2016-05-11T14:54:33-05:00 2015-06-30 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2014-07-01 582081599 DECATUR HEALTH RESOURCES INC DECA 4045011000 450 NORTH CHANDLER STREET DECATUR GA 30033 JOHN KATSIANIS EVP & CFO 4045015025 2016-05-11 1 AMY BIBBY P00445891 8282542254 2014 2016-08-17 19:52:53Z JOHN KATSIANIS 450 NORTH CHANDLER STREET DECATUR GA 30033 18839442 0 X WWW.DEKALBMEDICAL.ORG X 1994 GA TO PROVIDE LONG-TERM ACUTE CARE TO PATIENTS WHO REQUIRE SPECIALIZED, EXPERT CARE AND REHABILITATION. 8 4 0 3 0 0 2621127 2892134 16331308 15947110 291 0 0 198 18952726 18839442 1583274 1098279 0 0 0 11177589 0 0 0 17719665 7845905 19302939 20121773 -350213 -1282331 7185743 6073381 1106318 1273942 6079425 4799439 DECATUR RESOURCES, INC. ("DHR") SPECIALIZES IN THE TREATMENT OF MEDICALLY COMPLEX, CASTROPHICALLY INJURED OR CRITICALLY ILL PATIENTS WHO REQUIRES A LONGER HOSPITAL STAY THAN AT A TRADITIONALLY ACUTE CARE FACILITY, AND WHO REQUIRE SPECIALIZED, EXPERT CARE AND REHABILITATION. 0 0 16814987 1098278 15946802 DHR BEGAN PROVIDING LONG-TERM ACUTE CARE IN 1996 WITH 19 BEDS AND SINCE THEN HAS GROWN TO 44 BEDS, INCLUDING A SIX-BED SPECIAL CARE UNIT. ALL ROOMS ARE PRIVATE, ENSUING THAT PATIENTS EXPERIENCE MAXIUMUM COMFORT DURING THEIR STAY.DHR IS GEORGIA'S FIRST HOSPITAL TO EARN A CENTER FOR EXCELLENCE DESIGNATION AND GOLD SEAL DISEASE-SPECIFIC CERTIFICATION FOR WOUND CARE TREATMENT FROM THE JOINT COMMISSION (2010) - ALSO THE NATION'S FIRST AND ONLY HOSPITAL TO EARN THE JOINT COMMISSION'S GOLD SEAL DISEASE - SPECIFIC CERTIFICATION FOR THE TREATMENT OF PATIENTS ON VENTILATORS WHO ARE DIAGNOSED WITH RESPIRATORY FAILURE. PLEASE SEE SCHEDULE O FOR A CONTINUATION OF PROGRAM SERVICE ACCOMPLISHMENTS. 16814987 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 GA X JOHN KATSIANIS 4045015025 2701 NORTH DECATUR ROAD DECATUR GA 30033 JOHN A SHELTON JR DMC PRESIDENT/CEO 2.00 44.00 X X 0 707128 36730 DAVID JOLLAY CHAIRMAN 2.00 2.50 X X 0 0 0 ROBERT WILSON VICE CHAIRMAN 2.00 4.50 X X 0 0 0 DANIEL THOMPSON JR SECRETARY 2.00 2.50 X X 0 0 0 CHARLES CLIFTON MD TREASURER 2.00 2.50 X X 0 2482 0 MILTON BODEN MD CHIEF OF STAFF- DOWNTOWN DECATUR 2.00 X 0 17080 0 TERRI TENHOOR MD CHIEF OF STAFF- NORTH DECATUR 2.00 42.00 X 0 11666 0 GREGORY LEVETT SR DIRECTOR 2.00 2.50 X 0 0 0 JOHN KATSIANIS DMC EVP & CFO 2.00 44.00 X 0 377050 31124 DANE HENRY DMC COO 2.00 44.00 X 0 364388 32603 0 1479794 100457 0 0 1 0 MORRISON MANAGEMENT PO BOX 102289 ATLANTA GA 303682289 MANAGEMENT SERVICES 177966 G4S SECURE SOLUTIONS LLC PO BOX 277469 ATLANTA GA 303847469 SECURITY SERVICES 144623 SOUTHEASTERN LUNG CARE 2665 NORTH DECATUR ROAD SUITE 430 DECATUR GA 30033 PULMONARY SPECIALIST 132980 3 2892134 2892134 NET PATIENT REVENUE 623000 15946802 15946802 CAFETERIA 722210 276 276 DISCOUNTS EARNED 900099 32 32 15947110 MISCELLANEOUS REVENUE 900009 198 198 198 18839442 