PIEDMONT HENRY HOSPITAL INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- PIEDMONT HENRY HOSPITAL INC (EIN 58-2200195)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-15
- IRS object ID
- 201401359349301340
- Schema version
- 2012v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-15T12:26:15-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 55 IVAN ALLEN BLVD SUITE 1000 | AddressLine1 |
| City | ATLANTA | City |
| State | GA | State |
| ZIP Code | 30308 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582200195 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Piedmont Henry Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % MARIE GAFFNEY | InCareOfName |
| Name Control | PIED | NameControl |
| Phone | 6786041001 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1133 Eagles Landing Parkway | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | Stockbridge | City |
| State | GA | State |
| ZIP Code | 30281 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CHARLES SCOTT | Name |
| Title | PRESIDENT & CEO | Title |
| Date Signed | 2014-05-15 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4048748300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Charles Scott | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1133 Eagles Landing Parkway | AddressLine1 |
| City | Stockbridge | City |
| State | GA | State |
| ZIP Code | 30281 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 226483555 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.piedmont.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1995 | YearFormation |
| State Legal Domicile | GA | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1891 | TotalNbrEmployees |
| Total Nbr Volunteers | 150 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 5533297 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 665469 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 191810104 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 224201894 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2956325 | InvestmentIncomePriorYear |
| Investment Income Current Year | -7788 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1333902 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1618428 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 201633628 | TotalRevenuePriorYear |
| Total Revenue Current Year | 226478003 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 122515 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 73645 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 80268846 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 86371495 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 140494375 | OtherExpensePriorYear |
| Other Expenses Current Year | 137773002 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 220885736 | TotalExpensesPriorYear |
| Total Expenses Current Year | 224218142 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -19252108 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2259861 | RevenuesLessExpensesCY |
| Total Assets BOY | 236732030 | TotalAssetsBOY |
| Total Assets EOY | 257030689 | TotalAssetsEOY |
| Total Liabilities BOY | 159257048 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 171603601 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 77474982 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 85427088 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 196444655 | Expense |
| Grants | 73645 | Grants |
| Revenue | 224467999 | Revenue |
| Description | 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, 2013, THE HOSPITAL HAD 12,101 IN-PATIENT ADMISSIONS WITH A TOTAL OF 54,779 DAYS OF IN-PATIENT HOSPITALIZATION. ER VISITS TOTALED 76,217 AND OUTPATIENT VISITS TOTALED 64,729. SURGICAL SERVICES WERE PROVIDED TO 9,491 PATIENTS. | Description |
| Total Program Service Expense | 196444655 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | true | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 71 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 1891 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | true | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | GA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MARIE GAFFNEY | NamePerson |
| Telephone Number | 6788426007 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2727 PACES FERRY RDBLDG 2 STE 700 | AddressLine1 |
