2016-05-16T13:33:12-05:00 2015-06-30 KPMG LLP 300 NORTH GREENE STREET SUITE 400 GREENSBORO NC 27401 990 2014-07-01 580566213 Piedmont Hospital Inc % MARIE GAFFNEY PIED 4044251303 1968 PEACHTREE ROAD NW ATLANTA GA 30309 TERESA L WILSON VP Corporate Finance 2016-05-12 SHAWN M HUTCHINSON P01048557 3362753394 2014 2016-12-15 16:53:06Z DR PATRICK BATTEY 1968 PEACHTREE ROAD NW ATLANTA GA 30309 917283528 false X WWW.PIEDMONTHOSPITAL.ORG X 1905 GA SEE PART III 15 8 3979 400 4617870 -213133 2458191 2389881 800870088 864240416 1187502 794606 11753608 12974850 816269389 880399753 189449 142498 0 0 267334929 277982656 0 0 0 525146253 531167511 792670631 809292665 23598758 71107088 4703096865 993021220 4061143241 623643531 641953624 369377689 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 692727585 142498 857382086 PIEDMONT HOSPITAL ("PH") IS A 488-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, 2015, THE HOSPITAL HAD 27,321 IN-PATIENT ADMISSIONS WITH A TOTAL OF 143,045 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 50,211 AND OUTPATIENT VISITS TOTALED 291,549. SURGICAL SERVICES WERE PROVIDED TO 22,123 PATIENTS. 692727585 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 false 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 3979 true true true false false false false false false false false false X 15 8 false false false false true true true true true false false false true true true true true true true false GA X MARIE GAFFNEY 6788426007 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 Dr Carol T Aitcheson Board member 1.0 39.0 X 0 664126 34353 Dr Letha Yurko Griffin Board member 1.0 0.0 X 0 0 0 Mr Gary T Jones Board member 1.0 0.0 X 0 0 0 Dr Bryant Wilson Board Member 1.0 38.0 X 0 555320 51079 Dr JULIET ASHER Board member 1.0 39.0 X 0 167484 17951 Mr Shouky Shaheen Board member 1.0 0.0 X 0 0 0 Dr Patrick M Battey Board Member 1.0 39.0 X 0 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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. 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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 HOSPITAL'S MOST RECENT CHNA WAS CONDUCTED IN PARTNERSHIP WITH THE HAYSLETT GROUP, THE LEAD CONVENER OF GEORGIA'S PARTNER UP FOR PUBLIC HEALTH CAMPAIGN. THE OVERALL HEALTH NEEDS ASSESSMENT EFFORT WAS LED BY THE PIEDMONT HEALTHCARE COMMUNITY BENEFITS TEAM, AND ASSISTED BY COMMUNITY HEALTH ADVISORS (FOR STAKEHOLDER INTERVIEWS). STAKEHOLDERS WERE CONTINUALLY ENGAGED DURING THIS PROCESS, WITH A PARTICULAR FOCUS ON THOSE GROUPS, ORGANIZATIONS, AND INDIVIDUALS REPRESENTING THE MOST VULNERABLE MEMBERS OF THE HOSPITAL'S 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 TWO 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 PROCESS, INCLUDING THE IDENTIFICATION OF KEY HEALTH PRIORITIES AND DEVELOPMENT OF IMPLEMENTATION PLAN STRATEGIES. SCHEDULE H, PART V, SECTION C, LINE 7D: PUBLIC AVAILABILITY OF CHNA IN ADDITION TO MAKING ITS CHNA AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT HOSPITAL SENT A COPY TO EACH PARTICIPANT IN THE CHNA (ABOUT 200 PEOPLE), DISTRIBUTED THE ASSESSMENT TO COMMUNITY CENTERS AND