2017-05-15T20:29:44-05:00 2016-06-30 KPMG LLP 300 NORTH GREENE STREET SUITE 400 GREENSBORO NC 27401 990 2015-07-01 580566213 Piedmont Hospital Inc % MARIE GAFFNEY PIED 4044251303 1968 PEACHTREE ROAD NW ATLANTA GA 30309 TERESA WILSON VP CORPORATE FINANCE 4044251303 2017-05-15 true SHAWN M HUTCHINSON P01048557 3362753394 2015 2021-01-29 14:40:06Z DR PATRICK BATTEY 1968 PEACHTREE ROAD NW ATLANTA GA 30309 964838832 false X WWW.PIEDMONTHOSPITAL.ORG X 1905 GA SEE PART III 14 7 4293 425 2320783 -1661526 2389881 1432004 864240416 924914883 794606 1834687 12974850 14266217 880399753 942447791 142498 163027 0 0 277982656 301242608 0 0 0 531167511 576974615 809292665 878380250 71107088 64067541 993021220 994983966 623643531 639258423 369377689 355725543 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 763946744 163027 926655849 PIEDMONT HOSPITAL ("PH") IS A 529-BED FACILITY THAT HAS BEEN SERVING THE CITY OF ATLANTA IN FULTON COUNTY, GEORGIA, FOR MORE THAN A CENTURY. OVER 1,000 PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN THE CITY 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 27,203 IN-PATIENT ADMISSIONS WITH A TOTAL OF 142,978 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 54,445 AND OUTPATIENT VISITS TOTALED 276,998. SURGICAL SERVICES WERE PROVIDED TO 22,862 PATIENTS. 763946744 true true false false false false false false false true true false false false true true false true false false false false false false false false true true true true 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 4293 true true true false false false false false false false false false X 14 7 false false false false true true true true true false false false true true true true true true true false GA X MARIE GAFFNEY 6782716007 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 Mr Gary T Jones Board member 1.0 0.0 X 0 0 0 Dr Bryant Wilson Board Member 1.0 39.0 X 0 545457 32961 Dr JULIET ASHER Board member 1.0 39.0 X 0 186497 22220 Mr Shouky Shaheen Board member 1.0 0.0 X 0 0 0 Dr Patrick M Battey CEO/Board Member 50.0 5.0 X X 716690 25405 26708 Dr Hewitt W Matthews Board member 1.0 0.0 X 0 0 0 Mr Douglas Stuart Chairman/Board Member 1.0 0.0 X X 0 0 0 Dr Xavier Duralde Board Member 1.0 0.0 X 0 0 0 Dr Adrian Douglass Board Member 1.0 39.0 X 0 329662 31540 Mr Walter Perrin Board Member 1.0 0.0 X 0 0 0 Mr William Linginfelter Board Member 1.0 0.0 X 0 0 0 Dr Saeid Khansarinia Board Member 1.0 39.0 X 0 573197 24968 Dr Brian Thomas Board Member/Physician 5.0 0.0 X 60463 0 0 Dr Robert Miller Board Member/Physician 3.0 1.0 X 17325 0 0 Mr Charlie Hall Treasurer through 7/31 1.0 54.0 X 0 968459 86411 Mr Leslie A Donahue President/CEO THROUGH 12/31/15 24.0 1.0 X 1367091 0 184728 Mr Jay D Mitchell Secretary 1.0 54.0 X 0 830565 104679 Mr Michael McAnder Treasurer from 08/1/2015 1.0 54.0 X 0 403512 45901 Mr Thomas Arnold CFO through 9/30/15 34.0 21.0 X 480847 108109 77185 MR EDWARD LOVERN COO 55.0 0.0 X 766470 0 93396 Ms Sheryl Klink CFO from 10/1/2015 45.0 10.0 X 78976 324432 35452 Ms GABRIELLA WHEELER DIRECTOR OF TRANSPLANT LAB 55.0 0.0 X 235466 0 31030 Ms Debbie Reeves