15946802 0 506 1098279 1098279 9520147 7616118 1904029 1657442 1325954 331488 1110201 888161 222040 290351 232281 58070 703104 562483 140621 27410 21928 5482 3945 3156 789 28826 23061 5765 1355771 1084617 271154 217014 217014 MEDICAL SUPPLIES 2621233 2621233 REPAIRS & MAINTENANCE 751670 601336 150334 BAD DEBT EXPENSE 446367 446367 MEDICAL PROVIDER TAX 188008 188008 102005 102005 20121773 16814987 3306786 0 870 3140 3787352 3768235 226756 251238 500 7929 24242402 22199563 3011436 2042839 158829 0 7185743 6073381 592627 728816 513691 545126 1106318 1273942 X 6079425 4799439 6079425 4799439 7185743 6073381 X -1282331 2345 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 15150078 13875845 1274233 9088093 8323718 764375 4231 4231 2042839 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 19176 ASSET RETIREMENT OBLIGATION 525950 545126 X PART X, LINE 2: THE SYSTEM, DMC, DHR, AND THE FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. VENTURES IS A TAXABLE ENTITY AND ANNUALLY FILES A CORPORATE TAX RETURN. WITH RESPECT TO ITS FOR-PROFIT ENTITY, AS WELL AS ANY UNRELATED BUSINESS INCOME GENERATED AT THE TAX-EXEMPT ENTITIES, THE SYSTEM RECORDS INCOME TAXES USING THE ASSET AND LIABILITY METHOD UNDER WHICH DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL ACCOUNTING AND TAX BASES OF ASSETS AND LIABILITIES. DEFERRED TAX ASSETS OR LIABILITIES AT THE END OF EACH PERIOD ARE DETERMINED USING THE CURRENTLY ENACTED TAX RATE EXPECTED TO APPLY TO TAXABLE INCOME IN THE PERIOD THAT THE DEFERRED TAX ASSET OR LIABILITY IS EXPECTED TO BE REALIZED OR TO BE SETTLED. THE SYSTEM HAS EVALUATED ITS TAX POSITIONS AND HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF JUNE 30, 2015 AND 2014. FISCAL YEARS ENDED ON OR AFTER JUNE 30, 2012 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. 1 1 X 1 X 1 X 1 0 1 1 2276423 1619496 656927 0.03340 2276423 1619496 656927 0.03340 98 28047 28047 0.00140 98 28047 28047 0.00140 98 2304470 1619496 684974 0.03480 1 179279 5601026 6007148 -406122 X 1 1 1 1 DEKALB MEDICAL AT DOWNTOWN DECATUR 450 NORTH CANDLER STREET DECATUR GA 30030 X LONG-TERM ACUTE CARE DEKALB MEDICAL AT DOWNTOWN DECATUR 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X SEE PART V, SECTION D X 1 12 1 HTTP://WWW.DEKALBMEDICAL.ORG/DOWNTOWN-DECATUR/ABOUT-US/ 0 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X 1 X X X X 1 0 0 X X 0 0 DEKALB MEDICAL AT DOWNTOWN DECATUR PART V, SECTION B, LINE 5: PUBLIC HEALTH PROFESSIONALS FROM THE ROLLINS SCHOOL OF PUBLIC HEALTH AT EMORY UNIVERSITY AGREED TO TAKE THE LEAD IN CONDUCTING A CHNA ON BEHALF OF DEKALB MEDICAL AT DOWNTOWN DECATUR ("DECATUR HOSPITAL"). IN ORDER TO OBTAIN THE COMMUNITY PRIORITIES, IN-DEPTH INTERVIEWS WERE CONDUCTED WITH VARIOUS STAKEHOLDERS. STAKEHOLDERS WERE DEFINED AS INDIVIDUALS, OR GROUPS OF INDIVIDUALS, WHO WERE ACTIVE PARTICIPANTS IN THE TRANSITION