2014-05-15T12:26:15-05:00 2013-06-30 ERNST & YOUNG US LLP 55 IVAN ALLEN BLVD SUITE 1000 ATLANTA GA 30308 990 2012-07-01 582200195 Piedmont Henry Hospital Inc % MARIE GAFFNEY PIED 6786041001 1133 Eagles Landing Parkway Suite Stockbridge GA 30281 CHARLES SCOTT 2014-05-15 4048748300 2012 2015-11-30 17:44:51Z Charles Scott 1133 Eagles Landing Parkway Stockbridge GA 30281 226483555 false X www.piedmont.org X 1995 GA 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. 11 6 1891 150 0 5533297 665469 191810104 224201894 2956325 -7788 1333902 1618428 201633628 226478003 122515 73645 0 0 80268846 86371495 0 0 0 140494375 137773002 220885736 224218142 -19252108 2259861 236732030 257030689 159257048 171603601 77474982 85427088 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 196444655 73645 224467999 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. 196444655 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 false true true true false false false false false false false false false false false false false false true true true false false false true 71 0 true 1891 true false false false false false false false false false false X 11 6 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 RDBLDG 2 STE 700 ATLANTA GA 30324 X Dr Todd Schmidt 1.0 1.0 X 0 3640 0 Mr Gregory A Hurst 1.0 54.0 X 0 3697079 49764 Mr Charles Scott 54.0 1.0 X X 0 509471 66694 Dr Gopal C Rao 1.0 0.0 X 0 0 0 Mr Charles J Jeff Mills 1.0 2.0 X 0 0 0 Ms Joyce Rodgers 1.0 0.0 X 0 0 0 Ms Kay Pippin 1.0 0.0 X 0 0 0 Dr Ronnie Brownsworth 1.0 54.0 X 0 725035 100555 Ms Sheryl M Simpson-Jones 1.0 0.0 X 0 0 0 Mr Steve Kay 1.0 0.0 X 0 0 0 Mr Thomas Arnold 1.0 54.0 X 0 426559 57730 Mr Charlie Hall 1.0 54.0 X 0 681955 185689 Mr Jay D Mitchell 1.0 54.0 X 0 591859 78751 Mr Gary Chawk 55.0 0.0 X 0 359116 2486 Mr Jeffrey A Cooper 55.0 0.0 X 0 234922 23431 Ms Karen A Kiel 55.0 0.0 X 0 196279 24412 Ms Yveta Seise 55.0 0.0 X 158630 0 3356 Mr Walter P Evans 55.0 0.0 X 150918 0 20787 Ms Natalie R Wilkerson 55.0 0.0 X 141916 0 18438 Ms Rhonda L Deas 40.0 0.0 X 139479 0 398 Ms Mykeesha C Fowler 55.0 0.0 X 136183 0 6707 727126 7425915 639198 27 false true false 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 37 518302 147167 665469 PATIENT SERVICE REVENUE 622110 224201894 224201894 0 0 224201894 -8958 -8958 0 0 463580 5552 458028 0 458028 458028 1170 0 1170 1170 1170 0 0 0 0 CAFETERIA REVENUE 722310 894295 0 894295 NUTRITION & HEALTH 621999 93406 93406 0 0 OTHER REVENUE 621999 172699 172699 0 0 1160400 226478003 224467999 0 1344535 0 73645 73645 0 0 0 0 71621756 61562146 10059610 0 9834041 8452814 1381227 4915698 4225270 690428 1741543 1741543 156704 156704 0 0 0 0 20263382 13555317 6708065 343576 343576 6102377 6056085 46292 739563 739563 0 2995061 2752162 242899 182980 114381 68599 0 9944 9944 3927268 3927268 0 13263788 12188095 1075693 2919872 213851 2706021 MEDICAL SUPPLIES & DRUGS 39410612 39410612 BAD DEBT EXPENSE 39046391 39046391 REPAIRS & MAINTENANCE 3763523 3643267 120256 HOSPITAL TAX 2260217 2260217 646201 399352 246849 224218142 196444655 27773487 0 1108703 154691 0 0 0 0 19127833 21350910 0 0 0 0 0 0 4558613 3777281 1284359 724050 336767732 171060253 174775779 165707479 2743253 1849940 0 0 2829559 2352873 0 0 30303931 61113465 236732030 257030689 31551359 35300629 0 0 0 0 61408017 60073741 0 0 0 0 5019950 2956396 0 0 61277722 73272835 159257048 171603601 X 77474982 85138345 0 288743 0 0 77474982 85427088 236732030 257030689 X 2259861 1599868 4092377 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11832946 11832946 170718051 45261215 125456836 6661989 5494248 1167741 147554746 120304790 27249956 165707479 DUE FROM RELATED PARTIES 60507966 BOND ISSUE COSTS 396044 OTHER ASSETS 209455 61113465 0 DUE TO RELATED PARTIES 73272835 73272835 X ASC 740 FOOTNOTE (FKA FIN 48) SCHEDULE D, PART X, LINE 2 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. true true X true X true X true true false true true 3397021 3397021 0.01830 20331365 20134510 196855 0.00110 1813277 1813277 0 25541663 21947787 3593876 0.01940 94647 0 94647 0.00050 363140 0 363140 0.00200 22575 0 22575 0.00010 12504 0 12504 0.00010 492866 0 492866 0.00270 26034529 21947787 4086742 0.02210 2500 0 2500 4625 0 4625 7125 0 7125 true 39046391 1171392 56513652 52181485 4332167 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 X X X X X X X X X X true false true true 200. true 300. true X X X X true true X X X X true false true X false false 1 Laurel Park

1133 Eagles Landing Parkway Stockbridge GA 30281

Skilled Nursing Facility 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. true Tuition Reimbursement 39 73645 MONITORING THE USE OF GRANT FUNDS SCHEDULE I, PART I, LINE 2 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 true true X X X X X true true false false false false false false false Mr Charlie Hall 0 419345 0 138502 0 124108 0 159774 0 25915 0 867644 0 0 Mr Jay D Mitchell 0 408181 0 134332 0 49346 0 57676 0 21075 0 670610 0 0 Mr Gary Chawk 0 56074 0 0 0 303042 0 0 0 2486 0 361602 0 0 Mr Jeffrey A Cooper 0 187483 0 24744 0 22695 0 13131 0 10300 0 258353 0 0 Ms Karen A Kiel 0 161062 0 22100 0 13117 0 12258 0 12154 0 220691 0 0 Ms Yveta Seise 145630 0 4500 0 8500 0 0 0 3356 0 161986 0 0 0 Mr Walter P Evans 109504 0 0 0 41414 0 0 0 20787 0 171705 0 0 0 Ms Natalie R Wilkerson 94251 0 25000 0 22665 0 0 0 18438 0 160354 0 0 0 Mr Gregory A Hurst 0 684153 0 757434 0 2255492 0 33437 0 16327 0 3746843 0 0 Mr Charles Scott 0 355096 0 56553 0 97822 0 46710 0 19984 0 576165 0 0 Dr Ronnie Brownsworth 0 463526 0 152991 0 108518 0 77618 0 22937 0 825590 0 0 Mr Thomas Arnold 0 293773 0 84605 0 48181 0 38702 0 19028 0 484289 0 0 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 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 59825603 0 0 false false true true A false false false false 0.00000 0.00000 0.00000 false false false true A false false false true false false 0 false 0 false true A true REBATE COMPUTATION 0 SCHEDULE K, PART IV, LINE 2C THE REBATE CALCULATION WAS LAST PERFORMED ON APRIL 28, 2011. 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. 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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.