| City | ATLANTA | City |
| State | GA | State |
| ZIP Code | 30324 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (21 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| Dr Todd Schmidt | |||||||||
| Board Member | 1.0 | 1.0 | X | 0 | 3640 | 0 | |||
| Mr Gregory A Hurst | |||||||||
| Chairman | 1.0 | 54.0 | X | 0 | 3697079 | 49764 | |||
| Mr Charles Scott | |||||||||
| President & CEO | 54.0 | 1.0 | X | 0 | 509471 | 66694 | X | ||
| 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 Kay Pippin | |||||||||
| Board Member | 1.0 | 0.0 | X | 0 | 0 | 0 | |||
| Dr Ronnie Brownsworth | |||||||||
| Board Member | 1.0 | 54.0 | X | 0 | 725035 | 100555 | |||
| 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 | 426559 | 57730 | |||
| Mr Charlie Hall | |||||||||
| Treasurer | 1.0 | 54.0 | 0 | 681955 | 185689 | X | |||
| Mr Jay D Mitchell | |||||||||
| Secretary | 1.0 | 54.0 | 0 | 591859 | 78751 | X | |||
| Mr Gary Chawk | |||||||||
| CFO | 55.0 | 0.0 | 0 | 359116 | 2486 | X | |||
| Mr Jeffrey A Cooper | |||||||||
| VP of Operations | 55.0 | 0.0 | 0 | 234922 | 23431 | X | |||
| Ms Karen A Kiel | |||||||||
| VP/Chief Nursing Officer | 55.0 | 0.0 | 0 | 196279 | 24412 | X | |||
| Ms Yveta Seise | |||||||||
| Clinical Coordinator | 55.0 | 0.0 | 158630 | 0 | 3356 | X | |||
| Mr Walter P Evans | |||||||||
| Director of Decision Support | 55.0 | 0.0 | 150918 | 0 | 20787 | X | |||
| Ms Natalie R Wilkerson | |||||||||
| Director of Application Servic | 55.0 | 0.0 | 141916 | 0 | 18438 | X | |||
| Ms Rhonda L Deas | |||||||||
| Registered Nurse | 40.0 | 0.0 | 139479 | 0 | 398 | X | |||
| Ms Mykeesha C Fowler | |||||||||
| Director of Pharmacy | 55.0 | 0.0 | 136183 | 0 | 6707 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 727126 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 7425915 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 639198 | TotalOtherCompensation |
| Number Individuals GT100 K | 27 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HOSPITAL MEDICINE ASSOCIATES LLC | |||||
| PO Box 634850 | CINCINNATI | OH | 452634850 | HOSPITALIST SERVICES | 1393575 |
| ARAMARK CTS INC | |||||
| 12483 COLLECTIONS CENTER DRIVE | CHICAGO | IL | 60693 | EQUIP MAINTENANCE | 1081194 |
| LEXICODE CORPORATION | |||||
| PO Box 142589 | IRVING | TX | 750142589 | CODING MGT SERVICES | 1034985 |
| ALLIANCE LAUNDRY TEXTILE SERVICES | |||||
| 7990 SECOND FLAGS DRIVE STE A | AUSTELL | GA | 30168 | Laundry Services | 821993 |
| STEWART WITHERELL | |||||
| 195 FORSTON CIRCLE | ATHENS | GA | 32606 | CONSULTING | 760504 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 37 | NumberOfContractorsGT100K |
| Government Grants | 518302 | GovernmentGrants |
| All Other Contributions | 147167 | AllOtherContributions |
| Total Contributions | 665469 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENUE | Description |
| Business Code | 622110 | BusinessCode |
| Total Revenue Column | 224201894 | TotalRevenueColumn |
| Related Or Exempt Function Income | 224201894 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 224201894 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -8958 | TotalRevenueColumn |
| Exclusion | -$8,958 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 463580 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 5552 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 458028 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 458028 | TotalRevenueColumn |
| Exclusion | $458,028 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1170 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1170 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1170 | TotalRevenueColumn |
| Exclusion | $1,170 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Direct Expenses | 0 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|---|
| CAFETERIA REVENUE | 722310 | 894295 | 0 | $894,295 | |
| NUTRITION & HEALTH | 621999 | 93406 | 0 | $0 | 93406 |
| OTHER REVENUE | 621999 | 172699 | 0 | $0 | 172699 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1160400 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 226478003 | TotalRevenueColumn |
| Related Or Exempt Function Income | 224467999 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $1,344,535 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73645 | Total |
