2014-02-14T16:29:21-06:00 2013-03-31 721396621 CARR RIGGS & INGRAMLLC 4360 CHAMBLEE DUNWOODY RD STE 420 ATLANTA GA 30341 990 2012-04-01 510141601 SHEPHERD CENTER INC SHEP 4043507310 2020 PEACHTREE ROAD NW ATLANTA GA 30309 STEPHEN B HOLLEMAN 4043507310 2014-02-01 1 TARA D WHITE P00910505 7704576606 2012 2015-11-30 17:44:51Z GARY R ULICNY 2020 PEACHTREE ROAD NW ATLANTA GA 30309 166941800 0 X WWW.SHEPHERD.ORG X 1975 GA SEE SCHEDULE O FOR A COMPLETE DESCRIPTION OF SHEPHERD CENTER'S MISSION STATEMENT.SHEPHERD CENTER'S MISSION IS TO HELP PEOPLE WITH A TEMPORARY OR PERMANENT DISABILITY CAUSED BY INJURY OR DISEASE REBUILD THEIR LIVES WITH HOPE, INDEPENDENCE, AND DIGNITY, ADVOCATING FOR THEIR FULL INCLUSION IN ALL ASPECTS OF COMMUNITY LIFE WHILE PROMOTING SAFETY AND INJURY PREVENTION. 23 19 1617 714 124930 -113762 11570889 10681134 142403110 148756388 1453926 3324598 3458379 3980492 158886304 166742612 0 0 0 0 88141524 93478887 0 0 0 50971124 54329082 139112648 147807969 19773656 18934643 323341883 346135803 88522197 84798875 234819686 261336928 X SHEPHERD CENTER'S PRIMARY PURPOSE IS TO PROVIDE ACUTE AND REHABILITATIVE HOSPITAL CARE TO PATIENTS WITH SPINAL CORD INJURIES, ACQUIRED BRAIN INJURIES, MULTIPLE SCLEROSIS, AND OTHER NEUROMUSCULAR AND UROLOGICAL DISEASES. CONTINUED ON SCHEDULE O.WE STRIVE TO BE THE MOST COMPREHENSIVE CATASTROPHIC CARE SPECIALTY HOSPITAL IN THE WORLD COMMITTED TO IMPROVING OUR PATIENTS' LIVES. 0 0 95684197 148756388 IN REFERENCE TO THE PROVISION OF PATIENT CARE SERVICES, SHEPHERD CENTER IS DEDICATED TO HELPING PEOPLE WHO HAVE EXPERIENCED CATASTROPHIC INJURY OR DISEASE REBUILD THEIR LIVES WITH HOPE, DIGNITY, AND INDEPENDENCE, ADVOCATING FOR THEIR FULL INCLUSION IN ALL ASPECTS OF COMMUNITY LIFE. IN THE LAST FISCAL YEAR, SHEPHERD CENTER INCURRED EXPENSES TO PROVIDE SERVICES FOR 940 INPATIENT ADMISSIONS, 42,109 INPATIENT DAYS, 48,673 OUTPATIENT VISITS, AND 14,703 DAY PATIENT DAYS. 11672470 8610264 BECAUSE OF THE GENEROUS FINANCIAL SUPPORT OF THE COMMUNITY, SHEPHERD CENTER IS ABLE TO PROVIDE MANY COMMUNITY FUNDED SERVICES THAT ARE NOT AVAILABLE IN OTHER HOSPITALS. SHEPHERD CENTER OFFERS SERVICES SUCH AS FAMILY HOUSING AND TRAINING, EXPANDED THERAPEUTIC RECREATION SERVICES, ASSISTIVE TECHNOLOGY AND ADAPTIVE EQUIPMENT, AND VOCATIONAL TRAINING, AS WELL AS MEDICAL CARE FOR PATIENTS WITHOUT THE ABILITY TO PAY FOR THESE SERVICES. 3882573 3675271 WITH REGARD TO RESEARCH ACTIVITY, SHEPHERD CENTER IS A SITE FOR LEADING-EDGE RESEARCH AND PROVIDES IMPORTANT OUTCOMES TRACKING THAT HELP SHAPE THE FACE OF REHABILITATION IN THE UNITED STATES. OUR VISION IS TO BE A CENTER OF EXCELLENCE IN PATIENT CARE, PARTICIPATING IN RESEARCH THAT WILL ACHIEVE THE HIGHEST OUTCOMES AND IMPROVE THE LIVES OF OUR PATIENTS AND FAMILIES. 111239240 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 0 1 331 0 1 1617 1 1 1 0 0 0 0 0 0 0 0 0 X 23 19 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 GA SC FL TN AL NC X NORA MANGRUM 4043507320 2020 PEACHTREE RD NW ATLANTA GA 303091402 FRED V ALIAS 1.00 X 0 0 0 GREGORY ANDERSON 1.00 X 0 0 0 DAVID F APPLE JR MD 24.00 1.00 X 124835 0 16493 JAMES M CASWELL JR 1.00 X 0 0 0 SARA S CHAPMAN 1.00 X 0 0 0 CLARK H DEAN 1.00 X 0 0 0 JOHN S DRYMAN 1.00 X 0 0 0 DAVID H FLINT 1.00 X 0 0 0 DONALD P LESLIE MD 40.00 1.00 X 634013 0 15557 DOUGLAS LINDAUER 1.00 X 0 0 0 JULIAN B MOHR 1.00 X 0 0 0 C TALBOT NUNNALLY III 1.00 X 0 0 0 SALLY D NUNNALLY 1.00 X 0 0 0 J HAROLD SHEPHERD 1.00 X 0 0 0 W