2017-05-15T20:28:57-05:00 2016-06-30 KPMG LLP 300 NORTH GREENE STREET SUITE 400 GREENSBORO NC 27401 990 2015-07-01 582200195 Piedmont Henry Hospital Inc % MARIE GAFFNEY PIED 6786041001 1133 Eagles Landing Parkway Stockbridge GA 30281 TERESA WILSON VP CORPORATE FINANCE 6786041001 2017-05-15 true SHAWN M HUTCHINSON P01048557 3362753394 2015 2021-01-29 14:40:06Z Charles Scott 1133 Eagles Landing Parkway Stockbridge GA 30281 304002097 false X www.piedmonthenry.org X 1995 GA SEE PART III 12 8 1677 150 0 48711 9856 284577764 302828888 -2199744 -1173190 1710291 1880268 284137022 303545822 61370 25040 0 0 90721701 104606013 0 0 0 178011288 193122880 268794359 297753933 15342663 5791889 191382017 198011867 83297965 83834757 108084052 114177110 TO PROVIDE HEALTHCARE MARKED BY COMPASSION AND SUSTAINABLE EXCELLENCE IN A PROGRESSIVE ENVIRONMENT, GUIDED BY PHYSICIANS, DELIVERED BY EXCEPTIONAL PROFESSIONALS, AND INSPIRED BY THE COMMUNITIES WE SERVE. false false 263663042 25040 302980894 PIEDMONT HENRY HOSPITAL ("PHH") IS A 215-BED FACILITY LOCATED IN THE CITY OF STOCKBRIDGE IN HENRY COUNTY, GEORGIA. OVER 400 PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN STOCKBRIDGE AND THE GREATER METROPOLITAN ATLANTA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2016, THE HOSPITAL HAD 13,034 IN-PATIENT ADMISSIONS WITH A TOTAL OF 60,962 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 84,039 AND OUTPATIENT VISITS TOTALED 57,845. SURGICAL SERVICES WERE PROVIDED TO 9,486 PATIENTS. 263663042 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 true false false false false false false false false false false false false false false true true false false false true X 0 0 true 1677 true false false false false false false false false false false X 12 8 false false false false true true false true true false false false true true true true true true true true true GA X MARIE GAFFNEY 4702716007 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 Dr Todd Schmidt Board Member/Physician 4.0 3.0 X 35400 4400 0 DR COLLYN STEELE BOARD MEMBER 1.0 0.0 X 0 0 0 Mr Gregory A Hurst CHAIRMAN 1.0 54.0 X X 0 1938824 25168 Mr Charles Scott President & CEO 54.0 1.0 X X 798566 0 119498 Dr Gopal C Rao Board Member 1.0 0.0 X 0 0 0 Mr Charles J Jeff Mills Board Member 1.0 2.0 X 0 0 0 Ms Joyce Rodgers Board Member 1.0 0.0 X 0 0 0 MS JUNE WOOD Board Member 1.0 0.0 X 0 0 0 Ms Sheryl M Simpson-Jones Board Member 1.0 0.0 X 0 0 0 Mr Steve Kay Board Member 1.0 0.0 X 0 0 0 Mr Thomas Arnold Board Member 1.0 54.0 X 0 588956 77185 DR WILLIAM OSBORNE BOARD MEMBER 1.0 1.0 X 0 0 0 Mr Charlie Hall Treasurer through 7/31/15 1.0 54.0 X 0 968459 86411 Mr Jay D Mitchell Secretary 1.0 54.0 X 0 830565 104679 Mr Michael McAnder Treasurer from 8/1/15 1.0 54.0 X 0 403512 45901 Mr Jeffrey A Cooper VP of Operations 55.0 0.0 X 253409 0 23112 Dr Jagdeep Singh CMO through 9/2/15 25.0 0.0 X 711285 0 16258 MS SHERRY HENDERSON CHIEF FINANCIAL OFFICER 55.0 0.0 X 330571 0 25491 Mr Frederick Willms CMO from 9/3/15 through 2/7/16 25.0 30.0 X 89624 394797 21329 Ms Frances Marthone Chief Nursing Officer 55.0 0.0 X 238460 0 28651 Ms Jessa Okuma Pharmacist 55.0 0.0 X 182297 0 16796 Ms BARBARA RAINONE SR. 