Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
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| FORM 990, PART VI, LINE 3 | MANAGEMENT DELEGATED HENRY DEVELOPMENT VENTURES, INC. ("HDV") CONTRACTS WITH PIEDMONT HENRY HOSPITAL, INC., TO PROVIDE ALL MANAGEMENT PERSONNEL, MANAGEMENT SYSTEMS, AND INFRASTRUCTURE. THE CONTRACT IS AUTOMATICALLY RENEWABLE IN ONE-YEAR PERIODS. IN EXCHANGE FOR THE MANAGEMENT SERVICES PROVIDED, HDV PROVIDES THE PREMISES FOR AN URGENT CARE CENTER AT COST; PROVIDES REAL ESTATE OWNERSHIP, DEVELOPMENT, AND MANAGEMENT OF HEALTH CARE RELATED FACILITIES; ASSISTS IN PROVIDING GUARANTEES, ENDORSEMENTS, AND/OR AGREEMENTS IN CONJUNCTION WITH LONG-TERM FINANCING VEHICLES IN SUPPORT OF THE HOSPITAL; ASSISTS IN COMMUNITY EDUCATION, POLICY DEVELOPMENT, PUBLIC RELATIONS, AND OTHER EFFORTS TO BENEFIT THE IMPROVEMENT OF THE HEALTH STATUS OF CONSTITUENTS OF THE HOSPITAL; AND PROVIDES SERVICES AS CONTEMPLATED IN THE GOVERNING DOCUMENTS OF HDV. |
| FORM 990, PART VI, SECTION A, LINE 6 | ORGANIZATION'S SOLE MEMBER PIEDMONT HENRY HOSPITAL, INC., IS THE SOLE MEMBER OF HENRY DEVELOPMENT VENTURES, INC. ("HDV"). |
| FORM 990, PART VI, SECTION A, LINE 7A | ELECTION OF GOVERNING BODY THE BOARD OF PIEDMONT HENRY HOSPITAL APPOINTS THE MEMBERS OF THE BOARD OF DIRECTORS OF HENRY DEVELOPMENT VENTURES. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS OF GOVERNING BODY POLICIES AND DECISIONS OF THE HENRY DEVELOPMENT VENTURES BOARD OF DIRECTORS ARE SUBJECT TO THE APPROVAL OF OR RATIFICATION BY THE PIEDMONT HENRY HOSPITAL BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | 990 REVIEW PROCESS INFORMATION NEEDED TO COMPLETE HENRY DEVELOPMENT VENTURES' FORM 990 IS COMPILED BY INDIVIDUALS IN PIEDMONT HENRY HOSPITAL'S ("PHH") FINANCE DEPARTMENT. THE INFORMATION IS REVIEWED BY PHH'S CONTROLLER AND VP/CFO. THE 990 IS THEN PREPARED INTERNALLY BY PIEDMONT HEALTHCARE, INC.'S (PHH'S SOLE MEMBER) TAX DIRECTOR AND SUBMITTED TO AN EXTERNAL TAX PREPARER FOR REVIEW. COPIES OF FORM 990 ARE PROVIDED TO PHH'S AND HDV'S CEO FOR REVIEW PRIOR TO FILING. |
| 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 PIEDMONT HENRY HOSPITAL 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 HENRY HOSPITAL AND HDV 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 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. |
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