CLYDE SHEPHERD III 1.00 X 0 0 0 JAMES E STEPHENSON 1.00 X 0 0 0 JAMES D THOMPSON 1.00 X 0 0 0 JAMES H SHEPHERD JR 40.00 1.00 X X 286293 0 15443 GARY ULICNY PHD 40.00 1.00 X X 660204 0 24031 EMORY A SCHWALL 4.00 X X 0 0 0 WILLIAM C FOWLER 2.00 X X 0 0 0 STEPHEN B GOOT 2.00 X X 0 0 0 ALANA SHEPHERD 20.00 20.00 X X 0 0 0 STEPHEN B HOLLEMAN 40.00 1.00 X X 359555 0 23781 WILMA BUNCH 40.00 X 211786 0 16705 MITCHELL J FILLHABER 40.00 X 304331 0 16031 BROCK BOWMAN MD 40.00 X 480437 0 21072 TAMARA KING 40.00 X 211780 0 20269 MICHAEL JONES 40.00 X 310686 0 22820 SCOTT H SIKES 1.00 40.00 X 257654 0 14323 SARAH MORRISON 40.00 X 203996 0 20143 GERALD BILSKY MD 40.00 X 453415 0 11995 SHERRILL LORING MD 40.00 X 487298 0 0 JOHN MUSSER MD 40.00 X 484656 0 8558 ERIK SHAW MD 40.00 X 527916 0 17163 BEN THROWER MD 40.00 X 568703 0 21247 6567558 0 285631 106 0 1 0 PIEDMONT HOSPITAL PO BOX 725507 ATLANTA GA 31139 MEDICAL SERVICES 4353386 CHOATE CONSTRUCTION 8200 ROBERTS DRIVE SUITE 600 ATLANTA GA 303504147 CONSTRUCTION WORK/RENOVATION SERVICES 2672543 SIEMENS MEDICAL SOLUTIONS C/O MELLON BANK DEPT AT 12001 DEPT DALLAS TX 753120733 SOFTWARE IMPLENETATION 1781578 GLOBALSTAR CONSULTING LLC PO BOX 974414 DALLAS TX 753974414 COMPUTER CONSULTING SERVICES 1701843 HIMFORMATICS 1735 BUFORD HWY STE 215-311 CUMMING GA 30041 COMPUTER CONSULTING SERVICES 1226982 30 1840471 8840663 220853 10681134 NET INPATIENT SERVICE 900099 111799623 111799623 NET OUTPATIENT SERVICE 900099 30516299 30516299 NET DAYPATIENT SERVICE 900099 6440466 6440466 148756388 3457818 3457818 383300 47578 335722 335722 335722 18390 151610 -133220 -133220 -133220 CAFETERIA REVENUE 900099 1217119 1217119 ADMINISTRATIVE FEES 532000 62847 62847 RENTAL INCOME 532000 62083 62083 2302721 2302721 3644770 166742612 151394831 124930 4541717 X 6853190 4663053 2190137 69700357 55858479 13841878 1881056 1881056 3535394 2833296 702098 11508890 4627710 6881180 164576 71708 92868 158144 158144 127104 127104 9991728 7562105 2429623 348937 490 348447 2806948 1537295 1269653 1757901 1757901 2491521 508400 1983121 951734 711910 239824 527804 288982 238822 936898 936898 8424470 1873514 6550956 384305 94447 289858 MEDICAL SUPPLIES 17494778 16312255 1182523 BAD DEBT EXPENSE 3482655 0 3482655 EQUIPMENT RENTAL & MAIN 2196183 1665631 530552 OTHER DIRECT EXPENSES 1965026 323889 1641137 118370 12306076 -12187706 147807969 111239240 36568729 0 10174786 13268418 24238510 15917586 673367 879918 29461673 31719757 1212204 1404501 2122505 1496937 227685327 98625039 126526286 129060288 126315056 149716325 2617496 2672073 323341883 346135803 13902749 12913077 918230 39103 67200000 65400000 6501218 6446695 88522197 84798875 X 176379764 198734401 16119646 20070512 42320276 42532015 234819686 261336928 323341883 346135803 X 18934643 5106436 2476163 X X 0 1 X 1 1 1 X 56006 14812 70818 111168422 111239240 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 37087 49024 56528 70818 213457 250000 250000 250000 250000 1000000 1500000 31048 42730 44752 56006 174536 PART IV, SUPPLEMENTAL INFORMATION: SHEPHERD CENTER, INC. EMPLOYS MARK JOHNSON AS DIRECTOR OF ADVOCACY. DURING FISCAL YEAR 2013, HE AND ADVOCACY SPECIALIST, CAROL JONES, WERE INVOLVED IN THE FOLLOWING ACTIVITIES: 1. MAINTAINED ADVOCACY LISTSERV, A LISTING OF ADVOCACY OPPORTUNITIES FOR STAFF AND CONSUMERS (GRASSROOTS - LINE 1A). 2. SUPPORTED EFFORTS TO INCREASE AND IMPROVE HOME AND COMMUNITY BASED SERVICES (GRASSROOTS - LINE 1A). 