OTHER LOCATIONS THAT PRIMARILY SERVE AN UNINSURED POPULATION, SENT A COPY TO LEGISLATIVE AND ELECTED OFFICIALS, AND WIDELY DISTRIBUTED THE ASSESSMENT TO OTHER PIEDMONT HEALTHCARE HOSPITALS. SCHEDULE H, PART V, SECTION C, LINE 11 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. OTHER KEY HEALTH ISSUES EMERGED DURING THE FY13 CHNA THAT WERE NOT THE FOCUS OF THE IMPLEMENTATION PLAN FOR FY14 THROUGH FY16. THESE ISSUES INCLUDED MENTAL HEALTH, VIOLENT CRIME, AND HIV/AIDS/STDS. WITH RESPECT TO MENTAL HEALTH, THE HOSPITAL DID NOT HAVE THE RESOURCES TO MAKE A MEANINGFUL IMPACT ON THE ISSUE AS PIEDMONT HOSPITAL DOES NOT PROVIDE MENTAL HEALTH SERVICES IN-HOUSE. FURTHER, AS A HEALTHCARE PROVIDER, PIEDMONT HOSPITAL IS UNABLE TO SIGNIFICANTLY REDUCE THE OCCURRENCE OF VIOLENCE IN THE COMMUNITY. HOWEVER, THE HOSPITAL WILL CONTINUE TO SUPPORT AWARENESS AND EXPLORE COMMUNITY-BASED PARTNERSHIPS AROUND THESE TWO ISSUES. FINALLY, WHILE PIEDMONT HOSPITAL DID NOT ELECT TO FOCUS ON HIV/AIDS/STDS IN ITS IMPLEMENTATION, IT WILL CONTINUE TO PROVIDE CARE AND SUPPORT TO THOSE PATIENTS WITH THESE HEALTH CONDITIONS AND WILL EXPLORE ADDITIONAL OPPORTUNITIES FOR COMMUNITY-BASED PARTNERSHIPS AROUND PREVENTION. 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, INC'S (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 $809,292,666, LESS BAD DEBT EXPENSE OF $49,327,505 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 ORGANIZATION'S 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 MANAGEMENT'S 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. PHC'S 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 HOSPITAL'S 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 20.57 PERCENT OF PH'S PATIENT SERVICE REVENUE. PH'S POLICY IS TO TREAT MEDICARE PATIENTS, REGARDLESS OF THE EXTENT TO WHICH MEDICARE ACTUALLY PAYS FOR THE TREATMENT. FOR MANY SERVICES, MEDICARE'S REIMBURSEMENT IS LESS THAN THE COST OF THE CARE PROVIDED, RESULTING IN SHORTFALLS THAT ARE TO BE ABSORBED BY THE HOSPITAL IN HONOR OF PH'S 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. COMMUNITY REPRESENTATION SCHEDULE H, PART V, LINE 5 PIEDMONT HOSPITAL'S MOST RECENT CHNA WAS CONDUCTED IN PARTNERSHIP WITH THE HAYSLETT GROUP, THE LEAD CONVENER OF GEORGIA'S PARTNER UP FOR PUBLIC HEALTH CAMPAIGN. THE OVERALL HEALTH NEEDS ASSESSMENT EFFORT WAS LED BY THE PIEDMONT HEALTHCARE COMMUNITY BENEFITS TEAM, AND ASSISTED BY COMMUNITY HEALTH ADVISORS (FOR STAKEHOLDER INTERVIEWS). STAKEHOLDERS WERE CONTINUALLY ENGAGED DURING THIS PROCESS, WITH A PARTICULAR FOCUS ON THOSE GROUPS, ORGANIZATIONS, AND INDIVIDUALS REPRESENTING THE MOST VULNERABLE MEMBERS OF THE HOSPITAL'S 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 TWO 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 PROCESS, INCLUDING THE IDENTIFICATION OF KEY HEALTH PRIORITIES AND DEVELOPMENT OF IMPLEMENTATION PLAN STRATEGIES. PUBLIC AVAILABILITY OF CHNA SCHEDULE H, PART V, LINE 7D IN ADDITION TO MAKING ITS CHNA AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT HOSPITAL SENT A COPY TO EACH PARTICIPANT IN THE CHNA (ABOUT 200 PEOPLE), DISTRIBUTED THE ASSESSMENT TO COMMUNITY