2014-05-14T13:38:15-05:00 2013-06-30 621517792 PERSHING YOAKLEY & ASSOCIATES P C ONE CHEROKEE MILLS 2220 SUTHERLAND AVE KNOXVILLE TN 37919 990 2012-07-01 581966795 DEKALB MEDICAL CENTER INC DEKA 4045011000 2701 NORTH DECATUR ROAD DECATUR GA 30033 JOHN KATSIANIS 4045011000 2014-05-14 1 SUSAN P CLARKCPAFHFMA P00017549 8656730844 2012 2015-11-30 17:44:51Z JOHN SHELTON 2701 NORTH DECATUR ROAD DECATUR GA 30033 520443080 0 X WWW.DEKALBMEDICAL.ORG X 1991 GA TO IMPROVE PATIENTS' LIVES THROUGH THE DELIVERY OF EXCELLENT HEALTH AND WELLNESS SERVICES. 7 5 4402 240 100270 -151885 3340510 18234939 443625483 494259365 5960679 7942626 8941 6150 452935613 520443080 1777045 418960 0 0 204971666 223950366 0 0 0 253340341 299736908 460089052 524106234 -7153439 -3663154 379429709 382261284 256486577 244167202 122943132 138094082 AT DEKALB MEDICAL CENTER, INC. ("DMC"), OUR MISSION IS TO IMPROVE LIVES THROUGH THE DELIVERY OF EXCELLENT HEALTH AND WELLNESS SERVICES IN PARTNERSHIP WITH OUR PHYSICIANS. 0 0 326619396 418960 351671487 DEKALB MEDICAL AT NORTH DECATUR - 21,242 PATIENTS DISCHARGED (INCLUDES NICU AND EXCLUDES BABIES) FROM THE HOSPITAL FOR A TOTAL OF 104,510 DISCHARGED DAYS. THERE WERE 179,449 VISITS TO THE HOSPITAL DURING THE YEAR. 48134232 111827667 DEKALB MEDICAL AT HILLANDALE - 5,486 PATIENTS DISCHARGED FROM THE HOSPITAL FOR A TOTAL OF 25,519 DISCHARGED DAYS. THERE WERE 99,051 VISITS TO THE HOSPITAL DURING THE YEAR. 39776877 30760211 DEKALB MEDICAL PHYSICIAN NETWORK - 131,377 PATIENTS WERE TREATED IN THE PHYSICIANS OFFICES DURING THE FISCAL YEAR. 414530505 1 1 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 1 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 1 510 0 1 4402 1 1 1 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 GA X JOHN KATSIANIS 4045015025 2701 NORTH DECATUR ROAD DECATUR GA 30033 OLIVER LEE 0.50 X 0 0 0 DAVID JOLLAY 0.50 X 0 0 0 ROBERT E WILSON 0.50 X 0 0 0 CHARLES CLIFTON MD 0.50 X 0 0 0 KENNETH HARPER MD 0.50 5.00 X 0 0 0 RAOUL MAYER MD 0.50 5.00 X 11667 0 0 JOHN A SHELTON JR 40.00 X X 786231 0 36134 JOHN KATSIANIS 40.00 X 0 0 0 MAL UNDERWOOD 40.00 X 175894 0 0 DANE HENRY 40.00 X 340712 0 23720 ROY GILBREATH 40.00 X 7020 0 246 CHARLES BARCLAY 40.00 X 386829 0 27711 CHERYL IVERSON 40.00 X 197549 0 36600 JAMES FORSTNER 40.00 X 205796 0 25591 JOEL SCHUESSLER 40.00 X 180026 0 11276 MARK TROCINO 40.00 X 324382 0 18716 STEPHEN THOMAS MD 40.00 X 339987 0 24520 SUSAN HARRIS 40.00 X 191584 0 28110 AUGUSTINE CONDUAH MD 40.00 X 798384 0 30653 DAVID HOLLADAY MD 40.00 X 841974 0 27688 RAYMOND LAWHEAD MD 40.00 X 544651 0 20267 SHAINUL BHATIA MD 40.00 X 504232 0 48674 KALAI PARTHIBAN MD 40.00 X 401657 0 31635 DIANE P HARDEN 0.00 X 174547 0 19057 THOMAS CRAWFORD 0.00 X 140861 0 0 CATHLEEN WHEATLEY 0.00 X 338613 0 5177 ERIC NORWOOD 0.00 X 572325 0 23862 7464921 0 439637 198 1 1 0 DEKALB ANESTHESIA ASSOCIATES PA 21717 W PARK CT STE A STONE MTN GA 30087 ANESTHESIOLOGY SRVCS 3343863 MORRISON MANAGEMENT PO BOX 102289 ATLANTA GA 30368 MANAGEMENT SERVICES 2204129 SEGAR GROUP 14355 PROVIDENCE ROAD ALPHARETTA GA 30004 CONSTRUCTION SRVCS 1362617 METRO VASCULAR PC 2675 N DECATUR ROAD SUITE 210 DECATUR GA 30033 SURGICAL SERVICES 1210459 SODEXO INC & AFFILIATES PO BOX 536922 ATLANTA GA 30353 MANAGEMENT SERVICES 828592 51 17950582 118591 165766 18234939 NET PATIENT REV N DECATUR 621990 343544424 