3. PROMOTED NATIONAL DISABILITY EMPLOYMENT AWARENESS MONTH AND RELATED ACTIVITIES IN OCTOBER 2012 (GRASSROOTS - LINE 1A). 4. SERVED ON THE ADVISORY BOARD OF RESPECTABILITY, A NATIONAL, NON-PROFIT, NON-PARTISAN ORGANIZATION WHOSE MISSION IS TO RESHAPE THE ATTITUDES OF AMERICAN SOCIETY SO THAT PEOPLE WITH DISABILITIES CAN MORE FULLY PARTICIPATE AND CONTRIBUTE TO SOCIETY (GRASSROOTS - LINE 1A). 5. PARTICIPATED IN PROMOTING THE NATIONAL DISABILITY ALLIANCES PUBLIC POLICY AGENDA (NDLA,HTTP://WWW.DISABILITYLEADERSHIP.NET)(DIRECT LOBBYING - LINE 1B). 6. PARTICIPATED IN GEORGIA'S ANNUAL DISABILITY DAY AT THE CAPITOL, FEBRUARY 21, 2013 (DIRECT LOBBYING - LINE 1B). 42320276 211739 42532015 41432723 887553 42320276 43555890 -2123167 41432723 43196059 359831 43555890 41657033 1539026 43196059 1.00000 0 0 16628506 16628506 100894460 32588160 68306300 99684555 65265332 34419223 10477806 771547 9706259 129060288 ANNUITIES PAYABLE 6446695 6446695 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE CENTER APPLIES THE PROVISIONS OF ACCOUNTING STANDARDS FOR INCOME TAXES. THESE PROVISIONS REQUIRE THAT A TAX POSITION BE RECOGNIZED OR DERECOGNIZED BASED ON A "MORE-LIKELY-THAN-NOT" THRESHOLD. THIS APPLIES TO POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE CENTER DOES NOT BELIEVE ITS CONSOLIDATED FINANCIAL STATEMENTS INCLUDE ANY MATERIAL UNCERTAIN TAX POSITIONS. 1 1 1 X 250.000000000000 0 1 1 1 0 1 1 1 2174 3729040 231744 3497296 0.02370 1 885 700003 0 700003 0.00470 2 3059 4429043 231744 4197299 0.02840 68 17447 5797794 59499 5738295 0.03880 2 14 250836 0 250836 0.00170 8 4592 544927 0 544927 0.00370 37 350 3551517 148576 3402941 0.02300 1 16 52158 3206 48952 0.00030 116 22419 10197232 211281 9985951 0.06750 118 25478 14626275 443025 14183250 0.09590 1 1700 599998 46568 553430 0.00370 1 1680 164327 0 164327 0.00110 3 688 54641 0 54641 0.00040 5 4068 818966 46568 772398 0.00520 0 1471340 0 11288462 16050204 -4761742 X 1 1 1 1 SHEPHERD CENTER INC

2020 PEACHTREE ROAD NW ATLANTA GA 30309

X X SHEPHERD CENTER INC 1 1 X X X X X X X X X 12 1 0 1 X X X X X X X X 1 0 1 1 250.000000000000 0 1 X X X X X X X X 1 1 X X X X X X 0 0 0 X X 0 0 2 SHEPHERD PATHWAYS

1942 CLAIRMONT ROAD DECATUR GA 30033

OUTPATIENT CENTER SERVING BRAIN INJURY PATIENTS BEYOND THERAPY TENNESSEE

277 MALLORY STATION FRANKLIN TN 37067

OUTPATIENT CENTER PROVIDING INTENSIVE REHABILITATION SERVICES PART II: SHEPHERD CENTER'S COMMUNITY BUILDING ACTIVITIES ARE CONCENTRATED IN THE FOLLOWING AREAS:ADVOCACYSHEPHERD CENTER'S ADVOCACY PROGRAM IS RESPONSIBLE FOR THE FOLLOWING:1.SERVE AS A PRIMARY LIAISON BETWEEN SHEPHERD CENTER AND THE DISABILITY COMMUNITY.2.PROVIDE DAY-TO-DAY EXPERTISE ON DISABILITY RIGHTS ISSUES.3.PROMOTE DISABILITY RIGHTS.4.SUPPORT THE DEVELOPMENT OF LOCAL AND NATIONAL CAMPAIGNS RELATED TO HOME AND COMMUNITY BASED SERVICES (HCBS), ACCESSIBLE, AFFORDABLE, INTEGRATED HOUSING, AFFORDABLE, INTEGRATED HOUSING, REUSE EFFORTS AND INCLUSIVE EMERGENCY MANAGEMENT.5.SERVE ON AMERIGROUP'S AGING AND DISABILITY ADVISORY BOARDIN FYE 2013 MARK JOHNSON, DIRECTOR OF ADVOCACY AT SHEPHERD CENTER, PROMOTED EFFORTS TO INCREASE AND IMPROVE HOME AND COMMUNITY BASED SERVICES AND DISABILITY EMPLOYMENT AWARENESS.HOUSINGHAVING THE FAMILIES AND LOVED ONES INVOLVED IN REHABILITATION AFTER A CATASTROPHIC INJURY IS IMPERATIVE TO THE SUCCESSFUL TRANSITION TO COMMUNITY, HOME, WORK AND/OR SCHOOL. SHEPHERD CENTER OFFERS COMPLIMENTARY HOUSING FOR 30 DAYS FOR FAMILIES WHO TRAVEL MORE THAN 60 