CENTERS AND OTHER LOCATIONS THAT PRIMARILY SERVE AN UNINSURED POPULATION, SENT A COPY TO LEGISLATIVE AND ELECTED OFFICIALS, AND WIDELY DISTRIBUTED THE ASSESSMENT TO OTHER PIEDMONT HEALTHCARE HOSPITALS. ADDRESSING COMMUNITY HEALTH NEEDS SCHEDULE H, PART V, LINE 11 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. OTHER KEY HEALTH ISSUES EMERGED DURING THE FY13 CHNA THAT WERE NOT THE FOCUS OF THE IMPLEMENTATION PLAN FOR FY14 THROUGH FY16. THESE ISSUES INCLUDED MENTAL HEALTH, VIOLENT CRIME, AND HIV/AIDS/STDS. WITH SCHEDULE H, PART VI, LINE 2: NEEDS ASSESSMENT DURING FISCAL YEAR 2013, PIEDMONT HOSPITAL CONDUCTED AND RATIFIED A FORMAL NEEDS ASSESSMENT AND IMPLEMENTATION PLAN. THE ASSESSMENT BEGAN WITH A REVIEW OF PUBLICLY AVAILABLE HEALTH AND SOCIOECONOMIC DATA THAT WAS THEN COMPILED AND ANALYZED BY THE HAYSLETT GROUP, THE LEAD CONVENER OF GEORGIA'S PARTNER UP FOR PUBLIC HEALTH CAMPAIGN. THE OVERALL HEALTH NEEDS ASSESSMENT EFFORT WAS LED BY THE PIEDMONT HEALTHCARE COMMUNITY BENEFITS TEAM, AND ASSISTED BY COMMUNITY HEALTH ADVISORS (FOR STAKEHOLDER INTERVIEWS). STAKEHOLDERS WERE CONTINUALLY ENGAGED DURING THIS PROCESS, WITH A PARTICULAR FOCUS ON THOSE GROUPS, ORGANIZATIONS, AND INDIVIDUALS REPRESENTING THE MOST VULNERABLE MEMBERS OF THE HOSPITAL'S 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 TWO 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 PROCESS, INCLUDING THE IDENTIFICATION OF KEY HEALTH PRIORITIES AND DEVELOPMENT OF IMPLEMENTATION PLAN STRATEGIES. THE PIEDMONT HOSPITAL BOARD OF DIRECTORS APPROVED THIS COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN TO ADDRESS IDENTIFIED HEALTH ISSUES ON MAY 21, 2013. DURING FISCAL YEAR 2015, PIEDMONT HOSPITAL CREATED A COMMUNITY BENEFIT-SPECIFIC ANNUAL REPORT AVAILABLE TO THE PUBLIC THAT HIGHLIGHTED ITS PROGRESS ON THE FY13 CHNA IMPLEMENTATION PLAN PRIORITIES AND ACTION ITEMS. THIS REPORT ALSO INCLUDED INFORMATION ON THE HOSPITAL'S COMMUNITY PARTNERS AND STAKEHOLDERS, AND UPDATED COMMUNITY HEALTH DATA AND STATISTICS FOR EACH OF ITS SERVICE COMMUNITIES. 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. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION PIEDMONT HOSPITAL IS LOCATED IN FULTON COUNTY. IN 2015, APPROXIMATELY 984,293 PEOPLE LIVED IN FULTON COUNTY AND ABOUT 26 PERCENT OF ADULTS WERE UNINSURED. APPROXIMATELY 14 PERCENT OF THE OVERALL ADULT POPULATION IN FULTON COUNTY REPORTED THAT IT WAS UNABLE TO SEE A DOCTOR IN 2015 DUE TO COST, AND 11 PERCENT REPORTED IT WAS IN POOR OR FAIR HEALTH, WHICH IS LOWER THAN THE STATE AVERAGE OF 16 PERCENT. THERE WAS ONE PRIMARY CARE DOCTOR FOR EVERY 1,014 RESIDENTS IN FULTON COUNTY. NEARLY EIGHT PERCENT OF ADULT RESIDENTS HAVE BEEN DIAGNOSED WITH DIABETES, WHICH IS LOWER THAN GEORGIA'S AVERAGE OF 11 PERCENT. APPROXIMATELY 17.6 PERCENT OF ADULTS AND 26 PERCENT OF CHILDREN IN FULTON COUNTY LIVE BELOW THE POVERTY LEVEL. IN BOTH FULTON COUNTY AND THE STATE OF GEORGIA, APPROXIMATELY 50 PERCENT OF CHILDREN QUALIFY FOR FREE LUNCH. THE UNEMPLOYMENT RATE IN FULTON IS 8.6 PERCENT, WHICH IS ABOVE THE STATE RATE OF 8.2 PERCENT. FULTON COUNTY HAS A HIGH SCHOOL GRADUATION