2015-05-15T13:06:16-05:00 2014-06-30 KPMG LLP 300 NORTH GREENE STREET SUITE 400 GREENSBORO NC 27401 990 2013-07-01 581272768 PIEDMONT HEALTHCARE FOUNDATION INC % MARIE GAFFNEY PIED 4044251303 1968 Peachtree Road NW Suite Atlanta GA 303091285 CHARLIE HALL Treasurer 2015-05-13 SHAWN M HUTCHINSON P01048557 2013 2016-03-07 17:11:31Z MR KEVIN BROWN 1968 Peachtree Road NW Atlanta GA 303091285 1485334 false X www.piedmont.org X 1976 GA SEE PART III 33 29 0 29 0 118500 533210 0 0 1905871 952124 0 0 2024371 1485334 0 0 0 0 1251176 803179 0 0 0 565607 351636 1816783 1154815 207588 330519 23549285 28623052 4408942 7043626 19140343 21579426 X THE PIEDMONT HEALTHCARE FOUNDATION PROVIDES THE VOLUNTEER LEADERSHIP THAT ASSURES PIEDMONT HEALTHCARE'S PHILANTHROPIC SUPPORT IS GENERATED, STEWARDED, AND TRANSFORMED INTO VALUABLE GIFTS FOR ITS COMMUNITIES. false false 760428 0 0 REALIZING THAT PIEDMONT HEALTHCARE RELIES UPON THE GENEROSITY AND VISION OF COMMUNITY-MINDED CITIZENS, THE PIEDMONT HEALTHCARE FOUNDATION ("PHF") PROVIDES THE VOLUNTEER LEADERSHIP THAT ASSURES PIEDMONT HEALTHCARE'S PHILANTHROPIC SUPPORT IS GENERATED, STEWARDED AND TRANSFORMED INTO VALUABLE GIFTS MEETING THE IMMEDIATE AND FUTURE HEALTHCARE NEEDS OF THE REGION. DURING FISCAL YEAR 2014, PHF PLAYED AN INTEGRAL ROLE IN THE GENERATION AND MANAGEMENT OF OVER $7.6 MILLION IN GRANTS AND CONTRIBUTIONS FOR ITSELF AND THE ORGANIZATIONS IT SUPPORTS. (SEE SCHEDULE O FOR ADDITIONAL INFORMATION) 760428 true true false false false false false false false false true false false true true true false true false false false false false false false false false false false true false false false false false false false false false false false false false true false false false true 0 0 0 false false false false false false false false false false X 33 29 true false false false true true true true true false false false true true true true true false false false GA X MARIE GAFFNEY 6788426007 2727 PACES FERRY RD BLDG 2 STE 70 ATLANTA GA 30339 X Mr Mark Dunaway Board Member 1.0 0.0 X 0 0 0 Dr Regis W Haid Jr Board Member 1.0 0.0 X 0 0 0 Ms Claire Herd Crumbley Board Member 1.0 0.0 X 0 0 0 Ms Patricia Dickey Board Member 1.0 0.0 X 0 0 0 Mr Milton H Jones Jr Board Member 1.0 0.0 X 0 0 0 Mr Otis F Jones III Board Member 1.0 0.0 X 0 0 0 Mr Stephen Kane Board Member 1.0 0.0 X 0 0 0 Ms Ann Estes Klamon Board Member 1.0 0.0 X 0 0 0 Mr Lawrence Larry Klamon Board Member 1.0 0.0 X 0 0 0 Mr James Jim Landon Board Member 1.0 0.0 X 0 0 0 Ms Jane Lanier Board Member 1.0 0.0 X 0 0 0 Dr Cody McClatchey Board Member 1.0 39.0 X 0 598756 20237 Mr Hugh Nunnally Board Member 1.0 0.0 X 0 0 0 Mr Dennis McEntire Board Member 1.0 0.0 X 0 0 0 Mr I Allen Meadors Board Member 1.0 0.0 X 0 0 0 Dr Robert Rob Miller Board Member 1.0 0.0 X 0 0 0 Mr Robert A Yellowlees Board Member 1.0 0.0 X 0 0 0 Mr Yancey Lanier McCollum Board Member 1.0 0.0 X 0 0 0 Mr Wm Douglass Doug Smith Board Member 1.0 0.0 X 0 0 0 Dr Juliet Asher Board Member 1.0 39.0 X 0 179570 