MILES FROM ATLANTA TO GET TO SHEPHERD CENTER. THIS SUPPORT IS CRUCIAL AND APPRECIATED BY FAMILIES AS IT ENABLES THEM TO FOCUS ON THEIR LOVED ONE GETTING BETTER AND NOT THE FINANCIAL BURDENS AND STRESS THAT COMES WITH MOVING FROM HOME FOR CARE. COMPLIMENTARY HOUSING IS ALSO OFFERED FOR DAY PROGRAM PATIENTS AS A WAY TO EXPERIENCE WHAT THEY HAVE LEARNED IN THE INPATIENT SETTING AND PUT IT TO WORK IN A SAFE ENVIRONMENT. THE HOUSING PROGRAM HELPS ALLEVIATE STRESS AND UNCERTAINTY AS PATIENTS TRANSITION BACK TO THEIR HOME AND COMMUNITY. IN ORDER TO PROVIDE A PEER SUPPORT COMMUNITY FOR MILITARY PATIENTS, HOUSING IS PROVIDED AT BISCAYNE PLACE, AN APARTMENT COMPLEX WITHIN TWO MILES OF SHEPHERD CENTER. MOST EVERY FAMILY MEMBER THAT STAYS IN THE WOODRUFF FAMILY RESIDENCE CENTER HAS SHARED THAT, BY HAVING HOUSING AVAILABLE TO THEM, SHEPHERD CENTER HAS ALLEVIATED THE STRESS AND WORRY OF TRYING TO FIND AND PAY FOR A PLACE TO STAY. PLUS, THEY ARE SO CLOSE TO THEIR LOVED ONES AT THE HOSPITAL, IT GIVES THEM A SENSE OF SECURITY AND CONVENIENCE THEY WOULDN'T HAVE HAD OTHERWISE. INJURY PREVENTIONBRIDGET METZGER, A FORMER SPINAL CORD INJURY CASE MANAGER WAS HIRED IN OCTOBER, 2012 TO DIRECT SHEPHERD CENTER'S NEW INJURY PREVENTION PROGRAM. MAJOR PROJECTS IN THE FIRST YEAR INCLUDED:- MIDDLE SCHOOL TBI & SCI PREVENTION SCIENCE CURRICULUM, WHICH REACH APPROXIMATELY 1300 SEVENTH GRADE STUDENTS IN COBB COUNTY SCHOOLS.- PRODUCTION OF TWO EXCELLENT 35-MINUTE VIDEOS OF OUR VISITS WITH FORMER PATIENTS AND STAFF TO CAMPBELL MIDDLE SCHOOL IN SPRING 2013. THE VIDEOS ARE A POWERFUL TOOL FOR SCHOOLS TO TEACH STUDENTS ABOUT TBI AND SCI, CAREERS IN THE FIELD, WHAT LIFE IS LIKE AFTER INJURY AND HOW YOUNG PEOPLE CAN AVOID GETTING HURT THEMSELVES.- FIRST ANNUAL EMPLOYEE SAFE DRIVING WEEK, APRIL 2013.- PEDESTRIAN SAFETY CAMPAIGN WITH A FOCUS ON PEACHTREE STREET, SEPTEMBER 2013. PART III, LINE 4: AS STATED IN THE FOOTNOTES OF SHEPHERD CENTER'S FINANCIAL STATEMENTS, THE CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS NET REVENUE OR ACCOUNTS RECEIVABLE.THE CENTER MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY AND THE ESTIMATED COSTS OF THOSE SERVICES AND SUPPLIES. THE AMOUNTS OF CHARGES FOREGONE, BASED ON ESTABLISHED RATES, AND ESTIMATED COSTS AND EXPENSES INCURRED TO PROVIDE CHARITY CARE IN FY 2013 WERE $9,057,392 AND $3,723,058, RESPECTIVELY, RESULTING IN A 41.11% COST FACTOR. THIS COST FACTOR WAS APPLIED TO GROSS BAD DEBT EXPENSE OF $3,579,451 TO GET THE AMOUNT ON PART III, LINE TWO. PART III, LINE 9B: ACCORDING TO SHEPHERD CENTER'S DEBT COLLECTION POLICY, ALL PATIENTS ARE ASKED TO COMPLETE A FINANCIAL SCREENING AT THE TIME OF REGISTRATION. IF A PATIENT IS APPROVED FOR ASSISTANCE BASED ON THE FINANCIAL DATA SUPPLIED, ANY PATIENT BALANCES WILL BE APPLIED TO A CHARITY ALLOWANCE BASED ON THE HOSPITAL'S FINANCIAL ASSISTANCE TO PATIENTS POLICY. SHEPHERD CENTER, INC. PART V, SECTION B, LINE 11: SEE PART VI, LINE 3 EXPLANATION FOR A COMPLETE DISCLOSURE OF HOW DISCOUNTED ELIGIBILITY IS DETERMINED. SHEPHERD CENTER, INC. PART V, SECTION B, LINE 12H: FAMILY SIZE SHEPHERD CENTER, INC. PART V, SECTION B, LINE 14G: WHEN PATIENTS ARE SCHEDULED OR AN ADMISSION REFERRAL IS MADE, APPROPRIATE FINANCIAL SCREENING IS PROVIDED. SHEPHERD CENTER, INC. PART V, SECTION B, LINE 20D: SHEPHERD CENTER DISCOUNTS CARE FOR PATIENTS WHO HAVE THE ABILITY TO PAY USING THE AVERAGE DISCOUNT APPLICABLE TO ALL OUR MANAGED CARE CONTRACTS. PART VI, LINE 2: SHEPHERD