2015-05-15T13:04:52-05:00 2014-06-30 KPMG LLP 300 NORTH GREENE STREET SUITE 400 GREENSBORO NC 27401 990 2013-07-01 582200195 Piedmont Henry Hospital Inc % MARIE GAFFNEY PIED 6786041001 1133 Eagles Landing Parkway Suite Stockbridge GA 30281 CHARLIE HALL Treasurer 2015-05-13 SHAWN M HUTCHINSON P01048557 2013 2016-03-07 17:11:31Z Charles Scott 1133 Eagles Landing Parkway Stockbridge GA 30281 247835267 false X www.piedmonthenry.org X 1995 GA SEE PART III 12 8 1716 157 0 665469 131055 224201894 246573195 -7788 -176455 1618428 1270842 226478003 247798637 73645 77098 0 0 86371495 81381356 0 0 0 137773002 154364360 224218142 235822814 2259861 11975823 257030689 393195595 171603601 295796141 85427088 97399454 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 206546072 77098 246599755 PIEDMONT HENRY HOSPITAL ("PHH") IS A 215-BED FACILITY LOCATED IN THE CITY OF STOCKBRIDGE IN HENRY COUNTY, GEORGIA. OVER 400 PRIMARY CARE AND SPECIALTY PHYSICIANS ON THE MEDICAL STAFF MEET THE PROFESSIONAL CLINICAL NEEDS OF CHILDREN, ADULTS, AND SENIORS WITHIN STOCKBRIDGE AND THE GREATER METROPOLITAN ATLANTA MARKET, REGARDLESS OF ANY INDIVIDUAL'S ABILITY TO PAY FOR SERVICES. FOR THE YEAR ENDED JUNE 30, 2014, THE HOSPITAL HAD 12,363 IN-PATIENT ADMISSIONS WITH A TOTAL OF 55,557 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 79,451 AND OUTPATIENT VISITS TOTALED 62,023. SURGICAL SERVICES WERE PROVIDED TO 9,114 PATIENTS. 206546072 true true false false false false false false false false true false false true 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 true false false false true X 0 0 true 1716 true false false false false false false false false false false X 12 8 false false false false true true false true true false false false true true true true true true true true true GA X MARIE GAFFNEY 6788426007 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 Dr Todd Schmidt Board Member/On-Call Physician 4.0 1.0 X 32250 10810 0 DR COLLYN STEELE BOARD MEMBER 1.0 0.0 X 0 0 0 Mr Gregory A Hurst Chairman 1.0 54.0 X X 0 1463938 498020 Mr Charles Scott President & CEO 54.0 1.0 X X 0 479118 88346 Dr Gopal C Rao Board Member 1.0 0.0 X 0 0 0 Mr Charles J Jeff Mills Board Member 1.0 2.0 X 0 0 0 Ms Joyce Rodgers Board Member 1.0 0.0 X 0 0 0 MS JUNE WOOD Board Member 1.0 0.0 X 0 0 0 Ms Sheryl M Simpson-Jones Board Member 1.0 0.0 X 0 0 0 Mr Steve Kay Board Member 1.0 0.0 X 0 0 0 Mr Thomas Arnold Board Member 1.0 54.0 X 0 406055 78170 DR WILLIAM OSBORNE BOARD MEMBER 1.0 1.0 X 0 0 0 Mr Charlie Hall Treasurer 1.0 54.0 X 0 1256584 175391 Mr Jay D Mitchell Secretary 1.0 54.0 X 0 593701 111333 Mr Jeffrey A Cooper VP of Operations 55.0 0.0 X 0 250509 17279 MS SHERRY HENDERSON CHIEF FINANCIAL OFFICER 55.0 0.0 X 0 188532 3209 Ms Yveta Seise Clinical Coordinator 55.0 0.0 X 141210 0 11775 Mr Walter P Evans FINANCE DIRECTOR 55.0 0.0 X 144910 0 7441 Ms BARBARA RAINONE SR. DIR. OF CLINICAL SERVICES 55.0 0.0 X 139145 0 10294 MR CONRAD ROBINSON PHARMACY OPERATIONS MANAGER 55.0 0.0 X 137294 0 7560 