2014-05-14T10:41:23-05:00 2013-06-30 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 317081309 990 2012-07-01 581973570 FLOYD HEALTHCARE MANAGEMENT INC FLOY 7065096074 304 TURNER MCCALL BLVD ROME GA 301620233 RICHARD T SHEERIN 7065096074 2014-05-15 true JACQUELINE G ATKINS 2298837878 2014-05-14 2012 2015-11-30 17:44:51Z X KURT STUENKEL 304 TURNER MCCALL BLVD ROME GA 301620233 346715902 false X WWW.FLOYD.ORG X 1990 GA OPERATE A NON-PROFIT HOSPITAL SYSTEM AND SUPPORT 501 (C)(3) ORGANIZATIONS 17 12 3290 220 1443124 108931 451500 2485440 313013978 322128422 2064697 1770360 4600337 5442632 320130512 331826854 3516540 1899816 0 165867051 175508158 0 196611 143580224 149879280 312963815 327287254 7166697 4539600 321675722 348973368 213447564 218203492 108228158 130769876 OPERATE A NON-PROFIT HOSPITAL SYSTEM AND SUPPORT 501 (C)(3) ORGANIZATIONS false false 261930732 1899816 321385532 FLOYD HEALTHCARE MANAGEMENT, INC. OPERATES FLOYD MEDICAL CENTER, A GENERAL ACUTE CARE HOSPITAL, AND FLOYD BEHAVIORAL HEALTH CENTER, A PSYCHIATRIC UNIT. SEE ADDITIONAL DISCLOSURES AT SCHEDULE O, "SUPPLEMENTAL INFORMATION TO FORM 990". 261930732 true true false true false false false false false false true false false true true true true false false false false false false false false false true true true true true true false false false false false true true false true false false false false false true true false false false true 316 0 3290 true true true false false false false false false false false false X 17 12 false false true false false true false true true false false true true true true true false true true true true GA X RICHARD T SHEERIN 7065096074 304 TURNER MCCALL BLVD ROME GA 30161 X ROBERT HOLCOMBE JR MD 41.00 1.00 X 371363 0 21727 JAMES COLLINS JR MD 41.00 1.00 X 275035 0 0 BRAD WARD MD 41.00 1.00 X 204174 0 11630 JERRY NORMAN 1.00 3.00 X 8950 0 0 J ROGER SUMNER 1.00 2.00 X 4750 3000 0 JOHN S FREEMAN 1.00 3.00 X 6125 750 0 DAVID JOHNSON 1.00 2.00 X 3600 2750 0 LARRY KUGLAR 1.00 2.00 X 5625 0 0 FRANK SHELLEY 1.00 2.00 X 5625 0 0 JOHN MAYES 1.00 2.00 X 5609 0 0 TIM MAHANAY 1.00 1.00 X 4250 750 0 GEORGE BOSWORTH MD 1.00 2.00 X X 4125 750 0 KAY CHUMBLER 1.00 2.00 X 2500 2250 0 GARRY FRICKS 1.00 1.00 X 3750 0 0 WILLIAM V WIGLEY 1.00 1.00 X X 3625 0 0 CARL HERRING MD 1.00 1.00 X 2875 0 0 MARK MANIS 1.00 2.00 X 0 0 0 KURT STUENKEL 40.00 5.00 X 1402161 0 70505 RICHARD T SHEERIN 40.00 5.00 X 431630 0 50779 JOSEPH BIUSO MD 40.00 X 445382 0 50420 WARREN RIGAS 40.00 X 426768 0 55629 C WADE MONK 40.00 X 391400 0 65739 SHEILA HORNER 40.00 X 305708 0 9775 GREG POLLEY 40.00 X 283654 0 73054 DAN SWEITZER 40.00 X 270939 0 41191 DEE RUSSELL MD 40.00 X 253444 0 25951 ALISON LAND 40.00 X 246549 0 36572 REBEKAH LOWREY MD 40.00 X 240129 0 6852 BETH BRADFORD 40.00 X 203164 0 13253 ROBERT PURCELL 40.00 X 202539 0 35997 DAVID EARLY 40.00 X 175113 0 17858 KIMBERLY SCOGGINS 40.00 X 169746 0 13653 JOHN HARDWELL MD 40.00 X 787057 0 18166 MATTHEW T CORNFORTH MD 40.00 X 604275 0 11218 LOUIS A SPENCER MD 40.00 X 561033 0 21493 JOEL JAGER MD 40.00 X 517847 0 23788 GARRETT H BARNESMD 52.00 X 501854 0 40462 9332373 10250 715712 168 false true false BRASFIELD AND GORRIE LLC PO BOX 11407 BIRMINGHAM AL 352461407 GEN CONTRACTOR 8292094 CERNER CORP PO BOX 412702 KANSAS CITY MO 641412702 IT SERVICES 7773109 ARAMARK MANAGEMENT SERVICES PO BOX 233 ROME GA 301610233 ENVIRON SVCS 4000432 DUFFEY SOUTHEAST PO BOX 108 CEDARTOWN GA 301250108 GEN CONTRACTOR 2960261 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 303682289 DIETARY SVC 2786666 63 2485440 2485440 PATIENT SERVICE REVENUE 623000 319244581 319244581 FAMILY PRACTICE CAPITATION 621990 1440950 1440950 REFERENCE LAB 621500 866991 866991 SUBWAY/STARBUCKS 722513 575900 575900 322128422 1419516 1419516 3597434 306273 3291161 3291161 3291161 14582625 350964 14439912 142833 142713 208131 350844 350844 263 30 233 233 CAFETERIA 722513 1451237 1451237 MISCELLANEOUS INCOME 621990 644212 644212 FAMILY PRACTICE REVENUE 621110 28334 28334 27455 27455 2151238 331826854 321385532 1443124 6512758 1655913 1655913 243903 243903 6076958 6076958 131892656 113623969 18118337 150350 8954494 7465613 1478955 9926 19023230 15943711 3058320 21199 9560820 7126007 2424109 10704 651812 651812 231612 231612 32371 32371 31674214 24180944 7493270 2331563 250049 2081514 11119437 8166242 2951549 1646 5067707 803849 4263858 15476484 13552756 1923728 2707326 1205786 1498754 2786 689094 509106 179988 189352 189352 22693303 19872525 2820778 2704449 915532 1788917 MEDICAL SUPPLIES 43004237 42939424 64813 R&M 5564662 2555276 3009386 LICENSE & TAXES 3388423 171795 3216628 DUES & SUBSCRIPTIONS 1161883 319039 842844 1191351 429293 762058 327287254 261930732 65159911 196611 -82982 2722055 21299969 39160943 49651972 50531968 111928 93134 617200 804674 10156932 10017186 3516658 3664480 331202358 157342901 171816039 173859457 56491768 46952106 1491848 1583919 1132664 1040826 5471726 18542620 321675722 348973368 33108358 30833373 123849124 122815472 16080247 35702371 40409835 28852276 213447564 218203492 X 108228158 130769876 108228158 130769876 321675722 348973368 X 4539600 1016684 16985434 X false true X true false X SCHEDULE A, PART IV - REASON FOR NON-PRIVATE FOUNDATION STATUS ON JANUARY 1, 1998 FLOYD HEALTHCARE MANAGEMENT, INC. ACQUIRED BY LEASE ALL OF THE ASSETS OF THE HOSPITAL AUTHORITY OF FLOYD COUNTY AND THEREBY BECAME THE LICENSED OPERATOR OF FLOYD MEDICAL CENTER, A GENERAL, ACUTE CARE HOSPITAL WITH 300+ BEDS. SINCE THAT TIME, FLOYD HEALTHCARE MANAGEMENT, INC. HAS CONTINUED TO OPERATE FLOYD MEDICAL CENTER AS A NON-PROFIT HOSPITAL, OFFERING A WIDE ARRAY OF SERVICES TO THE COMMUNITY, INCLUDING AN EMERGENCY ROOM WHICH SEES APPROXIMATELY 80,000 PATIENTS PER YEAR AND A BUSY OUTPATIENT INDIGENT CLINIC. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 32371 32371 false SCHEDULE C, PART II-B, LINE 1 THE ORGANIZATION PAYS MEMBERSHIP DUES TO NATIONAL AND STATE ORGANIZATIONS. A PORTION OF THOSE DUES IS ALLOCATED TO LOBBYING ACTIVITIES IN WHICH THOSE ORGANIZATIONS PARTICIPATE. 12929005 12929005 118049348 40996652 77052696 14377700 7852779 6524921 170368482 108493470 61875012 15477823 15477823 173859457 DUE FROM RELATED PARTIES 9369382 OTHER RECEIVABLES 5384945 DEFERRED FINANCING COSTS 1993427 ESTIMATED THIRD PARTY PAYORS 1794866 18542620 ACCRUED PENSION 19510756 MALPRACTICE CLAIMS 6621508 ACCRUED INTEREST 2720012 28852276 X 332595788 1016684 306303 1322987 331272801 554053 554053 331826854 325865341 328053 328053 325537288 1749966 1749966 327287254 LIABILITY UNDER FIN 48 FOOTNOTE SCHEDULE D, PAGE 3, PART X THE CORPORATION IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)3 OF THE INTERNAL REVENUE CODE. THE CORPORATION APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE CORPORATION ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JUNE 30, 2013 AND 2012 OR FOR THE YEARS THEN ENDED. THE CORPORATION'S OPEN AUDIT PERIODS ARE FOR TAX YEARS ENDED 2010-2012. REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSES 306,273 COST OF GOODS SOLD 30 REVENUE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 4B GAIN ON SALE/LEASEBACK MOB 94,053 CAPITAL CONTRIBUTIONS 460,000 EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 306,273 COST OF GOODS SOLD 30 PMCI EXPENSES NOT INCLUDED ON THE 990 21,750 EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 4B GAIN ON SALE/LEASEBACK MOB 94,053 EQUITY TRANSFER 1,655,913 true true X true X 1.25000 true X 3.25000 true true false true true 21542939 21542939 0.06580 54770448 48119389 6651059 0.02030 76313387 48119389 28193998 0.08610 4404200 1440949 2963251 0.00900 1188997 4925 1184072 0.00360 5593197 1445874 4147323 0.01260 81906584 49565263 32341321 0.09870 true 38063455 20173631 74676924 79004537 -4327613 X true true 1 1 FLOYD HEALTHCARE MANAGEMENT INC FLOYD MEDICAL CENTER

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P O BOX 233 ROME GA 30165

EMERGENCY SERVICES EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I LINE 7 COLUMN F IN DERIVING THE DENOMINATOR TO BE USED FOR COLUMN F THE FOLLOWING ADJUSTMENTS WERE MADE TO THE TOTAL EXPENSES REPORTED ON FORM 990 PART IX LINE 25 FORM 990 PART IX LINE 25 XXX-XX-XXXX ADD EXPENSES REPORTED IN PART VIII 306303 DENOMINATOR FOR COLUMN F XXX-XX-XXXX COSTING METHODOLOGY EXPLANATION PART I LINE 7 THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATIONS A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS 2008 SEE ALSO THE DESCRIPTION FOR PART III LINE 4 BAD DEBT EXPENSE EXPLANATION PART III LINE 4 AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT AND WRITTEN OFF TO BAD DEBT EXPENSE THE FIGURE ON PART III LINE 3 REPRESENTS MANAGEMENTS ESTIMATE APPROXIMATELY 53 BASED ON AN ANALYSIS OF SELF PAY PATIENTS ABILITY TO PAY THEIR OUTSTANDING ACCOUNT THIS ANALYSIS INCLUDES REVIEWING THE PATIENTS CREDIT HISTORY INCOME LEVELS AND OVERALL COLLECTIBILITY OF THE ACCOUNT EXCERPT FROM AUDITED FINANCIAL STATEMENTS ALLOWANCE FOR DOUBTFUL ACCOUNTS ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE THE CORPORATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRDPARTY COVERAGE THE CORPORATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IF NECESSARY FOR EXAMPLE FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRDPARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY FOR RECEIVABLES ASSOCIATED WITH SELFPAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLES AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL THE CORPORATION RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE THE DIFFERENCE BETWEEN THE STANDARD RATES OR THE DISCOUNTED RATES IF NEGOTIATED AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS THE HOSPITALS ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELFPAY PATIENTS WAS 96 AND 95 OF SELFPAY ACCOUNTS RECEIVABLE AT JUNE 30 2013 AND 2012 RESPECTIVELY IN ADDITION THE HOSPITALS SELFPAY WRITEOFFS INCLUDING WRITE OFFS FOR CHARITY AND INDIGENT PATIENTS INCREASED APPROXIMATELY 9000000 FROM 96000000 FOR FISCAL YEAR 2012 TO 105000000 FOR FISCAL YEAR 2013 THE INCREASE IN WRITEOFFS WAS MOSTLY ATTRIBUTED TO AN INCREASE IN BAD DEBT WRITE OFFS FOR 2013 THE HOSPITAL CHANGED ITS CHARITY CARE AND UNINSURED DISCOUNT POLICIES DURING FISCAL YEAR 2013 TO COMPLY WITH IRS REGULATION 501R MEDICARE EXPLANATION PART III LINE 8 MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS COLLECTION PRACTICES EXPLANATION PART III LINE 9B FOR PATIENTS RECEIVING ONLY A PORTION OF THEIR BILL AS CHARITY THE REMAINING PORTION OF THE BILL IS TREATED THE SAME AS ALL OTHER PATIENTS IN REGARDS TO COLLECTIONS NEEDS ASSESSMENT PART VI FLOYD HEALTHCARE MANAGEMENT INC FHMI COMPLETED A HEALTH CARE NEEDS ASSESSMENT IN CHATTOOGA FLOYD AND POLK COUNTIES IN FISCAL YEAR 2012 THIS INCLUDED A RANDOM PAPER SURVEY OF RESIDENTS OF EACH COUNTY AS WELL AS INTERVIEWS WITH COMMUNITY LEADERS AND HEALTH CARE PROFESSIONALS AND FOCUS GROUPS IN ADDITION FHMI DEVELOPES A STRATEGIC PLAN THAT IS UPDATED ANNUALLY THE STRATEGIC PLAN TAKES INTO CONSIDERATION HEALTH NEEDS FOR OUR SERVICE AREA IN ADDITION TO UTILIZATION OF SERVICES COMMUNITY PARTICIPATION AND QUALITY OF SERVICES PROVIDED PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI FHMI COMMUNICATES THIS INFORMATION THROUGH SIGNAGE IN THE EMERGENCY CARE CENTER PATIENT REGISTRATION AREAS IN THE BUSINESSPATIENT FINANCIAL SERVICES OFFICES AND IN THE OFFICES OF OUR FINANCIAL COUNSELORS DURING TIMES OF PREADMISSION AS WELL AS ONSITE REGISTRATION THE ACCESSREGISTRATION STAFF DISCUSS POLICIES WITH THE PATIENTPATIENTS FAMILY IF APPROPRIATE AFTER DISCHARGE AND DURING THE COLLECTION PERIOD OUR STAFF ONCE AGAIN DISCUSS OUR FINANCIAL ASSISTANCE POLICIES IN ADDITION THERE IS A DEMONSTRATED WORDOFMOUTH COMMUNICATION OF THESE POLICIES THROUGH OUR PATIENT POPULATION COMMUNITY INFORMATION PART VI LOCATED IN NORTHWEST GA FHMI DBA FLOYD MEDICAL CENTER FMC IS BASED IN ROME GA WHICH IS THE COUNTY SEAT FOR FLOYD COUNTY ABOUT 60 MILES NORTH OF ATLANTA AND 60 MILES SOUTH OF CHATTANOOGA TN THE 163000 2011 ESTIMATE RESIDENTS OF THE THREECOUNTY REGION ARE SERVED BY FMC AND TWO SMALLER HOSPITALS THE POPULATION BASE IS APPROXIMATELY 81 CAUCASIAN 15 AFRICAN AMERICAN AND 4 OTHER ETHNICITIES NORTHWEST GA IS A MEDICAL AND EDUCATIONAL HUB THREE OF THE LARGEST EMPLOYERS IN THE THREECOUNTY AREA ARE HEALTH CARE PROVIDERS THE AREA IS ALSO HOME TO FOUR POSTSECONDARY EDUCATIONAL INSTITUTIONS STILL THE MANUFACTURING SECTOR REMAINS AN ECONOMIC FORCE IN THE AREA AS IN OTHER PARTS OF THE COUNTRY THE UNEMPLOYMENT RATE REMAINED IN DOUBLE DIGITS IN 2011 AND ALMOST 19 OF RESIDENTS ARE BELOW THE FEDERAL POVERTY LEVEL JUST UNDER ONETHIRD OF THE ADULT POPULATION HAS NOT GRADUATED HIGH SCHOOL MALIGNANT CANCER PRIMARILY LUNG CANCER AND CARDIOVASCULAR DISEASE ARE THE PRIMARY CAUSES OF DEATH IN THESE COUNTIES HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI FHMI IS THE SAFETYNET HEALTH CARE PROVIDER FOR NORTHWEST GEORGIA IN ADDITION TO PROVIDING EMERGENCY CARE SERVICES FMC HAS GONE THE EXTRA STEP OF PROVIDING 24HOUR COVERAGE FOR SURGERY AND OTHER SERVICES TO MAINTAIN STATUS AS A LEVEL II TRAUMA CENTER FHMI IS ALSO THE SITE FOR THE REGIONAL POISON CONTROL CENTER HOUSES THE REGIONS ONLY LEVEL III NEONATAL INTENSIVE CARE UNIT AND OPERATES A FAMILY MEDICINE RESIDENCY PROGRAM THAT OPERATES THE FLOYD COUNTY CLINIC TO PROVIDE BASIC HEALTH CARE SERVICES FOR THE ECONOMICALLY DISADVANTAGED IN THE COMMUNITY IN ADDITION TO THESE SERVICES FHMI ACTIVELY PROMOTES HEALTH AND SAFETY THROUGHOUT THE COMMUNITY THROUGH VARIOUS COMMUNITY BENEFIT ACTIVITIES INCLUDING BUT NOT LIMITED TO BICYCLE SAFETY HELMET GIVEAWAYS AND CLINICS SCHOOLBASED CHILD SAFETY PROGRAMS MOBILE MAMMOGRAPHY AND ACTIVE SPEAKERS BUREAU CHILDBIRTH CLASSES COMMUNITY HEALTH SCREENINGS AND HEALTH FAIRS AN ANNUAL CAMP FOR CHILDREN WITH DIABETES HEALTH CARE INTERNSHIPS EXTERNSHIPS AND SHADOWING OPPORTUNITIES AND SUPPORT FOR COMMUNITYWIDE INITIATIVES WITH HEALTH PARTNERS INCLUDING THE NORTHWEST GEORGIA CANCER COALITION CANCER NAVIGATORS AND THE FREE CLINIC OF ROME AFFILIATED HEALTH CARE INFORMATION PART VI FLOYD HEALTHCARE MANAGEMENT INC FHMI OPERATES FLOYD MEDICAL CENTER FMC A GENERAL ACUTE CARE HOSPITAL AND FLOYD BEHAVIORAL HEALTH CENTER A PSYCHIATRIC UNIT THESE TWO FACILITIES SERVE THE AREAS OF FLOYD COUNTY AND THE NORTHWEST GEORGIA REGION OTHER AFFILIATED ORGANIZATIONS INCLUDE HOSPITAL AUTHORITY OF FLOYD COUNTY A NONPROFIT ORGANIZATION THAT SUPPORTS FMC AND OPERATES POLK MEDICAL CENTER A 25BED CRITICAL ACCESS HOSPITAL LOCATED IN CEDARTOWN GA FLOYD HEALTHCARE RESOURCES INC A NONPROFIT ORGANIZATION WHICH FACILITATES THE OPERATIONS OF FMC FOR THE BENEFIT OF CITIZENS LOCATED IN FLOYD COUNTY AND THE NORTHWEST GEORGIA REGION HOSPITAL AUTHORITY OF FLOYD COUNTY SELF INSURANCE TRUST A NONPROFIT ORGANIZATION THAT SUPPORTS THE HOSPITAL AUTHORITY OF FLOYD COUNTY THIS ORGANIZATION PROVIDES FUNDING TO SATISFY MALPRACTICE AND COMPREHENSIVE GENERAL PATIENT CLAIMS AGAINST THE AUTHORITY AND FHMI FLOYD HEALTH CARE FOUNDATION INC A NONPROFIT ORGANIZATION THAT PROMOTES HEALTH CARE BY PROVIDING SUPPORT TO TAXEXEMPT HEALTH CARE ORGANIZATIONS AND PUBLIC CHARITIES IN AND AROUND THE ROME GEORGIA AREA POLK MEDICAL CENTER INC A 25BED CRITICAL ACCESS HOSPITAL WHICH PROVIDES INPATIENT AND OUTPATIENT SERVICES LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED PART VI GEORGIA FLOYD HEALTHCARE MANAGEMENT INC LINE NUMBER 1 PART V LINE 3 PART V LINE 3 THE INTERESTS OF THE COMMUNITIES WERE ENLISTED THROUGH A SURVEY PROCESS COMMUNITY