RATE OF 90.4 PERCENT, WHICH IS HIGHER THAN GEORGIA'S AVERAGE OF 84.7 PERCENT. VIOLENCE IS A SIGNIFICANT ISSUE IN FULTON COUNTY, WHERE CRIME RATES SOAR ABOVE BOTH STATE AND NATIONAL BENCHMARKS. IN 2015, THERE WERE 856 VIOLENT CRIME INCIDENTS PER EVERY 100,000 RESIDENTS, WHICH IS MORE THAN DOUBLE THE STATE AVERAGE. MENTAL HEALTH IS ALSO AN ISSUE IN FULTON COUNTY. THERE IS ONLY ONE MENTAL HEALTH PROVIDER FOR EVERY 528 COUNTY RESIDENTS AND FULTON RESIDENTS REPORT AN AVERAGE OF 2.7 "POOR MENTAL HEALTH DAYS IN A GIVEN MONTH". 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 ABOUT SIX PERCENT OF FULTON COUNTY'S POPULATION DOES NOT LIVE WITHIN CLOSE PROXIMITY OF A GROCERY STORE THAT SELLS FRESH FRUIT AND VEGETABLES, AND APPROXIMATELY HALF OF THE COUNTY'S RESTAURANTS ARE FAST FOOD ESTABLISHMENTS. 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 2015, PIEDMONT ATLANTA INCREASED ITS NUMBER OF PRIMARY COMMUNITY BENEFIT PROGRAMS BY 36 PERCENT. SOME OF THE HOSPITAL'S PROGRAMS INCLUDED: 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 A NEW COMMUNITY WALKING PROGRAM CALLED WALK WITH A DOC, IN PARTNERSHIP WITH THE ATLANTA BELTLINE; FACILITATING COMMUNITY EDUCATION PROGRAMMING AROUND NUTRITION, INCLUDING A TWO-PART GROCERY SHOPPING EDUCATION PROGRAM AT THE CENTER FOR BLACK WOMEN'S WELLNESS; THE OPERATION OF PIEDMONT'S CANCER WELLNESS CENTER, WHICH PROVIDED A BROAD SPECTRUM OF COMPREHENSIVE, INDIVIDUAL SUPPORT AND CARE; IMPLEMENTING 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 PIEDMONT'S 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 CREATING A LOW-INCOME PATIENT COMMUNITY RESOURCE GUIDE 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 2015, THE PIEDMONT HEALTHCARE SYSTEM INCLUDED FIVE 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 HOSPITAL'S SOLE MEMBER. THE SYSTEM'S FIVE HOSPITALS ARE PIEDMONT HOSPITAL, A 488-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; AND PIEDMONT HENRY HOSPITAL, A 215-BED ACUTE-CARE COMMUNITY HOSPITAL IN STOCKBRIDGE. 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 TUITION REIMBURSEMENT 60 139898 SCHEDULE I, PART I, LINE 2: MONITORING THE USE OF GRANT FUNDS TUITION REIMBURSEMENT: THE ORGANIZATION'S 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 APPLICANT'S 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 ORGANIZATION'S 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 0 450387 0 275624 0 250458 0 268619 0 14576 0 1259664 0 0 Dr Carol T Aitcheson Board member 0 647892 0 0 0 16234 0 10400 0 23953 0 698479 0 0 Dr Bryant Wilson Board Member 0 521947 0 0 0 33373 0 33400 0 17679 0 606399 0 0 Dr JULIET ASHER Board member 0 164372 0 0 0 3112 0 6493 0 11458 0 185435 0 0 Mr Thomas Arnold CFO 321878 0 77881 0 38901 0 142769 0 18403 0 599832 0 0 0 Dr Patrick M Battey Board Member 0 398559 0 0 0 7563 0 10400 0 15153 0 431675 0 0 Mr Leslie A Donahue President and CEO 556248 0 165919 0 281588 0 472060 0 14897 0 1490712 0 0 0 Dr Adrian Douglass Board Member 0 376049 0 0 0 5083 0 10400 0 16417 0 407949 0 0 Dr William Knopf FORMER Chief Operating Officer 0 0 0 0 850000 0 0 0 0 0 850000 0 0 0 Ms GABRIELLA WHEELER DIRECTOR