Ms Mykeesha C Fowler Director of Pharmacy 55.0 0.0 X 150909 0 1580 Dr Ronnie Brownsworth FORMER Board Member 0.0 55.0 X 0 680408 119108 Ms Karen A Kiel FORMER Chief Nursing Officer 0.0 0.0 X 0 303796 5895 745718 5633451 1135401 37 true true false HOSPITAL MEDICINE ASSOCIATES LLC PO Box 634850 CINCINNATI OH 452634850 HOSPITALIST SERVICES 756877 OWENS AND MINOR 3375 COBB INTERNATIONAL BLVD NW KENNESAW GA 30152 LOGISTICS 351391 WORKFORCE CAPITAL PO BOX 823461 PHILADELPHIA PA 191823461 STAFFING 222070 ALLIANCE LAUNDRY TEXTILE SERVICES 7990 SECOND FLAGS DRIVE STE A AUSTELL GA 30168 Laundry Services 452735 EAGLES LANDING OB-GYN 350 COUNTRY CLUB DRIVE STE D STOCKBRIDGE GA 30281 MEDICAL SERVICES 200000 14 52721 78334 131055 PATIENT SERVICE REVENUE 621110 246265422 246265422 MANAGEMENT FEE REVENUE 900099 235430 235430 OTHER OPERATING REVENUE 900099 72343 72343 246573195 -162374 -162374 0 0 618343 18729 599614 0 599614 599614 3820 17901 -14081 -14081 -14081 0 0 0 CAFETERIA REVENUE 900099 644668 644668 NUTRITION & HEALTH 900099 21000 21000 OTHER REVENUE 900099 5560 5560 671228 247798637 246599755 1067827 25235 25235 51863 51863 0 0 0 0 68778346 59118106 9660240 8528 7330 1198 8071226 6937593 1133633 4523256 3887948 635308 396439 396439 173258 173258 0 0 0 0 15615332 10445975 5169357 581749 389165 192584 8335366 8272135 63231 2116439 2100384 16055 0 3401111 3125281 275830 34763 21730 13033 0 0 7528181 7528181 9230717 9230717 11146274 10242311 903963 2583079 189184 2393895 BAD DEBT EXPENSE 53772438 53772438 MEDICAL SUPPLIES & DRUGS 35521199 35521199 HOSPITAL TAX 2041792 2041792 MISCELLANEOUS EXPENSES 1886223 1165686 720537 235822814 206546072 29276742 0 154691 868452 0 0 0 23042 21350910 27240648 0 0 0 0 0 0 3777281 3715889 724050 618517 189484548 29715771 165707479 159768777 1849940 1853565 0 0 2352873 0 0 1375301 61113465 197731404 257030689 393195595 35300629 25595456 0 0 0 0 60073741 59381857 0 0 0 0 2956396 1591226 0 0 73272835 209227602 171603601 295796141 X 85138345 96948708 288743 450746 0 0 85427088 97399454 257030689 393195595 X 11975823 500 -3957 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12160000 12160000 139522815 10640880 128881935 1421910 422019 999891 36276133 18652872 17623261 103690 0 103690 159768777 DUE FROM RELATED PARTIES 197224967 BOND ISSUE COSTS 370998 OTHER ASSETS 135439 197731404 0 DUE TO RELATED PARTIES 208501257 OTHER LIABILITIES 726345 209227602 X SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE (FKA FIN 48) PHC ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF THE INCOME TAXES TOPIC OF THE ASC (ASC 740). UNDER THE REQUIREMENTS OF ASC 740, TAX-EXEMPT ORGANIZATIONS MAY BE REQUIRED TO RECORD AN OBLIGATION AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS TAX EXPOSURE ITEMS. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT JUNE 30, 2014 AND 2013. true true X true X true X true true false true true 3697060 0 3697060 0.02030 21994880 23610600 -1615720 2022046 1609691 412355 0.00230 27713986 25220291 2493695 0.02260 58777 0 58777 0.00030 477968 0 477968 0.00260 56780 0 56780 0.00030 5000 0 5000 141259 0 141259 0.00080 739784 0 739784 0.00400 28453770 25220291 3233479 0.02660 42860 0 42860 0.00020 42860 0 42860 0.00020 true 53772438 1613173 51186169 48834704 2351465 X true true 1 1 Piedmont Henry Hospital 1133 Eagles Landing Parkway Stockbridge GA 30281 www.piedmonthenry.org X X X SNF, Rehab Services Clinic Piedmont Henry Hospital true X X X X X X X X 13 true false true X www.piedmonthenry.org X X X X X X X X X X true false true true 200. true 300. true X X X true true X X X X true false X X X X true X false false 1 Laurel Park 1133 Eagles Landing Parkway Stockbridge GA 30281 Skilled Nursing Facility SCHEDULE H, PART VI, LINE 1 1. REQUIRED DESCRIPTIONS PUBLIC AVAILABILITY OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A A REPORT ON PIEDMONT HENRY HOSPITAL, INC'S ("PHH") COMMUNITY BENEFITS IS FOUND WITHIN PIEDMONT HEALTHCARE, INC'S (PIEDMONT HENRY HOSPITAL'S SOLE MEMBER) ANNUAL REPORT, WHICH IS WIDELY DISTRIBUTED TO THE PUBLIC BOTH THROUGH PRINTED COPIES MADE AVAILABLE TO COMMUNITY MEMBERS UPON REQUEST AND THROUGH PUBLICATION ON THE PIEDMONT HEALTHCARE WEBSITE. ADDITIONALLY, THE REPORT WAS MAILED TO PHH AND PIEDMONT HEALTHCARE BOARD MEMBERS, STATE AND LOCAL ELECTED OFFICIALS, AND OTHER KEY STAKEHOLDERS. PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I, LINE 7(F) THE DENOMINATOR USED FOR THE CALCULATION OF COLUMN (F), PERCENT OF TOTAL EXPENSE, WAS THE AMOUNT OF TOTAL FUNCTIONAL EXPENSES ON FORM 990, PART IX, LINE 25, COLUMN (A) of $235,822,814, LESS BAD DEBT EXPENSE OF $53,772,438 FROM FORM 990, PART IX, LINE 24(A). FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST SCHEDULE H, PART I, LINE 7 A RATIO OF PATIENT CARE COST TO CHARGES, CONSISTENT WITH WORKSHEET 2, WAS USED TO REPORT THE AMOUNTS IN PART I, LINES 7A-7D. FOR AMOUNTS ON LINES 7E-7K, ACTUAL EXPENSES FOR EACH COMMUNITY BENEFIT ACTIVITY ARE TRACED AND REPORTED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. COMMUNITY BUILDING ACTIVITIES SCHEDULE H, PART II PIEDMONT HENRY HOSPITAL PROVIDED EDUCATION AROUND CERTAIN PUBLIC HEALTH ISSUES (E.G. OBESITY) AND PROVIDED SPECIFIC TOOLS TO HELP ENABLE COMMUNITY GROUPS AND COALITIONS TO BEST ADDRESS THOSE ISSUES. THESE TOOLS INCLUDE GENERAL EDUCATIONAL MATERIALS AS WELL AS INFORMATION SPECIFIC TO THE LOCAL COMMUNITY, SUCH AS SUGGESTIONS FOR ACTIVITIES AND ACTIONS THE COMMUNITY COULD UNDERTAKE TO HELP ITS RESIDENTS BECOME MORE ACTIVE AND EMPOWERED IN THEIR HEALTH. ADDITIONALLY, PHH PROVIDED FOR THE FUNDING OF A PUBLIC HEALTH CONSULTANT WHO WORKED DIRECTLY WITH KEY COMMUNITY MEMBERS AND ELECTED OFFICIALS IN INITIATING SUCH PROJECTS, WHICH INCLUDED A WALKABILITY FEASIBILITY STUDY AND AN OVERALL EVALUATION OF OPPORTUNITIES WITHIN THE COMMUNITY TO BETTER THE OVERALL HEALTH OF ITS RESIDENTS. BAD DEBT EXPENSE CALCULATION AND FOOTNOTE SCHEDULE H, PART III, LINE 4 BASED ON PRIOR EXPERIENCE AND CERTAIN DEMOGRAPHICS AND OTHER INFORMATION OBTAINED DURING