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OF CLINICAL SERVICES 55.0 0.0 X 157801 0 21846 Ms Mykeesha C Fowler Director of Pharmacy 55.0 0.0 X 169362 0 12214 Mr Michael Collins Pharmacist 55.0 0.0 X 156529 0 8278 Dr Ronnie Brownsworth FORMER Board Member 0.0 55.0 X 0 945179 118095 3123304 6074692 750912 65 true true false BRASFIELD AND GORRIE LLC PO Box 11407 BIRMINGHAM AL 352460351 CONSTRUCTION SERVICS 769909 MEDICAL SOLUTIONS INC 1010 NORTH 102ND STREET SUITE 300 OMAHA NE 68114 NURSING SERVICES 4692744 UNIVERSAL PROTECTION SERVICES 26375 NETWORK PLACE CHICAGO IL 606731263 SECURITY SERVICES 418940 CLARUS LINEN SYSTEMS 7990 SECOND FLAGS DRIVE STE A AUSTELL GA 30168 Laundry Services 467743 WORKFORCE CAPITAL LLC PO BOX 823461 PHILADELPHIA PA 191823461 STAFFING SERVICES 549219 14 7633 2223 9856 PATIENT SERVICE REVENUE 621110 302488421 302488421 MANAGEMENT FEE REVENUE 900099 208739 208739 OTHER OPERATING REVENUE 900099 131728 131728 302828888 -1175415 -1175415 0 0 1311592 404521 907071 0 907071 907071 53979 51754 2225 2225 2225 0 0 0 CAFETERIA REVENUE 900099 817401 817401 OTHER REVENUE 900099 155796 155796 973197 303545822 302984684 551282 25040 25040 0 0 0 1346363 1157260 189103 355642 355642 85800336 73749278 12051058 0 11833083 10171083 1662000 5270589 4530315 740274 0 913412 913412 82571 82571 0 0 0 19940484 13339313 6601171 1136271 760116 376155 15129075 15014309 114766 5288101 5247986 40115 0 2483679 2282253 201426 82349 51476 30873 0 0 7081853 7081853 8240750 8240750 8993923 8264516 729407 869090 63652 805438 BAD DEBT EXPENSE 70986416 70986416 MEDICAL SUPPLIES & DRUGS 43835313 43835313 HOSPITAL TAX 2521302 2521302 MISCELLANEOUS EXPENSES 5538291 3422664 2115627 297753933 263663042 34090891 0 1349541 989518 0 0 14060 71200 24290679 27124825 0 0 0 0 0 0 4242293 3954493 852318 756686 206887892 46794630 155441537 160093262 3309428 3309428 0 0 0 0 1375301 1375301 506860 337154 191382017 198011867 20473446 22696249 0 0 0 0 60311405 58633242 0 0 0 0 346179 103279 0 0 2166935 2401987 83297965 83834757 X 107715799 113659591 368253 517519 0 0 108084052 114177110 191382017 198011867 X 5791889 301169 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12160000 12160000 145670634 19747844 125922790 1968306 771930 1196376 46264251 26272356 19991895 824701 2500 822201 160093262 0 OTHER LIABILITIES 2401987 2401987 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, 2016 AND 2015. true true X true X true X true true false true true 8189178 0 8189178 0.03610 9816421 8354215 1462206 0.00640 2933064 1376496 1556568 0.00690 20938663 9730711 11207952 0.04940 50657 0 50657 0.00020 1332888 0 1332888 0.00590 14385 0 14385 0.00010 7320 0 7320 75280 0 75280 0.00030 1480530 0 1480530 0.00650 22419193 9730711 12688482 0.05590 617 0 617 617 0 617 true 70986416 2129592 50757439 56047050 -5289611 X true true HENRY RAD ONCOLOGY RADIATION & ONCOLOGY SERVICES 0.6 1 1 Piedmont Henry Hospital INC 1133 Eagles Landing Parkway Stockbridge GA 30281 www.piedmonthenry.org X X X SNF, Rehab Services Clinic Piedmont Henry Hospital INC 1 false false true X X X X X X X X 16 true true false true X WWW.PIEDMONTHENRY.ORG X X true 13 true WWW.PIEDMONTHENRY.ORG false true X 200. 300. X X true true X X X true X WWW.PIEDMONTHENRY.ORG X WWW.PIEDMONTHENRY.ORG X WWW.PIEDMONTHENRY.ORG 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 HENRY HOSPITAL'S ("PHH") ORIGINAL CHNA WAS CONDUCTED DURING THE HOSPITAL'S 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 HENRY 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, PHH 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 ITS SIX 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 HENRY 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 HENRY 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 HENRY HOSPITAL FOCUSED ON REDUCING INSTANCES OF PREVENTABLE HEART DISEASE AND STROKE BY UTILIZING COMMUNITY-WIDE AWARENESS CAMPAIGNS AND PROVIDING EDUCATION THAT ENCOURAGES COMMUNITY MEMBERS TO REDUCE THEIR RISKS THROUGH HEALTHY BEHAVIORS. DURING FY16, PIEDMONT HENRY 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 HENRY 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, PHH 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 HENRY HOSPITAL WILL DEVELOP THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS IN FY17. 