OF THE PATIENT TO THE LTAC. THESE INCLUDED THE DISCHARGE PLANNERS, CURRENT PATIENTS, AND PATIENTS' FAMILIES. DISCHARGE PLANNERS FROM TWO OF LTAC'S MAJOR REFERRAL SOURCES - DEKALB MEDICAL CENTER AND EMORY HEALTHCARE WERE INTERVIEWED. DEKALB MEDICAL AT DOWNTOWN DECATUR PART V, SECTION B, LINE 7D: THE HOSPITAL FACILITY'S CHNA IS AVAILABLE TO THE PUBLIC ONLINE AT:HTTP://WWW.DEKALBMEDICAL.ORG/DOWNTOWN-DECATUR/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTPART V, SECTION B, LINE 10A:THE HOSPITAL FACILITY'S IMPLEMENTATION STRATEGY IS AVAILABLE TO THE PUBLIC AT:HTTP://WWW.DEKALBMEDICAL.ORG/DOWNTOWN-DECATUR/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT DEKALB MEDICAL AT DOWNTOWN DECATUR PART V, SECTION B, LINE 11: IN COMPLIANCE WITH 501(R)(C) OF THE INTERNAL REVENUE CODE, ALL THREE HOSPITALS OF THE DEKALB MEDICAL SYSTEM CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION PLAN. THE IMPLEMENTATION PLANS WERE APPROVED BY THE BOARD OF DIRECTORS ON JUNE 10, 2013. THE NEXT FULL CHNAS AND IMPLEMENTATION PLAN ARE DUE IN 2016. SINCE THIS IS THE FIRST YEAR OF THE IMPLEMENTATION PLAN, SOME STRATEGIES HAVE BEEN STARTED, BUT HAVE NOT BEEN IMPLEMENTED LONG ENOUGH TO ASSESS RESULTS. PUBLIC HEALTH PROFESSIONALS FROM THE ROLLINS SCHOOL OF PUBLIC HEALTH AT EMORY UNIVERSITY AGREED TO TAKE THE LEAD IN CONDUCTING A CHNA ON BEHALF OF DEKALB MEDICAL AT DOWNTOWN DECATUR ("DECATUR HOSPITAL"). IN ORDER TO OBTAIN THE COMMUNITY PRIORITIES, IN-DEPTH INTERVIEWS WERE CONDUCTED WITH VARIOUS STAKEHOLDERS. STAKEHOLDERS WERE DEFINED AS INDIVIDUALS, OR GROUPS OF INDIVIDUALS, WHO WERE ACTIVE PARTICIPANTS IN THE TRANSITION OF THE PATIENT TO THE LTAC. THESE INCLUDED THE DISCHARGE PLANNERS, CURRENT PATIENTS, AND PATIENTS' FAMILIES. DISCHARGE PLANNERS FROM TWO OF LTAC'S MAJOR REFERRAL SOURCES - DEKALB MEDICAL CENTER AND EMORY HEALTHCARE WERE INTERVIEWED.BASED ON THE PATIENT AND DISCHARGE PLANNER INTERVIEWS, PRIORITIES WERE IDENTIFIED. THOSE PRIORITIES WERE ANALYZED AND AN IMPLEMENTATION PLAN WITH STRATEGIES IDENTIFIED FOR SELECTED PRIORITIES WAS DEVELOPED. THIS WAS APPROVED BY THE DECATUR HEALTH RESOURCES BOARD OF DIRECTORS IN JUNE 2013.THE IMPLEMENTATION PLAN WAS ACCOMPLISHED BY A TEAM OF DEKALB REGIONAL HEALTH SYSTEM STAFF (INCLUDING STAFF FROM DEKALB MEDICAL AT DOWNTOWN DECATUR) AND PUBLIC HEALTH PROFESSIONALS WHO SPEARHEADED THE DEVELOPMENT OF THE CHNA. THE IMPLEMENTATION PLAN IDENTIFIED AS PRIORITIES (1) THE NEED FOR EDUCATION TOOLS FOR PATIENT TRANSITION FROM LTAC TO HOME CARE, AND USE OF AVAILABLE HEALTH CARE RESOURCES IN THE COMMUNITY INCLUDING LTAC AND (2) THE NEED FOR PROFESSIONAL EDUCATION AND COMMUNICATION TO IMPROVE QUALITY OF CARE AND PATIENT AWARENESS.THE IMPLEMENTATION PLANS WILL HELP GUIDE THE DEKALB SYSTEM HOSPITALS' EFFORTS TOWARDS COMMUNITY HEALTH NEEDS THAT HAVE BEEN IDENTIFIED THROUGH THE CHNAS. ALL THE STRATEGIES