| Program Services | 73645 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 71621756 | Total |
| Program Services | 61562146 | ProgramServices |
| Management And General | 10059610 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9834041 | Total |
| Program Services | 8452814 | ProgramServices |
| Management And General | 1381227 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4915698 | Total |
| Program Services | 4225270 | ProgramServices |
| Management And General | 690428 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1741543 | Total |
| Program Services | 1741543 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156704 | Total |
| Management And General | 156704 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20263382 | Total |
| Program Services | 13555317 | ProgramServices |
| Management And General | 6708065 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 343576 | Total |
| Management And General | 343576 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6102377 | Total |
| Program Services | 6056085 | ProgramServices |
| Management And General | 46292 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 739563 | Total |
| Program Services | 739563 | ProgramServices |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2995061 | Total |
| Program Services | 2752162 | ProgramServices |
| Management And General | 242899 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 182980 | Total |
| Program Services | 114381 | ProgramServices |
| Management And General | 68599 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9944 | Total |
| Program Services | 9944 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3927268 | Total |
| Management And General | 3927268 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13263788 | Total |
| Program Services | 12188095 | ProgramServices |
| Management And General | 1075693 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2919872 | Total |
| Program Services | 213851 | ProgramServices |
| Management And General | 2706021 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES & DRUGS | 39410612 | 39410612 | |
| BAD DEBT EXPENSE | 39046391 | 39046391 | |
| REPAIRS & MAINTENANCE | 3763523 | 3643267 | 120256 |
| HOSPITAL TAX | 2260217 | 2260217 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 646201 | Total |
| Program Services | 399352 | ProgramServices |
| Management And General | 246849 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 224218142 | Total |
| Program Services | 196444655 | ProgramServices |
| Management And General | 27773487 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1108703 | BOY |
| EOY | 154691 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19127833 | BOY |
| EOY | 21350910 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4558613 | BOY |
| EOY | 3777281 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1284359 | BOY |
| EOY | 724050 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 336767732 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 171060253 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 174775779 | BOY |
| EOY | 165707479 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2743253 | BOY |
| EOY | 1849940 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2829559 | BOY |
| EOY | 2352873 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30303931 | BOY |
| EOY | 61113465 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 236732030 | BOY |
| EOY | 257030689 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31551359 | BOY |
| EOY | 35300629 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61408017 | BOY |
| EOY | 60073741 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5019950 | BOY |
| EOY | 2956396 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 61277722 | BOY |
| EOY | 73272835 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 159257048 | BOY |
| EOY | 171603601 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77474982 | BOY |
| EOY | 85138345 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 288743 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 77474982 | BOY |
| EOY | 85427088 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 236732030 | BOY |
| EOY | 257030689 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2259861 | ReconcilationRevenueExpenses |