Nursing 40.0 0.0 X 250274 0 12500 Mr Mark Cohen Chief Quality Officer 55.0 0.0 X 650467 0 17267 Mr Joseph Sprinkle Exec Director of Radiology 55.0 0.0 X 228185 0 21742 Ms Kelly Hulsey Chief Nursing Officer 55.0 0.0 X 299010 0 26083 Dr Carol T Aitcheson Former Board Member 1.0 39.0 X 0 552481 33570 Dr Harry M McFarling III Former Chairman 8.0 3.0 X 118300 0 0 Dr William Knopf FORMER CMO & COO 0.0 0.0 X 882692 0 0 Ms Denise Ray Former Chief Operating Officer 0.0 55.0 X 0 633113 88536 6152256 5480889 996877 288 true true false CLARUS LINEN SYSTEMS 7990 Second Flags Drive Suite A AUSTELL GA 30168 LAUNDRY SERVICES 1260464 MEDICAL SOLUTIONS LLC 1010 N 102ND STREET SUITE 300 OMAHA NE 68114 NURSING STAFFING 11064578 EPIC RESPONSE LLC 3045 CHASTAIN MEADOWS PARKWAY NW MARIETTA GA 30066 WATER DAMAGE RESTORA 888822 INGLETT AND STUBBS LLC 5200 RIVERVIEW ROAD SE MABLETON GA 30126 ELECTRICAL CONSTRUCT 859057 RADIOLOGY ASSOCIATES OF ATLANTA 1984 PEACHTREE RD STE 505 ATLANTA GA 30309 RADIOLOGY SERVICES 981756 19 100670 1331334 1432004 HEALTHCARE SERVICES 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THE BOARD RETAINS CONTROL OF DESIGNATED ASSETS AND MAY AT ITS DISCRETION SUBSEQUENTLY USE THESE ASSETS FOR OTHER PURPOSES. 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 10430881 0 10430881 0.01300 20828161 16838521 3989640 0.00500 10548610 357293 10191317 0.01270 41807652 17195814 24611838 0.03070 47722 0 47722 0.00010 3118535 0 3118535 0.00390 468916 0 468916 0.00060 3635173 0 3635173 0.00460 45442825 17195814 28247011 0.03530 3117 0 3117 3117 0 3117 true 81353957 2440619 179022625 202018836 -22996211 X true true Peachtree ORTHO Orthopedic Surgery 0.15 0.0 0.85 Digestive Healthcare Endo/GI Surgery 0.15 0.0 0.85 1 1 PIEDMONT HOSPITAL INC 1968 PEACHTREE ROAD NW ATLANTA GA 30309 WWW.PIEDMONThospital.ORG X X X PIEDMONT HOSPITAL INC false false true X X X X X X X X 16 true true false true X www.piedmonthospital.org X X true 13 true www.piedmonthospital.org false true X 200. 300. X true true X X true X www.piedmonthospital.org X www.piedmonthospital.org X www.piedmonthospital.org X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION C, LINE 5: COMMUNITY REPRESENTATION PIEDMONT 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 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 HOSPITAL INTERVIEWED REPRESENTATIVES OF LOCAL AND REGIONAL PUBLIC HEALTH ENTITIES, MINORITY POPULATIONS, THE FAITH-BASED COMMUNITIES, LOCAL BUSINESS OWNERS, THE PHILANTHROPIC COMMUNITY, MENTAL HEALTH AGENCIES, ELECTED OFFICIALS, AND OTHER RELEVANT COMMUNITY STAKEHOLDERS. ADDITIONALLY, THE HOSPITAL CONDUCTED FOCUS GROUPS MADE UP OF LOW-INCOME AND UNINSURED PATIENTS, AS WELL AS CONSUMER AND PATIENT ADVOCATES REPRESENTING A VARIETY OF VULNERABLE PATIENTS. ALL INTERVIEWS, FOCUS GROUPS AND MEETINGS INFORMED THE CHNA PROCESSES, INCLUDING THE IDENTIFICATION OF KEY HEALTH PRIORITIES AND DEVELOPMENT OF IMPLEMENTATION PLAN STRATEGIES. SCHEDULE H, PART V, LINE 6A: HOSPITALS INCLUDED IN CURRENT CHNA PROCESS DURING FY16, THE PIEDMONT HEALTHCARE SYSTEM CONDUCTED THE SECOND CHNA FOR 