IDENTIFIED ARE TO ENHANCE AND IMPROVE THE HEALTH OF THE COMMUNITY AND THE PEOPLE THE HOSPITALS SERVE. DEKALB MEDICAL AT DOWNTOWN DECATUR PART V, SECTION B, LINE 16I: AVAILABILITY OF FAP APPLICATION DISCUSSED DURING THE FINANCIAL COUNSELING PROCESS. DEKALB MEDICAL AT DOWNTOWN DECATUR PART V, SECTION B, LINE 23: THE FAP REQUIRES A COMPLETE WRITE OFF OR ADJUSTMENT OF TOTAL CHARGES OR A PORTION OF CHARGES IF PATIENT IS FAP ELIGIBLE AND IS BASED ON FEDERAL POVERTY GUIDELINES (FPG). DEKALB MEDICAL AT DOWNTOWN DECATUR PART V, SECTION B, LINE 24: THE HOSPITAL CURRENTLY UTILIZES AN AUTOMATIC BILL PROCEDURE WHICH PREPARES THE FIRST BILL AT GROSS CHARGES. DISCOUNTS AND WRITE-OFFS ARE APPLIED AFTER THE FIRST BILL. IN TAX YEAR ENDING JUNE 30, 2015, THE FACILITY BILLED ALL FAP ELIGIBLE PATIENTS AT GROSS BUT COLLECTED LESS THAN GROSS BASED ON FAP AND FPG. PART I, LINE 6A: DECATUR HEALTH RESOURCES, INC. IS INCLUDED IN THE COMMUNITY BENEFIT REPORT PRODUCED BY DEKALB MEDICAL CENTER, INC., A RELATED ENTITY. PART I, LINE 7: A COST-TO-CHARGE RATIO, DERIVED FROM THE SCHEDULE H APPLICABLE WORKSHEETS, INCLUDING WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, WAS USED TO DETERMINE CHARITY CARE. ACTUAL EXPENSE DATA IS ACCUMULATED WITHIN THE GENERAL LEDGER WHICH ADDRESSES ALL PATIENT SEGMENTS INCLUDING INPATIENT, OUTPATIENT, EMERGENCY ROOM, COMMERCIAL INSURANCE, GOVERNMENT INSURANCE, UNINSURED AND SELF-PAY. THE TOTAL OPERATING EXPENSE WAS DIVIDED BY PATIENT REVENUES TO CALCULATE AN OVERALL RATIO THAT WAS THEN APPLIED TO INDIGENT AND CHARITY CARE CHARGES TO ARRIVE AT COST. PART I, LN 7 COL(F): THE BAD DEBT COST ON PART III, LINE 2 IS CALCULATED BY MULTIPLYING TOTAL BAD DEBT EXPENSE BY THE RATIO OF TOTAL OPERATING EXPENSE TO TOTAL GROSS PATIENT CHARGES. PART III, LINE 4: PER THE DEKALB REGIONAL HEALTH SYSTEM, INC. AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS: "THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES, IN THE NORMAL COURSE OF BUSINESS, THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ITS ASSESSMENT OF THESE AND OTHER FACTORS BY PAYOR CATEGORY, AND ADJUSTS THE ALLOWANCE AND RELATED PROVISION ACCORDINGLY. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, MANAGEMENT ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A RELATED PROVISION, IF NECESSARY, FOR PAYORS WITH KNOWN FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL (PATIENT APPORTIONMENT), MANAGEMENT RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.HISTORICAL EXPERIENCE HAS DEMONSTRATED THAT A SIGNIFICANT PORTION OF THE SYSTEM'S UNINSURED OR UNDER-INSURED PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE, ARE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THEREFORE, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS RELATED TO THESE PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. THE SYSTEM DOES NOT MAINTAIN A