343544424 NET PATIENT REV HILLANDALE 621990 111827667 111827667 NET PATIENT REV PRIMARY CARE 621110 30760211 30760211 MEANINGFUL USE 900099 2553146 2553146 WELLNESS CENTER 713940 738530 738530 4835387 4703744 100270 31373 494259365 4521640 4521640 6150 0 6150 6150 6150 3390486 30500 0 0 3390486 30500 3420986 3420986 520443080 494127722 100270 7980149 418960 418960 190792631 156201537 34591094 6462410 5290762 1171648 13057272 11253296 1803976 13638053 11155696 2482357 942966 942966 491125 491125 409585 409585 30072154 18424163 11647991 3016329 2570 3013759 82614322 79018638 3595684 9004897 1227520 7777377 21822404 9347715 12474689 325134 81288 243846 411969 127818 284151 105540 105540 21533361 606141 20927220 5597652 1145956 4451696 BAD DEBT 105146313 105146313 REPAIRS AND MAINTENANCE 10598919 9778337 820582 MEDICARE PROVIDER TAX 4726752 4726752 MEMBERSHIP, DUES & SUBS 1181124 263667 917457 1736362 313376 1422986 524106234 414530505 109575729 0 12249518 2157643 7165490 7286276 58112119 62084350 5921091 6458559 1743794 1055388 415601304 294945232 128925596 120656072 160126020 167588235 1413807 1687182 3772274 13287579 379429709 382261284 38057988 43429244 189316202 186537230 29112387 14200728 256486577 244167202 X 122404058 137519927 539074 574155 122943132 138094082 379429709 382261284 X -3663154 2553019 16261085 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 37179 37179 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: DUES PAID TO GEORGIA HOSPITAL ASSOCIATION WERE $101,038; OF THIS AMOUNT, $25,260 OR APPROXIMATELY 25%, WENT FOR LOBBYING. DUES PAID TO AMERICAN HOSPITAL ASSOCIATION WERE $50,396; OF THIS AMOUNT, $11,919 OR APPROXIMATELY 23.65%, WENT FOR LOBBYING. 539074 873035 837954 574155 549831 826617 837374 539074 585490 672897 708556 549831 1999808 7300 -1277654 143964 585490 2836621 261659 -1045126 53346 1999808 1.00000 0 0 403305 403305 234614252 141187732 93426520 175560961 147964407 27596554 5022786 5793093 -770307 120656072 SELF INSURANCE RESERVES 3560007 ASSET RETIREMENT OBLIGATION 5207503 FAIR VALUE OF INTEREST RATE SWAPS 2069288 DUE FROM RELATED PARTY 157167 ESTIMATED THIRD PARTY LIABILITIES 3206763 14200728 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TO PURCHASE EQUIPMENT, GRANT FUNDS FOR THE CANCER CENTER, PURCHASE SAFETY EQUIPMENT FOR THE EMERGENCY RESPONSE UNIT, AND FUND THE WELLNESS ON WHEELS PROGRAM. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: PER THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS FOR DEKALB REGIONAL HEALTH SYSTEM, INC. AND SUBSIDIARIES: THE SYSTEM, DEKALB MEDICAL CENTER, INC., DEKALB MEDICAL CENTER FOUNDATION, INC., AND DECATUR HEALTH RESOURCES, INC. ARE EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, AS WELL AS STATE INCOME TAX. VENTURES IS A TAXABLE ENTITY AND ANNUALLY FILES A CORPORATE TAX RETURN. WITH RESPECT TO ITS FOR-PROFIT ENTITY, AS WELL AS ANY UNRELATED BUSINESS INCOME GENERATED AT THE TAX-EXEMPT ENTITIES, THE SYSTEM RECORDS INCOME TAXES USING THE ASSET AND LIABILITY METHOD UNDER WHICH DEFERRED TAX ASSETS AND LIABILITIES ARE DETERMINED BASED ON THE DIFFERENCES BETWEEN THE FINANCIAL ACCOUNTING AND TAX BASES OF ASSETS AND LIABILITIES. DEFERRED TAX ASSETS OR LIABILITIES AT THE END OF EACH PERIOD ARE DETERMINED USING THE CURRENTLY ENACTED TAX RATE EXPECTED TO APPLY TO TAXABLE INCOME IN THE PERIOD