| Reconcilation Prior Adjustment | 1599868 | ReconcilationPriorAdjustment |
| Reconcilation Other Changes | 4092377 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11832946 | OtherCostOrOtherBasis |
| Book Value | 11832946 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 170718051 | OtherCostOrOtherBasis |
| Depreciation | 45261215 | Depreciation |
| Book Value | 125456836 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6661989 | OtherCostOrOtherBasis |
| Depreciation | 5494248 | Depreciation |
| Book Value | 1167741 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 147554746 | OtherCostOrOtherBasis |
| Depreciation | 120304790 | Depreciation |
| Book Value | 27249956 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildings | |
| Total Of Book Value Land Buildings | 165707479 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM RELATED PARTIES | 60507966 |
| BOND ISSUE COSTS | 396044 |
| OTHER ASSETS | 209455 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 61113465 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO RELATED PARTIES | Description |
| Amount | $73,272,835 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 73272835 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | ASC 740 FOOTNOTE (FKA FIN 48) | Identifier |
| Return Reference | SCHEDULE D, PART X, LINE 2 | ReturnReference |
| Explanation | THE COMPANY ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF THE INCOME TAXES TOPIC OF 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 AS OF JUNE 30, 2013. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3397021 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3397021 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01830 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20331365 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 20134510 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 196855 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1813277 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1813277 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 25541663 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21947787 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3593876 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01940 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 94647 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 94647 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 363140 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 363140 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00200 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22575 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 22575 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12504 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 12504 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 492866 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 492866 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26034529 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21947787 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 4086742 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02210 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2500 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 2500 | NetCommunityBuildingExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 4625 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 4625 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7125 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 7125 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $39,046,391 | BadDebtExpenseAmount |
| Amount Attributable To | 1171392 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 56513652 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 52181485 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 4332167 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Piedmont Henry Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1133 Eagles Landing Parkway | AddressLine1 |
| City | Stockbridge | City |
| State | GA | State |