20684 Ms Jennifer Thomasson Board Member 1.0 0.0 X 0 0 0 Ms Barbara Tumperi Board Member 1.0 0.0 X 0 0 0 Mr Mike Vigil Board Member 1.0 0.0 X 0 0 0 Ms Vicki Turner Board Member 1.0 1.0 X 0 0 0 Mr Bertram Bert Levy Chairman 1.0 0.0 X X 0 0 0 Mr Thomas J Asher Board Member 1.0 0.0 X 0 0 0 Mr Parks W Avery Board Member 1.0 0.0 X 0 0 0 Dr Patrick M Battey Board Member 1.0 39.0 X 0 675298 16657 Mr Stephen Berman Board Member 1.0 0.0 X 0 0 0 Ms Veronica Biggins Board Member 1.0 0.0 X 0 0 0 Mr Kevin Brown President & CEO 1.0 54.0 X X 0 1120796 189110 Dr Grady S Clinkscales Jr Board Member 1.0 0.0 X 0 0 0 Mr Joel Cowan Board Member 1.0 0.0 X 0 0 0 Mr Charlie Hall Treasurer 1.0 54.0 X 0 1256584 175391 Mr Jay D Mitchell Secretary 1.0 54.0 X 0 593701 111333 Mr Mendal Bouknight VP of Philanthropy 55.0 0.0 X 0 334354 55437 Ms Debbie Gramling Former Secretary 0.0 55.0 X 0 191681 12714 0 4950740 601563 0 true true false 0 533210 533210 0 952124 952124 0 0 0 0 0 0 0 0 0 0 1485334 952124 0 0 0 0 0 0 600384 376063 224321 0 191453 119926 71527 11342 7105 4237 8861 8861 6194 6194 0 0 0 0 21189 21189 3594 3594 127913 80125 47788 0 0 41049 25713 15336 10060 10060 0 0 0 0 5534 5534 0 NEWSLETTER EXPENSE 56868 56868 PROFESSIONAL DUES 10640 10640 MISCELLANEOUS EXPENSE 59734 37417 22317 1154815 760428 394387 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 26197 26197 234913 230008 10352 4905 22252338 25751608 0 0 0 0 0 0 1260398 2840342 23549285 28623052 14653 14683 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4394289 7028943 4408942 7043626 X 15567510 17760316 3572833 3819110 0 0 19140343 21579426 23549285 28623052 X 330519 2372535 -263971 X false true X true false X X X false false false PIEDMONT HOSPITAL INC 580566213 03 true true true 0 FAYETTE COMMUNITY HOSPITAL DBA PIEDMONT FAYETTE HOSPITAL INC 582322328 03 true true true 0 PIEDMONT MOUNTAINSIDE HOSPITAL INC 352228583 03 true true true 0 PIEDMONT NEWNAN HOSPITAL INC 205077249 03 true true true 0 PIEDMONT HENRY HOSPITAL INC 582200195 03 true true true 0 5 0 SCHEDULE A, PART I, LINE 11H, COLUMN (VII) AMOUNT OF SUPPORT ALTHOUGH THE PIEDMONT HEALTHCARE FOUNDATION DID NOT PROVIDE DIRECT SUPPORT TO THE ORGANIZATIONS LISTED IN SCHEDULE A, PART I, IT PLAYED AN INTEGRAL ROLE IN GENERATING AND MANAGING FOR THOSE ORGANIZATIONS GRANTS AND CONTRIBUTIONS IN THE AMOUNTS LISTED BELOW: PIEDMONT HOSPITAL, INC. - $2,453,191 FAYETTE COMMUNITY HOSPITAL DBA PIEDMONT FAYETTE HOSPITAL - $327,090 PIEDMONT MOUNTAINSIDE HOSPITAL, INC. - $51,380 PIEDMONT NEWNAN HOSPITAL, INC. - $516,779 PIEDMONT HENRY HOSPITAL, INC. - $131,055 TOTAL - $3,479,495 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 234913 230008 4905 4905 DUE FROM RELATED PARTIES 2840342 2840342 0 DUE TO RELATED PARTIES 6730402 DEFERRED LIABILITY 298541 7028943 X SCHEDULE D, PART X, LINE 2 ASC 740 FOOTNOTE PHC ACCOUNTS FOR INCOME TAXES UNDER THE PROVISIONS OF THE INCOME TAXES TOPIC OF THE ASC (ASC 740). UNDER THE REQUIREMENTS OF ASC 740, TAX-EXEMPT ORGANIZATIONS MAY