THAT THE DEFERRED TAX ASSET OR LIABILITY IS EXPECTED TO BE REALIZED OR TO BE SETTLED. ALL SUCH INCOME TAX ACCOUNTING IS IMMATERIAL TO THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2013 AND 2012. THE SYSTEM APPLIES ASC 740, INCOME TAXES, WHICH PROVIDES GUIDANCE ON WHEN TAX POSITIONS ARE RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS AND HOW THE VALUES OF THESE POSITIONS ARE DETERMINED. THERE IS CURRENTLY NO IMPACT ON THE SYSTEM'S CONSOLIDATED FINANCIAL STATEMENTS AS A RESULT OF THE APPLICATION OF ASC 740. 1 1 X 1 X 1 X 1 1 1 0 1 1 8941027 8941027 0.02130 72205912 63044868 9161044 0.02190 81146939 63044868 18102071 0.04320 10110 1135213 1135213 0.00270 3595 3871918 3871918 0.00920 1742 196550 196550 0.00050 15447 5203681 5203681 0.01240 15447 86350620 63044868 23305752 0.05560 1 35345677 0 96257031 90864224 5392807 X 1 0 2 1 DEKALB MEDICAL AT NORTH DECATUR

2701 NORTH DECATUR ROAD DECATUR GA 30033

X X X A 2 DEKALB MEDICAL AT HILLANDALE

2801 DEKALB MEDICAL PARKWAY LITHONIA GA 30058

X X X A FACILITY REPORTING GROUP A 1 X X X X X X X X X 12 1 0 1 X X X X X X X X 0 0 1 1 200.000000000000 1 250.000000000000 1 X X X X X X X 1 1 X X 1 0 1 X 0 1 3 DEKALB MEDICAL PRIMARY CARE

2701 NORTH DECATUR ROAD DECATUR GA 30033

PRIMARY CARE DEKALB MEDICAL SPECIALTY CARE

2701 NORTH DECATUR ROAD DECATUR GA 30033

SPECIALIST CARE DEKALB MEDICAL OCCUPATIONAL MEDICINE GRO

2701 NORTH DECATUR ROAD DECATUR GA 30033

OCCUPATIONAL MEDICINE PART I, LINE 3C: THE ORGANIZATION USES FEDERAL POVERTY GUIDELINES. PART I, LINE 7: A COST-TO-CHARGE RATIO, DERIVED FROM THE SCHEDULE H APPLICABLE WORKSHEETS, INCLUDING WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, WAS USED TO DETERMINE CHARITY CARE. ACTUAL EXPENSE DATA IS ACCUMULATED WITHIN THE GENERAL LEDGER WHICH ADDRESSES ALL PATIENT SEGMENTS INCLUDING INPATIENT, OUTPATIENT, EMERGENCY ROOM, COMMERCIAL INSURANCE, GOVERNMENT INSURANCE, UNINSURED AND SELF-PAY. THE TOTAL OPERATING EXPENSE WAS DIVIDED BY PATIENT REVENUES TO CALCULATE AN OVERALL RATIO THAT WAS THEN APPLIED TO INDIGENT AND CHARITY CARE CHARGES TO ARRIVE AT COST. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ XXX-XX-XXXX. PART III, LINE 4: PER THE DEKALB REGIONAL HEALTH SYSTEM, INC. AND SUBSIDIARIES CONSOLIDATED FINANCIAL STATEMENTS: "THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES, IN THE NORMAL COURSE OF BUSINESS, THE ADEQUACY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON ITS ASSESSMENT OF THESE AND OTHER FACTORS BY PAYOR CATEGORY, AND ADJUSTS THE ALLOWANCE AND RELATED PROVISION ACCORDINGLY. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, MANAGEMENT ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A RELATED PROVISION, IF NECESSARY, FOR PAYORS WITH KNOWN FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL (PATIENT APPORTIONMENT), MANAGEMENT RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICES ON THE BASIS OF 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 AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.THE SYSTEM'S WRITE-OFFS INCREASED $49,776,000 DURING 2013 FROM $62,196,000 IN FISCAL YEAR 2012 TO $111,972,000 IN FISCAL YEAR 2013. THIS INCREASE WAS DUE TO MULTIPLE FACTORS. DURING FISCAL YEAR 2012, THE SYSTEM IMPLEMENTED A NEW PATIENT ACCOUNTING SYSTEM, WHICH NEGATIVELY IMPACTED THE PRIORITIZATION OF COLLECTIONS ON SELF-PAY