CENTER'S MISSION IS TO HELP PEOPLE WITH A TEMPORARY OR PERMANENT DISABILITY CAUSED BY INJURY OR DISEASE REBUILD THEIR LIVES WITH HOPE, INDEPENDENCE AND DIGNITY, ADVOCATING FOR THEIR FULL INCLUSION IN ALL ASPECTS OF COMMUNITY LIFE WHILE PROMOTING SAFETY AND INJURY PREVENTION. SHEPHERD CENTER IS COMMITTED TO PROVIDING THE RESOURCES AND TOOLS OUR PATIENTS NEED TO FACILITATE THE SUCCESSFUL TRANSITION BACK TO LIFE AND COMMUNITY AFTER A CATASTROPHIC INJURY.FROM DAY ONE, SHEPHERD CENTER HAS FOCUSED ON PATIENT-CENTERED CARE AND HAS DEVELOPED A CONTINUUM THAT IS UNIQUE IN THE SETTING OF AN ACUTE CARE, REHABILITATION HOSPITAL. BECAUSE OF THE VALUE-ADDED PROGRAMS OFFERED AT SHEPHERD CENTER, OUR PATIENTS HAVE THE RESOURCES TO RE-LEARN ACTIVITIES OF DAILY LIVING AND ACHIEVE THE GOALS THEY SET FOR THEMSELVES POST-INJURY. THOSE GOALS INCLUDE RETURNING TO HOME, SCHOOL AND/OR WORK. THEY ALSO INCLUDE "GETTING THEIR LIFE BACK" IN REGARD TO REGAINING THE ABILITY TO ENJOY LIFE THROUGH SOCIAL EVENTS, HOBBIES, AND LEISURE ACTIVITIES, AS WELL AS PROVIDING FOR THEMSELVES AND THEIR FAMILY. THE VALUE-ADDED PROGRAMS AID IN REGAINING ONE'S LIFE AND REBUILDING THEIR HOPE, BUT ARE OFTEN NOT REIMBURSED BY INSURANCE OR MEDICARE/MEDICAID. THEY ARE ESSENTIAL IN A PATIENT'S SUCCESSFUL RECOVERY. SHEPHERD CENTER BELIEVES THESE PROGRAMS DIRECTLY CONTRIBUTE TO THE MUCH GREATER THAN AVERAGE CLINICAL OUTCOMES ACHIEVED BY OUR PATIENTS. SHEPHERD CENTER'S RETURN TO HOME AND COMMUNITY RATES FOR SPINAL CORD INJURY PATIENT ARE 87 PERCENT AS COMPARED TO THE NATIONAL AVERAGE OF 73 PERCENT AND FOR BRAIN INJURY PATIENTS 93 PERCENT AS COMPARED TO THE NATIONAL AVERAGE OF 65 PERCENT. SHEPHERD CENTER'S CLINICAL OUTCOMES HAVE BEEN RECOGNIZED SINCE 2000 AS A TOP 10 REHABILITATION HOSPITAL BY U.S. WORLD & NEWS REPORT. PART VI, LINE 3: IT IS SHEPHERD CENTER'S POLICY TO EXTEND ITS SERVICES TO AS MANY PATIENTS AS IT CAN WITHIN THE FINANCIAL RESOURCES THAT ARE AVAILABLE. THOSE WHO DO NOT HAVE FINANCIAL RESOURCES TO PAY FOR THEIR CARE WILL BE CONSIDERED FOR FINANCIAL ASSISTANCE. IT IS CRITICAL TO SAFEGUARD FUNDS AVAILABLE FOR THIS PURPOSE BY ASSURING THAT THIS ASSISTANCE PROGRAM IS THE "PAYER OF LAST RESORT" AND IS ONLY PROVIDED TO THOSE WHO HAVE PROVEN AN INABILITY TO PAY.WHEN PATIENTS ARE SCHEDULED OR AN ADMISSION REFERRAL IS MADE, APPROPRIATE FINANCIAL SCREENING IS PROVIDED. THE FIRST STEP OF THIS SCREENING WILL INCLUDE DETERMINING WHETHER THIRD PARTY PAYER RESOURCES ARE AVAILABLE TO COVER THE COST OF CARE FOR THE INPATIENT OR DAY PATIENT CHARGES IN FULL. IF THERE ARE NO THIRD PARTY PAYER RESOURCES AVAILABLE, OR THERE IS EXPECTED TO BE PATIENT LIABILITY BALANCES DUE AFTER INSURANCE, THE FINANCIAL COUNSELOR WILL COMPLETE A "PRE-SCREENING" USING THE FINANCIAL ASSISTANCE SCREENING FORM. IF FINANCIAL RESOURCES DO NOT APPEAR TO BE AVAILABLE AND THE PATIENT LIABILITY IS EXPECTED TO EXCEED $5,000, THE PATIENT OR GUARANTOR WILL BE ASKED TO COMPLETE A "PATIENT FINANCIAL EVALUATION" FORM TO OBTAIN ADDITIONAL INFORMATION THAT WILL FURTHER ASSIST IN THE ASSESSMENT OF THEIR ELIGIBILITY FOR CHARITY ASSISTANCE. THE PATIENT OR GUARANTOR WILL BE REQUIRED TO COMPLETE THE APPLICATION IN FULL AND PROVIDE SUPPORTING EVIDENCE TO SUBSTANTIATE INCOME. MINIMUM SUPPORTING EVIDENCE FOR INCOME INCLUDES:- PAY STUBS REPRESENTING CURRENT INCOME OF HOUSEHOLD.