FORUMS AND DIRECT INPUT FROM REPRESENTATIVES OF THE GEORGIA DEPARTMENT OF PUBLIC HEALTH THE SURVEY PROCESS WAS COMPLETED ON A CONVENIENCE BASIS AT PUBLIC EVENTS USING AN INSTRUMENT DESIGNED TO CAPTURE THE PUBLICS PERCEPTION OF HEALTH AND HEALTHCARE SERVICES IN THE COMMUNITY THE SURVEY INSTRUMENT AND RESULTS ARE INCLUDED IN THE CHNA THE INTERESTS OF THE COMMUNITY ARE ALSO REPRESENTED IN THE CHNA THROUGH PRIMARY DATA COLLECTED AT PUBLIC INPUT SESSIONS HELD IN EACH COUNTY CARE WAS TAKEN TO INVITE A CROSSSECTION OF THE COMMUNITY WITH REPRESENTATIVES FROM BUSINESS HEALTHCARE NONPROFITS PUBLIC HEALTH LOCAL GOVERNMENT AND EDUCATIONAL INSTITUTIONS DISTRICT PUBLIC HEALTH REPRESENTATIVES WERE ASKED TO REVIEW RAW DATA AND PROVIDE ASSISTANCE DEVELOPING PRIORITY NEEDS FLOYD HEALTHCARE MANAGEMENT INC LINE NUMBER 1 PART V LINE 5C PART V LINE 5C THE 2011 CHNA HAS BEEN DISTRIBUTED UPON REQUEST TO OTHER NONPROFIT AGENCIES IN THE AREA TO ASSIST WITH GRANTS COPIES HAVE ALSO BEEN MADE AVAILABLE TO ELECTED OFFICIALS CHAMBERS OF COMMERCE AND EDUCATIONAL INSTITUTIONS IN THE AREA FLOYD HEALTHCARE MANAGEMENT INC LINE NUMBER 1 PART V LINE 20D PART V LINE 20D FLOYD USES A SLIDING SCALE BASED ON FEDERAL POVERTY GUIDELINES true HOSPITAL AUTHORITY OF FLOYD COUNTY 304 TURNER MCCALL BLVD ROME GA 301610233 586001173 501C3 1655913 PENSION PLAN FUNDING 1 COBRA INSURANCE PREMIUM 37 103432 TUITION 60 140471 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 IT IS THE POLICY OF THE ORGANIZATION TO ESTABLISH PROCEDURES TO POTENTIALLY SECURE PAYMENT FOR HEALTHCARE SERVICES VIA EXTENSION OF INSURANCE BENEFITS THROUGH COBRA. THIS EXTENSION OF INSURANCE COVERAGE WILL BE PROVIDED ON A CASE-BY-CASE BASIS. THE HOSPITAL'S ROLE IN COVERAGE PAYMENT WILL BE REVIEWED MONTHLY; THERE IS NO OBLIGATION FOR THE HOSPITAL TO CONTINUE COVERAGE PAYMENT BEYOND THE INITIAL STATED LENGTH. THIS COVERAGE PAYMENT IS NOT TYPICALLY INTENDED FOR LONGER THAN A SPECIFIC SERVICE EVENT. IN GENERAL, ASSIGNED STAFF WILL EXAMINE PATIENTS FOR POTENTIAL QUALIFICATION FOR THIS PROGRAM. UPON QUALIFICATION, PAYMENT OF THE INSURANCE PREMIUM IS MADE TO THE EMPLOYER/INSURANCE COMPANY. PATIENT LIABILITY WILL BE EVALUATED AND DISCUSSED WITH THE PATIENT/GUARANTOR PRIOR TO DISCHARGE. THIS DISCUSSION WILL FOLLOW THE SAME PROTOCOL AS OTHER PATIENTS WITH RESIDUAL LIABILITIES. FINALLY, A 1099 TAX FORM IS ISSUED TO THE PATIENT. TUITION POLICY: THE ORGANIZATION PROVIDES OPPORTUNITIES FOR TRAINING, DEVELOPMENT, AND ADVANCEMENT WHICH ARE CONSISTENT WITH INDIVIDUAL ABILITY AND PERFORMANCE AS WELL AS BUDGETARY LIMITATIONS AND NEEDS OF THE ORGANIZATION. FHMI WILL SHARE IN THE COST OF TUITION AND BOOKS FOR CLASSROOM AND/OR CORRESPONDENCE COURSES FOR ELIGIBLE EMPLOYEES. THE EDUCATION MUST BE DIRECTLY RELATED TO THE EMPLOYEE'S DUTIES OR A POSITION TO WHICH THE EMPLOYEE MIGHT REASONABLY BE EXPECTED TO PROGRESS BY REASON OF PROMOTION. APPROVAL FROM THE EMPLOYEE'S DEPARTMENT HEAD, HUMAN RESOURCES DIRECTOR, AND APPLICABLE VICE PRESIDENT MUST BE GRANTED PRIOR TO ENROLLMENT, AND A GRADE OF B OR HIGHER MUST BE MAINTAINED. ALL EDUCATIONAL ASSISTANCE WILL BE SET UP AS A "FORGIVABLE LOAN" CONTRACT BETWEEN THE EMPLOYEE AND FHMI. THE LOAN WILL BE REPAID BY SERVICE. REIMBURSEMENT IS MADE SUBJECT TO RECEIPTS AND PROOF OF AWARDED GRADES. X X X true true X X X X X false true false false false true false false false ROBERT HOLCOMBE JR MD 370538 825 21727 393090 JAMES COLLINS JR MD 272816 2219 275035 BRAD WARD MD 202678 1496 11630 215804 KURT STUENKEL 562050 277045 563066 45476 25029 1472666 RICHARD T SHEERIN 304665 113251 13714 34947 15832 482409 JOSEPH BIUSO MD 303705 129451 12226 44297 6123 495802 WARREN RIGAS 305003 108051 13714 33902 21727 482397 C WADE MONK 271181 110351 9868 45871 19868 457139 SHEILA HORNER 210823 82151 12734 9775 315483 GREG POLLEY 199578 79951 4125 41874 31180 356708 DAN SWEITZER 177639 70451 22849 26103 15088 312130 DEE RUSSELL MD 178764 69726 4954 25951 279395 ALISON LAND 169411 70451 6687 21225 15347 283121 REBEKAH LOWREY MD 210602 26571 2956 6852 246981 BETH BRADFORD 175161 26441 1562 13253 216417 ROBERT PURCELL 177887 24114 538 24779 11218 238536 DAVID EARLY 151923 22884 306 17858 192971 KIMBERLY SCOGGINS 99866 63251 6629 13653 183399 JOHN HARDWELL MD 786318 739 18166 805223 MATTHEW T CORNFORTH MD 603955 320 11218 615493 LOUIS A SPENCER MD 559893 1140 21493 582526 JOEL JAGER MD 517314 533 23788 541635 GARRETT H BARNESMD 501090 764 18969 21493 542316 FRINGE OR EXPENSE EXPLANATION SCHEDULE J, PAGE 1, PART I, LINE 1A TRAVEL FOR COMPANIONS SPOUSAL TRAVEL EXPENSES ARE REIMBURSED WHEN ATTENDANCE IS NECESSARY AND APPROPRIATE. THE POLICY RECOGNIZES THAT GOVERNING BOARD MEMBERS AND SENIOR EXECUTIVES ARE OFTEN PLACED IN SOCIAL SITUATIONS AT SUCH MEETINGS AND WOULD REPRESENT THE HOSPITAL OPTIMALLY WITH THE ASSISTANCE OF THEIR SPOUSES. CONSEQUENTLY, THESE BENEFITS ARE NOT INCLUDED IN THEIR TAXABLE WAGES. SPOUSAL TRAVEL EXPENSES REQUIRE PRIOR APPROVAL AND ARE LIMITED TO EVENTS WHERE BOARD MEMBERS AND SENIOR EXECUTIVES ATTEND. REIMBURSEMENT SHALL BE LIMITED TO TRANSPORTATION EXPENSE NOT TO EXCEED THE AIR TRAVEL RATE IN COACH CLASS AND OUT-OF-POCKET EXPENSES WITH