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 REPORTS AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT 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 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 HOSPITAL FOCUSED ON REDUCING INSTANCES OF PREVENTABLE HEART DISEASE AND HYPERTENSION 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 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 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 HOSPITAL 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 HOSPITAL WILL DEVELOP THE IMPLEMENTATION STRATEGY TO ADDRESS THESE PRIORITY NEEDS IN FY17. SCHEDULE H, PART VI, LINE 1: REQUIRED DESCRIPTIONS PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A A REPORT ON PIEDMONT HOSPITAL, INC'S ("PH") COMMUNITY BENEFITS IS FOUND WITHIN PIEDMONT HEALTHCARE, INCS (PIEDMONT 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 PH 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 $803,099,857, LESS BAD DEBT EXPENSE OF $81,353,957 FROM FORM 990, PART IX, LINE 24(B). 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. PH 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 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 19.48 PERCENT OF PHS PATIENT SERVICE REVENUE. PHS 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 PHS 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 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 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 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 WE CAN BETTER SERVE OUR PATIENTS AND COMMUNITIES. APPROXIMATELY 775 EMPLOYEES FROM ACROSS THE PIEDMONT HEALTHCARE SYSTEM RESPONDED TO THE SURVEY. THE PIEDMONT 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 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 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 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 HOSPITAL IS LOCATED IN FULTON COUNTY. IN 2016, APPROXIMATELY 984,554 PEOPLE LIVED IN FULTON COUNTY AND ABOUT 25 PERCENT OF ADULTS WERE UNINSURED. APPROXIMATELY 15 11 PERCENT OF THE OVERALL ADULT POPULATION IN FULTON COUNTY REPORTED IT WAS IN POOR OR FAIR HEALTH, WHICH IS LOWER THAN THE STATE AVERAGE OF 19 PERCENT. THERE WAS ONE PRIMARY CARE DOCTOR FOR EVERY 970 RESIDENTS IN FULTON COUNTY. NEARLY 11 PERCENT OF ADULT RESIDENTS HAVE BEEN DIAGNOSED WITH DIABETES, WHICH IS LOWER THAN GEORGIAS AVERAGE OF 11 PERCENT. APPROXIMATELY 25 PERCENT OF CHILDREN IN FULTON COUNTY LIVE BELOW THE POVERTY LEVEL AND 52 PERCENT OF CHILDREN QUALIFY FOR FREE LUNCH, AS COMPARED TO A RATE OF 53 PERCENT FOR THE STATE OF GEORGIA. THE UNEMPLOYMENT RATE IN FULTON IS 7.2 PERCENT, WHICH IS ROUGHLY EQUAL TO THAT OF THE STATE. FULTON COUNTY HAS A HIGH SCHOOL GRADUATION RATE OF 86 PERCENT, WHICH IS HIGHER THAN GEORGIAS AVERAGE OF 73 PERCENT. HEART DISEASE AND HYPERTENSION ARE MAJOR ISSUES FOR FULTON COUNTY. THERE ARE APPROXIMATELY 1,240 HEART DISEASE-RELATED DEATHS IN FULTON COUNTY EACH YEAR AND 28 PERCENT OF ADULTS IN THE COUNTY HAVE BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE. IN ADDITION, ONE IN FIVE ADULTS ARE NOTABLY PHYSICALLY