ADMISSION, THE ORGANIZATION BELIEVES A PORTION OF THE BAD DEBT EXPENSES AT COST IS ATTRIBUTABLE TO PATIENTS THAT WOULD OTHERWISE QUALIFY FOR CHARITY CARE. DESPITE ITS BEST EFFORTS TO EDUCATE PATIENTS ABOUT QUALIFYING FOR ITS CHARITY CARE PROGRAM (AS DISCUSSED IN PART IV, QUESTION 3 BELOW), MANY UNINSURED PATIENTS EITHER REFUSE OR FAIL TO COMPLETE A CHARITY CARE APPLICATION OR PROVIDE SUFFICIENT INFORMATION AT THE TIME OF ADMISSION, DURING THEIR STAY, OR AFTER BEING DISCHARGED TO QUALIFY FOR ASSISTANCE UNDER THE ORGANIZATION'S CHARITY CARE POLICY. THE AMOUNT REPORTED ON PART III, LINE 3, WAS DETERMINED BY TAKING THE AVERAGE ACCEPTANCE RATE FOR ALL CHARITY CARE APPLICATIONS RECEIVED DURING THE YEAR MULTIPLIED BY THE NUMBER OF DENIALS THAT WERE ATTRIBUTABLE TO INSUFFICIENT INFORMATION. THAT TOTAL WAS THEN ADJUSTED DOWNWARD FOR THE 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. PHH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE ARE NOT REPORTED AS REVENUE. 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 INDENTIFYING 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 3 PIEDMONT HENRY HOSPITAL'S MOST RECENT CHNA WAS CONDUCTED IN PARTNERSHIP WITH THE HENRY COUNTY GOVERNMENT, HENRY COUNTY HEALTH DEPARTMENT, HENRY COUNTY SHERIFF'S OFFICE, HENRY COUNTY BOARD OF EDUCATION AND HENRY COUNTY CHAMBER OF COMMERCE. HOSPITAL AND PIEDMONT HEALTHCARE STAFF REVIEWED PUBLICLY AVAILABLE HEALTH AND SOCIOECONOMIC DATA, AS WELL AS DATA COLLECTED THROUGH FOCUS GROUPS, COMMUNITY MEETINGS, AND A COMMUNITY HEALTH SURVEY. THE COMMUNITY HEALTH SURVEY WAS MADE AVAILABLE IN 61 COUNTY-BASED LOCATIONS AS WELL AS ON THE HOSPITAL'S WEBSITE. ALL RESPONSES TO THE SURVEY WERE AGGREGATED, ANALYZED, AND INTERPRETED BY A FACULTY MEMBER OF THE GEORGIA SOUTHERN UNIVERSITY'S JIANN-PING HSU COLLEGE OF PUBLIC HEALTH. EIGHT FOCUS GROUPS REPRESENTING DIFFERENT FACETS (BOTH BROAD AND SPECIFIC) OF THE COMMUNITY WERE ASSEMBLED TO PROVIDE FURTHER COMMUNITY INPUT. FOCUS GROUPS WERE FACILITATED BY A FACULTY MEMBER OF MERCER UNIVERSITY, WHO ALSO ANALYZED AND DOCUMENTED THE FINDINGS. HOSPITAL AND COMMUNITY PARTNERS THEN MET WITH A GEORGIA SOUTHERN UNIVERSITY PUBLIC HEALTH FACULTY MEMBER TO DISCUSS EMERGING TRENDS (AS WELL AS THE TOP CAUSES OF DEATH) AND PRIORITIZATION OF IDENTIFIED NEEDS. IN THE THIRD QUARTER OF FISCAL YEAR 2013, TWO COMMUNITY MEETINGS WERE HELD TO DETERMINE WAYS TO ADDRESS IDENTIFIED HEALTH PRIORITIES AND DEVELOP AN IMPLEMENTATION PLAN. PUBLIC AVAILABILITY OF CHNA SCHEDULE H, PART V, LINE 5C IN ADDITION TO MAKING ITS CHNA AVAILABLE ON ITS WEBSITE AND BY REQUEST, PIEDMONT HENRY 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 VI, LINE 2 2. NEEDS ASSESSMENT DURING FISCAL YEAR 2013, PIEDMONT HENRY HOSPITAL CONDUCTED AND RATIFIED A FORMAL NEEDS ASSESSMENT AND IMPLEMENTATION PLAN. THE ASSESSMENT WAS CONDUCTED IN PARTNERSHIP WITH THE HENRY COUNTY GOVERNMENT, HENRY COUNTY HEALTH DEPARTMENT, HENRY COUNTY SHERIFF'S OFFICE, HENRY COUNTY BOARD OF EDUCATION AND HENRY COUNTY CHAMBER