RESPECT TO LODGING AND FOOD. REIMBURSEMENT SHALL BE LIMITED TO LODGING BASED ON DOUBLE ACCOMMODATIONS. FLOYD HEALTHCARE MANAGEMENT, INC. ("FHMI") PROVIDES THE CEO WITH A MONTHLY AUTO ALLOWANCE. EACH YEAR THE AMOUNT THAT IS NONBUSINESS RELATED IS INCLUDED IN TAXABLE INCOME. FHMI PROVIDES A MEMBERSHIP TO THE LOCAL COUNTRY CLUB FOR THE CEO AND CMO. ANY AMOUNT CONSIDERED NONBUSINESS IS INCLUDED IN THE RECIPIENT'S TAXABLE INCOME. SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 KURT STUENKEL 0 534,087 0 COMPENSATION CONTINGENT UPON NET EARNINGS OF ORGANIZATION SCHEDULE J, PAGE 1, PART I, LINE 6A BONUS/INCENTIVE AWARDS: ALL MEMBERS OF THE EXECUTIVE TEAM FOR FHMI PARTICIPATE IN AN INCENTIVE COMPENSATION PLAN UNDER WHICH ANNUAL YEAR-END BONUSES ARE PAID BASED ON INDIVIDUAL AND CORPORATE-WIDE ACHIEVEMENT OF SPECIFIC GOALS AND OBJECTIVES. ONE OF THE GOALS RELATES TO THE ORGANIZATION'S NET INCOME. THESE BONUSES ARE A CASH-BASED SYSTEM. OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III THE CEO PARTICIPATES IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WHICH IS FUNDED ANNUALLY IN AN AMOUNT WHICH, WHEN ADDED TO OTHER SOURCES OF RETIREMENT INCOME, WILL AFFORD A RETIREMENT INCOME AT A TARGETED PERCENTAGE OF PRE-RETIREMENT COMPENSATION. THE SERP IS A NON-QUALIFIED RETIREMENT PLAN, AND AS SUCH THE ANNUAL FUNDING PAYMENTS PAID INTO IT ARE TAXABLE TO THE PARTICIPANT IN THE YEAR IN WHICH MADE. EFFECTIVE WITH CALENDAR YEAR 2009, MR. STUENKEL'S SERP IS A CASH-BASED PROGRAM. ADDITIONALLY, OF THE 1,402,161 LISTED AS COMPENSATION FOR MR. STUENKEL, 277,045 REPRESENTS A PERFORMANCE BASED PAYMENT ARISING FROM THE 2012 PERFORMANCE PERIOD AND 534,087 REPRESENTS THE NONQUALIFIED SERP PLAN. ACCORDINGLY, MR. STUENKEL'S SALARY FOR 2012 WOULD HAVE BEEN 591,029 EXCLUDING THE 2012 PORTION OF THE INCENTIVE BASED PAYMENT AND THE SERP PLAN AMOUNT. A HOSPITAL AUTHORITY OF FLOYD COUNTY REVENUE CERTIFICATES 2003 586001973 343575ER3 2003-12-17 40000000 HOSPITAL IMPROVEMENTS false false false B HOSPITAL AUTHORITY OF FLOYD COUNTY 2009 REVENUE ANTICIPATION BONDS 586001973 343575FQ4 2009-06-30 40000000 IMPROVEMENTS/DEFEASE 2005-2006 BONDS false false false C HOSPITAL AUTHORITY OF FLOYD COUNTY REVENUE BOND SERIES 2012 A 586001173 343575GH3 2012-06-27 20000000 CAPITAL IMPROVEMENTS false false false D HOSPITAL AUTHORITY OF FLOYD COUNTY REVENUE BONDS SERIES 2012B 586001173 343575GY6 2012-06-27 31885000 DEFEASE 2003 REVENUE SERIES BONDS false false false A 11983883 40710583 1572553 25989711 576451 12571868 2004 false false true true B 40232146 1332751 18595720 588380 18170340 2010 false false true true C 20074922 279011 243560 19552351 2013 false false true true D 34970725 444814 36387986 388296 1777 2013 false false true true A false false false false false false false true B false false false false false false false true C false false false false false false false true D false false false false false false false true A false false false false false false false false false B false false false false false false false false false C false false false false false false false false false D false false false false false false false false false A false DIFFERENCES IN ISSUE PRICE EXPLANATION SCHEDULE K HOSPITAL AUTHORITY OF FLOYD COUNTY PART II LINE 4 COLUMN A THE DIFFERENCE IN THE ISSUE PRICE REPORTED IN SCHEDULE K PART I AND TOTAL PROCEEDS OF ISSUE REPORTED IN SCHEDULE K PART II IS A PREMIUM ASSOCIATED WITH THE 2003 ISSUE HOSPITAL AUTHORITY OF FLOYD COUNTY PART II LINE 4 COLUMN B THE DIFFERENCE IN THE ISSUE PRICE REPORTED IN SCHEDULE K PART I AND TOTAL PROCEEDS OF ISSUE REPORTED IN SCHEDULE K PART II IS A PREMIUM ASSOCIATED WITH THE 2009 ISSUE HOSPITAL AUTHORITY OF FLOYD COUNTY PART II LINE 4 COLUMN C THE DIFFERENCE IN THE ISSUE PRICE REPORTED IN SCHEDULE K PART I AND TOTAL PROCEEDS OF ISSUE REPORTED IN SCHEDULE K PART II IS A PREMIUM ASSOCIATED WITH THE 2012A ISSUE HOSPITAL AUTHORITY OF FLOYD COUNTY PART II LINE 4 COLUMN D THE DIFFERENCE IN THE ISSUE PRICE REPORTED IN SCHEDULE K PART I AND TOTAL PROCEEDS OF ISSUE REPORTED IN SCHEDULE K PART II IS A PREMIUM ASSOCIATED WITH THE 2012B ISSUE PART II LINE 6 COLUMN D EXPENDITURES INCLUDE 2252148 IN FUNDS FROM THE SERIES 2002 DEBT SERVICE RESERVE FUNDS BRAD WARD MD BOARD MEMBER EDUCATIONAL LOAN X 150285 93134 false true true 93134 SHEILA B HORNER VP OF NURSING 2215 TUITION PAYMENT JOSHUA POLLEY FAMILY-KEY EMP 55056 EMPLOYEE WAGES false ROXANNE NORMAN FAMILY-BD MBR 39630 EMPLOYEE WAGES false BEN RIGAS FAMILY-KEY EMP 10013 EMPLOYEE WAGES false JOAN BIUSO FAMILY-KEY EMP 17247 EMPLOYEE WAGES false DAVID JOHNSON BOARD MEMBER BANKING SERVICES false ADDITIONAL INFORMATION SCHEDULE L PART V LISTED ABOVE ARE THE FAMILY MEMBERS OF CORPORATE OFFICERSKEY EMPLOYEES AND BOARD MEMBERS WHO ARE ACTIVELY EMPLOYED AND COMPENSATED BY FHMI THE ORGANIZATION MANINTAINS A BANK ACCOUNT FOR MALPRACTICE SELF INSURANCE FUND ACTIVITY AT UNITED COMMUNITY BANK DIRECTOR DAVID JOHNSON IS AN OFFICER AT UNITED COMMUNITY BANK SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS FORM 990, PAGE 6, PART VI, LINE 4 THE ORGANIZATION AMENDED ITS BYLAWS AS OF FEBRUARY 25, 2013 TO REVISE THE NUMBER