INACTIVE AND ONE IN FOUR IS OBESE. ACCESS TO HEALTHY FOODS COULD BE AN ISSUE AS ONE IN FIVE FAMILIES HAVE EXPERIENCED FOOD INSECURITY WITHIN THE LAST YEAR. VIOLENCE IS ALSO A SIGNIFICANT ISSUE IN FULTON COUNTY, WHERE CRIME RATES SOAR ABOVE BOTH STATE AND NATIONAL BENCHMARKS, AS IS MENTAL HEALTH. THERE IS ONLY ONE MENTAL HEALTH PROVIDER FOR EVERY 490 COUNTY RESIDENTS AND FULTON RESIDENTS REPORT AN AVERAGE OF 3.5 "POOR MENTAL HEALTH DAYS IN A GIVEN MONTH". SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH PIEDMONT 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 OR QUALIFYING FOR FINANCIAL ASSISTANCE, INCLUDING THOSE COVERED BY MEDICARE AND MEDICAID; AND AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFYING PHYSICIANS. IN FY 2016, PIEDMONT HOSPITAL OFFERED A NUMBER OF PROACTIVE COMMUNITY BENEFIT PROGRAMS, INCLUDING BUT NOT LIMITED TO: CONTINUING AND EXPANDING THE LIVE BETTER PROGRAM, WHICH WORKS TO FOSTER COMMUNITY COLLABORATION AND GRASSROOTS HEALTH IMPROVEMENT PROGRAMS SUCH AS SCHOOL BASED GARDENING PROGRAMS; CONTINUING ITS COMMUNITY WALKING PROGRAM CALLED WALK WITH A DOC, IN PARTNERSHIP WITH THE ATLANTA BELTLINE; FACILITATING COMMUNITY EDUCATION PROGRAMMING AROUND NUTRITION AT THE GRANT PARK CLINIC AND THE GRANT PARK FARMERS MARKET; THE OPERATION OF PIEDMONT'S CANCER WELLNESS CENTER, WHICH PROVIDED A BROAD SPECTRUM OF COMPREHENSIVE, INDIVIDUALIZED SUPPORT AND CARE; CONTINUING A HEART-RELATED PUBLIC AWARENESS CAMPAIGN TO EDUCATE THE COMMUNITY AND REDUCE THE INSTANCES OF HEART DISEASE, HYPERTENSION, AND OTHER HEART RELATED CONDITIONS; CONTINUING TO OFFER PIEDMONTS SIXTY PLUS PROGRAM, WHICH PROMOTES EFFICIENT AND EFFECTIVE UTILIZATION OF HEALTHCARE RESOURCES THROUGH READMISSION REDUCTION INTERVENTIONS, COMPLEX CARE COORDINATION, FACILITATION OF COMMUNITY PARTNERSHIPS AND COALITION BUILDING, AND PROVIDER TRAINING AND SYMPOSIUMS; AND DRAFTING A LOW-INCOME PATIENT COMMUNITY RESOURCE GUIDE IN BOTH ENGLISH AND SPANISH THAT WAS DISTRIBUTED IN HOSPITALS, DIRECTLY 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 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 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 Atlanta Beltline Partnership Inc 250 Williams Street Ste 2115 Atlanta GA 30303 562464486 501(c)(3) 10000 Support Grant Park Family Health Center Inc 1340 Boulevard SE Atlanta GA 30315 581577640 501(C)(3) 10000 HPV TESTING Sponsorship Center for Black Women's Wellness 477 Windsor St SW Ste 309 Atlanta GA 30312 582212203 501(c)(3) 10000 Support 3 0 TUITION REIMBURSEMENT 69 127427 SCHEDULE I, PART I, LINE 2: MONITORING THE USE OF GRANT FUNDS SPONSORSHIPS: MONEY IS GIVEN TO CHARITABLE ORGANIZATIONS WHICH PRIMARILY PROMOTE HEALTH CARE CAUSES. THE GRANTS ARE ADMINISTERED AND MONITORED THROUGH PIEDMONT HEALTHCARES PUBLIC RELATIONS DEPARTMENT. TUITION REIMBURSEMENT: THE ORGANIZATIONS HUMAN RESOURCES DEPARTMENT APPROVES REQUESTS FOR TUITION REIMBURSEMENT. IF THERE IS A QUESTION CONCERNING THE JOB RELATEDNESS OF A COURSE, THE DIRECTOR OF HUMAN RESOURCES WILL CONSULT THE EDUCATION DIRECTOR AND THE INDIVIDUAL APPLICANTS DEPARTMENT DIRECTOR. TOGETHER