OF COMMERCE. HOSPITAL AND PIEDMONT HEALTHCARE STAFF REVIEWED PUBLICLY AVAILABLE HEALTH AND SOCIOECONOMIC DATA, AS WELL AS DATA COLLECTED THROUGH FOCUS GROUPS, COMMUNITY MEETINGS, AND A COMMUNITY HEALTH SURVEY. THE COMMUNITY HEALTH SURVEY WAS MADE AVAILABLE IN 61 COUNTY-BASED LOCATIONS AS WELL AS ON THE HOSPITAL'S WEBSITE. ALL RESPONSES TO THE SURVEY WERE AGGREGATED, ANALYZED, AND INTERPRETED BY A FACULTY MEMBER OF THE GEORGIA SOUTHERN UNIVERSITY'S JIANN-PING HSU COLLEGE OF PUBLIC HEALTH. EIGHT FOCUS GROUPS REPRESENTING DIFFERENT FACETS (BOTH BROAD AND SPECIFIC) OF THE COMMUNITY WERE ASSEMBLED TO PROVIDE FURTHER COMMUNITY INPUT. FOCUS GROUPS WERE FACILITATED BY A FACULTY MEMBER OF MERCER UNIVERSITY, WHO ALSO ANALYZED AND DOCUMENTED THE FINDINGS. HOSPITAL AND COMMUNITY PARTNERS THEN MET WITH A GEORGIA SOUTHERN UNIVERSITY PUBLIC HEALTH FACULTY MEMBER TO DISCUSS EMERGING TRENDS (AS WELL AS THE TOP CAUSES OF DEATH) AND PRIORITIZATION OF IDENTIFIED NEEDS. IN THE THIRD QUARTER OF FISCAL YEAR 2013, TWO COMMUNITY MEETINGS WERE HELD TO DETERMINE WAYS TO ADDRESS IDENTIFIED HEALTH PRIORITIES AND DEVELOP AN IMPLEMENTATION PLAN. THE PIEDMONT HENRY HOSPITAL BOARD OF DIRECTORS APPROVED THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION PLAN TO ADDRESS IDENTIFIED HEALTH ISSUES THROUGH A UNANIMOUS VOTE ON APRIL 22, 2013. DURING FISCAL YEAR 2014, PIEDMONT HENRY HOSPITAL UPDATED ITS CHNA TO INCLUDE THE LATEST AVAILABLE DATA AND IT CONVERTED THE DESIGN FROM A STANDARD REPORT TO AN INFOGRAPHIC IN ORDER TO INCREASE READABILITY. THE INFOGRAPHIC WAS ALSO UPDATED WITH COMMUNITY BENEFIT PROGRAMS IMPLEMENTED IN FISCAL YEAR 2014. SCHEDULE H, PART VI, LINE 3 3. PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY PIEDMONT HEALTHCARE UNDERSTANDS THAT NOT EVERYONE WILL HAVE THE ABILITY TO PAY THEIR HOSPITAL BILL DUE TO THEIR INSURANCE STATUS OR A LIMITED INCOME, AND BECAUSE OF THIS, PIEDMONT HENRY HOSPITAL OFFERS FINANCIAL ASSISTANCE TO QUALIFYING PATIENTS. INFORMATION ABOUT AND CONTACT NUMBERS FOR FINANCIAL ASSISTANCE ARE PROVIDED IN NOTICES INSERTED IN PATIENT BILLS AND POSTED IN EMERGENCY ROOMS, IN THE CONDITIONS OF ADMISSION FORM, AT ADMITTING AND REGISTRATION DEPARTMENTS, AT HOSPITAL BUSINESS OFFICES, AT PATIENT FINANCIAL SERVICES OFFICES THAT ARE LOCATED ON FACILITY CAMPUSES, AND AT OTHER PUBLIC PLACES THE HOSPITAL MAY ELECT, INCLUDING LOCAL LOW-COST CLINICS PRIMARILY TREATING UNINSURED POPULATIONS. PIEDMONT HENRY HOSPITAL ALSO PUBLISHES AND WIDELY PUBLICIZES A SUMMARY OF THIS FINANCIAL ASSISTANCE CARE POLICY ON ITS FACILITY WEBSITE, WHICH INCLUDES A LINK TO THE FULL POLICY AND APPLICATION. REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY STAFF OR MEDICAL STAFF MEMBER AT THE HOSPITAL, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. SCHEDULE H, PART VI, LINE 4 4. COMMUNITY INFORMATION PIEDMONT HENRY HOSPITAL IS LOCATED IN HENRY COUNTY, AN URBAN COMMUNITY SOUTH OF ATLANTA, GEORGIA. IN 2014, APPROXIMATELY 209,000 PEOPLE LIVED IN HENRY COUNTY. THE COUNTY