OF BOARD MEMBERS FROM 12, 11 OF WHICH WERE ELECTED, TO 18 (17 OF WHICH ARE ELECTED BY THE ORGANIZATION'S BOARD OF DIRECTORS AND ONE, THE CEO, WHO SITS ON THE BOARD AS EX OFFICIO). REQUIRED REPRESENTATION SHALL NOW INCLUDE TWO FLOYD COUNTY COMMISSIONERS (ONE OF WHOM WAS APPOINTED BY THE FLOYD COUNTY COMMISSION AS A MEMBER OF THE HOSPITAL AUTHORITY OF FLOYD COUNTY, A RELATED ORGANIZATION), TWO ADDITIONAL MEMBERS OF THE HOSPITAL AUTHORITY OF FLOYD COUNTY, THREE PRACTICING PHYSICIANS EMPLOYED BY THE CORPORATION, AND TWO BOARD MEMBERS FROM POLK MEDICAL CENTER, INC. PREVIOUSLY ONLY ONE COUNTY COMMISSIONER SERVING ON THE BOARD WAS REQUIRED AND REPRESENTATION FROM POLK COUNTY WAS UNNECESSARY. THE AMENDED BYLAWS ALSO PLACED LIMITATIONS AND RULES RESPECTING CERTAIN DIRECTORS' ACTIONS AND RESPONSIBILITIES. THE ORGANIZATION'S CEO MAY NOT SERVE AS CHAIRMAN OF THE BOARD AND SHALL NOT BE COMPENSATED FOR SERVICES ON THE BOARD. THE CEO SHALL NOT PARTICIPATE IN ANY BOARD DELIBERATION OR DECISION CONCERNING ANY CONTRACT DISPUTE ISSUE, COMPENSATION ISSUE OR DISCIPLINARY ISSUE RESPECTING A MEMBER OF THE BOARD OF DIRECTORS WHO IS A PHYSICIAN EMPLOYED BY THE ORGANIZATION. ALSO, NO MEMBER OF THE BOARD WHO IS A PHYSICIAN EMPLOYED BY THE ORGANIZATION SHALL PARTICIPATE IN ANY BOARD DELIBERATION OR DECISION RESPECTING THE HIRING OR FIRING OF THE CEO OR IN ANY BOARD DECISION RESPECTING DISCIPLINARY ACTION OR COMPENSATION OF THE CEO. ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A THE ORGANIZATION'S BOARD MAKES ALL DECISIONS RELATED TO APPOINTMENT OF MEMBERS OF THE BOARD. THE CEO IS AUTOMATICALLY A MEMBER OF THE BOARD BY VIRTUE OF HIS POSITION IN THE ORGANIZATION. BY CONTRACT, THE ORGANIZATION AGREES TO HAVE TWO OF THE FLOYD COUNTY BOARD COMMISSIONERS ON THE BOARD. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B THE ORGANIZATION'S CEO, CFO, CONTROLLER, LEGAL COUNSEL AND EMPLOYEES OF FHMI REVIEW THE FORM 990 FOR FINANCIAL AND DISCLOSURE ACCURACY. PRIOR TO ITS FILING, A COPY OF THE ORGANIZATION'S 990 RETURN IS POSTED ON THE BOARD OF DIRECTOR'S SECURE WEBSITE FOR THEIR REVIEW. MANAGEMENT WILL SEND AN EMAIL NOTIFYING MEMBERS OF ITS POSTING. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C FLOYD HEALTHCARE MANAGEMENT, INC. ("FHMI") HAS A WRITTEN POLICY RESPECTING CONFLICTS OF INTEREST AND DISCLOSURE OF SAME. GENERALLY SPEAKING, THE POLICY REQUIRES ANY "COVERED PERSON" WHO BELIEVES HE HAS A CONFLICT OF INTEREST TO: -DISCLOSE THE EXISTENCE AND NATURE OF THE CONFLICT OF INTEREST (INCLUDING ALL FACTS KNOWN RESPECTING THE SUBJECT MATTER) TO THE CHAIRMAN OF THE BOARD; -PLAY NO PART, DIRECTLY OR INDIRECTLY, IN THE DELIBERATION OR VOTE OF THE BOARD OF DIRECTORS WITH RESPECT TO THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS; AND -ABSENT HIMSELF FROM THAT PORTION OF THE MEETING AT WHICH THE CONFLICT OF INTEREST IS DISCUSSED. THE DEFINITION OF A "COVERED PERSON" INCLUDES ALL BOARD MEMBERS, OFFICERS AND MEMBERS OF SENIOR MANAGEMENT OF FHMI. WHEN A COVERED PERSON DISCLOSES A POTENTIAL CONFLICT OF INTEREST TO THE BOARD CHAIRMAN, THE CHAIRMAN IS OBLIGED TO BRING THE MATTER TO THE ATTENTION OF THE FULL BOARD. THE BOARD DETERMINES WHETHER A CONFLICT OF INTEREST ACTUALLY EXISTS. IF THE BOARD DETERMINES THAT THERE IS A CONFLICT OF INTEREST, THE TRANSACTION OR MATTER GIVING RISE TO THE CONFLICT OF INTEREST MAY NOT PROCEED UNLESS THE BOARD DETERMINES, BY A MAJORITY VOTE, THAT, DESPITE THE CONFLICT OF INTEREST, THE TRANSACTION/MATTER IS NEVERTHELESS IN THE CORPORATION'S BEST INTEREST AND IS FAIR AND REASONABLE TO THE CORPORATION. IN ADDITION TO THE REQUIREMENT THAT A COVERED PERSON DISCLOSE A POTENTIAL CONFLICT OF INTEREST AT THE TIME IT ARISES, EACH COVERED PERSON IS ALSO REQUIRED TO SUBMIT, ON AN ANNUAL BASIS, A `CONFLICT AND DISCLOSURE OF INTEREST QUESTIONNAIRE'. THIS MULTI-QUESTION DOCUMENT SERVES AS A REMINDER AND PROMPTS EACH COVERED PERSON TO PONDER THOSE AREAS AND SITUATIONS WHERE A POTENTIAL CONFLICT MIGHT EXIST. ADDITIONALLY, ANY PROPOSED TRANSACTION AT FHMI WHICH INVOLVES AN "INSIDER" (I.E., A BOARD MEMBER, OFFICER, MANAGER, ETC.) IS SCRUTINIZED, WITH THE ASSISTANCE OF CORPORATE LEGAL COUNSEL, FROM THE STANDPOINT OF WHETHER THE TRANSACTION WILL RESULT IN ANY EXCESS BENEFIT TO THE INSIDER. TYPICALLY THIS INVOLVES OBTAINING APPROPRIATE DATA REGARDING COMPARABILITY WHICH IS PROVIDED TO THE BOARD FOR ITS USE IN DETERMINING THAT THE CONSIDERATION BEING PAID TO THE INSIDER AS A PART OF THE TRANSACTION IS REASONABLE AND DOES NOT EXCEED THE VALUE OF THE BENEFIT RECEIVED BY FHMI. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A IT IS THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE OF FLOYD HEALTHCARE MANAGEMENT, INC. BOARD TO ACTIVELY MANAGE AND MONITOR EXECUTIVE COMPENSATION. TO DO SO, THE COMMITTEE HAS ESTABLISHED THE FOLLOWING OBJECTIVES FOR THE EXECUTIVE COMPENSATION PROGRAM: -PROVIDE A COMPETITIVE TOTAL COMPENSATION EARNING OPPORTUNITY TO RECRUIT, RETAIN, AND REWARD THE EXECUTIVES NEEDED TO MEET THE COMMUNITY'S HEALTHCARE NEEDS, NOW AND IN THE FUTURE; -PROVIDE PAY OPPORTUNITIES THAT WILL REWARD THE EXECUTIVE TEAM WHEN ORGANIZATIONAL PERFORMANCE IN KEY AREAS IS DEMONSTRATED; -INCENTIVE COMPENSATION UNDER THE EXECUTIVE INCENTIVE COMPENSATION PLAN IS PAYABLE ONLY IN THE EVENT THE ORGANIZATION'S OPERATING MARGIN FROM OPERATING REVENUE EXCEEDS CERTAIN PARAMETERS ESTABLISHED BY THE COMPENSATION COMMITTEE; -ENSURE THAT THE COMPENSATION PROGRAMS ARE EASY FOR ALL INTERESTED PARTIES TO UNDERSTAND. ANNUALLY, THE COMMITTEE REVIEWS THE APPROPRIATENESS OF THE TOTAL COMPENSATION PROVIDED TO EACH EXECUTIVE: -AS RELATED TO THE COMPETITIVE MARKET PAY RATES; -AS RELATED TO THE INDIVIDUAL'S ROLE AND RESPONSIBILITY IN THE ORGANIZATION; -AS IT PERTAINS TO VARIABLE OR INCENTIVE EARNING OPPORTUNITIES RELATING TO THE PERFORMANCE OF THE ORGANIZATION. TO DETERMINE THE MARKET RATES FOR EACH POSITION, THE COMMITTEE UTILIZES AN OUTSIDE CONSULTANT TO SURVEY COMPARABLE ORGANIZATIONS TO DEVELOP AN APPROPRIATE RANGE OF PAY FOR EACH EXECUTIVE POSITION. THIS RANGE GENERALLY REFLECTS THE PAY PRACTICES AND LEVELS OF COMPARABLE ORGANIZATIONS IN GEORGIA, THE SOUTHEAST, AND ACROSS THE COUNTRY. SPECIFICALLY, THE COMMITTEE REVIEWS DATA FOR MARKET RATES OF BASE SALARY AND TOTAL COMPENSATION (THE COMBINATION OF BASE SALARY AND BONUSES). AFTER REVIEWING THIS DATA, THE COMMITTEE ASSESSES THE APPROPRIATENESS OF THE BASE PAY LEVELS FOR EACH EXECUTIVE WITHIN A RANGE THAT GENERALLY REFLECTS INDUSTRY NORMS. IN ADDITION TO MONITORING BASE SALARIES, THE COMMITTEE IS RESPONSIBLE FOR ADMINISTERING THE EXECUTIVE INCENTIVE COMPENSATION PROGRAM. THE PROGRAM IS DESIGNED TO: -FURTHER ALIGN EXECUTIVE PAY WITH THE STRATEGIC AND OPERATIONAL ACHIEVEMENTS OF THE ORGANIZATION; -WHEN THE ORGANIZATION ACHIEVES RESULTS IN KEY AREAS OF PERFORMANCE, TO APPROPRIATELY REWARD EXECUTIVES ACCORDING TO THAT PROGRAM; THE COMMITTEE HAS ALSO ESTABLISHED SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAMS (SERPS). THESE SERPS WERE DESIGNED WITH THE ADVICE AND HELP OF CONSULTANTS AND ARE DESIGNED TO RETAIN AND REWARD EXECUTIVES WITH RETIREMENT OPPORTUNITIES THAT ARE CONSISTENT WITH MARKET PRACTICES IN GEORGIA, THE SOUTHEAST, AND ACROSS THE COUNTRY. IN 2001, THESE PLANS VESTED TWO EXECUTIVES. IT IS THE PHILOSOPHY OF THE FHMI BOARD THAT THE COMBINATION OF THE INCENTIVE EARNING OPPORTUNITY, THE BASE SALARY, AND THE SERPS WILL PROVIDE A COMPETITIVE COMPENSATION LEVEL TO EACH EXECUTIVE THAT REFLECTS THE MARKET FOR EACH POSITION AND ORGANIZATION PERFORMANCE. THE COMMITTEE HAS DEVELOPED THE PROGRAM TO RECRUIT, RETAIN, AND REWARD EXECUTIVES IN ORDER TO MEET THE PRESENT AND FUTURE NEEDS OF THE ORGANIZATION TO PROVIDE A HIGH QUALITY OF PATIENT CARE TO THE COMMUNITY IN A COST EFFECTIVE MANNER. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B SEE NARRATIVE UNDER PART VI, LINE 15A. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC WHEN THE REQUEST IS MADE AT THE ADMINISTRATIVE OFFICE OF THE FILING CORPORATION. RELATED ORGANIZATIONS FORM 990, PAGE 7, PART VII FORM 990, PART VII SECTION A - COMPENSATION FROM RELATED ORGANIZATIONS MEMBERS OF THE BOARD OF DIRECTORS FOR FLOYD HEALTHCARE RESOURCES, INC., RELATED PARTY OF FLOYD HEALTHCARE MANAGEMENT, INC., RECEIVE A STIPEND FOR EACH BOARD MEETING ATTENDED. FOR THE 2012 TAXABLE YEAR, DIRECTORS JOHNSON, BOSWORTH, CHUMBLER, AND SUMNER ALSO SERVED ON THE BOARD OF FLOYD HEALTHCARE RESOURCES, INC. THREE BOARD MEMBERS (COLLINS, HOLCOMBE, AND WARD) ARE PHYSICIANS WHO ARE EMPLOYED AND COMPENSATED BY FHMI. DIRECTOR DAVID JOHNSON IS A SENIOR OFFICER OF UNITED COMMUNITY BANK. FHMI MAINTAINS AN ACCOUNT FOR MALPRACTICE SELF-INSURANCE ACTIVITY AT UNITED COMMUNITY BANK. FORM 990, PART VII SECTION A - COMPENSATION DR. CARL HERRING BOARD MEMBER CARL HERRING, MD IS A PRACTICING NEUROSURGEON WHO HAS CLINICAL PRIVILEGES AT FLOYD MEDICAL CENTER (FMC). AS SUCH, HE IS A PARTY TO A CONTRACT UNDER WHICH FMC PAYS THE NEUROSURGEONS ON ITS MEDICAL STAFF A PER DIEM FOR COVERING TRAUMA CALL IN THE EMERGENCY ROOM. UNDER THIS CONTRACT, THE NEUROSURGEON COVERING CALL FOR THE DAY DURING CALENDAR YEAR 2012 WAS PAID A PER DIEM OF 2,000. FMC HAS DETERMINED WITH THE ASSISTANCE OF OUTSIDE EXPERT VALUATION CONSULTANTS THAT THIS AMOUNT IS CONSISTENT WITH FAIR MARKET VALUE. ADDITIONALLY, DR. HERRING IS AN EMPLOYEE AND SHAREHOLDER IN THE HARBIN CLINIC, LLC, A 140+ DOCTOR MULTI-SPECIALTY GROUP MEDICAL PRACTICE. FMC HAS NUMEROUS CONTRACTS WITH HARBIN CLINIC UNDER WHICH HARBIN SUPPLIES ITS PHYSICIANS TO SERVE AS MEDICAL DIRECTORS OF VARIOUS DEPARTMENTS AND SERVICE LINES AT FMC, INCLUDING RESPIRATORY THERAPY, BARIATRICS, NEUROLOGY, VASCULAR LAB, HOSPICE, BREAST CENTER, INPATIENT REHAB, INFECTIOUS DISEASE, ETC. UNDER THESE CONTRACTS HARBIN CLINIC IS PAID FAIR MARKET COMPENSATION BASED ON AN HOURLY RATE FOR THE ACTUAL TIME EXPENDED BY ITS PHYSICIANS IN THE PERFORMANCE OF THE DUTIES CALLED FOR IN THESE CONTRACTS. OTHER COMMENTS & DISCLOSURES: FLOYD MEDICAL CENTER IS A 300+ BED GENERAL, ACUTE-CARE HEALTH INSTITUTION, OFFERING A WIDE RANGE OF SPECIALIZED SERVICES AND PROGRAMS. SUCH SERVICES AND PROGRAMS INCLUDE: ACUTE, MEDICAL/SURGICAL CARE; AMBULANCE SERVICE; BLOOD BANK; CANCER CARE UNIT; CARDIOVASCULAR LABORATORY; CORONARY CARE UNIT; CHAPLAIN SERVICE; CHEMICAL DEPENDENCY UNIT; CRISIS INTERVENTION; CT SCANNER; DIABETES CARE