OF TRANSPLANT LAB 194442 0 11960 0 298 0 8004 0 15490 0 230194 0 0 0 Mr Jay D Mitchell Secretary 0 436573 0 266765 0 35961 0 210888 0 18401 0 968588 0 0 Mr Jyoti Prempeh VP of Clinical Support Svcs 182780 0 27885 0 746 0 7211 0 10850 0 229472 0 0 0 Mr Mark Cohen Chief Quality Officer 442823 0 75376 0 46035 0 45113 0 12484 0 621831 0 0 0 Mr Paul Herd Medical Director 220800 0 0 0 0 0 4123 0 0 0 224923 0 0 0 Ms Debbie Gramling Former Secretary 0 77032 0 0 0 82747 0 1699 0 4471 0 165949 0 0 Ms Denise Ray Former Chief Operating Officer 0 347019 0 186327 0 43723 0 157013 0 13931 0 748013 0 0 MR EDWARD LOVERN COO AS OF 07/28/13 424915 0 123901 0 34539 0 203956 0 11735 0 799046 0 0 0 Ms Kelly Hulsey Chief Nursing Officer 186430 0 32700 0 18022 0 4152 0 10591 0 251895 0 0 0 SCHEDULE J, PART I, LINE 1A: OTHER COMPENSATION ITEMS THE FOLLOWING EMPLOYEES EACH RECEIVED A DISCRETIONARY SPENDING ACCOUNT IN THE FIXED AMOUNT OF $11,769. SPENDING ACCOUNTS WERE INCLUDED IN THE EMPLOYEES' TAXABLE WAGES: LESLIE DONAHUE EDWARD LOVERN THOMAS ARNOLD 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 DEBBIE GRAMLING AND WILLIAM KNOPF RECEIVED SEVERANCE PAYMENTS TOTALING $78,593 AND $850,000, RESPECTIVELY, DURING CALENDAR YEAR 2014. SCHEDULE J, PART I, LINE 4B: SUPPLEMENTAL COMPENSATION INFORMATION LES DONAHUE AND CHARLIE HALL RECEIVED PAYMENTS TOTALING $189,801 AND $214,686, RESPECTIVELY, FROM THEIR SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: JAY MITCHELL THOMAS ARNOLD MARK COHEN EDWARD LOVERN 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 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 SCHEDULE K, PART I, LINE A 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 K. AS SUCH, THE 2009B SERIES BONDS HAVE BEEN REMOVED FROM COLUMN A. HOSPITAL AUTHORITY OF FAYETTE COUNTY BONDS ISSUED 11/24/2009 SCHEDULE K, PART 1, LINE B 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 SCHEDULE K, PART II, LINE 3, COLUMNS A & B 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 0.00000 0.00000 0.00000 false false false true B false false false false 0.00000 0.00000 0.00000 false false false true C false true true true false 0.00000 0.00000 0.00000 false false false true D false true true true false 0.00000 0.00000 0.00000 false false false true A false true 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 FORM 990, PART V, LINE 1A: NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2014 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 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 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 HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PH'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S TAX DIRECTOR AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. PRIOR TO FILING, COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., THE ORGANIZATION'S 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 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 HOSPITAL IS SET BY THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC. THE PIEDMONT HEALTHCARE, INC., BOARD OF DIRECTOR'S 