SEAT OF THIS COMMUNITY IS MCDONOUGH, AND THERE ARE THREE OTHER MAIN CITIES: HAMPTON, LOCUST GROVE, AND STOCKBRIDGE. ABOUT ONE IN FIVE ADULTS IN HENRY COUNTY IS UNINSURED, AND ONE IN FIVE REPORTED THAT THEY WERE UNABLE TO SEE A DOCTOR DUE TO COST. HENRY COUNTY HAS ONE PRIMARY CARE PROVIDER FOR EVERY 2,116 RESIDENTS, WHICH IS FEWER PROVIDERS PER MEMBER OF THE POPULATION THAN THE STATE AVERAGE OF ONE PROVIDER FOR EVERY 1,598 RESIDENTS. MORE THAN 12 PERCENT OF ADULTS IN HENRY COUNTY REPORTED THAT THEY WERE IN POOR OR FAIR HEALTH, WHICH IS LESS THAN GEORGIA'S AVERAGE OF 16 PERCENT. MORE THAN 10 PERCENT OF ADULTS AND 16 PERCENT OF CHILDREN IN HENRY COUNTY LIVE BELOW THE POVERTY LINE. IN ADDITION, 40 PERCENT OF THE CHILDREN IN THE COMMUNITY QUALIFY FOR FREE LUNCH. THE UNEMPLOYMENT RATE IN HENRY COUNTY IS NINE PERCENT AND MORE THAN 89 PERCENT OF THE COUNTY HAS A HIGH SCHOOL DIPLOMA. HENRY COUNTY HAS ONE MENTAL HEALTH PROVIDER FOR EVERY 2,038 RESIDENTS, COMPARED TO GEORGIA'S AVERAGE OF ONE PROVIDER FOR EVERY 1,478 RESIDENTS. COUNTY RESIDENTS REPORT AN AVERAGE OF 2.9 "POOR MENTAL HEALTH" DAYS EACH MONTH, WHILE GEORGIA RESIDENTS REPORT ON AVERAGE 3.3 DAYS. HENRY COUNTY'S TEEN BIRTH RATE FOR 2014 WAS 32 BIRTHS PER 1,000 WOMEN, WHICH IS LESS THAN GEORGIA'S RATE OF 48 BIRTHS PER 1,000 WOMEN. PREGNANT TEENS ARE AT HIGHER RISK OF HAVING PREGNANCY-INDUCED HYPERTENSION, PREECLAMPSIA, AND BABIES WITH LOW BIRTH-WEIGHT. ONE IN FOUR ADULTS IN HENRY COUNTY IS NOTABLY PHYSICALLY INACTIVE, WHICH IS ABOUT THE SAME NUMBER OF ADULTS WHO IS OBESE. ACCESS TO HEALTHY FOODS IS AN ISSUE IN HENRY COUNTY, AS ABOUT EIGHT PERCENT OF THE POPULATION DOES NOT LIVE WITHIN CLOSE PROXIMITY OF A GROCERY STORE THAT SELLS FRESH FRUIT AND VEGETABLES. SCHEDULE H, PART VI, LINE 5 5. PROMOTION OF COMMUNITY HEALTH PIEDMONT HENRY HOSPITAL ACTIVELY PROMOTES THE HEALTH OF ITS COMMUNITY THROUGH COMMUNITY-BASED HEALTH SCREENINGS; EDUCATIONAL ACTIVITIES; THE OPERATION OF A 24-HOUR EMERGENCY DEPARTMENT AVAILABLE TO THE ENTIRE COMMUNITY; THE OPERATION OF AN EMERGENCY ROOM OPEN TO ALL MEMBERS OF THE COMMUNITY WITHOUT REGARD TO ABILITY TO PAY; A GOVERNANCE BOARD COMPOSED OF COMMUNITY MEMBERS; USE OF SURPLUS REVENUE FOR FACILITIES IMPROVEMENT, PATIENT CARE, AND MEDICAL TRAINING, EDUCATION, AND RESEARCH; THE PROVISION OF INPATIENT HOSPITAL CARE FOR ALL PERSONS IN THE COMMUNITY ABLE TO PAY, INCLUDING THOSE COVERED BY MEDICARE AND MEDICAID; AND AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFYING PHYSICIANS. SCHEDULE H, PART VI, LINE 6 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 2014, 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 HENRY 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 157-BED, ACUTE-CARE COMMUNITY HOSPITAL IN FAYETTEVILLE; PIEDMONT MOUNTAINSIDE HOSPITAL, A 42-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 7. STATE OF FILING OF COMMUNITY BENEFIT REPORT PIEDMONT HENRY HOSPITAL IS NOT REQUIRED TO FILE A COMMUNITY BENEFIT REPORT; HOWEVER THE HOSPITAL IS REQUIRED TO FILE