| ZIP Code | 30281 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.piedmonthenry.org | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | SNF, Rehab Services Clinic | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Piedmont Henry Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Needs Assessment Conducted | 13 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | true | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 300. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Insurance Status | X | InsuranceStatus |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Laurel Park | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1133 Eagles Landing Parkway | AddressLine1 |
| City | Stockbridge | City |
| State | GA | State |
| ZIP Code | 30281 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | Skilled Nursing Facility | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 1. REQUIRED DESCRIPTIONS | SCHEDULE H, PART VI, LINE 1 | 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 $224,218,142, LESS BAD DEBT EXPENSE OF $39,046,391 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. 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. 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. |
| 2. NEEDS ASSESSMENT | SCHEDULE H, PART VI, LINE 2 | 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. |
| 3. PATIENT EDUCATION OF ASSISTANCE ELIGIBILITY | SCHEDULE H, PART VI, LINE 3 | 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. |
| 4. COMMUNITY INFORMATION | SCHEDULE H, PART VI, LINE 4 | PIEDMONT HENRY HOSPITAL IS LOCATED IN HENRY COUNTY, AN URBAN COMMUNITY SOUTH OF ATLANTA, GEORGIA. IN 2012, JUST OVER 207,300 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. THE US CENSUS ESTIMATES THAT ANNUAL POPULATION GROWTH IN HENRY COUNTY IS JUST AT 2 PERCENT. HENRY COUNTY HAS LARGE CAUCASIAN AND AFRICAN AMERICAN POPULATIONS, WITH THE TWO GROUPS COMPRISING APPROXIMATELY 50 PERCENT AND 40 PERCENT OF THE TOTAL POPULATION IN 2012, RESPECTIVELY. THE HISPANIC AND ASIAN POPULATIONS TOGETHER COMPRISE NEARLY 10 PERCENT. OF THE TOP FIVE CAUSES OF DEATH IDENTIFIED IN HENRY COUNTY, ALL ARE CONDITIONS COMMONLY ASSOCIATED WITH AN UNHEALTHY LIFESTYLE, SUCH AS THE USE OF TOBACCO, HIGH FAT DIETS, AND A LACK OF EXERCISE. FOR EXAMPLE, 20 PERCENT OF THE COUNTY'S ADULT POPULATION REPORTS THAT IT SMOKES, WHICH IS A FIGURE SLIGHTLY HIGHER THAN THE STATE AVERAGE OF 19 PERCENT AND MUCH HIGHER THAN THE NATIONAL AVERAGE OF 14 PERCENT. THE MOTOR VEHICLE CRASH RATE IS THE SAME AS THE STATE AVERAGE OF 17 PERCENT. APPROXIMATELY 12 PERCENT OF THE COUNTY REPORTS HEAVY AND/OR BINGE DRINKING, WHICH IS A FIGURE LOWER THAN THE STATE AVERAGE OF 14 PERCENT BUT HIGHER THAN THAT OF THE NATIONAL AVERAGE OF 8 PERCENT. ONE IN FOUR ADULTS IN HENRY COUNTY IS NOTABLY PHYSICALLY INACTIVE AND 28 PERCENT OF ADULTS ARE OBESE. ACCESS TO HEALTHY FOODS IS AN ISSUE, AS ABOUT 9 PERCENT OF THE POPULATION DOES NOT LIVE WITHIN CLOSE PROXIMITY OF A GROCERY STORE THAT SELLS FRESH FRUIT AND VEGETABLES, AND OVER HALF OF THE RESTAURANTS IN THE COUNTY SERVE FAST FOOD. |
| 5. PROMOTION OF COMMUNITY HEALTH | SCHEDULE H, PART VI, LINE 5 | 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. |
| 6. AFFILIATED HEALTH CARE SYSTEM | SCHEDULE H, PART VI, LINE 6 | 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 2013, 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. |
| 7. STATE OF FILING OF COMMUNITY BENEFIT REPORT | SCHEDULE H, PART VI, LINE 7 | 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. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Tuition Reimbursement | TypeOfGrant |
| Number Of Recipients | 39 | NumberOfRecipients |
| Amount Of Cash Grant | 73645 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | MONITORING THE USE OF GRANT FUNDS | Identifier |
| Return Reference | SCHEDULE I, PART I, LINE 2 | ReturnReference |
| Explanation | 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Class Or Charter Travel | X | FirstClassOrCharterTravel |
| Discretionary Spending Account | X | DiscretionarySpendingAccount |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mr Charlie Hall | ||||||||||||||
| Treasurer | 0 | 419345 | 0 | 138502 | 0 | 124108 | 0 | 159774 | 0 | 25915 | 0 | 867644 | 0 | 0 |
| Mr Jay D Mitchell | ||||||||||||||
| Secretary | 0 | 408181 | 0 | 134332 | 0 | 49346 | 0 | 57676 | 0 | 21075 | 0 | 670610 | 0 | 0 |
| Mr Gary Chawk | ||||||||||||||
| CFO | 0 | 56074 | 0 | 0 | 0 | 303042 | 0 | 0 | 0 | 2486 | 0 | 361602 | 0 | 0 |
| Mr Jeffrey A Cooper | ||||||||||||||