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 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 $(2,495,445) RELATED TO TIMING OF REVENUE RECOGNITION; AN INTERCOMPANY TRANSFER OF LIABILITIES OF $(340,200,411); AND NET CHANGES IN RESTRICTED FUNDS OF $739,034. CTMR MANAGEMENT LLC 1968 PEACHTREE RD NW ATLANTA GA 30309 MEDICAL GA 0 0 PH PCL-II LLC 1968 PEACHTREE RD NW ATLANTA GA 30309 MEDICAL GA 0 0 PH PIEDMONT WEST AMBULATORY SURGERY CENTER 1800 Howell Mill Rd Ste 200 ATLANTA GA 30318 264422348 SURGERY GA -821385 5405594 PH Piedmont Healthcare INC 1800 HOWELL MILL ROAD SUITE 850 Atlanta GA 30318 581503902 HC Management GA 501(C)(3) 11 C NA false FAYETTE COMMUNITY HOSPITAL INC 1255 HIGHWAY 154 WEST FAYETTEVILLE GA 30214 582232328 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT MOUNTAINSIDE HOSPITAL INC 1266 HIGHWAY 515 SOUTH JASPER GA 30143 352228583 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT NEWNAN HOSPITAL INC 745 POPLAR ROAD NEWNAN GA 30265 205077249 HOSPITAL GA 501(C)(3) 3 PHC false PIEDMONT HEALTHCARE FOUNDATION INC 2001 PEACHTREE ROAD NE SUITE 400 ATLANTA GA 30309 581272768 FUNDRAISING GA 501(C)(3) 11 B PHC false PIEDMONT HEART INSTITUTE INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 263553500 HEALTHCARE GA 501(C)(3) 7 PHC false PIEDMONT HENRY HOSPITAL INC 1133 EAGLES LANDING PARKWAY STOCKBRIDGE GA 30281 582200195 Hospital GA 501(C)(3) 3 PHC false HENRY DEVELOPMENT VENTURES INC 1133 EAGLES LANDING PKWY Stockbridge GA 30281 582200734 RE Holding GA 501(C)(2) N/A PHH false CENTER FOR HEALTH AND LEARNING INC 3001 MERCER UNIVERSITY DRIVE ATLANTA GA 30341 262442849 EDUCATION GA 501(C)(3) 11 A NA false Peachtree OrthopAedic Surgery Center 2001 Peachtree Road NE Suite 705 Atlanta GA 30309 582562721 SURGERY GA NA RELATED 812512 746486 false 0 false 0.15000 Digestive Healthcare of Georgia 95 Collier Road NW suite 4075 Atlanta GA 303091721 582406657 HEALTHCARE GA NA RELATED 386686 173677 false 0 false 0.15000 HENRY RADIATION ONCOLOGY CENTER LLC 275 PROFESSIONAL COURT SUITE A STOCKBRIDGE GA 30281 582200195 HEALTHCARE GA NA N/A 0 0 0 0.00000 PIEDMONT MEDICAL CARE CORPORATION 2727 PACES FERRY RD SUITE 1-1100 ATLANTA GA 30339 582092768 HEALTHCARE GA NA C-CORP 0 0 0.00000 false THE PIEDMONT CLINIC INC 2727 PACES FERRY ROAD SUITE 1-1100 ATLANTA GA 30339 582005358 HEALTHCARE GA NA C-CORP 0 0 0.00000 false PIEDMONT HEART INSTITUTE PHYSICIANS INC 95 COLLIER ROAD NW STE 2045 ATLANTA GA 30309 260593850 HEALTHCARE GA NA C-CORP 0 0 0.00000 false AMSTER MCRAE INSURANCE COMPANY PO BOX 1159 GRAND CAYMAN GRAND CAYMAN CJ KY1-1102 980427603 Related INSURANCE CJ NA C-CORP 0 0 0.00000 false PIEDMONT WELLSTAR HEALTHPLANS INC 2859 PACES FERRY ROAD SUITE 600 ATLANTA GA 30339 461922499 HEALTH INSURANCE GA NA C-CORP 0 0 0.00000 false false false false false false false false false true false false false false false true true false false SCHEDULE R, PART I, LINE 1: DISREGARDED ENTITIES CTMR MANAGEMENT, LLC, AND PCL-II, LLC, OPERATE AS DEPARTMENTS OF PIEDMONT HOSPITAL AND ARE INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. 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 TWO ENTITIES.