ACCOUNTS, LEADING TO AN INCREASE IN THE RELATED ACCOUNTS RECEIVABLES AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS THROUGHOUT FISCAL YEAR 2012. DURING FISCAL YEAR 2013, THE SYSTEM IMPLEMENTED STRATEGIC PROCESS CHANGES TO ADDRESS THIS ISSUE; HOWEVER, THE RESOLUTION OF THESE AGED ACCOUNTS CONTRIBUTED TO THE INCREASE IN SELF-PAY WRITE-OFFS. FURTHER, AS A RESULT OF ONGOING POOR ECONOMIC CONDITIONS, THE SYSTEM HAS SEEN AN INCREASE IN SELF-PAY PATIENT VOLUMES (AS EVIDENCED BY THE GROWTH IN SELF-PAY PATIENT SERVICE CHARGES SHOWN IN THE TABLES BELOW). AS NOTED ABOVE, HISTORICAL EXPERIENCE HAS DEMONSTRATED THAT A SIGNIFICANT PORTION OF THE SYSTEM'S UNINSURED OR UNDER-INSURED PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE, ARE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THEREFORE, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS RELATED TO THESE PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. THE SYSTEM DOES NOT MAINTAIN A SIGNIFICANT ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, NOR DOES IT INCUR SIGNIFICANT WRITE-OFFS, RELATED TO THIRD PARTY PAYORS." PART III, LINE 9B: THE CURRENT BILLING AND COLLECTION POLICY DOES NOT CONTAIN PROVISIONS FOR COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE BUT THE FAP OR "CHARITY POLICY" DOES AS IT OUTLINES THE COMPLETE WRITE OFF OR SLIDING SCALE AMOUNTS FOR WHICH THE INDIVIDUAL WILL BE RESPONSIBLE. PART VI, LINE 2: IN COMPLIANCE WITH 501(R)(C) OF THE INTERNAL REVENUE CODE, BOTH DEKALB MEDICAL CENTER HOSPITAL FACILITIES CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION PLAN. THE IMPLEMENTATION PLANS WERE APPROVED BY THE BOARD OF DIRECTORS ON JUNE 10, 2013. THE NEXT FULL CHNAS AND IMPLEMENTATION PLAN ARE DUE IN 2016. SINCE THIS IS THE FIRST YEAR OF THE IMPLEMENTATION PLAN, SOME STRATEGIES HAVE BEEN STARTED, BUT NOT LONG ENOUGH TO ASSESS RESULTS.THE DEKALB COUNTY BOARD OF HEALTH (BOH) HAS A LONG HISTORY OF CONDUCTING COMMUNITY NEEDS HEALTH ASSESSMENTS AND THE DEKALB MEDICAL SYSTEM HAS PARTICIPATED IN AND SUPPORTED THOSE EFFORTS. THE DEKALB COUNTY BOH AGREED TO TAKE THE LEAD IN CONDUCTING COMMUNITY HEALTH ASSESSMENTS ON BEHALF OF DEKALB MEDICAL CENTER AND DEKALB MEDICAL AT HILLANDALE. IN ADDITION TO DEKALB SYSTEM HOSPITALS USING THE CHNAS AND IMPLEMENTATION PLANS, THEY ARE ALSO BEING USED AS THE COMMUNITY HEALTH ASSESSMENT. AFTER REVIEWING THE INFORMATION FROM THE CHNA, A STAKEHOLDER'S MEETING WAS CONVENED WITH OVER 30 REPRESENTATIVES OF COMMUNITY GROUPS, LOCAL GOVERNMENT AND OTHER PROVIDERS WHO REVIEWED THE RECENTLY COMPLETED CHNA, VALIDATED THE FINDINGS, PROVIDED INPUT FOR FUTURE CHNAS AND DEVELOPED A LIST OF COMMUNITY HEALTH PRIORITIES. USING THIS LIST OF PRIORITIES, THE HOSPITALS DEVELOPED IMPLEMENTATION PLANS WITH STRATEGIES IDENTIFIED FOR SELECTED PRIORITIES WHICH THE HOSPITALS DETERMINED THEY COULD MOST EFFECTIVELY ADDRESS. STRATEGIES FOR OTHER IDENTIFIED PRIORITIES WERE NOT DEVELOPED BECAUSE THERE ARE OTHER ORGANIZATIONS WITH MORE EXPERTISE DEALING WITH THOSE HEALTH ISSUES OR A LACK OF RESOURCES, AT THE HOSPITAL-LEVEL, TO ADDRESS THE PARTICULAR HEALTH ISSUE. PRIORITIES SUCH AS COLORECTAL CANCER, FALL PREVENTION, MATERNAL AND INFANTS HEALTH, AND PNEUMOCOCCAL AND PERTUSSIS VACCINATIONS, AMONG OTHERS, WERE IDENTIFIED AS PRIORITIES TO BE ADDRESSED BY HOSPITALS IN THE DEKALB SYSTEM.THE IMPLEMENTATION