SIGNIFICANT ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, NOR DOES IT INCUR SIGNIFICANT WRITE-OFFS, RELATED TO THIRD PARTY PAYORS. PART III, LINE 8: MEDICARE ALLOWABLE COST PER THE AS-FILED MEDICARE COST REPORT IS USED TO DETERMINE MEDICARE COSTS. REVENUE RECEIVED FROM MEDICARE INCLUDING CO-PAYS / DEDUCTIBLES FROM THE AS-FILED MEDICARE COST REPORT. PART III, LINE 9B: THE CURRENT BILLING AND COLLECTION POLICY DOES NOT CONTAIN PROVISIONS FOR COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE BUT THE FAP OR "CHARITY POLICY" DOES AS IT OUTLINES THE COMPLETE WRITE OFF OR SLIDING SCALE AMOUNTS FOR WHICH THE INDIVIDUAL WILL BE RESPONSIBLE. PART VI, LINE 2: UNDERSTANDING THAT A HEALTH COMMUNITY IS ABOUT MORE THAN JUST THE ABSENCE OF DEATH AND DISEASE, WE ALSO CONTRIBUTE TO THE ECONOMIC VITALITY AND CREATION OF QUALITY JOBS RIGHT HERE AT HOME. NAMED THE 2010 CORPORATION OF THE YEAR BY THE DEKALB COUNTY CHAMBER OF COMMERCE FOR OUR ROLE AS AN ACTIVE CORPORATE CITIZEN AND PROPONENT OF DIVERSTITY, THE FOLLOWING PROGRAMS HAVE HELPED BUILD THE HEALTH OF OUR COMMUNITY:1) WE HELP REDUCE TEEN PREGNANCY AND SEXUALLY TRANSMITTED DISEASE BY PROVIDING FREE PREVENTION EDUCATION THROUGH OUR PUBERTY ROCKS PROGRAM FOR PRE-TEENS;2) WE SUPPORT 100 BLACK MEN OF DEKALB IN THE EFFORT TO PROVIDE HIGHER EDUCATION TO AT-RISK YOUTH;3) WE PARTNER WITH THE PHYSICIANS'S CARE CLINIC TO PROVIDE NEARLY 2,000 LOW OR NO COST PATIENT VISITS A YEAR INCLUDING LAB WORK AND PRESCRIPTION MEDICATIONS TO AREA LOW-INCOME AND UNINSURED RESIDENTS;4) WE SPONSOR A FREE ANNUAL CANCER SCREENING DAY ON TWO OF OUR HOSPITAL CAMPUSES;5) WE HAVE RECENT HEALTHY WORKPLACE INIATIVES INCLUDE SMOKE-FREE BUILDINGS INSIDE AND OUT, A NO-NICOTINE HIRING POLICY AND ADOPTION OF HEALTHY FOOD OPTIONS IN HOSPITAL CAFETERIAS;6) WE COLLECT AND DONATE SURPLUS MEDICAL SUPPLIES TO MEDSHARE INTERNATIONAL IN SUPPORT OF HEALTH INITIATIVES IN LESS FORTUNATE COUNTRIES;7) WE HAVE AN OPEN MEDICAL STAFF THAT ATTRACTS UNLIMITED, HIGHLY TRAINED MEDICAL TALENT TO SERVE THE AREA;8) WE ARE A MAJOR SPONSOR OF THE LEADERSHIP DEKALB INITIATIVE TO PROMOTE COMMUNITY CONNECTIVITY AND ACTION PLANS FOR ECONOMIC DEVELOPMENT, SUSTAINABILITY AND IMPROVEMENT OF THE QUALITY OF LIFE IN DEKALB COUNTY;9) DEKALB MEDICAL PROVIDES FURTHER ENRICHMENT AND EMPLOYMENT OPPORTUNITIES BY CHAMPIONING WORKPLACE SUCCESS FOR YOUTH AND ADULTS WITH DISABILITIES. PARTNERING WITH THE NATIONALLY RECOGNIZED TOMMY NOBIS CENTER, DEKALB MEDICAL CONTRACTS WITH THE CENTER, DEKALB MEDICAL CONTRACTS WITH THE CENTER TO PROVIDE SWITCHBOARD OPERATORS FOR THE HEALTH SYSTEM;10) WE PARTNER WITH DEKALB COUNTY HIGH SCHOOLS TO PROVIDE MENTALLY AND PHYSICALLY CHALLENGED STUDENTS WITH VOCATIONAL TRAINING AND REAL-LIFE WORK EXPERIENCE IN THE HEALTHCARE INDUSTRY. THE STUDENTS, WHO RECEIVE SCHOOL CREDIT, SERVE AS VOLUNTEERS IN OUR CAFETERIA, LAUNDRY