1 Laurel Park 1133 Eagles Landing Parkway Stockbridge GA 30281 Skilled Nursing Facility SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A A REPORT ON PIEDMONT HENRY HOSPITAL, INC.'S ("PHH") COMMUNITY BENEFITS IS FOUND WITHIN PIEDMONT HEALTHCARE, INC.S (PIEDMONT HENRY 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 PHH 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 $297,753,933, LESS BAD DEBT EXPENSE OF $70,986,416 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 EITHER REFUSE OR FAIL TO 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. PHH 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 HENRY 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 16.78 PERCENT OF PHHS PATIENT SERVICE REVENUE. PHHS 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 PHHS 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 ASSESSMENT DURING FISCAL YEAR 2016, PIEDMONT HENRY 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 HENRY 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 HENRY 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 HENRY HOSPITAL BOARD OF DIRECTORS APPROVED ITS CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT IN JUNE, 2016. A FORMAL IMPLEMENTATION STRATEGY IS IN PROGRESS AND WILL BE COMPLETED FOR EACH PIEDMONT HEALTHCARE HOSPITAL FACILITY, INCLUDING PIEDMONT HENRY HOSPITAL, DURING FY17. 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 HENRY 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 HENRY 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 HENRY HOSPITAL IS LOCATED IN HENRY COUNTY, AN URBAN COMMUNITY SOUTH OF ATLANTA, GEORGIA. IN 2016, APPROXIMATELY 206,349 PEOPLE LIVED IN HENRY COUNTY. THE COUNTY SEAT OF THIS COMMUNITY IS MCDONOUGH, AND THERE ARE THREE OTHER MAIN CITIES: HAMPTON, LOCUST GROVE, AND STOCKBRIDGE. ABOUT ONE IN FIVE ADULTS IN HENRY COUNTY IS UNINSURED, HENRY COUNTY HAS ONE PRIMARY CARE PROVIDER FOR EVERY 2,030 RESIDENTS, WHICH IS FEWER PROVIDERS PER MEMBER OF THE POPULATION THAN THE STATE AVERAGE OF ONE PROVIDER FOR EVERY 1,540 RESIDENTS. IN FACT, APPROXIMATELY 32 PERCENT OF ADULTS DO NOT HAVE A REGULAR DOCTOR, WHICH IS ONE OF THE HIGHEST RATES IN THE SERVICE REGION. HOWEVER, HENRY COUNTY HAS ONE MENTAL HEALTH PROVIDER FOR EVERY 810 RESIDENTS, AS COMPARED TO GEORGIAS AVERAGE OF ONE PROVIDER FOR EVERY 850 RESIDENTS. MORE THAN 16 PERCENT OF ADULTS IN HENRY COUNTY REPORTED THAT THEY WERE IN POOR OR FAIR HEALTH, WHICH IS LESS THAN GEORGIAS AVERAGE OF 19 PERCENT. COUNTY RESIDENTS REPORT AN AVERAGE OF 3.5 "POOR PHYSICAL HEALTH" DAYS EACH MONTH, WHICH IS EQUAL TO REGIONAL RATES. ROUGHLY 11 PERCENT OF ADULTS IN HENRY COUNTY LIVE BELOW THE POVERTY LINE. IN ADDITION, 41 PERCENT OF THE CHILDREN IN THE COMMUNITY QUALIFY FOR FREE LUNCH. THE UNEMPLOYMENT RATE IN HENRY COUNTY IS 7.3 PERCENT AND MORE THAN 89 PERCENT OF THE COUNTY HAS A HIGH SCHOOL DIPLOMA. ONE IN FOUR ADULTS IN HENRY COUNTY IS NOTABLY PHYSICALLY INACTIVE, AND ONE IN THREE ADULTS IS OBESE. OBESE RESIDENTS IN HENRY COUNTY HAVE