THEY WILL MAKE A RECOMMENDATION. THE DIRECTOR OF HUMAN RESOURCES WILL HAVE RESPONSIBILITY FOR ASSURING THAT THE TUITION REIMBURSEMENT REQUEST MEETS THE STANDARDS SET FORTH IN THE ORGANIZATIONS TUITION REIMBURSEMENT POLICY STATEMENT. IF THE EMPLOYEE DISAGREES WITH THE DIRECTOR OF HUMAN RESOURCES EVALUATION, THE EMPLOYEE MAY TAKE THE REQUEST TO HIS/HER ADMINISTRATIVE REPRESENTATIVE. FINAL APPROVAL FOR ELIGIBILITY OF TUITION REIMBURSEMENT RESTS WITH ADMINISTRATION. X true true true true false false false false false true false Mr Charlie Hall Treasurer through 7/31 0 288179 0 570436 0 109844 0 77609 0 8802 0 1054870 0 Dr Carol T Aitcheson Former Board Member 0 527760 0 0 0 24721 0 15900 0 17670 0 586051 0 Dr Bryant Wilson Board Member 0 424819 0 0 0 120638 0 15900 0 17061 0 578418 0 Dr JULIET ASHER Board member 0 182522 0 0 0 3975 0 9730 0 12490 0 208717 0 Mr Thomas Arnold CFO through 9/30/15 270640 87036 193669 16538 21073 70688 0 3803 2694 555338 110803 Dr Patrick M Battey CEO/Board Member 497249 24479 185602 0 33839 926 14426 1474 10130 678 741246 27557 Mr Leslie A Donahue President/CEO THROUGH 12/31/15 582119 0 400273 0 384699 0 103229 0 81499 0 1551819 0 0 Dr Adrian Douglass Board Member 0 298786 0 22097 0 8779 0 15900 0 15640 0 361202 0 Dr Harry M McFarling III Former Chairman 118300 0 0 0 0 0 0 0 0 0 118300 0 0 0 Dr William Knopf FORMER CMO & COO 0 0 0 0 882692 0 0 0 0 0 882692 0 0 0 Ms GABRIELLA WHEELER DIRECTOR OF TRANSPLANT LAB 181275 0 28305 0 25886 0 14662 0 16368 0 266496 0 0 Mr Jay D Mitchell Secretary 0 455192 0 320118 0 55255 0 84898 0 19781 0 935244 0 Ms Debbie Reeves Nursing 199328 0 29848 0 21098 0 496 0 12004 0 262774 0 0 Mr Mark Cohen Chief Quality Officer 460081 0 161010 0 29376 0 4154 0 13113 0 667734 0 0 Mr Joseph Sprinkle Exec Director of Radiology 170659 0 37615 0 19911 0 11867 0 9875 0 249927 0 0 Ms Denise Ray Former Chief Operating Officer 0 405654 0 188302 0 39157 0 73628 0 14908 0 721649 0 MR EDWARD LOVERN COO 431553 0 295205 0 39712 0 81134 0 12262 0 859866 0 0 Ms Kelly Hulsey Chief Nursing Officer 215163 0 80760 0 3087 0 14575 0 11508 0 325093 0 0 Dr Saeid Khansarinia Board Member 0 513183 0 4899 0 55115 0 15900 0 9068 0 598165 0 Mr Michael McAnder Treasurer from 08/1/2015 0 261688 0 125000 0 16824 0 43125 0 2776 0 449413 0 Ms Sheryl Klink CFO from 10/1/2015 70909 222240 0 100352 8067 1840 1923 13977 3842 15710 84741 354119 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS THE FOLLOWING EMPLOYEES EACH RECEIED A DISCRETIONARY SPENDING ACCOUNT IN THE AMOUNT INDICATED. SPENDING ACCOUNTS WERE INCLUDED IN THE EMPLOYEES TAXABLE WAGES: THOMAS ARNOLD $11,769.27 PATRICK BATTEY $11,868.17 LESLIE DONAHUE $11,769.27 EDWARD LOVERN $11,769.27 SCHEDULE J, PART I, LINE 3: COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT 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 WILLIAM KNOPF RECEIVED SEVERANCE PAYMENTS TOTALING $882,692 DURING CALENDAR YEAR 2015. SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL COMPENSATION INFORMATION LES DONAHUE AND CHARLIE HALL RECEIVED PAYMENTS TOTALING $303,650 AND $69,687, RESPECTIVELY, FROM