTE 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 FAYETTE 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 FAYETTE HOSPITAL BOARD OF DIRECTORS APPROVED THE IMPLEMENTATION STRATEGY TO ADDRESS IDENTIFIED HEALTH ISSUES ON AUGUST 10, 2016.
SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ASSISTANCE ELIGIBILITYPIEDMONT 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 FAYETTE 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 FAYETTE 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 INFORMATIONPIEDMONT FAYETTE HOSPITAL IS LOCATED IN FAYETTE COUNTY WHERE, IN 2017, APPROXIMATELY 110,714 PEOPLE LIVED. ONE OUT OF FOUR FAYETTE CHILDREN QUALIFIES FOR FREE LUNCH AND SEVEN PERCENT OF THE CHILDREN IN THE COUNTY ARE UNINSURED. THE UNEMPLOYMENT RATE IN FAYETTE COUNTY IS 5.1 PERCENT, WHICH IS BELOW GEORGIAS RATE OF 5.9 PERCENT. ROUGHLY 92 PERCENT OF FAYETTE COUNTY RESIDENTS HAVE A HIGH SCHOOL DIPLOMA, A FIGURE HIGHER THAN GEORGIAS RATE OF 80 PERCENT. FAYETTE COUNTY HAS ONE PRIMARY CARE PHYSICIAN FOR EVERY 880 RESIDENTS, COMPARED TO THE GEORGIA RATIO OF ONE PRIMARY CARE PHYSICIAN FOR EVERY 1,530 RESIDENTS. ABOUT 14 PERCENT OF ADULTS IN FAYETTE COUNTY ARE CURRENTLY UNINSURED, WHICH IS LESS THAN GEORGIAS RATE OF 22 PERCENT. APPROXIMATELY 13 PERCENT OF THE OVERALL ADULT POPULATION REPORTED THEY WERE IN "POOR OR FAIR HEALTH", WHICH IS LOWER THAN THE GEORGIA RATE OF 17 PERCENT. THERE IS ONE MENTAL HEALTH PROVIDER PER 680 RESIDENTS WHILE THE STATE AVERAGES ONE PROVIDER PER 900 RESIDENTS. FAYETTE COUNTY RESIDENTS REPORTED SUFFERING THREE "POOR MENTAL HEALTH DAYS" IN THE PRIOR MONTH. ABOUT 13 PERCENT OF ADULT RESIDENTS HAVE BEEN DIAGNOSED WITH DIABETES, AN AMOUNT HIGHER THAN THE GEORGIA AVERAGE OF 11 PERCENT. IT IS NOTABLE THAT 20 PERCENT OF THE FAYETTE POPULATION IS INACTIVE AND 31 PERCENT IS OBESE. INACTIVE AND 31 PERCENT IS OBESE.
SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTHPIEDMONT FAYETTE 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 COMPRISED 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 FAYETTE HOSPITAL 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 PARTNERSHIPS WITH THE FAYETTE C.A.R.E. CLINIC TO STRENGTHEN HOSPITAL-CLINIC COMMUNICATIONS THROUGH SHARED MEDICAL RECORDS AND EXPAND THE CLINICS CAPACITY WITH ADDITIONAL STAFF; CONTINUING ITS COMMUNITY WALKING PROGRAM CALLED WALK WITH A DOC; CONTINUING A COMMUNITY HAND-WASHING CAMPAIGN CALLED CATCH ME CLEAN TO REDUCE INSTANCES OF INFECTIOUS DISEASE, PARTICULARLY THE INFLUENZA VIRUS; OFFERING ACCESS TO PIEDMONT'S CANCER WELLNESS CENTER, WHICH PROVIDES A BROAD SPECTRUM OF COMPREHENSIVE, INDIVIDUALIZED SUPPORT FROM THE POINT OF DETECTION AND DIAGNOSIS AND 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 SYSTEMTHE 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 REPORTPIEDMONT FAYETTE HOSPITAL IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT; HOWEVER THE HOSPITAL IS REQUIRED TO FILE WITH THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH INFORMATION ON ITS INDIGENT AND CHARITY CARE, AS WELL AS ITS MEDICAID AND MEDICARE SHORTFALLS.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1The Joseph Sams SchoolBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1280 BRANDYWINE BLVDAddressLine1Txt
CityFayettevilleCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30214ZIPCd
FieldValueIRS element (for citing)
Recipient EIN581584379RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$6,000CashGrantAmt
Purpose Of Grant30th Annual Dinner Date and Auction SponsorPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE I, PART I, LINE 2: MONITORING THE USE OF GRANT FUNDSFormAndLineReferenceDesc
ExplanationCORPORATE SPONSORSHIPS: MONEY IS GIVEN TO CHARITABLE ORGANIZATIONS WHICH PRIMARILY PROMOTE HEALTH CARE CAUSES. THE GRANTS ARE ADMINISTERED AND MONITORED THROUGH THE ORGANIZATIONS PUBLIC RELATIONS DEPARTMENT.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Discretionary Spending AcctYes (X)DiscretionarySpendingAcctInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
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 PaymentsYes (true)AnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (15 entries)

TitleTitleTxtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountOther Compensation Filing OrgOtherCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
Mr Jay D Mitchell
Secretary thru 10/14/16$364,196$283,927$332,833$15,900$15,421$1,012,277$297,318
Dr Frederick Willms
VP of Medical Affairs$39,833$1,269$1,118$42,220$309,390$101,400$20,560$15,900$8,606$455,856
Mr J Michael Burnett
PRESIDENT & CEO/Board Member$407,686$190,882$33,799$92,332$19,128$743,827
Ms Sheryl Klink
Former CFO$371,905$87,633$11,891$15,900$19,044$506,373
Mr Thomas Oberst
Pharmacist$137,676$550$47,452$10,580$13,276$209,534
Ms Rhonda Manos
Director of Pharmacy$156,978$20,455$17,412$9,827$11,925$216,597
Mr Gregory A Hurst
Board Member$729,306$455,448$732,079$15,900$9,693$1,942,426$684,530
Dr Charles W Pettus
Board Member$674,999$124,455$15,900$14,116$829,470
Mr John Miles
Former CFO$256,049$87,395$5,420$15,900$18,637$383,401
Mr Scott Wolfe
CFO$296,440$88,218$8,089$13,601$13,043$419,391
Mr Michael McAnder
Sec: 10/14/16-2/27/17 & Treas$564,255$356,500$49,183$104,390$9,456$1,083,784
Mr David Nipper
COO$266,532$82,680$6,456$15,884$18,585$390,137
Mr Edward Miller
Medical Physicist$163,084$575$15,515$6,086$185,260
Ms Cheryl Beard
Nursing Admin Supervisor$97,783$1,150$82,261$7,651$1,409$190,254
Ms Merry Heath
CNO$183,378$43,235$3,386$13,694$8,433$252,126

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMSJAMES MICHAEL BURNETT RECEIVED A DISCRETIONARY SPENDING ACCOUNT TOTALING $12,000.04, A FIXED AMOUNT DETERMINED BY HIS JOB LEVEL. THIS SPENDING ACCOUNT WAS INCLUDED IN MR. BURNETTS TAXABLE WAGES.
SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTORTHE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT FAYETTE HOSPITAL IS SET BY THE ENTITY'S PARENT, PIEDMONT HEALTHCARE, INC. PLEASE SEE THE SCHEDULE O NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A & 15B FOR ADDITIONAL INFORMATION.
SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL COMPENSATION INFORMATIONJAY MITCHELL AND GREGORY HURST RECEIVED SERP PAYMENTS IN THE AMOUNTS OF $297,318 AND $684,530, RESPECTIVELY. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: J. MICHAEL BURNETT MICHAEL MCANDER SHERYL KLINK JOHN MILES SCOTT WOLFE DAVID NATHAN NIPPER FREDERICK WILLMS
SCHEDULE J, PART I, LINE 7: NON-FIXED PAYMENTSCERTAIN EMPLOYEES PARTICIPATED IN AN "ANNUAL INCENTIVE PLAN" UNDER WHICH THEY RECEIVED NON-FIXED BONUS PAYMENTS BASED ON JOB LEVEL AND SEVERAL DIFFERENT PERFORMANCE METRICS.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILEDALL CALENDAR YEAR 2016 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT FAYETTE HOSPITAL BY ITS SOLE MEMBER, PIEDMONT HEALTHCARE, INC. (EIN 58-1503902), PURSUANT TO AN AGREEMENT WITH THE IRS TO FILE ALL FORMS 1099 FOR THE PIEDMONT HEALTHCARE SYSTEM ON A COMBINED BASIS.
FORM 990, PART VI, SECTION A, LINE 6: ORGANIZATION'S SOLE MEMBERPIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT FAYETTE HOSPITAL ("PFH").
FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODYTHE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT FAYETTE HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT FAYETTE HOSPITAL.
FORM 990, PART VI, SEC A, LINE 7B: DECISIONS OF GOVERNING BODYPIEDMONT FAYETTE HOSPITAL'S BOARD POLICIES AND DECISIONS MUST BE FILED, IMMEDIATELY AFTER ADOPTION, WITH THE SECRETARY OF THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS. SUCH POLICIES AND DECISIONS OF THE PIEDMONT FAYETTE HOSPITAL BOARD OF DIRECTORS ARE NOT SUBJECT TO THE APPROVAL OF OR RATIFICATION BY THE PIEDMONT HEALTHCARE BOARD, BUT SHOULD THE NEED ARISE, THEY MAY BE RESCINDED BY THE PIEDMONT HEALTHCARE BOARD THROUGH A MAJORITY VOTE OF ITS DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11B: 990 REVIEW PROCESSINFORMATION NEEDED TO PREPARE PIEDMONT FAYETTE HOSPITALS FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATIONS FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PFHS CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.S TAX DIRECTOR AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. PRIOR TO FILING, COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., THE ORGANIZATIONS SOLE MEMBER, FOR BOARD REVIEW.
FORM 990, PART VI, SEC B, LINE 12C: conflict of interest policyCOMPLIANCE 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 FAYETTE HOSPITAL ARE PROVIDED TRAINING ON CONFLICT OF INTEREST ISSUES, INCLUDING REPORTING REQUIREMENTS, AT NEW-EMPLOYEE ORIENTATION AND AT LEAST ANNUALLY THEREAFTER. NONCOMPLIANCE WITH THE CONFLICT OF INTEREST POLICY MUST BE REPORTED TO PIEDMONT 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 COMPENSATIONCOMPENSATION FOR EXECUTIVES OF PIEDMONT FAYETTE 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 (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 XI, LINE 9: RECONCILIATION OF NET ASSETSCHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF $5,340,747 OF INTERCOMPANY TRANSFERS OF LIABILITIES; AND BOOK/TAX DIFFERENCES RELATED TO REVENUE RECOGNITION OF $(11,308).