| VP of Operations | 0 | 187483 | 0 | 24744 | 0 | 22695 | 0 | 13131 | 0 | 10300 | 0 | 258353 | 0 | 0 |
| Ms Karen A Kiel | ||||||||||||||
| VP/Chief Nursing Officer | 0 | 161062 | 0 | 22100 | 0 | 13117 | 0 | 12258 | 0 | 12154 | 0 | 220691 | 0 | 0 |
| Ms Yveta Seise | ||||||||||||||
| Clinical Coordinator | 145630 | 0 | 4500 | 0 | 8500 | 0 | 0 | 0 | 3356 | 0 | 161986 | 0 | 0 | 0 |
| Mr Walter P Evans | ||||||||||||||
| Director of Decision Support | 109504 | 0 | 0 | 0 | 41414 | 0 | 0 | 0 | 20787 | 0 | 171705 | 0 | 0 | 0 |
| Ms Natalie R Wilkerson | ||||||||||||||
| Director of Application Servic | 94251 | 0 | 25000 | 0 | 22665 | 0 | 0 | 0 | 18438 | 0 | 160354 | 0 | 0 | 0 |
| Mr Gregory A Hurst | ||||||||||||||
| Chairman | 0 | 684153 | 0 | 757434 | 0 | 2255492 | 0 | 33437 | 0 | 16327 | 0 | 3746843 | 0 | 0 |
| Mr Charles Scott | ||||||||||||||
| President & CEO | 0 | 355096 | 0 | 56553 | 0 | 97822 | 0 | 46710 | 0 | 19984 | 0 | 576165 | 0 | 0 |
| Dr Ronnie Brownsworth | ||||||||||||||
| Board Member | 0 | 463526 | 0 | 152991 | 0 | 108518 | 0 | 77618 | 0 | 22937 | 0 | 825590 | 0 | 0 |
| Mr Thomas Arnold | ||||||||||||||
| Board Member | 0 | 293773 | 0 | 84605 | 0 | 48181 | 0 | 38702 | 0 | 19028 | 0 | 484289 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| OTHER COMPENSATION ITEMS | SCHEDULE J, PART I, LINE 1A | EXPENSES FOR FIRST-CLASS TRAVEL ARE PAID ON BEHALF OF CERTAIN EXECUTIVES. THESE ITEMS ARE NOT REPORTED ON THE EMPLOYEE'S FORM W-2, HOWEVER, THE COMPANY IS REIMBURSED FOR ANY PERSONAL EXPENSES INCURRED BY THE EMPLOYEE. THE FOLLOWING EMPLOYEES RECEIVED DISCRETIONARY SPENDING ACCOUNTS IN FIXED AMOUNTS DETERMINED BY JOB LEVEL. THESE SPENDING ACCOUNTS WERE INCLUDED IN EACH EMPLOYEE'S TAXABLE WAGES: CHARLES SCOTT GREGORY A. HURST CHARLIE HALL RONNIE BROWNSWORTH JAY MITCHELL THOMAS ARNOLD |
| COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR | SCHEDULE J, PART I, LINE 3 | 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. |
| SUPPLEMENTAL COMPENSATION INFORMATION | SCHEDULE J, PART I, LINE 4A | GARY CHAWK RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $277,380. |
| SUPPLEMENTAL COMPENSATION INFORMATION | SCHEDULE J, PART I, LINE 4B | GREGORY A. HURST RECEIVED PAYMENTS TOTALING $2,124,476 FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: CHARLES SCOTT CHARLIE HALL JAY MITCHELL RONNIE BROWNSWORTH THOMAS ARNOLD |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hospital Authority of Henry County | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 581274549 | IssuerEIN |
| CUSIP Number | 426357FM6 | CUSIPNumber |
| Date Issued | 2004-04-28 | DateIssued |
| Issue Price | 60485003 | IssuePrice |
| Description Of Purpose | 91-Bed Hospital Addition | DescriptionOfPurpose |
| Defeased | false | Defeased |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Pool Financing | false | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 2915000 | AmountRetired |
| Amount Bond Defeased | 0 | AmountBondDefeased |
| Total Proceeds | 60485003 | TotalProceeds |
| Amount In Reserve Fund | 0 | AmountInReserveFund |
| Capitalized Interest | 218467 | CapitalizedInterest |
| Refunding Escrow | 0 | RefundingEscrow |
| Issuance Costs From Proceeds | 372900 | IssuanceCostsFromProceeds |
| Credit Enhancement | 286500 | CreditEnhancement |
| Working Capital Expenditures | 0 | WorkingCapitalExpenditures |
| Capital Expenditures | 59825603 | CapitalExpenditures |
| Other Spent Proceeds | 0 | OtherSpentProceeds |
| Amount Unspent | 0 | AmountUnspent |
| Current Refunding | false | CurrentRefunding |
| Advance Refunding | false | AdvanceRefunding |
| Final Allocation Made | true | FinalAllocationMade |
| Adequate Books And Recds Maintaind | true | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedProperty |
| Any Lease Arrangements | false | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | false | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | false | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | false | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedProp |
| Remedial Action Taken | false | RemedialActionTaken |
| Non Qualified Bond Remed Procdrs | true | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiled |
| Rebate Not Due Yet | false | RebateNotDueYet |
| Exception To Rebate | false | ExceptionToRebate |
| No Rebate Due | true | NoRebateDue |