ROOM AND MOTHER-BABY UNITS;11) WE PARTICIPATE IN NUMEROUS CAREER DAYS, ENCOURAGING THE SCIENCE AND MATH EDUCATION THAT'S NEEDED TO PROVIDE COMPETENT HEALTH WORKERS OF THE FUTURE;12) WE SUPPORT A DEKALB WORKFORCE DEVELOPMENT PARTNERSHIP THAT PROVIDES TRAINING PROGRAMS, EDUCATION AND A CLINICAL SITE FOR PATIENT CARE TECHNICIAN CERTIFICATION; AND13) WE MAINTAIN A PARTNERSHIP WITH GEORGIA PERIMETER COLLEGE AND MERCER UNIVERSITY TO PROVIDE CLINICAL ROTATIONS, PRECEPTORSHIPS, EDUCATION AND INSTRUCTION TO GEORGIA'S FUTURE NURSES. PART VI, LINE 3: PATIENTS PROVIDED CARE BY THE HOSPITAL MEET WITH A FINANCIAL COUNSELOR AFTER THEIR CARE IS RENDERED. ELEGIBILITY CRITERIA FOR VARIOUS FINANCIAL ASSISTANCE PROGRAMS IS REVIEWED WITH THE PATIENT INCLUDING CHARITY, MEDICAID, OR OTHER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS. BILLING STATEMENTS RECEIVED BY A PATIENT ADVISE THEM TO CONTACT THE FINANCIAL COUNSELING DEPARTMENT ABOUT THESE PROGRAMS. PART VI, LINE 4: DEKALB REGIONAL HEALTH SYSTEM SERVES THE POPULATION OF DEKALB COUNTY, GA (54% AFRICAN AMERICAN, 35% WHITE, 4% ASIAN) AS WELL AS ROCKDALE AND GWINNETT COUNTIES. THE MEDIAN INCOME OF DEKALB COUNTY IS APPROXIMATELY $51,700 AND ABOUT 17% OF THE COUNTY RESIDENTS LIVE BELOW THE POVERTY LEVEL. APPROXIMATELY 9% OF THE POPULATION IS OVER AGE 65 AND 24% OF THE POPULATION IS UNDER AGE 18. PART VI, LINE 6: DEKALB REGIONAL HEALTH SYSTEM, INC. IS THE PARENT ENTITY WHICH PROVIDES SUPPORT TO DEKALB MEDICAL CENTER, INC., DECATUR HEALTH RESOURCES, INC. AND DEKALB MEDICAL CENTER FOUNDATION, INC. DEKALB MEDICAL CENTER, INC. OPERATES TWO ACUTE CARE HOSPITALS AND A PHYSICIAN PRACTICE NETWORK TO PROVIDE HEALTHCARE SERVICES TO THE RESIDENTS OF DEKALB COUNTY, GEORGIA AND SURROUNDING COUNTIES. DECATUR HEALTH RESOURCES PROVIDES LONG-TERM ACUTE CARE HOSPITAL SERVICES TO PATIENTS WHO NEED ADDITIONAL TIME TO RECOVER FROM SERIOUS ILLNESS. DEKALB MEDICAL CENTER FOUNDATIONS'S MISSION IS TO STRENGTHEN THE LINK BETWEEN DEKALB REGIONAL HEALTH SYSTEM AND THE COMMUNITY IT SERVICES THROUGH COMMUNICATION, EDUCATION, SERVICE AND PHILANTHROPY. PART VI, LINE 7, REPORTS FILED WITH STATES GA 1 DEKALB MEDICAL CENTER INC 2701 NORTH DECATUR ROAD DECATUR GA 30033 581966795 501(C)(3) 1098278 SUPPORT FOR PATIENT CARE 1 PART I, LINE 2: THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. SCHOLARSHIP FUNDS ARE REMITTED TO THE EDUCATIONAL INSTITUTIONS DIRECTLY. FOR OTHER GRANTS, VARIOUS PROCEDURES ARE IN PLACE DEPENDING ON GRANT TYPE, INCLUDING REQUIREMENTS TO SUBMIT APPLICATIONS FOR REVIEW AND APPROVAL. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL. 0 0 0 0 0 0 0 0 0 JOHN A SHELTON JR DMC PRESIDENT/CEO 0 615202 0 55684 0 36242 0 16900 0 19830 0 743858 0 0 JOHN KATSIANIS DMC EVP & CFO 0 353370 0 0 0 23680 0 9100 0 22024 0 408174 0 0 DANE HENRY DMC COO 0 337971 0 0 0 26417 0 9100 0 23503 0 396991 0 0 FORM 990, PART VI, SECTION A, LINE 6 DEKALB REGIONAL HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF DECATUR HEALTH RESOURCES, INC. FORM 990, PART VI, SECTION A, LINE 7A EACH BOARD OF DIRECTORS MEMBER NOMINATED TO THE DECATUR HEALTH RESOURCES, INC. BOARD IS SUBJECT TO APPROVAL BY THE BOARD OF DIRECTORS OF DEKALB REGIONAL HEALTH SYSTEM, INC. IN ACCORDANCE WITH THE DECATUR HEALTH RESOURCES BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B DEKALB REGIONAL HEALTH SYSTEM, INC. MUST APPROVE CAPITAL EXPENDITURES IN EXCESS OF $2,000,000, ACQUISITIONS, REORGANIZATIONS, MERGERS AND/OR CONSOLIDATIONS, BUDGETS AND ANY REVISIONS AND REVISIONS OF THE ARTICLES OF INCORPORATION FOR DECATUR HEALTH RESOURCES, INC. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PREPARED BY AN UNRELATED, INDEPENDENT ACCOUNTING FIRM AND SUBMITTED TO THE AUDIT COMMITTEE OF THE DEKALB REGIONAL HEALTH SYSTEM, INC. BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL PRIOR TO FILING. A COPY OF FORM 990 IS ALSO PROVIDED TO THE DECATUR HEALTH RESOURCES, INC. BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ALL OFFICERS, DIRECTORS, AND INDIVIDUALS IN MANAGEMENT LEVEL POSITIONS TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. THESE CONFLICT OF INTEREST DISCLOSURES ARE REVIEWED BY THE ORGANIZATION'S GENERAL COUNSEL TO ASSURE COMPLIANCE WITH THE POLICY. ADDITIONALLY, BOARD MEMBERS ARE ASKED TO RECUSE THEMSELVES ON ANY MATTERS OF INTEREST BEFORE THE BOARD IN WHICH A CONFLICT OF INTEREST MAY EXIST. ANY RECUSAL IS DOCUMENTED WITHIN THE MINUTES OF THE BOARD OR COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15B ALL OFFICERS ARE COMPENSATED BY DEKALB MEDICAL CENTER, INC., A RELATED ENTITY. COMPENSATION IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE DEKALB REGIONAL HEALTH SYSTEM, INC. BOARD OF DIRECTORS. THE COMMITTEE UTILIZES AN INDEPENDENT CONSULTANT TO ASSIST IN SETTING COMPENSATION LEVELS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. ANY WRITTEN REQUEST FROM THE PUBLIC TO VIEW THESE DOCUMENTS WOULD BE REVIEWED AND ACTED UPON BY THE ORGANIZATION'S BOARD OF DIRECTORS. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS 2,345. PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. DEKALB MEDICAL CENTER INC 2701 NORTH DECATUR ROAD DECATUR GA 30033 581966795 ACUTE CARE HOSITAL GA 501(C)(3) LINE 3 DEKALB REGIONAL HEALTH SYSTEM INC 0 DEKALB REGIONAL HEALTH SYSTEM INC 2701 NORTH DECATUR ROAD DECATUR GA 30033 582034958 SUPPORT OF DMC, INC. & DHR, INC. GA 501(C)(3) LINE 11B, II N/A 0 DEKALB MEDICAL CENTER FOUNDATION INC 2701 NORTH DECATUR ROAD DECATUR GA 30033 581924605 FUNDRAISING ON BEHALF OF DMC, INC. GA 501(C)(3) LINE 11A, I DEKALB REGIONAL HEALTH SYSTEM INC 0 DRHS VENTURES INC 2701 NORTH DECATUR ROAD DECATUR GA 30033 201864828 JOINT VENTURE GA N/A C 0 0 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0