THEIR SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: THOMAS ARNOLD MARK COHEN KELLY HULSEY SHERYL KLINK EDWARD LOVERN MICHAEL MCANDER JAY MITCHELL DENISE RAY 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 DEVELOPMENT AUTHORITY OF FULTON COUNTY 581639487 359900ZX8 2009-11-24 178554761 See Part VI - Supplemental Info false false false B HOSPITAL AUTHORITY OF FAYETTE COUNTY 582629223 31222TAJ2 2009-11-24 43204335 See Part VI - Supplemental Info false false false C COWETA COUNTY DEVELOPMENT AUTHORITY 581057672 223658PW9 2010-10-27 99459357 Construct and Equip a New Hospital false false false A 28915000 0 229999726 0 0 0 7212 0 0 0 229992514 0 2009 true false true true B 7000000 0 41759371 0 0 0 1885 0 0 0 41757486 0 2009 true false true true C 0 0 99459357 0 0 0 0 0 0 99459357 0 0 2012 false false true true A false true true true false 0.01000 0.00000 0.01000 true false 0.00000 false true B false true true true false 0.01000 0.00000 0.01000 false false false true C false true true true false 0.00000 0.00000 0.00000 false false false true A false true false false true false 0 false 0 false true B false true false false true false 0 false 0 false true C false true false false false false 0 false 0 false true A true B true C true DEVELOPMENT AUTHORITY OF FULTON COUNTY BONDS ISSUED 11/24/2009 ON NOVEMBER 24, 2009, PIEDMONT HEALTHCARE, INC., (PIEDMONT HOSPITAL'S SOLE MEMBER, EIN: 58-1503902) ENTERED INTO A BOND ISSUANCE AGREEMENT WITH THE DEVELOPMENT AUTHORITY OF FULTON COUNTY CONSISTING OF THE FOLLOWING SERIES: SERIES 2009A; CUSIP # 359900ZX8; ISSUE PRICE $166,454,761 (FIXED RATE) SERIES 2009B; CUSIP # 359900ZY6; ISSUE PRICE $70,000,000 (VARIABLE RATE) SERIES 2009C; CUSIP # NONE; ISSUE PRICE $62,100,000 (FIXED RATE) THE ISSUE WAS USED TO REFUND BONDS ISSUED ON 04/07/1999, 06/14/2001, 04/13/2003, 12/15/2005, AND 12/13/2007. THE 2009C BONDS WERE USED TO REPAY A LINE OF CREDIT (SUN TRUST NOTE) THAT FUNDED CONSTRUCTION AND RENOVATION PROJECTS. THE 2009B SERIES BONDS WERE REFINANCED BY THE 2014 BOND ISSUE INCLUDED IN THIS SCHEDULE. AS SUCH, THE 2009B SERIES BONDS HAVE BEEN REMOVED FROM COLUMN A. HOSPITAL AUTHORITY OF FAYETTE COUNTY BONDS ISSUED 11/24/2009 ON NOVEMBER 24, 2009, PIEDMONT HEALTHCARE, INC., (PIEDMONT HOSPITAL'S SOLE MEMBER, EIN: 58-1503902) ENTERED INTO A BOND ISSUANCE AGREEMENT WITH THE HOSPITAL AUTHORITY OF FAYETTE COUNTY CONSISTING OF THE FOLLOWING SERIES: SERIES 2009A; CUSIP # 31222TAJ2; ISSUE PRICE $36,204,335 (FIXED RATE) SERIES 2009B; CUSIP # 31222TAH6; ISSUE PRICE $36,645,000 (VARIABLE RATE) SERIES 2009C; CUSIP # NONE; ISSUE PRICE $7,000,000 (FIXED RATE) THE ISSUE WAS USED TO REFUND BONDS ISSUED ON 04/07/1999, 06/14/2001, 04/13/2003, 12/15/2005, AND 12/13/2007. THE 2009C BONDS WERE USED TO REPAY A LINE OF CREDIT (SUN TRUST NOTE) THAT FUNDED CONSTRUCTION AND RENOVATION PROJECTS. THE 2009B SERIES BONDS WERE REFINANCED BY THE 2014 BOND ISSUE INCLUDED IN THIS SCHEDULE. AS SUCH, THE 2009B SERIES BONDS HAVE BEEN REMOVED FROM COLUMN B. TOTAL PROCEEDS OF ISSUE THE 2009 BOND ISSUES LISTED IN COLUMNS A & B OF PART I ARE COMBINED ON THE FORM 8038 FILED