| Variable Rate Issue | false | VariableRateIssue |
| Hedge Identified In Books And Recds | false | HedgeIdentifiedInBooksAndRecds |
Name Of Hedge Provider NameOfHedgeProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGIC |
Name Of GIC Provider NameOfGICProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvested |
| Written Proc To Monitor Reqs | true | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | true | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | REBATE COMPUTATION | Identifier |
| Return Reference | 0 | ReturnReference |
| Explanation | SCHEDULE K, PART IV, LINE 2C THE REBATE CALCULATION WAS LAST PERFORMED ON APRIL 28, 2011. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S SOLE MEMBER | FORM 990, PART VI, SECTION A, LINE 6 | PIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT HENRY HOSPITAL ("PHH"). |
| ELECTION OF GOVERNING BODY | FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF PIEDMONT HEALTHCARE, PIEDMONT HENRY HOSPITAL'S SOLE MEMBER, APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT HENRY HOSPITAL. |
| DECISIONS OF GOVERNING BODY | FORM 990, PART VI, SECTION A, LINE 7B | 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. |
| 990 REVIEW PROCESS | FORM 990, PART VI, SECTION B, LINE 11B | 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 COMPLIANCE MANAGER 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. |
| CONFLICT OF INTEREST POLICY | FORM 990, PART VI, SECTION B, LINE 12C | COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARE'S SENIOR VICE PRESIDENT OF COMPLIANCE. 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. |
| EXECUTIVE COMPENSATION | FORM 990, PART VI, SECTION B, LINE 15A, 15B | COMPENSATION FOR EXECUTIVES OF PIEDMONT HENRY HOSPITAL IS SET BY THE BOARD OF DIRECTORS OF AND PAID BY PIEDMONT HEALTHCARE, INC. THE PIEDMONT HEALTHCARE, INC., BOARD OF DIRECTORS EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("THE COMMITTEE") IS COMPOSED OF AT LEAST THREE MEMBERS, 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 COMMITTEE HAS BEEN AUTHORIZED BY THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS TO PERFORM THE FOLLOWING FUNCTIONS: -SELECT AN EXTERNAL EXECUTIVE COMPENSATION CONSULTANT ("THE CONSULTANT"). THE COMMITTEE CURRENTLY UTILIZES TOWERS WATSON FOR EXECUTIVE COMPENSATION CONSULTING SERVICES. -WORK WITH THE PRESIDENT/CEO TO FORMULATE AND IMPLEMENT ANNUAL PERFORMANCE OBJECTIVES. THE COMMITTEE MEETS ANNUALLY WITH PIEDMONT HEALTHCARE'S CEO AND KEY SENIOR EXECUTIVES. -TO REVIEW AND APPROVE EXECUTIVE PERFORMANCE OBJECTIVES FOR THE FISCAL YEAR. -ANNUALLY ASSESS PRESIDENT/CEO PERFORMANCE. THE COMMITTEE MEETS ANNUALLY WITH THE CEO AND KEY SENIOR EXECUTIVES. -TO REVIEW THE ACCOMPLISHMENTS OF THE EXECUTIVE PERFORMANCE OBJECTIVES AFTER THE CLOSE OF THE FISCAL YEAR. -ASSESS AND IMPLEMENT POLICIES REGARDING PRESIDENT/CEO PERFORMANCE AND COMPENSATION. THE COMMITTEE HAS DEVELOPED AN EXECUTIVE COMPENSATION PHILOSOPHY AND REVIEWS THE PHILOSOPHY ANNUALLY. THE COMMITTEE SEEKS INPUT AND GUIDANCE FROM THE CONSULTANT TO ENSURE THAT THE PHILOSOPHY IS REASONABLE AND COMPARABLE TO THAT OF SIMILAR ORGANIZATIONS. -APPROVE LONG- AND SHORT-TERM GOALS TO BE USED IN CONNECTION WITH EXECUTIVE STAFF COMPENSATION PROGRAM AS RECOMMENDED BY THE PRESIDENT/CEO AND VALIDATED BY THE COMPENSATION CONSULTANT. THE COMMITTEE MEETS ANNUALLY WITH THE CEO AND KEY SENIOR EXECUTIVES AS WELL AS THE CONSULTANT TO REVIEW SALARY ADJUSTMENTS AND INCENTIVE PAY FOR THE CEO, SENIOR EXECUTIVES, AND EXECUTIVES THROUGHOUT THE ORGANIZATION. THE COMMITTEE MEETS WITH THE CONSULTANT ANNUALLY TO RECEIVE INPUT AND RECOMMENDATIONS TO ENSURE THAT SALARY ADJUSTMENTS, INCENTIVES, AND BENEFITS ARE REASONABLE AND COMPARABLE TO THOSE OF LIKE ORGANIZATIONS. -PERFORM ANY TASKS RELATED TO EXECUTIVE PERFORMANCE AND COMPENSATION, INCLUDING BUT NOT LIMITED TO, APPROVAL OF EXECUTIVE EMPLOYMENT CONTRACTS, AND EXECUTIVE BENEFITS. THE COMMITTEE SEEKS INPUT FROM THE CONSULTANT, AS WELL AS EXTERNAL LEGAL ADVISORS, WHEN IT IS NECESSARY TO DEVELOP AND/OR AMEND EXECUTIVE EMPLOYMENT CONTRACTS AND BENEFITS. |
| DISCLOSURE OF GOVERNING, CONFLICT OF INTEREST AND FINANCIAL DOCUMENTS | FORM 990, PART VI, SECTION C, LINE 19 | 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. |