HIGHER RATES OF HEART DISEASE, MORE VISITS TO THE ER FOR STROKE AND HYPERTENSION, INCREASED RISK OF HOSPITALIZATION FOR OBSTRUCTIVE HEART DISEASE AND INCREASED RISK FOR DIABETES. ACCESS TO HEALTHY FOODS IS AN ISSUE IN HENRY COUNTY, AS ABOUT SIX PERCENT OF THE POPULATION DOES NOT LIVE WITHIN CLOSE PROXIMITY OF A GROCERY STORE THAT SELLS FRESH FRUIT AND VEGETABLES. SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH PIEDMONT HENRY 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 2016, PIEDMONT HENRY HOSPITAL OFFERED VARIOUS PROACTIVE COMMUNITY BENEFIT PROGRAMS. SOME OF THESE PROGRAMS INCLUDED: CONTINUING THE "LIVE BETTER" PROGRAM, WHICH WORKS TO FOSTER COMMUNITY COLLABORATION AND GRASSROOTS HEALTH IMPROVEMENT PROGRAMS; CONTINUING THE SAMS CARE PROGRAM 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 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; 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 2016, THE PIEDMONT HEALTHCARE SYSTEM INCLUDED SIX FULL-SERVICE HOSPITALS, A PHILANTHROPIC FOUNDATION, 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 henry HOSPITALS SOLE MEMBER. THE SYSTEMS SIX HOSPITALS ARE PIEDMONT HOSPITAL, A 529-BED ACUTE TERTIARY CARE FACILITY IN ATLANTA; PIEDMONT FAYETTE HOSPITAL, A 189-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; AND PIEDMONT NEWTON HOSPITAL, A 97-BED ACUTE-CARE COMMUNITY HOSPITAL IN COVINGTON. 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 HENRY 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 Hands of Hope Clinic 1010 Hospital Drive Building B Stockbridge GA 30281 421591970 501(c)(3) 6500 Support MAGNOLIA GOLF GROUP 1000 NORTHFIELD COURT SUITE 120 ROSWELL GA 30076 N/A 10000 REAL MEN WEAR PINK EVENT SPONSORSHIP 1 1 SCHEDULE I, PART I, LINE 2: MONITORING THE USE OF GRANT FUNDS 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 true true false false false false false true false Mr Charlie Hall Treasurer through 7/31/15 0 288179 0 570436 0 109844 0 77609 0 8802 0 1054870 Mr Jay D Mitchell Secretary 0 455192 0 320118 0 55255 0 84898 0 19781 0 935244 Mr Jeffrey A Cooper VP of Operations 199224 0 51470 0 2715 0 14167 0 8945 0 276521 0 Dr Jagdeep Singh CMO through 9/2/15 237279 0 86604 0 387402 0 1424 0 14834 0 727543 0 Ms Frances Marthone Chief Nursing Officer 181455 0 42430 0 14575 0 10814 0 17837 0 267111 0 Ms Jessa Okuma Pharmacist 114010 0 917 0 67370 0 8086 0 8710 0 199093 0 Ms BARBARA RAINONE SR. DIR. OF CLINICAL SERVICES 125672 0 13262 0 18867 0 9711 0 12135 0 179647 0 Ms Mykeesha C Fowler Director of Pharmacy 129783 0 11367 0 28212 0 10234 0 1980 0 181576 0 Mr Gregory A Hurst CHAIRMAN 0 729163 0 508565 0 701096 0 15900 0 9268 0 1963992 Mr Charles Scott President & CEO 417949 0 129379 0 251238 0 75504 0 43994 0 918064 0 Dr Ronnie Brownsworth FORMER Board Member 0 520512 0 368358 0 56309 0 95248 0 22847 0 1063274 Mr Thomas Arnold Board Member 0 357676 0 193669 0 37611 0 70688 0 6497 0 666141 MS SHERRY HENDERSON CHIEF FINANCIAL OFFICER 266229 0 55502 0 8840 0 15900 0 9591 0 356062 0 Mr Michael Collins Pharmacist 118887 0 917 0 36725 0 6255 0 2023 0 164807 0 Mr Michael McAnder Treasurer from 8/1/15 0 261688 0 125000 0 16824 0 43125 0 2776 0 449413 Mr Frederick Willms CMO from 9/3/15 through 2/7/16 77240 268608 0 117619 12384 8570 0 15900 2819 2610 92443 413307 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS CHARLES SCOTT RECEIVED A DISCRETIONARY SPENDING ACCOUNT TOTALING $11,769, A FIXED AMOUNT DETERMINED BY HIS JOB LEVEL. THIS SPENDING ACCOUNT WAS INCLUDED