- ANYTHING THAT PROVIDES PROOF OF INCOME, I.E., W2S, PRIOR YEAR INCOME TAX FORMS, LETTERS FROM EMPLOYERS ETC. - IF NO INCOME, LETTER FROM PERSON PROVIDING ROOM & BOARD TO PATIENT IS REQUIRED.ONCE THE FINANCIAL ASSISTANCE FORM IS COMPLETE THE FINANCIAL COUNSELOR WILL REVIEW TO ASSURE THAT SUPPORTING DOCUMENTATION IS ATTACHED, PROVIDE ALL THE CALCULATIONS REQUIRED, AND PROVIDE A PRELIMINARY ASSESSMENT OF ELIGIBILITY. ELIGIBILITY WILL BE BASED ON THE CRITERIA ESTABLISHED BY SHEPHERD CENTER AS FOLLOWS:A. CURRENT INCOME MUST NOT EXCEED 250% OF THE FEDERAL POVERTY GUIDELINES FOR THE CURRENT YEAR. B. IF INCOME EXCEEDS 250% OF THE FEDERAL POVERTY GUIDELINES, ADDITIONAL INFORMATION MAY BE REQUIRED FROM THE PATIENT OR GUARANTOR TO DETERMINE IF ASSISTANCE CAN BE GRANTED BASED ON A "MEDICALLY NEEDY" SITUATION RESULTING FROM THE CATASTROPHIC EVENT NECESSITATING ADMISSION TO SHEPHERD CENTER.IF THE PATIENT STILL DOES NOT MEET CRITERIA, THE FINANCIAL COUNSELOR WILL ESTABLISH DEPOSIT REQUIREMENTS BASED ON THE EXPECTED LENGTH OF STAY AND WILL OFFER THE PATIENT PAYMENT OPTIONS INCLUDING, BUT NOT LIMITED TO: (SEE ALSO FINANCIAL ARRANGEMENTS POLICY FOR SELF PAY PATIENTS)- BANK LOAN- VISA/MASTERCARD/DISCOVER/AMERICAN EXPRESS- NINETY-(90) DAY PAYMENT PLAN, AS DETAILED IN THE CREDIT & COLLECTIONS POLICY IF THE PRELIMINARY ASSESSMENT APPROVES THE PATIENT FOR FINANCIAL ASSISTANCE, THE FINANCIAL COUNSELOR WILL PRESENT THE PACKET TO THE MANAGER OF PATIENT FINANCIAL SERVICES FOR REVIEW AND QUALIFICATION APPROVAL. IN ADDITION, THE PROGRAM DIRECTOR WILL SIGN TO APPROVE THAT THE USE OF FUNDS MEETS CLINICAL APPROPRIATENESS FOR THEIR AREA. FOR INPATIENTS AND DAY PATIENTS, THE PATIENT WILL NEED TO MEET ASSET REQUIREMENTS. EXPECTATION WOULD BE THAT ASSETS OTHER THAN THOSE LISTED BELOW AND DISPOSABLE INCOME AFTER REASONABLE LIVING EXPENSES WOULD BE USED TO SATISFY A PORTION OR ALL OF THE FINANCIAL REQUIREMENTS OF THE PATIENT'S CARE. ASSETS THAT MAY BE EXCLUDED FROM CONSIDERATION ARE:- PATIENT'S HOME WITH NO MORE THAN 25% OR $25,000 EQUITY, WHICHEVER IS LESS. THE REQUIREMENTS TO USE HOME EQUITY CAN BE WAIVED IF THE PATIENT IS UNABLE TO MAKE PAYMENTS ON ADDITIONAL DEBT.- IF THE PATIENT HAS APPLIED FOR GEORGIA MEDICAID, THE FINANCIAL ASSISTANCE PROGRAM FORM SHOULD BE COMPLETED AND IF SUCH CHARGES ARE ULTIMATELY NOT COVERED OR UNCOLLECTIBLE THE PATIENT IS DEEMED ELIGIBLE FOR FINANCIAL ASSISTANCE. ALL FINANCIAL AND OTHER MITIGATING CIRCUMSTANCES ARE REVIEWED BY THE MANAGER OF PATIENT FINANCIAL SERVICES WHO THEN MAKES THE FINAL DECISION REGARDING ELIGIBILITY. IF ASSISTANCE IS NOT APPROVED THE FINANCIAL COUNSELOR WILL COORDINATE THE NOTIFICATION TO THE PATIENT. PAYMENT ARRANGEMENTS WILL BE COMPLETED AS LISTED ABOVE AND BASED ON THE FINANCIAL ARRANGEMENTS POLICY. IF APPROVED FOR FULL ASSISTANCE OR ASSISTANCE FOR PATIENT LIABILITY OVER INSURANCE AMOUNTS, THE FINANCIAL COUNSELOR WILL NOTIFY THE PATIENT. THE COVERED AMOUNT WILL BE WRITTEN-OFF PURSUANT TO ESTABLISHED POLICY AFTER DISCHARGE OR INSURANCE IS FINALIZED. PART VI, LINE 4: SHEPHERD CENTER DEFINES COMMUNITY BENEFIT AS A PLANNED, ORGANIZED, AND MEASURED APPROACH TO SERVICES AND ACTIVITIES THAT SPECIFICALLY ADDRESS THE HEALTHCARE NEEDS OF PEOPLE WITH SPINAL CORD AND BRAIN INJURY, MULTIPLE SCLEROSIS, CHRONIC PAIN, OTHER NEUROMUSCULAR DISEASES, AS WELL AS THE FAMILY OR LOVED ONES IMPACTED. PATIENTS AT SHEPHERD CENTER GET MORE THAN MEDICAL CARE, BUT RECEIVE THE FULL CONTINUUM OF CARE -- FROM EVALUATION AND MEDICAL TREATMENT TO REHABILITATION AND LIFELONG SUPPORT PROGRAMS -- THAT EXTENDS BACK TO THEIR COMMUNITIES. OUR PATIENT