BE REQUIRED TO RECORD AN OBLIGATION AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS TAX EXPOSURE ITEMS. THERE WERE NO MATERIAL UNCERTAIN TAX POSITIONS AT JUNE 30, 2014 AND 2013. false true false false false false false true false Dr Cody McClatchey Board Member 0 598756 0 0 0 0 0 1979 0 18258 0 618993 0 0 Dr Juliet Asher Board Member 0 176614 0 0 0 2956 0 6769 0 13915 0 200254 0 0 Mr Charlie Hall Treasurer 0 430535 0 165124 0 660925 0 163138 0 12253 0 1431975 0 626778 Mr Jay D Mitchell Secretary 0 417372 0 160152 0 16177 0 95568 0 15765 0 705034 0 0 Mr Mendal Bouknight VP of Philanthropy 0 264961 0 34882 0 34511 0 41497 0 13940 0 389791 0 0 Dr Patrick M Battey Board Member 0 554729 0 115064 0 5505 0 10200 0 6457 0 691955 0 0 Mr Kevin Brown President & CEO 0 520289 0 540004 0 60503 0 180200 0 8910 0 1309906 0 0 Ms Debbie Gramling Former Secretary 0 146311 0 29015 0 16355 0 0 0 12714 0 204395 0 0 SCHEDULE J, PART I, LINE 3 COMPENSATION OF THE CEO/EXECUTIVE DIRECTOR THE COMPENSATION FOR THE PRESIDENT/CEO OF PIEDMONT HEALTHCARE FOUNDATION IS SET AND PAID BY THE ENTITY'S PARENT, PIEDMONT HEALTHCARE, INC. PLEASE SEE THE SCHEDULE O NARRATIVE FOR FORM 990, PART VI, SECTION B, LINE 15A & 15B FOR ADDITIONAL INFORMATION. SCHEDULE J, PART I, LINE 4B SUPPLEMENTAL COMPENSATION INFORMATION CHARLIE HALL RECEIVED A PAYMENT OF $626,778 FROM HIS SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. THE FOLLOWING EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN, BUT DID NOT RECEIVE CURRENT YEAR PAYMENTS: KEVIN BROWN JAY MITCHELL MENDAL BOUKNIGHT SCHEDULE J, PART I, LINE 7 CERTAIN EMPLOYEES PARTICIPATED IN AN "ANNUAL INCENTIVE PLAN" UNDER WHICH THEY RECEIVED NON-FIXED BONUS PAYMENTS BASED ON JOB LEVEL AND SEVERAL DIFFERENT PERFORMANCE METRICS. FORM 990, PART I, LINES 5 & 15, PART VII, AND PART IX, LINE 7 EMPLOYEES AND SALARY EXPENSE PIEDMONT HEALTHCARE FOUNDATION, INC., DOES NOT DIRECTLY COMPENSATE ITS EMPLOYEES OR EXECUTIVES. RATHER, EMPLOYEES OF THE ORGANIZATION ARE COMPENSATED BY PHF'S PARENT, PIEDMONT HEALTHCARE, INC. THE ACTUAL SALARY EXPENSE ATTRIBUTED TO THE FOUNDATION'S EMPLOYEES IS THEN ALLOCATED TO PHF BY PIEDMONT HEALTHCARE, AND IS REFLECTED HEREIN AS A FUNCTIONAL EXPENSE OF THE ORGANIZATION. FORM 990, PART III, LINE 4A DESCRIPTION OF PROGRAM SERVICES THE PIEDMONT HEALTHCARE FOUNDATION, INC., PLAYED AN INTEGRAL ROLE IN GENERATING THE FOLLOWING GRANTS AND CONTRIBUTIONS FOR ITSELF AND THE ORGANIZATIONS IT SUPPORTS: PIEDMONT HOSPITAL, INC. - $2,453,191 FAYETTE COMMUNITY HOSPITAL DBA PIEDMONT FAYETTE HOSPITAL -$327,090 PIEDMONT MOUNTAINSIDE HOSPITAL, INC. - $51,380 PIEDMONT NEWNAN HOSPITAL, INC. - $516,779 PIEDMONT HENRY HOSPITAL, INC. - $131,055 PIEDMONT HEART INSTITUTE, INC. - $3,671,624 PIEDMONT HEALTHCARE FOUNDATION, INC. - $538,210 TOTAL - $7,689,329 FORM 990, PART VI, SECTION A, LINE 2 RELATIONSHIPS WITH BOARD MEMBERS MR. LAWRENCE (LARRY) KLAMON, A MEMBER OF THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE FOUNDATION, IS MARRIED TO