| RECONCILIATION OF NET ASSETS | FORM 990, PART XI, LINE 9 | CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF BOOK/TAX DIFFERENCES OF $(144,358); THE TRANSFER OF $3,947,992 OF ASSETS FROM THE DISSOLVED HENRY MEDICAL CENTER FOUNDATION TO PIEDMONT HENRY HOSPITAL; AND OTHER CHANGES TO TEMPORARILY RESTRICTED ASSETS OF $288,743. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY OCCUPATIONAL MEDICINE LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1133 EAGLES LANDING PKWY | AddressLine1 |
| City | STOCKBRIDGE | City |
| State | GA | State |
| ZIP Code | 30281 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582632131 | EIN |
| Primary Activities | MEDICAL | PrimaryActivities |
| Legal Domicile State | GA | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PHH | BusinessNameLine1 |
Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| PIEDMONT HEALTHCARE INC | ||||||||||
| 1968 PEACHTREE RD NW | ATLANTA | GA | 30309 | 581503902 | MANAGEMENT | GA | 501(C)(3) | 11 C | NA | false |
| PIEDMONT HOSPITAL INC | ||||||||||
| 1968 PEACHTREE RD NW | ATLANTA | GA | 30309 | 580566213 | HOSPITAL | GA | 501(C)(3) | 3 | PHC | false |
| FAYETTE COMMUNITY HOSPITAL INC | ||||||||||
| 1255 HIGHWAY 54 WEST | FAYETTEVILLE | GA | 30214 | 582322328 | HOSPITAL | GA | 501(C)(3) | 3 | PHC | false |
| PIEDMONT MOUNTAINSIDE HOSPITAL INC | ||||||||||
| 1244 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 HEART INSTITUTE INC | ||||||||||
| 95 COLLIER ROAD NW SUITE 2045 | ATLANTA | GA | 30309 | 263553500 | HEALTHCARE | GA | 501(C)(3) | 7 | PHC | false |
| PIEDMONT HEALTHCARE FOUNDATION INC | ||||||||||
| 1968 PEACHTREE RD NW | ATLANTA | GA | 30309 | 581272768 | FUNDRAISING | GA | 501(C)(3) | 11 D | PHC | false |
| HENRY DEVELOPMENT VENTURES INC | ||||||||||
| 1133 EAGLES LANDING PKWY | STOCKBRIDGE | GA | 30281 | 582200734 | RE HOLDING | GA | 501(C)(2) | N/A | PHH | true |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HENRY RADIATION ONCOLOGY CENTER LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 275 PROFESSIONAL COURT STE A | AddressLine1 |
| City | RIVERDALE | City |
| State | GA | State |
| ZIP Code | 30274 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 582200195 | EIN |
| Primary Activity | HEALTHCARE | PrimaryActivity |
| Legal Domicile State | GA | LegalDomicileState |
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | 414056 | ShareOfTotalIncome |
| Share Of EOY Assets | 2629310 | ShareOfEOYAssets |
| Disproportionate Allocations | false | DisproportionateAllocations |
| Code V | $0 | CodeVAmount |
| General Or Managing Partner | false | GeneralOrManagingPartner |
| Percentage Ownership | 0.50000 | PercentageOwnership |
Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | Province Or StateAddressForeign/ProvinceOrState | CountryAddressForeign/Country | Postal CodeAddressForeign/PostalCode | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PIEDMONT MEDICAL CARE CORPORATION | ||||||||||||||||||
| 2727 PACES FERRY RD STE 1-1100 | ATLANTA | GA | 30339 | 582092768 | HEALTHCARE | GA | PHC | C-CORP | 0 | 0 | 0.00000 | false | ||||||
| THE PIEDMONT CLINIC INC | ||||||||||||||||||
| 2727 PACES FERRY RD STE 1-1100 | ATLANTA | GA | 30339 | 582005358 | HEALTHCARE | GA | PHC | C-CORP | 0 | 0 | 0.00000 | false | ||||||
| PIEDMONT HEART INSTITUTE PHYSICIANS INC | ||||||||||||||||||
| 95 COLLIER ROAD NW SUITE 2045 | ATLANTA | GA | 30309 | 260593850 | HEALTHCARE | GA | PHC | C-CORP | 0 | 0 | 0.00000 | false | ||||||
| AMSTER MCRAE INSURANCE COMPANY | ||||||||||||||||||
| 980427603 | RELATED INSURANCE | PHC | C-CORP | 0 | 0 | 0.00000 | false | PO BOX 1159 | GRAND CAYMAN | GRAND CAYMAN | CJ | KY 1-1102 | CJ | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PIEDMONT HEALTHCARE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | E | TransactionType |
| Amount Involved | 60073741 | AmountInvolved |
| Method Of Amt Determination | ACTUAL | MethodOfAmtDetermination |
Form990 Schedule R Part VII Form990ScheduleRPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DISREGARDED ENTITIES | Identifier |
| Return Reference | SCHEDULE R, PART I, LINE 1 | ReturnReference |
| Explanation | THE LIMITED LIABILITY COMPANY LISTED IN SCHEDULE R, PART I, OPERATES AS A DEPARTMENT OF PIEDMONT HENRY HOSPITAL AND IS INCORPORATED INTO THE HOSPITAL'S BOOKS AND RECORDS. 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. | Explanation |