BY PIEDMONT HOSPITAL. HOWEVER, FOR PURPOSES OF SCHEDULE K REPORTING, PIEDMONT HOSPITAL HAS BROKEN OUT THE BOND ISSUED BASED ON THE AUTHORITY (I.E. FAYETTE OR FULTON) THAT ISSUED THE BONDS. CONSEQUENTLY, THE REPORTING IN COLUMNS A & B WILL NOT TIE TO THE FORM 8038 FILED WITH THE IRS AT THE TIME OF ISSUANCE. A Development Authority of Fulton County 581506878 3599006J1 2014-11-19 23635000 Construction/Purchase of Equipment false false false B Hospital Authority of Fayette County 582629223 31222TAL7 2014-11-19 11420000 Construction/Purchase of Equipment false false false C Development Authority of Fulton County 581506878 2014-11-19 64095000 Refinancing false false false D Hospital Authority of Fayette County 582629223 2014-11-19 30640000 Refinancing false false false A 0 0 25900651 0 0 0 0 0 0 14851300 0 11049351 false false false true B 0 0 12601856 0 0 0 0 0 0 2100000 0 10501856 false false false true C 0 0 64095000 0 0 0 0 0 0 0 64095000 0 true false true true D 0 0 30640000 0 0 0 0 0 0 0 30640000 0 true false true true A false false false false 0 false false false true B false false false false 0 false false false true C false true true true false 0 false false false true D false true true true false 0 false false false true A false true false false true false 0 false 0 false true B false true false false true false 0 false 0 false true C false true false false true false 0 false 0 false true D false true false false true false 0 false 0 false true A true B true C true D true SCHEDULE K, PART IV, LINE 2C: REBATE CALCULATION THE REBATE CALCULATIONS FOR THE 2014 SERIES A DEVELOPMENT AUTHORITY OF FULTON COUNTY REVENUE BOND ISSUE AND HOSPITAL AUTHORITY OF FAYETTE COUNTY REVENUE ANTICIPATION CERTIFICATES WERE 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 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 HOSPITAL, INC. ("PH") FORM 990, PART VI, SECTION A, LINE 7A: ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B: DECISIONS OF GOVERNING BODY PIEDMONT HOSPITALS BOARD POLICIES AND DECISIONS MUST BE FILED, IMMEDIATELY AFTER ADOPTION, WITH THE SECRETARY OF THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS. SUCH POLICIES AND DECISIONS OF THE PIEDMONT 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 HOSPITALS FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATIONS FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PHS 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 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 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, SECTION B, LINE 15A, 15B: EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT 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. 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 $(168,064) RELATED TO TIMING OF REVENUE RECOGNITION; AN INTERCOMPANY TRANSFER OF LIABILITIES OF $(76,257,446); AND NET CHANGES IN RESTRICTED FUNDS OF $(1,423,329). 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SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LIMITED LIABILITY COMPANIES AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK FOR THESE THREE ENTITIES.