MS. ANN ESTES KLAMON, WHO IS ALSO A PHF BOARD MEMBER. MR. TOM ASHER, A MEMBER OF THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE FOUNDATION, IS THE FATHER OF DR. JULIET ASHER, WHO IS ALSO A PHF BOARD MEMBER, AS WELL AS AN EMPLOYED PHYSICIAN OF ANOTHER PIEDMONT HEALTHCARE SUBSIDIARY. FORM 990, PART VI, SECTION A, LINE 6 ORGANIZATION'S SOLE MEMBER PIEDMONT HEALTHCARE, INC., (EIN 58-1503902) IS THE SOLE MEMBER OF PIEDMONT HEALTHCARE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HEALTHCARE APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF GOVERNING BODY PIEDMONT HEALTHCARE FOUNDATION'S BOARD POLICIES AND DECISIONS MUST BE FILED, IMMEDIATELY AFTER ADOPTION, WITH THE SECRETARY OF THE PIEDMONT HEALTHCARE BOARD OF DIRECTORS. SUCH POLICIES AND DECISIONS OF THE PIEDMONT HEALTHCARE FOUNDATION BOARD OF DIRECTORS ARE NOT SUBJECT TO THE APPROVAL OF OR RATIFICATION BY THE PIEDMONT HEALTHCARE BOARD, BUT SHOULD THE NEED ARISE, THEY MAY BE RESCINDED BY THE PIEDMONT HEALTHCARE BOARD THROUGH A MAJORITY VOTE OF ITS DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW PROCESS INFORMATION NEEDED TO PREPARE PIEDMONT HEALTHCARE FOUNDATION'S FORM 990 IS COMPILED BY INDIVIDUALS IN PIEDMONT HEALTHCARE, INC.'S FINANCE DEPARTMENT. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S TAX DIRECTOR AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. PRIOR TO FILING, COPIES OF FORM 990 ARE PROVIDED TO THE BOARD OF DIRECTORS OF PIEDMONT HEALTHCARE, INC., THE ORGANIZATION'S SOLE MEMBER, FOR BOARD REVIEW. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED BY ORGANIZATION MANAGEMENT IN COORDINATION WITH PIEDMONT HEALTHCARE'S CHIEF COMPLIANCE OFFICER. ALL SENIOR LEADERS, BOARD MEMBERS, PHYSICIAN EMPLOYEES, NURSE PRACTITIONERS/PHYSICIAN ASSISTANTS AND EMPLOYEES AND NON-EMPLOYEES ENGAGED IN RESEARCH ARE REQUIRED TO ANNUALLY DISCLOSE ALL MATTERS WHICH COULD POTENTIALLY CONSTITUTE A CONFLICT OF INTEREST. MATTERS DISCLOSED UNDER THE POLICY MUST BE REVIEWED IN WRITING BY THE PIEDMONT HEALTHCARE CONFLICT OF INTEREST COMMITTEE IN ORDER TO DETERMINE WHETHER A CONFLICT EXISTS AND, IF SO, WHETHER TO ELIMINATE OR MANAGE THE CONFLICT. ALL BOARD MEMBERS AND EMPLOYEES OF PIEDMONT HEALTHCARE FOUNDATION ARE PROVIDED TRAINING ON CONFLICT OF INTEREST ISSUES, INCLUDING REPORTING REQUIREMENTS, AT NEW-EMPLOYEE ORIENTATION AND AT LEAST ANNUALLY THEREAFTER. NONCOMPLIANCE WITH THE CONFLICT OF INTEREST POLICY MUST BE REPORTED TO PIEDMONT HEALTHCARE'S SENIOR VICE PRESIDENT OF COMPLIANCE FOR INVESTIGATION, AND REMEDIAL STEPS MUST BE TAKEN AS APPROPRIATE UNDER THE PIEDMONT HEALTHCARE DISCIPLINARY POLICIES. FORM 990, PART VI, SECTION B, LINE 15A, 15B EXECUTIVE COMPENSATION COMPENSATION FOR EXECUTIVES OF PIEDMONT HEALTHCARE FOUNDATION IS SET BY THE BOARD OF DIRECTORS OF ITS SOLE MEMBER, PIEDMONT HEALTHCARE, INC., AND PAID ON BEHALF OF THE FOUNDATION BY PIEDMONT HEALTHCARE, INC. THE PIEDMONT HEALTHCARE, INC., BOARD OF DIRECTOR'S EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("THE