POPULATION HAS UNIQUE NEEDS THAT ARE TYPICALLY UNDERSERVED, WHICH MAKES SHEPHERD AN IMPORTANT LIFELINE AND RESOURCE FOR OUR PATIENTS THROUGHOUT THEIR LIFE. SHEPHERD CENTER'S COMMUNITY INCLUDES CURRENT PATIENTS AND THEIR FAMILY, AS WELL AS FORMER PATIENTS AND THEIR FAMILY.SHEPHERD CENTER TAKES A LEADERSHIP ROLE IN EDUCATING HEALTHCARE PROFESSIONALS (PHYSICIANS, NURSES, AND THERAPISTS) WHO SPECIALIZE IN SPINAL CORD AND BRAIN INJURY REHABILITATION. WE ALSO SERVE AS A STRONG COMMUNITY ADVOCATE, MONITORING LEGISLATION AND RELATED ISSUES THAT IMPACT THE DISABILITY COMMUNITY. SHEPHERD CENTER'S REACH EXTENDS BEYOND METRO ATLANTA TO ALL OF GEORGIA, THE UNITED STATES AND THE WORLD, AS THE LEADING SPECIALTY HOSPITAL FOR THIS PATIENT POPULATION. AS A RECOGNIZED ADVOCATE FOR PEOPLE LIVING WITH DISABILITIES, SHEPHERD CENTER HAS CHANGED THE LANDSCAPE IN ATLANTA AND BEYOND TO BE MORE RECEPTIVE OF PEOPLE WITH DISABILITIES LIVING IN OUR COMMUNITY. SHEPHERD CENTER HAS TREATED PATIENTS FROM ALL 50 STATES AND NEARLY 50 FOREIGN COUNTRIES. REPORTS FILED WITH STATES PART VI, LINE 7 GA X X X X X 0 0 0 0 0 1 0 0 0 DONALD P LESLIE MD 531677 0 102336 0 0 0 11040 0 4517 0 649570 0 0 0 JAMES H SHEPHERD JR 220317 0 65976 0 0 0 10250 0 5193 0 301736 0 0 0 GARY ULICNY PHD 508626 0 151578 0 0 0 11250 0 12781 0 684235 0 0 0 STEPHEN B HOLLEMAN 291480 0 68075 0 0 0 11000 0 12781 0 383336 0 0 0 WILMA BUNCH 194786 0 17000 0 0 0 11250 0 5455 0 228491 0 0 0 MITCHELL J FILLHABER 261831 0 42500 0 0 0 3250 0 12781 0 320362 0 0 0 BROCK BOWMAN MD 465437 0 15000 0 0 0 8250 0 12822 0 501509 0 0 0 TAMARA KING 196780 0 15000 0 0 0 11231 0 9038 0 232049 0 0 0 MICHAEL JONES 264577 0 46109 0 0 0 11207 0 11613 0 333506 0 0 0 SCOTT H SIKES 242404 0 15250 0 0 0 4823 0 9500 0 271977 0 0 0 SARAH MORRISON 186996 0 17000 0 0 0 8489 0 11654 0 224139 0 0 0 GERALD BILSKY MD 438415 0 15000 0 0 0 11250 0 745 0 465410 0 0 0 SHERRILL LORING MD 466198 0 21100 0 0 0 0 0 0 0 487298 0 0 0 JOHN MUSSER MD 469656 0 15000 0 0 0 0 0 8558 0 493214 0 0 0 ERIK SHAW MD 512916 0 15000 0 0 0 5775 0 11388 0 545079 0 0 0 BEN THROWER MD 522738 0 45965 0 0 0 9593 0 11654 0 589950 0 0 0 PART I, LINE 6 THE SHEPHERD CENTER'S BOARD OF DIRECTORS APPROVED A "SHEPHERD SHARE" BONUS TO QUALIFIED EMPLOYEES FOR FY 2012 THAT WAS PAID IN FY 2013. THE BOARD'S DETERMINATION OF THE AWARD INCLUDES PATIENT OUTCOMES, CUSTOMER SERVICE (INTERNAL AND EXTERNAL) AND OTHER JUDGMENTAL FACTORS. A DEVELOPMENT AUTHORITY OF FULTON COUNTY 581506878 359900ZT7 2009-11-04 56000000 PROVIDE FUNDS TO REFUND 4/20/05 ISSUE FOR HOSPITAL EXPANSION 0 0 0 B DEVELOPMENT AUTHORITY OF FULTON COUNTY 581506878 359597EB3 2010-12-02 13900000 PROVIDE FUNDS TO REFUND 9/29/97 ISSUE FOR HOSPITAL RENOVATIONS 0 0 0 A 1000000 56000000 56000000 2007 1 0 1 1 B 3500000 13900000 13900000 1998 1 0 1 1 A 0 1 1 0 0 0.00000 0.01400 0.01400 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 LINDA SHEPHERD FAMILY MEMBER 38994 EMPLOYEE 0 SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: LINDA SHEPHERD (D) DESCRIPTION OF TRANSACTION: EMPLOYEE COMPENSATION X 29 144444 MARKET VALUE X 1 2000 FAIR MARKET VALUE X GIFT CARDS 1 25000 FAIR MARKET VALUE X VARIOUS GIFTS 1 40000 FAIR MARKET VALUE X VARIOUS SMALL ITEMS 18 9409 FAIR MARKET VALUE 0 1 0 FORM 990, PART VI, SECTION A, LINE 2 FAMILY RELATIONSHIP: JAMES SHEPHERD (CHAIRMAN OF THE BOARD), ALANA SHEPHERD (RECORDING SECRETARY), J. HAROLD SHEPHERD (BOARD MEMBER), AND W. CLYDE SHEPHERD, III (BOARD