IN MR. SCOTT'S TAXABLE WAGES. SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT HENRY 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 4A: SUPPLEMENTAL COMPENSATION INFORMATION DR. JAGDEEP SINGH RECEIVED SEVERANCE PAYMENTS TOTALING $385,886 DURING CALENDAR YEAR 2015. SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL COMPENSATION INFORMATION THE FOLLOWING EMPLOYEES RECEIVED PAYMENTS FROM THEIR SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS: CHARLES SCOTT $202,621 CHARLIE HALL $69,687 GREG HURST $627,541 THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: THOMAS ARNOLD RONNIE BROWNSWORTH SHERRY HENDERSON MICHAEL MCANDER JAY MITCHELL FREDERICK WILLMS 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. A HOSPITAL AUTHORITY OF HENRY COUNTY 581274549 426357GF0 2014-11-19 53420000 REFINANCING & CONSTRUCTION false false false A 0 0 60502832 0 0 0 0 0 0 0 57193404 3309428 true false false true A false true false false 0.01000 0.01000 false false false true A false true true false 0 false 0 false true A true SCHEDULE K, PART IV, LINE 2C: REBATE CALCULATION THE REBATE CALCULATION FOR THE 2014 SERIES A HOSPITAL AUTHORITY OF HENRY COUNTY BOND ISSUE WAS LAST PERFORMED ON NOVEMBER 19, 2015. FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2015 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT HENRY 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 HENRY HOSPITAL ("PHH"). FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT HENRY HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT HENRY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT HENRY 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 HENRY 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 HENRY HOSPITALS FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATIONS FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PHHS 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, SECTION B, LINE 12C: CONFLICT OF INTEREST POLICY COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARE'S CHIEF COMPLIANCE OFFICER. ALL SENIOR LEADERS, BOARD MEMBERS, PHYSICIAN EMPLOYEES, NURSE PRACTITIONERS/PHYSICIAN ASSISTANTS AND EMPLOYEES AND NON-EMPLOYEES ENGAGED IN RESEARCH ARE REQUIRED TO ANNUALLY DISCLOSE ALL MATTERS WHICH COULD POTENTIALLY CONSTITUTE A CONFLICT OF INTEREST. MATTERS DISCLOSED UNDER THE POLICY MUST BE REVIEWED IN WRITING BY THE PIEDMONT HEALTHCARE CONFLICT OF INTEREST COMMITTEE IN ORDER TO DETERMINE WHETHER A CONFLICT EXISTS AND, IF SO, WHETHER TO ELIMINATE OR MANAGE THE CONFLICT. ALL BOARD MEMBERS AND EMPLOYEES OF PIEDMONT HENRY HOSPITAL ARE PROVIDED TRAINING ON CONFLICT OF INTEREST ISSUES, INCLUDING REPORTING REQUIREMENTS, AT NEW-EMPLOYEE ORIENTATION AND AT LEAST ANNUALLY THEREAFTER. NONCOMPLIANCE WITH THE CONFLICT OF INTEREST POLICY MUST BE REPORTED TO PIEDMONT HEALTHCARE'S SENIOR VICE PRESIDENT OF COMPLIANCE FOR INVESTIGATION, AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. FORM 990, PART VI, SECTION B, LINE 15A, 15B: EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT HENRY HOSPITAL IS SET BY THE BOARD OF DIRECTORS OF AND PAID ON BEHALF OF THE HOSPITAL BY 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. 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 BOOK/TAX DIFFERENCES OF $(882,035) RELATING TO DIFFERENCES IN THE TIMING OF REVENUE RECOGNITION; AND $1,182,004 OF INTERCOMPANY TRANSFERS OF LIABILITIES. 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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.