COMMITTEE") IS COMPOSED OF AT LEAST THREE MEMBERS OF THE PHC BOARD OF DIRECTORS, SERVING TERMS OF THREE YEARS, AND THE MAJORITY OF WHICH ARE COMMUNITY DIRECTORS WHO GENERALLY DO NOT HAVE CONFLICTS OF INTEREST RELATED TO FULFILLMENT OF THE DUTIES AS OUTLINED BELOW. THE EXECUTIVE PERFORMANCE AND COMPENSATION COMMITTEE ("COMMITTEE") OVERSEES EXECUTIVE PERFORMANCE AND COMPENSATION ON BEHALF OF THE PHC BOARD, SUBJECT TO THE ULTIMATE AUTHORITY AND OVERSIGHT OF THE BOARD. THE COMMITTEE ALSO FORMULATES POLICIES AND MAKES DECISIONS IN ORDER TO ENSURE A HIGH LEVEL OF EXECUTIVE PERFORMANCE. THIS COMMITTEE IS AUTHORIZED TO ACT ON BEHALF OF THE PHC BOARD AS SET OUT IN THIS CHARTER, AND THE COMMITTEE IS ALSO CHARGED WITH PROVIDING RECOMMENDATIONS AND PERIODIC REPORTS TO THE PHC BOARD REGARDING EXECUTIVE PERFORMANCE AND COMPENSATION. FUNCTIONS OF THE COMMITTEE -ASSESS AND IMPLEMENT POLICIES REGARDING PERFORMANCE, COMPENSATION AND BENEFITS OF THE PRESIDENT/CEO AND OTHER EXECUTIVES AS DETERMINED BY THE COMMITTEE -SELECT AN EXECUTIVE COMPENSATION CONSULTANT WHO REPORTS TO THE COMMITTEE -ANNUALLY REVIEW THE PRESIDENT/CEO SUCCESSION PLAN -FORMULATE AND IMPLEMENT ANNUAL PERFORMANCE OBJECTIVES FOR THE PRESIDENT/CEO, AND REVIEW AND APPROVE ANNUALLY RECOMMENDATIONS FROM THE PRESIDENT/CEO RELATING TO COMPENSATION, PERFORMANCE OBJECTIVES, AND SUCCESSION PLANS FOR EVP EXECUTIVES -ANNUALLY ASSESS PRESIDENT/CEO PERFORMANCE; IF NECESSARY, IMPLEMENT ACTION PLAN WITH PRESIDENT/CEO INPUT TO IMPROVE HIS/HER PERFORMANCE; ADJUST COMPENSATION AS APPROPRIATE; THE COMMITTEE CHAIR SHALL CONSULT WITH THE PHC GOVERNANCE COMMITTEE CHAIR AND THE PHC BOARD CHAIR AND SHALL COORDINATE THE ANNUAL PERFORMANCE REVIEW OF THE PHC PRESIDENT/CEO, UNLESS THE PHC BOARD CHAIR HAS A REAL OR PERCEIVED CONFLICT OF INTEREST, IN WHICH CASE THE COMMITTEE CHAIR SHALL DETERMINE THE PROPER REVIEW PROCESS -REVIEW AND APPROVE LONG TERM AND SHORT TERM GOALS TO BE USED IN CONNECTION WITH EVP COMPENSATION PROGRAMS AS RECOMMENDED BY THE PRESIDENT/CEO AND VALIDATED BY THE COMPENSATION CONSULTANT -PERIODICALLY REVIEW COMPENSATION, IF ANY, FOR THE PHC BOARD CHAIR AND ALL BOARD CHAIRS OF THE PHC SUBSIDIARIES -ESTABLISH OTHER POLICIES AND PROCEDURES, AND PERFORM OTHER TASKS, RELATED TO EXECUTIVE PERFORMANCE AND COMPENSATION, INCLUDING BUT NOT LIMITED TO, APPROVAL OF EXECUTIVE EMPLOYMENT CONTRACTS AND BENEFITS -PERIODICALLY REPORT SIGNIFICANT DECISIONS AND ANY ADDITIONAL REQUESTED INFORMATION TO THE PHC BOARD FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURE OF GOVERNING, CONFLICT OF INTEREST, AND FINANCIAL DOCUMENTS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THESE DOCUMENTS SHOULD BE REQUESTED FROM PIEDMONT HEALTHCARE, INC'S LEGAL COUNSEL. FORM 990, PART XI, LINE 9 CHANGES TO NET ASSETS REPORTED ON PART XI, LINE 9 ARE COMPRISED OF $(510,250) OF BOOK/TAX DIFFERENCES RELATED TO REVENUE RECOGNITION AND $246,279 OF INCREASES TO TEMPORARILY RESTRICTED FUNDS. 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