MEMBER). FAMILY & BUSINESS RELATIONSHIP: LINDA SHEPHERD (EMPLOYEE) BUSINESS RELATIONSHIP: JAMES E. STEPHENSON BUSINESS RELATIONSHIP: DAVID H. FLINT FORM 990, PART VI, SECTION B, LINE 11 THE FORM IS PREPARED BY CARR, RIGGS & INGRAM, LLC WITH THE ASSISTANCE OF THE ACCOUNTING STAFF AT THE SHEPHERD CENTER. THE RETURN IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER WITH FURTHER CONSULTATION WITH CRI FOR ALL QUESTIONS THAT ARE UNCLEAR AS TO MEANING AND INTENT. THE CHIEF FINANCIAL OFFICER THEN REVIEWS THE FORM 990 WITH THE CHAIRMAN OF THE BOARD, THE CHIEF EXECUTIVE OFFICER, AND THE EXECUTIVE DIRECTOR OF THE SHEPHERD CENTER FOUNDATION FOR THEIR INPUT AND APPROVAL. THE SHEPHERD CENTER PROVIDES EACH MEMBER OF THE BOARD WITH A FINAL COPY OF THE FILED 990 UPON COMPLETION OF THE PROCESS. FORM 990, PART VI, SECTION B, LINE 12C THE SHEPHERD CENTER BOARD OF DIRECTORS ARE PRESENTED WITH A CONFLICT OF INTEREST QUESTIONNAIRE ON AN ANNUAL BASIS AND THEY INDICATE THEIR COMPLIANCE BY SIGNING THE DOCUMENT, WHICH IS KEPT ON FILE IN ADMINISTRATION. IN ADDITION, ON AN ANNUAL BASIS, THE SHEPHERD CENTER ACCOUNTING STAFF AS WELL AS THE CHIEF FINANCIAL OFFICER REVIEW ALL 1099'S BEFORE DISTRIBUTION FOR BOARD MEMBER NAMES/COMPANIES. THE STAFF ALSO CHECK WITH THE DEVELOPMENT OFFICE FOR ANY ADDITIONAL INFORMATION REGARDING BOARD MEMBER AFFILIATIONS WITH OTHER ENTITIES WITH WHICH THE SHEPHERD CENTER DOES BUSINESS. FORM 990, PART VI, SECTION B, LINE 15 THE SHEPHERD CENTER UTILIZES A BOARD COMPENSATION COMMITTEE TO DETERMINE COMPENSATION FOR THE CEO AND OTHER EXECUTIVE MANAGEMENT. THIS COMMITTEE UTILIZES OUTSIDE CONSULTANTS (FOR EXAMPLE, SULLIVAN COTTER), INDUSTRY COMPENSATION SURVEYS, AND REVIEWS OF SIMILAR ORGANIZATIONS' FORM 990 TO DETERMINE APPROPRIATENESS OF COMPENSATION. THE SHEPHERD CENTER UTILIZES TOWER WATSON DATA SERVICES COMPENSATION SURVEYS TO DETERMINE WHETHER OR NOT A COMPENSATION PACKAGE IS IN LINE WITH OUR REGION AND RELATIVE BED SIZE. THE HUMAN RESOURCES DIRECTOR ANALYZES THE DATA AND GETS APPROVAL FROM THE CEO. FORM 990, PART VI, SECTION C, LINE 18 AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST. FORM 990, PART IX: SHEPHERD CENTER HAS ALLOCATED A PORTION OF THE EXPENSES OF THESE INDIRECT COST CENTERS TO PROGRAM SERVICE EXPENSE: DEPRECIATION, ENGINEERING, INFORMATION SYSTEMS, COMMUNICATIONS, QUALITY AND OUTCOMES MANAGEMENT, SECURITY, SEATING CLINIC, TRANSPORATION, COMPLIANCE AND AUDIT, RISK MANAGEMENT, CODING AUDIT, AND RENOVATIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGES IN TEMPORARILY RESTRICTED NET ASSETS 3,950,866. CHANGE IN INTERCOMPANY ACCOUNTS -1,686,445. CHANGES IN PERMANENTLY RESTRICTED NET ASSETS 211,739. ROUNDING 3. FORM 990, PART XI, LINE 2C NO CHANGE HAS OCCURRED FROM PRIOR YEAR. SHEPHERD CENTER FOUNDATION 2020 PEACHTREE ROAD NW ATLANTA GA 30309 201238224 FUNDRAISING FOR SHEPHERD CENTER EXCLUSIVELY GA 501(C)(3) 509(A)(1) N/A 0 SSC AFFILIATES INC 2020 PEACHTREE ROAD NW ATLANTA GA 30309 581921355 RETAIL PHARMACY, MEDICAL SUPPLY, AND GIFT SHOP GA SHEPHERD CENTER INC C 298430 1259941 1.00000 0 1 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 1 0 1 SSC AFFILIATES INC A 62083 FMV SSC AFFILIATES INC F 350000 FMV SSC AFFILIATES INC L 62847 FMV SHEPHERD CENTER FOUNDATION INC M 892049 FMV SHEPHERD CENTER FOUNDATION INC N 11734 FMV SSC AFFILIATES INC O 774479 FMV SHEPHERD CENTER FOUNDATION INC O 1284163 FMV SSC AFFILIATES INC Q 684344 FMV SHEPHERD CENTER FOUNDATION INC S 9043162 FMV