WITH THE GEORGIA DEPARTMENT OF COMMUNITY HEALTH INFORMATION ON ITS INDIGENT AND CHARITY CARE, AS WELL AS ITS MEDICAID AND MEDICARE SHORTFALLS. true HENRY COUNTY CHAMBER OF COMMERCE 1709 GA HWY 20 WEST MCDONOUGH GA 30253 581025691 501(C)(6) 9500 0 1 Tuition Reimbursement 20 51863 SCHEDULE I, PART I, LINE 2 MONITORING THE USE OF GRANT FUNDS MONEY IS GIVEN TO CHARITABLE ORGANIZATIONS WHICH PRIMARILY PROMOTE HEALTH CARE CAUSES. THE GRANTS ARE ADMINISTERED AND MONITORED THROUGH THE ORGANIZATION'S PUBLIC RELATIONS DEPARTMENT. A REQUEST FOR TUITION REIMBURSEMENT SHOULD BE APPROVED BY THE DEPARTMENT DIRECTOR AND SUBMITTED ON THE APPROPRIATE FORM TO THE HUMAN RESOURCES DEPARTMENT PRIOR TO THE BEGINNING OF EACH QUARTER OR SEMESTER COURSE OR PROGRAM. THE REQUEST MUST BE SUBMITTED AT LEAST TWO WEEKS BEFORE THE COURSE BEGINS TO BE CONSIDERED FOR REIMBURSEMENT. APPLICATIONS FOR REIMBURSEMENT MAY BE OBTAINED IN THE HUMAN RESOURCES DEPARTMENT. THE HUMAN RESOURCES DEPARTMENT WILL THEN APPROVE OR DISAPPROVE THE REQUEST. 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 X X X X true true false false false false false true false Mr Charlie Hall Treasurer 0 430535 0 165124 0 660925 0 163138 0 12253 0 1431975 0 626778 Mr Jay D Mitchell Secretary 0 417372 0 160152 0 16177 0 95568 0 15765 0 705034 0 0 Mr Jeffrey A Cooper VP of Operations 0 219443 0 28856 0 2210 0 9674 0 7605 0 267788 0 0 Ms Karen A Kiel FORMER Chief Nursing Officer 0 53297 0 21799 0 228700 0 2221 0 3674 0 309691 0 0 Ms Yveta Seise Clinical Coordinator 132163 0 3743 0 5304 0 3169 0 8606 0 152985 0 0 0 Mr Walter P Evans FINANCE DIRECTOR 112064 0 14165 0 18681 0 5095 0 2346 0 152351 0 0 0 Ms Mykeesha C Fowler Director of Pharmacy 143407 0 7475 0 27 0 0 0 1580 0 152489 0 0 0 Mr Gregory A Hurst Chairman 0 665778 0 292140 0 506020 0 486484 0 11536 0 1961958 0 464910 Mr Charles Scott President & CEO 0 379360 0 75426 0 24332 0 75928 0 12418 0 567464 0 0 Dr Ronnie Brownsworth FORMER Board Member 0 475907 0 182395 0 22106 0 101419 0 17689 0 799516 0 0 Mr Thomas Arnold Board Member 0 301839 0 88221 0 15995 0 60421 0 17749 0 484225 0 0 MS SHERRY HENDERSON CHIEF FINANCIAL OFFICER 0 124480 0 10000 0 54052 0 0 0 3209 0 191741 0 0 SCHEDULE J, PART I, LINE 3 COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT HENRY HOSPITAL IS SET AND PAID 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 MS. KAREN KIEL RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $227,078 DURING CALENDAR YEAR 2013. SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL COMPENSATION INFORMATION GREGORY A. HURST AND CHARLIE HALL RECEIVED PAYMENTS TOTALING $464,910 AND $626,778, RESPECTIVELY, FROM THEIR SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: CHARLES SCOTT JAY MITCHELL RONNIE BROWNSWORTH THOMAS ARNOLD JEFFREY COOPER SCHEDULE J, PART I, LINE 7 CERTAIN EMPLOYEES PARTICIPATED IN AN "ANNUAL INCENTIVE PLAN" UNDER WHICH THEY RECEIVED NON-FIXED BONUS PAYMENTS BASED ON JOB LEVEL AND SEVERAL DIFFERENT PERFORMANCE METRICS. A Hospital