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1FAYETTE SURGERY CENTER LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11255 HIGHWAY 54 WESTAddressLine1Txt
CityFayettevilleCityNm
State AbbreviationGAStateAbbreviationCd
ZIP30214ZIPCd
FieldValueIRS element (for citing)
Primary ActivitiesSurgeryPrimaryActivitiesTxt
Legal Domicile StateGALegalDomicileStateCd
Total Income$0TotalIncomeAmt
End Of Year Assets$0EndOfYearAssetsAmt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1PFHBusinessNameLine1Txt

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (16 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)11cNAfalse
PIEDMONT HOSPITAL INC
1968 PEACHTREE ROAD NWAtlantaGA30309580566213HospitalGA501(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 HEALTHCARE FOUNDATION INC
2001 PEACHTREE ROAD NE SUITE 400AtlantaGA30309581272768FUNDRAISINGGA501(c)(3)11BPHCfalse
CENTER FOR HEALTH AND LEARNING INC
3001 MERCER UNIVERSITY DRATLANTAGA30341262442849EDUCATIONGA501(C)(3)11ANAfalse
PIEDMONT NEWTON HOSPITAL INC
5126 HOSPITAL DRIVE NECOVINGTONGA30014582155150HOSPITALGA501(C)(3)3PHCfalse
PIEDMONT ATHENS REGIONAL FOUNDATION INC
1199 PRINCE AVENUEATHENSGA30606581978389FUNDRAISINGGA501(C)(3)11BNAfalse
PIEDMONT ATHENS REGIONAL HEALTH RESOURCE
1199 PRINCE AVENUEATHENSGA30606581930580DEVELOPMENTGA501(C)(3)11BNAfalse
PIEDMONT ATHENS REGIONAL MEDICAL CENTER
1199 PRINCE AVENUEATHENSGA30606582179986HOSPITALGA501(C)(3)3NAfalse
ATHENS REGIONAL PHYSICIAN SERVICES INC
1199 PRINCE AVENUEATHENSGA30606582332921HEALTHCAREGA501(C)(3)11BNAfalse
ATHENS REGIONAL SPECIALTY SERVICES INC
1199 PRINCE AVENUEATHENSGA30606271975001HEALTHCAREGA501(C)(3)3NAfalse
REGIONAL FIRSTCARE INC
1199 PRINCE AVENUEATHENSGA30606582362733URGENT CAREGA501(C)(3)11BNAfalse

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtUBI Code VUBICodeVAmt
HENRY RADIATION ONCOLOGY CENTER LLC
275 PROFESSIONAL COURT STE ASTOCKBRIDGEGA30281582200195HEALTHCAREGANA$0$0$0
PEACHTREE ORTHOPAEDIC SURGERY CENTER
2001 PEACHTREE RD NE STE 705ATLANTAGA30309582562721SURGERYGANA$0$0$0
DIGESTIVE HEALTHCARE OF GA ENDOSCOPY CTR
95 COLLIER RD NW STE 4075ATLANTAGA30309582406657HEALTHCAREGANA$0$0$0
SOUTHERN CRESCENT RADIATION ONCOLOGY CTR
275 PROFESSIONAL COURT STE ARIVERDALEGA30274464307929RADIATIONGANA$0$0$0
GRIFFIN RADIATION ONCOLOGY CENTER LLC
275 PROFESSIONAL COURT STE ARIVERDALEGA30274464307692RADIATIONGANA$0$0$0
FOUR WINDS HEALTH LLC
3350 RIVERWOOD PKWY STE 1850ATLANTAGA30339451273930HEALTHCAREGANA$0$0$0
GEORGIA HEALTH COLLABORATIVE LLC
2727 PACES FERRY RD BLDG 2 STE 70ATLANTAGA30339461500639HEALTHCAREGANA$0$0$0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (5 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/CountryCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
PIEDMONT MEDICAL CARE CORPORATION
2727 PACES FERRY RD STE 1-1100AtlantaGA30339582092768HealthcareGANAC Corp$0$00.00000false
THE PIEDMONT CLINIC INC
2727 PACES FERRY RD STE 1-1100AtlantaGA30339582005358HealthcareGANAC Corp$0$00.00000false
PIEDMONT HEART INSTITUTE PHYSICIANS INC
95 COLLIER ROAD NW STE 2045AtlantaGA30309260593850HealthcareGANAC Corp$0$00.00000false
AMSTER MCRAE INSURANCE COMPANY
980427603Related INSURNAC Corp$0$00.00000falsePO BOX 1159Grand Cayman KYCJCJ
PIEDMONT WELLSTAR HEALTHPLANS INC
2859 PACES FERRY RD STE 600ATLANTAGA30339461922499HEALTH INSURAGANAC 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

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE R, PART I, LINE 1: DISREGARDED ENTITIESFormAndLineReferenceDesc
ExplanationTHE LIMITED LIABILITY COMPANY LISTED IN SCHEDULE R, PART I, OPERATES AS A DEPARTMENT OF PIEDMONT FAYETTE HOSPITAL AND IS INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LLC AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.ExplanationTxt