UNIT; LITHOTRIPSY, MEDICAL/SURGICAL INTENSIVE CARE; MAGNETIC RESONANCE IMAGING; NEUROLOGY; LEVEL III NEWBORN NURSERY/NEONATAL INTENSIVE CARE UNIT; OB/GYN; ORTHOPEDIC SURGERY, OUTPATIENT SURGERY CENTER; PATIENT REPRESENTATIVES; PEDIATRIC CARE; PHARMACY; DIAGNOSTIC RADIOLOGY; A 24-HOUR EMERGENCY SERVICE; ENDOSCOPIC LABORATORY; FAMILY PRACTICE RESIDENCY PROGRAM; PRIMARY CARE PHYSICIAN NETWORK; HEALTH EDUCATION AND PROMOTION; HOSPITAL AUXILIARY; INDUSTRIAL MEDICINE PROGRAM; INPATIENT REHABILITATION UNIT; LAPAROSCOPIC CHOLECYSTECTOMY SURGERY; LASER SURGERY; PHYSICAL THERAPY; OCCUPATIONAL THERAPY; SPEECH THERAPY; POISON CONTROL CENTER; POST-OPERATIVE RECOVERY ROOM; PROGRESSIVE INTENSIVE CARE UNIT; RESPIRATORY CARE SERVICES; SOCIAL WORK SERVICES; ULTRASOUND; CONGESTIVE HEART FAILURE CLINIC; WOUND OSTOMY CLINIC; BREAST CENTER, MOBILE MAMMOGRAPHY. DURING FISCAL YEAR 2013, PATIENT DAYS AT FLOYD MEDICAL CENTER TOTALED 77,117 AND DISCHARGES TOTALED 13,939. FLOYD MEDICAL CENTER PROVIDED APPROXIMATELY 73,303,000 IN DIRECT CHARITY AND INDIGENT CARE, AND IT INCURRED UNREIMBURSED MEDICARE AND MEDICAID ADJUSTMENTS OF 292,752,000 AND 144,132,000 RESPECTIVELY. A COPY OF THE REPORT TO THE COMMUNITY FOR FLOYD MEDICAL CENTER CAN BE FOUND AT WWW.FLOYD.ORG/ABOUT/INDEX.HTM. RECONCILIATION OF CHANGES - OTHER FORM 990, PART XI, LINE 9 RENTAL EXPENSES 306,273 COST OF GOODS SOLD 30 GAIN ON SALE/LEASEBACK MOB -94,053 CAPITAL CONTRIBUTIONS -460,000 RENTAL EXPENSES -306,273 COST OF GOODS SOLD -30 PMCI EXPENSES NOT INCLUDED ON THE 990 -21,750 GAIN ON SALE/LEASEBACK MOB 94,053 EQUITY TRANSFER 1,655,913 OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 9 AMORTIZATION OF ACTUARIAL LOSS 3,239,574 AMORTIZATION OF PRIOR SERVICE CREDIT 29,062 CURRENT YEAR ACTUARIAL LOSS 13,704,095 PMCI NET ASSETS ON PY RETURN 12,750 EQUITY TRANSFER -1,655,913 CAPITAL CONTRIBUTIONS 460,000 PMCI EXPENSES NOT INCLUDED ON 990 21,750 PRIOR YEAR ADJUSTMENT -47 TOTAL INCREASE IN NET ASSETS 16,985,434 FLOYD EMERGENCY PHYSICIANS LLC 304 TURNER MCCALL BLVD ROME GA 301620233 050608795 ER SVC GA 7241377 3823589 FHMI FLOYD PHYSICIANS LLC 304 TURNER MCCALL BLVD ROME GA 301620233 205415285 SPEC PHYS GA 2332427 629745 FHMI HOSPITAL AUTHORITY OF FLOYD COUNTY 304 TURNER MCCALL BLVD ROME GA 301620233 586001173 HEALTHCARE GA 501C3 3 NA false FLOYD HEALTHCARE RESOURCES INC 304 TURNER MCCALL BLVD ROME GA 301620233 582010524 HEALTHCARE GA 501C3 9 NA false HOSPITAL AUTHORITY OF FLOYD COUNTY SELF INSURANCE TRUST 304 TURNER MCCALL BLVD ROME GA 301620233 586140617 TRUST GA 501C3 11D FHMI FLOYD HEALTHCARE MANAGEMENT INC true FLOYD HEALTH CARE FOUNDATION INC PO BOX 233 ROME GA 301620233 581375074 FOUNDATION GA 501C3 11A FHMI FLOYD HEALTHCARE MANAGEMENT INC true POLK MEDICAL CENTER INC 420 E SECOND AVENUE STE 102 ROME GA 301613210 453957368 HOSPITAL GA 501C3 3 FHMI FLOYD HEALTHCARE MANAGEMENT INC true FLOYD HEALTH VENTURES INC 304 TURNER MCCALL BLVD ROME GA 30162 581925982 MED SVCS GA N/A true false false true true false false false false false false false true true true true true true false false ALL ENTITIES N AMOUNT INDETERMINABLE ALL ENTITIES O AMOUNT INDETERMINABLE ALL ENTITIES Q AMOUNT INDETERMINABLE FLOYD HEALTH CARE FOUNDATION INC C 460000 CASH POLK MEDICAL CENTER INC D 11297127 GENERAL LEDGER BALANCE FLOYD HEALTH CARE FOUNDATION INC M AMOUNTS INDETERMINABLE ALL OTHER ENTITIES M AMOUNTS INDETERMINABLE ALL ENTITIES L AMOUNT INDETERMINABLE ALL ENTITIES N AMOUNT INDETERMINABLE ALL ENTITIES O AMOUNT INDETERMINABLE ALL ENTITIES Q AMOUNT INDETERMINABLE FLOYD HEALTH CARE FOUNDATION INC C 460000 CASH POLK MEDICAL CENTER INC D 11297127 GENERAL LEDGER BALANCE FLOYD HEALTH CARE FOUNDATION INC M AMOUNTS INDETERMINABLE ALL OTHER ENTITIES M AMOUNTS INDETERMINABLE ALL ENTITIES L AMOUNT INDETERMINABLE ADDITIONAL INFORMATION SCHEDULE R PART I DISREGARDED ENTITIES IN SEPTEMBER 2004 FLOYD HEALTHCARE MANAGEMENT INC FHMI SPONSORED THE CREATION OF FLOYD EMERGENCY PHYSICIANS LLP FEP A GEORGIA LIMITED LIABILITY COMPANY FHMI IS THE SOLE MEMBEROWNER OF FEP AND HAS THE SOLE AUTHORITY TO APPOINT FEPS FIVEPERSON BOARD OF DIRECTORS FEP WAS FORMED FOR THE PURPOSE OF HIRING OR OTHERWISE ENGAGING EMERGENCY PHYSICIANS TO PROVIDE PROFESSIONAL MEDICAL SERVICES TO PATIENTS PRESENTING TO FLOYD MEDICAL CENTERS EMERGENCY CARE CENTER IN AUGUST 2006 FHMI SPONSORED THE CREATION OF FLOYD PHYSICIANS LLC FP A GEORGIA LIMITED LIABILITY COMPANY FHMI IS THE SOLE MEMBEROWNER OF FP AND HAS THE SOLE AUTHORITY TO APPOINT FPS FIVEPERSON BOARD OF DIRECTORS FP WAS FORMED FOR THE PURPOSE OF HIRING OR OTHERWISE ENGAGING PHYSICIANS TO PROVIDE PROFESSIONAL MEDICAL SERVICES TO PATIENTS PART IV TAXABLE SUBSIDIARIES IN DECEMBER OF 1990 THE HOSPITAL AUTHORITY OF FLOYD COUNTY GEORGIA AUTHORITY SPONSORED THE CREATION OF FLOYD HEALTH VENTURES I INC VENTURES A GEORGIA NONPROFIT TAXABLE CORPORATION VENTURES I HAS A FOURPERSON BOARD OF DIRECTORS THE MEMBERS OF WHICH ARE APPOINTED BY THE AUTHORITY BECAUSE VENTURES I IS A NONPROFIT NONSTOCK CORPORATION THE AUTHORITY DOES NOT HAVE AN OWNERSHIP INTEREST VENTURES HAS BEEN INACTIVE FOR A NUMBER OF YEARS THERE WERE NO TRANSFERS BETWEEN FHMI AND TAXABLE SUBSIDIARIES