Authority of Henry County 581274549 426357FM6 2004-04-28 60485003 91-Bed Hospital Addition false false false A 2915000 0 60485003 0 218467 0 372900 286500 0 59607136 0 0 false false true true A false false false false 0 false false false true A false false false true false false 0 false 0 false true A true REBATE COMPUTATION SCHEDULE K, PART IV, LINE 2C THE REBATE CALCULATION WAS LAST PERFORMED ON APRIL 28, 2014. FORM 990, PART V, LINE 1A NUMBER OF FORMS 1099 FILED ALL CALENDAR YEAR 2013 FORMS 1099 WERE FILED ON BEHALF OF PIEDMONT HENRY HOSPITAL BY ITS SOLE MEMBER, PIEDMONT HEALTHCARE, INC. (EIN 58-1503902), PURSUANT TO AN AGREEMENT WITH THE IRS TO FILE ALL FORMS 1099 FOR THE PIEDMONT HEALTHCARE SYSTEM ON A COMBINED BASIS. FORM 990, PART VI, SECTION A, LINE 6 ORGANIZATION'S SOLE MEMBER PIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT HENRY HOSPITAL ("PHH"). FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT HENRY HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT HENRY HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY PIEDMONT HENRY HOSPITAL'S BOARD POLICIES AND DECISIONS MUST BE FILED, IMMEDIATELY AFTER ADOPTION, WITH THE SECRETARY OF THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS. SUCH POLICIES AND DECISIONS OF THE PIEDMONT HENRY HOSPITAL BOARD OF DIRECTORS ARE NOT SUBJECT TO THE APPROVAL OF OR RATIFICATION BY THE PIEDMONT HEALTHCARE BOARD, BUT SHOULD THE NEED ARISE, THEY MAY BE RESCINDED BY THE PIEDMONT HEALTHCARE BOARD THROUGH A MAJORITY VOTE OF ITS DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW PROCESS INFORMATION NEEDED TO PREPARE PIEDMONT HENRY HOSPITAL'S FORM 990 IS COMPILED BY INDIVIDUALS IN THE ORGANIZATION'S FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PHH'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 HENRY HOSPITAL ARE PROVIDED TRAINING ON CONFLICT OF INTEREST ISSUES, INCLUDING REPORTING REQUIREMENTS, AT NEW-EMPLOYEE ORIENTATION AND AT LEAST ANNUALLY THEREAFTER. NONCOMPLIANCE WITH THE CONFLICT OF INTEREST POLICY MUST BE REPORTED TO PIEDMONT HEALTHCARE'S SENIOR VICE PRESIDENT OF COMPLIANCE FOR INVESTIGATION, AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. FORM 990, PART VI, SECTION B, LINE 15A, 15B EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT HENRY HOSPITAL IS SET BY THE BOARD OF DIRECTORS OF AND PAID ON BEHALF OF THE HOSPITAL BY PIEDMONT HEALTHCARE, INC. THE PIEDMONT HEALTHCARE, INC., BOARD OF 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. THIS COMMITTEE IS AUTHORIZED TO ACT ON BEHALF OF THE PHC BOARD AS SET OUT IN THIS 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 GOVERNING, CONFLICT OF INTEREST AND FINANCIAL 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 $(3,957) RELATING TO DIFFERENCES IN THE TIMING OF REVENUE RECOGNITION. 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SEPARATE BOOKS AND RECORDS ARE NOT MAINTAINED FOR THE LLC AND ASSETS AND INCOME CANNOT BE READILY DETERMINED. AS SUCH, COLUMNS (D) AND (E) IN PART I HAVE BEEN LEFT BLANK.