PLANS WILL HELP GUIDE THE DEKALB SYSTEM HOSPITALS' EFFORTS TOWARDS COMMUNITY HEALTH NEEDS THAT HAVE BEEN IDENTIFIED THROUGH THE CHNAS. ALL THE STRATEGIES IDENTIFIED ARE TO ENHANCE AND IMPROVE THE HEALTH OF THE COMMUNITY AND THE PEOPLE THE HOSPITALS SERVE. PART VI, LINE 3: PATIENTS PROVIDED CARE BY THE HOSPITAL MEET WITH A FINANCIAL COUNSELOR AFTER THEIR CARE IS RENDERED. ELEGIBILITY CRITERIA FOR VARIOUS FINANCIAL ASSISTANCE PROGRAMS IS REVIEWED WITH THE PATIENT INCLUDING CHARITY, MEDICAID, OR OTHER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS. BILLING STATEMENTS RECEIVED BY A PATIENT ADVISE THEM TO CONTACT THE FINANCIAL COUNSELING DEPARTMENT ABOUT THESE PROGRAMS. PART VI, LINE 4: DEKALB REGIONAL HEALTH SYSTEM SERVES THE POPULATION OF DEKALB COUNTY, GA (54% AFRICAN AMERICAN, 35% WHITE, 4% ASIAN) AS WELL AS ROCKDALE AND GWINNETT COUNTIES. THE MEDIAN INCOME OF DEKALB COUNTY IS APPROXIMATELY $51,700 AND ABOUT 17% OF THE COUNTY RESIDENTS LIVE BELOW THE POVERTY LEVEL. APPROXIMATELY 9% OF THE POPULATION IS OVER AGE 65 AND 24% OF THE POPULATION IS UNDER AGE 18. PART VI, LINE 5: UNDERSTANDING THAT A HEALTHY COMMUNITY IS ABOUT MORE THAN JUST THE ABSENCE OF DEATH AND DISEASE, WE ALSO CONTRIBUTE TO THE ECONOMIC VITALITY AND CREATION OF QUALITY JOBS RIGHT HERE AT HOME. NAMED THE 2010 CORPORATION OF THE YEAR BY THE DEKALB COUNTY CHAMBER OF COMMERCE FOR OUR ROLE AS AN ACTIVE CORPORATE CITIZEN AND PROPONENT OF DIVERSITY, THE FOLLOWING PROGRAMS HAVE HELPED BUILD THE HEALTH OF OUR COMMUNITY: 1) WE HELP REDUCE TEEN PREGNANCY AND SEXUALLY TRANSMITTED DISEASE BY PROVIDING FREE PREVENTION EDUCATION THROUGH OUR PUBERTY ROCKS PROGRAM FOR PRE-TEENS; 2) WE SUPPORT 100 BLACK MEN OF DEKALB IN THE EFFORT TO PROVIDE HIGHER EDUCATION TO AT-RISK YOUTH; 3) WE PARTNER WITH THE PHYSICIANS'S CARE CLINIC TO PROVIDE NEARLY 2,000 LOW OR NO COST PATIENT VISITS A YEAR INCLUDING LAB WORK AND PRESCRIPTION MEDICATIONS TO AREA LOW-INCOME AND UNINSURED RESIDENTS; 4) WE SPONSOR A FREE ANNUAL CANCER SCREENING DAY ON TWO OF OUR HOSPITAL CAMPUSES; 5) WE HAVE RECENT HEALTHY WORKPLACE INIATIVES INCLUDE SMOKE-FREE BUILDINGS INSIDE AND OUT, A NO-NICOTINE HIRING POLICY AND ADOPTION OF HEALTHY FOOD OPTIONS IN HOSPITAL CAFETERIAS; 6) WE COLLECT AND DONATE SURPLUS MEDICAL SUPPLIES TO MEDSHARE INTERNATIONAL IN SUPPORT OF HEALTH INITIATIVES IN LESS FORTUNATE COUNTRIES; 7) WE HAVE AN OPEN MEDICAL STAFF THAT ATTRACTS UNLIMITED, HIGHLY TRAINED MEDICAL TALENT TO SERVE THE AREA; 8) WE ARE A MAJOR SPONSOR OF THE LEADERSHIP DEKALB INITIATIVE TO PROMOTE COMMUNITY CONNECTIVITY AND ACTION PLANS FOR ECONOMIC DEVELOPMENT, SUSTAINABILITY AND IMPROVEMENT OF THE QUALITY OF LIFE IN DEKALB COUNTY; 9) DEKALB MEDICAL PROVIDES FURTHER ENRICHMENT AND EMPLOYMENT OPPORTUNITIES BY CHAMPIONING WORKPLACE SUCCESS FOR YOUTH AND ADULTS WITH DISABILITIES. PARTNERING WITH THE NATIONALLY RECOGNIZED TOMMY NOBIS CENTER, DEKALB MEDICAL CONTRACTS WITH THE CENTER TO PROVIDE SWITCHBOARD OPERATORS FOR THE HEALTH SYSTEM; 10) WE PARTNER WITH DEKALB COUNTY HIGH SCHOOLS TO PROVIDE MENTALLY AND PHYSICALLY CHALLENGED STUDENTS WITH VOCATIONAL TRAINING AND REAL-LIFE WORK EXPERIENCE IN THE HEALTHCARE INDUSTRY. THE STUDENTS, WHO RECEIVE SCHOOL CREDIT, SERVE AS VOLUNTEERS IN OUR CAFETERIA, LAUNDRY ROOM AND MOTHER-BABY UNITS; 11) WE PARTICIPATE IN NUMEROUS CAREER DAYS, ENCOURAGING THE SCIENCE AND MATH EDUCATION THAT'S NEEDED TO PROVIDE COMPETENT HEALTH WORKERS OF THE FUTURE; 12) WE SUPPORT A DEKALB WORKFORCE DEVELOPMENT PARTNERSHIP THAT PROVIDES TRAINING PROGRAMS, EDUCATION AND A CLINICAL SITE FOR PATIENT CARE TECHNICIAN CERTIFICATION; AND 13) WE MAINTAIN A PARTNERSHIP WITH GEORGIA PERIMETER COLLEGE AND MERCER UNIVERSITY TO PROVIDE CLINICAL ROTATIONS, PRECEPTORSHIPS, EDUCATION AND INSTRUCTION TO GEORGIA'S FUTURE NURSES. PART VI, LINE 6: DEKALB REGIONAL HEALTH SYSTEM, INC. IS THE PARENT ENTITY WHICH PROVIDES SUPPORT TO DEKALB MEDICAL CENTER, INC., DECATUR HEALTH RESOURCES, INC. AND DEKALB MEDICAL CENTER FOUNDATION, INC. DEKALB MEDICAL CENTER, INC. OPERATES TWO ACUTE CARE HOSPITALS AND A PHYSICIAN PRACTICE NETWORK TO PROVIDE HEALTHCARE SERVICES TO THE RESIDENTS OF DEKALB COUNTY, GEORGIA AND SURROUNDING COUNTIES. DECATUR HEALTH RESOURCES PROVIDES LONG-TERM ACUTE CARE HOSPITAL SERVICES TO PATIENTS WHO NEED ADDITIONAL TIME TO RECOVER FROM SERIOUS ILLNESS. DEKALB MEDICAL CENTER FOUNDATIONS'S MISSION IS TO STRENGTHEN THE LINK BETWEEN DEKALB REGIONAL HEALTH SYSTEM AND THE COMMUNITY IT SERVICES THROUGH COMMUNICATION, EDUCATION, SERVICE AND PHILANTHROPY. REPORTS FILED WITH STATES PART VI, LINE 7 GA PART V, LINE 8 FACILITY REPORTING GROUP A SEE BELOW FACILITY 1 -- NORTH DECATUR & HILLANDALE PART V, SECTION B, LINE 3: AFTER REVIEWING THE INFORMATION FROM THE CHNA, A STAKEHOLDER'S MEETING WAS CONVENED WITH OVER 30 REPRESENTATIVES OF COMMUNITY GROUPS, LOCAL GOVERNMENT AND OTHER PROVIDERS WHO REVIEWED THE RECENTLY COMPLETED CHNA, VALIDATED THE FINDINGS, PROVIDED INPUT FOR FUTURE CHNAS AND DEVELOPED A LIST OF COMMUNITY HEALTH PRIORITIES. FACILITY 1 -- NORTH DECATUR & HILLANDALE PART V, SECTION B, LINE 7: AFTER REVIEWING THE INFORMATION FROM THE CHNA, A STAKEHOLDER'S MEETING WAS CONVENED WITH OVER 30 REPRESENTATIVES OF COMMUNITY GROUPS, LOCAL GOVERNMENT AND OTHER PROVIDERS WHO REVIEWED THE RECENTLY COMPLETED CHNA, VALIDATED THE FINDINGS, PROVIDED INPUT FOR FUTURE CHNAS AND DEVELOPED A LIST OF COMMUNITY HEALTH PRIORITIES. USING THIS LIST OF PRIORITIES, THE HOSPITALS DEVELOPED IMPLEMENTATION PLANS WITH STRATEGIES IDENTIFIED FOR SELECTED PRIORITIES WHICH THE HOSPITALS DETERMINED THEY COULD MOST EFFECTIVELY ADDRESS. STRATEGIES FOR OTHER IDENTIFIED PRIORITIES WERE NOT DEVELOPED BECAUSE THERE ARE OTHER ORGANIZATIONS WITH MORE EXPERTISE DEALING WITH THOSE HEALTH ISSUES OR A LACK OF RESOURCES, AT THE HOSPITAL-LEVEL, TO ADDRESS THE PARTICULAR HEALTH ISSUE. PRIORITIES SUCH AS COLORECTAL CANCER, FALL PREVENTION, MATERNAL AND INFANTS HEALTH, AND PNEUMOCOCCAL AND PERTUSSIS VACCINATIONS, AMONG OTHERS, WERE IDENTIFIED AS PRIORITIES TO BE ADDRESSED BY HOSPITALS IN THE DEKALB SYSTEM. FACILITY 1 -- NORTH DECATUR & HILLANDALE PART V, SECTION B, LINE 14G: AVAILABILITY OF FAP APPLICATION DISCUSSED DURING THE FINANCIAL COUNSELING PROCESS FACILITY 1 -- NORTH DECATUR & HILLANDALE PART V, SECTION B, LINE 20D: DEKALB'S FAP REQUIRES A COMPLETE WRITE OFF OR ADJUSTMENT OF TOTAL CHARGES OR A PORTION OF CHARGES IF PATIENT IS FAP ELIGIBLE AND IS BASED ON FEDERAL POVERTY GUIDELINES (FPG). FACILITY 1 -- NORTH DECATUR & HILLANDALE PART V, SECTION B, LINE 22: THE HOSPITAL CURRENTLY UTILIZES AN AUTOMATIC BILL PROCEDURE WHICH PREPARES THE FIRST BILL AT GROSS CHARGES. DISCOUNTS AND WRITE-OFFS ARE APPLIED AFTER THE FIRST BILL. IN TAX YEAR ENDING 06/30/2013, THE FACILITY BILLED ALL FAP ELIGIBLE PATIENTS AT GROSS BUT COLLECTED LESS THAN GROSS BASED ON FAP AND FPG. 1 DEKALB REGIONAL HEALTH SYSTEM INC 2701 NORTH DECATUR ROAD DECATUR GA 30033 582034958 501(C)(3) 418960 SUPPORT FOR PATIENT CARE 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. SCHOLARSHIP FUNDS ARE REMITTED TO THE EDUCATIONAL INSTITUTIONS DIRECTLY. FOR OTHER GRANTS, VARIOUS PROCEDURES ARE IN PLACE DEPENDING ON GRANT TYPE, INCLUDING REQUIREMENTS TO SUBMIT APPLICATIONS FOR REVIEW AND APPROVAL. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL. X X X X X 1 0 0 0 0 0 0 0 0 JOHN A SHELTON JR 610291 0 135294 0 40646 0 16250 0 19884 0 822365 0 0 0 MAL UNDERWOOD 175894 0 0 0 0 0 0 0 0 0 175894 0 0 0 DANE HENRY 300375 0 17435 0 22902 0 8636 0 15084 0 364432 0 0 0 CHARLES BARCLAY 349472 0 13151 0 24206 0 21250 0 6461 0 414540 0 0 0 CHERYL IVERSON 163510 0 11024 0 23015 0 14213 0 22387 0 234149 0 0 0 JAMES FORSTNER 176021 0 12639 0 17136 0 24650 0 941 0 231387 0 0 0 JOEL SCHUESSLER 159597 0 11756 0 8673 0 8568 0 2708 0 191302 0 0 0 MARK TROCINO 211324 0 90111 0 22947 0 13437 0 5279 0 343098 0 0 0 STEPHEN THOMAS MD 300466 0 22050 0 17471 0 8750 0 15770 0 364507 0 0 0 SUSAN HARRIS 172214 0 8063 0 11307 0 14961 0 13149 0 219694 0 0 0 AUGUSTINE CONDUAH MD 780898 0 0 0 17486 0 8750 0 21903 0 829037 0 0 0 DAVID HOLLADAY MD 818232 0 0 0 23742 0 13750 0 13938 0 869662 0 0 0 RAYMOND LAWHEAD MD 520009 0 0 0 24642 0 13750 0 6517 0 564918 0 0 0 SHAINUL BHATIA MD 480261 0 0 0 23971 0 38250 0 10424 0 552906 0 0 0 KALAI PARTHIBAN MD 384196 0 0 0 17461 0 5712 0 25923 0 433292 0 0 0 DIANE P HARDEN 163906 0 0 0 10641 0 10654 0 8403 0 193604 0 0 0 THOMAS CRAWFORD 0 0 0 0 140861 0 0 0 0 0 140861 0 0 0 CATHLEEN WHEATLEY 5366 0 13950 0 319297 0 4636 0 541 0 343790 0 0 0 ERIC NORWOOD 0 0 0 0 572325 0 0 0 23862 0 596187 0 0 0 PART I, LINE 4A THE INDIVIDUALS BELOW RECEIVED SEVERANCE PAYMENTS TOTALING THE FOLLOWING: ERIC NORWOOD $570,003 THOMAS BARCLAY $140,861 SUPPLEMENTAL INFORMATION PART III MAL UNDERWOOD'S COMPENSATION WAS PAID TO HIMFORMATICS, LLC FOR HIS SERVICE AS INTERIM CHIEF FINANCIAL OFFICER OF DEKALB REGIONAL HEALTH SYSTEM, INC. FROM JUNE 2012 THROUGH JANUARY 2013. NO BENEFITS WERE PROVIDED. A THE DEKALB COUNTY HOSPITAL AUTHORITY 586011209 24047CCC0 2003-12-10 28325646 REFUND 2003A SERIES 0 0 0 B THE DEKALB COUNTY HOSPITAL AUTHORITY 586011209 24047CDH8 2010-05-03 180623920 REFUND SERIES 2010 0 0 0 A 28325646 2691072 177160 2003 1 0 1 1 B 180623920 14114456 3168280 19992698 2011 1 0 1 1 A 0 0 0 0 0.00840 0.00000 0.00840 0 0 0 B 0 0 0 0 0.00840 0.00000 0.00840 0 0 0 A 1 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 DEKALB ANESTHESIA ASSOCIATES PROVIDER OF MEDICAL SERVICES TO DMC 3343864 CHARLES CLIFTON, M.D., MEMBER OF THE DMC BOARD OF DIRECTORS, IS AN OWNER OF DEKALB ANESTHESIA ASSOCIATES. 0 FORM 990, PART VI, SECTION A, LINE 6 DEKALB REGIONAL HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF DEKALB MEDICAL CENTER, INC. FORM 990, PART VI, SECTION A, LINE 7A EACH BOARD OF DIRECTORS MEMBER NOMINATED TO THE DEKALB MEDICAL CENTER, INC. BOARD IS SUBJECT TO APPROVAL BY THE BOARD OF DIRECTORS OF DEKALB REGIONAL HEALTH SYSTEM, INC. IN ACCORDANCE WITH THE DEKALB MEDICAL CENTER BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B DEKALB REGIONAL HEALTH SYSTEM, INC. MUST APPROVE CAPITAL EXPENDITURES IN EXCESS OF $2,000,000, ACQUISITIONS, REORGANIZATIONS, MERGERS AND/OR CONSOLIDATIONS, BUDGETS AND ANY REVISIONS AND REVISIONS OF THE ARTICLES OF INCORPORATION FOR DEKALB MEDICAL CENTER, INC. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PREPARED BY AN UNRELATED, INDEPENDENT ACCOUNTING FIRM AND SUBMITTED TO THE FINANCE COMMITTEE OF THE DEKALB REGIONAL HEALTH SYSTEM, INC. BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. A COPY OF FORM 990 IS ALSO PROVIDED TO THE DEKALB MEDICAL CENTER, INC. BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ALL OFFICERS, DIRECTORS, AND INDIVIDUALS IN MANAGEMENT LEVEL POSITIONS TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT ANNUALLY. THESE CONFLICT OF INTEREST DISCLOSURES ARE REVIEWED TO ASSURE COMPLIANCE WITH THE POLICY. ADDITIONALLY, BOARD MEMBERS ARE ASKED TO RECUSE THEMSELVES ON ANY MATTERS OF INTEREST BEFORE THE BOARD IN WHICH A CONFLICT OF INTEREST MAY EXIST. ANY RECUSAL IS DOCUMENTED WITHIN THE MINUTES OF THE BOARD OR COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 ALL OFFICERS ARE COMPENSATED BY DEKALB MEDICAL CENTER, INC., A RELATED ENTITY. COMPENSATION IS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE DEKALB REGIONAL HEALTH SYSTEM, INC. BOARD OF DIRECTORS. THE COMMITTEE UTILIZES AN INDEPENDENT CONSULTANT TO ASSIST IN SETTING COMPENSATION LEVELS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. ANY WRITTEN REQUEST FROM THE PUBLIC TO VIEW THESE DOCUMENTS WOULD BE REVIEWED AND ACTED UPON BY THE ORGANIZATION'S BOARD OF DIRECTORS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: MINIMUM PENSION LIABILITY 16,617,154. FMC CHANGE - INTEREST RATE SWAPS -356,069. NETWORK MEDICAL PROVIDERS 2701 NORTH DECATUR ROAD DECATUR GA 30033 582121470 PHYSICIAN SERVICES GA 0 0 DEKALB MEDICAL CENTER INC DEKALB MEDICAL SPECIALTY CARE GROUP LLC 2701 NORTH DECATUR ROAD DECATUR GA 30033 263454941 PHYSICIAN SERVICES GA 0 0 DEKALB MEDICAL CENTER INC DEKALB MEDICAL PRIMARY CARE GROUP LLC 2701 NORTH DECATUR ROAD DECATUR GA 30033 263454827 PHYSICIAN SERVICES GA 0 0 DEKALB MEDICAL CENTER INC DEKALB MEDICAL OCCUPATIONAL MEDICINE GROUP LLC 2701 NORTH DECATUR ROAD DECATUR GA 30033 263455069 PHYSICIAN SERVICES GA 0 0 DEKALB MEDICAL CENTER INC DEKALB MEDICAL HOSPITALISTS 2701 NORTH DECATUR ROAD DECATUR GA 30033 582639633 PHYSICIAN SERVICES GA 0 0 DEKALB MEDICAL CENTER INC DECATUR NETWORK MEDICAL PROVIDER 2701 NORTH DECATUR ROAD DECATUR GA 30033 586300825 PHYSICIAN SERVICES GA 0 0 DEKALB MEDICAL CENTER INC DEKALB MEDICAL CENTER FOUNDATION INC 2701 NORTH DECATUR ROAD DECATUR GA 30033 581924605 FUNDRAISING ON BEHALF OF DMC GA 501(C)(3) LINE 11B, II DEKALB REGIONAL HEALTH SYSTEM INC 0 DEKALB REGIONAL HEALTH SYSTEM 2701 NORTH DECATUR ROAD DECATUR GA 30033 582034958 SUPPORT DMC, INC. GA 501(C)(3) LINE 3 N/A 0 DECATUR HEALTH RESOURCES INC 450 NORTH CANDLER STREET DECATUR GA 30030 582081599 LONG TERM ACUTE CARE GA 501(C)(3) LINE 11C, III-FI DEKALB REGIONAL HEALTH SYSTEM INC 0 DRHS VENTURES INC 2701 NORTH DECATUR ROAD DECATUR GA 30033 201864828 JOINT VENTURE GA N/A C 0 DEKALB PHYSICIAN HOSPITAL ORGANIZATION INC 250 E PONCE LEON AVENUE STE 434 DECATUR GA 30030 582110792 PHYSICIANS SERVICES GA DEKALB MEDICAL CENTER INC C 709474 406168 0.50000 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1